bluuebunny/crossref_metadata_2025 huggingface dataset:
Children With Self-Injurious Behavior
Authors: Hyman Susan L. , Fisher Wayne , Mercugliano Marianne , Cataldo Michael F.
Published: December 2021

Self-injurious behavior is a serious problem that is not uncommon among individuals with mental retardation. Medical and developmental characteristics of 97 children, adolescents, and young adults (age range 11 months to 21 years, 11 months) assessed and treated for self-injurious behavior in a specialized, interdisciplinary inpatient unit between 1980 and 1988 were reviewed. This population differed from those reported in previous studies in that it was of school age and predominantly community based. Severe or profound mental retardation was present in 82.5% of our patients. The causative diagnoses associated with self-injurious behavior were similar to those of severe mental retardation alone. Associated disabilities represented at greater than expected frequencies included pervasive developmental disorders, visual impairment, and a history of infantile spasms. Most patients (81.4%) engaged in more than one type of self-injurious behavior. The most common topographies were head banging, biting, head hitting, body hitting, and scratching. Physical injury was documented in 77% of cases; the injuries most frequently reported were excoriations, scars/callus formation, hematomas, and local infection. As community placement of handicapped individuals continues to increase, pediatricians will be called upon to monitor patients who engage in self-injurious behavior.
Maternal Smoking and Childhood Asthma
Authors: Weitzman Michael , Gortmaker Steven , Walker Deborah Klein , Sobol Arthur
Published: December 2021

According to a substantial literature, passive smoking by children is associated with an increased incidence of lower respiratory illness and diminished pulmonary function. The relationship between passive smoking and childhood asthma, however, is not clear. Data from the Child Health Supplement to the 1981 National Health Interview Survey were analyzed with information about 4331 children aged 0 to 5 years to study the relationship between maternal smoking and (1) the prevalence of childhood asthma, (1) the likelihood of taking asthma medication, (3) the age of onset of children's asthma, and (4) the number of hospitalizations among children with and without asthma. An odds ratio for asthma of 2.1 was shown by multivariate logistic regressions among children whose mothers smoke 0.5 packs of cigarettes or more per day compared with children of nonsmokers (P = .001). In similar analyses maternal smoking of 0.5 packs per day was identified as an independent risk for children's use of asthma medications (odds ratio 4.6, P = .0006) and for asthma developing in the first year of life (odds ratio 2.6, P = .0006). Maternal smoking is also associated with increased numbers of hospitalizations by its association with an increased risk of asthma as well as by contributing to hospitalizations independently of a child having asthma. Among children with asthma, however, maternal smoking is not associated with increased numbers of hospitalizations. It was concluded that maternal smoking is associated with higher rates of asthma, an increased likelihood of using asthma medications, and an earlier onset of the disease. These findings have implications for renewed efforts to discourage smoking in families, especially during pregnancy and the first 5 years of children's lives.
Providing Therapeutic Services to Children in Special Educational Placements: An Analysis of the Related Services Provisions of Public Law 94-142 in Five Urban School Districts
Authors: Palfrey Judith S. , Singer Judith D. , Raphael Ellen S. , Walker Deborah K.
Published: December 2021

Using the sample of 1726 special education students from the Collaborative Study of Children With Special Needs, the authors describe the related services being provided to the children and then analyze the relationship between service provision and class placement. Related services are provided in all settings, with a concentration in special schools and special classes. For even the most severely involved children the trade-off with academics is no more than 1 hour per day. It is argued that schools now are major sites of therapeutic service provision for children with special needs.
Retinal Hemorrhage After Cardiopulmonary Resuscitation in Children: An Etiologic Reevaluation
Authors: GOETTING MARK G. , SOWA BONNIE
Published: December 2021

Retinal hemorrhage detected after cardiopulmonary resuscitation has important medical, social, and legal implications. When a child is brought to the hospital in circulatory arrest, these hemorrhages raise the question of preceding trauma, frequently child abuse.1 Several authors have suggested that retinal hemorrhage may be virtually pathognomonic of child abuse.2,3 We have questioned this belief because our experience, as well as that of others,4,5 suggests that retinal hemorrhage may result from resuscitative efforts. We therefore undertook a prospective study to evaluate whether cardiopulmonary resuscitation can cause retinal hemorrhage.

MATERIALS AND METHODS

During a 4-month period, all children admitted to the Pediatric Critical Care Medicine Service who underwent cardiopulmonary resuscitation were considered for inclusion in the study.
Transient Organic Aciduria and Methemoglobinemia With Acute Gastroenteritis
Authors: KAY MARK A. , O'BRIEN WILLIAM , KESSLER BRADLEY , MCVIE ROBERT , URSIN SUSONNE , DIETRICH KENNETH , MCCABE EDWARD R. B.
Published: December 2021

Acute gastroenteritis remains a common medical problem in the pediatric population and diarrhea may be life threatening in the neonate. Organic aciduria has been observed in children with short bowel, malabsorption, and Hirschsprung's disease,1-6 and methemoglobinemia has been observed in children with acute diarrheal disease.7-15 The two infants described here, however, represent the initial report of concomitant transient organic aciduria and methemoglobinemia in patients with diarrhea. Awareness of the association of these findings will be valuable in directing the clinical evaluation of similar patients.
A Horrifying Television Commercial That Led to Constipation
Authors: PILAPIL VIRGILIO R.
Published: December 2021

I would like to call attention to an unusual event that led to constipation in a child I recently examined.

CASE REPORT

A 3-year-old boy who had been constipated for 6 weeks was brought to my office. He had previously moved his bowels approximately once a day and had been toilet trained for at least 6 months. However, the frequency of bowel movements had decreased to approximately every 4 days and his stools were usually hard. He had initially complained of anal discomfort and refused to move his bowels. Eventually, he began to move his bowels but only infrequently, while standing up, and while wearing a diaper.
Hereditary Fructose Intolerance in the Vomiting Infant
Authors: EDSTROM CYNTHIA S.
Published: December 2021

Hereditary fructose intolerance is one of numerous entities included in the differential diagnosis of vomiting in infancy. Caused by a deficiency of fructose-1-aldolase, it is inherited as an autosomal recessive trait.1 The symptoms are often subtle and may be confused with more common disorders such as gastroesophageal reflux, milk protein allergy, or improper feeding practices. The following case emphasizes the need to consider the diagnosis of hereditary fructose intolerance in the vomiting infant.

CASE REPORT

A 9-week-old male infant was admitted with vomiting that was unresponsive to outpatient management. The first child of unrelated parents, he was born full term, with a birth weight of 4.1 kg, after an uncomplicated pregnancy and delivery.
Intensive Care Management of Acute Asthma in Children
Authors: CANNY GERARD J. , LEVISON HENRY
Published: December 2021

In Reply.—

We appreciate Dr Krohn's interest in our review of the intensive are management of acute asthma in children. We certainly agree that the death of the 17-year-old boy, while he was working a a restaurant, may have been due to acute anaphylaxis, possibly related to ingestion of sulfites and monosodium glutamate.
Solar Intensity and Sun Protection
Authors: WEYRAUCH KARL F. , BOIKO PATRICIA E.
Published: December 2021

To the Editor.—

Weinstock et al1 observed "a significant association of melanoma with latitude of residence during the teenage years," thereby implying a direct relationship between solar radiation intensity and increasing tropical latitude. However, for specific locations, this relationship may not be true. For example, average daily solar radiation in Spokane, WA (latitude 47 degrees, 40 minutes, elevation 2400 feet), was 1314 BTU during July, compared to 862 BTU in Charleston, SC (latitude 32 degrees, 53 minutes, elevation sea level).2
Evaluating Persistent Sleeplessness in Children
Authors: SCHMITT BARTON D.
Published: December 2021

To the Editor.—

Kahn's recent study on persistent sleeplessness in children is an important addition to the sleep disorder literature.1 Some elaboration on the presenting symptoms of these children would help the reader implement these findings in clinical practice. In the abstract, the authors state that for 17 children (who later proved to be allergic to cow's milk protein) initially "no explanation was found for the sleep difficulties in spite of an extensive workup." Yet in Table 2 we see that 5 of the 17 children had at least three episodes of wheezing at night, 7 of 17 had eczema, 8 of 17 had diarrhea and vomiting, and 10 of 17 had chronic rhinitis and otitis.
Evaluating Persistent Sleeplessness in Children
Authors: KAHN A. , MOZIN M. J. , REBUFFAT E. , SOTTIAUX M. , MULLER M. F.
Published: December 2021

In Reply.—

Dr Schmitt's questions address the difficulty of evaluating the origin of persistent sleeplessness in children, and more precisely of differentiating between the cases of sleeplessness due to food intolerance and the much more frequently encountered situations in which a child's insomnia is the result of parental sleep mismanagement. The medical evaluation is complicated by the fact that a dissociation can at times exist between the families' initial complaints and the final diagnosis of food intolerence.
Clinical Experience With Haemophilus influenzae Type b Conjugate Vaccines
Authors: Mäkelä P. Helena , Eskola Juhani , Peltola Heikki , Takala Aino K. , Käyhty Helena
Published: December 2021

The importance of Haemophilus influenzae type b as the main cause of serious bacteremic infections in young children and the consequent need for preventive measures have been widely appreciated since the 1970s. The knowledge that serum antibodies to the polysaccharide capsule of H influenzae type b increase with age and correlate with resistance to this infection1-3 encouraged work toward a vaccine based on the H influenzae type b polysaccharide. Such a vaccine2,4 was used in 1974 in a field trial in Finland.3,5 Two important lessons were learned. First, vaccine-induced antibodies to the polyribosylribitol-phosphate (PRP) polysaccharide correlated with protection from disease caused by H influenzae type b, so that the serum anti-PRP concentration predicting protection could be estimated as 1 µg/mL.6 Second, the vaccine was not effective in infancy; protection and serum antibody concentrations above 1 µg/mL were not observed before 18 to 24 months of age.

The poor immunogenicity of PRP in infancy has been observed in a large number of studies2-8 and is shared by other bacterial polysaccharides.9 Although the reason for this is not known, the most likely hypothesis associates poor immunizing ability in infancy with the "T-independent" nature of these polysaccharide antigens. Such antigens would be unable to stimulate T lymphocytes; therefore, immunity to them would depend exclusively on B cells and antibodies produced by them. If infants, by and large, lack B cells that could be stimulated directly by a polysaccharide antigen, they cannot respond to the polysaccharide vaccine.

This hypothesis immediately suggests possibilities for improvement of the vaccine.
Commentary: Results of Efficacy Trials in Alaska and Finland of Haemophilus influenzae Type b Conjugate Vaccine
Authors: Ward Joel
Published: December 2021

One of the currently licensed Haemophilus influenzae type b polysaccharide conjugate vaccines currently recommended for use in children 18 months of age and older, polyribosylribitol-phosphate-diphtheria toxoid (PRP-D, Connaught Laboratories), has been evaluated in two studies for its protective efficacy in children immunized before 6 months of age.1 The peak incidence of invasive disease caused by H. influenzae type b occurs in children 6 to 18 months of age; therefore, prevention of this disease depends on the efficacy of vaccines in this younger age group.

In a large, randomized, unblinded trial conducted in Finland, relatively low levels of antibody were induced after a series of three primary PRP-D immunizations at 3, 4, and 6 months of age. Despite these limited immunogenicity results, a high level of protective efficacy was shown during a 3-year period (protective efficacy of 87%, 95% confidence intervals 50% to 96%).

Another trial, which was randomized, double blind, and placebo controlled, was conducted among 2113 Native Alaskan infants immunized (20 µg/0.5 mL) at 2, 4, and 6 months of age as part of their routine childhood immunizations. This population was chosen for the trial because it has the highest known incidence of invasive disease caused by H influenzae type b, and a trial in such a high-risk population could be conducted more carefully, with fewer study subjects, and in a shorter period of time. As in the Finnish trial, in this younger age group immune responses to PRP-D vaccine were meager, apparent only after the third dose of vaccine at 6 months of age.
Haemophilus influenzae Type b Conjugate Vaccine (Meningicoccal Protein Conjugate): Immunogenicity and Safety at Various Doses
Authors: Yogev Ram , Arditi Moshe , Chadwick Ellen Gould , Amer Michael D. , Sroka Pamela A.
Published: December 2021

The Haemophilus influenzae vaccine consisting of purifled type b capsular polysaccharide (polyribosylribitolphosphate [PRP]) was shown in Finland to be protective, with 90% efficacy in children older than 18 to 23 months of age.1 However, a wide range of estimates of vaccine efficacy has been reported in the United States after its licensure in 1985.2,3 These estimates range from –55%2 to +89%.3 In addition, the PRP vaccine was not effective in children younger than 18 months of age, in whom 70% to 80% of meningitis cases occur. A further development was the introduction of H influenzae type b polysaccharide-protein conjugate vaccines such as the PRP-D. These conjugate vaccines were found to be more immunogenic than PRP vaccine in children of all ages.4,5 Two doses of PRP-D in infants 7 months of age and older induced antibody levels equal to or greater than levels in infants 24 months of age who received the PRP vaccine alone. Recently, Eskola et al6 reported that repeat vaccinations with PRP-D at 3, 4, 6, and 14 months of age was 83% protective (95% confidence interval, 26% to 96%). Yet PRP-D vaccine elicits only low serum antibody levels in infants younger than 7 months of age. Because of the discrepancy in efficacy results for the PRP vaccine in the United States and Finland and the lack of data about the protective efficacy of PRP-D vaccine in infants in the United States, the PRP-D vaccine is currently recommended only for children 18 months of age or older.7 Clearly, a vaccine that is more immunogenic in the younger population is needed.
Meconium Aspiration Syndrome: Have We Made a Difference?
Authors: Wiswell Thomas E. , Tuggle Joseph M. , Turner Barbara S.
Published: December 2021

Meconium aspiration syndrome (MAS) and its associated complications are reviewed from the period before the routine use of intubation and suctioning to the present (1973 through 1987). Of the 176 790 neonates born during this period, the amniotic fluid was stained in 21 472 (12.15%). Subsequently, MAS developed in 1162 (5.41%) of the meconium-stained neonates. Male neonates were more prone to the disorder than female neonates (P = .022). There were no racial predilections for MAS. The incidence of MAS significantly decreased during the 15 years (P = .043). Of the neonates with MAS, 49 (4.22%) died as a direct consequence of the disorder. The death rate significantly declined during the study period (P = .041). Of the neonates with MAS, 345 (29.7%) required mechanical ventilation, and 134 (11.53%) had pneumothoraxes. Among neonates with MAS, the requirement for mechanical ventilation, as well as the incidence of pneumothoraxes, did not decrease from 1973 through 1987. The incidence of MAS has declined since the advent of combined obstetric and pediatric suctioning of the oropharynx and trachea. Furthermore, there are significantly fewer deaths from the disorder. These declines were likely influenced by other improvements in perinatal care, which have occurred since the early 1970s. The results do not support the contention that severe MAS and resultant deaths can be prevented altogether.
Increased Cerebral Blood Flow Velocity in Infants of Mothers Who Abuse Cocaine
Authors: van de Bor Margot , Walther Frans J. , Sims Maureen E.
Published: December 2021

The pharmacologic effects of cocaine are considered to be secondary to an enhancement of the effects of circulating catecholamines. The effect of intrauterine cocaine exposure on the cerebral blood flow velocity was studied in 20 full-term newborn infants whose urine screens were positive for cocaine and in 18 nonexposed healthy full-term newborn infants whose urine screens were negative for cocaine metabolites. On the first day of life, peak systolic, end diastolic, and mean flow velocities in the pericallosal, internal carotid, and basilar arteries and mean arterial blood pressures were significantly greater in infants who had been exposed to cocaine. On day 2, cerebral blood flow velocities and mean arterial blood pressures were similar in exposed and nonexposed infants. The increase in mean arterial blood pressure and in cerebral blood flow velocity on the first day of life indicates a hemodynamic effect of cocaine that may put the infant exposed to cocaine at a greater risk of intracranial hemorrhage.
Infant Temperament and School Age Behavior: 6-Year Longitudinal Study in a Pediatric Practice
Authors: Wasserman Richard C. , DiBlasio Christine M. , Bond Lynne A. , Young Paul C. , Colletti Richard B.
Published: December 2021

We conducted a retrospective cohort study in a pediatric practice to assess the association between parents' ratings of temperamental difficulty (observations of specific infant behaviors) and perceptions of temperamental difficulty (impressions of one's infant as compared with other infants) in infancy and behavior problems at school age. Mothers of 129 infants, who had completed the Revised Infant Temperament Questionnaire at the 4-month visit, completed the Child Behavior Checklist when the child was 6 years of age. Teachers of 102 of these children completed the teacher Child Behavior Checklist. Temperamental difficulty was defined by assessments of rhythmicity, approach/withdrawal, intensity, mood, and adaptability. Initial analyses revealed that low socioeconomic status (r = -.29, P = .001), ratings of temperamental difficulty (r = .17, P = .06), and perceptions of temperamental difficulty (r = .22, P = .02) at 4 months of age were associated with increased maternal rating of behavior problems at 6 years of age (all 2-tailed tests). However, a multivaniate regression analysis showed only low socioeconomic status (P < .01) and increased perceptions of temperamental difficulty (P = .02) associated with maternal behavior problem scores. Teacher behavior problem scores were associated only with low socioeconomic status (r = -.27, P = .01). These results suggest that the link between difficult infant temperament and later behavior problems is complex and probably reflects both child factors and parent attitudes about what constitutes typical infant behavior.
Evaluation of an Infrared Tympanic Membrane Thermometer in Pediatric Patients
Authors: KENNEY RICHARD D. , FORTENBERRY JAMES D. , SURRATT S. SUZETTE , RIBBECK BETH M. , THOMAS WILLIAM J.
Published: December 2021

Body temperature measurement provides important information for evaluation of pediatric patients. Because of the role that central nervous system thermoreceptors play in temperature homeostasis, accurate measurement at core body sites has long been sought.1 Rectal temperature, often considered the "gold standard" for clinical use, does not correlate well with deep measurements.2,3 Pulmonary artery catheters and deep rectal probes measure core temperature accurately4 but are not practical for clinical use.

The tympanic membrane shares the same vascular supply that perfuses the hypothalamus and is an excellent, readily accessible site for core temperature measurement.1 Although indwelling contact-type tympanic membrane temperature probes provide accurate data, patient discomfort and complications such as perforation have restricted their use.4,5
Vitamin E for Prevention of Perinatal Intracranial Hemorrhage
Authors: POLAND ROLAND L.
Published: December 2021

Vitamin E was discovered in the early 1920s by Evans and Bishop1 who found that its absence from the diet of rats led to reproductive failure. The chemical identification of the vitamin was accomplished in 1936,2 and the alcohol was named α-tocopherol [Greek: tokos = offspring; pherein = to bear]. Disease due to deficiency of vitamin E is rare since the vitamin is present in a large variety of foodstuffs including human colostrum and milk, grains, nuts, and other vegetable oils, eggs, and liver. However, human deficiency syndromes that include myopathic and neuropathic disorders have been described in association with chronic fat malabsorption.3
Circumcision
Authors: SCHOEN EDGAR J.
Published: December 2021

In Reply.—

Dr Wiswell essentially agrees with the content and documentation of the report of the Task Force on Circumcision. However, he believes that the benefits of newborn circumcision outweigh the risks, whereas our report simply pointed out the advantages and disadvantages of circumcision without taking a position for or against the procedure.

The points in Wiswell's letter are well taken. His work on the increased risks of urinary tract infections (UTIs) in uncircumcised male infants had an important role in the decision of the American Academy of Pediatrics to convene our Task Force and review its position on new-born circumcision.
Adoption of Hepatitis B Virus-Infected Foreign-Born Children
Authors: HOSTETTER MARGARET K. , JOHNSON DANA
Published: December 2021

In Reply.—

We thank Dr Sokol for his detailed comments on hepatitis B virus (HBV) infection in internationally adopted children. Several issues which he has raised deserve special attention.

1. Previous reports of HBV infection in internationally adopted children had detected a substantially lower preyalence of this disease than did our study.1-5 Indeed, two studies in Korean infants3,5 place the prevalence of HBV infection at 2.8% to 4.3%, a figure which is approximately one third of that reported for Asian countries as a whole in surveillance studies conducted by the World Health Organization.6
Abdominal Trauma - Child Abuse
Authors: DWORKIND MARCIA , MCGOWAN GEORGE , HYAMS JEFFREY
Published: December 2021

To the Editor.—

The development of severe abdominal pain and vomiting in an infant is frequently an ominous event with a large differential diagnosis including midgut volvulus, intussusception, and incarcerated hernia. Recently we cared for an infant who developed an acute abdomen as a result of child abuse which was not appreciated until after laparotomy.

A 3-month-old girl was transferred to our hospital with a history of an acute onset of vomiting, diarrhea, fever, and lethargy.
Inadequate Breast Feeding and Jaundice
Authors: NEWMAN JACK
Published: December 2021

To the Editor.—

It is not surprising that Kemper et al1 found that mothers of jaundiced babies were more likely to wean their infants before le month of age than those mothers whose infants were not jaundiced. However, one aspect of this problem was not discussed in their article. Is it not possible that not only might mothers stop breast-feeding earlier because of the jaundice, but also that the jaundice itself might be a symptom of inadequate feeding and therefore result in earlier termination of breast-feeding?
Routine Cholesterol Screening in Childhood
Authors: ROBERTSON L. D.
Published: December 2021

To the Editor.—

I am alarmed by the article by Garcia and Moodie1 on "Routine Cholesterol Surveillance in Childhood" that appeared in the November 1989 issue of Pediatrics—alarmed not because they found about 20% of their study had hypercholesterolemia and not because almost half of these children would not have been detected if only children from families with known risk factors had been screened. What is alarming is that people with knowledge of only one part of a complex picture can publish in a respected national pediatric journal sweeping recommendations such as "...all children should have a random, nonfasting cholesterol test performed"; and, after a lipid profile is done in those who are positive on the initial screening, "...the large group of children with hypercholesterolemia identified should be part of a well designed study to evaluate the efficacy of drug therapy..."
Routine Cholesterol Screening in Childhood
Authors: GARCIA RICHARD E.
Published: December 2021

In Reply.—

Dr Robertson is concerned about cholesterol screening in childhood as it relates to changing the diet of American children and subjecting a large number of children to pharmacotherapy for hypercholesterolemia. He raises several questions regarding the cost of a cholesterol screening program and whether or not there is evidence that dietary therapy (or drug therapy) will really make a difference as far as future coronary artery disease is concerned.

The purpose of the cholesterol screening program was to identify children with hypercholesterolemia and to discuss with their families the various coronary risk factors which are recognized as important for future coronary artery disease.
Newborn Screening for Cystic Fibrosis Is Complicated by Age-Related Decline in Immunoreactive Trypsinogen Levels
Authors: Rock Michael J. , Mischler Elaine H. , Farrell Philip M. , Wei Lee-Jen , Bruns W. Theodore , Hassemer David J. , Laessig Ronald H.
Published: December 2021

Detection of elevated levels of immunoreactive trypsinogen (IRT) in dried neonatal blood spots has been used as a screening test for cystic fibrosis. In other cystic fibrosis newborn-screening studies, a sweat chloride test is generally performed only if an infant has a persistent IRT level above a selected cutoff value on both the initial and subsequent specimens. Neither the timing of the second specimen nor the value of the cutoff point for the second specimen has been comprehensively evaluated. In this randomized, controlled study, 145 024 infants were screened in the neonatal period for cystic fibrosis using the 99.8 percentile (180 ng/mL) as the neonatal cutoff point. A total of 129 infants had elevated neonatal IRT levels and had negative results on sweat tests (false-positive by IRT screening). A total of 54 children with cystic fibrosis were identified in the screened and comparison groups. Excluding patients with meconium ileus, 4 infants with cystic fibrosis had neonatal IRT values less than 180 ng/mL, and an additional 9 infants with cystic fibrosis had values decline to less than 180 ng/mL within the first 2½ months of age. The IRT values of infants with and without cystic fibrosis overlapped considerably beyond 30 days of age. These findings suggest that further refinement of cystic fibrosis screening methodology will be necessary to achieve an acceptable sensitivity and specificity.
Global and Specific Disease-Related Information Needs of Cystic Fibrosis Patients and Their Families
Authors: Henley Lesley D. , Hill Ivor D.
Published: December 2021

A cross-sectional survey of 60 families with a child with cystic fibrosis was undertaken to assess how much family members wanted to be told about the illness, to determine specific information needs concerning selected medical and psychosocial topics, and to determine whether this information had been provided in the past. Self-administered index measures were designed for this purpose. Most family members wanted complete and comprehensive information about cystic fibrosis. A minority of family members claimed they had not received basic medical information. Fathers and siblings wanted more medical information than mothers and patients. The majority of parents and patients wanted a great deal more information on the possible effects of cystic fibrosis on the patient's career, social life, marriage, and reproductive capacity. In general, family members had been given more medical than psychosocial information. Index measures were independent of the effects of patients' age, Shwachman score, and period since diagnosis. Social class was significantly associated with fathers' index measures of their specific information needs and information not given previously.
Home Visitors and Child Health: Analysis of Selected Programs
Authors: Chapman Jean , Siegel Earl , Cross Alan
Published: December 2021

The relationships between selected child health outcomes and programmatic interventions using home visitors are analyzed. The following features of seven programs are systematically reported: program characteristics; description of the home visitors; program objectives, sample size, and research design; outcome measures and reported data. A number of issues such as funding and long-term viability, use of professional or paraprofessional visitors, visitor selection and supervision, and evaluation of home visitor programs require clarification and are discussed. It is concluded that home visitor programs can contribute to child health outcomes such as increased birth weight, improved prenatal care, improved maternal-infant interaction, and improved use of community resources. Pediatricians can be supportive of such programs at many levels: becoming aware of the existence and range of services of home visitor programs in their area that serve families with children and referring families to those programs; being available to advise programs that are in the planning stages; providing advocacy at the local, state, and national level for the funding and development of such programs; and taking the initiative to join multidisciplinary efforts to develop new programs.
Dose-Response Relationship of Inhaled Metaproterenol Sulfate in Preschool Children With Mild Asthma
Authors: Nussbaum Eliezer , Eyzaguirre Mario , Galant Stanley P.
Published: December 2021

The dose-response relationship of single doses of nebulized metaproterenol sulfate 5% inhalant solution was evaluated by placebo-controlled, parallel-group study of 30 children, aged 3 to 6 years old, with stable asthma. Total respiratory resistance, the primary variable used to assess response, was measured by the forced oscillation method for a period of 6 hours from the start of inhalation. When comparisons were made between metaproterenol sulfate and saline, only 0.01 and 0.02 mL/kg showed significant bronchodilation (P < .05) in percent change from baseline and area under the curve. However, no significant differences were seen between these doses. Moreover, the effect was sustained for 3 hours with both higher doses. Minimal side effects were observed. Metaproterenol sulfate 5% inhalant solution at a dose of 0.01 mL/kg seems to be optimal to elicit significant and sustained bronchodilatory response in preschool children with mild asthma.
Multicenter Trial of Single-Dose Modified Bovine Surfactant Extract (Survanta) for Prevention of Respiratory Distress Syndrome
Authors: Soll Roger F. , Hoekstra Ronald E. , Fangman John J. , Corbet Anthony J. , Adams James M. , James L. Stanley , Schulze Karl , Oh William , Roberts Jesse D. , Dorst John P. , Kramer Sandra S. , Gold A. Jack , Zola Elizabeth M. , Horbar Jeffrey D. , McAuliffe Timothy L. , Lucey Jerold F. ,   The Ross Collaborative Surfactant Prevention Study Group
Published: December 2021

A multicenter, prospective randomized controlled trial was performed comparing the efficacy of a single intratracheal dose of modified bovine surfactant extract (Survanta, 100 mg/kg, Abbott Laboratory, North Chicago, IL) with air placebo in preventing respiratory distress syndrome. Infants were enrolled if they were estimated to be between 24 and 30 weeks' gestation, weighed between 750 and 1250 g, and were intubated and stabilized within 15 minutes after birth. A total of 160 infants were treated (79 with surfactant, 81 with air placebo) between 4 and 37 minutes after birth (median time 12 minutes). Of these, 5 infants were excluded from the final analysis. The 72-hour average values for the arterial-alveolar oxygen ratio, fraction of inspired oxygen, and mean airway pressure were calculated from the area under the curve of scheduled values measured throughout 72 hours. Clinical status was classified using five ordered categories (no supplemental oxygen or assisted ventilation, supplemental oxygen only, continuous positive airway pressure or assisted ventilation with intermittent mandatory ventilation ≤6 breaths/min, assisted ventilation with intermittent mandatory ventilation >6 breaths/min, death). Chest radiographs at 24 hours were graded for severity of respiratory distress syndrome. Infants receiving Survanta had less severe radiographic changes at 24 hours of age and decreased average fraction of inspired oxygen (31% vs 42%, P = .002) compared with control infants. No differences were noted in the average arterial-alveolar oxygen ratio, mean airway pressure, or clinical status on days 7 and 28. A beneficial effect was noted in the incidence of pneumothorax (P = .057) and an increase was noted in the incidence of necrotizing enterocolitis (P = .052). No differences in incidence of patent ductus arteriosus, intraventricular hemorrhage, sepsis, or bronchopulmonary dysplasia were seen. According to results of a secondary analysis, there was improvement in the fraction of inspired oxygen and a greater number of survivors without bronchopulmonary dysplasia in the subgroup of infants weighing <1000 g who were treated with surfactant. It was concluded that a single dose of Survanta given shortly after birth resulted in decreased severity of chest radiographic findings 24 hours after treatment and improved oxygenation during 72 hours after treatment, but did not improve other acute measures of disease severity or clinical status later in the neonatal period. The group at highest risk for respiratory distress syndrome (infants with birth weights between 750 and 999 g) may benefit the most from preventive therapy.
Earlier Rather Than Later
Authors: MCANARNEY ELIZABETH R.
Published: December 2021

Clinicians caring for pregnant adolescents recognize their patients' risk for having behavioral problems.1 Not all pregnant adolescents, however, experience such problems. In their article in this issue, Elster and colleagues2 reports that young urban mothers who engaged in three or more problem behaviors were more likely than were urban women who reported no problem behaviors to have had a child before they were 19 years of age.

The interrelationship of adolescent problem behaviors was originally described approximately 20 years ago by Jessor et al.3,4 High-risk behaviors did cluster and young persons involved in one problem behavior were likely to engage in others (sexual intercourse, marijuana use, and problem drinking).4
Solar Pool Blankets: Another Water Hazard
Authors: SULKES STEPHEN B. , VAN DER JAGT ELISE W.
Published: December 2021

Despite prevention efforts, pool immersion accidents continue to occur all too frequently. In this article we describe a new danger associated with an advance in swimming pool technology, the "solar pool blanket."

CASE REPORTS

Patient 1

A 30-month-old boy with infantile autism was noted to be missing by his parents, who, after an initial look at their above-ground pool, found him submerged under the intact pool blanket, pulseless and breathless 5 minutes later. Cardiopulmonary resuscitation was performed, and he was transported to a local hospital, where he arrived comatose with decerebrate posturing. His rectal temperature was 33.7°C and his arterial pH was 7.0. Diazepam, phenobarbital, and mannitol were administered and he was intubated and hyperventilated.
Adult Respiratory Distress Syndrome in Full-Term Newborns
Authors: FAIX ROGER G. , DIPIETRO MICHAEL A.
Published: December 2021

In Reply.—

We appreciate the interest and continuing contributions of Drs Pfenninger and Tschaeppeler. We agree with their assessment that the difference in mortality rates is probably attributable to selection differences. All five of their infants would have been excluded from our series, since proven sepsis and documented persistent pulmonary hypertension were both among the criteria for exclusion. As we noted in our article, the low mortality in our series was not surprising because of such exclusions.
Hypoplastic Left Heart Syndrome: Natural History in a Geographically Defined Population
Authors: Morris Cynthia D. , Outcalt Jacquelyn , Menashe Victor D.
Published: December 2021

Advances in surgical treatment of hypoplastic left heart syndrome with the Norwood procedure and cardiac transplantation have made essential the understanding of the natural history of hypoplastic left heart syndrome. In a geographically defined population, we ascertained the prevalence of hypoplastic left heart syndrome in children born in Oregon from 1971 through 1986. Clinical and anatomic data were extracted from the charts of the 98 affected children and the survival rate was calculated. Hypoplastic left heart syndrome occurred in 0.162 per 1000 live births in Oregon during this period. No syndrome complex was prevalent and 84% were free of other congenital malformations. However, there was an increased occurrence of congenital heart defects in first-degree relatives of probands with hypoplastic left heart syndrome. Of the affected children 15 ± 4% died on the first day of life, 70 ± 5% died within the first week, and 91 ± 3% died within 30 days. No secular change in survival occurred during the study. Palliation with the Norwood procedure was performed in 20 children. Although survival was significantly improved with this surgery (P = .01), the effect was observed principally through 30 days of life and only one of these children remains alive. Hypoplastic left heart syndrome is a lethal congenital heart defect in children and poses management and ethical dilemmas.
Can Home Visitation Improve the Health of Women and Children at Environmental Risk?
Authors: Olds David L. , Kitzman Harriet
Published: December 2021

We reviewed randomized trials of prenatal and infancy home-visitation programs for socially disadvantaged women and children. Some home-visitation programs were effective in improving women's health-related behaviors during pregnancy, the birth weight and length of gestation of babies born to smokers and young adolescents, parents' interaction with their children, and children's developmental status; reducing the incidence of child abuse and neglect, childhood behavioral problems, emergency department visits and hospitalizations for injury, and unintended subsequent pregnancies; and increasing mothers' participation in the work force. The more effective programs employed nurses who began visiting during pregnancy, who visited frequently and long enough to establish a therapeutic alliance with families, and who addressed the systems of behavioral and psychosocial factors that influence maternal and child outcomes. They also targeted families at greater risk for health problems by virtue of the parents' poverty and lack of personal and social resources.
Prevention of Mother-to-Child Transmission of Human T-Lymphotropic Virus Type-I
Authors: Tsuji Yoshiro , Doi Hiroshi , Yamabe Tooru , Ishimaru Tadayuki , Miyamoto Tsutomu , Hino Shigeo
Published: December 2021

Human T-cell lymphotropic virus type I (HTLV-I), an etiologic human retrovirus of adult T-cell leukemia/lymphoma (ATLL), causes approximately 60 new cases of ATLL each year in Nagasaki Prefecture; essentially all cases are fatal, and they account for approximately 0.5% of total deaths in the area. The estimated life risk for an HTLV-I carrier to develop ATLL is approximately 5%. The major transmission pathway of HTLV-I peculiarly endemic in the Nagasaki Prefecture was studied. The prevalence of HTLV-I infection in children of carrier mothers (21%) was significantly higher than that in children in the general population in the area (1%), and more than 85% of mothers of carrier children were carriers. The breast milk of carrier mothers contained HTLV-I-infected cells and was infectious for marmoset via oral administration. A retrospective survey of children of carrier mothers showed that the prevalence of carrier children of carrier mothers was 17 (39%) of 44 and 0 (0%) of 10 when they were given breast milk only or formula only, respectively. These data provide a powerful basis for devising an intervention measure to block the endemic cycle of HTLV-I; ie, if carrier mothers refrain from breast-feeding, the incidence of ATLL will be significantly reduced some 50 years later.
Should Tetracycline Be Contraindicated for Therapy of Presumed Rocky Mountain Spotted Fever in Children Less Than 9 Years of Age?
Authors: Abramson Jon S. , Givner Laurence B.
Published: December 2021

Antibiotic treatment for suspected Rocky Mountain spotted fever usually must be started prior to confirmation of the diagnosis because of the following: (1) currently available laboratory diagnostic methods usually do not allow definitive diagnosis of Rocky Mountain spotted fever until the second week of illness, and (2) delays in the initiation of antimicrobial therapy until confirmation of diagnosis may lead to significant morbidity and mortality, the latter being as high as approximately 25% in untreated cases.1,2 In areas of high incidence, such as North Carolina, a heightened index of suspicion, especially during the season of peak incidence (May through September) means that a large number of patients with compatible signs and symptoms will be treated annually for presumed Rocky Mountain spotted fever.3
Persistent Bacteremia
Authors: PATRICK CHRISTIAN C. , KAPLAN SHELDON L. , BAKER CAROL J. , MASON EDWARD O.
Published: December 2021

In Reply.—

The first issue raised by Drs Noel and Edelson is that of the reported in vitro heteroresistance of coagulase-negative staphylococci.1 They suggest that this phenomenon could have been expressed by some of the isolates infecting our patients and explain the persistent bacteremia. Although such speculation should be investigated, there are no published studies proving or refuting its validity. Heteroresistance among strains of Staphylococcus aureus has been analyzed with respect to clinical outcome, and no persistent infections were observed.2
Why Use Indomethacin?
Authors: ROSENFELD CHARLES R.
Published: December 2021

To the Editor.—

The recent article by Van Bel et al1 on the effects of indomethacin on cerebral blood flow velocity was extremely interesting, especially the suggestion that there may have been substantial cardiovascular effects of this cyclooxygenase inhibitor that were independent of its effects on prostaglandin synthesis. Furthermore, their hypothesis that the reduction in heart rate also provided indirect evidence for a systemic effect, ie, an increase in peripheral vascular resistance and a decrease in cardiac output, should be of interest to all neonatalogists using this drug, especially in sick or compromised neonates.
Denver Developmental Test Problems
Authors: HERSHER LEONARD
Published: December 2021

To the Editor.—

Although 80% of pediatricians feel that their training in assessing a child's development was inadequate,1 it is estimated that between 20 million to 30 million children have been screened worldwide with the Denver Developmental Screening Test.2

With ith so many children tested by so many inadequately trained physicians or their assistants, it is virtually unavoidable that the test sometimes will be used incorrectly. One effect of improper testing may be the not inconsiderable raising of anxiety among parents who are told that their children are developmentally delayed when in fact they are entirely normal.
Routine Cholesterol Surveillance in Childhood
Authors: GARCIA RICHARD E.
Published: December 2021

In Reply.—

Dr Feldman objects to the recommendation that all children have a cholesterol screening test, citing issues of parental anxiety, cost, and the absence of controlled clinical trials to prove the efficacy of reducing cholesterol levels in reducing all-cause mortality.

The authors feel that informing parents that it is unhealthy for children to consume an excess of cholesterol and saturated fat is at least as appropriate as informing them that smoking, physical inactivity, and obesity are unhealthy.
Tin-protoporphyrin in the Management of Children With Crigler-Najjar Disease
Authors: MCDONAGH ANTONY F.
Published: December 2021

To the Editor.—

Rubaltelli et al1 recently described the use of tin-protoporphyrin (SnPp) to block bilirubin formation in a child with the potentially fatal Crigler-Najjar Type II disease, a genetic disorder characterized by an inability to conjugate and excrete bilirubin in the normal way. Although repeated administration of SnPp failed to suppress the plasma bilirubin concentration significantly in their patient, perhaps because of the buffering effect of a relatively large extravascular pool of bilirubin, it did appear to diminish the need for phototherapy, suggesting that SnPp might be a useful adjuvant to phototherapy in the treatment of Crigler-Najjar disease.