bluuebunny/crossref_metadata_2025 huggingface dataset:
African-American Youth: Essential Prevention Strategies for Every Pediatrician
Authors: Murray-Garcia Jann
Published: December 2021

National statistics of morbidity and mortality warrant our urgent attention to the issue of effective prevention strategies among African-Americans. Implicit, explicit, and often internalized messages of inferior value, negative expectations, and expendability remain a part of everyday life for African-American youth. This sociopolitical disenfranchisement has a direct impact on their health and development and on our ability to provide effective preventive and therapeutic intervention.

Pediatricians enjoy a deserved perception of expertise in those areas that bear directly on the healthy physical and psychosocial development of all children. We have not heretofore optimally exploited this perceived and real expertise in prevention efforts among African-American children. We ourselves are in need of reeducation. We need to first shatter the insidious conceptual barriers of our own impotence as well as the perceived impotence of African-American patients in our collective abilities to inspire and affect change. On a patient-by-patient basis, among our regional pediatric communities and in the public policy arena, we can be involved in the process that restores to our African-American patients a sense of full citizenship and potential within our society. Without adoption of this process of sociopolitical reenfranchisement, our best-intended efforts at prevention in this community will always tragically fall short of their full and critically needed potential.
PATHOLOGIST SAYS FIVE CHILDREN DIED OF DELIBERATE SUFFOCATION
Authors: L. J. F.
Published: December 2021

Testifying in the trial of a woman charged with killing her five young children, the chief forensic pathologist of the New York State Police said today that all five had been deliberately suffocated and were not, as was originally believed, victims of crib death.

The case of Mrs. Hoyt, a 48-year-old housewife raised in this rural county, has drawn national attention because the deaths of her five children had been cited for two decades as textbook cases of so-called crib death, on sudden infant death syndrome.

... Defense lawyers have declined to say whether Mrs. Hoyt will testify in her own defense.

If she does, she will no doubt face questions from the prosecution about the confession she made and signed last spring. A police investigator has testified that in her statement, which she has since recanted, she voluntarily told him how she had suffocated each of her children: Eric, Molly, and Noah were smothered with pillows. Julie was pressed against her mother's chest until her breathing stopped. James–who was 2½ years old, the only child to survive past the age of 3 months–was suffocated with a bath towel.

The prosecutor had quoted Mrs. Hoyt as saying she could not bear hen children's crying.

The defense lawyer has argued that Mrs. Hoyt's confession was signed under duress–without a lawyer present, without benefit of her reading glasses, and without having been properly instructed of her rights.
Atlantoaxial Instability in Down Syndrome: Subject Review
Authors:   Committee on Sports Medicine and Fitness
Published: December 2021

This Policy Statement was retired February 2008.

DEFINITION OF THE PROBLEM

In 1984, the American Academy of Pediatrics (AAP) published a position statement on screening for atlantoaxial instability (AAI) in youth with Down syndrome.1 In that statement, the AAP supported the requirement introduced by the Special Olympics in 1983 that lateral neck radiographs be obtained for individuals with Down syndrome before they participate in the Special Olympics' nationwide competitive program for developmentally disabled persons. Those participants with radiologic evidence of instability are banned from certain activities that may be associated with increased risk of injury to the cervical spine. This policy seemed to be prudent in light of the information available at that time. However, the AAP Committee on Sports Medicine and Fitness recently has reviewed the data on which this recommendation was based and has decided that uncertainty exists concerning the value of cervical spine radiographs in screening for possible catastrophic neck injury in athletes with Down syndrome. The 1984 statement therefore has been retired. This review discusses the available research data on this subject.

BACKGROUND

AAI, also called atlantoaxial subluxation, denotes increased mobility at the articulation of the first and second cervical vertebrae (atlantoaxial joint). This condition is found not only in patients who have Down syndrome but also in some patients who have rheumatoid arthritis, abnormalities of the odontoid process of the axis, and various forms of dwarfism.1 The causes of AAI are not well understood but may include abnormalities of the ligaments that maintain the integrity of the C-1 and C-2 articulation, bony abnormalities of C-1 or C-2, or both.1-11
Recommendations for the Use of Live Attenuated Varicella Vaccine
Authors:   Committee on Infectious Diseases
Published: December 2021

In the American Academy of Pediatrics policy statement entitled "Recommendations for the Use of Live Attenuated Varicella Vaccine" by the Committee on Infectious Diseases that appeared in the May 1995 issue of Pediatrics, there is a typographical error.

On page 793 under the heading Recommendations for Vaccine Use in the fifth line of the first paragraph the word mild should be wild.
A Call to Action: The Institute of Medicine Report on Emergency Medical Services for Children
Authors: Knapp Jane F.
Published: December 2021

Emergency Medical Services for Chi (EMS-C) must be recognized as a public responsibility; the "market" cannot be relied on to produce the kind of planning and cooperation required to make services available to all who need them.1 The Institute of Medicine (IOM) Report on Emergency Medical Services For Children.

Each year millions of American chi become seriously ill or injured. If you have ever encountered a child who did not receive the medical care they needed or deserved under these circumstances you understand what EMS-C is all about. The familiar adage, "Children are not small adults," emphasizes that their care must be an integral part of a system not an afterthought once the adults have been addressed. The achievement of the desired level of competence for EMS-C in the larger system is hampered by many factors. These include lack of organization, equipment, training, and a tack of understanding of the child's unique problems and needs.

In response to these needs, Congress approved a demonstration grant program in 1984. The purpose of the program was threefold: to expand access to EMS-C, to improve the quality available through existing Emergency Medical Systems (EMS), and to generate knowledge and experience that would be of use to all states and localities seeking to improve their system.

Continuing interest prompted the formation of the Committee on Pediatric Emergency Medical Services by the IOM. This 19-member committee Chaired by Dr Donald N. Medearis, Jr released their report in the summer of 1993. The IOM report entitled Emergency Medical Services for Chi is available in both a soft cover 25-page summary and the full text (see Appendix).
Implementation of the Recommendations of the Institute of Medicine Report, Emergency Medical Services for Chi: Registered Nurses
Authors: Henderson Deborah Parkman , Thompson June D.
Published: December 2021

Registered nurses are the single largest group of health care providers in the United States. Their role in emergency medical services for chi and approaches to implementation of the Institute of Medicine recommendations as they relate to nursing care are discussed.
Infantile Colic: Child and Family Three Years Later
Authors: Rautava Päivi , Lehtonen Liisa , Helenius Hans , Sillanpää Matti
Published: December 2021

Objective. To assess differences in family functioning or child-rearing attitudes within families with previously colicky infants and to assess whether the children differed in their behavior, development, or frequency of allergies.

Study Design. A controlled, prospective study with infants (3 months to 3 years of age) and their families.

Participants. Three hundred thirty-eight infants with and 866 infants without exhibited colic and their families.

Methods. Questionnaires to mothers and nurses regarding infantile colic (3 months of age); questionnaires to mothers, fathers, and nurses regarding interactions within the family, parents' satisfaction with daily life, child caring, child behavior, and development (3 years old); the Denver Developmental Screening Test (parents filled out at home during the whole 3 years of infant development); the Achenbach Behavior Checklist for 2- to 3-year-old children (the 3-year visit at a well baby clinic).

Results. The families of previously colicky infants demonstrated more dissatisfaction with the arrangements of daily family responsibilities and with the amount of both leisure time and shared activities. The children in the colic group had more sleeping problems and more frequent temper tantrums (at 3 years of age) than the control group.

Conclusions. The families with colicky infants had more distress 3 years later. Families with colicky infants should be provided practical support in improving daily family functioning and child rearing. In addition, underlying problems in family relationships should be managed appropriately.
Life Events and Other Risk Factors for Somatic Symptoms in Adolescence
Authors: Poikolainen Kari , Kanerva Riitta , Lönnqvist Jouko
Published: December 2021

Objective. To determine mental health risk factors related to somatic symptoms, common in adolescence.

Design. Cross-sectional study.

Setting. Ten schools, corresponding approximately to Us senior high schools, in two cities in Finland.

Subjects. A total of 1429 adolescents with no serious disease or injury during the previous 12 months.

Results. Frequent or rather frequent occurrence of two or more symptoms was reported by 44% of the female students and 28% of the male students during the past 6 months. Regression analyses showed that among female students, somatic symptoms were associated positively with serious illness or injury in the family, an increased number of arguments between parents, and breaking up with boyfriends or girlfriends; among male students, symptoms were associated with an increased absence of a parent from the home and trouble with siblings; and among both sexes, they were associated with failing examinations. Among male students, changing to new schools was associated with fewer symptoms. Symptom scores associated positively with trait anxiety, trait depression, an immature defense style, and alcohol or drug use among both sexes. Among male students, smoking was associated with more symptoms, and among female students, high self-esteem was associated with fewer symptoms.

Conclusions. These findings suggest that mental health risk factors are strong correlates of somatic symptoms among adolescents with no serious disease. Follow-up studies are needed to clarify the predictive value of these factors.
THALIDOMIDE MAKES A COMEBACK
Authors: L. J. F.
Published: December 2021

Thalidomide, the drug responsible for the deformities of thousands of babies born in the 1950s, appears to be making a comeback. Scientists have recently reported that the sedative, once widely prescribed in Europe for morning sickness but long since banned for such use, may inhibit the AIDS virus as well as alleviate certain symptoms associated with tuberculosis and cancer.

The first American patent for thalidomide was issued in 1958, but last week Gilla Kaplan, an associate professor of immunology at Rockefeller University who pioneered the new thalidomide research, received a patent covering new potential applications for the drug.

"Thalidomide is really the treatment of choice for leprosy," she said. "It alleviates the weight loss and fevers. I figured if I knew how thalidomide worked I would understand what is causing the symptoms."

"... thalidomide slows the body's production of a substance known as tumor necrosis factor alpha, a protein that at normal levels actually helps combat infection and malignant cells. But high concentrations of the protein appear to result in fever, weight loss, and other symptoms in patients with cancer, tuberculosis, and AIDS.
Independent Parental Administration of Prednisone in Acute Asthma: A Double-Blind, Placebo-Controlled, Crossover Study
Authors: Grant Cameron C. , Duggan Anne K. , DeAngelis Catherine
Published: December 2021

Objective. To determine the effectiveness of a single dose of prednisone administered by a parent to a child early in an asthma attack.

Design. A randomized, double-blind, placebo-controlled, crossover study with children enrolled for 12 months (6 months prednisone, 6 months placebo).

Setting. A primary-care clinic and emergency department of an inner-city teaching hospital from March 1992 through May 1993.

Children. Children 2 to 14 years of age enrolled in this clinic who had made two or more outpatient (emergency department or primary-care clinic) visits for acute asthma in the preceding year.

Selection. There were 204 eligible children, of whom 86 were contacted and enrolled; of these, 78 (91%) completed the study.

Intervention. Capsules containing prednisone (2 mg/kg up to 60 mg) or placebo. Parents were instructed to give their child one capsule for an asthma attack that had not improved after a dose of the child's regular acute asthma medicine.

Measurements. Parents were interviewed every 3 months. Computerized patient records and chart reviews were used to verify parent reports. Outcome measures were the numbers of outpatient visits and hospitalizations for treatment of acute asthma.

Results. Neither the total number of attacks nor the number for which medicine was used differed significantly by arm of study. There was a larger number of attacks resulting in outpatient visits when children were in the group that received prednisone (1.1 ± 0.59 versus 0.59 ± 0.86). This trend was less pronounced but persisted when limited to attacks for which the medicine was given (0.58 ± 0.99 versus 0.35 ± 0.55). Neither the number of attacks resulting in admission nor the number of hospital days differed significantly by arm of study.

Conclusions. A single dose of prednisone available for use at home early in an asthma attack was associated with an increase in outpatient visits made for acute asthma. When prednisone was given for an attack, there was no reduction in outpatient visits. This intervention can not be recommended for children with asthma. These results should be confirmed in other pediatric populations.
The Cost of Implementation of the Clinical Laboratory Improvement Amendments of 1988—The Example of Pediatric Office-Based Cholesterol Screening
Authors: Tershakovec Andrew M. , Brannon S. Diane , Bennett Michael J. , Shannon Barbara M.
Published: December 2021

Objective. To measure the additional costs of office-based laboratory testing due to the implementation of the Clinical Laboratory Improvement Amendments of 1988 (CLIA '88), using cholesterol screening for children as an example.

Methods. Four-to ten-year-old children who received their well child care at one of seven participating pediatric practices were screened for hypercholesterolemia. The average number of analyses per day and days per month were derived from the volume of testing completed by the practices. Nurses and technicians time in the screening process were measured and personnel costs were calculated based on salary and fringe benefit rates. Costs of supplies, analyzing control samples, instrument calibration, and instrument depreciation were included. Costs estimates of screening were then completed. CLIA '88 implementation costs were derived from appropriate proficiency testing and laboratory inspection programs.

Results. In six practices completing a low volume of testing, 2807 children (5 to 6 children per week) were screened during the observation period, while 414 (about 25 children per week) were screened in one high-volume practice implementing universal screening over a 4-month period. For the six low-volume practices, the cost of screening was $10.60 per child. This decreased to $5.47 for the high-volume practice. Estimated costs of CLIA '88 implementation, including additional proficiency testing and laboratory inspection, added $3.20 per test for the low-volume practices, and $0.71 per test for the high-volume testing.

Conclusions. Implementation of CLIA adds significantly to the cost of office-based chemistry laboratory screening. Despite these additional expenses, the cost of testing is still within a reasonable charge for laboratory testing, and is highly sensitive to the volume of tests completed.
Neurologic Manifestations of In Utero Cocaine Exposure in Near-Term and Term Infants
Authors: King Terri A. , Perlman Jeffrey M. , Laptook Abbot R. , Rollins Nancy , Jackson Gregory , Little Bertis
Published: December 2021

Objective. To determine whether the incidence of neurosonographic and neurologic abnormalities is higher in cocaine-exposed infants at birth.

Methods. In utero exposure to cocaine was investigated in 39 term and near-term infants with positive urine screens for cocaine only and 39 matched control infants without drug exposure admitted to the regular term newborn nursery. Serial evaluations were performed on each infant on postnatal days 1 and 2 and included a cranial sonogram, a neurologic and behavioral assessment for drug withdrawal, and Doppler interrogation of the anterior and middle cerebral arteries.

Results. There were no differences between groups in neurosonographic abnormalities. Grade I or II intraventricular hemorrhage occurred in 11% of cocaine-exposed and 11% of control infants. There were no cases of grade III intraventricular hemorrhage, cystic periventricular leukomalacia, or neonatal stroke. Head size was smaller in cocaine-exposed infants, ie, 32.7 ± 0.1 cm versus 33.8 ± 0.1 cm. The neurologic examination was similar between groups with regard to tone, reflexes, and cranial nerves. Behavioral scores were higher on both days, in cocaine-exposed versus control infants, ie, 4.4 ± 0.5 versus 2.7 ± 0.3 on day 1 and 5.0 ± 0.5 versus 1.71 ± 0.31 on day 2. Cerebral blood flow velocity measurements in the anterior cerebral artery were similar between groups on both days of examination. However, cocaine-exposed infants demonstrated a significant increase in flow velocity from day 1 to day 2, ie, 0.48 ± 0.03 to 0.57 ± 0.04. There was a concomitant decrease in the pulsatility index from day 1 to day 2 in the cocaine-exposed, ie, 0.74 ± 0.02 to 0.69 ± 0.02, but not in the control infants. No differences were noted in the flow velocities in the middle cerebral arteries between groups.

Conclusions. Term and near-term infants admitted to a regular nursery who are exposed to cocaine in utero: (1) do not exhibit an increased incidence of neurosonographic abnormalities; (2) do exhibit altered behavior consistent with drug withdrawal; and (3) do demonstrate changes in flow velocity in the anterior cerebral artery consistent with the vasoconstrictive effects of the drug. However, these changes were not accompanied by changes in the neurologic examination or altered care. The long-term neurodevelopmental implications of these subtle abnormalities in the neonatal period remain to be determined.
A UNIVERSITY AND FOUR SCIENTISTS MUST PAY FOR PILFERED WORK
Authors: L. J. F.
Published: December 2021

A Federal judge in Baltimore today ordered the University of Alabama and four of its scientists to pay the Government and a researcher a total of $1.9 million for stealing her work and using it as their own to obtain Federal grants.

The case, decided by a jury, was unusual because the researcher, Dr Pamela A. Berge, an epidemiologist who now works for Pfizer Inc, had gone to court under the Federal False Claims Act, a Civil War-era statute rarely used in cases involving scientific misconduct.

...Officials at Alabama, speaking for the university and the four scientists, said in a statement that the verdict was "not consistent with or supported by the evidence" and would likely be appealed.

The jury found that each of the scientists had individually committed malicious acts of fraud against Dr Berge by claiming her work as his own, by using it to gain grants, and by publishing it in a scientific journal without crediting her. The university was held liable for aiding the fraud. The jury said the Government had been harmed by the fraudulent claims in applications for grants.

The university was ordered to pay $1.66 million, of which Dr Berge's share would be $498 000 and the remainder the Federal Government's. The scientists—Drs Robert F. Pass, Sergio B. Stagno, Charles Alford, and Karen B. Fowler—were ordered to pay collectively $50 000 in compensatory damages to Dr Berge and $215 000 in punitive damages.
A Population-Based Study of Severe Firearm Injury Among Children and Youth
Authors: Zavoski Robert W. , Lapidus Garry D. , Lerer Trudy J. , Banco Leonard I.
Published: December 2021

Background. Firearm injuries are a major cause of pediatric mortality and morbidity in the United States. To date, population-based studies describe the epidemiology of firearm-related deaths; however, the patterns of severe, nonfatal pediatric firearm-related injuries are not as well defined.

Objectives. To determine the epidemiology of severe firearm-related deaths and injuries among a statewide population of children and youth ages birth to 19 years.

Methods. Demographic, geographic, and cost data were analyzed from Connecticut death certificates for 1988 through 1992 and hospital discharge data for 1986 through 1990 for firearm-related unintentional, self-inflicted, and assaultive injury among children and youth ages birth to 19 years.

Results. There were 219 firearm deaths: 68% homicides, 25% suicides, 6% unintentional, and 1% of undetermined intent, resulting in an annual age-specific death rate of 6.6 per 100 000 persons. There were 533 hospitalizations for gunshot wounds (16 per 100 000); 41% were assaults, 1% suicide attempts, 39% unintentional gunshot wounds, 1% legal interventions, and 18% of undetermined intent. More than 80% of deaths from gunshot wounds and hospitalizations occurred among 15- to 19-year-old males, most occurring in Connecticut's five largest cities. Most firearm homicides occurred among urban residents; most firearm suicides occurred among nonurban residents; and unintentional shootings were evenly distributed between urban and nonurban residents. The total cost of firearm-related hospitalizations averaged $864 000 per year.

Conclusions. Firearms are a major cause of mortality and morbidity of Connecticut children and youth, exceeded only by motor vehicles as a cause of death among those 1 to 19 years of age. Handguns were responsible for a disproportionate amount of trauma compared with other firearm types. The epidemiology of pediatric gunshot injuries requires a range of strategies for prevention. Physicians caring for families with children must include firearm injury prevention counseling as a routine part of anticipatory guidance.
The Hair Collar Sign: Marker for Cranial Dysraphism
Authors: Drolet Beth Ann , Clowry Lawrence , McTigue M. Kathleen , Esterly Nancy B.
Published: December 2021

Objective. To call attention to a cutaneous marker for neural tube closure defects of the scalp, the "hair collar" sign. This finding consists of a ring of long, dark, coarse hair surrounding a midline scalp nodule.

Methods and Results. Four children with small congenital scalp nodules and the hair collar sign were studied from the standpoint of clinical findings, radiologic scans, and histology of the excised nodules. All four had an overlying vascular stain in addition to the hair collar. Patients 1 and 2 were found to have encephaloceles, and one had heterotopic brain tissue. The fourth family refused surgery, but the clinical and radiologic findings were consistent with a diagnosis of atretic encephalocele. One infant had agenesis of the corpus callosum and a Dandy-Walker malformation as associated findings.

Conclusions. The "hair collar" sign should alert the pediatrician to the possibility of ectopic neural tissue in the scalp and/or underlying central nervous system malformations.
Disciplining Young Children: The Role of Verbal Instructions and Reasoning
Authors: Blum Nathan J. , Williams George E. , Friman Patrick C. , Christophersen Edward R.
Published: December 2021

Pediatricians are often asked to advise parents who are having difficulty managing the oppositional behaviors of their toddlers and preschool-age children. A large number of articles provide advice to pediatricians and parents on effective disciplinary strategies. However, despite the fact that verbal explanations, reasoning, and instructions are commonly used by parents, few articles directly address the use of these strategies to affect children's behavior.

In this paper, we review studies that explicitly investigate the ability of adults' verbal explanations or instructions to alter the behavior of young children. These studies suggest that under most circumstances, verbal explanations and instructions are not effective in changing young children's problem behaviors. We then discuss how theories in developmental and behavioral psychology help explain the limitations of using verbal reasoning and instructions to change young children's problem behaviors. Finally, we provide some recommendations for parents on the use of verbal explanations and instructions in disciplining young children.
CHARACTERIZATION OF CAT DANDER-SPECIFIC T LYMPHOCYTES FROM ATOPIC PATIENTS
Authors: Hopp Russell J.
Published: December 2021

Cat dander is well recognized by T cells from patients who are cat-allergic. I cells recognize multiple cat dander proteins. These I cells rapidly produce cytokines (ie, IL-4) to turn on IgE production.
MILESTONES MARKING THE KNOWLEDGE OF ADVERSE REACTIONS TO FOOD IN THE DECADE OF THE 1980s
Authors: Miller Betty
Published: December 2021

Purpose of the Study. This study outlines the significant advances made to our understanding of adverse reactions to foods and food additives in the last decade.

The milestones are listed in order of overall importance and are discussed in depth in the review.

1. Establishing double-blind, placebo-controlled food challenge (DBPCFC) as the "gold-standard" for defining specific patient population to be used in scientific studies. (VanMetre, May, Bock)

2. Recognition of the key role food allergy plays in the pathogenesis of atopic dermatitis. (Sampson, May)

3. Identifying the group of foods most likely to be associated with true allergic reactions.

Analysis of DBPCFC in children has shown that 93% of allergic reactions occurred to eight foods (in order of frequency): egg, peanut, milk, soy, tree nuts, crustacean-type shellfish, fish, and wheat. Corn and chocolate allergy was rarely found. (Bock, Sampson, Atkins)

4. Food allergy has a natural history.

In a prospective study of 501 children, Bock found that, of 15 cases of allergy proven by DBPCFC in the first year of life, none of the 15 cases was reactive beyond 24 months of age. In contrast, long-term follow-up of patients who have experienced peanut anaphylaxis revealed that clinical sensitivity lasts for at least 14 years. (Bock, Atkins)

5. Food allergy cross-sensitivity (clinical reactivity) does not extend equally to all members of a biologic food family.

Although immunologic cross-reactivity between peanut, soy, and other peas/beans could be regularly found in allergic patients, clinically important cross-reactions demonstrated by DBPCFC were rare. (Bernhisel -Broadbent, Sampson)
RISK FACTORS FOR THE PERSISTENCE OF RESPIRATORY SYMPTOMS IN CHILDHOOD ASTHMA
Authors: Greos Leon S.
Published: December 2021

Respiratory symptoms persisted or recurred during young adulthood in a majority of childhood asthmatics with moderate to severe disease. The prognosis for females with childhood asthma is worse than for males.
AN ESTIMATE OF THE PREVALENCE OF ASTHMA AND WHEEZING AMONG INNER-CITY CHILDREN
Authors: Furukawa Clifton T. , Kinberg Kirk A.
Published: December 2021

The prevalence of asthma among innercity children may be substantially higher than has been appreciated. This may imply that in this population a large number of children with asthma may be inadequately diagnosed and treated.
REDUCTION OF MORBIDITY IN ASTHMATIC CHILDREN GIVEN A SPACER DEVICE
Authors: Cvietusa Peter
Published: December 2021

Introducing a spacer device to patients in a busy, inner-city pediatric emergency department is an effective and efficient intervention that improves the function of asthmatic children by shortening the time to resolution of cough and wheeze, and by reducing school absenteeism.
SALMETEROL XINAFOATE AS MAINTENANCE THERAPY COMPARED WITH ALBUTEROL IN PATIENTS WITH ASTHMA
Authors: Oro Amy , Goldsobel Alan
Published: December 2021

The use of salmeterol inhaled twice daily compared with either placebo or albuterol gave significant increases in morning and evening peak flow as well as sustained increases in FEV1, and reduced asthma symptoms throughout the day and night. Responses were similar at day 1 and week 12 and no deterioration of asthma control was observed within the study period.
THE EFFECT OF INHIBITION OF 5-LIPOXYGENASE BY ZILEUTON IN MILD TO MODERATE ASTHMA
Authors: Landwehr Lawrence P. , Spahn Joseph D.
Published: December 2021

Zileuton, a drug that inhibits the action of 5-lipoxygenase can decrease symptoms, bronchodilator use, and improve airway function in patients with mild to moderate asthma. Dosing regimens associated with greater inhibition of leukotriene production were also associated with greater improvement (ie, 600 mg four times a day or 2.4g/day). These findings support the role of leukotrienes in the pathogenesis of asthma and suggest that agents modulating their formation or activity may be of therapeuutic benefit in mild to moderate asthma.
IDENTIFICATION OF HERPESVIRUS-LIKE DNA SEQUENCES IN AIDS-ASSOCIATED KAPOSI'S SARCOMA
Authors: Dreyfus David H. , Liu Andrew H.
Published: December 2021

The authors propose that this evidence supports the role of a previously unknown herpesvirus as an infectious agent associated with KS.
SENSITIVE DETECTION AND EARLY PROGNOSTIC SIGNIFICANCE OF p24 ANTIGEN IN HEAT-DENATURED PLASMA OF HUMAN IMMUNODEFICIENCY VIRUS TYPE 1-INFECTED INFANTS
Authors: Cotton Mark E.
Published: December 2021

Purpose of Study. To investigate the effect of heat-dissociated release of complexed antigen on the sensitivity of commercial p24 antigen assays, to compare it with polymerase chain reaction (PCR) and viral culture, and to examine its prognostic utility in HIV-1 infected infants. Acid-mediated release of antigen from immune complexes is inefficient in the presence of high titers of antibody to p24 antigen.

Study Population. Six hundred ninety banked serum or plasma samples from 305 patients of a cohort were studied (median age, 11 months), including 142 samples from 53 infected patients. In addition, 113 samples from cohort children were analyzed prospectively.

Methods. Standard commercial p24 enzyme immuno-assay (EIA) with and without heat dissociation of serum prior to assay. Positive results were subjected to confirmatory neutralization. PCR and culture were performed by standard techniques.

Results. In the retrospective cohort study, the specificity of heat dissociation was 96.9% in 390 uninfected samples after initial testing and 100% after neutralization. Sensitivity among 125 postnatal infected samples was, at a detection level of 2 pg/mL, 96% (97% neutralizable) compared with 47.7% for nonheat-dissociated antigen (76% neutalizable), 96% for PCR, and 77% for viral culture. These results were confirmed in the prospective study. Symptomatic children had heat-dissociated p24 antigen levels twice that of asymptomatic patients, most noticeable in the first 2 years of life (P = .004). Four of five patients with a heat-dissociated p24 assay absorbance greater than 0.9 in the first 6 months of life died (range, 5 to 18 months of age), while only four of 15 with lower absorbance within the first 6 months died (range, 5 to 26 months), suggesting a prognostic use for this test.
CYSTIC FIBROSIS HETEROZYGOTE RESISTANCE TO CHOLERA TOXIN IN THE CYSTIC FIBROSIS MOUSE MODEL
Authors: Dreyfus David H. , Liu Andrew H.
Published: December 2021

The authors propose that the widespread distribution of cystic fibrosis may reflect an underlying benefit to heterozygous individuals for CFTR mutations via increased resistance to secretory diarrhea. Ironically, in the homozygous state, CFTR disfunction leads to increased infection with a variety of respiratory and other pathogens, thus negating any benefit to human homozygotes.
Perinatal Regionalization Versus Hospital Competition: The Hartford Example
Authors: Richardson Douglas K. , Reed Kate , Cutler J. Christopher , Boardman Robert C. , Goodman Karen , Moynihan Timothy , Driscoll Jane , Raye John R.
Published: December 2021

Objectives. The increasingly competitive health care environment may undermine effective traditional regional organizations. It is urgent to document the benefits of perinatal regionalization for the emerging health care system. We present a case study that illustrates many of the challenges to and benefits of perinatal regionalization in the 1990s.

Background. The controversy in Hartford was sparked by a proposed merger of two major pediatric services into a full-service children's hospital. Community hospitals reacted with plans to upgrade their obstetrics/neonatal facilities toward level II (intermediate) or II+ (intensive) neonatal intensive care units (NICUs). The fear that unrestricted competition would drive up overall health care costs prompted the hospital association and Chamber of Commerce to retain consultants to evaluate the number and location of regional NICU beds.

Methods. The consultant team interviewed stake-holders in area hospitals, health maintenance organizations, insurance companies, businesses, state agencies, and community groups, and analyzed quantitative data on newborn discharges.

Results. The existing system worked remarkably well for clinical care, training, referrals, and provider and patient satisfaction. There was a high level of inter-hospital collaboration and regional leadership in obstetrics and pediatrics, but strong and growing competition between their hospitals. Hospital administrators enumerated the competitive threats that obligated them to compete and the financial disincentives to support the regional structures. Business leaders and insurance executives emphasized the need to control costs. Analysis of discharge data showed marginal adequacy of NICU beds but maldistribution between NICUs, particularly between level III and level II units. The consultants recommended no new beds based on population projections, declining lengths of stay nationally, and substantial gains available from aggressive back-transport of convalescing infants. The consultants emphasized the need for all stakeholders to support the regional infrastructure (referral, transport, education, evaluation, quality assurance) and to modify competition when it impaired effective regionalization.

Conclusions. Regionalization permits better care at lower cost, yet competition may disrupt this effective system. Active cooperation by stakeholders is vital. Substantial new research is required to define optimal regional organization.
Nucleated Erythrocytes and Intraventricular Hemorrhage in Preterm Neonates
Authors: Green, David W. , Hendon Barbara , Mimouni Francis B.
Published: December 2021

Objectives. Increased circulating nucleated erythrocytes (NRBCs) in the newborn period can be markers of chronic fetal hypoxia, which in turn may be a risk factor for intracranial hemorrhage (IVH). To evaluate the relation between chronic intrauterine hypoxia and IVH, we compared the courses of the absolute NRBC (ANRBC) count in preterm newborns with and without intracranial hemorrhage.

Methods. We measured ANRBC counts in the first 6 days of life in appropriate for gestational age newborns at 32 weeks' gestation or earlier with (n = 46) and without (n = 103) IVH, who were not at risk for altered erythropoiesis.

Results. The ANRBC counts at birth were higher in infants who developed severe IVH than in control infants without IVH (P < .03). The ANRBC counts peaked on day 2 or 3 in newborns with IVH, but declined continuously from a peak on day 1 in the control group. Stepwise regression analysis of multiple variables revealed that the grade of IVH had the greatest impact on ANRBC counts. An ANRBC count of at least 2.0 x 109/L on day 1 of life had a sensitivity of 63% and a specificity of 79% in predicting grade III or IV IVH.

Conclusion. An elevated or increasing ANRBC count in a preterm newborn is a potential marker for an impending or present severe IVH, respectively, and may reflect a state of altered prenatal or postnatal erythropoiesis.
Guidelines for Pediatric Emergency Care Facilities
Authors:   Committee on Pediatric Emergency Medicine
Published: December 2021

This Policy Statement was retired January 2004.

Emergency care for life-threatening pediatric illness and injury requires specialized resources including equipment, drugs, trained personnel, and facilities. The American Medical Association Commission on Emergency Medical Services has provided guidelines for the categorization of hospital pediatric emergency facilities that have been endorsed by the American Academy of Pediatrics (AAP).1 This document was used as the basis for these revised guidelines, which define:

1. The desirable characteristics of a system of Emergency Medical Services for Children (EMSC) that may help achieve a reduction in mortality and morbidity, including long-term disability.

2. The role of health care facilities in identifying and organizing the resources necessary to provide the best possible pediatric emergency care within a region.

3. An integrated system of facilities that provides timely access and appropriate levels of care for all critically ill or injured children.

4. The responsibility of the health cane facility for support of medical control of pre-hospital activities and the pediatric emergency care and education of pre-hospital providers, nurses, and physicians.

5. The role of pediatric centers in providing outreach education and consultation to community facilities.

6. The role of health cane facilities for maintaining communication with the medical home of the patient.

Children have their emergency care needs met in a variety of settings, from small community hospitals to large medical centers. Resources available to these health care sites vary, and they may not always have the necessary equipment, supplies, and trained personnel required to meet the special needs of pediatric patients during emergency situations.
Behavioral and Cognitive Effects of Anticonvulsant Therapy
Authors:   Committee on Drugs
Published: December 2021

In 1985, the Committee on Drugs reviewed evidence, primarily from adult studies, indicating that anticonvulsant therapy may have detrimental effects on behavior and cognition.1 It was recommended that pediatricians judiciously review indications for the use of antiepileptic medications, weigh the efficacy versus the side effects of specific drugs, and be alert to reported changes in patient behavior, mood, or cognitive function. Furthermore, the Committee noted the need for the development of brief neuro-psychologic screening tests to identify subtle intellectual and behavioral side effects as well as the need for the delineation of behavioral and cognitive effects of specific antiepileptic medications in children.

This commentary presents an overview of current pediatric studies of antiepileptic drugs and cognitive/behavioral function.

Behavioral Effects

Behavioral disturbances, reported in 20% to 30% of children with epilepsy,2 are frequently unrelated to the anticonvulsant drug regimen, but may result from disordered cerebral function or occur as a secondary reaction to the illness.3 Some children with seizures differ behaviorally from healthy controls both before the initiation of treatment and after its cessation. Behavioral differences are most prominent with absence and partial seizures.4

The most comprehensive incidence data on the behavioral side effects of antiepileptic drugs derive from a study of 392 children receiving long-term monotherapy with phenobarbital, primidone, phenytoin, carbamazepine, on valprnoate for treatment of epilepsy on febrile convulsions.5 As shown in the Table, behavioral effects were most commonly reported in patients treated with phenobarbital, and were relatively uncommon in children treated with primidone, phenytoin, on valproate. Drowsiness and longer sleep were associated with higher plasma levels of phenobarbital, whereas signs of excitation tended to occur at lower dosages and resolved when higher on stable plasma levels were achieved.
Cow's Milk and the Diabetes Debate
Authors: Elliott Robert B.
Published: December 2021

I write to you concerning the recommendations from a special advisory group of the American Academy of Pediatrics (Pediatrics. 1994;94:752-754). These recommendations concern infant feeding practices and the risk of subsequent type I diabetes.

The wording of these recommendations may be misunderstood by practicing pediatricians. At the moment, the epidemiologic and animal experimental data provide reasonable grounds for suspicion that some cow's milk components may be diabetogenic at least in some individuals, but this suspicion has not been subjected to scientific confirmation as of yet.
Concern About Guidelines
Authors: Lallier Chuck
Published: December 2021

I enjoyed reading Dr Paul Young's article "The Management of Febrile Infants by Primary-Care Pediatricians in Utah: Comparison With Published Practice Guidelines" in the May 1995 issue of Pediatrics.

It seems we, as general pediatricians, are barraged with an increasing number of "guidelines" for the management of everything from fever to hyperbilirubinemia. These guidelines are very useful in helping one think of diagnostic/treatment options, but need to leave a lot of room for variation with the individual patient.
Letters to the Editor
Authors: Kohl Steve
Published: December 2021

Dr Stein raises several important concerns about the varicella vaccine. It is true that varicella virus vaccine must be kept frozen at an average temperature of 5°F (-15°C), as per the vaccine package information. It is also recommended that the vaccine be discarded if not used within 30 minutes of reconstitution. Never-theless, it has been demonstrated that even if vaccine is left at room temperature (25-30° C) for 6 hours, the viral titer only falls from 1770 plaque-forming units (PFU) to 400 to 500 PFU.1
Simultaneous Administration of Haemophilus influenzae Type b Vaccine With Acellular or Whole-Cell Pertussis Vaccine: Effects on Reactogenicity and Immune Responses to Pertussis Vaccines
Authors: Rennels Margaret B. , Reed George F. , Decker Michael D. , Edwards Kathryn M. , Pichichero Michael E. , Deloria Maria A. , Englund Janet A. , Anderson Edwin L. , Steinhoff Mark C. , Deforest Adamadia , Meade Bruce D.
Published: December 2021

Objective. To evaluate the effect of simultaneous Haemophilus influenzae type b conjugate (Hib) vaccination on the safety and immunogenicity of selected acellular (DTaP) and whole-cell (DTP) pertussis vaccines with diphtheria and tetanus toxoids combined.

Methods. Enrollment of infants into a large multicenter study of the safety and immunogenicity of 13 DTaP and 2 DTP vaccines was partially completed when the first Hib vaccine, HbOC (Haemophilus b oligosaccharide conjugate vaccine), was licensed for use in infants. Thereafter, at each immunization most infants received HbOC simultaneously with DTaP (or DTP), administered in opposite thighs. Postvaccination geometric mean titers or concentrations (GMTs) of pertussis antibodies as measured by six different assays were compared pairwise among groups of infants receiving 0, 1, 2, or 3 simultaneous HbOC immunizations. The incidence of reactions was compared between infants who received only DTaP or DTP and those who received HbOC simultaneously.

Results. Comparison of postvaccination GMTs was possible among groups of infants receiving different numbers of simultaneous immunizations for 10 of the 13 DTaP and both DTP vaccines. Increased HbOC exposure had no consistent dose-response effect on antibody titers for DTaP or DTP vaccines in any assay. Significant diferences between groups in postvaccination GMTs were observed with 4 DTaP vaccines in 1 to 2 assays each; the GMTs were higher with increasing HbOC exposure for 2 DTaP vaccines and lower for 2 others. There was no significant increase in reactions with simultaneous HbOC and DTaP immunization.

Conclusions. Based on these retrospective analyses, there did not seem to be an interference in pertussis immunogenicity or alteration in reactogenicity associated with the simultaneous administration of HbOC and DTaP. These findings are encouraging with respect to the development of DTaP-Hib combination vaccines.
Association of Reactions After Consecutive Acellular or Whole-Cell Pertussis Vaccine Immunizations
Authors: Deloria Maria A. , Blackwelder William C. , Decker Michael D. , Englund Janet A. , Steinhoff Mark C. , Pichichero Michael E. , Rennels Margaret B. , Anderson Edwin L. , Edwards Kathryn M.
Published: December 2021

Objective. To evaluate the relative frequency of adverse reactions after initial and subsequent immunizations among infants receiving primary immunization with acellular (DTaP) or whole-cell (DTP) pertussis vaccine with diphtheria and tetanus combined.

Methods. We examined the occurrence of common reactions in 2127 infants within 48 hours after immunization at 2, 4, and 6 months with one of 13 DTaP or with Lederle DTP (WCL). Data on at least two consecutive immunizations were available for 357 WCL recipients and 1770 DTaP recipients. For these analyses, reactions evaluated included fever of 100.4°F (38°C) or greater, redness of 21 mm or larger, swelling of 21 mm or larger, moderate or severe pain, moderate or severe fussiness, loss of appetite, drowsiness, and vomiting.

Results. With one exception, reactions were approximately 1.5 to 8 times more likely to occur in WCL recipients if the same reaction had been observed at the previous immunization (the single exception was redness after the second immunization). Both initial and repeated reactions were less likely in DTaP than in WCL recipients. As with WCL recipients, risks of repeated reactions in DTaP recipients were higher than the risks of initial reactions (from 2.5 to 24 times as high).

Conclusion. Reactions after a second or third immunization with either WCL or DTaP vaccine are more likely to occur in infants who had the same reaction after the preceding immunization. Absolute risks of repeated reactions tended to be lower after DTaP vaccine than after the WCL vaccine.