bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Televised Drug Commercials on Children
Authors: Sheiman Deborah J.
Published: December 2021

Pediatric quality care must consider the effects of psychological and sociological influences on the child. One such influence that should be brought to the attention of pediatricians is the effects on children of televised commercials for nonprescription drugs. The average American child views an estimated 1,000 commercials for nonprescription drugs each year.

Children are more vulnerable than adults to television commercial advertising. Under the age of 5, they have very little, if any, comprehension of the selling intent of commercials.
Letters to the Editor
Authors: Nelson Karin B. , Ellenberg Jonas H.
Published: December 2021

The sources of information concerning treatment of febrile seizures in our recent study were medical records written at the time of treatment of an initial or later febrile seizure, the nine scheduled interval histories, and a full history of the child's medical experience recorded when registrants reached the age of 7 years. However, information on drug usage, unlike the remainder of the information utilized in these studies, was not based upon structured portions of the questionnaires and was not systematically available for all registrants.
The Relationship between Maternal Hypertensive Disease of Pregnancy and the Incidence of Idiopathic Respiratory Distress Syndrome
Authors: Yoon Jing Ja , Kohl Schuyler , Harper Rita G.
Published: December 2021

The relationship between maternal hypertensive disease of pregnancy (HDOP) and idiopathic respiratory distress syndrome (IRDS) was analyzed in 2,105 premature infants weighing between 1,000 and 2,199 gm and born between January 1968 and December 1975 at the Kings County Hospital Center and State University Hospital. HDOP was diagnosed in 250 mothers of 2,105 infants studied. The incidence of IRDS (15.2%) in the HDOP group was significantly lower than the 29.9% in the non-HDOP group (P < .001). In infants whose gestational age was 32 weeks or less, the incidence of IRDS was 26.1% in the HDOP group and 40.8% in the non-HDOP group (P < .01). In infants whose gestational age was 33 weeks or more, the incidence (9.3%) in the HDOP group was significantly lower than the 18.4% in the non-HDOP group (P < .005). The low incidence of IRDS in the HDOP group remained even after eliminating infants with known predisposing and protecting factors from the development of IRDS. The incidence of IRDS was inversely related to the severity of maternal toxemia. The total mortality and mortality with IRDS were not significantly different in both HDOP and non-HDOP groups. When the infants did not develop IRDS, the mortality rate in the HDOP group was significantly higher than that in the non-HDOP group especially in the lower gestational age group. These data suggest that chronic stress accelerates fetal lung maturation and severe chronic stress is even more effective in accelerating fetal lung maturation. When maternal toxemia was severe enough to accelerate the fetal lung maturation, the mortality rate of the infants without IRDS increased.
New Concepts in Phototherapy: Photoisomerization of Bilirubin IXα and Potential Toxic Effects of Light
Authors: Cohen Arnold N. , Ostrow J. Donald
Published: December 2021

New information is summarized, indicating that configurational photoisomerization of bilirubin at the 5 and 15 carbon bridges is the major mechanism of bilirubin photocatabolism in vivo, and that singlet oxygen photooxidation plays only a minor role. The literature is reviewed concerning potentially damaging photodynamic reactions that are observed in vitro with vitamins, proteins, lipids, and nucleic acids, and their possible relationship to the limited number of toxic side-effects that have been detected with clinical phototherapy of neonatal jaundice. Secondary toxic effects, mediated by bilirubin photoderivatives or by retina-neuroendocrine pathways are also considered. Areas requiring further investigation are delineated.
Neonatal Salt Loss in the Hypertensive Form of Congenital Adrenal Hyperplasia
Authors: Holcombe J. H. , Keenan B. S. , Nichols B. L. , Kirkland R. T. , Clayton G. W.
Published: December 2021

The 11β-hydroxylase deficiency (11OHD) form of congenital adrenal hyperplasia is diagnosed infrequently during the newborn period. A child presumed to have the 21-hydroxylase deficiency form of congenital adrenal hyperplasia was studied extensively as an infant. The diagnosis was based on ambiguous genitalia, elevated 17-ketosteroids, evidence of urinary 11-ketopregnanetriol, and salt loss. Severe hypertension was detected at 11 years, and 11β-hydroxylase deficiency was confirmed with elevated plasma 11-deoxycorticosterone and 11-deoxycortisol, low cortisol, and normalization of blood pressure following glucocorticoid replacement. Impaired aldosterone biosynthesis and salt loss were demonstrated during dexamethasone therapy. Salt loss during infancy does not distinguish between the 11β- and 21-hydroxylase deficiency forms of congenital adrenal hyperplasia.
A Comparison of Fluorescent and Nonfluorescent Light Sources for Phototherapy
Authors: Warshaw Joseph B. , Gagliardi Jeryl , Patel Anil
Published: December 2021

We have compared fluorescent and nonfluorescent light sources for phototherapy for newborn infants with hyperbilirubinemia. Phototherapy was provided by a tungsten halogen lamp and conventional fluorescent lights with identical radiant flux of 6 µW/sq cm. For 22 infants treated with the nonfluorescent lamp the mean duration of phototherapy was 33.77 hours and the mean reduction of bilirubin was 3.84 mg/100 ml/day. This did not differ significantly from infants treated with conventional fluorescent lights. The nonfluorescent light can be utilized for infants in incubators or on radiant warmers. These results provide additional support for the relationship between radiant flux as a practical measure of phototherapy dose and the clinical response of a reduction in serum bilirubin.
A Simplified Procedure for Pediatric Vaginal Examination: Use of Veterinary Otoscope Specula
Authors: Billmire M. Elaine , Farrell Michael K. , Dine Mark S.
Published: December 2021

Examination of the prepubertal vagina is not part of the routine pediatric examination. However, there are situations in which adequate visualization and examination of the vagina are necessary. Frequently vaginal examination is hampered by examiner insecurity and lack of adequate instruments. Nasal specula, eye droppers for aspirating secretions,1 a test tube illuminated by a penlight,2 and a vaginoscope or cystoscope3 have been recommended but have been used with limited success.

Pediatric residency training underemphasizes gynecology.4 Many pediatricians feel inadequate and uncomfortable when faced with a patient with a vaginal complaint. They either avoid the examination or undertake it with such trepidation that the child's anxiety is increased.
Wall Socket Electrical Burns: Relevance to Health Education?
Authors: Young Thomas L. , Reisinger Keith S.
Published: December 2021

Although it is generally accepted that the maintenance of health ought to be the major objective of health professionals, the prevention of illness has largely been secondary to treatment of existing disease in clinical practice and in research. One example of this dichotomy between goals and practice is the approach that the medical profession has taken with regard to accidents, which cause more injuries and deaths in children and young adults than any single disease process.1 Whereas millions of dollars and countless hours are spent in caring for individuals injured in accidents, research directed toward prevention of accidents and subsequent injury has been so sparse that many facets of this field have not been investigated beyond a cursory examination.
Antidepressant Effect of Vitamin C
Authors: Cocchi Pietro , Silenzi Mario , Calabri Giuseppe , Salvi Giuseppe
Published: December 2021

Mental disturbances are not an uncommon complication of therapy with various corticosteroids and ACTH.1,2 We have found that ascorbic acid relieves the depression syndrome associated with ACTH in one patient being treated for chronic hepatitis.

A 5-year-old girl was admitted to the Clinic because of HB8Ag-positive chronic hepatitis. Since a liver biopsy revealed an active process, she underwent prolonged long-acting synthetic ACTH therapy given in different courses. On the first week of treatment the patient appeared "depressed" and less sociable to the ward nurses.
Medical Treatment of Ductus Arteriosus
Authors: Ivey Hallam H. , Wells Hugh H. , Kattwinkel John
Published: December 2021

In the April 1978 issue of Pediatrics (61:534, 1978) Lewis and Lurie report the use of prostaglandin E1 (PGE,1) (Upjohn) infusion for 29 days in a small-for-gestational age, premature infant with severe tetralogy of Fallot. We have had a similar experience using an intermittent infusion of PGE1, for 18 days in a term infant with transposition of the great vessels and high pulmonary pressure after a balloon septostomy. In an effort to maintain patency of the ductus arteriosus and increased pulmonary blood flow, we began a peripheral infusion of PGE1 at a dose of 0.1 µg/kg/min (the same dose as used by Lewis and Lurie).
Should Molluscum Be Treated?
Authors: Weston William L. , Lane Alfred T.
Published: December 2021

Major textbooks of pediatrics1-7 and dermatology8-11 as well as special editions on pediatric dermatology12 suggest that molluscum contagiosum requires treatment in infants and children. Pricking the surface of the lesion and expressing the contents is the most frequently recommended therapy1,4-7,9,11 but curettage is also frequently suggested.2-4,6,7,10 Podophyllin, Cantharone, trichloroacetic acid, benzoyl peroxide gels, phenol, glacial acetic acid, liquid nitrogen cryotherapy, surgical excision, oral tetracycline, and thiosemicarbazol are suggested in one or another of these references as alternative measures.
Systolic Blood Pressure in a Population of Infants in the First Year of Life: The Brompton Study
Authors: de Swiet Michael , Fayers Peter , Shinebourne Elliot Anthony
Published: December 2021

Systolic blood pressure (BP) was measured by the Doppler technique and random zero sphygmomanometer in a sample of infants between the ages of 4 days (n = 1,740) and 1 year (n = 1,338). Mean systolic BP rose from 76 mm Hg at age 4 days to 96 mm Hg at age 6 weeks in babies awake, and showed little further variation at 6 months and 1 year. The BP was approximately 6 mm Hg higher in babies awake than asleep. Blood pressure was nearly normally distributed at all ages and the 95th percentile for BP of babies awake was 95 mm Hg at 4 days and 113 mm Hg between 6 weeks and 1 year. A comparison of intra-arterial and Doppler BP confirmed that both inflation bag length and cuff width are important for accurate measurement.
Early Diagnosis of Neonatal Sepsis
Authors: Philip Alistair G. S. , Hewitt Jean R.
Published: December 2021

To better define the need for antibiotic therapy, several tests recommended as helpful in diagnosing neonatal sepsis were evaluated in 376 neonates during the first week after birth. The five most useful tests (with definitions of abnormality) were: band/total neutrophils ([unknown]0.2); leukocyte count (<5,000/cu mm); latex-C-reactive protein (positive >0.8 mg/100 ml); ESR ([unknown]15 mm for the first hour); and latex haptoglobin (positive >25 mg/100 ml). When these five tests were applied early (at the time infection was suspected and blood culture sent), 28 of 30 cases (93%) subsequently proven to have infection had two or more abnormal tests. This compares with only 24 of 320 babies (8%) with no subsequently documented evidence of infection. Of all babies who had two or more tests positive (n = 71), 39% had proven sepsis, and an additional 23% had "very probable" infection. The combination of leukopenia and an elevated band/total neutrophil ratio seems to be particularly predictive of sepsis (13 of 17 babies with this combination had proven sepsis). When less than two tests were positive, the probability that sepsis was not present was 99%. These simple, rapid tests require no special laboratory facilities and provide a valuable adjunct in the early detection of the neonate with sepsis.
Transcutaneous Oxygen Monitoring During Neonatal Transport
Authors: Clarke Thomas A. , Zmora Ehud , Chen Joung-Huei , Reddy Gopal , Merritt T. Allen
Published: December 2021

The use of transcutaneous Po2 monitoring during neonatal transport was found to be feasible and clinically useful in maintaining the partial pressure of arterial oxygen within a desired range. Adjustment of fractional inspiratory oxygen (FIO2) to maintain transcutaneous Po2 between 50 to 70 torr resulted in a greater number of infants arriving at a tertiary center without either hypoxemia or hyperoxemia.
Otitis Media in Infants and Children
Authors: Paradise Jack L.
Published: December 2021

EDITOR'S NOTE. This review article was recruited for Pediatrics in Review. It proved longer than anticipated and too long for Pediatrics in Review, but all who reviewed it agreed that it covers the important subject of otitis media in such a comprehensive fashion that it should be published intact. We are publishing it in Pediatrics, but listing the Educational Objectives from the 1979-80 PREP and indexing it in April 1980 Pediatrics in Review in order for readers to find it readily when reviewing for recertification or the self-administered graded exam. (R.J.H.)

EDUCATIONAL OBJECTIVES: (1) Appropriate knowledge to evaluate and manage the child with chronic or recurrent otitis media (Recent Advances 79/80); (2) Appropriate knowledge to evaluate middle-ear disease in children suspected of having impaired hearing (Recent Advances 79/80); (3) Appropriate knowledge to evaluate and manage the child with cleft palate and otitis media (Recent Advances 79/80); (4) Appropriate evaluation of a child with recurrent upper respiratory infections and impaired hearing, and knowledge to diagnose and manage: (a) sensorineural hearing loss, (b) otitis media, (c) obstruction of the auditory canal, (d) perforation of tympanic membranes, or (e) cholesteatoma (Topics 79/80).

Pediatrics 65:917-943, 1980; otitis media, cleft palate and otitis media, myringotomy, tympanometry, tympanostomy tubes, hearing deficit due to otitis media.

Otitis media, next to the simple upper respiratory infection, is the most common organic disease confronting the practicing pediatrician.1-3 Moreover, otitis media has important economic and health care implications for a variety of other reasons: it must be considered in the differential diagnosis of obscure fevers; it is often the basis for prescribing commonly used agents such as antimicrobials, decongestants, and antihistamines; it may be involved in the development of bacterial meningitis and other central nervous system infections; and it often constitutes the basis for undertaking one or more of the most frequently performed operations of infancy and childhood, namely, myringotomy with or without tympanostomy tube insertion, adenoidectomy, and tonsillectomy.
Vulnerable Children: Parents' Perspectives and the Use of Medical Care
Authors: Levy Janice C.
Published: December 2021

In a study of use of five general pediatric services, 750 parents were interviewed on site about their decisions on how and when to seek medical care for their children. Parents' fears that a particular child was "vulnerable"—ie, uniquely threatened by an episode of illness—was a recurrent concern (reported by 27%), explaining many of their medical visits. Medical record review indicated that in 40%, there was no clinical basis for these parent concerns. One important source of these unwarranted concerns was fear of recurrence of an earlier medical problem, long since resolved. In some families, the role of social and environmental issues in generating a high level of concern was evident. Vulnerable children made more visits per year and made many more of their visits to the emergency room, and their parents more often expressed dissatisfaction with care received. Recognition of reasons underlying parents' sense of the child's special status may do much to allay unnecessary fears and promote more appropriate use of health care facilities.
Failure-to-Thrive: A Study in a Primary Care Setting Epidemiology and Follow-up
Authors: Mitchell Wendy G. , Gorrell Ralph W. , Greenberg Robert A.
Published: December 2021

A cohort of 312 children followed in three rural primary care centers was studied. All cases of failure-to-thrive were identified (30) and compared to the remainder of the group. With the use of data from medical records, children with history of failure-to-thrive were found to be significantly lighter and shorter than the remainder of the population in each of the first five years of life. More cases had family problems. No differences were found in demographic characteristics or chronic illnesses. In the second phase of the study, cases and an equal-sized control group, from the same social setting, matched for age, sex, mother's marital status, and family problems, were examined at 3 to 6 years of age to assess outcome. This included physical examination, the McCarthy Scale of Children's Abilities, a behavior questionnaire, and an interview to assess life events. Cases were lighter but not shorter than controls. No instances of occult organic disease causing failure-to-thrive were identified. No behavioral or developmental deficits could be attributed to the failure-to-thrive.
Strangulation in Childhood: Epidemiology and Clinical Course
Authors: Feldman Kenneth W. , Simms Roy J.
Published: December 2021

A review of 233 cases of childhood strangulation was made to determine injury epidemiology. Consistent patterns of injury were observed. Crib and playground equipment strangulations are already the subject of Consumer Product Safety Commission (CPSC) preventative regulations. High chair-, playpen mesh-, pacifier cord-, and clothing-related injuries would be amenable to prevention by improved product safety regulation. The CPSC has been petitioned to remedy the first two of these hazards. Many crib and rope strangulations can only be prevented by direct patient counseling. Although Congress empowered and required the CPSC to recognize and correct unsafe products, its surveillance systems may obscure the very design defects that cause injury. Likewise, political considerations may slow enactment of new design regulations. Physicians who treat childhood accident victims are in a position to recognize hazardous products and lobby for their improvement. Of the 233 cases 38 were further evaluated to delineate the clinical course of childhood strangulation. Victims who fail to resume normal cardiopulmonary function by the time of hospitalization have a poor prognosis for neurologic recovery with current modes of therapy. Improved treatment of hypoxic and ischemic cerebral injury might prevent some of the deaths and handicaps resulting from strangulation.
Family History of Asthma in Infants with Bronchopulmonary Dysplasia
Authors: Nickerson Bruce G. , Taussig Lynn M.
Published: December 2021

The role of genetic or familial factors in the development of bronchopulmonary dysplasia (BPD) has not been evaluated. Detailed histories concerning asthma, allergy, and other lung diseases were obtained on first and second degree relatives of 17 infants with BPD, and 21 infants who had hyaline membrane disease but who did not develop BPD (HMD group). All infants in the BPD and HMD groups had hyaline membrane disease requiring assisted ventilation and greater than 50% inspired oxygen in the first five days of life. The diagnosis of HMD and BPD were made on radiographic and clinical criteria. Of the 17 infants with BPD, 13 had first or second degree relatives with physician-diagnosed asthma, compared to seven of 21 in the HMD group (P < .01). In addition, a significantly greater number of relatives of BPD infants (P < .005) had been hospitalized for their asthma as compared to HMD relatives. There were no differences between the groups for allergic rhinitis, eczema, bronchitis, emphysema, chronic cough, smoking, or wheezing with respiratory illnesses. These results suggest the possibility that airways with a genetic predisposition for reactivity may become highly reactive following neonatal lung disorders and their treatment. These irritable airways may then contribute to the development, or progression, or both of BPD.
Isolation of Toxin Producing Clostridium difficile from Two Children with Oxacillin- and Dicloxacillin-Associated Diarrhea
Authors: Brook Itzhak
Published: December 2021

Clostridium difficile was isolated from the feces of two infants who had developed watery diarrhea with blood-tinged stain. One child suffered from diarrhea after five days of parenteral oxacillin therapy; the diarrhea subsided within three days of cessation of therapy. The other infant developed diarrhea following four days of oral dicloxacillin; the diarrhea subsided within two days of cessation of therapy. C difficile was no longer detectable in the stools of the infants at that time. Tissue culture assay showed the presence of preformed fecal toxin and demonstrated the toxigenicity of the fecal isolates of C difficile and reference strains. These findings show that C difficile may play a role in diarrhea associated with oxacillin and dicloxacillin in children.
On the Feeding of Supplemental Foods to Infants
Authors: Barness Lewis A. , Dallman Peter R. , Anderson Homer , Collipp Platon Jack , Nichols Buford L. , Walker W. Allan , Woodruff Calvin W. , Roy Claude
Published: December 2021

Recommendations and practices of feeding solid foods to infants are widely divergent in the United States and in other countries. Although few differences in health are noted from such divergent practices, the consequences may be subtle or may require long-term, careful observations.

The previous Committee on Nutrition statement1 on this subject reviewed the history of the use of solid foods and showed that solid or supplemental foods were seldom offered to infants before 1 year of age until about 1920. Breast milk, for the most part, or modified cow's milk formulas supplied all or most of the nutritional needs of infants during the first year. The first supplements to the diet were cod liver oil to prevent rickets and orange juice to prevent scurvy.

Over the next 50 years recommendations were made that some cereals and strained vegetables and fruits be introduced at about 6 months of age to: (a) supply iron, vitamins, and possibly other factors; and (b) help prepare the infant for a more diversified diet. A much wider variety of infant foods became available, and these were introduced into the infant's diet earlier and earlier. Some of the reasons for earlier introduction of solid foods were the desire of mothers to see their infants gain weight rapidly, the ready availability of convenient forms of solid foods, and the mistaken assumption that added solid foods help the infant to sleep through the night.

INFANT FEEDING PERIODS

Infant feeding should be considered in three overlapping stages: the nursing period, during which breast milk or an appropriate formula is the source of nutrients; a transitional period, during which specially prepared foods are introduced in addition to breast milk or a formula; and a modified adult period, during which the majority of the nutrients come from the foods available on the family table.
Letters to the Editor
Authors: Kelly Dorothy H. , Shannon Daniel C.
Published: December 2021

We agree with the authors that a thorough search for the etiology of the episode must be made. The differential diagnosis to be considered includes sepsis, pneumonia, anemia, seizure disorder, intercranial hemorrhage, meningitis, hypoglycemia, hypocalcemia, hyponatremia, congestive heart failure, reflux, and respiratory center depression. However, one must remember that if an abnormality is found, it is not necessarily the etiology. Since these spells are potentially lethal, an infant should be very carefully observed for evidence of apnea, bradycardia, and hypoventilation following treatment of the discovered abnormality prior to discharge.
Comparison of Rifampin and Ampicillin in Day Care Center Contacts of Haemophilus influenzae Type b Disease
Authors: Gessert Charles , Granoff Dan M. , Gilsdorf Janet
Published: December 2021

A prospective, randomized, crossover trial was conducted comparing therapy with rifampin to therapy with ampicillin in eradicating Haemophilus influenzae type b carriage. Twenty-eight carriers were identified in a day care center following exposure to a patient with H influenzae type b meningitis; 26 children were randomly assigned to treatment with either ampicillin (100 mg/kg for five days) or rifampin (20 mg/kg for four days). Cultures were repeated two and four days after discontinuing therapy. In the initial trial, 6/17 children (35%) remained culture positive after treatment with ampicillin compared to 0/9 children treated with rifampin (P = .106). The six children who were ampicillin treatment failures had H influenzae type b isolates sensitive to that drug. These children were subsequently treated with rifampin and their cultures became negative. (For both trials, P = .027.) Repeat cultures 30 days after therapy in 20 treated children revealed one culture positive for H influenzae type b. No further cases developed in the day care center (four months of follow-up). These data suggest that rifampin may be more effective than ampicillin in chemoprophylaxis of contacts of H influenzae type b disease.
Excessive Weight Loss and Food Aversion in Athletes Simulating Anorexia Nervosa
Authors: Smith Nathan J.
Published: December 2021

The dominant role of athletic activities in our society and the extent and intensity of sports participation by large numbers of young people create stresses causing a whole new constellation of health problems, both emotional and physical. One such problem is excessive weight loss and food aversion in athletes. The condition is in many ways similar to primary anorexia nervosa as commonly encountered in young women. The athlete avoiding food and experiencing extreme weight loss is most often a male, however, and does not suffer from severe, deep-seated emotional problems. He is typically a serious and outstanding student athlete fearing failure in meeting expectations of admiring coaches, teammates, and parents. The prognosis is excellent under the treatment by an informed, reassuring physician. The athlete's physician should provide a precise definition of optimum level of fatness for given sports participation. Guidance should be given in such a way that the desired level of fatness can be safely achieved, without threatening health and fitness.
Meningitis Due to Haemophilus influenzae Type b Resistant to Both Ampicillin and Chloramphenicol
Authors: Kenny Jean F. , Isburg Carroll D. , Michaels Richard H.
Published: December 2021

A strain of Haemophilus influenzae type b with considerable resistance to both ampicillin and chloramphenicol was recovered from a South Dakota child with meningitis. There was an initial lack of response to conventional doses but the child improved after a brief period of 200 mg/kg/day of chloramphenicol. The organism showed in vitro resistance to ampicillin, carbenicillin, tetracycline, and chloramphenicol (for each antibiotic the minimal inhibitory concentration (MIC) was 8 µg/ml or greater with a bacterial challenge of 105 colony-forming units (CFU)/ml), but it was sensitive to both streptomycin and rifampin (MIC 1.6 µg/ml and 0.5 µg/ml, respectively). Isobolograms constructed from the results of testing various concentrations of ampicillin and chloramphenicol showed additive effects with high bacterial inocula (105 or 107 CFU/ml), but antagonism with low inocula (102 or 104 CFU/ml).
Financing Training in Pediatric Ambulatory Care
Authors: McKay R. James
Published: December 2021

The article "An Economic Analysis of a Pediatric Housestaff Practice," which appears in this issue of Pediatrics,1 focuses on a subject of major current concern to academic, practicing, and future practicing pediatricians.

The faculties of departments of pediatrics traditionally have been oriented toward inpatient and subspecialty care, on the basis that only in this way is it possible to provide the expertise and experience necessary for the care of patients ill with serious or rare diseases and for optimal teaching of students and housestaff about these conditions.

Now these same departments, faced with a societal emphasis on delivery of health care to all children, must somehow convert their traditional educational approach to one that is more consonant with the times.
Teenage Suicide
Authors: Cohen Michael I. , Bright George , Dudenhoeffer Frank , Guthrie Andrew , Hammar Sherrell , Ice Anne-Marie , Jenkins Renee R. , Long William A. , Shen Jerome T. Y. , Klein Luella , Felice Marianne E.
Published: December 2021

Suicide is the fourth leading cause of death during the teenage years, preceded in frequency only by trauma, malignancy, and homicide.1 Recent statistics indicate that the number of suicides in adolescents has risen dramatically in the past decade, resulting in approximately 5,000 deaths per year. For youths 15 to 19 years old, the figures have actually doubled from 1968 to 1976; 11 boys per 100,000 in the population are now dying by suicide each year.2 Even among adolescents 10 to 14 years old, the trend is increasing and went from 116 to 158 deaths per year between 1968 and 1976. As distressing as these data appear, it is more alarming to realize that suicides are notoriously under-reported.

Suicide affects youngsters from all races and socioeconomic groups. For every suicide completed, between 50 and 200 are attempted. Boys succeed in their suicide attempts more frequently than girls, mainly because they use more lethal methods, such as firearms or hanging. Girls generally attempt suicide by ingesting pills and are more frequently resuscitated. The pediatrician can provide a significant resource in preventing adolescent suicide by identifying youngsters at high risk and recognizing behavioral clues in youngsters contemplating suicide.

CLINICAL PRESENTATIONS OF ADOLESCENTS CONTEMPLATING SUICIDE

Youngsters planning suicide frequently provide behavioral clues to their intent, such as giving away prized possessions or writing notes or poems expressing death themes. If the pediatrician suspects that a teenager is contemplating suicide, he should ask the adolescent directly about suicidal thoughts. Inquiring about suicide does not cause suicide! Quite the contrary, the adolescent may be relieved that someone has heard his cry for help.
Perinatal Herpes Simplex Virus Infections
Authors: Brann Alfred W. , Hall Robert T. , Harper Rita G. , Little George A. , Maisels M. Jeffrey , McCracken George H. , Poland Ronald L. , Sunshine Philip , Whittinghill John A. , Allen James R. , Alper Milton A. , Cefalo Robert C. , Hasselmeyer Eileen , Heerens Robert E. , Hey Dennis , Mortimer Edward A. , Fulginiti Vincent A. , Brunell Philip A. , Calderon Ernesto , Cherry James D. , Ector Walton L. , Gershon Anne A. , Gotoff Samuel P. , Hughes Walter T. , Peter Georges , Hinman Alan R. , Jordan William S. , Larke R. P. Bryce , Meyer Harry M.
Published: December 2021

Because of the relative paucity of data on the epidemiology and management of perinatal herpes simplex virus (HSV) infections, the following recommendations represent the best current judgments of the Committees on Fetus and Newborn and Infectious Diseases of the American Academy of Pediatrics.

HSV infection of the newborn is associated with a case fatality rate of 60% and at least half of the survivors have significant neurologic or ocular sequelae, or both. Approximately 75% of isolates from affected neonates are HSV-2 and 25% are HSV-1. Although preliminary data suggest that antiviral chemotherapy is effective in reducing mortality and morbidity resulting from neonatal HSV infections, measures designed to prevent infection of newborns are currently the most important means of controlling neonatal infections.

A maternal source of infection can be found in about 90% of neonatal cases. Maternal HSV infection is usually caused by type 2 strains and involves the labia, cervix, and/or vagina. The majority of genital infections are asymptomatic and difficult to recognize on clinical examination, making identification of women whose infants are in jeopardy very difficult.

EPIDEMIOLOGY

Maternal Infection

Primary HSV infection during pregnancy may be associated with spontaneous abortion, prematurity, and rarely with congenital anomalies. The risk of infection to the newborn appears to be the highest in primary genital infection of the pregnant woman, but is also high in recurrent infection. Women with a history of recurrent genital HSV infection, those with active disease during the current pregnancy, and those whose sexual partners have proven genital HSV infection should be monitored with virologic or cytologic studies, or both, at least twice during the last six weeks of pregnancy.
Pharmacokinetics of Rifampin in Infants and Children: Relevance to Prophylaxis Against Haemophilus influenzae Type b Disease
Authors: McCracken George H. , Ginsburg Charles M. , Zweighaft Teresa C. , Clahsen Joan
Published: December 2021

Pharmacokinetic studies of rifampin were performed in 38 infants and children after administration of three different oral formulations. Mean peak serum concentrations of from 9 to 11.5 µg/ml were observed one hour after a 10-mg/kg dose and the average half-life was 2.9 hours. Patients who received rifampin suspension in applesauce had smaller serum concentrations and area-under-the-curve values than did those who were given suspension alone. The mixture of rifampin powder and applesauce resulted in more variable serum levels. The concentrations of drug in tears from 18 subjects were similar to those in serum. All but one of 118 saliva specimens obtained from two to eight hours after the 10-mg/kg dose had antimicrobial activity. Of samples taken at two hours, 95% contained rifampin levels that exceeded the minimal bacterial concentration for 15 Haemophilus influenzae type b strains. Bactericidal activity against Haemophilus correlated with salivary rifampin concentrations and was detectable in virtually all specimens containing [Unknown]0.8 µg/ml. These data provide the pharmacokinetic basis for rifampin prophylaxis of close contacts of H influenzae type b disease, but are insufficient alone to recommend routine usage of rifampin for this purpose until results of additional epidemiologic studies are available.
Intraventricular Hemorrhage: A Prospective Evaluation of Etiopathogenesis
Authors: Dykes Francine Duda , Lazzara Anthony , Ahmann Peter , Blumenstein Brent , Schwartz James , Brann Alfred W.
Published: December 2021

In a study population of 151 newborn infants less than 35 weeks gestation, who required intensive care for more than 24 hours, clinical and biochemical factors associated with the presence of intraventricular hemorrhage (IVH) were prospectively evaluated. The diagnosis of IVH was confirmed by computed tomography, ventricular tap, or autopsy. Alveolar rupture was highly correlated with the presence of IVH. Other factors associated with IVH were: hypoxemia, hypercarbia, mechanical ventilation, peak inflation pressure >25 cm H2O, inspiratory to expiratory ratio >1:1, patent ductus arteriosus, bicarbonate administration after the first day of life, volume expansion in the first day of life, hypotension, stages III and IV hyaline membrane disease, and intrauterine growth retardation. Early bicarbonate administration (first day), sodium administration >8 mEq/kg/day, acidosis and birth weight ≤1,200 gm were associated with IVH only in the infants who died with IVH. Factors not associated with IVH were Apgar ≤5 at one and five minutes, birth weight, gestational age, male sex, osmolality ≥300, serum sodium ≥150, hypothermia, continuous distending pressure > 6 cm H2O, positive end-expiratory pressure > 5 cm H2O, outborn birth, obstetric trauma, or coagulopathy. Certain therapeutic interventions may lead to an increase incidence of intracerebral hemorrhage in the high-risk preterm infant.
Effects of Early Intervention and Stimulation on the Preterm Infant
Authors: Leib Susan A. , Benfield D. Gary , Guidubaldi John
Published: December 2021

To test the hypothesis that early intervention can enhance the development of high-risk preterm infants, a prescribed multimodal sensory enrichment program, within a regional neonatal intensive care unit, was designed and implemented. Twenty-eight appropriate-for-gestational age infants with birth weights between 1,200 and 1,800 gm were selected for study. To prevent control group contamination by the enrichment procedure, the first 14 infants were designated as the control group, and the next 14 as the treatment group. Treated infants had significantly higher developmental status than control infants, as measured by the Bayley Scales of Infant Development, at six months past the maternal expected date of confinement (F = 14.98, P < .001, and F = 16.46, P < .001 for the mental and motor scales, respectively). Mean infant weight gain per day and mean total weight gain during the hospitalization were not significantly different for the two groups although the treatment group received significantly less calories per kilogram per day than the control group (F = 9.02 P < .006). Our data suggest that a prescribed intervention program for high-risk preterm infants appears to enhance the quality of development as measured at six months past the expected date of confinement. Further studies are necessary to determine the long-term value of early intervention and the apparent ability of infants receiving an enrichment program to utilize calories more efficiently than control infants.
An Economic Analysis of a Pediatric Housestaff Practice
Authors: Weiss Jeffrey , De Jong Allan
Published: December 2021

Pediatric residency programs that stress primary care education are attempting to develop ongoing model practice experiences for their house officers. This paper describes such a model practice and outlines the expenses and revenues involved. In the initial 12 months of operation, revenues have offset 64% of total program costs. Our methods of balancing financial and educational goals are discussed. Program directors are urged to make cost analysis an important part of the evaluation of innovative primary care programs.
Reduced Incidence of Parenting Inadequacy Following Rooming-in
Authors: O'Connor Susan , Vietze Peter M. , Sherrod Kathryn B. , Sandler Howard M. , Altemeier William A.
Published: December 2021

Low-income mother-infant pairs were randomly assigned to rooming-in (N = 143) or to routine (N = 158) postpartum contact to determine whether rooming-in affects subsequent adequacy in parenting. At mean age 17 months, two rooming-in and ten control children had experienced inadequate parenting. One rooming-in and eight control children were hospitalized for these problems. One rooming-in and five control families were reported to Protective Services for mistreatment of the study child; five control and no rooming-in children were in the care of adults other than their parents at the time of data analysis. In this study, rooming-in correlated with fewer subsequent cases of parenting inadequacy.
Efficacy of Prenatal and Postpartum Home Visits on Child Health and Development
Authors: Larson Charles P.
Published: December 2021

This study is a controlled evaluation of the efficacy of home visits designed to promote better child health and development for infants of working class families. Each of the 115 mother-infant pairs meeting the study criteria was assigned to one of three comparable groups: group A received home visits starting prenatally; group B received visits from six weeks post partum; and group C received no visits. Home observations were completed by an independent evaluator at 6 weeks, 6, 12, and 18 months of age. Significant differences favoring group A over groups B and C were found at each evaluation period. These included: (1) a reduced accident rate; (2) higher scores on assessments of home environment and maternal behavior; and (3) a lower prevalence of mother-infant interaction or feeding problems and of nonparticipant fathers. Aside from a reduction in the accident rate, group B did not benefit from the home visits when compared to control infants. The results support the efficacy of home visits, but only if a prenatal visit is included. These findings suggest that a unique relationship is created between the mother and home visitor and this relationship is sensitive to the timing of the initial encounter.
Patterns of Perceptual and Academic Deficits Related to Early Chronic Otitis Media
Authors: Zinkus Peter W. , Gottlieb Marvin I.
Published: December 2021

The effects of chronic otitis media during the first three years of life on developing auditory processing skills were examined. Two groups of children with auditory processing deficits were compared in areas of language development, intellectual factors, auditory processing skills, and academic capabilities. One group of children with auditory processing deficits had a history of severe chronic otitis media during the first three years of life, whereas a second group had auditory processing deficits but no history of early middle ear infections. The results indicate that subjects who had a history of chronic otitis media were slower in developing word combinations, had depressed verbal intelligence scores, manifested pervasive auditory processing deficits, and were significantly poorer in reading. A profile has been constructed that permits early detection of the child at risk.
Middle Ear Function in Learning-Disabled Children
Authors: Bennett Forrest C. , Ruuska Susan H. , Sherman Roberta
Published: December 2021

To investigate the possible association of chronic otitis media and school learning problems, past and current middle ear status in 53 learning-disabled (LD) children was compared to that of 56 control children without learning problems. A history of recurrent otitis media was obtained in 23% of the LD children and in 9% of the control children. Thirty-eight percent of LD children and 16% of control children had hearing abnormalities on pure tone audiometry; 49% of LD children and 21% of control children had abnormal tympanometry. LD children had significantly more middle ear malfunction than control children. Chronic, undetected middle ear problems may play a role in the etiology of some school learning disabilities.
Neonatal Staphylococcal Scalded Skin Syndrome: Massive Outbreak Due to an Unusual Phage Type
Authors: Curran John P. , Al-Salihi Farouk L.
Published: December 2021

A massive outbreak of the staphylococcal scalded skin syndrome due to an organism with an unusual phage pattern, occurred during a 115-day period and involved 68 newborns. Generalized exfoliative dermatitis was seen in 24 babies, and Staphylococcus aureus was isolated from 23. Fourteen isolates were phage typed, with 13 reported as the epidemic strain 29/79/80/3A/3C/54/75. Eight babies had generalized scarlatiniform eruption without exfoliation (staphylococcal scarlet fever). Cultural data were available from six, all positive for S aureus. Four organisms were typed and reported as the epidemic strain. Of 34 infants with bullous impetigo 20 had cultures that were positive for S aureus, and four were phage typed, revealing the epidemic strain. Illness was mild in all patients; there were no deaths and no invasive forms of staphylococcal infection. The male to female ratio of generalized exfoliative disease was 5:1. The concept of a neonatal staphylococcal scalded skin syndrome, comprised of a triad of skin disorders induced by an exotoxin elaborated by certain strains of coagulase positive S aureus, is confirmed.
Adolescent Suicide: On Taking Arms Against a Sea of Troubles
Authors: Eisenberg Leon
Published: December 2021

Suicide imposes a triple burden on the family: grief at loss, as with any death; rage at desertion, for this was a deliberate death; and guilt at having failed the victim. When the suicide is a young person, the distress among the survivors is the greatest; it shakes us all to be forced to recognize that the despair of youth can be so profound. The doctor is plagued by the question: Could I have forestalled it? All are frightened. Few go through life without at least fleeting thoughts of suicide. Confrontation with its cold actuality makes us shudder at ourselves. Suicide is a disorder for which there can be no treatment.

Religion, law, and medicine are at one in agreeing that suicide should be prevented. But "should" is not the same as "can." The problem is daunting: Is prevention possible?

Any serious attempt at an answer requires us to put the problem in epidemiologic perspective by examining national data on rates and secular trends in adolescent suicide. So informed, we can then consider the opportunities for effective intervention through public health measures as well as at the level of personal encounter medicine in clinical practice.

DEATHS FROM VIOLENCE

Although the health of American adolescents, as measured by most indicators of morbidity and mortality, improved rapidly over the first 60 years of this century, mortality rates among those between 15 and 24 years of age have actually risen by 11% during the past 20 years. This is principally because of increasing deaths from violence (accidents, homicides, and suicides) which account for three fourths of all deaths in this age group.1
Periodic Breathing in Siblings of Sudden Infant Death Syndrome Victims
Authors: Kelly Dorothy H. , Walker Alexander M. , Cahen Lucienne , Shannon Daniel C.
Published: December 2021

To determine the incidence of periodic breathing (PB) episodes during sleep, 48 subsequent sudden infant death syndrome siblings and 48 control infants, matched by sex, gestational age, and chronologic age, were studied by home pneumogram technique. The sudden infant death syndrome siblings had a statistically significant increase in the percent of sleep time spent in PB, in the number of episodes/100 minutes of PB, in the longest episode of PB, and in the average duration of all episodes of PB. We conclude that PB is present in a higher amount in sudden infant death syndrome siblings as compared to control infants.
Simple Method for Determining the Caloric and Fat Content of Human Milk
Authors: Lemons James A. , Schreiner Richard L. , Gresham Edwin L.
Published: December 2021

The Committee on Nutrition of the American Academy of Pediatrics has recently advocated breast-feeding for the normal, full-term newborn, unless contraindicated for specific reasons (including a desire by the mother not to breast-feed) or when breast-feeding is unsuccessful.1 This recommendation reflects the renewed interest throughout the world in providing human milk to the healthy infant. Further, expressed breast milk (either from the infant's mother or from donors) is being fed with increased frequency to the preterm or sick infant.2,3 The adequacy of human milk to meet the nutritional needs of all preterm babies has not been documented, however, as recently reviewed by Fleischman and Finberg.4
Sterilization and the Retarded Female: Another Perspective
Authors: Crain Lucy S.
Published: December 2021

Drs Vining and Freeman should be commended for their recent excellent summary of sterilization of retarded individuals and their comment: "the retarded are not homogeneous and that decisions regarding sterilization and hysterectomy must be individualized."1

I feel compelled to note, however, that menstruation should not be viewed as an "unwanted impediment," but as a very normal function of female life. In fact, surgical termination of menses by hysterectomy for the purpose of improved hygiene or of contraception seems to me somewhat like attempting to kill gnats with a bazooka!