bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk Factors for Attempted Suicide During Adolescence
Authors: Slap Gail B. , Vorters Dolores F. , Chaudhuri Sharmila , Centor Robert M.
Published: December 2021

It is unknown whether adolescents can provide the information necessary to identify their risk for attempted suicide. The present study was designed to determine whether data collected directly from adolescents can be used to develop a simple model for differentiating suicidal from nonsuicidal adolescents. Patients aged 13 to 19 years hospitalized for medical complications of serious suicide attempts (n = 56) or for acute illnesses unrelated to injuries or ingestions (n = 248) completed self-administered questionnaires pertaining to psychosocial function, recent stress, alcohol and drug use, and health care use. Compared with ill adolescents, suicidal adolescents had poorer mental health, impulse control, family relationships, and school performance; higher 3-month stress scores and alcohol-use scores; and more use of 7 of 12 drugs (P <.05). Compared with ill adolescents, suicidal adolescents were more likely to report previous suicide attempts (39% vs 10%, P <.001) and previous mental health care (27% vs 8%, P < 001) but were less likely to identify a primary care site (61% vs 87%, P < .001). In a logistic regression model based on previous suicide attempts, previous mental health care, poor school performance, marijuana use, and dependence on the emergency room for primary care, 84% of the suicidal and 55% of the ill adolescents were correctly identified. If validated prospectively, these five self-administered questions may constitute a helpful screen for the rapid identification of suicidal adolescents.
WORKING DURING PREGNANCY
Authors: Student
Published: December 2021

Nearly two million working women give birth each year, and studies show that a growing number of them are working later into their pregnancies, sometimes up to first contraction. . .The National Center for Health Statistics dected a. . .trend in unpublished and recently analyzed 1982 data it collected from 2000 working women 15 to 44 years old. . . Thirty-five percent were still on the job in the ninth month of pregnancy, nearly twice the 19 percent reported in a similar study in 1973. Eleven percent worked right up to birth.
OPINION FROM GREAT BRITIAN CONCERNING WITHDRAWAL OF TREATMENT FROM NEWBORN INFANTS
Authors: Student
Published: December 2021

Discussion and debate about decision making should form an important part of the continuing education of medical and nursing staff in neonatal units. Often it may be helpful to discuss cases which the staff have not been involved with the care of the baby and here film material can be valuable. Discussions with parents whose children died in the neonatal period or who survived with or without damage may be valuable, as are role play techniques. The aim of such continuing education is to improve decision-making practice in a situation where it is probably impossible to evolve specific guidelines to cover all eventualities. If a decision has been taken to cease active treatment, it is then the responsibility of the staff to ensure that a baby dies quickly and as painlessly as possible.
Anatomically Correct Dolls Used in Interviews of Young Children Suspected of Having Been Sexually Abused
Authors: Leventhal John M. , Hamilton Julia , Rekedal Susan , Tebano-Micci Anna , Eyster Cynthia
Published: December 2021

To determine the value of using anatomically correct dolls in diagnostic interviews of young children suspected of being sexually abused, the records of 83 children who were less than 7 years of age and who were evaluated at Yale-New Haven Hospital because of a suspicion of sexual abuse were reviewed. The dolls were used in 60 cases (72%). When the dolls were used, children provided significantly more information than by interview alone about what had happened and about the identity of the suspected perpetrator. Children less than 3 years of age, however, were unable to provide details about the abuse despite the use of the dolls. The ratings of the likelihood that sexual abuse had occurred were based on all of the information in the case including that obtained through the diagnostic interview with the dolls. When these ratings were compared with the ratings based on evidence obtained solely from noninterview data, the likelihood of abuse was higher in 35% of the cases. It was concluded that substantially more information is provided by young children when anatomically correct dolls are used and that the likelihood of detection of abuse is increased when information from the child is included in the assessment.
Intraventricular Hemorrhage
Authors: PERLMAN JEFFREY M.
Published: December 2021

In this issue, Philip et al present data concerning the declining incidence of intraventricular hemorrhage in the premature infant in the 1980s without planned intervention. Before discussing the implications of this work, it may be useful to review some of the pertinent features of intraventricular hemorrhage in the neonate.

Intraventricular hemorrhage is characteristic of the premature infant, particularly the infant less than 32 weeks' gestation. Bleeding typically emanates from capillaries in subependymal germinal matrix, a gelatinous area containing an elaborate but immature capillary bed which, in turn, is subserved by an abundant arterial and venous supply. It is a transitional zone that becomes less prominent during the last 12 to 16 weeks of gestation and is essentially exhausted at term.
Twenty-Two Years and the Same Questions About Croup Treatment
Authors: EDEN ALVIN N.
Published: December 2021

As the principal investigator of two of the nine studies reviewed by Kairys et al in their article, I was particularly interested in their results. By pooling the data from nine previous investigations, their results support the use of corticosteroids in the treatment of hospitalized children with croup. Although our two studies did not demostrate any therapeutic effect of steroids, not being a statistician, I cannot really take issue with the conclusions of their meta-analysis.
MORE, NOT LESS, INFORMATION NEEDED ABOUT RISKS
Authors: Student
Published: December 2021

Aflatoxin in corn, alar in apples, bovine growth hormone in milk, cyanide in grapes, faulty wiring in jet aircraft: What Science magazine has labeled "the scare of the week" is taking a psychological toll. But safety is hardly ever free. To produce more of it, the output of some other valued good or service must be reduced. To make sensible choices between greater safety and the alternatives, scientists argue, Americans need more and better information presented in ways that stimulate a sense of perspective.
HIGH COST OF THE DEMAND FOR ZERO RISK
Authors: Student
Published: December 2021

The cost of a common childhood vacination, for diphtheria, pertussis and tetanus, rose from 50 cents in 1982 to $11.40 in 1986, as its manufacturer, the Lederle Laboratory division of American Cyanamid Company, amassed cash to pay legal claims for rare but predictable side effects.
Validity of the Medical Record for Evaluation of Telephone Management
Authors: Wood Pamela Runge
Published: December 2021

The purpose of this study was to determine whether the medical record provides accurate documentation of the telephone encounter. The study was a "blinded" comparison of audiotaped telephone encounters and corresponding medical records; it was carried out in the continuity clinic of a primary care pediatric resident-training program. During their first month of rotation through the outpatient department, 17 PL-I residents received one or two calls made by a "simulated mother" using standardized scripts. Transcripts of these calls and the corresponding written medical records were rated by an examiner unaware of the resident's identity. A standardized instrument was used to measure three aspects of performance: General History Taking, Specific History Taking, and General Management. A percentage of agreement was calculated for each scale, and rating scores of audiotapes and written records were compared. Twenty-seven pairs of audiotape and written documentation were analyzed. The mean percentage of agreement between audiotapes and written records was high: 78% for General History Taking, 78% for General Management, 77% for Specific History Taking. Rating scores of the audiotape and the medical record were significantly correlated for two of the scales: General Management (r = .55, P< .01) and Specific History Taking (r = .50, P < .01). Most aspects of the telephone encounter were well documented in the medical record. However, several descrepancies were noted when audiotapes and medical records were compared for the presence of specific items. With the exception of the Specific History Taking scale, there was no correlation between the length of the written record and the percentage of agreement. These data show that the medical record provides useful information about adequacy of telephone management.
Sudden Infant Death Syndrome in Twins
Authors: Beal Susan
Published: December 2021

The incidence of sudden infant death syndrome is higher among twins than it is among singleton infants. Incidence of sudden infant death syndrome in twins in South Australia, is discussed, as well as some features of these twins and the health of the cotwins. The literature concerning the status of the cotwin is reviewed.
FROM THE ANNALS OF HEALTH SUPERVISION
Authors: Wasserman Richard C.
Published: December 2021

Dr. Wasserman:

I brought my son Corey in for his 4-year checkup 1/6/89. You were talking to him about wearing seat belts. He told you that he wears one but his Mom doesn't.

When I left that day, we both put on our seat belts and minutes later we were in a car accident.

I just want to thank you for reminding us to wear a seat belt. It saved both of us from being hurt.

So a new rule in our household is when we get into a vehicle, the first thing is to make sure we have our seat belts on.
Renal Abnormalities in Schoolchildren
Authors: Sheih Chung-Pin , Liu Mong-Bing , Hung Cheng-Shen , Yang Kun-Hou , Chen Wan-Yu , Lin Ching-Yuang
Published: December 2021

To establish prevalence of some renal abnormalities in schoolchildren, an epidemiologic study of 132 686 schoolchildren, including 69 903 boys and 62 783 girls, was conducted from March 1987 to May 1988 in the city of Taipei. At the health station of each school, the students were screened quickly by a physician with portable real-time ultrasound equipment. When a renal abnormality was detected or suspected, the examinee was referred to Taipei Municipal Women and Children's Hospital for further investigation. Radiologic and urologic procedures were then selectively performed to establish the correct diagnosis. Renal abnormalities were detected in 645 students (approximately 0.5% of total population screened). There were 256 cases of hydronephrosis, 103 cases of unilateral renal agenesis, 128 cases of unilateral small kidney, 90 cases of renal cystic disorders, 30 cases of ectopic kidney, and 38 cases of other abnormalities. Surgically correctable lesions were demonstrated in 50 of these students. Rapid renal ultrasonography was found to effectively detect some renal abnormalities initially, and prevalence could then be established after further investigations.
Targeting of Heme Oxygenase Inhibitors to the Spleen Markedly Increases Their Ability to Diminish Bilirubin Production
Authors: Landaw Stephen A. , Drummond George S. , Kappas Attallah
Published: December 2021

Incorporation of heme oxygenase inhibitors into phosphatidyl choline liposomes markedly enhanced localization of these agents within the spleen as compared with the localization observed following their administration in aqueous vehicle. The increased concentration of inhibitor within splenic microsomes led to a near complete and sustained blockade of heme oxygenase activity and thus to a marked diminution in biliary bilirubin output. These studies suggest that heme oxygenase inhibitors administered within liposomes may so effectively block bilirubin production in the human newborn that ancillary methods for treating this important clinical problem may be reduced to a minimum.
Should Parents of Children With Congenital Heart Disease and Life-Threatening Dysrhythmias Be Taught Cardiopulmonary Resuscitation?
Authors: HIGGINS SARAH S. , HARDY CHRISTIAN E. , HIGASHINO STANLEY M.
Published: December 2021

In conclusion, CPR at home can be successfully performed by parents who have been given adequate training. As a result of the findings of this study, our recommendation is that training in CPR should be taught to all parents of children with life-threatening dysrhythmias and complex congenital heart disease.
Think of Pesticide Poisoning
Authors: WEIDNER CHRISTINE
Published: December 2021

Pesticide poisoning is going undiagnosed or misdiagnosed throughout the United States. Children are being told that they are suffering symptoms of influenza or food poisoning when, in fact, in many instances, it may be pesticide poisoning. The symptoms of subacute pesticide poisoning are similar to that of food poisoning or influenza and include: severe headache, nausea, vomiting, diarrhea, difficulty in breathing, minor skin rash, fatigue, depression, frequency of urination, blurry vision, and vaginal bleeding. The symptoms usually resolve themselves within 24 to 48 hours after the exposure.
Cow's Milk Formula and Infantile Colic
Authors: CAREYMD WILLIAM B.
Published: December 2021

No experienced pediatric clinician doubts the existence of cow's milk allergy in infants. The controversy concerns how often cow's milk proteins cause excessive crying or "colic" in otherwise well young infants. Three interesting papers from our colleagues in Malmö, Sweden, leave the question unanswered despite the considerable sophistication in their research design.

In their first report in 1982, they concluded that in a double-blind study "cow's milk seems to be a major cause of infantile colic in formula-fed infants." However, in the only part that was double-blind, fewer infants improved while receiving soy formula (18%) than did those receiving cow's milk formula (29%).
In Reply: Cow's Milk Formula and Infantile Colic
Authors: LOTHE LASSE , LINDBERG TOR
Published: December 2021

In reply to Dr Carey, we want to emphasize that the criterion for entering a study was that our definition of colic (as quoted by Dr Carey) was fulfilled (ie, "crying of about 3 hours or longer per day. . ."). In our report, an unfortunate misprint occurred. On page 264, first paragraph of the "Results" section, line 5, is written "infants receiving cow's milk-based formula cried 1.5 hours per day or more." It should have been "3 hours per day or more."

In the double-blind trial, we decided to reduce the time of crying to > 1.5 hours per day to accept the reaction as positive for the following reasons: Experienced pediatricians know that the adverse reaction to food in a food-allergic (intolerant) infant is dose dependent.
Plasma Cholesterol Levels of 6585 Children in the United States: Results of the Know Your Body Screening in Five States
Authors: Resnicow Ken , Morley-kotchen Jane , Wynder Ernst
Published: December 2021

Medical and public health recommendations regarding detection and treatment of hyperlipidemia in children have generally been based on two principal epidemiologic studies: the Lipids Research Clinics Population Study (1972 to 1976) and the Bogalusa Heart Study (1973 to 1974). The present study was initiated to further describe the distribution of plasma cholesterol levels in a multiracial sample of American children. Between 1984 and 1988, the total cholesterol levels of 6585 children from 22 schools were measured as part of the Know Your Body School Health Program. For the entire population, ages 5 to 18 years, the mean total cholesterol concentration was 166.4 mg/dL. Total cholesterol was significantly greater in girls (168 mg/dL) than in boys (165 mg/dL), although sex differences were inconsistent across race/ethnicity. The mean value for blacks, 173 mg/dL, and Hispanics, 168 mg/dL, was higher than for Asians, 165 mg/dL, and whites, 163 mg/dL. Across race/ethnicity, values tended to peak between ages 8 and 10 years for girls and approximately 10 years of age for boys. These values are slightly higher than those reported in the Lipids Research Clinics and Bogalusa studies. Public health implications of these findings are discussed.
HOW TO PROLONG LACTATION IN MOTHERS OF VLBW INFANTS
Authors: Student
Published: December 2021

We have carried out a randomised trial [of skin to skin contact with their mothers] among babies of less than 1500 gm...Mothers using skin to skin contact lactated for four weeks longer on average than the control group....[This maneuver] can enjoyably be offered to very low birthweight infants especially in developing countries where mother's lactation is vital.
Enterococcal Sepsis in Neonates: Features by Age at Onset and Occurrence of Focal Infection
Authors: Dobson Simon R. M. , Baker Carol J.
Published: December 2021

Fifty-six neonates with enterococcal septicemia in a single hospital from 1977 through 1986 were studied. The incidence was low and constant until 1983, when an increase, attributable to infections in infants older than 7 days of age (late-onset), was noted. These infants were more premature (mean gestational age 29.5 vs 36.9 weeks) and had lower birth weights (mean 1250 vs 2700 g) than those with early-onset enterococcal sepsis, and in most the infections were characterized by a nosocomial origin. Infants with early-onset infection had a mild illness with respiratory distress typical of other etiologic agents or diarrhea without focal infection. By contrast, late-onset enterococcal sepsis was heralded by severe apnea, bradycardia, circulatory collapse, and increased ventilatory requirements. Focal infections, including scalp abscess or catheter-related infection (23% each), meningitis or pneumonia (15% each), were common. Rapid clinical improvement and clearance of bacteremia resulted from therapy with an aminoglycoside and either ampicillin or vancomycin, but only if abscesses were drained and intravascular catheters were removed. Mortality rates for early-onset, late-onset, and necrotizing entercolitis-associated infection were 6, 8, and 17%, respectively. Enterococcus is a frequent cause of late-onset septicemia in premature neonates, and empiric therapy should include appropriate antimicrobial agents.
Comparison of Genital Examination Techniques in Prepubertal Girls
Authors: McCann John , Voris Joan , Simon Mary , Wells Robert
Published: December 2021

The results of three separate methods used to examine prepubertal girls are compared and a technique for measuring hymenal orifice diameters from colposcopic photographs is presented. A total of 172 girls who were examined by three techniques during their evaluation in a clinic for suspected child sexual abuse victims were studied. Their ages ranged from 10 months to 11 years with a mean of 5 years, 8 months. The examination techniques used were the supine position with labial separation, the supine position with labial traction, and the knee-chest position. The knee-chest position (98%) and the supine traction method (96%) proved to be superior to the supine separation technique (86%) in opening the vaginal introitus. The largest vertical transhymenal diameters were produced in the knee-chest position, whereas the greatest transverse horizontal spans were generated by the supine traction procedure. Other soft tissue changes were noted but not quantified. A multimethod approach to the examination of the sexually abused child is recommended to take advantage of the strengths of each technique.
Weight and Menstrual Function in Patients With Eating Disorders and Cystic Fibrosis
Authors: Weltman Elizabeth A. , Stern Robert C. , Doershuk Carl F. , Moir Robin N. , Palmer Karin , Jaffe Arthur C.
Published: December 2021

Many patients with eating disorders have menstrual dysfunction. In patients with anorexia nervosa, amenorrhea has been linked to weight loss. However, many patients with bulimia nervosa, even those of average or greater than average weight, also experience menstrual abnormalities, including amenorrhea. It was hypothesized that low weight per se is not responsible for menstrual dysfunction in patients with eating disorders. First, 16 patients with bulimia nervosa of average weight and 29 patients with cystic fibrosis of below average weight of similar menstrual age were compared. Of the patients with bulimia nervosa, 11 (73%) had had secondary amenorrhea at some time compared with 8 (28%) of the patients with cystic fibrosis (P < .01). At the time of study, 6 (40%) of the patients with bulimia nervosa and 21 (78%) of the patients with cystic fibrosis were having regular cycles (P < .01). Next 18 patients with anorexia nervosa were compared with 18 patients with cystic fibrosis matched for weight and menstrual age. Although 18 (100%) of the patients with anorexia nervosa had had secondary amenorrhea, only 6 (33%) of the patients with cystic fibrosis had amenorrhea. Although only 1 (6%) of the anorexia nervosa group was currently having regular cycles, 14 (78%) of the patients with cystic fibrosis were (P < .0001). Closer approximation to ideal body weight was associated with regular menses only in the cystic fibrosis group. Exercise did not appear related to regularity of menstruation in any group. Body weight is not the major factor responsible for menstrual abnormalities in patients with eating disorders.
Mitral Valve Prolapse: Associations with Symptoms and Anxiety
Authors: Arfken Cynthia L. , Lachman Anthony S. , McLaren Margaret J. , Schulman Peter , Leach Charles N. , Farrish Grover C. M.
Published: December 2021

Mitral valve prolapse has been studied extensively in the adult population, but less is known about it in children. Therefore, 813 children between 9 and 14 years of age were examined by a team of cardiologists and technicians. The children also responded to a questionnaire concerning the presence of symptoms and the What I Think and Feel anxiety instrument. The prevalence of mitral valve prolapse using auscultatory criteria was 4.2% (6.2% for girls, 2.3% for boys). Of those with mitral valve prolapse, 85% had a solitary click, 9% had a click and systolic murmur, and 6% had multiple clicks. Children with auscultatory mitral valve prolapse were less likely to have symptoms than those free of cardiac abnormalities. No difference in average anxiety scores was detected between the two groups. It is concluded that auscultatory mitral valve prolapse is common in children and not accompanied by an increased likelihood of symptoms or anxiety.
The Pediatrician as a Role Model in the Career Choice of Medical Students
Authors: STRAIN JAMES E.
Published: December 2021

The results of the recent residency matching program revealed a decline in the number of US medical school graduates applying for positions in pediatric training programs. In 1987, 1366 graduating seniors, 10% of the graduating class, applied for 2009 PL 1 positions. In 1989, 1256, 9.3% of those graduating, applied for 2068 positions. Sixty-eight percent of PL 1 positions were filled by graduates of US medical schools in 1987, and an additional 14% (284) by foreign medical graduates.
Extracorporeal Membrane Oxygenation Trials
Authors: MEINERT CURTIS L.
Published: December 2021

The randomized trial reported by O'Rourke and coworkers1 (they call it a randomized study but why not call it what it is?) provides insight into the dilemma faced when trying to evaluate a therapy believed, rightly or wrongly, to be efficacious. The fact that extracorporeal membrane oxygenation therapy for persistent pulmonary hypertension of the newborn was introduced in 1976 but not tested in a trial until years later, and then only after it was already viewed in many quarters as effective, is a sad comment on how therapies are introduced and accepted into the armamentarium of treatments.2,3
Munchausen Syndrome by Proxy: Father as a Perpetrator
Authors: MAKAR ADEL F. , SQUIER PAULA J.
Published: December 2021

We conclude that fathers, as well as mothers and female caretakers, can be the perpetrators in Munchausen syndrome by proxy. Those same fathers may be even more difficult to detect when they do not fit previously described personalities and traits associated with mothers. We do not know if this case was an isolated incident or if some cases go undetected because fathers are not suspected as perpetrators. We hope that the case described in this article will alert the medical community to the possibility of either parent as a perpetrator in Munchausen syndrome by proxy.
The Extracorporeal Membrane Oxygenation Debate
Authors: RHINE WILLIAM D. , FISCHER ALLEN F. , STEVENSON DAVID K.
Published: December 2021

To the Editor.—

We are concerned about the statistical inferences, assumptions for comparisons, and arguments of logic implicit in the recent article on survival of infants with persistent pulmonary hypertension with ECMO (extracorporeal membrane oxygenation).1 The authors did acknowledge the difficulties of retrospective review, especially over 8 years when obstetrical and neonatal care should be improving. However, other details not reported on their patient population and classification might yield important information for this historical comparison.
The Extracorporeal Membrane Oxygenation Debate
Authors: GROSS IAN
Published: December 2021

In Reply.—

Drs Short, Rhine et al, and Clark et al raise a number of interesting issues in their letters, some of which were addressed in our article.1

Before responding to the specific issues, I would like to emphasize that our paper does not contest the fact that ECMO may be a effective rescue therapy for some infants with persistent pulmonary hypertension, particularly those who are in dire straights on arrival from a referring hospital.
More Concerning Asthma and Exercise
Authors: ALTENBURGER KARL M.
Published: December 2021

To the Editor.—

In the position paper on Exercise and the Asthmatic Child,1 the Sections on Allergy and Immunology and Diseases of the Chest fail to focus on the primary obstacle facing these children. In most educational settings, the free and easy access to metered dose inhalers is denied. Most school systems "allow" the used of metered dose inhalers but require students to keep their inhalers in a central administrative office or nurse's station. In practice, this means that students are separated from their peers (and thus made to feel "different") and, if they are lucky, after 10 to 15 minutes (too often longer) they are able to rejoin their classmates whose physical activities are already well underway.
Periventricular Echodensities Detected by Cranial Ultrasonography: Usefulness in Predicting Neurodevelopmental Outcome in Low-Birth-Weight, Preterm Infants
Authors: Bennett Forrest C. , Silver Gail , Leung Edna J. , Mack Laurence A.
Published: December 2021

Forty-eight low-birth-weight, preterm graduates of the University of Washington's neonatal intensive care unit who had received periodic, serial scanning by means of cranial ultrasonography during the first 4 to 6 weeks of life were longitudinally observed in an interdisciplinary neurodevelopmental follow-up program to a mean corrected age of 18 months. Mean birth weight for the sample was 1286 g; mean gestational age was 29 weeks. Periventricular echodensities were graded from 0 to 3, with 0 indicating no densities and 3 indicating cystic formation. Intracranial hemorrhage was graded in the conventional manner from 0 to IV. Neurodevelopmental outcome was assessed by means of a neurologic examination and the Bayley Scales of Infant Development. To synthesize the results, neurodevelopmental outcome for each subject was classified as normal, demonstrating minor abnormalities, or demonstrating major abnormalities. Multiple statistical analyses with various subgroupings of subjects consistently indicated severe intracranial hemorrhage (grades III and/or IV) to be a better predictor of overall neurodevelopmental outcome than grade of periventricular echodensity, including small cysts. These results suggest a wide range of outcomes after detection of periventricular echodensities and caution against communicating overly pessimistic prognoses in many cases.
Infant Stimulation Curriculum for Infants With Cerebral Palsy: Effects on Infant Temperament, Parent-Infant Interaction, and Home Environment
Authors: Palmer Frederick B. , Shapiro Bruce K. , Allen Marilee C. , Mosher Barbara S. , Bilker Stacey A. , Harryman Susan E. , Meinert Curtis L. , Capute Arnold J.
Published: December 2021

To assess the effects of intervention in cerebral palsy, 48 infants 12 to 19 months of age, with mild to severe spastic diplegia, were randomly assigned to receive either 6 months of infant stimulation followed by 6 months of physical therapy (test group) or 12 months of neurodevelopmental physical therapy (contrast group). The infant stimulation protocol consisted of cognitive, motor, sensory, and language activities. Outcome was assessed after 12 months by using Carey Infant Temperament Questionnaire subscores (activity, rhythmicity, adaptability, approach, threshold, intensity, mood, distractibility, and persistence); Roth Mother-Child Relationship Evaluation subscores (acceptance, overprotection, overindulgence, rejection); and Home Observation for Measurement of the Environment subscores (maternal responsiveness, avoidance of restriction and punishment, organization of environment, play materials, maternal involvement, and variety of daily stimulation). Motor and cognitive outcomes suggesting advantage for the test group have been reported previously. After 12 months of intervention, mothers with infants in the contrast group showed a greater improvement in emotional and verbal responsiveness as measured by the Home Observation for Measurement of the Environment (mean score change in control group = 1.2, test group = 0.3 P < .04). None of the 19 other measures differed significantly between treatment groups in change from baseline. This study demonstrates no short-term systematic effect on temperament, maternal-infant interaction, or home environment attributable to the inclusion of an infant stimulation curriculum in an intervention program for infants with spastic diplegia. It suggests that motor and cognitive advantages associated with infant stimulation are not mediated by measurable changes in the psychosocial variables studied.
Behavioral Deficits in Rats With Minimal Cortical Hypoplasia Induced by Methylazoxymethanol Acetate
Authors: Mercugliano Marianne , Hyman Susan L. , Batshaw Mark L.
Published: December 2021

Methylazoxymethanol, a short-acting antimitotic agent, produces marked cortical hypoplasia in fetuses when injected into pregnant rats. These offspring also have increased cortical concentrations of biogenic amines associated with hyperactivity and learning deficits. In this experiment, rats with a relatively mild degree of methylazoxymethanol-induced cortical hypoplasia were studied to determine whether these neurochemical and behavioral abnormalities persisted. Sprague-Dawley pregnant rats were injected intraperitoneally on day 15 of gestation with methylazoxymethanol acetate (25 mg/kg). Total brain weight was reduced by 12% and cortical slab weight by 28% in methylazoxymethanol-exposed offspring. They were more active than control rats and showed a trend toward slower learning in a swim maze. Affected offspring had increased cortical concentrations of norepinephrine, 5-hydroxyindoleacetic acid, and glycine. There was no significant difference in the concentrations of serotonin, γ-aminobutyric acid, aspartic acid, glutamic acid, or glutamine. Methylazoxymethanol-lesioned animals with mild cortical hypoplasia remained measurably hyperactive and may serve as a model for the study of neurotransmitter and neuropathologic abnormalities associated with hyperactivity in children with microcephaly.
Symptomatic Atlantoaxial Instability Associated With Medical and Rehabilitative Procedures in Children With Down Syndrome
Authors: Msall Michael E. , Reese Mary E. , DiGaudio Kathleen , Griswold Kim , Granger Carl V. , Cooke Robert E.
Published: December 2021

The Canadian College of Medical Genetics recently questioned the rationale for radiographic screening for atlantoaxial instability in Down syndrome. We report a case series of four children with Down syndrome with symptomatic atlantoaxial instability and followed for more than 5 years. In all cases a medical or rehabilitational procedure was associated with significant apnea, cardiopulmonary compromise, or severe neurological impairments. None of these patients were screened radiographically. The need for protocols to detect atlantoaxial instability in children with Down syndrome undergoing medical and rehabilitational procedures is highlighted by these cases.
Serum Total Cholesterol Screening for the Detection of Elevated Low-Density Lipoprotein in Children and Adolescents: The Bogalusa Heart Study
Authors: Dennison Barbara A. , Kikuchi David A. , Srinivasan Sathanur R. , Webber Larry S. , Berenson Gerald S.
Published: December 2021

The use of serum total cholesterol measurement was evaluated as a screening tool to predict elevated levels of low-density lipoprotein cholesterol in 2857 children and adolescents, aged 5 to 17 years, examined in 1981 and 1982. Subjects were from the biracial community of Bogalusa, Louisiana. For selected serum total cholesterol values (150 to 210 mg/dL, 3.88 to 5.43 mmol/L), sensitivities were higher for blacks than whites and higher for females than males, whereas the positive predictive values were higher for whites than blacks and higher for males than females. With the age-, race-, and sex-specific 95th percentiles of serum total cholesterol levels as cutoff points, only 44% to 50% of subjects with elevated low-density lipoprotein cholesterol levels (≥95th percentile) were detected, and approximately 50% of those identified had false-positive results. Lowering the serum total cholesterol cutoff point increased the sensitivity, but decreased the specificity and positive predictive value. At the 75th percentiles of serum total cholesterol levels, sensitivities were 92% to 95% for females and 100% for males and specificities were 78% to 79%, but the false-positive results increased to 81% to 84%. The low cost and ease of obtaining serum total cholesterol measurements contribute to its appeal as a screening tool for hyperlipidemia. However, its poor test characteristics make serum total cholesterol measurement inefficient as a screening tool for detecting elevated levels of low-density lipoprotein cholesterol in children and adolescents.
Fryns Syndrome: An Autosomal Recessive Disorder Associated With Craniofacial Anomalies, Diaphragmatic Hernia, and Distal Digital Hypoplasia
Authors: Cunniff Christopher , Jones Kenneth Lyons , Saal Howard M. , Stern Harvey J.
Published: December 2021

Fryns syndrome is an autosomal recessive, genetically determined condition with variable expression, which includes abnormal facial features, diaphragmatic hernia, distal limb abnormalities, and malformations of the cardiovascular, gastrointestinal, genitourinary, and central nervous systems. Five cases of children with Fryns syndrome, including an example of familial recurrence and a case of long-term survival, are described. This report brings to 25 the number of cases reported in the literature and further serves to illustrate the clinical variability of this disorder.
Di George Anomaly and Velocardiofacial Syndrome
Authors: Stevens Cathy A. , Carey John C. , Shigeoka Ann O.
Published: December 2021

The velocardiofacial syndrome is an autosomal dominant disorder characterized by cleft palate, cardiac anomalies, characteristic facies, and learning disabilities. The Di George anomaly involves developmental defects of the third and fourth pharyngeal pouches, resulting in thymic and parathyroid hypoplasia and cardiac defects. The cases of individuals in two families help substantiate the notion that the Di George anomaly occurs as a feature of the velocardiofacial syndrome. The proband in family 1 was a male infant with persistent hypocalcemia and cardiac defects consisting of truncus arteriosus, atrial septal defect, ventricular septal defect, and abnormal aortic arch vessels. Autopsy revealed absence of thymic and parathyroid tissue, and the Di George anomaly was diagnosed. His father had a submucous cleft palate, T cell dysfunction, and facial features consistent with the velocardiofacial syndrome. This is the third case of male-to-male transmission of velocardiofacial syndrome. The proband of family 2 was a 4-year-old girl with developmental delay, persistent neonatal hypocalcemia, ventricular septal defect, T cell dysfunction, and facial features of the velocardiofacial syndrome. The Di George anomaly has been reported to occur in at least 18 different disorders. The observation that the Di George anomaly is a component manifestation of the velocardiofacial syndrome in these two families provides further evidence that the Di George anomaly is not a distinct syndrome of a single origin but rather a heterogeneous developmental field defect. It is proposed that all previously reported cases of autosomal dominant Di George anomaly are examples of the velocardiofacial syndrome.
Percutaneous Catheterization of the Axillary Vein in Infants and Children
Authors: Metz Richard I. , Lucking Steven E. , Chaten Frank C. , Williams Thomas M. , Mickell John J.
Published: December 2021

The axillary vein was evaluated as an alternative access site for central venous catheterization in critically ill infants and children. Children were placed in the Trendelenberg position (when possible) with arm abducted 100 to 130°. The vein was entered parallel and inferior to the artery. Success rate for catheterization was 79% (41/52). Catheter diameter range was 3 to 8.5 F and catheter length range was 5 to 30.5 cm. Median patient weight was 7.0 kg (3.0 to 59 kg). Median age was 0.91 years (14 days to 9 years). All central lines ended in the subclavian, innominate, or superior vena cava. Median catheter duration was 8 days (2 to 22 days). A total of 338 patient catheter-days were studied. Central venous pressure was successfully monitored in five of five attempts. Complications with insertion (3.8% of attempts) included one pneumothorax and one hematoma. Complications during catheter duration (9.8% of catheters, 1.1% per catheter-day) included one instance each of venous stasis, venous thrombosis, catheter sepsis, and parenteral nutrition infiltration. No complication contributed to a patient mortality. Success and complication rates were comparable with those in jugular catheterization studies in children. The axillary approach is an acceptable route for central venous catheterization in critically ill infants and children.
Effect of Intramuscular Vitamin E on Mortality and Intracranial Hemorrhage in Neonates of 1000 Grams or Less
Authors: Fish Wendy H. , Cohen Mervyn , Franzek Deborah , Williams Janice M. , Lemons James A.
Published: December 2021

A randomized, double-blind study to determine the effect of intramuscular vitamin E on mortality and intracranial hemorrhage (ICH) was performed. One hundred forty-nine neonates with birth weights ≤l000 g and ≤24 hours of age were grouped by weight (501 to 750 g and 751 to 1000 g) and randomized to treatment or control. The treatment group received intramuscular injections of vitamin E (dl-α-tocopherol) on days 1, 2, 4, and 6 of life. The control group received intramuscular injections of placebo on the same schedule. All neonates initially received oral vitamin E (100 mg/kg/day dl-α-tocopheryl acetate), which was subsequently adjusted to keep serum levels at 0.5 to 3.5 mg/dL. Ultrasonographic examinations of the head were performed as possible on days 1, 5 to 7, and 12 to 14. Hemorrhage was defined as mild if less than or equal to grade II ICH, or severe if grade III or IV. No significant differences in neonatal or total hospital mortality between groups were found. However, all ICH, as well as severe ICH, were significantly less in the vitamin E-treated 501 to 750-g subgroup (all ICH: 60% vs 29%; severe ICH: 32% vs 4%). When survivors were analyzed separately, a significant decrease in severe ICH was seen in the vitamin E-treated neonates (25% vs 5%). Necrotizing enterocolitis and sepsis did not occur more frequently in the neonates treated with intramuscular injections of vitamin E. Other than two cases of mild induration at injection sites, no deleterious side effects of treatment were identified. Vitamin E may have a role in the prevention of severe ICH in premature neonates weighing between 501 and 750 g.
Kangaroo Baby Care: Just a Nice Experience or an Important Advance for Preterm Infants?
Authors: WHITELAW ANDREW
Published: December 2021

"Kangaroo baby care" or "skin-to-skin contact" describes the practice of holding a preterm infant naked (except for a diaper) between the mother's breasts. The baby's face pokes out of the top of the mother's dress like a baby kangaroo's. Rey and Martinez in Bogota, Colombia1 pioneered the home care of premature infants as small as 1000 g, the mother being taught to hold her baby head-up kangaroo-style to encourage lactation, prevent aspiration, and reduce rejection. Education and motivation of the mother in the care of preterm infants makes obvious sense in the developing world, but kangaroo baby care has also been applied in many developed countries in conjunction with neonatal intensive care rather than as a replacement for incubators and monitors.2-4
Recommendations on Extracorporeal Membrane Oxygenation
Authors:   Committee on Fetus and Newborn
Published: December 2021

Considerable work has been done to demonstrate the effectiveness of extracorporeal membrane oxygenation (ECMO) for certain neonates in imminent danger of death from a narrow range of conditions causing hypoxemia and respiratory distress not responsive to other forms of therapy. Many clinicians are convinced that infants with congenital diaphragmatic hernia and other forms of persistent transitional circulation with pulmonary hypertension, unresponsive to more conventional forms of respiratory support, have been saved through the use of ECMO. However, experience with ECMO has been quite individualized, seldom studied prospectively, and based on criteria that are not generalizable between institutions. Data concerning the longer term outcome of patients who have been treated with ECMO are sparse, and concerns persist about the consequences of carotid artery and/or jugular vein ligation, prolonged anticoagulation, and long-term circulatory bypass. There is a clear need for more information about this technique. Nevertheless, it appears that new ECMO centers are evolving on the basis of current enthusiasm and without a thorough appreciation of the complexity, intensity, potential hazards, and uncertainties of this form of therapy.

The committee makes the following recommendations.

1. The establishment of an ECMO center for newborn infants should occur only when a regional requirement for one has been demonstrated. In addition, the proposed center must demonstrate (a) the ability to manage a stable and successful regional neonatal/perinatal care program, (b) the availability and skills of appropriate personnel to perform ECMO, and (c) ready access to an organized functioning neonatal transport system.

2. ECMO centers should be established only in institutions with a recognized level III regionnal neonatal/perinatal center with appropriate coverage by pediatric medical and surgical subspecialists.
Ceftriaxone vs Cefotaxime for Treatment of Haemophilus influenzae Meningitis
Authors: ARDITI MOSHE , YOGEV RAM
Published: December 2021

In Reply.—

The issues raised by Madson and Grose do not relate directly to our report, which describes a case of cefuroxime treatment failure in Haemophilus influenzae meningitis and reviews the literature.1 However, since the issues they raised are important we offer this response.

The decision to choose which of the newer cephalosporins to use for treatment of bacterial meningitis must be based on available experience which includes efficacy data, safety and toxicity record, and relative coast analysis.
Topical Skin Anesthesia Before Inserting Hemodialysis Cannula
Authors: BIANCHETTI MARIO B. , SPECK SILVANA , OETLIKER OSKAR H.
Published: December 2021

To the Editor.—

A new topical anesthetic cream based on a eutectic mixture containing equiponderal amounts of lidocaine based and pnilocaine base has been developed recently.1 In a controlled study, Halpérin2 demonstrated convincingly that this ointment reduces substantially the pain caused by venous, subcutaneous drug reservoir, and lumbar punctures in children submitted to painful diagnostic and therapeutic procedures because of cancer.

Pain inflicted by insertion of large cannulas into arteriovenous fistulas in children and adolescents on regular hemodialysis is cause of concern for children on regular hemodialysis.
Rickets and Metabolic Disorders
Authors: MORRISON STUART C. , KERR DOUGLAS S.
Published: December 2021

In Reply.—

We have reviewed the letter from Drs Ozsoylu and Besim and have reviewed the metabolic data from our patient with tyrosinosis to determine if there was evidence of rickets in our patient. At the time that the published x-rays were obtained, the patient had normal serum calcium and phosphorus. However, a month earlier, when the x-rays appeared normal apart from probable osteopenia, the patient did have persistent hypophosphatemia, 1.5 to 1.8 mg/dL (normal 4.0 to 6.0 mg/dL), and elevated alkaline phosphatase, 956 IU/L (normal 50 to 380 IU/L).
Parental Presence in the Emergency Department
Authors: BAUCHNER HOWARD , VINCI ROBERT , WARING CHRIS
Published: December 2021

In Reply.—

We read Dr Connolly's letter with great interest. We agree that no policy should be established with regard to parental presence during procedures in an emergency department. Additional variables that are probably important include the physician's experience, the type of procedure being performed, the anxiety of the parents and physicians, and the familiarity that the physician has with the family. In general, parents should be asked if they would like to be present (at least for many procedures) and more importantly shown ways to help their child.
Dangers of Arterial Catheters in Critically III Neonates
Authors: REZNIK VIVIAN M. , ANDERSON JACK , GRISWOLD WILLIAM R. , SEGALL MICHAEL L. , MURPHY JEROME L. , MENDOZA STANLEY A.
Published: December 2021

In Reply.—

We read with interest the comments made by Drs Weinberg et al concerning our management of the infant reported in Pediatrics.1 We agree with their conclusion that arterial catheters in critically ill neonates are potentially dangerous and should be monitored closely.

We disagree with Dr Weinberg's contention that thrombolytic therapy was not indicated in this case. Our patient demonstrated deteriorating renal function due to the thrombus. In view of progression of renal failure on hepanin therapy, thrombolytic therapy was clearly appropriate in this case.