bluuebunny/crossref_metadata_2025 huggingface dataset:
Plasma Atrial Natriuretic Peptide in Patients With Congenital Heart Diseases
Authors: Matsuoka Suguru , Kurahashi Yoshihide , Miki Yohko , Miyao Masuhide , Yamazaki Yasuhiro , Nishiuchi Takeshi , Saito Shiro
Published: December 2021

The plasma level of human α-atrial natriuretic peptide was measured in healthy children and patients, 1 month to 15 years of age, with congenital heart diseases. Significant increases were found in patients with a ventricular septal defect, tricuspid valve atresia, patent ductus arteriosus, and atrial septal defect but not in those with pulmonary valve stenosis or tetralogy of Fallot.

The levels were significantly higher in children with ventricular septal defects (221 ± 123 pg/mL) or patent ductus arteriosus (124 ± 38 pg/mL) than in those with atrial septal defects (65 ± 42 pg/mL) (P < .01). The increased levels appeared to be correlated with enlargement of the left atrium (r = .85, P < .01) but not with the right atrial size or the mean right atrial pressure. They were higher in younger than in older healthy infants, but this age difference did not affect the results. These findings indicate that human α-atrial natriuretic peptide is released into the circulation in response to chronic atrial expansion in patients with congenital heart disease and may have an important role in volume homeostasis.
Amino Acids in Premature Infants
Authors: RÄIHÄ NIELS C. R.
Published: December 2021

To the Editor.—

In a recent paper in Pediatrics, Heird et al1 reported their evaluation of the use of a new amino acid mixture for parenteral nutrition in low birth weight infants. On the basis of their results the authors made the following statement: "These observations refute the concept that the metabolic capacity of LBW infants for amino acids is limited in comparison to that of term infants, older infants, and chi1dren."1(p49) Such a conclusion is not justified on the basis of the presented data.
Amino Acids in Premature Infants
Authors: HEIRD WILLIAM C.
Published: December 2021

In Reply.—

Dr Raiha is correct. Our data1 do not necessarily "refute" the concept of the LBW infant's metabolic immaturity. However, they raise the issue of the clinical significance of the well-documented developmental delays in hepatic activities of several enzymes involved in metabolism of amino acids. Specifically, these data suggest that enzymatic immaturities are of limited clinical significance with respect to the LBW infant's tolerance of parenterally administered amino acids. No differences in plasma amino acid pattern were observed between LBW infants weighing less than 1,250 g at birth and those weighing more than 1,250 g, between the LBW infant population1 and the population of term infants and older children studied earlier,2 or between LBW infants who received a typical peripheral vein regimen and those who received a typical central vein regimen.
Shallow Versus Deep Endotracheal Suctioning in Young Rabbits: Pathologic Effects on the Tracheobronchial Wall
Authors: Bailey Carey , Kattwinkel John , Teja Kuldeep , Buckley Thomas
Published: December 2021

The traditional technique for endotracheal suctioning of intubated neonates consists of inserting a catheter until resistance is met, withdrawing slightly, and applying suction. The extent of tissue damage caused by the traditional (deep) technique v that caused by an alternative shallow technique was studied with an animal model. Six 3-week-old rabbits were anesthetized, intubated, and suctioned every i5 minutes for six hours by neonatal intensive care unit nurses who were unaware of the study purpose. Three rabbits were suctioned by means of the deep technique, whereas the other three received shallow suctioning achieved by inserting the catheter no further than a premeasured distance. Light microscopy showed significantly increased necrosis and inflammation following deep suctioning. Electron microscopy revealed greater loss of cilia and increased mucus with the deep technique. To confirm our initial assumption that the deep technique is still used extensively by neonatal intensive care units throughout the country, a mail survey was conducted. Of the 405 (43%) neonatal intensive care unit physicians who responded, 82% reported frequent or exclusive use of the deep technique for routine suctioning. In this study, the fact that deep suctioning results in significantly more tracheobronchial pathology than does a shallow, premeasured technique is shown. It is recommended that nurseries change their current practice and adopt the shallow technique for routine suctioning of intubated neonates.
Dietl Syndrome: Intermittent Ureteropelvic Junction Obstruction as a Cause of Episodic Abdominal Pain
Authors: FLOTTE TERENCE R.
Published: December 2021

Intermittent ureteropelvic junction obstruction, often associated with an aberrant vessel to the lower pole of the kidney, may cause a distinct clinical syndrome of episodic crampy upper abdominal pain, nausea, and vomiting known as a Dietl crisis. Although Josef Dietl1 first described this clinical entity in 1864, and numerous reports appear in the English language urologic and radiologic literature dating back to 1909,2 there has been only one recent report in the pediatric literature.3 In the latter report, renal ultrasonography was recommended as a screen for intermittent ureteropelvic junction obstruction in children with recurrent abdominal pain. We recently saw two patients in whom the diagnosis of intermittent ureteropelvic junction obstruction was not made by ultrasound.
Snowmobile Statement
Authors:   Committee on Accident and Poison Prevention
Published: December 2021

Small, speedy, lightweight snowmobiles are popular and readily available to children and adolescents in the snowbelt states. There are no uniform requirements for either vehicle registration or driver licensure. Therefore, the number and condition of snowmobiles, and the extent of their use, are unknown. Nevertheless, in 1985 the Consumer Product Safety Commission recorded 62 deaths directly attributable to snowmobiles. In addition, the National Electronic Injury Surveillance System reported that 12,687 snowmobile injuries were treated in emergency rooms in 1985, and another 11,829 injuries were treated in 1986. Of these, 18% occurred in children younger than 14 years of age and 48% occurred in adolescents and young adults between the ages of 15 and 24 years. Three quarters of the accident victims were boys. Alcohol use was frequently mentioned as a contributing factor.

Head injuries are the leading cause of death; drowning is a close second. The risk of drowning is highest in early winter before lakes are firmly frozen and again during the spring thaw.1 Fractures of the lower extremity, frequently severe, are the most common nonfatal injury.2 Injury can also result from frostbite and hypothermia. Hearing loss can result from prolonged exposure to excessive engine noise.3

RECOMMENDATIONS

Snowmobiles are inappropriate for use by children and young adolescents and should not be used by children younger than 16 years of age. For these children, we recommend more developmentally appropriate winter recreational activities. Consistent with this recommendation, we believe that advertisements should not be directed at the young adolescent, nor should advertisements depict adolescents driving snowmobiles.
Fluctuations in Arterial Blood Pressure in Premature Infants
Authors: ETCHES PHILIP C. , FINER NEIL N.
Published: December 2021

To the Editor.—

Perlman and Thach1 presented interesting data from premature infants with respiratory distress syndrome associating fluctuations in esophageal pressure with fluctuations in arterial blood pressure. We would like to ask two questions. First, in the section reporting data analysis, it was stated that, to avoid bias in the selection process of epochs for measurement, corresponding respiratory pressure changes were ignored, but it is not stated how this was done. We agree that it would be essential to ignore the esophageal pressure tracing when selecting these epochs, but to do this the esophageal tracing should be completely obscured, and we would like to be reassured that this was, in fact, done.
Lyme Disease: Acute Focal Meningoencephalitis in a Child
Authors: FEDER HENRY M. , ZALNERAITIS EDWIN L. , REIK LOUIS
Published: December 2021

Nervous system involvement in Lyme disease was originally described as meningitis, cranial neuritis, and radiculoneuritis,1-3 but Lyme disease can also involve the brain parenchyma. We describe a child whose first manifestation of Lyme disease was an acute, focal meningoencephalitis with signs and symptoms such as fever, headache, slurred speech, hemiparesis, seizure, and CSF pleocytosis.

CASE REPORT

A 7-year-old boy was hospitalized Aug 27, 1985, because of hemiparesis. Six weeks prior to admission he had vacationed at Old Lyme, CT. There was no history of rash or tick bite. He had been well until eight hours prior to admission when fever and headache developed.
Health Needs of Homeless Children
Authors:   Committee on Community Health Services
Published: December 2021

Families with children represent more than one third of the homeless population nationally and more than 50% of the homeless population in many cities. Lack of a permanent dwelling deprives children of the most basic necessities for proper growth and development. Homeless children have unique risks that compromise their health status. Pediatricians are encouraged to be aware of this growing population of children and include them in their service and advocacy efforts.

BACKGROUND

A homeless person is defined by the National Governors Association as "an undomiciled person who is unable to secure permanent and stable housing without special assistance." The US General Accounting Office defines homeless individuals as those persons who lack resources and community ties necessary to provide for their own adequate shelter.

Estimates of the number of people who lacked access to conventional dwelling or residence in 1987 range from 350,000 to more than 3 million.1 Although there is disagreement concerning the exact number of homeless persons, there is consensus that the numbers are large and continuing to increase.2 The average increase from 1986 to 1987 in the number of people needing shelter was 20%, and one quarter of this need could not be met with existing emergency shelters. (US Conference of Mayors, unpublished data, December 1987).

Several societal problems contribute to the increasing rate of homelessness among American families, including lack of affordable housing; decrease in availability of rent subsidies; unemployment, especially among those who have held only marginal jobs; personal crises such as divorce and domestic violence; cutbacks in public welfare programs; substance abuse; and deinstitutionalization of the mentally ill.
Perinatal Human Immunodeficiency Virus Infection
Authors:   Task Force on Pediatric AIDS
Published: December 2021

Infection with human immunodeficiency virus (HIV), the causative agent of acquired immunodeficiency syndrome (AIDS) has become a significant medical problem during the 1980s. Hundreds of infants and thousands of women have been reported to have AIDS. In addition, there are thousands more women infected with HIV, at risk for AIDS, and capable of transmitting HIV to their fetuses/infants if they become pregnant.

DEFINITIONS

Perinatal, the time period including pregnancy through 28 postnatal days; congenital (intrauterine) infection, infection acquired transplacentally; intrapartum infection, infection acquired during the time of delivery; postnatal infection, infection acquired after pregnancy and delivery; HIV infection, asymptomatic or symptomatic infection with HIV; AIDS, meeting the Centers for Disease Control definition for AIDS.

EPIDEMIOLOGIC FEATURES OF AIDS AND HIV

The primary risk factor for AIDS in infants is congenital (and possibly intrapartum) exposure to a mother infected with HIV. Other risks have included transfusion of blood or clotting factor concentrates. However, since the institution of routine testing of blood donors, these risks have become extremely small. Because the majority of women with AIDS (78%) are of childbearing age, it is important that the physician inquire about risk factors in women of childbearing age to provide optimal care and prevention of HIV transmission. The primary risk factors for AIDS in the reported cases in women are IV drug abuse (49%), hetero-sexual transmission from a person known to be at risk of HIV infection (28%), and transfusion or clotting factor therapy before blood was screened in middle 1985 (11%).1,2 Although the sex distribution of pediatric AIDS cases is relatively even (54% boys, 46% girls), the racial distribution of pediatric AIDS is uneven: blacks 54%, Hispanics 24%, whites 21%, and others 1%.3
Caution on Statistics
Authors: MALLOY MICHAEL H. , REED GEORGE F.
Published: December 2021

To the Editor.—

We read with some concern the article by Maisels and Gifford.1 Although we agree with the results as they are calculated, we would like to express our concern about the logistic modeling used in the analysis. Most important, we would like to caution prospective users of logistic regression of the hazards of using the stepwise procedure. Although, the stepwise procedure will win you variables that demonstrate significant associations, it may exclude variables that are more important biologically to modeling the risk factors for the disease being studied.2
Caution on Statistics
Authors: MAISELS M. JEFFREY , ANTLE CHARLES
Published: December 2021

In Reply.—

We appreciate the comments of Drs Malloy and Reed, and we agree (with some embarrassment) that our use of the term "risk-ratio" is inappropriate; we should have used "odds" and this term should be substituted for risk ratio throughout the paper.1

We also agree that one should be cautious in the interpretation of observational data subjected to multivariate logistic analysis. We were certainly aware of the variables considered biologically important in the modeling of risk factors for neonatal jaundice.
Mucocutaneous and Invasive Candidiasis Among Very Low Birth Weight (< 1,500 Grams) Infants in Intensive Care Nurseries: A Prospective Study
Authors: Faix Roger G. , Kovarik Steven M. , Shaw Thomas R. , Johnson Robert V.
Published: December 2021

To determine whether mucocutaneous candidiasis presages the development of invasive candidiasis and to assess factors influencing the development of mucocutaneous candidiasis and invasive candidiasis among infants requiring neonatal intensive care, all infants admitted to our neonatal intensive care unit during a 47-month period were prospectively examined twice weekly for mucocutaneous candidiasis. Because 16 of 18 (89%) infants in whom invasive candidiasis (defined by positive cultures of blood, CSF, deep tissue or ≥2 suprapubic urine aspirates) developed had birth weights <1,500 g, further analysis was focused toward the very low birth weight group. Of 358 very low birth weight infants hospitalized for >three days and serially studied until discharge from the neonatal intensive care unit, mucocutaneous candidiasis developed in 28 (7.8%), invasive candidiasis developed in 16 (4.5%), and in 323 there was no evidence of mucocutaneous candidiasis or invasive candidiasis. Although many risk factors were shown by univariate analysis to be significantly more common among those with invasive candidiasis and mucocutaneous candidiasis, adjustment for the covariant effects of duration of hospitalization and gestational age revealed that only prolonged duration of antibiotic therapy and duration of endotracheal intubation were significantly associated with invasive candidiasis. Invasive candidiasis developed later in nine of 28 (32%) infants with mucocutaneous candidiasis despite nystatin therapy of mucocutaneous candidiasis in all nine (median duration of therapy before invasive candidiasis, nine days). Very low birth weight infants in whom mucocutaneous candidiasis develops are at significantly greater risk of invasive candidiasis developing later than those in whom mucocutaneous candidiasis did not develop (9/28 v 7/330, P < .001).
DISTURBING ASSERTIONS CONCERNING MALPRACTICE
Authors: Student
Published: December 2021

There's an astonishing dearth of information of actual incidents of [medical] malpractice, as opposed to the number that are brought to some stage of litigation. The best available data . . . [indicates] one episode of malpractice in every one hundred hospital admissions. Patricia M. Danzon, an economist ... has compared that finding with a tabulation of malpractice claims brought in the same period. She estimates that only 10% of the incidents of genuine negligence led to a claim.
Miseducation: Young Children at Risk
Authors: ELKIND DAVID
Published: December 2021

Imagine talking to a fetus in utero via a "pregaphone," showing infants flash cards of various esoteric insects and famous composers, teaching infants to swim to protect themselves from drowning, or giving preschoolers lessons in everything from reading to karate. Consider having young children witness the "birthing" of their siblings, describing to them the horrors of nuclear war, the "bad touching" of child abuse, and the symptoms of AIDS. These practices are not the excesses of a small number of overenthusiastic East Coast parents but have become commonplace across America today. A program for teaching youngsters about child abuse comes from Fargo, ND.
Report of Consensus Meeting, December 5 to 6, 1986
Authors:   TASK FORCE MEMBERS
Published: December 2021

Errors in measurement of tcPo2 that misrepresent arterial values are dangerous because they may lead to exposure of the premature to inappropriately high oxygen levels. This is particularly so because, in the field, tcPo2 values are frequently used as estimates of Pao2 values and not merely for oxygen trending. The tcPo2 electrode is such that underestimation of Pao2 is particularly likely at high Pao2 values (> 100 mm Hg) with minor errors in technique or minor variations in electrode design. Recent evidence suggests that small details in design may have rendered some of the current commercial tcPo2 electrodes inaccurate in the hyperoxic range, with consequent risk to premature infants for eye or lung damage. Good performance of a tcPo2 electrode requires certain benchmark standards that are described in this report. Users must thoroughly understand the underlying physiology and the required technique. Limitations of the technique are not widely understood and marketing, in some instances, appears to be misleading regarding the simplicity of the method. Each manufacturer needs to present performance data obtained on the skins of human neonates, throughout the range of Po2 values for which use is recommended, using the device that is being marketed and specifying crucial details such as operating temperature. Despite these limitations, the Task Force believes that this technique, when a quality electrode is used, and performed with care and understanding, is a valuable tool in newborn intensive care.
SI Units
Authors:   COMMITTEE ON DRUGS
Published: December 2021

Le Systeme International d'Unites or SI units is a system of measure that is an outgrowth of the metric system, widely used in countries other than the United States. This system comprises seven base units from which all other measurements are made (Table).

The aim of SI units is to (1) provide a coherent system of measure, (2) ensure that quantities and units are uniform in concept and style, and (3) minimize the number of multiples and submultiples in common use. A more complete review of metrification and SI units has been published in this journal.

The conversion to SI units was mandated in December 1984 by the American Medical Association House of Delegates to "provide physicians and other scientists in the United States with an improved common language for fluent scientific communication between nations as well as between sciences."

In several published articles there have been suggestions that the United States should, during the next year, begin uniformly reporting laboratory test data in SI units, including drug concentrations in molar units. Although drugs would continue to be prescribed in mass units, the desirability of prescribing and dispensing drugs in molar units has been suggested.

The focus of this commentary is to summarize the problems and inconsistencies of expressing drug concentrations in molar units, assuming that prescribing and dispensing would continue in mass units.

PHARMACOKINETIC CALCULATIONS

In a recent study tenfold dosing errors were demonstrated, resulting from mathematical miscalculations while using traditional units. The introduction of additional calculations for conversion to SI units, and the fact that SI units involve decimal places with several significant figures, will likely magnify this type of error.
Indications for Cholesterol Testing in Children
Authors:   COMMITTEE ON NUTRITION
Published: December 2021

The American Academy of Pediatrics' Committee on Nutrition believes that a child with a family history of either early coronary heart disease or hyperlipidemia should have a complete evaluation, including serum or plasma measurement of cholesterol, other lipids, and lipoproteins. On the other hand, the Committee on Nutrition does not favor universal testing of blood cholesterol levels of children either in the hospital or in the office of the private physician. At this time, the value of routine testing appears outweighed by the disadvantages; office testing has additional limitations.

We believe that universal cholesterol testing should not be part of continuing well-child care for the following reasons.

1. The standardization of equipment and the measurement of cholesterol are fraught with difficulties. Precision and accuracy are essential cornponents of any laboratory measurement. Survey data show that replicate measurements of a sample containing 240 mg/dL of cholesterol resulted in values ranging from 192 to 288 mg/dL. Because a low-fat diet could only be expected to decrease the cholesterol level 10% to 15% (204 to 216 mg/dL), an improvement could thus be obscured by the error of the measurement.

2. Many of the instruments suggested for the measurement of cholesterol in the office have not been adequately standardized for field conditions. Cholesterol measurements obtained from an assortment of instruments available commercially ranged from 187 to 379 mg/dL (the reference standard was 262 mg/dL). Hospital laboratories are often precise but not always accurate; office determinations frequently lack both precision and accuracy. Moreover, proper performance of this laboratory procedure requires technical skill not always available in the office.
In Reply: Discharge Pack Study
Authors: WIRTZ STEPHEN J. , FRANK DEBORAH A. , SORENSON JAMES R.
Published: December 2021

We welcome the opportunity to clarify the five issues raised by Mr Gelardi. First, Mr Gelardi implies that the 18-day difference in exclusive breast-feeding duration between women receiving the commercial compared with those receiving the research discharge pack, although statistically significant, is not clinically relevant. The study only followed up women for 122 days; this difference represents 15% of the follow-up period. Because the protective effects of breast-feeding against allergens and infective agents are greatest in the first few weeks of life, we would argue that a 15% extension of the duration of exclusive breast-feeding during that period is clinically beneficial.
Social Competence and Behavioral Adjustment of Children Who Are Long-Term Survivors of Cancer
Authors: Mulhern Raymond K. , Wasserman Abby L. , Friedman Alice G. , Fairclough Diane
Published: December 2021

Relatively little is known about the special needs of long-term survivors of childhood cancer or the factors that make this growing population vulnerable to chronic psychologic disorders. We therefore surveyed 183 children who had been treated for cancer at St Jude Children's Research Hospital and were free of the disease for ≥2 years after completing therapy. Parental responses to the Child Behavior Checklist, a standardized inventory of social competence and behavioral problems, were analyzed in relation to demographic and medical variables, as well as the children's appearance and functional status. School-related problems and somatic complaints of undetermined origin were increased fourfold relative to age- and gender-adjusted rates for peer groups in the general population. The presence of functional but not cosmetic impairments increased the risk of academic and adjustment problems. An older age at evaluation, treatment with cranial irradiation, and residence in a single-parent household were also associated with an increased risk of psychologic problems. General pediatricians must eventually assume responsibility for the extended follow-up care of children who have survived a malignancy. Their awareness of the high-risk groups described in this report should facilitate more timely identification of problems and referral of the children to appropriate services.
Infant-Feeding Practices and Their Relationship With Diarrheal and Other Diseases in Huascar (Lima), Peru
Authors: Brown Kenneth H. , Black Robert E. , de Romaña Guillermo Lopez , de Kanashiro Hilary Creed
Published: December 2021

Longitudinal studies of the feeding practices and morbidity from infectious diseases of 153 Peruvian newborns from an underprivileged, periurban community were completed during their first year of life. Feeding practices were assessed by monthly questionnaires, and illnesses were identified by thrice-weekly, community-based surveillance. All infants were initially breast-fed, but only 12% were exclusively breast-fed at 1 month of age. At 12 months of age, 86% of children still received some breast milk. Incidence and prevalence rates of diarrhea in infants younger than 6 months of age were less among those who were exclusively breast-fed compared with those who received other liquids or artificial milks in addition to breast milk. The diarrheal prevalence rates doubled with the addition of these other fluids (15.2% v 7.1% of days ill, P < .001). Infants for whom breast-feeding was discontinued during the first 6 months had 27.6% diarrheal prevalence. During the second 6 months of life, discontinuation of breast-feeding was also associated with an increased risk of diarrheal incidence and prevalence. Upper and lower respiratory tract infections occurred with lesser prevalence among exclusively breast-fed younger infants. The prevalences of skin infections by category of feeding practice were not as consistent, but exclusively breast-fed infants tended to have fewer skin infections during the initial months of life and older infants who continued to breast-feed had fewer infections than those who did not. None of the results could be explained by differences in the socioeconomic status of the infants' families.
TABs
Authors: Student
Published: December 2021

There's a name that some disabled people have for those of us who can walk and talk and finger the pages of a magazine. They call us TABs—"temporarily able-bodied." It means that someday, perhaps not too long off, our bodies will begin to fail . . . the world we take for granted will be foreclosed.
Self-Regulation of Salivary Immunoglobulin A by Children
Authors: Olness Karen , Culbert Timothy , Uden Donald
Published: December 2021

In a prospective randomized controlled study, the possibility that children could regulate their own salivary immunoglobulins was investigated using cyberphysiologic techniques. Fifty-seven children were randomly assigned to one of three groups. Group A subjects learned self-hypnosis with permission to increase immune substances in saliva as they chose; group B subjects learned self-hypnosis with specific suggestions for control of saliva immunoglobulins; group C subjects were given no instructions but received equal attention time. At the first visit, saliva samples (baseline) were collected, and each child looked at a videotape concerning the immune system and was tested with the Stanford Children's Hypnotic Susceptibility Scale. At the second visit, an initial saliva sample was collected prior to 30 minutes of self-hypnosis practice or conversation. At the conclusion of the experiment, a third saliva sample was obtained. Salivary IgA and IgG levels for all groups were stable from the first to the second sampling. Children in group B demonstrated a significant increase in IgA (P < .01) during the experimental period. There were no significant changes in IgG. Stanford Children's Hypnotic Susceptibility Scale scores were stable across groups and did not relate to immunoglobulin changes.
Dietary Replacement in Preschool-Aged Hyperactive Boys
Authors: Kaplan Bonnie J. , McNicol Jane , Conte Richard A. , Moghadam H. K.
Published: December 2021

A 10-week study was conducted in which all food was provided for the families of 24 hyperactive preschool-aged boys whose parents reported the existence of sleep problems or physical signs and symptoms. A within-subject crossover design was used, and the study was divided into three periods: a baseline period of 3 weeks, a placebo-control period of 3 weeks, and an experimental diet period of 4 weeks. The experimental diet was broader than those studied previously in that it eliminated not only artificial colors and flavors but also chocolate, monosodium glutamate, preservatives, caffeine, and any substance that families reported might affect their specific child. The diet was also low in simple sugars, and it was dairy free if the family reported a history of possible problems with cow's milk. According to the parental report, more than half of the subjects exhibited a reliable improvement in behavior and negligible placebo effects. In addition, several nonbehavioral variables tended to improve while the children received the experimental diet, particularly halitosis, night awakenings, and latency to sleep onset.
AMERICAN SURRENDER TO THE CALL OF A TELEPHONE
Authors: Student
Published: December 2021

The telephone is now so imbedded in human behavior that it is hard to imagine what life was like without it . . . It is said that the man in charge [of a campaign during World War I to get Americans to answer the telephone promptly] later remarked "I can state that I am personally responsible for making the American people the only people in the world who will interrupt sex to answer the telephone."
FREQUENCY OF RICKETS IN INFANCY IN BOSTON IN 1898
Authors: C. T. E.
Published: December 2021

Classic cases of rickets are now rarely seen in the pediatric practice of Boston physicians. But 90 years ago, 8 out of 10 infants under 2 years of age, seen at the Boston Infants' Hospital, were found to have had rickets, as noted below.

Four hundred consecutive infants under two years of age, medical out-patients at the Infants' Hospital, were examined for evidences of rickets. Eighty percent showed more or less marked signs. A rosary was present in every case. Only those enlargements were considered as a rosary which could be felt both parallel and vertical to the long axis of the rib. It was the only symptom in 40 percent. It was accompanied by but one other symptom in 20 percent. The single associated symptom was most often delayed dentition, next, enlargement of the cranial eminences. Delayed dentition occurred in more than 50 percent. Large fontanelle, large eminences, retraction at the diaphragm, and the enlargement of the epiphyses of the extremities were each present in about 15 per cent but were symptoms of later development. Marked rhachitic deformities were rare. About 40 percent of the cases were Russian and Polish Jews. Only 12 per cent came from the southern races. Breast milk was a part of the diet in 43 per cent and formed the whole in 18 per cent. The only influence acting on all alike was improper hygienic surroundings. These therefore must be considered as the most potent cause of rickets in Boston and vicinity.
REFLUX AND APPARENT LIFE-THREATENING EVENTS: LARGE-SCALE STUDIES NEEDED
Authors: Student
Published: December 2021

Clearly, more studies are required into silent (gastro-oesophageal) reflux in infants after (apparent life-threatening events) ALTE. If a high incidence is confirmed, the next step would be to establish the best medical therapy for reflux. Subsequently, a trial would be needed to show whether antireflux therapy reduced the rate of subsequent adverse events compared with conservative management. Such a study would require hundreds of infants to show a conclusive fall in the rate of recurrence of ALTE, thousands to document a reduction in subsequent mortality, and an intermediate number if both outcomes were combined.
NO FOSTER CARE AVAILABLE
Authors: Student
Published: December 2021

They are nomad children, hundreds of New York City children who are moved each night from one foster care home to another. These children, ranging from infancy to adolescence, spend most of their days in field offices of the city's Special Services for Children. At night they are shuttled from borough to borough, carrying what few possessions they have in plastic bags. These children have been lost in the maze of the city's foster care system.
Cocaine Exposure Among Children Seen at a Pediatric Hospital
Authors: Shannon Michael , Lacouture Peter G. , Roa Jaime , Woolf Alan
Published: December 2021

The results of 1,680 consecutive urine and serum toxicologic screens from 1,120 patients, performed in a children's hospital during a 19-month period were surveyed. Among this sample, 52 (4.6%) patients had specimens that contained cocaine and/or metabolite. Fifteen specimens contained ethanol, a benzodiazepine, or a narcotic in addition to cocaine. Four patients were neonates, whereas three were infants from 1 to 7 months of age. The remaining 45 patients were adolescents with a mean age of 19 years. Among the adolescents, 11 had a significant chronic illness. In 19 patients (37%), cocaine exposure was unsuspected until the results of testing for toxic substances were known. The reasons for hospital evaluation included depression/attempted suicide in 19 patients, seizure in five, chest pain in 5, motor vehicle accident in three, syncope in three, abdominal pain in two, pneumomediastinum in two, accidental self-immolation in one, and apnea in one. Twenty patients required medical hospitalization for a total of 268 patient-days. One patient, a neonate, died. There is a striking prevalence of cocaine exposure in the pediatric age group. Among adolescents, this exposure may occur despite the presence of chronic illness. Although the age distribution appears bimodal, infants and young children may also have unsuspected exposure to this toxin. Greater awareness of cocaine exposure in childhood will be needed by primary and tertiary care pediatricians to identify affected children and provide appropriate intervention.
Circle of Willis Blood Velocity and Flow Direction After Common Carotid Artery Ligation for Neonatal Extracorporeal Membrane Oxygenation
Authors: Raju Tonse N. K. , Kim Shin Y. , Meller Janet L. , Srinivasan Gopal , Ghai Vivek , Reyes Hernan
Published: December 2021

The velocity and direction of blood flow in the circle of Willis arteries were measured in three infants who underwent right common carotid artery ligation for extracorporeal membrane oxygenation treatment. Within 15 minutes of common carotid artery ligation, blood flow was detected in one infant's right middle cerebral artery; however, the velocity was reduced to 50% of the preextracorporeal membrane oxygenation level. The velocity remained 50% to 70% lower than normal during the 88 hours of extracorporeal membrane oxygenation therapy. In the other two infants, the velocity changes were less severe. By 2 to 10 weeks after weaning from extracorporeal membrane oxygenation, the velocities in the left cerebral arteries were increased to 116% to 217% of the corresponding right cerebral vessels. Following common carotid artery ligation, a retrograde direction of flow was noted in the first (A1) segment of the right anterior cerebral artery and in the right posterior communicating artery, whereas the direction of flow was normal in the corresponding vessels on the left. After common carotid artery ligation, the vertebrobasilar and the contralateral internal carotid systems appear to be the main sources of reperfusion of the right cerebral hemisphere via the circle of Willis. Furthermore, because of the known variants of the circle anatomy, a noninvasive pulsed Doppler method could be used to evaluate the flow patterns in the circle of Willis arteries, both before and after common carotid artery ligation for extracorporeal membrane oxygenation.
Group A Streptococcus-Associated Upper Respiratory Tract Infections in a Day-Care Center
Authors: Smith Thomas D. , Wilkinson Virginia , Kaplan Edward L.
Published: December 2021

Little information is available about the epidemiology of group A streptococcal upper respiratory tract infections in child day-care centers. During an initial 3-month period, symptomatic upper respiratory tract infections associated with throat cultures or rapid antigen detection tests positive for group A streptococci developed in 55 of 214 (26%) children and adult staff in one day-care center. When the entire day-care center population (except for those receiving antibiotics at the time) was then surveyed, 52 of 146 (36%) children and two of 24 (8%) adult staff had throat cultures positive for group A streptococci. Of the 54 group A streptococcal isolates found during the survey, the three most frequently encountered serotypes were M2, T2/28 (35%), M3,T3/13 (30%), and M-NT, T25 (20%). Rapid antigen detection was performed at the same time as the throat culture in the first 98 individuals examined during the culture survey but was positive in only 11 (35%) of 31 individuals with positive throat cultures. Sensitivity of the rapid antigen test was related to degree of positivity of the throat culture but not to age. The overall group A streptococcal positivity rate was 49% for 187 children and 33% for 27 adult staff; 18 of 66 (27%) children younger than 3½ years of age were found to have group A streptococci in their upper respiratory tracts. This is the first report of high prevalence rates of group A streptococci associated with upper respiratory tract infections in a day-care center. The group A Streptococcus may represent a significant upper respiratory tract pathogen in the day-care setting.
Taurine in Pediatric Nutrition: Review and Update
Authors: Gaull Gerald E.
Published: December 2021

Taurine was long considered an end product of the metabolism of the sulfur-containing amino acids, methionine and cyst(e)ine. Its only clearly recognized biochemical role had been as a substrate in the conjugation of bile acids. Taurine is found free in millimolar concentrations in animal tissues, particularly those that are excitable, rich in membranes, and generate oxidants. Various lines of evidence suggest one major nutritional role as protecting cell membranes by attenuating toxic substances and/or by acting as an osmoregulator. The totality of evidence suggests that taurine is nonessential in the rodent, it is an essential amino acid in the cat, and it is conditionally essential in man and monkey. Absence from the diet of a conditionally essential nutrient does not produce immediate deficiency disease but, in the long term, can cause problems. Taurine is now added to many infant formulas as a measure of prudence to provide improved nourishment with the same margin of safety for its newly identified physiologic functions as that found in human milk. Such supplementation can be justified by the finding of improved fat absorption in preterm infants and in children with cystic fibrosis, as well as by salutary effects on auditory brainstem-evoked responses in preterm infants. Experimental findings in animal models and in human cell models provide further justification for taurine supplementation of infant formulas.
SMALL VERSUS LARGE TRIALS
Authors: L. J. F.
Published: December 2021

Eight small RCTs (total patients, 527) of prophylactic phototherapy reported before the 1974 start of a cooperative trial (total 922 pts.) revealed a mean difference in serum bilirubin on the 4th day of 4.73 ± 0.35 mg/dl (1 SE). Cooperative trial diff. at day 4 was 4.0 ± .22 mg/dl (approximate S.E.). Seven small studies (444 pts.) of treatment published from 1971 to 1982 revealed mean difference of 2.16 ± .33 mg/dl. Cooperative study found differences at day 4 of 2.4 ± mg/dl in 276 mature infants and 3.8 ± 0.50 mg/dl in 141 infants weighing from 2000-2499 g. The risk difference for patients requiring exchange transfusions (DerSimonian and Laird method) was 0.08 ± 0.34 for the seven small studies and 0.06 ± 0.041 for the mature infants and 0.211 ± 0.56 for those weighing 2000-2499 g. Mean quality score of ten small phototherapy trials was 0.35 + 0.021 (1 SE) compared with 0.42 ± 0.022 for 376 previously scored miscellaneous trails. It is concluded that meta-analysis of many small studies of varying quality is very close to the results of a large cooperative trial.
BARZUN ON TESTING STUDENTS
Authors: Student
Published: December 2021

Multiple-choice questions test nothing but passive-recognition knowledge, not active usable knowledge.

Knowing something means the power to summon up facts and their significance in the right relations. Mechanical testing does not foster this power. It is one thing to pick out Valley Forge, not Dobbs Ferry or Little Rock, as the place where George Washington made his winter quarters; it is another, first, to think of Valley Forge and then to say why he chose it rather than Philadelphia, where it was warmer.

In subjects that require something other than information—the development of skill, as in reading, writing and mathematics—straining toward a plausible choice is not instructional. Nobody ever learned to write better by filling in blanks with proffered verbs and adjectives. To write is to fill a totally blank sheet with words of your own.

Instead of forcing—and coaching—young minds in form-filling exercises, telling them "choose and take a chance," schools would be well advised to return to Ralph Waldo Emerson's "Tell us what you know."
ANOTHER EXAMPLE OF OUTCOME-RELATED PUBLICATION BIAS
Authors: Student
Published: December 2021

A social worker . . . submitted a fictitious article to 140 journals in social work and related disciplines. The article pretended to analyze the value of a "social work intervention" in which an asthmatic child was temporarily separated from its parents in an effort to relieve symptoms . . . In half the articles, the findings supported the effectiveness of a social worker intervening, while in the other half the intervention was judged ineffective . . . Social work journals favored the positive version of the article, which supported the value of social work intervention, and often shunned the negative version . . . "The referees of these journals are not able to apply objectivity or the standards of science," [the researcher] said.
SUBGROUP ANALYSES ISSUE: ASTROLOGICAL BIRTH SIGN, FOR EXAMPLE
Authors: Student
Published: December 2021

[In a large trial], reliable indication of subgroups of patients among whom treatment is particularly advantageous (or among whom it is ineffective) is unlikely to be possible. When a trial is clearly positive overall many subgroup analyses are considered, false negative results in some particular subgroups must be expected. For example, a subdivision of the patients in [international streptokinase/aspirin trial] with respect to their astrological birth signs appears to indicate that for patients born under Gemini or Libra there was a slightly adverse effect of aspirin on mortality . . . while for all patients born under other signs there was a strikingly beneficial effect . . . It is, of course, clear that the best estimate of the real size of the treatment effect in each astrological subgroup is given not by the results in that subgroup alone but by the overall results in all subgroups combined.
SOME OF THE CHARGES IN THE E-FEROL INDICTMENT: COUNTS XX THROUGH XXV
Authors: Student
Published: December 2021

The Grand Jury further charges:

2A. Under Title 21, United States Code, Sections 352 (a) and 321 (n) in that the labeling for said drug [E-Ferol] was false and misleading in that said drug was recommended and suggested as appropriate for intravenous use in premature infants, when defendants knew of, and failed to reveal in the labeling, the following material facts:

(1) The drug had been reported to defendants to be associated with serious, life threatening injuries to premature infants, even when E-Ferol was used under the conditions of use prescribed, recommended, and suggested in the labeling of the drug product;

(2) No adequate investigation was conducted by the defendants to determine the validity of the associations of E-Ferol to said injuries that had been reported to them;

(3) No scientifically adequate or well controlled studies existed that established that E-Ferol could be safely and effectively used under the conditions of use prescribed, recommended, and suggested in the labeling of the drug product; and

(4) The safety and effectiveness of E-Ferol had not been established for use in premature infants.
Fragile X Syndrome: Recognition in Young Children
Authors: Simko Aaron , Hornstein Lusia , Soukup Shirley , Bagamery Nancy
Published: December 2021

In recent years, a number of articles have appeared in the literature concerning the fragile X syndrome; however, in few cases was the diagnosis of the syndrome in young children discussed. A review of 20 children younger than 7½ years of age who had the fragile x syndrome seen at the Cincinnati Center of Developmental Disorders was undertaken in an attempt to establish guidelines that would aid the practicing physician in determining which children should have a chromosomal analysis. All children were developmentally delayed; 95% had speech delays. Short attention span with hyperactivity, temper tantrums, mouthing of objects persisting at an age beyond when it would be expected, autistic behaviors, and poor gross motor coordination were seen in 50% or more of the children. Mental retardation was present in the family history of 65%, and 90% had a family history of at least one of the following mental retardation, learning disabilities, or hyperactivity. The most common physical findings were long and/or wide and/or protruding ears, prominent jaw and/or long face, high arched palate, and a flattened nasal bridge. The fragile x syndrome can be recognized by noting key aspects of the behavioral and family histories as well as the physical findings.
Unsuspected Infectious Diseases and Other Medical Diagnoses in the Evaluation of Internationally Adopted Children
Authors: Hostetter Margaret K. , Iverson Sandra , Dole Kathryn , Johnson Dana
Published: December 2021

Seven simple screening tests—hepatitis B profile, urine culture for cytomegalovirus, Mantoux test for tuberculosis, stool examination for ova and parasites, VDRL, complete blood cell count, and vision and hearing screening—were used to evaluate 52 consecutive children at a pediatric clinic for international adoptees. In 63% of these children, unsuspected medical diagnoses were made by a combination of history, physical examination, and appropriate screening tests. When only those children previously examined by a physician in the United States were included in our analysis, the rate of unsuspected diagnosis remained high (67%). Omission of screening tests was the single most frequent cause of missed diagnoses, of which the majority were infectious diseases. More than 50% of our newly established diagnoses carried the potential for long-term sequelae without proper treatment. These data emphasize that internationally adopted children should receive a thorough screening evaluation for medical problems that may adversely affect their growth and development.