bluuebunny/crossref_metadata_2025 huggingface dataset:
CURRENT URINARY MASS SCREENING FOR CATECHOLAMINE METABOLITES AT 6 MONTHS OF AGE MAY BE DETECTING ONLY A SMALL PORTION OF HIGH-RISK NEUROBLASTOMAS: A CHROMOSOME AND N-myc AMPLIFICATION STUDY
Authors: L. J. F.
Published: December 2021

We studied 96 infants and children with untreated neuroblastomas. Chromosomes of tumor cells were analyzed in 68, and N-myc copy numbers were determined in 67 patients. Patients found by a mass screening program for 6-month-old infants (group A1, 39 patients) or those less than 12 months of age found clinically (group A2, 13 patients) were rarely in the disseminated stage . . .

. . . Most tumors found by the screening showed known characteristics predicting a good prognosis, and the majority of tumors showing characteristics predicting a poor prognosis were found in patients aged between 12 and 36 months. Our chromosome and N-myc amplification studies suggest that a low-risk tumor does not usually evolve to a high-risk tumor. Thus the current mass screening program may be detecting only a small portion of highly malignant neuroblastomas at the earliest stage. Infants should be screened twice, at 6 months as well as at 12 months of age, for the early detection of high-risk neuroblastomas.
PROGRESS IN PEDIATRIC PHARMACOLOGY
Authors: L. J. F.
Published: December 2021

The survey by the Pharmaceutical Manufacturers Association has identified 114 drugs and vaccines that are being developed specifically for pediatric use. . .

• The 114 medicines involve 127 clinical testing research projects, since some are being tested for more than one use. An example is Prokine, a colony stimulating factor being tested by Hoechst-Roussel and Immunex for two kinds of blood disorders, for cancer, and for bone marrow transplantation.

• 56 companies are involved in these research projects, a very broad base of companies that again, I think, reflects the strong research capabilities of the private sector.

• Nearly two-thirds of the projects are in the final stages of development: 45 are in the Phase III human clinical tests and another 35 are at the Food and Drug Administration for review.

• Fully a quarter of our research projects—32 to be exact—are for rare diseases and are designated as orphan drugs on the chart.
Endothelin in the Urine of Children with the Hemolytic Uremic Syndrome
Authors: SIEGLER RICHARD L. , EDWIN SAMUEL S. , CHRISTOFFERSON RYAN D. , MITCHELL MURRAY D.
Published: December 2021

The pathogenic cascade leading to acute renal failure and hypertension in classic childhood hemolytic uremic syndrome (HUS) presumably is initiated by injury to the renal vascular endothelial cells. Multisystem involvement often occurs, apparently as a consequence of widespread endothelial cell perturbation. There is evidence that endothelial cell injury can be caused by circulating Shiga-like toxins (verotoxins) produced by certain diarrhea-producing enteric organisms (eg, Escherichia coli 0157:H7). Platelet and coagulation cascade activation probably occur secondarily with subsequent platelet-fibrin deposition within the renal microvasculature. Kidney biopsy specimens, however, often fail to show structural damage sufficient to account for the severe oliguric renal failure that often occurs in the syndrome.
Use and Misuse of Oral Therapy for Diarrhea
Authors: O'BANION LAURA
Published: December 2021

The article, "Use and Misuse of Oral Rehydration Therapy for Diarrhea," reveals a very low rate of pediatrician adherence to guidelines of the American Academy of Pediatrics and the World Health Organization for oral rehydration. I recently conducted a small study that may shed some light on one underlying factor.

A telephone survey of 14 major pharmacies, including the outpatient pharmacies of two teaching hospitals with departments of pediatrics, revealed that not a single pharmacy carried any of the recommended oral rehydration solutions.
In Reply: Use and Misuse of Oral Therapy for Diarrhea
Authors: SNYDER JOHN D.
Published: December 2021

As Dr O'Banion points out, most of the oral therapy solutions available in the United States are classified as maintenance solutions by the American Academy of Pediatrics (AAP). However, as mentioned in the paper, these solutions have proven to be very effective treatment for children with dehydration in this country.

Solutions conforming to the AAP recommendations as rehydration solutions are not as widely available in this country. The WHO/UNICEF oral rehydration salts formulation, which is supplied as inexpensive packets throughout the world, is not found easily in the US.
In Reply: Response to Pneumococcal Vaccine
Authors: SHAPIRO GAIL G.
Published: December 2021

We regret any confusion concerning the definition of an adequate response to pneumococcal vaccine as defined in the article "Immunologic Defects in Patients with Refractory Sinusitis." The citation of Dr Schiffman's work in this area was intended to credit his research on the value of assessing pneumococcal responsiveness as an indication of immunologic integrity. Because we studied a sample of children and wished to focus on the lowest concentration of antibody that could be considered protective, we chose the value of 200 mg/L, citing the work of Lawrence, who looked at the percentage of children attaining this level after immunization, and noting that 97% and 98% for antigens 3 and 7, respectively, did so.
SIDS and Hypoxanthine
Authors: BECKWITH J. BRUCE
Published: December 2021

The study by Rognum and Saugstad concerning elevated hypoxanthine levels in the vitreous humor of victims of Sudden Infant Death Syndrome (SIDS) made a laudable attempt to correct for postmortem increases in this marker of hypoxia, but I am concerned that the authors have not sufficiently recognized some characteristics of SIDS that could have confounded their study.

Because SIDS usually occurs unobserved during presumed sleep, with the body being discovered an undetermined number of hours later, the true postmortem interval is rarely known.
Coughing and Bed Sheet Wrapping
Authors: COHLAN SIGNEY Q. , STONE SHIRLEY M. , ZIMMERMAN SOL S.
Published: December 2021

We read with interest and expectation the proposal by Lavigne et al for an alternative to the reinforced suggestion bedsheet wrapping technique for the management of psychogenic cough. Their conclusion is based on a behavioral technique used in only four cases, in which cougher and parent count the number of coughs per half hour at varying intervals; then goals are negotiated to gradually lower the coughs per half hour to zero by persuasion and, in one instance, by adding monetary rewards. Three patients improved in about 2 weeks.
Breast-Feeding and Infectious Illness, Power and Confidence Intervals
Authors: HOPKINSON JUDY
Published: December 2021

The article "Relationship Between Infant Feeding and Infectious Illness: A Prospective Study of Infants During the First Year of Life" by Rubin et al in the April issue of Pediatrics was provocative. Like Mulford, I too am concerned about the definitions of breast-feeding used in the study. Breast-feeding and formula-feeding are defined in such a way that the study actually examines the impact of the degree of breast-feeding on health of breast-fed infants. This may be an important issue in Denmark where the incidence of breast-feeding at 1 month is more than 90%.
Destructive Brain Lesions of Presumed Fetal Onset: Antepartum Causes of Cerebral Palsy
Authors: Scher Mark S. , Belfar Hanae , Martin Jerry , Painter Michael J.
Published: December 2021

Antepartum events have been associated with fetal brain injury and may contribute to later neurological sequelae. However, children with these injuries may be asymptomatic or exhibit few clinical signs during the neonatal period. Six neonates are presented with destructive brain lesions of fetal onset based on radiological and neurophysiological studies at birth. No intrapartum difficulties were noted in any of the cases. Two maternal histories were significant for either placental bleeding or toxemia during the second or third trimesters of pregnancy. Fetal porencephaly from presumed intraventricular hemorrhage was documented by serial abdominal sonography for these two children. No causes could be assigned for the remaining four patients with destructive brain lesions. All six children had normal results on neurological examinations at birth, although four neonates later presented with isolated seizures at 8 to 30 hours of life which resolved after administration of anti-epileptic medication. In all cases initial neonatal electroencephalographic records showed abnormalities consisting of major background asymmetries or seizures. Initial documentation of cerebral lesions was made by fetal sonography (two patients) and computed tomography scan (four patients) during the initial 30 hours of life, timing the lesions to the antepartum period. Cerebral palsy has been documented in all children; one child had resolution of her deficits by 6 months of age. Better surveillance of events during the antepartum period may help identify specific pathophysiological conditions that contribute to cerebral palsy. Neurophysiological and imaging studies should be used during the immediate newborn period for neonates believed to have cerebral lesions based on maternal sonography or isolated seizures.
Fluoride Ingestion in Children: A Review of 87 Cases
Authors: Augenstein W. Lynn , Spoerke David G. , Kulig Ken W. , Hall Alan H. , Hall Priscilla K. , Riggs Betty S. , El Saadi Magdi , Rumack Barry H.
Published: December 2021

All cases of fluoride ingestion in children younger than 12 years old reported to the Rocky Mountain Poison Center between January 1 and December 31, 1986, were retrospectively reviewed. Eighty-seven cases were identified. Eighty-four cases involved accidental ingestion of dental fluoride products in the home (tablets, drops, rinses) in children 8 months to 6 years old. Two older children (8 and 9 years old) became symptomatic after fluoride treatment by a dentist. A 13-month-old child died after ingesting an unknown amount of sodium fluoride insecticide, the only insecticide exposure in our series. Postmortem total serum calcium value was 4.8 mg/dL (normal 8.8 to 10.3). No other patients had serious symptoms or sequelae. Twenty-six (30%) of 87 became symptomatic, with gastrointestinal symptoms (nausea, vomiting, diarrhea, abdominal pain) in 25 patients and drowsiness in 1. Only 3 patients became symptomatic later than 1 hour after ingestion. Analysis of data from 70 cases with sufficient information revealed that as the amount of fluoride ingested increased, the percentage of patients with symptoms increased. Not including the fatal case, 6 patients had serum calcium levels measured, and all were normal. Children who ingested up to 8.4 mg/kg of elemental fluoride in dental products had mild and self-limited symptoms, mostly gastrointestinal.
Human Immunodeficiency Virus Infection in Urban Adolescents: Can We Predict Who Is at Risk?
Authors: D'Angelo Lawrence J. , Getson Pamela R. , Luban Naomi L. C. , Gayle Helene D.
Published: December 2021

Few studies have evaluated the extent of human immunodeficiency virus (HIV) in the adolescent population. However, there has been growing concern that sexual and drug experimentation common in this age group may increase their risks of transmitting the virus. Between October 1, 1987, and January 31, 1989, a blinded, unlinked HIV seroprevalence study was conducted among all adolescents aged 13 through 19 receiving ambulatory care at Children's National Medical Center and having blood drawn for other routine medical indications. Overall, seroprevalence in this group of patients was 0.37% (3.7/1000), with the highest prevalence in females (4.7/1000) and patients 18 through 19 years of age (5.6/1000). Of adolescents considered at high risk who were offered and accepted voluntary HIV testing during the same time period, 4.1% (41/1000) were positive. Inasmuch as this represents only 38% of all of the positive tests obtained in the blinded testing phase of the study, it may indicate that a substantial proportion of HIV-positive adolescent patients may be missed by using standard criteria and methods of identifying risk and/or that those most at risk may be reluctant to be tested for HIV infection. The results suggest that HIV infection is present in this population of urban adolescents and that the seroprevalence rate is higher than in other nonselect groups. Moreover, using traditional risk factors as screening criteria may not identify the majority of those infected. Trends need to be followed and further studies conducted in an attempt to define which adolescents are at highest risk for HIV infection.
NEW YORK NURSERY SCHOOLS HARDER TO GET INTO THAN HARVARD!
Authors: L. J. F.
Published: December 2021

All over New York this week, parents are nervously waiting to hear about school. Nursery school. . .

Getting into nursery school is much like everything else in this city: it is an ordeal. Applying to the schools, where for roughly $5,000 a year 3- and 4-year-olds spend a few hours a day in classrooms that look like toy stores, is a process that tests a parent's stamina and ingenuity. . .

What makes the admissions process even worse is how nursery school takes on a life-and-death importance. To many parents, who would deny this publicly, admission to certain nursery schools looms as the springboard to an Ivy League degree, if not success in adult life. . .

The applications asked all about my husband and myself, and why we were applying to the school. One inquired, "What are your child's special talents and abilities?"

At the age of 2, my child has talents that are yet to be determined.

". . .It is harder to get into our nursery school than it is to get into Harvard."
Psychosomatic Musculoskeletal Pain in Childhood: Clinical and Psychological Analyses of 100 Children
Authors: Sherry David D. , McGuire Tona , Mellins Elizabeth , Salmonson Kathy , Wallace Carol A. , Nepom Barbara
Published: December 2021

The clinical and psychological findings on 100 children with psychosomatic musculoskeletal pain seen at a major pediatric rheumatology referral center are reported. Most (76%) were female, median age was 13 years, and median duration of symptoms was 1 year. Multiple painful sites were common (66%). The pain was constant (63%) or intermittent (37%); 45% had hyperesthesia, and almost all maintained a cheerful affect when complaining of severe pain. Two predominant abnormal family milieu were seen. One was cohesive, stable, and organized, but intolerant of separation and individuation. The other was chaotic, emotionally unsupportive, with high levels of conflict. Members of the cohesive family type reported significantly less distress than members of chaotic families. Enmeshment between mother and child was common in both family types. Although frequently viewed as bright, most of these children had normal intelligence, and some had unrecognized academic difficulty. These children, compared with those with arthritis, had a significantly lower global well-being score. Clinical depression was unusual (11%). Most (97%) responded favorably to intensive physical and occupational therapy along with individual or family psychotherapy; 78% become symptom free or fully functional. Children with these signs and symptoms should have full psychological evaluations and respond well to treatment directed toward decreasing pain and restoring function.
Weaver Syndrome: A Case Without Early Overgrowth and Review of the Literature
Authors: Ramos-Arroyo Maria A. , Weaver David D. , Banks Evelyn R.
Published: December 2021

A female child with Weaver syndrome is described. She did not show the excessive growth characteristic of this syndrome until after adequate caloric intake was achieved by feeding through a gastric feeding tube. Her inadequate nutrition was a result of feeding difficulties during infancy. In addition, she had recurrent pulmonary infections, apneic spells, and severe developmental delay. She died at 16 months of sepsis, congestive heart failure, and respiratory arrest. The autopsy revealed marked atrophy of the brain and cardiac ventricular hypertrophy. Most of the brain changes were thought to be from hypoxia.
Symptoms and Signs in Infants Younger Than 6 Months of Age Correlated With the Severity of Their Illness
Authors: Morley C. J. , Thornton A. J. , Cole T. J. , Fowler M. A. , Hewson P. H.
Published: December 2021

Symptoms and signs were recorded for 1007 infants younger than 6 months of age seen at home (298) or hospital (709) and correlated with four grades of illness severity. Most symptoms, present in the preceding 3 days, were associated with all grades of illness. Only four symptoms were not reported in well infants: a fluid intake less than a third of normal, convulsions, frank blood in the stools, and bile-stained vomiting. By comparison, many signs were seen only in ill infants. Those associated only with moderate or serous illness were marked retraction of the lower ribs, high-pitched or moaning cry, expiratory grunt, loss of alertness, central cyanosis, and severe hypotonia. Although these will not identify all seriously ill infants, parents and professionals should be taught to recognize these important symptoms and signs of serious illness.
Glutaryl-Coenzyme A Dehydrogenase Deficiency: A Distinct Encephalopathy
Authors: Hoffmann Georg F. , Trefz Friedrich K. , Barth Peter G. , Böhles Hans-Josef , Biggemann Brigitte , Bremer Hans J. , Christensen Ernst , Frosch Michael , Hanefeld Folker , Hunneman Donald H. , Jacobi Hans , Kurlemann Gerd , Lawrenz-Wolf Burkhard , Rating Dietz , Roe Charles R. , Schutgens Ruud B. H. , Ullrich Kurt , Weisser Jochen , Wendel Udo , Lehnert Willy
Published: December 2021

Clinical course, diagnostic and therapeutic management, and neurodevelopmental outcome were evaluated in 11 patients with glutaryl-coenzyme A dehydrogenase deficiency. In 9 patients macrocephalus was present at or shortly after birth and preceded the neurological disease. In 7 children an acute illness resembling encephalitis appeared after a period of normal development; 2 had developmental delay and progressive "dystonic cerebral palsy." Later, all 9 displayed typical signs of a disorder of the basal ganglia. In 1 patient with macrocephalus the disorder was diagnosed before the onset of neurological disease; in another it was diagnosed prenatally. Computed tomography and magnetic resonance imaging scans revealed severe generalized cerebral atrophy, most striking in the frontal and temporal lobes in 10 patients. Further deterioration was halted after initiation of treatment consisting of low-protein diets, special formulas low in lysine and tryptophan, and supplements of riboflavin and L-carnitine. Only 1 patient showed a slight clinical improvement. Later, dietary therapy was discontinued in 2 older patients and relaxed in a third without observed adverse effects. Two patients in whom treatment could be initiated before the onset of neurological symptoms have developed normally. However, duration of follow-up (6 and 29 months) does not yet allow classification of glutaryl-coenzyme A dehydrogenase deficiency as a treatable disorder. Total body production of glutaric acid, reflected in the daily urinary output, was efficiently reduced by therapeutic measures. Levels of glutaric acid in plasma and cerebrospinal fluid remained unchanged, which may in part explain the overall unsatisfactory outcome. All patients presented with a severe secondary deficiency of carnitine. L-Carnitine appears to play an important pathobiochemical role in the pathogenesis of the disorder. It is concluded that glutaryl-coenzyme A dehydrogenase deficiency is an acute to subacute neuropathic disorder of infancy or early childhood. Later in the course of the disease further deterioration appears to subside. The lack of significant metabolic derangements may cause this disorder to remain frequently undiagnosed. Glutaryl-coenzyme A dehydrogenase deficiency should have high priority in the differential diagnosis of any child with acute profound dyskinesia, subacute motor delay accompanied by increasingly severe choreoathetosis, and dystonia. It should especially be considered when there is macrocephalus in an infant together with progressive atrophic changes on computed tomography or nuclear magnetic resonance imaging, as neurological handicap can potentially still be prevented.
Clofibrate Treatment of Neonatal Jaundice
Authors: GABILAN J. C. , BENATTAR C. , LINDENBAUM A.
Published: December 2021

In Reply.—

I. Erkul, H. Yavuz, and A. Ozel's remarks concerning adverse and possibly pathogen effects of clofibrate in man are very important and deserve accurate answers. The potential carcinogenic effect of clofibrate in rat and mouse is well known; its mechanism has not been resolved, but it occurs only after extended treatment involving high doses of the drug.1-4 In man, some authors have speculated on the possible occurrence of colonic tumors, due to the increase in fecal excretion of cholesterol, degradation of which by intestinal bacteria might produce carcinogenic substances.5,6
Neuroblastoma Represents Distinct Clinical-Biologic Entities: A Review and Perspective From the Quebec Neuroblastoma Screening Project
Authors: Woods William C. , Lemieux Bernard , Tuchman Mendel
Published: December 2021

Data are presented suggesting that neuroblastoma represents at least two distinct clinical-biologic entities. One, favorable neuroblastoma, is associated with young age and early stage at diagnosis, triploid karyotypes, no 1p abnormalities or N-myc gene amplification, more mature catecholamine synthesis and excretion, and excellent clinical outcome despite no or minimal therapy. The other, unfavorable neuroblastoma, is associated with older age and advanced stage, pseudodiploid karyotypes and 1p deletions, N-myc oncogene amplification, less mature catecholamine synthesis and excretion, and poor outcome despite aggressive multimodality therapy including bone marrow transplantation. Favorable neuroblastomas rarely, if ever, evolve into unfavorable disease. Unresolved issues regarding this hypothesis and implications for the efficacy of preclinical detection through mass screening are discussed.
Infant Obesity, Weight Reduction with Normal Increase in Linear Growth and Fat-free Body Mass
Authors: PEIPERT JOYCE M. , STALLINGS VIRGINIA A. , BERRY GERARD T. , HENSTENBURG JULE ANNE D.
Published: December 2021

Dietary caloric restriction, as a means to induce weight loss, is seldom used as a treatment of obesity in infancy for fear that permanent stunting of growth may result.1-4 Thus, there is little information on controlled weight loss as the treatment for infant obesity or, more importantly, its effect on growth in length, head circumference, and fat-free body mass during weight loss.5 We present a case of an obese infant who, secondary to a metabolic disorder, required nutritional support both intravenously and by nasogastric tube. During 15 months, the patient's resting energy expenditure (REE) was measured to determine an appropriate caloric intake to promote weight loss and later weight maintenance.
Location of Port-Wine Stains and Likelihood of Complications
Authors: LUEDER GREGG T.
Published: December 2021

To the Editor.—

I read with interest Location of Port-Wine Stains and the Likelihood of Ophthalmic and/or Central Nervous System Complications by Tallman et al.1 Knowing the incidence of complications in patients with port-wine stains (PWS) is important, both for counseling families regarding risks and for justifying screening recommendations. Although the article provides some useful information, I feel that further comment is warranted.

The authors found a 7% incidence of glaucoma in patients with PWS in the trigeminal distribution (18 of 274 patients).
Allergic Reactions to MMR Vaccine
Authors: KALET ADINA , BERGER DAVID K. , BATEMAN WILLIAM B. , DUBTTSKY JEFFREY , COVTTZ KATHLEEN
Published: December 2021

To the Editor.—

We are writing to notify health care providers that the risk of allergic reactions to the measles, mumps, rubella (MMR) vaccine may be more common that recognized previously.1,2 Epidemiologic data suggest that life-threatening allergic reactions to the single antigen measles or MMR vaccine are extremely rare, less than 71.6 reactions per one million doses.2 Studies performed on college campuses reported no significant difference in reactions between the vaccine recipients and the unvaccinated controls, and no allergic reactions were reported after measles vaccination.3,4
Psychosocial Intervention
Authors: COHEN GEORGE J.
Published: December 2021

To the Editor.—

Barry Zuckerman's commentary1 on family history and psychosocial intervention which appeared in the May 1991 issue of Pediatrics deserves the attention of every practicing pediatrician. Inquiring about mental health problems in the family history and guiding the affected family to help is a worthwhile approach to prevention of further disability.

In a similar vein, The National Consortium for Child and Adolescent Mental Health Services, of which the American Academy of Pediatrics is a member, recently issued the following position statement:

Responsible procedure in treatment, admission and discharge of hospitalized adult psychiatric patients is to record if there are children in the home, and, if so, to inquire about their mental, developmental and health status.
Department of Red Faces
Authors: CHAO JASON
Published: December 2021

To the Editor.—

There is a typographical error in Table 2 which accompanied the article "Safe Handling of Vaccines" by Casto and Brunell.1 On page 110, in the second column for poliovirus vaccine live (oral), it states that "it will remain fluid at temperatures above 14°C." This should read above minus (–)14°C. The correct information is contained in the package insert for oral poliovirus vaccine.
Department of Red Faces
Authors: CASTO DANIEL T. , BRUNELL PHILIP A.
Published: December 2021

In Reply.—

Dr. Chao is correct. Oral poliovirus vaccine will remain fluid at temperatures above minus (–)14°C. We appreciate his calling our attention to the typographical error that we missed in proof.
The Anser System
Authors: LEVINE M. D.
Published: December 2021

To the Editor.—

In a report by Glascoe, Martin, and Humphrey,1 a comparative review of developmental screening tests was offered to readers of Pediatrics. With that review, the authors provided a description and comments on the Anser System.2 Its inclusion is perplexing, because the Anser System is not a developmental screening test.

The Anser System comprises a series of questionnaires for use by pediatricians (primarily) as part of the evaluation (but not the screening) of children with learning and developmental problems.
Perineal Confusion
Authors: KELLOGG NANCY D. , PARRA JUAN M.
Published: December 2021

In Reply.—

Dr Eman's comments regarding our paper highlight several of the problems and the confusion encountered when trying to define normal and abnormal anogenital anatomy. Our study is the first to describe anatomically and scientifically the existence of the linea vestibularis.

We would like to summarize some of the points made in our paper. First, we described a white spot or line located in the midline of the posterior vestibule, but not extending to the posterior attachment of the hymen.
A Different View of Surfactant Development
Authors: PHIBBS RODERIC H.
Published: December 2021

In Reply.—

Dr Kattwinkel suggests in his letter that there has been no serious effort by investigators in neonatology and pulmonary biology to identify the best possible surfactant for use for replacement therapy in hyaline membrane disease. Furthermore, he implies that there has been a national or perhaps international conspiracy to ignore natural human surfactant in the large clinical trials done to date. In reaching these opinions, Dr Kattwinkel seems to have ignored several facts of which he should be aware.
Candy Cigarettes: Do They Encourage Children's Smoking?
Authors: Klein Jonathan D. , Forehand Billie , Oliveri Janice , Patterson Charlotte J. , Kupersmidt Janis B. , Strecher Victor
Published: December 2021

Candy and bubble gum cigarettes are packaged to resemble cigarette brands, and so they may encourage young children to smoke. Two studies of the role of these products in the development of children's attitudes and behaviors toward smoking were conducted. In the first study, six focus group interviews were conducted with 25 children in three age groups (4 through 5, 6 through 8, and 9 through 11 years old). Children in each group were shown five candy and snack foods and asked about their opinions and experiences with each item. In the second study, 195 seventh-grade students in a southeastern city school system were surveyed about their cigarette smoking and candy cigarette use. In the focus groups, candy cigarettes were recognized by most children. Young children played with the candy cigarettes more than with other candy or snack items and made general references to smoking behaviors. Older children made favorable references to smoking behavior; most knew which stores sold candy cigarettes, and many had chosen to buy and use these items, despite parental disapproval. Candy cigarettes may play a role in the development of children's attitudes toward smoking as an acceptable, favorable, or normative behavior. Elimination of these products should be part of efforts to prevent initiation of smoking by children.
Herpes Simplex Virus in Childhood Erythema Multiforme
Authors: Weston William L. , Brice Sylvia L. , Jester Joy D. , Stockert Scott , Huff J. Clark , Lane Alfred T.
Published: December 2021

Although an association between herpes simplex virus (HSV) infection and erythema multiforme (EM) minor has been documented in adults, this has not been reported in the pediatric population. This study assessed the potential role of HSV infection in the pathogenesis of EM minor in children. Erythema multiforme skin lesions from 20 children, aged 1 to 16 years, were examined for the presence of HSV by using the polymerase chain reaction. The children included all fit strict clinical criteria for EM minor. Ten had a clinical history of an antecedent herpes infection ("herpes-associated EM"), and 10 did not ("idiopathic EM"). Herpes simplex virus DNA was detected in skin lesions of 8 of 10 children with herpes-associated EM and in 8 of 10 with idiopathic EM. Control skin biopsies from children with other bullous inflammatory diseases were negative. In addition, no HSV could be detected in a biopsy of normal uninvolved skin of a child in whom HSV was present in lesional skin. In situ hybridization on selected biopsies by means of an HSV-specific riboprobe confirmed the presence of HSV and localized it to the epidermis. It is concluded that HSV is a significant precipitating factor for EM minor in children, as it is in adults, and that clinicians should maintain a high index of suspicion of HSV even in the absence of a known history of herpes infection.
Tissue-Type Plasminogen Activator, Plasminogen Activator Inhibitor, and Histidine-Rich Glycoproteins in Stressed Human Newborns
Authors: Corrigan James J. , Jeter Monette A.
Published: December 2021

Normal newborns have reduced levels of tissue-type plasminogen activator (tPA). Stressed newborns have an increased prevalence of thrombotic diseases. An impaired release of tPA and/or increased plasminogen activator inhibitor (PAI) is associated with thrombotic risk in the adult patient. The purpose of this study was to assay the plasma levels of tPA, PAI, histidine-rich glycoprotein (HRG), and other fibrinolytic proteins in 15 severely stressed newborns. The stressed babies showed significantly higher (p < .001) levels of tPA antigen compared with normal newborns. Also, PAI activity and PAI-1 antigen levels were increased. Levels of both HRG and plasminogen were higher in the stressed group but the ratio of HRG to plasminogen was the same as that in the normal control newborns (1:3), suggesting an insignificant effect of HRG.d-dimers were significantly elevated in the stressed newborns. However, 8 patients died and 4 of these were found to have massive thrombotic disease on autopsy. These results show that the newborn when stressed will increase tPA levels and activate the lytic system. However, the activity is suboptimal inasmuch as PAI activity did not decrease and thrombotic disease was observed.
Dobutamine Pharmacokinetics and Cardiovascular Responses in Critically Ill Neonates
Authors: Martinez Alma M. , Padbury Jamés F. , Thio Siang
Published: December 2021

The pharmacokinetics and pharmacodynamics of dobutamine were studied in 13 critically ill neonates requiring inotropic support. Dobutamine was administered as a constant infusion in increasing doses of 2.5, 5, and 7.5 µg/kg per minute. During dobutamine infusions, there were significant increases in cardiac output measurements above preinfusion values. There were no statistically significant changes in systolic or diastolic blood pressure or heart rate during the infusions. The mean calculated threshold value, or the minimum plasma concentration necessary for a change in cardiac output, was 39±8 ng/mL. The mean plasma clearance rate was 90±38 mL/min per kilogram and was most consistent with first-order kinetics over the range of dosages studied. Plasma catecholamine levels were unchanged during the dobutamine infusions. These data suggest that dobutamine is an effective but limited inotropic agent in the neonate. Dobutamine may be most beneficial when cardiogenic failure is present.
Prospective Randomized Comparison of High-Frequency Oscillatory and Conventional Ventilation in Respiratory Distress Syndrome
Authors: Clark Reese H. , Null Donald M. , Gerstmann Dale R. , deLemos Robert A.
Published: December 2021

A prospective randomized trial with a crossover design was conducted to compare the efficacy and safety of two distinct strategies of high-frequency oscillatory ventilation (HFOV) to conventional intermittent mandatory ventilation (CV) in the management of respiratory distress syndrome. Only premature neonates with a birth weight less than 1.751 kg were eligible for enrollment into the study. Of 83 patients studied, 26 patients were assigned to CV-only, 27 to HFOV for 72 hours followed by CV (HFOV/CV), and 30 to HFOV-only until extubation. There was no difference among the three groups with respect to the incidence of pulmonary airleak, intraventricular hemorrhage, or death. The highest incidence of chronic lung disease was in the CV-only group. Although both HFOV groups had a lower incidence of chronic lung disease assessed at 30 days and 36weeks postconception age, the difference was statistically significant only between the CV-only and HFOV-only groups (65% vs 30% at 30 days; P = .008; 38% vs 10% at 36 weeks postconception age, P = .013). These results suggest that use of HFOV as the predominant mode of ventilation in the management of respiratory distress syndrome is as safe as CV and can contribute to a decreased incidence of chronic lung disease. Furthermore, a short (72-hour) period of HFOV support does not provide the same advantage as continuous HFOV.
Covering the Costs of Care in Neonatal Intensive Care Units
Authors: Imershein Allen W. , Turner Carolyn , Wells Janice G. , Pearman Allen
Published: December 2021

The continued rise of health care costs, despite private and governmental control efforts, has sustained cost containment as a central issue for health care researchers and policy makers. In keeping with these concerns, the Florida Health Care Cost Containment Board conducted a study of neonatal intensive care units (NICUs) in Florida to ascertain the costs, charges, and net revenues associated with NICU services in individual hospitals, to document cost shifting and cross-subsidization as a means of financing NICU care for indigent populations, and to assess the fiscal impact of NICUs in state-sponsored vs non-state-sponsored Regional Perinatal Intensive Care Center hospitals providing NICU care. Hospitals in the state-sponsored program reported a loss of approximately $16.5 million in contrast to the non-state-sponsored hospitals, which reported a gain of $1 million. Payment being generated by privatepay patients amounted to almost 60% of total revenues but constituted less than one third of the costs in statesponsored hospitals, indicating a high level of cost shifting. Government support of state-sponsored NICUs, while substantial, has been insufficient; increasing constraints on this funding source would likely worsen the deficit and increase the necessity of cost shifting.
Lead Intoxication in Infancy
Authors: Shannon Michael W. , Graef John W.
Published: December 2021

Four years of experience in the evaluation and management of lead intoxication in the first year of life were reviewed. This study was conducted in a lead referral program within the state of Massachusetts, whose comprehensive lead laws include extensive (and now mandatory) lead screening of all children. Over the period of study, 50 (14%) of 370 new patients enrolled in the program were Infants aged 12 months or younger. Median age of these infants was 11 months (range 1 through 12 months). Mean peak lead level was 39.0 µg/dL while the mean peak erythrocyte protoporphyrin concentration was 111.9 µg/dL of whole blood. Thirty-two percent of infants were ambulatory at the time lead intoxication was diagnosed; only 24% had a history of pica. Twenty-six percent of parents were welfare dependent. Apparent sources of plumbism included household renovation (n = 20), direct ingestion of paint chips (n = 10), formula preparation with lead-contaminated water (n = 9), lead dust importation (n = 1), and congenital exposure to elevated maternal lead level (n = 1). In 9 cases the source was not found. When this profile was compared with that of a randomly selected group of 47 children aged 18 through 30 months, who were seen in the lead program during the same interval, apparent sources of intoxication in the older group were paint chip ingestion (n = 41), household renovation (n = 2), and unknown (n = 4) (P < .0001). On the basis of these data, it is concluded that lead intoxication in infants is common and has significantly different origins from that in toddlers. Lead intoxication from infant formula reconstituted with contaminated water may account for many of these cases. These findings support recommendations that lead screening begin at the age of 6 months for children with any likelihood of lead exposure.
The Denver II: A Major Revision and Restandardization of the Denver Developmental Screening Test
Authors: Frankenburg William K. , Dodds Josiah , Archer Philip , Shapiro Howard , Bresnick Beverly
Published: December 2021

Since the Denver Developmental Screening Test was first published 23 years ago, it has been utilized worldwide and restandardized in more than a dozen countries. Concerns raised through the years by test users about specific items and features of the Denver Developmental Screening Test, coupled with a need for more current norms, have prompted a major revision and restandardization of the test. For the revision, 336 potential items were administered to more than 2000 children. The average number of times each item was administered was 540. Using regression analysis, composite norms for the total sample and norms for subgroups (based on gender, ethnicity, maternal education, and place of residence), were used to determine new age norms. The final selection of the 125 Denver II items was based on the following criteria: ease of administration and scoring, item appeal to child and examiner, item test-retest and inter-rater reliability, minimal "refusal" scores, minimal "no opportunity" scores, minimal subgroup differences, and a smooth step-like progression of ages at which 90% of children could perform the tasks. The major differences between the Denver II and the Denver Developmental Screening Test are: 1) an 86% increase in language items; 2) two articulation items; 3) a new age scale; 4) a new category of item interpretation to identify milder delays; 6) a behavior rating scale; and 7) new training materials.
Suppression of Bilirubin Production in the Crigler-Najjar Type I Syndrome: Studies with the Heme Oxygenase Inhibitor Tin-Mesoporphyrin
Authors: Galbraith Richard A. , Drummond George S. , Kappas Attallah
Published: December 2021

The heme oxygenase inhibitor tin-mesoporphyrin was used to moderate hyperbilirubinemia in two 17-year-old boys with Crigler-Najjar type I syndrome. Both patients had histories of recent, progressive neurological deterioration and plasma bilirubin concentrations on admission to the hospital were 34.5 and 28.5 mg/dL. Throughout hospitalization lasting more than 400 days, both patients underwent 10 hours of phototherapy nightly and consumed constant weight-maintaining diets. They were treated with intermittent plasmapheresis and two periods of tin-mesoporphyrin therapy comprising, in the first study period, 40 doses of 0.5 µmol/kg body weight and in the second study period, 70 doses of 1.0 µmol/kg body weight. Plasma bilirubin concentrations were decreased in both patients to varying degrees as was the rebound hyperbilirubinemia which occurs after plasmapheresis. The prolonged treatments with the inhibitor were well-tolerated and no progression of the preexisting neurological impairments occurred during the clinical trials. The results of this study suggest that the clinical application of an effective heme oxygenase inhibitor can provide a potentially useful, pharmacological adjunct to presently available therapeutic modalities for controlling episodes of acute, severe jaundice in this but lethal disorder.
Vaccine Storage Practices in Pediatric Offices
Authors: Bishai David M. , Bhatt Sucheta , Miller Lee T. , Hayden Gregory F.
Published: December 2021

Fifty pediatric offices and clinics in the metropolitan Los Angeles area were visited to assess vaccine storage practices. Questionnaires were administered to the personnel responsible for vaccine storage and the vaccine refrigerators were inspected. Only 16% of vaccine storage coordinators could cite appropriate storage temperatures for vaccines and 18% were unaware that heat can harm certain vaccines. Refrigerator thermometers were checked at least weekly in only 20% of offices, and 22% of the refrigerators had inappropriately high temperatures. Vaccines were routinely stored outside of the refrigerator uninsulated during the practice day in 16% of the offices visited. It is concluded that vaccine storage errors occur in pediatric offices at an unacceptably high frequency. Pediatricians should familiarize themselves with the guidelines for optimal vaccine storage in order to minimize the potential for vaccine failure in primary care practice.
Localization of Human Immunodeficiency Virus Core Antigen in Term Human Placentas
Authors: Mattern Carl F. T. , Murray Karen , Jensen Allison , Farzadegan Homayoon , Pang Jenny , Modlin John F.
Published: December 2021

Evidence of human immunodeficiency virus (HIV) replication was sought in human placentas obtained at term from pregnancies complicated by maternal HIV infection. Placentas were obtained from the pregnancies of 19 HIV-seropositive women, 4 women who were seronegative, and 4 untested women with no risk factors for HIV infection. These placentas were each examined by immunoperoxidase immunocytochemistry using monoclonal anti-p24/55 antibodies. In addition, minced placental tissue from 11 of the seropositive pregnancies and the 3 seronegative pregnancies were co-cultivated with stimulated human peripheral blood mononuclear cells. The clinical status of the infants born to the HIV-seropositive women was assessed when the infants were 8 to 28 months of age. P24/55 antigen was detected in 5 of the 19 placentas of the HIV-seropositive pregnancies and in none of the 8 placentas of seronegative or low-risk pregnancies. This HIV core viral antigen was located exclusively in the cytoplasm of villous cells with morphological characteristics of macrophages. The HIV antigen-containing cells were very sparsely distributed. Staining of the trophoblast was not observed in any placental specimen. Human immunodeficiency virus was isolated in culture from 3 of the 11 placentas from seropositive pregnancies. Clinical follow-up has not revealed a relationship between infection of the infant and either p24/55 antigen identification or isolation of virus from the placenta. Virological and histological evidence of HIV replication is found in approximately one fourth of placentas obtained at term from pregnancies complicated by maternal HIV infection. Replicating virus appears localized to sparse macrophages located within the chorionic villi, but specifically not within the trophoblastic layer. It is unlikely that identification of HIV in the placenta either by culture or by immunocytochemistry will predict infection of infants born to seropositive women.
Neurodevelopment of Preterm Infants: Neonatal Neurosonographic and Serum Bilirubin Studies
Authors: Graziani Leonard J. , Mitchell Donald G. , Kornhauser Michael , Pidcock Frank S. , Merton Daniel A. , Stanley Christian , McKee Linda
Published: December 2021

In this study of 249 preterm infants of less than 34 weeks's gestation, the relationships between maximal serum total bilirubin concentrations during the neonatal period, neonatal cranial ultrasonographic abnormalities, and severe neurodevelopmental sequelae are described. The subjects, who were selected on the basis of serial cranial ultrasonographic findings, had repeated neurologic and developmental examinations during late infancy and early childhood that established the presence (n = 45) or absence (n = 204) of spastic forms of cerebral palsy. Of the 204 subjects without cerebral palsy, 23 scored abnormally low on standardized developmental testing during early childhood. All but seven of the subjects with cerebral palsy had grade III/IV intracranial hemorrhage or moderate to severe periventricular echogenicity or both, ultrasonographic abnormalities that probably reflect a disruption in the blood-brain barrier as well as extravasation of blood into brain tissue; however, analysis of the data did not suggest that these cranial ultrasonographic abnormalities increased either the maximum serum bilirubin concentration during the neonatal period or the susceptibility of the subjects to neurologic damage from hyperbilirubinemia. Also, there was no evidence to suggest that bilirubinemia in the range studied (2.3 to 22.5 mg/100 mL total serum bilirubin) was causally related to cerebral palsy, early developmental delay, or the development of periventricular cysts in this population of preterm infants. Univariate analyses revealed that Apgar scores were significantly lower, while grade III/IV intracranial hemorrhage, large periventricular cysts, moderate to severe periventricular echodensity, ventriculomegaly, assisted ventilation, and bronchopulmonary dysplasia occurred significantly more often in infants with cerebral palsy than in those without cerebral palsy; however, a stepwise logistic regression revealed that of these clinical variables only large periventricular cysts, moderate to severe periventricular echodensity, and the need for assisted ventilation were associated with the occurrence of cerebral palsy at a statistically significant level. Apgar scores and average birth weight were significantly lower, and duration of assisted ventilation was significantly longer, but neurosonographic findings did not differ in the 23 developmentally delayed infants compared with the normal group.