bluuebunny/crossref_metadata_2025 huggingface dataset:
Urinary Tract Infections
Authors: CRAIN ELLEN F. , GERSHEL JEFFREY C.
Published: December 2021

In Reply.—

Dr Roscelli calls attention to the 16 infants in our sample with positive urine cultures but negative urinalyses and admission diagnoses other than urinary tract infection (UTI). These patients, Dr Roscelli suggests, could have had asymptomatic bacteriuria with a different source for their fever. Although we doubt that these infants had asymptomatic bacteriuria, in theory it is possible that the bacteriuria was not the cause of the fever. However, as Dr Roscelli states, "at this time there no way to determine if the bacteriuria is causing the patient's fever or is simply an incidental finding."
Immunization of High-Risk Infants Younger Than 18 Months of Age with Split-Product Influenza Vaccine
Authors: Groothuis Jessie R. , Meiklejohn Gordon , Lauer Brian A. , Levin Myron J. , Rabalais Gerard P.
Published: December 2021

Influenza is an important cause of serious illness in very young children with cardiopulmonary disease. A 4-year study was conducted at two centers to assess immunogenicity and safety of influenza split-product vaccine in children aged 3 to 18 months with bronchopulmonary dysplasia and congenital heart disease. A total of 113 children were studied: 62 children 3 to 5 months of age and 51 children 6 to 18 months of age. Sera were drawn prior to first and second immunization and 3 weeks after second immunization and were tested by hemagglutination inhibition; protection was defined as >1:32. Ninety-five children were surveyed for adverse reactions. Seroresponses were age and antigen specific. Best responses for all ages were to A/Mississippi (H3N2) (97%). Children older than 6 months of age had better seroresponses to A/Leningrad (H3N2) (73%, P < .03) and B/Victoria (62%, P < .02) than did children younger than 6 months of age. Seroconversion rates to the remaining anere low. Only 9% of children experienced adverse reactions; all but one were mild. The immunologic mechanisms responsible for preventing serious influenzal disease and more effective immunization strategies need to be defined for very young high-risk children.
Children With Chronic Illness: Family and Parent Demographic Characteristics and Psychosocial Adjustment
Authors: Cadman David , Rosenbaum Peter , Boyle Michael , Offord David R.
Published: December 2021

This paper presents the results of an epidemiologic study that compares and contrasts psychosocial characteristics of parents and family units of children with chronic illness or physical disability (chronic health problems) with those of healthy children. Data were derived from the Ontario Child Health Study of 1869 randomly selected families, with 3294 children aged 4 to 16 years. In the absence of significant differences between parents and families of children with chronic illness alone and those with physical disability, these groups were combined for analysis, for which odds ratios (OR) or t tests were used. Significant positive findings included increased rates of parental treatment for "nerves" (mothers' OR = 2.1, fathers' OR = 1.9) and increased maternal negative affect scores (Bradburn Affect Balance Scale) (P < .001) among parents of children with chronic health problems. Important negative findings (95% confidence interval of the OR included 1) included no increase in single-parent families (OR = 1.2), social isolation (OR = 1.0), or alcohol problems (OR = 1.2) among parents of children with chronic health problems. Categorically defined family dysfunction did not differ between the two groups (OR = 1.1). These data contrast with several clinic-based studies and suggest that, in a widely generalizable population survey, families of children with chronic health problems including physical disability do not suffer a marked excess of dysfunction, although some indicators of individual parent psychosocial problems were modestly elevated. It is concluded that clinicians working with children with chronic health problems should always assess psychosocial well-being. They must, however, be careful to avoid expectation bias or overinterpretation of stress and not assume that a large burden of significant psychosocial dysfunction exists among these parents and families, simply because they have a child with a chronic health problem.
Extraordinary Urinary Frequency
Authors: ASNES RUSSELL S. , MONES RICHARD L.
Published: December 2021

To the Editor.—

It was with considerable interest that we read the article "Extraordinary Urinary Frequency" by Zoubek et al which was published recently in Pediatrics.1 Pediatricians frequently encounter children who have a main complaint of pollakiuria, the descriptive term which refers to an increase in the frequency of urination during a specified time period. We previously reported a small group of children with this complaint and discussed it's differential diagnosis and an approach to treatment.2
Extraordinary Urinary Frequency
Authors: BLOOM DAVID A. , SEDMAN AILEEN B. , ZOUBEK JAROSLAVA
Published: December 2021

In Reply.—

Thank you for the second letter regarding our paper on extraordinary urinary frequency. We would like to respond to this as well.

We thank Drs Asnes and Mones for their comments. Pollakiuria and pollakisuria are synonyms for urinary frequency. Pollakis is a Greek term for often, although it has rather infrequent application in medical English, being limited only to pollakiuria and pollakidipsia in Dorland's Dictionary.1 The Oxford English Dictionary employs this prefix only in one word, the botanic term, pollakanthic.2
Butterfly-Shaped Mark
Authors: OAKES W. JERRY
Published: December 2021

To the Editor.—

I write to take strong exception with the recent article by Metzker and Shamir describing butterfly-shaped flat capillary hemangiomas occurring over the midline of the lumbar spine.1 The authors conclude that these lesions have not been described before, that they do not warrant further investigation, and that when seen in conjunction with a myelomeningocele that there was "no apparent relationship between the two entities."

Flat capillary hemangiomas occurring over the lumbar spine are one of the four long recognized cutaneous stigmata of occult spinal dysraphism.2-6
Improved Neonatal Survival Following Multiple Doses of Bovine Surfactant in Very Premature Neonates at Risk for Respiratory Distress Syndrome
Authors: Hoekstra Ronald E. , Jackson J. Craig , Myers Thomas F. , Frantz Ivan D. , Stern Mitchell E. , Powers William F. , Maurer Michael , Raye John R. , Carrier Steven T. , Gunkel J. Harry , Gold Alan J.
Published: December 2021

To determine whether multiple doses of bovine surfactant would improve neonatal mortality in very premature neonates, we conducted two multicenter controlled trials under identical protocols; the results were combined for analysis. Four hundred and thirty neonates born between 23 and 29 weeks gestation and weighing 600 to 1250 g at birth were assigned randomly at birth to receive either 100 mg of phospholipids/kg of Survanta, a modified bovine surfactant (n = 210), or a sham air placebo (n = 220) within 15 minutes of birth. Neonates who developed respiratory distress syndrome and required mechanical ventilation with at least 30% oxygen could be given up to three more doses in the first 48 hours after birth. Dosing was performed by investigators not involved in the clinical care of the neonates; nursery staff were kept blinded as to the treatment assignment. Cause of death was determined by a panel of three independent, board-certified neonatologists after blindly reviewing case report forms and autopsy reports. Fewer Survanta-treated neonates died of any cause (11.4% vs 18.8%, P = .031), died of respiratory distress syndrome (1.9% vs 15.6%, P < .001), and either died or developed bronchopulmonary dysplasia due to respiratory distress syndrome (39.5% vs 49.1%, P = .044). The incidence of respiratory distress syndrome was also lower in Survanta-treated neonates (28.0% vs 56.9%, P < .001), and the Survanta-treated neonates' oxygenation and ventilatory status were improved significantly at 72 hours. Survanta-treated neonates were also at lowered risk of developing pulmonary interstitial emphysema (23.3% vs 36.9%, P = .002) and other forms of pulmonary air leaks (9.6% vs 20.8%, P .002). We conclude that multiple doses of Survanta reduce mortality and morbidity due to respiratory distress syndrome during the neonatal period.
Emerging Developmental Sequelae in the `Normal' Extremely Low Birth Weight Infant
Authors: Collin Marc F. , Halsey Carey L. , Anderson Craig L.
Published: December 2021

Thirty-six extremely low birth weight (<1000 g birth weight) children received neurodevelopmental testing in infancy (mean age = 19.1 months), and again in early childhood (mean age = 46.5 months). Children were categorized into a high-risk group (n = 20) if bronchopulmonary dysplasia and/or Grades III or IV intracranial hemorrhage were present or a low-risk group (n = 16) if neither were present. Using standardized testing and neuromotor examination, 24 (67%) of 36 children showed normal infant development. Only 11 (31%) of 36 children (P < .005) had normal development upon reassessment in early childhood. A decline in developmental status occurred in both groups. This indicates that for the extremely low birth weight population, normal infant development is poorly predictive of continued normal development. With or without major complications, extremely low birth weight places children at substantial risk for ongoing and emerging developmental problems with age.
Survival After Neonatal Myocardial Infarction
Authors: BOULTON JOHN , HENRY RICHARD , RODDICK LAURENCE G. , ROGERS DAVID , THOMPSON LINDA , WARNER GARRY
Published: December 2021

These are case reports of two children with structurally normal hearts and with normal coronary arteries, who survived myocardial infarction in the early neonatal period. They are only the third and fourth reported survivors of neonatal myocandial infarction and the first in which hypercholesterolemia is postulated to have played an important role.

The most likely cause of the myocardial infarction was thrombosis or thromboembolism. Changes in hemostatic function associated with hypencholesterolemia may be relevant.
Factor V Inhibitor Developing After Liver Transplantation in a 3-Year-Old Child
Authors: GORDON BRUCE , HAIRE WILLIAM , DUGGAN MICHAEL , LANGNAS ALAN , SHAW BYERS
Published: December 2021

Acquired inhibitors of blood coagulation have been recognized with increasing frequency since the classic review by Margolius et al in 1961.1 The most common acquired inhibitor is directed against factor VIII and usually arises in patients with classical hemophilia.2 Inhibitors directed against factor V are considered rare; only 30 cases have been reported in the literature.3-6 The majority of these cases occur in patients olden than 60 years and many have arisen following major surgical operations. Patients present with variable bleeding tendency and a prolonged partial thromboplastin time (PTT) and prothrombin time (PT), which fail to correct with the addition of normal plasma.
Prescription Drug Advertising Direct to the Consumer
Authors:   Committee on Drugs
Published: December 2021

There is a rapidly growing practice within the pharmaceutical industry of advertising prescription products directly to the general public through media, such as television, radio, newspapers, and popular magazines. Proponents of direct-to-consumer advertising of prescription drugs have asserted that advertising is a source of useful information for the patient. However, it is the position of the Academy that patient education regarding prescription drugs is provided best by the physician within the context of patient care and not through advertising that is designed primarily to promote the sale and consumption of a specific product. Such advertising contributes little, if anything, to the quality of health care while posing multiple problems that may be counterproductive to the provision of optimal pharmacotherapy for pediatric patients.

The Academy's opposition to direct-to-consumer advertising of prescription drugs stems from its long tradition of advocacy for children and young people, along with a concern regarding the potential negative impact of such advertising on the health care of children and adolescents. The Academy's objection to consumer advertising of specific prescription products does not apply to general health information provided through public service announcements sponsored by the pharmaceutical industry.

Prescription drugs are unique in the marketplace in that they are selected for use by the physician rather than by the consumer. They are designated by law to be used within the patient-physician relationship for the protection and welfare of the patient. In choosing a therapeutic agent for a particular patient's illness, a physician takes into consideration a multitude of complex factors, including the patient's diagnosis, medical history, previous medication interolances, adverse drug reactions, possible drug interactions, chemical dependency, and the array of products that potentially may be used.
Topics in Chronic Granulomatous Disease
Authors: UMEKI SHIGENOBU
Published: December 2021

To the Editor.—

Such phagocytic cells as neutrophils and macrophages are crucial elements in the host defense against bacterial

[See table in the PDF file]

and fungal infections. Microbicidal activity depends to a large extent on NADPH oxidase system, which can be activated by stimuli (bacteria, fungi) and which generates the superoxide anion and other highly reactive forms of reduced oxygen.1,2 The neutrophil NADPH oxidase system is composed functionally of membrane-bound catalytic components (which consist of at least two constituents, the low potential cytochrome b5583-5 and flavoprotein5) and soluble cytosolic components6,7 which participate as either catalytic or regulatory elements.
AAP Task Force Report Erratum
Authors: STRAIN JAMES E.
Published: December 2021

To the Editor.—

The Task Force Report on the Future Role of the Pediatrician in the Delivery of Health Care (Pediatrics. 1991;87:401-409) contains two errors. On page 402, column 2, paragraph 1, the sentence reads "A 24% increase in total patient contacts ..." The sentence should read: "A 7% increase in total patient contacts ..." The citation for this is Marder WD, Kletke PR, Silberger AB, et al. Physician Supply and Utilization by Specialty: Trends and Projections.
Readmissions of Children With Diabetes Mellitus to a Children's Hospital
Authors: Glasgow Allen M. , Weissberg-Benchell Jill , Tynan W. Douglas , Epstein Sandra F. , Driscoll Chris , Turek Jane , Beliveau Ev
Published: December 2021

The characteristics of children with diabetes readmitted to Children's Hospital during a 5-year period, 1984 to 1989, were compared with those characteristics of new-onset patients admitted for stabilization and education and to outpatients in the Children's Hospital diabetes program to determine which characteristics were associated with patients who were readmitted. Changes in the frequency of readmissions were examined to determine whether the introduction of a diabetes team and a program that emphasizes the importance of ensuring that patients at risk of readmission consistently received insulin injections resulted in a reduction of readmissions. Readmissions occurred more frequently in patients who were black (71% compared with 38% of new-onset patients and 31% of outpatients) (P < .001), from one-parent homes (56% compared with 27% of new-onset patients and 24% of outpatients) (P < .001), and without third-party insurance (45% compared with 18% of new-onset patients and 15% of outpatients) (P < .001). Readmissions were very common at 14 to 15 years of age (39% of readmissions vs 18% of outpatients) and very uncommon in children younger than age 9 (6% of readmissions vs 27% of outpatients) (P < .001). Fewer readmissions for ketoacidosis occurred in the summer than in any other season (P < .05). Readmissions fell by 47% over the 5-year period while new-onset patients increased by 85%. The reduction in frequency of readmissions was due to fewer readmissions for ketoacidosis and fewer readmissions in blacks, in patients from one-parent homes, and in patients without third-party insurance. It is concluded that patients at risk of readmission can be identified and that a comprehensive program with a diabetes team that recognizes that episodes of ketoacidosis are due to missed insulin injections can substantially reduce the frequency of readmissions.
Pediatric Heart Transplantation at Stanford: Results of a 15-Year Experience
Authors: Baum David , Bernstein Daniel , Starnes Vaughn A. , Oyer Philip , Pitlick Paul , Stinson Edward , Shumway Norman
Published: December 2021

The long-term results of pediatric heart transplantation were evaluated in 53 patients, aged 0.25 to 18.94 years, who received transplants at Stanford University Medical Center between 1974 and 1989. Indications for transplantation were idiopathic cardiomyopathy (68%), congenital heart disease (21%), endocardial fibroelastosis (8%), and doxorubicin cardiomyopathy (3%). Immunosuppression was achieved with combinations of cyclosporine, prednisone, and azathioprine. Thirty-seven of 42 recipients leaving the hospital after transplantation were alive and in New York Heart Association class I at study's end. Cumulative survival was 79% at 1 year, 76% at 3 years, and 69% at 5 years. Fourteen recipients have survived more than 5 years (5.1 to 12.4 years). Hospital readmission for illness has been infrequent, decreasing from 6.8 days to 0.9 days per year over 5 years. Eleven patients have required no rehospitalization. Posttransplant deaths were due to infection (19%), rejection (4%), pulmonary hypertension (4%), coronary artery disease (2%), and lymphoproliferative disease (2%). Retransplantation was required for intractable rejection in 4 patients and advanced coronary artery disease in 2. Hypertension and elevated blood urea nitrogen and creatinine levels were common in individuals receiving cyclosporine. Growth was often impaired in prepubertal children receiving daily prednisone. Based on this 15-year experience, it is concluded that heart transplantation represents a reasonable alternative for selected young patients with end-stage cardiac disease.
Randomized, Controlled Trial Comparing Longterm Sulfonamide Therapy to Ventilation Tubes for Otitis Media With Effusion
Authors: Bernard Philippe A.M. , Stenstrom Robert J. , Feldman William , Durieux-Smith Andree
Published: December 2021

Several studies have indicated that either the surgical insertion of ventilation tubes (VTs) or long-term treatment with sulfonamide-based antibacterials is effective in the management of otitis media with effusion (OME; otherwise known as serous otitis media, secretory otitis media, and glue ear) when compared with a notreatment control or placebo. This controlled trial is the first to compare directly the effectiveness of these two treatments for long-standing OME. Outcome variables are treatment success rates, hearing thresholds, recurrent acute otitis media episodes, and side effects of medication or complications of VT placement. One hundred twenty-five children (aged 2.5 to 7 years) who met the usual indications for surgery (long-standing [>3 months] OME and conductive hearing loss) were randomly assigned to "medical" treatment (sulfisoxazole 75 mg/kg per day for 6 months) or "surgical" treatment (bilateral insertion of VTs). Subjects underwent pure-tone audiometry (500, 1000, 2000, 4000 Hz) and otomicroscopic examination at 2, 4, 6, 12, and 18 months. A significantly greater proportion of medical subjects (67%) than surgical subjects (48%) were treatment failures at 6, 12, or 18 months (P = .0208). Surgical subjects had significantly better hearing at 2 and 4 months (P values < .01) but not at 6, 12, and 18 months (P values > .2). A significantly greater proportion of surgical subjects (50%) experienced complications of treatment than did medical subjects (9%) (P < .001). Thirty-three percent of candidates for VT placement did not require surgery when treated with a 6-month course of sulfisoxazole. Given these findings, together with the low cost of sulfonamide, a 6-month trial of antimicrobial therapy is recommended for children with long-standing OME, before considering VT placement.
Preparedness of Practicing Pediatricians to Manage Emergencies
Authors: Schweich Paula J. , DeAngelis Catherine , Duggan Anne K.
Published: December 2021

To determine pediatrician preparedness to manage emergencies, a nationally representative random sample of 1000 non-hospital-based pediatricians was surveyed about (1) types of emergencies encountered and methods of transport to an emergency facility, (2) availability and use of equipment and medications in the office, and (3) determinants of pediatrician confidence in managing emergencies. The proportion of pediatricians who had encountered specific emergencies ranged from 86% for meningitis to 22% for cardiopulmonary arrest. The majority transported acutely ill children to an emergency department by ambulance. Availability of individual pieces of equipment and medications in offices ranged from 97% for epinephrine 1:1000 to 11% for bone marrow needles for intraosseous access. Combinations of equipment available to manage particular emergencies ranged from 61% for severe dehydration to 11% for cardiopulmonary arrest. The equipment available in a pediatrician's office was significantly related to the type of primary work setting. Pediatrician confidence in managing the initial stabilization of emergencies ranged from 58% for seizures to 25% for epiglottitis. Confidence was related significantly to year residency was completed, Advanced Cardiac or Advanced Pediatric Life Support training, work setting, and the availability of equipment in the office. Continuing education regarding initial office management of and equipment for common emergencies should improve the pediatrician's confidence and competence in this area.
Randomized, Placebo-Controlled Trial of Iron Supplementation in Infants With Low Hemoglobin Levels Fed Iron-Fortified Formula
Authors: Irigoyen Matilde , Davidson Leslie L. , Carriero Damaris , Seaman Carol
Published: December 2021

In spite of the declining prevalence of irodeficiency anemia, a large proportion of low-income infants have "low-normal" (11-11.5 g/dL) and "low" (< 11 g/dL) hemoglobin (Hgb) values. Because most of these infants are fed iron-fortified formulas, it was of interest whether additional iron supplementation would enhance Hgb values. A cohort of 334 healthy, inner-city, minority, 6-month-old infants, fed iron-fortified formulas, with Hgb values ranging from 9 to 11.5 g/dL, participated in a double-blind, randomized, placebo-controlled trial of supplemental iron at 0, 3, and 6 mg/kg per day for 3 months. Hemoglobin values increased significantly with age, regardless of assignment to placebo or supplemental iron (means for the entire cohort: 6 months 10.9 g/dL, 8 months 11.2, 10 months 11.3, and 12 months 11.4). The proportion of "responders" (Hgb level increased ≥1 g/dL) was 34% and did not differ significantly by placebo or iron dose. There were no significant differences in mean corpuscular volume or levels of erythrocyte porphyrins or serum ferritin between treatment groups. The implications of this clinical trial are twofold: (1) screening healthy infants fed iron-fortified formula at the age of 6 months is not justified, regardless of socioeconomic status; (2) the clinical practice of routinely treating low-income, "low-Hgb" infants with iron supplementation, without regard to dietary considerations, is unwarranted.
Verbal Dyspraxia in Treated Galactosemia
Authors: Nelson C. Donald , Waggoner Diane D. , Tuerck Judith M. , Donnell George N. , Buist Neil R. M.
Published: December 2021

Galactosemia is an inborn error of metabolism that causes life-threatening illness a few days after galactose-containing milk is fed to a newborn. Early treatment with a strict lactose-free diet results in rapid improvement, and, until recently, it was thought that the long-term prognosis in such infants was usually good. The speech characteristics of 24 patients treated for galactosemia were examined. Fifty-four percent had the specific speech disorder, verbal dyspraxia. This finding was not related to age at diagnosis, severity of symptoms in the newborn period, or to biochemical control. There may be, however, a relation between dyspraxia and diminished IQ scores observed in the group of patients with dyspraxia judged as "severe." The findings indicate the association of a specific and unusual speech defect with a specific and rare metabolic disorder.
Low-Dose Zidovudine in Children With an Human Immunodeficiency Virus Type 1 Infection Acquired in the Perinatal Period
Authors: Blanche Stephane , Duliege Anne-Marie , Debré Marianne , Griscelli Claude , Navarette Maria Soledad , Kouzan Serge , Tardieu Marc , Rouzioux Christine , Seldrup Jorgen
Published: December 2021

This report describes the one-year results of a noncomparative study designed to assess the safety and tolerance of low-dose zidovudine (azidothymidine) given orally to 60 human immunodeficiency virus type 1-infected infants and children. At baseline, the mean age was 1.9 years (±1.4), and all were symptomatic: 43% were P2A and 57% were P2B to F according to the Centers for Disease Control classification. All the patients received zidovudine for at least 6 months, and 52 of them (87%) completed a full year of therapy. The mean duration of follow-up was 346 days (±42) (range, 183 to 366 days).

The initial therapy consisted of four daily doses of 100 mg/m2 (400 mg/m2 per day, equivalent to 20 mg/kg per day). However, this treatment was modified when neutropenia or anemia was observed. Twenty-nine children (48%) remained at the initial therapy for the entire study. Zidovudine dosage was adjusted 92 times in the other 31 children (52%), mostly due to neutropenia (83%). Altogether, the time under full-dose therapy represented 81% of the total duration of the protocol for all patients. Children with mild symptoms, P2A at study entry, were more likely to remain under full-dose therapy than children with severe symptoms, P2B to F: the time under full-dose therapy represented 91% of the duration of the protocol for the former group and only 74% for the latter one (P < .02). No clinical adverse experiences were attributed directly to zidovudine. Thirty-seven children were prescribed trimethoprim-sulfametoxazole as a prophylaxis for Pneumocystis carinii pneumonia. In a multivariate analysis, this comedication had no influence on the hematologic tolerance of zidovudine.
Shoes for Children: A Review
Authors: Staheli Lynn T.
Published: December 2021

1. Optimum foot development occurs in the barefoot environment.

2. The primary role of shoes is to protect the foot from injury and infection.

3. Stiff and compressive footwear may cause deformity, weakness, and loss of mobility.

4. The term "corrective shoes" is a misnomer.

5. Shock absorption, load distribution, and elevation are valid indications for shoe modifications.

6. Shoe selection for children should be based on the barefoot model.

7. Physicians should avoid and discourage the commercialization and "media"-ization of footwear. Merchandizing of the "corrective shoe" is harmful to the child, expensive for the family, and a discredit to the medical profession.
The Academic Generalist: Still an Endangered Species? A Response
Authors: HAGGERTY ROBERT J.
Published: December 2021

I shared the commentary by Taussig and Ey1 with the Project Directors of the six participating sites of the General Pediatrics Academic Development Program. The authors of the commentary raise several important questions, which we collectively answer.

1. Three years of fellowship training (rather than the two provided in the program) should be required. All of us agree enthusiastically with this statement and believe that at least half of fellowship training time should be protected for research. In the 2-year program of the General Pediatrics Academic Development Program, at least 50% of the fellows' time was dedicated to research, more than many fellowships in subspecialities.
Summary of the Annual Meeting Section on Urology, American Academy of Pediatrics
Authors: Kogan Barry A.
Published: December 2021

Members of the Section on Urology of the American Academy of Pediatrics met for 2½ days in conjunction with the 59th Annual Meeting of the American Academy of Pediatrics in Boston, Massachusetts, October 6 to October 8, 1990. The meeting was presided over by Chairperson David T. Mininberg of Cornell University, New York. The papers presented at this meeting that are of interest to the practicing pediatrician are summarized here according to topic.

The Pediatric Urology Medal, awarded to an individual who has made outstanding contributions to the field of pediatric urology, was presented to Dr Frank Hinman, Jr. of the University of California. San Francisco. Dr Hinman was recognized for his many years of work dedicated to improving the urologic care of children. A foremost clinician, teacher, and researcher, he has contributed particularly to the understanding of urinary tract infections and bladder dysfunction in children, particularly those children who have "Hinman Syndrome," the non-neurogenic neurogenic bladder. Dr Hinman has been a strong advocate for the specialized urologic care of children for many years.

GENITOURINARY NEOPLASMS

Wilms' tumor is one disease in which there has been impressive progress in recent years, particularly with the advent of effective chemotherapy that has enabled these children to have increased disease-free survival. Montgomery and co-workers from the Mayo Clinic reviewed the experience of patients with bilateral Wilms' tumor during the past 16 years. Ten-year survival was 69%. Seventy-five percent of the failures resulted from recurrent disease (which generally occurred early), and 25% resultes from treatment complications.
Encouraging the Use of Bicycle Helmets
Authors: GOLDSMITH RICHARD
Published: December 2021

To the Editor.—

The recent statement by the Committee on Accident and Poison Prevention,1 in support of the use of bicycle helmets, is a thoroughly appropriate and timely pronouncement. Statistics on cycling accidents have been published in Pediatrics and elsewhere for many years, and it is certainly not a revelation that helmets will reduce serious risk in bicycle injuries. If one rides enough miles for enough years a spill is virtually inevitable. As an avid cyclist, I have sustained my own fair share of falls in the past.
The Use of Dexamethasone in Premature Infants at Risk for Bronchopulmonary Dysplasia or Who Already Have Developed Chronic Lung Disease: A Cautionary Note
Authors: FRANK LEE
Published: December 2021

To the Editor.—

The distressingly high incidence of bronchopulmonary dysplasia (BPD) in today's very low birth weight premature infant population and the prolonged morbidity and tumultuous clinical problems associated with BPD in these tiny infants have led to a trial usage of dexamethasone treatment to try to assuage these problems in this patient population. The report of Kazzi et al1 is noteworthy because the authors not only indicate in clear fashion the failure of relatively prolonged dexamethasone treatment to ameliorate the hospital course of infants with BPD (in a randomized prospective double-blind study), but they also clearly identify potential risk factors associated with dexamethasone treatment that are of concern to them as clinical investigators, risk factors based both on clinical and experimental animal studies.
The Use of Dexamethasone in Premature Infants at Risk for Bronchopulmonary Dysplasia or Who Already Have Developed Chronic Lung Disease: A Cautionary Note
Authors: AVERY GORDON B.
Published: December 2021

In Reply.—

Beauty, it is said, is in the eye of the beholder. One can read the literature on treatment of early bronchopulmonarly dysplasia (BPD) with dexamethasone and make the case either that the lady is beautiful or that she is ugly. On the beautiful side, most observers have noted a rapid improvement in lung compliance and a higher incidence of acute weaning off the respirator. Some studies have shown shortened time in oxygen and even shorter hospitalization.
Fever under 8 Weeks of Age and Urinary Tract Infection
Authors: CRAIN ELLEN F. , GERSHEL JEFFREY C.
Published: December 2021

In Reply.—

Dagan suggests that the infants in our sample with normal results of urinalysis may have had some other cause for their fever, although they had urine culture results that met Hellerstein's1 criteria for urinary tract infection (UTI). Five infants with catheter or suprapubic specimens identified as being at low risk for sepsis had normal urinalysis results. Dagan notes that in only two of these cases was the bacterial count > 105 colony-forming units (CFU).
Nosedrops and S.I.D.S
Authors: HICKSON GERALD B.
Published: December 2021

In Reply.—

The purpose of our paper was to examine the question of safety concerning over-the-counter (OTC) release of promethazine.1 Our stated opinion, that the drug is not appropriate for OTC release, was based on more than a suggested relationship with SIDS, but also on the drug's common side effect of sedation, ability to act as a cerebral stimulant even in therapeutic doses inducing hallucinations, convulsions and encephalopathy in some children, case reports concerning promethazine use and apparent life-threatening events, the potential for families to misuse this drug due to its sedative and antiemetic properties, and most importantly, FDA standards of safety for OTC medications which require "a low potential for harm which may result from abuse under conditions of wide spread availability."2
The Infant With Acute, Unexplained, Excessive Crying
Authors: Poole Steven R.
Published: December 2021

This study describes 56 infants who presented to the Emergency Department of The Children's Hospital of Denver during a 1-year period with an episode of excessive, prolonged crying, without fever and without a cause that was apparent to the parents. The final diagnoses included a broad array of conditions, of which 61% were considered serious. The history provided clues to the final diagnosis in 20% of cases. Physical examination revealed the final diagnosis in 41% and provided clues to the diagnosis in another 13%. Accurate diagnosis requires a thorough physical examination, which should include careful skin inspection underneath all clothing, palpation of all large bones, fluorescein staining of the cornea, eversion of eyelids, rectal examination, retinal examination, and thorough neurologic examination. "Screening" laboratory tests, except for urinalysis and urine culture, were of little help. This study indicates that for those patients in whom the physical examination is not diagnostic, the persistence of excessive crying after the initial examination predicts the presence of a serious cause. Those infants who cease crying before or during the initial assessment are unlikely to have a serious cause. Recommendations for a stepwise assessment are offered.
Reviews of Lay Literature in Child-Care: What Parents Are Reading
Authors: GLASCOE FRANCES PAGE , MOORE WILLIAM O. , BAUMGAERTEL ANNA
Published: December 2021

B. Ingersoll. Your Hyperactive Child: A Parents' Guide to Coping with Attention Deficit Disorder. New York: Doubleday, 1988; list price $8.95 (No. 19 on the 1990 bestseller list of books on child care from Ingram Book Co., distributor of trade books).

This scholarly book offers thorough coverage of current research on the medical aspects of attentional problems and yet manages to lend clarity to the topic. The description and inclusion of various behavior rating scales is quite helpful. Several of the fad treatments such as optometric training and dietary restrictions are thoughtfully discussed although rather gently dismissed. The book also offers brief but quality advice for teachers and parents on improving communication between home and school, keeping track of assignments, and use of token economies and other reward systems. Other valuable approaches such as self-monitoring and self-reinforcement, tutoring, summer school, and counseling receive insufficient attention. The most serious omission is the lack of emphasis on attentional problems in relation to academic deficits and the need to rule out learning problems as a part of making the diagnosis of Attention Deficit/Hyperactivity Disorder. Otherwise, the author offers excellent recommendations for parents on managing children's behavior and helping them with peer relationships.
Prolactin and Cortisol Levels in Various Paroxysmal Disorders in Childhood
Authors: Zelnik Nathanel , Kahana Luna , Rafael Anat , Besner Irit , lancu Theodore C.
Published: December 2021

The hormonal response of the anterior pituitary to various epileptic and nonepileptic events in children was studied. Postictal serum prolactin and cortisol levels were measured in 17 children with epilepsy, 23 with febrile seizures, and 10 with syncope or breath-holding spells. The levels were compared with those of 30 children with nonspecific fever, and 23 afebrile children served as control subjects. Significantly higher (P <.01) prolactin levels (26.5 ± 3.3 ng/mL, mean ± SEM) were found in the epileptic group, compared with levels in children with febrile seizures (13.2±1.0 ng/mL), fever (11.2±0.9 ng/mL), syncope (7.3±0.9 ng/mL), and the control group (7.9± 0.6 ng/mL). In contrast, serum cortisol levels were nonspecifically elevated in the epileptics and patients with febrile seizures or fever only. These findings suggest that elevated prolactin levels may be found after epileptic seizures and much less after febrile seizures, but not after breath-holding spells or syncopal events. Cortisol secretion appears to be nonselectively triggered by all stressful events, such as epileptic and febrile seizures, and fever. Elevated prolactin levels (>15 ng/mL) associated with seizures may help in differentiating epileptic from febrile seizures or syncope.
Legal Proof of Child Sexual Abuse in the Absence of Physical Evidence
Authors: De Jong Allan R. , Rose Mimi
Published: December 2021

Child sexual abuse criminal court cases from a 12-month period were reviewed to determine the frequency and significance of physical evidence in legally "proven" felony cases with penetration. One hundred fifteen consecutive cases were reviewed, and 87 (76%) had resulted in conviction of the perpetrator on felony charges. Charges of vaginal rape were made in 88 cases, and oral and/or anal sodomy in 67 cases. Physical evidence was present in only 23% of all cases that resulted in felony convictions. Felony convictions were obtained in 67 (79%) of 85 cases without physical evidence and in only 20 (67%) of 30 cases with physical evidence. Eight of the 10 cases without physical evidence that did not result in conviction involved victims younger than 7 years of age. Cases involving the youngest victims had a significantly lower conviction rate (12 of 23), despite a very high frequency (13 of 23) of physical evidence (P<.0005). Physical evidence was neither predictive nor essential for conviction. Successful prosecution, particularly in cases involving the youngest victims, depended on the quality of the verbal evidence and the effectiveness of the child victim's testimony.
Immunogenicity of Subcutaneous Versus Intramuscular Oka/Merck Varicella Vaccination in Healthy Children
Authors: Dennehy Penelope H. , Reisinger Keith S. , Blatter Mark M. , Veloudis Barbara A.
Published: December 2021

To compare the immunogenicity and safety of varicella vaccine by either subcutaneous or intramuscular injection, 166 healthy children aged 12 months to 10 years old who had no prior history of varicella were enrolled from two pediatric practices and randomly assigned to receive 0.5 mL of a single lot of varicella vaccine. Sera from the day of and 6 weeks postvaccination were tested for varicella antibody by gpELISA. Parents recorded clinical events occurring in the 6 weeks following vaccination. In the 132 evaluable children, the mean prevaccination titer was 0.3 gpELISA units for both groups. Sixty-three (97%) of the 65 receiving varicella vaccine by the subcutaneous route seroconverted compared with 67 (100%) of 67 immunized intramuscularly. Postvaccination geometric mean titer in the subcutaneous group was 6.9 ± 7.0 gpELISA units and did not differ significantly from the geometric mean titer of 10.5 ± 4.4 in the intramuscular group. Varicella vaccine was generally well tolerated by either route; 21% of both groups complained of reactions at the injection site and 7% had a varicella-like rash. Although varicella vaccine is recommended to be given subcutaneously, the results of this study indicate that inadvertent intramuscular administration of varicella vaccine is not reason for revaccination.
Sucrose as an Analgesic for Newborn Infants
Authors: BRUCK ERIKA
Published: December 2021

The very convincing and scientific article by Blass and Hoffmeyer' reminds me of one of my earliest recollections as a medical student. In 1930, in my first clinical semester, I audited a course in surgery given by Professor Ferdinand Sauerbruch, a brilliant and world-renowned surgeon—eccentric, dramatic, and not known for compassion with either patients or students. The lecture was given in a large amphitheater at the Charité (University Hospital) in Berlin; the subject was pylorormyotomy.
SHOULD THE DIRECTOR HAVE MADE A HOUSE CALL?
Authors: L. J. F.
Published: December 2021

Opportunities to woo political doubters are not ignored by NIH. Orrin G. Hatch, of Utah, was a typical anti-spending, anti-Government Republican when in 1981 he ascended to the chairmanship of the Senate Committee on Labor and Human Resources, which has NIH in its law-writing jurisdiction. Several years later, Senator Hatch explained how he underwent a political conversion, as far as NIH is concerned. "While showering one morning," he told a meeting of cancer specialists, "I found a lump under my arm. I felt I was going to die." Mr Hatch said he called the director of the National Cancer Institute, a component of NIH, "and he told me to come right out there." The lump was diagnosed as harmless. From then on, Senator Hatch was in the NIH camp.
BOY AWARDED $28.7 MILLION
Authors: L. J. F.
Published: December 2021

PHOENIX—A jury awarded $28.7 million to a 5-year-old boy, who contracted AIDS through an unauthorized blood transfusion, and his parents in what his attorney believes is the largest award of its kind.

The Maricopa County Jury on Friday awarded $26.7 million to Alex Edwards and $1 million to each of his parents, Roy and Pat Edwards.

The jury on May 23 found [the physician and his group] liable for Alex's AIDS infection through the unauthorized transfusion shortly after the boy's birth in 1985.
Technical Skills Required in General Pediatric Practice
Authors: Oliver Thomas K. , Butzin Diane W. , Guerin Robert O. , Brownlee Robert C.
Published: December 2021

Several years ago the American Board of Pediatrics developed a list of 101 technical procedures, which was sent to directors of accredited pediatric programs (N = 231). There was a 70% response and 72 of 101 procedures were considered necessary for residents to develop competency by at least 80% of the program directors. The list of 72 procedures was then sent to 500 randomly selected general pediatricians from a pool size of 10 304. The response rate was 35%. Forty-nine of the 72 procedures were considered necessary by 80% of those responding and one third of the skills (24 of 72) could be classified as absolutely necessary because more than 95% of practitioners considered them to be. Only 7 procedural skills were considered unnecessary by more than 50% of practitioners. It is suggested that program directors consider the 24 skills as ones that should be taught and competence in performing them be verified and recorded.
Pediatric Prehospital Care in Urban and Rural Areas
Authors: Seidel James S. , Henderson Deborah Parkman , Ward Patrick , Wayland Barbara Wray , Ness Beverly
Published: December 2021

There are limited data concerning pediatric prehospital care, although pediatric prehospital calls constitute 10% of emergency medical services activity. Data from 10 493 prehospital care reports in 11 counties of California (four emergency medical services systems in rural and urban areas) were collected and analyzed. Comparison of urban and rural data found few significant differences in parameters analyzed. Use of the emergency medical services system by pediatric patients increased with age, but 12.5% of all calls were for children younger than 2 years. Calls for medical problems were most common for patients younger than 5 years of age; trauma was a more common complaint in rural areas (64%, P = .0001). Frequency of vital sign assessment differed by region, as did hospital contact (P < .0001). Complete assessment of young pediatric patients, with a full set of vital signs and neurologic assessment, was rarely performed. Advanced life support providers were often on the scene, but advanced life support treatments and procedures were infrequently used. This study suggests the need for additional data on which to base emergency medical services system design and some directions for education of prehospital care providers.
Pediatrician's Practice Choices: Differences Between Part-time and Full-time Practice
Authors: Fritz Nancy E. , Lantos John D.
Published: December 2021

A national survey was used to study the differences in career and family patterns of pediatricians who work part-time (PT) vs those who work full-time (FT). A questionnaire mailed to 375 members of the American Academy of Pediatrics asked about age, marital status, number of children, type of practice, hours worked in particular duties, and attitudes about their choices. Sixty-five percent (n = 216) of the questionnaires were completed. The mean age of both the PT and FT women was 40 years, and FT men averaged 46 years. Thirty-seven percent of women had worked PT at some point in their careers; 21% were currently working PT. Only 70% of the FT women were married compared with 97% and 95% of PT women and FT men. The FT women had significantly fewer children (mean 1.27, compared with 2.34 for PT women and 2.39 for FT men). Part-time women in academic medicine tended to do little research or administrative work, but they had more teaching responsibilities. Almost all the PT women were happy with their decisions and careers despite the feeling among many that they had made career compromises. Many of the FT pediatricians wanted to work less. It is concluded that many women, particularly those with children, choose PT work in order to combine career and family duties. These choices may lead to different career paths for women pediatricians. By recognizing these different career paths, it may be possible for academic institutions to benefit from the unique contributions that PT women pediatricians can make.