bluuebunny/crossref_metadata_2025 huggingface dataset:
Extremity Injuries in Children: Predictive Value of Clinical Findings
Authors: Rivara Frederick P. , Parish Ruth Ann , Mueller Beth A.
Published: December 2021

This study sought to identify clinical predictors of extremity fracture in children with trauma. There were 189 children 1 to 15 years of age with 209 extremity injuries seen during a 9-month period. Gross deformity and point tenderness were the best predictors of upper extremity fracture; these two findings correctly identified 81% of children with fractures and 82% of these without fractures. Gross deformity and pain on motion best predicted lower extremity fracture, with 97% of children with fractures correctly identified. The study showed that physical examination is predictive of fractures in extremity injuries of children, regardless of age. In the absence of the specific physical findings identified by the study, the probability of diagnosing a fracture by roentgenographic findings is low.
State Reporting of Live Births of Newborns Weighing Less Than 500 Grams: Impact on Neonatal Mortality Rates
Authors: Wilson Ann L. , Fenton Lawrence J. , Munson David P.
Published: December 2021

The National Center for Health Statistics reports that in 1983 65% of all infant deaths in the United States occurred in the neonatal period. Of these reported neonatal deaths, 17% were of infants weighing less than 500 g at birth. There was, however, variation in state-reported incidence of live births of newborns in this weight cohort (0.2 to 2.2 per 1,000 live births). Thé states with the lowest neonatal mortality rate have the lowest incidence of birth weights less than 500 g (ρ = .77). If it is assumed that mortality for this weight category is nearly 100%, there is marked variation (5% to 32%) in the contribution of this weight cohort to a state's total neonatal mortality rate. Contributing to this variation may be definitions of live birth used by states. The World Health Organization defines a live birth as the product of conception showing signs of life "irrespective of the duration of pregnancy" and this definition is used by 33 states. Only one state (Ohio) includes the gestational criteria of "at least 20 weeks" in its definition of live birth. There is evidence to suggest that definitions are not uniformly used within individual states. For example, in 1983, 20 states did not report any live births with weights less than 500 g among their "other" populations of nonwhite, nonblack residents. Half of these states, however, use the World Health Organization definition of live birth. Despite the exclusionary wording in Ohio's definition of live birth, 16% of newborns who died in that state had birth weights less than 500 g. Inconsistency in state definitions and possible variations in reporting live births less than 500 g affect state comparisons of infant and neonatal mortality rates.
Prevalence of Positive Epicutaneous Tests Among Infants, Children, and Adolescents
Authors: Weston William L. , Weston Janet A. , Kinoshita Jacki , Kloepfer Sharon , Carreon Lawrence , Toth Sarah , Bullard Debra , Harper Katherine , Martinez Sandra
Published: December 2021

We studied 314 otherwise healthy children younger than 18 years of age with epicutaneous testing, and found that 20% of those tested had at least one positive epicutaneous test result. Neomycin, nickel, and potassium dichromate were the most prevalent allergens detected in our study group. We found that sensitization occurred at less than 5 years of age for all but fragrance allergens. Aluminum chambers and the American Academy of Dermatology Patch Test Kit were found to be safe for use in infants, children, and adolescents.
Individualized Behavioral and Environmental Care for the Very Low Birth Weight Preterm Infant at High Risk for Bronchopulmonary Dysplasia: Neonatal Intensive Care Unit and Developmental Outcome
Authors: Als Heidelise , Lawhon Gretchen , Brown Elizabeth , Gibes Rita , Duffy Frank H. , McAnulty Gloria , Blickman Johan G.
Published: December 2021

We hypothesize that the respiratory and functional states of the very low birth weight infant with bronchopulmonary dysplasia can be improved in the neonatal intensive care unit by prevention of inappropriate sensory input. To test this hypothesis, we developed for preterm newborns a behavior observation method that catalogues specific reaction patterns according to putative stress and relaxation behaviors. We then collected behavioral information and heart rate, respiratory rate, and transcutaneous PO2 readings before, during, and after routine care-giving interventions. Eight control and eight experimental infants were selected for study based on the following criteria: birth weight <1,250 g, gestational age <28 weeks, on the respirator >24 hours in first 48 hours of life at ≥0.6O FiO2 for more than two hours during first 48 hours of life. Additionally, the two groups were comparable on other medical and demographic variables, including severity of respiratory status for the first ten days and incidence of intraventricular hemorrhage, patent ductus arteriosus, and socioeconomic status. Systematic observations were conducted on days 10, 20, and 30 after birth and at 36 and 40 weeks postconception. For the intervention infants, our observations were discussed with the infants' primary nurses, and individualized modifications for each infant's care plan were implemented based on these observations. Experimental infants showed significantly briefer stays on the respirator (P < .01) and in increased FiO2 (P < .05). Their feeding behavior was normalized significantly earlier (P < .01). Experimental infants also showed significantly better behavioral regulation scores at 1 month after their mothers' estimated dates of confinement (post-EDC), as measured with the Assessment of Preterm Infants' Behavior, significantly better Mental and Psychomotor Developmental Indices at 3, 6, and 9 months post-EDC, as measured with the Bayley Scales of Infant Development, and significantly better behavioral regulation scores at 9 months post-EDC, as measured in a videotaped play observation. Measurements of weight, height, and head circumference at 3, 6, and 9 months post-EDC showed no differences. All assessments were performed by one of two trained testers not familiar with the goals of the study or the group status of the infant. These results support the hypothesis that very low birth weight preterm babies profit significantly both medically and developmentally from individualized behavioral care in the neonatal intensive care unit.
Questioning Role of Hypochloremia in Bronchopulmonary Dysplasia
Authors: GOODMAN GARY , PERKIN RONALD M.
Published: December 2021

To the Editor.—

In response to the article "Is Chloride Depletion an Important Contributing Cause of Death in Infants With Bronchopulmonary Dysplasia?" (Pediatrics l986;77:212-216), we are compelled to point out that furosemide (Lasix) therapy may well be directly responsible for the metabolic alterations observed. Hazinski (J Pediatr l985;l06:8l-85) beautifully demonstrated in rabbits that chronic furosemiode administration not only caused metabolic alkalosis (pH 7.46) associated with hypochloremia (Cl 84 mEq/L) but also resulted in compensatory alveolar hypoventilation and secondary respiratory acidosis (Paco2 55 mmHg).
Vesicoureteral Reflux in Asymptomatic Siblings of Patients With Known Reflux: Radionuclide Cystography
Authors: Van den Abbeele Annick D. , Treves S. Ted , Lebowitz Robert L. , Bauer Stuart , Davis Royal T. , Retik Alan , Colodny Arnold
Published: December 2021

The familial nature of vesicoureteral reflux among siblings of patients with vesicoureteral reflux has been reported to be from 8% to 32%. These included both symptomatic and asymptomatic siblings. The incidence of vesicoureteral reflux in asymptomatic siblings, however, has not been studied extensively. Sixty asymptomatic siblings of patients known to have vesicoureteral reflux were studied with radionucide voiding cystography. Their ages ranged from 2 months to 15 years (mean, 4.2 years). Vesicoureteral reflux was detected in 27 of 60 (45%) of the siblings. Vesicoureteral reflux was unilateral in 15 and bilateral in 12 of the siblings. Radionucide cystography is more sensitive than radiographic cystography and results in a very low radiation dose to the patient. The gonadal dose with radionucide cystography is only 1.0 to 2.0 mrads. Because of these features, radionuclide cystography is a nearly ideal technique for the diagnosis of vesicoureteral reflux in siblings of patients with known vesicoureteral reflux. All siblings (symptomatic or asymptomatic) of patients with known vesicoureteral reflux should have a screening radionuclide cystography.
Who Says There Is a Handgun Epidemic?
Authors: CHRISTOFFEL KATHERINE K. , CHRISTOFFEL TOM
Published: December 2021

In Reply.—

Dr Schrein raises two objections to our commentary on handguns: he (1) challenges the validity of our use of the term "epidemic" and (2) doubts whether the risk posed by handguns is greater than that of other consumer products, such as cars, BMX bikes, skateboards, and curling irons.

An epidemic is an "occurrence in a community or region of ...health related events clearly in excess of normal expectancy."1 The handgun death toll in this country meets this definition beyond any doubt.
Questions About Early Enteral Feeding Study
Authors: EDWARDS KAREN S. , JOHNSON ROBERT WOOD
Published: December 2021

To the Editor.—

Osterag et al (Pediatrics 1986;77:275-280) report that early feeding of sick very low birth weight infants does not increase the incidence of necrotizing enterocolitis. However, the authors failed to address the high likelihood of a false-negative result due to the small sample sizes.

With only 17 neonates in each group, the power of the study to detect an increase in the incidence of necrotizing enterocolitis from .35 to .55 is only 33%. In other words, there is a 67% chance that an increase of this size was missed.
Randomized Controlled Trial of Exogenous Surfactant for the Treatment of Hyaline Membrane Disease
Authors: Gitlin Jonathan D. , Soll Roger F. , Parad Richard B. , Horbar Jeffrey D. , Feldman Henry A. , Lucey Jerold F. , Taeusch H. William
Published: December 2021

We conducted a prospective, randomized, unblinded, controlled trial of exogenous bovine surfactant (surfactant TA) in premature infants requiring ventilator support for the treatment of severe hyaline membrane disease. Forty-one low birth weight infants with severe hyaline membrane disease were randomly assigned to saline or surfactant therapy and treated within eight hours of birth. Significant improvements in oxygenation (increased arterial/alveolar Po2) and respiratory support (decreased mean airway pressure) were seen in the group receiving surfactant within four hours after treatment. These improvements were maintained in the surfactant-treated infants, who also had fewer pneumothoraces and fewer number of days in environments of fractional inspiratory oxygen greater than 0.4 mm Hg. No problems were associated with administration of surfactant, and no acute side effects were detected. We conclude that exogenous surfactant, administered early in the course of severe hyaline membrane disease, is an effective therapy that can diminish the amount of respiratory support required during the first 48 hours of life.
Optimal Thermal Management for Low Birth Weight Infants Nursed Under High-Powered Radiant Warmers
Authors: Malin Seth W. , Baumgart Stephen
Published: December 2021

Servocontrol of skin temperature for the critically ill premature neonate nursed on a radiant warmer bed has been assumed to be analogous to skin temperature control for infants nursed in convection-warmed incubators. There are significant differences between these two warming techniques, and no definitive data exist to aid the clinical specialist in governing radiant warmer control. Eighteen low birth weight premature infants less than 2 weeks of age were studied under powerful overhead radiant warmers to determine the optimal skin temperature for servocontrol of radiant heater output. Anterior abdominal wall temperature was servocontrolled at 35.5°, 36.5° and 37.5°C in a randomized fashion for three periods of 90 minutes each after thermal equilibrium was established. Oxygen consumption was measured during the entire 90-mm sample period at each temperature by a computerized metabolic apparatus to determine the optimal thermal neutral control temperature defined as minimal oxygen consumption with normal body temperature. Skin, deep rectal, and environmental temperature measurements, as well as behavior assessments, were made concurrently. Oxygen consumption was significantly elevated at 35.5°C (8.62± 0.73 mL/kg/min, mean±SEM) compared with 36.5°C (7.30±0.55 mL/kg/min). Changing servocontrol temperature to 37.5°C produced no further significant decrease in oxygen consumption (7.41±0.70 mL/kg/min), and nine infants manifested supranormal deep rectal temperatures (>37.5°C). Optimal abdominal skin temperature control at 36.5°C (slightly warmer than previously reported but less than 37.5°C) is recommended for premature neonates nursed on radiant warmer beds. Frequent monitoring of core temperature for these infants is strongly recommended to avoid central hyperthermia.
Oral Vitamin E Supplementation for the Prevention of Anemia in Premature Infants: A Controlled Trial
Authors: Zipursky A. , Brown E. J. , Watts J. , Milner R. , Rand C. , Blanchette V. S. , Bell E. F. , Paes B. , Ling E.
Published: December 2021

Serum vitamin E levels are reduced in newborn infants. It has been reported that this deficiency is responsible, in part, for the development of anemia in premature infants during the first 6 weeks of life. The efficacy of vitamin E supplementation for the prevention of anemia in premature infants has been studied in a randomized, controlled, and blinded trial. Premature infants whose birth weights were less than 1,500 g were given, by gavage, 25 IU of dl-α-tocopherol or a similar volume of the drug vehicle. Treatment was continued for the first 6 weeks of life. A total of 178 infants were studied. Vitamin E levels were significantly higher in a supplemented group by day 3 and for the remainder of the 6-week period. At 6 weeks of age, there was no significant difference between the supplemented and unsupplemented groups in hemoglobin concentration, reticulocyte and platelet counts, or erythrocyte morphology. It is concluded that there is no evidence to support a policy of administering vitamin E to premature infants to prevent the anemia of prematurity.
Medicolegal Problems in the Management of Cardiac Arrhythmias in Children
Authors: Garson Arthur
Published: December 2021

Malpractice actions against pediatricians treating patients with arrhythmias have been recurrent in four general areas. Optimal medical management may not be widely recognized. Cases illustrating the following concepts are presented. (1) Intravenous verapamil therapy in babies may cause apnea, hypotension, and bradycardia; (2) continued episodes of atrial flutter in a child may cause sudden death; quinidine may be related to the death; (3) children with "familial seizure disorders" may in fact have the long QT interval syndrome. The QT interval must be measured on the ECG in patients with unexplained seizures; (4) "supraventricular tachycardia with aberration" is uncommon in children. Rapid heart rates with QRS complexes that are different from the sinus complexes are likely to be ventricular tachycardia. These situations must be recognized as potential problems and must be treated appropriately.
Deleading Dilemma: Pitfall in the Management of Childhood Lead Poisoning
Authors: Rey-Alvarez Susana , Menke-Hargrave Theresa
Published: December 2021

Deleading is a dangerous process which, if improperly done, can result in acute lead intoxication. The following case report illustrates what happened to an already-lead-poisoned child's lead level when he was not excluded from his apartment during deleading. Supportive evidence is provided from 12 additional cases recently seen by the same pediatric practice. The issues behind the failure of these families to vacate their apartments during deleading are discussed, and the need for lead-poisoning prevention programs to address these issues, particularly that of providing alternative shelter during deleading, is stressed. Society should adequately fund such programs so that they become a reality.
Vaginal Chlamydia trachomatis Prevalence in Sexually Abused Prepubertal Girls
Authors: Fuster Carlos Daniel , Neinstein Lawrence S.
Published: December 2021

The prevalence rate of Chlamydia trachomatis in the vagina of prepubertal sexually abused children was examined. Additionally, the culture technique was compared to direct immunofluorescence assay (DFA) for diagnosing chlamydial infections in the vaginas of prepubertal children. The study group included 50 consecutive prepubertal girls examined for sexual abuse in an urban pediatric hospital's emergency room. Vaginal swabs were obtained for culture and direct immunofluorescence assay of C trachomatis and for gonorrhea culture. of these, 8/47 (17%) of the Chlamydia cultures, 4/43 (9.3%) of the direct immunofluorescence assay specimens, and 0/49 gonorrhea cultures were positive for Chlamydia. All patients with positive findings by direct immunofluorescence assay also had positive chlamydial cultures. Of the four other patients with positive cultures for Chlamydia, two had negative findings by direct immunofluorescence assay and two had inconclusive results reported. Twenty-nine patients had a syphilis serologic study performed, and all had negative results. There was no significant difference between the Chlamydia-positive and -negative groups with regards to age, race, nature of the abuse, frequency of abuse, and symptoms or findings on physical examination. Although not statistically significant, children with cultures positive for C trachomatis reported rectal penetration five times and vaginal penetration twice as often as those children with C trachomatis-negative results. This study demonstrates a significant prevalence of vaginal chlamydial infections in sexually abused children. Vaginal cultures for C trachomatis should be included in the medical evaluation of sexually abused girls. The culture technique was superior to the direct immunofluorescence assay in this group of patients.
Microwave Oven Burns to Children: An Unusual Manifestation of Child Abuse
Authors: Alexander Randell C. , Surrell James A. , Cohle Stephen D.
Published: December 2021

Two children sustained full-thickness burns as a result of being placed in microwave ovens. Well demarcated burns occurred on the skin surfaces closest to the microwave-emitting devices. Morbidity was limited to complications of direct thermal effects. One of the children sustained a distinctive pattern of relative sparing of tissue layers without electrical burn features, such as nuclear streaming and charring, at the entrance site. In both instances eventual identification of this unusual etiology was initiated by child abuse concerns.
Elevated Catecholamine Levels and Abnormal Hypoxic Arousal in Apnea of Infancy
Authors: Rodriguez Antonio M. , Warburton David , Keens Thomas G.
Published: December 2021

Arousal from quiet sleep in response to a hypoxic challenge fails to occur in many patients with apnea of infancy. It was hypothesized that catecholamine-mediated responses might be involved in the depressed hypoxic arousal response in apnea of infancy and that these differences would be reflected in serum catecholamine concentrations. Fifteen infants with a median age of 5.5 months and a history of unexplained apnea during sleep were studied. Two hypoxic challenges (PiO2, 80 mm Hg) were given for three minutes or until arousal from quiet sleep occurred. Of the 15 patients with apnea of infancy 11 (73%) did not arouse to hypoxia. These infants had serum epinephrine levels that were elevated 4.1-fold while awake (P < .05), 3.4-fold during quiet sleep (P < .02), and 3.5-fold during hypoxia (P < .05). They also had serum norepinephrine levels that were elevated threefold while awake (P < .05), 5.3-fold during quiet sleep (P < .001), 3.2-fold during hypoxia (P < .02), and 12-fold during recovery from hypoxia (P < .001) in comparison with the corresponding levels in the four (23%) infants who aroused normally to hypoxia. It is speculated that elevated circulating catecholarnines are associated with abnormal hypoxic arousal responses in children with apnea of infancy.
Transcutaneous Oxygen Monitors Are Reliable Indicators of Arterial Oxygen Tension (If Used Correctly)
Authors: ROOTH G. , HUCH A. , HUCH R.
Published: December 2021

The following recommendations should always be kept in mind:

1. Each new transcutaneous equipment, or modification of equipment, must be adequately tested in vivo as well as in vitro.

2. The users must have basic understanding of the principles and the major requirements for applying the tcPo2 technique.

3. Calibration procedures must be carefully adhered to according to the manufacturer's instruction.

4. The temperature of the electrode must be kept at 44°C for premature infants and at 44° or 45°C for term infants if the clinical aim is to estimate arterial Po2 levels. Resetting of the electrode must then be done every two hours. For sick infants, this may be needed more frequently.

5. Whenever there is cause to compare tcPo2 values with arterial ones, the latter must be obtained from an appropriate vessel. Great care must be taken when drawing and analyzing blood for Po2. The infant should not be crying.

6. Significantly lower transcutaneous Po2 values than arterial Po2 values are due to either one or several of the errors indicated above or to an insufficient circulation under the electrode. In recent years, technical or clinical errors seem to have become more and more common. Thereby the technique has unjustly fallen into disrepute.

7. Insufficient circulation under the electrode rarely occurs in the newborn infant and then only in those who are in overt shock.
Medical Necessity for the Hospitalization of the Abused and Neglected Child
Authors:   Committee on Hospital Care
Published: December 2021

Denial of payment for services rendered to some children hospitalized with the diagnosis of child abuse or neglect has been called to the attention of the Committee on Hospital Care (COHC) of the American Academy of Pediatrics. Specifically, peer review organizations have denied that such admissions are medically required, regarding child abuse as a social rather than a medical problem. Refusals are particularly common if the final diagnosis does not identify a fracture or other physical problem.

The COHC believes that, in most areas of the country and for most children, the hospital remains the proper place for initial diagnosis and treatment of suspected child abuse and neglect. It is often the only facility available. Often, the diagnosis of the extent of injury is unclear and diagnostic tests that cannot be performed immediately on an outpatient basis are indicated. Monitoring of parent-child interactions by nursing, social service, and other staff cannot be accomplished in an outpatient setting. Attending physicians, who often may be unacquainted with the parents, will acquire information most rapidly and efficiently by working in conjunction with the hospital team. Accurate diagnosis and disposition are facilitated speedily. Refusal of payment could seriously interfere with the prompt and adequate investigation of suspected child abuse cases.

In addition, the hospital provides a haven during the diagnostic workup in which to ensure the patient's safety. Physicians may admit a child not only for medical evaluation but also to ensure that the all-important social evaluation takes place. Because abusive parents may not comply with the need to keep scheduled appointments, hospitalization is usually the only way to complete an assessment.
All-Terrain Vehicles: Two-, Three-, and Four-Wheeled Unlicensed Motorized Vehicles
Authors:   Committee on Accident and Poison Prevention
Published: December 2021

This Policy Statement was revised. See https://doi.org/10.1542/peds.2022-059279.

TWO-WHEELED VEHICLES

Miniature motorcycles intended for off-road use by children and adolescents have enjoyed wide popularity since the 1960s.1 Manufacture of these small two-wheeled motor vehicles is not regulated by any federal motor vehicle safety standards. Neither the rider nor the vehicle are required to be licensed. Some of these vehicles are small enough for a 4-year-old child and many are intended for use by school-aged children.2

Minibikes, weighing less than 45 kg (100 lb), are the smallest and most primitive of these vehicles. The more sophisticated minicycles are constructed to resemble miniature motorcycles. Trailcycles are larger than minicycles and have power and design characteristics that make them suitable for rough terrain. All of these vehicles have a short wheelbase and a low profile; thus, they are relatively unstable and poorly visible.3

Injuries

In 1978, there were approximately 19,000 motorbike-related injuries treated in emergency rooms. Nearly half of these injuries were attributed to accidents involving the minibike (US Consumer Product Safety Commission, news release, Aug 27, 1979). In 1982, there were an estimated 12,000 children 14 years of age and younger who suffered minibike- and trailbike-related injuries (National Electronic Injury Surveillance data, National Information Clearing House, US Consumer Product Safety Commission, 1985). Since 1980, the Consumer Product Safety Commission has collected at least 24 death certificates that implicate minibikes and trailcycles. Half of those who died were children 14 years of age or younger. Children often use these vehicles illegally on roadways. Injury typically results from falls or collisions with fixed objects or other motor vehicles.
Rheumatic Fever in Children and Adolescents in Hawaii
Authors: Chun L. T. , Reddy D. Venu , Yamamoto Loren G.
Published: December 2021

Case records of hospitalized children (age 4 to 18 years) with acute rheumatic fever on Oahu, HI, were reviewed for the 4-year period from Oct 1, 1980, to Sept 30, 1984. Ninety-eight cases met the modified Jones criteria. The overall incidence of rheumatic fever was 13.4 hospitalized children per 100,000 children per year and that for recurrent attacks was 2.5. Of the 98 with rheumatic fever, 73 had polyarthritis, 33 had carditis, and ten had chorea. Polynesian/part-Polynesian children accounted for 76 of the 98 cases. The incidence of rheumatic fever in Hawaiian/part-Hawaiian was 18.0 and for Samoan children was 206 hospitalized children per 100,000 per year. The relative risks were 7.7 and 88 times that of the white children, respectively. Rheumatic fever continues to cause significant morbidity in children in Hawaii, especially in Polynesian children.
Vitamin Dosages in Premature Infants
Authors: WALSH WILLIAM F.
Published: December 2021

The article "Evaluation of a Pediatric Multiple Vitamin Preparation For Total Parenteral Nutrition in Infants and Children" by Moore et al (Pediatrics 1986; 77:530-538) confused me. The study of vitamin levels is crucial to making recommendations, but why would the authors choose to give all premature infants 65% of the recommended dose for infants and children, when the package insert clearly states, "Infants less than 1 kg: the daily dose should not exceed 30% of the contents. Do not exceed this daily dose"?
STUDIES ON THE PREVENTION OF MUMPS
Authors: HENLE GERTRUDE , HENLE WERNER
Published: December 2021

THE development of satisfactory procedures for the propagation of mumps virus in the chick embryo has brought within reach the possibility of immunization against the disease. Before discussing the various approaches to prevention of mumps, it is well to define clearly the need for such vaccines and who should be vaccinated.

Mumps on the whole is a childhood disease and usually mild when restricted to the salivary glands. In the adult the disease may be more severe, particularly on account of socalled complications such as the involvement of the reproductive glands in the male. In view of this experience vaccination of children should be attempted only if (a) a prolonged immunity can be attained or (b) if certain other clinical conditions in the child render an attack of mumps undesirable at a particular time. In the latter case as well as in adults vaccination may he considered of value even if only a short term immunity can be induced. Vaccines appear desirable for susceptible parents, for instance, who have been exposed by their children, for hospital staffs in contact with mumps patients, and for college students or military personnel, where outbreaks of the disease may interrupt the normal course of training.

A second point to be considered concerns the question of susceptibility. It has been well established, particularly since the advent of specific immunologic procedures, that mumps virus causes overt disease in about two thirds of human beings; in the other third the infection remains inapparent but nevertheless induces permanent immunity.
AUREOMYCIN IN THE TREATMENT OF FIBROCYSTIC DISEASE OF THE PANCREAS
Authors: STOWENS DANIEL
Published: December 2021

A group of patients with fibrocystic disease of the pancreas was treated with aureomycin over periods of 12 to 24 months. Gratifying clinical improvement and increases in utilization of dietary protein were observed.
RETROPERITONEAL TERATOMAS IN INFANCY AND CHILDHOOD
Authors: ARNHEIM ERNEST E.
Published: December 2021

The histogenesis, pathologic and clinical features, diagnosis and treatment of retroperitoneal teratomas in infancy and childhood, based upon a study of 44 cases, are reviewed. Two cases of benign retroperitoneal teratomas with recovery, and one case of malignant retroperitoneal teratoma with subsequent death are presented.

Retroperitoneal teratomas were usually noted in female infants under the age of 1 year as large, left-sided, abdominal tumors extending into the lumbar region, rarely causing symptoms, and revealing areas of ossification on roentgen examination.

In this series 6.8% of the teratomas had undergone malignant changes, and 29.5% of the tumors were not operated upon and were described at autopsy.

Successful treatment of retroperitoneal teratomas was dependent upon early operation, careful operative technic through a liberal transperitoneal incision, and adequate preoperative and postoperative management. The operative mortality was 29%.

The histologic features constituted an important factor in prognosis: 10 cases of benign retroperitoneal teratoma in infancy and childhood were well for periods of over one year after operation, and no cure of malignant retroperitoneal teratoma has been reported in this age group.
INTRACRANIAL COMPLICATIONS OF CONGENITAL DERMAL SINUSES
Authors: MATSON DONALD D. , INGRAHAM FRANC D.
Published: December 2021

Ten patients are presented in whom intracranial extension of a congenital dermal sinus was disclosed by operation. The complications of this lesion include infection in the form of meningitis, abscess formation and osteomyelitis as well as hydrocephalus due to obstruction of the spinal fluid pathways.

In unexplained meningitis, the entire midline area of skin over the neural axis should be examined carefully for evidence of a dermal sinus opening. Whenever a dimple or subcutaneous mass is found in the midline of the scalp, RGs should be examined carefully for an underlying skull defect. When such a defect exists, intracranial exploration is indicated.

Surgical treatment previous to development of intracranial infection is relatively simple and should be rewarded by complete cure. Excision after infection has occurred is difficult and the results in this group have been poor.
PSEUDOMONAS AERUGINOSA INFECTION AS A COMPLICATION OF THERAPY IN PANCREATIC FIBROSIS (MUCOVISCIDOSIS)
Authors: GARRARD STERLING D. , RICHMOND JULIUS B. , HIRSCH MARVIN M.
Published: December 2021

Four cases of proved pancreatic fibrosis in which Ps. aeruginosa was the organism associated with the terminal, bronchopulmonary manifestations have been presented. These children had received prolonged antibacterial therapy varying from one to five years.

Ps. aeruginosa, or similarly resistant organisms, which ordinarily have a low pathogenicity, may become predominant and invasive as a result of prolonged antibacterial therapy. The opportunity for the emergence of resistant strains would seem to be enhanced by recent recommendations advocating continuous antibacterial therapy with a single compound. Intermittent therapy, alternating the various antibacterial agents and correlating their use with careful bacteriologic studies of the nasopharyngeal and tracheobronchial flora, would seem to be the logical approach to treatment in the light of present knowledge of the development of bacterial resistance. Mixtures of two antibiotics having a different mechanism of action may be more desirable than the use of a single agent.
CONGENITAL MEGACOLON (HIRSCHSPRUNG'S DISEASE)
Authors: SWENSON ORVAR
Published: December 2021

A NEW concept of the pathology and surgical treatment of congenital megacolon has been published. The pathology was described as absence of ganglion cells in Auerbach's plexus in the rectosigmoid and rectum. This segmental congenital defect in the myenteric plexus was postulated to account for the absence of peristalsis in the distal colon. Surgical resection of the functionally defective bowel relieved these patients. The following clinical experiences and experiments sustain this concept.

Colostomy above the rectosigmoid in four patients with congenital megacolon relieved abdominal distention and colonic stasis. Six months after colostomy closure, these four patients, in whom rectosigmoid resection was not performed, suffered a complete recurrence of the disease. Reopening the colostomy in these patients again relieved all their symptoms with return of the colon to approximately normal size. The dilatation and hypertrophy of the colon seem to have been secondary to a functional obstruction in the rectum and rectosigmoid.

Tracings of large bowel peristalsis were made to determine the nature of the rectosigmoid dysfunction. Three small rubber tubes with balloons attached were inserted through a transverse colostomy and positioned so that one balloon was at the splenic flexure, one in the descending colon, and one in the rectosigmoid. The balloons were inflated with 10 cc. of air and attached to recording manometers. Normal recordings were secured from two patients who had transverse colostomy as a result of right colectomy for gangrenous intussusception. The kymograph tracings showed a progression of the peristaltic waves from the transverse colon to the anus.
Round Table Discussion
Authors: MCGUINNESS AIMS C. , JODAR E. O. , MILLER JOHN FLEEK
Published: December 2021

I shall talk first about diphtheria, tetanus and whooping cough, and the use of single and then multiple antigens. Following this we will have a short period for discussion.

Diphtheria: Up to World War II it was generally assumed that most of the adult population of the United States was immune to diphtheria. Many studies since 1941 have shown this is no longer the case. Depending upon locality 25 to 50% of our adult population now is susceptible. Infants of susceptible mothers likewise are not immune, and there has been an increasing amount of diphtheria in infants under 6 months of age. This phenomenon, of course, is due to the steadily decreasing carrier rates. Immunity to diphtheria depends upon constant restimulation which now, in general, must be provided artificially. Immunity following active immunization cannot be counted on lasting more than 3 to 4 years.

Reactions to diphtheria toxoid have been one of the chief problems in diphtheria immunization, especially in older children and adults. Methods of purification developed by Pillemer and others in recent years have made available vastly superior toxoids which also contain considerably less alum than the pre-War products. One must remember, however, that some individuals are sensitive to toxoid itself, and such persons will react adversely to the material regardless of its freedom from impurities. Most infants and young children are not sensitive to diphtheria toxoid. Older children and adults should receive a Schick test and Schick test control prior to immunization in order to rule out those who definitely are sensitive to the material.
EFFECT OF ADRENOCORTICOTROPHIC HORMONE ON RHEUMATIC FEVER
Authors: DORFMAN ALBERT , SMULL KATHERINE , BERGENSTAL DELBERT M. , HOWARD ROBERT , MULLER RICHARD , OLESON DUNLAP , SENZ EDWARD
Published: December 2021

ACTH therapy represses the manifestations of active rheumatic fever including those of carditis. There is as yet no conclusive evidence as to whether ACTH therapy affects the natural course of rheumatic fever. A relatively large percentage of patients in this study showed evidence of reactivation of disease on withdrawal of drug.

As used in these studies ACTH therapy did not uniformly prevent death due to acute rheumatic pancarditis. There is no evidence to indicate whether treatment of active rheumatic fever with ACTH changes the incidence of late valvular deformities.
CASE OF ADRENOGENITAL SYNDROME WITH HYPERTENSION TREATED WITH CORTISONE
Authors: SHEPARD THOMAS H. , CLAUSEN SAMUEL W.
Published: December 2021

A 2½ year old patient with adrenogenital syndrome due to adrenal hyperplasia proved by biopsy and with the clinically unusual symptom of hypertension has been treated with cortisone acetate. This therapy resulted in reduction of the hypertension. The adrenogenital syndrome may be due to pituitary stimulation of the adrenal cortex. The hypertension possibly is due to compensatory zona glomerulosa changes secondary to abnormal secretion of adrenal androgens.
Health Codes for Newborn Care
Authors: Caravella Salvatore J. , Clark David A. , Dweck Harry S.
Published: December 2021

A survey was conducted of the health departments in each of the 50 states, Washington, DC, and the Commonwealth of Puerto Rico to determine the present legal mandates for newborn care. Each of the 52 health departments were queried regarding birth certificates, identification procedures, prophylactic eye care, umbilical cord care, use of vitamin K, Apgar scoring, and metabolic screening. In each category, the departments were asked whether the procedures were mandatory or optional. Birth certificates are uniformly required within the health codes of all states. Although in-hospital identification of newborns is required in most states, four states specifically require arm banding, and only New York State requires footprinting. Eye prophylaxis with silver nitrate is required in 49 states, with erythromycin or tetracycline allowed as topical alternatives in 42 states. Clamping of the umbilical cord is addressed by eight states. Parenteral vitamin K administration is mandated by only five states. Apgar scoring is addressed by 25 states. Newborn metabolic screening is available in every health department, although significant variations exist in the tests available.
Wrong Dose Warning
Authors: FIKAR CHARLES R.
Published: December 2021

To the Editor.—

I wish to bring to attention a potentially serious error appearing in Dr Hoekelman's recently published textbook.1 The concentration recommended for intracardiac epinephrine is 1:1,000, but the usually recommended concentration is 1:10,000.2 Diluting the 1:1,000 epinephrine may avoid complicating ventricular arrhythmias.
School Performance and Theophylline
Authors: SCHRIVER ROBERT C.
Published: December 2021

To the Editor.—

My interest in the article by Rachelefsky et al (Pediatrics 1986;78:1133-1138) stems in part from the heightened media coverage it received. I must admit as a professional biostatistician that I have some difficulties with regard to its conclusions.

The authors report a P value equal to .004 for the intergroup comparison of change scores for the teacher's behavioral assessment. However, the statistically significant change (P = .04), a reduction for placebo and an increase for theophylline, in the posttreatment score when compared to the pretreatment score is completely ignored.
Nationwide Survey on Kawasaki Disease in Japan
Authors: Yanagawa Hiroshi , Kawasaki Tomisaku , Shigematsu Itsuzo
Published: December 2021

Results of the statistical analysis of a nationwide survey of patients with Kawasaki disease diagnosed within a 2-year 6-month period, from July 1982 to December 1984, are as follows. (1) The cumulative number of patients reported by the end of 1984 was 63,399 (36,891 boys and 26,508 girls; male to female ratio 1.4). (2) There were two epidemic years, 1979 and 1982, in which the numbers of patients were more than twofold that of the previous years. (3) A curve plotted for age-specific incidence rate showed a unimodal peak at age 1 year. (4) Steroid therapy was used for 6.3% of the patients, aspirin for 89.8%, antibiotics for 57.6%, and γ-globulin for 11.4%. (5) The proportion of sibling cases was 1.4% and that of recurrent cases was 3.9% of all cases reported. (6) The incidence of cardiac sequelae in 1 month after disease onset was 17.2%.
Familial Apple Peel Jejunal Atresia: Surgical, Genetic, and Radiographic Aspects
Authors: Seashore John H. , Collins Francis S. , Markowitz Richard I. , Seashore Margretta R.
Published: December 2021

Fifty-seven cases of apple peel jejunal atresia have been reported in the English literature. Patients with this anomaly have a high incidence of prematurity (70%), malrotation (54%), short gut syndrome (74%), multiple atresias (15%), complications (63%), and mortality (54%). Mortality has decreased from 63% to 47% since 1970. We report three new cases of apple peel jejunal atresia, including two from one family. Radiographic evidence of high small bowel obstruction and a malrotated microcolon on preoperative roentgenogram with barium enema should suggest this diagnosis. Five families, including ours, have been reported in which more than one child was affected, and it has been suggested that this disorder is transmitted by an autosomal recessive gene. However, the occurrence of conventional intestinal atresia in other siblings, the association with multiple atresias, and discordance in a set of apparently monozygotic twins indicate that there may be a more complex spectrum of genetic transmission. Subsequent siblings are at increased risk for apple peel atresia or related malformations. Prenatal ultrasound can facilitate early diagnosis and treatment.
Multicenter Trial of Cryotherapy for Retinopathy of Prematurity: Preliminary Results
Authors:   Cryotherapy for Retinopathy of Prematurity Cooperative Group
Published: December 2021

We report the preliminary 3-month outcome of a multicenter randomized trial of cryotherapy for treatment of retinopathy of prematurity (ROP). Transscleral cryotherapy to the avascular retina was applied to one randomly selected eye when there was threshold disease (defined as five or more contiguous or eight cumulative 30° sectors [clock hours] of stage 3 ROP in zone 1 or 2 in the presence of "plus" disease). An unfavorable outcome was defined as posterior retinal detachment, retinal fold involving the macula, or retrolental tissue. At this writing, 172 infants had been examined 3 months after randomization. An unfavorable outcome was significantly less frequent in the eyes undergoing cryotherapy (21.8%) compared with the untreated eyes (43%). While the surgery was stressful, no unexpected complications occurred during or following treatment. These data support the efficacy of cryotherapy in reducing by approximately one half the risk of unfavorable retinal outcome from threshold ROP.
Relaxation and Examination for Sexual Abuse
Authors: HANSEN KAREN KIRHOFER , PALMER WILLIAM M.
Published: December 2021

To the Editor.—

We were pleased with the article by Herman-Giddens and Frothingham concerning physical findings in sexually abused girls (Pediatrics 1987;80:203-208). Their experiences were similar to ours after evaluation of more than 2,263 cases of alleged sexual abuse since 1980. No mention was made, however, of the effect of the degree of a patient's relaxation during the examination on the appearance of the vaginal opening. We have seen numerous children in whom the truly enlarged size of an apparently small vaginal opening became obvious when the patient relaxed.
Recommended Changes in Pediatric Education: The Impact on Pediatrician Involvement in Health Care Delivery to Adolescents
Authors: Chastain David O. , Sanders Joe M. , DuRant Robert H.
Published: December 2021

In an attempt to examine the extent of implementation of the recommendations issued by the Task Force on Pediatric Education for increased emphasis on adolescent medicine during residency training, pediatricians' perceptions of their skills and abilities to provide health care to adolescents were evaluated. A sample of 558 pediatricians selected at random and 385 members of the American Academy of Pediatrics' Section on Adolescent Health (SAH) completed a 41-item questionnaire. The physicians' perceived levels of skill in ten areas were analyzed while simultaneously assessing the impact of SAH membership, year of graduation from medical school, gender, and percentage of practice time devoted to adolescents on each issue. SAH members, as expected, ranked their levels of skill significantly higher than did the other pediatricians in all areas surveyed. A significant percentage of the SAH pediatricians, however, indicated that their skills were acquired through postresidency fellowship training. There was an increasing trend among all pediatricians in their perceived levels of skill to deliver health care to adolescents during the past several decades, but there has been no appreciable increase in such perceived skill levels since the task force issued its recommendations. In fact, pediatricians graduating from medical school in the decade prior to 1976 who are not SAH members ranked their skills higher than did non-SAH pediatricians who graduated in the past 10 years. These data lead to the conclusion that the recommendations of the Task Force on Pediatric Education have not been adequately implemented.
Cow's Milk Whey Protein Elicits Symptoms of Infantile Colic in Colicky Formula-Fed Infants: A Double-Blind Crossover Study
Authors: Lothe Lasse , Lindberg Tor
Published: December 2021

There are several causes of infantile colic. The aim of this study was to evaluate, under controlled conditions, whether bovine whey proteins can elicit symptoms of infantile colic in colicky formula-fed infants. The mean age for entering the study was 6.4 weeks and the mean age for colic debut was 3.7 weeks. In 24 of 27 infants with severe colic, the symptoms disappeared when they were given a cow's milk-free diet (Nutramigen). These 24 infants were entered into a double-blind crossover study. The infants (receiving cow's milk-free diet) were given the contents of identical capsules with each meal during day 6. The same procedure was repeated on day 10. The capsules contained either whey protein powder (with Nutramigen added) or human albumin powder (with Nutramigen added). Eighteen infants receiving the whey protein-containing capsules reacted with colic, two infants receiving placebo reacted with colic (P< .001), and four infants did not react at all. Crying hours per day for the 24 infants were 5.6 hours for formula-fed infants and 0.7 hour for cow's milk-free diet-fed infants (P< .001). Crying hours per day were 3.2 hours for the infants receiving whey protein capsules and 1.0 hour for those receiving placebo (P< .001). In conclusion, bovine whey protein can elicit symptoms of infantile colic in colicky formula-fed infants.