bluuebunny/crossref_metadata_2025 huggingface dataset:
Williams Syndrome: Features in Late Childhood and Adolescence
Authors: Pagon Roberta A. , Bennett Forrest C. , LaVeck Beverly , Stewart Katherine B. , Johnson Jennifer
Published: December 2021

Nine children with the Williams syndrome were evaluated for physical, neurodevelopmental, and behavioral characteristics to record the natural history of this disorder. The study subjects, who ranged in age from 10 years to 20 years, generally showed lower than expected cognitive functioning with four of the nine functioning in the severely retarded range. However, all the children showed uneven developmental profiles, compared to measured IQ, with reading abilities exceeding the expected level and visual-motor skills deficient for overall performance expectations. All but one child had evidence of supravalvular aortic stenosis on echocardiography, but there was little morbidity from cardiovascular disease in this group of patients. Although all had grown at or below the fifth percentile in early childhood, seven now were above the fifth percentile for height. Personality attributes that characterize younger children with Williams syndrome persisted in this group of older children.
Inborn Errors of Metabolism
Authors: BURTON BARBARA K.
Published: December 2021

In Reply.—

I thank Drs Wiswell and Weisse for their interesting observations regarding the occurrence of intracranial hemorrhage in term infants with inborn errors of metabolism. There is no question that intracranial hemorrhage is a potentially devastating, although presumably uncommon, complication of these disorders. In my personal experience, neonates with inborn errors of metabolism who have experienced intracranial hemorrhages have all had obvious predisposing factors, such as severe metabolic acidosis, which would provide a clue to the underlying diagnosis.
LIDIAN EMERSON, WIFE OF RALPH WALDO EMERSON, ON THE DEATH OF HER FIVE-YEAR-OLD SON (1842)
Authors: C. T. E.
Published: December 2021

Lidian Jackson Emerson (1802-1892), the second wife of Ralph Waldo Emerson, corresponded with a large circle of relatives and friends between 1826 and 1876. In a letter to her sister, dated February 4, 1842, she described her grief on the death of her five-year-old son who had died a week before of scarlet fever.

Dear Lucy,

What shall I say—I feel at this moment almost comfortless—but I will write on and better hopes and feelings will return, so that I shall not make you grieve the more by my letter. My faith that all is yet well—all is better than ever—never quite leaves me—and sometimes I am cheerful, and no one would think one of my greatest sources of happiness had so lately stopped. . . . Such another bud of lovliest promise we may not hope for. I find it was not parental partiality that made us believe Waldo [her son] to be an uncommonly interesting child. Others have felt his loveliness, and now speak of him and of the impression he made upon them, in terms which surprise as much as they gratify us. Indeed it seems as if wherever he went the eyes that saw him have witness to him—the ear that heard him, bless him. He was an angel with wings but half concealed. But his body and mind were so healthful—he was far from any thing like precocity—that it had never occurred to us that Earth would be but a little while his home....

Mr. Emerson is very sorrowful. He has an unwavering faith that all is right; but sees not how the departure of the child is to be more to us than his presence would have been. I tell him I am sure, though I too, see not how—that greatly as he was blessed in the possession of such a treasure he is still more high blessed in its recall. I can give you no idea of the joy and hope the pride—the rapture, with which he regarded Waldo; he was always his companion and his best society. . . . I did not imagine till Waldo was taken from us, how deeply I loved him. He died in the evening and after all was over we sat together (Mr. Emerson, Mother and myself) and talked of our loss—and I then felt able to endure my bereavement. But after we had separated for the night and I was left alone with the baby—and Ellen [a three-year-old daughter] who was to take her father's place in my bed that I might take care of her, grief desolating grief came over me like a flood—and I feared that the charm of earthly life was forever destroyed. I saw not how I could ever feel happy again. I thought of the words "Time brings such wondrous easing" and believed Time could bring no easing to us. I lived over my life with the child and recalled all his sweet and lovely traits. His innocence, his wisdom, his generosity, his love for his mother I wished I could forget them all. . . . I was not worthy to be his mother—except my love for him made me worthy.
Varicella in Pediatric Orthotopic Liver Transplant Recipients
Authors: McGregor Robert S. , Zitelli Basil J. , Urbach Andrew H. , Malatack J. Jeffrey , Gartner J. Carlton
Published: December 2021

From May 1981 to May 1984, 90 pediatric patients underwent liver transplantation and 65 patients survived as of May 1986. Two of the nonsurvivors died with complications related to clinical varicella. Of these 67 patients (65 survivors and two nonsurvivors who died of varicella-related causes), 51 patients were determined to be varicella susceptible. Clinical disease developed in no patients with serologic evidence or clinical history of varicella prior to transplantation. Eighteen susceptible patients were exposed and received zoster immune globulin and varicella did not develop. Clinical disease developed in eight patients despite zoster immune globulin, although one patient received it 96 hours after exposure. Six patients received no zoster immune globulin and clinical varicella developed. In all, varicella developed in 14 patients. Thirteen were admitted to the hospital and treated with intravenous acyclovir. Of those treated, two died of causes related to complications of varicella. The remaining patients treated with acyclovir had mild disease. The one patient not treated with acyclovir also had mild disease. We conclude that patients contracting varicella after liver transplantation while receiving maintenance immunosuppressive agents should be treated with intravenous acyclovir. Generally, when treated with acyclovir while receiving maintenance immunosuppressive drugs, these patients have mild clinical disease. Patients recently treated with high-dose prednisone and cyclosporine may have severe clinical disease resulting in death.
Professional Liability Coverage for Residents
Authors:   COMMITTEE ON MEDICAL LIABILITY
Published: December 2021

The American Academy of Pediatrics joins with other responsible medical and hospital organizations in urging that the "Essentials of Accredited Residences" be modified and amended to require any institution seeking accreditation of its residency programs (1) to protect resident staff members by providing adequate professional liability coverage (or its equivalence in military/governmental institutions) during the entire training period and continuing thereafter to cover any claims filed for events occurring during the training period, (2) to provide a written description of the details of the program to each individual resident at the time of his or her acceptance into the program, and (3) to provide written documentation to the resident about the institution's policy regarding "moonlighting" (practicing medicine outside the official residency program whether or not for compensation, such as working as a camp physician or day-care consultant) and to include specific inclusion/exclusion clauses regarding such activity.
BRITISH BARRISTERS FOR NO-FAULT
Authors: Student
Published: December 2021

After years of inertia there are now almost daily developments on the issue of compensating those injured by medical treatment. Probably the most important recent development has been the support expressed for no fault compensation by eminent lawyers at the annual bar conference . . . Around the world—and particularly in the United States—lawyers have been one of the main forces obstructing the introduction of such schemes. The support expressed for introducing such a no fault scheme by the chairman of the Law Commission and the judge who made the first£lm award in a case of medical negligence must thus greatly increase the pressure on the government to act.
In Reply: Lipid Composition of Milk From Mothers With Cystic Fibrosis
Authors: BITMAN JOEL , HAMOSH MARGIT , WOOD D. L. , FREED L. M. , HAMOSH P.
Published: December 2021

This report from Golembeski and Emery adds to the small quantity of literature in this field.

Drs Golembeski and Emery claim that they are presenting information that counters our statement,"The abnormalities in fatty acid composition of the cystic fibrosis milk may contraindicate its use for the nursing infant." However, no data regarding fatty acid composition were presented. In their Table, only total lipids are shown. In our study, we acknowledged that mean total lipids were sufficient to supply the energy needs of the nursing infant.
α-Fetoprotein Normal Values
Authors: CAGLAR MUSA K. , BAKKEREN J. A.J.M. , GEVEN WIL B.
Published: December 2021

We recently read the letter to the editor written by Gale et al. As a result of the remarkable improvements in neonatal intensive care, an increasing number of premature babies are now able to survive beyond the neonatal period. Therefore, there also seems to be a great need to know the normal values of α-fetoprotein in these babies that were not fully mentioned in that article. Goraya et al reported plasma α-fetoprotein levels in premature babies of various gestational ages, including some term neonates.
Intrapartum Asphyxia and Cerebral Palsy
Authors: HERMANSEN MARCUS C.
Published: December 2021

Freeman and Nelson recently presented a review of the relationship between fetal distress and subsequent cerebral palsy. Their review supported the theory that most cases of cerebral palsy are not caused by birth asphyxia. However, the review and its conclusions must be interpreted cautiously because the authors omitted important data that contradict their theory.

At least five studies have presented data comparing pH at birth and Apgar scores (Table). In all five studies, some infants with acidemia had a one-minute Apgar score of 7 or more.
Precut Endotracheal Tubes for Orotracheal Intubation
Authors: KATZMAN GERALD H.
Published: December 2021

Recently, I visited several neonatal units and delivery areas. I noted that the endotracheal tubes used for orotracheal intubation are of a length required for nasotracheal intubation. There is a line on the tube marked with the words "oral" on the side closer to the tip and "nasal" on the farther side.

Various techniques have been recommended for managing endotracheal tubes in newborns. The use of endotracheal tubes, precut by the manufacturer for orotracheal intubation, represents an additional method that has several advantages.
Rug Shampoo and Kawasaki Disease
Authors: Fatica Nunzia S. , Ichida Fukiko , Engle Mary Allen , Lesser Martin L.
Published: December 2021

Following personal interviews with 63 families of children with Kawasaki disease and with 63 control families with children paired for race, sex, and age, no epidemiologic differences were seen except for use of rug shampoo within 1 month of onset in 16 episodes in 15 children with Kawasaki disease in 14 families (24% of children, 22% of families) compared with two families of control children (3%, P < .005). Explanations for this strong association of recent rug shampoo and Kawasaki disease include the question of recall bias as well as the possibility that an agent in the shampooing process does cause or does contribute to illness.
Fatal Rhabdomyolysis Following Influenza Infection in a Girl With Familial Carnitine Palmityl Transferase Deficiency
Authors: Kelly Kevin J. , Garland Jeffery S. , Tang Thomas T. , Shug Austin L. , Chusid Michael J.
Published: December 2021

Severe rhabdomyolysis following an influenza B infection developed in a previously well 13-year-old girl. There was no history of trauma. Her course was complicated by episodes of severe hyperkalemia, hypocalcemia, hyperphosphatemia, and myoglobinuria. Renal failure, hypertension, and life-threatening arrhythmias developed; she died. Muscle biopsy revealed that this girl had carnitine palmityl transferase deficiency. An asymptomatic sister was demonstrated to have the same disorder. Although carnitine palmityl transferase deficiency is usually associated with mild bouts of rhabdomyolysis that become apparent only in adulthood, severe forms of this disorder may be seen in children. Life-threatening rhabdomyolysis and myoglobinuria may follow any infection associated with decreased intake. If carnitine palmityl transferase deficiency is diagnosed in a proband, other siblings should be evaluated so that proper preventative measures can be undertaken to help prevent the development of symptoms in susceptible individuals who have not been recognized to have the disease.
SECOND THOUGHTS
Authors: Student
Published: December 2021

Observations of mothers who had cared for a lifetime for severely handicapped children:

"At the time we wanted him to live, preferred that he would, but now realise this was a mistake.... The strain of caring has been overwhelming."

"I really had no idea what I had let myself in for.... Now we are imprisoned for life.... There is no future for us."

"The do gooders on TV make my blood boil. They have no idea what a child like this involves."
LIQUOR INDUSTRY BIRTH DEFECT SUITS
Authors: L. J. F.
Published: December 2021

Seattle, April 20—Already faced with declining sales and increasingly hostile public attitudes, the alcoholic beverage industry is bracing for the first in a series of trials in which they are blamed for causing birth defects.

The nation's first lawsuit on behalf of children suffering from fetal alcohol syndrome, a birth defect that is the leading known cause of mental retardation, is scheduled to go to trial Monday in Federal District Court here.

In the suit, two parents who admit they are alcoholics say a distiller's failure to warn of the link between moderate or heavy whisky consumption and birth defects was the cause of their child's impairment.

The suit alleges that liquor manufacturers have a duty to warn consumers that drinking during pregnancy can lead to birth defects. Lawyers for the distiller argue that, because most people already know of the dangers of drinking, the company had no duty to warn of the specific health hazards.
ECONOMIC BENEFIT OF PRESCHOOL EDUCATION
Authors: Student
Published: December 2021

Perry Pre-School Project in Ypsilanti, Michigan. . . began in the 1960s to offer one or two years of education to 3-year-olds from poor families. Researchers calculated that for each dollar spent, society received $7 in higher tax contributions and lower expenditures on remedial education, crime and welfare.
Corticosteroids in the Management of Cystitis Secondary to Chronic Granulomatous Disease
Authors: COLLMAN REBECCA J. , DICKERMAN JOSEPH D.
Published: December 2021

Chronic granulomatous disease refers to a group of inherited disorders characterized by a deficit in phagocytic-cell oxidative metabolism, resulting in recurrent pyogenic infections due to defective intracellular killing of microorganisms.1 Granulomas form in various organs or tissues, presumably in an attempt to "wall off" the infection, and these can be a major cause of morbidity when vital structures are obstructed or compromised. Cultures of the granulomas are usually negative, although antibiotics have been advocated in the treatment of this complication. Recently, three patients with chronic granulomatous disease-two with gastrointestinal and genitourinary involvement2 and one with pulmonary involvement3—were treated with corticosteroids, which resulted in an amelioration of symptoms.
Statement of Principle
Authors:   AAP Provisional Committee on International Child Health
Published: December 2021

Since its inception, the American Academy of Pediatrics (AAP) has been concerned with child health throughout the world. Although dramatic successes have been scored, the change of fundamental conditions necessary to produce major improvements in the lives and well being of children in many instances has not occurred. Morbidity and mortality rates for children remain tragically and unacceptably high. Low birth weight, malnutrition, preventable infections, waterborne diseases, diarrhea, alcohol and drug abuse, armed conflict, and other calamities take a heavy toll on children.

Efforts to help stem the tide of disabling and lethal diseases in children have been mounted by many private, public, and multinational agencies. The AAP applauds and supports UNICEF, the Child Survival Programs, and other agencies in their efforts to promote mass immunizations, develop safe water supplies, improve nutrition, and foster the delivery of health services to children worldwide. The Academy believes the ultimate key to improving primary health care for all children is the development of partnerships in service, education, research, and advocacy by pediatricians throughout the world. To achieve this goal, a Task Force on International Child Health was established in 1987 to make and implement recommendations for improving global child health. The task force was recently assigned provisional committee status.

The Academy's past international efforts have been principally focused in this hemisphere. Latin American countries were officially organized as districts and chapters in 1942, and a Committee on International Child Health was formed in the 1960s to facilitate collaboration between the United States and Latin American countries.
Early Treatment for Congenital Hypothyroidism
Authors: FISHER DELBERT A.
Published: December 2021

In Reply.—

We pointed out in our letter1 two observations from the now extensive worldwide experience with newborn hypothyroid screening. These are (1) that 10 mg/kg, daily, of oral sodium l-thyroxone begun before 45 days of age nórmalizes 5-to 7-year IQ values (relative to a control population) in a population of infants with congenital hypothyroidism detected by newborn screening and evaluated to date; (2) that correlations between the levels of serum thyroxine and TSH as markers of the severity of clinical thyroxine deficiency and bone maturation as a marker of tissue thyroxine deficiency in the neonatal period correlate with lower IQ values in some, but not all, screening programs.
Sports Deficit Disorder
Authors: BURKE BRYAN L. , MCGEE DANIEL P.
Published: December 2021

Decisions are sometimes made for odd reasons. While looking for a partner, I found one person in whom I was quite interested. He was a caring person, a competent pediatrician, and a humorous fellow. What sold me on Dan McGee, though, was that he had a lower lifetime Little League batting average than I did. Now, you have to understand a little bit about me. I have always wanted to be a good athlete, but my body has never been able to fulfill my brain's desire. Always getting chosen last gets old pretty quickly, especially when you want to be the star.
Measles One More Time
Authors: Brunell Philip A.
Published: December 2021

Although measles vaccine has been licensed for more than a quarter of a century, we have failed to eradicate the disease. It appeared as though we might be approaching this goal in 1983 when only 1497 cases were reported. In 1989, however, we had approximately 17 000 cases. Prior to this there were a series of "miniepidemics" in 1971, 1976, and 1986, occurring at increasing intervals each with fewer cases than the previous one (Fig 1).1 The epidemic of 1989 was a clear departure from this pattern. One of the responses was to recommend a routine two-dose schedule of measles vaccine.
Prevalence of Human Immunodeficiency Virus Seropositivity in Pediatric Emergency Room Patients Undergoing Phlebotomy
Authors: Schweich Paula J. , Fosarelli Patricia D. , Duggan Anne K. , Quinn Thomas C. , Baker James L.
Published: December 2021

Information on the prevalence of human immunodeficiency virus (HIV) infection among children and adolescents requiring medical care is sparse. A small but significant risk of seroconversion occurs in health care workers who handle blood and body fluids of patients infected with HIV. The prevalence of HIV seropositivity in children who had phlebotomy as part of emergency care was measured. Of 749 blood samples, 21 (2.8%) tested positive for HIV antibody by enzyme-linked immunosorbent assay and Western Blot analysis: 14 samples from 6 patients with hemophilia, 6 from 3 patients with acquired immunodeficiency syndrome/acquired immunodeficiency syndrome-related complex, and 1 from a patient with asthma. Of these 21 blood samples, 10 were from 4 children previously known to be HIV positive, 4 were from patients with a known parental risk factor, and 16 were from patients with known history of blood transfusion. One sample was from a children with unknown HIV status and no documented risk factors. Procedures included 9 venipunctures, 17 intravenous line placements, 1 lumbar puncture, and 1 pelvic examination. Most patients with HIV seropositivity had been known to be HIV seropositive or at significant risk for HIV seropositivity. Although the potential risk to health care workers from children without known risk factors for HIV seropositivity was small in this population, the currently recommended infection-control precautions should always be observed.
Persistent Pulmonary Hypertension and ECMO
Authors: BRUCKHEIMER ELCHANAN , EIDELMAN ARTHUR I.
Published: December 2021

To the Editor.—

We read with interest Dr Gross' letter1 concerning the relationship between inborn and outborn infants with persistent pulmonary hypertension and the relevance of "classical" extracorporeal membrane oxygenation (ECMO) inclusion criteria and outcome of therapy. We wholly agree with his observation that early skilled respiratory treatment of infants with persistent pulmonary hypertension to a large extent can obviate the need for ECMO, and we wish to report our experience.

As has been noted, the major category of patients requiring ECMO are those with severe meconium aspiration syndrome.2
Child Health Services in England and Wales: An Overview
Authors: Goodwin Shirley
Published: December 2021

Child health services in England and Wales are rendered largely through the National Health Service and Social Security. The activities of local authorities are also important to child health. The structure and scope of services offered children by each of these is presented and discussed, with special attention to changes anticipated during the next 2 years. The care of children is integrated into the system serving all ages, so that services are difficult to evaluate and resources are shared with other groups. Health policy for children is fragmentary, although encouraging trends are visible in the evolution of existing policy. The impact of impending changes in hospital, community, and general practitioner services on the care of children is unclear at this time.
Postneonatal Mortality: A Performance Indicator of the Child Health Care System
Authors: Kessel Samuel S.
Published: December 2021

This discussion presents the rationale for using postneonatal mortality as a proxy health status measure, briefly reviews some recent epidemiologic observations and international comparisons related to postneonatal mortality, focuses on implications of postneonatal mortality as a performance indicator of the child health care delivery system, especially for vulnerable infants, and concludes with some thoughts about policy issues concerning health care for children.

A first birthday has been heralded as one of life's most celebrated and significant anniversaries. This is not only a personal moment marking a milestone along life's continuum, it is also a sentinel measure or indicator of the health status of the children living in a particular society and indeed of the society itself.

We have characterized this qualitative marker as an infant mortality rate. We have also differentiated two age periods during the first year of life, the first 28 days and the 11 months remaining until 1 year of age, yielding neonatal and postneonatal mortality rates. Traditionally, these two rates have been considered to be reflective of nature and nurture, or endogenous and exogenous events; neonatal mortality is associated more closely with biologic processes in utero and at delivery, whereas postneonatal mortality is influenced more by parenting or caring for the infant directly, and consequently more amenable to the effects of proper interventions.

Our accumulated knowledge clearly indicates, however, that both nature and nurture affect the well-being of the infant. Moreover, the distinction between neonatal mortality and postneonatal mortality based solely on "age-at-death" may be less useful today; advances in life-saving perinatal technology often extend survival beyond the first 28 days of life but not beyond the first birthday.
Informational Needs of Parents of Sick Neonates
Authors: Perlman Nitza B. , Freedman Jonathan L. , Abramovitch Rona , Whyte Hilary , Kirpalani Haresh , Perlman Max
Published: December 2021

Sixty-one parents of 43 neonates in a neonatal intensive care unit were interviewed within 3 days of their first conference with the neonatologist to assess their needs for medical information. The conference with the physician and the interview with the investigator were audiotaped. Information given by the physician and information recalled by the parents was categorized and rated by the investigator. The physicians gave very detailed information about diagnosis in 77% of cases whereas 39% of the parents recalled diagnostic information in great detail. Respective percentages for prognosis were 16 and 33; for current management (eg, investigation, therapy), 28 and 66; and for cause of illness, 16 and 18. The statistical significance of the differences between the very detailed information in the physician-parent conferences and in the parent-investigator interviews was, by category,<.002,<.041,<.004, and not significant, respectively. Information in the respective categories was described as "most helpful" by 20%, 67%, 90%, and 8% of parents. All but one of the parents stated that they wanted the whole truth. Physician uncertainty in providing information was significantly associated with severity of illness. It is concluded that while parents wanted information in all categories, they paid most attention to that relating to management. Physician-parent discordances with respect to information about management, diagnosis, and prognosis suggest directions for future investigation of the optimal content of information for parents in this context.
Reviews of Lay Literature in Child-Care: What Parents Are Reading
Authors: GLASCOE FRANCES PAGE , MOORE WILLIAM O. , BAUMGAERTEL ANNA
Published: December 2021

P. Mayle. What's Happening to Me? New York: Carol Publishing, 1975; list price $8.95 (No. 6 on the 1990 bestseller list of books on child care from Ingram Book Co., distributor of trade books).

In need of prompt revision to address AIDS-era issues, this book, which is written for adolescents in puberty, is an odd, amusing, and aggravating mixture of goofy cartoons designed to appeal to young children, a reading level which varies from elementary to high school, and medical content which ranges from accurate to euphemistic and incorrect (especially about acne treatment, fertilization of eggs, sex hormones, and female external genitalia). The emphasis on normal variability in penis and breast size is helpful as is the guilt-free acceptance of masturbation and encouragement to achieve social and mental maturity before having children. Despite the drawbacks, the book may be useful for prepubescent children who need light exposure to the issues of puberty. Parental guidance is advised, at least until a revision is published.
Human Immunodeficiency Virus [Acquired Immunodeficiency Syndrome(AIDS) Virus] in the Athletic Setting
Authors:   Committee on Sports Medicine and Fitness
Published: December 2021

Because athletes may bleed following trauma, they represent a theoretical risk to others if they are infected with the human immunodeficiency virus [HIV, acquired immunodeficiency syndrome (AIDS) virus]. Two questions have concerned coaches, athletic trainers, and school administrators: Should an athlete known to be infected with HIV be allowed to participate in competitive sports, and should the universal precautions recommended for health care workers be used when handling athletes' blood and body fluids?

The risk of infection from skin exposure to the blood of a child or adolescent infected with HIV is unknown, but it is apparently minute and is much less than the risk of HIV infection by needlesticks from infected patients of approximately 1:250. Although it is theoretically possible that transmission of HIV could occur in sports such as wrestling and football in which bleeding and skin abrasions are common, no such transmission has been reported in these sports. There is one report of possible transmission of HIV involving a collision between soccer players. However, this report from Italy remains undocumented.

If an HIV-infected athlete would choose to pursue another sport, this possible risk to others would be avoided; but, in the absence of any proven risk, involuntary restriction of an infected athlete is not justified. Informing others of the athlete's status would probably lead to his or her exclusion due to inappropriate fear and prejudice and therefore should also be avoided. This advice must be reconsidered if transmission of HIV is found to occur in the sports setting.
Hypercholesterolemia Screening Questioned
Authors: STEINER NANCY J.
Published: December 2021

In Reply.—

As stated in the title and text of the paper, the specific objective of this research is to evaluate the efficacy of screening strategies based on selected risk factors to identify all adolescents with hypercholesterolemia. The findings demonstrate that targeted screening does not detect effectively all individuals with hypercholesterolemia. Therefore, the logical alternative for a practitioner who wants to identify all teens with hypercholesterolemia must be to screen all individuals.

Although Dr Sheps agrees with my findings that the American Academy of Pediatrics' criteria for hypercholesterolemia screening are not predictive of high cholesterol levels in adolescents, he disagrees with the conclusion that to identify adequately all individuals with hypercholesterolemia, all teens must be screened.
Chronic Fatigue Immune Dysfunction Syndrome: An Epidemic?
Authors: SADEH AVI , CARSKADON MARY A. , ACEBO CHRISTINE , DAHL RONALD
Published: December 2021

To the Editor.—

The report described a study of 15 adolescents with a complaint of chronic fatigue.1 In an effort to encompass all possible sources of chronic fatigue, evaluation of the patients included physical examinations, virologic tests, and psychological studies.

We believe that insufficient attention was given to assessing the sleep-wake system as a possible source of chronic fatigue in at least some of these adolescents. Certainly, inadequate sleep (which is common among adolescents, see Carskadon2) can result in symptoms of chronic fatigue.
COAGULATION STUDIES IN THE NEWBORN INFANT
Authors: HEYN RUTH M. , ROZENFELD IRVING H. , GROSSMAN BURTON J. , STUART JAMES D.
Published: December 2021

Determinations of the whole blood clotting time, prothrombin concentration, protamine titration, platelet count, and clot lysis were done on 10 infants with erythroblastosis fetalis on the first, third and fifth days of life.

On the first day of life the average whole blood clotting time was 27 minutes as compared to an average of 14 minutes in the normal infant. The protamine titration was increased beyond normal adult values in 60% of the infants as compared with 23% of normal infants. The prothrombin concentration was comparable to that of the normal infant.

Eight of these infants received replacement transfusions and repeat determinations of the above factors immediately after transfusion showed a return to normal of the protamine titration.

Heparin sensitivity tests done on three of the treated infants before and after transfusion were essentially normal.

On the third day of life the average whole blood clotting time was 10½ minutes in the treated infants as contrasted with 25 minutes in the normal infant. Protamine titrations were normal in all infants. The average prothrombin concentration was 77% as compared with 65% in the normal three day infant.

On the fifth day of life all determinations were normal except for those from three infants who had increased protamine titrations.
UNIPOLAR LEAD ELECTROCARDIOGRAPHY IN CHILDREN
Authors: VEASY L. GEORGE , ADAMS FORREST H.
Published: December 2021

A brief discussion of theory of unipolar lead electrocardiography has been presented. The findings on 50 normal infants and children and 72 cases of congenital heart disease have been presented. The advantage of the unipolar limb and precordial leads over standard electrocardiography has been confirmed by the study presented. The R/S ratios and ventricular activation time offered more reliable criteria for hypertrophy than did the ST segment and T-wave changes.
OXIMETER STUDIES IN NEWBORN INFANTS DURING CRYING
Authors: PREC KLARA J. , CASSELS DONALD E.
Published: December 2021

The arterial oxygen saturation was determined in 135 healthy newborn infants during sleep and while crying with a direct reading single scale oximeter. In the first group, consisting of infants from one hour and 30 minutes to 3 days of age, 66% showed a decrease of oxygen saturation with crying, 27% an increase and 6.8% no change. In the second group, which includes all infants between 4 and 9 days of age, 59% showed an increase in saturation with crying, 21% a decrease and 22.4% no change. In comparison, the mean results in these two groups are in the opposite direction. These changes are statistically significant. Twenty-eight infants were studied also while breathing oxygen (73%-98.5%), and the results compared with those in room air were found to show an identical trend.

It is concluded that increases in arterial oxygen saturation with crying, which occur most frequently in older infants, are probably due to an increase in alveolar oxygen tension secondary to improved pulmonary ventilation during crying.

The paradoxic decrease in saturation during crying, which was found in a large percentage of infants of the younger group, is suggestive of the presence of a transitory venous-arterial shunt. This shunt could be either through atelectatic areas of the lung or through the foramen ovale, which is only functionally closed and can open whenever the pressure in the right auricle exceeds the left auricular pressure. There is some available evidence to support the latter possibility.
Bias and `Overcall' in Interpreting Chest Radiographs in Young Febrile Children
Authors: Kramer Michael S. , Roberts-Bräuer Renée , Williams Robert L.
Published: December 2021

Few studies have examined the diagnostic validity of the examining physician's interpretation of chest radiographs in young febrile children, and none (to our knowledge) the extent to which the "official" (ie, the radiologist's) reading may be biased by access to the examining physician's reading and to other clinical information. The authors studied 287 consecutive chest radiographs obtained in 286 febrile children 3 to 24 months of age without chronic cardiopulmonary disease or known asthma who presented to a children's hospital emergency department between March 1989 and August 1990. The readings by treating pediatricians, official pediatric radiologists, and a "blind" pediatric radiologist were compared. Official radiologists had access to the treating pediatricians' readings and the clinical information provided on the radiography requisition. The blind radiologist knew only that each child was 3 to 24 months of age and febrile, and he was asked to judge the presence or absence of pneumonia. Using the blind radiologist's reading as the "gold standard" for judging validity of the treating physicians' and official radiologists' readings, sensitivity (.677 vs .647), specificity (.828 vs .849), positive predictive value (PPV, .537 vs .571), and kappa index (κ, .462 vs .475) were quite similar. By contrast, agreement by the treating physicians was considerably higher with the official radiologists' readings as gold standard: sensitivity = .756, specificity = .922, PPV = .795, and κ = .688. When the treating physician's reading was positive, the official radiologists' positivity rate was much higher than the blind radiologist's (74.4% vs 51.8%, P < .005), sensitivity was high (.884) but specificity was low (.436), PPV was .663, and κ was .326. When the treating physicians' reading was negative, however, the pattern was reversed: positivity = 8.5% vs 12.8% (P not significant), sensitivity = .240, specificity = .937, PPV = .353, and κ = .205. Surprisingly, none of the three sets of readings appeared to be influenced by the reporting of clinical signs and symptoms on the radiography requisition. These results indicate that official radiologists are strongly biased by the treating physician's reading. Since such a bias can lead to unnecessary antibiotic treatment and hospital admission, strategies to reduce it should receive high priority.
My Last Will and Testament on Rapid Elimination and Ultimate Global Eradication of Poliomyelitis and Measles
Authors: Sabin Albert B.
Published: December 2021

It is a special pleasure for me to participate in today's symposium, in honor of my cousin Saul Krugman's 80th birthday and to celebrate his important contributions to our knowledge of infectious diseases. It so happens that I have also spent my life in the pursuit of knowledge of infectious diseases, and yet, despite our close family relationship—he is the son of my mother's brother—our paths rarely crossed until he was 35 years old. It was then that Saul, without any special training in bacteriology, virology, immunology, or pathology, decided to spend his life in academic pediatrics and infectious diseases. Was there any link between Saul's career in infectious diseases and my own, which began 64 years ago? In October 1946, after 5 years as a flight surgeon and a 6 months' residency at the Willard Parker Hospital, then the center for all the horrible communicable diseases of children in New York City, Saul applied for a residency in pediatrics. But there were no vacancies for this 35-year-old World War II veteran. It was then that Saul came to Cincinnati to seek my advice. In 1940, after a pediatric residency at Hopkins, Dr Robert Ward came to my laboratory to work on polio and other viruses. In 1943, when I left Cincinnati to join the Army, Robbie Ward was not accepted by the Army because of an old tuberculous lesion acquired on the wards of the Hopkins Harriet Lane Hospital, and he joined John R. Paul at Yale to work on polio and hepatitis.
Hypercalcemia in Association with Subcutaneous Fat Necrosis of the Newborn: Studies of Calcium-Regulating Hormones
Authors: COOK JENNIFER S. , STONE MARY SEABURY , HANSEN JAMES R.
Published: December 2021

Subcutaneous fat necrosis of the newborn is an uncommon disorder that occurs during the first few weeks of life as firm subcutaneous nodules on the cheeks, buttocks, back, arms, and thighs. This disorder, which initially was described by Harrison and McNee in 1926,1 typically affects full-term newborns who have experienced perinatal distress. Subcutaneous fat necrosis of the newborn usually resolves over a period of months, but may result in death due to its association with hypercalcemia.

The association between subcutaneous fat necrosis of the newborn and hypercalcemia was first reported by Clay in 19562; however, the mechanism that results in hypercalcemia remains incompletely understood.3-7
Mother-to-Child Transmission of Human Immunodeficiency Virus Type 1: Risk of Infection and Correlates of Transmission
Authors: Gabiano Clara , Tovo Pier-Angelo , de Martino Maurizio , Galli Luisa , Mazza Antonio , Giaquinto Carlo , Loy Anna , Ferrazzin Antonio , Schoeller Mariangela Clerici , Giovannini Marcello , Ferranti Gabriella , Rancilio Laura , Caselli Desireé , Segni Giuseppe , Livadiotti Susanna , Conte Aristide , Rizzi Marco , Viggiano Domenico , Tozzi Alberto E. , Cappello Nazario
Published: December 2021

One thousand eight hundred eighty-seven children born to human immunodeficiency virus type 1 (HIV-1) seropositive mothers, including 1045 infants prospectively followed up from birth, were studied. Intravenous drug use was the most frequent maternal risk factor, although the percentage of women infected by sexual contact increased from 5.8% in 1985 to 28.5% in 1990. Of the 551 first children followed up from birth and older than 15 months of age, 101 (18.3%) acquired infection and seroconverted to HIV-1. Another 31 (5.6%) asymptomatic seronegative children showed the presence of viral markers, for an apparent mother-to-off-spring transmission rate of 23.9%. Overlapping results were seen in 22 second-born children followed up from birth. Of 59 sibships with definite infection status, when the first child was infected, 14 (40%) of 35 second children were infected, whereas when the first child was not infected, only 2 of 24 (8.3%) second children were infected. Discordance in HIV-1 transmission was found in 1 of 18 pairs of twins. Univariate and multivariate analyses of possible risk factors for HIV-1 transmission performed on the entire population of children and in the cohort of those followed up from birth were basically in agreement in indicating that the development of symptoms in the mother before delivery and breast-feeding (indeed adopted in only 22 infants in whom HIV-1 infection was identified at birth) were significantly and independently associated with a higher transmission rate. In addition, girls were more frequently infected than boys. Preterm delivery and low birth weight correlated with maternal drug use. Child's infection status did not influence gestational age nor birth weight. In contrast, maternal infection itself seemed to reduce fetal growth, which was further impaired when the mother was symptomatic.
Meconium Aspiration Syndrome (MAS)
Authors: WAAGE GUNNAR
Published: December 2021

To the Editor.—

In the article "Intratracheal Suctioning, Systemic Infection, and the Meconium Aspiration Syndrome," Wiswell and Henley review their experience with meconium-stained babies from 1985 to 1989.

Dr Wiswell compares two groups of neonates, those intubated and those not intubated. The rationale for not intubating neonates included (1) the lack of meconium in the hypopharynx, (2) the apparent vigor of the child, and (3) thin-consistency meconium. The literature agrees that the majority of meconium-stained neonates fall into such a category; however, Dr Wiswell finds only 19% of neonates in this category.
Behavior, Biology, and the Meanings of Temperamental Constructs
Authors: Kagan Jerome
Published: December 2021

The renascence of temperamental constructs in discussions of both normal and pathologic development, after almost a century of polite suppression, is accompanied by the same methodologic and epistemologic issues that plague all inquiry into the relation between biologic and psychologic phenomena. During the half-century following World War I, when behavioristic explanations were ascendant, the burden of explanation for many behaviors rested on conditioned habits acquired through contingent interaction with the environment. If a habit happened to become associated with a physiologic reaction, it was usually treated as an epiphenomenon of the conditioned response.

The study of temperamentally based behaviors has changed this attitude because the physiology is not viewed as epiphenomenal. Many investigators assume that children who belong to a particular temperamental category inherit a low or a high threshold for particular physiologic reactions to specific incentives. The sequence of behavioral profiles that develops is a joint product of both the child's physiology and the environments encountered. For example, about 20% of healthy 1- to 2-year-old white children react consistently to unfamiliar events that are difficult to assimilate or to cope with—like thunderstorms, large animals, or strangers—with both limbic discharge and an initial restraint on activity, sometimes accompanied by withdrawal. We call such children inhibited.1 The limbic activity accompanies the behavioral phenomena without being causal in the traditional meaning of that term.

It is also understood that the temperamentally inhibited child must be differentiated from the shy child who was not born with any temperamental bias favoring limbic reactivity to unfamiliarity, but happened to experience an environment that promoted the acquisition of timidity and restraint.
Neonatal Therapeutic Intervention Scoring System: A Therapy-Based Severity-of-Illness Index
Authors: Gray James E. , Richardson Douglas K. , McCormick Marie C. , Workman-Daniels Kathryn , Goldmann Donald A.
Published: December 2021

Severity-of-illness scales have proven valuable able in assessing clinical outcomes and resource consumption in adult and pediatric intensive care, but they have been less extensively developed for neonatal care. The National Therapeutic Intervention Scoring System (NTISS) was created by modifying the Therapeutic Intervention Scoring System (TISS). From the 76 original TISS items, 42 were deleted and 28 added to form the NTISS. Like TISS, NTISS assigns score points from 1 to 4 for various intensive care therapies. Admission-day NTISS scores were calculated for 1643 newborns admitted to three neonatal intensive care units (NICUs) between November 1, 1989, and September 30, 1990. NTISS scores ranged from 0 to 47 with a mean of 12.3 ± 8.7 (SD). There was little correlation with birth weight (r = -.11) or gestational age (r = -.17), but NTISS scores were highly correlated with expected markers of illness severity, including mortality risk estimates by neonatal attending physicians (r = .70, P < .0001), in-hospital mortality rates (P < .05), and a measure of nursing acuity (Medicus) (r = .05), and a measure of nursing acuity (Medicus) (r = .69, P < .0001). In addition, admission-day NTISS scores were found to be predictive of both NICU length of stay (r = .37, P < .0001) and total hospital charges for survivors (r = .65, P < .0001). It is concluded that NTISS is a valid measure of therapeutic intensity that is independent of birth weight and can be used as an indicator of neonatal illness severity and resource utilization. Further validation in other NICUs is required.
Carnation Marketing Practices
Authors: MACDONALD LAURIE
Published: December 2021

To the Editor.—

I would like to comment on Dr Frank A. Oski's Letter to the Editor concerning low-iron infant formulas which appeared in the February 1992 issue of Pediatrics.1

Dr Oski's concern over the large volume of low-iron infant formula sold is shared by us at Carnation Nutritional Products. To this end, we broke with the industry practice of offering both low-iron and iron-fortified formulations when, in early 1989, we introduced Carnation Good Start and Carnation Follow-Up Formula in iron-fortified forms only.
Presurgical Routine Screening
Authors: LACKMANN GERD M. , TÖLLNER UWE
Published: December 2021

To the Editor.—

We read with interest the article "Preoperative History and Coagulation Screening in Children Undergoing Tonsillectomy."1 In 1990, we performed a prospective study on the incidence of previously undetected pediatric diseases in children who were admitted to our hospital for surgical procedures.2 497 children aged 2 months to 16 years were enrolled in the study. All children were cared for by a pediatrician as well as by colleagues from specific surgical departments, eg, ear, nose, and throat surgery (50.9%), gastrointestinal surgery (17.3%), urology (12.9%), traumatology (11 .9%), oral surgery (4.2%), neurosurgery (0.4%), and others (2.4%).