bluuebunny/crossref_metadata_2025 huggingface dataset:
Cognitive and Academic Functioning of Homeless Children Compared With Housed Children
Authors: Rubin David H. , Erickson Candace J. , Agustin Mutya San , Cleary Sean D. , Allen Janet K. , Cohen Patricia
Published: December 2021

Background. During the past 10 years, the number of homeless families has increased in every region of the United States. Despite several studies of this population, there are few data regarding the cognitive functioning of these homeless children. The aim of this controlled study was to determine the effect of homelessness on cognitive and academic functioning of children aged 6 to 11 years.

Methods. Homeless children (N = 102) and their mothers living in shelters were compared with a housed group of children (N = 178) and their mothers selected from the homeless child's classroom in New York City between August 1990 and August 1992. Groups were compared using standardized cognitive and academic performance instruments.

Results. Controlling for child's age, sex, race, social class, and family status, verbal intelligence (estimated by the Peabody Picture Vocabulary Test) and nonverbal intelligence (estimated by the Raven's Progressive Matrices) were not significantly different between the groups. However, academic achievement (measured by the Wide Range Achievement Test-Revised [WRAT-R]) was significantly poorer in reading (75% of homeless children compared with 48% of housed children were below grade level), spelling (72.4% of homeless children compared with 50% of housed children were below grade level), and arithmetic (53.6% of homeless children compared with 21.7% of housed children were below grade level). These dramatic differences in academic performance did not appear to be related to the mother's report of the number of days missed from school or the length of homelessness, but were associated with: (1) the number of school changes for the WRAT-R reading subtest, and (2) grade repetition for the WRAT-R spelling subtest.

Conclusions. These data demonstrate no difference in cognitive functioning between homeless and housed children. However, homeless children performed significantly more poorly than housed children in tests of academic performance.
The Association Between Parental Smoking and the Diet Quality of Low-income Children
Authors: Johnson Rachel K. , Wang MinQi , Smith Melissa J. , Connolly Gregory
Published: December 2021

Objective. To assess the association between parental smoking and the diet quality of children residing in low-income households in the United States.

Methods. Data from 515 low-income children (less than or equal to 185% of the poverty line), ages 2 to 17, who participated in the 1989 and 1990 United States Department of Agriculture Continuing Survey of Food Intakes of Individuals were examined. Diet quality was assessed by examining the average daily amount of nutrients consumed per 1000 kcal for protein, fiber, and 14 essential vitamins and minerals as well as total energy, percent of energy from total fat and saturated fat, and cholesterol and sodium intakes using the 3-day average of one 24-hour recall and 2 days of diet records. Parental smoking was categorized as four levels (nonsmoker; 1 to 10, 11 to 20, and more than 20) on the basis of the average number of cigarettes smoked per day by the sample child's parents. Analysis of covariance examined differences in the children's nutrient intake among the four smoking categories while controlling for race, mother's age and occupation, child age, and sex.

Results. Low-income children with parents who smoked (n = 235) were more likely to be white (P < .001), had younger mothers (P < .05), and were more likely to have mothers employed in blue-collar occupations (P < .001) than children whose parents were nonsmokers (n = 280). Children whose parents smoked 11 or more cigarettes per day had lower vitamin A intakes and higher total energy and sodium intakes than children whose parents smoked ten or fewer cigarettes per day. Children whose parents smoked more than 20 cigarettes per day had a higher percentage of energy from saturated fat, and children whose parents smoked 11 to 20 cigarettes per day had the highest cholesterol intakes in comparison with the rest of the sample. Parental smoking was also related to total fiber intake per 1000 kcal, with children of smokers having lower fiber intakes than children of nonsmokers.

Conclusions. On average, low-income children of smokers had a poorer diet quality than low-income children of nonsmokers, thus increasing their future risk of chronic disease.
DOLLS FROM HELL
Authors: L. J. F.
Published: December 2021

Wanna have a kid, kid? Baby Think It Over will make you think twice. . . On a May evening in 1993, Richard and Mary Jurmain watched a television documentary on teenage pregnancy. The camera followed students who were given bags of flour or eggs to carry around for several days. The idea was to teach teenagers how delicate infants are and how much care they require. The implied moral: Young people should think long and hard before becoming parents.

. . . Why not try to produce a realistic doll to teach teenagers about the responsibilities of parenting? . . . Jurmain produced his prototype doll. It weighed 6 pounds 8 ounces, measured 20½ inches long, and wailed like a real infant. He named the product Baby Think It Over.

Baby Think It Over dolls are usually assigned to students in a high school home economics or health class for a few days. Increasingly, teachers are introducing the dolls into junior high classrooms. The doll comes in white, black, Hispanic and Asian versions, and both sexes. The Jurmains also sell a "crack baby" model that simulates the violent shaking and incessant crying of a baby born dependent on drugs because the mother used them during pregnancy. The crack baby dolls are especially difficult to soothe.

Teachers say that a few students have stabbed their dolls, hurled them out of windows and ripped the electronic circuitry out in order to quiet the crying. These students flunk the assignment, of course, and are usually recommended for counseling.

Rick Jurmain updated the circuitry of the doll this fall so that a digital readout can now tell a teacher how much abuse—rough shaking, say, or dropping—the doll suffered . . . Jurmain says he's found a way to make the next generation of dolls wet.
The Changing Profile of Homozygous β-Thalassemia: Demography, Ethnicity, and Age Distribution of Current North American Patients and Changes in Two Decades
Authors: Pearson Howard A. , Cohen Alan R. , Giardina Patricia-Jane V. , Kazazian Haig H.
Published: December 2021

Background. The age of patients with homozygous β-thalassemia is increasing because of better treatment and decreased births. A countering influence is immigration of ethnic groups with a high prevalence of thalassemia.

Methods. A questionnaire sent to 48 North American centers requested information about current patients with homozygous β-thalassemia: age, clinical severity, and ethnicity. An 83% response was obtained. Twelve reference hospitals that participated in similar surveys in 1972 and 1984 were included.

Results. Five hundred eighteen patients with homozygous β-thalassemia represent most North American patients. Four hundred forty-three (86%) of these had transfusion-dependent thalassemia major (TM); 75 (14%) had thalassemia intermedia (TI). Sixty-two percent were of Greek and Italian ancestry. There were approximately equal numbers of patients with TM in 5-year intervals between 0 and 25 years of age. Thereafter, the number of patients fell sharply. The mean age (±SD) of the patients with TM was 16.1 ± 9.2 years. Striking differences were seen in Italian and Greek patients compared with those of other ancestries. Sixty-six percent of the 271 Italian and Greek patients with TM were older than 16 years of age, whereas 77% of the 172 patients of other ethnic groups with TM were younger than 15 years of age. The mean age of the 75 patients with TI was greater than that of the patients with TM. Seventy-three percent of African-American patients with thalassemia had TI, compared with 0% of Southeastern Asian patients. Comparisons of patients with TM from the 12 reference hospitals for two decades show increasing mean ages of TM patients (1973, 11.4 ± 6.7 years; 1985, 14.2 ± 7.3 years; and 1993, 16.1 ± 9.2 years).

Conclusions. There are probably only 750 to 1000 patients with homozygous β-thalassemia in North America. Only about 15 to 20 new cases are diagnosed each year. The increasing mean age and age distribution indicate that modern therapies are effective, but immigration of non-Mediterranean ethnic groups with thalassemia has resulted in more, younger patients. TM is increasingly becoming a disease of young adults.
Pulmonary Administration of Vasoactive Substances by Perfluorochemical Ventilation
Authors: Wolfson Marla R. , Greenspan Jay S. , Shaffer Thomas H.
Published: December 2021

Objectives. Therapeutic management of respiratory distress syndrome, pneumonia, and pulmonary hypertension includes delivery of biologically active agents to the neonatal lung. However, mechanical abnormalities of the lung, intrapulmonary shunting, ventilation-perfusion mismatching, and elevated surface tension impede effective systemic or intratracheal delivery of agents to the lung during conventional gas ventilation. The objective of this study was to test the hypothesis that perfluorochemical (PFC) liquid ventilation can be used for pulmonary administration of vasoactive drugs (PAD) and to compare these responses to those elicited with intravascular (IV) administration during tidal liquid ventilation.

Methods. Cardiovascular responses of 16 preterm and neonatal lambs to randomized doses of acetylcholine, epinephrine, and priscoline were studied. Physiologic gas exchange and acid-base balance were maintained using previously described tidal liquid ventilation techniques. In subgroups of animals, the distribution pattern of carbon 1- and choline 14-labeled dipalmitoylphos-phatidylcholine (14C-DPPC) in saline and the responses to priscoline after hypoxia-induced pulmonary hypertension and hypoxemia administered during liquid ventilation were studied.

Results. Dose-response curves for PAD and IV administration demonstrated progressive, dose-dependent, cholinergic responses to acetylcholine (decreased mean systemic arterial pressure [MAP] and heart rate), sympathomimetic responses to epinephrine (increased MAP and heart rate), and α-adrenergic blockade responses to priscoline (decreased MAP and mean pulmonary arterial pressure). Compared with IV administration, PAD of priscoline resulted in a significantly greater decrease in pulmonary relative to systemic arterial pressure; this response was potentiated by hypoxia, reduced pulmonary pressures to near normal values, and improved oxygenation. The 14C-DPPC in saline was distributed relatively homogeneously throughout the lung by PAD, with 80% of the lung pieces receiving amounts of 14C-DPPC with ±20% of the mean value.

Conclusions. This study demonstrates that vasoactive agents can be delivered to the lung directly by PAD during PFC liquid ventilation. The inherent advantages of this method relate to the physical properties of PFC liquid ventilation as a vehicle (respiratory gas solublity, low surface tension-enhancing distribution, and inertness precluding interaction) and physiological properties of the lung as an exchanger.
The Contribution of Missed Opportunities to Childhood Underimmunization in Baltimore
Authors: Holt Elizabeth , Guyer Bernard , Hughart Nancy , Keane Virginia , Vivier Patrick , Ross Alan , Strobino Donna
Published: December 2021

Objective. To determine the community-wide incidence of missed opportunities to vaccinate, to describe the clinical settings in which they occur, and to estimate the impact of missed opportunities on immunization coverage.

Design and Methods. We abstracted outpatient medical records from a random, community-based sample of 2-year-old children whose residence was inner-city Baltimore. The date of each vaccine and the date, diagnoses, and temperature at each visit were collected for 502 children at 98 different provider sites.

Main Outcome Measures. Missed opportunities to vaccinate and up-to-date vaccination status.

Results. By 24 months of age, 75% of the children had at least one missed opportunity and only 55% were up-to-date for the 4:3:1 series. Missed opportunities occurred at more than one third of eligible visits for each vaccine, including >20% of preventive care visits. Diagnoses commonly associated with missed opportunities were "well child," otitis media, upper respiratory infection, gastroenteritis, skin infection, and resolving illness. If no missed opportunities had occurred, 73% of the children would have been up-to-date by 24 months.

Conclusions. Missed opportunities occurred commonly at providers serving inner-city children in Baltimore and represent a major factor in underimmunization. Reduction of missed opportunities by accurate screening at all visits and adherence to the contraindication guidelines is a provider-based, low-cost method to increase immunization coverage.
Breastfeeding and the Working Mother: Effect of Time and Temperature of Short-term Storage on Proteolysis, Lipolysis, and Bacterial Growth in Milk
Authors: Hamosh Margit , Ellis Lorie A. , Pollock Darren R. , Henderson Theresa R. , Hamosh Paul
Published: December 2021

Background. Women who breastfeed have to store expressed milk while at work for later feeding to their infants; however, storage conditions are often not optimal.

Objective. To assess microbial growth and stability of milk protein and lipid at 15°C to 38°C for up to 24 hours.

Methods. Sixteen healthy women who breastfed exclusively, either at home (n = 11) or who expressed milk for their infants (n = 5), were studied during early (1 month) or late (5 to 6 months) lactation. Expressed milk was stored at 15°C, 25°C, and 38°C for 1 to 24 hours for quantitation of pH, proteolysis, and lipolysis; bacterial growth was quantified at 0, 4, 8, and 24 hours of storage.

Results. Milk pH decreased 2 units by 24 hours of storage at all temperatures tested. Proteolysis was minimal during milk storage at 15°C or 25°C for 24 hours and was apparent only after 24 hours of storage at 38°C. Lipolysis was rapid, starting in the first hours of storage and progressing to 8% at 24 hours. Thus, while the greatest increment in proteolysis products was a 40% increase above baseline after 24 hours of storage at 38°C, free fatty acid concentration at this storage time was 440% to 710% higher than in freshly expressed milk. Bacterial growth was restricted mainly to nonpathogens, was minimal at 15°C throughout the 24 hours of storage, was low at 25°C for the first 4 to 8 hours, and was considerably higher at 38°C even during the relatively short period of 4 hours.

Conclusions. Storage of human milk is safe at 15°C for 24 hours, whereas at 25°C it is safe for 4 hours. Milk should not be stored at 38°C. Minimal proteolysis during storage suggests that milk proteins probably maintain their structure and function during short-term storage, while the marked lipolysis might slow bacterial growth during this time.
Protein Requirements of Infants and Children: Growth During Recovery From Malnutrition
Authors: Graham George G. , MacLean William C. , Brown Kenneth H. , Morales Enrique , Lembcke Jorge , Gastañaduy Arturo
Published: December 2021

Objective. To evaluate the adequacy of protein intakes now recommended as safe for infants and toddlers.

Methods. Subjects were recovering malnourished infants, age 5.3 to 17.9 months, length age (LA) 2.5 to 6.4 months, weight age (WA) 1.5 to 5.2 months, weight/length (W/L) 78% to 100% of National Center for Health Statistics data; and toddlers age 11.4 to 31.6 months, LA 6.1 to 17.9 months, WA 3.9 to 12.0 months, W/L 79% to 99%. Infants were assigned at random to formulas with 5.5%, 6.7%, or 8.0% energy as 60:40 whey:casein protein. The 5.5% was based on FAO-WHO-UNU safe protein and average energy for ages 2.5 to 6.0 months. Toddlers received 4.7% (recommended for 6 to 18 months), 6.4%, or 8.0%. Identical concentrations (weight/kcal) of other nutrients were maintained; intakes were adjusted weekly to reach, in 90 days, the 50th percentile of weight for a LA 3 months greater than the initial one.

Results. Infants consumed 125 ± 11 (SD), 116 ± 10, and 126 ± 14 kcal and 1.7 ± 0.1, 1.9 ± 0.2, and 2.5 ± 0.3 g protein Kg-1· d-1; gained 2.4 ± 0.7, 2.9 ± 0.7, and 2.6 ± 0.5 months in LA, and reached a W/L of 105 ± 5, 103 ± 6, and 105 ± 5% of reference. Sum of four fat-folds (Σ FF) grew 13.1 ± 6.9, 10.4 ± 4.8, and 11.7 ± 5.3 mm to 32.5 ± 5.2, 31.7 ± 4.7, and 30.5 ± 5.5 mm; arm muscle areas (AMA) 57%, 51%, 70% to 1004 ± 109, 1017 ± 110, and 1004 ± 116 mm2, still low; arm fat areas (AFA) 93%, 66%, and 93% to higher-than-normal 598 ± 105, 610 ± 101, and 541 ± 116 mm2. Regression of intake on weight gain estimated energy for maintenance + activity to be 81.0 ± 7.5 (SEM) kcal · kg-1· d-1, and cost of gain (storage + metabolic cost) as 7.6 ± 1.7 kcal/g, with no significant effect of % protein.

Toddlers consumed 107 ± 9, 103 ± 12, and 105 ± 10 kcal and 1.3 ±0.1, 1.6 ± 0.2, and 2.1 ± 0.2 g protein kg-1 · d-1; gained 3.3 ± 0.7, 2.9 ± 0.6, and 3.3 ± 0.7 months in LA; to a W/L of 102 ± 1, 102 ± 3, and 101 ± 4%. Σ FF grew 9.2 ± 4.0, 7.4 ± 4.3, and 6.0 ± 3.8 to 28.9 ± 5.2, 30.5 ± 3.7, and 27.0 ± 2.7 mm; AMA 31%, 33%, and 34% to 1121 ± 115, 1124 ± 110, and 1117 ± 120 mm2; AFA 53%, 44%, and 45% to higher-than-normal 578 ± 106, 636 ± 99, and 569 ± 68 mm2. Cost of maintenance + activity was 70.8 ± 3.8 (SEM) kcal · kg-1 · d-1, that of weight gain 9.7 ± 1.35 kcal/g, with no effect of % protein.

Conclusions. Within age groups, there were no significant protein-related differences in growth. In both infants and toddlers, high-energy intakes resulted in mild obesity, with lean body mass still deficient. Protein intakes two SD below the means in the lowest protein/energy cells, 1.5 g · kg-1 · d-1 for infants and 1.1 g · Kg-1 · d-1 for toddlers, should still be safe for nearly all children of comparable biological ages.
Evaluating Intensive Family Preservation Programs: A Methodological Review
Authors: Heneghan Amy M. , Horwitz Sarah M. , Leventhal John M.
Published: December 2021

Objectives. To determine the adequacy of evaluations of family preservation services (FPS), which are designed to support families and prevent out-of-home placements of children at risk of abuse or neglect, and to assess the effectiveness of FPS at reducing out-of-home placements of children.

Data Sources. References published from 1977 to 1993 were identified from a computerized search of databases for English-language publications using the key phrases "family preservation," "child abuse," and "family-based services." Unpublished references were identified by mail or phone from a listing of more than 200 programs in a national directory.

Selection of Studies. Of 802 references initially identified, 46 program evaluations were reviewed. Ten studies met the following inclusion criteria: (1) evaluated an intensive family preservation program, (2) included outcome data in the report, and (3) used a comparison group. Five were randomized trials, and 5 were quasi-experimental studies (nonrandomized).

Data Extraction. Descriptive information about the programs and evaluations was collected. To determine methodological quality, two independent raters used a 15- item questionnaire to examine the assignment of families to treatment groups, the interventions provided, and the outcomes assessed. A composite score of 11 or greater represented an acceptable study, 6 to 10 represented an adequate study, and 5 or less represented an unacceptable study.

Results. Only two studies were rated acceptable, four were adequate, and four were unacceptable. Methodological shortcomings included poorly defined assessment of risk, inadequate descriptions of the interventions provided, and nonblinded determination of the outcomes. Rates of out-of-home placements were 21% to 59% among families who received FPS and 20% to 59% among comparison families. The relative risk of placement was significantly reduced by FPS in only two studies (one randomized trial and one quasi-experimental study).

Conclusions. Despite current widespread use of FPS to prevent out-of-home placements of children, evaluations of FPS are methodologically difficult and show no benefit in reducing rates of out-of-home placements of children at risk of abuse or neglect in 8 of 10 studies. Consistent, methodologically rigorous evaluations are needed to determine the effectiveness of FPS and to guide social policy for high-risk children and their families.
The Relationship Between Idiopathic Mental Retardation and Maternal Smoking During Pregnancy
Authors: Drews Carolyn D. , Murphy Catherine C. , Yeargin-Allsopp Marshalyn , Decouflé Pierre
Published: December 2021

Objectives. Smoking has been linked to small cognitive, achievement, and behavioral deficits but has not been associated with more severe cognitive impairments. This investigation evaluated the relationship between maternal smoking during pregnancy and idiopathic mental retardation (MR).

Methods. Data on maternal smoking during pregnancy were obtained during face-to-face interviews with the mothers of 221 children with idiopathic MR and the mothers of 400 children attending public school. All children had been born in the five-county metropolitan Atlanta area in 1975 or 1976 and were living in the area when they were 10 years of age. We used exposure odds ratios (ORs) to assess the relationship between maternal smoking and MR, controlling for sex, maternal age at delivery, race, maternal education, economic status, parity, and alcohol use.

Results. Maternal smoking during pregnancy was associated with slightly more than a 50% increase in the prevalence of idiopathic MR (adjusted OR, 1.6; 95% confidence interval, 1.0-2.4), and children whose mothers smoked at least one pack a day during pregnancy had more than a 75% increase in the occurrence of idiopathic MR (OR, 1.9;95% confidence interval, 1.0-3.4). This increase was neither accounted for by other sociodemographic risk factors for MR nor explained by an increase in the prevalence of low birth weight among the children of smokers.

Conclusions. Our data suggest that maternal smoking may be a preventable cause of mental retardation.
Lead Levels, Home Dust, and Proximity to Lead Smelters
Authors: Landrigan Philip J.
Published: December 2021

The article by Kimbrough et al (Pediatrics. 1995;95:550-554) concerning a survey of blood lead levels among children residing near a closed, heavily contaminated lead smelter found that 78 of 490 preschoolers (16%) had blood lead levels at or above the Centers for Disease Control and Prevention action level of 10 µg/dL. By contrast, the prevalence of elevated blood lead levels among all preschool children in the United States is 8.9%.1 Kimbrough et al found that blood lead levels were positively correlated with home dust lead levels, soil lead levels, hours of outdoor play, and levels of lead in indoor paint.
Treatment of Familial Hypercholesterolemia in Children and Adolescents: Effect of Lovastatin
Authors: Lambert Marie , Lupien Paul-J , Gagné Claude , Lévy Emile , Blaichman Shirley , Langlois Sylvie , Hayden Michael , Rose Vera , Clarke Joe T. R. , Wolfe Bernard M. J. , Clarson Cheril , Parsons Howard , Stephure David K , Potvin Diane , Lambert Jean ,   Canadian Lovastatin in Children Study Group
Published: December 2021

Objective. Familial hypercholesterolemia (FH), an inherited autosomal dominant disorder of lipoprotein metabolism, is associated with premature atherosclerosis. The recommended pediatric therapy consists of dietary intervention and, when necessary, treatment with bile acid-binding resins. However, compliance has been poor in many children. Therefore, our objectives were to determine the efficacy, safety, and tolerance of the short-term use of lovastatin, a 3-hydroxy 3-methylglutaryl coenzyme A reductase inhibitor, in the control of severe FH in a male pediatric population and to evaluate the dose-response relationship.

Methods. Sixty-nine male patients with FH 12.9 ± 2.4 years of age (mean ± SD) participated in this multicenter, randomized, double-blind trial. After a 4-week placebo period, the patients were allocated to four treatment groups (lovastatin 10, 20, 30, or 40 mg/d) for 8 weeks. Plasma lipid and apolipoprotein (Apo) concentrations were measured every 2 weeks. Clinical and laboratory evidence of adverse events was monitored periodically throughout the study.

Results. All lovastatin doses reduced total cholesterol (—17% to —29%), low-density lipoprotein cholesterol (—21% to —36%), and ApoB (—19% to —28%) concentrations. A dose-response relationship was seen, and between-group comparisons showed that results were significantly improved up to a dose of 30 mg/d. We observed a 7% increase in high-density lipoprotein cholesterol and a 4% increase in ApoA1 concentrations. The medication was well tolerated by all patients. No serious clinical adverse experience was reported. Lovastatin increased aspartate aminotransferase concentrations, but there was no evidence of a dose-response relationship, and no value exceeded two times the upper limit of normal. No significant change in alanine aminotransferase was observed. Three patients had marked (more than three times the upper limit of normal) asymptomatic elevations in their creatine kinase values, which returned spontaneously to normal, and no action was required regarding the drug.

Conclusions. Lovastatin is an effective therapy for severe FH in children and adolescents. It was well tolerated, and the occurrence of adverse experiences of clinical significance was very low. Long-term pediatric studies are indicated.
Safe Transportation of Premature and Low Birth Weight Infants
Authors:   Committee on Injury and Poison Prevention,   Committee on Fetus and Newborn
Published: December 2021

Special considerations are essential to ensure the safe transportation of premature and low birth weight infants. Both physical and physiologic issues must be considered in the proper positioning of these infants. This statement discusses current recommendations based on the latest research and provides guidelines for physicians who counsel parents of very small infants on the choice of the best car safety seats for their infants.
Efficacy of Low-dose Dextromethorphan in the Treatment of Nonketotic Hyperglycinemia
Authors: Alemzadeh Ramin , Gammeltoft Karsten , Matteson Karla
Published: December 2021

Nonketotic hyperglycinemia (NKH) is an inborn error of glycine degradation causing muscular hypotonia, seizures, apnea, and lethargy; it has a poor prognosis. Accumulation of glycine in the brain is thought to cause excessive stimulation of the N-methyl-D-aspartate receptor. Dextromethorphan (DM), an N-methyl-D-aspartate receptor antagonist, in doses of 5 to 35 mg/kg per day has been shown to have beneficial therapeutic effects in some patients with NKH. We report the case of a 1-year-old infant with NKH, seizure disorder, and psychomotor delay who was clinically seizure free during treatment with sodium benzoate, arginine, benzodiazepam, and phenobarbital. Although sodium benzoate normalized serum glycine levels (103 to 125 µmol/L), cerebrospinal fluid glycine levels remained elevated (42 to 47 µmol/L), with epileptiform activity on electroencephalography. The addition of low-dose DM (0.25 mg/kg per day) to the treatment led to improvement of electroencephalographic activity, resolution of nystagmus with increased eye contact, and modest progression of developmental milestones. These data suggest that DM at doses significantly lower than previously reported may be beneficial in some patients with NKH. Treatment with low-dose DM needs further evaluation.
White Blood Cells and Cerebrospinal Fluid
Authors: Scarano Joseph J.
Published: December 2021

I would like to thank Drs Carraccio, Blotny, and Fisher1 for their recent study on cerebrospinal fluid (CSF) analysis. However, the presented data do not define the CSF absolute neutrophil count (ANC), upper limit of ANC, and standard deviation of ANC for their patients. I would like to review this potentially valuable information. The authors referred to the study by Rodewald et al2 who found nucleated and segmented leukocyte counts to be important CSF indicators.
Letter To The Editor
Authors: May Duane L.
Published: December 2021

The manufacturers of the Varivax vaccine include a warning which states that Varivax recipients should also avoid contact with susceptible high-risk individuals (newborns, pregnant women, immunocompromised persons). In contrast, our health maintenance organization recommends that family members of HIV-positive individuals should receive the Varivax vaccine with the obvious intent of preventing chickenpox within the family complex.

I would appreciate your comment as to the risk of immunizing a sibling when there is a newborn within the family complex, particularly if the mother of that newborn had chickenpox as a child, meaning the newborn would have passive immunity to chickenpox for a number of months.
Evaluation of Penicillins, Cephalosporins, and Macrolides for Therapy of Streptococcal Pharyngitis
Authors: Shulman Stanford T.
Published: December 2021

Objective. To review recent clinical experience with treatment of acute streptococcal pharyngitis with penicillins, cephalosporins, and macrolide antibiotics.

Methods. Literature review and analysis.

Results and Conclusions. Oral penicillin V administered two to three times daily for 10 days is the treatment of choice for acute streptococcal pharyngitis and is the oral standard against which other treatments should be measured. A single intramuscular dose of benzathine penicillin also remains highly effective. Recent studies evaluating alternative oral agents given for less than 10 days or in once-daily regimens have yielded promising results. Studies should make efforts to exclude chronic streptococcal carriers with intercurrent viral pharyngitis because their inclusion in treatment trials substantially confounds the data. As issues of health care costs assume increasing importance, the cost of newer antimicrobial agents will deter their usage for acute streptococcal pharyngitis.
Adherence to Physicians' Instructions as a Factor in Managing Streptococcal Pharyngitis
Authors: Dajani Adnan S.
Published: December 2021

Adherence to physicians' instructions, including taking medications as prescribed, is essential for the proper treatment of streptococcal pharyngitis and the prevention of rheumatic fever. Nonadherence can be in many forms, including failure to have prescriptions filled, omission of doses, errors in dosing or administration time, and premature discontinuation of medication. Adherence is dependent on the physician, the patient, the illness, and the medication. Proper communication by the physician and prescribing inexpensive medications that can be taken once or twice daily are simple, yet important actions that improve adherence.
Rheumatic Fever Prophylaxis Using Benzathine Penicillin G (BPG): Two-week Versus Four-week Regimens: Comparison of Two Brands of BPG
Authors: Kassem Ahmed Samir , Zaher Salah R. , Shleib Hamida Abou , El-Kholy Abdel Ghany , Madkour Ahmed A. , Kaplan Edward L.
Published: December 2021

Objective. This prospective study was aimed at answering two important questions: 1) Is a biweekly schedule of 1.2 million U intramuscular benzathine penicillin G (BPG) superior to a 4-week one in the prevention of upper respiratory Group A beta-hemolytic streptococcal (GABHS) infections and rheumatic fever (RF) recurrences? 2) Is there a difference in the bioavailability of BPG obtained from different manufacturers?

Methodology. Three hundred sixty rheumatic patients aged 4 to 20 years were randomly assigned to either a biweekly (190 patients) or 4-week (160 patients) BPG prophylactic schedule and were followed-up monthly for 2 years by clinical examination, throat swab culture for GABHS and measurement of antistreptolysin O titer to detect GABHS infection and/or recurrences of RF (according to revised Jones' Criteria). Thereafter, 34 rheumatic subjects, aged 8 to 16 years were randomly assigned to receive a 4-week injection of 1.2 million U of either a locally manufactured BPG brand (22 patients) or an imported one (12 patients). Sera of all patients were tested for penicillin level by plate diffusion method on days 1, 2, 3, 4, 5, 6, 7, 14, 21, and 28 after the intramuscular injection of BPG.

Results. The GABHS infection rate was found to be 0.2% and 0.3% for patients on the biweekly and 4-week BPG schedules, respectively, with no significant differences between them. However, the RF recurrence rate/patient/year for the 4-week schedule patients (0.12) was double that for the biweekly schedule ones (0.06). Estimation of the bioavailability of the two different brands of BPG demonstrated a difference in their pharmacokinetics and a decrease in the serum penicillin concentration below the minimum inhibitory concentration 3 weeks after the injection of either brand.

Conclusion. Although a biweekly schedule may not be superior in preventing upper respiratory GABHS infection, it may play a role in preventing the sequelae of such infections. The short duration of penicillinemia explains the superiority of the 2-week schedule in RF prophylais. The difference in the pharmacokinetics of penicillin brands might contribute to the high recurrence rate of RF reported in Egypt.
The Evolution of Therapy for Dehydration: Should Deficit Therapy Still Be Taught?
Authors: Holliday Malcolm
Published: December 2021

Objective. To describe the evolution of rehydration therapy for cholera and diarrhea! dehydration from its beginning in 1832 to the present. To reaffirm the central role for extracellular fluid (ECF) expansion and question the continued teaching of deficit therapy in many current pediatric texts.

Methodology. I reviewed the rationale underlying three treatment strategies: rapid parenteral infusions of saline solutions to restore ECF; deficit therapy to replace specific electrolyte and water losses; and oral rehydration therapy (ORT) to effect both. I used crude mortality rates as the measure of outcomes.

Results. (1) Beginning in 1832 for cholera and 1918 for infant diarrheal dehydration, parenteral saline infusions were infused to replace losses of salt and water; they were very effective in salvaging moribund dehydrated patients by quickly restoring ECF volume and renal perfusion. Mortality rates dropped from more than 60% to less than 30%. (2) Deficit therapy as it evolved in the 1950s defined potassium and other fluid and electrolyte defidts and replaced them using specific but complicated fluid and electrolyte replacement regimens. Mortality rates dropped to single digits. (3) ORT, with intravenous expansion of ECF volume when indicated, rapidly corrected specific fluid and electrolyte disorders with a very simple therapeutic regimen. Mortality rates dropped to less than 1%.

Conclusions. The simpler, more effective ORT regimen should be taught as standard therapy for diarrheal dehydration. Principles of body fluid physiology should be taught in their own right.
Serum Leptin in Children With Obesity: Relationship to Gender and Development
Authors: Hassink Sandra G. , Sheslow David V. , de Lancey Elizabeth , Opentanova Irina , Considine Robert V. , Caro Jose F.
Published: December 2021

Background. The identification of the ob gene and its adipocyte-specific protein leptin has provided the first physiologic links to the regulatory system controlling body weight. In adults, elevations of serum leptin concentrations were closely correlated with the percentage of body fat. This study investigated whether leptin concentrations were elevated in obese children and the relationship between leptin concentrations and gender, pubertal stage, and race.

Methods. Seventy-seven children (44 girls and 33 boys), mean age, 11.3 years, with a body mass indices (BMIs) greater than 95% for age, race, and gender (mean BMI, 34.4) constituted the obese group. Thirty children (20 girls and 10 boys), mean age, 13.3 years, with BMIs less than 85% for age, race, and sex formed the control group. Radioimmunoassay for serum leptin was performed on a blood sample collected from each child after an overnight fast.

Results. The mean serum concentration of leptin in the obese group was 38.6 (SD, 21) ng/mL compared with 7.8 (SD, 6.5) ng/mL in the control group. Serum leptin concentrations were highly correlated with BMI (r = .88). Analysis of covariance revealed a main effect for Tanner stage and gender.

Conclusions. As in adults, obese children have high concentrations of serum leptin, which were highly correlated with arm fat and BMI. Increased adipose tissue in children is associated directly with serum leptin concentration. Leptin concentrations were found to vary with Tanner stage independent of adiposity. Compared with boys, girls had increased leptin concentrations independent of adiposity. It was hypothesized that children manifest a relative "leptin resistance" to support increased growth and development of reproductive capacity.
The Risk of Seizure Recurrence After a First Unprovoked Afebrile Seizure in Childhood: An Extended Follow-up
Authors: Shinnar Shlomo , Berg Anne T. , Moshe Solomon L. , O'Dell Christine , Alemany Marta , Newstein David , Kang Harriet , Goldensohn Eli S. , Hauser W. Allen
Published: December 2021

Objective. To assess the long-term recurrence risks after a first unprovoked seizure in childhood.

Methods. In a prospective study, 407 children who presented with a first unprovoked seizure were then followed for a mean of 6.3 years from the time of first seizure.

Results. One hundred seventy-one children (42%) experienced subsequent seizures. The cumulative risk of seizure recurrence was 29%,37%,42%, and 44% at 1,2,5, and 8 years, respectively. The median time to recurrence was 5.7 months, with 53% of recurrences occurring within 6 months, 69% within 1 year, and 88% within 2 years. Only 5 recurrences (3%) occurred after 5 years. On multivariable analysis, risk factors for seizure recurrence included a remote symptomatic etiology, an abnormal electroencephalogram (EEG), a seizure occurring while asleep, a history of prior febrile seizures, and Todd's paresis. In cryptogenic cases, the risk factors were an abnormal EEG and an initial seizure during sleep. In remote symptomatic cases, risk factors were a history of prior febrile seizures and age of onset younger than 3 years. Risk factors for late recurrences (after 2 years) were etiology, an abnormal EEG, and prior febrile seizures in the overall group and an abnormal EEG in the cryptogenic group. These are similar to the risk factors for early recurrence.

Conclusions. The majority of children with a first unprovoked seizure will not have recurrences. Children with cryptogenic first seizures and a normal EEG whose initial seizure occurs while awake have a particularly favorable prognosis, with a 5-year recurrence risk of only 21%. Late recurrences do occur but are uncommon.
Parental Availability for the Care of Sick Children
Authors: Heymann S. Jody , Earle Alison , Egleston Brian
Published: December 2021

Objective. Parents have always played a critical role in the care of sick children. Although parents' roles remain crucial to children's health, parental availability has declined during the past half century. The percentage of women with preschool children who work has risen almost fivefold in 45 years from 12% in 1947 to 58% in 1992. The percentage of women in the paid work force with school-aged children has almost tripled in the same period, from 27.3% to 75.9%. Research has examined the effects of a variety of parental work conditions on children. However, past research has not examined how working conditions affect the ability of parents to care for their sick children. In this article, we examine how often the children of working parents get sick and whether parents receive enough paid leave to care for their sick children.

Methodology. This analysis makes use of two national surveys, which provide complementary information regarding the care of sick children. The National Longitudinal Survey of Youth is a longitudinal survey of a nationally representative probability sample of 12 686 men and women; the National Medical Expenditure Survey is a panel survey of 34 459 people. First, we estimated the family illness burden. Second, we looked in detail at the number of days of sick leave mothers had. Third, we examined whether mothers who had sick leave had it consistently during a 5-year period. Finally, we conducted a logistic regression to determine what factors were significant predictors of both lacking sick leave.

Results. More than one in three families faced a family illness burden of 2 weeks or more each year. Yet, 28% of mothers had sick leave none of the time they were employed between 1985 and 1990. Employed mothers of children with chronic conditions had less sick leave than other employed mothers. Thirty-six percent of mothers whose children had chronic conditions had sick leave none of the time they were employed. Although 20% of working parents who did not live in poverty lacked sick leave, 38% of parents who did live in poverty lacked sick leave. The problem is also more marked for nonwhite parents. Although 23% of working white parents lacked paid sick leave, 31% of nonwhite parents lacked sick leave. One in six families that lacked sick leave had to cover for more than 4 weeks of family illness during the year.

Conclusion. In 1993, the US Congress passed the Family and Medical Leave Act (FMLA). However, by limiting the medical leave to the care of major illnesses, primarily those requiring hospitalization, the FMLA does not address the majority of children's sick care needs. For the common childhood illnesses that are not covered by the FMLA, employed parents often must rely on their sick leave if they are to care for their sick children themselves. Yet, we found that many employed parents lack sick leave. This is particularly true of parents of children with chronic conditions and poor and minority families.
Maternal Risks for Very Low Birth Weight Infant Mortality
Authors: Sumits Tracey , Bennett Robert , Gould Jeffrey
Published: December 2021

Objective. To determine whether known maternal risk factors for low birth weight directly contribute to infant mortality among very low birth weight infants.

Design. Retrospective population-based, case-control study.

Setting. Four hospitals in the Oakland, California, area: one community, two private, one health maintenance organization.

Participants. All live-born singleton very low birth weight (<1500 g) infants born to Oakland residents over a 3-year period. Cases were infants who died before their first birthday, identified by computerized linkage of birth and death certificates. For each case, a surviving control was selected to match for birth weight, sex, and race. Forty matched pairs were identified in total.

Outcome Measures. Prevalence of maternal risk factors among cases versus controls.

Results. After controlling for other factors known to influence either birth weight or infant mortality, maternal cocaine use (odds ratio [OR] = 5.43), prior infant death (OR = 27.14), and planned pregnancy (OR = 6.33) were significantly associated with the survival of very low birth weight infants.

Conclusions. Some maternal risk factors for low birth weight confer a survival advantage to very low birth weight infants. Our data reveal that maternal cocaine use is independently associated with survival among this subset of infants. Prior research supports the observed relationship as well as the scientific plausibility of a cocaine-mediated survival advantage among premature infants. Our study also showed both planned pregnancy and prior infant death to be independently associated with infant survival among this subset of infants, sugesting that maternal behaviors may play a role in determining birth weight-specific mortality. These data should be systematically evaluated to better define their relationship to infant mortality.
THE MAKING OF A PHYSICIAN
Authors: Darby C. P.
Published: December 2021

We must be aware that freedom from organic disease alone can not be our goal. The optimal functioning of the individual must be our aim, and that it occur in an environment conducive to a fuller life. We must be aware that man does not live by bread alone, nor by his antihypertensive pill alone. We must be citizens of the community, helping to make it a better place for the raising of our children, for a fuller educational opportunity, for the development of the arts and other cultural aspects which help raise man above the level of animal life.

Thus, the making of a doctor almost begins at his mother's knee. Nurtured further by society and its educational and Cultural institutions, he is finally given a privilege by society, to act in a responsible way in furthering the health, both physical and mental, of those he calls his patients. (Delivered to medical students and faculty, School of Medicine, University of South Dakota, May 1976 by Mitchell I. Rubin, MD, Emeritus Professor of Pediatrics, State University of New York at Buffalo, and Consultant in Pediatrics, Medical University of South Carolina).
IMMUNOLOGIC CROSS-REACTIVITY AMONG CEREAL GRAINS AND GRASSES IN CHILDREN WITH FOOD HYPERSENSITIVITY
Authors: Sachs Martin I.
Published: December 2021

Clinically insignificant cross-reactivity exists among cereal grains and grasses. The authors suggest that elimination of all grains from the diet of a patient with grain allergy is unwarranted.
PEDIATRIC ADENOIDAL HYPERTROPHY AND NASAL AIRWAY OBSTRUCTION: REDUCTION WITH AQUEOUS NASAL BECLOMETHASONE
Authors: Tracy James M. , Kobayashi Roger H.
Published: December 2021

Significant reductions in adenoidal hypertrophy and nasal airway obstructive symptoms followed administration of aqueous nasal beclomethasone.
GENETIC SUSCEPTIBILITY TO ASTHMA— BRONCHIAL HYPERRESPONSIVENESS COINHERITED WITH MAJOR GENE FOR ATOPY
Authors: Chipps Bradley E.
Published: December 2021

The study demonstrates that the level of serum IgE is coinherited with the trait to have bronchial hyperresponsiveness to histamine. This appears to be on chromosome 5q near the locus that regulates IgE production and may be a polygenic phenomenon.
NEBULIZED DEXAMETHASONE VERSUS ORAL PREDNISONE IN THE EMERGENCY TREATMENT OF ASTHMATIC CHILDREN
Authors: Bollinger Mary E. , Wood Robert A.
Published: December 2021

Inhaled dexamethasone is at least as effective as oral prednisone in the emergency treatment of moderately ill asthmatic children. These subjects had more rapid clinical improvement with fewer relapses as well.
REVISED FOOD AND DRUG ADMINISTRATION (FDA) LABELING GUIDELINES FOR THEOPHYLLINE ORAL DOSAGE FORMS
Authors: Kamada Alan K.
Published: December 2021

The revised labeling for oral theophylline products recently issued in January 1995 by the United States' Food and Drug Administration is reviewed. Important revisions have been made in the following sections: Clinical Pharmacology, Indications and Usage, Warnings, Precautions, Overdosage, and Dosage and Administration. Specifically, factors known to alter theophylline absorption, disposition, and metabolism are now listed in the Clinical Pharmacology section, as are mean values for clearance and half-life of the drug in different populations (age groups, physiologic states). Theophylline is no longer indicated for the treatment of acute bronchoconstriction (consistent with present treatment guidelines), but only as maintenance therapy for chronic asthma symptoms. In the Warnings and Precautions sections, drugs and other factors that necessitate a change in theophylline dose are listed and details for properly monitoring serum theophylline concentrations have been added. The revised overdosage section now notes the frequency of clinical manifestations of overdosage, differences between acute and chronic overdose, and contains new recommendations for overdose management. Finally, in the Dosage and Administration section a slow (9-day) dosage titration scheme, aimed at reducing transient caffeine-like adverse effects, and a lower target peak serum concentration of 10 to 15 µg/mL are recommended.