bluuebunny/crossref_metadata_2025 huggingface dataset:
Lumbar Cerebrospinal Fluid Opening Pressure Measured in a Flexed Lateral Decubitus Position in Children
Authors: Ellis Robert
Published: December 2021

Objective. Lumbar punctures in children are generally performed in a flexed position. Published normal ranges for cerebrospinal fluid (CSF) opening pressure require measurement in an extended position, and flexion is known to increase lumbar CSF pressure. This study sought to determine a normal range (mean ± 2 SD) for lumbar CSF opening pressure measured in a flexed lateral decubitus position in children.

Methods. Opening pressure was measured in 33 children receiving diagnostic lumbar punctures or prophylactic intrathecal chemotherapy. Measurements were performed in a flexed lateral decubitus position. Patients with medical conditions affecting CSF pressure were excluded.

Results. Opening pressure (mean ± SD) was 19.0 ± 4.4 cm H2O. Opening pressure was not significantly affected by patient age or sex. Intrathecal chemotherapy and sedation also did not affect CSF pressure.

Conclusions. The normal range for lumbar CSF opening pressure measured in a flexed lateral decubitus position in children is 10 to 28 cm H2O.
Letter to the Editor
Authors: Scarfone Richard J.
Published: December 2021

We appreciate the comments of Drs Perry and Allison. As they pointed out, the oral administration of prednisone, unlike corticosteroids given intramuscularly or intravenously, is not likely to exacerbate the respiratory distress and hypoxemia of an acutely wheezing child. We would like to emphasize that corticosteroids, regardless of the route of administration, have a delayed onset of action in acute asthma. In our study, had decisions regarding hospitalization been made after 2 hours of care, the hospitalization rates of the prednisone and placebo groups would have been about the same.
MIXED MESSAGE FROM CANADA
Authors: L. J. F.
Published: December 2021

Fewer doctors in Canada eye greener pastures, says a survey by Medical Post, a trade magazine. Some 45% "seriously" consider leaving Canada, compared with 49% in a 1979 survey. The U.S. is the most likely relocation choice, though 64% believe that Canada's government-run health system offers a better working climate than the U.S. and 87% think that patients get better care in Canada.
Rural-Urban Blood Lead Differences in North Carolina Children
Authors: Norman Edward H. , Bordley W. Clayton , Hertz-Picciotto Irva , Newton Dale A.
Published: December 2021

Objective. To examine the prevalence of and risk factors for having a blood lead elevation among young children in a predominantly rural state.

Methods. 20 720 North Carolina children at least 6 months and <6 years of age were screened between November 1, 1992 and April 30, 1993 using either capillary or venous measurements of blood lead. Children were tested through routine screening programs that target low-income families and, hence, were not randomly selected. Eighty-one percent of the children were screened through local public health departments, and 19% were tested at private clinics.

Results. The estimated prevalences of having an elevated blood lead level among those tested were: 20.2% (≥10 µg/dL), 3.2% (≥15 µg/dL), and 1.1% (≥20 µdL). Black children were at substantially increased risk of having a blood lead ≥15 µ/dL (odds ratio (OR) 2.1, 95% confidence interval (CI) 1.7 to 2.5). Children aged 2 years old had an elevated risk (OR = 1.4, 95% CI 1.1 to 1.7) compared to 1-year-olds, and males were at slightly increased risk (OR = 1.2, 95% CI = 1.0 to 14). Living in a rural county was nearly as strong a risk factor as race (OR = 1.9, 95% CI = 1.6 to 24). The effect of rural residence was even greater among certain subgroups of children already at highest risk of having an elevated blood lead. The type of clinic (public vs private) where a child was screened was not associated with blood lead outcome. These same trends were seen for children with blood lead levels ≥20 µ/dL.

Conclusions. Among children screened from rural communities, the prevalence of elevated blood lead is surprisingly high. Though few physicians have embraced universal lead screening, these data support the need for greater awareness of lead exposure in children living outside of inner-cities.
Risk Factors for Delayed Immunization Against Measles, Mumps, and Rubella in Colorado Two-Year-Olds
Authors: Miller Lisa A. , Barón Anna E. , Marine William M. , Hoffman Richard E. , Melinkovich Paul
Published: December 2021

Objectives. 1) To examine a wide range of potential risk factors for delayed childhood immunization against measles, mumps, and rubella and 2) to determine the parental response to proposed solutions regarding the problem of delayed childhood immunization.

Design. A case-control study in which subjects had (controls) or had not (cases) received measles, mumps, and rubella vaccine (MMR) by 2 years of age. Parents of subjects were also surveyed to find out whether they thought selected proposals to improve immunization rates would be successful.

Results. Maternal education of high school or less at the time of the child's birth, more than or equal to two moves between birth and age 2, maternal age <21 years of age at the time of the child's birth, more than or equal to two older siblings, participation in The Special Supplemental Food Program for Women, Infants, and Children (WIC), participation in the federal food stamp program, and incorrect knowledge of the recommended age for MMR significantly elevated the odds ratio (OR) for delayed immunization. At least two older siblings (OR = 3.2), maternal age <21 years of age at the time of the child's birth (OR = 2.8), and incorrect knowledge of the recommended age for MMR (OR = 2.7) remained significant risk factors in a multivariate logistic regression model. Insurance status and cost factors were not significant risk factors for delayed immunization. Parents thought that reminders for immunizations and a central record system would have made obtaining immunizations easier.

Conclusions. Based on our findings of the importance of immunization knowledge and demographic characteristics as risk factors for delayed immunization, we suggest that a message (the recommended age for immunizations) and a target group for that message (families who move frequently, have older children, and are headed by younger parents) be evaluated as an intervention to improve immunization rates.
Universal Hepatitis B Immunization: The Dose of HBIg That Should Be Administered at Birth
Authors: Vegnente Angela , Iorio Raffaele , de Rosa Elena
Published: December 2021

In the article entitled "Universal Hepatitis B Immunization" (Pediatrics 1992;89:795-800) it is confirmed that perinatal transmission of hepatitis B virus (HBV) infection from hepatitis B surface antigen (HBsAg)-positive carrier mothers to their infants may be efficaciously prevented by combined passive-active immunization, the efficacy of which has been previously well-documented.1,2 In that report the Committee on Infectious Diseases recommends, in particular, that infants born to HBsAg-positive mothers should receive the dose of 0.5 mL of hepatitis B immunoglobulin (HBIg) at or shortly after birth.
PHARMACOKINETICS OF PREDNISOLONE TRANSFER TO BREAST MILK
Authors: Kamada Alan
Published: December 2021

Because of the low amounts of pred- nisolone recovered from breast milk, it is concluded that administration of prednisolone to nursing mothers does not appear to poise a clinically significant risk to breast-fed infants. It is also suggested that infant exposure to prednisolone through breast milk can be minimized by dosing prednisolone at infrequent intervals and avoiding nursing for at least 4 hours following a dose.
Sedation Protocols—Why So Many Variations?
Authors: Coté Charles J.
Published: December 2021

The Committee on Drugs (COD) of the American Academy of Pediatrics (AAP), along with its many consultants, has spent considerable time addressing the difficult issue of appropriate care for sedated pediatric patients. The Committee's concern has been the continued appearance of reports, nearly always from nonmedical journal sources ("word of mouth", newspapers), of children suffering adverse events (morbidity and mortality) after sedation for procedares that in themselves should not result in any such complications, eg, radiologic investigations.1-4

The original "Guidelines for the Elective Use of Conscious Sedation, Deep Sedation, and General Anesthesia in Pediatric Patients" were published in 1985.5 These were constructed because of concern regarding a number of deaths that occurred in the dental office.6
Challenges to Implementing the Current Pediatric Cholesterol Screening Guidelines Into Practice
Authors: Dennison Barbara A. , Jenkins Paul L. , Pearson Thomas A.
Published: December 2021

Objective. The Expert Panel on Blood Cholesterol Levels in Children and Adolescents of the National Cholesterol Education Program (NCEP) recommends selective screening of children for high blood cholesterol. We determined the number of children, who, according to the guidelines, should be targeted for cholesterol screening.

Design. Population survey.

Setting. Permanent household residents in Otsego County, NY.

Participants. Total population-based sample of 17 444 households (86.6% response rate) including 44 565 participants, of whom 10 457 were children, aged 2 through 19 years.

Main outcome measures. Percent of children qualifying for cholesterol screening under the NCEP Children's Panel guidelines.

Results. Children from two-parent families were more likely to have known family history of coronary heart disease (CHD) before 60 years of age (41.8% vs 25.8%, P < .001), and twice as likely as children from single-parent families to have known parental hypercholesterolemia (18.8% vs 9.5%, P < .001). Only 39% of parents reported having had their cholesterol level checked; they were better educated and more likely to have health insurance. Parents with a first-degree relative with CHD before 60 years of age were more likely to report having their cholesterol level checked and to report a high cholesterol level. We calculated that 27% of children (18% of children from single-parent households and 29% of children from two-parent households) would report a known family history of premature CHD (ie, CHD before 55 years of age) and qualify for lipoprotein analysis, and that 11% of children would qualify for total cholesterol screening because of known parental hypercholesterolemia without a family history of premature CHD. Thirty-five percent of children had incomplete or unavailable family health history and/or unknown parental cholesterol status.

Conclusions. In this population, 38% of children would be targeted for cholesterol screening, exceeding the estimate of the NCEP Children and Adolescents Panel. The selection process, however, would tend to miss children from single-parent families, children with incomplete family health history, and children whose parents have not had their cholesterol levels measured. The currently recommended pediatric cholesterol screening policy needs to be evaluated further in additional communities and population settings. Alternative cholesterol screening strategies are needed when family health history is incomplete and/or parental cholesterol status is unknown.
UCONN DEVISES A POINT SYSTEM TO RATE PROFESSORS' PRODUCTIVITY
Authors: L. J. F.
Published: December 2021

STORRS, Conn., Jan. 9 (AP)—The University of Connecticut has devised a system that intends to measure how productive its professors are ...

The plan would give each academic department a set of scores. The departments would be scored on a scale of zero to five in each of 10 categories, including research productivity, service to the state, national reputation, undergraduate teaching and graduate teaching. Progress in the categories would be measured over several years against goals set by the professors themselves and would be taken into account in budget decisions...

Higher education experts said UConn's point system is part of a larger movement to make professors at public universities account for the hours they work and the research, teaching and service they perform.
Letter to the Editor
Authors: Blackman Paul H.
Published: December 2021

I was pleased to see your journal report that gun ownership levels appear to be highest where firearms abuse tends to be lowest,1 despite the authors' long-held beliefs that there was a direct relationship between firearms availability and firearms misuse. Having noted that, however, the hypothesized conclusions could best be described as puzzling. They concluded that "mothers who were single and had low social status . . . are particularly aware of the dangers of guns, and so choose not to arm themselves," thus showing that "awareness of gun risks . . . holds out the possibility that education of families attending [pediatric] practices will help to reduce in-home firearms exposure of children, adolescents, and their adults."
Meeting the Challenges of Vaccine-Preventable Diseases in Child Day Care
Authors: Cochi Stephen L. , Atkinson William L. , Dini Eugene F. , Adams William G. , Gershon Anne A.
Published: December 2021

Recent advances in the development of new and improved vaccines have resulted in both the prospect of additions to the list of vaccine-preventable childhood diseases and opportunities to more effectively prevent diseases that are already vaccine-preventable.1 The recently revised schedule of routine vaccinations for all children as recommended by the Advisory Committee on Immunization Practices (ACIP) of the US Public Health Service is shown in the Table. The challenges of applying these new or improved vaccines, in light of our current understanding of the epidemiology of the diseases and a more efficient monitoring system for ensuring age-appropriate vaccination, is to more effectively control vaccine-preventable diseases in child day-care settings.

BACKGROUND

The nation experienced a marked increase in measles cases during 1989 and 1990. From 1980 to 1988, a median of 3124 measles cases was reported annually. During 1989 to 1991, a major resurgence of measles occurred, with a total of 55 622 cases reported during this period.

The resurgence of measles was associated with a change in the epidemiology of reported cases. From 1980 to 1988, a median of 29% of cases occurred among children under 5 years of age.2 However, during 1989-1991, preschool-age children accounted for 37% to 49% of all reported cases.2,3 Many of these cases were reported from areas with large outbreaks of measles among predominantly unvaccinated black and Hispanic children living in large urban areas such as Los Angeles, New York City, Chicago, and Dallas. These cases among preschool-age children were associated with a large number of complications of measles.
Hepatitis Infections in the Day-Care Setting
Authors: Hurwitz Eugene S. , Deseda Carmen C. , Shapiro Craig N. , Nalin David R. , Freitg-Koontz M. Jayne , Hayashi Jun
Published: December 2021

The hepatitis session reviewed current knowledge of the epidemiology and public health importance of hepatitis A (HAV) and hepatitis B virus (HBV) in day care centers (DCCs), current recommendations and prevention measures, areas that need additional research, and the potential for new preventive measures.

HEPATITIS A

The clinical characteristics, modes of transmission, risk factors for day-care-related outbreaks, and characteristics of hepatitis A virus outbreaks have been well described previously.1 Within the day-care setting, HAV is transmitted via the fecal-oral route, either person to person (between children and staff); via contaminated food (often in association with individuals who prepare food and care for diapered children); or possibly via fomites on contaminated surfaces or toys. In young children, in contrast to adults, hepatitis A may be difficult to recognize, as clinical illness is frequently nonspecific and mild, consisting primarily of malaise, nausea, fever, and diarrhea. Fewer than 5% of children under 3 years of age and only about 10% of those 4 to 6 years of age develop jaundice and are thus easily recognized as having hepatitis. Consequently, recognition of hepatitis A outbreaks in the day-care setting is often dependent upon recognizing hepatitis A in adults (parents or staff) who have had contact with day-care centers (DCCs).

The initial recognition of DCCs as important sources of hepatitis A virus transmission both within the centers and in the communities they serve occurred in the mid-1970s.2,3 Early studies focused on describing the characteristics of DCCs in which hepatitis A outbreaks occurred, including DCCs with large numbers (≥50) of children in diapers and centers that are open more than 15 hours per day.2
Concurrent Session on Health Promotion: A Summary
Authors: Taras Howard L. , Trahms Cristine M. , Mangu Pamela B. , Wong Faye L.
Published: December 2021

Health promotion in child care encompasses components of environmental health and safety, individual and group preventive health practices, medical care, and health education. Child-care providers, children in child day care, and their families have all been appropriate targets for such efforts. It is not surprising, therefore, that goals for health promotion have been vast, complex, and difficult to reach. The purposes of this session are to outline specific and essential elements of health promotion in child day care and to identify realistic ways to make progress toward achieving them.

HEALTH EDUCATION AND CHILD DAY CARE

To achieve a healthier environment in child day care, it is essential to raise the sense of awareness about the importance of preventive health practices. This is important for child day-care providers, parents of children attending child care, and children. Packaged health curricula for preschool-age children and toddlers have been designed specifically for child day-care settings. Although their ability to improve child health practices is still under investigation, these curricula serve to intensify awareness among children and providers about the importance of safety and hygiene. Health education for preschoolers can also be taught more informally and without a set curriculum. Child day-care providers can add a health component to other activities during the day. A few extra words added to statements made to preschoolers can transform routine instructions into health-promotion messages. "Let's wash our hands before we eat, so that we don't eat the germs that are on our hands after playing outside" is an example.
Rey-Martinez Kangaroo Mother Program: An Alternative Way of Caring for Low Birth Weight Infants? One Year Mortality in a Two Cohort Study
Authors: Charpak Nathalie , Ruiz-Peláez Juan G. , Charpak Yves
Published: December 2021

Objectives. To assess the effectiveness and safety of the Kangaroo mother intervention (KMI).

Design. Observational, analytic, prospective (two cohorts) study.

Setting. Two large tertiary care obstetric hospitals, one offering "traditional" care and the other KMI.

Patients. Newborn infants with birth weights ≤ 2000 g, who survive the neonatal period and are eligible for an in-patient minimal care unit (MCU) (having overcome major adaptation problems to extra uterine life).

Interventions. "Kangaroo infants" (KI) were discharged as soon as they were eligible for MCU, regardless of weight or gestational age. Infants were kept 24 hours a day in an upright position, in skin-to-skin contact and firmly attached to the mother's chest until the KMI was not tolerated anymore. Control babies (from the other facility) were kept in incubators at the MCU until they satisfied usual discharge criteria for the control hospital. Both groups were followed periodically up to the age of 1 year.

Results. Three hundred thirty-two eligible infants were recruited, 162 at the Kangaroo hospital and 170 at the control hospital. KI came from a much lower socioeconomic class and were more ill before eligibility. Relative risk of death was higher for KI (RR 1.9), although this figure was reversed after adjusting for weight at birth and gestational age (RR 0.5). KI grew less in the first 3 months and had a higher proportion of developmental delay at 1 year, and a multivariate analysis failed to control for the large baseline differences in socioeconomic levels and babies' health status between the two cohorts.

Conclusions. In spite of major baseline differences between studied cohorts, the survival of LBW infants in Bogotá is similar between the KMI and the "traditional care". Questions remain about quality of life, especially regarding weight gain and neurodevelopment, that may be answered by a Randomized Controlled Trial.
Evaluating the Accuracy of Transcribed Computer-Stored Immunization Data
Authors: Wilton Richard , Pennisi Alfred J.
Published: December 2021

Objective. To evaluate the accuracy of immunization records transcribed into a computer-based immunization tracking system and to assess factors that contribute to inaccurate or incomplete immunization record keeping.

Design. Computer-stored immunization records were analyzed for 2098 children up to 2 years of age at the time of their most recent well-child visit to the UCLA Children's Health Center over a 12-month period. For children whose immunizations were not up to date, the computer-stored records were analyzed for sources of inaccuracy by comparison with the handwritten records from which the computer-stored data were transcribed.

Results. An underimmunization rate of 22.5% (472 of 2098) was observed based on analysis of the computer-stored records. Comparison of the computer-stored and handwritten records revealed an overall transcription error rate of at least 10.2%. In addition, 38.4% of these apparently underimmunized children had received unrecorded immunizations from providers outside UCLA. When transcription errors were corrected and other available sources of immunization data were taken into account, the estimated rate of underimmunization decreased from 22.5% to 10.9%.

Conclusion. Unavoidable inaccuracies can diminish the utility of the data recorded in an immunization tracking system. Some inaccuracies are related to the process of transcription, but failures to record and communicate immunization data consistently also contribute to the inaccuracy of computer-stored immunization records.
Letter to the Editor
Authors: Miller Anton R.
Published: December 2021

Drs Bess and Paradise are to be commended on their timely, intelligent, and well-informed response1 to the National Institutes of Health (NIH) Consensus Statement2 that advocates universal screening for infant hearing impairment. I share their concerns and have been arguing along similar lines since the release of the statement.

It is lamentable that so many of the recommendations we make as dinicians involved in the care and habilitation of children with permanently impaired hearing are based on theoretical assumptions, anecdotal evidence, and impressions informed by "clinical experience."
Clinical Features and Viral Excretion in An Infant with Primary Human Herpesvirus 7 Infection
Authors: Asano Yoshizo , Suga Sadao , Yoshikawa Tetsushi , Yazaki Takehiko , Uchikawa Takashi
Published: December 2021

Objective. To find clinical features of a virologically-confirmed patient with primary human herpesvirus 7 (HHV-7) infection and a relationship of the excretion of viruses between HHV-7 and human herpesvirus 6 (HHV-6).

Patient and Methods. A 13-month-old boy who had a known prior history of exanthem subitum at 6 months of age developed fever for 3 days and a skin rash appeared as the fever was resolving. The course was accompanying with nonspecific signs and symptoms such as anorexia, irritability, mild diarrhea, palpebral edema, mild inflammation of pharynx, and mild occipital and cervical lymphadenopathy. Heparinized blood samples were used for isolation of HHV-6 and HHV-7 and detection of both virus DNA sequences by a nested polymerase chain reaction (PCR) amplification. Samples from other body sites were also tested for their DNA sequences using the PCR. Both virus antibody activity was measured by an indirect immunofluorescent assay or a neutralization test.

Results. Cultured mononuclear cells from the patient at the acute stage of the disease produced morphologic changes, which reacted only with the monoclonal antibody to HHV-7 but not with the antibody to HHV-6. Both viruses were not isolated from blood obtained at the convalescent stage. An antibody response of the patient indicated a seroconversion to HHV-7 but not to other microbial agents including HHV-6 and Mycoplasma pneumoniae. Both virus DNA sequences were detected in peripheral blood mononuclear cells at acute and convalescent stages. HHV-7 DNA was excreted into saliva and transiently into stool at an early convalescent stage followed by HHV-6 excretion into saliva. No HHV-7 and HHV-6 was excreted into urine.

Conclusions. Clinical features of a virologically confirmed patient with primary HHV-7 infection were comparable with those of primary HHV-6 infection and HHV-7 infection may reactivate HHV-6.
Can Magnesium Sulfate Reduce the Risk of Cerebral Palsy in Very Low Birthweight Infants?
Authors: Nelson Karin B. , Grether Judith K.
Published: December 2021

Objectives. To investigate whether in utero exposure to magnesium sulfate (MgSO4) was associated with a lower prevalence of cerebral palsy (CP) in infants born weighing <1500 g.

Design. Singleton infants weighing <1500 g at birth (very low birthweight, VLBW) and surviving to 3 years with moderate or severe congenital CP were identified among 155 636 children born 1983 through 1985 in four California counties. VLBW children with CP were compared with randomly selected VLBW control survivors with respect to whether their mothers received MgSO4 to prevent convulsions in preeclampsia or as a tocolytic agent, and other information abstracted from labor and delivery records.

Results. During the admission for delivery, 7.1% of the 42 VLBW infants with later CP and 36% of the 75 VLBW controls were exposed to MgSO4 (odds ratio (OR) .14, 95% confidence interval (CI) .05, .51). The overall association of MgSO4 with reduced risk of CP was also observed in the subgroup of infants born to women who were not preeclamptic (OR .25, CI .08, .97). Infants with CP were less often exposed antenatally to MgSO4 whether or not there was cotreatment with non-MgSO4 tocolytics (other tocolytics administered, OR for MgSO4 exposure .23, CI .06, 1.2; other tocolytics not administered, OR for MgSO4 .08, CI .02, .68), or antenatal corticosteroids (steroids given, OR for MgSO4 exposure .24, CI .06, 1.3; steroids not given, OR for MgSO4, .08, CI .02, .72). Apparent benefit of magnesium was observed in the presence or absence of a variety of characteristics of pregnancies, births, and infants.

Conclusion. In this observational study, in utero exposure to MgSO4 was more frequent in controls than in children with CP, suggesting a protective effect of MgSO4 against CP in these VLBW infants.
Children, Adolescents, and Advertising
Authors:   Committee on Communications
Published: December 2021

Advertising is a powerful force in American culture. It exists to sell products and services. In 1750 BC the Code of Hammurabi made it a crime, punishable by death, to sell anything to a child without first obtaining a power of attorney. In the 1990s, selling products to American children has become a standard business practice.

American children have viewed an estimated 360 000 advertisements on television before graduating from high school.1 Additional exposures include advertisements on the radio, in print media, on public transportation, and billboards. Commercials have even entered the classroom through programs like Channel One—video equipment packaged with current events programming that contains commercials.

The principal goal of commercial children's television is to sell products to children, with food and toys being the two most frequently advertised product categories.2 Advertisers generally use two approaches to sell their products. The traditional method places commercials in programs that are attractive to children. These commercials promote products unrelated to the program being shown. The second approach, begun in 1982, features toy action figures as the main characters of a program. Because these programs are often developed by the marketing division of toy companies to market specific toys, they are frequently referred to as "program-length commercials."

The Children's Television Act of 1990 mandates that all broadcasters carry children's educational or instructional programming as a condition for license renewal. One of the problems of the current law is that stations can cite public service announcements (PSAs) or short vignettes as evidence of compliance.
Informed Consent, Parental Permission, and Assent in Pediatric Practice
Authors:   Committee on Bioethics
Published: December 2021

A re-analysis of informed consent leads to the identification of important limitations and problems in its application to pediatric practice. Two additional concepts are needed: parental permission and patient assent. The American Academy of Pediatrics believes that in most cases, physicians have an ethical (and legal) obligation to obtain parental permission to undertaken recommended medical interventions. In many circumstances, physicians should also solicit a patient assent when developmentally appropriate. In cases involving emancipated or mature minors with adequate decision-making capacity, or when otherwise permitted by law, physicians should seek informed consent directly from patients.
Deflazacort in Pediatric Rheumatic Diseases Needs a Frequent Follow-up of Bone Densitometry
Authors: Falcini Fernanda , Trapani Sandra , Ermini Marialisa , Bartolozzi Giorgio
Published: December 2021

Osteoporosis is the most important side effect of long-term steroid treatment.1 Fractures are a frequent consequence of osteoporosis and mainly affect the spine (height loss, kyphosis, severe acute or chronic back pain, and complete immobility).2 In children the management of this complication is difficult particularly when a full dose of steroids is required to control the underlying disease. Recently it has been suggested that Deflazacort (DFL), an oxazolinic acid derivative of prednisone, may have a bone sparing effect when compared with prednisone.3
FDA TO MAKE IT EASIER FOR DRUG MAKERS TO GIVE PEDIATRIC-DOSE DATA TO DOCTORS
Authors: L. J. F.
Published: December 2021

The Food and Drug Administration plans to make it easier for pharmaceutical manufacturers to provide doctors with information on the proper doses of prescription drugs for children.

FDA Commissioner David Kessler is expected to announce plans today to allow manufacturers in some circumstances to provide pediatric-use information on drug labels, even if they haven't held full-blown clinical trials involving children. The information would be based on extrapolations from adult studies, plus other data about the effects on children.
Asthma and Immunoglobulin E Antibodies After Respiratory Syncytial Virus Bronchiolitis: A Prospective Cohort Study With Matched Controls
Authors: Sigurs N. , Bjarnason R. , Sigurbergsson F. , Kjellman B. , Björkstén B.
Published: December 2021

Objective. To study the occurrence of bronchial obstructive symptoms and immunoglobulin (Ig) E antibodies after respiratory syncytial virus (RSV) bronchiolitis in infancy. Previous studies of this subject have mostly been retrospective or without controls, or the controls have not been followed prospectively.

Design. This was a prospective cohort study with matched controls.

Participants. Forty-seven infants had experienced RSV bronchiolitis severe enough to cause hospitalization at a mean age of 3½ months. For each child with RSV infection, two controls were acquired from the local Child Health Center and matched for date of birth, sex, and residence. Only one control was obtained for one RSV child, and the control group thus contained 93 children.

Methods. All the children underwent two follow-up examinations, the first one at a mean age of 1 year and the second at a mean age of 3 years. At the first follow-up, a skin-prick test against egg white was performed, and serum IgG antibodies against RSV were measured. At the second follow-up, serum IgE antibodies were measured using screening tests for common food and inhalant antibodies, and skin-prick tests against egg white, cat, birch, and mite allergen were performed. Hereditary and environmental factors (passive smoking, indoor furred animals) and duration of breast-feeding were recorded.

Results. At the first follow-up, 89% in the RSV group and 27% in the control group had IgG antibodies against RSV (P < .001). At the second follow-up, asthma, defined as three episodes of bronchial obstruction verified by a physician, was found in 11 of 47 children (23%) in the RSV group and in 1 of 93 children (1%) in the control group (P < .001). A positive test for IgE antibodies was noted in 14 of 44 (32%) RSV children and in 8 of 92 (9%) children in the control group (P = .002). An analysis of risk factors for the development of asthma and IgE antibodies on the whole group of 140 children showed that RSV bronchiolitis was the most important risk factor, and a family history of atopy or asthma further increased the risk.

Conclusions. Respiratory syncytial virus bronchiolitis during the first year of life apparently is an important risk factor for the development of asthma and sensitization to common allergens during the subsequent 2 years, particularly in children with heredity for atopy/asthma.
PROFESSORS BATTLING TELEVISION TECHNOLOGY
Authors: L. J. F.
Published: December 2021

Questions about the extent to which technology will displace college professors have led to the resignation of the chancellor of the University of Maine in what some see as a forerunner to conflicts at other colleges.

Under a plan by Chancellor J. Michael Orenduff, the University of Maine would have created an eighth campus, this one without buildings or professors, but using only two-way televised classes. Rather than add a class in say, economics at one campus, students would simply watch its broadcast from another campus.

... universities are experimenting with what has come to be called distance learning or video-conferencing—the use of two-way television and two-way audio to replicate the classroom while permitting students to remain at home or at remote places.
Childhood Thrombosis
Authors: Nuss Rachelle , Hays Taru , Manco-Johnson Marilyn
Published: December 2021

Objective. The objective of our study was to evaluate the age, sex, clinical conditions, family history, site, catheter association, means of radiologic evaluation, development of pulmonary involvement, prevalence of antithrombin III, protein C and protein S deficiencies, and lupus anticoagulants in children who suffered a thrombotic event.

Methods. Data were collected on children over 1 month of age who had or developed a thrombotic event from 1987 through 1993 at two pediatric centers.

Results. Sixty-one children (mean age, 10 years) suffered a thrombotic event. Males and females were equally affected. A variety of clinical prothrombotic conditions similar to those described in adults could be identified for two thirds of the children. Family history was positive in seven children. The primary thrombotic site for two thirds of the children was the central nervous system and other centrally located blood vessels. Diagnosis of the primary thrombotic site was primarily by ultrasound. A central vascular access device was associated with 25% of thromboses. Lung involvement occurred in 20%. Two thirds of the children were evaluated for a lupus anticoagulant and a deficiency of protein C and protein S; two thirds had one of these diagnosed. For further analyses, children without an underlying prothrombotic systemic illness or precipitant at the time of thrombosis (n = 20) were compared to those with these conditions (n = 41). Central nervous system thromboses were significantly increased in the children without prothrombotic conditions. The prevalence of a deficiency of protein C or protein S or the presence of a lupus anticoagulant approached 90% in the group without prothrombotic conditions as compared with 50% in the other group.

Conclusion. We conclude that prospective multicenter pediatric thrombosis studies are warranted to confirm our preliminary findings of a high incidence of lupus anticoagulants and protein C and protein S deficiency in children with thromboses.
Effects of Late-Afternoon Methylphenidate Administration on Behavior and Sleep in Attention-Deficit Hyperactivity Disorder
Authors: Kent Jeffrey D. , Blader Joseph C. , Koplewicz Harold S. , Abikoff Howard , Foley Carmel A.
Published: December 2021

Objective. This study evaluated the effects on behavior and sleep of methylphenidate (MPH) administered at 4 PM to children with attention-deficit hyperactivity disorder (ADHD).

Methodology. Twelve children admitted to a child psychiatric inpatient service with ADHD participated in a double-blind, crossover study in which they received a 4 PM dose of either 15 mg of MPH, 10 mg of MPH, or a placebo in random order for 12 consecutive days. Ratings of behavior, including ADHD symptoms, pertaining to the period from dose administration until sleep onset, were supplied nightly by hospital staff. Sleep latency and sleep adequacy were also assessed for each night.

Results. MPH resulted in markedly improved behavioral control compared with placebo; there was no difference between 15-mg and 10-mg MPH doses. MPH did not alter sleep latencies observed with the placebo. Children were more often rated as less tired on awakening after nights that they received 10 mg of MPH compared with 15 mg of MPH and the placebo. Weight loss was apparent among 83% of the patients, but dinner intake did not vary with third-dose condition.

Conclusions. Morning and noon administration of stimulants to children with ADHD is a near-universal practice, but many clinicians avoid a third, late-afternoon administration for fear of inducing insomnia. This study's findings show that children with ADHD derive substantial symptom reduction from MPH administered in late afternoon, with no untoward effects on sleep. Therefore, three-times-a-day dosing should be considered for those children exhibiting ADHD symptoms in the evening. Adverse effects on sleep latency were not apparent in the sample overall. Nonetheless, monitoring for possible aggravation of sleep problems and weight loss remains sound treatment practice.
Drug-Exposed Infants
Authors:   Committee on Substance Abuse, 1994 to 1995
Published: December 2021

Recent studies have documented that an increasing number of women of childbearing age are using licit and illicit substances. Although statistical data are insufficient, there are indications that approximately 1 in 10 infants may have been exposed to illicit drugs in utero. The Office of Applied Studies 1992 National Household Survey1 revealed that 6.8% of women of childbearing age admitted to having used an illicit drug in the month before questioning. Recent state surveys have shown that between 8% and 12% of women delivering in their hospitals had used illegal drugs at some time during the pregnancy, including just before delivery.2-5 These studies support information from a study in Pinellas County, FL, which demonstrated that illicit substance use during pregnancy occurs in all racial and socioeconomic lines.6,7 In addition to the use of illegal drugs, the use of alcohol or nonprescribed drugs shortly before delivery is also identified as a problem.8

These incidence data parallel the increasing number of infants being admitted to special-care nurseries for complications caused by intrauterine exposure to alcohol and other drugs. Drug-exposed infants also often go unrecognized and are discharged from the newborn nursery at increased risk for a complex of medical and social problems, including abuse and neglect.

This statement addresses illicit substance use in pregnancy and its medical, educational, social, mental health, and legal consequences for children and families. The Academy recently has developed a separate statement to address the issue of infants exposed to alcohol in utero.9

The Problem

All illicit drugs reach the fetal circulation by crossing the placenta and can cause direct toxic effects on the fetus, as well as fetal and maternal dependency.10
RESPIRATORY REACTIONS PROVOKED BY DOUBLE-BLIND FOOD CHALLENGES IN CHILDREN
Authors: Greos Leon S.
Published: December 2021

Symptoms of the upper and lower respiratory tract are commonly provoked in children with atopic dermatitis during food challenge, but significant pulmonary obstruction (>20% fall in FEV1) is uncommon.
CHEMOSENSITIVITY AND PERCEPTION OF DYSPNEA IN PATIENTS WITH A HISTORY OF NEAR-FATAL ASTHMA
Authors: Welch Michael J. , Chipps Bradley E.
Published: December 2021

A reduced perception of hypoxemia and airway narrowing may play an important role in causing life-threatening attacks of asthma.
PARADOXICAL BRONCHOCONSTRICTION WITH NEBULIZED ALBUTEROL BUT NOT WITH TERBUTALINE
Authors: Greos Leon S.
Published: December 2021

Paradoxical bronchoconstriction to β-agonists has been reported previously, and has been attributed to hypotonicity or acidity of solution or to preservatives such as benzalkonium chloride. As both solutions studied were isotonic, of like acidity, and preservative- and additive-free, these factors were not likely to be contributing to the results observed. Paradoxical bronchocontriction to β-agonists is not necessarily a class effect, but can attributed to treatment with one specific agent while not observed with other agents in the class.
AMINOPHYLLINE THERAPY DOES NOT IMPROVE OUTCOME AND INCREASE ADVERSE EFFECTS IN CHILDREN HOSPITALIZED WITH ACUTE ASTHMATIC EXACERBATIONS
Authors: Furukawa Clifton T.
Published: December 2021

There was no benefit and increased adverse effects associated with the use of aminophylline in addition to standard albuterol and intravenous steroid therapy.
Children, Adolescents, and Television
Authors:   Committee on Communications
Published: December 2021

In 1984 the American Academy of Pediatrics (AAP) issued a statement that cautioned pediatricians and parents about the potential for television to promote violent or aggressive behavior and obesity.1 The influence of television on early sexual activity, drug and alcohol use and abuse, school performance, and perpetuation of ethnic stereotypes was also stressed. In 1990, the AAP reaffirmed its concerns about the negative effects of television on children and adolescents and provided recommendations to pediatricians and parents for prevention and management of these effects.2

In 1993, most children in the United States still spent more time (outside of school hours) watching television than performing any other activity except sleeping. According to recent Nielsen data,3 the average child and adolescent watches television between 21 and 23 hours per week, with the youngest children viewing the most hours per week. Although the amount of commercial television viewed by children has declined since 1980, the most recent estimates of television viewing do not include the use of videocassette recorders. Therefore, the amount of time that children in our country spend in front of the television set has probably not decreased significantly in the past decade.

Television's influence on children is a function of the length of time they spend watching and the cumulative effect of what they see. By the time the average child reaches age 70, he or she will have spent approximately 7 to 10 years watching television.4 Therefore, the passive nature of television may displace other more active and meaningful experiences of the world.
Clinical and Behavioral Adaptation to Managed Care: Stepwise Suggestions for Survival
Authors: Pappelbaum Stanley J.
Published: December 2021

The rapid growth of managed care has left many physicians concerned and often bewildered about the new realities of the day. Essentially, managed care is a euphemism for a different kind of authority, responsibility, and accountability. Under "unmanaged care," authority, responsibility, and accountability were gained from and directed toward the patient. This arrangement has been supplanted by a new system in which the physician derives his authority from and is responsible and accountable to both the patient and the managed care company. The diagnosis of managed care is easy enough. It is a chronic disease; it does not go away. For those who can make the adjustment, managed care will not end careers. Rather, it will require a realignment, an adaptation to the societal mandate for "value." With care, foresight, and professionalism, this realignment can be navigated successfully, and disruption in the lives of pediatricians and patients can be held to a minimum.
Neonatal Thrombosis: Report of a Prospective Canadian and International Registry
Authors: Schmidt Barbara , Andrew Maureen
Published: December 2021

Objective. We sought to obtain representative data on the risk factors, diagnosis, current management, and short-term outcome of neonatal thrombosis.

Research Design. A case registry was established at McMaster University. Standardized questionnaires were mailed to collaborators at participating centers every 4 to 6 months.

Setting. Eighty-five level III and modified level II neonatal units in North America, Europe, and Australia were invited to join the registry.

Patients. Eligible infants were born between January 1990 and June 1993. Large-vessel thrombosis was diagnosed during the first month of life or up to 44 weeks post-conception after premature birth. The clinical impression of thrombotic vessel obstruction was confirmed using at least one imaging technique.

Results. Physicians in 64 centers expressed their willingness to participate. A total of 97 cases (excluding stroke) were registered from 29 centers. Spontaneous renal venous thrombosis (n = 21) was diagnosed at a median age of 2 days. The other venous (n = 39), arterial (n = 33), and mixed (n = 4) thromboses presented later; 89% of them were associated with an intravascular catheter and 29% with systemic infection. Doppler ultrasonography was the definitive diagnostic test in 68% of cases; contrast angiography was performed infrequently (14%). A third of all patients (but 62% of infants with renal venous thrombosis) received supportive therapy only. Thrombolytic agents were prescribed for 28% of catheter-associated venous thromboses and 30% of all arterial thromboses. The remainder of the patients were given heparin. Most patients (82%) survived to hospital discharge. Mortality rates were highest among infants with aortic thrombosis or central venous line-associated thrombosis affecting the right atrium or the superior vena cava (33%).

Conclusions. Neonatal thrombosis is diagnosed fairly rarely. With the exception of spontaneous renal venous thrombosis, almost all cases are associated with indwelling catheters. Doppler ultrasound techniques are the most popular means of confirming the diagnosis in virtually all centers. Treatment varies greatly among different centers, probably because of the lack of scientific evidence about the optimum management of affected infants.