bluuebunny/crossref_metadata_2025 huggingface dataset:
Poliomyelitis: Its Global Demise?
Authors: WELLER THOMAS H.
Published: December 2021

During the summer of 1955, Massachusetts suffered its most severe epidemic of poliomyelitis with 3,950 cases. Those who were pediatric residents or parents during this period retain vivid memories of the physical and emotional problems of that summer. Some 1,035 cases were admitted to the Children's Hospital in Boston and the corridors in the isolation unit became occluded with clanking Drinker respirators.1 The year 1955 also saw the licensing of inactivated poliomyelitis vaccine, followed in 1961-1962 by the licensing of live attenuated oral vaccines. Extensive utilization of poliomyelitis vaccines has led to the virtual eradication of poliomyelitis in the United States, and now poliomyelitis is a disease out of sight and out of mind for contemporary pediatric residents and parents in the United States.
Use of Tricyclic Medications in Children
Authors: RAUBER ALBERT , MARONCELLI REGINA
Published: December 2021

In Reply.—

Our attention was first caught by Food and Drug Administration statistics1 that showed that across the nation, the incidence of toxic events paralleled the number of prescriptions for tricyclic antidepressants except when one of them was prescribed for a child or sibling less than 10 years of age and suffering from enuresis. In these circumstances, there was a greater risk of a poisoning episode than when the drug was prescribed for neuropsychiatric reasons for an adult.
Use of Denver Developmental Screening Test
Authors: ALLAN WALTER C. , DRANSFIELD DOUGLAS A. , TITO ALISON M.
Published: December 2021

In Reply.—

We would agree with VanDervoort and Lee that the Denver Developmental Screening Test is a screening instrument and as such does not make a diagnosis of developmental delay. We referred to the test because it had been administered to all infants and because it represents a commonly known set of developmental landmarks. It was our purpose to emphasize the differences between the group of infants who had grade IIB or grade III hemorrhage with posthemorrhagic hydrocephalus and the infants in other categories.
Children as Victims of Parental Conflict
Authors: REINHART MICHAEL A.
Published: December 2021

To the Editor.—

The article by Nelson1 included particularly vivid examples of the manner in which children may become victims of parental conflict. In the experience of University of California Davis Medical Center's Suspected Child Abuse and Neglect Team, similar cases (although less severe) account for approximately 2% of the physical abuse cases reviewed. Social services agencies tend to view such occurrences as "accidents," and are reticent to provide services to such families. Physicians must take an active role in advocating that the families and children receive appropriate services.
Meat Tenderizer and Bee Stings
Authors: FIKAR CHARLES R.
Published: December 2021

In Reply.—

Cardoni et al have scientifically studied the question of whether a papain paste, in the form of commercially available meat tenderizer, is efficacious in bee sting treatment. Their experimental model (Toxicon 1981;19:851-855) showed no beneficial effect of topically applied papain. However, as stated in that article, their method of artificially injecting the venom via syringe and needle may explain the lack of efficacy. Some bees leave the stinger and venom sack at the wound site.
Use of a Microcomputer for Calculation of Total Parenteral Nutrition for Very Low-Birth-Weight Infants
Authors: ARMON Y. , ROLL D. , BRANSKI D. , GALE R.
Published: December 2021

To the Editor.—

In addition to the various uses of microcomputers in general pediatrics described by Schwartz and Hammer1 and their use for self-evaluation in pediatric practice as noted by Gouyon et al,2 we would like to draw attention to another application as used in our neonatal intensive care unit.

We have developed an interactive microcomputer program for the daily calculation of total parenteral and combined parenteral and enteral nutrition for very low-birth-weight infants and other sick neonates.
Reduction of Oxygen Consumption, Insensible Water Loss, and Radiant Heat Demand with Use of a Plastic Blanket for Low-Birth-Weight Infants Under Radiant Warmers
Authors: Baumgart Stephen
Published: December 2021

Eight very low-birth-weight premature infants (mean birth weight 1.11 ± 0.05 [SEM] kg, mean gestation 30 ± 1 weeks, and mean age 9 ± 2 days) were studied under servocontrolled radiant warmers with and without a loosely fitted, transparent, and flexible Saran plastic blanket. Metabolic rate was significantly less in all infants when covered by the blanket (oxygen consumption was 7.99 ± 1.13 mL/kg/min v 9.00 ± 1.10 mL/kg/min uncovered, P < .001). There were also significant reductions in insensible water loss (1.86 ± 0.18 v 1.25 ± 0.20 mL/kg/h, P < .01) and in heat demand from the radiant warmer (14.3 ± 1.3 v 9.9 ± 1.4 mW/cm2, P < .001) when infants were nursed under the blanket compared with the control condition, respectively. Covering the critically ill, very low-birth-weight infant nursed under a radiant heater with a thin, transparent layer of Saran is beneficial in reducing oxygen consumption, insensible water loss, and the need for exposure to high levels of radiant heat. Further investigation to confirm the benefits and possible complications of plastic blankets should be conducted before routine use can be recommended.
Learning Disability: 10-Year Follow-up
Authors: Hartzell Harry E. , Compton Carolyn
Published: December 2021

A 10-year follow-up of 114 learning-disabled students has been conducted, gathering information on their academic achievement, social success, and job satisfaction. These students have been compared with 144 siblings without learning disabilities. Significantly lower levels of school attainment, academic success, and social success are found for the learning-disabled group. No difference is found in level of job satisfaction. Significant positive factors contributing to school success in the learning-disabled group were high IQ, less severe learning disability, positive personality characteristics in the child, effective family function, strong family support, high occupational level of family breadwinner, and high education level attained by the mother. Negative factors are a more severe degree of learning disability, the presence of hyperactivity, and a concomitant disability in mathematics.
Cord Plasma α-Fetoprotein Values and Neonatal Jaundice
Authors: Tan K. L. , Loganath A. , Roy A. C. , Goh H. H. , Karim S. M. , Ratnam S. S.
Published: December 2021

Umbilical cord plasma α-fetoprotein (AFP) values were determined in 127 infants with hyperbilirubinemia (56 glucose-6-phosphate dehydrogenase (G-6-PD) deficient and 71 G-6-PD normal) and 136 control subjects (73 G-6-PD deficient and 63 G-6-PD normal). The mean α-fetoprotein value of 173 ± 35.2 (SD) mg/L for the group of infants with hyperbilirubinemia was significantly greater than that (122 ± 21.7 mg/L) for the control infants (P < .001). G-6-PD status and sex did not significantly affect the α-fetoprotein values. Using an α-fetoprotein level of 130 mg/L as a "cut-off" value, the incidence of false-positive results was 25.5% and the incidence of false-negative results was 11.8%. This test can be used as a screening procedure to detect infants at high risk for hyperbilirubinemia.
E-Ferol: What Happened and What Now?
Authors: PHELPS DALE L.
Published: December 2021

In October 1983, an intravenous form of vitamin E was marketed as a nutritional supplement but promoted and used pharmacologically for the prevention of retinopathy of prematurity (ROP). By April 1984, E-ferol was recalled following the deaths of 38 infants who had received the drug. Why did they die, does vitamin E even prevent ROP, and can it be given safely?

WHY DID THEY DIE?

Naturally occurring vitamin E is tocopherol, a fatty alcohol that is absorbed unchanged with other fats from the gastrointestinal tract. Several esters of the parent compound are available. The acetate ester is the form generally found in oral preparations, and the form available in parenteral multivitamin preparations.
Annual Summary of Vital Statistics—1983
Authors: Wegman Myron E.
Published: December 2021

Data for this article, as in previous reports,1 are drawn principally from the Monthly Vital Statistics Report,2-7 published by the National Center for Health Statistics. The international data come from the Demographic Yearbook8 and the quarterly Population and Vital Statistics Report,9 both published by the Statistical Office of the United Nations, which has also been kind enough to provide directly more recent data. Except for mortality data by cause and age, which are based on a 10% sample, all the US data for 1983 are estimates by place of occurrence based upon a count of certificates received in state offices between two dates, one month apart, regardless of when the event occurred. Experience has shown that for the country as a whole the estimates are very close to the subsequent final figures. There are, however, considerable variations in a few of the states, particularly in comparing data by place of occurrence with data by place of residence. State information should be interpreted cautiously.
Clinical Trial of the Treatment of Colic by Modification of Parent-Infant Interaction
Authors: Taubman Bruce
Published: December 2021

A study evaluating the treatment of colic by modification of the parent-infant interaction was carried out in a private practice setting. The study population consisted of 30 normal colicky infants and 30 control infants matched for age in weeks, sex, and the presence of siblings. The two groups were similar with regard to sociodemographic and other variables with the exception that mothers of colicky infants were older (P < .005). Quantitative measurements of crying were obtained using prospective diaries of infant behavior. Colicky infants were found to cry 2.6 ± 1.1 h/d as compared with 1.0 ± 0.5 h/d for control infants (P < .001). The treatment of these infants was based on the assumption that colic results from inappropriate parental responses to the baby's crying and consisted of counseling the parent on more effective responses. This resulted in the infants' crying decreasing from 2.6 ± 1.1 h/d to 0.8 ± 0.3 h/d (P < .001), no different from the average of the control group. It is concluded that a major cause of colic is the misinterpretation of infant cries leading to ineffective responses, and that this can be managed by counseling parents on how to respond to infant crying.
Loss of Intellectual Function in Children with Phenylketonuria After Relaxation of Dietary Phenylalanine Restriction
Authors: Seashore Margretta R. , Friedman Estelle , Novelly Robert A. , Bapat Vijaya
Published: December 2021

Fourteen patients with classic phenylketonuria (PKU) were treated with a phenylalanine restricted diet from early infancy. All had satisfactory dietary control, with serum phenylalanine concentrations ranging between 2 to 5 mg/dL. Dietary restriction was discontinued in all these children between ages 5 and 6 years, and a free diet allowed. Developmental testing was performed using the Cattell Infant Intelligence Scales (1 to 2 years), Stanford-Binet Intelligence Scale (2 to 4 years), Wechsler Intelligence Scale for Children (WISC) and the revised version (WISC-R) (<5 years). Mean IQ for the group (Stanford-Binet and WISC) at termination of dietary therapy was 104 ± 13. Four to 7 years after discontinuation of dietary therapy, mean IQ for the group was 90 ± 13. The severity correlated, to some degree, with duration of unrestricted diet, but not with initial serum phenylalanine concentrations, age at initiation of therapy, or IQ at time diet was discontinued. Several children are experiencing difficulties, both attentional and academic, in school. Two children have had a change in the EEG from normal to abnormal. Neurologic testing performed after 4 to 7 years off diet demonstrated deficits in visual-motor integration or cognitive problem-solving in most children. The mean developmental age for the group for perceptual-motor integration was 1.2 years below the mean chronologic age of the group. This deterioration in intellectual function suggests that discontinuation of the phenylalanine-restricted diet is hazardous for some children with classic phenylketonuria.
Television's Impact on Children
Authors: Zuckerman Diana M. , Zuckerman Barry S.
Published: December 2021

Television has a major impact on children's knowledge, attitudes, and behavior. Research has demonstrated the association between television viewing and four areas: (1) children's aggressive behavior; (2) racial and sex-role stereotypes; (3) decreased interest in reading and school activities; and (4) poorer health habits and attitudes. Methodological limitations make it difficult to draw firm conclusions about a causal relationship between television viewing and children's behavior. Representative studies in these four areas are reviewed, important methodological concerns are pointed out, and conclusions from the research findings are drawn. The implications of the data for pediatricians and other health professionals are discussed.
Factors Affecting Head Growth and Intellectual Function in Children of Drug Addicts
Authors: Lifschitz Marta H. , Wilson Geraldine S. , Smith E. O'Brian , Desmond Murdina M.
Published: December 2021

The effect of maternal heroin and methadone use on head growth and neurodevelopmental performance was studied in preschool children of untreated heroin addicts (n = 25), women receiving methadone therapy (n = 26), and a drug-free comparison group (n = 41) who had been followed from birth. The mean birth head circumference of both groups of drug-exposed infants was significantly below that of the comparison group; however, the only factors determined by multiple regression analysis as associated with head size at birth were maternal nutritional status and birth weight. By preschool age, head size did not differ significantly among groups. The factors associated with postnatal head growth were birth weight, intrapartum risk score, and race. Data show an increased incidence of low-average and mildly retarded intellectual performance in the drugexposed children. Regression analyses demonstrated that amount of prenatal care, prenatal risk score, and home environment were most predictive of intellectual performance and that the degree of maternal narcotic use was not a significant factor.
Palpebral Fissure Length in Black and Hispanic Children: Correlation with Head Circumference
Authors: Iosub Silvia , Fuchs Magdalena , Bingol Nesrin , Stone Richard K. , Gromisch Donald S. , Wasserman Edward
Published: December 2021

Palpebral fissure length and head circumference were measured in 170 black and 170 Hispanic normal children aged 1 month to 16 years. Eye measurement values were compared with those for white children. It was found that black children have longer palpebral fissures than whites and in certain age groups, than Hispanics. A statistically significant correlation between palpebral fissure length and head circumference was established in black children.
Value of Random Urinary Homovanillic Acid and Vanillylmandelic Acid Levels in the Diagnosis and Management of Patients with Neuroblastoma: Comparison with 24-Hour Urine Collections
Authors: Tuchman Mendel , Morris Christopher L. , Ramnaraine Margaret L. , Bowers Larry D. , Krivit William
Published: December 2021

Urinary homovanillic acid (HVA) and vanillymandelic acid (VMA) levels were determined in random samples and in 24-hour collections from 13 patients with neuroblastoma and 22 patients without neuroblastoma. Random sample levels were compared with levels in 24-hour collections and showed a positive correlation of 95% for HVA (N = 59) and 93% for VMA (N = 52). No false positives or false negatives occurred using random samples for diagnosis. Nonneuroblastoma (normal) HVA (N = 126) and VMA (N = 119) levels are reported for different age groups. Sequential random HVA and VMA determinations in patients with neuroblastoma during and after therapy are shown. Random urinary HVA and VMA levels are shown to be adequate for utilization in the diagnosis of neuroblastoma and sequential determinations of random HVA and VMA are shown to be helpful in the follow-up of those patients.
Oral Dexamethasone for Treatment of Persistent Middle Ear Effusion
Authors: Macknin Michael L. , Jones Paul K.
Published: December 2021

A double-blind controlled study of oral dexamethasone (in a 2-week tapering dose from .15 mg/kg/d) v placebo in 49 pediatric patients (mean age 3.7 years) with persistent asymptomatic middle ear effusion of three or more weeks duration was conducted. Middle ear effusion resolution was determined by a myringotomy-validated algorithm that combined pneumatic otoscopy and tympanometry. Four weeks after completing treatment, 1/26 (4%) patients receiving dexamethasone and 2/23 (9%) patients receiving placebo had completely cleared their middle ear effusion (95% confidence interval -0.05 ± 0.14). Five of 26 (19%) patients receiving dexamethasone and 6/23 (26%) patients receiving placebo had improved their hearing in all affected ears by 10 dB or more (95% confidence interval -0.07 ± 0.23). Oral dexamethasone as used in this study was not effective in treating persistent middle ear effusion in children.
Premature Infants in Car Seats
Authors: Bull Marilyn J. , Stroup Karen Bruner
Published: December 2021

Advancements in health care have made it possible for many premature infants weighing less than 2.2 kg (5 lb) to be discharged from the hospital. Medical professionals, however, have no information available from which to make recommendations on which child safety seats are most appropriate for safely transporting the low-birth-weight infant. Current federal safety standards do not specify the minimum weight of an infant for which a seat is appropriate. The suitability of various types of infant car safety seats for premature infants was documented by placing 2.0-kg (4 lb 8 oz) babies in a representative sample of seat models. Ease and ability of the seat to fit the size of the infant and allow for proper positioning of the baby was noted. Each seat was measured from the seat back to crotch strap and shoulder strap to seat bottom to provide a basis for comparison of various seat models. Convertible seats with seat back to crotch strap height of 14 cm (5½ in) or less provided relatively good support for the infant. Seats with longer seat back to crotch strap distances allowed the infant to slouch. Seats with lap pads or shields were uniformly unacceptable.
Nutrient Intakes of Formula-Fed Infants and Infants Fed Cow's Milk
Authors: Montalto Michael B. , Benson John D. , Martinez Gilbert A.
Published: December 2021

Twenty-four-hour dietary intake data from the second National Health and Nutrition Examination Survey (NHANES II), 1976-1980, were analyzed to compare nutrient intakes among infants 7 to 12 months of age who were fed mixed diets containing solid foods and either infant formula or cow's milk. Solid foods fed to the infants in both groups were low in iron and linoleic acid, and high in sodium, potassium, and protein, relative to Recommended Dietary Allowances. Infants who were fed cow's milk received lower median intakes of iron (7.8 mg V 14.9 mg), linoleic acid (1.8 g v 6.1 g), and vitamin C (39 mg v 64 mg), and higher median intakes of protein (41 g V 25 g), sodium (1,000 mg v 580 mg), and potassium (1,630 mg V 1,020 mg) than formula-fed infants. Seventy-five percent of the infants fed cow's milk had iron intakes below the Recommended Dietary Allowance; 69% had sodium intakes above the range of estimated safe and adequate daily dietary intake. Linoleic acid provided less than 3% of energy intake for 74% of the infants fed cow's milk. Differences in nutrient intakes were due not only to different concentrations of nutrients in each of the milk feedings but also to the different amounts and types of solid foods fed to the two groups of infants.
Risk Factors of Diabetic Retinopathy
Authors: MARKS IRA
Published: December 2021

To the Editor.—

In their article on risk factors for diabetic retinopathy in youth, Malone et al1 make note of the recent report of Goldstein and associates2 of a direct association between antecedent long-term glycemic control and the development of diabetic retinopathy in a population with age and duration of diabetes similar to those in the study population of Malone et al.

However, Malone et al do not mention a significant difference between their study group and that of Goldstein et al: the group of Malone et al had no well-controlled diabetics whereas the group of Goldstein et al had many.
Does Statistical Significance Equal Real Significance
Authors: FERGUSSON D. M.
Published: December 2021

In Reply.—

Hersher's letter resurrects an old controversy about methods of assessing the size of effect in epidemiologic research. The basis of this conflict is implicit in the figures he quotes: on the one hand high exposure to adverse life events was associated with a sixfold increase in risks of hospital admission, whereas on the other hand, the life events measure explained only 3% of the variance in hospital admission. The former statistic suggests an association of importance, whereas the amount of explained variance is disappointingly small.
Symptoms of Respiratory Illness in Young Children and the Use of Wood-Burning Stoves for Indoor Heating
Authors: Honicky Richard E. , Osborne J. Scott , Akpom C. Amechi
Published: December 2021

The occurrence of symptoms of respiratory illness among preschool children living in homes heated by wood-burning stoves was examined by conducting an historical prospective study (n = 62) with an internal control group (matched for age, sex, and town of residence). Exposures of subjects were not significantly different (P > .05) with respect to parental smoking, ureaformaldehyde foam insulation, and use of humidifiers. The control group made significantly greater use of gas stoves for cooking whereas the study group made greater use of electric stoves for cooking and of air filters (P <.05). Only one home used a kerosene space heater. During the winter of 1982, moderate and severe symptoms in all categories were significantly greater for the study group compared with the control group (P < .001). These differences could not be accounted for by medical histories (eg, allergies, asthma), demographic or socioeconomic characteristics, or by exposure to sources of indoor air pollution other than wood-burning stoves. Present findings suggest that indoor heating with wood-burning stoves may be a significant etiologic factor in the occurrence of symptoms of respiratory illness in young children.
Unusual Syndrome Among Premature Infants: Association With a New Intravenous Vitamin E Product
Authors: Lorch Vichien , Murphy M. Dianne , Hoersten Linda R. , Harris Eva , Fitzgerald Jean , Sinha Sachchida N.
Published: December 2021

Eight small, premature infants developed an unusual symptom complex of pulmonary deterioration, thrombocytopenia, liver failure, ascites, and renal failure. five infants died; the health of the other three infants improved and they were discharged from the hospital. This unusual syndrome occurred after introduction of a new intravenous vitamin E product (E-Ferol, α-tocopherol acetate) for routine use in the intensive care nursery. Even though no definite conclusion was reached as to its cause, the administration of this intravenous vitamin E product appears to be a significant risk factor.
Adolescents and Ritalin
Authors: HUESSY HANS R.
Published: December 2021

To the Editor.—

I continue to see patients in late adolescence with serious social and psychological problems that had been treated successfully with Ritalin. The medication was stopped at age 12 years because "the condition goes away at that age."

Attention deficit disorder may indeed spontaneously remit at any age. Such remissions are unpredictable. Many patients continue with their problems long into adult life.

If a child had problems related to attention deficit disorder of sufficient degree to warrant the use of medication, such medication should be continued as long as it exerts an obviously beneficial effect.
Role of National Organizations in the Education and Evaluation of Professionals Who Care for Children
Authors: Burg Fredric D.
Published: December 2021

Imagine a time when any family with a sick child can be assured that any physician licensed to care for their young has had a planned educational experience designed to assist that physician to perform in a competent fashion. Imagine a time where any physician licensed to care for their young has recently demonstrated competency in managing the problems facing their sick child. Imagine a time when programs accredited to educate physicians will routinely document the ability of their students to perform competently.

The purpose of this paper is to provide suggestions for ways to improve the system of education and evaluation of professionals responsible for the health care of infants, children, and adolescents in the United States of America.

These suggestions are based on an empirical analysis of the existing systems. On the basis of that analysis, I believe that the systems, as presently designed and operated, are not fully meeting the needs of our profession. There are steps that we can and should take to improve these important processes, and I believe that we should begin to work to enhance and make better our educational and evaluative systems. Hopefully, from these efforts a model for others within the health care world will emerge.

This paper will have four parts. First, a presentation of the functions that a system of national organizations should carry out in the education and evaluation of those persons professionally responsible for the health care of children. Second, a discussion of how those functions are presently met through the activities of national organizations.
Epilepsy and Swimming
Authors: FREEMAN JOHN M.
Published: December 2021

To the Editor.—

In the article on prevention of childhood injuries, Greensher states that "it is prudent to recommend limiting swimming (in patients with epilepsy) until these patients are seizure-free for 1 year."

We believe that all activities that children—and adults—undertake carry some risk. The risk is slightly greater for a child with epilepsy than for one without. The dimensions of that risk depend on the frequency and type of seizures. However, there are major risks in limiting activities for children and adults.
Gallbladder Disease Terminology
Authors: LOGAN GEORGE B. , THISTLE JOHNSON L.
Published: December 2021

To the Editor.—

Diseases of the gallbladder and bile ducts, while uncommon among infants and children, still occur with sufficient frequency that they must be remembered by all pediatric clinicians. One of the problems in this regard is that of terminology.

If stones are present in the gallbladder or ducts there is no problem, though one has to know that pigmented and nonpigmented (usually cholesterol) stones are both found in children. Cholelithiasis, with or without cholecystitis, is the proper diagnosis.
Evaluation of Two Tetravalent (ACYW135) Meningococcal Vaccines in Infants and Small Children: A Clinical Study Comparing Immunogenicity of O-Acetyl-Negative and O-Acetyl-Positive Group C Polysaccharides
Authors: Peltola Heikki , Safary Assad , Käyhty Helena , Karanko Viena , André Francis E.
Published: December 2021

Two different tetravalent polysaccharide vaccines against group A, C, Y, and W135 meningococci were given to 118 infants aged 6 to 23 months; the same vaccines were administered in a second dose 12 months later to those infants aged 6 to 11 months at first vaccination. Forty of the infants received vaccine containing the nonacetylated group C polysaccharide C(OAc-) and 78 the acetylated group C polysaccharide C(OAc+) together with group A, Y, and W135 polysaccharides. All polysaccharides, at a dose of 30 µg, induced antibody responses after administration of both vaccines in all age groups although the responses were better in the older infants. Acetylation of the sialic acid of the group C polysaccharide did not significantly influence the response. Rapid decreases in the antibody titers after the first vaccination stressed the need for one or more revaccinations. Vaccination elicited mild local and systemic reactions. Elevated temperatures were more common in the youngest infants but only four developed fever exceeding 38.5°C (101.3°F). We conclude that tetravalent (ACYW135) meningococcal vaccine is safe and immunologically effective in children younger than age 2 years. However, revaccinations may be required to maintain immunity.
Iatrogenic Arteriovenous Fistula After Multiple Arterial Punctures
Authors: Ontell Sheryl J. , Gauderer Michael W. L.
Published: December 2021

Multiple arterial punctures in the neonate can result in iatrogenic arteriovenous fistula formation. In one case, a 3-month-old infant who had been born prematurely was noted to have physical findings consistent with arteriovenous malformation following approximately 90 arterial blood gas determinations over a 13-week period. The area was explored and the lesion was treated surgically with good results.
Digital Ischemia in the Neonate Following Intravenous Therapy
Authors: Wehbé Marwan A. , Moore John H.
Published: December 2021

Ischemia and gangrene in the hand can result from attempted intravenous cannulation in the neonate. This disastrous complication can be avoided with an understanding of the blood supply of the hand. Once ischemia occurs, amputation is the usual end result, but it may be averted by early diagnosis and treatment.
Prevention of Preterm Births: A Perinatal Study in Haguenau, France
Authors: Papiernik E. , Bouyer J. , Dreyfus J. , Collin D. , Winisdorffer G. , Guegen S. , Lecomte M. , Lazar P.
Published: December 2021

A reduction in preterm births has been observed in Haguenau (Eastern France) during a 12-year intervention study with a program for prevention of preterm deliveries. The Perinatal Study of Haguenau was an observation tool used in a stable population, and it allowed measurement of the way women have progressively responded to the new proposals in prenatal care. It also allowed measurement of the results of the interventions: low birth weight (less than 2,500 g) and preterm birth rates (less than 37 weeks of gestation) among single live births. The total duration of the study was divided into three periods of four years (1971 through 1974, 1975 through 1978, and 1979 through 1982), for which the numbers of single live births are 5,763, 4,957, and 5,919, respectively. For the same periods, the low-birth-weight rates, 4.6%, 4.0%, and 3.8%, respectively, showed a significant decrease (P < .001). Following a similar pattern, the rates of preterm birth were 5.4%, 4.1%, and 3.7% (a significant reduction with P < .001). These improvements in pregnancy outcome do not disappear after standardization of mother's age, high blood pressure, or social class distribution. These findings, which concur with the results of others, enhance the hypothesis of a direct relationship between a prevention program and a reduction in preterm birth rates.
Predictive Value of Abnormal Physical Examination Findings in Ill-Appearing and Well-Appearing Febrile Children
Authors: McCarthy Paul L. , Lembo Robert M. , Baron Michael A. , Fink Howard D. , Cicchetti Domenic V.
Published: December 2021

In order to study the occurrence and positive predictive value of history and physical examination findings suggestive of serious illness in ill-appearing and well-appearing febrile children, 103 consecutive children aged ≤24 months with fever ≥38.3°C were evaluated from July 1, 1982 to Nov 24, 1982. Patients were initially classified by an attending physician (A) as to whether they appeared ill (Yale Observation Scale score >10) or well (scale score ≤10). The history was then taken by two attending physicians (A and B) and a resident; the physical examination was performed by attending physician B and the same resident. As history and physical examination findings were elicited, they were scored as to whether they did or did not suggest a serious illness. Serious illness was defined as the presence of a positive laboratory test. Ill-appearing patients had a significantly greater (P < .001, Fisher's exact test) occurrence of physical examination findings suggesting serious illness (14 of 22, 64%) than well-appearing children (12 of 81, 15%). The positive predictive values of abnormal physical examination findings for serious illness in ill-appearing (11 of 14, 79%) and well-appearing children (3 of 12, 25%) were significantly different (P = .02 by Fisher's exact test). The trends for abnormal history findings in ill-appearing and well-appearing children were similar to those for abnormal physical examination findings but did not achieve statistical significance. The results, indicating an important interaction between a febrile child's appearance and physical examination findings, are discussed in terms of probability reasoning in clinical decision making.
Gastrointestinal Injury in Polycythemic Term Infants
Authors: Black Virginia D. , Rumack Carol M. , Lubchenco Lula O. , Koops Beverly L.
Published: December 2021

Necrotizing enterocolitis is uncommon among term infants. In this group, necrotizing enterocolitis has been associated with two risk factors: polycythemia and umbilical catheterization. During a randomized trial of partial plasma exchange transfusion for treatment of polycythemia, an increased risk of gastrointestinal problems was noted. Eight hyperviscous patients treated with partial plasma exchange transfusion, no symptomatically treated patients, and no control infants developed typical necrotizing enterocolitis (blood in the stools, pneumatosis, and systemic signs). The incidence of necrotizing enterocolitis was significantly greater among patients treated with exchange transfusion compared with patients treated symptomatically or control subjects (P < .001).
Pediatric Generalists in an Academic Setting
Authors: ADLER ROBERT , KORSCH BARBARA M.
Published: December 2021

A generation ago, the general pediatric practitioners participating in patient care, education, and research in academic centers, usually were members of a part-time faculty based in private practice outside of the center. They were respected consultants and teachers who constituted attractive role models for students and trainees. They modeled the practice of pediatrics not only from a technical perspective, but also exemplified the humane role of pediatricians with their young patients and their families, as well as within the community.

As technology became more complex and constituted a larger proportion of care provided in the hospital, community-based physicians found it increasingly difficult to keep up with technical progress and found themselves less effective and less respected in the academic world.
Protein-Fortified Milk in Premature Infants
Authors: GREER FRANK R.
Published: December 2021

To the Editor.—

Rönnholm and colleagues1 have documented the increase in serum amino acid levels in premature infants fed human milk fortified with human milk protein. They have also demonstrated that serum amino acid concentrations were not affected by supplements of medium-chain triglyceride (MCT) oil. Of practical, clinical interest would be whether or not these supplements of fat or protein had any effects on the growth parameters in these infants? The authors have not addressed this issue in their report; yet, this would have a major impact on its clinical significance.
Risk Factors for Retrolental Fibroplasia: Experience with 3,025 Premature Infants
Authors: Purohit Dilip M. , Ellison R. Curtis , Zierler Sally , Miettinen Olli S. , Nadas Alexander S.
Published: December 2021

The rate of retrolental fibroplasia in relation to prenatal and neonatal characteristics was explored on the basis of a cohort of 3,025 neonates with birth weight less than 1,750 g. The overall rate of retrolental fibroplasia of any degree at hospital discharge was 11%, varying from 43% for those with birth weight between 500 and 749 g to 3% for those in the 1,500- to 1,750-g category. Among the potential determinants, the main interest was in nonhyperoxic characteristics, conditional on measures of prematurity and oxygen supplementation. Maternal diabetes and antihistamine use during the last 2 weeks of pregnancy were associated with significantly higher rates of retrolental fibroplasia, whereas toxemia was associated with lower rates. Frequent apneic spells, bronchopulmonary dysplasia, and sepsis in the neonate were also associated with significantly higher rates. On the other hand, the data indicate no independent role of low Apgar score, intraventricular hemorrhage, exchange transfusion, patent ductus arteriosus, or certain other characteristics previously postulated as risk factors.
Teaching Car Passenger Safety to Preschool Children
Authors: Chang Albert , Dillman Arline S. , Leonard Elaine , English Patricia
Published: December 2021

An educational curriculum entitled "Bucklebear" was designed to increase safety seat and seat belt use in young children enrolled in preschool programs (day care centers and nursery schools). Three basic concepts were emphasized: (1) "buckling up" is a good habit for everyone for every ride; (2) the back seat is the best seat; and (3) there are desirable passenger behaviors. The curriculum included training workshops with teachers, parent meetings, classroom lessons, sound filmstrip, puppet play, and many other activities. Six experimental programs and seven control programs with 402 and 427 enrolled children, respectively, participated. After their participation in the educational curriculum, children in the experimental program increased their use of a safety seat or seat belt from 21.9% to 44.3%. These children also increased their knowledge and simulated practice of car passenger safety.
Why Orajel?
Authors: MACK RONALD B.
Published: December 2021

To the Editor.—

I believe Pediatrics casts a long shadow in the lives of many of its readers; I know it does for me. Therefore, it disturbs me to see an advertisement (Pediatrics 1985;75:A47) concerning the use of benzocaine-containing baby Orajel for "teething" pain. I realize that the ad contains no direct endorsement by the Academy, but it does imply, at least to me, tacit approval by its very existence in the journal. The section in the ad marked "Important Note" implies that the Committee on Drugs of the American Academy of Pediatrics believes that Orajel is alright to use because it does not contain alcohol.
Health Insurance, Medical Care, and Children's Health
Authors: VALDEZ R. BURCIAGA , LEIBOWITZ ARLEEN , WARE JOHN E. , DUAN NAIHUA , GOLDBERG GEORGE A. , KEELER EMMETT B. , LOHR KATHLEEN N. , MANNING WILLARD G. , ROGERS WILLIAM H. , CAMP PATRICIA , SHERBOURNE CATHY A. , BROOK ROBERT H. , NEWHOUSE JOSEPH P.
Published: December 2021

We welcome this opportunity to respond to previously published commentaries by Drs Haggerty, Starfield, and Dutton on our discussions of how cost sharing affects the use of medical services and health status.1,2 Our purpose in responding is threefold: to reiterate succinctly the major conclusions of the Rand Health Insurance Experiment, to respond to issues raised by the commentators, and to emphasize certain points of agreement with them. Our goal is to promote a better understanding of the experiment and spur further discussion about the structure of health insurance for children.

WHAT DID WE SHOW?

In the Rand Health Insurance Experiment, a total of 1,844 children from six areas participated in a randomized experiment on the effects of cost sharing in health insurance policies.
Endotracheal Tube Placement in Infants
Authors: GOLDENRING JOHN M.
Published: December 2021

To the Editor.—

The use of illuminated endotracheal tubes as described by Drs Heller and Cotton may represent a significant advance. In addition to decreasing radiation exposures and costs thereof with initial intubations, there may be an additional saving by identifying endotracheal tubes that have come out of position, either riding up too high, or, more commonly, slipping down into a mainstem bronchus. The use of the tube tip light source may also be very helpful in the rapid evaluation of a decompensating neonate by quickly indicating that the cause of poor gases is a change in the endotracheal tube position.
Apnea Monitoring—It Doesn't Discriminate
Authors: DRANSFIELD DOUGLAS
Published: December 2021

To the Editor.—

The discussion section of the paper by Orr et al1 left this reader with an implication that obstructive apnea predicts being at risk for sudden infant death syndrome (SIDS) or, at least, that they are causally related. The authors state (p 835), "These data are especially relevant to the observations of Guilleminault et al who found that the frequency of upper airway obstruction effectively discriminates [emphasis added] infants with a high risk for SIDS from normal control infants."
Children's Hospital Nuclear Warhead Bomb
Authors: JOHNSON CHARLES F.
Published: December 2021

To the Editor.—

I appreciate the liberal editorial attitude displayed by your and your staff that has enabled me to publish:

1 cartoon

1 poem

and 1 scholarly article

during the past several years in Pediatrics. The following article from Time magazine (March 4, 1985) has stimulated my creative interests into a new direction.

Bigger bucks for smarter bombs. Missile-guidance computer programs so complex that they can be written and tested only by other computer programs.
Improving the Delivery of Prenatal Care and Outcomes of Pregnancy: A Randomized Trial of Nurse Home Visitation
Authors: Olds David L. , Henderson Charles R. , Tatelbaum Robert , Chamberlin Robert
Published: December 2021

We evaluated a comprehensive program of prenatal and postpartum nurse home visitation. The program was designed to prevent a wide range of health and developmental problems in children born to primiparous women who were either teenagers, unmarried, or of low socioeconomic status. During pregnancy, women who were visited by nurses, compared with women randomly assigned to comparison groups, became aware of more community services; attended childbirth classes more frequently; made more extensive use of the nutritional supplementation program for women, infants, and children; made greater dietary improvements; reported that their babies' fathers became more interested in their pregnancies; were accompanied to the hospital by a support person during labor more frequently; reported talking more frequently to family members, friends, and service providers about their pregnancies and personal problems; and had fewer kidney infections. Positive effects of the program on birth weight and length of gestation were present for the offspring of young adolescents (<17 years of age) and smokers. In contrast to their comparison-group counterparts, young adolescents who were visited by nurses gave birth to newborns who were an average of 395 g heavier, and women who smoked and were visited by nurses exhibited a 75% reduction in the incidence of preterm delivery. (P ≤ .05 for all findings.
Failure of the Overgown to Prevent Nosocomial Infection in a Pediatric Intensive Care Unit
Authors: Donowitz Leigh G.
Published: December 2021

In a pediatric intensive care unit we conducted a 1-year prospective study of 454 patients to determine whether wearing a gown decreased the overall nosocomial infection rate, incidence of intravascular catheter colonization, breaks in handwashing technique, and traffic.

The overall infection rate was 26 (13%) of 198 admissions during the gown-wearing periods v 23 (9%) of 256 admissions for the periods when gowns were not worn (P < .25). Of 348 intravascular catheter tips cultured 16 (4.6%) were colonized during gown-wearing periods compared with 21 (6.3%) of 330 when no gowns were worn (P < .25). Of 78 patient contacts 54 (69%) were followed by no handwashing during gown-wearing periods and 59 (70%) of 84 contacts were followed by no handwashing during periods when no gowns were worn. The mean occurrence of visits per patient per hour and total visits per hour differed between gown-wearing and no-gown-wearing periods by analysis of variance, P < .01 and P < .005, respectively. Although traffic was decreased during periods of gown use, overgowns are an expensive, ineffective method of decreasing nosocomial infection rates, vascular catheter colonization rates, and breaks in handwashing technique.
Benefits of Orotracheal and Nasotracheal Intubation in Neonates Requiring Ventilatory Assistance
Authors: McMillan Douglas D. , Rademaker Alfred W. , Buchan Kenneth A. , Reid Amanda , Machin Geoffrey , Sauve Reginald S.
Published: December 2021

To investigate differences in orotracheal (OT) and nasotracheal (NT) intubation for ventilatory assistance, we randomly assigned 91 neonates to be intubated via either of the two routes: 46 infants were assigned to the OT group and 45 infants were assigned to the NT group. Inability to intubate the nostril in three neonates, and respiratory or cardiac instability during attempted NT intubation in three neonates, resulted in the assignment of 52 infants to the OT group and 39 infants to the NT group; patients in both groups were of comparable size, sex, and clinical problems. Initial malposition of the endotracheal tube and need to retape, reposition, or replace the tube during the mean duration of intubation of 247 ± 42 hours for the OT group and 273 ± 57 hours for the NT group were similar. Daily Gram stains of tracheal aspirates showed that inflammation (> ten polymorphonuclear cells per 400 power fields) was common (51% OT group, 53% NT group). Cultures grew potential pathogens in 37% of the patients from the OT group and 31% of the NT group. There was no difference in the clinical or radiologic incidence of pneumonia. Postextubation problems were comparable: atelectasis, 48% OT and 59% NT; stridor, 15% OT and 26% NT. OT intubation may be preferred for prolonged ventilatory assistance in neonates because of the relative ease of initial intubation.
DESCARTES ON TRUTH AND PROBABILITY
Authors: Student
Published: December 2021

It is a truth very certain that when it is not in our power to determine what is true we ought to follow what is most probable.
Necrotizing Tracheobronchitis: Case Report
Authors: Mimouni Francis , Ballard Jeanne L. , Ballard Edgar T. , Cotton Robin T.
Published: December 2021

A 33-week-gestation infant with respiratory distress syndrome is reported. At five days of age, acute life-threatening tracheal obstruction occurred, which was relieved after removal of a plug during bronchoscopy. Histologic examination of the plug revealed partially necrotic tracheal mucosa, compatible with the diagnosis of necrotizing tracheobronchitis. At 31 days of age, obstruction recurred due to the development of a tracheal stricture, which resolved after tracheal reintubation (to maintain patency) and corticosteroid therapy. Tracheal stricture may be a long-term complication of necrotizing tracheobronchitis, when the initial episode does not lead to death from obstruction.