bluuebunny/crossref_metadata_2025 huggingface dataset:
Urinary β2-Microglobulin in Full-Term Newborns: Evidence for Proximal Tubular Dysfunction in Infants With Meconium-Stained Amniotic Fluid
Authors: Cole J. W. , Portman R. J. , Lim Y. , Perlman J. M. , Robson A. M.
Published: December 2021

Urinary concentrations of β2-microglobulin (β2M) and creatinine were measured in normal term infants and in those born with meconium-stained amniotic fluid. None of the infants or their mothers had conditions known to modify β2M excretion. Measurements of β2M were made on urines collected by bagging; urines obtained from diapers were not satisfactory. Urinary β2M concentrations increased significantly (P < .02) in the normal infants from the first day (0.36 ± 0.29 mg/L: n = 29) to the third day (0.60 ± 0.43 mg/L: n = 21) postpartum. Compared with the normal infants, values for the infants with meconium-stained amniotic fluid were increased significantly on days 1 (1.64 ± 2.16 mg/L: n = 25: P < .005) and 3 (2.12 ± 2.04 mg/L: n = 23: P < .005). Levels exceeded two standard deviations above the normal mean in 12 of the 26 infants with meconium-stained amniotic fluid on postpartum day 1, and 12 of the 23 infants with meconium-stained amniotic fluid on day 3. Urinary creatinine levels were similar in both the normal infants and those with meconium-stained amniotic fluid. All infants with meconium-stained amniotic fluid with a one-minute Apgar score of 6 or less had an elevated urinary β2M concentration. The elevated levels of urinary β2M in infants with meconium-stained amniotic fluid indicate the existence of tubular dysfunction, probably mild acute tubular necrosis secondary to hypoxia.
Acute Lithium Poisoning in a Child With Dystonia
Authors: GOETTING MARK G.
Published: December 2021

Lithium is commonly used to treat bipolar depression in adults. Several recent studies demonstrate the efficacy of the drug for certain behavioral and affective disorders in children.1 There is also evidence that lithium may be therapeutic in a diverse group of clinical problems including premenstrual syndrome, neutropenia, cluster headaches, certain movement disorders, and syndrome of inappropriate antidiuretic hormone secretion.2-6 Thus, it appears that lithium use will increase, resulting in its greater availability for accidental poisoning. Currently, this is a rare event. A recent literature review disclosed no reports of single-dose intoxications either in childhood or manifesting as dystonia. The following is a description of a child who presented with dystonia associated with lithium ingestion.
The Business of Missing Children
Authors: BERGMAN ABRAHAM B.
Published: December 2021

No pediatric issue has so captured the attention of the American public during the past year as that of missing children. It is impossible to escape the haunting faces who peer out at us from television screens, milk cartons, breakfast cereal boxes, grocery sacks, bus posters, and business envelopes. Corporations vie with each other over sponsorship of public service campaigns to "publicize the plight of missing children," while television stations compete with a whole variety of specials.

Naturally, whenever emotional concerns of such magnitude are raised, politicians are sure to become involved with stern demands for "immediate action." In May 1985, no less than three separate congressional committees held hearings on missing children all in the same week.
Knowledge of Cystic Fibrosis in Patients and Their Parents
Authors: Nolan Terry , Desmond Katharine , Herlich Roberta , Hardy Susan
Published: December 2021

A standardized questionnaire was used to assess knowledge about cystic fibrosis in 28 patients with cystic fibrosis (aged 10 to 21 years) and in the parents of 25 of these patients. Knowledge of disease pathophysiology and treatment was generally comprehensive and detailed; knowledge of the genetics was fair. However, there were conspicuous deficits in the awareness of reproductive risks and of male sterility. Significant predictors of patient knowledge were patient age, sex, and educational level and parental age. Predictors of parent knowledge were Shwachman score, socioeconomic status, and sex of responding parent. Patients rely heavily on parents for information about cystic fibrosis. More than one third of both patients and parents sought more information about the disease and its implications.
Acute Medical Care of Severe Head Injury Is Not Enough
Authors: FREEMAN JOHN M.
Published: December 2021

As indicated by Jacobson et al in this issue (Pediatrics 1986;77:236) significant head trauma is a major and frequent occurrence in adolescents and in younger children as well. The major advances in emergency medical services—helicopter transport, trauma centers, and management of increased pressure—has had dramatic effects on the survival rate and, probably, on the quality of survival of children with closed head injury. However, discharge from the hospital of a child who is able to walk, although often considered the end point by the surgical team, is clearly not sufficient for the parent and child.

As Jacobson and his colleagues indicate, discharge is not the end but the start of many problems.
Identification of a High-Risk Group for Sudden Infant Death Syndrome Among Infants Who Were Resuscitated for Sleep Apnea
Authors: Oren Joseph , Kelly Dorothy , Shannon Daniel C.
Published: December 2021

Of the 1,153 infants who completed montoring by Aug 1, 1984, through our program at Massachusetts General Hospital, 76 infants had an initial apnea spell during sleep which was characterized by a change in tone and color, was unresponsive to repeated vigorous stimulation, and was terminated only after mouth to mouth resuscitation. The infants were hospitalized for observation and evaluation, and no cause could be identified. All were discharged on a home apnea or cardiorespiratory monitor, and subsequent episodes of apnea and/or bradycardia were reviewed. We grouped infants based on the intervention used to terminate subsequent episodes: Group 1, resuscitation; group 2, vigorous stimulation; and group 3, neither resuscitation or vigorous stimulation. There was no significant difference in clinical features or in the results of the initial evaluation in groups 1 and 2, compared with group 3. However, the mortality rate was significantly higher in group 1 (4/13) and group 2 (3/12) than in group 3 (3/51) (P < .007). Siblings of victims of sudden infant death syndrome (n = 8) were at a significantly higher risk of an adverse outcome (two deaths and four resuscitations) than nonsiblings (P < .02). A seizure disorder that developed during monitoring was associated with a high mortality (4/11 v 6/65, P < .02). We conclude that these relatively rare infants who have sleep-onset apnea that responded only to resuscitation and have a subsequent similar episode or are siblings of victims of sudden infant death syndrome or develop a seizure disorder during monitoring have a very high risk of dying (31%, 25%, and 36% respectively). Physical examination, past medical history other than siblings of sudden infant death syndrome status, and laboratory evaluation on presentation were not helpful in predicting outcome in these 76 infants.
Benzyl Alcohol Toxicity: Impact on Mortality and Intraventricular Hemorrhage Among Very Low Birth Weight Infants
Authors: Hiller Janet L. , Benda Gerda I. , Rahatzad Mohammadtaglii , Allen James R. , Culver David H. , Carlson Christina V. , Reynolds John W.
Published: December 2021

Benzyl alcohol preservative in intravascular flush solutions has been reported to cause neurologic deterioration and death in very low birth weight infants. Following the widespread discontinuation of the use of such solutions in newborns, scattered reports of decreased mortality and decreased incidence of intraventricular hemorrhage among small premature infants appeared in the pediatric literature. To better assess the true impact of benzyl alcohol toxicity in this group of infants, we undertook a detailed review of the medical records of all babies <1,250 g birth weight admitted to our neonatal intensive care unit for 13 months before and 13 months after the use of solutions containing benzyl alcohol was stopped. Significant decreases were found in both mortality rate (from 80.7% to 45.7%) and incidence of grade III/IV intraventricular hemorrhage (from 46% to 19%) among infants <1,000 g birth weight who did not receive the preservative compared with those who did. No significant changes were found in several other prenatal factors that could have contributed to this improvement in survival. We conclude that benzyl alcohol toxicity contributed significantly to both mortality and the occurrence of major intraventricular hemorrhage among infants weighing <1,000 g at birth and that solutions containing benzyl alcohol should never again be used in the care of such infants.
Benzyl Alcohol Toxicity: Impact on Neurologic Handicaps Among Surviving Very Low Birth Weight Infants
Authors: Benda Gerda I. , Hiller Janet L. , Reynolds John W.
Published: December 2021

Benzyl alcohol perservative in solutions used to flush intravascular catheters has been linked with increased mortality and incidence of intraventricular hemorrhage in small preterm infants. This study evaluated the outcome of surviving very low birth weight infants exposed to benzyl alcohol while in our neonatal intensive care unit. Surviving infants, less than 1,250 g birth weight, admitted during the 12 months prior to discontinuation of benzyl alcohol (period I), were compared with those infants admitted during the 12 months after discontinuation of benzyl alcohol (period II). Survivors were enrolled in a follow-up program. Results of the study demonstrated that infants from period II had fewer neurologic handicaps. The incidence of cerebral palsy decreased from 50% to 2.4% (P < .001), and the presence of cerebral palsy and developmental delay combined decreased from 53.9% to 11.9% (P < .001). Several factors other than benzyl alcohol exposure were examined for their importance on outcome but were found not to be related to it. It is concluded that the dramatic improvement in outcome could be the result of discontinuation of benzyl alcohol.
Evaluation of a Pediatric Multiple Vitamin Preparation for Total Parenteral Nutrition in Infants and Children I. Blood Levels of Water-Soluble Vitamins
Authors: Moore M. C. , Greene H. L. , Phillips B. , Franck L. , Shulman R. J. , Murrell J. E. , Ament M. E.
Published: December 2021

This study represents the first attempt to evaluate the response to the only intravenous vitamin preparation (MVI Pediatric) for infants and children receiving total parenteral nutrition. Eighteen preterm infants (group 1), 26 term infants and children receiving total parenteral nutrition for 2 to 4 weeks (group 2A), and eight infants and children receiving total parenteral nutrition for 3 to 6 months (group 2B) were studied. Term gestation infants and children up to 11 years of age received daily vitamin doses that approximated the 1974 Recommended Dietary Allowances and coincided with the 1975 American Medical Association Nutrition Advisory Group total parenteral nutrition dosage guidelines for children weighing more than 10 kg. Preterm infants received 65% of these dosages. RBC transketolase (vitamin B1), glutathione reductase (B2), and glutamic oxaloacetic transaminase (B6) activities were maintained at normal levels, and niacin levels were maintained within the reference range (7.1 ± 0.32 µg/mL) in all study patients. Pantothenate, biotin, and ascorbate were maintained at reference levels in groups 2A and 2B. In group 1, ascorbic acid was increased significantly during treatment from 1.53 ± 0.16 to 3.60 by seven days and to 2.54 ± 0.62 by day 28 of treatment (reference normals = 0.99 ± 0.1 mg/dL). RBC folate was maintained within the reference range of 411 ± 76 pg/mL; however, pantothenate and biotin levels increased significantly to more than 2 SD above reference values during treatment, and vitamin B12, levels, which were above the reference range initially, were maintained at more than 2 SD above the reference range throughout treatment. The elevation in vitamin B12 was seen in both group 1 and 2 patients. Overall, the recommended dosages appeared adequate to prevent deficiency; however, the elevated levels of several vitamins in premature infants indicated that further studies should be done to determine more appropriate dosage levels for this group of high-risk patients.
Predicting Outcome in Low Birth Weight Infants
Authors: FISCHER ALLEN F. , FRANKEL LORRY R. , STEVENSON DAVID K.
Published: December 2021

To the Editor.—

We read with interest the paper by Gaylord et al,1 in which a statistical method was developed for predicting mortality in low birth weight infants. Using a multivariate linear discriminant analysis to determine the variables most predictive of death, they were able to predict mortality in infants of less than 1,500 g birth weight who developed pulmonary interstitial emphysema using only birth weight and the highest peak expiratory pressure on day 1 of life.
On Partial Splenectomy in Gaucher's Disease
Authors: STELLIN G. P. , LILLY J. R. , GITHENS J. H.
Published: December 2021

To the Editor.—

In a recent issue of Pediatrics (1985;76:398-401), Bar-Maor and Govrin-Yehudain describe three children with Gaucher's disease who had a partial splenectomy for hypersplenism and mechanical problems. Neither hypersplenism nor massive splenomegaly recurred in clinical follow-up that was 4, 3, and ½ years, respectively. We warn that partial splenectomy in patients with Gaucher's disease may not always be so long-lasting. Hypersplenism and splenomegaly recurred in our patient within 9 months.

Our patient was a 4-year-old girl with the diagnosis of type III Gaucher's disease which was made at 2 years of age.
Abnormal Shoulder Girdle Muscle Tone in Premature Infants During Their First 18 Months of Life
Authors: Georgieff Michael K. , Bernbaum Judy C.
Published: December 2021

To document the incidence of and neonatal factors associated with abnormal shoulder girdle muscle tone in premature infants at follow-up, we studied 125 consecutively admitted infants weighing < 1,750 g treated in The Children's Hospital of Philadelphia intensive care nursery and subsequently seen in the Neonatal Follow-up Program up to 18 months of age. Fifty-seven infants (46%) displayed abnormal shoulder girdle muscle tone which presented clinically as scapular retractions. These infants had significantly lower birth weights (P < .001) and gestational age (P < .001) as well as a higher incidence of acute and chronic pulmonary disease (P < 0.01) and CNS insults (P < .05) when compared with infants without scapular retractions. The 57 infants with scapular retractions were further divided into two groups: 42 infants (74%) in whom scapular retractions were associated with generalized mild hypertonicity and 15 infants (26%) in whom scapular retractions compensated for trunk and neck hypotonicity. The infants with scapular retractions and hypotonicity had a significantly higher incidence of neonatal neurologic morbidity including seizures, major resuscitations, and birth asphyxia (P < .01) when compared with the infants with scapular retractions and hypertonicity. Shoulder girdle tone abnormalities in the first year of life inhibit crawling, sitting, and object manipulation and, therefore, may manifest as delays in motor development. Identification of infants with significant neonatal risk factors for tone abnormalities is important to allow for earlier therapeutic intervention.
Bicycle Helmet Use by Children
Authors: Weiss Barry D.
Published: December 2021

Children are the most frequent victims of bicycling accidents. Among fatal accidents, head injury is the most common cause of death. Because bicycling helmets may reduce the risk of serious head injury, this study was undertaken to determine the frequency with which children and adolescents in various age groups use bicycle helmets. Students were observed arriving at four elementary schools, three junior high schools, three senior high schools, and one university campus. The number of students riding bicycles and the percentage wearing helmets were noted. Of 108 elementary schools bicyclists, only two (1.85%) wore helmets. None of 103 junior high bicyclists and only two of 107 (1.86%) senior high bicyclists wore helmets. Ten percent (15/150) of university bicyclists wore helmets; this is a significantly higher rate than in the other age groups (χ2 = 10.27, P < .01). The failure of school-aged children to wear bicycling helmets represents a potentially serious health hazard. Pediatricians and family physicians have a unique opportunity to provide education to families and communities about the importance of using helmets.
Psychologic Adjustment of the Family With a Member Who Has Cystic Fibrosis
Authors: Cowen Leslie , Mok Jacqueline , Corey Mary , MacMillan Harriet , Simmons Robert , Levison Henry
Published: December 2021

Seventy-eight percent of the 384 patients 2 years of age and older who were enrolled in the Cystic Fibrosis Clinic at the Hospital for Sick Children participated in this study of family adjustment to cystic fibrosis. Residence with at least one parent at the time of the survey was a condition for inclusion in the study. The effect of the disease on the family was assessed using three questionnaires: an inventory of family problems as perceived by the parents and two standardized measures of family interaction. Measures of behavior and selfconcept in each patient and sibling, physical disease parameters for each patient, and demographic characteristics of the families were examined and analyzed in relation to the responses to the questionnaires on family interaction. Families of patients with cystic fibrosis were found to function very well, with normal mean scores on both standardized profiles. Children with cystic fibrosis showed more behavior problems than expected from the test norms, and healthy siblings of children with cystic fibrosis had behavior problem scores midway between those with the disease and norm scores. Measures of self-concept were remarkably similar for patients and siblings and showed levels at or above those for children and young adults in the general population. Parents psychosocial scores were influenced by the patients' physical parameters, but the severity of the disease generally was unrelated to psychosocial scores of patients and siblings. A notable exception was the correlation of emotional disturbance with amount of hospitalization in patients older than 12 years of age.
Involuntary Smoking—A Hazard to Children
Authors:   Committee on Environmental Hazards
Published: December 2021

Children who live in households with smokers are involuntarily exposed to sidestream and secondhand cigarette smoke. The health hazards that result from passive smoking will be reviewed. This statement updates a 1982 American Academy of Pediatrics statement on the environmental consequences of tobacco smoking.1

COMPOSITION OF SIDESTREAM AND SECONDHAND SMOKE

Sidestream smoke arises from the burning end of a cigarette.2,3 Secondhand or exhaled mainstream smoke is drawn into the respiratory tract of the smoker and then is exhaled. Both sidestream and secondhand smoke contain measurable quantities of such toxins as carbon monoxide (CO), ammonia, nicotine, and hydrogen cyanide. They also contain carcinogens, including benzo[a] pyrene, dimethylnitrosamine, tar, formaldehyde, and β-naphthylamine.2 Concentrations of most of these materials are higher in sidestream than in mainstream smoke.2 Air-sampling surveys have documented the involuntary exposure of nonsmokers to the products of cigarette combustion.2,3 These studies have shown that smoking in enclosed rooms can produce CO levels greater than the national ambient air quality standard of 9 ppm.4 Similarly, elevated concentrations of airborne nicotine, benzo[a] pyrene, and suspended particulates have been documented.4

Biologic evaluations of nonsmokers involuntarily exposed to cigarette smoke have demonstrated elevations of 1% to 3% in carboxyhemoglobin concentration.5 Biologic evaluations of involuntary smokers have also found increased levels of nicotine and of cotinine,6,7 the major metabolite of nicotine, in the urine and saliva. In addition, studies have demonstrated increased activity of enzymes that metabolize benzo[a]pyrene in the placentas of women who smoke8 and, possibly, in the placentas of women involuntarily exposed to cigarette smoke.9
Nonketotic Hyperosmolal Diabetic Coma in a Child: Management With Low-Dose Insulin Infusion and Intracranial Pressure Monitoring
Authors: Vernon Donald D. , Postellon Daniel C.
Published: December 2021

Nonketotic hyperosmolal diabetic coma, which is rare in children, is associated with a high mortality in both children and adults. We report a case of nonketotic hyperosmolal diabetic coma in a 3½-year-old child, who was successfully managed with low-dose insulin infusion and invasive intracranial pressure monitoring and recovered without sequelae. Despite severely elevated serum glucose (2,660 mg/dL) and osmolality (435 mosm/kg) levels, there was no elevation of intracranial pressure during her treatment. This case illustrates that insulin should be used cautiously and at low dose in this disease, and that intracranial pressure monitoring is of use in the management of such patients. The pathogenesis and clinical features of nonketotic hyperosmolal diabetic coma are briefly reviewed.
Measles Elimination
Authors: LEVY DAVID
Published: December 2021

To the Editor.—

The Public Health Service deserves enormous credit for its campaign to eliminate measles in the United States. The recent review1 attests to this fact. I must, however, disagree with the conclusion of the article. The glaring omission is that measles is again on the increase. After a record low of 1,436 cases reported in 1983, 1984 saw an increase of about 69.3% to 2,534 cases, and 1985 will probably see more cases than 1984.2 The statement in the conclusion, "Although 2% to 10% of vaccinated persons will remain susceptible, there is no reason to believe that such individuals can lead to sustained transmission of measles in the United States," is totally unfounded and deters the pediatrician from the future challenges of measles.
Comparative Effectiveness of Amoxicillin and Amoxicillin-Clavulanate Potassium in Acute Paranasal Sinus Infections in Children: A Double-Blind, Placebo-Controlled Trial
Authors: Wald Ellen R. , Chiponis Darleen , Ledesma-Medina Jocyline
Published: December 2021

This study compared the relative effectiveness of two antimicrobial preparations, amoxicillin and amoxicillin-clavulanate potassium (Augmentin), in the treatment of acute maxillary sinusitis in children 2 to 16 years of age. Of 171 children with persistent (ten to 30 days' duration) nasal discharge or daytime cough or both, 136 (80%) had abnormal maxillary sinus radiographs. These children were stratified by age and severity of symptoms and randomly assigned to receive either amoxicillin, amoxicillin-clavulanate potassium, or placebo. After the exclusion of 28 children with throat cultures positive for group A Streptococcus and 15 who did not complete their medication, the remaining 93 children were evaluated: 30 received amoxicillin, 28 received amoxicillin-clavulanate potassium, and 35 received placebo. Clinical assessment was performed at three and ten days. On each occasion, children treated with an antibiotic were more likely to be cured than children receiving placebo (P < .01 at three days, P < .05 at ten days). The overall cure rate was 67% for amoxicillin, 64% for amoxicillin-clavulanate potassium, and 43% for placebo.
Central Venous Catheter Insertion by Femoral Vein: Safety and Effectiveness for the Pediatric Patient
Authors: Kanter Robert K. , Zimmerman Jerry J. , Strauss Richard H. , Stoeckel Kathleen A.
Published: December 2021

Prospective observations made during surveillance of routine central venous catheterizations for hemodynamic monitoring were evaluated to determine the safety and effectiveness of femoral insertion of central venous catheters and to demonstrate the feasibility of teaching pediatric residents to perform this procedure. During a 19-month period of observation, 29 pediatric patients requiring a central venous catheter underwent attempted percutaneous femoral vein catheterization. Femoral catheterization was successful in 86% of patients attempted, and insertions by pediatric residents were successful in 68% of patients attempted. Arterial puncture was the only significant complication of insertion, occurring in 14%, and was not associated with adverse sequelae. During 33 months of observations, complications of indwelling femoral central venous catheters did not significantly exceed the frequency for internal and external jugular, subclavian, and antecubital central venous catheters. During more than 4 years of observation, the significant complications associated with indwelling femoral central venous catheters were swelling of the leg or documented thrombosis in 11 % of 74 critically ill patients. These observations indicate safety and effectiveness of femoral central venous catheters which compares favorably to central venous catheter insertion by other routes. In contrast to previous reports of central venous catheter insertion via subclavian and internal jugular veins, we observed no cardiorespiratory compromise as a result of femoral central venous catheter complications. Skill in this technique is a feasible educational goal for pediatric residents.
Common Bile Duct Obstruction Due to an Intraluminal Mass of Candidiasis in a Previously Healthy Child
Authors: Carstensen Henrik , Nilsson Karl Olof , Nettelblad Sven-Caspar , Cederlund Claes-Göran , Hildell Jan
Published: December 2021

A 36/12-year-old previously healthy girl had intermittent attacks of abdominal pain following a blunt abdominal trauma. At admission to the hospital, she had jaundice and hepatomegaly. Results of laboratory tests indicated an obstructive pattern, and ultrasonography revealed an intraluminal mass in the distal common bile duct. At surgery, the mass was confirmed as the cause of obstruction, and it was removed. Microscopic analysis indicated that the amorphous material was fungi infested. Growth cultures from bile and feces yielded Candida albicans. Postoperative treatment with T-tube drainage and antimycotic drugs led to an uneventful recovery. Clinical, biochemical, and ultrasonographic follow-up have shown no evidence of recurrence. A possible cause and effect relationship between the trauma and the development of biliary obstruction is suggested.
Idiopathic External Hydrocephalus: Natural History and Relationship to Benign Familial Macrocephaly
Authors: Alvarez Luis A. , Maytal Joseph , Shinnar Shlomo
Published: December 2021

External hydrocephalus was identified in 63 infants. The 36 infants in whom external hydrocephalus was idiopathic constitute the study population. The group was homogeneous. Although not all were macrocephalic at birth, the head circumference exceeded the 95th percentile in all cases by 1 year of age, and subsequent head growth was parallel to the 95th percentile. The head computed tomographic scan showed a characteristic picture of a prominent interhemispheric fissure, a collection of subarachnoid fluid over the frontal convexities, and prominent basal cisternae. Mild ventriculomegaly was present in ten cases. These abnormalities resolved after 18 to 24 months of age. No infant required therapy for the condition. Development was normal in 32 infants, suspect in three, and clearly abnormal in only one of the 36 infants. However, of the 32 infants with normal development, 14 were found to be delayed in gross motor development and five in language development at a prior time. There was a family history of macrocephaly in 88% of cases. Several families had a mixture of members with external hydrocephalus and benign familial macrocephaly throughout several generations. These findings suggest that idiopathic external hydrocephalus is a relatively benign, self-limited condition that resolves without treatment and is closely related to benign familial macroceophaly.
Neonatal Zygomycotic Necrotizing Cellulitis
Authors: White Christopher B. , Barcia Peter J. , Bass James W.
Published: December 2021

Zygomycosis is a rare infection that should be suspected in any patient with a fulminant necrotizing cellulitis in an area recently covered with adhesive bandages or dressings. Early diagnosis and treatment are essential for patient survival.
Determination of Cerebral Death in the Pediatric Intensive Care Unit
Authors: Drake Beth , Ashwal Stephen , Schneider Sanford
Published: December 2021

The clinical course, laboratory data, outcome, and autopsy findings in 61 pediatric patients with suspected brain death were reviewed. In 58% of patients, the initial EEG was isoelectric, and cerebral blood flow was absent. In six of nine children, the initial EEG, which showed activity, became isoelectric by 72 hours. In no child without demonstrable cerebral flow did flow resume in later studies. In four of five children who had initial EEG activity despite absent cerebral flow, an isoelectric EEG developed on repeated study. The average time from initial insult until clinically suspected brain death was 29.5 hours and 61.5 hours until brain death was confirmed. The time from confirmation of brain death until discontinuation of life support systems was 32 hours in the majority of patients. Our current protocol for evaluating pediatric patients with suspected brain death is reviewed with emphasis on the clinical examination, laboratory studies, and use of serial EEGs and radionuclide cerebral blood flow determinations.
Black Teenage Fathers: What Happens When the Child Is Born?
Authors: Rivara Frederick P. , Sweeney Patrick J. , Henderson Brady F.
Published: December 2021

This study explored the changes in the lives of teenage fathers, from prenatally to 9 and 18 months postpartum, and compared them to a group of nonfather peers. At 18 months postpartum, more fathers were heads of households and fewer were still in school, although there were no differences in employment status. Although only 7.5% of the teenage parents were married, 37% lived together or had daily contact; only three had contact less often than weekly. In the 18 months since the first interview, there was a decrease in contact in 34%, an increase in contact in 19%, and no change in the frequency of contact in 46%. Two thirds of teenage fathers stayed with the mother during labor and 25% were in the delivery room. Only one father had no contact with his child 18 months later; 12% lived with the child and 25% saw the child daily. The most common reasons for not living with the child were that the baby was too young, finances, and problems in the relationship with the woman. This study demonstrates that the fathers appeared to suffer few adverse consequences of teenage pregnancy. However, the majority of fathers continued to be involved in the lives of the mother and child, and we believe they should be included in programs for teenage parents and their children.
Aversive Taste Treatment of Finger and Thumb Sucking
Authors: FRIMAN PATRICK C. , BARONE VINCENT J. , CHRISTOPHERSEN EDWARD R.
Published: December 2021

Thumb sucking is common and adaptive in infancy and early childhood. But when sucking occurs beyond 4 years of age, a common result can be an anterior, open bite that requires expensive orthodontic correction.1 Prolonged sucking may also be a factor in class II malocclusion, narrowing of the dental arches, mucosal trauma, and digital malformation.1-4 In addition to the physical sequelae of sucking, the habit, because it is not socially approved, can generate persistent negative feedback which can adversely affect a child's self-esteem.5

Thumb sucking is a frequently reported child behavior problem that, in some children, can be associated with broader behavior disorders that require treatment.
Preventing Child Abuse and Neglect: A Randomized Trial of Nurse Home Visitation
Authors: Olds David L. , Henderson Charles R. , Chamberlin Robert , Tatelbaum Robert
Published: December 2021

A program of prenatal and infancy home visitation by nurses was tested as a method of preventing a wide range of health and developmental problems in children born to primiparas who were either teenagers, unmarried, or of low socioeconomic status. Among the women at highest risk for care-giving dysfunction, those who were visited by a nurse had fewer instances of verified child abuse and neglect during the first 2 years of their children's lives (P = .07); they were observed in their homes to restrict and punish their children less frequently, and they provided more appropriate play materials; their babies were seen in the emergency room less frequently during the first year of life. During the second year of life, the babies of all nurse-visited women, regardless of the families' risk status, were seen in the emergency room fewer times, and they were seen by physicians less frequently for accidents and poisonings than comparison group babies (P ≤ .05 for all findings, except where indicated.) Treatment differences for child abuse and neglect and emergency room visits were more significant among women who had a lower sense of control over their lives.
Fat Emulsion Tolerance in Very Low Birth Weight Neonates: Effect on Diffusion of Oxygen in the Lungs and on Blood pH
Authors: Brans Yves W. , Dutton Elizabeth B. , Andrew Donna S. , Menchaca Elizabeth M. , West Donna L.
Published: December 2021

Forty-one very low birth weight neonates (820 to 1,510 g and 27 to 34 weeks of gestation) requiring total parenteral nutrition were randomly assigned to one of three regimens of administration of fat emulsion for a period of eight days. Groups I and II received the emulsion at a constant rate for, respectively, 24 and 16 hours, beginning with a daily dosage of 1 g/kg and increasing daily by 1 g/kg to a maximum of 4 g/kg. Group III received the emulsion at a constant rate or 4 g/kg for 24 hours. Blood pH and alveolar-arteriolar gradient of oxygen diffusion in the lungs were measured at regular intervals. The various regimens and rates of fat infusion appeared to have no deleterious effect on blood pH and alveolar-arteriolar oxygen diffusion gradient. Infusion rates as used in the study for appropriate for gestational age very low birth weight neonates appear to be safe, although caution is always warranted when dealing with tiny neonates whose pulmonary reserve is minimal. In view of data from other studies, it is suggested to infuse fat at a constant rate for 24 hours to avoid overloading the clearance mechanisms of fat particles from plasma.
Serum Apolipoproteins A-I and B in 2,854 Children From a Biracial Community: Bogalusa Heart Study
Authors: Srinivasan Sathanur R. , Freedman David S. , Sharma Chakravarthi , Webber Larry S. , Berenson Gerald S.
Published: December 2021

Serum apolipoprotein A-I (apo A-I) and apolipoprotein B (apo B) profiles were examined in 2,854 children, 5 to 17 years of age, from a total biracial community. Black boys had higher apo A-I levels than white boys (P < .001), whereas girls showed no such racerelated difference. Black-white difference in apo A-I persisted among boys with similar triglyceride levels provided that triglyceride levels were high. The ratio of highdensity lipoprotein cholesterol (HDL-C)/apo A-I was higher in black than in white children, irrespective of sex (P < .001). Only black children showed sex-related differences for apo A-I (boys > girls, P < .05). Sex-related differences were seen in white children for HDL-C/apo A-I ratio (boys > girls, P < .001) and in children of both races for apoB (girls > boys, P < .01). Age-related changes were more apparent for apo A-I and HDL-C/apo A-I ratio than for apo B. A progressive decrease in apo A-I was noted during sexual maturation only in white boys. The magnitude of inverse association of apo B to HDL-C was less strong in black children (P < .01). Although apo A-I was inversely correlated with very low-density lipoprotein cholesterol and triglycerides in white children, no association was noted in black children. These findings are indicative of intrinsic metabolic differences among the race-sex groups, resulting in variability in lipoprotein composition and levels and atherogenic potential.
Early Physical Therapy Effects on the High-Risk Infant: A Randomized Controlled Trial
Authors: Piper Martha C. , Kunos V. Ildiko , Willis Diana M. , Mazer Barbara L. , Ramsay Maria , Silver Kenneth M.
Published: December 2021

A prospective, randomized, controlled trial was conducted to assess the effects of early physical therapy on infants at risk for neurologic sequelae and to evaluate the impact of such early treatment on the prevention or minimization of future handicaps. A cohort of 134 infants who had received care in two Montreal inborn neonatal intensive care units was identified prospectively. Infants were stratified according to prognosis and birth weight and were randomly assigned to either an experimental or control group. Babies assigned to the experimental group received early physical therapy, whereas those allocated to the control group received conventional follow-up care. Outcome measures were administered by independent evaluators at 12 months and included measures of neurologic status, motor and overall development, and physical growth. No statistically significant differences on any of the measured outcomes at 12 months were found between the experimental and control groups. Infants weighing less than 750 g at birth, regardless of group assignment, consistently demonstrated significant delays in their growth and development when compared with their heavier peers. The early physical therapy program investigated in this study was not efficacious in altering the pattern of motor development in those high-risk infants participating in the trial.
Severe Primary Hyperparathyroidism in a Neonate With Two Hypercalcemic Parents: Management With Parathyroidectomy and Heterotopic Autotransplantation
Authors: Cooper Linda , Wertheimer Joseph , Levey Raphael , Brown Edward , Leboff Meryl , Wilkinson Robert , Anast Constantine S.
Published: December 2021

A neonate with severe primary hyperparthyroidism was successfully managed by parathyroidectomy and heterotopic autotransplantation (one third of one gland of the infant was implanted in the forearm). In vitro studies of parathyroid tissue from the infant revealed a severe defect in parathyroid suppressibility. Postoperatively, the infant had modest hypercalcemia, normal serum immunoreactive parathyroid hormone levels, hypermagnesemia, and relative hypocalciuria. The parents were related and both had asymptomatic hypercalcemia with mean serum immunoreactive parathyroid hormone levels that were within the normal range. Similar to the findings in the infant postoperatively, relative hypocalciuria in the presence of hypercalcemia was found in the mother; in contrast, the father had hypercalciuria. The presumed dominantly transmitted hypercalcemia in this kindred is consistent with familial hypocalciuric hypercalcemia with a confounding factor of ethanol possibly accounting for the hypercalciuria in the father.
Acidosis and Hepatic Portal Venous Gas: Indications for Surgery in Necrotizing Enterocolitis
Authors: Buras Robert , Guzzetta Philip , Avery Gordon , Naulty Cheryl
Published: December 2021

A retrospective review of cases of necrotizing enterocolitis seen at the Children's Hospital National Medical Center during the past 5 years was performed to identify factors that indicate a need for surgical intervention. The study group consisted of 92 neonates. Persistent acidosis and hepatoportal venous gas were significantly more common in babies requiring surgery than in those who were managed medically. Other physical, radiologic, and laboratory factors did not occur more frequently in those children going to surgery. Neonates with hepatoportal venous gas or persistent acidosis should be treated aggressively, and surgical intervention should be considered early in this group. Such an approach may serve to reduce morbidity and mortality in the future.
Concealed Pulmonary Abscess: Diagnosis by Computed Tomography
Authors: Johnson J. Fred , Shiels William E. , White Christopher B. , Williams Blan D.
Published: December 2021

During childhood, an acute pneumonia with bulging margins usually reflects an abundant production of exudate. However, an unexplained persistence of an expansile pneumonia following therapy indicates that the infectious process may be isolating itself by forming an abscess. Previous reports emphasize that such abscesses are rarely diagnosed prior to thoracotomy or autopsy. Computed tomography facilitates an earlier disclosure of an abscess or empyema that is producing a persistent but unexplained expanding opacification on plain film.
Southeast Asian Children in America: The Impact of Change
Authors: Messer Michael M. , Rasmussen Norman H.
Published: December 2021

This is a review of the psychiatric literature on acculturation and child development in Southeast Asian refugees. Each age group suffers somewhat differrently from refugee experience, and these differences are described further. In addition, to aid the acculturation and developmental processes, treatment approaches are suggested. This article should be useful to pediatricians who care for refugee children and are unfamiliar with the psychiatric literature about refugees.
Currency, Competency, and Credibility: New Directions for Pediatric Continuing Education
Authors: SMITH MARTIN H.
Published: December 2021

One of the historic cornerstones of the American Academy of Pediatrics has been the development of educational programs designed to assure the highest quality of pediatric care. Although our commitment to this goal remains unwavering, changes in the manner in which pediatric care is—and will be—rendered demand that we constantly look for new and better ways to satisfy the educational needs of the membership.

Toward that end, the Academy recently has embarked on a nationwide search for a director of the Department of Education at the Academy's Elk Grove Village, IL, headquarters. A search committee comprised of Blair E. Batson, MD, Floyd W. Denny, Jr, MD, and Doris A. Howell, MD, has been appointed to pursue this effort.
Forensic Evaluation of the Sexually Abused Child
Authors: Enos William F. , Conrath Theodore B. , Byer James C.
Published: December 2021

Results of a 16-year forensic study of 162 cases are presented. A forensic examination protocol is delineated, laboratory specimens/evidence collection methods given, and an anatomical chart of the prepubescent female genitalia with a pictorial atlas of female abuse trauma provided. The number of child victims per 100,000 at-risk population was static v the population increase and increased v victim's age. More than 80% of all cases and 82.1% of positive cases involved girls. Of all victims, approximately 40% were positive based on history, physical evidence, laboratory evidence, and/or eyewitness deposition. Alleged incestual perpetrators accounted for 21.97% of female and 3.3% of male cases reported and 20% of female and 0% of positive for findings of sexual abuse.
Perspectives in Adolescent Tuberculosis: Three Decades of Experience
Authors: Lee Nemir Rosa
Published: December 2021

Three hundred seventy-one adolescents and young adults, 10 to 20 years of age, were treated for tuberculosis during a 29-year period. There were 258 patients tuberculin positive without disease, 37 with calcifications on chest roentgenographs, and 76 with active tuberculous disease. All patients received chemotherapy. Active tuberculosis was more common in the 10- to 12-year-old patients. The greater number of tuberculin reactors in this age group suggests that endocrine factors related to the onset of puberty may play a role in conversion. No significant sex difference was apparent. Drug toxicity was rarely a problem. Pregnancy subsequent to therapy was not associated with progression or reactivation of disease. Two (possibly three) patients who were properly treated and compliant with the drug regimen had reactivation disease 4 to 14 years later. Cavitary pulmonary disease occurred in the two compliant patients. Meningitis, believed to be tuberculous, occurred in the suspected case. Two of these received isoniazid prophylaxis for skin test conversion only. In one patient, treated with two drugs for primary tuberculosis in the past, tuberculous pneumonia developed later. All three recovered. Although reactivation does occur, it is rare. Because most tuberculin reactors were discovered in the 10- to 12-year age group when screened routinely in high school, this procedure should not be abandoned.
Correction of Congenital Auricular Deformities by Splinting in the Neonatal Period
Authors: Brown Forst E. , Colen Lawrence B. , Addante Rocco R. , Graham John M.
Published: December 2021

Many congenital ear deformities involve abnormal plical folding. This appears to be a result of deficient intrinsic and extrinsic auricular muscle activity as well as intrauterine pressure effects. These deformities can usually be corrected by appropriate splinting in the neonatal period, a time when estrogen activity is increased and the ear is very malleable. The methods used and the results of treatment are presented.
Earring Aspiration and Other Jewelry Hazards
Authors: Becker Patricia G. , Turow Judith
Published: December 2021

Jewelry wearing among very young children is increasing. Ear piercing is being practiced even in neonates. Accompanying these phenomena is the ever-present risk of ingestions and aspirations of small jewelry items, notably earring pieces. We present two cases that illustrate some of the real and potential hazards of these small jewelry pieces. Relatively safe jewelry items and specific safety measures are discussed.
Pharyngeal Culturing and Reporting of Pediatric Gonorrhea in Connecticut
Authors: MCCLURE EMILY M. , STACK MARY R. , TANNER TIMOTHY , THEVENIN JOSEPH , GOFSTEIN RALPH M. , HELGERSON STEVEN D.
Published: December 2021

A team of students from the Department of Epidemiology and Public Health, Yale University School of Medicine, has been investigating an increase in reported infections with Neisseria gonorrhea statewide in children 13 years of age or less, excluding neonates, in Connecticut. In particular, there was a marked increase in reported infections in one city between 1983 and 1984. The results suggest that much of a statewide increase during that time may have been due to improved recognition, predominantly due to the use of pharyngeal cultures in this city, and raise disturbing questions about the adequacy of recognition, culturing, and reporting from other parts of the state.
Eosinophilic Fasciitis Presenting As Inflammatory Polyarthritis
Authors: OLSON NANCY Y. , LINDSLEY CAROL B. , KEPES JOHN J.
Published: December 2021

Eosinophilic fasciitis is an uncommon disorder characterized by peripheral blood eosinophilia, hypergammaglobulinemia, and scleroderma-like inflammation of skin and fascia. Joint contractures occur but typically without synovitis and effusion. Our patient presented with symmetric polyarthritis and subsequently characteristic features of eosinophilic fasciitis developed. It is important to consider this disorder in patients presenting with arthritis as well as those presenting with skin changes because prior treatment with corticosteriods can alter biopsy findings, leading to diagnostic confusion, and possible adverse effects on the long-term treatment regimen.