bluuebunny/crossref_metadata_2025 huggingface dataset:
Preventive Dental Care: The Role of the Pediatrician
Authors: Herrmann Henry J. , Roberts Michael W.
Published: December 2021

The pediatrician can assist the dental profession in preventing dental disease and maintaining the oral health of children. Pediatricians are urged to counsel parents in dietary and oral hygiene practices that will prevent dental caries and to refer patients for professional dental care when appropriate. Systemic fluoride supplements should be prescribed when needed but only after a careful review of requirements and daily consumption.
Reduction in Pulmonary Function and Increased Frequency of Cough Associated With Passive Smoking in Teenage Athletes
Authors: Tsimoyianis George V. , Jacobson Marc S. , Feldman Joseph G. , Antonio-Santiago Maria T. , Clutarlo Bella C. , Nussbaum Michael , Shenker I. Ronald
Published: December 2021

Previous studies have suggested that passive smoking (involuntary inhalation of tobacco smoke by nonsmokers) reduces small airways function. We evaluated the exposure to passive smoking and its effects on pulmonary function and symptoms in a group of 12- to 17-year-old high school athletes (N = 209; 119 boys and 90 girls) at their annual presport participation physical examinations. A structured interview was used to assess pulmonary symptoms, personal smoking habits, and passive cigarette smoke exposure. All athletes performed forced expiratory maneuvers on a portable spirometer. We measured forced vital capacity, forced expiratory volume in 1 second, and forced expiratory flow 25% to 75% (FEF25-75). The best of three FEF25-75 measured was used. Less than 70% of predicted FEF25-75 was considered abnormal. Of the 209 athletes, 7.7% were active smokers and were excluded. Of the remaining 193 athletes, 68.4% were currently exposed to passive smoking. We found a fourfold increase in incidence of low FEF25-75 and/or cough in athletes exposed to passive smoking compared with athletes not exposed: 18 of 132 exposed athletes (13.6%) had low FEF25-75 and/or cough compared with two of 61 unexposed athletes (3.3%) who had low FEF25-75 and cough (P = .02). Boys were more frequently exposed to passive smoking than girls (74% of boys [80/108] v 61% of girls [52/85]), but the effects were more pronounced in girls. These data show a relationship between exposure to passive smoking and early pulmonary dysfunction in young athletes. The frequent exposure to passive smoke and the high prevalence of dysfunction in this population, generally considered to be healthy, is of particular concern.
Pneumococcal and Haemophilus influenzae Type b Antigen Detection in Children at Risk for Occult Bacteremia
Authors: Rubin Lorry G. , Carmody Lillian
Published: December 2021

We prospectively evaluated pneumococcal and Haemophilus influenzae type b antigen detection in serum and urine of young (3 to 30 months of age) febrile (temperature ≥ 39°C) children at risk for occult bacteremia. Patients with septic shock, meningitis, or epiglottitis were excluded. Of 576 patients, 16 had pneumococcal bacteremia (final diagnoses: primary bacteremia, nine; otitis media, four; pneumonia, two; unknown, one), and five had H influenzae b bacteremia (final diagnoses: primary bacteremia, two; cellulitis, two; arthritis, one). Latex agglutination was positive in all five patients with H influenzae b bacteremia (positive in three of three urine specimens, three of four sera tested) but only one of 16 patients with pneumococcal bacteremia (positive in one of seven urine samples, zero of 13 sera tested). Both assays had specificities of greater than 95%. Nonspecific agglutination occurred in 7% of specimens tested. Enzyme immunoassay for pneumococcal antigen, although more sensitive than latex agglutination, failed to detect antigen in ten sera and three urine specimens from patients with pneumococcal bacteremia. Thus, neither latex agglutination nor enzyme immunoassay was sufficiently sensitive for detection of occult pneumococcal bacteremia. Latex agglutination for H influenzae b holds promise as a sensitive and specific test for rapid diagnosis of occult bacteremia due to H influenzae b.
Pentobarbital Therapy Does Not Improve Neurologic Outcome in Nearly Drowned, Flaccid-Comatose Children
Authors: Nussbaum Eliezer , Maggi J. Carlos
Published: December 2021

The effect of pentobarbital therapy was studied prospectively in 31 nearly drowned children in a flaccid state of coma. Each child was assigned to one of two sequential treatment groups. Group A: 16 children were treated with hypothermia and IV pentobarbital, achieving serum levels >25 µ/mL within 48 hours of admission. Group B: 15 children were treated with hypothermia but no pentobarbital. All patients received "conventional therapy" (ie, Paco2 20 to 25 mm Hg, Pao2 90 to 100 mm Hg, fluid restriction, pancuronium bromide, and furosemide or mannitol). Analysis of variance failed to detect differences for age, estimated time of submersion, arterial pH, core temperature, and mean intracranial pressure between the patients prior to treatment with pentobarbital. In Group A, six patients (37%) recovered completely and were neurologically intact, six patients (37%) had severe brain damage and four patients (26%) died. In Group B, six patients (40%) recovered completely, six patients (40%) survived with brain damage, and three patients (20%) died. There were no statistical differences between the two groups (P > .05, χ2 analysis) for the mortality rate, survival with brain damage, and complete recovery. The results suggest that: (1) pentobarbital therapy does not improve neurologic outcome for nearly drowned, flaccid-comatose children; (2) previous claims implying better outcome with hypothermia combined with pentobarbital therapy may be attributed to the effect of hypothermia alone; and (3) pentobarbital therapy may not be justified in nearly drowned, flaccid-comatose victims.
Language Growth in Children With Expressive Language Delay
Authors: Fischel Janet E. , Whitehurst Grover J. , Caulfield Marie B. , DeBaryshe Barbara
Published: December 2021

Developmental expressive language disorder is a frequently occurring condition in children, characterized by severe delay in the development of expressive language compared with receptive language and cognitive skills. Opinions differ regarding whether expressive language delay is a disorder worthy of active intervention or an indication of normal variation in the onset of expressive language. The purpose of this research was to follow for 5 months 26 2-year-old children in whom expressive language disorder had been carefully diagnosed to discover the rate of improvement and its predictors. Improvement was variable, with approximately one third of the children showing no improvement, one third showing mild improvement, and one third in the normal range at posttest. Nearly two thirds of the variance in improvement could be accounted for by three child variables measured by the pretest: parentally reported vocabulary size, parentally reported problems with having regular meals, and observed frequency of quiet activity not requiring the parent's management. A screening procedure involving only one of those variables, reported vocabulary size, was 81% accurate in identifying children's improvement status. The implications of these results for the management of children with expressive language disorder are discussed.
Early Treatment of Congenital Hypothyroidism
Authors: FISHER D. A. , FOLEY B. L.
Published: December 2021

Mass population screening of newborn infants for congenital hypothyroidism was introduced in 1974 and now is a routine and effective means of early diagnosis of congenital hypothyroidism throughout most of the industrialized world. A large number of affected infants and children have been treated with replacement thyroid hormone, and several reports of IQ measurements and functional assessments of 5-to 7-year-old treated children now are available. These reports document normal mean IQ values, satisfactory school performance, and minimal motor dysfunction in treated children. However, there have been reported correlations between lower IQ values and biologic parameters of the hypothyroid state in the neonatal period among several reported studies, and it is not yet clear whether early adequate treatment will reverse all of the effects of congenital hypothyroidism.
Reduced Incidental Light Exposure: Effect on the Development of Retinopathy of Prematurity in Low Birth Weight Infants
Authors: Ackerman Barbara , Sherwonit Elaine , Williams Joanne
Published: December 2021

In a recent study, it was reported that incidental lighting within the newborn intensive care unit setting may play a role in the development of retinopathy of prematurity. Consequently, the routine clinical management in the intensive care nursery at Yale-New Haven Hospital was modified to include shielding each premature infant's isolette, thereby decreasing the intensity of the nursery lights on an infant's eyes from a median light level of 55 foot-candles to 15 foot-candles. The effect of this reduction of light level on the incidence of retinopathy of prematurity in 161 premature infants was prospectively investigated. This group was then compared with a historic control group of 129 premature infants with similar characteristics who had been exposed to standard nursery lighting. There was no difference in the incidence and severity of retinopathy of prematurity between the two groups.
Pediatricians and the Pneumatic Otoscope: Are We Playing It By Ear?
Authors: Cavanaugh Robert M.
Published: December 2021

The amount of positive pressure delivered during pneumatic otoscopy was recorded in 53 healthy pediatric patients. The pressures generated ranged from 338 to 1134 mm H2O. The mean pressure introduced was 748 mm H2O with the bulb and 502 mm H2O through the mouthpiece. The mean intraobserver variation in pressure delivered to each patient was 199 and 125 mm H2O with these two methods of insufflation, respectively. These data document the wide variation in pressures generated with the pneumatic otoscope and suggest that the feasibility of modifying this instrument into a standardized, objective pneumatic system should be explored.
INSINCERE RESEARCH
Authors: Student
Published: December 2021

My personal experience suggests that achievement in research correlates only poorly with both clinical skills and teaching ability. One way of reducing fraud in science is to stop blackmailing people into undertaking research to which they are not intellectually committed and to give to those who are considerably improved facilities.
Victimization of Mothers of Abused Children: A Controlled Study
Authors: McKibben Linda , De Vos Edward , Newberger Eli H.
Published: December 2021

To search for indicators of violence against mothers of child abuse victims by husbands or boyfriends, the women's medical records were reviewed and compared to records of mothers of a nontraumatized child comparison group. Of the 32 children ascertained in a 6-month interval, the records of mothers of 19 (59.4%) were diagnostic or highly suggestive of current or previous victimization. Although the prevalence of documented violence against the mothers of children in the comparison group was an unexpectedly high 16%, the case-control difference was highly significant (P < .001). Although differences were found in the (younger) ages and (higher) parity of mothers of abused children, these differences did not predict risk of mothers' exposures to violence in a multivariate analysis. The rate of violence against single mothers of child abuse victims, however, was four times the rate against mothers who were married (P = .022). These findings suggest a need to broaden the diagnostic conceptualization of child abuse to include maternal victimization and argue for including data concerning maternal risk in formulating diagnoses and disposition plans for abused children.
TEENAGE PREGNANCY IN THE UNITED STATES AS SEEN FROM BRITAIN
Authors: Student
Published: December 2021

Lack of access to contraception is especially severe among teenagers [in the U.S.]; although the pattern of premarital sexual intercourse is broadly similar in Britain and the U.S.A., teenage pregnancies are almost five times as common in the U.S.A. Eighty percent of the annual 1.1 million pregnancies among American teenagers are unwanted and 450,000 end in legal abortions (60 abortions for every 1000 women aged 18-19).
Increased Cerebral Blood Flow and Plasma Epinephrine in Hypoglycemic, Preterm Neonates
Authors: Pryds O. , Christensen N. J. , Friis-Hansen B.
Published: December 2021

Cerebral blood flow, plasma epinephrine, and plasma norepinephrine were measured in 25 spontaneously breathing, preterm neonates (mean gestational age 30.4 weeks) 2 hours after birth, during a routine screening for low blood glucose levels. Increased cerebral blood flow and plasma epinephrine values were observed when blood glucose levels were low, whereas plasma norepinephrine was constant throughout the blood glucose range. Hypoglycemia (defined as blood glucose concentration <30 mg/dL) was found in 13 neonates who were treated with intravenous glucose and milk enterally. Blood glucose levels were normal in the remaining 12 control neonates who received milk by a gastric line. Approximately 30 minutes after treatment with intravenous glucose and/or milk, cerebral blood flow had decreased by a mean of 11.3% in the 13 hypoglycemic neonates but was still 37.5% higher than cerebral blood flow in the control neonates despite normalization of plasma epinephrine concentration. Mean arterial blood pressure and blood gas values were identical between groups throughout the investigation. It is suggested that a normal coupling between cerebral metabolic demands and flow is present in very preterm neonates and that epinephrine may play a role in the cerebral hyperperfusion. Although none of the neonates had clinical signs of hypoglycemia, the data suggest that counterregulatory mechanisms are invoked when blood glucose values are <30 to 45 mg/dL.
Intestinal Myiasis Caused by Parasarcophaga crassipalpis (Diptera: Sarcophagidae)
Authors: SHIOTA TSUNEZO , YOSHIDA YUKIO , HIRAI SACHIYO , TORII SHOZO
Published: December 2021

Intestinal myiasis occurs when fly eggs or larvae that were previously deposited in food are ingested and survive in the gastrointestinal tract. Some infested patients are asymptomatic; others have abdominal pain, vomiting, and diarrhea. Although babies and small children seem more susceptible to intestinal myiasis than adults, probably the age distribution can be explained by childhood activity, fearlessness of wormlike creatures, and experimentation.1,2 The signs and symptoms of intestinal myiasis can easily be confused with other intestinal disturbances. In this article, we describe the clinical course of intestinal myiasis in a 4-year-old boy with severe abdominal pain.

CASE REPORT

The patient was a 4-year-old previously healthy boy residing in Osaka City, Japan.
Recommendations for Developmental Monitoring: The Role of Surveillance
Authors: DWORKIN PAUL H.
Published: December 2021

In Reply.—

Dr Cunningham raises several important issues regarding developmental surveillance in general and, more specifically, the early identification of children with mild mental retardation. Dr Cunningham equates surveillance with "eyeball" estimates of development. Although I agree (and acknowledge in my review) that subjective impressions of children's developmental status are often inaccurate, the process of developmental surveillance is actually far more sophisticated. It includes eliciting and attending to parental concerns, making accurate and informative longitudinal observations of children, and obtaining a relevant development history.
Economy, Convenience, and Safety: Can We Have It All?
Authors: WIDOME MARK D.
Published: December 2021

In this issue of Pediatrics, we learn about the dangers of travel in the cargo beds of pick-up trucks,1 a problem that is both old and new. Although we may have only recently given this hazard the attention it deserves, the issues surrounding safe travel in pick-up trucks are common to most other injury control problems. This is but the latest example of the challenge encountered when safety measures appear to threaten individual freedom, personal convenience, or economic "reality."

In the South, the Southwest, and much of rural America, the pick-up truck is, for many families, the only practical vehicle for both work and family transportation.
The Doughnut Sign
Authors: BLUM ALEXANDER
Published: December 2021

To the Editor.—

Determining whether breast tissue is present in an obese child can be difficult. We have found in obese children without breast development a palpable depression ion beneath the nipple in the center of the areola when they are examined in the supine position. It feels like a doughnut; a depression surrounded by firm tissue. It is possible that the depression represents the area of future ductal development. We have no biopsy material to confirm this hypothesis.
Preventive Care for Children: Immunization in England and Wales
Authors: Goodwin Shirley
Published: December 2021

Immunization rates against common, notifiable diseases of childhood have improved steadily in England and Wales, although the 90% target rates for 1990 have not been achieved. The organization of the immunization program is described, with attention to service delivery, mechanisms of assurance, and consideration of the remaining barriers to further improvement incoverage.
Eleven Plasma Proteins as Indicators of Protein Nutritional Status in Very Low Birth Weight Infants
Authors: Polberger Staffan K. T. , Fex Göran A. , Axelsson Irene E. , Räihä Niels C. R.
Published: December 2021

Concentrations of 11 plasma proteins were measured in 28 healthy, growing, very low birth weight, appropriate-for-gestational-age infants fed varying levels of human milk protein intake (range 1.7 to 3.9 g/kg per day). Significant positive correlations were found between ween mean protein intake and concentrations of 7 of the plasma proteins studied (transthyretin, retinol-binding protein, and transferrin: P < .001; vitamin D-binding protein and apolipoprotein B: P < .01; albumin and apolipoprotein A I: P < .05). A weak negative correlation with mean protein intake was seen for the plasma level of orosomucoid, whereas no significant correlations were found for the plasma concentrations of fibronectin and α1-antichymotrypsin. Protein intake, not energy intake, constituted the main contribution to the changes in the concentrations of transthyretin, retinol-binding protein, and transferrin. The levels of plasma transthyretin and transferrin were also strongly correlated with weight and length growth of the infants during the study as well as with other indicators of protein nutritional status such as preprandial concentrations of plasma amino acids and serum and urine urea. These data indicate that of the 11 plasma proteins studied, transthyretin, transferrin, and retinol-binding protein are the most suitable to evaluate protein nutritional status in very low birth weight infants.
Morbidity Estimates of Conditions Originating in the Perinatal Period: United States, 1986 Through 1987
Authors: Becerra José E. , Fry Yvonne W. , Rowley Diane L
Published: December 2021

Morbidity estimates of conditions originating in the perinatal period have not been reported in the United States. Conditions originating in the perinatal period were identified according to the International Classification of Diseases. The National Hospital Discharge Survey provided a weighted, nationally representative sample of newborns discharged each year from short-stay, nonfederal hospitals. From 1986 through 1987, 33.7% of all newborns had at least one nonteratologic perinatal condition. However, 6.8% of all newborns had physiologic jaundice as their only discharge diagnosis. Nonphysiologic jaundice was diagnosed in 4.4%, maternal causes of perinatal morbidity in 3.1%, birth trauma in 2.5%, fetal distress in 2.3%, birth asphyxia in 2.1%, and infections specific to the perinatal period in 2.0% of all newborn discharges. The average hospital stay for all newborns was 3.5 days, but it was 5.3 days for newborns with at least one nonteratologic perinatal condition and 2.6 for newborns discharged without a morbid condition. This study provides nationally representative estimates of perinatal morbidity useful for comparisons with smaller hospital-based samples. In addition, the study provides estimates of the public health impact of these conditions in terms of hospital stay days.
Perinatal Human Immunodeficiency Virus (HIV) Testing
Authors:   Task Force on Pediatric AIDS
Published: December 2021

PERINATAL INFECTIONS

The primary route of human immunodeficiency virus (HIV) infection in infants is vertical transmission from HIV-infected mothers. This is of particular concern as the number of infected women and the number of children infected by perinatal transmission continue to increase rapidly. The number of perinatally acquired acquired immunodeficiency syndrome (AIDS) cases increased 17% in 1989 and 21% in 1990. Similarly, the number of heterosexually acquired AIDS cases increased 27% in 1989 and 40% in 1990. There is evidence that vertical transmission of HIV can occur in utero (congenital/transplacental, similar to rubella),1,2 in the postpartum period (breast-feeding), and perhaps in the intrapartum period (similar to hepatitis B).3 The relative frequency and efficiency of transmission during each of these periods remains uncertain. The best estimates of vertical transmission from an HIV-seropositive mother to the fetus range from 12.9% to 39%4-6 Although the risk of transmission appears to be increased in women who are symptomatic, this point is still unclear.5 Preliminary information suggests that the presence of high levels of high-affinity/avidity antibodies to specific epitopes of the gp 120 of HIV may be protective and may decrease or prevent vertical transmission,7-10 although others have not been able to confirm this finding.11 More detailed information on perinatal HIV infection,12 and infection control13 in pediatric HIV infection is available in previously published statements from the AAP Task Force on Pediatric AIDS.

SEROPREVALENCE

Anonymous seroprevalence data from newborn specimens are being collected in 44 states, Puerto Rico, and the District of Columbia. In some states, seroprevalence data are available by metropolitan area and/or by hospital of birth.
Talented Students
Authors: MILLS CAROL J.
Published: December 2021

In Reply.—

It is with pleasure that I respond to the thoughtful remarks of Kim and Kwasman. Their concerns are well-founded and remarkably in accord with the philosophy and practice followed by the Center for Talented Youth (CTY) at Johns Hopkins University.

Kim and Kwasman observed that frustration and disillusionment with school are not restricted to gifted children. As they point out, "all students whose needs are not met adequately at an early age become frustrated and disillusioned with school."
REPORT OF TWO YEARS' EXPERIENCE IN THE TRANSPORTATION OF PREMATURE INFANTS IN NEW YORK CITY
Authors: WALLACE HELEN M. , LOSTY MARGARET A. , BAUMGARTNER LEONA
Published: December 2021

This report has presented some facts about premature infants based on a two year experience in the transportation of 1,209 small prematurely born infants to special "premature centers" in New York City. The data point the way for further developments in a program of care for the premature infant and in the prevention of premature labor. The importance of the parallel development of a sound maternity program and a special program to care for the prematurely born infant is emphasized.
TETANY AND PARATHYROID HYPERPLASIA IN THE NEWBORN INFANT: INFLUENCE OF DIETARY PHOSPHATE LOAD
Authors: GARDNER LYTT I.
Published: December 2021

Three cases of newborn tetany are described, pointing out the relationship between dietary phosphate load and the manifestations of this disease.

An additional three newborn infants are described who showed other symptomatology than tetany in association with dietary phosphate load.

[See Table 1 in Source Pdf].

Data concerning diet, cause of death and degree of parathyroid hyperplasia are tabulated in eight newborns who were found to have parathyroid hyperplasia at autopsy. Similar data are tabulated on eight newborns and five older children who were found to have normal parathyroid glands at autopsy.

Several other factors possibly involved in newborn tetany and newborn parathyroid hyperplasia are discussed. The importance of measuring serum inorganic P in the differential diagnosis of neonatal distress is pointed out.
We Have the Solution: Now What's the Problem?
Authors: KLEINMAN RONALD E.
Published: December 2021

The largest outbreak of the current cholera pandemic and the first to strike the Western hemisphere in this century began in Peru in January of 1991. Two hundred seventy-four thousand, seven hundred sixty-eight cases were reported as of August 7, 1991, with an average case-fatality rate of just over 1%.1 For more than 30 years cholera has served as the paradigm for watery diarrhea, fully treatable by fluid and electrolyte replacement therapy. More than 20 years of experience, including this most recent epidemic in our own hemisphere, has proven the effectiveness of this therapy when given by mouth. It is hard to imagine a more impressive benefit from a cheap and simple therapy.
Neonatal Screening for Dependents of Active-Duty Military Personnel
Authors: PETTETT GARY
Published: December 2021

To the Editor.—

In the February issue of Pediatrics the Committee on Genetics issued their most recent statement and recommendations on newborn screening for metabolic/inherited disorders.1 Within the text of this statement there is incorrect information concerning newborn screening for dependents of active-duty military personnel. In the commentary on universal screening (Goal 21p346) the Committee reports: The absence of a standardized neonatal screening policy or program for dependents of the United States Uniformed Services also placed them at increased risk for failure to be screened, particularly those born outside the US.
Stroke in an Early Adolescent with Systemic Lupus Erythematosus and Coexistent Antiphospholipid Antibodies
Authors: DUNGAN DAVID D. , JAY M. SUSAN
Published: December 2021

Thromboembolic events in systemic lupus erythematosus (SLE) are an occasional but significant occurrence. Cerebrovascular disease in adults with SLE has been well described.1-4 Antiphospholipid antibodies, such as lupus anticoagulant, an immunoglobulin directed against the platelet phospholipid component of the prothrombin activator complex, and the false-positive serologic tests for syphilis, which detect reaginic antibodies that react with the purified beef cardiolipin substrate of these assays, have been reported for a long time in association with these events.5-9 More recently, development of an assay for anticardiolipin antibodies, immunoglobulins directed against the phosphodiester group of negatively charged phospholipids, has led to wider exploration of this subset of antiphospholipid antibodies and their relation to thrombosis.10,11
Risk of Sepsis in Newborns With Severe Hyperbilirubinemia
Authors: Maisels M. Jeffrey , Kring Elizabeth
Published: December 2021

Because bacterial infection is a potential cause of hyperbilirubinemia, some authors suggest that newborns with significant unexplained indirect hyperbilirubinemia should be evaluated for sepsis. We reviewed the charts of 306 newborns admitted to a pediatric ward within 21 days of birth with a diagnosis of indirect hyperbilirubinemia (peak serum bilirubin level 316 ± 48, range 217 to 498 µmol/L) (18.5 ± 2.8, 12.7 to 29.1 mg/dL). Ninety percent were fully or partially breast-fed. Sepsis was identified in 0 of 306 newborns (upper 95% confidence limit for the risk of sepsis = 1%). The overwhelming majority of newborns who require readmission to hospital for indirect hyperbilirubinemia are healthy, breast-fed newborns and do not need to be investigated for sepsis. If indirect hyperbilirubinemia is ever the only manifestation of bacteremia or incipient sepsis, it must be a rare event.
Bronchopulmonary Dysplasia Criteria: A Mathematical Impossibility
Authors: NORTHWAY WILLIAM H.
Published: December 2021

In Reply.—

Drs Schwartz, Stayer, and Pasquariello1 correctly noted the typographical error in the diagnostic criteria for bronchopulmonary dysplasia in "Bronchopulmonary Dysplasia: Twenty-five Years Later"2 They are also correct that a Pao2 above 500 mm Hg is not achievable at sea level in 21% oxygen. More importantly, a Pao2 above 500 mm Hg is achievable and is not a mathematical impossibility with supplemental oxygen at sea level but is clearly not part of the diagnostic criteria cited.
Alternative Child Care in France: Advances in the Study of Motor, Interactive, and Social Behaviors of Young Children in Settings Allowing Them to Move Freely in a Group of Peers
Authors: Montagner Hubert , Gauffier Gérard , Epoulet Bernard , Restoin Albert , Goulevitch Robert , Taule Marguerite , Wiaux Bernard
Published: December 2021

This paper reports new data on the emergence and development from the 9th to 19th month of age of motor, interactive, and social behaviors of 17 children with peers in a milieu that allows the "conquest" of the third dimension of space without limitation of their motor activity. Their motor skills and social behaviors appear more precocious and complex than previously indicated by scientific publications, clinical observations, and developmental scales.

1. The motor skills that allow the "conquest" of climbing structures (ascents of a spiral staircase and a ramp) are already observed before the age of 12 months in some children (ascents of the ramp) or nearly half of them (ascents of the staircase). Complex social behaviors (multimodal interactions from here and there along a holed partition, imitations, cooperations, anticipation of the behavior of the partner) also emerge before 12 months.

2. The age range from 12 to 14 to 15 months is characterized by consolidation of the motor skills that allow the "conquest" of the third dimension of the space and a rapid increase of the imitations and interactions around the holed partition.

3. The age range from 14 to 18 months is characterized by diversification of the posturomotor patterns during ascents and descents of staircase and ramp and the growing predominance of the standing position. This is also a phase of significant increase in frequency of imitations and cooperations and of emergence of complex forms of cooperation.

4. Aggression is infrequent at all ages.
Effects of Television on Metabolic Rate: Potential Implications For Childhood Obesity
Authors: Klesges Robert C. , Shelton Mary L. , Klesges Lisa M.
Published: December 2021

The effects of television viewing on resting energy expenditure (metabolic rate) in obese and normal-weight children were studied in a laboratory setting. Subjects were 15 obese children and 16 normal-weight children whose ages ranged from 8 to 12 years. All subjects had two measures of resting energy expenditure obtained while at rest and one measurement of energy expenditure taken while viewing television. Results indicated that metabolic rate during television viewing was significantly lower (mean decrease of 211 kcal extrapolated to a day) than during rest. Obese children tended to have a larger decrease, although this difference was not statistically significant (262 kcal/d vs 167 kcal/d, respectively). It was concluded that television viewing has a fairly profound lowering effect of metabolic rate and may be a mechanism for the relationship between obesity and amount of television viewing.
Prader-Willi Syndrome: Consensus Diagnostic Criteria
Authors: Holm Vanja A. , Cassidy Suzanne B. , Butler Merlin G. , Hanchett Jeanne M. , Greenswag Louise R. , Whitman Barbara Y. , Greenberg Frank
Published: December 2021

The diagnosis of Prader-Willi syndrome (PWS) is based on clinical findings that change with age. Hypotonia is prominent in infancy. Obesity, mild mental retardation or learning disability, and behavior problems, especially in association with food and eating result in a debilitating physical and developmental disability in adolescence and adulthood. No consistent biological marker is yet available for PWS in spite of recent research activity in cytogenetics and molecular genetics. Diagnostic criteria for PWS were developed by consensus of seven clinicians experienced with the syndrome in consultation with national and international experts. Two scoring systems are provided: one for children aged 0 to 36 months and another one for children aged 3 years to adults. These criteria will aid in recognition of the syndrome in hypotonic infants and in obese, mildly retarded, behaviorally disturbed adolescents and adults. They will also ensure uniform diagnosis for future clinical and laboratory research in PWS.
Fatal Child Abuse and Sudden Infant Death Syndrome: A Critical Diagnostic Decision
Authors: Reece Robert M.
Published: December 2021

Distinguishing between an unexpected infant death due to sudden infant death syndrome (SIDS) and one due to fatal child abuse challenges pediatricians, family physicians, pathologists, and child protection agencies. If child abuse is suspected, the physician must fuffill mandated legal obligations to report the case to the appropriate authorities. Coroners, medical examiners, and pathologists have the added responsibility of rendering a medicolegal opinion as to the cause and manner of death. Child protection agencies need to ensure that other children in the home are not at risk. Law enforcement personnel and prosecutors need to proceed if the law has been broken. All agree that the state of our knowledge in this area is incomplete and ambiguity exists in some cases. For everyone concerned, it is necessary and desirable, within the limits of our capability, to know the cause and manner of an infant death. This process requires application of current knowledge, a desire to know the reasons for the deaths, the resources necessary to conduct essential procedures, and the sensitivity and wisdom to perform the task without causing distress to innocent family members.

The history relevant to this decision is a relatively short one. In the first half of this century, searching for the reasons infants die was the lonely province of a few clinicians, researchers, and pathologists who examined the retrospective traces of infant deaths. Bergman1 recounts the slow progression of knowledge about sudden unexpected infant death in the pathologists' laboratories and morgues where Werne and Garrow2 and then Adelson and Kinney3 proposed etiologies for "crib death" other than suffocation.
SIDS and Sleeping Position
Authors: SHANNON DANIEL C. , HUNT CARL E.
Published: December 2021

In Reply.—

Guntheroth and Spiers,1 displeased with our commentary in Pediatrics,2 have raised many issues. However, the key question is whether the scientific data incriminating the prone position as a contributor to SIDS warrant a recommendation to change sleeping position at this time. Based on our critical review of the literature, we conclude that this recommendation was premature and unwarranted.

Accepting the current definition of SIDS as the sudden death of an infant that remains unexplained even after a thorough postmortem examination, death scene investigation, and review of the clinical history, one can decide which of the 15 published studies in which a statistical association is described between prone sleeping and SIDS is acceptable.
The Changing Role and Responsibilities of a Chairman—Letters
Authors: STRASBURGER VICTOR C.
Published: December 2021

To the Editor.—

Dr Brent's article on academic chairmen (Pediatrics. 1992;90:50-57) was terrific—insightful, helpful, and much needed. If I may be so bold as to add one further insight and suggestion: When chairmen of academic departments are selected, invariably it seems to be done by the "weight of the c.v." approach. An outstanding researcher does not necessarily make an outstanding chairman. (In fact, one could argue that there are skills needed for bench or clinical research that are antithetical to those needed to chair an academic department.)
The Changing Role and Responsibilities of a Chairman—Letters
Authors: Michael ALFRED F.
Published: December 2021

To the Editor.—

Dr Brent's article was superb and hit many nails on the head. It was great reading.
The Use of Cow's Milk in Infancy
Authors: KLEINMAN RONALD E.
Published: December 2021

In Reply.—

The Committee on Nutrition of the American Academy of Pediatrics recently recommended that the introduction of whole cow's milk into an infant's diet should be delayed until 1 year of age.1 The relationship between insulin-dependent diabetes mellitus (IDDM) and bovine albumin is well established in rat and mouse models of IDDM. However, the relationship between the ingestion of dairy products and diabetes in humans is still at a very preliminary stage. The recent report of 146 Finnish children with antibodies to a fraction of bovine albumin certainly will stimulate further investigation but, as MacLaren and Atkinson point out, this single observation does not prove that cow milk protein is either the cause or promotor of diabetes mellitus in humans.
Epilepsy as a Risk Factor for Submersion Injury in Children
Authors: Diekema Douglas S. , Quan Linda , Holt Victoria L.
Published: December 2021

The purpose of this study was to determine the risk of submersion injury and drowning among children with epilepsy and to define further specific risk factors. In a population-based retrospective cohort study the authors identified and reviewed records of all 0- through 19-year-old residents of King County Washington, who suffered a submersion incident between 1974 and 1990. Children with epilepsy were compared with those without epilepsy with regard to age, sex, site of incident, supervision, outcome, and presence of preexisting handicap. Relative risks were determined using population-based estimates of epilepsy prevalence. Of 336 submersions, 21 (6%) occurred among children with epilepsy. Children with epilepsy were more likely to be greater than 5 years old (86% vs 47%) and more likely to submerge in a bathtub (38% vs 11%). The relative risk of submersion for children with epilepsy was 47 (95% confidence interval [CI] 22 to 100) in the bathtub and 18.7 (95% CI 9.8 to 35.6) in the pool. The relative risk of drowning for children with epilepsy was 96 (95% CI 33 to 275) in the bathtub and 23.4 (95% CI 7.1 to 77.1) in the pool. These data support an increased risk of submersion and drowning among children with epilepsy.
Effects of Time-in-Clinic, Clinic Setting, and Faculty Supervision on the Continuity Clinic Experience
Authors: Osborn Lucy M. , Sargent Janice R. , Williams Scott D.
Published: December 2021

Study objective. To evaluate the effects of setting, type of supervision, and time in clinic on the resident continuity clinic experience.

Design. Prospective cohort with preintervention and postintervention measures.

Settings. Pediatric residents selected one of three clinic settings for their continuity clinic experience. These included a traditional, university-based clinic, private practice offices, and publicly funded community-based clinics.

Subjects. All pediatric residents at the University of Utah Health Sciences Center, July 1985 through June 1991.

Interventions. Using varied clinic sites, matching residents one or two to one with preceptors for their continuity clinic, increasing continuity clinic from 1 to 2 half-days per week.

Measurements and main results. Residents in private offices had the most varied experience, seeing more patients, more acute care, and a broader age range of patients than residents at other sites. They were more likely both to be observed by their preceptors during patient visits and to observe their preceptors delivering care. Because the number of patients seen per session rose, increasing continuity clinic time from one to two half-days per week more than doubled the number of patients seen per week. Increased time away from hospital did not affect scores on the Pediatric In-Training Examination. While test scores were similar for incoming residents, those in private offices scored higher on the final Behavioral Pediatrics Examination (P < .05).

Conclusions. Clinic setting, time in clinic, and faculty supervision affect the quality of the continuity clinic experience. Increased time in clinic resulted in a broader exposure to patients. Residents placed in private offices had a more varied patient mix, were more closely supervised, and seemed to gain primary care skills more rapidly than residents at other sites.
Increased Leukocyte Elastase of the Tracheal Aspirate at Birth and Neonatal Pulmonary Emphysema
Authors: Fujimura Masanori , Kitajima Hiroyuki , Nakayama Masahiro
Published: December 2021

Objective. The authors have previously shown the association of elevated neonatal serum IgM and chorioamnionitis in infants in whom pulmonary emphysema characteristic of Wilson-Mikity syndrome subsequently developed. This paper extends the observation to the measurement of polymorphonuclear leukocyte elastase-α1-proteinase inhibitor complex (PMN elastase-α1-PI) in tracheal aspirates of infants with chronic lung disease.

Patients. Tracheal aspirates were obtained from 90 very low birth weight neonates within 24 hours of birth. Serum also was collected within 72 hours of birth, and placentas were examined for signs of inflammation.

Results. The mean PMN elastase-α1-PI was significantly elevated (21.8 µg/mg albumin) in infants with a pulmonary emphysema syndrome like that designated by Wilson-Mikity compared either with those with bronchopulmonary dysplasia (1.5 µg/mg albumin, P < .01) or those with respiratory distress syndrome in whom bronchopulmonary dysplasia did not develop (2.3 µg/mg albumin, P < .01). Infants with pulmonary emphysema had a significantly elevated mean serum IgM and a high incidence of chorioamnionitis.

Conclusions. The level of PMN elastase-α1-PI was increased in the tracheal aspirates of newborns in whom pulmonary emphysema developed. Intrauterine inflammation may increase the level of PMN elastase in the fetal respiratory tract. This increase in PMN elastase-α1-PI in fetal lung tissue may cause lung injury in utero, resulting in postnatal pulmonary emphysema consistent with the Wilson-Mikity syndrome following ventilation.
Shunts in Patients With Respiratory Distress Syndrome
Authors: EVANS NICK
Published: December 2021

To the Editor.—

Although I agree with many of the echocardiographic findings of Walther et al1 they have not given us sufficient data to draw their main conclusion: that large right-to-left (R-L) shunts are common in preterm neonates with severe respiratory distress syndrome (RDS).

They base this conclusion on two observations. First, they believe that aortopulmonary pressure differences are small in these neonates. Pulmonary arterial pressures in RDS are high2 but, as previously published data have shown,3 they are predominantly subsystemic and therefore not likely to be conducive to a large R-L shunt.
INTERVIEWS WITH CHILDREN WHO EXPERIENCED MAJOR LIFE STRESS: FAMILY AND CHILD ATTRIBUTES THAT PREDICT RESILIENT OUTCOMES
Authors: Wyman Peter A. , Cowen Emory L. , Work William C. , Raoof Anisa , Gribble Patricia A. , Parker Gayle R. , Wannon Michael
Published: December 2021

Demographically comparable groups of children exposed to major life-stress, with stress resilient (SR) and stress affected (SA) outcomes at ages 10 to 12, were interviewed to assess perceptions of their caregiving environments, peer relationships, and themselves. SR children compared with SA children reported more: (1) positive relationships with primary caregivers, (2) stable family environments, (3) inductive and consistent family discipline practices, and (4) positive expectations for their futures. SR girls viewed their mothers as more nurturing than did SA girls. Perceptions of fathers, quality of peer relationships, and global self-concept did not differentiate the groups. A discriminant function analysis identified four variables that correctly classified 74% of the subjects as SR or SA. Findings support the view that caregiver-child relationships play a key role in moderating children's developmental outcomes under conditions of high stress.
Down Syndrome and Omphalocele: An Underrecognized Association
Authors: Reddy Vinay N. , Aughton David J. , DeWitte David B. , Harper Cheryl E.
Published: December 2021

Omphalocele is associated with Down syndrome,1 and the concurrence of omphalocele and Down syndrome has been reported several times.1-8 However, these observations are not noted in standard genetic reference books (such as references 9 through 15), genetic databases (such as POSSUM), or pediatric textbooks (such as references 16 through 18). We report a further case of omphalocele associated with Down syndrome, in which the presence of this "atypical" major anomaly, combined with initially good muscle tone and marked but transient facial edema, led to a brief delay in recognizing the clinical diagnosis of Down syndrome.

CASE REPORT

The propositus was born to a 33-year-old, gravida 2, para 1 woman via primary cesarean section for face presentation after a 41-week pregnancy that was complicated by maternal hypertension and by premature onset of labor early in the third trimester, controlled by bed rest.
Acrodermatitis-Like Syndrome in Organic Aciduria
Authors: Blecker U. , Vandenplas Y. , De Meirleir L. , De Raeve L. , Ramet J.
Published: December 2021

Methylmalonic aciduria (MMA) is an autosomal recessive in-born error of metabolism with a variation in the severity of the clinical manifestations, ranging from asymptomatic patients to fulminating neonatal forms causing severe ketosis, acidosis, hyperammonemia, pancytopenia, coma, and death. Severe cases can be treated with high doses of vitamin B12 and a diet low in proteins.

We describe an exceptional manifestation of MMA. A 14-month-old boy with a neonatal manifestation of MMA was admitted during an intercurrent infection with ketoacidosis and hypoglycemia.
Sex Difference in Disability and Handicap at Five Years of Age in Children Born at Very Short Gestation
Authors: Verloove-Vanhorick S. P. , Veen S. , Ruys J. H. , Ens-Dokkum M. H. , Schreuder A. M. , Brand R.
Published: December 2021

Objective. The objective of this study was to examine the relationship between sex and disabilities or handicaps at 5 years of age in infants born at less than 32 weeks gestation.

Design. From the nationwide collaborative survey starting in 1983, including perinatal data obtained during routine perinatal care and follow-up assessments by the attending pediatricians, data from 1008 infants fulfilling the criteria were used. At age 5 years, a detailed assessment was performed by three specially trained pediatricians in 96% surviving infants (n = 648), of which 345 were boys. Each child was categorized as disabled or handicapped, using World Health Organization definitions.

Results. The prevalence of handicaps was three times greater in boys than in girls (21% vs 7%, odds ratio 3.2). Adjustment for gestational age and birth weight (logistic regression analysis) did not change this (odds ratio 3.5). Further adjustment by including perinatal variables such as idiopathic respiratory distress syndrome did not alter the odds ratios. The male excess in handicaps was not related to lower mortality, and therefore was not a mere consequence of a higher survival rate. The excess in handicaps was found in all assessed areas.

Conclusions. Infants' sex seems to be an important determinant of handicaps. The perinatal variables used in the present study do not explain the difference in handicaps. These findings emphasize the need to include the sex distribution of a study population more systematically in analyses in future studies concerning long-term outcome of very preterm birth or low birth weight.