bluuebunny/crossref_metadata_2025 huggingface dataset:
In Defense of Circumcision
Authors: WISWELL THOMAS E.
Published: December 2021

In Reply.—

Do neonatal circumcisions need infant consent? Obviously, no. Because neonates are minors, the burden is on the parents to make the necessary decision based on informed consent. The general belief in the past 10 to 15 years has been that there is no medical indication for routine performance of circumcision in the newborn. However, we recently published data demonstrating a decreased incidence of urinary tract infections during the first year of life in circumcised male infants.1
Salicylate Toxicity Rediscovered
Authors: HOWRIE DENISE L.
Published: December 2021

In Reply.—

We thank Dr Pearlman for his comments regarding our brief report. We were aware of Drs Shirreff and Pearlman's previous observations. However, it was clear that many physicians and laypersons in the community were unaware of the continued availability of methyl salicylate as a candy-flavoring agent, a "previously unappreciated source" in our area. We hoped that our report would serve as a reminder that a well-known and highly toxic substance is still accessible to children.
Zinc and Copper Balances in Preterm Infants
Authors: Tyrala Eileen E.
Published: December 2021

Preterm infants are at risk for copper and zinc depletion if sufficient quantities of these nutrients are not provided in a bioavailable form in postnatal life. The purpose of this study was to determine whether the use of a whey-predominant, 50% medium chain triglyceride formula with relatively high concentrations of zinc and copper would promote the achievement of the in utero accretion rate for zinc and copper in the preterm infant. Two groups of five preterm infants were fed a diet containing 12.5 mg/L of zinc and either 0.9 mg/L or 2.1 mg/L of copper. Seventy-two-hour metabolic balance studies were performed at an average postconceptual age of 34 weeks and an average weight of 1,549 g. All infants were in positive zinc balance and nine of ten achieved the in utero accretion rate for zinc for a 34-week gestation fetus (≥0.432 mg/d). Three infants receiving the high copper formula and two receiving the lower copper formula were in positive copper balance. Two infants from each group achieved the in utero accretion rate for copper for a 34-week gestation fetus (0.088 mg/d). A formula that provides 12.5 mg/L of zinc permits positive zinc balance and zinc retention similar to in utero rates. A formula that provides as much as 2.1 mg/L of copper, however, may not always permit positive copper balance.
Risk Factors for Traumatic Infant Death in Oregon, 1973 to 1982
Authors: Emerick Sara J. , Foster Laurence R. , Campbell Douglas T.
Published: December 2021

A retrospective study of risk factors for traumatic infant deaths in Oregon occurring from 1973 through 1982 was performed using vital records and medical examiner records. A total of 146 such deaths occurred during this period. Relative risks were calculated for various risk factors in the study group compared with all Oregon births. Factors found to be significantly associated with all traumatic deaths were low maternal age, out-of-hospital birth, unwed mother, late or no prenatal care, low birth weight, and low maternal education. Race, sex, and birth order were not associated with traumatic infant death. The traumatic deaths were grouped into homicides and accidents. The same risk factor associations, with the exception of out-of-hospital birth, were found for each group.
Purpura Fulminans in a Chinese Boy With Congenital Protein C Deficiency
Authors: Yuen Patrick , Cheung Alfred , Lin Hsiang Ju , Ho Faith , Mimuro Jun , Yoshida Nobuhiko , Aoki Nobuo
Published: December 2021

Severe and recurrent purpura fulminans developed in a Chinese boy at one day of age. Results of coagulation studies performed on the patient during attacks were compatible with the diagnosis of disseminated intravascular coagulation. Subsequent investigations have revealed that the patient is homozygous and that his parents are heterozygous for protein C deficiency. Cryoprecipitate and fresh frozen plasma induced a remission, and administration of warfarin has been successful in preventing recurrence of attacks for as long as 8 months without infusion of any plasma components. None of the family members who are heterozygous for protein C deficiency have had thrombotic episodes.
Amiodarone Therapy Effects on Childhood Thyroid Function
Authors: Costigan D. Colm , Holland F. John , Daneman Denis , Hesslein Peter S. , Vogel Michael , Ellis Graham
Published: December 2021

Thyroid function was systematically evaluated in 15 consecutive children (mean age 13.7 years, range 0.5 to 19.5 years) before and serially during treatment with amiodarone (Cordarone), a potent antiarrhythmic agent. Amiodarone is known to affect thyroid homeostasis by competitive inhibition of 5'-monodeiodinase, which converts l-thyroxine (T4) to triiodothyronine (T3) and reverse T3 (rT3) to 3,3'-diodothyronine (T2), and also by the direct effects of its high iodine content (37% by weight). Clinical and/or biochemical evidence of hypothyroidism occurred in three patients, two of whom required treatment with l-thyroxine. An additional patient had persistent hyperthyroxinemia but no clinical evidence of hyperthyroidism. Results from the patients who remained euthyroid showed characteristic alterations in serum thyroid function tests. These included significant increases in serum T4, rT3, basal thyroid-stimulating hormone and thyroid-stimulating hormone response to thyrotropin-releasing hormone testing. These changes were considered to be compensatory adjustments by the pituitary-thyroid axis to competitive inhibition of 5'-monodeiodinase by the amiodarone. Routine screening of thyroid function is needed to allow early detection of hypothyroidism when these compensations fail to occur.
Gelatin Sign: Ultrasonographic Evidence of Cerebral Necrosis in Infants
Authors: COLAN RICHARD V.
Published: December 2021

Since its introduction, real-time ultrasonographic imaging of the neonatal brain has proven valuable in detecting a variety of pathologic and anatomic disturbances of the newborn brain.1-3 High resolution scanning heads, bedside technique, and video recording also allow study of the intracranial movement and responses to intrinsic and extrinsic forces. This paper reports six cases of infants with severe brain disease of widely different etiologies, in which abnormal response was found to cranial percussion, termed the "gelatin sign."

MATERIALS AND METHODS

A total of 506 consecutive real-time cranial ultrasound scans were obtained in 333 cases from a Level 3, regional neonatal intensive care unit. The scans were ordered by attending neonatologists to study the CNS in low birth weight infants and infants suspected of having intracranial disease.
Measles Elimination
Authors: ORENSTEIN WALTER A. , HINMAN ALAN R.
Published: December 2021

In Reply.—

The effort to control and eliminate measles in the United States has had tremendous success, as mentioned by Dr Levy. The reported cases in 1983 represented a 99.7% reduction from the annual average of 525,000 in the 10 years preceding vaccine licensure. Although the 69.3% increase from 1983 to 1984 might seem alarming, the provisional total of 2,534 reported cases still represents less than 0.5% of the cases reported annually during the prevaccine era.
Will Neonatology Vanish in 1995?
Authors: CRAFT HUGH , SIEGEL EARL
Published: December 2021

To the Editor.—

It was encouraging to see the results of the recent study from France on the prevention of preterm births published in Pediatrics.1 Pediatricians have long supported preventive measures to improve infant and child health. But, pediatricians, in general, and neonatologists, in particular, have been slow to assume an advocacy position for an obvious, important preventive effort, namely, reducing the incidence of low birth weight.

During the last 20 years, the United States has experienced a dramatic improvement in neonatal mortality, from rates of neonatal death of 18 per 1,000 live births in 1965 to 6.8 per 1,000 live births today.2,3
Will Neonatology Vanish in 1995?
Authors: PAPIERNIK EMILE
Published: December 2021

In Reply.—

The interest of neonatologists in preventing preterm deliveries is remarkable in the United States. In France, where a policy of prevention was developed nationally in 1971, the first impulse also came from the neonatologists and specifically Alex Minkowski, who challenged the obstetricians to propose a real prevention program. The results of this program have now been published.1 incidence of very low birth weight infants in France in 1972 was 0.8 and in 1981 0.4.2
Value of Childhood Blood Pressure Measurements and Family History in Predicting Future Blood Pressure Status: Results From 8 Years of Follow-up in the Bogalusa Heart Study
Authors: Shear Charles L. , Burke Gregory L. , Freedman David S. , Berenson Gerald S.
Published: December 2021

The value of BP measurements and family history of cardiovascular disease in predicting future BP status was studied in 1,501 children, initially 2 to 14 years of age, who were examined four times during an 8-year period in the Bogalusa Heart Study. Correlation coefficients between year 1 and year 9 BPs were as follows for systolic and diastolic BPs, respectively: 0.41 and 0.35 (P < .0001). These correlations were significant in all age groups. For children in the upper quartile of BP at any one prior examination, the percentage remaining in the year 9 upper quartile ranged from 41% to 52% for systolic BP and 35% to 44% for diastolic BP. Three serial BP measurements in the upper quartile increased the percentages remaining in the upper quartile to 68% for systolic BP and 62% for diastolic BP. Conversely, of those children not in the upper quartile of systolic BP at year 9, 96.8% did not have all three prior measurements in the upper quartile. Family history of hypertension was shown to independently predict year 9 systolic BP status. These results confirm the importance of serial BP measurements and family history of hypertension for the practicing physician.
Children in Alcohol-Related Motor Vehicle Crashes
Authors: Margolis Lewis H. , Kotch Jonathan , Lacey John H.
Published: December 2021

Review of North Carolina traffic crash data revealed that alcohol use, although associated with 7.9% of motor vehicle crashes involving children, accounted for 15.4% of the motor vehicle-related deaths and 10.4% of the injuries. The largest proportion of these deaths were child passengers in a vehicle in which the driver had been drinking, followed by child passengers in multiple-vehicle crashes in which the other driver had been drinking. The smallest proportion of deaths were child pedestrians. These findings suggest that, in addition to supporting more stringent alcohol control legislation, health care providers should be admonishing parents about the deadly hazards of drinking and driving to the children in their care.
Safety Seat Use for Children With Hip Dislocation
Authors: Bull Marilyn J. , Weber Kathleen , Stroup Karen Bruner
Published: December 2021

Treatment of children with congenitally dislocated hips requires that an infant be placed into a plaster spica cast for a duration of 3 to 12 months. Because the use of a safety seat is difficult, if not impossible, for children fitted with a brace or spica cast, a solution for safe transportation was developed. A Century child restraint model 100 or the Century model 300 was selected as appropriate for modification. Seat padding was removed from the lower sides of the plastic shell, and the shell was cut. The seat padding was replaced and taped tightly to the outer side of the shell. An impact test of the modified safety seat at the University of Michigan Transportation Research Institute indicated that the modification of the shell did not compromise the performance of the restraint system. Seats with this modification have been loaned to children treated at the James Whitcomb Riley Hospital for Children with satisfactory results.
Statement on Time-Limited Certification
Authors: PIEL CAROLYN F.
Published: December 2021

At its annual meeting in November 1985, the American Board of Pediatrics (ABP) established a policy of time-limited certification. This new policy will become effective for those individuals who are certified in general peditrics after April 30, 1988. By this action, the ABP provides assurance to the public that pediatricians certified after this date have been and will continue to be evaluated periadically by the ABP. Anyone certified prior to this date will not be affected by this new policy; however, those who choose to do so may achieve certification renewal on a voluntary basis.

The duration of the original certificate issued after April 30, 1988, will be 7 years.
Chance and Ventricular Septal Defect
Authors: NORA JAMES J.
Published: December 2021

To the Editor.—

Newman1 has restated the multifactorial inheritance hypothesis of the etiology of congenital heart diseases to emphasize the element of chance (which is, of course, inherent in the hypothesis) and proposes what he considers to be a new hypothesis. There is, of course, a very large element of chance in multifactorial inheritance for an individual with a genetic predisposition to ventricular septal defect or other congenital heart defect also to have a genetic predisposition to an environmental teratogen and finally to have these two predispositions triggered during the very short vulnerable period of cardiogenesis (approximately 1 month or less in duration for most lesions).
Importance of Using Standardized Birth Weight Increments to Report Neonatal Mortality Data
Authors: Hermansen Marcus C. , Hasan Shirin
Published: December 2021

Neonatal mortality statistics are frequently reported in 100-g increments of birth weight. We tabulated our mortality statistics using two methods of incrementation: 500 to 599 g, 600 to 699 g, 700 to 799 g, etc. (method A) and 501 to 600 g, 601 to 700 g, 701 to 800 g, etc (method B). In each 100-g weight group, the mortality was less using method B. The average reduction in mortality using method B was 4.1%. Use of the two different methods creates difficulty in making meaningful comparisons of various published reports. We recommend that all future studies use method A, as that method is more consistent with previous recommendations of the World Health Organization.
Phototherapy for Neonatal Hyperbilirubinemia
Authors: BRYLA DOLORES A. , BROWN AUDREY , GARTNER LAWRENCE , LIPSITZ PHILIP
Published: December 2021

In Reply.—

We appreciate the thoughtful review and comments of Dr Poland regarding the analysis of mortality in the NICHD phototherapy study. The essence of Dr Poland's letter seems to be that, for infants of birth weights less than 1,000 g, a difference of mortality was observed with more deaths in the phototherapy group than the control group and that this difference may be a real difference even though it was not found to be statistically significant.
Evaluation of the Capillary Microhematocrit as a Screening Test for Anemia in Pediatric Office Practice
Authors: Young Paul C. , Hamill Barbara , Wasserman Richard C. , Dickerman Joseph D.
Published: December 2021

The capillary microhematocrit test is widely used to screen pediatric patients for anemia. Recently, it has been suggested that this method produces spuriously elevated values compared with venous hematocrits measured by a Coulter electronic counter and might consequently fail to detect children who are truly anemic. To address this issue we studied 66 white children 9 months to 14 years of age whose capillary hematocrits were either below, equal to, or one or two points above the lower limit of normal for age. Venous specimens were obtained simultaneously with the capillary sample; hemoglobin, hematocrit, and mean corpuscular volume results were obtained using a Coulter electronic counter. Using published standards of venous hemoglobin, we determined the sensitivity, specificity, and predictive values of the capillary microhematocrit in this population of patients with low or borderline values. Twenty of the 66 patients had venous hemoglobin values less than the lower limit of normal. The sensitivity of the microhematocrit was 90.0%; the specificity was 43.5%. The predictive values for a normal (negative) hematocrit was 90.1%; the predictive value for a low (positive) hematocrit was 40.9%. We conclude that the microhematocrit method using capillary blood will miss very few patients with significantly low venous hemoglobin values and is thus an acceptable screening test for anemia. Because it does not require expensive equipment or special skill to obtain the specimen or perform the test, it is ideal for physicians' offices or nonhospital-based clinics.
Cerebral Cysticercosis: Treatment With Praziquantel
Authors: Norman Robert M. , Kapadia Chandrika
Published: December 2021

An infant with cerebral cysticercosis had marked clinical and radiographic improvement following treatment with praziquantel. Computed tomographic appearance and radioimmunoassay were helpful in establishing the diagnosis. Disappearance or size reduction of all active lesions were documented by computed tomography 6 months after praziquantel treatment. Simultaneous administration of dexamethasone during praziquantel treatment is essential to prevent reactive cerebral edema during treatment.
High-Risk Youth and Health: The Case of Excessive School Absence
Authors: Weitzman Michael , Alpert Joel J. , Klerman Lorraine V. , Kayne Herbert , Lamb George A. , Geromini Karen Roth , Kane Karen T. , Rose Lynda
Published: December 2021

Excessive school absence is a major educational and social problem in the United States, yet very little is known about its etiology or how to prevent or ameliorate it. This paper reports results from a series of related studies conducted in seven Boston middle schools (grades 6, 7, and 8) to test the hypotheses that (1) health problems and unmet health needs are major characteristics distinguishing excessively absent students from regular attenders and (2) that a health-oriented approach using medically mediated interventions is effective in reducing absences among excessively absent students. There were no significant differences between regular attenders and excessively absent students on multiple measures of student and family health status, health habits, and health service utilization patterns in a casecontrol study. The intervention program was not associated with a significant decrease in absence school-wide or for participating students. We conclude that demographic and educational characteristics of students exert a greater effect on their behavior in regard to absence from school than do health status or receipt of health services and that a health-oriented approach, such as the one used here, will not have a major impact on what remains one of the most profound educational and social problems involving children in the United States today.
Megavitamins and Hyperactivity
Authors: HASLAM ROBERT H. A.
Published: December 2021

In Reply.—

We became interested in studying the effect of megavitamins in children with attention deficit disorders following a report on megavitamins published in 1976.1 Our research protocol, which was developed at that time, was designed to replicate a report2 that suggested that more than 500 children had benefited "significantly with decreased hyperactivity and improved concentration and attention span which led to improved capacities for learning" with the daily use of massive doses of niacin, ascorbic acid, pyridoxine, and calcium pantothenate.
Vitamin E Problems
Authors: FRIEDMAN ZVI
Published: December 2021

To the Editor.—

I read with great interest the commentary by J. A. Lemons and M. J. Maisels on vitamin E.1 The timing for such a critical review of the subject could not be more appropriate because vitamin E is now being prescribed widely and in large doses to very low birth weight infants. I have two basic comments to the report by Lemons and Maisels.

First, the authors reported their experience with the oral administration of vitamin E and pointed out that serum levels are frequently elevated following the oral administration of 100 mg/kg of vitamin E. Thirty-eight percent of their patients had serum levels greater than 3.5 mg/dL, whereas 13% exceeded 5.5 mg/dL.
Life Insurance for Disabled Children
Authors: M R J
Published: December 2021

In Reply.—

Dr Vince's letter was submitted to an insurance consultant, who verified that Dr Vince's scheme would work in the United States as well as in Canada. He also stated the following with regard to the issue of dissemination of information in the second paragraph of Dr Vince's letter:

The life insurance industry many years ago created the Medical Information Bureau. All data submitted to any participating insurer is transmitted in code form to the Bureau, where it is filed. It is accessible only to participating insurers and certainly never to prospective employers.
Insomnia and Cow's Milk Allergy in Infants
Authors: KAHN A. , BLUM D. , MONTAUK L.
Published: December 2021

In Reply.—

Dr Lecks reminds us that the entity called "infantile colic" is frequently encountered in infants younger than 3 months of age. It is characterized by signs of paroxysmal abdominal pain, severe crying, a flushed face, and a tense abdomen. The painful episodes occur mainly during the late afternoon or early evening hours. The paroxysmal pain can last several hours and appears to be relieved with the passage of feces or when the child falls asleep, usually exhausted.
Incidence, Presentation, and Outcome of Spinal Cord Disease in Children With Systemic Cancer
Authors: Lewis Donald W. , Packer Roger J. , Raney Beverly , Rak Ihor W. , Belasco Jean , Lange Beverly
Published: December 2021

During a 40-month period, in 24 of 643 (4%) newly diagnosed patients with systemic cancer younger than 18 years of age (range: 3 months to 17 years) spinal cord disease developed. Patients with spinal cord disease included 21 children with metastatic spinal cord compression, two with treatment-related transverse myelopathies, and one with an anterior spinal artery stroke. Spinal cord disease occurred in 13 of 102 children (12%) with sarcomas, six of 82 (7%) with neuroblastomas, and four of 94 (4%) with lymphomas. Spinal cord compression occurred as the presenting sign of malignancy in six children (four with sarcomas and two with lymphomas). In the remaining 15 patients, cord compression occurred a median of 13 months after initial diagnosis, and in four patients it occurred at the time of first relapse. Symptoms of metastatic cord compression included back pain in 17 patients (80%), weakness in 14 (67%), sphincter dysfunction in 12 (57%), and sensory abnormalities in three (14%). Findings on plain radiographs of the spine were abnormal in only seven of 20 patients with cord compression, and myelography was needed to differentiate compression from other causes of spinal cord disease. Treatment included high-dose corticosteroids followed by operation (seven patients) or radiotherapy (14 patients). After treatment, nine of 15 nonambulatory patients became ambulatory, and five of 10 incontinent patients regained sphincter control. None of the patients with nonmetastatic spinal cord disease had a satisfactory outcome. Incorrect and delayed diagnosis was frequent in children with spinal cord disease (median time from onset of symptoms to diagnosis, 2 weeks) and 12 children were paraplegic and ten had loss of sphincter control at diagnosis. Spinal cord disease is a relatively common neurologic emergency in children with cancer, especially in those with sarcoma, and requires immediate investigation and intervention.
Sibling Grief in Reaction to Sudden Infant Death Syndrome
Authors: Burns Elizabeth A. , House J. Daniel , Ankenbauer Mary R.
Published: December 2021

Much of the literature that exists regarding psychologic outcomes of sudden infant death syndrome (SIDS) has focused on parental grief or family response; at least two studies suggest that a SIDS death also affected siblings. It is believed that children who experience the death of a sibling due to SIDS do grieve. Factors related to bereavement are the child's age at the time of the sibling's death, special circumstances of the SIDS death, and explanations and grieving response of the parents. However, no information currently exists that characterizes the course of the grief response of these children. Studies have indicated that about 1 year is a normal grieving period for adults. This study was conducted to evaluate the time frame of children's grief response to the death of a sibling from SIDS. A questionnaire was designed that incorporated child grieving behaviors from several sources; 151 questionnaires were distributed to families in which a SIDS death had occurred in the past 16 years in Iowa and Illinois. Information was obtained from 43 families for 50 children who were older than 2 years of age at the time of the sibling's death. With respect to the length of children's grief response, 54% were reported to have grieved longer than 1 year and only 40% were reported to have grieved less than 6 months. Thus, it appears that the length of the grieving response for these children is similar to that described for adults.
Oral and Dental Aspects of Child Abuse and Neglect
Authors:   Committee on Early Childhood, Adoption, and Dependent Care
Published: December 2021

In all 50 states, physicians are required to report suspected cases of child abuse and neglect to social service or law enforcement agencies. Dentists are similarly required to report such suspected cases in most states and are allowed to report in all states; however, a minority of dentists are aware of these legal requirements.1-4 Physicians and dentists could aid in educating each other and in collaborating to increase the detection, treatment, and prevention of these disorders. Physicians typically receive limited training in dental injury and disease and thus may not detect dental abuse or neglect as readily as they do child abuse and neglect involving other areas of the body.

PHYSICAL ABUSE

Because craniofacial injuries occur in half of child abuse cases,3,5,6 evaluation of these injuries is essential. Some authorities believe the oral cavity may be a central focus for physical abuse because of its significance in communication and nutrition.2 The injuries are most commonly inflicted as blunt trauma with an instrument, eating utensil, hand, or finger or by scalding liquids or caustic substances. The abuse may result in ecchymoses, lacerations, traumatized or avulsed teeth, facial fractures, burns, or other injuries. Discolored teeth may result from repeated trauma.7,8 Gags applied to the mouth may leave bruises, lichenification, or scarring at the corners of the mouth. 9 Multiple injuries, injuries in different stages of healing, injuries inappropriate for the child's stage of development, and/or a discrepant history should arouse suspicion of abuse.

SEXUAL ABUSE

The oral cavity is a frequent site of sexual abuse in children.
Virilizing Adrenocortical Tumors in Childhood
Authors: GREEN ORVILLE C.
Published: December 2021

In Reply.—

The biochemical data reported by Honour, Price, and Grant from their publication in 1984 is of interest, and we regret that we did not include it in our review due to overlapping submission and publication dates. They have added 12 additional cases of virilizing tumors to the literature with the very important demonstration of bio-chemical heterogeneity in the secretion and serum analysis of the hormones produced. Their point that serum dehydroepiandrosterone and testosterone levels may not define the steroidogenic potential of a specific tumor is useful knowledge, and we agree that additional androgens should be evaluated by newer techniques if these two assays are not diagnostic.
Overinterpreting Sleep Problems
Authors: VENTIS DEBORAH G. , FOSS-GOODMAN DEBORAH
Published: December 2021

To the Editor.—

We write in regard to the article, "Sleep Problems Seen in Pediatric Practice," by Lozoff et al (Pediatrics 1985; 75:477-483). Overinterpretation of problems that may be typical of development in young children is a pitfall in developmental-behavioral pediatrics which can be the result, in part, of methodologic and statistical inadequacies. Two of the most serious problems that may occur are use of designs that do not provide a direct test of the theoretical question(s) posed and speculation about causality where causal ordering cannot be determined.
Emergency Medical Services and the Pediatric Patient: Are the Needs Being Met? II. Training and Equipping Emergency Medical Services Providers for Pediatric Emergencies
Authors: Seidel James S.
Published: December 2021

Emergency medical services have been organized to meet the needs of adult patients. A study was undertaken to determine the training in pediatrics offered to paramedics and emergency medical technicians throughout the United States and the equipment carried by prehospital care provider agencies. Most training (50%) takes place at colleges and universities and the remainder at hospitals and emergency medical services agencies. Many programs (40%) have less than ten hours of didactic training in pediatrics and 41% offer ten hours or less of clinical experience. Some programs offer no training in pediatric emergency medicine. The most common deficiencies in pediatric equipment included back-boards, pediatric drugs, resuscitation masks, and small intravenous catheters. More attention to training and equipping prehospital personnel for pediatric emergencies may help to improve outcomes of out-of-hospital resuscitations of infants and children.
Circumcision Debate
Authors: COHEN MARK L.
Published: December 2021

To the Editor.—

It appears that the circumcision pendulum is swinging back, before it even had a chance to swing forth. I am prepared to believe that Wiswell and his colleagues1 will be proved right and that the operation really does protect against urinary tract infection. Although the possibility still exists that the gene coding for the Escherichia coli receptor in bladder mucosa is linked to the one that induces noncircumcision-directed behavior in a parent, I am willing to concede the point.
Circumcision Debate
Authors: OZERE R. L.
Published: December 2021

To the Editor.—

Drs Wiswell, Smith, and Bass (Pediatrics 1985;75:901-903) report an association between circumcision and decreased frequency of urinary tract infection in infancy. This report has all the makings of a pediatric cause celebre, perhaps overshadowing the significance or lack of same of this study. They indicate that their latest study includes a series of infants, 92% of whom were cultured by bladder tap, with the same observed difference in frequency of urinary tract infection between the circumcised and noncircumcised.
Developmental Approach to Preventing the Sexual Abuse of Children
Authors: Jenny Carole , Sutherland Shirley E. , Sandahl Bonnie B.
Published: December 2021

Child sexual abuse is a common and potentially damaging experience. Preventing and detecting abuse should be a part of primary care pediatric practice. A protocol is presented the goal of which is to teach children and parents reasonable protective behaviors.
Sensitivity of the Denver Developmental Screening Test in Speech and Language Screening
Authors: Borowitz Kathleen C. , Glascoe Frances P.
Published: December 2021

A retrospective study was undertaken to determine whether the Denver Developmental Screening Test (DDST) language sector is a sensitive screen of speech and language development. Seventy-one children between 18 and 66 months of age with suspected developmental problems were referred to screening clinics conducted by a child evaluation team. Each child was screened using the DDST (revised) and another screening measure of speech and language development. Statistically significant differences were found between the DDST language sector and the speech-language screening in identification of expressive language and articulation problems. No significant difference was found with receptive language. The DDST failed to identify more than one half of the children with expressive language and/or articulation problems. These results demonstrate that the DDST may fail to identify children with speech and language impairment. Professionals involved in developmental screening need to be advised of alternative speech and language screening measures.
Accumulating Evidence: Using Meta-Analysis to Carry Out Research Reviews in Pediatrics
Authors: LIGHT RICHARD J.
Published: December 2021

In pediatric research, as in most fields, new findings generate the most excitement. Summarizing old ones has traditionally been a task assigned to research assistants. But as research results accumulate, should we make stronger efforts to see what a body of research, taken overall, tells us? And would systematic methods to do this improve on the ad hoc or idiosyncratic efforts of the past?

In this spirit, several books and articles have recently appeared describing procedures called meta-analysis.1-9 They urge both researchers and policymakers to improve the quality of research reviews by making them more systematic, and they outline simple but concrete techniques for doing this.
Necrotizing Tracheobronchitis
Authors: KIRPALANI H. , PERLMAN M. , FRIEDBERG J. , CUTZ E.
Published: December 2021

To the Editor.—

We read with interest the report by Mimouni et al1 of a case of necrotizing tracheobronchitis. We agree that survival is possible for patients with necrotizing tracheobronchitis. We recently reported eight cases of necrotizing tracheobronchitis diagnosed prospectively (between January 1983 and September 1984) and 12 cases identified retrospectively.2 From these cases, we identified characteristic clinical findings. These findings, which follow, should alert clinicians early enough to institute therapy for necrotizing tracheobronchitis.

Necrotizing tracheobronchitis supervenes on a previously stable course in an infant requiring mechanical ventilation.
All-Terrain Vehicles—Who Says Four-Wheelers Are Safer?
Authors: SNEED R. C.
Published: December 2021

To the Editor.—

After a paucity of information on all-terrain vehicles (ATV's) in the medical literature, several reports have appeared recently raising concerns about injuries associated with these vehicles.1-7

Since our own report, the Spain Rehabilitation Center has been involved with four additional all-terrain vehicle accidents resulting in serious, permanent injury.5 A 6-year-old girl sustained on a three-wheel all-terrain vehicle a depressed skull fracture and penetrating brain injury resulting in quadriparesis, coma, transient aphasia, and after 12 months, persistent cognitive deficits.
Questioning Role of Hypochloremia in Bronchopulmonary Dysplasia
Authors: BRINSON ALAN
Published: December 2021

To the Editor.—

The title of the recent report by Perlman et al asks an important question for those of us who frequently treat infants who have bronchopulmonary dysplasia ("Is Chloride Depletion an Important Contributing Cause of Death in Infants With Bronchopulmonary Dysplasia?" Pediatrics l986;77:2l2-2l6). They suggest that chloride deficiency may be an important factor in the poor outcome of patients with bronchopulmonary dysplasia. While I am sure no one will seriously suggest that severe hypochloremia will not have a deleterious effect on an already seriously ill infant, I do have questions regarding how they arrived at their conclusion.
Super Effective Diaper Can Cause Confusion
Authors: LAVIN ARTHUR
Published: December 2021

To the Editor.—

In the first 24 hours after birth, 93% of all newborns urinate, and by the end of the first 48 hours, 99% of all newborns have urinated.1,2 For the next 6 months the infant will urinate, on the average, 20 times a day,3,4 requiring four to eight diaper changes a day. Frequency of diaper changing is often used as a guide to newborn hydration status. Here I report the discovery of a new confounding variable that may mislead pediatricians who use frequency of diaper changing as a measure of urine output.
Kernicterus Research and the Basic Sciences: A Prospect for Future Development
Authors: STERN LEO , BRODERSEN ROLF
Published: December 2021

Kernicterus was a major problem of pediatrics in the first half of this century. Important progress has taken place since pediatricians have mastered rhesus disease, introduced exchange transfusion, avoided giving sulfonamides, and have placed at risk infants under blue light. These measures, and above all the general improvements in intensive care in modern neonatology units, have reduced the problem so that kernicterus is now mainly seen as secondary to prematurity, respiratory distress, and severe infections.1 There, it remains a challenge to both clinical and basic science. The mechanism (or mechanisms?) of bilirubin transfer from plasma to brain has not been settled; agreement has not been reached on laboratory methods for predicting kernicterus; and satisfactory guidance about which drugs to avoid, other than the bilirubin-displacing sulfonamides, remains to be given.
Sudden Infant Death Syndrome
Authors: STIVRINS PATRICIA
Published: December 2021

To the Editor.—

I believe that the article by Davidson Ward (Pediatrics 1986;77:451-455) may adversely influence the use of home cardiorespiratory monitoring in the United States. There are several serious problems with this paper.

1. The authors admit that they only had responses from 35% of the apnea programs and 40% of the vendors in their state. This may have very seriously distorted their findings.

2. Death should not be the lone evaluation mode for benefit for home monitoring.
Who Says There Is a Handgun Epidemic?
Authors: SCHREIN DANIEL D.
Published: December 2021

To the Editor.—

I noted with interest the commentary on handguns in the May 1986 issue of Pediatrics (1986;77:781-782). The word "epidemic" caught my eye and I would like to know how significant the epidemic is to our children. Is it any where near the epidemic proportions of auto accidents, BMX bike injuries, skateboard injuries, or pornography? With the estimate of 40 to 50 million handguns in the United States it should not be difficult to figure the ratio of injuries or deaths in children per hand gun available.
Questions About Early Enteral Feeding Study
Authors: GRYLACK LAWRENCE
Published: December 2021

To the Editor.—

I would like to comment on the article by Ostertag et al, "Early Enteral Feeding Does Not Affect the Incidence of Necrotizing Enterocolitis" (Pediatrics 1986;77:275-280). Support for the concept of early gastrointestinal nutrition in the high-risk newborn comes from animal studies that showed that dogs with bowel ischemia that were given intraluminal substrate (10% glucose) had higher levels of adenosine triphosphate in mucosal cells and less morphologic damage than animals without that infusion.1
Questions About Early Enteral Feeding Study
Authors: RADECKI LEONARD , KHAWAM JEAN R. , BEAUMONT ED , SHAW THOMAS , JONES ALAN , FERDIG JUDY
Published: December 2021

To the Editor.—

We were amazed at the report on the incidence of necrotizing enterocolitis and feeding practice (Pediatrics 1986;77:275-280). The rate of necrotizing enterocolitis in both groups of patients is astronomical and yet acceptable to the authors.

During a 2-year period in our neonatal intensive care unit, the incidence of necrotizing enterocolitis was 9/1,114 admissions (0.08%). The incidence in infants with birth weights less than 1,500 g was 8/159 (3.08%); for infants with birth weights less than 1,000 g it was 3/101 (2.9%).
Aspiration of Makeshift Pacifier
Authors: JOHNSON GUY H.
Published: December 2021

To the Editor.—

The recent paper by Millunchick and McArtor (Pediatrics 1986;77:369-370) succinctly describes the danger of aspiration associated with the use of a makeshift pacifier and suggests that intensive care and normal nurseries purchase one-piece commercial pacifiers. Although the recommendation to avoid the use of contrived pacifiers is certainly well founded, the limitation to one-piece pacifiers seems overly restrictive.

Multipiece pacifiers are just as safe as the one-piece varieties. Strict federal safety standards (16CFR Part 1511) apply to all pacifiers.
Infant Pneumonitis Associated With Cytomegalovirus, Chlamydia, Pneumocystis, and Ureaplasma: Follow-up
Authors: Brasfield Dana M. , Stagno Sergio , Whitley Richard J. , Cloud Gretchen , Cassell Gail , Tiller Ralph E.
Published: December 2021

A total of 205 infants who were hospitalized when younger than 3 months of age for pneumonitis were followed longitudinally. Of these patients, 145 (70%) had evidence of infection with one or more pathogens. The most common etiologic agents were Chlamydia trachomatis 61/193 (36%), respiratory syncytial virus 33/142 (23%), cytomegalovirus 42/203 (20%), Pneumocystis carinii 30/171 (17%), and Ureaplasma urealyticum 21/125 (16%). The initial clinical presentation was characterized by cough, rales, normal temperature, and diffuse obstructive airways disease by chest roentgenogram. Regardless of etiology; significant association occurred for cough and cytomegalovirus, apnea and Pneumocystis, and conjunctivitis and Chlamydia. Longitudinal follow-up demonstrates a mortality of 7/205 (3.4%). Morbidity was manifest as recurrent wheezing episodes in 86/187 (46%) patients, persistently abnormal chest roentgenographic findings for at least 12 months in 17/109 (15%) patients, and abnormal pulmonary functions in 15/25 (60%) patients. These abnormalities occurred irrespective of prematurity, atopy, or the initial etiologic agent associated with the pneumonitis. These data add further evidence that respiratory infections during infancy may well be predecessors of obstructive airways disease in later life.
Can We Rediscover the Bedside?
Authors: GEME JOSEPH W. ST
Published: December 2021

Osler1 beckoned us to the bedside to learn clinical medicine. He knew that fundamental human biology could be found there too.2

We know now that the clinic will become the ultimate bedside for the care of children. The clinic will also become the essential site for the teaching of the art and science of this care. The education of family physicians and internists and the care of adults is moving swiftly in the same direction.3 The control of prematurity, trauma, and poverty will erase the existing remnants of pediatric inpatient care and bedside teaching.

During the lingering years of hospital pediatrics, perhaps no more than the end of this century, let us encourage the full use of the traditional bedside for our educational programs.
Asbestos Exposure in Schools
Authors:   Committee on Environmental Hazards
Published: December 2021

Asbestos-induced cancer and asbestosis are diseases that are almost never seen in children. Practicing pediatricians should not expect to see any asbestos-related disease in their patients. There is a mounting concern, however, that exposure to asbestos in childhood, particularly in school settings, can put children at increased risk later in life for diseases caused by asbestos. Pediatricians are frequently asked to advise school authorities and parents on the dangers posed by asbestos. In this statement, current information on asbestos exposure in schools is reviewed and basic remedial approaches to prevent significant exposure to children are described.

BACKGROUND

Asbestos was used as a spray-on material in the construction of school ceilings, primarily during the 1950s through early 1970s, because of its acoustical, fire-proofing, and decorative qualities. Such dried materials can, over time, become friable; this process is dramatically speeded up by any external factors that disrupt the structural integrity of the ceiling material. Friable asbestos often flakes off as a fine dust that settles on surfaces but is readily resuspended in classroom air.

Asbestos was also used in insulating materials for pipes, boilers, and structural beams in schools. Less commonly, this use of asbestos may be a problem for children when deteriorating conditions lead to disruption and spread of asbestos fibers. In 1973, the US Environmental Protection Agency (EPA) banned most uses of spray-on asbestos materials. Concern for potential long-term effects in children surfaced dramatically in 1976 when flaking of asbestos ceiling materials was noted in six schools in one state. The initial public health strategy, which continues unchanged, was that (1) medical screening and follow-up of children so exposed should not be recommended because of the transient and uncertain degree of exposure, the probable rarity of significant asbestos-related disease, and the extremely long latent periods (probably 30 or more years) for any effects that might occur, and (2) public health efforts should focus on the prevention of exposure to assure that any long-term risks are minimized or completely removed.
ON TELLING DIFFICULT TRUTHS
Authors: Student
Published: December 2021

To deprive the patient of honest communication because we cannot know everything is not only confused thinking but immoral....This argument also raises another human failing—to confuse the difficult with the unimportant. Passing information to people who have more restricted background, whether through lack of experience or of understanding, can be extremely difficult and time-consuming, but this is no reason why it should be shunned. Quite the reverse. Like the difficult passages in a piece of music, these tasks should be practiced, studied and techniques developed so that communication is efficient and effective.
Health Supervision Visits: Should the Immunization Schedule Drive the System?
Authors: HAGGERTY ROBERT J.
Published: December 2021

The Centers for Disease Control (CDC) recently recommended that the vaccines usually given at the 15- and 18-month visits could be given simultaneously at 15 months, thereby omitting the 18-month well-child visit.

There is little doubt that measles-mumps-rubella (MMR) immunization, now recommended by the American Academy of Pediatrics to be given at 15 months of age, and the diphtheria-tetanus-pertussis (DTP) and oral polio booster immunizations, now recommended to be given at 18 months of age, could be given together with no problem at 15 months. But this is not a good enough reason to abandon the 18-month well-child visit. Although I will not argue that we have solid evidence for the effectiveness of any well-child procedures other than immunizations, I believe that the 18-month visit is one of the more important ones and should not be discontinued for all children.
MEDICINE'S DILEMMA
Authors: Student
Published: December 2021

Since medicine, unlike religion, aspires to be a science, it is torn by conflict between the need for criticism and the fear of it.
FEROCIOUS FERRETS
Authors: Marcuse Edgar K.
Published: December 2021

Some 33 infants and young children have been reported in California as having been attacked by pet European ferrets (descendants of the European polecat, Mustela putorius, not to be confused with the endangered black-footed ferret, Mustela nigripes, of the Great Plains). The animals seem attracted to babies, perhaps due to odors resembling those of suckling rabbits. Typically, attacks are made when parents are absent or asleep; the ferret escapes its cage and jumps into the baby's crib. One infant died; others nearly bled to death. One lost her nose, another half of both ears. Up to hundreds of bites were rapidly inflicted on all parts of the face, the result resembling ground beef according to some observers, although all exposed parts of the body are attacked as well. Older children and adults were bitten on the face and extremities, the animal often holding on tenaciously until killed or pried loose.

Bites may be unreported to avoid loss of illegal ferrets. Sometimes ferrets are confused with weasels due to inability to differentiate them. Ferrets are more massive. Weasels and European ferrets differ in length (inches from nose tip to tail tip), weight and color as follows: Weasels—7½ to 22 in, 1½ to 11 oz, brown above, white or yellow below. May turn white in winter. End of tail black throughout year. Ferret—17½ to 22 in, 1 to 6 lb, yellow-buff undercoat overlaid with blackish guard hairs. Blackish mask, limbs and tail (entire length). May be albino.