bluuebunny/crossref_metadata_2025 huggingface dataset:
Pediatric Defibrillation: Importance of Paddle Size in Determining Transthoracic Impedance
Authors: Atkins Dianne L. , Sirna Sara , Kieso Robert , Charbonnier Francis , Kerber Richard E.
Published: December 2021

Transthoracic impedance is a major determinant of successful defibrillation or cardioversion, but no data are available concerning the range and determinants of transthoracic impedance in children. Transthoracic impedance was measured in ten ambulatory infants, 6 weeks to 9 months of age, and 37 children, 1.5 to 15 years of age, using a previously validated "test pulse" technique that measures transthoracic impedance without actually delivering a shock. We used hand-held "pediatric" (21 cm2) and "adult" (83 cm2) electrode paddles coated with either Redux paste or Redux creme. Transthoracic impedance in children was 108 ± 24 Ω (range 61 to 212 Ω) using pediatric paddles. Using adult paddles lowered the transthoracic resistance by 47% to 57 ± 11 Ω (range 29 to 101 Ω), P < .05. In infants, transthoracic impedance (measured only with pediatric paddles) was 94 ± 17 Ω (range 74 to 124 Ω). Using Redux paste as the coupling agent reduced transthoracic impedance by 13% (P < .05). Transthoracic impedance was significantly but poorly related to body weight and body surface areas, but the correlations were not sufficiently high to be clinically useful. These data indicate that the larger adult electrode paddles will minimize transthoracic impedance and should be used when the child's thorax is large enough to permit electrode to chest contact over the entire paddle surface. This transition occurred at an approximate weight of 10 kg.
Controversial Techniques in Allergy
Authors: SHAPIRO GAIL G. , ANDERSON JOHN A.
Published: December 2021

Ten years ago a commentary appeared in Pediatrics entitled "Allergy Skin Testing: Science or Quackery?"1 This statement was a rejoinder to a commentary in Pediatrics in 19752 that included allergy skin testing in a list of laboratory procedures that are abused for financial gain. The gist of the reply was that allergy skin tests themselves were not the problem because they were valid bioassays for IgE antibody to specific antigens. Abuse and quackery set in when numerous, indiscriminately chosen skin tests were performed instead of an appropriate history, physical examination, and carefully selected tests based on that evaluation.

The allergy skin test was at that time and remains today the most sensitive test for specific allergic antibody in the skin, its presence there reflecting its presence in the blood and respiratory tract.
Passive Immunization Against Varicella in Children Receiving Cancer Chemotherapy
Authors: FELDMAN SANDOR , LOTT LENNIE
Published: December 2021

In Reply.—

Our review1 did not reveal or imply that passive immunoprophylaxis was not effective in preventing or modifying varicella in children with cancer. Individual patients benefited from immunoprophylaxis. Overall, this form of prevention cannot be expected to statistically decrease the frequency of varicella in a childhood cancer population. The number of children at risk is large, whereas the number of children in whom the infection develops is relatively small. Too few children receive prophylaxis to have a statistical impact on the number of cases relative to the large number of children at risk.
Urine Output Measurement in Premature Infants
Authors: COOKE RICHARD J. , WERKMAN SUSAN , WATSON DONNA
Published: December 2021

Determination of urine output is important for clinical care and research of the premature infant. This is achieved by placing a urine bag with adhesive edges on the infant, aspirating the bag, and determining the volume of urine therein. Unfortunately, urine leakage occurs around the bag. To account for such losses, the infant is placed on a preweighed, absorbent diaper. Urine output then is determined from the volume of urine in the bag and the increase in the weight of the diaper that has occurred between urine collections. The purpose of this study was to quantitate the confounding effect of evaporation on diaper weights when diapers are placed under a radiant warmer or in an isolette.
Adolescent Pregnancy
Authors:   COMMITTEE ON ADOLESCENCE
Published: December 2021

There is a continuing nationwide concern regarding the high prevalence of adolescent/teenage/ school-aged pregnancy. The terms adolescent pregnancy, teenage pregnancy, and school-aged pregnancy all have been applied to pregnancy at an age and/or developmental stage that is considered premature or inappropriate, especially with respect to outcome. Whereas fertility is determined by biologic factors, the impact of pregnancy and its consequences have biologic, psychosocial, and environmental determinants. The term "adolescence" is applied to the period of psychosocial development from childhood to adulthood that corresponds to chronologic ages 10 or 12 to 21 years. Adolescent pregnancy has different implications for the 18- or 19-year-old high school graduate who is married or planning marriage than for the 13-or 14-year-old middle school student who may be beginning the process of adolescence. Although recognizing this broad spectrum, the Committee on Adolescence has chosen the term "adolescent pregnancy" for this and related statements. Our primary concern is the individual in early to middle adolescence (younger than the age of 18 years) who is biologically and/or psychosocially immature, and for whom pregnancy is, often unplanned, if not unwanted.

Explanations for the high prevalence have ranged from inadequate sex education to sexual promiscuity. In this statement current research data will be reviewed and relevant information will be provided so that pediatricians and others responsible for the health care of adolescents can appreciate the implications and consequences of adolescent sexual activity and early childbearing.

SEXUAL ACTIVITY

The current problems resulting from teenage pregnancy cannot be appreciated fully without understanding adolescent sexual behavior and the secular changes that have taken place.
Counseling the Adolescent About Pregnancy Options
Authors:   COMMITTEE ON ADOLESCENCE
Published: December 2021

Sexuality is part of adolescent development, but some of its consequences, including premature sexual intercourse, pregnancy, and sexually transmitted diseases, have emerged as major health concerns for pediatricians. One million adolescent girls are estimated to become pregnant annually, and one third of these pregnancies end in abortion. The frequency with which pediatricians may encounter issues of pregnancy and abortion is high, and the reality of having to deal with these problems must be appreciated.

The Committee on Adolescence has prepared this statement with three guiding principles: (1) it should represent an unbiased guide to Academy Fellows faced with the problems of adolescent pregnancy and abortion; (2) none of the options offered will be universally preferred by either patients or physicians and, indeed, all carry the potential for patient disability; (3) the pediatrician, the adolescent patient, and other concerned individuals must be given adequate freedom of action to achieve their cumulative working decision.

The pediatrician should examine his or her own attitudes and beliefs about sexuality in the adolescent. Feelings about premarital sex, pregnancy, and abortion are personal, individual, and deeply rooted. Pediatricians and other health professionals must refrain from allowing their own sexual and moral standards to interfere with optimal care. For pediatricians who wish to counsel young people but lack the experience or confidence, there are numerous regional and national educational opportunities to learn about counseling teenagers. Some pediatricians may wish to participate in preceptorship training with professionals knowledgeable concerning pregnancy counseling. If pediatricians decide not to counsel their teenage patients about sexual matters such as pregnancy and abortion, they have a responsibility to refer their patients to counseling facilities experienced and sensitive to the needs of adolescents.
Adolescent Medicine
Authors: WESSEL MORRIS A.
Published: December 2021

The splendid summary by McAnarney of 30 years of progress in adolescent medicine stimulates me to reflect on my experience in the private practice of pediatrics and adolescent medicine during this period. I recognized the need to improve my skills in relating to adolescent patients 30 years ago when many children I first knew as newborns were reaching the second decade of life. I was fortunate to be entering the adolescent field at a time when Roswell Gallagher and his colleagues were providing thought-provoking seminars throughout the country. I remember these gatherings and the formal and informal discussions as being extremely helpful at that moment in my professional life.
Parental Perceptions of Health Status and Psychologic Adjustment of Children With Asthma
Authors: Perrin James M. , MacLean William E. , Perrin Ellen C.
Published: December 2021

The relationship between severity of illness and psychologic adjustment was evaluated in 46 children with asthma. Two measures of the severity of asthma were used: the first, a composite objective measure based on clinical history and the second, parental estimates of the severity of their child's illness. Psychologic adjustment was measured by the Health Resources Inventory, a parental report of childhood behavior. Parental estimates of severity were correlated significantly with the objective measure of severity (r = .39; P < .01), although a concordance value of 54% indicated marked lack of agreement between parental and objective ratings. As a group, children in this study achieved apparently normal adjustment scores, although scores ranged widely across all categories of severity. Children whose parents ranked their asthma as mild or severe had significantly lower adjustment scores (F = 3.28; P < .05) than did those children rated by their parents as having moderate asthma. Children's ranks on the composite objective measure of severity were not associated with their adjustment scores, although children with greater use of medication had lower adjustment scores than did children with little or moderate medication use (P < .05). The relationship of severity of illness to psychologic adjustment is complex. Children at all levels of severity may demonstrate problems of adjustment, suggesting that attention to psychologic risk should not be limited only to children with severe asthma.
Neonatal Hyperparathyroidism: The Natural Course in the Absence of Surgical Intervention
Authors: Harris Sally S. , D'Ercole A. Joseph
Published: December 2021

The case of a premature infant with the onset of hypercalcemia and apparent primary hyperparathyroidism in the immediate neonatal period is presented. Although the treatment in most such cases has been parathyroidectomy, this infant was managed medically and survived infancy without apparent complications. We believe her disorder represents the neonatal manifestations of familial hypocalciuric hypercalcemia. Her course supports the contention that this disorder may be self-limited in some infants and that appropriate medical management can preclude the need for surgical intervention in selected cases.
Increasing Breast Milk Production for Premature Infants With a Relaxation/Imagery Audiotape
Authors: Feher Stephen D. K. , Berger Lawrence R. , Johnson John D. , Wilde Judith B.
Published: December 2021

Many women whose premature infants are hospitalized in a newborn intensive care unit choose to express breast milk for their babies. Yet anxiety, fatigue, and emotional stress are powerful inhibitors of lactation. To facilitate the breast-feeding experience, intervention mothers were given a 20-minute audio cassette tape based on relaxation and visual imagery techniques. At a single follow-up expression of milk at the hospital approximately 1 week after enrollment, they expressed 63% more breast milk than a randomized group of control mothers. The fat content of the breast milk in the two groups was not significantly different. Among a small group of mothers whose infants were receiving mechanical ventilation, the increase in milk volume compared with that of control mothers was 121%. Longer-term effects of the relaxation/ imagery approach (such as extending the duration of breast-feeding or reducing parental stress after hospital discharge) and the physiologic basis for the increased volume of expressed milk (improved milk production v more efficient milk ejection) are appropriate topics for future research.
Ureaplasmal Pneumonia and Sepsis Associated With Persistent Pulmonary Hypertension of the Newborn
Authors: Waites Ken B. , Crouse Dennis T. , Philips Joseph B. , Canupp Kay C. , Cassell Gail H.
Published: December 2021

Ureaplasma urealyticum was isolated from the lower respiratory tract of three infants with persistent pulmonary hypertension of the newborn. In one, cultures positive for U urealyticum were obtained on multiple occasions from trachea, blood, and pleural fluid prior to the infant's death on postnatal day 6. Autopsy findings confirmed the presence of severe pneumonia and the organism was again recovered from multiple sites. A second infant had no apparent predisposing factors for development of persistent pulmonary hypertension of the newborn but U urealyticum and Staphylococcus epidermidis were recovered from the trachea antemortem and from lung tissue obtained during autopsy on the 12th postnatal day. The third infant had persistent pulmonary hypertension of the newborn and a pulmonary infiltrate within hours after birth with tracheal cultures positive for both U urealyticum and Mycoplosma hominis. Erythromycin was given for ten days, and the infant gradually improved. Prolonged ventilation with supplemental oxygen was necessary, and chronic lung disease developed. This is the first report of neonatal ureaplasmal pneumonia with sepsis and persistent pulmonary hypertension of the newborn as well as the first time a microorganism other than streptococci has been specifically implicated in the pathogenesis of persistent pulmonary hypertension of the newborn. Respiratory infections with U urealyticum or other bacteria should be considered as possible causative or contributory factors in infants with persistent pulmonary hypertension of the newborn.
SHIFT IN FOCUS REGARDING CEREBRAL PALSY
Authors: Student
Published: December 2021

[There is evidence] to support the view that the aetiological origins of most cases of cerebral palsy must be sought outside the immediate perinatal period.
DIFFERENCES IN MEDICAL PRACTICE (UNITED STATES, ENGLAND, WEST GERMANY, FRANCE)
Authors: Student
Published: December 2021

Differences in medical practice among countries are more significant than any similarities. Some examples: the prescribed doses of the same drug may vary among these four countries by as much as ten to twentyfold. The form of the drug varies; French patients have seven times the chance of getting a drug in suppository form as Americans. Surgeries per capita are performed twice as often in the United States as they are in England. Mastectomy rates are three times higher here than there. American surgeons perform coronary bypass surgery at six times the rate of their British colleagues. Blood pressure levels considered high enough to require treatment in the United States are considered normal in England. Blood pressure in the low-to-normal range is considered desirable in the United States; in West Germany, low blood pressure is considered cause for treatment. Antibiotics are used far more often here than in Europe. The list of such astonishing comparisons goes on and on.
DOES PERTUSSIS VACCINE CAUSE PERMANENT BRAIN DAMAGE? UNITED KINGDOM COURT RULES
Authors: Student
Published: December 2021

1. The preliminary issue to be determined by the court is, can pertussis vaccine cause permanent brain damage in young children? The question relates to pertussis vaccine manufactured in the United Kingdom and applies to all children whether or not they were neurologically normal before vaccination. The burden of proof rests on the Plaintiff and the standard of proof is that of the balance of probability. It must be shown that it is more likely than not that the vaccine can cause permanent brain damage.

2. The medical and expert opinion is deeply divided on the issue.

3. The question is not answered by showing that there is a respectable and responsible body of medical opinion that the vaccine can, albeit rarely, cause permanent brain damage, or that this view is/may be more widely held than the contrary.

4. Similarly the advice contained in the contra-indications against pertussis vaccination . . . cannot be relied upon as though it were evidence . . . that the vaccine in fact causes permanent brain damage.

5. Reports of . . . encephalopathy resulting in . . . brain damage or death where the onset occurs shortly after DTP vaccination, raises the hypothesis that the vaccine may cause brain damage or death. It does not prove the hypothesis. Such reports do not take account of events occurring by chance, for which no explanation can be found. What they do establish is that encephalopathy resulting occasionally in permanent brain damage or death does sometimes occur in close temporal proximity to pertussis vaccination.

6. I have reviewed the evidence and reasoning of the Plaintiffs and Defendants' expert witnesses . . . . I have found myself more impressed both by the cogency and quality of the evidence and reasoning of the experts called on behalf of the Defendants.

7. When I embarked on consideration of the preliminary issue, I was impressed by the case reports and what was evidently a widely held belief that the vaccination could, albeit rarely, cause permanent brain damage. I was ready to accept that this belief was well founded. But over the weeks that I have listened to and examined the evidence and arguments, I have become more and more doubtful that this is so. I have now come to the clear conclusion that the Plaintiff fails to satisfy me on the balance of probability that pertussis vaccine can cause permanent brain damage in young children. It is possible it does, the contrary cannot be proved. But in the result the Plaintiff's claim must fail.
ICONOCLASTS AT WORK
Authors: Student
Published: December 2021

To assess the predictive value for perinatal brain damage of acidosis at birth, alone or in combination with the Apgar score at 5 minutes, a cohort of 982 liveborn infants delivered over the two months was studied prospectively. Metabolic acidosis determined from the umbilical artery at birth [was] a poor predictor of perinatal brain damage.
DELUGE OF THROW AWAYS IN HOSPITALS
Authors: Student
Published: December 2021

Yesterday, after finishing a routine thoracic operation, I looked in dismay at the three large (30 gallon size) plastic bags filled with refuse generated during the three-hour procedure.

What was inside those bags?

Disposable paper items: surgical gowns, surgical drapes, envelopes, bags of all sizes.

Sponges, small and large.

Disposable plastic items: syringes, pumps, boxes of various sizes, tubing, bottles, bags, staplers, suction fluid containers, esophageal temperature probes.

Disposable metal items: needles, staples, cartridges, scalpels, electrical cautery tips and wiring, scissors, electrocardiogram pads and wiring.

Disposable rubber items: gloves, bottle stoppers, tubing, urinary catheters.

In addition, a large variety of other disposable items, too many to mention, are thrown away as garbage.

This deluge of disposable equipment is quite new. Fifteen to 20 years ago, very little disposable equipment was used, and I am not wrong in saying that this same operation, at that time, would not have generated more than a handful of refuse.
Prepaid Group Practice Effects on the Utilization of Medical Services and Health Outcomes for Children: Results From a Controlled Trial
Authors: Valdez R. Burciaga , Ware John E. , Manning Willard G. , Brook Robert H. , Rogers William H. , Goldberg George A. , Newhouse Joseph P.
Published: December 2021

A total of 693 children between the ages of 0 and 13 years were randomly assigned to either a staff model HMO or to one of several fee-for-service insurance plans in Seattle to evaluate differences in medical expenditures and health outcomes. Although the fee-for-service plans varied the amount of cost sharing (0% to 95%), all children were covered for the same medical services, for either 3 or 5 years. No differences in imputed total expenditures were observed for children assigned to the HMO or any of the fee-for-service plans. Children with cost-sharing fee-for-service plans, however, had fewer medical contacts and received fewer preventive services than those assigned to the HMO. Nonetheless, children with the cost-sharing fee-for-service plans were perceived (by their mothers) to be in better health overall than those assigned to the HMO. No significant differences regarding physiological outcomes (eg, visual acuity, hemoglobin level) were observed between the two groups. The results of this experiment neither strongly support nor indict fee-for-service or prepaid care for children.
Systemic Lupus Erythematosus in the First Decade of Life
Authors: Lehman Thomas J. A. , McCurdy Deborah K. , Bernstein Bram H. , King Karen K. , Hanson Virgil
Published: December 2021

To evaluate whether the onset of systemic lupus erythematosus in the first decade of life was Associated with a unique pattern of racial preponderance, sexual preponderance, genetic predisposition, or disease expression, the medical records of 23 children with systemic lupus erythematosus prior to their tenth birthdays were compared with the medical records of 82 children in whom lupus was diagnosed between their tenth and 20th birthdays. No statistically significant differences in sex distribution, racial (ethnic) background, family history, mode of onset, morbidity, or mortality rates were found between the two age groups. The frequently held view that children with early-onset lupus do worse probably relates to the fact that even though they survive as long as children with the older-onset disease, they die younger because they have the onset of their lupus at a younger age.
Fatal Farm Injuries Among Young Children
Authors: Salmi L. Rachid , Weiss Harold B. , Peterson Peggy L. , Spengler Robert F. , Sattin Richard W. , Anderson Henry A.
Published: December 2021

Death certificate data concerning farm-related injury deaths among children 0 to 9 years of age in Wisconsin and Illinois for the period of 1979 to 1985 were reviewed. Average annual farm-related injury death rates were 3.2 per 100,000 rural children in Wisconsin (62 deaths) and 1.5 per 100,000 in Illinois (32 deaths). Rates were three times higher among boys than girls. The occurrence of two harvest-related peaks and the absence of fatality in children less than 1 year of age suggest that presence of children on the farm when supervision is diminished is a key factor in farm-related fatalities. Moving machinery (tractors, wagons, and trucks) was the source of injury in approximately 55% of all deaths. Drowning accounted for 15% of all farm-related deaths. Two fatalities related to gravity box wagons could have easily been prevented with simple safety devices. These findings suggest a need for developing environmental interventions in farms. This will require the allocation of more resources to farm safety programs and a revision of current farm safety legislation.
ANENCEPHALIC ORGAN DONORS
Authors: Student
Published: December 2021

[There are] two policy choices: we can abandon attempts to justify use of anencephalic infants as organ donors because there is currently no clinically accepted means to declare brain death in these infants; or we can carry out the research necessary to establish a clinically valid procedure for doing so. A Canadian group has decided to take the second route and experiment on methods to use as organ donors anencephalic newborns who can be validly declared brain-dead on classic criteria. The group has developed a basic protocol that calls for the parents to agree, prior to birth, that: (1) the infant will be resuscitated; (2) periodic testing will be done to determine brain death (removal from the ventilator at six-to-twelve-hour intervals for a ten-minute period to determine ability to breathe spontaneously; (3) organ donation is acceptable; and (4) a definite time limit (to be determined by the parents but not more than fourteen days) after which the infant will be removed from the ventilator and permitted to die. Low-dose morphine is administered to prevent potential suffering on the part of the infant, although whether anencephalic newborns can suffer is unknown.
LAW OF THE DISREGARD OF NEGATIVE INFORMATION
Authors: Student
Published: December 2021

Facts that fit into a preconceived hypothesis attract attention, are singled out and remembered. Facts that are contrary to it are disregarded, treated as an exception, and forgotten.—
Low Morbidity and Mortality of Status Epilepticus in Children
Authors: Maytal Joseph , Shinnar Shlomo , Moshé Solomon L. , Alvarez Luis A.
Published: December 2021

In an ongoing study of status epilepticus, 193 children with status epilepticus of varying causes have been followed up for a mean period of 13.2 months. Of these, 97 patients were recruited prospectively. The patients' ages ranged from 1 month to 18 years (mean, 5.0 years). The cause of the status epilepticus was classified as idiopathic in 46 cases, remote symptomatic in 45, febrile in 46, acute symptomatic in 45, and progressive neurologic in 11. The mortality and incidence of sequelae following status epilepticus was low and primarily a function of etiology. Seven children died within 3 months of having the seizure. New neurologic deficits were found in 17 (9.1%) of the 186 survivors. All of the deaths and 15 of the 17 sequelae occurred in the 56 children with acute or progressive neurologic insults. Only two of the 137 children with other causes sustained any new deficits (P < .001). Duration of the status epilepticus affected outcome only within the acute symptomatic group (P < .05). Neurologic sequelae occurred in 29% of infants younger than 1 year of age, 11% of children 1 to 3 years of age, and 6% of children older than 3 years of age. However, this was a reflection of the greater incidence of acute neurologic disease in the younger age groups. Within each cause, age did not affect outcome. Of the 193 children, 61 (32%) had a history of prior unprovoked seizures. Of the 125 surviving children with no history of prior unprovoked seizures, 37 (30%) had subsequent unprovoked seizures. It is concluded that the morbidity of aggressively treated status epilepticus in children, in the absence of an acute neurologic insult or progressive neurologic disorder, is low.
WHY IS THE SCHOOL DROP-OUT RATE SO HIGH?
Authors: Student
Published: December 2021

Eighty percent of students entering school feel good about themselves and who they are. By the fifth grade only 20 percent have high self-esteem. By the time students become seniors in high school, the percentage who have managed to keep a positive level of self-esteem has dropped to 5 percent.

Students encounter the equivalent of 60 days each year reprimanding, nagging and punishment. During 12 years of schooling a student is subject to 15,000 negative statements. That's three times the amount of positive statements received.
Pneumogram Recordings in Infants Resuscitated for Apnea of Infancy
Authors: Oren Joseph , Kelly Dorothy H. , Shannon Daniel C.
Published: December 2021

Infants who sustained a spell of apnea of infancy during which they were resuscitated have been shown to be at increased risk for sudden infant death syndrome. To determine the value of the pneumogram as a predictor of outcome in this population, the first pneumogram obtained of 51 such infants was analyzed. The infants were grouped on the basis of subsequent outcome during a course of monitoring: group 1—infants who died during a subsequent event; group 2—infants who received resuscitation or vigorous stimulation to terminate a subsequent spell; group 3—infants who survived and did not have a significant subsequent episode. The results for these infants were compared with those of a control group matched for age and sex. A detailed, blinded computer analysis revealed no significant difference in the results of the pneumogram analysis between the three groups. It did not identify the infants in whom apneic spells necessitating resuscitation subsequently developed or those who died. However, when compared with the control group, infants with apnea of infancy had significantly higher mean respiratory rates, heart rates, and tachycardia indexes. It is concluded that, although the first pneumogram does not predict the risk of an adverse outcome in a population of infants with severe apnea of infancy, it does reveal subtle cardiorespiratory differences between study and control infants.
Schools and Sex Education: Does It Work?
Authors: Stout James W. , Rivara Frederick P.
Published: December 2021

The literature was critically reviewed to determine whether evidence exists to support sex education in the schools as a method of altering sexual behavior, contraception, and adolescent pregnancy. Five studies were identified in which the effects of sex education on these outcomes were evaluated. The available evidence indicates that there is little or no effect from schoolbased sex education on sexual activity, contraception, or teenage pregnancy.
Auditory Brainstem Responses and Clinical Follow-up of High-Risk Infants
Authors: Kramer Steven J. , Vertes Dianne R. , Condon Marie
Published: December 2021

Auditory brainstem response (ABR) evaluations were performed on 667 high-risk infants from an infant special care unit. Of these infants, 82% passed the ABR. Those infants who failed the ABR were classified into two groups, those who failed at 30 dB hearing level and those who failed at 45 dB hearing level. All of the infants were encouraged to return for otologic/audiologic follow-up in 1, 3, or 6 months, depending on the initial ABR results. All of the infants with severe hearing impairments came from the group who failed at 45 dB hearing level. The incidence of severe sensorineural hearing impairment in this population was estimated to be 2.4%. For the group that failed at 30 dB hearing level, 80% of those who were abnormal at follow-up were considered to have conductive hearing disorders and 20% had mild sensorineural hearing impairments. In addition, infants enrolled in a parent-infant program for hearing impaired by 6 months of age were from the ABR program; however, several infants entered the parent-infant program at a relatively late age because they did not meet the high-risk criteria, they were from other hospitals, or they were not detected by the ABR program.
LOW ANTIOXIDANT ACTIVITY IN SERUM OF PREMATURE NEONATES
Authors: Student
Published: December 2021

Antioxidant activity showed a significant positive association with birth-weight . . . The present data suggest one important effect of increased non-heme iron may be to neutralize much of the premature infant's scarce antioxidant activity, thereby sharply increasing vulnerability to oxygen.
Newborn Screening Fact Sheets
Authors:   COMMITTEE ON GENETICS
Published: December 2021

These newborn screening fact sheets were developed by the Committee on Genetics of the American Academy of Pediatrics with considerable assistance and consultation from many individuals. The fact sheets were not designed to advocate specific newborn screening tests but rather to inform pediatricians about these tests. Many states are considering addition of new tests to their screening batteries, whereas others may be reviewing their current screening panel to reduce the number of disorders for which tests are offered. This information should assist pediatricians in developing appropriate positions based on the needs of their patients and of their geographic regions.

In addition, the information in these fact sheets may assist the pediatrician in understanding the individual tests, their characteristics, and their strengths and weaknesses. Such information is important for evaluating policies and procedures.

Our knowledge base regarding newborn screening is changing rapidly and there are numerous areas of controversy. We have attempted to provide a consensus viewpoint, but it must be recognized that experts in this field do not always agree. Pediatricians who desire additional information should contact the specialists in their region or those involved at a national level. Brief bibliographies have been provided to assist the clarification of some of these points.

These fact sheets will require revision in the future. Your comments and suggestions will be appreciated.

NOTE ON COST: The costs quoted here are those for the screening tests in a regionalized laboratory. There is a program cost of approximately $1 to $2 for specimen handling, administration, equipment depreciation, and overhead that has been traditionally ascribed to phenylketonuria.
CAPITATION: A NEW DEATH-DEFYING TREATMENT!
Authors: Student
Published: December 2021

The technology for perfusing a severed head has important potential advantages, for research and for prolonging life in a conscious and communicative state with, probably, less pain than many dying people suffer today. The difficult question is whether the advantages outweigh the disadvantages and dangers ... Would anyone want the operation? I have been contacted by half a dozen people who want to know how soon the operation will be available and how much it will cost. Some are dying; others are paralysed. Most said that if the mind remains clear and the head can still think, remember, see, read, hear, and talk and if the operation leads to numbness rather than pain below the neck then they would want it.
TOBACCO CHARADES
Authors: Student
Published: December 2021

Taxpayers underwrite price supports for tobacco farmers while also paying the Surgeon General to try to eliminate tobacco use. Cigarette companies squeeze ever-increasing profits from the very health fears surrounding smoking. Filter cigarettes were widely introduced in the 1950's in response to the first studies showing that smoking causes lung cancer. Although, as the author notes, "there was no evidence" that filter-tipped cigarettes "offered any significant protection from the diseases of smoking," they turned out to be both cheaper to make and more attractive to smokers than nonfilters, boosting the industry's profits on two counts. The potential legal liability in making and selling cigarettes insures their continuing profitability by keeping would-be competitors out of the market. Banning cigarette advertising on television hardly dented sales, but saved the tobacco companies billions, which they, in turn, have invested in business like General Foods, CBS and life insurance companies (which charge smokers high rates).
FAME
Authors: Student
Published: December 2021

Fame is a shuttlecock only kept aloft by being hit from opposing sides.
WHERE HAVE ALL THE DOCTORS GONE ...?
Authors: Student
Published: December 2021

Applications to medical schools have been declining for more than a decade, with the steepest drops coming in the last four years. From 1974 to 1987, applications contracted by 31 percent, from 46,624 to 28,123, an average decline of about 2.4 percent a year. But in the last year of that decline, from 1986 to 1987, the number fell by more than 10 percent, from 31,323 to 28,123.
DOES THIS SOUND FAMILIAR?
Authors: Student
Published: December 2021

A study of the statistical intuitions of experience research psychologists revealed a lingering belief in what may be called the "law of small numbers," according to which even small samples are highly representative of the populations from which they are drawn. The responses of these investigators reflected the expectation that a valid hypothesis about a population will be represented by a statistically significant result in a sample with little regard for its size. As a consequence researchers put too much faith in the results of small samples and grossly overestimated the replicability of such results. In the actual conduct of research, this bias leads to the selection of samples of inadequate size and to overinterpretation of findings.
Neonatal Neurodevelopmental Examination as a Predictor of Neuromotor Outcome in Premature Infants
Authors: Allen Marilee C. , Capute Arnold J.
Published: December 2021

There was a marked correlation (P < .000001) between neonatal neurodevelopmental examination results and neuromotor outcome at 1 year of age or older in 210 high-risk premature infants (mean birth weight 1,107 g, mean gestational age 28.4 weeks). This neonatal examination consisted of assessment of posture, extremity and axial tone, deep tendon reflexes, pathologic reflexes, primitive reflexes, symmetry, oromotor function, cranial nerve function, auditory and visual responses, and behavior. Premature infants whose neonatal neurodevelopmental examination results were abnormal had significantly higher incidences of both cerebral palsy (38% v 6%, P < .000001) and minor neuromotor dysfunction (27% v 13%, p < .05) than did premature infants whose examination results were normal. This correlation continued to be highly significant even with the analysis of subgroups (infants born at or before 27 weeks' gestation, infants with chronic lung disease discharged with oxygen supplementation, infants with periventricular hemorrhage) and when a variety of individual perinatal, demographic, and social variables were used as controls. Normal or nearly normal neonatal neurodevelopmental examination results can be used to reassure parents of high-risk premature infants. Although abnormal neonatal neurodevelopmental examination results cannot be used to diagnose handicap in premature infants, they can be used to select a group of high-risk infants who should be carefully monitored during infancy and childhood.
WHO IS AT FAULT?
Authors: Student
Published: December 2021

Doctors, lawyers, architects, and other professionals strike a bargain with society: Leave us alone, they say, and we will take care of you ...

But do professionals warrant the trust placed in their hands?

Headlines shout of bridges and buildings toppling. Health care cost escalate. Our children compare poorly in knowledge of science, math, and foreign languages with those of other countries. Malpractice suits skyrocket. Greed corrupts Wall Street. America has lost the industrial muscle that was once the envy of the world.

Has our army of experts, whom we entrust to take care of us, let us down?

Or, on the other hand, have we let them down, shackling them in regulation, keeping them from doing their jobs, impeding them in the free exercise of their expertise?
Demographic Factors Influencing the Initiation of Breast-Feeding in an Israeli Urban Population
Authors: Birenbaum Emanuel , Fuchs Camil , Reichman Brian
Published: December 2021

The influence of demographic and prenatal factors on the initiation of breast-feeding in an urban Israeli population was evaluated by interviewing 1,000 parturients prior to discharge from the hospital. The mothers were all Jewish, none were single, and none were social welfare dependents. Of these mothers, 72% were breast-feeding, 6% stated an intent to breast-feed, and 22% were formula-feeding their infants. A significantly increased rate of breast-feeding was found among mothers with the following characteristics: those of orthodox religious belief, high educational level, in the academic and paraacademic professions, nonsmokers, those who worked outside of the home during the pregnancy, those who had previous breast-feeding success, and mothers whose husbands' attitude toward breast-feeding was positive. The decision to breast-feed was made prior to delivery in 85% of mothers. Participation of the mother and/or father in antenatal preparation courses did not significantly influence the initiation of breast-feeding. Multivariant analysis with a stepwise logistic regression model delineated the four factors most significantly associated with the initiation of breast-feeding: positive spousal attitude toward breast-feeding, orthodox religious belief, nonsmoking, and work outside of the home during the pregnancy. The expected probability for initiating breast-feeding was computed for the various combinations of these four categories and ranged from .94 with all factors present to .33 in the absence of these characteristics.
Prevalence of Child Sex Rings
Authors: Wild N. J.
Published: December 2021

Within a geographically defined population of 710,000, 31 child sex rings were identified by the police during a 2-year period. A total of 47 male perpetrators aged 16 to 82 years and 334 children aged 4 to 15 years were involved. The perpetrators usually operated alone or in pairs. Three rings were expanding and developing into semicommercial enterprises, however and four or more men participated in them. Children acting as ringleaders recruited victims for the perpetrator in 22 rings, usually in exchange for money. The offenses reported included fondling and masturbation (30 rings), oral, anal, or vaginal intercourse (21 rings), and production of child pornography (two rings). In addition, two adolescent prostitution rings involving 12- to 18-year-old boys were investigated by the police. During the 2-year period these sex rings accounted for 4.6% of all cases of child sexual abuse reported to the police and 6.6% of the subsequent prosecutions.
Can Developmental Screening Tests Identify Children Who Are Developmentally at Risk?
Authors: Meisels Samuel J.
Published: December 2021

Developmental screening tests are in widespread use, but few reliable and valid tests are available. The most frequently used screening instrument for detecting young children who are at risk for developmental delays is the Denver Developmental Screening Test (DDST). Although the DDST has excellent test specificity, overreferring few children, results from more than a dozen studies of the DDST's concurrent and predictive validity fail to replicate the original validation and demonstrate a uniformly poor sensitivity, ie, a high proportion of underreferrals. Whether samples are stratified by age, risk, duration of time between predictor and outcome, or type of outcome measure used, these studies demonstrate that the DDST underrefers children at nearly a 2:1 ratio. Several other screening tests with more optimal psychometric properties are presented. It is urged that caution be exercised in using tests for predicting the risk of developmental problems in young children unless the tests have acceptable levels of sensitivity and specificity.
Growth Plate: Roentgenologic Findings in a Case of Tyrosinosis
Authors: MORRISON S. , KERR D.
Published: December 2021

Widening and cupping of the metaphysis together with dense bony spicules projecting from the metaphysis into the epiphyseal plate were originally described in patients with phenylketonuria. Later, similar changes were also identified in patients with homocystinuria. The frequency of these changes is far greater in patients with homocystinuria than in those with phenylketouria, however. We describe a case in which similar but not identical findings were found in a patient with tyrosinosis. To our knowledge, this has not been previously described.

CASE REPORT

Persistent diarrhea developed in a baby girl when she was approximately 6 weeks of age. Abdominal distention developed, with flatulence, although there was no change in her appetite.
Science of Reading
Authors: OXMAN ANDY
Published: December 2021

There is a scientific basis on which to make decisions about clinical reading just as there is for decisions about clinical practice. Recognizing this does not make coping with the clinical literature or coping with clinical practice a less formidable challenge. It can, however, help clinicians to arrive at answers that are more likely to be valid and clinically applicable and to do so with greater efficiency.

Proper utilization of the medical literature, like proper research methodology, is essential for ensuring that medical care does more good than harm. Like science in general, it "consists in the creation of simplicity out of complexity" and it rewards us with the joy of discovery.
IS ANYONE PAYING ATTENTION
Authors: Student
Published: December 2021

Look at the kids on every street corner, in the arcades, huddled beneath movie marquees. Then ask yourself how long it will be before New York—before America—ends up with millions of abandoned children like India or South America.
Newborn Screening for Sickle Cell Disease
Authors: GROSS THOMAS
Published: December 2021

Vichinsky and colleagues in their recent article concerning the effect on mortality of newborn screening for sickle cell disease claim that "the data indicate that newborn screening, when coupled with extensive follow-up and education, will significantly decrease patient mortality." Critical review of their data, however, does not support this conclusion. Of the 89 patients with sickle cell disease identified in their screening program, one individual died of septicemia for a cumulative mortality of 1.1% (not 1.8% that was quoted).
Pseudomonas Meningitis Therapy Recommendation Questioned
Authors: SAVARINO STEPHEN J. , RENNELS MARGARET B. , DRUSANO GEORGE L.
Published: December 2021

In the July 1988 report of the Committee on Infectious Diseases, it was proposed that cefotaxime or ceftazidime, either alone or in combination with an aminoglycoside, should be satisfactory in the treatment of Pseudomonas meningitis. As clearly stated, individual therapy ought be guided by results of susceptibility tests of the causative organism. We suggest that, with this in mind, cefotaxime is usually not a reasonable choice for antibiotic therapy in patients with this disease. The mean MIC50 and MIC90 values of cefotaxime against clinical isolates of Pseudomonas aeruginosa range between 16 to 32µg/mL and 32 to >128µg/mL, respectively.
In Reply: Pseudomonas Meningitis Therapy Recommendation Questioned
Authors: MCCRACKEN GEORGE H.
Published: December 2021

Savarino et al are correct in pointing out that cefotaxime is an inappropriate antibiotic for treatment of pseudomonas infections, especially of the CNS. The erroneous recommendation in the Committee's statement (Pediatrics 1988;81:904-907) was a typographical error that was not discovered when the galley proof was reviewed.

Pseudomonas meningitis is best treated, at least initially, with a combination of an aminoglycoside and either ceftazidime or on anti-Pseudomonas penicillin such as ticarcillin or piperacillin.
Statistical Power
Authors: MAURO ROBERT D.
Published: December 2021

Pediatrics, July 1988, contained two articles, each of which had a "negative result" as its primary conclusion. That is, in each study the authors looked for a statistically significant difference between two groups and found none. A third study? in the same issue also concluded "no difference" in an important comparison between its study and control groups. Yet, none of the three articles gave any clue as to the statistical power of the study to have found a clinically important difference between the two groups, if such a difference truly existed, given the number of patients included in their samples.
In Reply: Statistical Power
Authors: GRAVEL JUDITH S. , MCCARTON CECELIA M. , RUBEN ROBERT J.
Published: December 2021

We appreciate the concern expressed by Dr Mauro and agree that power is an important consideration both before a study has been initiated and when discussing one's results. Dr Mauro has done a service to both readers and authors alike by reminding us that when one does not find an effect it is appropriate to report the power of the finding.

Accordingly, the power information for our study is as follows. Based on the literature we reviewed in our introduction, we postulated that we would find a large difference between the two groups studied.