bluuebunny/crossref_metadata_2025 huggingface dataset:
Working During Pregnancy: Effects on the Fetus
Authors: Naeye Richard L. , Peters Ellen C.
Published: December 2021

In order to determine whether pregnancy outcome was altered when women were employed outside their homes, 7,722 pregnancies were analyzed. Gestations were not shortened but newborns of women who worked in the third trimester weighed 150 to 400 gm less than newborns of mothers who remained at home. The growth retardation was greatest when women were underweight pregravid and had a low pregnancy weight gain, when they were hypertensive, or when the work required standing. The growth retardation remained after the data were stratified by race, socioeconomic status, and other maternal factors that commonly influence fetal growth. The frequency of large placental infarcts progressively increased when women continued stand-up work into late gestation. Such infarcts reached a peak of 250/1,000 births after the 37th week of gestation in stand-up workers. Low uteroplacental blood flow is a likely explanation for both the fetal growth retardation and the large placental infarcts.
Developmental Changes in Hemoglobin F Levels During the First Two Years of Life in Normal and Heterozygous β-Thalassemia Infants
Authors: Metaxotou-Mavromati Anna D. , Antonopoulou Helene K. , Laskari Sophie S. , Tsiarta Helene K. , Ladis Vasilis A. , Kattamis Christos A.
Published: December 2021

To study the developmental pattern of hemoglobin F (HbF) during the first two years of life, levels of HbF were estimated in two groups of infants: 117 normal infants and 98 heterozygotes for β-thalassemia, all aged between 1 and 24 months. The results may be summarized as follows: (1) Levels of HbF in β-thalassemia heterozygotes were significantly higher than those of normal infants of the same age (P < .01). (2) A reference curve for the decline of HbF in infants with β-thalassemia trait was established to facilitate the diagnosis of heterozygotes during this period of life. (3) Hemoglobin A2 (HbA2) was also higher in β-thalassemia heterozygotes than in normal infants of the same age. HbA2 increases with increasing age, reaching normal adult values at age 5 to 6 months. It is postulated that the higher level of HbF in heterozygous infants during the first two years of life is associated with the presence of the β-thalassemia gene, which influences the increased synthesis of HbF in red cells.
Serious Air Rifle Injuries in Children
Authors: Blocker Sterling , Coln Dale , Chang Jack H. T.
Published: December 2021

Seven potentially lethal air gun injuries in children are reported. Multiple-pump action air rifles have penetration velocities far in excess of the classic Daisy "BB" guns. However, these lethal weapons are sold to be used by children. Lack of effective regulatory legislation coupled with parental ignorance will continue to allow for serious injuries and deaths in children. Physicians should be aware of the potential lethality of any air gun injuries.
FIVE YEARS OF ANTI-SMOKING MEASURES IN FRANCE
Authors:   Student
Published: December 2021

On 9 July 1976 the French parliament adopted a law which, while binding on advertisers, primarily appealed to the individual's sense of public duty and responsibility.

The main provisions of this law were: a ban on all tobacco advertising on television and radio, in cinemas or by posters, and qualitative and quantitative restrictions on advertising in the press; a compulsory statement of the nicotine and tar content on each cigarette pack, together with the words "abuse is dangerous"; a ban on smoking in certain public places and on public vehicles.

Within the information campaigns against smoking, three major series of educational messages were developed. The first series stresses the dangers of tobacco for health; the second calls for protection of the rights of non-smokers; and the third series, aimed particularly at young people, attempts to destroy the mystique of smoking and emphasizes its antisocial character.

In 1975 about 44% of the adult population were smokers. After the information campaigns were launched this proportion fell to 36% in 1979. Within four years over 2 million French people stopped smoking.

While the trend has not been so favourable among young people, the growth of smoking has nevertheless been arrested. In 1977, 46% of 12- to 18-year-olds said they smoked, even if only occasionally. Early in 1980 the corresponding figure was 43%.

It can be seen very clearly that the spread of smoking in France has been halted and that tobacco consumption per smoker has been stabilized at the 1975 level.
MEDICAL INDUSTRIAL COMPLEX
Authors:   Student
Published: December 2021

The fees of private physicians, ... are rising because of the failure of both doctors and insurance companies to control them; more and more doctors face conflicts of interest between their duty to their patients and their quest for high incomes based on expanding technologies and unneccessary medical procedures; and the nation is producing far too many specialists whose narrow focus raises the costs of health care even more astronomically ... the future independence—[of American physicians] and the welfare of their patients— are profoundly threatened by the growth of doctors as businessmen whose profit-making ownership of health care facilities is creating an enromously expensive "medical-industrial complex."
Catheter Tip Localization During Umbilical Venous Exchange Transfusion and Necrotizing Enterocolitis
Authors: Thangavel Murugesa , Pomerance Jeffrey J. , Raj Christina
Published: December 2021

Necrotizing enterocolitis (NEC) is a potentially fatal disease in the newborn period. Although the condition has been recognized for many years,1 the etiology is poorly understood.

NEC following umbilical venous exchange transfusion has been reported.2-6 In each reported instance, the umbilical venous catheter tip was either malpositioned in the liver or portal vein or its location was unknown. We report an infant who developed NEC following umbilical venous exchange transfusion, in whom the catheter tip was located in the inferior vena cava.

CASE REPORT

Baby boy U, weighing 3,495 gm at birth, was born by normal spontaneous vaginal delivery after 40 weeks' gestation.
Value of Parental Documentation of Medical Events
Authors: Doub Nancy H.
Published: December 2021

One of the most difficult aspects of the practice of pediatric medicine is the art of soliciting from parents an accurate, unbiased summary of the signs and symptoms of an illness. It is only human nature that a parent, who desires immediate relief for their child, reacts emotionally to a medical event. Sometimes, however, medical judgments are made by the parent and inconsequential events are expounded while more important medical events are never mentioned. Even the most skillful pediatrician sometimes has difficulty decoding these statements and distilling anxiety and overt concern from the actual medical event.
Boob Tube Time
Authors: Weissbluth Marc
Published: December 2021

The recent study on television viewing by hospitalized children observed a mean daily weekday duration of 3.9 hours.1 The authors compare this with a duration of 3.5 hours for nonhospitalized children. However, there are no factual data presented in their references justifying the 3.5 hour figure. A recent survey of all sixth and twelfth grade students in California showed a median daily duration of 2.0 hours.2 Similarly, the mean duration of daily television viewing obtained from a survey of more than 2,000 children of different ages was 2.2 hours.
In Reply: Boob Tube Time
Authors: Guttentag Deborah N. W.
Published: December 2021

The finding of mean television viewing time of 3.5 hours daily for nonhospitalized children was based on the average of 25 viewing hours per week presented by Rubinstein1 referenced in our paper.2 In fact, 3.5 hours of daily viewing may be a conservative estimate according to figures presented in some of our other references3,4 as well as audience viewing surveys reported in Action for Children's Television literature, which suggest the figure may actually be closer to 4.0 hours per day for the average child.
In Reply: Lactose Breath Hydrogen Test
Authors: Barr Ronald G. , Watkins John B. , Perman Jay A.
Published: December 2021

We agree with Sheps' comments about the evaluation of diagnostic tests. In particular, the influence of the prevalence of the condition to the predictive value of the test is important when a test is used in a different setting (eg, community vs university hospitals) or with a different ethnic population1—a particularly important consideration when one is interested in detecting isolated lactase insufficiency in older children. However, we were reticent to consider the sensitivity and specificity obtained in this series to be representative of the test in general because of the many recognized factors that might affect these test characteristics.1,2
PSYCHOLOGY OF PREFERENCES
Authors:   Student
Published: December 2021

Recent investigations of the psychology of preferences have demonstrated several intriguing discrepancies between subjective and objective conceptions of decisions. For example, the threat of a loss has a greater impact on a decision than the possibility of an equivalent gain. Most people are also very sensitive to the difference between certainty and high probability and relatively insensitive to intermediate gradations of probability. The regret associated with a loss that was incurred by an action tends to be more intense than the regret associated with inaction or a missed opportunity. These observations and others of a similar character contribute to the understanding of how people make decisions and to the elucidation of some puzzles of rational choice . . . .

We asked a large number of physicians to consider the following problem:

Imagine that the U.S. is preparing for the outbreak of a rare Asian disease, which is expected to kill 600 people. Two alternative programs to combat the disease have been proposed. Assume that the exact scientific estimates of the consequences of the programs are as follows: If Program A is adopted, 200 people will be saved. If Program B is adopted, there is a 1/3 probability that 600 people will be saved and a 2/3 probability that no people will be saved. Which of the two programs would you favor.

The majority response to this problem is a risk-averse preference for Program A over Program B.

Other respondents were presented with the same problem but a different formulation of the programs: If Program C is adopted, 400 people will die.
Amylase in Human Milk
Authors: Lindberg Tor , Skude Gunnar
Published: December 2021

Amylase activity and isoenzyme pattern were determined in human milk from various stages of lactation and were compared with that in duodenal juice. The activity is high in colostrum and somewhat lower in milk from day 15 to day 90 after delivery. In this period of lactation, human milk contains higher amounts of amylase than duodenal juice from infants aged 1 to 6 months. Low activity was found in milk from 90 days or more after delivery. The amylase is of the salivary type. A pH of 5.3 does not inactivate the amylase; there is considerable human milk amylase activity in duodenal juice after a meal of human milk. Human milk amylase could thus contribute to the breast-fed infant's ability to digest starch.
Modified Apparatus for Aspiration of Meconium from the Airway
Authors: Fazen Louis E.
Published: December 2021

The standard treatment for the newborn with meconium-stained amniotic fluid consists of prompt visualization of the pharynx, hypopharynx, and trachea and suction of any meconium fluid present.1 This report describes a simple, inexpensive apparatus to facilitate the suctioning of meconium under direct laryngoscopy (Figure). The modified apparatus consists of a plastic adapter from an adult red rubber bronchial aspirating catheter (Davol bronchial aspirating catheter with suction control, Davol, Inc, Providence, RI) attached to a standard pediatric endotracheal tube. The 3.5-cm sized endotracheal tube has a large enough bore for suctioning the pharynx and hypopharynx and can also be used for endotracheal suctioning.
Letter to the Editor
Authors: Schwartz Richard H. , Rodriguez William J. , Grundfast Kenneth M.
Published: December 2021

We agree with Allen and Bunce that our study was not perfect. We appreciate their interesting statistical analysis and comments on methodology. If the hypothetical situations they postulate actually did occur, then certainly the conclusions we reached would be highly questionable.

However, Allen and Bunce may be overly skeptical and unrealistic. For example, to suppose that all urines were collected on a single day and that there were a great number of patients who questioned the purpose of the urine collection and then tried to feign greater compliance seems unlikely.
Letter to the Editor
Authors: Valente Mario
Published: December 2021

In their fine article1 Shaywitz et al have done themselves a disservice both in the title as well as in their failure to realize the significance of these two cases. What in essence the authors are describing are two children with autism secondary to the fetal alcohol syndrome. I find this most fascinating for as I wrote in another letter several years ago,2 autism is a syndrome of either known or unknown etiology and time has only confirmed this impression.
Expanding Phenotype of Fetal Hydantoin Syndrome
Authors: Kousseff Boris G. , Root Edward R.
Published: December 2021

We read with interest the article by Bartoshesky et al1 on ophthalmic and lethal cardiac malformations in the newborn exposed to diphenylhydantoin in utero. The article makes an important point about previously undescribed clinical features of fetal hydantoin syndrome and emphasizes the generalized effect of diphenylhydantoin as a teratogen. To elaborate further on this point, we wish to share our clinical observations in two patients with fetal hydantoin syndrome.

One patient,2 a male (Figure), showed subcutaneous vascular abnormalities (cystic hygromas, telangiectasias, and capillary phlebectasias) on the anterior neck and both axillae, in addition to developmental delay, esotropia, epicanthal folds, high palate, triphalangeal thumbs, hypoplastic nails, inguinal hernia, and seven arches on the fingertips.
Adult Respiratory Distress Syndrome in an Infant
Authors: Droge Molly A. , Jewett Catherine V. , Schmalstieg Frank C.
Published: December 2021

The review of adult respiratory distress syndrome (ARDS) in children by Lyrene and Truog1 summarizes their experience in 15 children ranging in age from 15 months to 14 years. We wish to emphasize that this syndrome may occur in very young infants.

We have cared for a previously well 6-week-old infant who had the clinical presentation, course, and ventilatory data compatible with ARDS. The infant was found dusky and gasping in her crib and was noted at a local hospital to be tachypneic and in marked respiratory distress (Pao2 was 29 mm Hg on room air).
Severe Hemolytic Anemia in Black Children with Glucose-6-Phosphate Dehydrogenase Deficiency
Authors: Shannon Kevin , Buchanan George R.
Published: December 2021

The clinical spectrum of hemolytic anemia as a consequence of oxidant stress in black children deficient in erythrocyte glucose-6-phosphate dehydrogenase (G-6-PD) has not been well described in the pediatric literature. During a 3½-year period 14 hospitalized black G-6-PD-deficient children with moderate to severe hemolytic reactions were studied. The vast majority (13/14) were boys and were less than 3 years of age. Nine of the patients required blood transfusion. Eleven of the 14 episodes occurred with infection (five bacterial, six viral); those children with viral syndromes tended to have more severe hemolysis. Naphthalene was responsible for three episodes, but oxidant drugs were implicated in no instances. Findings on the blood smears of most subjects included irregular dense misshapen erythrocytes with asymmetrical distribution of hemoglobin and an adjacent membrane-bound clear zone ("eccentrocytes"). It is concluded that hemolytic reactions in the black G-6-PD-deficient child may be severe, are most commonly associated with infection, and are frequently characterized by distinctive erythrocyte morphology.
A CASE OF SUDDEN INFANT DEATH SYNDROME (SIDS) AS REPORTED IN 1863
Authors: C. T. E.
Published: December 2021

On March 9, 1863, Dr David Cheever, Adjunct Professor of Clinical Surgery at the Harvard Medical School, presented the following case report of the sudden infant death syndrome at a meeting of the Boston Society for Medical Improvement.1 His report is one of the earliest descriptions of this syndrome in the American medical literature.

An infant, 10 weeks old, apparently in perfect health, suddenly died while sleeping, and after having been asleep one and a half hours. There had been no struggle, and the face was not livid. On post-mortem examination, Dr C. found no morbid appearances, except some serous effusion in the ventricles and at the base of the brain; the latter organ was also somewhat congested. The thoracic organs were all healthy, and the larynx free of obstruction. An infant cousin of the child had died in a precisely similar manner. Dr C. was unable to account for the death, unless the effusion might possibly have been accumulating insidiously for some time until it became sufficient to destroy life.
THE FIRST DESCRIPTION OF GAVAGE FEEDING OF NEWBORN INFANTS (1850)
Authors: C. T. E.
Published: December 2021

Gavage feeding of premature or debilitated infants was first described by Marchant at a meeting of the Academy of Medicine in Paris on December 23, 1850.1 Marchant's report of about 200 words is worth citing in full because gavage feeding was eventually found to be of life-saving value in feeding many premature infants.

My translation follows:

Care to Give to Newborns

1. Infants are often born in a debilitated state labeled frequently by the accoucheurs under the name of feebleness of birth: respiration is poorly developed; and the ability to swallow food is impossible; the smallest quantity of liquid placed in the mouth passes into the larynx and leads to suffocation. Feeding being impossible, the newborn infants die infallibly with a period of time that varies from a few hours to one or two days.

2. Asphyxiated infants brought back to life by artificial respiration are often in a state of prolonged asphyxia, and chilling of the infant has not been adequately prevented. In all these cases I intend to use a method of artificial feeding by using a rubber sound [catheter] of a number 14 Charrière [14 French]. The introduction of the catheter into the infant's esophagus is neither dangerous nor difficult. By this means, one will be able to overcome the [infant's] weakness and save a life which is the target of strong feelings and attachment; and one that humanity directs us to preserve.

Apparently, Marchant's report went unnoticed because it was not until March 22, 1884 that the practice of gavage feeding was introduced by Tarnier at the Maternité Hospital in Paris.
Eosinophilic Nonallergic Rhinitis in Children
Authors: Rupp Garry H. , Friedman Roger A.
Published: December 2021

Eosinophilic nonallergic rhinitis is a newly described symptom complex reported to occur in a significant percentage of adult patients who have symptoms of perennial rhinitis. They are characterized by nasal eosinophilia, negative allergy skin tests, and a normal serum immunoglobulin E concentration. Twelve children, aged 6 to 17 years, who represent the syndrome of eosinophilic nonallergic rhinitis, have been identified. All have severe perennial rhinitis and nasal eosinophilia. Physical examination revealed pale, boggy membranes with a clear nasal discharge in ten of 12 patients. All 12 patients had a normal serum IgE concentration. All patients initially received an antihistamine-decongestant preparation with subjective improvement in seven of 12 patients. The remaining five patients were placed on a regimen of either topical or systemic steroids and all five had dramatic responses with marked improvement of symptoms. The negative skin tests and normal serum IgE help distinguish this entity from allergic rhinitis, whereas the positive nasal eosinophilia and response to steroids will differentiate eosinophiic nonallergic rhinitis from vasomotor rhinitis. Eosinophilic nonallergic rhinitis is an important cause of perennial rhinitis in children and better knowledge of this entity should lead to more aggressive and efficacious therapy.
SLEEP DISRUPTIONS
Authors: Haggerty Robert J.
Published: December 2021

Questionnaires about infant sleep patterns were sent by mail to a random sample of 1,158 families with 1 to 2 year olds. Returned questionnaires (67%) indicated that 20% of the children woke five or more times a week. Characteristics of 55 children with severe waking problems and their families were compared with 30 nonwaking control children. The wakers more commonly had other behavior and temperamental difficulties, irritability in the early months, and an adverse perinatal history. Their families had more stress and their mothers were more likely to have psychiatric symptoms. The role of various factors in the genesis and maintenance of sleep disruptions is discussed.
Letter to the Editor
Authors: Chadwick Douglas W.
Published: December 2021

The article by Greer et al1 provokes some comment.

The implication is that there may not be enough vitamins in mother's milk. However, as a private practitioner of general pediatrics and an ardent supporter of breast-feeding for more than 16 years, it has been my routine practice to recommend breast-feeding alone for at least four to six months (or longer—14 months of age is the record so far) with no supplementary vitamins to the infant save a prescription for fluoride drops plus a multivitamin and mineral tablet daily for the mother.
A Simple Modification of the Intermittent Gavage Feeding Technique in Low-Birth-Weight Infants
Authors: Stronati Mauro , Lombardi Giuseppina , Rondini Giorgio
Published: December 2021

We appreciated the article by Pereira and Lemons,1 the subsequent correspondence of Minoli and Moro,2 and Lemons' reply.3 We would like to suggest a simple modification of the intermittent gavage feeding technique in low-birth-weight infants in use in our division.

A syringe without the barrel is connected to the orogastric feeding tube and suspended from the top of the incubator. Formula or breast milk is placed in the syringe in the amount required; it then falls by gravity, thus avoiding sudden abdominal distention.4,5
Commentary on Parenteral Nutrition
Authors:   Committee on Nutrition
Published: December 2021

Nutritional requirements of young infants, both premature and full-term, can be met better by recognizing the absorptive and digestive limitations present. When gastrointestinal disease is superimposed on an immature digestive system, special support frequently is needed to maintain adequate growth. This support can be offered as parenteral nutrition or with specialized enteral feeding techniques and formulations. Because parenteral solutions are formulated to provide complete nutritional support, they may be used for short as well as extended periods of time. Recommendations for use include: 1. Careful catheter placement and confirmation of position by roentgenogram; strict adherence to aseptic techniques and established guidelines of catheter care; and laboratory and clinical monitoring of patients for intolerance. 2. Protein, in the form of crystalline amino acids, should be provided at a rate of 2 to 3 g/kg/d. The concentration of carbohydrate, as glucose (dextrose), should be advanced in a methodical manner to ensure tolerance.
RLQ Pain = Surgery?
Authors: STRASBURGER VICTOR C.
Published: December 2021

To the Editor.—

Ravitch's article1 is elegantly written but, unfortunately, ill-conceived. Ravitch would have us send to surgery any child with abdominal pain and right-lower-quadrant (RLQ) tenderness in whom no other diagnosis can be found. Why? Because the incidence of mortality for appendectomies is less than 1% and because the risk of missing a perforation is unacceptably high. Not so—if Ravitch had chosen to cite the recent surgical literature instead of reveling in McBurney's original observations, he would have found an important study from Johns Hopkins2 in which children with abdominal pain were all admitted to the hospital for intensive observation.
Testosterone Need Questioned
Authors: DANNENHOFFER ROBERT , CRAWFORD JOHN D.
Published: December 2021

To the Editor.—

We have read with interest the report of Rosenfeld et al1 describing the effects of testosterone treatment in boys with constitutional growth delay. We are concerned, however, by a number of methodologic flaws, which may have led the authors to recommend testosterone where none is needed. On entry into the study, the treatment and control groups are not similar and thus, not comparable. The treatment group is significantly taller (149.9 v 143.0 cm, P < .05) and somewhat older (15.2 v 14.6 years, P > .05).
A Partially Blind Study
Authors: FORSYTH BRIAN
Published: December 2021

To the Editor.—

I would like to suggest that the article entitled: "Cow's Milk Formula as a Cause of Infantile Colic: A Double-Blind Study"1 would be better entitled: Infantile Colic and Confusion with Milk Formulas: A Partially Blinded Study. The authors of the article suggest that their results demonstrate that infantile colic was "cow's milk dependent in 71% of the infants in the study" and "53% of these infants also showed an adverse reaction to soy." With this, I disagree.
A Partially Blind Study
Authors: LOTHE L. , LINDBERG T. , JAKOBSSON I.
Published: December 2021

In Reply.—

In reply to Forsyth we want to refer to our recent publication in this journal. Once again we emphasize that our conclusion that cow's milk seems to be one major factor in causing infantile colic is based on the results of the whole study (ie, not only the double-blind test, but also the outcome of the cow's milk challenges at follow-up). Concerning the 18% (11 infants) who did not react adversely to soy formula, seven infants received it as the first challenge and four as the second.
Circumcision Continues
Authors: HERRERA ALFREDO J.
Published: December 2021

In Reply.—

The reason why Brenneman feels that parental Information given prenatally is successful in decreasing the circumcision rate is probably because he believes there is not any clear medical indication for circumcision (in the majority of cases), and he gives that input to the parents as I believe he should. However, I am afraid he is in the minority group. Of a survey of 400 pediatricians and obstetricians across the country, we found that 50% believe for one reason or another that circumcision is indicated in the male newborn, 33% do not believe so, and 17.4% are undecided.
Pharyngeal Gonorrhea
Authors: CHACKO MARIAM R.
Published: December 2021

In Reply.—

We are pleased to have Emans and Silber support our recommendations regarding screening for pharyngeal gonorrhea in high-risk urban adolescents. We are also glad to note that our data are consistent with the study done by Silber et al.1 It is important to reemphasize that in our study, of the 80 patients with gonorrhea, 15% had only pharyngeal gonorrhea, and therefore would have been missed if throat cultures had not been taken. In addition, approximately, half (6/12) were detected at a family planning visit and at the time were considered totally asymptomatic.
Hospital-Based Rental Programs to Increase Car Seat Usage
Authors: Colletti Richard B.
Published: December 2021

The ability of hospital-based car seat rental programs to provide car seats inexpensively throughout an entire state and the effect of these rental programs on car seat usage by newborns were evaluated. In July 1979 individuals and groups committed to child passenger safety formed a coalition called Vermont SEAT (Seatbelts Eliminate Automobile Tragedies). During the next 3 years SEAT asked the major hospitals in the state to allow volunteers to operate car seat rental programs on their premises. The number of rental programs increased from 0 to 13; the percentage of newborns born in a hospital with a rental program increased from 0% to 99%. The estimated statewide rate of car seat usage by newhorns, based on observations at discharge at five hospitals, increased from 15% to 70%. These findings suggest that a network of hospital-based car seat rental programs operated by volunteers can make car seats readily available throughout a state or region, and can significantly increase car seat usage by newborns. It is recommended that such programs be a part of comprehensive strategies to improve child passenger safety.
Postoperative Ketotic Hyperglycemia During Prostaglandin E1 Infusion in Infancy
Authors: COHEN MARK H. , NIHILL MICHAEL R.
Published: December 2021

Prostaglandin E1 (PGE-1) has recently been approved for intravenous infusion in infants as a palliative treatment in selected cardiovascular anomalies (E. Micalizzi, personal communication, 1981). These include lesions in which patency of the ductus arteriosus is necessary to assure either pulmonary or systemic blood flow.1

In addition to its vasoactive properties, PGE-1 has many metabolic properties, some of which are now coming under close scrutiny. This case report describes the postoperative course of an infant who, while under treatment with PGE-1, became severely hyperglycemic with apparent ketoacidosis.

CASE REPORT

J.R. was the product of a 35-week gestation as determined by dates. The mother was an insulin-dependent diabetic with renal-vascular involvement.
Criteria for Diastolic Pressure: Revolution, Counterrevolution, and Now a Compromise
Authors: MOSS ARTHUR J.
Published: December 2021

In 1967, an editorial entitled, "The Criterion for Diastolic Pressure: Revolution and Counterrevolution" appeared in a cardiology journal.1 The comments centered on deliberations of three committees appointed through the years by the American Heart Association. The charge of these committees was, among other things, to resolve the issue of whether the fourth phase of Korotkoff sounds (muffling) or the fifth phase (cessation) is the proper index of diastolic pressure.

In 1939, the American Heart Association, together with the Cardiac Society of Great Britain and Ireland, recommended quite definitely that the fourth phase should be considered the index of diastolic pressure.2

REVOLUTION

In 1951, a second committee of the American Heart Association reversed the recommendation of the 1939 International Committee and stated that the fifth phase was to be regarded as the more reliable index of diastolic pressure.3
Acute Versus Chronic Salicylate Poisoning
Authors: GAUDREAULT PIERRE , TEMPLE ANTHONY R. , LOVEJOY FREDERICK H.
Published: December 2021

In Reply.—

Fink's letter affords us the opportunity to elaborate on certain points addressed in our paper. In the last decade the mode of presentation of aspirin intoxication has changed. Since the introduction of safety caps and the limitation of children's aspirin to 36 per bottle, the incidence of acute aspirin intoxication has decreased.1 However, salicylate intoxication following chronic ingestion of an excessive amount of aspirin has increased. In this study we wished to evaluate the relative severity and nature of salicylate intoxication following chronic exposure as opposed to a single ingestion.
Central Venous Catheter Complications
Authors: HOELZER DENNIS J. , L'HOMMEDIEU CHARLES S
Published: December 2021

To the Editor.—

We read with interest the paper of Dolcourt and Bose.1 We commend them on their technical expertise and success rate in establishing central venous access. There are several conclusions with which we take issue.

1. Duration of Line Usage. The authors report that their catheters remained in place for a mean of 24.8 days (variance of 15.9 days). More informative would be median days of usage. They compare their results with other reports and claim that their catheters lasted twice as long.
Flaws in Study of Management of Children with Febrile Illness
Authors: SOMAN MICHAEL P.
Published: December 2021

To the Editor.—

I found the recent article1 comparing the management of febrile children by pediatricians and general practitioners to be quite thought provoking but seriously flawed. The section regarding variability in laboratory use was interesting, but not enough information on subjects (particularly age and degree of temperature) was given to compare the care by either group of physicians with recent age-specific recommendations.2-4 More importantly, the most relevant outcome conclusion was that "no significant differences in the measured outcomes of episodes of febrile illness seen by pediatricians or generalists was found."
Naldecon Claims Disputed
Authors: SMULL NED W.
Published: December 2021

In Reply.—

The points in the letter are well taken. There is no intent by the Academy to carry advertising that may be misleading in Pediatrics. Usual procedures for internal review of advertising copy were not adequate in this instance. The ad has been withdrawn from future publication in Pediatrics until appropriate modifications are made.
A Perimortem Protocol for Suspected Genetic Disease
Authors: Kronick Jonathan B. , Scriver Charles R. , Goodyer Paul R. , Kaplan Paige B.
Published: December 2021

A considerable portion of pediatric deaths represent disease with risk of recurrence in subsequent family members. Procedures to obtain samples of body fluids and tissues suitable for diagnosis of mendelian and chromosomal disorders are described. These procedures, the "perimortem protocol," are used in studying children who died of suspected but undiagnosed genetic disease.
Teaching Hospitals Today and the Challenge for Excellence
Authors: GEME JOSEPH W. ST.
Published: December 2021

The contemporary pediatric chairman exists in an extraordinary professional milieu. The challenge for academic leaders in this deacde becomes more rigorous with each passing day. No longer will the traditional attributes of teacher, clinician, and biomedical researcher suffice. The chairman must also become a competitive academic-administrative leader with additional skills in personnel management and entrepreneurial business pursuits. At the same time, the arena in which he or she toils, the teaching hospital, has become an economic battle-ground.

Competition for patient population and teaching material in our academic medical centers is intense. Can we meet it? Nonteaching community hospitals surround every teaching institution. These hospitals provide primary and secondary hospital care with much less fuss.
Valproate Teratogenicity
Authors:   Committee on Drugs
Published: December 2021

In a recent statement entitled, "Valproic Acid: Benefits and Risks" we reported that despite the presence of teratogenic effects in animals there existed only one possible case in man.1 Recently the Centers for Disease Control has reported that the use of valproic acid (Depakene), during the first trimester of pregnancy, may increase the risk of having a child with spina bifids.2 The report, based upon a study undertaken in Rhône-Alpes, France,3,4 quotes an estimated risk of 1.2%. Based upon this information, we believe that a woman who becomes pregnant while on valproic acid should consult with her physician about prenatal testing for neural tube defects. Additional recommendations for the counseling of women who require anticounvulsant treatment during pregnancy have been published previously.5
Principles of Child Health Care Financing
Authors:   Committee on Child Health Financing
Published: December 2021

Whether it is through employment, personal means, a publicily financed plan or a privately purchased plan, the financing of health care must provide for appropriate pediatric care. An unacceptable level of mortality and morbidity persists today among American children, and it is clear that archaic and inequitable financing mechanisms contribute to this circumstance.

Waste, inefficiency, and discrimination against children in current financing systems must give way to improvements that maximize access to comprehensive pediatric care and ensure the quality of the care.

As both the public and private sectors continue to explore the redesign of health financing, the following principles are among those against which the Academy will weigh proposed changes.

1. Children's Right to Access to the Health Care System.

• All children have a right to health care.

• Financial barriers should not prevent children from receiving comprehensive health care.

• When families are unable to provide for adequate health financing, through employment, purchase of a private plan, or personal means, children should be covered by a comprehensive public plan.

• Health care financing systems should permit reasonable options for the patient to choose appropriate providers of services.

2. Standards for Comprehensiveness and Quality Assurance.

• Health care financing systems should cover medical care needed by infants, children, and adolescents, including prenatal consultations, newborn care, preventive care, health supervision, and treatment services through age 21 years.

• Heealth care financing systems should encourage continuity of care by primary care physicians.

• Health care financing systems should recognize the value eof cognitive services in addition to procedural services.

• Health care financing systems should cover physician-directed ancillary and rehabilitative services.
Breast-Feeding or Infant Formula Should Be Continued for 12 Months
Authors: WOODRUFF CALVIN
Published: December 2021

To the Editor.—

The age at which the feeding of fresh homogenized cow's milk can produce occult blood loss has not been determined. The most recent study1 suggests that iron-replete infants fed less than 1 L/day are susceptible when less than age 140 days but not between 140 and 196 days (4.7 to 6.5 months). This study used the Hemoccult test, a relatively insensitive test for blood in the stool. A review of the feeding histories of 12 infants previously reported22 and four studied subsequently who had evidence of iron deficiency anemia associated with the ingestion of large amounts of fresh homogenized cow's milk (1 to 2 L daily) showed that eight of the 16 infants hed received infant formula with or without iron for at least 6 months, and four others for at least 3 months.
Transverse Myelitis and Penicillin
Authors: WEIR MICHAEL R. , FEARNOW RONALD G.
Published: December 2021

To the Editor.—

The review by Beregson et al1 was of particular interest to staff pediatricians at William Beaumont Army Medical Center due to a recent case of transverse myelitis following gluteal injection of benzathine penicillin. The case promoted a review of the literature, and that report is being prepared for publication (W. Stafford, H. Mena, W. S. Piskun, et a, in preparation). We concluded that preparations or mixtures are not safe in the gluteal musclature of children less than 2 to 3 years of age.
Transverse Myelitis and Penicillin
Authors: BERGESON PAUL S.
Published: December 2021

In Reply.—

Weir and Fearnow have made an extremely important observation and have thereby contributed significantly to the emedical literature. Their proposed mechanism of injury is lucid and logical. This report represents a strong consideration regarding the use of the gluteal area for intramuscular injections in infants, even when appropriate technique is used. How safe is the injection of nonviscous, lucent materials in this area? Further studies are urgently needed to clarify this point. Finally, pediatric practitioners must make honest reports of complications resulting from intramuscular injections (such as the above letter) to allow us to gain understanding in this area.
Multiple Anaerobic Pulmonary Abscesses
Authors: BEHRENTS ROLF G. , DIETRICH CARL P. , SABAT MICHAEL R. , WENGER TERRENCE L. , YONALLY JAMES F.
Published: December 2021

To the Editor.—

In response to the article by Stern et al, "Multiple Microaerophilic Streptococal Lung Abscesses After Orthodontic Treatment" (Pediatrics 1982;70:722-724), we, of course, concur that the possibility of lung abscesses following supine-position aspiration of minute, orally contaminated substances should be considered by orthodontists as well as all other appropriate practitioners. The "message" that is ultimately derived from the paper is timely, and it is within reason that this situation could occur.

However, in the case presented, we do feel the circumstantial evidence is too tenuous and fragile to constitute reasonable proof that the situation did in fact occur. The authors suggest that the concisely described infection (in this presumably previously healthy patient) was caused, with little question, by an uneventful aspiration of some orally contaminated flecks of dental cement during the application of orthodontic appliances.
Renal Calcification in Premature Infants
Authors: GOLDSMITH MARTIN A.
Published: December 2021

To the Editor.—

Hufnagle et al1 reported on ten premature infants who developed renal calcifications while receiving long-term furosemide therapy for bronchopulmonary dysplasia. A similar case has been reported,2 and I have been informed of another premature male infant with bronchopulmonary dysplasia who developed a left renal calculus while receiving chronic furosemide therapy. At six months of age, the infant developed hydronephrosis, which required nephrostomy for decompression and removal of the calculus (N. Visveshwara, personal communication, 1982).
Coming of Age in General Pediatrics
Authors: Green Morris
Published: December 2021

Changes that have occurred in the practice of pediatrics in the last decade are reviewed. It is suggested that in the future, general ambulatory pediatrics be conceptualized for practice and educational purposes by forming three levels of care based on the following determinants: length of time and number of visits required for the specific service provided, level of competence needed, complexity of the problem, involvement of other professionals, setting, and specific needs of the patient. Growth in Level I general ambulatory care services will come from parental and adolescent visits and sports medicine. Extension of general ambulatory care at Levels II and III will result from differentiation of general pediatrics into areas of special interest such as child development, behavior, neurology, allergy, developmental disabilities, and adolescence. Arrangements to facilitate the provision of care in Levels II and III by the practitioner are suggested. Pediatric biomedical and psychosocial homeostasis are discussed using a model that encompasses the child, his family, and his environment on one axis and problems, vulnerabilities, strengths, and potentialities on the other. The need to examine the content and outcome of health supervision visits is emphasized.
Five-Year Follow-up Study of Recipients of Live Varicella Vaccine Using Enhanced Neutralization and Fluorescent Antibody Membrane Antigen Assays
Authors: Asano Yoshizo , Albrecht Paul , Vujcic Luba K. , Quinnan Gerald V. , Kawakami Katsuro , Takahashi Michiaki
Published: December 2021

Twenty-six healthy children susceptible to varicella were inoculated with the OKA strain of live attenuated varicella vaccine. All of the recipients showed good antibody responses without adverse clinical reactions. The seropositivity rate 5 years after vaccination was 100% by the enhanced neutralization test and 96% by the fluorescent antibody membrane antigen (FAMA) test. None of the recipients contracted varicella in spite of documented contact exposure. None of the children developed herpes zoster during the 5-year observation period. The results suggest that attenuated varicella vaccine has long-term protective efficacy.
Estrogen Treatment of Tall Girls: Risk of Thrombosis?
Authors: Blombäck Margareta , Hall Kerstin , Ritzén E. Martin
Published: December 2021

In 34 girls who were treated with large doses of ethinylestradiol because of expected excessive tall stature, antithrombin activity in the blood was followed before, during, and after treatment. All girls showed lower levels of antithrombin during treatment than before or after estrogen administration; the mean concentration during treatment was at or below the lower limit of control values (-2 SD). In three girls, the antithrombin levels were so low that the medication was withdrawn. There was no difference between the mean levels of antithrombin activity in the three groups treated with 0.25, 0.50, or 1.0 mg of ethinylestradiol. Deficiency of antithrombin is known to be associated with an increased risk of thrombosis. Therefore, antithrombin concentrations in blood should be determined before and during treatment with large doses of estrogens.
Aluminum Toxicity
Authors: GRISWOLD W. R. , REZNIK VIVIAN M. , MENDOZA S. A.
Published: December 2021

In Reply.—

As we mentioned in the discussion section of our paper,1 parathyroidectomy may have been deleterious to this patient. The experience of Hodsman et al2 with the inappropriateness of parathyroidectomy in nondialyzed uremic patients with osteomalacia could not be applied to our patient because that literature was not in print at the time our patient was treated.

Evidence for toxicity of aluminum has, until recently, been controversial. The literature of the past year clearly shows that aluminum can be toxic to bone.
Hazards of Battery Ingestions
Authors: TEMPLE DAVID M. , McNEESE MARGARET C.
Published: December 2021

In Reply.—

The guidelines for management of battery ingestion presented by Mofenson et al certainly exhibit compromise between those physicians who advocate immediate removal of all batteries1,2 and those who essentially advocate "cautious observation only"3 one the battery is to the stomach. Since our article4 was submitted in July 1982, several additional case reports have come to our attention.3 Five of these cases involved a battery that lodged in the eosphagus. All patients in this group experienced significant if not fatal complications.
Fluorocarbon Propellants and Central Nervous System Stimulation in Asthma
Authors: ADINOFF ALLEN , TELLEZ PATRICK
Published: December 2021

To the Editor.—

Pressurized aerosols used in the treatment of asthma contain a mixture of fluorocarbons as propellants. Although the possible cardiac toxicity of these substances in asthmatics has been discussed,1 little attention has been given to the stimulatory effects on the central nervous system. We have observed a patient who demonstrated behavior that, we feel, illustrates this point.

J.C. is a 12-year-old girl who has had asthma since infancy and who has required alternate-day corticosteroids for the past 3 years.