bluuebunny/crossref_metadata_2025 huggingface dataset:
Genetic Disorders and Major Extracardiac Anomalies Associated With the Hypoplastic Left Heart Syndrome
Authors: Natowicz Marvin , Chatten Jane , Clancy Robert , Conard Katrina , Glauser Tracy , Huff Dale , Lin Angela , Norwood William , Rorke Lucy B. , Uri Antonia , Weinberg Paul , Zackai Elaine , Kelley Richard I.
Published: December 2021

All pediatric autopsies of patients with hypoplastic left heart syndrome seen during an 11-year interval were reviewed to determine the frequency of underlying chromosomal and single-gene defects and idiopathic major extracardiac anomalies associated with this common, lethal congenital heart abnormality. Of 83 patients identified, nine had underlying chromosomal abnormalities, four had single-gene defects, ten had one or more major extracardiac anomalies without an identifiable chromosomal or mendelian disorder, and two were infants of insulin-dependent diabetic mothers. Overall, 23 patients (28%) had a genetic disorder and/or major extracardiac anomaly. The substantial prevalence of genetic causes of and major extracardiac anomalies associated with hypoplastic left heart syndrome underscores the need for a detailed genetic evaluation for all patients with hypoplastic left heart syndrome.
Varicella Exposure Time
Authors: BRUNELL PHILIP A.
Published: December 2021

To the Editor.—

The statement by Johnson et al1 that varicella was "protective against 96% of exposures" is misleading. Protection implies that disease was prevented. A continuing household exposure, eg, to a sibling, would be expected to produce an attack rate approaching 100%.2 Only four vaccinees had this type of exposure; 49 had other less intense types of exposure. The outcomes of other types of exposure are far less predictable but normally are not nearly as likely to result in varicella.3
Varicella Exposure Time
Authors: JOHNSON CANDICE E.
Published: December 2021

In Reply.—

Dr Brunell's concerns are valid, and we certainly agree that protective efficacy can only be defined by prospective controlled trials, such as that of Weibel et al (N EngI J Med 1984;310:1409). However, we disagree with the concept that data about protection can only be derived from family exposure data. Arbeter et al (Pediatrics 1986;78(suppl):748-756) reviewed all studies of varicella vaccine in healthy children and combined household day-care and playmate exposures as we did.
Birth Weight and Childhood Growth
Authors: Binkin Nancy J. , Yip Ray , Fleshood Lee , Trowbridge Frederick L.
Published: December 2021

Most previous studies of the relationship between birth weight and childhood growth have concentrated on the growth of low birth weight infants. To examine this relationship throughout the full range of birth weights, growth data for children <5 years of age from the Tennessee Special Supplemental Food Program for Women, Infants, and Children linked to birth certificate records for 1975 to 1985 were used. Growth status was compared for 500-g birth weight categories from 1,000 g to 4,999 g using mean Z scores and the percentage of children more than 2 SD above or less than 2 SD below the median for height for age, weight for age, and weight for height. Infants with lower birth weights were likely to remain shorter and lighter throughout childhood, especially those who were intrauterine growth retarded rather than premature. Conversely, those infants with higher birth weights were likely to remain taller and heavier and to have a higher risk of obesity. Birth weight is a strong predictor of weight and height in early childhood, not only for low birth weight children but also for those of normal and high birth weight.
Unusual Clustering of Allergic Bronchopulmonary Aspergillosis in Children With Cystic Fibrosis
Authors: Maguire Sabine , Moriarty Patricia , Tempany Edward , FitzGerald Muiris
Published: December 2021

Allergic bronchopulmonary aspergillosis has been recognized in association with cystic fibrosis in children since 1965. Since then, however, there have been a paucity of reports of pediatric cystic fibrosis complicated by allergic bronchopulmonary aspergillosis, and, in most cases, these have been diagnosed retrospectively. A cluster of five acute cases seen during a 4-month period in a single cystic fibrosis center with a systemic illness and deterioration in respiratory status are described. In all five patients, reversible bronchoconstriction and infiltrative changes on x-ray films suggested the diagnosis. This was confirmed by the presence of (1) peripheral blood eosinophilia, (2) elevated total IgE and Aspergillus fumigatus-specific IgE, and (3) circulating serum precipitins against A fumigatus in all cases. All children tested had positive type 1 immediate hypersensitivity to skin tests for A fumigatus, in sputum eosinophilia, and Aspergillus cultured from sputum. Only three of five children were previously noted to be atopic and none had severe advanced suppurative lung disease. All children had previously received bronchodilator therapy and appropriate antibiotics. Following treatment with corticosteroids, acute symptoms and radiologic changes resolved for 1 to 5 months. To date, no children have had recurrence of their allergic bronchopulmonary aspergillosis while receiving alternate-day steroid treatment for 6 months.
Acute Renal Failure at Onset of Therapy for Advanced Stage Burkitt Lymphoma and B Cell Acute Lymphoblastic Lymphoma
Authors: Stapleton F. Bruder , Strother Douglas R. , Roy Shane , Wyatt Robert J. , McKay Charles P. , Murphy Sharon B.
Published: December 2021

Aggressive therapeutic maneuvers to reduce the risk for acute renal failure are routine in the management f children receiving therapy for advanced stage Burkitt lymphoma and B cell acute lymphoblastic leukemia. The case histories of 40 children entered into a prospective treatment protocol for high-risk disease revealed that ten of 40 patients (25%) had acute renal failure, two at the time of hospital admission and eight in whom renal insufficiency developed 12 to 132 hours following initiation of cytotoxic chemotherapy. Admission values for serum lactic dehydrogenase and serum uric acid were not statistically different between patients with and without subsequent renal failure. Urine output in the 12 hours prior to antineoplastic therapy was 2.9 ± 0.8 mL/kg/h in the eight children in whom renal failure developed and 5.3 ± 0.4 mL/kg/h in the patients who did not (P < .01). The urinary flow rate in the 24 hours following initiation of chemotherapy was significantly lower in children in whom renal impairment developed (1.0 ± 0.2 mL/kg/h, mean ± SE) compared with those who did not (3.7 ± 0.3 mL/kg/h, P < .001). Renal failure could not be attributed to hyperuricemia or hyperphosphatemia in the majority of patients with renal failure. One to four hemodialysis treatments (2.5 ± 0.3) were required for the ten patients. Serum creatinine concentrations returned to normal in the nine survivors. Response to initial antineoplastic therapy was not affected by the presence of renal failure. Renal failure continues to be a major clinical problem in children with Burkitt lymphoma and B cell lymphoblastic leukemia. Oliguria during initial fluid management should alert physicians to patients who may require dialysis during induction chemotherapy.
Progress of a Harlequin Fetus to Nonbullous Ichthyosiform Erythroderma
Authors: Lawlor Frances
Published: December 2021

The term harlequin fetus is used to describe the most severe form of congenital ichthyosis. All except one previously reported patient died during the first few weeks of life. The development of one such fetus to the age of 2 years 6 months is reported, along with a photographic record of progress. Details of the progress of another harlequin fetus to 6 months of age are given. The clinical diagnosis of the former patient is nonbullous ichthyosiform erythroderma.
Bacillus Species Isolates From Cerebrospinal Fluid in Patients Without Shunts
Authors: Feder Henry M. , Garibaldi Richard A. , Nurse Brenda A. , Kurker Raymond
Published: December 2021

Of 849 CSF cultures done at Hartford Hospital, nine were positive for nonanthrax Bacillus species. Differentiation of true nonanthrax Bacillus species infection from contamination requires careful consideration of the clinical findings, the clinical course, and the laboratory data. In seven patients the nonanthrax Bacillus species represented contamination. In two patients the nonanthrax Bacillus species represented true infection. In one of these infected patients, nonanthrax Bacillus species complicated a cranial gun shot wound. Bacillus cereus meningitis developed in the second patient, a premature infant, following sepsis from a contaminated IV catheter. Nonanthrax Bacillus species, especially B cereus, can be resistant to penicillins and cephalosporins when nonanthrax Bacillus species infections are being treated, susceptibility testing should always be performed.
Spoiled Child Syndrome
Authors: McIntosh Bruce J.
Published: December 2021

People often speak of children as being "spoiled," and many parents worry about the possibility of spoiling their infants and children. Many pediatricians, however, are uncomfortable with this term because it is a poorly defined and derogatory expression. Some would even deny that infants and children can be spoiled. Avoiding the use of the expression spoiled can create difficulties in communicating with parents concerned about their children's behavior. In this article, the spoiled child syndrome will be defined and those patterns of behavior that characterize it will be distinguished from other patterns of difficult behavior which may be confused with it. The spoiled child syndrome is characterized by excessive selfcentered and immature behavior, resulting from the failure of parents to enforce consistent, age-appropriate limits. Many of the problem behaviors that cause parental concern are unrelated to spoiling as properly understood. Such behaviors are often age-related normal behaviors, reactions to family stresses, or patterns of behavior determined by factors inherent in the child. Pediatricians can provide counseling and reassurance for such behaviors and, by helping parents understand the etiology of true spoiling, can encourage the use of behavior modification techniques for its prevention and treatment.
SELF-HELP MOVEMENT
Authors: Student
Published: December 2021

[There is] a social movement of "self-help" and "mutual aid" that is surging in the United States and worldwide. The movement includes Parents Anonymous, Emphysema Anonymous, Overeaters Anonymous, Debtors Anonymous, Pill Addicts Anonymous, California Smokers Anonymous, Gamblers Anonymous, Depressives Anonymous, Prison Families Anonymous, Impotence Anonymous, Cocaine Anonymous, WWL2M (Women Who Love Too Much) and thousands of others.
Discharge Pack Study
Authors: GELARDI ROBERT C.
Published: December 2021

Frank and colleagues reported a significant increase in the duration of exclusive breast-feeding among 157 multiethnic low-income mothers receiving a research discharge pack. This represented a median increase in reported duration between those receiving a research discharge pack and those receiving a commercial discharge pack of only 2½ weeks. There are several serious questions, however, about this conclusion by the authors. For example, the authors note that "among the women who received research counseling, the research discharge pack was associated with lower rates of rehospitalization of infants than was the commercial pack (1% v 14%, P = .014, two-tailed).
Child Abuse by Drowning
Authors: Griest Karen J. , Zumwalt Ross E.
Published: December 2021

Drowning as a form of subtle fatal child abuse is difficult to distinguish from accidental immersion or from sudden unexpected natural death when the circumstances of immersion are concealed. Homicidal drownings are unwitnessed, usually occurring in the home, and the victims are young, either infants or toddlers. Accidental drownings are more likely to involve toddlers or older children in public areas such as swimming pools, drainage ditches, lakes, and rivers. This is especially true in rural areas. In cities, bathtubs remain a major site of accidental childhood drownings. Perpetrators of deliberate drownings often fit the sociopathologic profile of a child abuser. Because there is often a survival interval between immersion and death, pathologic findings consistent with postimmersion syndrome suggest the cause of death. Foreign material in the lungs, if immersion was other than in clear tap water, and injuries of the face are other positive correlating factors. A thorough investigation of the circumstances and cooperation between the investigating agency and the pathologist are essential to determine the correct manner of death in these cases.
Immunosuppressive Therapy Versus Bone Marrow Transplantation for Children With Aplastic Anemia
Authors: Werner Eric J. , Stout Robert D. , Valdez Leticia P. , Harris Richard E.
Published: December 2021

A total of 15 patients 1 to 16 years of age were treated for aplastic anemia (13 of a severe degree) and followed-up for a mean of 24 months (range 2 to 64 months). Six patients had an HLA-matched sibling and underwent allogeneic bone marrow transplantation. Nine patients who lacked a suitable donor were given immunosuppressive therapy. Antithymocyte globulin was the initial treatment for eight of these nine patients. Two patients who failed to respond to antithymocyte globulin were then treated with cyclosporine A. Pretreatment age, hematologic measurements, duration of follow-up, and interval prior to therapy were similar between the two groups. All of the patients receiving bone marrow transplants had a complete response and now have normal blood cell counts. Six of nine patients (67%) responded to antithymocyte globulin and are now transfusion free, although three have mild thrombocytopenia. Both patients given cyclosporine A had a good response and are also transfusion free. Patients who underwent marrow transplantation had a significantly shorter period of transfusion dependence for RBCs (9 v 4 weeks, P < .005) and platelets (5 v 21 weeks, P < .05). The patients given immunosuppressive therapy have significantly lesser platelet counts in follow-up but have similar values for both hemoglobin and absolute granulocyte counts. Although HLA-matched bone marrow transplantation leads to a faster and more complete recovery for children with aplastic anemia, immunosuppressive therapy can provide a good outcome for children with this disorder.
Morbidity for Survivors of Extracorporeal Membrane Oxygenation: Neurodevelopmental Outcome at 1 Year of Age
Authors: Glass Penny , Miller Marilea , Short Billie
Published: December 2021

Extracorporeal membrane oxygenation is an important technology in the treatment of high-risk infants whose long-term outcome is being followed prospectively at our institution. The extracorporeal membrane oxygenation procedure allows temporary cardiopulmonary support for critically ill full-term neonates who are refractory to maximum ventilatory and medical management as a consequence of severe persistent pulmonary hypertension. The technique necessitates both the permanent ligation of the right common carotid artery and jugular vein and systemic heparinization. The survivors constitute a unique group of high-risk infants, from the standpoint of the hypoxic-ischemic insults preceding extracorporeal membrane oxygenation and the risks associated with the procedure. Our results indicate that most of our survivors are developing normally at 1 year. Major morbidity, in terms of either significant developmental delay (Bayley mental and motor indices less than 70) or significant neuromotor abnormality, occurred in only 10% of these infants. Poor outcome was associated with major intracranial hemorrhage and chronic lung disease. Ligation of the right carotid artery and jugular vein was not associated with a consistent lateralizing lesion. Long-term follow-up through school age is essential.
Gastric Lipolysis and Fat Absorption in Preterm Infants: Effect of Medium-Chain Triglyceride or Long-Chain Triglyceride-Containing Formulas
Authors: Hamosh Margit , Bitman Joel , Liao Teresa H. , Mehta N. R. , Buczek R. J. , Wood D. L. , Grylack L. J. , Hamosh P.
Published: December 2021

The extent of gastric lipolysis, fat absorption, and infant weight gain was studied in 12 preterm infants (gestational age 28.75 ± 0.50 weeks, postnatal age 6.08 ± 0.81 weeks) fed medium-chain triglyceride or long-chain triglyceride formula for 1 week in a crossover design. The former formula contained 42% of 8:0 and 10:0 and 19% of 12:0, 14:0, and 16:0; the latter formula contained only 7% of 8:0 and 10:0 and 46% of 12:0, 14:0, and 16:0. Gastric aspirates were obtained on the second and third day of formula feeding for quantitation of lipase activity and of the extent of gastric lipolysis. Fat balance studies were conducted during the last three days of each feeding regimen. The study showed that (1) there was marked hydrolysis of formula fat in the stomach during feeding of either medium-chain triglyceride formula or long-chain triglyceride formula (20% and 16%, respectively); (2) lipase activity in the gastric aspirates was less during feeding of medium-chain triglyceride formula than before the meal, which suggested stimulation of lipase secretion by long-chain fatty acid released from long-chain triglyceride formula fat or more rapid binding of lipase to ingested lipid in the medium-chain triglyceride formula; (3) fatty acid distribution in glycerides and free fatty acids showed preferential release of medium-chain (8:0, 10:0) and long-chain unsaturated (18:1, 18:2) fatty acids in the stomach. The low content of 8:0 and 10:0 in gastric triglyceride and free fatty acids suggested that medium-chain fatty acids were absorbed directly in the stomach. (4) fat balance studies showed almost identical absorption rates (84.6% ± 3.1% and 82.8% ± 4.0%) and weight gain (23.0 ± 1.5 g/d and 20.8 ± 1.8 g/d) during feeding of either medium-chain triglyceride or long-chain triglyceride formula. In this study, in which each infant was fed either formula alternately, it was shown that although the extent of fat digestion varied among infants, medium-chain and long-chain triglyceride were absorbed to the same extent by most infants.
Preductal and Postductal Transcutaneous Oxygen Tension Measurements in Premature Newborns With Hyaline Membrane Disease
Authors: Pearlman Stephen A. , Maisels Jeffrey
Published: December 2021

Pre- and postductal transcutaneous oxygen tension (tcPo2) was measured in 23 preterm infants with hyaline membrane disease to estimate the degree of right to left ductal shunting. The study was done during the first 24 hours of life and the data were recorded continuously. The studies were 11.9 ± 4.0-hours long, (mean ± SD) and the difference between the pre- and postductal tcPo2 (ΔTcPo2) was measured every 100 seconds. Of 9,872 determinations, the ΔtcPo2 was ≤15 mm Hg in 90.1%, 16 to 29 mm Hg in 9.3%, and ≥ 30 mm Hg in 0.6%. It was concluded that large differences between pre- and postductal oxygen tension are rare in infants with hyaline membrane disease. The results of this and other published data suggest that it is unlikely that measurement of Pao2 in the descending aorta or tcPo2 below the ductus places infants at an increased risk of having retinopathy of prematurity develop.
SETTING A LIMIT IN SCOTLAND
Authors: Student
Published: December 2021

A fatal accident inquiry in Glasgow has investigated the death of a girl born at 26 weeks gestation, weighing 675 grams, who was not resuscitated. . . . The sheriff conducting the inquiry ruled that the doctor behaved in a correct professional manner by assessing the weight, gestation and general condition of the infant before deciding not to resuscitate.
Measles Outbreak Among Unvaccinated Preschool-Aged Children: Opportunities Missed by Health Care Providers to Administer Measles Vaccine
Authors: Hutchins Sonja S. , Escolan Jaime , Markowitz Lauri E. , Hawkins Carl , Kimbler Anita , Morgan Richard A. , Preblud Stephen R. , Orenstein Walter A.
Published: December 2021

A measles outbreak in an inner-city area primarily involved preschool-aged children younger than 5 years of age. The reasons why 31 unvaccinated preschool children with measles disease had not been vaccinated were investigated. For some patients, health care providers missed opportunities to vaccinate eligible patients against measles. Of the 26 patients whose full immunization status was known, ten (38%) were vaccinated with diphtheria and tetanus toxoids and pertussis vaccine and/or oral poliovirus vaccine at a time when they could have received measles vaccine simultaneously, according to recommendations of the Immunization Practices Advisory Committee and the American Academy of Pediatrics. In addition, five of ten health care providers interviewed missed at least one opportunity to administer measles vaccine because of a minor illness that was not a contraindication to vaccination. Unvaccinated patients were more likely to receive health care in the public sector, have single mothers, and have parents who had no knowledge of existing vaccines; they were less likely to be age-appropriately immunized with other antigens. If measles immunization levels among preschool children in the United States are to be increased, education of both health care providers and parents, coupled with innovative strategies targeted to preschool children, particularly of low socioeconomic groups in inner cities, are needed.
Field Experiments of Television Violence With Children: Evidence for an Environmental Hazard?
Authors: Gadow Kenneth D. , Sprafkin Joyce
Published: December 2021

The findings from 20 field experiments were examined to determine the short-term effects of viewing aggression-laden television shows on child social behavior. The available literature provides little support for an effect that is peculiar to aggressive content. In fact, although almost all studies showed elevated levels of antisocial behavior following the viewing of similar material, they also revealed similar, and sometimes greater, effects in response to low or nonaggressive fare. These findings are discussed with regard to their clinical relevance for preventive medicine and implications for imposing "wholesome" television programming on child viewers.
Randomized Trial of Taurine Supplementation for Infants \g=le\1,300-Gram Birth Weight: Effect on Auditory Brainstem-Evoked Responses
Authors: Tyson Jon E. , Lasky Robert , Flood Debbie , Mize Charles , Picone Tom , Paule Charles L.
Published: December 2021

Taurine may be important to the developing eye and brain of the small preterm infant. A blinded randomized trial was conducted to determine whether taurine supplementation of healthy infants of \g=le\1,300 g birth weight until their discharge from the hospital increases their growth rate, neurobehavioral development, electroretinographic development, or maturation of auditory brainstem-evoked responses. Infants were fed with Similac Special Care as desired, which was prepared to contain < 5 mg/L of taurine or 45 mg/L of taurine, a concentration similar to that of human milk. Infants who did not receive taurine supplementation (n = 19) and those who did (n = 18) were similar with respect to condition at study entry, caloric intake, and growth rates throughout the study, and electroretinographic findings and scores on the Brazelton Behavioral Assessment Scale at 37 weeks' postmenstrual age. Infants who received taurine supplementation had greater overall plasma taurine concentrations. The group receiving taurine supplementation also had more mature auditory-evoked responses at 37 weeks' postmenstrual age with a modest (0.2 to 0.5 ms) but consistent reduction (P < .05) in the interval between stimulus and response at two different stimulation rates. Although further study is needed, taurine intake appears to influence auditory system maturation of preterm infants.
IMPLICATIONS OF MULTIPLE AUTHORSHIP
Authors: Student
Published: December 2021

Authorship cannot be conferred; it may be undertaken by one who will shoulder the responsibility that goes with it. To a responsible writer, an article, with his name on it, is the highest product of his mind and art, his property, as nearly flawless as he can make it, founded in his character and evidence of it. If that describes the acceptable standard, medical writers, a responsible group, are in present need of reconsidering the implications of joint authorship. The reader of a report issued by two or more authors has a right to assume that each author has some authoritative knowledge of the subject, that each contributed to the investigation, and that each labored on the report to the extent of weighing every word and quantity in it.
Computer Use in Pediatric Education
Authors: GURURAJ VYMUTT J. , ROGERS PATRICIA FIELDS , PATRICK JENNY K.
Published: December 2021

During the past two decades, there has been an increasing awareness among educators of the potential use of the computer in medical education. Its use in research studies and in creating such educational instruments as unit lessons, patient simulations, lecture aides and testing and evaluation materials has been discussed in the literature. The computer thus has been noted to be a beneficial educational tool. Much has been written predicting the inevitable and continued expansion of the computer in medical education as well as the implications of its future use for medical students, residents, and faculty To date, however, there is little documentation regarding the actual use of computers in pediatric education.
Children, Adolescents, and Television—1989: II. The Role of Pediatricians
Authors: STRASBURGER VICTOR C.
Published: December 2021

The article in this issue of Pediatrics by Gadow and Sprafkin and Singer's rebuttal should alert pediatricians to several important concepts regarding television and its effects on children and adolescents: (1) This is an extremely complex area of research and one with which most pediatricians are unfamiliar. Trying to tease out the effects of television on human behavior can be a methodologic "mission impossible" because television is ubiquitous and human behavior is complex. (2) Most research in this field has been done by experts in social and educational psychology and communication. Therefore, the medical literature is sparse. (3) Pediatricians need to avoid the intellectual trap of minimizing the importance of television's effect on child and adolescent behavior simply because the literature does not contain straightforward, statistically validated research.
DOUBT
Authors: Student
Published: December 2021

Doubt is the beginning, not the end, of wisdom.
SMALL SAMPLE SIZE SCIENTIST
Authors: Student
Published: December 2021

The believer in the law of small numbers practices science as follows:

1. He gambles his research hypotheses on small samples without realizing that the odds against him are unreasonably high. He overestimates power.

2. He has undue confidence in early trends (e.g., the data of the first few subjects) and in the stability of observed patterns (e.g., the number and identity of significant results). He overestimates significance.

3. In evaluating replications, his or others', he has unreasonably high expectations about the replicability of significant results. He underestimates the breadth of confidence intervals.

4. He rarely attributes a deviation of results from expectations to sampling variability, because he finds a causal "explanation" for any discrepancy. Thus, he has little opportunity to recognize sampling variation in action. His belief in the law of small numbers, therefore, will forever remain intact.
BELIEF IN THE LAW OF SMALL NUMBERS
Authors: Student
Published: December 2021

People have erroneous intuitions about the laws of chance. In particular, they regard a sample randomly drawn from a population as highly representative, that is, similar to the population in all essential characteristics. The prevalence of the belief and its unfortunate consequence for psychological research are illustrated by the responses of professional psychologists to a questionnaire concerning research decisions.
Routine Chest Radiographs in Pediatric Intensive Care: A Prospective Study
Authors: Hauser Gabriel J. , Pollack Murray M. , Sivit Carlos J. , Taylor George A. , Bulas Dorothy I. , Guion Christopher J.
Published: December 2021

The clinical value of routine chest radiographs was prospectively evaluated in a pediatric intensive care unit. Physicians were asked to predict findings of clinical impact in 353 routine morning chest radiographs performed in 101 patients after examining the patients. In 81 instances (23%), the clinical impact of the chest radiographs was incorrectly predicted and significant alterations in management would have potentially been missed had the chest radiographs not been available. These 81 chest radiographs included 72 unpredicted radiographic changes of clinical significance, and nine chest radiographs in which a significant radiographic change was incorrectly predicted. Thirty five (43.2%) of these 81 chest radiographs had unpredicted pulmonary findings and 46 (56.8%) showed unpredicted appliance malpositions. Incorrect predictions were significantly associated with radiographs from patients who were younger, intubated, mechanically ventilated, and had indwelling central venous catheters. Level of training of the predicting physicians did not affect prediction accuracy. In analysis of 43 routine postintubation chest radiographs and 39 routine postcentral venous catheter placement chest radiographs, appliance malpositions were disclosed in 34.9% and 43.6%, respectively. Routine daily and postappliance placement chest radiographs have significant clinical value in the pediatric intensive care unit.
Retinopathy of Prematurity: A New Epidemic?
Authors: Gibson Donna L. , Sheps Samuel B. , Schechter Martin T. , Wiggins Sandra , McCormick Andrew Q.
Published: December 2021

This study provides the first empiric evidence for the existence of a new epidemic of retinopathy of prematurity-induced blindness. Data from a population-based register of handicapping conditions in the Canadian province of British Columbia, and a birth weight-specific census of live-born infants in British Columbia, were used to determine annual, population-level incidences of retinopathy of prematurity-induced blindness during 1952 to 1983. Changes in incidence since the end of the original epidemic (1954) were determined by subdividing the 29-year period (1955 to 1983) into two intervals (1955 to 1964 and 1965 to 1983). Standardized incidence ratio analyses revealed a marginally significant increase in the overall incidence of retinopathy of prematurity-induced blindness in the later as compared with the earlier period. Infants weighing 750 to 999 g at birth had a significantly increased standardized incidence ratio of 3.07 (95% confidence interval 1.26, 11.06). No increases in risk were observed in heavier or lighter weight infants. Because ascertainment and diagnostic changes do not explain the weight-specific increases in incidence, these results provide the first population-level evidence for a new epidemic.
Reduction of Mortality, Morbidity, and Respiratory Distress Syndrome in Infants Weighing Less than 1,000 Grams by Treatment With Betamethasone and Ritodrine
Authors: Papageorgiou Apostolos N. , Doray Jean-Luc , Ardila Rosendo , Kunos IIdiko
Published: December 2021

The efficacy of betamethasone has been questioned in infants of less than 28 week's gestation. From January 1983 to June 1986, 86 infants weighing 600 to 1,000 g were born at our center. Control of labor was attempted with ritodrine in all patients with ≤5 cm cervical dilation. If control were obtained, betamethasone was given 30 minutes later. Significant differences were found between the 33 infants born after 24 hours of betamethasone and those delivered before in terms of survival 90.1% v 56.6% (P = .001), respiratory distress syndrome 27.2% v 73.6% (P = .0001), and need for intermittent positive pressure ventilation 42.4% v 81.1% (P = .0005). The average hospital stay for β3-treated infants was 82 days v 99 days for nontreated infants. The average exposure to O2 after betamethasone was 12.7 days v 20.2 days, (P = .01), although need for intermittent positive pressure ventilation was similar (23 days) in the two groups. In infants who survived > 48 hours, the incidence of patent ductus arteriosus in the β-group was 18.8% (6/32) v 44.4% (16/36) in the nontreated group (P = .04). Our data suggest that in infants weighing less than 1,000 g, control of labor with ritodrine for a minimum of 24 hours and administration of betamethasone can reduce significantly not only the incidence of respiratory distress syndrome but also mortality and morbidity.
Acute Asthma: Observations Regarding the Management of a Pediatric Emergency Room
Authors: Canny Gerard J. , Reisman Joseph , Healy Rosalean , Schwartz Clive , Petrou Constantine , Rebuck Anthony S. , Levison Henry
Published: December 2021

Because inadequate assessment and inappropriate treatment of acute asthma have been implicated as contributing factors in morbidity and even deaths, the management of acute asthma, as practiced in an emergency room, were reviewed. The study population comprised 1,864 children (mean age 5.6 years; 65% boys) who attended the emergency room with acute asthma on 3,358 occasions during a 16-month period. Visits occurred more commonly in winter and usually in the evenings; 93% were self-referred and the mean duration of symptoms was 41 hours. Most acute episodes were associated with infection. Although chest auscultation, heart rate, and respiratory rate were recorded during the majority of visits, evidence that pulsus paradoxus had been measured could be found for only 1% of visits. Results of lung function and blood gas values were rarely recorded, but chest radiographs were obtained in 18% of visits. Drugs used in the emergency room included β2-agonisth (93% of visits), theophylline (16%), and systemic steroids (4%), but no child received anticholinergic therapy. In 26% of patient visits, admission to hospital occurred; one patient died. The erratic fashion in which asthma severity appears to have been assessed and the failure to document whether lung function had been measured are causes for concern. The surprisingly high hospitalization rate may have been avoided if bronchodilators and corticosteroids had not been underused in the emergency room.
High-Versus Low-Dose, Frequently Administered, Nebulized Albuterol in Children With Severe, Acute Asthma
Authors: Schuh Suzanne , Parkin Patricia , Rajan Aziza , Canny Gerald , Healy Rosalean , Rieder Michael , Tan Yok K. , Levison Henry , Soldin Steven J.
Published: December 2021

Thirty-two 5- to 17-year-old children who had severe, acute asthma were randomly assigned to receive either high doses (0.15 mg/kg of body weight per dose) or low doses (0.05 mg/kg of body weight per dose) of nebulized albuterol every 20 minutes for six doses. Compared with the low-dose regimen, the high-dose regimen resulted in significantly greater improvement in forced expiratory volume in 1 second, forced vital capacity, and wheeze score and a lower hospitalization rate. The changes in heart rate, respiratory rate, blood pressure, white blood cell count, and serum potassium concentration did not differ significantly between the groups. The incidence of side effects, which included tremor, hyperactivity, and vomiting, was not significantly different in the two populations. Serum albuterol levels varied widely, but there was no correlation between the levels and the increase in heart rate or other side effects. Highdose, frequently administered, nebulized albuterol appears both safe and effective in treating severe, acute asthma in children.
Searching MEDLINE for Randomized Clinical Trials Involving Care of the Newborn
Authors: Kirpalani Haresh , Schmidt Barbara , McKibbon K. Ann , Haynes R. Brian , Sinclair John C.
Published: December 2021

Randomized clinical trials make up only a small fraction of published articles concerning care of the newborn infant and an even smaller fraction of articles about all human subjects. The busy pediatrician who wants to keep abreast of the medical literature requires strategies to detect such relevant studies promptly and reliably. Computer searching of MEDLINE is an attractive, potentially powerful but not sufficiently validated means of achieving this goal. Therefore, the sensitivity, specificity, and positive predictive value of two MEDLINE search strategies designed to detect randomized clinical trials for prevention and treatment of newborn diseases among all original articles about human subjects appearing in ten pediatric and general medical journals during 1985 were determined. The yield of both MEDLINE searches was compared to that of a manual search. Fifty-three randomized clinical trials of newborn care were identified by hand search among 233 articles concerning care of the newborn and 2,988 original articles about human subjects. The sensitivities of the MEDLINE searches were 53% and 34%, respectively, and the positive predictive values were 82% and 69%, respectively. Specificity of both computer searches was virtually 100%. Twenty-one randomized clinical trials were not identified by either MEDLINE search strategy, 17 of them for failure of the indexer to assign any methodologic terms at all or failure to assign sufficiently stringent methodologic terms. Consequently, sensitivities were higher, 77% and 68% respectively, when no methodologic terms were used during repeat searches. However, positive predictive values decreased concomitantly to 20% or less. It is concluded that searching MEDLINE for randomized clinical trials is not yet sufficiently sensitive to be recommended as the sole strategy of keeping up with this literature.
OUT OF CONTROL
Authors: Student
Published: December 2021

Outpatient visits to hospitals were up 7.1 percent earlier this year [1988]. The number of visits to doctors tests and diagnostic procedures have exploded . . . Any savings from controlling costs in hospitals has been more than wiped out by the growth in other types of care.
Prevention of Child Maltreatment: What Is Known
Authors: Dubowitz Howard
Published: December 2021

There has been increasing awareness of the need to prevent child maltreatment. In this review, prevention programs that have been evaluated are critically assessed. This is based on computer searches of the relevant literature spanning the last decade and final reports regarding prevention programs to state and federal agencies. Although many programs have been implemented, relatively few have been evaluated, and of those that have been, many have serious methodologic flaws. Interventions that do appear promising include home visiting, lay counseling, group and family therapy, and education about sexual abuse. In addition, comprehensive programs that address the multiple contributory factors of child maltreatment appear to be a valuable approach. Suggestions are made as to how the practicing pediatrician might play a preventive role. Finally, there is a need for good evaluation research of prevention programs.
Auriculotemporal Syndrome Seen Clinically as Food Allergy
Authors: BECK SUZANNE A. , BURKS A. WESLEY , WOODY ROBERT C.
Published: December 2021

Adverse food reactions are common complaints to the general pediatrician. True hypersensitivity reactions are only a small part of the overall incidence of reactions. Other conditions that are initially thought to be food allergies include enzyme deficiencies, food poisoning, and pharmacologic agents in foods. We describe four children with parental complaints of "food allergies." For each child, auriculotemporal or Frey syndrome was later diagnosed. Because of its benign nature, Frey syndrome is important to recognize to avoid unnecessary laboratory testing and extensive referrals.

CASE REPORTS

Patient 1

A 4-year-old white girl had a history of food allergy that caused flushing of the left cheek. According to the mother, this flushing seemed most apparent after the child ingested red foods such as tomatoes, strawberries, and red candy.
Developmental Screening—Expecting the Impossible?
Authors: DWORKIN PAUL H.
Published: December 2021

In this issue of Pediatrics, Meisels addresses a topic that has received considerable attention within the child development literature—the validity of the Denver Developmental Screening Test (DDST). The author summarizes data from 13 studies to document the limited sensitivity of the test. However, several of the studies cited by Meisels are themselves weakened by methodologic problems. For example, in four of the so-called replication studies, applications were actually examined for which the DDST was not originally designed, such as identifying developmental delay among biologically vulnerable infants, screening for speech and language problems, and identifying children with moderate to severe delays.
Rett Syndrome
Authors: TREVATHAN EDWIN
Published: December 2021

Recent case reports of Rett syndrome should help pediatricians recognize this important syndrome. Since the article by Moeschler et al was submitted for publication, new diagnostic criteria for Rett syndrome have been developed and published by a 41-member Rett syndrome Diagnostic Criteria Work Group representing the Centers for Disease Control and the International Rett Syndrome Association. The new diagnostic criteria, which have gained acceptance by investigators worldwide, differ significantly from the older criteria used by Moeschler et al in that they have been separated into necessary, supportive, and exclusion criteria and do not limit Rett syndrome to females.
Were the Good Old Days Better?
Authors: VADAKAN VIBUL V.
Published: December 2021

Regarding the article concerning resident stress by Bergman (Pediatrics 1988;82:260-263), it should be emphasized that pediatricians in residency training two decades ago worked under immeasurably greater stress. Complete blood counts, urinalyses, CSF examinations, Gram stains, and bilirubin measurements were routinely performed by interns and residents in the ward laboratory. Interns were on call every other night for the entire year. There was 1 week of vacation and an annual stipend of a few hundred dollars.

The present-day trainee starts work at 8 or 9 AM with a contingent of clerks, nurses, and technicians to draw blood, fill out laboratory slips, and provide other forms of assistance.
In Reply: Were the Good Old Days Better?
Authors: BERGMAN ABRAHAM B.
Published: December 2021

In the obvious belief that privation is good for the soul, Dr Vadakan wants a return to the "school of hard knocks." All that is missing is a call for hair shirts and cold showers. In fact, Dr Vadakan's residency program sounds plush to me. At Boston Children's Hospital, where I trained, we did not get paid at all. I attempted to point out in my article that, although we complained mightily, the "scut work," which Vadakan describes, was more satisfying than the blizzard of clerical work that confronts current housestaff. Another large difference is that the patient problems they now face are infinitely more complex than the ones we dealt with "in the old days."
In Reply: The Anencephalic Controversy
Authors: MILUNSKY AUBREY
Published: December 2021

The letters of Drs Karrer, Wyatt, and Goodwin discuss issues that are largely covered in the papers of Landwirth and Botkin and my commentary. There is little more substantive information that can be added, but I would like to correct a point made in Dr Karrer's letter concerning an important tangential issue.

In my commentary I mentioned as an aside that pediatricians, when consoling grief-stricken parents, should encourage them to hold their baby and point to the normal body parts after having first placed a bonnet on the child's head.
Bilirubin, Intraventricular Hemorrhage, and Phenobarbital
Authors: VALAES TIMOS N.
Published: December 2021

Kuban et al decided that data from their previous excellent study concerning phenobarbital prophylaxis of intraventricular hemorrhage offered the opportunity to examine two a posteriori formulated hypotheses, namely, that (1) intraventricular hemorrhage increases biirubin levels and (2) phenobarbital decreases bilirubin concentrations. Several lines of evidence support their conclusions, but important objections should be raised regarding the methods of analysis followed. It seems that phototherapy has become so much a fact of life in the neonatal intensive care units that the authors did not realize how important and pervasive this treatment was in modulating the serum bilirubin concentrations encountered in their population.
In Reply: Sports and Sickle Cell Trait
Authors: NELSON MICHAEL A.
Published: December 2021

Sickle cell trait was included because, at that time, a great deal of speculation and new information was forthcoming regarding sudden death in military recruits who had sickle cell trait. The members of the Sports Medicine Committee believed that it was important to indicate that, in spite of these new concerns, there were no data to indicate that anyone with sickle cell trait should not be included in any athletic activities.

Sickle cell disease was excluded because it is a disease with variable expression and one which is characterized by numerous exacerbations and periods of quiescence.
CHILDREN CONTINUE TO SMOKE
Authors: Student
Published: December 2021

Children, especially girls, are smoking at younger ages. Smoking among high school seniors, which had been declining for years, leveled off from 1980 through 1987. One-quarter of high school seniors who have ever smoked had their first cigarette by the sixth grade, and half by the eighth grade. There is a growing consensus that smoking prevention education needs to begin in elementary school.
GOVERNMENT TOPS DOUBLESPEAK AWARDS
Authors: Student
Published: December 2021

Doctors at a Philadelphia hospital who described a patient's death as a "diagnostic misadventure of a high magnitude." Sen. Orrin Hatch, who referred to capital punishment as "our society's recognition of the sanctity of human life."
POOR KIDS
Authors: Student
Published: December 2021

With the increasing number of single-parent households, children have come to have the highest poverty rate in the nation. In the mid-l960s, poverty among children was no worse than for the population as a whole; today, one child out of four is poor, and children are 50 percent more likely to be living in poverty (defined by the Government as an income of $11,204 or less for a family of four) than is the population as a whole.
NATURE'S SENIORITY
Authors: Student
Published: December 2021

I am not convinced that atomic energy, which is currently said to be man's best hope for a better life, is his best hope at all, on even a good bet. I am not sure energy is his basic problem, although the weight of opinion is against me. I would feel more optimistic about a bright future for man if he spent less time—proving he can outwit Nature and more time tasting her sweetness—and respecting her seniority.