bluuebunny/crossref_metadata_2025 huggingface dataset:
Examining High-Risk Children for Learning Problems in the Health Care Setting
Authors: Blackman James A. , Bretthauer Julie
Published: December 2021

The validity of the Pediatric Evaluation of Educational Readiness (PEER) in evaluating high-risk 5-year-old children who passed developmental screenings through age 30 months was assessed by comparing it with a battery of standardized psychoeducational tests. High-risk children who "failed" the PEER scored significantly below those who "passed" the PEER on tests of verbal, perceptual-motor, and preacademic skills. Furthermore, scores on the PEER of the high-risk group were significantly below those of a normal comparison group. When the standardized test battery was used as the true indicator of developmental concerns, the sensitivity of the PEER averaged 0.60; specificity averaged 0.88. The overall hit rate was 78%. False-positive rate was 27%, the false-negative rate, 20%. Observations of behavior, including attention and activity, correlated at the .63 level (P < .001) with those made independently by a psychometrist. The correlation of these observations to ratings of behavior by parents on the Child Behavior Checklist was .32 (P < .001). It is concluded that the PEER distinguishes between groups of children at risk and not at risk for learning problems; however, in individual cases, the PEER and the standardized test agreed that a child had problems only 60% of the time. Thus two out of five children who may have problems would be missed by the PEER. The observations of behavior feature of the PEER seemed to be a reliable measure and to have some relationship to concerns indicated by parents. With the health history and physical examination, the PEER can assist in the developmental surveillance of children known to be at risk for learning problems. However, based on this study, it cannot be recommended for screening of general populations.
Retinopathy of Prematurity-Induced Blindness: Birth Weight-Specific Survival and the New Epidemic
Authors: Gibson Donna L. , Sheps Samuel B. , Hong Soo , Schechter Martin T. , McCormick Andrew Q.
Published: December 2021

A recent population-based study in the Canadian province of British Columbia showed that, since the mid-1960s, there has been a significant increase in the incidence of retinopathy of prematurity-induced blindness in infants weighing 750 to 999 g at birth. To determine the impact of changing birth weight-specific survival on this new epidemic, all infants born in the province in the period 1952 through 1986 and known to the British Columbia Health Surveillance Registry as having retinopathy of prematurity-induced blindness were identified. In addition, the birth registration records for the 1 299 740 infants born in British Columbia in the same period and the death records of the 22 940 British Columbia-born infants who died in the province before the end of their first year of life were linked using a combination of probabilistic and manual record linkage techniques. These linked records and the records from the Health Surveillance Registry were used to calculate birth weight-specific incidence rates of retinopathy of prematurity-induced blindness in liveborn infants and first-year-of-life survivors. The rates, in 5-year intervals, showed that, in both liveborn infants and first-year survivors, the highest birth weight-specific rates occurred during the first epidemic of retinopathy of prematurity, which ended in British Columbia in 1954. Since the mid- to late-1960s, the incidence of retinopathy of prematurity-induced blindness in liveborn infants weighing less than 1000 g increased steadily whereas in infants weighing 1000 to 1499 g, incidence decreased slightly since the original epidemic ended. However, the experience of first-year-of-life survivors is substantially different. In survivors weighing 500 to 749 g at birth, incidence has decreased since the mid-1970s, whereas in survivors weighing 750 to 999 g, incidence has been stable since 1965. In infants weighing 1000 to 1499 g, the slight trend toward decreasing rates observed in livebirths since the end of the original epidemic is more pronounced. Thus, these results substantiate the idea that the new epidemic of retinopathy of prematurity-induced blindness in infants weighing less than 1000 g is a function of increasing birth weight-specific survival.
The Academic Generalist: An Endangered Species Revived
Authors: Haggerty Robert J.
Published: December 2021

The role of a generalist in academic medicine has been diminished because of the proliferation of specialized research and treatment in the hands of the subspecialist. Yet many observers believe that this has resulted in gaps in research and teaching concerning common health problems, especially those seen in office practice. To correct this trend, The Robert Wood Johnson Foundation has supported for 10 years a fellowship program to prepare academic pediatric generalists. A total of 111 pediatricians have completed the fellowship. Two thirds are now in full-time academic positions. By late 1988, they had published 332 papers and had received more than $20 million in grant support. A majority of departments of pediatrics have relabeled their divisions of ambulatory pediatrics as divisions of general pediatrics and have broadened these divisions' responsibilities. In spite of some difficulty obtaining research support, the careers of these fellows and the changes in pediatric departments support the thesis that there is a need for and a rebirth of academic general pediatrics.
Self-limited Neonatal Familial Hyperparathyroidism Associated With Hypercalciuria and Renal Tubular Acidosis in Three Siblings
Authors: Nishiyama Soroku , Tomoeda Shinichi , Inoue Fumitaka , Ohta Takao , Matsuda Ichiro
Published: December 2021

Three siblings with neonatal familial hyperparathyroidism diagnosed at age 4 months, 2 months, and 5 days, respectively, were treated. Hypercalciuria, nephrocalcinosis, and renal tubular acidosis were present in each child. In all three, there were higher responses of serum parathyroid hormone to serum calcium and higher elevation of serum calcium with oral calcium loading. The metabolism of vitamin D and calcitonin seemed to be intact. Hypercalcemia associated with the abnormal response of parathyroid hormone secretion disappeared when the children passed the age of approximately 2 years, although renal tubular acidosis and nephrocalcinosis remained. An autosomal recessive inheritance seems likely.
Decreased Bone Density in Adolescent Girls With Anorexia Nervosa
Authors: Bachrach Laura K. , Guido David , Katzman Debra , Litt Iris F. , Marcus Robert
Published: December 2021

Osteoporosis develops in women with chronic anorexia nervosa. To determine whether bone mass is reduced in younger patients as well, bone density was studied in a group of adolescent patients with anorexia nervosa. With single- and dual-photon absorptiometry, a comparison was made of bone mineral density of midradius, lumbar spine, and whole body in 18 girls (12 to 20 years of age) with anorexia nervosa and 25 healthy control subjects of comparable age. Patients had significantly lower lumbar vertebral bone density than did control subjects (0.830 ± 0.140 vs 1.054 ± 0.139 g/cm2) and significantly lower whole body bone mass (0.700 ± 0.130 vs 0.955 ± 0.130 g/cm2). Midradius bone density was not significantly reduced. Of 18 patients, 12 had bone density greater than 2 standard deviations less than normal values for age. The diagnosis of anorexia nervosa had been made less than 1 year earlier for half of these girls. Body mass index correlated significantly with bone mass in girls who were not anorexic (P < .05, .005, and .0001 for lumbar, radius, and whole body, respectively). Bone mineral correlated significantly with body mass index in patients with anorexia nervosa as well. In addition, age at onset and duration of anorexia nervosa, but not calcium intake, activity level, or duration of amenorrhea correlated significantly with bone mineral density. It was concluded that important deficits of bone mass occur as a frequent and often early complication of anorexia nervosa in adolescence. Whole body is considerably more sensitive than midradius bone density as a measure of cortical bone loss in this illness. Low body mass index is an important predictor of this reduction in bone mass.
New Colorimetric Test for Rapid Diagnosis of Streptococcal Pharyngitis: A Warning
Authors: Gerber Michael A. , Facklam Richard R. , Randolph Martin F. , DeMeo Kathleen K.
Published: December 2021

During the last few years there has been a dramatic proliferation of rapid tests for the diagnosis of group A β-hemolytic streptococcal pharyngitis.1 It is important for physicians to realize that the Food and Drug Administration does not approve these diagnostic tests as it would approve a pharmacologic agent, but simply permits a manufacturer to sell the test. Consequently, unacceptably inaccurate rapid tests for group A streptococci have been marketed in the past and could potentially appear again at anytime.

In 1986, we studied a new enzyme fluorescence procedure (Strep-A-Fluor, Bio-Spec Inc, Dublin, CA) for the rapid diagnosis of group A β-hemolytic streptococcal pharyngitis.2
Basal Cell Carcinoma in a 12-Year-Old Boy
Authors: Comstock Jody , Hansen Ronald C. , Korc Antoinette
Published: December 2021

Basal cell carcinomas are common skin tumors occurring in white adults that are mainly attributable to ultraviolet-B exposure.1 They grow slowly, invade locally, and rarely metastasize.2 Basal cell carcinomas appear most frequently on the head, neck, and upper extremities. The majority occur on the face and the relative risk for recurrent tumor is high in certain sites, especially the nose.3 It is uncommon to see actinically induced basal cell carcinomas in children. There are well documented associations of basal cell carcinomas in children with the nevoid basal cell carcinoma syndrome, xeroderma pigmentosum, nevus sebaceus of Jadassohn, preceding exposure to x-irradiation, or preceding scar from a burn or trauma.4-10
Infant Feeding Redux
Authors: Cone Thomas E.
Published: December 2021

Just when it appeared that conflicts about the proper way to feed infants had been resolved, the recent debate about the propriety of some commercial firms advertising on television as well as selling milk formulas directly to mothers in supermarkets has reenergized the issue of infant feeding.1 That infant formulas have reached a state where they may even be considered by some to be safe enough for feeding most infants without the advice of health care professionals demonstrates the huge leap forward in the evolution of infant formula feeding. A short historical review will help us to understand how we have reached our present knowledge of infant feeding practices.
Osteoporosis: A "New Morbidity" for Dieting Female Adolescents?
Authors: Kreipe Richard E. , Forbes Gilbert B.
Published: December 2021

Almost half of the adult skeletal mass is laid down during the adolescent years. The concept of the "bone bank" reminds us that "deposits" of calcium are normally made to the skeleton until about 35 years of age in females. Subsequently, there are continuous "withdrawals" of bone mineral and loss of skeletal mass, eventually resulting in osteopenia (significantly reduced bone mass) and osteoporosis (osteopenia associated with atraumatic fractures) in more than 20 million postmenopausal women, at an annual cost of $7 to 10 billion in the United States.1

Because there is no cure, prevention of the most common and conspicuous physical finding of adult osteoporosis, the so-called "dowager's hump" (marked thoracic kyphosis due to vertebral compression fractures), as well as the more serious complications, such as hip fractures, must focus on optimizing the peak bone mass and maintaining the skeletal mass.
Safe Transportation of Newborns Discharged From the Hospital
Authors:   Committee on Accident and Poison Prevention
Published: December 2021

All newborns discharged from hospitals should be transported home in infant car safety seats that are designed appropriately to safely transport healthy newborns, premature infants, or infants with special needs.

Assuring that newborns are restrained properly when riding for the first time sets the stage for continued compliance with a measure that can save their lives or prevent serious injury. Correctly used infant/child safety seats are 71% effective in preventing fatalities due to car crashes, and 67% effective in preventing injury requiring hospitalization.1 With 100% correct use, about 53 000 injuries and 500 deaths could be prevented each year in the United States among children from birth to 4 years of age.2

Although the Every Ride, Safe Ride program of the American Academy of Pediatrics has made major contributions to child passenger safety, including the passage of legislation in all 50 states requiring infants and children to ride properly restrained, newborns continue to be discharged from hospitals without infant car safety seats or in ones that are not being used correctly. A recent study of hospital discharge policies and procedures has shown that only 26% of hospitals with obstetric services have a policy concerning the discharge of newborns in car safety seats. Of those hospitals that have a policy, 64% waive the requirement that newborns be discharged in a car safety seat if the parents do not supply a seat upon discharge.3 A similar study of hospitals accounting for 90% of annual births in Michigan showed that only 24% of hospitals discuss the use of car safety seats with parents, and only 4% demonstrate their use.4
A Year in Retrospect (Pediatric Training)
Authors: Simon Harold K.
Published: December 2021

I sit here late into my Pediatric Internship, approximately 1 year after "The Match of 1989." I have just been up all night in the emergency department after reading the article, "The Pediatrician as a Role Model in the Career Choice of Medical Students"1 by Dr Strain, and the first question that I ask myself is, "Would I do it all over again if I had the chance?" In considering my response, I think back to college when I decided to pursue a career in medicine.
Letter to the Editor
Authors: Halsey Neal , Holt Elizabeth
Published: December 2021

Dr Brunskill's primary point appears to be in the final sentence of his letter. As noted in our discussion, we are well aware of the potential for hidden confounding factors in retrospective observational studies... We attempted to minimize this possibility by obtaining information on an extensive list of factors that might have confounded the relationship between vaccination and mortality and by controlling for these factors through multivariate analysis.1 Despite our rigor, we could have failed to measure all possible confounding variables.
Cardiac Arrests at Home
Authors: Rosenberg Herschel , Kissoon Niranjan
Published: December 2021

The article by Higgins et al1 is provocative because it contradicts previous reports of the generally poor outcomes of out-of-hospital pediatric cardiac arrests.2-4 The 46% survival rate for their group in which parents were taught cardiopulmonary resuscitation (CPR) in fact exceeds reported outcomes for in-hospital cardiac arrests.5 This report also conflicts with previous reports that have failed to show a benefit from pre-hospital CPR in pediatric arrests.3,4 Their findings are encouraging but should be interpreted with caution in view of several limitations of their study.
Letter to the Editor
Authors: Katzman Gerald H.
Published: December 2021

The commentary, "Between a "Rock" and a Hard Place: Perinatal Drug Abuse,"1 provides much food for thought. Particularly the statement referring to drug-dependent mothers, "In the past, society failed to offer this group of women the protection and nurturing that they needed—will we now penalize them further?", deserves further elaboration. Indeed, it is clear to many familiar with the "drug culture" that members of this pathologic society did not have complete control over their destiny.
Letter to the Editor
Authors: Chavkin Wendy , Kandall Stephen R.
Published: December 2021

We welcome the opportunity to comment on the thoughtful letters written in response to our commentary, "Between a "Rock" and a Hard Place: Perinatal Drug Abuse."1 We agree with Dr Katzman's major point that many of the underlying causes of subsequent drug abuse stem from early childhood influences. This point underscores the need for pediatricians not only to become involved actively in teaching human relations to young children, but also to develop and promote school-based programs which teach the specifics of sex education, drug prevention, etc.
$125 MILLION QUESTION: WHAT DO DRUGS COST?
Authors: L. J. F.
Published: December 2021

How much do new drugs cost to develop?

Ask officials at U.S. pharmaceutical companies how much they spent taking a drug from test tube to market and they invariably will say "about $125 million." The figure's accuracy, however, is hotly disputed by regulators and industry critics.

Indeed, the amount isn't derived from direct accounting of the spending on a specific drug. Instead, it is based on an academic study, sponsored by drug makers in the late 1970s, which added up total R&D costs and divided it by the number of drugs produced. Back then, the study said the bill for a new drug was $80 million. It was updated to $125 million a few years ago by adding in inflation...

...A Food and Drug Administration official contends that half the 30 drugs for use in life-threatening illnesses approved in the 1980s were first discovered abroad, and that much of the testing was done by foreign companies. Moreover...much of the research for the drugs first came out of university labs partly sponsored by federal grants.
Early Solid Feeding and Recurrent Childhood Eczema: A 10-Year Longitudinal Study
Authors: Fergusson David M. , Horwood L. John , Shannon Frederick T.
Published: December 2021

The relationship between early solid feeding practices and risks of recurrent or chronic eczema in childhood was examined in a birth cohort of New Zealand children studied to the age of 10. By the age of 10 years, 7.5% of children had chronic or recurrent eczema. There were clear and consistent associations between the diversity of the child's diet during the first 4 months and risks of eczema. Even when due allowance was made for a range of confounding factors—including parental atopic illness, atopic illness in siblings, the child's early milk diet, and family social background—children exposed to four or more different types of solid food before 4 months had risks of recurrent or chronic eczema that were 2.9 times those of children who were not exposed to early solid feeding. It is concluded that early exposure to a diet diverse in potential food antigens may act to predispose susceptible children to recurrent or chronic childhood eczema.
A Comparative Review of Developmental Screening Tests
Authors: Glascoe Frances P. , Martin Elaine D. , Humphrey Steven
Published: December 2021

Public Law 99-457 amends the Education of the Handicapped Act to include services for children from birth through 3 years. Inasmuch as detection and referral of children with developmental delays continues to reside largely with pediatricians and other health care professionals, developmental screening, using standardized tests, is increasingly important. To help physicians select from the array of instruments, 19 different screening tests were administered by a pediatrician and rated by a panel of pediatricians and a special educator. While the panel found few tests that fit within the time constraints of pediatric practice, several tests approached standards for educational and psychologic tests. These included the Battelle Developmental Inventory Screening Test, Infant Monitoring System, Developmental Indicators for Assessment of Learning-Revised, Screening Children for Related Early Educational Needs, and the Developmental Profile II.
Single- Versus Multiple-Dose Surfactant Replacement Therapy in Neonates of 30 to 36 Weeks' Gestation With Respiratory Distress Syndrome
Authors: Dunn Michael S. , Shennan Andrew T. , Possmayer Fred
Published: December 2021

To assess the efficacy of a multiple-dose protocol of surfactant replacement therapy in neonates of 30 to 36 weeks' gestation, 75 neonates were randomly assigned to control, single-dose surfactant, or multiple-dose surfactant groups. Neonates at less than 6 hours of age with a diagnosis of respiratory distress syndrome were eligible. Subjects were randomly assigned to receive either 100 mg/kg of bovine surfactant or air placebo. Neonates in the multiple-dose group were eligible to receive up to three additional doses as indicated. Neonates in both surfactant groups showed a positive response to treatment, with marked improvement in oxygenation by 10 minutes postinstillation (P < .0001). Both surfactant groups had better oxygenation than control subjects at lower ventilatory parameters over the first 24 hours. A deterioration in oxygenation and ventilatory requirements was seen in both treatment groups starting 6 to 12 hours after the first dose. The deterioration in oxygenation could be minimized by the use of multiple doses; however, extra doses had no effect on diminishing ventilatory requirements or time to extubation. It is concluded that surfactant therapy at less than 6 hours of age is effective in acutely reducing oxygen and ventilatory requirements in neonates of 30 to 36 weeks' gestation with respiratory distress syndrome. It appears that multiple doses of surfactant have a greater effect on sustaining improvements in oxygenation than on ventilatory requirements. Further study is required to determine optimal dosage and retreatment strategy.
Serial Munchausen Syndrome by Proxy
Authors: Alexander Randell , Smith Wilbur , Stevenson Richard
Published: December 2021

Five cases of Munchausen syndrome by proxy (MSBP) are presented in which more than one child in the family was victimized. There was a high incidence of maternal psychiatric histories, marital difficulties, and Münchhausen syndrome in the mothers themselves. Seventy-one percent of the children in the families were known to be victims of MSBP; four of these children (31%) died. Multiple-child MSBP may reflect more significant maternal psychopathology than found in other cases of MSBP, or it may indicate the deteriorating consequences to the mother and other children in the family if this syndrome is not identified with the first child and effective interventions made.
Haemophilus influenzae Type b Polysaccharide-Diphtheria Toxoid Conjugate Vaccine in Vaccinated Children Who Developed Haemophilus Disease
Authors: WEINBERG GEOFFREY A. , MURPHY TRUDY V. , GRANOFF DAN M.
Published: December 2021

Children in whom invasive Haemophilus influenzae type b disease develops despite previous immunization with conventional type b polysaccharide vaccine (polyribosylribitol phosphate [PRP]) have been reported to have impaired serum anticapsular antibody responses following recovery from H influenzae type b disease.1,2 Recently, these "vaccine failure" patients also have been found to have impaired antibody responses to reimmunization with PRP vaccine.3 The reasons are not understood because most of the children have normal serum concentrations of immunoglobulins, including IgG2.1-4 They also are more than 3 years of age at the time of reimmunization, an age group in which most healthy children respond to PRP vaccine.
Children With Health Impairments in Schools
Authors:   Committee on Children with Disabilities,   Committee on School Health
Published: December 2021

Chronic illnesses are defined as conditions that last at least 3 months, require extensive hospitalization or in-home health services, or at the time of diagnosis are likely to do so. Chronic illnesses affect at least 10% to 15% of American children.1 Two to four percent of children have severe illnesses that interfere daily with the usual activities of childhood.2 Rheumatoid arthritis, asthma, leukemia and other malignancies, spina bifida, seizure disorders, neuromuscular diseases, acquired immunodeficiency syndrome, and other chronic conditions are found most frequently in this population. There are also small but increasing numbers of children dependent on specific technologies, such as respirators, and children who require procedures, such as tube feeding or bladder catheterization.

Recent medical and surgical advances have improved markedly the morbidity and mortality rates of chronically ill children. Increasing numbers of children with many diverse conditions now survive to adulthood and are able to attend school and pursue their educational and social development.3 Children, including those with chronic health conditions, deserve the opportunity to develop to their fullest potential through the benefits of education and health care.

CHRONICALLY ILL CHILDREN IN SCHOOLS

What most distinguishes chronically ill children and their families is their need for access to coordinated specialized health care services to a degree not required by other children. Individualized attention to their special health needs in school is of critical importance. The illnesses and their treatments frequently lead to greater than usual school absence and may hinder educational progress.4 Illness or mediations may also limit alertness or diminish physical stamina.
Drug-Exposed Infants
Authors:   Committee on Substance Abuse
Published: December 2021

Recent studies have documented that an increasing number of women of childbearing age are abusing licit and illicit substances. Although statistical data are insufficient, there are indications that approximately 1 in 10 infants may be exposed to illicit drugs during pregnancy. The National Institute on Drug Abuse 1988 National Household Survey1 revealed that 8.8% of women of childbearing age admitted to having used an illicit drug in the month before questioning. A recent survey of 36 private and public hospitals2 showed that approximately 11% of women delivering in these hospitals had used illegal drugs at some time during their pregnancies. A preliminary study in Pinellas County, Florida, demonstrated that cocaine and marijuana use during pregnancy were almost equally distributed across racial and socioeconomic lines.3

These incidence data parallel the increasing number of infants being admitted to special-care nurseries for complications caused by their intrauterine exposure to alcohol and other drugs. It is also important to consider that drug-exposed infants often go unrecognized and are discharged from the newborn nursery to homes where they are at increased risk for a complex of medical and social problems including abuse and neglect.

This statement addresses illicit substance use in pregnancy and its medical, social, mental health, and legal consequences for children and families. The Academy is developing a separate statement to address the issue of infants exposed to alcohol in utero.

THE PROBLEM

All illicit drugs reach the fetal circulation by crossing the placenta and can cause direct toxic effects on the fetus, as well as fetal and maternal dependency.
Clofibrate Treatment of Neonatal Jaundice
Authors: Gabilan J. C. , Benattar C. , Lindenbaum A.
Published: December 2021

To the Editor.—

Kappas et al1 have reported the results of Sn-protoporphyrin use in the management of hyperbilirubinemia in full-term newborns with direct Coombs-positive ABO incompatibility. A commentary, "A New Era in Therapy for Hyperbilirubinemia,"2 emphasizes the great interest of this pharmacologic means of prevention of neonatal hyperbilirubinemia (inhibition of the transformation of heme into bilirubin) by the action of Sn-protoporphyrin on heme oxygenase. Anthony F. McDonagh in the Journal of Pediatrics shows that the efficiency of tin-porphyrin is limited and that phototoxic risks exist which should lead the authors to be cautious in current practice.3
Surfactant Replacement Therapy With a Single Postventilatory Dose of a Reconstituted Bovine Surfactant in Preterm Neonates With Respiratory Distress Syndrome: Final Analysis of a Multicenter, Double-blind, Randomized Trial and Comparison With Similar Trials
Authors: Fujiwara Tetsuro , Konishi Mineo , Chida Shoichi , Okuyama Kazuo , Ogawa Yunosuke , Takeuchi Yutaka , Nishida Hiroshi , Kito Hideaki , Fujimura Masanori , Nakamura Hajime , Hashimoto Takeo ,   Surfactant-TA Study Group
Published: December 2021

The effects of a single dose of surfactant TA were assessed in premature neonates (birth weight 750 to 1749 g) with respiratory distress syndrome (RDS) in a multicenter, double-blind, randomized clinical trial. Only neonates with surfactant deficiency and without ultrasonographic evidence of intracranial hemorrhage ≥grade II were enrolled. Fifty-four patients received surfactant (100 mg of phospholipid per kilogram of body weight) and 46 patients received an air placebo within 8 hours of life. Treatment with this surfactant resulted in a significant reduction in the severity of RDS with a concomitant increase in the proportion of neonates with mild disease. The frequency of pulmonary interstitial emphysema and of pneumothorax was significantly lower in treated neonates compared with control neonates (2% vs 26%, P = .0008, and 7% vs 39%, P = .0004, respectively). The frequency of intracranial hemorrhage was significantly lower in the surfactant group compared with the control group (20% vs 54%, P = .0008) and was also reduced for the smallest nenoates in the surfactant group (13% vs 73%, P = .00008). When categorized according to severity of intracranial hemorrhage and severity of bronchopulmonary dysplasia, the surfactant group was at a significant advantage (adjusted Cochran-Mantel-Haenszel X2 = 10.72, P < .001 and X2 = 4.43, P = .036, respectively). The proportion of neonates surviving without intracranial hemorrhage and/or bronchopulmonary dysplasia was 63% in the surfactant group vs 26% in the control group (P = .0004); as for the smallest neonates, it was 58% in the surfactant group vs 4% in the control group (P = .0002). There were no differences between the groups with respect to the frequency of patent ductus arteriosus (46% vs 37%), pulmonary hemorrhage (6% vs 7%), necrotizing enterocolitis (0% vs 2%), sepsis (4% vs 2%), retinopathy of prematurity (13% vs 22%), or death (15% vs 22%). It is concluded that treatment with the single-dose surfactant regimen used in this study reduces the severity of respiratory distress during the 48 hours after treatment and decreases the major pulmonary morbidity and intracranial hemorrhage in premature neonates with RDS. Further studies are needed to determine whether (1) treatment at birth or as soon as after RDS is diagnosed and (2) the use of multiple dose of this surfactant would result in any additional benefits.
Haemophilus influenzae Type b Conjugate Vaccines: Immunization of Children at 15 Months of Age
Authors:   Committee on Infectious Diseases
Published: December 2021

This statement updates previous information and recommendations regarding Haemophilus influenzae type b conjugate vaccines. The four vaccines that have received extensive clinical investigation and/or licensure by the United States Food and Drug Administration (FDA) are listed in the Table. Previously, the Committee recommended that all infants be immunized at 18 months of age with one of the two conjugate vaccines, designated PRP-D and HbOC, that were licensed at that time.1, 2 A third conjugate vaccine, designated PRP-OMP and consisting of the capsular polysaccharide of H influenzae type b complexed with outer membrane proteins of Neisseria meningitidis, was licensed by the FDA in December 1989. Currently, the FDA has approved labeling for PRP-OMP, HbOC, and PRP-D vaccines that states "Administration of Haemophilus b Conjugate Vaccine may be considered for children as young as 15 months of age when it is expected that the child will not return at 18 months for Haemophilus b immunization." After review of the data available on immunogenicity for PRP-D, HbOC, and PRP-OMP administered to children at 15 months of age, the Committee concludes that all children should be immunized at 15 months of age.

BACKGROUND

Before the introduction of immunization against H influenzae type b, it was estimated that annually approximately 16 000 cases of invasive infection occurred in the United States in children 5 years of age or younger.3 About 26.6% of cases occurred in children 18 months of age or older, and approximately an additional 9.3% occurred in children 15 to 17 months of age.
Clioquinol (lodochlorhydroxyquin, Vioform) and lodoquinol (Diiodohydroxyquin): Blindness and Neuropathy
Authors:   Committee on Drugs
Published: December 2021

This Policy Statement was retired January 2011.

Clioquinol and iodoquinol are found in topical compounds for dermatologic use. Their application in pediatrics has been for treatment of diaper dermatitis, although the current labeling for these products advises against their use in children younger than 2 years of age. The Table lists a few of the many agents currently available that contain clioquinol or iodoquinol. Some nonprescription products also contain clioquinol.

Since our 1974 commentary on the toxicity of these drugs to children,1 additional reports of toxicity following skin application have become available. Both clioquinol and iodoquinol have been known to cause serious and irreversible optic atrophy and peripheral neuropathy.2 This class of drugs was associated with several thousand cases of subacute myelo-optic neuropathy in Japan.3-5 The clinical picture was that of a subacute onset of peripheral weakness and sensory loss, spastic paraparesis, and blindness, occurring in combination in various degrees. The most common symptoms were muscular weakness of the lower extremities and dysesthesia spreading to the trunk.

A World Health Organization committee convened in 1977 to prepare a list of essential drugs and excluded clioquinol because it considered the risks of treatment greater than the potential benefit.6 Other authoritative sources of drug information state that "clioquinol has limited topical antibacterial and antifungal activity"7 and that "routine use of either compound (clioquinol or iodoquinol) is not recommended."8

A recent clinical study examined the percutaneous absorption of clioquinol.9 Five healthy male subjects received one application (5 g) of 3% clioquinol cream applied for 12 hours to a 200 cm2 area of the forearm (1.1% of body surface area).
Fever and Petechiae in Children
Authors: BAKER RAYMOND C. , SEGUIN JOHN H. , LESLIE NANCY , GILCHRIST MARY J. R. , MYERS MARTIN G.
Published: December 2021

In Reply.—

Our recent study of children with fever and petechiae included all children admitted to the Emergency Department during the 1 year of the study. Therefore, the 7% incidence of meningococcemia is a true incidence of meningococcemia in children admitted to an emergency facility with fever and petechiae.

Although we agree that including the patients in whom an organism was not documented would have enhanced the statistical power of our results, we chose to exclude them due to the wide spectrum of illness represented in this group, both in severity of illness (ranging from viral syndrome to partially treated, presumed bacterial meningitis) and in presumed organism (viral versus bacterial).
The Work of Pediatric Residents
Authors: SCHINDLER ALAN M.
Published: December 2021

To the Editor.—

So it took a federal grant and three PhDs to tell us1 what we all know: the pediatric resident is "the optimal hospital staff provider." Any pediatric resident would tell us that, gratis, if we could catch her between the emergency department, ward, nursery, or ambulance transport—admitting patients, discharging patients; resuscitating children, intubating children, placing chest tubes; doing ward clerk work; starting intravenous infusions, drawing blood, taking blood to the lab, getting blood from the blood bank; moving cribs and beds; obtaining cultures, making Gram stains, reading Gram stains; retrieving radiographs, reading radiographs, giving medications, changing dressings, removing sutures; changing diapers, feeding babies, loving babies; picking up trash from the floors; teaching students, organizing conferences; writing orders, writing notes, dictating charts.
The NICHD Phototherapy Study
Authors: SCHEIDT PETER C. , BRYLA DOLORES A. , NELSON KARIN B. , HIRTZ DEBORAH G. , HOFFMAN HOWARD J.
Published: December 2021

In Reply.—

Dr Perlman expresses concern that readers of "Phototherapy for Neonatal Hyperbilirubinemia: Six-Year Follow-up of the National Institute of Child Health and Human Development Clinical Trial"1 could interpret our conclusions that phototherapy demonstrated a beneficial reduction or prevention of brain damage. We neither stated or meant to imply that phototherapy was observed to prevent brain injury. The statement in our concluding paragraph that phototherapy was "at least as effective as management with exchange transfusion" refers to "control of neonatal hyperbilirubinemia without evidence of adverse outcome" earlier in the sentence.
Periventricular Leukomalacia (PVL) and Myelination
Authors: WELCH R. J. , BYRNE PAUL
Published: December 2021

To the Editor.—

The study of Van de Bor et al1 appears to demonstrate differences in myelination between infants with and without periventricular leukomalacia (PVL). However, we feel that it does not demonstrate, as stated, that PVL causes delayed myelination, whereas periventricular-intraventricular hemorhage (PIVH) does not. Because the study group did not contain any survivors with intraparenchymal hemorrhage, caution must be used in stating that PIVH does not influence subsequent myelination.

Myelination is a complex process which continues into adulthood.
Efficacy of Methylphenidate Among Mentally Retarded Children With Attention Deficit Hyperactivity Disorder
Authors: Handen Benjamin L. , Breaux Anna Marie , Gosling Amy , Ploof Dianna L. , Feldman Heidi
Published: December 2021

Twelve children with IQ scores of 50 to 74 (educable mental retardation) who met rigorous diagnostic criteria for attention deficit hyperactivity disorder participated in a double-blind crossover study of the efficacy of two doses of methylphenidate compared with placebo. Dependent measures included behavioral ratings, classroom work output, laboratory measures of attention and learning, and direct observations of social behavior. Improvement with medication on the Conners Hyperactivity Index was observed in 75% of subjects. Significant increases in work output, on-task behavior, and attentional skills were associated with methylphenidate. However, gains in measures of attention were not associated with improvement in learning, as measured by a paired associate learning task. Additionally, no significant increases in appropriate social interactions during free play were associated with methylphenidate. The results suggest that mentally retarded children with attention deficit hyperactivity disorder respond to methylphenidate at similar rates and in similar domains to that of the nonretarded population.
Guidelines for Urgent Care in School
Authors:   Committee on School Health
Published: December 2021

Minor injuries and illnesses can occur in children during the course of the school day. They are usually well-handled by the school nurse in consultation with a physician who serves as the school medical advisor. True medical emergencies are rare. Many school systems have part-time school medical advisors and nurses who are responsible for more than one school building and may not be readily available. Therefore, the burden of emergency recognition and management may fall on teachers, principals, or other personnel within a school.

It is important for school administrators in consulation with the school medical advisoringand nursing service to formulate a guide for emergency care. The Committee on School Health of the American Academy of Pediatrics suggests the following:

1. Every school district should identify individuals als who are authorized and trained to make urgent medical care decisions.

2. An emergency care manual and standing orders for first aid should be written and made available to nurses, athletic staff, and faculty volunteers.1

3. Procedures should be in place to summon help in catastrophic and urgent care situations from emergency sources within the community including rescue squads and, where available, the 911 system. Transportation to a hospital or medical facility should be accessible.

4. The school nurse in each building should be the key person to carry out the program as she or he is most familiar with the students' health problems. All nurses should be trained in a program of emergency came developed by physicians, emergency medical technicians, and/or other nurses with special training in emergency care1
Why We Need a National Child Health Policy
Authors: Harvey Birt
Published: December 2021

Although the federal government has long had an interest in the health of children, action in support of this interest has been limited, fragmented, and inequitable. While health problems are increasing and becoming more complex and while policy leaders, business groups, and the public recognize that action is necessary, no response has been forthcoming. Development of a policy with measurable goals is needed. Resources must be allocated and data collected to periodically evaluate progress toward goals and to appropriately redirect resources.
Tetracycline for Rocky Mountain Spotted Fever
Authors: YAGUPSKY PABLO
Published: December 2021

To the Editor.—

In a recent editorial, Abramson and Givner addressed the problem of using tetracycline in young children for therapy of presumed Rocky Mountain spotted fever (RMSF), due to the potential risk of tooth discoloration.1 The risk appears to depend on the specific agent used (doxycycline causes less staining than do other tetracyclines, possibly because of its lower binding to calcium) and the degree of exposure to tetracycline.2 Unfortunately, current therapeutic recommendations do not provide clear guidelines on the optimal dosage required to treat RMSF.
Tetracycline for Rocky Mountain Spotted Fever
Authors: LEGGIADRO ROBERT J.
Published: December 2021

To the Editor.—

I read with interest the editorial by Abramson and Givner on the use of tetracycline for suspected Rocky Mountain spotted fever (RMSF) in children younger than 9 years of age.1 Their discussion of the relative risks and benefits of tetracycline or chloramphenicol for RMSF and their conclusion that the contraindication of tetracycline (due to its risk of teeth-staining) in all children younger than 9 years old does not seem warranted is relevant to another tick-borne infection, tularemia.2
Tetracycline for Rocky Mountain Spotted Fever
Authors: ABRAMSON JON S. , GIVNER LAURENCE B.
Published: December 2021

In Reply.—

Both Drs Yagupsky and Leggiadro agree with the recommendation that tetracycline would be appropriate for selected indications in children younger than 9 years of age. Dr Yagupsky raises the additional point that controlled studies to establish the length of therapy for the treatment of most rickettsial diseases, including Rocky Mountain spotted fever, are lacking. At our institution, we currently treat children with suspected or proven Rocky Mountain spotted fever until they are afebrile for 2 days or for 5 days total (whichever is longer).
Constitutional Delay of Growth: Expected versus Final Adult Height
Authors: LaFranchi Stephen , Hanna Cheryl E. , Mandel Scott H.
Published: December 2021

Constitutional delay of growth and puberty is believed to represent a variation of normal growth, and it is expected that children with this condition will grow for a longer duration than average and reach a height that is normal for their genetic potential. The records of children with constitutional delay of growth and puberty who were initially seen in the Pediatric Endocrine Clinic at the Oregon Health Sciences University between 1975 and 1983 were retrospectively reviewed. Criteria for study included a height more than 2 SD below the mean, a significantly delayed bone age, and a normal growth velocity on follow-up. Forty-two subjects were located and final adult height measurements were obtained. At contact, the 29 male subjects (mean age = 23.9 years) were 169.5 ± 4.5 cm tall (mean ± SD), and the 13 female subjects (mean age = 20.5 years) were 156 ± 3.8 cm tall. Adult height predictions during follow-up, using either the Bayley-Pinneau or Roche-Wainer-Thissen method, were close to final adult heights. The males were 1.2 SD and the females 1.3 SD below the 50th percentile as adults. This finding was not fully explained by genetic short stature; the males fell 5.1 cm and the females 5.3 cm below target heights based on midparental heights. It is concluded that this discrepancy is most likely explained by a selection bias of the shortest children referred to and observed in a subspecialty clinic, although a defect in human growth hormone secretion or function in children at the far end of the spectrum of constitutional delay of growth and puberty cannot be excluded.
Ambulatory Blood Pressure Patterns in Children and Adolescents: Influence of Renin-Sodium Profiles
Authors: Harshfield Gregory A. , Pulliam Derrick A. , Alpert Bruce S. , Stapleton F. Bruder , Willey Elaine S. , Somes Grant W.
Published: December 2021

A renin-sodium nomogram for normotensive children and adolescents was developed at our institution. The ambulatory blood pressure patterns of subjects classified by the nomogram were then compared. A biracial sample of 159 children and adolescents were classified as having a low, intermediate, or high renin-sodium profile based on the relationship between their plasma renin activity and 24-hour urinary sodium excretion. Casual (106/58 vs 107/61 vs 106/62 mm Hg) and awake (116/69 vs 117/69 vs 116/70 mm Hg) blood pressure values were comparable among subjects with low, intermediate, and high renin-sodium profiles. Subjects with high renin-sodium profiles, however, had a smaller decline in systolic blood pressure with sleep than did subjects with low renin-sodium profiles (7 vs 11 mm Hg; P < .04), and higher diastolic blood pressure readings during sleep than subjects with intermediate renin-sodium profiles (65 vs 62 mm Hg; P < .05). Subjects with high renin-sodium profiles also had greater variance of diastolic blood pressure readings during sleep than either subjects with low renin-sodium profiles (P < .01) or those with intermediate renin-sodium profiles (P < .02). The blunted nocturnal decline and increased nocturnal variance of blood pressure among subjects with high renin-sodium profiles may be a marker or mechanism for the future development of essential hypertension.