bluuebunny/crossref_metadata_2025 huggingface dataset:
Phenolphthalein-Induced Fixed Drug Eruption: A Cutaneous Complication of Laxative Use in a Child
Authors: ZANOLLI MICHAEL D. , MCALVANY JOANNE , KROWCHUK DANIEL P.
Published: December 2021

Drug eruptions are a common dermatologic problem faced by pediatricians. Among the most distinctive of these is the fixed drug eruption, a cutaneous inflammatory reaction manifested by solitary or multiple, well-defined, erythematous macules that may become bullous.1,2 Lesions usually occur within a few hours of ingesting the drug, characteristically recur in the same location with each subsequent dose, and leave residual hyperpigmentation. To illustrate the importance and unique features of this unusual reaction, we report the case of a child who experienced a recurrent fixed drug eruption induced by phenolphthalein-containing, nonprescription laxatives.

CASE REPORT

An 8-year-old African-American girl was brought to the Dermatology Clinic for evaluation of pruritic and occasionally swollen "dark spots" that had been present on her face and arms for months.
The Lead Debate Goes On
Authors: BANNER WILLIAM , VUIGNIER BARBARA I. , PAPPAS JANNETTE B.
Published: December 2021

In Reply.—

I am glad that Dr Marcus has pinched himself and woken up to 1993 hope he will now review some of the literature that he alludes to in his letter.

Although I also believe that the intentions of the CDC in publishing their Guidelines are honorable, they have placed us in an untenable position. Early drafts of the CDC statement1 on "Preventing Lead Poisoning in Young Children" provided some guidance on the issue of screening in low-risk areas.
Surfactant Therapy in Full-term Neonates With Severe Respiratory Failure
Authors: Khammash Hatem , Perlman Max , Wojtulewicz Julian , Dunn Michael
Published: December 2021

Objective. In light of the paucity of published data on the use of surfactant in full-term infants with respiratory failure due to meconium aspiration syndrome and respiratory distress syndrome, we report our experience with this therapy. Our goal was to explore possible justification for randomized controlled trials of surfactant treatment in similar patients at an earlier, less severe stage of the disease.

Methods. Retrospective consecutive case series of 20 infants with severe meconium aspiration syndrome and 29 infants with severe respiratory distress syndrome who received bovine surfactant between March 1990 and December 1992 in three neonatal intensive care units in a regionalized setting. Outcome of treatment was assessed by comparing changes in several respiratory indices including the oxygenation index, between 4 and 6 hours and 1 and 3 hours before and after the first dose of surfactant. Differences were analyzed using analysis of variance for repeated measures, with treatment and time as co-variates.

Results. In the meconium aspiration group the mean oxygenation index decreased from 36 ± 12 at 1 to 3 hours presurfactant to 24 ± 14 at 1 to 3 hours postsurfactant (P < .001). In the patients with respiratory distress syndrome the mean oxygenation index fell from 30 ± 17 at 1 to 3 hours presurfactant to 12 ± 6 at 1 to 3 hours postsurfactant (P = .0001). Three of 20 patients with meconium aspiration syndrome and 3 of 29 patients with respiratory distress syndrome received extracorporeal membrane oxygenation.

Conclusions. Surfactant therapy in full-term infants with respiratory failure due to the meconium aspiration and respiratory distress syndromes is often effective in improving gas exchange. A randomized controlled trial of surfactant therapy at an earlier stage in the course of the illness should be performed.
Prevalence of Undetected Tinea Capitis in Household Members of Children with Disease
Authors: VARGO KAREN , COHEN BERNARD A.
Published: December 2021

The epidemiology of tinea capitis has changed over the past 40 years. The major organism responsible for tinea capitis today is Trichophyton tonsurans. This dermatophyte accounts for more than 90% of ringworm infections of the scalp in the United States and replaces Microsporum audouinii and to a lesser extent Microsporum canis, which were associated with the ringworm epidemics of the 1940s.1-4

Trichophyton tonsurans is an anthropophilic organism producing endothrix invasion of the hair shaft that does not fluoresce on Wood's light examination.5 Tinea capitis is epidemic in black school-age children, but only rarely in whites. The reason for this racial predilection is not known.1
Hepatitis B Immunization
Authors: FARBER JON MATTHEW
Published: December 2021

To the Editor.—

As a practicing pediatrician, I have two major reservations with the current recommendations of the Committee on Infectious Diseases for universal Hepatitis B Virus (HBV) immunization. The first reservation is practical; the second is theoretical.

The Committee realized that administering three injections of different vaccines at the same time is something most parents and pediatricians would wish to avoid, and also that requiring an extra office visit for HBV vaccination was not attractive.
Movies, Guns, and Kids
Authors: BOEN JAMES R. , SAMPSON DEBORAH L.
Published: December 2021

To the Editor.—

Professionals in pediatric medicine can be effective in preventing firearm injuries to children. In addition to influencing gun control legislation, pediatricians can promote gun safety awareness through counseling and education, and we believe that a pediatrician counseling adolescents or parents of younger children regarding handgun policy will be more persuasive by being more authoritative.

It has been suggested that pediatricians counseling patients about home safety issues include education about the risks of keeping guns in the home.1
Clinical Trials and P Values
Authors: LANTOS JOHN D.
Published: December 2021

In Reply.—

Here is the question: Are randomized trials so superior to other knowledge-generating techniques that we should not consider a fact to have been established unless it has been established by such a trial? If so, then the use of clinical interventions which have not been studied using randomized trials is wrong. if not, then we need to determine how such trials should be combined with other techniques, and how results of different techniques should be interpreted to lead to the best possible patient care, the incorporation of new therapeutic interventions into practice, and the timely discarding of techniques which are no longer sufficiently efficacious.
Appointment-Keeping Behavior in Adolescents: Factors Associated With Follow-up Appointment-Keeping
Authors: Irwin Charles E. , Millstein Susan G. , Ellen Jonathan M.
Published: December 2021

Study objectives. To identify the sociodemographic and Health Belief Model predictors of follow-up appointment-keeping behavior.

Design. Prospective observational study.

Settings. General adolescent medical clinic.

Patients and measurements. Sequential sample of 166 adolescents (aged 12 to 20 years, mean = 15.9 years) enrolled in the clinic. The population was 75% female; the racial-ethnic distribution of the sample was 37.9% black, 29.8% white, 11.2% Asian, 14.3% Hispanic, and 6.8% "other" background. Subjects' social class was primarily lower-middle (60.5%) and middle class (28.6%). A subsample was randomly assigned to be interviewed about their beliefs concerning their follow-up appointment and the constructs of the Health Belief Model.

Results. Forty-eight percent of the total sample failed to keep their follow-up appointment. There was a significant positive correlation between social class and appointment keeping (F = 5.07; df = 5,110; P = .026). Neither race-ethnicity nor who made the appointment were found to be associated with follow-up appointment-keeping. The only construct of the Health Belief Model found to be significantly associated with appointment keeping was the number of potential negative outcomes resulting from noncompliance perceived by the subject (F = 6.85; df 1,74; P = .011).

Conclusions. Clinicians must work with adolescents to improve their understanding of the potential negative outcomes associated with noncompliance to improve appointment-keeping behavior.
Infant Mortality Statistics Do Not Adequately Reflect the Impact of Short Gestation
Authors: Carver Jane D. , Tan Lukas H. , MCDermott Robert J. , Jacobson Howard N. , Sherin Kevin M. , Kanarek Keith , Pimentel Bernardo
Published: December 2021

Objective. To determine the accuracy of National Center for Health Statistics cause-specific infant mortality data. The National Center for Health Statistics compiles these data by applying World Health Organization (WHO) selection rules to death certificate data. The WHO rules arrange medical entities into a hierarchical order and select a single underlying cause of death (ULCD).

Design. A comparison was made between ULCD assigned to a cohort of 335 infant death certificates by (1) a neonatologist panel, and (2) application of WHO selection rules by the Florida State Office of Vital Statistics (OVS).

Results. Among the 146 infants with birth weights 1500 to 4649 g, agreement between neonatologists and OVS was 88%, while among the 189 infants with birth weights 0 to 1499 g (very low birth weight), agreement was just 41%. Neonatologists selected short gestation as the underlying cause of death for 82% of very low birth weight infant records, vs 25% by OVS. Due to the application of specific WHO selection rules, OVS frequently selected immediate causes of death, such as "cardiac arrest," as the ULCD, even when the medical certifier had indicated short gestation as the ULCD. In vital statistics reports, many of these immediate causes are reported as "other respiratory conditions of newborn," or "all other perinatal conditions."

Conclusion. WHO ULCD selection rules should be modified to allow short gestation to have a higher priority over immediate causes of infant death.
Atopic Dermatitis: Role of Food and House Dust Mite Allergens
Authors: Casimir G. J. A. , Duchateau J. , Gossart B. , Cuvelier Ph. , Vandaele F. , Vis H. L.
Published: December 2021

Objective. The aim of this study was to evaluate the humoral immune response to cow milk (CM) protein, soya protein, and house dust mites in a group of 64 CM-fed infants, who had atopic dermatitis as the sole atopic manifestation, by measuring not only IgE but also specific IgG antibodies (Ab) against bovine β-lactoglobulin, soya flour aqueous extracts, and Der P1 antigens.

Methods. A CM-free diet (Nan HA, Nestle) was given to these 64 CM-fed infants and the sensitivity to CM proteins was established by a positive challenge test with the offending food in improved infants. The serum was obtained just before the start of the CM-free diet, at the first consultation. The patients were classified into two groups according to their clinical response to the hypoallergenic formula.

Results. Thirty-one infants (group 1) improved dramatically (positive challenge test), and 33 (group 2) did not improve with the exclusion diet but did improve after eviction of dust-producing items in the environment. The two groups were different in terms of their total IgE immunoglobulin concentration (higher in group 1, P < .05) and concentration of specific IgE Ab against CM protein (more frequent in group 1, P < .01). The IgG Ab concentrations against β-lactoglobulin, the major CM antigen (P < 10-4), and against soya protein (P < .01) were significantly more elevated in the group improved by the diet, with a threshold above which the response to the exclusion diet could be predicted as positive. On the contrary, the level of specific IgG Ab against house dust mites was four times higher in group 2 than in group 1. Twenty-nine of the 33 infants of group 2 improved after eviction of dust-producing items in the environment.

Conclusions. It is proposed that specific IgG Ab concentrations against β-lactoglobulin, soya protein, and Der P1 antigen be determined in infants and children suffering from atopic dermatitis as a means of predicting the response to an exclusion diet, and a possible role of house dust mites in the pathogenicity of the disease is suggested.
Drowning in Infants, Children, and Adolescents
Authors:   Committee on Injury and Poison Prevention
Published: December 2021

Drowning and near-drowning are major causes of childhood mortality and morbidity from injury. From 1980 to 1985, drowning was the second leading cause of injury death of infants and children younger than 15 years of age in the United States.1 In 18 of the 50 states, drowning was the number one cause of unintentional injury death of children 1 to 4 years of age.1 Children less than 5 years of age and young people aged 15 to 24 years have the highest drowning rates.2 Drowning, by definition, is fatal; near-drowning is sometimes fatal. Drowning has been defined as a death resulting from suffocation within 24 hours of submersion in water; victims of near-drowning survive for at least 24 hours.3 For every child who drowns, four children are hospitalized for near-drowning.4 One third of those who are comatose on admission but survive suffer significant neurologic impairment.4 The annual lifetime cost attributable to drowning and near-drowning in children less than 15 years of age is $384 million.3 The annual cost of care per year in a chronic care facifity for an impaired survivor of a near-drowning event is approximately $100 000.4

There is no national surveillance system that defines the circumstances surrounding a drowning event well enough to enable the development of effective preventive strategies for children. A need exists to establish uniform state or local surveillance systems that consider developmental age groupings and geographic location and that account for environmental and behavioral factors that place children at risk. To design preventive strategies aimed at specific risk factors, such surveillance systems must define in sufficient detail the circumstances under which the drowning event occurred, preventive measures used, rescue efforts made, and the outcomes.
Nipple Confusion
Authors: WALKER MARSHA
Published: December 2021

To the Editor.—

I wish to comment on the article "Single Daily Bottle Use in the Early Weeks Postpartum and Breast-Feeding Outcomes."1 Several of the conclusions of this article contradict what I see in clinical practice as a lactation specialist. The selection and definition of the sample groups puzzle me. Specifically, there is no totally breast-fed group. This is a design flaw that many breast-feeding research studies exhibit. An infant being fed up to two bottles a week and infants fed by bottle in the hospital are not totally breast-fed and have experienced the use of an artificial nipple.
Nipple Confusion
Authors: NEWMAN JACK
Published: December 2021

To the Editor.—

Cronenwett et al1 have jumped to a completely unwarranted conclusion from the data they present in their article on bottle use, that "no support was found for the nipple confusion hypotheses" Rather, there is no support to make such a statement. There seems to be confusion in the minds of the authors by what is meant by "nipple confusion" or "nipple preference."

In the first place, those of us who handle breast-feeding problems on a daily basis would not argue that the occasional bottle, introduced once breast-feeding was well underway and both mother and baby were doing well, would cause serious problems in most instances.
Nipple Confusion
Authors: AUERBACH KATHLEEN G.
Published: December 2021

To the Editor.—

The results of Cronenwett et al1 are interesting for the answers they provide and the questions they generate.

Most striking in their discussion is the authors' dismissal of "nipple confusion" in light of the timing of their investigations into the effect of regular bottle-feedings for breast-feeding infants. I have observed that infants who are exposed to rubber nipples before they have learned how to effectively suckle the human breast2 seem to try to use the breast as if it were a rubber nipple.
Nipple Confusion
Authors: CRONENWETT LINDA
Published: December 2021

In Reply.—

The issue that seemed to cause the most concern stemmed from our comment about not finding support for the nipple confusion hypothesis. Certainly, there was no intent on our part to deny that some infants have difficulty with the latching on and sucking patterns necessary for breast-feeding. In our study, our point was merely that the vast majority of participants had babies who alternated between bottle and breast early in the postpartum period and subsequently for prolonged breast-feeding periods.
Are the King County SIDS Data Generalizable?
Authors: BROOKS JOHN G.
Published: December 2021

To the Editor.—

I wish to applaud Dr Haas and his colleagues for taking advantage of the probably unique, well-validated, longitudinal sudden infant death syndrome (SIDS) database in King County, WA, to try to clarify the interpretation and implications of the multiple reports of consistent associations between certain clinical and demographic characteristics and the occurrence of SIDS.1 I am concerned, however, that most of the differences which they report in prevalence of specific risk factors in each of their three subgroups of SIDS cases ("classic SIDS," "probable SIDS," "ossible SIDS"), result from the specific criteria which they used to define the three groups.
Heart Murmurs. If You Allow for Mistakes Costs Are Even Higher!
Authors: DANFORD DAVID A. , NASIR ARWA , GUMBINER CARL
Published: December 2021

In Reply.—

Dr Toews' thoughtful letter highlights an important assumption which we made in our analysis of costs of specific strategies in the evaluation of heart murmurs in children. The presumption is made that echocardiography is performed in a diagnostically definitive fashion so that diagnostic inaccuracies are not encountered in the echocardiography-first strategy. We agree that this presupposes the availability of echocardiographic equipment appropriate for use in infants and children, technical support staff with adequate training and ongoing experience, and experienced pediatric echocardiographers to interpret the images.
Passive Tobacco Exposure and Sudden Infant Death Syndrome
Authors: LEE PETER N.
Published: December 2021

To the Editor.—

Drs Schoendorf and Kiely1 report increased risk of SIDS, both in mothers smoking during and after pregnancy ("combined exposure") and in mothers smoking only afterward ("passive exposure"). Most previous studies2-18 that reported that maternal smoking is associated with SIDS considered only smoking during pregnancy, but some2,4,11,15 considered smoking after pregnancy. However, I am unaware of any previous study which attempted separation of smoking during and after pregnancy. Although such an attempt is commendable, certain problems with the analysis and data of Drs Schoendorf and Kiely merit comment.
ON THE IMPORTANCE OF BEING OUT OF STEP
Authors: Student
Published: December 2021

Unfashionable people and unfashionable ideas have often been of decisive importance to the progress of science...The problems...are how to recognize the fruitful unfashionable idea, and how to support it.
Attitudes and Practices Regarding Analgesia for Newborn Circumcision
Authors: Wellington Nancy , Rieder Michael J.
Published: December 2021

Study objective. To determine attitudes regarding routine use of analgesia for newborn circumcision among primary care physicians in southwestern Ontario.

Design. Questionnaire survey conducted among all family physicians and pediatricians belonging to the London Academy of Medicine. The majority of pediatric primary care in this region is provided by family physicians.

Setting. Metropolitan center in Southwestern Ontario.

Respondents. A questionnaire was mailed to 279 physicians; 171 (61%) responded.

Results. Seventy-four (43%) respondents performed circumcisions. Among physicians performing circumcisions, a minority (17; 24%) used any form of analgesia. The most commonly used analgesic (14; 20%) was oral ethanol. Only 3 (4%) physicians used dorsal penile nerve block. The most common reasons listed for not employing analgesia were lack of familiarity with analgesia use among neonates (56%), lack of familiarity with the technique of dorsal penile block (50%), and concern over adverse effects of analgesic drugs (49%) and regional analgesia (44%). Only a small minority of physicians (7; 12%) responded that they believe that neonates do not feel pain, and 20 (35%) believe that neonates do not remember pain.

Conclusions. Despite evidence that neonates perceive pain and that there is a physiologic stress response to circumcision which can be reduced if analgesia is employed, the vast majority of physicians performing newborn circumcisions either do not employ analgesics or employ analgesics of questionable efficacy. Lack of familiarity with the use of analgesics among neonates and with dorsal penile block in particular are the most common reasons cited for lack of analgesic use. Educational efforts and research into less invasive techniques of analgesia for newborn circumcision are urgently required.
Association of the Common Cold in the First Trimester of Pregnancy With Birth Defects
Authors: Zhang Jun , Cai Wen-wei
Published: December 2021

Objective. To examine the association between the common cold with or without fever in the first 3 months of pregnancy and birth defects in offspring.

Design. A case-control study.

Setting. Data are from the Shanghai Birth Defects Monitoring Program, conducted in 29 hospitals in Shanghai, China from October 1, 1986 to September 30, 1987.

Subjects. A total of 986 birth defects cases, 990 frequency-matched live birth controls, and 159 stillbirth controls.

Results. Modestly elevated risk of birth defects was identified among women who reported having a cold with or without fever in the first trimester of pregnancy. Notably increased relative risks were observed for anencephalus (odds ratio [OR] = 3.9, 95% confidence interval [CI] = 2.0 to 7.7), spina bifida (OR = 4.1, 95% CI = 1.7 to 9.7), hydrocephalus (OR = 2.3, 95 % CI = 1.1 to 5.1), cleft lip (OR = 2.2, 95 % CI = 1.4 to 3.4), and undescended testicle (OR = 1.8, 95 % CI = 1.0 to 3.0). Our study further found that the overall relative risks were consistent by using two different control groups, suggesting that this association was unlikely to be due to recall or report bias.

Conclusion. Common cold in the first trimester of pregnancy may be associated with an increased risk of birth defects in offspring. However, these findings should be interpreted cautiously.
A SCIENTIFIC TRAP
Authors: Student
Published: December 2021

The National Waste Policy Act sets up a scientific trap in which the public is encouraged to demand or expect what is close to certainty (from virtually "flawless science"), and in which scientists and engineers are encouraged to believe or pretend that they can supply it.
AND NEVER THE TWAIN SHALL MEET
Authors: Student
Published: December 2021

Many Americans, sensitized by the media to the dangers of cigarette smoking, have been appalled to discover on their visits to the Far East that most adult Chinese smoke. The Chinese, on the other hand, consume little alcohol and express bewilderment about the hazardous and excessive drinking in the West.
Is There a Relationship Between Dietary Fat and Stature or Growth in Children Three to Five Years of Age?
Authors: Shea Steven , Basch Charles E. , Stein Aryeh D. , Contento Isobel R. , Irigoyen Matilde , Zybert Patricia
Published: December 2021

Study objective. To determine whether a moderately reduced fat diet affects the stature or growth of healthy preschool children.

Design. Cohort study with mean of 25 months of follow-up.

Setting. Primary care pediatrics practice at a large urban medical center.

Subjects. A predominately Hispanic group of 215 children aged 3 to 4 years at baseline.

Measurements and main results. The children's diet was assessed using four 24-hour recalls and three Willett semiquantitative food-frequency questionnaires administered to the children's mothers over a 1-year baseline period. Stature was defined in terms of height, weight, and body mass index at baseline. Growth was defined in terms of change during follow-up in height, weight, and body mass index. Total fat provided a mean of 27.1% of caloric intake in the lowest quintile of intake compared with 38.4% in the highest quintile. There were no differences in stature or growth across quintiles of children defined by consumption of total fat, saturated fat, or cholesterol. These findings were consistent across the two methods of diet assessment. Children who consumed a smaller percentage of total calories from fat consumed significantly less total calories, saturated fat, cholesterol, calcium, and phosphorus, as well as more carbohydrates, iron, thiamine, niacin, vitamin A, and vitamin C.

Conclusions. These data support the safety of a moderately reduced fat diet in healthy preschool children. Maintenance of calcium and phosphorus intake should be part of any program of dietary fat reduction. Substitution of low-fat milk for whole milk, rather than elimination of whole milk, is one such strategy.
Recombinant Erythropoietin in Anemia of Prematurity: Five Years Later
Authors: SHANNON KEVIN
Published: December 2021

In 1988, Dr James Stockman discussed the anemia of prematurity in a fascinating editorial that anticipated much of what has unfolded as therapeutic trials using recombinant human erythropoietin (r-HuEPO) were initiated. Dr Stockman began by addressing the implications of then-recent results from my laboratory and from that of Robert Christensen which demonstrated large numbers of committed erythroid progenitors in the blood and bone marrow of small premature babies that responded normally to r-HuEPO in vitro. These data effectively closed the pathophysiologic loop in anemia of prematurity and strongly implicated inadequate production of erythropoietin (EPO) as the underlying reason erythropoiesis is quantitatively insufficient in this clinical setting (see reference 4 for a review). By then, early studies had shown that treatment with r-HuEPO corrects the anemia associated with chronic renal failure, a disorder that resembles anemia of prematurity in that it is characterized by low EPO levels and inadequate red cell production.
EFFECTS OF EARLY INTENSIVE SPORTS TRAINING
Authors: L. J. F.
Published: December 2021

It has been suggested that the intensive training of athletes from a young age could be bad for the developing body—a good reason not to screen for potential champions too young. However, that idea has been firmly repudiated by one of the biggest studies of young athletes ever carried out. In the study, known as the Training of Young Athletes (TOYA), a sample of 453 British children aged between 8 and 12, both athletes and non-athletes, were followed for five years to measure the effects of sport on the developing body.

. . ."There is no evidence that athletic activity affects physical development," says Nicola Muffulli, an orthopaedic surgeon who ran and analysed the F1 million programme, funded by the Sports Council. "This contradicts some predictions from the US," he adds. American scientists had quoted studies of forced exercise by laboratory animals to suggest that children could be injured more easily. "But the outcome of our study clearly means that elite sports participation does not mean you run a higher risk of being injured," says Muffulli.
Missed Immunization Opportunities
Authors: DERAUF DAVID D. , DERAUF D. CHRISTIAN
Published: December 2021

We read with great interest the recent studies in Pediatrics on missed opportunities for childhood immunization. Given the current national debate on ways to control health care costs and the recent proposals for federal procurement of all vaccine supplies, it is encouraging and illuminating to know that significant increases in immunization rates might be achieved without tremendous additional expense.

One of the major limitations of these studies, clearly acknowledged by the authors of the first but not the second study, was the inability to assess the role of immunization record availability in missed opportunities. Our experience leads us to agree that lack of immunization records contribute to missed opportunities for immunization far more often than the 2% of visits suggested by the first study.
In Reply: Missed Immunization Opportunities
Authors: MCCONNOCHIE KENNETH M. , ROGHMANN KLAUS J.
Published: December 2021

Drs Derauf and Derauf make an important point. The reduction of missed immunization opportunities is a very cost-effective way to deal with low vaccination rates in our cities, and the portable record might overcome one of the major obstacles to using immunization opportunities, namely, lack of immunization status information at the medical encounter. As suggested, the effectiveness of the portable record might be vastly improved by making it more attractive through use of baby pictures. Complimentary ideas include the use of reminder stickers on these cards for the next appointment and expanding the cards into "baby passports" that include developmental data and other screening information.
RESPIRATORY SYNCYTIAL VIRUS MORBIDITY AND MORTALITY ESTIMATES IN CONGENITAL HEART DISEASE PATIENTS: A RECENT EXPERIENCE
Authors: L. J. F.
Published: December 2021

In conclusion, present respiratory syncytial virus mortality rates in pediatric patients with congenital heart disease are much less than those described nearly a decade ago. Patients with pulmonary hypertension have increased mortality rates as measured by duration of hospitalization, need for and duration of intensive care, and requirement and duration of mechanical ventilation. However, greatly increased mortality risk is not currently seen in congenital heart disease patients with pulmonary arterial hypertension compared with those congenital heart disease patients without this diagnosis. The substantially reduced mortality rate differences observed between the present congenital heart disease patients and patients of a decade ago are probably due to advances in pediatric intensive care medicine and surgical management of heart disease. It is unlikely that the availability of ribavirin alone has been responsible for the marked reduction in respiratory syncytial virus congenital heart disease mortality rates. Appropriately designed studies addressing efficacy, cost-effectiveness, and short- and long-term safety of ribavirin use in patients with congenital heart disease are still needed.
Parent Dissatisfaction With Neonatal Intensive Care Unit Care and Suggestions for Improvements
Authors: LUCEY JEROLD F.
Published: December 2021

The article, "The Principles for Family-Centered Neonatal Care," in this issue is unique. I believe it is the first article we've published that is authored by a group of parents.

This special group of parents whose infants were cared for in intensive care nurseries was selected because of their previous attempts in the lay literature to communicate with the medical establishment through newspapers, association newsletters, books, or television interviews. They are unhappy with the present situation, and they want to see change.

Ross Laboratories sponsored a 2-day meeting of some of these parents with a small group of neonatologists. pediatricians, social workers, and intensive care nursery nurses.
Arterial Catheters and Retinopathy of Prematurity Risk: Need for a Multicenter Controlled Trial
Authors: RAPISARDI GHERARDO , DONZELLI GIAN PAOLO , FROSINI RICCARDO , CAMPA LUCIANA
Published: December 2021

To the Editor.—

During the period from January 1, 1987, to December 31, 1992, a total of 891 infants were admitted to the neonatal intensive care unit (NICU), A. Meyer Children's Hospital, Department of Pediatrics, University of Florence, Italy. Of these infants, 406 had a gestational age ≤33 weeks, and 273 were very low birth weight (≤1500 g, VLBW). Of them 779 (87.4%) survived. All the survivors were examined regularly by two experienced ophthalmologists, starting from the third or fourth postnatal week and then repeatedly at least every 2 weeks until retinal vascularization was completed.
Penicillin-Resistant Systemic Pneumococcal Infections in Children: A Retrospective Case-Control Study
Authors: Tan Tina Q. , Mason Edward O. , Kaplan Sheldon L.
Published: December 2021

Objective. To determine whether there are any risk factors that differentiate children with systemic infections due to Streptococcus pneumoniae relatively or fully resistant (minimum inhibitory concentration >0.1 µg/mL) to penicillin from those children with infections due to S pneumoniae susceptible to penicillin.

Design. Retrospective case-control study.

Setting. A large children's hospital.

Participants. Forty-three children with systemic penicillin-resistant S pneumoniae infections identified at Texas Children's Hospital over the 51-month period from January 1989 through March 1993. Each case had one or two controls matched only for age and date of S. pneumoniae infection. Sixty-six controls were selected from a group of 341 children with susceptible isolates.

Outcome measures. Variables compared included gender, race, diagnosis, underlying conditions, past hospitalization, geographic area of residence, antibiotic use in past month, amoxicillin-clavulanic acid use in past month, and outcome.

Results. Thirty-seven patients (86%) had relatively resistant isolates (minimum inhibitory concentration range 0.125 to 1.0 µg/mL) and six patients (15%) had fully resistant isolates (minimum inhibitory concentration range 2.0 to 8.0 µg/mL). Thirty-three percent of the cases vs 36% of the controls had underlying conditions. Seventy-one percent of the cases vs 39% of the controls had received antibiotics in the previous month. Compared with their matched controls, the patients with penicillin-resistant systemic pneumococcal infections were more likely (P = .02) to have received a course of antibiotics within the month prior to their infection.

Conclusion. The only identified associated risk factor in children who developed a systemic penicillin-resistant pneumococcal infection appears to have been the use of antibiotics within the month prior to their infection.
The Inconspicuous Penis
Authors: Bergeson Paul S. , Hopkin Robert J. , Bailey Robert B. , MCGill Leigh C. , Piatt Janice P.
Published: December 2021

Objective. To describe the etiology and management of the group of abnormalities referred to as the inconspicuous penis.

Design. Analysis of 19 cases seen over a period of 2 years by chart review.

Setting. Children's hospital in a major metropolitan area.

Patients. Nineteen boys referred to two pediatric urologists over a period of 2 years with penises that appeared abnormally small, but on palpation and measurement, were found to have a normal shaft with a normal stretched length. Diagnoses included were buried penis, webbed penis, and trapped penis. Patients ages ranged from 1 week to 13 years.

Findings. There were eight patients (42%) with trapped penis, and all were complications of circumcision (age 1 week to 7 months). Of nine (47%) patients with buried penis, two had been circumcised prior to diagnosis. One (5%) patient had webbed penis and one (5%) had combined buried and webbed penis.

Intervention. Six trapped penises were surgically repaired, and two resolved spontaneously. Five patients with buried penis had surgical repair, and two are being followed up for probable repair at age 9 to 12 months. Two were not repaired because of medical conditions or parental concerns. The webbed penis was surgically repaired as was the combined buried and webbed penis. The repairs were all successful and had no complications.

Conclusions. Inconspicuous penis encompasses a group of conditions in which the penis appears small but the shaft can be normal or abnormal in size. Circumcision is contraindicated in these patients until they have been evaluated by a urologist. Further study is needed to determine the natural history of these disorders and to better define which patients will benefit from surgical intervention and at what age.
Clinical Features and Epidemiology of Invasive Kingella kingae Infections in Southern Israel
Authors: Yagupsky Pablo , Dagan Ron , Howard Charles B. , Einhorn Menachem , Kassis Imad , Simu Alexander
Published: December 2021

Objective. To characterize the clinical spectrum and epidemiology of invasive Kingella kingae infections in children living in southern Israel.

Design. Five-year observational, descriptive study.

Population. Children in whom K. kingae was isolated from blood or other normally sterile body fluid.

Results. Twenty-five patients with invasive K. kingae infection (13 male and 12 female) were identified. Twenty-four of these children were younger than 2 years. The annual incidence was 14.3, 27.4, and 31.9 cases per 100 000 children ≤4 years, ≤24 months, and ≤12 months, respectively. Seventeen (68%) of 25 patients sought treatment between July and December. Concomitant upper respiratory tract infection or stomatitis was observed in 14 (56%) of the patients, suggesting a respiratory or buccal source for the infection. Four children were bacteremic: 2 of them suffered from a lower respiratory tract infection, and the remaining 2 had bacteremia with no evident focal infection. Twenty-one children had skeletal infections and none of them was bacteremic; 16 had septic arthritis, 3 had osteomyelitis, 1 had both osteomyelitis and septic arthritis of the adjacent joint, and 1 had dactylitis of the hand. Involvement of the ankle was unusually frequent among children with septic arthritis, whereas the calcaneus was involved in 3 of the 4 children with osteomyelitis. Antibiotic treatment resulted in full recovery in all cases, and only 2 patients with septic arthritis required surgical drainage.

Conclusion. Kingella kingae is a much more common cause of invasive infection in young children than has been previously recognized. The disease has a clear seasonal pattern, usually affects the skeletal system, frequently involves unusual bones and joints, and follows a benign course.
Childhood-Onset Systemic Lupus Erythematosus: Antiphospholipid Antibodies in 37 Patients and Their First-Degree Relatives
Authors: Molta Charles , Meyer Olivier , Dosquet Christine , de Oca Marcela Montes , Babron Marie-Claude , Danon Françoise , Kaplan Cécile , Clémenceau Sylvie , Castellano Françoise , Levy Micheline
Published: December 2021

Objective. Antiphospholipid antibodies (aPL) are noted with increased frequency in patients with systemic lupus erythematosus (SLE). The main manifestations found to be associated with aPL are arterial and venous thrombotic events, thrombocytopenia, and recurrent pregnancy loss This study is an attempt to define the incidence of aPL in patients with childhood-onset SLE and in their relatives and to correlate their presence with clinical manifestations, and especially, to evaluate the risk of thrombosis in aPL-positive subjects.

Methodology. We studied 37 unrelated patients and 107 of their first-degree relatives. VDRL, IgG and IgM anticardiolipin, and IgG antiphosphatidylethanolamine antibodies were studied in all probands during periods of clinical remission and in first-degree relatives at the time of interview. Lupus anticoagulant had only been studied in probands during an SLE flare-up.

Results. Thirty-eight percent of probands and 19% of relatives were positive for at least one aPL, with little over-lap between the different aPL studied. -No aPL-negative proband developed thrombosis. Two of the aPL-positive probands had thrombotic events before testing, and a third one showed thrombosis after testing. Only two probands had high levels of IgG aCL and showed thrombosis. The occurrence of aPL positivity in relatives was not always related to its presence in probands. None of the aPL-positive relatives had hadthrombosis, but recurrent fetal loss was noted in one aPL-positive mother with SLE. Although there was a high frequency of SLE, SLE-like disease, auto-immune disorders or positive serological findings for lupus in first-degree relatives, many of these relativew did not test positive for aPL.

Conclusion. The high levels of IgG aCL may be considered a risk factor for thrombosis. Findings in relatives suggest a multifactorial origin for autoimmune disease and antibody production.
Hypervitaminosis D After Prolonged Feeding With a Premature Formula
Authors: NAKO YASUSHI , FUKUSHIMA NAOBUMI , TOMOMASA TAKESHI , NAGASHIMA KANJI , KUROUME TAKAYOSHI
Published: December 2021

Hypervitaminosis D is one of the causes of severe hypercalcemia in children. Most cases of hypervitaminosis D during childhood are due to an excessive supplementation of vitamin D by physicians or parents.1,2

To prevent metabolic bone disease of prematurity (rickets of prematurity), formulas designed for premature infants ("premature formulas"), which contain more calcium and vitamin D than standard formulas, are given to premature infants in addition to human milk.1 In some cases, separate vitamin D products are also given to these infants, although requirements for vitamin D and calcium intake in the premature infant and the formerly premature infant have not been fully estimated.1
The Origin of the National Institute of Child Health and Human Development
Authors: Cooke Robert E.
Published: December 2021

In the life history of any person, certain dates stand out with clarity. The most precise, of course, is the birth date. The estimated date of confinement is fairly accurate, and our predictions are helped greatly by modern sonography. Somewhat less precise a date is the last menstrual period, because there may be some confusion when spotting occurs in the middle of the menstrual cycle. When conception is considered, dates and events are very imprecise: When exactly was the twinkle in Dad's eye, when was there a special vacation, or when was there an extra-cold night? This date tends to be considerably less reliable.
MOTHER GETS 6 YEARS FOR DRUGS IN BREAST MILK
Authors: L. J. F.
Published: December 2021

CORONA, Calif., Oct. 27 (AP)—In a case that appears to broaden the prosecution of women who pass drugs to their infants through their bodies, a woman was sentenced here Monday to six years in prison because her breast milk, tainted with methamphetamine, had killed her baby daughter.

In recent years, 160 women in 24 states have been charged with delivering drugs to their babies either during pregnancy or, through the umbilical cord, immediately after childbirth. But the case here in this town 40 miles southeast of Los Angeles is apparently the first in the nation based on the passing of drugs through breast milk.
Family History of Coronary Artery Disease and Cholesterol: Screening Children in a Disadvantaged Inner-City Population
Authors: Wadowski Stephen J. , Karp Robert J. , Murray-Bachmann Renee , Senft Carl
Published: December 2021

Background and purpose. Little information relating to cholesterol levels and screening for hypercholesterolemia in inner-city children exists. For this study, given the disrupted family backgrounds of many of our patients and the unreliability of family histories, our hypothesis was that in comparison with other samples, family history of coronary heart disease would be a poor screening tool for the identification of children with elevations in total serum cholesterol (TSC).

Subjects and methods. During 15 months, more than 400 pediatric outpatients, 2 through 14 years old, were screened for a family history of atherosclerotic disease. These children were attending a clinic serving a disadvantaged black and Hispanic population at Kings County Hospital Center. Nonfasting TSC levels were measured in 300 children. Positive risk for coronary heart disease was determined by the presence of a family history of coronary heart disease (defined as angina, stroke, or myocardial infarction in any parent or grandparent) at less than 55 years age.

Results. The mean TSC level was 4.27 mmol/L (SD ± 0.85) (165.0 mg/dL [SD ± 32.81]). The 29.4% of this population with a history suggestive of high risk for hypercholesterolemia had a mean TSC of 4.48 mmol/L (SD ± 0.971) (173.2 mg/dL [SD ± 37.5]), and those with no risk history had a mean TSC of 4.18 mmol/L (SD ± 0.750) (161.4 mg/dL [SD ± 29.91) (P < .005). Use of family history of coronary artery disease as a screening tool had a sensitivity of 39.3%, a specificity of 74.5%, and a positive predictive value of 39.8% for detection of moderate hypercholesterolemia (TSC ≥ 4.66 mmollL [180 mg/dL]).

Conclusions. This population's mean TSC level did not differ (P > .10) from those obtained in multiple large studies of average North American populations, and the predictive value and sensitivity of family history as a screening tool was comparable, although the prevalence of a positive family history was greater. The findings may be due to a greater prevalence of coronary artery disease at a young age in these families. In this population, a positive risk history is an important indicator for further evaluation of these children.
Letter to the Editor
Authors: Bhushan Vidya , Paneth Nigel , Kiely John L.
Published: December 2021

Drs Sola and Piecuch argue that the birth cohort prevalence is not the only way to express the frequency of cerebral palsy in the population and we agree.

Birth cohort prevalence is analogous to cumulative incidence, and is the most suitable measure for monitoring secular trends. Our focus on birth cohort prevalence derived from its dependence on changing patterns of newborn survival, which is a surrogate measure of newborn care, and its independence of the birth rate which is not related to medical factors which we purport to monitor in pennatal epidemiology. Besides, birth cohort prevalence is used in many population-based studies, which makes comparisons possible.
Clinical Comparison of Localized Intestinal Perforation and Necrotizing Enterocolitis in Neonates
Authors: Buchheit John Q. , Stewart Dan L.
Published: December 2021

Objective. To better define the prognosis of neonates with gastrointestinal perforation and improve their management.

Methods. We reviewed the results of physical examinations, laboratory results, and radiographic tests of 42 patients in whom gastrointestinal perforation was diagnosed in our neonatal intensive care unit.

Results. Twenty-one patients had necrotizing enterocolitis and 21 had localized intestinal perforation. Perinatal history, gender, race, birth weight, and estimated gestational age were similar for both groups. Patients with localized perforation were more likely to have had an umbilical artery catheter in place within 48 hours of perforation, to have received higher doses of indomethacin, to have undergone primary surgical repair, and to have survived until discharge from the hospital. Patients with necrotizing enterocolitis were more likely to have received enteral feedings and to have had a metabolic acidosis and leukopenia at the time the perforation was diagnosed.

Conclusions. We conclude that localized intestinal perforation and necrotizing enterocolitis, although similax in the organ system they affect, are distinctly different in clinical correlates and outcome. The increased awareness of localized perforations may help those taking care of neonates to diagnose this condition more accurately and to discuss its implications with family members.
DO BIRDS GET HOOKED ON HAND-OUTS?
Authors: L. J. F.
Published: December 2021

Bird lovers opposed to the welfare state can rest easy. American ecologists have found that if you feed birds in the winter, they will not, as most people believe, end up dependent on hand-outs and unable to fend for themselves.

Margaret Brittingham and Stanley Temple, of the University of Wisconsin at Madison observed birds visiting a feeder one winter. They found that regular visitors coped with finding food just as well as birds that had never used a feeder (Journal of Field Ornithology, vol 63, p 190).