bluuebunny/crossref_metadata_2025 huggingface dataset:
Physical Fitness and the Schools
Authors:   Committee on Sports Medicine,   Committee on School Health
Published: December 2021

During the last decade our concept of what "physical fitness" means has undergone a major change. Traditionally the "physically fit" child was one who had obvious motor (or athletic) abilities, ordinarily defined by such parameters as muscle strength, agility, speed, and power. But the high levels of power, speed, and agility necessary for success in most competitive sports have little or no relevance in the daily lives of most adults. Today, the words "physical fitness" imply optimal functioning of all physiologic systems of the body, particularly the cardiovascular, pulmonary, and musculoskeletal systems.1

DEFINING PHYSICAL FITNESS

Physical fitness is now considered to include five components: muscle strength and endurance, flexibility, body composition (ie, degree of fatness), and cardiorespiratory endurance. Good cardiorespiratory endurance may be associated with a lessened chance of disability or death due to cardiovascular disease. Schools in the United States have traditionally emphasized sports such as football and baseball, both of which require agility and skill but are not particularly fitness enhancing. Aerobic activities (eg, activities requiring maintenance of 75% of maximal heart rate for 20 to 25 minutes), if performed at least three times a week, can lead to enhanced cardiorespiratory endurance. This improvement in fitness can be achieved by swimming, running, bicycling, field hockey, aerobic dancing, fast walking, etc.

SCHOOL PROGRAMS

Unfortunately, just as the understanding of the importance of health-related physical fitness has become widespread, our ability to direct youth activities toward fitness is being countered by several new pressures: (1) Financial strains may lead public school systems to reduce physical education budgets.
Sexual Behavior in the Home
Authors: ROSENFELD ALVIN
Published: December 2021

In Reply.—

Dr Smith states that "if the estimates of incest are accurate, then some of the 576 families in the sample would be expected to think and behave incestuously." If Sigmund Freud was correct, thinking incestuously, at least unconsciously, is normal, perhaps even a sign of healthy emotional development; behaving incestuously is psychopathologic and illegal.

How frequent is actual incest between parents and/or stepparents and their children? Finkelhor1 used a broad definition of "victimization" and surveyed 530 women and 266 men attending colleges and universities.
Treatment of Swallowing Syncope
Authors: WOODY ROBERT C.
Published: December 2021

In Reply.—

Dr Kenigsberg's letter does suggest a possible alternative therapy for patients with swallowing syncope.
Familial Hiatal Hernia
Authors: LEUNG ALEXANDER K. C.
Published: December 2021

To the Editor.—

Hubert and Toyama1 reported a 2-month-old infant and his mother with hiatal hernia at the age of 2 months and suggested that the condition is transmitted by an autosomal dominant gene.

Unlike congenital diaphragmatic hernia, most reviews fail to mention the familial occurrence of gastroesophageal reflux or hiatal hernia. Crabb et al2 described a family in which eight members in three generations had gastroesophageal reflux. In 1984, I reported a 13-month-old girl with gross gastroesophageal reflux.3
Intrauterine Growth and Gestational Duration Determinants
Authors: Kramer Michael S.
Published: December 2021

Despite the general recognition that low birth weight can be caused by many factors, confusion and controversy remain about which factors have independent causal effects, as well as the quantitative importance of those effects. Previous research findings have often been conflicting because of a failure to distinguish intrauterine growth retardation from prematurity, differences in focus (means v rates), inadequate control for confounding variables, and insufficient statistical power. This review of the English and French language medical literature published between 1970 and 1984 is based on a critical assessment and meta-analysis of 895 studies concerning 43 potential determinants of intrauterine growth or gestational duration. Based on methodologic standards established a priori for each candidate determinant, the best studies were used to assess the existence and magnitude of an independent causal effect on birth weight, gestational age, prematurity, and intrauterine growth retardation. Factors with well-established direct causal impacts are identified, and their relative importance is indicated for "typical" developing and developed country settings. Modifiable factors with large effects are targeted for public health intervention in the two settings. Finally, factors of potential quantitative importance, but for which data are either unavailable or inconclusive, are highlighted as priorities for future research.
Safety and Efficacy of Haemophilus influenzae Type b Polysaccharide Vaccine
Authors: GRANOFF DAN M. , OSTERHOLM MICHAEL T.
Published: December 2021

Haemophilus influenzae type b vaccine was licensed in the United States in the spring of 1985. Prior to licensure, extensive data had accumulated, indicating that this vaccine was safe and was immunogenic in children >18 to 23 months of age. Furthermore, in a large efficacy trial conducted in Finland, the vaccine also was found to be approximately 80% protective in preventing invasive type b Haemophilus disease in children 24 to 35 months of age (95% confidence interval 8, 95).1,2 Unfortunately, it was ineffective in children <18 months of age, the group most susceptible to Haemophilus disease, and it was of uncertain efficacy in those 18 to 23 months of age.
Soaps and Shampoos in Pediatric Practice
Authors: Morelli Joseph G. , Weston William L.
Published: December 2021

Cleansing of the skin and hair is part of the daily routine of all neonates, infants, toddlers, children, and adolescents. Numerous soap and shampoo products are available to the consumer. The pediatrician is often asked to comment on the safety and efficacy of these products. Little information is available to help the pediatrician make a rational decision. The list of ingredients on the package are seldom useful and can be confusing. The theoretical and practical considerations leading to the addition of the major constituents of soaps and shampoos are reviewed and guidelines for the use of soaps and shampoos under normal circumstances and in a few selected conditions are suggested.
Early Intervention for Disabled Infants and Their Families: A Quantitative Analysis
Authors: Shonkoff Jack P. , Hauser-Cram Penny
Published: December 2021

In an evaluation of 31 selected studies, statistical procedures for synthesizing data (meta-analysis) were used to assess the effects of early intervention services on disabled children younger than 3 years of age and on their families. Results indicate that early intervention is effective in promoting developmental progress in infants and toddlers with biologically based disabilities. Programs that served a heterogeneous group of children, provided a structured curriculum, and targeted their efforts on parents and children together appeared to be the most effective. Definitive evaluation of the efficacy of early intervention programs is tempered by the restricted range of outcomes measured and by a paucity of information about the children and families enrolled in such programs, as well as about the specific nature of the services received. Despite their limitations, available data provide the basis for a rational pediatric approach to early intervention programs, while highlighting specific directions for further investigation.
Buffy Coat Transfusions in Neutropenic Neonates With Presumed Sepsis: A Prospective, Randomized Trial
Authors: Baley Jill E. , Stork Eileen K. , Warkentin Phyllis I. , Shurin Susan B.
Published: December 2021

Neonatal sepsis, accompanied by neutropenia, is associated with a high mortality. To determine whether granulocyte transfusions improve the survival of critically ill neutropenic infants, we prospectively randomized 25 infants to transfusion and nontransfusion groups, matching for birth weight (≤1,500 g or >1,500 g). Infants with necrotizing enterocolitis were randomized separately. Neutropenia was established by two successive absolute neutrophil counts ≤1,500 cells prior to randomization. The transfusion (n = 12) and nontransfusion (n = 13) groups did not differ with respect to clinical or hematologic characteristics. In 23 of 25, bone marrow aspirations were performed to determine the percentage of neutrophil storage pool. Granulocyte transfusions of buffy coats from single units of whole blood (0.1 to 0.9 x 109 polymorphonuclear leukocytes per kilogram) were given daily until the absolute neutrophil count increased to more than 1,500/µL. Only five infants, mostly those with necrotizing enterocolitis, required more than one transfusion. A circulating immature to total neutrophil ratio (I:T) ≥0.80 was not predictive of an infant with a neutrophil storage pool ≤7%, and neither an I:T <0.80 nor a neutrophil storage pool >7% were predictive of survival. Granulocyte transfusions did not improve survival when either comparing the whole group, those 17 infants with cultures positive for bacteria or viruses, the 19 infants with a circulating I:T ≥0.80, or the nine infants with a neutrophil storage pool ≤7%. We conclude that the efficacy of buffy coat transfusions remains questionable and recommend that additional studies be performed prior to routine clinical application.
Pediatrician's Role in Development and Implementation of an Individual Education Plan
Authors:   Committee on Children With Disabilities
Published: December 2021

According to the US Department of Education, 4.36 million children in the United States (more than 11% of children 3 to 21 years of age) received some special education services during the 1984/1985 school year.1 Therefore, it is likely that a sizeable percentage of children seen in a pediatric practice for initial evaluation and follow-up care will have a developmental disability that requires an individual education plan. Pediatricians must understand the importance of such a plan and be aware of their role in its development, implementation, and interpretation.

BACKGROUND

Public Law 94-142, the Education for All Handicapped Children Act of 1975, was intended as an educational bill of rights for handicapped children, guaranteeing them a free and appropriate education. The law required identification, diagnosis, education, and related services for children 5 to 18 years of age. In 1977, the age range was extended to include children between 3 and 21 years, with services for children between the ages of 3 and 5 years remaining optional. Not only were these services to be provided, but states were encouraged to seek out handicapped children who had not been previously served. Public Law 99-457, the Education of the Handicapped Act Amendments of 1986, further extends the range of the law by mandating services for children 3 to 5 years of age. This new law also provides funding for states to voluntarily develop programs that serve infants and toddlers (birth to 3 years of age) who are at risk for or are suspected of having handicapping conditions.
Pediatrics and Poverty
Authors: OBERG CHARLES N.
Published: December 2021

In Reply.—

In response to Dr Graham's concerns about the recently published commentary,1 I concur that the increase in poverty among our children is not attributable to a single administration. Indeed, the escalation commenced in the middle 1970s and has continued to the present time. However, the recent and significant budgetary reductions observed in the early 1980s appear to have reduced essential social support services at a time when such assistance was most in need.
Dietary Intakes
Authors: Nicklas Theresa A. , Farris Rosanne P. , Major Carolyn , Frank Gail C. , Webber Larry S. , Cresanta James L. , Berenson Gerald S.
Published: December 2021

Dietary patterns and racial differences in nutrient intake were observed in children 6 months to 4 years of age in the Bogalusa Heart Study. Even in this sample of young children, the composition of the intakes of the majority of children was not compatible with prudent recommendations of less than 35% and 10% of energy from total and saturated fat, respectively. Mean cholesterol intake of the 4-year-old children (390 mg) was approximately one half of the average daily adult levels. The polyunsaturated to saturated fatty acid ratio ranged from 0.41 to 0.53 and sucrose to starch ratio from 1.32 to 1.57, reflecting a high saturated fat and sucrose intake. White children had greater intakes of sucrose than black children; however, total fat and cholesterol intakes were greater in black children. Gender differences were noted among the 2, 3, and 4-year-old children: energy, sugar, and starch intakes were greater in boys, and cholesterol intake per 1,000 kcal was greater in girls. Mean intakes per 1,000 kcal in Bogalusa were higher for fat and carbohydrate and lower for protein than reported in the Second Health and Nutrition Examination Survey. However, when the National Research Council recommended dietary allowances for protein and energy are used for comparison, a more than adequate intake was noted in these children. The data found in this newborn-infant cohort contribute information regarding the early development of dietary habits that likely influence eating behavior in later childhood and adolescence.
Predictive Value of Parental Measures in Determining Cardiovascular Risk Factor Variables in Early Life
Authors: Rosenbaum P. A. , Elston R. C. , Srinivasan S. R. , Webber L. S. , Berenson G. S.
Published: December 2021

Parent-child associations of height, weight, subscapular skinfold thickness, blood pressure, and serum lipids and lipoproteins were observed in a cohort of 440 infants and their parents in Bogalusa, LA. The infants were examined according to a standardized protocol six times from birth to 7 years of age, and the parents were examined when the child was 2 years old. Regression analyses were performed with the value of the cardiovascular risk factor variable for the child as the dependent variable and race, sex of child, and either mother's value, father's value, or both mother's and father's values as the independent variables. The most significant relationship between parents and their children was for height (P < .005 at all ages of the child) and weight (P < .05 from age 1 year for father's regression coefficient and at all ages for mother's regression coefficient). Regression coefficients for parental serum lipids and lipoproteins tended to increase with the child's age. Child-father regression coefficients and child-mother regression coefficients were generally significant (P < .05) after age 2 years for total cholesterol. Less association was noted for triglycerides and lipoproteins. Parental diastolic BP was a poor predictor of children's values; the regression coefficients for systolic BP were higher and more significant. The longitudinal nature of this cohort study allows for examination of the changing patterns of familial association with aging and may provide insight as to the best age for examining children for cardiovascular risk factors to determine their relative risk for heart disease.
Myeloperoxidase Deficiency With Extensive Candidal Osteomyelitis of the Base of the Skull
Authors: Weber Michel L. , Abela Anthony , de Repentigny Louis , Garel Laurent , Lapointe Normand
Published: December 2021

A 6-year-old girl had a 7-month history of headaches and painful torticollis. A CT scan of the mastoids showed extensive bone destruction of the base of the skull and C-1. Biopsies of the retropharyngeal area and of the anterior aspect of C-1 were performed: histopathologic findings were suggestive of mycotic infection and cultures were positive for Candida albicans. The child was treated successfully with amphotericin B. The immunologic evaluation demonstrated the absence o myeloperoxidase in the neutrophils.
Renal Cell Carcinoma in Patients With Tuberous Sclerosis
Authors: Weinblatt Mark E. , Kahn Ellen , Kochen Joseph
Published: December 2021

An adolescent with anemia and weight loss was found to have bilateral renal cell carcinoma (hypernephroma). Further investigation revealed an underlying tuberous sclerosis that had escaped previous clinical detection. Several reports of this association were subsequently found when the world's literature was reviewed. Physicians treating patients with tuberous sclerosis should be aware of the possible development of these renal malignancies in their patients.
Primary Sclerosing Cholangitis in Children: Study of Five Cases and Review of the Literature
Authors: Sisto Alfred , Feldman Patricia , Garel Laurent , Seidman Ernest , Brochu Pierre , Morin Claude L. , Weber Andrée M. , Roy Claude C.
Published: December 2021

Primary sclerosing cholangitis in five children is described and 78 cases in the pediatric age group are reviewed. In 24% of the cases, primary sclerosing cholangitis is not associated with an underlying disease and may appear to be prolonged cholestasis of infancy. When an associated condition is present, chronic inflammatory bowel disease, in particular ulcerative colitis, is most common (47%). Histiocytosis X and a variety of immune disorders account for 15% and 10% of cases, respectively. Primary sclerosing cholangitis should be considered in the differential diagnosis of chronic liver disease in the pediatric age group, even in young infants. Results of this survey demonstrate that neither clinical features nor liver function tests are reliable diagnostic predictors, that histologic changes are often nonspecific, and that cholangiography is essential to establish the correct diagnosis.
Loiasis in an Expatriate American Child: Diagnostic and Treatment Difficulties
Authors: OLNESS KAREN , FRANCIOSI RALPH A. , JOHNSON MARGARET M. , FREEDMAN DAVID O.
Published: December 2021

On the basis of this experience, we recommend the following when faced with possible filariasis in an expatriate from Western Central Africa: (1) Attempt a clinical differentiation between L loa and other filarial infections present in West Africa. It is important to suspect loiasis because this is the only filarial infection that is readily curable; (2) ophthalmologic assessment to diagnose onchocerciasis; (3) if L loa is suspected, thick blood smears should be obtained from midmorning to midafternoon and stained with Giemsa or hematoxylin stains, after a concentration technique is used. Nighttime blood specimens should be obtained if the patient has been in an area where W. bancrofti is prevalent; (4) skin snip biopsies prepared as follows: Bilateral symmetrical skin snips should be taken. In the case of suspected West African filariasis, the pelvic girdle, iliac crest, and back of scapula are thought to have the highest yield. One snip from each of six different sites should be obtained. Each skin snip should be approximately 2 to 3 mm (a cornealoscleral biopsy forceps can be used). Each skin snip is placed in 100 µL (approximately one drop) of normal saline in a flat-bottomed microtiter plate. The plate is incubated at room temperature and checked periodically for 24 hours under a dissecting microscope (x20 to x40). If present, the small worms will be seen wiggling and squirming in the drop of saline; (5) serologic diagnostic methods are most efficient if human filarial antigens are used; (6) if treatment is with diethylcarbamazine, the initial dose should be small. During treatment with diethylcarbamazine, WBCs, differentials, and renal function must be monitored.
Blood Pressure Measurement
Authors: LONDE SOL
Published: December 2021

To the Editor.—

The report of the Second Task Force on Blood Pressure Control in Children1 recommends the use of K4 in preadolescent children because the authors say that K5 readings are frequently difficult to obtain in that age group, and K5 is easier to record in adolescents. We have used K5 in our studies because we are more certain of it. We have challenged the use of K4 because its recognition depends on subjective judgment of a qualitative change in the character of the sounds.2
Adolescent Varicocele
Authors: OKSTEIN CHARLES J.
Published: December 2021

To the Editor.—

The recent article on testicular histology in the adolescent with a varicocele (Pediatrics 1987;79:996-998) pointed out the potential histologic testicular damage that can occur in the presence of this condition. The authors stated that, in some cases of unilateral varicocele, histologic abnormalities were found in the contralateral testis. They further commented that early ligation of varicoceles would seem reasonable if it could be shown that progressive histologic damage could be arrested by the procedure.
Hypoxemia and Retinopathy of Prematurity
Authors: KATZMAN GERALD , SATISH MALINI , KRISHNAN VENKATESAN
Published: December 2021

To the Editor.—

We read with interest the article by Bancalari et al1 regarding the incidence of retinopathy of prematurity in neonates managed with and without transcutaneous Po2 monitoring. It occurred to us that Bancalari et al may be in a position to use their data to test an association that we observed in Toledo.

In our work, Pao2 was analyzed by assuming linear trending between individual Pao2 values determined from blood samples taken from umbilical artery catheters.
Organophosphate and Carbamate Poisoning in Infants and Children
Authors: Zwiener Robert J. , Ginsburg Charles M.
Published: December 2021

The clinical and laboratory features of moderate to severe organophosphate and carbamate toxicity in 37 infants and children are presented. Ingestion of an improperly stored liquid pesticide was the most common route of intoxication (76% of patients); five (14%) children became intoxicated after playing on carpets and floors of homes that had been sprayed or fogged by unlicensed exterminators. The transfer diagnoses were incorrect for 16 or 20 patients who were transferred to our center from another institution. Miosis (73%), excessive salivation (70%), muscle weakness (68%), and lethargy (54%) were the most common abnormal signs; 49% and 22% of patients had tachycardia and seizures, respectively, and 38% of children had respiratory insufficiency that required endotracheal intubation and mechanical ventilation. The results of erythrocyte and serum cholinesterase activity assays were concordant in 83% of patients. Thirty-four (92%) patients were treated with atropine and/or pralidoxime; three patients required only supportive care. Most patients had a prompt response to therapy; however, two patients with organophosphate toxicity required multiple doses of atropine during a 24-hour period; in both instances, the doses of atropine were subtherapeutic. There were no deaths. Pneumonitis and/or atelectasis developed in ten patients, including six who had ingested a petroleum distillate-containing insecticide.
Heritable Fraction of Unilateral Wilms Tumor
Authors: Li Frederick P. , Williams Wick R. , Gimbrere Kathreen , Flamant Francoise , Green Daniel M. , Meadows Anna T.
Published: December 2021

Heritability of the unilateral-sporadic (non-familial) form of Wilms tumor was examined in the offspring of 96 long-term survivors of the neoplasm. No Wilms tumor has developed in any of the 179 offspring of these patients. The maximum likelihood estimate of a hereditary Wilms tumor in our patients is zero and the corresponding 95% upper confidence limit ranges between 0.06 and 0.11, depending on penetrance. Among their offspring, the 95% upper bound of the risk of Wilms tumor is 0.02. These figures can be applied in genetic counseling of other survivors of unilateral-sporadic Wilms tumor.
Vitamin Dosages for Premature Infants
Authors: WALSH WILLIAM F.
Published: December 2021

To the Editor.—

I was confused by the article about multiple vitamin preparation for total parenteral nutrition by Moore et al (Pediatrics 1986;77:530-538). The study of vitamin levels is crucial to making recommendations, but why would the authors choose to give all premature infants 65% of the recommended dose for infants and children, when the package insert clearly states, "Infants less than 1 kg: the daily dose should not exceed 30% of the contents. Do not exceed this daily dose."?
Prediction of the Duration of Hospitalization in Patients With Respiratory Syncytial Virus Infection: Use of Clinical Parameters
Authors: McMillan Julia A. , Tristram Debra A. , Weiner Leonard B. , Higgins Anne Patti , Sandstrom Cathy , Brandon Robert
Published: December 2021

To assess the possibility that clinical data available at the time of hospital admission for patients with respiratory syncytial virus infection could predict the length of hospitalization without antiviral therapy, the charts of all 102 patients admitted with laboratory documented respiratory syncytial virus infection during 1982 to 1985 were reviewed. Two thirds (65) of the patients remained hospitalized greater than three days. Prolonged hospitalization could have been predicted for 40 of the 65 patients (61.5%) based on the need for intubation and ventilation on admission (14 patients) or the presence of underlying cardiac or respiratory disease (28 patients). Of the infants hospitalized when they were less than 2 months of age, 40% required intubation and mechanical ventilation, although only 16% had underlying cardiac or respiratory disease. Mechanical ventilation was required at the time of admission or subsequently for 14% (5/36) of the 2- to 4-month-old infants with respiratory syncytial virus infection. Among the 56 patients without underlying cardiac or respiratory disease who did not require intubation at the time of admission, 25 (45%) remained hospitalized longer than three days (mean hospital stay for these 25 patients, regardless of age, was six days). Neither the respiratory rate nor the presence or absence of fever on admission was useful in predicting the likelihood of a longer hospital stay for the patients who did not require intubation. In addition, none of the initial laboratory data, including the WBC count, the percentage of band forms or polymorphonuclear leukocytes, the presence or absence of hypoxia, or the chest x-ray film findings could be correlated with a longer or shorter duration of hospitalization. Initiation of a threeday course of aerosolized ribavirin for patients with respiratory syncytial virus infection who have underlying cardiopulmonary disease appears warranted. Ribavirin therapy might have allowed sufficient clinical improvement to shorten the hospital stay for almost half of the patients without underlying illness.
Misuse of Car Safety Seats
Authors: Bull Marilyn J. , Stroup Karen Bruner , Gerhart Susan
Published: December 2021

Correct use of car seats for small children is essential to prevent serious injuries and death from automotive accidents. Failure to use a car seat properly can contribute to serious injury or death of a child. A case study in which misuse of a car seat occurred is reported. The infant died of hemorrhage and shock secondary to liver laceration which resulted from excessive pressure over the abdomen sustained on impact. Surveys of car seat use for small children prior to and following a child restraint law are also reported. Observers noted types of car seats and specific forms of misuse. Survey results suggest that parents are more likely to misuse car seats for infants than toddlers. Medical professionals can reinforce the importance of proper car seat use by incorporating specific car seat use questions into the patient interview and by providing educational materials.
Culture Versus Biology: Children's Attitudes Toward Thinness and Fatness
Authors: Feldman W. , Feldman E. , Goodman J. T.
Published: December 2021

Many of the studies regarding children's acquisition of prevailing cultural concepts of physical attractiveness are flawed by small and unrepresentative samples, measurement instruments of questionable reliability and validity, and experimental designs that do not protect against bias. Additional studies in which these methodologic flaws are overcome must be carried out if we are to understand truly when and how cultural concepts of beauty are acquired. Nevertheless, the majority of the studies already done find that children acquire prevailing cultural values of beauty before adolescence and that thinness is desirable to girls considerably before puberty. It is suggested that the etiology of eating disorders and the reasons for their increasing prevalence will not be discovered by studying only clinical cases. We propose that those interested in this important health problem study children before adolescence in an attempt to learn how preoccupation with weight begins and why thinness is believed to be attractive. Once these are understood, a greater challenge will be the development and testing of interventions—be they in the schools or using the media—which can effectively prevent this public health problem. When culture and biology clash, people may suffer.
Heredofamilial Syndrome of Mesodermal Hamartomas, Macrocephaly, and Pseudopapilledema
Authors: Dvir Michaela , Beer Siegfried , Aladjem Mordechay
Published: December 2021

A 4½-year-old boy with macrocephaly, pseudopapilledema, lipoangiomatosis, macropenia, and spotted pigmentations of the glans is reported. Lipoid masses were found in the subcutaneous tissue, tonsils, and probably the left lung. Some of these findings are consistent with features already reported by Riley and Smith, later by Bannayan, and recently by Ruvalcaba et al. We propose to unify the features of this syndrome and name it macrocephaly, mamartomas, and papilledema syndrome. The inheritance in our described case seems to be autosomal dominant.
Antibodies to Rotaviruses in Chickens' Eggs: A Potential Source of Antiviral Immunoglobulins Suitable for Human Consumption
Authors: Yolken Robert H. , Leister Flora , Wee Siok-Bi , Miskuff Robin , Vonderfecht Steven
Published: December 2021

The prevalence of antibodies to human rotaviruses in commercially available eggs and egg products that are suitable for human consumption was investigated. The yolks of virtually all of the individual eggs and pasteurized pooled egg preparations contain antirotavirus antibodies detectable by means of enzyme immunoassay systems. Also, the eggs and egg preparations are capable of inhibiting the growth of two strains of rotaviruses in tissue culture. Chromatographic studies indicated that the antigen-binding activity is limited largely to the immunoglobulin fractions of the egg yolks. The antibody levels in eggs can be increased by the immunization of hens with purified rotavirus preparations, and the immunoglobulins isolated from the eggs of immunized hens can prevent the development of rotavirus gastroenteritis in experimentally infected animals. Egg preparations might serve as a practical source of antiviral antibodies suitable for consumption by infants and young children.
Blood Pressure Cuff Confusion
Authors: LOGGIE JENNIFER
Published: December 2021

To the Editor.—

Since the report of the Second Task Force on Blood Pressure Control in Children (Pediatrics 1987;79:1-25) was published, several individuals have asked me (1) why we changed the recommendation for cuff size from one that covers two thirds to one that covers three quarters of the upper arm and (2) what data formed the basis for this change in recommendations?

When I reread the published report to verify cuff size recommendations, it appeared to me that somewhere along the line a transcription error had taken place.
Vitamin E and Retinopathy of Prematurity
Authors: JOHNSON LOIS , ABBASI SORAYA , QUINN GRAHAM E. , OTIS CHARI , BOWEN FRANK W.
Published: December 2021

To the Editor.—

In the 1987 April issue of Pediatrics1 Dr Phelps and colleagues reported the results of their study of prophylactic vitamin E and retinopathy of prematurity and related them to those of other trials. They concluded that the evidence for efficacy of tocopherol in decreasing "severe" retinopathy of prematurity is not convincing and that its use in infants weighing ≤1,000 g at birth may be contraindicated and even produce death.

With regard to toxicity, the reader needs to be reminded that the fatalities referred to followed administration of high doses of a preparation of IV tocopherol acetate (E-Ferol) which was not subjected to field testing and was not used in any of the clinical trials.
First Step in Obtaining Child Health Care: Selecting a Physician
Authors: Hickson Gerald B. , Stewart David W. , Altemeier William A. , Perrin James M.
Published: December 2021

To investigate the process by which families identified and selected their children's current physicians, a close-ended questionnaire was administered to 750 families in a mail panel. Of 630 responses (84.0%), 244 had children in the home; 229 (93.9%) identified a regular and current physician for their youngest child. However, parents did not spend much time or energy selecting a physician and rarely explored medical expertise in their decisions. Families averaged 1.2 sources of information consulted per decision; few considered more than two physician choices and infrequently considered alternative types of doctors (pediatricians v family or general practitioners). selection priorities ranked in order of importance concerned parents' perceptions of their doctors' communication skills, accessibility, and quality as determined by recommendations of friends or physicians. Parents appeared less concerned with issues of cost and convenience. Families selecting pediatricians differed from those selecting family and general practitioners in sources of information used and selection priorities. The survey also identified 84 families who had changed or seriously considered changing the physician who was caring for their youngest child. The most frequent dissatisfaction was the perception that an illness was not being managed adequately, followed by believing that the doctor or staff were rude or unconcerned. Families unhappy with pediatricians expressed different reasons from those unhappy with family or general practitioners. The study results provide insight about the first step in obtaining child health care services, a relatively unexplored area of patient decision making.
Medical Care Costs of High-Risk Infants After Neonatal Intensive Care: A Controlled Study
Authors: Shankaran Seetha , Cohen Sanford N. , Linver Marsha , Zonia Susan
Published: December 2021

Total medical care costs were studied prospectively from neonatal intensive care unit (NICU) discharge to 3 years of age for 60 children, 35 of whom had neurologic and/or developmental deficits detected immediately following NICU discharge and 25 children did not. At the end of the study period the children were classified as unhandicapped (group A), mildly handicapped (group B), or moderately-severely handicapped (group C). Medical costs are reported per infant per month following NICU discharge (mean ± SD). The outpatient costs in group A were $31 ± 23 as compared with $86 ± 93 in group B and $109 ± 59 in group C (A < B, A < C; P < .001). The greatest contributor to outpatient costs was occupational and physical therapy (with unproven efficiency to date). The inpatient costs were $31 ± 56 in group A, $328 ± 574 in group B, and $542 ± 737 in group C (A < C; P < .01). The US Department of Agriculture estimates of medical costs of raising a child at home ranges from $22 to $26.80 per month. The cost of raising one of our NICU infants in an institution was $1,216 per month. Children with and without neurodevelopmental deficits after NICU discharge have significantly higher medical costs than children without.
Financing Health Care for Disabled Children
Authors: Newacheck Paul W. , McManus Margaret A.
Published: December 2021

Information about health care use, charges, and out-of-pocket expenses is critical to the development of an equitable and efficient treatment system for disabled children. Data from the 1980 National Medical Care Utilization and Expenditure Survey were used, and differences in use, charges, and out-of-pocket expenses for children with and without limitations in their activities due to chronic health problems are described. The results indicate that children limited in their activities used more medical services than other children, especially hospital-based services and services provided by health professionals other than physicians. Charges and out-of-pocket expenses were two to three times higher on average for disabled children, compared with other children. Charges and out-of-pocket expenses were also skewed; 10% of the sample children accounted for more than 60% of total charges and out-of-pocket expenses for the disabled population. The skewed distribution of out-of-pocket expenses suggests that financial burdens are unevenly shared by families of disabled children. Several public policy options designed to result in a more equitable distribution of financial risks are discussed.
AIDS, Children, and Breast-Feeding
Authors: CANTANI ARNALDO
Published: December 2021

To the Editor.—

The article by Rogers et al1 concerning AIDS in children draws attention to important epidemiologic and prognostic issues. As of Aug 1, 1987, the number of affected children reached 720—558 from the United States and 58 from Europe. However, the studies on vertically infected infants reviewed by me2-6 indicate that the incubation period of AIDS in such infants varies between 22 and 12 months.5 Rogers et al state that the incubation is 1 to 86 months.
Urine Latex Particle Agglutination
Authors: FRIEDMAN ALLAN D.
Published: December 2021

To the Editor.—

Ramsey et al1 recently reported their experience with two immunochemical methods for the detection of the capsular antigens of Haemophilus influenzae and Streptococcus pneumoniae in the urine and serum of patients with lower respiratory tract infection. S pneumoniae was detected in 26 urine specimens by bacterial coagglutination (Phadebact). H influenzae was detected by latex agglutination in nine patients.

From September 1986 to March 1987, we studied 26 patients with radiographically documented pneumonia.
Health Assessment and Screening During Adolescence
Authors: SCHWARTZ RICHARD H.
Published: December 2021

To the Editor.—

In the July 1987 supplement to Pediatrics, Drs Marks and Fisher1 suggest using a liver enzyme screen such as γ-glutamyl transpeptidase to detect alcohol-induced liver damage in the adolescent patient. I question the wisdom of this recommendation on two grounds. First, to my knowledge, there are no published reports concerning the accuracy and sensitivity of such a test in the adolescent patient. Evidence from my own experience, moreover, refutes the recommendation of Drs Marks and Fisher.
Live Attenuated Varicella Vaccine in Healthy 12- to 24-Month-Old Children
Authors: Johnson Candice E. , Shurin Paul A. , Fattlar Deborah , Rome Leonard P. , Kumar Mary L.
Published: December 2021

We studied live attenuated Oka/Merck varicella vaccine in 147 seronegative children 12 to 24 months of age and their 94 seronegative older siblings 2 to 12 years of age. The vaccine side effects were mild, consisting of a papular rash in 15 of 147 (10.2%) children 12 to 24 months and seven of 94 (7.4%) siblings. In a subset of 12- to 24-month-old children, modified fluorescent antibody test for membrane antigen was not detectable at seven days postimmunization but was detectable in 50% by 14 days and in 100% by 21 days. Within 6 weeks, 96.6% of children 12 to 24 months and 94.7% of siblings seroconverted. The geometric mean titer did not vary with age at immunization. One-year blood samples were obtained from 70 children 12 to 24 months of age who seroconverted; 92.9% retained detectable antibody. The geometric mean titer had decreased from 55.7 to 18.6. Of these 70 children, 34% had been exposed to varicella since immunization, and two cases of varicella were observed in seroconverters. Both cases were mild, with less than 50 vesicles. Oka/Merck varicella vaccine appears to be safe, highly immunogenic, and protective against 96% of exposures to natural varicella during the first year after vaccination in infants. Those cases of varicella that develop in immunized children appear substantially reduced in severity.
Neonatal Circumcision and Penile Problems: An 8-Year Longitudinal Study
Authors: Fergusson D. M. , Lawton J. M. , Shannon F. T.
Published: December 2021

The prevalence of penile problems was examined in a birth cohort of more than 500 New Zealand children studied from birth to 8 years of age. By 8 years, circumcised children had a rate of 11.1 problems per 100 children, and uncircumcised children had a rate of 18.8 per 100. The majority of these problems were for penile inflammation including balanitis, meatitis, and inflammation of the prepuce. However, the relationship between risks of penile problems and circumcision status varied with the child's age. During infancy, circumcised children had a significantly higher risk of problems than uncircumcised children, but after infancy the rate of penile problems was significantly higher among the uncircumcised. These associations were not changed when the results were adjusted statistically for the effects of a series of potentially confounding social and perinatal factors.
Infant Mortality Increase Despite High Access to Tertiary Care: An Evolving Relationship Among Infant Mortality, Health Care, and Socioeconomic Change
Authors: Wise Paul H. , First Lewis R. , Lamb George A. , Kotelchuck Milton , Chen D. W. , Ewing Andrea , Hersee Heather , Rideout Jeffrey
Published: December 2021

In this study, the determinants of an apparent increase in the infant mortality rate of an urban population with high access to tertiary neonatal care are reviewed. For a 4-year period (1980 to 1983), all infant deaths (n = 422) of the 32,329 births to residents of the City of Boston were analyzed through linked vital statistics data and a review of medical records. A significant increase in the infant mortality rate occurred in 1982 due to increases in three components of the infant mortality rate: the birth rate of very low birth weight infants (<1,500 g), the neonatal mortality rate of normal birth weight infants (≥2,500 g), and the mortality rate of infants dying during the postneonatal period (28 to 365 days). These increases were associated with inadequate levels of prenatal care. Although transient, the impact of the observed alterations in these infant mortality rate components was enhanced by a more long-standing phenomenon: the stabilization of mortality rates for low birth weight infants. This stabilization allowed the increases in other component rates to be expressed more fully than in previous years. In this report a mechanism is shown whereby fully regionalized neonatal care ultimately may confer to the infant mortality rate a heightened sensitivity to socioeconomic conditions and levels of adequate prenatal care.
Closed Chest Cardiac Massage in the Newborn Infant
Authors: David Ronald
Published: December 2021

The recommended techniques for external cardiac compression during cardiopulmonary resuscitation of the newborn are reviewed. The American Heart Association advises the rescuer to depress the infant's midsternum with the index and forefingers. An alternative recommendation is to encircle the chest with both hands and appose the thumbs on the midsternum. The cases reported here prove the superiority of the latter maneuver over the former in improving cardiac output and systemic blood pressures. The history of external cardiac compression in infants and children is briefly reviewed, further supporting the conclusion that the technique of encircling the chest with thumbs at midsternum is more efficacious and hence the preferred approach to closed chest cardiac massage in the newborn.
`A New Era in Therapy for Hyperbilirubinemia"
Authors: LUCEY JEROLD F.
Published: December 2021

The article by Kappas et al in this issue (pp 485-497) represents a promising and exciting new approach to the prevention of neonatal hyperbilirubinemia. This important advance is based on a decade of careful basic research before this first clinical study in infants was carried out. Pediatricians have long dreamed of the day when the bilirubin problem would be solved and they would be free of the constant worry about "what to do for a certain level of serum bilirubin."

There is an ancient Chinese proverb: "A journey of a thousand miles begins with a single step." Kappas et al have taken that step.
Rape and the Adolescent
Authors:   Committee on Adolescence
Published: December 2021

In recent years, the problem of rape and sexual abuse of young persons has received increasing medical and societal attention. Nearly 50% of reported rape victims are adolescents.1-3 Whereas the vast majority of offenses involve girls, the incidence of sexual assaults on young men also seems to be increasing.

Although community resources may vary considerably, most metropolitan areas now have special programs on facilities to assist the victims of sexual assault. Such assistance usually includes advice regarding the management of the acute crisis as well as guidelines for the collection of evidence and preparation for trial should legal action follow. Because so many of the victims are adolescents, they are being seen with increasing frequency in pediatric emergency rooms.

The adolescent who is forcibly assaulted may display a wide range of behaviors, such as hysterical crying, giggling, on agitation, and may have feelings of degradation, anger, rage, helplessness, and nervousness and rapid mood swings. The victim is often angry, confused, and filled with selfblame. Alternatively, the adolescent may appear calm and controlled, masking internal turmoil. In cases of forcible assault, long-term sequelae such as fears, nightmares and sleep disturbances, disturbed peer and sexual relationships, and psychosomatic complaints may develop. Some victims fear retaliation from their attacker and develop ritualistic behavior as a defense. Some believe their bodies to be permanently damaged and may even fear death as a consequence of the violent act they have experienced.

For the victim, the circumstances of the initial medical evaluation may be frightening and stressful.
Chlamydia and Suspected Sexual Abuse
Authors: HAMMERSCHLAG MARGARET R.
Published: December 2021

To the Editor.—

I read with interest the study by Fuster and Neinstein.1 However, I wish to address several aspects of the report regarding the significance of genital infection with Chlamydia trachomatis in children, clinical findings, and diagnosis.

The question of whether genital infection with C trachomatis in a prepubertal child is an indicator of sexual abuse is still controversial. Although it has been demonstrated that an abused child can acquire the infection after rape,2 the organism can also be present as the result of persistent perinatal infection.
Plea for Enhancing Neuronal Survival by Neurophysiologic Monitoring
Authors: BUSHORE MARTHA
Published: December 2021

Drs Nussbaum and Maggi provide us with thought-provoking information in their prospective study of nearly drowned children who incurred severe anoxic ischemic encephalopathy and were in a flaccid state of coma on admission to the pediatric intensive care unit. In their discussion, they note that there is not a uniform approach to management of severely comatose, nearly drowned children. Although the rationale for the protective role of barbiturates in the presence of anoxic-ischemic encephalopathy has a strong scientific basis, results of their study indicate that clinical outcome of patients treated with barbiturates does not support the scientific basis for their use.