bluuebunny/crossref_metadata_2025 huggingface dataset:
Bronchiolitis and Recurrent Wheezing
Authors: MCCONNOCHIE KENNETH M. , ROGHMANN KLAUS J.
Published: December 2021

In Reply.—

We appreciate the comments of Welliver regarding our recent article. His primary concerns relate to the issue of causality, particularly the methodology of establishing a causal relationship.

These concerns are addressed in our article (Pediatrics 1984;74:1-10) as follows:

Although a historical cohort study cannot, by its nature, prove causality, this study's findings are consistent with the hypothesis that bronchiolitis is a causal factor in wheezing. One may speculate that there is a latent factor accounting for the observed bronchiolitis-wheezing association (possibly a genetic factor common both to children who develop bronchiolitis and to children who wheeze during middle childhood years) that is measured by none of the methods employed in this study.
Rock in the Nose
Authors: FISCHER HOWARD
Published: December 2021

To the Editor.—

I would like to share with my colleagues a method of removing nasal foreign bodies which I recently had occasion to use. My 4-year-old daughter came into the house and announced that she had a "rock" in her nose. Inspection revealed a pebble lodged out of finger reach in the right nasal cavity. Keeping her upright, I occluded the nonobstructed side with finger pressure and blew into her mouth, after making a tight seal, much in the manner of mouth-to-mouth resuscitation.
Self-Examination by Adolescents
Authors: GOLDBLOOM RICHARD B.
Published: December 2021

Adolesence is a period of intense self-examination. More hours are spent contemplating the mirror during the teen years than at any other time of life. Physical change occurs so rapidly that teenagers may see someone different each time they consider their reflected images—the obverse of the Dorian Gray dilemma. This phenomenon has both pleasing and unsettling effects. The pleasures of growth and maturation are comingled with self-doubts and anxieties. The latter include worries about health and fears of illness—despite the fact that illness during adolescence is rarer than at any other period in the life-span.

In Western society, people are understandably preoccupied with preventing cancer and reducing cancer mortality, and early detection is considered an important key to this accomplishment.
Prolonged Infantile Apnea: 1985
Authors:   Task Force on Prolonged Infantile Apnea
Published: December 2021

Knowledge regarding the etiology and optimal management of prolonged infantile apnea and its relationship to sudden infant death syndrome (SIDS) is tentative. Consequently, infantile apnea is a controversial subject; professional discussion and media attention are often emotional and even erroneous.

Prolonged apnea is defined as cessation of breathing for at least 20 seconds or as a briefer episode of apnea associated with bradycardia, cyanosis, or pallor. Brief episodes of apnea are a normal occurrence in infants, but prolonged apneic episodes may lead to morbidity and rarely mortality. The vast majority of infants with prolonged apnea are not victims of SIDS; most SIDS victims were never observed to have had prolonged apnea prior to the terminal event. The risk of death from SIDS is somewhat greater in the group of infants with prolonged apnea than in the general population. Infants with sleep apnea who have required active intervention, such as positive pressure "resuscitation," may be at significant risk.

Apnea of undetermined etiology that occurs in the premature infant between the actual date of birth and the original due date is apparently not predictive of SIDS. There is, however, indication that preterm infants as a group and perhaps siblings of infants who were victims of SIDS are at somewhat increased risk.

Infants who have had an episode of prolonged apnea are perceived by parents and physicians as having experienced a life-threatening event and being at risk for another. Prolonged apnea can be a symptom of many disorders including infection, seizures, airway abnormalities, hypoglycemia or other metabolic problems, anemia (in preterm infants), gastroesophageal reflux, impaired regulation of breathing during sleeping and feeding, and abuse.
Manpower Needs in Neonatal Pediatrics
Authors:   Committee on Fetus and Newborn
Published: December 2021

In 1980, the American Academy of Pediatrics' Committee on the Fetus and Newborn and the Section on Perinatal Pediatrics estimated the need for neonatologists.1 That statement suggested that needs might be satisfied by 1983 and recommended reassessment in the early 1980s. The present report is a reevaluation of those needs and comments concerning the present and future manpower status of neonatal pediatrics.

The previous statement encouraged the participation of pediatricians in all levels of infant care. The Committee reaffirms this participation, especially in Level II care.2 Pediatricians directing Level II neonatal services should have 6 months of training in neonatal special care. Level III services should be directed by Sub-Board certified neonatologists.

Every subspecialty faces the difficult problem of defining its own manpower needs. Neonatal pediatrics is no exception; it is difficult to ascertain whether the present number of neonatologists is needed to provide optimum care or whether some current care practices are actually created because of the increasing number of neonatologists.3 Defining the manpower needs in neonatology requires answers to some important questions: (1) What is the current numerical, functional, and geographic status of the subspecialty? (2) How many pediatricians (non-Sub-Board eligible, Sub-Board eligible, and Sub-Board certified) are practicing exclusively in the area of newborn care? (3) How much actual involvement does the Board-certified pediatrician have in providing Level II newborn care? This statement attempts to address these questions.

As of April 1, 1984, there were 1,346 Sub-Board-certified neonatologists (unpublished data, American Board of Pediatrics). There are approximately 125 fellows graduating from neonatal training programs each year.4
Pediatricians, Antibiotics, and Office Practice
Authors: CROOK WILLIAM G.
Published: December 2021

To the Editor.—

In his letter, "Pediatricians, Antibiotics, and Office Practice," Disney discussed a telephone conference dealing with the choice and use of antibiotics.1 Seven pediatricians participated. Disney, past president of the American Board of Pediatrics was "astonished" and "alarmed" at the methods that certified pediatricians in practice were using to select antibiotics. He was especially concerned that laboratory studies were little used and that "They (the pediatricians) mostly stated that either the drug was picked at random or was selected by the doctor's preference for one drug or another chosen on the basis of available samples or side effects...."
Roentgenology and Malabsorption Syndromes
Authors: WEIZMAN ZVI , STRINGER DAVID A. , DURIE PETER R.
Published: December 2021

In Reply.—

We thank Smith for providing an interesting and important historical perspective regarding the radiologic manifestations attributed to intestinal malabsorption in childhood. The remarkable similarity in findings between our recent report and the earlier studies some 40 years ago, serves to emphasize the need for considerable caution in interpreting the significance of the so-called radiologic malabsorption pattern on small bowel follow-through examination. In addition, it should be emphasized that all subjects included in our report were evaluated with the use of nonflocculating contrast media, providing support for Smith's observation that these newer materials have failed to completely negate the problem of demonstrating radiologic manifestations of malabsorption in a normal child.
Prevention of Neonatal Respiratory Distress Syndrome by Tracheal Instillation of Surfactant: A Randomized Clinical Trial
Authors: Enhorning Goran , Shennan Andrew , Possmayer Fred , Dunn Michael , Chen Chee P. , Milligan John
Published: December 2021

With a randomized clinical trial, the possibility was assessed that a tracheal instillation of pulmonary surfactant prior to the first breath might prevent the development of some of the signs of neonatal respiratory distress syndrome. Of the 72 infants in the trial, all born at a gestational age of less than 30 weeks, 39 received 3 or 4 mL of surfactant, prepared from the lipids extracted from calf lung lavage. The treatment resulted in a significantly improved gas exchange during the first 72 hours of life. On the average, the arterial/alveolar Po2 ratio was 0.15 higher for the treated infants, and only about half as much extra oxygen had to be supplied. The respiratory support (peak inspiratory pressure x frequency) could be lowered significantly. Pulmonary interstitial emphysema occurred in 13 of the 33 control infants, but in only three of the 39 treated infants. Six of the control infants died in the neonatal period, but only one treated infant died. It is concluded that surfactant supplementation prior to the first breath is feasible and is of value as protection against the respiratory distress syndrome and the negative effects of hypoxia and ventilatory support.
Medical Management of Congenital Nasolacrimal Duct Obstruction
Authors: Nelson Leonard B. , Calhoun Joseph H. , Menduke Hyman
Published: December 2021

A consecutive series of 113 infants seen with congenital nasolacrimal duct obstruction were treated with local massage and topical antibiotic ointment. In 107 of the infants the obstruction was resolved within 8 months of initiation of this form of management. Nearly all of the infants were spared a surgical procedure that probably would have been performed if early probing of the nasolacrimal system had been advocated.
Fifteen-Year Follow-up of a Behavioral History of Attention Deficit Disorder
Authors: Howell David C. , Huessy Hans R. , Hassuk Bruce
Published: December 2021

A 15-year longitudinal study of 369 children originally classified in second grade as exhibiting or not exhibiting behaviors commonly associated with attention deficit disorder was made. Diagnostic data were collected on these children in second, fourth, and fifth grades and subsequent school performance was evaluated after ninth and twelfth grades. Interviews were conducted 3 years after their graduation from high school. The ninth and twelfth grade records reveal that those who had previously been identified as showing behavior related to attention deficit disorder later performed significantly more poorly in school and had poorer social adjustment. Interviews in early adulthood continued to reveal differences in outcome between normal subjects and those earlier classified as having attention deficit disorder. Many of these differences could not be directly attributed to poor academic performance. A subgroup of students who were rated favorably by their elementary school teachers were found to perform better during high school than other members of the normal group in academic areas, but they generally did not differ from normal subjects in nonacademic areas.
In Search of Wonder and Wisdom: Pediatrics in Transition
Authors: GEME JOSEPH W. ST
Published: December 2021

Pediatrics has become more complex in the last two decades, matched by similar sophistication throughout all of medicine. We have more medical schools, more students, and more physicians, and teaching hospitals are corporate academic medical centers engaged in fierce competition with community hospitals and innovative medical systems for the health care dollar. New, expanded 3-year curricula for pediatric residents are firmly set, but some pediatricians and, unfortunately, some medical students are skeptical about the future of the discipline and wonder appropriately what kind of pediatrics these young men and women will practice. Pediatric subspecialization has increased, particularly in neonatology, yet more than half of recently surveyed residents will engage in private or group practice.1
Prevention of Prematurity: Can We Do It in America?
Authors: COLE CYNTHIA H.
Published: December 2021

Everyone agrees that the solution to the problem of prematurity would be to prevent preterm births. The perinatal study in Haguenau1 is one of the largest published studies (> 16,000 live births) that demonstrate that prevention of premature births is possible. In a 12-year period (1971 to 1982), Papiernik et al achieved a 31% reduction (5.4% to 3.7%) of premature births. In the first 3 years of the study, they had essentially no change in the incidence of prematurity. It is interesting to speculate what would have happened had this study been performed in the United States. It probably would have been abandoned.
Vitamin E and the Prevention of Retinopathy of Prematurity
Authors:   Committee on Fetus and Newborn
Published: December 2021

In spite of numerous human and animal studies, the etiology of retinopathy of prematurity (previously called retrolental fibroplasia) remains obscure. Prevention attempts with judicious use and careful monitoring of supplemental oxygen, while decreasing the incidence, have not eradicated this complication of prematurity. Currently, retinopathy of prematurity is a condition that cannot be prevented in certain infants, especially those of very low birth weight.

One controlled trial suggested that the prophylactic oral administration of 100 mg/kg/d of free vitamin E to babies at highest risk, while not decreasing the incidence of retinopathy of prematurity, decreases the severity in affected infants.1 Three other controlled trials showed a lower incidence of severe retinopathy of prematurity in treated groups (25 mg/kg intramuscular or 25 mg/d oral, or variable intravenous doses), but none of these differences were statistically significant.2-4 These observations have led some authors to suggest that vitamin E be routinely administered to all infants weighing less than 1,500 g at birth.5,6

It must be noted that any effective prophylaxis with vitamin E in the United States would require that 22,000 surviving infants of birth weight less than 1,500 g be treated annually to prevent approximately 2,000 infants from developing the cicatricial sequelae of retinopathy of prematurity.7 The treatment of 20,000 infants who would not develop retinopathy of prematurity would be acceptable if it were certain that the administration of vitamin E was completely safe or, at least, that the benefits of its use outweighed the risks by a substantial margin. Preliminary reports, however, suggest the possibility of complications associated with the administration of pharmacologic doses of vitamin E.8,9
To Tube or Not to Tube: That Continues to Be the Question
Authors: CHAMBERLIN ROBERT W.
Published: December 2021

To the Editor.—

I wish to congratulate Drs. Teele, Klein, and Rosner on their study of otitis media with effusion (Pediatrics 1984;74:282-287). However, in their interpretation of the results, I think they are confusing statistical significance with clinical significance. They report a small, but statistically significant difference in scores on several speech and language tests for their sample as a whole (N = 200) for different time periods of effusions. They do not report how many of the children in each group were delayed enough to require speech therapy (clinical significance).
Relationship of Serum Bilirubin Levels to Ototoxicity and Deafness in High-Risk Low-Birth-Weight Infants
Authors: de Vries L. S. , Lary S. , Dubowitz L. M.S.
Published: December 2021

During a 4-year period, 12 premature infants, all less than 34 weeks of gestation and all with a bilirubin level above 240 µmol/L (14 mg/dL) were determined to have bilateral sensorineural deafness. In order to investigate how far the hyperbilirubinemia or any associated factor might have been a causative factor, all infants of 34 weeks of gestation or less who had a serum bilirubin level above 240 µmol/L were investigated. For a period of 4 years, 99 infants meeting these criteria were classified as high risk or low risk on the basis of perinatal risk factors. Eight of the 22 high-risk infants with birth weight less than 1,500 g, but only two of 43 high-risk infants with birth weight greater than 1,500 g were deaf (P < .05). The deaf infants were also matched with infants of normal hearing who had similar bilirubin levels and the same number of adverse perinatal factors. The mean duration of hyperbilirubinemia was significantly longer in the deaf infants (P < .02), and they appeared to have a greater number of acidotic episodes while they were hyperbilirubinemic. These findings suggest that in healthy preterm infants with birth weight greater than 1,500 g, high bilirubin levels carry little risk, whereas a serum bilirubin level greater than 240 µmol/L in highrisk preterm infants with birth weight of 1,500 g or less is associated with a high risk of deafness.
Congenital Posterior Choanal Atresia
Authors: Stahl Richard S. , Jurkiewicz M. J.
Published: December 2021

Although described more than two centuries ago, congenital choanal atresa remains an entity for which optimum treatment is not yet established. In a study of 29 cases of congenital choanal atresia during a 14-year period, 14 male and 15 female patients were diagnosed, in contrast with the 2:1 female-male ratio usually reported. Thirty-two operative procedures were performed on 16 surgically treated patients in the series. The two classes of surgical treatment, transpalatal and transnasal techniques, were marked by 66% and 73% recurrence rates, respectively, from 2 months to 6.5 years of follow-up. In previous studies, facial growth disturbances have been shown to result from transpalatal resection in the growing child, whereas transnasal techniques have been indicted as a cause of serious neurologic complications. Because no major morbidity resulted from 20 endonasal procedures in this series, early serial endonasal perforation is advocated as a means of establishing and maintaining a patent nasal airway until definitive transnasal repair can be performed when facial growth is more complete.
Virilizing Adrenocortical Tumors in Childhood: Eight Cases and a Review of the Literature
Authors: Lee Phillip D. K. , Winter Robert J. , Green Orville C.
Published: December 2021

Eight cases of adrenocortical tumor are presented with a review of the literature. Although such tumors are rare, they are important causes of inappropriate virilization and Cushing's syndrome in childhood. Clinical virilization with or without hypercortisolism was found in all eight children, who were 5 years old or younger. Excessive linear growth was noted, despite evidence of hypercortisolism. Serum levels of dehydroepian-drosterone, dehydroepiandrosterone sulfate, testosterone, and cortisol were elevated in all cases tested and appear to be useful diagnostic alternatives to the more traditional determinations of urine 17-ketosteroids and 17-hydroxycorticosteroida. Abdominal sonography and computed tomography have proven to be reliable tools for tumor localization. Surgical resection was the definitive therapy in all patients, and perioperative steroid replacement was essential. Histologic diagnosis appeared to have little bearing on prognosis, and the majority of pediatric patients have had clinically benign disease. At a mean follow-up of 3 years, seven of the eight children were alive and had no evidence of tumor recurrence.
Health Care and the Corridor Poor
Authors: OBERG CHARLES N.
Published: December 2021

There is no denying that health care costs have increased at an alarming rate, partially fueled by the increased demand created by programs such as Medicaid. In 1983, the total Federal and state outlays for Medicaid were $35.6 billion.13 As the 1980s progress, we will see a variety of cost-containment strategies. These will include Medicaid prepaid capitation projects, the initiation of copayments and deductibles, and further tightening of eligibility criteria. However, in our zeal to contain costs, let us not lose sight of or exacerbate the plight of the corridor poor.

There are alternatives that will allow us to incorporate the disenfranchised and uninsured during the coming decade. These initiatives may include the following.
Hunger Debate
Authors: MEYERS ALAN , SPIVAK HOWARD
Published: December 2021

To the Editor.—

Graham's1 recent commentary on malnutrition and infant mortality in the United States is dangerously misleading. The inaccuracy of some of his statements raise serious questions regarding his self-portrayal as an objective and unbiased commentator.

Graham criticizes the Massachusetts Nutrition Survey, a study that is as yet unpublished in the medical literature and, therefore, is inaccessible to most readers. He decries the use of the terms "stunting" and "wasting"; yet these terms, coined by Waterlow2,3 to describe the anthropometric presentation of (respectively) chronically and acutely undernourished children, have been widely used and internationally accepted.4
Educational Intervention by Computer in Childhood Asthma: A Randomized Clinical Trial Testing the Use of a New Teaching Intervention in Childhood Asthma
Authors: Rubin David H. , Leventhal John M. , Sadock Robert T. , Letovsky Ellen , Schottland Paul , Clemente Isabella , McCarthy Paul
Published: December 2021

To affect asthma-related knowledge, behavior, and morbidity, researchers tested a new educational intervention for children with asthma: an asthma-specific computer game called Asthma Command, which was specifically designed for this study. Sixty-five children with moderately severe asthma were randomly assigned to one of two groups, and 54 completed the study. Both groups were seen approximately six times during the 1 year of the study. Control subjects (n = 29) played routine computer games. Experimental subjects (n = 25) played Asthma Command. Compared with children in the control group, experimental subjects showed improvement in knowledge about asthma (P < .001), behavior related to the management of asthma (P < .008), and a trend toward the reduction of acute visits due to asthma (P < .13). Children in the experimental group also scored higher on the assessment of behaviors related to the management of asthma that were specifically addressed by the intervention provided by Asthma Command (P < .01). Differences between the control and experimental groups showed a greater improvement in the experimental group in 21 (84%) of the 25 outcome variables in the study (P = .004, Sign test). The study indicates that an asthma-specific computer game can significantly affect knowledge and behavior and may potentially affect morbidity in childhood asthma.
Progression of Neurovisceral Storage Disease With Supranuclear Ophthalmoplegia Following Orthotopic Liver Transplantation
Authors: Gartner J. Carlton , Bergman Ira , Malatack J. Jeffrey , Zitelli Basil J. , Jaffe Ronald , Watkins John B. , Shaw Byers W. , Iwatsuki Shunzaburo , Starzl Thomas E.
Published: December 2021

A 7-year-old girl with progressive ataxia, spasticity, supranuclear ophthalmoplegia, and sea-blue histiocytes in her bone marrow underwent orthotopic liver transplantation for hepatocellular carcinoma. After an initial period of stabilization, she has shown progression of neurologic symptoms with recurrence of storage material in the transplanted liver.
Retinopathy of Prematurity, Intraventricular Hemorrhage, and Oxidative Damage
Authors: CROWE JOHN , REA PHILLIP A. , ROLFE PETER
Published: December 2021

To the Editor.—

Hittner et al1 and Speer et al2 have recently reported that supplementation of vitamin E in premature infants reduces the incidence of retinopathy of prematurity and intraventricular hemorrhage, respectively. Ensuing correspondence3,4 has been primarily concerned with the potentially toxic effects of vitamin E. (It should be noted that, in contrast, Phelps5 found no evidence that the use of vitamin E reduced the incidence of intraventricular hemorrhage.)

However, we believe that the most significant aspect of these papers1,2 is their support of the hypothesis that both retinopathy of prematurity and intraventricular hemorrhage are manifestations of oxidative damage caused by oxygen-derived free radicals.
Zinc Deficiency and Edema
Authors: KUMAR SAVITRI P. , ANDAY ENDLA K.
Published: December 2021

In Reply.—

We thank Drs Golden and Golden for their comments, but we would like to point out several differences between the two patient groups which may explain the dissimilarity in response to zinc. Our patients were appropriately grown, very premature infants receiving adequate protein and caloric intake who were noted to be edematous and hypoproteinemic at less than 40 weeks' postconceptional age. As they were part of a vitamin E and retinopathy of prematurity study being conducted at that time, their serum levels were closely monitored to maintain vitamin E sufficiency.
New Abuse of Ipecac
Authors: ENTE GERALD , PENZER PAUL H.
Published: December 2021

To the Editor.—

There are three articles in the June issue of Pediatrics1-3 about ipecac without any mention of the new abuse of the drug. We think it is worthwhile to share with pediatricians the information that syrup of ipecac has become the latest addition to the drug abuse list.

More than 35,000 Americans, who have anorexia nervosa—bulimia syndromes are abusing syrup of ipecac repeatedly to induce vomiting after eating and bingeing. Ipecac is a cardiotoxic drug, and chronic repeated use can lead to permanent cardiac damage.
New Abuse of Ipecac
Authors: RUMACK BARRY H.
Published: December 2021

In Reply.—

The comments by Drs Ente and Penzer are very important. Although some individuals have abused syrup of ipecac and toxicity has been temporarily related to its use, there is no evidence to support the statement that 35,000 Americans are abusing the drug. The only cardiotoxicity ever reported with syrup of ipecac has been in the abuse state, and this has never been associated with emergency induction of emesis in recommended dosages. Unfortunately, a number of physicians have written to the Food and Drug Administration proposing a listing of syrup of ipecac as a prescription agent.
Reimmunization Following Early Immunization With Measles Vaccine: A Prospective Study
Authors: McGraw Terrence T.
Published: December 2021

A prospective study was designed to determine the response of previously immunized infants following administration of measles vaccine at 15 to 18 months of age. Upon entry into the study at 7 to 12 months of age, 14 of 127 infants had measles antibody. Measles vaccine was administered to infants in the experimental group on the day of entry into the study. Prior to measles, mumps, and rubella vaccine administration at 15 to 18 months of age, six of 23 infants in the control group and 80 of 90 infants in the experimental group had detectable antibodies. Following the (re)vaccination at 15 to 18 months of age, 20 of 21 infants in the control group and 49 of 52 infants in the experimental group had detectable antibody. Early measles immunization in this study did not interfere with the ultimate response to immunization at 15 to 18 months of age. These results support the policy of early immunization for those infants at risk for exposure to measles and reimmunization at 15 months of age.
Risk of Herpes Zoster in Children With Leukemia: Varicella Vaccine Compared With History of Chickenpox
Authors: Brunell Philip A. , Taylor-Wiedeman Jean , Geiser Clementina F. , Frierson Lisa , Lydick Eva
Published: December 2021

A study was undertaken to determine whether children immunized with live varicella vaccine are at greater risk of acquiring herpes zoster than children who have had varicella. Children with acute lymphocytic leukemia who had had varicella were compared with those who received live varicella vaccine. During the period of observation, 15 of 73 children who had varicella acquired herpes zoster and none of the 34 children who had been vaccinated. If the time of observation was adjusted for and the vaccinees who failed to have a sustained antibody response or who acquired chickenpox were removed, the risk of herpes zoster was still less in vaccinees (P = .0075). Because herpes zoster is common in children with acute lymphocytic leukemia, differences in the two groups could be discerned more readily than if normal children were compared. There is no reason to suspect that recipients of live varicella vaccine would be more likely to acquire herpes zoster than children who get varicella.
Spinal Cord Injury Associated With All-Terrain Vehicle Accidents
Authors: Sneed R. C. , Stover Samuel L. , Fine Philip R.
Published: December 2021

Five instances of three-wheeler, all-terrain vehicle accidents resulting in spinal cord injury are presented. Age range of victims was from 7 to 18 years. Of the five cases of spinal cord injury, three resulted in quadriplegia and two in paraplegia. Reports of all-terrain vehicle accidents in childhood from the US Consumer Product Safety Committee are also reviewed. Concerns are raised about the need for further data gathering about instances and types of injuries from these types of vehicles and the safety of use in all ages of children for these heavy, potentially high-speed vehicles.
Haemophilus influenzae Type b Disease in an Amish Population: Studies of the Effects of Genetic Factors, Immunization, and Rifampin Prophylaxis on the Course of an Outbreak
Authors: Granoff Dan M. , McKinney Thomas , Boies Eyla G. , Steele Norman P. , Oldfather John , Pandey Janardan P. , Suarez Brian K.
Published: December 2021

In 1982, an outbreak of Haemophilus influenzae type b disease occurred in a 379-member Amish community. In an attempt to control the outbreak after the occurrence of the second case of disease, we investigated the combination of (1) rifampin chemoprophylaxis of all carriers of H influenzae type b and their household contacts from 1 month to 5 years of age and (2) H influenzae type b polysaccharide vaccine immunoprophylaxis of all community members 12 months of age and older. Despite our intervention, two additional cases of bacteremic H influenzae type b disease occurred in the ensuing 5 months, one in a 22-month-old infant who had been immunized at 19 months of age and the other in a child who had not been immunized because she was younger than 12 months of age. The outbreak ended following rifampin prophylaxis of all community members younger than 15 years of age. All of the children with disease were genetically related to one another, and three of the four were inbred. However, analysis of their coancestry revealed that neither the average level of kinship nor the average inbreeding level of the affected children differed significantly from those of the other children in the community. Furthermore, none of the four children with disease shared a human leukocyte antigen haplotype. Our observations suggest that inbreeding was not a risk factor in this community. Furthermore, the combination of selective rifampin chemoprophylaxis of carriers of H influenzae type b and community-wide immunization with H influenzae type b polysaccharide vaccine in individuals 12 months of age or older was not an effective strategy for control of H influenzae type b disease in this closed population.
LIFE IS FLEETING
Authors: Student
Published: December 2021

. . . nature turns a dumb face toward us like a cow. When we read its wonders, we wonder whether we haven't written them ourselves. We are in ferment, but our greatness grows light like a bubble of froth. We sense that existence itself lacks substance; that its heaviness is that of wet air. The sublime . . . ah, the sublime is far off, though we call for its coming. Yes. Life falls short—is never what it should be.
Juvenile Chronic Myelogenous Leukemia: Surface Antigen Phenotyping by Monoclonal Antibodies and Cytogenetic Studies
Authors: Shannon Kevin , Nunez Gabriel , Dow Lois W. , Weinberg Arthur G. , Sato Yuichi , Stastny Peter , Buchanan George R.
Published: December 2021

Cells from three children with juvenile chronic myelogenous leukemia were studied using culture in semisolid media, cytogenetic analysis, and surface staining with the monocyte-specific monoclonal antibodies 61D3 and 63D3. The percentage of bone marrow mononuclear cells that were 61D3- and 63D3-positive was markedly increased in all three patients. Bone marrow and peripheral blood mononuclear cells exhibited exceptionally bright immunofluorescence with these antibodies. The presence of monocyte-specific antigens on the surface of juvenile chronic myelogenous leukemia cells suggests that they are derived from a precursor with monocytic characteristics. A specific chromosomal abnormality (47, XY+21) was present in fresh bone marrow cells from one patient; in contrast, 50 metaphases from phytohemagglutinin-stimulated peripheral blood contained a normal karyotype. The chromosomal abnormality was also identified in myeloid colonies grown in vitro from this patient. Granulocytic elements were demonstrated in tissue sections and in cultured myeloid colonies from this child. Our data suggest that malignant transformation in juvenile chronic myelogenous leukemia involves a myeloid progenitor population capable of differentiation in vitro to cells with monocytic or granulocytic characteristics.
G.K. CHESTERTON ON OUR SLIGHTLY FLAWED WORLD
Authors: Student
Published: December 2021

The real trouble with this world of ours is not that it is an unreasonable world, nor even that it is a reasonable one. The commonest kind of trouble is that it is nearly reasonable, but not quite.
Soft Tissue Calcification: A Complication of Vitamin E Injection
Authors: Barak Mila , Herschkowitz Sylvia , Montag Johanan
Published: December 2021

Two cases of gross soft tissue calcification following intramuscular administration of vitamin E in two premature babies are described. The drug was administered for prevention of retinopathy of prematurity. The relation between this complication and both the dosage used and the duration of the treatment is discussed. In spite of the extent of the calcifications, a benign course was observed. Other reports about this complication are reviewed.
AUTHORITARIANISM WINS
Authors: Student
Published: December 2021

Researchers in the perinatal field employ [randomized clinical trials] very rarely, and a variety of authoritarian strategies has been used to make carrying out RCTs difficult and to discredit those that reach completion and publication.
Bladder Injury and Uroascites From Umbilical Artery Catheterization
Authors: Dmochowski Roger R. , Crandell Sharon S. , Corriere Joseph N.
Published: December 2021

Umbilical artery catheterization in the newborn can lead to perforation of the bladder or urachal remnant with extravasation of urine into the peritoneal cavity. We present a case of such an injury that led to uroascites and respiratory distress. This injury usually requires prompt surgical repair for resolution.
A MISTAKEN VIEW OF SCIENCE
Authors: Student
Published: December 2021

The wrong view of science betrays itself in the craving to be right.
Physicians: Heed the Need for Hope
Authors: HALL BRYAN D.
Published: December 2021

Having diagnosed and followed more than 20 children with Williams syndrome during the past 15 years, I read with great admiration and empathy the article written by a mother of a child with Williams syndrome (Pediatrics 1985;75:962-968). Disregarding the mother's obvious literary abilities, and her and her husband's dogged determination to understand and deal with their son's difficulties, I found their need for hope expressed in such a sensitive but intellectual manner as to bring me to tears.
Insulin Pump Therapy in the Very Low Birth Weight Infant
Authors: Ostertag S. G. , Jovanovic L. , Lewis B. , Auld P. A. M.
Published: December 2021

Ten critically ill, very low birth weight infants less than 30 weeks' gestation were treated with exogenous insulin administered through a continuous insulin infusion pump (Betatron II, Cardiac Pacemaker, Inc). Infants were hyperglycemic to dextrose infusions greater than 6 mg/kg/min. The blood glucose concentration became normal in all infants within two to four hours, with varying requirements for continued insulin treatment. Tolerance to intravenous dextrose increased from a mean of 7.4 mg/kg/min to 11.2 mg/kg/min with aglycosuria. Energy intake increased from 49.5 calories/kg/d prior to insulin pump therapy to 70.4 calories/kg/d afterward (P < .01) with weight gain changed from –23 g/d to +13 g/d (P < .01). One unexpected observation was the apparent normalization of blood glucose homeostasis on higher dextrose doses among some infants after only one three- to six-hour treatment with insulin. The continuous insulin infusion pump is a flexible tool that allows insulin infusion rates to be changed as dictated by blood glucose values without altering other parenteral infusions.
Central Venous Silicone Elastomer Catheter Placement by Basilic Vein Cutdown in Neonates
Authors: Gilhooly Joseph , Lindenberg Jeffrey , Reynolds John W.
Published: December 2021

There is a need for central venous access in small premature infants and other neonates when enteral feeding is not tolerated or is contraindicated. We placed 83 small (0.635-mm od) silicone elastomer catheters by basilic vein cutdown through a subcutaneous tunnel in 79 patients during a 12-month period. Thirty-five patients (44%) weighed <1,000 g. Each patient on whom the procedure was attempted had successful placement of a catheter, and they remained in place a mean of 20 days (range three to 82). Patients had a mean weight gain of 15 g per day of catheter use. Sixty-two catheters (75%) were removed electively, 13 (16%) secondary to complications, six (7%) because of patient deaths (none catheter related), and two (2%) were accidentally dislodged. Two episodes of catheter-related sepsis (0.12 episodes per 100 days of catheter use) caused by Candida albicans and Staphylococcus epidermidis were encountered. Other complications included one subclavian vein thrombosis, eight catheter occlusions, and two local arm inflammations. This technique proved to be a safe, easy, and inexpensive method to administer parenteral nutrition to neonates, especially those weighing <1,000 g.
Growth and Intellectual Development
Authors: Wilson Darrell M. , Hammer Lawrence D. , Duncan Paula M. , Dornbusch Sanford M. , Ritter Philip L. , Hintz Raymond L. , Gross Ruth T. , Rosenfeld Ron G.
Published: December 2021

Data from the National Health Examination Survey (cycles II and III) provided a representative sample of 13,887 US youths (6 to 17 years of age) with which to examine the relationship between height (normalized for age and sex) and measures of intellectual development (Wechsler Intelligence Scale for Children) and academic achievement (Wide Range Achievement Test). Additionally, 2,177 subjects were studied first in cycle II and 2 to 5 years later in cycle III, forming a well-selected longitudinal study group in which to examine any association between linear growth and change in IQ scores. Wechsler Intelligence Scale for Children and Wide Range Achievement Test scores were significantly correlated with height in both cycle II and cycle III. However, no significant association between change in relative height and change in IQ scores could be detected in the longitudinal group. These data suggest that therapies designed to increase height are unlikely to alter measures of intellectual development or academic achievement.
Human Immunodeficiency Virus Seroprevalence in Pediatric Patients 2 to 14 Years of Age at Mama Yemo Hospital, Kinshasa, Zaire
Authors: Mann Jonathan M. , Francis Henry , Davachi Farzin , Baudoux Paola , Quinn Thomas C. , Nzilambi Nzila , Bosenge Ngaly , Colebunders Robert L. , Kabote Ndoko , Piot Peter , Asila Pangu Kaza , Curran James W.
Published: December 2021

Seroprevalence to human immunodeficiency virus (HIV) was determined among 368 children 2 to 14 years of age who were admitted to the pediatric service at Mama Yemo Hospital in Kinshasa, Zaire. Forty (11%) of these patients and only one (1%) of 92 healthy siblings of these patients were HIV seropositive (x2 = 8.68, P < .01). Seropositivity was associated with previous hospitalization, receipt of a blood transfusion prior to the current hospitalization (odds ratio 3.1; 95% confidence interval, 1.5 to 6.4), receipt of medical injections during the past year, and smaller household size. Clinically, HIV seropositivity was associated with the diagnoses of malnutrition and pneumonia. A higher proportion of seropositive children died during the current hospitalization (4/40 v 10/328); when patients with malaria were excluded, the in-hospital mortality of seropositive children was more than eight times higher than that of seronegative children (Fisher exact test, P = .006). Clarification of clinical, immunologic, and epidemiologic features of childhood HIV infection is urgently required because HIV appears to account for or complicate a substantial proportion of pediatric hospitalizations in Kinshasa.
Neurologic Manifestations of Human Immunodeficiency Virus Infection in Children
Authors: Epstein Leon G. , Sharer Leroy R. , Oleske James M. , Connor Edward M. , Goudsmit Jaap , Bagdon Leta , Robert-Guroff Marjorie , Koenigsberger M. Richard
Published: December 2021

This report describes the neurologic manifestations of 36 children with human immunodeficiency virus (HIV) infection. In this cohort, in 16 of 21 children with acquired immunodeficiency syndrome (AIDS), three of 12 children with AIDS-related complex, and one of three asymptomatic seropositive children, a progressive encephalopathy developed. Neurologic signs were often detected early but tended to worsen coincident with progression of the immunodeficiency. The presence of progressive encephalopathy correlated with the absence of serum neutralizing antibodies to HIV and with a poor, usually fatal, outcome. The incubation period from initial HIV infection in the perinatal period to the onset of progressive encephalopathy varied from 2 months to 5 years. Intrablood-brain barrier synthesis of HIV-specific antibodies was demonstrated in eight of 14 children with AIDS and AIDS-related complex, indicating active brain infection with HIV. In three cases this was unassociated with progressive neurologic signs. Unique neuropathologic findings in children who died with HIV infection further suggest that the progressive encephalopathy is the result of primary and persistent infection of the brain with this retrovirus. These findings broaden the spectrum of HIV infection in children and have important implications for the development of antiviral therapy.
One- to Three-Year Outcome for 14 Neonatal Survivors of Extracorporeal Membrane Oxygenation
Authors: Andrews Alice French , Nixon Cynthia A. , Cilley Robert E. , Roloff Dietrich W. , Bartlett Robert H.
Published: December 2021

Extracorporeal membrane oxygenation, using venoarterial or venovenous perfusion, is a safe and effective procedure in the term or near-term infant with life-threatening respiratory failure. Without extracorporeal membrane oxygenation, due to the severity of their disease, these children are at high risk for neurologic damage, chronic lung disease, and death. Because survival is not expected without extracorporeal membrane oxygenation therapy, there is no corresponding control group to which these survivors may be compared. In this report, we reviewed the outcome at 1 to 3 years in the first 14 survivors of extracorporeal membrane oxygenation treated at our institution. Seven of 14 neonatal extracorporeal membrane oxygenation survivors (50%) were normal or near normal at between 1 and 3 years of age. Ten (71%) had normal mental ability. We conclude that in neonates with high mortality risk from respiratory failure, near-normal growth and development can be expected in the majority who survive with extracorporeal membrane oxygenation treatment.
Suctioning Meconium From the Trachea: A New Solution to an Old Problem
Authors: EISNER PERRY
Published: December 2021

Meconium-stained amniotic fluid complicates between 5% and 15% of live births and is, therefore, a frequently encountered problem of both the pediatrician and obstetrician. The currently recommended protocol for combined obstetric and pediatric management is DeLee suction of the nasopharynx, mouth, and hypopharynx by the obstetrician as soon as the baby's head appears. Immediately after delivery, the pediatrician suctions the oropharynx and inspects the cords. If meconium is present, the infant is intubated and the pediatrician places his or her mouth over the endotracheal tube and sucks the meconium from the trachea as the tube is removed.1,2 While this procedure has been proven successful in decreasing the incidence of meconium aspiration syndrome, the possibility of meconium entering the resuscitator's mouth exists.
Colchicine Therapy in Sarcoid Arthropathy
Authors: RUBINSTEIN ISRAEL , BAUM GERALD L.
Published: December 2021

To the Editor.—

We read with great interest the article by Lindsley and Godfrey1 but wish to disagree with one of their conclusions. They suggested that oral corticosteroid therapy is the treatment of choice in sarcoid arthropathy because salicylate and other nonsteroidal anti-inflammatory drugs have only limited success in such cases. We believe, however, that this is not the case, because low-dosage colchicine therapy has provided good results in the agement of both the acute and chronic forms of sarcoid arthropathy when there was no adequate response to nonsteroidal anti-inflammatory agents and bed rest. Colchicine was first used in the treatment of sarcoid arthropathy by Kaplan,2,3 who reported a dramatic improvement, usually within a few days, with the use of 0.5 mg of oral colchicine daily. Subsequently, maintenance oral therapy with colchicine, 1 to 2 mg/d, was introduced to treat the chronic form of the disease, with similar beneficial results.3-7
Population-Based Studies of Varicella Complications
Authors: Guess H. A. , Broughton D. D. , Melton L. J. , Kurland L. T.
Published: December 2021

Population-based data on vanicella complications are presented using information both from national sample surveys of hospitalizations and physician office visits and from reviews of medical records for all cases occurring within one community (Olmsted County, Minnesota) during a specified period. Acute cerebellar ataxia is the most common neurologic complication of varicella and occurs about once in 4,000 vanicella cases among children younger than 15 years of age. Among adults, varicella pneumonia is the most common complication and results in hospitalization about once in every 400 varicella cases. Overall, varicella accounts for approximately 4,000 hospitalizations and 364,000 physician office visits annually in the United States and represents an important continuing source of childhood and adult morbidity.
Severe Injury and Death Associated With Home Infant Cardiorespiratory Monitors
Authors: Katcher Murray L. , Shapiro Mary Melvin , Guist Connie
Published: December 2021

Five cases of electrical injury to young children caused by misuse of components of home cardiorespiratory monitors are reported. The injuries, which included one electrocution, occurred when partially or completely disconnected electrode wires were inserted, by an older monitored child or preschool-aged sibling, into a live power cord or an uncovered wall outlet. Anticipatory guidance of home monitor users should emphasize potential electrical injuries and appropriate injury-control behaviors.