bluuebunny/crossref_metadata_2025 huggingface dataset:
Neonatal Bilirubin Workshop
Authors: Gartner Lawrence M. , Catz Charlotte S. , Yaffe Sumner J.
Published: December 2021

A neonatal bilirubin workshop took place at The Rockefeller University on June 20 through 22, 1993 to consider controversial issues in the field of neonatal jaundice and bilirubin neurotoxicity, particularly as they relate to management. The conference was sponsored by the National Institute of Child Health and Human Development (Pregnancy and Perinatology Branch, Center for Mothers and Children), The Rockefeller University, and the Consiglio Nazionale delle Richerche (Italy).

tk;4Presentations and discussion emphasized diagnosis, biochemistry, and mechanisms of bilirubin toxicity, the definition and consequences of kernicterus, and the appropriateness and safety of the various therapies currently in use. Identification of future research needs was an important agenda item.

The conferees agreed that conventional management of jaundice in the newborn with phototherapy and exchange transfusion, as well as with phenobarbital in certain situations, had significantly reduced the occurrence of "traditional" kernicterus. However, the conferees acknowledged that the classical definition of kernicterus was in need of re-examination in view of the potential of bilirubin as a CNS toxin.

Early discharge of newborns from the hospital has significantly altered diagnostic and therapeutic management of neonatal jaundice, transforming it into an outpatient problem. This transformation raises new questions regarding the best time to ascertain the cause(s) of jaundice and to identify risk factors to insure optimal management of the infant.

Review of the current state of knowledge of bilirubin metabolism focused on new methods for measurement of unconjugated and conjugated bilirubin, measurement of bilirubin synthesis rates, the molecular biology of bilirubin conjugation and the developmental role of the family of enzymes known as glucuronyl transferase(s), and the role of genetic and other host factors in determining the safety or toxicity of bilirubin in the newborn.
Toward Immunizing Every Child On Time
Authors: ORENSTEIN WALTER A. , BERNIER ROGER H.
Published: December 2021

Few procedures pediatricians undertake can compare with the impact of immunizations on their patients. A recent cost-benefit analysis by Battelle Medical Technology documented that approximately $29, $21, and $6 in total costs were saved for every dollar spent on diphtheria, tetanus, pertussis vaccines (DTP), measles, mumps, rubella vaccines (MMR), and oral poliovaccines (OPV), respectively (Hatziandreu et al, manuscript in preparation).

Immunization is also important because of its relationship to other aspects of primary care. Children who are underimmunized at 24 months of age are 3 to 12 times less likely to have been screened for anemia, tuberculosis, or lead.
THE PREVALENCE OF GENDER-ATYPICAL BEHAVIOR IN ELEMENTARY SCHOOL CHILDREN
Authors: Sandberg David E. , Meyer-Bahlburg Heino F.L. , Nat. Rer. , Ehrhardt Anke A. , Yager Thomas J.
Published: December 2021

Objective: To supplement the few small-scale studies on convenience samples of boys with an epidemiological study on the prevalence of gender-atypical behaviors (GABs) in boys and girls and to assess the influence of variation of age, ethnicity, and socioeconomic status. Method: The present study, a postal questionnaire survey, used an existing pool of GAB items for boys, developed comparable GAB items for girls, and analyzed parent-reported frequencies of GABs in a demographically heterogeneous community sample of 687 boys and girls age 6 to 10 years. Results: The majority of GABs were quite rare, but there was considerable variability in their prevalence. Nevertheless, many children show multiple GABs although each individual GAB at low frequency; for instance, 10 or more different GABs were exhibited by 22.8% of boys and 38.6% of girls. Only a few GABs varied significantly with age, ethnicity, or socioeconomic status. Conclusions: These data are of relevance to clinicians counseling parents who are worried about the occurrence of GABs in their children.
BOY HARMED BY LEAD TO GET $1.5 MILLION IN COURT SETTLEMENT
Authors: L. J. F.
Published: December 2021

A 5-year old boy who was poisoned by lead during his landlord's attempts to clear his apartment of lead-based paint will receive up to $1.5 million over his lifetime from the landlord's insurance company.

The boy has attention deficit disorder with hyperactivity. In reports filed with the Milwaukee County Circuit Court, doctors said the disorder had either been caused by the lead poisoning or had been made worse by it.

...In the summer of 1991, the city health department discovered that the boy's blood contained lead levels that were three times the Federal health standard.

In June 1992, the city ordered the owners of the apartment building, a converted 65-year-old frame house, to begin removing the lead-based paint. But instead of alleviating the victim's problem, their scraping of the paint spread lead dust throughout the home. As a result, lead levels increased to eight times the Federal standard. The family sued, contending negligence.
In Reply: Aminophylline Study: Not Enough Patients?
Authors: STRAUSS RAPHAEL E. , VALACER DAVID J.
Published: December 2021

In response to Dr Hornberger's inquiry about the power analysis of our study, patients excluded from the final statistical analysis were those who also required longer hospitalization rates, which raised the standard deviations for both groups considerably. These patients were removed from the study for either aminophylline toxicity or failure to respond to therapy. When the data for these cases were excluded, the standard deviation dropped to 0.82 and 0.53 for the aminophylline and placebo groups respectively, resulting in the relatively high power to detect a 1 day difference in hospitalization.
Media, Children, and Violence: A Public Policy Perspective
Authors: Charren Peggy , Gelber Andrew , Arnold Milton
Published: December 2021

Pediatrician advocacy concerning the impact of television violence on children should be clearly grounded in the holistic concern of pediatricians with children's health and well-being.

Pediatricians should not promote legislative or regulatory efforts to reduce children's exposure to television violence by proscribing certain kinds of program content. Instead, priority should be given to strategies that improve the content and quality of television programming viewed by children and that enhance the viewing choices made by children and their families. Such strategies include providing parent education and pressing for strong implementation of the Children's Television Act.

Pediatricians should dedicate their efforts to increasing the awareness of broadcasters and the general public, acting as educators and persuaders. In order to advocate and educate effectively, pediatricians need to amplify their own knowledge and understanding of television-related issues and their significance.

Finally, because children's exposure to television violence is but one part of a larger social context, pediatricians concerned with this issue should devote significant attention to related problems that diminish the health and well-being of children.
CROSS-CULTURAL PATTERNS IN EATING DISORDERS: A REVIEW
Authors: Pate Jennifer E. , Pumariega Andres J. , Hester Colleen , Garner David M.
Published: December 2021

Eating disorders were previously thought to be isolated to achievement-oriented, upper and middle class individuals in Western countries. It now appears that these disorders may be increasing in other sectors of society and in a number of diverse cultural settings. We review the studies that comprise the relevant cross-cultural research literature on eating disorders. We also discuss the changing cultural factors that may be contributing to the apparent increase in these disorders around the world and directions for future research on such factors.
ORGANS OF LIVEBORN ANENCEPHALIC CANNOT BE HARVESTED IN FLORIDA
Authors: Student
Published: December 2021

The Florida Supreme Court today upheld a lower court's ruling that prevented a baby born with much of her brain missing from being declared dead so that her organs could be used for transplants.
MAN THE MANIPULATOR
Authors: Student
Published: December 2021

Homo is not truly sapiens, the wise, but manipulans, the meddler. Uncontrolled manipulation of the environment has shown itself to be a recipe for disaster, and uncontrolled reproduction has exponentially increased its effects.
DATA DREDGING TURNS UP ANOTHER SPURIOUS ASSOCIATION
Authors: Student
Published: December 2021

Data from a large U.S. risk factor study (MRFIT) throw up a [biologically implausible] relation between cigarette smoking and suicide. . . It is likely that many more associations, for other exposures and other diseases, are equally spurious, but are protected by their lack of obvious implausibility.
An Approach to Ventilator-Dependent Neonates with Arthrogryposis
Authors: Bianchi Diana W. , Van Marter Linda J.
Published: December 2021

Objective. To identify the clinical factors and/or test results necessary to determine the diagnosis and prognosis for a group of neonates who presented with respiratory insufficiency and multiple contractures.

Methods. We performed a retrospective review of medical records and identified 15 newborns over a 10-year period (1980 through 1990) who had arthrogryposis multiplex congenita and required ventilator support at birth. We designed a 104 item data base to record clinical information; this was subsequently analyzed using the Clinfo data base program for statistical analysis.

Results. Fourteen of the 15 patients died. Of the fourteen, 13 were electively extubated after a variable time course (2 hours to 64 days). Autopsies performed on all 14 revealed an approximately equal distribution of central nervous system (CNS) malformations, peripheral neuropathies, and peripheral myopathies as the etiology. The single survivor had myasthenia gravis.

Conclusion. In neonates with arthrogryposis, ventilator dependence at birth carries a poor prognosis. Prenatal factors that potentially predict respiratory insufficiency for the fetus with arthrogryposis include decreased fetal movements, polyhydramnios, micrognathia, and thin ribs. The combination of a thorough physical examination and radiographic and neuromuscular studies may not result in a specific diagnosis, but it can indicate whether the abnormality is in the CNS, peripheral nerves or muscles. Before elective withdrawal of ventilatory support, an edrophonium chloride challenge test should be performed to rule out myasthenia gravis.
SURVEY SAYS MOST NONPROFIT GROUPS PAID CHIEF EXECUTIVES OVER $100,000 YEARLY
Authors: L. J. F.
Published: December 2021

NEW YORK—A survey of executive pay at 122 nonprofit organizations found that at least 99 of the groups paid their executives more than $100,000 a year. But in some cases, the survey found, other employees received far more. For instance, a professor of surgery at Cornell, earned $1.7 million in the fiscal year ended June 1991; the president of the university earned $111,131, less than 10% of that, although his benefits exceeded his salary that year. The survey didn't give details of the professor's pay.

At Lincoln Center in New York, the five highest-paid employees who aren't officers are stagehands, earning $110,467 to $146,820, the survey found. Only the president, with a salary of $315,000 in the fiscal year ended June 1992, earned more.
Anaphylaxis to Natural Rubber Latex in a Girl with Food Allergy
Authors: Llátser Rafael , Zambrano Concepción , Guillaumet Baltasar
Published: December 2021

Over the past few years, an increase in intraoperative and obstetric anaphylactic episodes has been related to rubber exposure. Individuals at high-risk for sensitization to latex include health care workers,1,2 rubber industry professionals,3 and children with spina bifida or congenital urogenital abnormalities who undergo frequent medical procedures.4,5 However, severe reactions have been observed in other subjects.6,7 Therefore, identifying patients at risk for anaphylaxis is essential before performing medical procedures involving rubber exposure.

Recently,8 similarities in the protein content between natural rubber and several fruits have been found. Those proteins are cross-reactive and may cause severe allergic reactions if the patient comes in contact with rubber products and eats fruit.
Intrathoracic Disease Associated With Mycobacterium avium-intracellulare Complex in Otherwise Healthy Children: Diagnostic and Therapeutic Considerations
Authors: Gupta Sandeep K. , Katz Ben Z.
Published: December 2021

Mycobacterium tuberculosis (MTB) is a well described human pathogen.1 Less commonly, atypical or nontuberculous mycobacteria (NTM) can cause disease in humans. Recent studies report that NTM account for one-third of all pathogenic mycobacterial isolates in the United States.2

Mycobacterium avium-intracellulare complex (MAI) is the most common NTM causing human disease.2 It is also the most common mycobacterial cause of cervical lymphadenitis in children in areas with low endemic rates of MTB infection.3 MAI/NTM infection other than cervical adenitis is unusual in children, except in those that are immunosuppressed.4 Rarely, MAI presents as mediastinal or endobronchial disease in otherwise healthy children.
Medical Conditions Affecting Sports Participation
Authors:   Committee on Sports Medicine and Fitness
Published: December 2021

In 1988 the American Academy of Pediatrics (AAP) published an analysis of medical conditions affecting sports participation.1 This statement was endorsed by the American Medical Association, replacing their own recommendations.2 A further modification of this analysis is presented here, with additions and changes that attempt to increase its accuracy and completeness and to include current information.

In Table 1, sports are categorized by their probability for collision or contact. In "collision" sports (eg, boxing, ice hockey, football, or rodeo), athletes purposely hit or collide with each other or inanimate objects, including the ground, with great force. In "contact" sports (eg, basketball and soccer), athletes routinely make contact with each other or inanimate objects, but usually with less force than in collision sports. Table 1 does not separate collision and contact sports because there is no clear dividing line between them. In "limited contact" sports such as softball and squash, contact with other athletes or inanimate objects is either occasional or inadvertent.

Sports with limited contact, for example downhill skiing and gymnastics, can be as dangerous as the contact or collision activities. Even in noncontact sports serious injuries can occur, such as in power lifting. Overuse injuries are not related to contact or collision. For all these reasons, the categorization of sports in Table 1 reflects imperfectly their relative risk of causing injury. The categorization does, however, give an idea of the comparative likelihood that participation in different sports results in acute traumatic injuries from blows to the body.

We assessed the medical conditions listed in Table 2 to determine whether participation would create an increased risk of injury or adversely affect the medical condition.
Letter to the Editor
Authors: Buchheit John Q. , Stewart Dan L.
Published: December 2021

We appreciate the comments of Drs The', Young, and Rosser regarding our article on localized intestinal perforation in neonates. Our cases appear to differ from those reported by Lloyd1 in 1979 in that approximately one-half of those cases were gastric perforations that were excluded from our study. Also, in the Lloyd series, very little clinical information is provided regarding associated disease states (ie, hyaline membrane disease or patent ductus arteriosus), maternal history, medications used, feeding history, exchange transfusions, or Apgar scores.
Letter to the Editor
Authors: Senturia Yvonne D. , Christoffel Katherine Kaufer , Donovan Mark
Published: December 2021

In response to Dr Blackman:

Dr Blackman's letter confuses several distinct issues: 1) gun exposure of children seen in pediatric practices, 2) teen gun use, 3) the root causes of violence (eg, poverty), and 4) his model of "a stable and moral family environment." Our paper addresses only the first issue. Guns in the homes of pediatric practice attenders are not the cause of all of society's ills, nor of all gun violence. On the other hand, guns in the home are a proven hazard,1-4 which pediatric counseling may help to reduce.
A Virtually Routine Procedure—Why!?
Authors: Ríos Enrique , Martinez Homero , Neuhauser Linda
Published: December 2021

We would like to bring to your attention the widespread practice of routine gastric lavage for newborns in Mexican hospitals.

We recently completed a study of newborn feeding in health institutions in Mexico.1 A stratified random sample was selected from three regions in Mexico (Mexico City, Sonora, and Chiapas). Health facilities were stratified by type of provider (government or private), size (number of deliveries per month), specialties (gynecology-obstetrics, general, maternity, rural clinic), and geographical location (north, central, and south).
The Anthracycline Cardiotoxicity Debate
Authors: Barber Gerald
Published: December 2021

I was fascinated by your decision to publish the recent article "Monitoring for Anthracycline Cardiotoxicity" by Dr Lipshultz et al. (Pediatrics. 1994;93:433-437). The article appears to be nothing more than a somewhat delayed letter to the Editor in response to the previously published "Guidelines for Cardiac Monitoring of Children During and After Anthracycline Therapy: Report of the Cardiology Committee of the Children's Cancer Study Group" (CCSG) (Pediatrics. 1992;89:942-949). In attempting to refute the recommendations of a national panel of experts, the authors present their opinions supported by no new data.
Letter to the Editor
Authors: Friedman Deborah M.
Published: December 2021

I was surprised to find the editorial comments by Steven Lipshultz1 published in the "article" section of Pediatrics without even a rebuttal by the Children's Cancer Study Group (CCSG).

This apparent attack on the "Steinherz recommendations"2 is really only mere opinion aimed against the expert panel of the CCSG, which had concluded that the anthracycline dose in a child should be modified if there were noninvasive evidence of cardiac toxicity even before the onset of clinical congestive heart failure.
Letter to the Editor
Authors: Silber Jeffrey H.
Published: December 2021

Lipshultz et al1 level some strong criticism at the Children's Cancer Study Group (CCSG) algorithm for screening anthracycline cardiotoxicity in pediatric oncology patients.2 However, their economic analyses suffer from significant errors in both the application and interpretation of well-described economic theory.

The key insight of the Lipshultz et al paper is one based on what they called "incremental" changes in dosage. Although the concept is correct, the methodology was not applied appropriately to their problem.
Letter to the Editor
Authors: Finlay Jonathan , Meadows Anna T.
Published: December 2021

We have read the paper by Lipshultz et al,1 that objects to the published recommendations for monitoring anthracycline cardiotoxicity,2 and we find no data to substantiate their opinion. In addition, they ignore their own data and instead make unjustified assumptions to reach unwarranted and dangerous conclusions.

The authors contend that if patients who receive anthracyclines are monitored, and if the therapy is modified on the basis of cardiac toxicity without overt failure, this will result in a net loss instead of benefit to the patients.
Letter to the Editor
Authors: Lipshultz Steven E. , Sanders Stephen P. , Colan Steven D. , Goorin Allen M. , Sallan Stephen E. , Krischer Jeffrey P.
Published: December 2021

The above letters confirm our belief that monitoring for anthracycline cardiotoxicity is not only an important and emotional issue, but a highly complex one. We wish to respond to several of the points raised therein.

First, our several references to "authors," "Steinherz and her colleagues," and "Steinherz et al," as well as using the full name of the committee in the abstract and concluding paragraph, should have made the multiple authorship of the Children's Cancer Study Group (CCSG) paper clear.
DIAGNOSES OF ATTENTION-DEFICIT HYPERACTIVITY DISORDER FROM PARENT REPORTS PREDICT DIAGNOSES BASED ON TEACHER REPORTS
Authors: Biederman Joseph , Faraone Stephen V. , Milberger Sharon , Doyle Alysa
Published: December 2021

Objective: For DSM-III attention deficit disorder (ADD), it was previously reported that, when a parent report leads to a diagnosis of ADD, it is highly likely that the teacher report will also be positive. This report seeks to generalize that finding to DSM-III-R attention-deficit hyperactivity disorder (ADHD). Method: In a population of 34 children meeting clinical criteria for DSM-III-R ADHD, parents and teachers independently responded to questions about individual ADHD symptoms. Results: Correlations between parents and teachers for individ ual symptoms were low to moderate; however, there was a 77% probability that the teacher report would result in a positive diagnosis given a positive parental diagnosis. This probability increased to 88% if "broad" teacher diagnoses of ADHD, defined by 35% of the 14 DSM-III-R symptoms, were included. Conclusions: In clinically-referred children, a clinical diagnosis of ADHD based on parent report is likely to be corroborated by a teacher report.
NEWSPAPERS TOLD: SIMPLIFY, SIMPLIFY
Authors: L. J. F.
Published: December 2021

BALTIMORE, April 1—American newspapers are dull and difficult to read. But different ways of writing news articles could help newspapers attract some of the readers they have lost.

That was the conclusion of a major study made public here this week at the annual convention of the American Society of Newspaper Editors. The study suggests that newspapers must challenge many of the rules that have governed journalism for generations.

The study was prepared by the group's literacy committee, which was formed partly because of growing alarm that young Americans do not read well enough to understand newspapers and are abandoning them as a result.

The literacy panel challenged the fundamental form used for newspaper articles, the "inverted pyramid," in which the top is heavy with important facts and trails off into less significant information.
COMPARISON OF PREVENTIVE INTERVENTIONS FOR FAMILIES WITH PARENTAL AFFECTIVE DISORDER
Authors: Beardslee William R. , Salt Patricia , Porterfield Katherine , Rothberg Phyllis Clarke , van de Velde Polly , Swatling Susan , Hoke Lizbeth , Moilanen Donna L. , Wheelock Ingrid
Published: December 2021

Twenty families participated in a random assignment trial of two cognitive psychoeducational preventive interventions for families with parental affective disorder. Twelve families were assigned to a clinician-based intervention and eight to a lecture-based intervention, with assessment prior to intervention and an average of 18 weeks following intervention. Both groups were satisfied and believed they received help from the intervention. The clinician-based group was significantly more satisfied overall, and reported significantly more changes in both behaviors and attitudes about their illness from pre- to postintervention. Both groups showed significant decrease in degree of upset over issues of concern from pre- to postintervention. The clinician-based group reported receiving significantly more help with their primary concern. The implications of these findings are discussed.
Recovery of Giardia lamblia Cysts From Chairs and Tables in Child Day-Care Centers
Authors: Cody Mildred M. , Sottnek Henry M. , O'Leary Virginia S.
Published: December 2021

More than 11 million children attend commercial child day care in the US. This number is expected to increase as more mothers of preschool children enter the work force. Infectious diseases are readily transmitted in child day-care settings,1-4 where children are in close contact with one another for approximately 50 hours per week. Diarrheal diseases are common in these settings. Infectious diarrhea can be transmitted by person-to-person contact1,2,5 and, possibly, by contact with fomites.1,3 Many food service surfaces including tables, kitchen counters, ware-washing sinks, and dinner plates in the centers are contaminated with bacterial levels that exceed public health standards.6,7

Giardia lamblia is a pathogenic intestinal protozoan that may produce an acute infection characterized by diarrhea and other clinical symptoms.8 It infects children in day care at a higher rate than the general population.2,5 Family members are at risk of acquiring G. lamblia transmitted from children attending child-care centers3 where infectious cysts of G. lamblia may be shed by infected symptomatic or asymptomatic individuals.1,5 Intervention strategies that rely on exclusion of infected children from day-care settings are expensive and do not control Giardia infections in the child day-care environment.4

We compared the use of a commercially available, indirect immunofluorescent procedure with direct microscopic examination to detect G. lamblia cysts in stools of children attending day-care centers. Because the detection of G. lamblia on environmental surfaces would show their potential for transmitting giardiasis, we used the immunofluorescent procedure to look for G. lamblia cysts on various surfaces. Cysts were removed by swabbing surfaces, recovered on membrane filters, and detected using the indirect immunofluorescent procedure on the filters.
Scabies Outbreak in a Day-Care Center
Authors: Sargent Susie J. , Martin Jena T.
Published: December 2021

Scabies is a highly contagious condition characterized by cutaneous infestation with the human itch mite, Sarcoptes scabiei var. hominis. Although not a reportable disease, its prevalence has increased in the US since the mid-1970s.1-3 Worldwide, outbreaks have generally occurred in association with conditions of crowding, poor hygiene, or malnutrition.4,5 However, the current nationwide resurgence has affected persons from all socioeconomic levels without regard to age, sex, or personal hygiene.4,6 While scabies is primarily spread by intimate personal contact, skin-to-skin transmission can also occur after prolonged casual contact such as occurs in institutional settings, nursing homes, and day-care centers. Mites can survive for 2 to 3 days on inanimate surfaces, which permits transmission via fomites such as clothes, furniture, floors, and bed linens. Persons with chronic skin disorders are more likely to transmit the mite to others because their infestations may be more difficult to diagnose and treat. Exfoliation of skin flakes may enhance transmission.

To our knowledge, there is no published account of a scabies outbreak in a day-care center. We describe an outbreak of scabies infestation in a hospital-affiliated child-care facility that ultimately involved the treatment of more than 600 people at a cost of more than $16 000 and took at least 4 months to eradicate. All of the childrens' parents were health-care workers at the nearby 1000-bed hospital, so there was potential for spread to patients and thus, a need for rapid control. Elimination of scabies within a day-care center may be particularly problematic unless a coordinated effort among staff, parents, and physicians can be established.
The Risks and Benefits of Cytomegalovirus Transmission in Child Day Care
Authors: Dobbins James G. , Adler Stuart P. , Pass Robert F. , Bale James F. , Grillner Lena , Stewart John A.
Published: December 2021

CONGENITAL CYTOMEGALOVIRUS DISEASE

Congenital infection with cytomegalovirus (CMV) is the leading viral cause of birth defects, and it is the major cause of severe, multiple birth defects in the US. Approximately 40 000 infants, or 1% of all births, are congenitally infected each year; 4000 of these infants are born with the severe defects that define the disease, and another 6000 will have developmental problems later in life. The remaining 30 000 infected infants have no recognizable damage. Defects frequently noted at birth include microcephaly, intracranial calcifications, hearing and vision damage, neurologic damage, and growth retardation. Developmental problems noted later may include partial loss of vision or hearing and learning disabilities.1

Infection of the fetus can result from both primary and recurrent maternal infection, although recurrent infections only rarely produce recognizable congenital disease with severe consequences. This distinction is important because public health intervention is based entirely on preventing primary CMV infection during pregnancy.

Cytomegalovirus

The cause of this damage, CMV, is a common virus that produces a life-long infection. Reactivation of earlier infections is possible, as is reinfection with a different strain of the virus. Usually, both primary and recurrent infections result in either inapparent or mild illness, although some adolescents and adults may develop mononucleosis. In some persons with an impaired immune system, however, infection can be devastating and life-threatening. Persons with AIDS, some transplant patients, cancer patients, and fetuses lack the ability to control infection with CMV.

Person-to-person transmission of the virus occurs through bodily fluids including breast milk, semen and vaginal secretions, blood, and particularly, saliva and urine.
A Community Outreach Program To Improve Vaccination Coverage in Family Home Day Care
Authors: Pertowski Carol A. , Wharton Melinda , Prim Tracey R. , Ziegler Robyn A. , Gilbert Bradley P. , Elcock Maryellen , Cochi Stephen L. , Rutherford George W.
Published: December 2021

Although preliminary data suggest that some unvaccinated children can be reached through licensed family day-care home providers, attaining age-appropriate vaccination coverage of these children will depend on the ability of providers to interpret records correctly. The baseline knowledge of providers may be insufficient to accomplish this without educational programs.
American Public Health Association/American Academy of Pediatrics Injury Prevention Standards
Authors: Lie Letty , Runyan Carol W. , Petridou Eleni , Chang Albert
Published: December 2021

Injury prevention is an integral part of quality child-care programs. National standards relating to injury prevention have been published by the APHA and the AAP. The majority of these standards are preventive in nature and stress injury prevention in the development of policies and procedures and in the implementation of daily practices in child-care programs. Although it may not be possible to prevent all injuries in child-care settings, it is important for care givers, parents, and health professionals to identify potential hazards in the child-care environment. Once these hazards are identified, preventive corrective actions directed toward both environmental modifications and individual behaviors can be promoted to keep the incidence of injuries as low as possible.
Epidemiology of Physician-Diagnosed Allergic Rhinitis in Childhood
Authors: Wright Anne L. , Holberg Catharine J. , Halonen Marilyn , Martinez Fernando D. , Morgan Wayne , Taussig Lynn M.
Published: December 2021

Objective. To investigate the natural history of and risk factors for allergic rhinitis in the first 6 years of life.

Methods. Parents of 747 healthy children followed from birth completed a questionnaire when the child was 6 years old. Data were obtained regarding physician-diagnosed allergic rhinitis (PDAR), associated symptoms, and age at onset. Risk-factor data were taken from earlier questionnaires, and data regarding immunoglobulin E (IgE) and skin-test reactivity were obtained at age 6.

Results. By the age of 6, 42% of children had PDAR. Children whose rhinitis began in the first year of life had more respiratory symptoms at age 6 and were more likely to have a diagnosis of asthma. Early introduction of foods or formula, heavy maternal cigarette smoking in the first year of life, and higher IgE, as well as parental allergic disorders, were associated with early development of rhinitis. Risk factors for PDAR that remained significant in a multivanate model included maternal history of physician-diagnosed allergy (odds ratio: 2.2, 95% confidence interval: 1.35-3.54), asthma in the child (4.06, 2.06-7.99), and IgE greater than 100 IU/mL at age 6 (1.93, 1.18-3.17). The odds for atopic as opposed to nonatopic PDAR were significantly higher only among those with high IgE and those who had dogs.

Conclusion. Allergic rhinitis developing in the first years of life is an early manifestation of an atopic predisposition, which may be triggered by early environmental exposures.
Salicylate Intoxication in an Infant With Ichthyosis Transmitted Through Skin Ointment—A Case Report
Authors: Abdel-Magid El Hassan Mohammed , Ahmed Fathel-Rahman El Awad
Published: December 2021

Accidental salicylate poisoning is becoming less common than it was three decades ago. There was a dramatic drop in the number of children who had this condition in countries where using childproof caps and limiting the number of pills per package was legalized and implemented.1 In some other countries, salicylate still remains a common cause of accidental poisoning among children.2,3 Salicylate intoxication almost always happens after oral ingestion.

Ichthyosis is a group of inherited keratinizing disorders characterized by visible scaling in distinctive patterns of distribution. Lamellar ichthyosis is an autosomal recessive disorder that is usually evident at birth, and is associated with erythroderma.
Letter to the Editor
Authors:   Executive Board of the Educational Audiology Association
Published: December 2021

We believe that universal newborn hearing screening is a necessity. Data indicate that the High Risk Register currently used in many hospitals and recommended by Bess and Paradise only identifies about 50% of congenital hearing impairments. Causing further consternation is the fact that the average age of identification of hearing impairment in the United States remains at 3 years of age. We know that 1/1000 children are born deaf and about 7/1000 have bilateral hearing impairments in the mild to severe range.
Infectious Disease in Child Day Care: An Overview
Authors: Osterholm Michael T.
Published: December 2021

In the early 1980s, the Minnesota Department of Health began to address the growing concern of the risk of infectious diseases in child day care by initiating a planning process that resulted in the first national symposium on infectious diseases in child day care. That symposium, which was held in June 1984 in Minneapolis, highlighted the fact that different vocabularies and points of reference would need to be bridged if day-care providers and regulators, clinicians, and public health practitioners are to work side-by-side in defining the risk of infectious diseases in day care and in developing appropriate prevention strategies.1 As a result of this meeting, the Minnesota Public Health Association submitted a resolution to the American Public Health Association (APHA) in the fall of 1984, stating that child-care standards, especially in the area of prevention of infectious diseases, were needed. This resolution, together with a simultaneous recommendation from the APHA's Maternal and Child Health Section for the development of health and safety standards for out-of-home child-care facilities, began a process which eventually led to the monumental effort now known as the American Public Health Association/American Academy of Pediatrics, National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs.2

In June, 1992, the Centers for Disease Control and Prevention sponsored the "International Conference on Child Day Care Health: Science, Prevention and Practice," a historic meeting bringing together concerned individuals from many disciplines to further define and set the future agenda for the science, prevention and practice of child day-care health.
ISPAD DECLARATION OF KOS
Authors: Weber Bruno , Brink Stuart
Published: December 2021

On September 4, 1993, on the island of Kos, the members of the International Study Group of Diabetes in Children and Adolescents (ISGD), assembled at our 19th annual international scientific meeting and in the process of transforming ISGD into the International Society of Pediatric and Adolescent Diabetes (ISPAD), renew their Hippocratic Oath by proclaiming their commitment to implement the St Vincent Declaration to promote optimal health, social welfare, and quality of life for all children and adolescents with diabetes around the world by the year 2000. We take this unique opportunity to reaffirm the commitments by diabetes specialists in the past and, in particular, unanimously pledge to work towards the following:

1. to make insulin available for all children and adolescents with diabetes;

2. to reduce the morbidity and mortality rate of acute metabolic complications or missed diagnosis related to diabetes mellitus;

3. to make age-appropriate care and education accessible to all children and adolescents with diabetes as well as to their families;

4. to increase the availability of appropriate urine and blood self-monitoring equipment for all children and adolescents with diabetes;

5. to develop and encourage research on diabetes in children and adolescents around the world; and

6. to prepare and disseminate written guidelines and standards for practical and realistic insulin treatment, monitoring, nutrition, psychosocial care and education of young patients with diabetes—and their families—emphasizing the crucial role of health care professionals—and not just physicians—in these tasks around the world.
Recombinant Human Erythropoietin Stimulates Erythropoiesis and Reduces Erythrocyte Transfusions in Very Low Birth Weight Preterm Infants
Authors: Shannon Kevin M. , Keith Julian F. , Mentzer William C. , Ehrenkranz Richard A. , Brown Mark S. , Widness John A. , Gleason Christine A. , Bifano Ellen M. , Millard Dietra D. , Davis Charles B. , Stevenson David K. , Alverson Dale C. , Simmons Charles F. , Brim Marlene , Abels Robert I. , Phibbs Roderic H.
Published: December 2021

Design and methods. We hypothesized that treatment with recombinant human erythropoietin (r-HuEPO) would stimulate erythropoiesis and would thereby reduce the need for erythrocyte transfusions in preterm infants. We treated 157 preterm infants born at 26.9 ± 1.6 weeks of gestation who weighed 924 ± 183 g at birth with either subcutaneous r-HuEPO (100 U/kg/d, 5 days per week) or placebo for 6 weeks in a randomized, double-blind, controlled clinical trial. All patients received oral iron and were managed according to uniform conservative transfusion guidelines.

Results. Treatment with r-HuEPO was associated with fewer erythrocyte transfusions (1.1 ± 1.5 per infant in the r-HuEPO group versus 1.6 ± 1.7 per infant in the placebo group; P = .046) and with a reduction in the volume of packed erythrocytes transfused (16.5 ± 23.0 mL versus 23.9 ± 25.7 mL per infant; P = .023). Overall, 43% of the infants in the r-HuEPO group and 31% of placebo-treated infants were transfusion-free during the study (P = .18). The volume of blood removed for laboratory tests and the need for respiratory support at the start of treatment had major effects on transfusion requirements independent of r-HuEPO. Reticulocyte counts were higher during treatment in the r-HuEPO group (P = .0001), and r-HuEPO-treated infants had higher hematocrit values at the end of the study (32% versus 27.3% in the placebo group; P = .0001). We found no differences in the incidence of major complications of prematurity between the treatment groups.

Conclusion. We conclude that treatment with r-HuEPO at a weekly dose of 500 U/kg stimulates erythropoiesis, moderates the course of anemia, is associated with a reduction in erythrocyte transfusions, and appears safe in very low birth weight preterm infants who are receiving iron supplements. Conservative transfusion criteria, minimization of phlebotomy losses, and treatment with r-HuEPO are complementary strategies to reduce erythrocyte transfusions in these infants.
DOCTORS' OWN GUIDELINES HURT THEM IN COURT
Authors: L. J. F.
Published: December 2021

Doctors are finding that they can get burned by cookbook medicine.

Recent court cases, as well as a Harvard University study, suggest that written guidelines on how to treat particular medical conditions have become powerful weapons for plaintiffs in malpractice cases. Where plaintiffs once had to rely on hired experts to argue that a procedure was botched, they can now point to official treatment recipes issued by physician groups themselves.

"Lawyers like me are using them in court all the time to say, "Gee, your own organization says this is a minimum standard of care, and you didn't follow it."

Ironically, doctors have embraced and developed guidelines in recent years, believing they could be used to fight malpractice suits. "The hope was that guidelines would say specifically what the standard of care was," says Troyen Brennan, a health law expert and an author of the Harvard study.

Medical groups have issued dozens of guidelines, from instructions on performing Caesarian deliveries to recommendations on treating intoxicated trauma patients ... the Harvard study warns that the rising use of guidelines in malpractice litigation could "chill physicians' interest" in writing new ones.

According to the Harvard study, which was released earlier this year by the School of Public Health, such guidelines are about three times more likely to be used against doctors than in their defense. The Harvard researchers examined 13 years of court decisions and 259 claims filed with malpractice insurers.

Where it's clear that a doctor met the required standards, the guidelines can aid physicians.
Obesity: A Game of Inches
Authors: Leibel Rudolph L.
Published: December 2021

Obesity, like baseball, is a game of inches. Weight gain cannot occur unless energy intake exceeds energy expenditure. Such positive energy balance is a sine qua non for normal growth in the child, and for obesity in the adult. Very small excesses of intake over expenditure can make a big difference if present over a long period of time. Consider the children in the study reported by Klesges et al1 elsewhere in this journal (pages 126-130). At about 4½ years of age, these children were estimated (by diet history) to have been ingesting about 2000 kcal per day. This is almost certainly an overestimate of the actual caloric intake of these children (see below).
REVISING MISS AMERICA'S STORY
Authors: L. J. F.
Published: December 2021

Concerned about news reports linking the hearing loss of the new Miss America to a childhood vaccination, the American Academy of Pediatrics said the actual culprit was a bacterial infection.

The Academy said in a statement on Thursday that it had learned from her pediatrician, Dr. Ted Williams of Dothan, AL, that the nerve damage to Heather Whitestone's ears was caused by a Hemophilus influenzae, or H-influenzae infection.
Infant Sleep Position: Pediatricians' Advice to Parents
Authors: Hudak Bonnie B. , O'Donnell Jane , Mazyrka Nadine
Published: December 2021

Objective. The American Academy of Pediatrics' (AAP) recommendation for side or supine sleep position in healthy babies has generated much controversy. We surveyed primary care physicians to determine the effect of the AAP statement on physician attitude toward infant sleep position and advice to parents.

Methods. We sent a 23-question survey to 194 physicians in Western New York. The survey addressed their attitude toward the AAP recommendations and its impact on their advice to parents.

Results. Of the 149 physicians treating newborns, 121 (82%) completed the questionnaire; 98% were aware of the AAP statement. The most common sources of information were the AAP (86%) and professional literature (77%). Of the respondents, 79% agreed with the AAP statement. Reasons for reservation were lack of data (64%), potential adverse consequences of supine position (52%), and their own experience (47%). Gender, years in practice, and type of reimbursement did not influence attitude toward the AAP recommendation. The AAP statement increased the frequency with which physicians routinely discussed sleep position from 34 to 70% (P < .02). Physicians recommending the prone position decreased from 57 to 7% (P < .001), while those recommending supine sleep position increased from 10 to 42% (P < .001).

Conclusions. Most physicians agreed with the AAP statement and more frequently discussed sleep position following the AAP recommendations. However, they did not routinely recommend supine sleep position. The majority (69%) recommended the side position even though it is unstable. Although the AAP statement has increased discussion of infant sleep position by primary care physicians in WNY, only a minority recommend that infants sleep supine.
Perinatal Brain Injury in Premature Infants Born to Mothers Using Alcohol in Pregnancy
Authors: Holzman Claudia , Paneth Nigel , Little Ruth , Pinto-Martin Jennifer ,   Neonatal Brain Hemorrhage Study Team
Published: December 2021

Objective. Alcohol has been shown to have teratogenic effects on the fetal central nervous system. However, little research has been done to assess the impact of prenatal alcohol exposure on premature infants, a group particularly vulnerable to perinatal brain injury.

Methods. We examined the relation between maternal alcohol use and the most common forms of brain injury in premature infants—germinal matrix/intraventricular hemorrhage (GM/IVH) and white-matter damage—in a large population-based cohort of infants weighing 2000 g or less. The analyses included 349 infants younger than 31 weeks' gestation who received at least one cranial ultrasound scan and whose mothers were queried about prenatal alcohol use in a postpartum interview.

Results. Infants of mothers who reported "moderate" alcohol use (fewer than seven drinks per week and fewer than three drinks per occasion) to "high" use (seven or more drinks per week and/or three or more drinks per occasion) before recognized pregnancy, and moderate alcohol use during pregnancy, were not at increased risk for brain injury. However, after controlling for potentially confounding factors, infants of women reporting high alcohol use during pregnancy were at increased risk of developing isolated brain hemorrhage (odds ratio [OR] = 5.5, 95% confidence interval [CI] = 1.2, 24.7), any brain hemorrhage (OR = 6.7, 95% CI = 1.8, 26.4), and white-matter damage (OR = 9.5, 95% CI = 1.9, 46.4).

Conclusion. Premature infants of women who report consuming seven or more drinks per week and/or three or more drinks per occasion during pregnancy have substantially elevated risks of both of the most common forms of brain injury in premature infants.
THE VALUE OF EXPERT ADVICE?
Authors: L. J. F.
Published: December 2021

"In 1900, Alexander Graham Bell, the second president of the National Geographic Society, invited prominent editors and publishers to Washington to seek their advice about the society's magazine. They gave him these suggestions:

1. Move to New York, because it is impossible to establish a popular magazine in Washington.

2. Change the name National Geographic to something simpler.

3. Forget about building circulation through membership in a geographic society; sell the magazine on newsstands instead.

4. Never mention the name National Geographic Society in the magazine because people abhor geography."

"... Bell cheerfully ignored all the suggestions,... and set the magazine on its way to becoming the largest popular journal of geography in the world. 9.2 million circulation."