bluuebunny/crossref_metadata_2025 huggingface dataset:
Persistently Low Blood Retinol Levels During and After Parenteral Feeding of Very Low Birth Weight Infants: Examination of Losses Into Intravenous Administration Sets and a Method of Prevention by Addition to a Lipid Emulsion
Authors: Greene Harry L. , Phillips Barry L. , Franck Linda , Fillmore Capri Mara , Said Hamid M. , Murrell Joel E. , Moore Mary E. Courtney , Briggs Robert
Published: December 2021

Very low birth weight infants have little storage of hepatic retinol and are, therefore, highly dependent upon an exogenous supply. The recent association between low serum retinol level and bronchopulmonary dysplasia and the persistently low serum levels of retinol during total parenteral nutrition prompted a prospective study to evaluate serial changes in serum retinol levels during 1 month of total parenteral nutrition (retinol dose 455 µg/d) and again during 1 month of total enteral feeding (retinol dose 200 to 300 µg/d) in the same infants. Infants were divided into two groups. Group 1 consisted of infants weighing less than 1,000 g (n = 24) and group 2 consisted of infants weighing 1,000 to 1,500 g (n = 17). Although initial mean levels of retinol were similar in both groups (14.8 ± 0.9 and 13.5 ± 0.7 µg/dL), there was wide variation between infants. In group 1 infants, there was a significant (P < .01) decline in retinol level by the second week of life (to 9.2 ± 1 µg/dL), which persisted during total parenteral nutrition, but increased to 13.4 ± 2 after 1 week of enthral feeding. This level was maintained throughout enteral feeding. In group 2 infants, there was no significant change in serum retinol level throughout the study. During total parenteral nutrition, several infants had retinol levels below 10 µg/dL, a level associated with signs of retinol deficiency in older children. Because losses of retinol are known to occur in smaller volume total parenteral nutrition solutions, it was speculated that losses of retinol in our patients were due to retinol losses in the total parenteral nutrition delivery system. Because lipid might prevent these losses, in vitro studies were done to compare retinol losses in total parenteral nutrition v the usual daily dose of Intralipid. Results indicated 80% loss of retinol in total parenteral nutrition compared to only 10% loss in Intralipid. Lipid stability, as monitored by light microscopy and laser light scatter, indicated no changes in the stability of the lipid particles with the addition of the vitamin.
Wheezing in Infants: The Response to Epinephrine
Authors: Lowell Darcy I. , Lister George , Von Koss Heidi , McCarthy Paul
Published: December 2021

There is significant controversy about the role of bronchodilator therapy for wheezing in infants. A double-blind, randomized trial of subcutaneous epinephrine v normal saline was conducted in children <24 months of age evaluated at Yale-New Haven Hospital. Respiratory assessments using a newly developed Respiratory Distress Assessment Instrument were made at baseline and 15 minutes after each of two injections. Relief of respiratory distress was assessed using strict a priori criteria based on changes in respiratory rate, wheezing, and retractions as scored in the Respiratory Distress Assessment Instrument. Significantly more children improved their respiratory status with epinephrine (nine of 16) than placebo (one of 14) (Fisher exact test, P = .0067). Paired data in individuals receiving placebo and then epinephrine confirmed this (Wilcoxon signed ranks test, P < .01). Sixty-three percent of patients <12 months and 92% of those 12 to 24 months improved with epinephrine, as did seven of ten children with respiratory syncytial virus bronchiolitis. In many children, response to the initial epinephrine injection was not indicative of final response. Results of this study demonstrate the effectiveness of epinephrine in the treatment of acute wheezing in children <24 months of age.
Kasabach-Merritt Syndrome: Therapeutic Considerations
Authors: Larsen Eric C. , Zinkham William H. , Eggleston Joseph C. , Zitelli Basil J.
Published: December 2021

During the past 15 years we have managed six children with capillary hemangiomas in association with consumptive coagulopathy—the Kasabach-Merritt syndrome. Their ages when first seen ranged from 2 weeks to 4 years with a mean of 19 months. In three of the patients, the hemangiomas remained small for many months and then suddenly enlarged and hemorrhagic diatheses appeared. The duration of the thrombocytopenia ranged from 5 to 20 months, a time span that in some of the patients was influenced by the type of treatment used. Each patient received a variety of therapies including the following: medications to control the coagulopathy; mechanical, cytolytic, and pharmacologic treatment to eradicate the lesion; and blood product support with platelets and cryoprecipitate for severe bleeding. A prompt elevation of the platelet count occurred in three of the patients after the lesion was biopsied. Subtotal resection of the lesion resulted in an immediate increase of the platelet count in one patient. A transient increase in platelet counts and fibrinogen levels was observed in another patient following several embolizations of a portion of the hemangioma. Other modes of therapy were difficult to evaluate, especially because the same therapy applied at different times in the same patient effected a different type of response. Eventually, all of the patients experienced resolution of their lesions and, with this, concomitant reversal of the coagulopathy.
Testicular Histology in the Adolescent With a Varicocele
Authors: Kass Evan J. , Chandra Roma S. , Belman A. Barry
Published: December 2021

A varicocele is a common cause of adult male infertility, and surgical ligation is a generally accepted mode of therapy. However, the guidelines for management of the adolescent with a varicocele are not clearly defined. Herein, we describe histologic abnormalities noted on testis biopsy in nine of 24 boys with moderate to large varicoceles. Surgical ligation of the varicocele is recommended when there is volume loss of the testis ipsilateral to the varicocele. All others should be reexamined periodically, and an attempt should be made to obtain a baseline semen analysis.
JUVENILE PERNICIOUS ANEMIA
Authors: REISNER EDWARD H. , WOLFF JAMES A. , MCKAY R. JAMES , DOYLE EUGENIA F.
Published: December 2021

Histories have been presented of two pairs of sibling children with recurrent macrocytic anemia with megaloblastic bone marrow responding specifically to liver extract and vitamin B12.

The clinical features and laboratory findings were similar to those of adult pernicious anemia in every respect except for the inconstant presence of histamine refractory achlorhydria. All the patients responded to vitamin B12 given parenterally, but in three to whom it was given by mouth no response was obtained. Two of these subsequently responded to oral B12 when it was accompanied by normal gastric juice. The other two developed histamine refractory achlorhydria while in hematologic remission. This is interpreted as proof that the anemia was due to deficient intrinsic factor in the gastric juice.

Three patients showed evidence of disease of the spinal cord, in two of whom the symptoms were severe. These symptoms were compatible with a diagnosis of dorsolateral sclerosis, and improved with antipernicious anemia therapy. In one of these patients, treated with folic acid, the neurologic lesions were aggravated severely.

Pernicious anemia due to the absence of gastric juice intrinsic factor occurs in children. The presence of free hydrochloric acid in the gastric contents does not preclude the possibility of the disease.
Bronchopulmonary Dysplasia and Care Techniques
Authors: PHILIP ALISTAIR G. S. , KESSLER DALE L.
Published: December 2021

To the Editor.—

Although the paper by Avery et al1 is both interesting and provocative, readers should be cautioned about the inherent limitations of data generated by a retrospective, multicentered study design.

First, the definition of chronic lung disease leaves much to be desired. The diagnosis was "arbitrarily defined" as an oxygen requirement greater than room air at 28 days of age. Evaluation of the need for oxygen at 3 months is a much more clinically relevant end point, but the numbers in this category were too small to evaluate adequately.
Minor Head Trauma in Children: An Intervention to Decrease Functional Morbidity
Authors: Casey Rosemary , Ludwig Stephen , McCormick Marie C.
Published: December 2021

Minor head trauma is common among children and evokes strong parental reaction. Parents often rush the child to an emergency department or consult their pediatrician by telephone despite the minor nature of the injury. In a previous report we showed that children with minor head trauma appear to have limitations in their usual daily activities and a high rate of school absenteeism. This study was a prospective, randomized trial of an intervention designed to reduce this functional morbidity after head trauma. Parents in the control group (n = 168) received routine discharge instructions. Parents in the intervention group (n = 153) received a discharge interview during which the nurse gave more explicit and behaviorally oriented instructions. The nurse also called intervention parents the next day to reassure them and to urge that the children return to their usual routine. One month after the injury a questionnaire was administered by telephone to assess physical health status, social or functional limitations, and behavior problems. The majority of parents (85%) were anxious, and this was not alleviated by previous experience with head trauma. Triage nurses incorrectly rated one third of the parents as not anxious. Physical health status, role activity indices, and behavior problems, were similar for the intervention and control groups 1 month after the head injury. Subsequent morbidity was highly correlated with parental anxiety. In managing children with minor head trauma, pediatricians and emergency department physicians must focus their discharge instructions on the parent's anxiety, emphasize the minor severity of the injury, and urge that the children return to their usual routine.
Campylobacter pyloridis-Associated Primary Gastritis in Children
Authors: Drumm B. , O'Brien A , Cutz E. , Sherman P.
Published: December 2021

Campylobacter pyloridis are spiral-shaped Gram-negative bacteria that have recently been associated with gastritis and peptic ulcer diseases in adults. The organisms have been identified in biopsy specimens of the gastric antrum by staining sections with silver stain. To determine the frequency of colonization of the antral mucosa with C pyloridis in association with gastritis in childhood, we retrospectively reviewed 53 cases in patients (mean age 11.9 years) in whom upper endoscopy with antral biopsy was performed for the evaluation of symptoms referable to the upper gastrointestinal tract. A silver impregnation method was used to detect the presence of C pyloridis. Nineteen of 53 antral biopsy specimens showed evidence of mucosal inflammation. Ten of these 19 patients had no apparent predisposing etiology for gastritis, and six of these ten had C pyloridis identified on antral biopsies. Nine of the 19 patients had secondary causes of gastric inflammation (two gastroduodenal Crohn disease, two eosinophilic gastroenteritis, four drug related, and one dys-γ-globulinema and lymphonodular hyperplasia). In contrast, none of these nine patients had C pyloridis demonstrated on antral biopsies. Silver stain for C pyloridis was negative in all 34 of the 53 children who had normal antral histologic findings. C pyloridis was not demonstrated by silver stain on any of the duodenal sections, although eight of the 19 children with gastritis and nine of the 34 children with normal antral histologic findings had histologic evidence of duodenal inflammation. We conclude that C pyloridis is associated with primary antral gastritis but not with secondary gastritis in the pediatric population.
Cardiovascular Changes in Preterm Infants Nursed Under Radiant Warmers
Authors: Walther Frans J. , Wu Paul Y.K. , Siassi Bijan
Published: December 2021

Radiant heat is known to increase insensible water loss and, to a certain extent, oxygen consumption. Little is known about its cardiovascular effects. We measured cardiac output, stroke volume, heart rate, and lower limb and skin blood flow in 20 preterm newborn infants nursed in an incubator and under a radiant warmer at an abdominal skin temperature of 36.5°C. Mean (±SEM) birth weight was 1.57 (0.06) kg, gestational age 31.7 (0.4) weeks, and weight at examination 1.69 (0.02) kg; median postnatal age was 15 days. Skin and limb blood flow measurements increased by 44% to 55% with radiant heat (P < .001 and P < .01, respectively). Cardiac output increased by 5.4% (P < .02) under the radiant warmer secondary to a small but significant (P < .05) increase in heart rate. The changes in cardiac output during radiant heat administration are comparable to those reported for oxygen consumption.
Red Blood Cell Distribution Width in Pediatric Microcytic Anemias
Authors: Novak Robert W.
Published: December 2021

The RBC distribution width has been reported to be of value in the discrimination of iron deficiency anemia from other microcytic anemias, but studies in pediatric populations are lacking. A population of 734 normal children was studied to establish age-appropriate normal values for RBC distribution width. The RBC distribution width of 47 patients with microcytic anemia was then evaluated. RBC distribution width was elevated in 19 of 22 patients with iron deficiency but was also increased in six of 14 patients with thalassemia trait and two of 11 patients with anemia secondary to inflammatory disease. The resulting discrimination was better than that obtained by using Mentzer's index or the discriminant function in the patients studied. The RBC distribution width, albeit a less then perfect tool, can be of value in evaluating pediatric patients with microcytic anemia.
Brain Death Determination in the Newborn
Authors: VOLPE JOSEPH J.
Published: December 2021

This commentary is addressed to the determination of brain death in the newborn and young infant and in particular is meant to elaborate the rationale for two aspects of the guidelines established by the Task Force on Brain Death in Children.1 The two aspects are (1) the application of the guidelines to term infants seven days of age or older and (2) the recommendation of an observation period of at least 48 hours in infants between seven days and 2 months of age.

The two essential requirements for the diagnosis of brain death are, first, the establishment of cessation of all brain functions, ie, cerebral and brainstem functions, and second, the demonstration that cessation of these functions is irreversible.
Psychosocial Screening
Authors: FRANKENBURG WILLIAM K.
Published: December 2021

To the Editor.—

The study by Borowitz and Glascoe (Pediatrics 1986;78:1075-1078) reported on the sensitivity of the Denver Developmental Screening Test (DDST). Although more studies validating psychosocial screening tests are needed to determine the efficacy of such tests, the study by Borowitz and Glascoe was misleading for two major reasons.

First, the authors did not interpret the DDST in the prescribed manner. They stated, "Standard administration and scoring of the DDST were used, resulting in a pass, fail, or questionable score for each of the four sectors of the test.
Circumcision
Authors: WISWELL THOMAS E.
Published: December 2021

In Reply.—

Thompson and Thompson conjecture that our previous findings of an increased risk for urinary tract infections may be explained by incomplete and/or biased end point determination over time.1,2 We disagree with their speculations.

First, the Thompsons refer to the apparent decline in the percentage of "hospitalized urinary tract infections" in circumcised boys (from 0.16% to 0.07%) as an indication of incomplete or differential end point determination over time. They are incorrect in this assumption.
Genetics in Pediatrics
Authors: HECHT FREDERICK
Published: December 2021

To the Editor.—

In the past I have been critical of the dearth of genetic communications in pediatric journals such as Pediatrics. The genetic articles, instead, have been published largely in genetic specialty journals to which most pediatricians do not subscribe.

When the late Stanley Wright was alive (he was a pediatrician and pioneering medical geneticist at UCLA), he urged me and other fledgling pediatric geneticists to report our results and their meaning in the pediatric journals.
Drug Errors
Authors: KOREN GIDEON
Published: December 2021

In Reply.—

In Canada, pediatric Lanoxin is available, as stated in our article, in a concentration of 0.05 mg/mL (Compendium of Pharmaceuticals and Specialties, ed 21. Ottawa, Canadian Pharmaceutical Association, 1986). This is another source of errors; physicians today moving from country to country should always check the stock solutions of drugs available and not assume that they are the same as at home.
Childhood Fever: Correlation of Diagnosis With Temperature Response to Acetaminophen
Authors: Baker M. Douglas , Fosarelli Patricia D. , Carpenter Richard O.
Published: December 2021

Many people believe that temperature response to antipyretics in febrile children varies according to diagnosis. To evaluate the validity of this premise, we prospectively studied the temperature response to acetaminophen of febrile children who came to an urban pediatric emergency and walk-in facility. The study group consisted of 1,559 patients between the ages of 8 weeks and 6 years whose temperatures when seen were greater than 38.4°C and who had not received antipyretic treatment within the previous four hours. Acetaminophen (15 mg/kg) was administered to each child and repeat temperatures were taken one and two hours later. Patient management was unaffected by the study, and physicians were unaware of the repeat temperature measurements. Telephone follow-up was conducted with the parents of each child within five days of the initial visit. Children with cultures positive for bacterial disease or chest x-ray films positive for pneumonia had slightly greater one- and two-hour temperature decreases compared with children with other diagnoses. Although statistically significant, we do not consider these differences in response to be clinically useful. We conclude that fever response to acetaminophen is not a clinically useful indicator by which to differentiate the causes of febrile illnesses in young children.
Infectious Diseases: Preventable Causes of Infant Mortality
Authors: Jason Janine M. , Jarvis William R.
Published: December 2021

After almost a century of improvement, the rate of decrease in US infant mortality rates began to level off during the period of 1982 to 1984. Rates actually increased in some states. Because much of the decline in infant mortality in this century can be attributed to advances in infectious disease treatment and prevention programs, we evaluated the current impact of infectious diseases on infant mortality. The National Center for Health Statistics mortality data for 1980 contains information on as many as 20 causes of death for a given individual. Using these data, we found that infectious diseases contributed to 12.5% of all infant deaths and to almost 400,000 years of potential life lost because of infant deaths. Infectious diseases contributed to 9% of deaths of low birth weight infants and to more than 18% of all deaths in the postneonatal period. Compared with white infants, a higher proportion of nonwhite infants died of causes related to infectious diseases. For black infants, the mortality rate related to infectious diseases was twice that for white infants. These data indicate that infectious diseases still are a major contributor to infant mortality, one of the 15 areas targeted for prevention by the federal government, and the data suggest that programs for reducing infant mortality should place increased emphasis on preventing infectious diseases.
Multiple Dose Activated Charcoal for Theophylline Poisoning in Young Infants
Authors: Shannon Michael , Amitai Yona , Lovejoy Frederick H.
Published: December 2021

Five cases are presented in which multiple doses of activated charcoal were given to infants 6 months of age or less, as treatment of theophylline overdose. This therapy was tolerated in all cases with apparent enhancement of theophylline elimination. Use of multiple dose activated charcoal appears to be a viable option in the treatment of young infants with theophylline poisoning.
Acute Rheumatic Fever in Western Pennsylvania and the Tristate Area
Authors: Wald Ellen R. , Dashefsky Barry , Feidt Cindy , Chiponis Darleen , Byers Carol
Published: December 2021

Acute rheumatic fever is reported to have declined and perhaps be vanishing. Prompted by the occurrence of 17 cases of acute rheumatic fever in an 18-month period in 1985 and 1986, we reviewed the records of 243 children with acute rheumatic fever who were cared for at Children's Hospital of Pittsburgh or Mercy Hospital between 1965 and 1986. Acute rheumatic fever was diagnosed using the modified Jones criteria and cases were classified by major criteria as arthritis, arthritis and carditis, carditis alone, carditis and chorea, chorea alone, and arthritis and chorea. Among the 17 recent patients, 59% had carditis, 30% had chorea, and 24% had arthritis alone. The proportion of children who had particular major manifestations was similar in the last two decades and in 1985 to 1986. The recent children with acute rheumatic fever ranged in age from 6 to 13 years with a mean and median age of 10 years. There were 16 white children and one Asian child. Only four children lived in an urban setting. When demographic features of the children were contrasted with those in the previous two decades, a decrease in the proportion of children who lived in urban areas and who were black was noted. Four children had a history of preceding sore throat but only three sought medical care; nine children had no memorable illness and four had either a nonrespiratory illness or a respiratory infection without sore throat. This resurgence of rheumatic fever serves as a reminder that a diligent approach to the diagnosis and therapy of streptococcal infections remains essential.
Idiopathic Cerebral Arterial Infarction With Paucity of Symptoms in the Full-Term Neonate
Authors: Roodhooft Anne Marie , Parizel Paul M. , Van Acker Karel J. , Deprettere André J. R. , Van Reempts Patrick J.
Published: December 2021

Two full-term neonates, one with convulsions and intermittent generalized hypotonia and one with poor sucking, temperature instability, and lethargy, are reported. CT scan findings suggested cerebral arterial infarction. Arteriography revealed occlusion of the middle cerebral artery, unilaterally in the first and bilaterally in the second patient. The evolution of the infarct could be followed on serial CT scans. No predisposing factors during pregnancy or delivery were found, and serious neurologic deficits developed in both children. These cases demonstrate that, even in full-term neonates with discrete or moderate neurologic symptoms and born after normal pregnancy and delivery, the possibility of vasoocclusive brain infarction should be considered. The diagnosis is suggested by imaging techniques, of which CT scanning seems to have the greatest value at present. This technique also permits the follow-up of the lesions. The prognosis for neurologic development appears to be variable: minor neurologic deficits as well as unexplained spastic hemiplegia in older children may be the consequence of inapparent cerebral arterial infarction in the neonatal period.
Phototherapy in the Management of Neonatal Hyperbilirubinemia: Efficacy With Light Sources Emitting More Than 500 Nanometers
Authors: Sbrana Giuseppe , Donzelli Gian Paolo , Vecchi Corrado
Published: December 2021

The clinical action of green fluorescent lamps, properly filtered to remove wavelengths of less than 500 nm, was investigated in a group of 23 newborns with different initial serum bilirubin concentrations. The serum bilirubin levels were measured at 6, 12, 24, and 48 hours after the beginning of phototherapy. These results are compared with those obtained, under the same experimental conditions, in a group exposed to commercial green lamps. Similar bilirubin decline rates were observed in the two experiments. In general, these data confirm the satisfactory clinical efficacy of the green light in phototherapy and prove, in particular, that the blue component present in the emission spectrum of the commercial green lamps has a negligible effect on the bilirubin degradation process.
Hymens in Newborn Female Infants
Authors: JENNY CAROLE , KUHNS MARY L. D. , ARAKAWA FUKIKO
Published: December 2021

Few physicians are comfortable testifying in courts of law. Fewer still are comfortable when the subject at hand involves sexual abuse and when there is often a paucity of physical or laboratory findings. Yet, with increasing public awareness, the number of cases of child sexual abuse involving the criminal justice system is dramatically increasing, with a concomitant need for expert witness testimony.

When sexual abuse is alledged, a physician may be asked to assess a child's genitalia and anus for signs of past sexual activity. In girls, this entails looking for changes in the hymen, such as tears or scarring, estimating the diameter of the introitus, and looking for dilation of the hymenal ring.1
Preventive Pediatrics: The Promise and the Peril
Authors: Eisenberg Leon
Published: December 2021

I was deeply honored to have been invited by the Canadian Paediatric Society to serve as its 18th Queen Elizabeth II Lecturer. Even as I relished the honor, I found it daunting, given the distinction of my predecessors. Having considered at length how best to respond, I chose to address prevention, a field with which pediatrics has been concerned since its inception as a specialty. Although the commitment of pediatrics to disease prevention has been unswerving, the diseases that have been the target of its efforts have necessarily changed as the distribution of disease in the population has changed and as scientific advances have created new opportunities for intervention.

What pediatricians were once almost alone among medical specialists in emphasizing has now become the target of government policy in Canada,1 the United States,2 and the United Kingdom.3 This, however, is not quite the triumph it may seem. Physicians who advocate prevention do so in the hope of avoiding unnecessary suffering and premature death for their patients. Politicians who do so may not be unmindful of these goals, but their primary motivation is controlling the costs of medical care. The US Forward Plan for Health2 was unabashed about it: "the primary focus of our program is a major attack on cost escalation." The differences in motivation between physicians and politicians have important consequences for health policy, consequences that imperil the promise of prevention.

Let me, then, begin with a few words of history, move on to the promise of preventive pediatrics in the years to come, and conclude by discussing the hazards associated with the use of prevention as a political rather than a medical slogan.
Overcoming Obstacles to Breast-Feeding in a Large Municipal Hospital: Applications of Lessons Learned
Authors: Winikoff Beverly , Myers Deborah , Laukaran Virginia Hight , Stone Richard
Published: December 2021

A project to overcome institutional constraints to breast-feeding was implemented in a large municipal hospital. Interventions included staff education, intensive training of a team of physicians and nurses, development of user-tested educational materials, and day and evening staffing by a breast-feeding counselor. A nearby hospital served as a control. Project evaluation entailed chart reviews at the intervention site and a control hospital (n = 812); interviews with mothers during their postpartum hospital stay and at return clinic visits (n = 180); and field observations in all areas of the hospital that provided prenatal, intrapartum, postpartum, and pediatric care. Comparisons of the incidence and pattern of breast-feeding were made before, midway through, and after the project. At the intervention site, the incidence of breast-feeding increased from 15% to 56%, and exclusive breast-feeding for more than 3/4 of feedings increased from 0% to 15%. At the control site, the respective changes were from 28% to 41% and from 5% to 7%. Formula use by breast-feeding women decreased but was nonetheless extensive, and the usual reason given by breast-feeding women for supplementation was a perceived insufficiency of breast milk. This may be due, in part, to the fact that bedside assistance to breast-feeding mothers was not integrated into the routine care provided by staff nurses but was relegated to the lactation nurse/counselors who were not available at all times. It is concluded that the process to overcome institutional constraints to breast-feeding is difficult but feasible. Repeated and extensive professional education helps create the context whereby clinical and administrative staff can reassess routines and policies.
Gastroduodenal Motility in Neonates: Response to Human Milk Compared With Cow's Milk Formula
Authors: Tomomasa T. , Hyman P. E. , Itoh K. , Hsu J. Y. , Koizumi T. , Itoh Z. , Kuroume T.
Published: December 2021

It is known that breast milk empties more quickly from the stomach than does infant formula. We studied the difference in gastroduodenal motility between neonates fed with human milk and those fed with infant formula. Twenty-four five-to 36-day-old neonates were fed with mother's breast milk or with a cow's milk-based formula. Postprandlial gastroduodenal contractions were recorded manometrically for three hours. Repetitive, high-amplitude nonmigrating contractions were the dominant wave form during the postprandial period. The number of episodes, duration, amplitude, and frequency of nonmigrating contractions were not different following the different feedings. The migrating myoelectric complex, which signals a return to the interdigestive (fasting) state, appeared in 75% of breast milk-fed infants but only 17% of formula-fed infants (P < .05) within the three-hour recording period. Because contractions were similar following the two meals, but a fasting state recurred more rapidly in breast-fed infants, we conclude that factors other than phasic, nonpropagated antroduodenal contractions were responsible for the differences in gastric emptying between breast milk and formula.
Child Abuse: The Conflict of Underdetection and Overreporting
Authors: SILVERMAN FREDERIC N.
Published: December 2021

In 1946, Caffey1 reported the association of multiple bone fractures and subdural hematomas in children and set the stage for the identification of what subsequently became known as the battered child syndrome. For the next 15 years, radiologists involved in the care of children added support to his observations and demonstrated that the lesions he described had a specificity that indicated physical trauma when a history of injury was lacking or even denied. These reports met with little response until Kempe and associates2 indicated, in a symposium at a meeting of the American Academy of Pediatrics in October 1961, the serious nature of the observations in relation to pediatric morbidity and mortality.
Exercise for Children Who Are Mentally Retarded
Authors:   Committee on Sports Medicine,   Committee on Children With Disabilities
Published: December 2021

Pediatricians should encourage participation in exercise and athletic programs for mentally retarded children. The right program can be a therapeutic tool resulting in better weight management, development of physical coordination, maintenance of cardiopulmonary fitness, and improved self-esteem.
Future Training of Pediatricians: Summary Report of a Series of Conferences Sponsored by the American Board of Pediatrics
Authors: Cleveland William W. , Brownlee Robert C.
Published: December 2021

Recently, the American Board of Pediatrics sponsored three conferences for consideration of specific issues relative to the training and practice of pediatricians. Two of these, to be described briefly, served as background for the third, which will be reported in detail.

The first meeting was held in San Antonio, TX, in January 1984, for the principal purpose of discussing the training and practice of subspecialists in pediatrics. The discussion was precipitated by a petition from the Sub-Board of Pediatric Hematology-Oncology to extend the period of training in hematology-oncology from 2 to 3 years. Dr David Nathan spoke on the certification of subspecialists. He questioned the concept, in general, and the specification of an exact period of time for training, in particular. He suggested that the length of training might be variable for the individual and occur at some time during the faculty appointment. Dr Charles Abildgaard presented the justification for extending training on behalf of the Sub-Board. The thrust of the argument was that the discipline has become so complex that 3 years are required to acquire clinical proficiency; the research component was also emphasized. His presentation precipitated general discussion of some questions related to practice: Should subspecialists function in community hospitals or only in academic medical centers? Should the Board certify only clinical competence or should there be certification of competence to do research? What will be the impact of the large number of graduating students and of the increasing number of women studying medicine and entering pediatrics?

At this meeting Dr Robert Brownlee proposed some changes in the pattern of certification.
Sexual Behavior in the Home
Authors: SMITH ROBERT SCOTT
Published: December 2021

To the Editor.—In an effort to discriminate "how typical families rear their children" from "abnormal sexual behavior in the home," Dr Rosenfeld et al got a large sample of parents to anonymously report their bathing practices.1 They found that " . . . parents give little coherent explanation of why they . . . stop bathing with the child of the opposite sex or stop siblings of different sexes from bathing together after they reach a certain age."
Blood Pressure
Authors: PARK MYUNG K.
Published: December 2021

To the Editor.—

Recently the National Heart, Lung, and Blood Institute Task Force on Blood Pressure Control in Children published revised normal BP standards and guidelines for children.1 I welcome this effort, as reliable normative data have been unavailable but are prerequisite for the early detection of hypertension and its proper treatment. The guidelines published by the Task Force for the detection of hypertension, the diagnostic evaluation, follow-up laboratory testing, and treatment are, in my opinion, excellent.
Meconium Suctioning
Authors: BECK ROBERT
Published: December 2021

To the Editor.—

With reference to Dr Eisner's comment (Pediatrics 1986;78:713) that it is technically difficult to intubate a neonate's trachea with a large suction catheter, I would reply that our neonatology group has enjoyed good success in suctioning meconium from below the cords in more than 1,600 meconium deliveries during the past 2 years using wall suction and a 10-F semistiff suction catheter with a side suction control valve (Superior suction catheter, Cumberland, RI).
Varicella in Children With Cancer: Impact of Antiviral Therapy and Prophylaxis
Authors: Feldman Sandor , Loft Lennie
Published: December 2021

To estimate the impact of antiviral therapy and prophylaxis on the natural course of the infection, 288 cases of varicella in children with cancer were reviewed. Among 127 patients with untreated infections, the overall mortality rate was 7%. Varicella-zoster virus pneumonitis developed in 28% of the untreated patients and was associated with a 25% mortality rate. Pneumonitis was much more likely to develop in patients with acute leukemia than in those with other malignancies (32% v 19%). Similarly, deaths due to pneumonitis were restricted to patients with acute leukemia. Lymphopenia (absolute lymphocyte count <500/µL) was significantly associated with varicella-zoster virus pneumonitis and a higher fatality rate among patients with this complication. Both acyclovir and adenine arabinoside, administered to 18 and 28 patients, respectively, stopped the progression of skin lesions; however, pneumonitis developed in none of the acyclovir recipients after two days of treatment, compared with 29% of the adenine arabinoside recipients (P = .03). Passive immunization in 45 children who subsequently had varicella was associated with an 11% incidence of varicella-zoster virus pneumonitis. Despite passive immunization of approximately 150 children, the attack rate of varicella at our institution remains unchanged. Results of this study demonstrate the efficacy of antiviral therapy and passive immunization in patients with childhood cancer and varicella, but prevention of the infection will require a universal vaccine.
Developmental Outcome Prediction From Acoustic Cry Analysis in Term and Preterm Infants
Authors: Lester Barry M.
Published: December 2021

It has been suggested that the cry may reflect the neurophysiologic integrity of the infant and relate to later developmental outcome. In this study, the cry was recorded at term conceptional age in 18 preterm and 13 term infants using a standardized procedure and analyzed by high-speed computer. At 18 months of age, a significant number of infants were correctly classified as scoring high or low on the Bayley Scales of Infant Development based on the mean and variability in the fundamental frequency, variability in the first formant, and the amplitude of the cry. At 5 years of age, a significant number of infants were correctly classified on the McCarthy General Cognitive Index and on the verbal, perceptual-performance, and quantitative subscales based on the variability of the fundamental frequency, variability of the first formant, and amplitude and duration of the cry. Although preliminary, this study supports the potential use of the cry as a noninvasive measure to detect developmental outcome in the infant at risk.
Orthotopic Liver Transplantation in Patients With Cystic Fibrosis
Authors: Cox Kenneth L. , Ward Richard E. , Furgiuele Terry L. , Cannon Robert A. , Sanders Kathleen D. , Kurland Geoffrey
Published: December 2021

An 11-year-old boy who had cystic fibrosis underwent an orthotopic liver transplantation. His immediate postoperative course was not unusually complicated when compared with other liver transplant recipients. Transplantation did not correct abnormalities in the sweat test or the respiratory disease. Cholestasis due to obstruction of the recipient duct with tenacious bile was cleared by instilling N-acetylcysteine into the duct. On the 48th day after the transplantation, he died of an intraventricular and intracerebral hemorrhage caused by an Aspergillus brain abscess. We conclude that certain patients with cystic fibrosis may be appropriate candidates for liver transplantation, but their pre- and postoperative management may need to differ from other liver transplant recipients.
Poor Prediction of Positive Computed Tomographic Scans by Clinical Criteria in Symptomatic Pediatric Head Trauma
Authors: Rivara Fred , Tanaguchi Darik , Parish Ruth Ann , Stimac Gary K. , Mueller Beth
Published: December 2021

A retrospective study of 98 children who received CT scanning for head trauma was conducted to determine whether clinical signs would accurately identify patients needing CT scans. The clinical findings of Glasgow Coma Scale score of 12 or less, altered consciousness on admission, and focal abnormalities on neurologic examination were each significantly associated with abnormal findings on CT scans (P < .01). However, 31% of the 51 patients with Glasgow Coma Scale scores greater than 12 had abnormal CT scan findings. No clinical findings, alone or in combination, accurately identified all patients with abnormal findings on CT scans.
Children as Witnesses in Child Sexual Abuse Trials
Authors: Landwirth Julius
Published: December 2021

When alleged child sexual abusers are prosecuted and brought to trial, child witnesses are often exposed to procedural requirements of the criminal justice system that may cause further psychologic trauma. These procedures are driven by the dual interests of pursuing the truth and protecting the constitutional rights of the accused to a fair trial with a presumption of innocence. Proposals for judicial reforms designed to balance both interests while shielding children from potential adverse effects of the process are discussed.
Moderately Elevated Blood Lead Levels: Effects on Neuropsychologic Functioning in Children
Authors: Faust David , Brown James
Published: December 2021

Investigations of moderately elevated lead levels and children's cognitive functioning have yielded conflicting results, although studies showing no effects used measures of limited sensitivity and breadth. In this study, a comprehensive neuropsychologic battery was used to determine whether deficits would be revealed. An experimental group of 15 children with a past history of moderately elevated lead levels, but subsequently without increased lead levels for at least a year, were compared with a control group matched by residential area, socioeconomic status, parental IQ, age, and gender. The experimental groups' performance was lower on the battery overall and on measures of motor skill, memory, language, advanced spatial functions, and concentration. The results suggest that exposure to moderately elevated lead levels exerts significant and nontransient effects on cognitive functions.
Vitamin E Levels in Premature Infants During and After Intravenous Multivitamin Supplementation
Authors: Phillips Barry , Franck Linda S. , Greene Harry L.
Published: December 2021

Serum vitamin E levels were measured in 19 infants weighing 1.0 to 1.5 kg, in 16 infants weighing less than 1 kg who received 65% of a vial (4.6 mg of vitamin E) of multivitamins (MVI Pediatric) daily, and in another group of 16 infants weighing less than 1 kg who received 30% of a vial (2.1 mg of vitamin E) daily. Supplementation was started within 12 hours of birth. Serum vitamin E levels were also measured after supplementation was discontinued in infants who had received 65% of a vial daily. Vitamin E sufficiency (levels equal to or greater than 0.5 mg/dL) was attained after 48 hours of supplementation in all infants receiving 65% of a vial daily and after 72 hours of supplementation in all infants receiving 30% of a vial daily. Vitamin E sufficiency was not maintained in all infants receiving 30% of a vial daily. Of the infants weighing less than 1 kg who received 65% of a vial daily, 31% had serum levels greater than 3.5 mg/dL, whereas no infant weighing less than 1 kg who received 30% of a vial daily had a level greater than 3.5 mg/dL (P < .05). Of the infants weighing less than 1 kg who received 30% of a vial daily, 56% had levels less than 1 mg/dL v 6% of infants less than 1 kg who received 65% of a vial daily (P < .01). Vitamin E levels decreased after MVI Pediatric supplementation with 65% of a vial was discontinued (P < .05). After MVI Pediatric was discontinued, some infants became vitamin E insufficient.
Theophylline Treatment in the Extubation of Infants Weighing Less Than 1,250 Grams: A Controlled Trial
Authors: Durand David J. , Goodman Ami , Ray Patricio , Ballard Roberta A. , Clyman Ronald I.
Published: December 2021

The role of theophylline in weaning infants weighing less than 1,250 g at birth from mechanical ventilation was evaluated. Infants were randomized into control or theophylline treatment groups when they required minimal ventilatory support (peak inspiratory pressure 12 cm H2O, positive end-expiratory pressure 2 cm H2O, rate 12 breaths per minute, and FiO2 < 0.3), and they were extubated 24 hours later. Infants required reintubation if they had (1) Paco2 > 55 mm Hg and pH < 7.20, (2) FiO2 > 0.5, or (3) apnea associated with a heart rate less than 100 beats per minute that required frequent stimulation (more than 20 episodes during a 16-hour period). Among 32 infants (birth weight <1,000 g) who reached minimal ventilatory support before seven days after delivery, 13 of 18 (72%) control infants required reintubation, whereas only four of 14 (28%) theophylline-treated infants required reintubation. On the other hand, among infants (birth weight <1,000 g) who reached minimal ventilatory support after seven days following delivery, only one of six (17%) of the control group required reintubation and no improvement could be seen with theophylline treatment. Similarly, among control infants (birth weight 1,001 to 1,250 g), only ten of 45 (23%) required reintubation after reaching low intermittent manditory ventilation settings. In summary, most infants recovering from respiratory distress syndrome who had birth weights (1) >1,000 g or (2) <1,000 g and who were older than seven days could be successfully extubated from minimal ventilatory support without theophylline treatment. In contrast, most infants with birth weights <1,000 g who reached minimal ventilatory support within seven days after delivery required reintubation; treatment with theophylline significantly improved the ability of this group to remain extubated.
Low-Level Fetal Lead Exposure Effect on Neurobehavioral Development in Early Infancy
Authors: Dietrich Kim N. , Krafft Kathleen M. , Bornschein Robert L. , Hammond Paul B. , Berger Omer , Succop Paul A. , Bier Mariana
Published: December 2021

A prospective method was used in this study to assess the effects of fetal lead exposure on neurodevelopmental status in 3- and 6-month old infants. At their first prenatal medical appointments, 305 lower socioeconomic status women residing in predesignated leadhazardous areas of Cincinnati were recruited. Lead was measured in whole blood in both the mother an fetalplacental unit (prenatal and cord) and the neonate (ten days and 3 months). All blood lead levels were less than 30 µg/dL. Infant development was assessed with the Bayley scales at 3 and 6 months of age. Multiple regression analyses which treated perinatal health factors such as birth weight and gestation as confounders indicated an independent, inverse relationship between both prenatal and neonatal blood lead levels and performance on the Bayley Mental Developmental Index at both ages. Male infants and infants from the poorest families appeared to be especially sensitive to these psychoteratogenic influences. Further study using a structural equations approach indicated that neurobehavioral deficits were partly mediated by lead-related reductions in birth weight and gestation.
Tocopherol Efficacy and Retinopathy of Prematurity
Authors: PHELPS DALE L.
Published: December 2021

In Reply.—

Drs Schick, Beck, and DeSilva raise an interesting question and one that was not examined in our study because umbilical artery catheter placement in both our centers was usually high. The actual denominators in the Schick group seem to be six incidences of retinopathy of prematurity per 24 (25%) high catheters and none per 18 low catheters for a total of 14%; whereas in our study, 31/160 infants weighing more than 1 kg had retinopathy of prematurity (19%).1
Larger Numbers Needed
Authors: WISWELL THOMAS E.
Published: December 2021

In Reply.—

Dr Altschul presents data on urinary tract infections during infancy and reports infection rates substantially lower than those we have previously reported.1,2 He then makes several conclusions based on these differences. His data indicate that the maximum infection rates would be 0.11% among girls and 0.02% and 0.12% among circumcised and uncircumcised boys, respectively. In contrast, from a population of 422,328 infants, we found the overall incidence of symptomatic urinary tract infection during the first year of life to be 0.57% in girls, 0.11% in circumcised boys, and 1.12% in uncircumcised boys.