bluuebunny/crossref_metadata_2025 huggingface dataset:
Toxoplasmosis: Maternal and Pediatric Findings in 23,000 Pregnancies
Authors: Sever John L. , Ellenberg Jonas H. , Ley Anita C. , Madden David L. , Fuccillo David A. , Tzan Nancy R. , Edmonds Dorothy M.
Published: December 2021

An analysis of the antibody titers to toxoplasmosis for 22,845 pregnant women in the Collaborative Perinatal Project was conducted in relation to clinical and laboratory findings in the mothers and children through 7 years of age. More than 900 observations were considered for each mother and child. The major findings were in the children and included a predicted doubling in the frequency of deafness among children born to women with antibody to toxoplasmosis, a predicted 60% increase in microcephaly, and a 30% increase in low IQ (<70) in association with the presence of high maternal antibody titer (256 to 512) to toxoplasma. A serologically defined high-risk group of mothers was identified on the basis of high indirect hemagglutination antibody levels or seroconversions and increased IgM toxoplasma antibody levels (indirect fluorescent antibody ≥32, enzyme-linked immunosorbent assay ≥0.7). Of the 15 pregnancies in this group, two children had congenital toxoplasmosis and three were stillborn.
Oxygen-Induced Retinopathy in Newborn Rats: Effects of Prolonged Normobaric and Hyperbaric Oxygen Supplementation
Authors: Ricci Benedetto , Calogero Giuseppe
Published: December 2021

An experimental study was conducted to verify the effects of prolonged normobaric and hyperbaric oxygen supplementation on retinal vessels in newborn animals. Nine litters of newborn Wistar rats were used in the following way. Two litters were used as controls. Two other litters received normobaric oxygen supplementation (FiO2 80%) for five days after birth. These rats were then removed and kept for five more days in room air. Retinopathy with marked peripheral retinal neovascularization was seen in these litters. Three other litters were exposed to the same treatment for ten days after birth, removed from oxygen, and kept for 15 more days in room air. Severe retinopathy with extraretinal proliferation and, in some cases, retinal detachment developed in these animals. Two other litters received hyperbaric (1.80 atm) oxygen supplementation (FiO2 80%) for ten days after birth and were then kept for 15 days in normobaric room air. These animals showed no evidence of peripheral retinopathy. It is possible that moderate hyperbarism exerts, in the newborn rat, a protective action against the toxic effects of oxygen supplementation on immature retinal vessels.
Live Virus Vaccines in Human Immunodeficiency Virus-Infected Children: A Retrospective Survey
Authors: McLaughlin Margaret , Thomas Pauline , Onorato Ida , Rubinstein Arye , Oleske James , Nicholas Stephen , Krasinski Keith , Guigli Pamela , Orenstein Walter
Published: December 2021

Live virus vaccines can cause serious adverse reactions when administered to immunocompromised patients. Because children infected with human immunodeficiency virus (HIV) may be immunosuppressed, immunization of these children with live virus vaccines is a potential problem. A retrospective survey was conducted by the New York City Department of Health, with consultation from the Centers for Disease Control, to evaluate the frequency of serious adverse events following receipt of live vaccines among children with HIV infection receiving pediatric care in New York City and New Jersey. Outpatient records of 319 children being cared for by 16 participating physicians were reviewed. Of the 319 charts, 221 (69%) contained vaccination histories. Perinatal transmission of HIV infection was suspected for 208 (94%) of the 221 cases and infection via transfusion for the remaining 13 (6%). Of the 221 for whom immunization histories were available, 180 (81%) had received at least one dose of live oral polio vaccine and 70 (32%) had received measles, mumps, and rubella vaccine. There were 120 children for whom a temporal relationship between immunization and onset of symptoms of immunodeficiency could be seen; 46/120 had received at least one dose of oral polio vaccine and 23/45 had received measles, mumps, and rubella vaccine after onset of symptoms. Although follow-up of this population has been limited, there were no reports of serious adverse events such as typical or atypical measles, paralytic poliomyelitis, or aseptic meningitis in the month following vaccination. New York City Department of Health and New Jersey State Department of Health surveillance records for adverse vaccine events following immunization support these findings; no child with vaccine-associated illness was noted to have acquired immunodeficiency syndrome or related illness for the period 1979 to 1986. No evidence was noted of serious adverse reactions following receipt of live virus vaccines in HIV-infected children.
Harvesting Organs for Transplantation From Dying Anencephalic Infants
Authors: MILUNSKY AUBREY
Published: December 2021

Pediatricians, vested with the care of newborns with anencephaly or irreparable congenital cardiac defects, would naturally think about heart transplantation to save the otherwise healthy children. Indeed, parents of anencephalic newborns have publically declared their wishes to help others through organ donations from their own terminally ill infants. Their actions would give solace and some meaning to an otherwise unmitigated catastrophe. Unfortunately, acceptance of an act by such grieving parents, at once so sensitive, gracious, and wellintentioned, unwittingly invites a cascade of medical, ethical, moral, and legal dilemmas. Attempts to save one life may threaten the dignity (or even life) of another, albeit terminal and vegetative.
Predictive Value of Early Continuous Electroencephalogram Monitoring in Ventilated Preterm Infants With Intraventricular Hemorrhage
Authors: Connell J. , de Vries L. , Oozeer R. , Regev R. , Dubowitz L. M.S. , Dubowitz V.
Published: December 2021

The contribution of early continuous fourchannel EEG monitoring to the evaluation of intraventricular hemorrhage in acutely ill preterm infants mechanically ventilated for acute respiratory distress was assessed in a prospective study of 54 infants of less than 34 weeks' gestation. Early abnormal EEG results correlated significantly with later outcome. They often preceded ultrasound evidence of hemorrhage and provided prognostically significant functional correlation with the grade of hemorrhage. Continuous EEG monitoring allows collection of significant data with minimal interference and could contribute to clinical management of high-risk preterm infants.
Changing Pattern of Retinopathy of Prematurity: A 37-Year Clinic Experience
Authors: Hoon A. H. , Jan J. E. , Whitfield M. F. , McCormick A. Q. , Richards D. P. , Robinson G. C.
Published: December 2021

A retrospective analysis was done of multidisciplinary neurodevelopmental assessments in 70 children who were legally blind because of cicatricial retinopathy of prematurity. The subjects lived in British Columbia and were born during a 37-year period between 1951 and 1987. The purpose of the study was to investigate changes in the perinatal characteristics and to evaluate the associated handicaps. All patients were assessed at least once in the Visually Impaired Program, British Columbia Children's Hospital. In the majority, the visual loss was profound. Since 1951, blinding retinopathy of prematurity has become a disease of progressively smaller and less mature infants. Since 1981, it has been almost entirely confined to infants of birth weight less than 1,000 g in British Columbia. The diagnosis of mild spastic diplegia was made more commonly in patients born after 1980 but, despite the progressive reduction in birth weight and gestational age during the study period, the number of patients without other associated handicaps remained constant (approximately 30%) during each successive decade.
Metoclopramide-Induced Methemoglobinemia
Authors: Kearns Gregory L. , Fiser Debra H.
Published: December 2021

The case of a 3-week-old male infant is described. After receiving an iatrogenic overdose of metoclopramide (1.0 mg/kg every six hours) throughout a 36-hour period for the treatment of suspected gastroesophageal reflux, he became cyanotic, lethargic, and irritable, he fed poorly, and he had diarrhea and respiratory distress. Methemoglobinemia (20.5%) and reduced oxyhemoglobin saturation (79%) were identified. The patient had an excellent clinical response following a single IV dose of methylene blue. Subsequently, methemoglobin reductase activity was normal and there was no measurable hemoglobin M. The diagnosis of methemoglobinemia should be considered in any infant receiving large doses of metoclopramide who has clinical findings of cyanosis, ashen color, or a history of lethargy and/or motor restlessness.
Insect Repellent, N,N-Diethyl-m-Toluamide, Effect on Ammonia Metabolism
Authors: Heick H. M.C. , Peterson R. G. , Dalpe-Scott M. , Qureshi I. A.
Published: December 2021

There appear to be at least three mechanisms for systemic reactions to diethyltoluamide. As with most substances, allergy is possible. The ingestion of large doses can produce seizures and coma by a direct action on the CNS. This occurs in experimental animals in which seizures and coma followed by death can be produced rapidly if sufficiently large doses are given. Finally, with smaller systemic doses as may occur with absorption during heavy topical use, there is also the possibility of a perturbation of ammonia metabolism. Diethyltoluamide may then pose a substantial hazard to individuals with defects in ammonia metabolism.
Factitious Hematuria With Underlying Renal Abnormalities
Authors: SALMON RICHARD F. , ARANT BILLY S. , BAUM MICHEL G. , HOGG RONALD J.
Published: December 2021

Factitious hematuria is a well-described cause of hematuria in adult patients but is rarely seen or considered in children.1-6 In this article, a 5-year-old girl with a history of gross hematuria with more than one pathologic explanation for recurrent hematuria is described. Because of persistent symptoms despite appropriate therapy, a factitious cause was considered.

CASE REPORT

The patient was the healthy product of the uncomplicated full-term pregnancy of an unmarried woman who reared the child in the home of her mother and sister. The diagnosis of urinary tract infection was made first at 2 years of age. In subsequent radiographic studies, two normal kidneys were identified, with complete duplication of the left collecting system and bilateral grade 2 vesicoureteric reflux.
Public Disclosure of Private Information About Victims of Abuse
Authors:   Task Force on Child Abuse and Neglect
Published: December 2021

Publication of information about child abuse victims and their families may be detrimental to the victims. This is particularly true of sexual abuse but may be just as serious in some cases of physical abuse and neglect. Many states lack laws that restrict publicity on child abuse victims and their families. As a result serious harm to children has occurred.

The American Academy of Pediatrics recommends that all states adopt laws forbidding public disclosure in the mass media of information that identifies victims of child abuse, their families, and perpetrators, who may be minors, unless ordered by a judge who has jurisdiction, as in a dependency hearing or in the trial of a perpetrator. The judge's criteria for public disclosure should be that the public interest in the case is already great and that the risk of harm to the child is small. Furthermore, the Academy recommends that the media exercise great caution in publishing any information that includes the names of victims of sexual or physical abuse.
Reye Study Criticized
Authors: ORLOWSKI JAMES P.
Published: December 2021

In Reply.—

I appreciate Dr Hall's thoughtful and thorough critique of our article. I will address each of her points to show that our conclusions are just as logical and based on as much scientific data as her alternate interpretations.

First, Reye syndrome should be the same disease in Australia (and anywhere else in the world) as it is in the United States. As Hall points out, our series1 is remarkably similar not only to the original series of Reye et al2 but also to her own series in Great Britain,3 studies from Asia,4 a study from Ireland,5 a recent study from Spain,6 a report from France,7 and a recent study from West Germany.8
Do Encopretic Children Have Clinically Significant Behavior Problems?
Authors: Friman Patrick C. , Mathews Judith R. , Finney Jack W. , Christophersen Edward R. , Leibowitz J. Michael
Published: December 2021

Pediatricians are increasingly recognized as the providers of choice for children with functional encopresis. The presence of clinically significant behavior problems could interfere with pediatric regimens for encopresis, however. To study the extent to which encopretic children exhibit behavior problems, we compared the scores on a standardized behavioral checklist for three randomly selected samples: a sample group of children with encopresis, a sample group of children with behavior problems, and a sample group of children without encopresis or behavior problems. All thres samples were matched for age and gender. An analysis of variance showed that the scores of children with encopresis did not differ from the normative sample but were significantly lower than the scores from the behavior problem sample (P < .00001). The results support the appropriateness of the trend toward expanding the primary pediatrician's role in the treatment of encopresis.
Service Utilization and Psychiatric Diagnosis in Pediatric Primary Care: The Role of the Gatekeeper
Authors: Costello Elizabeth J. , Burns Barbara J. , Costello Anthony J. , Edelbrock Craig , Dulcan Mina , Brent David
Published: December 2021

Levels of morbidity in 789 children 7 to 11 years of age attending two primary care pediatric clinics in a health maintenance organization were examined in relation to psychiatric disturbance. Physical morbidity was measured as mean number of illness episodes per year enrolled, based on the child's medical record. Two measures of psychiatric disturbance were compared: the pediatricians' judgment and a detailed assessment using standard psychiatric interviews with parent and child. Children identified by pediatricians as disturbed had more than twice as many physical illness episodes as nonidentified children. Children identified by the standard psychiatric assessment had the same number of physical illness episodes as nondisturbed children. Pediatricians showed high specificity but low sensitivity to mental illness. Their sensitivity in the high user group was double that in the low user group. These results suggest that (1) the association between mental illness and high use may be, in part, the result of the confounding factor of physicians' judgment; (2) in settings where primary care practitioners serve as "gatekeepers" to mental health services, the offset effect of lower medical service use following psychiatric treatment may be partially explained by this; (3) the source of referral must be taken into account when assessing the offset effect in other settings.
Child Abuse Programs and Pediatric Residency Training
Authors: Dubowitz Howard
Published: December 2021

Child maltreatment has become an increasingly important concern for pediatricians. The purpose of this study was to assess, via mailed questionnaires, the training and resources of pediatric residents in the area of child maltreatment. Responses were received from 72% of all US programs. The median amount of training was eight hours during the first and third years of training and seven hours during the second year; approximately half of this was clinical supervision in the care of maltreated children. Eighty-one percent of programs had an interdisciplinary team for suspected cases of child maltreatment. Only 17 of 167 programs reported a separate budget for their team. Although two thirds of programs were rated as adequate or better, 79% of respondents wanted to strengthen their teaching efforts. There appears to be a limited commitment by residency programs to enhance the competency of pediatricians in the area of child maltreatment. There is a need for improved training and resources.
Drug Dispensing by Physicians: Promoter's Claims Examined
Authors: Andritz Mary H. , Rogan Matthew P.
Published: December 2021

Experience in private pediatric practice is used to illustrate some potential advantages and disadvantages to patients and physicians of drug dispensing by physicians. Projections were based on the prescribing trends in the practice, the extent of patients' insurance reimbursement for prescriptions, the laws regarding dispensing, and the costs incurred when physicians purchase selected medications from a repackager or when patients procure them at a community pharmacy. Patients without insurance for prescriptions can potentially save money by purchasing medication at the physician's office but, in general, only if the physician's dispensing fee is minimal. Potential profits to physicians would be cut by an estimated 50% because of third-party enrollees choosing to have prescriptions filled at a pharmacy because of cost savings. Net profits are further reduced and may even be eliminated when the cost of physician and staff time to prepare, label, reorder, and maintain necessary records regarding dispensed medication are considered. Although it may be convenient for the patient to obtain initial supplies of medication at the time of an office visit, obtaining refills may be less convenient. The time and paperwork involved in dispensing by a physician cannot be considered as minimal interruptions in normal office procedure. The broad, attractive claims made in support of physician dispensing by physicians clearly overstate the benefits both to patients and to physicians.
Collaborative Research: Once More Into the Breach
Authors: CHARNEY EVAN
Published: December 2021

In this issue, Christoffel and associates1 described a new program of practice-based research involving community pediatricians and the Department of Pediatrics at Children's Memorial Hospital in Chicago. In one sense, all clinical research is practice based and has a long and honorable history in medicine. What has changed is that the gap between those who conduct research and those in clinical practice has widened. As the pathophysiology of diseases is better understood, the frontier of biomedical science has moved from the whole patient to the organ system, the cell, and, now, the molecular level. It is as if each generation of researchers has snapped a progressively higher power lens under the microscope, with a deeper but more narrow focus.
Health Care Delivery to Adolescents and Young Adults by Pediatricians
Authors: SANDERS JOE M.
Published: December 2021

The study by Joffe et al1 presents data that suggest pediatricians have still not made a definitive commitment to providing health care for adolescents and young adults. Although this article might be subjected to criticism based upon the relatively small sample size, the demographics of the population surveyed, and the randomization techniques used in the collection of data from questionnaires, the conclusion that physicians, in general and pediatricians in particular, are failing to meet their obligations to this population is probably valid. This is particularly distressing given the priority that the American Academy of Pediatrics has placed on the delivery of health care to this age group.
Molybdenum Cofactor Deficiency: Another Inborn Error of Metabolism With Neonatal Onset
Authors: MATSUO MASAFUMI , MAEDA EISAKU , NAKAMURA HAJIME , SAIKI KAYOKO
Published: December 2021

To the Editor.—

We agree with Dr Burton1 that the practicing physician has the responsibility for the initial recognition of inborn errors of metabolism. Because we have experienced many cases of inborn errors of metabolism in neonates who might have died soon after birth without a proper diagnosis, we advocate that every neonatologist has the responsibility of recognizing these disorders. To promote the early recognition, we must know the initial signs or symptoms of neonatal cases of inborn errors of metabolism and we have collected neonatal case reports in the literatures during the last 5 years.
Abnormal Pulmonary Outcomes in Premature Infants: Prediction From Oxygen Requirement in the Neonatal Period
Authors: Shennan Andrew T. , Dunn Michael S. , Ohlsson Ame , Lennox Kathryn , Hoskins Elizabeth M.
Published: December 2021

The follow-up records of 605 infants with birth weights of less than 1,500 g, with data available for 2 years after birth, were examined for evidence of abnormal pulmonary signs or symptoms. A total of 119 infants were identified and the neonatal oxygen requirements of these infants were compared with those of 486 infants who had normal pulmonary function. A requirement for oxygen at 28 days of life had a positive predictive value for abnormal pulmonary findings at the time of follow-up of only 38%, whereas 31% of those with normal pulmonary findings at the time of follow-up were still receiving oxygen at this age. The need for oxygen at 28 days was a good predictor of abnormal findings in infants of ≥3O weeks' gestational age at birth but became increasingly less useful as gestational age decreased It was found that, irrespective of gestational age at birth, the ment for additional oxygen at 36 weeks' corrected postnatal gestational age was a better predictor of abnormal outcome, increasing the positive predictive value to 63%. The prediction of a normal outcome remained 90% for infants not receiving oxygen at this corrected gestational age.
Ocular Findings in Infants Treated With Extracorporeal Membrane Oxygenator Support
Authors: Patrias Martin C. , Rabinowicz I. Matthew , Klein Michael D.
Published: December 2021

Eleven infants treated with extracorporeal membrane oxygenator support were examined for ocular complications. Four patients were noted to have retinal and external ocular vascular changes on the left but not on the right. These unilateral findings are believed to be related to right common carotid and internal jugular occlusion. The proposed mechanism involves three factors: cerebral venous congestion, impairment of cerebral and possibly retinal arterial autoregulation, and higher cerebral arterial blood flow on the left compared with the right.
Decline in Mortality Among Young Americans During the 20th Century: Prospects for Reaching National Mortality Reduction Goals for 1990
Authors: Hoekelman Robert A. , Pless I. Barry
Published: December 2021

A review of mortality data for persons younger than 25 years of age in the United States reveals striking declines in death rates since the turn of the century. Mortality among infants during their first year of life decreased from 1 in 6 in 1900 to 1 in 100 in 1986. Between 1900 and 1984 the annual death rate for children 1 through 4 years of age decreased from 1 in 50 to 1 in 2,000, for children 5 through 14 years of age, from 1 in 250 to 1 in 4,000, and for persons 15 through 24 years of age, from 1 in 165 to 1 in 1,000. Public health measures, advances in medical science, legislative initiatives, and the organization and delivery of health care have all contributed to these improvements in varying degrees during different decades. For the decade 1975 through 1984, the overall death rate decreased by 20%, with declines for all causes except suicide, cardiovascular diseases, and renal diseases. All of the surgeon general's mortality reduction goals for 1990 for America's youth should be reached except those for infant mortality and suicide. Improvement in these death rates will require better access to health care by those in need and reductions in environmental stress.
Elevated Levels of Hypoxanthine in Vitreous Humor Indicate Prolonged Cerebral Hypoxia in Victims of Sudden Infant Death Syndrome
Authors: Rognum Torleiv O. , Saugstad Ola D. , Øyasæter Stephanie , Olaisen Bjømar
Published: December 2021

Hypoxanthine levels in vitreous humor from 32 infants who died of sudden infant death syndrome (SIDS) were determined and compared with levels found in eight children who died of trauma, drowning, or hanging and with levels from seven neonates dying suddenly without long-standing antemortem hypoxia. Determination of hypoxanthine level was done with either a Po2 electrode method or high-performance liquid chromatography. The results obtained by both methods were significantly correlated therefore they were pooled. The median hypoxanthine level in victims of SIDS (380 µmol/L) was significantly higher (P < .001) than in the children who died violently (118 µmol/L). Moreover, the levels from the SIDS victims were significantly higher (P < .001) than those from the neonates who died without long-standing hypoxia (53 µmol/L). It is concluded that SIDS is probably not a sudden event but may be preceded by a relatively long period of respiratory failure and hypoxia.
47, XXX: What Is the Prognosis?
Authors: Linden Mary G. , Bender Bruce G. , Harmon Robert J. , Mrazek David A. , Robinson Arthur
Published: December 2021

Eleven unselected 47, XXX girls, now 15 to 22 years of age, have been observed from birth in a prospective study of children with sex chromosome anomalies. A description of their growth and development is presented. The 47, XXX infants were not generally distinguishable from chromosomally normal children in the first year of life, even though there was a slight delay in neuromotor development. By 2 years of age, developmental delays in speech and language often became evident, and speech therapy was often necessitated in the preschool years. Early school problems included speech and language deficiencies, lack of coordination, poor academic performance, and immature behavior; these persisted throughout the school years. By high school age, a 47, XXX girl was generally tall and often subject to somatic complaints. Sexual development was generally normal. Seven of the 11 propositae had a diagnosed psychiatric disorder or disturbance at some time during adolescence. Variability within this syndrome is great; one proposita is in college and another is mentally retarded. The frequency of the diagnosis of the 47, XXX karyotype by genetic amniocentesis is estimated to be 1/1000, the same incidence as in the newborn population. Expectant parents must be counseled as to the significance of this karyotype and prognostic information must be given. Suggested guidelines are included.
Massive Levothyroxine Overdose: High Anxiety—Low Toxicity
Authors: GORMAN RICHARD L. , CHAMBERLAIN JAMES M. , ROSE S. RUTHERFOORD , ODERDA GARY M.
Published: December 2021

The acute toxicity of levothyroxine ingestion is influenced by the dose ingested, the rate of conversion of thyroxine (T4) to triiodothyronine (T3), and the level of medical intervention. Approximately 21 million prescriptions for thyroid products were dispensed in the United States in 1986, accounting for 1.4% of all prescriptions. This wide availability leads to frequent acute overdoses. In 1986, the American Association of Poison Control Centers Data Collection System documented 2,231 acute toxic exposures to thyroid preparations.1

Several articles have appeared in the past few years concerning the relative toxicity and treatment of a patient with an acute ingestion of levothyroxine preparations.2-7
Religion and Child Abuse
Authors: FLETCHER JAMES L.
Published: December 2021

To the Editor.—

I read with interest in the January issue the statement by the American Academy of Pediatrics' Committee on Bioethics1 regarding religious exemptions from child abuse statutes. The Committee is to be commended for making it clear that they seek no vendetta but rather desire the "even" application to all caretakers of preventive measures for neglect and abuse of children. It is also well-stated that there are "two important sets of interest ... in apparent opposition—those of children in the benefits of proven medical and health care and those of parents in making decisions about their children's well being."1(p170)
Dosage of Acetylcysteine in Acetaminophen Poisoning
Authors: RUCK BRUCE , CARACCIO THOMAS R. , MOFENSON HOWARD C.
Published: December 2021

To the Editor.—

We received several calls from physicians planning to treat acetaminophen overdoses in adolescents with five doses of N-acetylcysteine (Mucomyst), orally. These physicians indicated that they obtained these guidelines from the Harriet Lane Handbook.1

The Harriet Lane Handbook1(p248) states the following "PO or NG: Mucomyst diluted 1:4 in a carbonated beverage as a loading dose of 140 mg/kg, then 70 mg/kg Q 4h for 5 doses (some recommend 18 doses)." The references cited in the handbook2,3 do not recommend five oral doses of N-acetylcysteine as stated and we could not find this recommendation in any other references.
Dosage of Acetylcysteine in Acetaminophen Poisoning
Authors: BRENT JEFFREY , RUMACK BARRY H. , KULIG KENNETH W.
Published: December 2021

To the Editor.—

The current (11th) edition of the Harriet Lane Handbook contains several serious errors we wish to bring to your attention. These are (1) an incorrect and inadequate 24-hour oral dosage regimen for which there is no scientific basis, (2) a dangerous recommendation for administering oral Mucomyst intravenously, (3) a suboptimal intravenous dosage regimen, (4) the erroneous assertion that N-acetylcysteine (NAC or Mucomyst) therapy is ineffective if initiated longer than ten hours postingestion, and (5) an incorrectly adapted nomogram for determining acetaminophen toxicity.
A Catch in `a Catch in the Reye'
Authors: ORLOWSKI JAMES P.
Published: December 2021

In Reply.—

Remington and his colleagues fail to explain why, if aspirin use increases the risk of Reye syndrome developing by 20-fold, the incidence of Reye syndrome in Australia is approximately the same as in the United States. To find that Reye syndrome is just as common in a medically sophisticated country where pediatric aspirin use is practically nonexistent contradicts aspirin as a risk factor.

Remington et al continue to relate the decline in the use of aspirin in the United States with a decrease in the incidence of Reye syndrome.
AIDS-Associated Lymphoma of the Brain in a Child
Authors: COCCHI PIETRO , CALABRI GIUSEPPE , SALVI GIUSEPPE , NIERI ROSSELLA , DE MARTINO MAURIZIO , DI LOLLO SILVIA
Published: December 2021

To the Editor.—

Non-Hodgkin primary lymphoma of the CNS in children with human immunodeficiency virus (HIV) infection has now been included by the Centers for Disease Control in the classification system of pediatric acquired immunodeficiency syndrome (AIDS).1 We report here a lymphoma of the brain associated with AIDS in a 12-month-old child.

The patient was a male infant, weighing 3,000 g at birth, born to a former intravenous drug-addict HIV-seropositive mother. His growth had always been poor.
Congenital Absence of the Hymen Only a Rumor?
Authors: MOR NAOMI , MERLOB PAUL
Published: December 2021

To the Editor.—

The authors of a recent article1 examined the hymenal anatomy in 1,131 newborn infants without major anomalies of the urogenital tract. Congenital absence of the hymen was not observed in this study, and its frequency was Calculated to be 0.00265 or less than 0.3%. They concluded that the lowest estimation of the frequency of this genital anomaly would be essentially zero.

As part of our monitoring system to determine the incidence of congenital malformations in our newborn population, we examined2 25,068 female newborns between 1974 and 1987.
Natural History of Fetal Ventriculomegaly
Authors: Hudgins Roger J. , Edwards Michael S.B. , Goldstein Ruth , Callen Peter W. , Harrison Michael R. , Filly Roy A. , Golbus Mitchell S.
Published: December 2021

The natural history of in utero ventriculomegaly was defined by a retrospective review of the outcome of 47 fetuses evaluated during a 5-year period by the Fetal Treatment Program at the University of California. In 20 fetuses, a diagnosis of ventriculomegaly associated with other severe abnormalities was made early in pregnancy. Termination of pregnancy was elected in 19 of 20 cases, and no fetus survived. In five fetuses, the diagnosis was made late in pregnancy and was associated with severe abnormalities. Fetuses were handled in a routine obstetric fashion and none survived. Of the other 22 fetuses 19 had stable and two had progressive ventriculomegaly; in one case, ventriculomegaly resolved in utero. Nineteen of these fetuses have survived, 13 with normal intellectual development and six with moderately to severely delayed development. Associated abnormalities were detected with ultrasonography in 74% of fetuses; there was a 20% false-negative rate of detection. Ventriculomegaly was isolated and progressive in two fetuses. In both cases, fetuses were delivered at term, and postnatally a shunting procedure was performed. Both children are neurologically normal. From our results and a review of the literature, which supports our findings, we were unable to define a group of fetuses with in utero ventriculomegaly that would benefit from in utero shunting.
Polysomnographic Studies of Infants Who Subsequently Died of Sudden Infant Death Syndrome
Authors: Kahn A. , Blum D. , Rebuftat E. , Sottiaux M. , Levitt J. , Bochner A. , Alexander M. , Grosswasser J. , Muller M. F.
Published: December 2021

The polygraphic findings from 11 future victims of sudden infant death syndrome (SIDS) are reported and compared with those of matched pairs of control infants. The recordings had been done to alleviate parental anxiety about sleep apnea. Four infants had siblings who were victims of SIDS. Two infants were studied 3.5 to 9.5 weeks before their deaths because of an unexplained apparent life-threatening event that had occurred during sleep. For each victim of SIDS, two control infants were selected from the 2,000 infants who had been tested in the same hospitals. They were matched for sex, gestational age, postnatal age, and weight at birth with the SIDS victims. Their polygraphic recordings had been performed within similar conditions. Each record was allocated a random code number and was analyzed without knowledge of the patient's identity by two independent scorers. Most sleep and cardiorespiratory variables studied did not differentiate SIDS victims from control infants. Only four variables significantly characterized the future SIDS victims: the maximal duration of central apneas, the number of sighs followed by a central apnea, the presence of obstructive apneas, and the presence of mixed apneas. Central apneas were longer during all sleep states in the SIDS victims compared with their matched controls, but none exceeded 14 seconds. Sighs immediately followed by an apnea were significantly less frequent in the future SIDS group. Obstructive and mixed sleep apneas were seen in eight of 11 SIDS victims and in only three of 22 control infants. They were significantly more frequent (total number of episodes: 89 in the SIDS group and three in the control group) and lasted longer in the SIDS victims than in the control group. The present data thus confirm some previous reports of an increase in obstructed breathing in infants who eventually die of SIDS. The observation of a reduced number of sighs followed by an apnea in this group raises the possibility of a lower peripheral chemoreceptor response in some of these infants. Although these observations do not establish risk predictors for infants who eventually become victims of SIDS, they add further indirect evidence for a possible sleep-related impairment of respiratory controls in some of these infants.
Acquired Circulating Anticoagulants in Children With Acquired Immunodeficiency Syndrome
Authors: Burns Edward R. , Krieger Ben-Zion , Bernstein Larry , Rubinstein Arye
Published: December 2021

The mechanism underlying the prolonged activated partial thromboplastin time (APTT) seen in some pediatric patients with acquired immunodeficiency syndrome (AIDS) and opportunistic infections was studied. A circulating inhibitor of coagulation was demonstrated in three patients. The inhibitor appears to be an immunoglobulin that interferes with some of the phospolipid-dependent coagulation reactions of the intrinsic pathway. This "AIDS anticoagulant" does not predispose the patient to clinical bleeding despite its ability to cause a marked prolongation of the APTT. As such, careful laboratory diagnosis of the cause of abnormal coagulation test results is necessary for children with AIDS.
Bilirubin Measurement Problems
Authors: MAISELS M. JEFFREY
Published: December 2021

In Reply.—

It is difficult to measure small concentrations of direct-reacting bilirubin accurately, particularly in the presence of significant indirect hyperbilirubinemia.1 Dr Pleasure's report draws attention to an important issue that has plagued us for many years, and it is distressing to note that there is little evidence that the situation has improved significantly during the last three decades.2-4

Two recent surveys disclosed high levels of interlaboratory variation in the measurements of total and direct serum bilirubin concentrations in neonatal sera.3,4
Renal Malformations in Patients With Turner Syndrome: Imaging in 141 Patients
Authors: Lippe Barbara , Geffner Mitchell E. , Dietrich Rosalind B. , Boechat M. Ines , Kangarloo Hooshang
Published: December 2021

Turner syndrome occurs in 1/2,000 to 1/5,000 live female births. The presence of renal malformations was evaluated in 141 patients with Turner syndrome and abnormalities were found in 47 (33%). Prior to 1980, IVP was the radiologic method used for initial screening, and subsequently, ultrasonography has been used as the initial imaging technique. With both methods, major malformations can be detected. Ten patients had a horseshoe kidney, 11 had double collecting systems, four had complete absence of one kidney, three had crossed ectopia, and one had a pelvic kidney. Three patients had ureteropelvic junction obstruction; two of these were asymptomatic and the obstructions were detected only because of the routine imaging. Two patients had ureterovesicular junction obstruction, with one studied as part of a routine evaluation for short stature. Four of these five patients required surgery. Ultrasonography should be used as the initial renal imaging study for all patients at the time the diagnosis of Turner syndrome is made.
Postoperative Necrotizing Fasciitis in Children
Authors: Farrell Leo D. , Karl Stephen R. , Davis Paul K. , Bellinger Mark F. , Ballantine Thomas V. N.
Published: December 2021

Necrotizing fasciitis is a rapidly progressive soft tissue infection, involving the skin, subcutaneous tissue, and superficial fascia. It is a rare but life-threatening complication in the postoperative patient. In the last 7 years, we have treated four children in whom necrotizing fasciitis developed after appendectomy for ruptured appendix, bilateral inguinal herniorrhaphy, or gastrostomy closure. These four patients and seven well-described children from the literature with necrotizing fasciitis following surgery form the basis of this review. The ages ranged from six days to 15 years (ean 4.5 years). There were eight boys and three girls. There were five clean, five clean-contaminated, and one contaminated surgical procedures. No patient had evidence of malignancy or diabetes. Two of our four patients had evidence of failure to thrive. Only one patient had an intraabdominal abscess. In ten, the infection started in the abdominal wall; in one, the infection started in the chest wall. In our four patients, three had neutropenia and fever, four had tachycardia, and two had wound crepitation and radiographic evidence of subcutaneous gas. Cultures of all ten wounds were positive for bacteria; six were positive for more than one organism. Blood culture results were positive in five of five patients who died and in only two of five patients who survived. All survivors had wide surgical debridement and were treated with broad-spectrum antibiotics. The mortality rate was 45% in the whole series. In our four patients, the only death occurred in a child with Down syndrome and failure to thrive whose parents refused further therapy. Necrotizing fasciitis may complicate clean surgical procedures in children without risk factors. Septicemia is a late and ominous sign. Early wide surgical debridement and broad-spectrum antibiotic use are necessary for survival. Skin grafting is often required for late coverage of these defects.
Transient Renal Dysfunction of the Neonate
Authors: HIJAZI ZIYAD , KELLER MARC S. , GAUDIO KAREN M. , SIEGEL NORMAN J.
Published: December 2021

We recently observed three neonates with transient oliguric acute renal failure associated with characteristic ultrasonographic findings. Their clinical courses, laboratory values, and ultrasonographic findings are discussed. The purpose of this report is to alert those who care for newborn infants to this entity of transient renal dysfunction and its characteristic ultrasonographic findings in the kidney.

CASE REPORTS

Case 1

A full-term girl weighed 3,770 g at birth and was delivered by vacuum extraction because of shoulder dystocia. Her mother's pregnancy was complicated by premature rupture of membranes of greater than 24 hours' duration and maternal fever with amnionitis at delivery. At birth the baby had a weak cry, decreased tone, and Apgar scores of 6 and 8, at one and five minutes, respectively.
Surfactant Replacement Therapy: Impact on Hospital Charges for Premature Infants With Respiratory Distress Syndrome
Authors: Maniscalco William M. , Kendig James W. , Shapiro Donald L.
Published: December 2021

Surfactant replacement therapy for neonatal respiratory distress syndrome has the potential to reduce morbidity and mortality of very premature infants. To investigate whether surfactant replacement therapy will also reduce hospital charges for these infants, we compared the hospital charges incurred by a group of patients treated with surfactant with charges of control patients. Mortality in the surfactant-treated group (8%) was significantly decreased compared with the control patients (29%). Average daily hospital charges in the surfactant-treated patients were 25% less than for the control patients. Most of the savings in daily hospital charges were due to a 52% reduction in daily charges for laboratory, x-ray, respiratory therapy, and other ancillary services. Similarly, ancillary charges for the first full week of hospitalization were significantly reduced by $1,883 for patients who received surfactant therapy. Analysis of the charges for the entire hospitalization revealed that surfactant-treated patients had a significantly smaller proportion of their charges that resulted from ancillary services and an increased proportion due to room charges. The average total hospital charges for the two groups were similar, but the total hospital charges to produce a surviving infant were $18,500 less in the surfactant-treated group than the charges to produce a survivor from the control group. It is likely that, in addition to a reduction in neonatal mortality and morbidity from respiratory distress syndrome, surfactant replacement therapy may also significantly reduce charges for ancillary services for these patients. In this way, surfactant therapy may be cost-effective by improving survival without increasing overall hospital costs.
Care of Adolescent Parents and Their Children
Authors:   COMMITTEE ON ADOLESCENCE
Published: December 2021

Adolescent parents and their children represent populations at increased risk for medical, psychologic, and social problems. The scope of the problem of adolescent pregnancy and the attendant obstetric/ perinatal complications are summarized in the American Academy of Pediatrics' paper, "Adolescent Pregnancy." Despite a decline in the rate of births to adolescents, the absolute number remains relatively constant because of the increase in adolescent girls. The number of children living with teenage mothers, therefore, remains significant. The health, psychosocial, and educational risks for children of young parents and the role of the pediatrician in prevention or early intervention to reduce those risks will be emphasized here.

MEDICAL RISKS TO INFANT AND MOTHER

Despite dramatic declines in maternal mortality and neonatal death rates in the past 40 years, related at least in part to improved availability and accessibility of obstetric and perinatal care, disproportionately high rates of both maternal and neonatal deaths continue to occur in young adolescents. This is especially true among nonwhite adolescents. Infant mortality coded with reference to the age of the mother varies among different localities, but some reports indicate that babies born to mothers aged 19 years and younger have a death rate higher than that of infants born to older women. Improvements in perinatal care have resulted in decreases in medical complications among babies born to teenage mothers, but mothers aged 14 years and younger continue to experience unacceptably high rates of adverse outcomes.

The most significant medical risks for infants of teenage mothers are likely related to the parental care those infants receive after the first year of life.
Hair Shampooing Technique and Pediatric Vulvovaginitis
Authors: BROWN JEFFREY L.
Published: December 2021

For many years there has been a general awareness that bubble bath products may cause pediatric vulvovaginitis. Presumably, detergent and perfume ingredients enter the child's open labia while she is seated in bathtub water and may not be removed when she leaves the tub. Perfumes are well known as skin-sensitizing agents, and detergents, such a lauryl sulfate, can remove natural skin oils and denature skin proteins. Damage to the stratum corneum skin barrier may result in redness, cracking, scaling, and papular lesions.
Hypothyroidism With Thyroxine-Binding Globulin Excess
Authors: LEUNG ALEXANDER K.C. , MCARTHUR ROBERT G.
Published: December 2021

We read the article by Alain and Zipf who reported a 4-year-old boy with elevated thyroxine-binding globulin (TBG) level, elevated serum concentrations of both tri-iodothyronine (T3) and thyroxine (T4), short stature, delayed bone age, and an exaggerated thyroid-stimulating hormone (TSH) response to thyrotropin-releasing hormone stimulation. The child showed a marked improvement in growth with T3 therapy. In searching through the literature, we have come across a few more examples of TBG excess associated with hypothyroidism.
ON LIMITING HARM
Authors: Student
Published: December 2021

Must great harm often follow as part of the natural course of progress in medicine? I believe the answer. . . is no. While it is unrealistic to believe we can formulate any principles for determining with certainty what will prove therapeutically effective, we can develop ways of limiting the harm done until the answer is obtained. In my view, it is essential that we minimize the harm caused by premature claims of cures, by unbridled ambition, and by uncritically enthusiastic promotion. This end can be accomplished only by establishing procedures for testing innovative therapies before they are broadly used.