bluuebunny/crossref_metadata_2025 huggingface dataset:
PREGNANT TEEN-AGERS ARE OUTCASTS NO LONGER
Authors: L. J. F.
Published: December 2021

In the "old days" of the 1960's, 50's and 40's, pregnant teen-agers were pariahs, banished from schools, ostracized by their peers or scurried out of town to give birth in secret.

Today, pregnant teen-agers are even beginning to be viewed by some of their peers as role models. No longer are they shunned or ridiculed, but supported and embraced in their decisions to give birth, keep their babies, continue their educations and participate in school activities. Some adults, however, including many who in their youth considered the treatment of pregnant girls detestable, are never-the-less shocked by these attitudes.

When I was in high school, girls got pregnant and they disappeared," said Richard Schuldt of Eau Clair, Wis. "Now, my pregnant daughter goes on ‘The Montel Williams Show.’ " Mr. Schuldt's daughter April was elected homecoming queen at her high school last year when she was five months pregnant.
The Practice Of Pediatrics in the Era of Vaccines Effective Against Haemophilus influenzae Type b
Authors: Givner Laurence B. , Woods Charles R. , Abramson Jon S.
Published: December 2021

The practice of pediatrics is forever altered when a vaccine is effective in dramatically reducing the incidence of (or even eradicating) an infectious disease. As the targeted disease is rapidly declining in incidence, there are often exciting changes in the practice of pediatrics, with far-reaching effects in the everyday treatment of patients. Such is the case now due to the effectiveness of the conjugated polysaccharide vaccines against Haemophilus influenzae type b (Hib). The resultant rapid decline in the incidence of invasive disease due to Hib during the past several years has been documented in numerous studies.1-3 The effects of this dramatic decline in Hib disease on the approach to children who have (presumed) infectious diseases are the subject of this editorial.
Assessing Physical Activity and Fitness in the Office Setting
Authors:   Committee on Sports Medicine and Fitness
Published: December 2021

The terms physical activity, exercise, and physical fitness are often confused and sometimes used interchangeably. Physical activity is defined as any body movement produced by skeletal muscle that results in energy expenditure.1 Exercise is physical activity that is planned and repetitive with a goal of improving physical fitness. Physical fitness is a set of attributes that are health-related, skill-related, or both. Physical fitness is difficult to address without discussing its components. The American Alliance of Health, Physical Education, Recreation, and Dance (AAHPERD) identifies the five components of health-related physical fitness as cardiorespiratory endurance, muscular strength, muscular endurance, flexibility, and body composition.2 There are no guidelines for pediatricians in regard to addressing physical activity and fitness in the office setting.

This statement will review fitness assessment options and recommend practical interventions.

BENEFITS OF EXERCISE

Cardiovascular fitness is important in the prevention of adult coronary artery disease, hypertension, and obesity. In adults, to produce an increase in cardiorespiratory fitness, an exercise must be performed for a minimum duration of 20 minutes, three times a week, at an intensity of at least 60% of maximum heart rate. This is the basis for the exercise recommendations of the American College of Sports Medicine,3 which were also adopted for the Health Objectives for 1990.4

More recent studies have suggested that less intense physical activity also benefits health. An increasing number of scientists are promoting moderate to vigorous activity,5 because maximizing cardiovascular fitness may not be necessary to elicit changes in lifelong health. The greatest benefits of physical activity in adults are achieved when the least active individuals become moderately active.6
Asthma Treatment in the Emergency Department
Authors: Perry Robert F. , Allison E. Jackson
Published: December 2021

We commend Dr Scarfone and colleagues1 (Pediatrics, October 1993) for proposing a medically sound, clinically efficacious, and easily implemented protocol for the front-line treatment of the symptomatic asthmatic child brought to the emergency department setting; a practical adjunct to the currently accepted standard treatment regimen that serves to substantially reduce the number of asthma-related hospital admissions while measurably raising the comfort level of those physicians faced with the decision to commit such children to an extended course of inpatient therapy.
A Short-Term Study of Nitrofurantoin Prophylaxis in Children Managed With Clean Intermittent Catheterization
Authors: Johnson Hjalman W. , Anderson John D. , Chambers G. Keith , Arnold William J.D. , Irwin Beverly J. , Brinton Jocelyne R.
Published: December 2021

Objective. Because there is no evidence for the effectiveness of antibiotic prophylaxis in children with neurogenic bladder, the value of once-daily nitrofurantoin macrocrystals was assessed in a selected population with neurogenic bladder due to meningomyelocele.

Methods and trial population. Children with significant urinary tract abnormalities other than neurogenic bladder were excluded. A urinary tract "infection" was defined as ≥108 colony forming units of bacteria/L of urine together with pyuria of ≥50 x 106 leukocytes/L, and/or symptoms consistent with an urinary tract infection. Fifty-six children participated in a 24-week double-blinded, placebo-controlled cross-over study. The infeclion status was assessed at two weekly intervals or if relevant clinical manifestations occurred.

Results. For the whole trial the average percentage of "infections" per urine sample for each patient was reduced from 39% on placebo to 19% on single daily dose prophylaxis (P < .0003). For the first 12 weeks of the trial corresponding figures were 45% on placebo and 22% on prophylaxis (P < .0018). There was evidence for a marked carryover protective effect of nitrofurantoin into the placebo arm of the trial.

Conclusion. Nitrofurantoin is an effective prophylactic agent during a 3-month period. Long-term studies are needed to confirm the reasonable expectation of a beneficial effect on urinary tract damage.
Are Infants With Bronchopulmonary Dysplasia at Risk for Sudden Infant Death Syndrome?
Authors: Gray Peter H. , Rogers Yvonne
Published: December 2021

Objective. To compare the incidence of sudden infant death syndrome (SIDS) and apparent life-threatening event (ALTE) in infants with bronchopulmonary dysplasia (BPD) and birth weight-matched control infants in view of the changing pattern of chronic lung disease of prematurity.

Methods. The study population consisted of 78 preterm infants of 26 to 33 weeks gestation who were diagnosed as having BPD and discharged. The 78 control infants were matched with the study infants for birth weight categories. Infants unable to maintain adequate oxygenation without supplemental oxygen when they were feeding well and thriving were discharged on home oxygen. All infants were at least 8 months of age at follow-up and information concerning the occurrence of any ALTE was obtained by direct parent interview.

Results. No infant died during the period of follow-up. Seven (8.9%) of the study group compared with eight (10.5%) of the control infants had an ALTE. Three infants (one study, two control infants) were hospitalized for further investigation. No infant discharged on the home oxygen program had an ALTE.

Conclusions. The data from this study suggest that preterm infants with BPD are not at increased risk from SIDS compared with preterm infants without this condition. This may be related to close monitoring of the infants' oxygenation status and the provision of home oxygen when appropriate, which should eliminate episodes of unrecognized and untreated hypoxemia. Home monitoring for infants with BPD may not be warranted.
Prenatal Exposure to Cigarettes in Infants With Obstructive Sleep Apneas
Authors: Kahn André , Groswasser José , Sottiaux Martin , Kelmanson Igor , Franco Patricia , Rebuffat Elizabeth , Dramaix Michèle , Wayenberg Jean Louis
Published: December 2021

Objective. To investigate the effect of prenatal smoking on infant respiratory behavior during sleep.

Methods. A questionnaire concerning family habits and infants' history was completed for 550 healthy infants before a 9-hour night polysomnographic study. Because the data for 41 infants were not available for analysis, 509 subjects were studied: 115 were newborns evaluated within 1 week after birth, and 394 were healthy infants admitted at 11 weeks of life (range 5 to 29 weeks) after various research protocols.

Results. According to the smoking frequency of the mothers during pregnancy, the subjects were defined as "nonsmokers" (no cigarette smoked during pregnancy; n = 400), "light smokers" (1 to 9 cigarettes per day; n = 37), or "smokers" (10 or more cigarettes per day; n = 72). Compared with nonsmokers and light smokers, "smoking" mothers had a significant increase in the number of episodes of uterine bleeding during the pregnancy. Their infants had lower birth weights and more frequent episodes of profuse sweating during sleep. Infants of smokers also had more frequent and longer obstructive sleep apneas than those of the two other groups. For infants of smokers the relative risk for obstructive apneas was 2.76 (95% confidence interval: 1.63 to 4.69; P = .001) The relation between prenatal smoking and postnatal manifestation of obstructive sleep apneas demonstrated a dose-response pattern. Paternal smoking during pregnancy increased the risk of obstructive apneas only in the infants of smoking mothers, but not in those of the two other groups. Maternal smoking after birth did not add significantly to the risk of obstructive apneas. The effect of smoking was seen in older infants, as well as in the newborns not yet exposed to ambient cigarette smoke. A stepwise logistic regression, using obstructive sleep apneas as the dependent variable identified three significant independent variables: smoking during pregnancy (P = .001), profuse sweating during sleep (P = .001), and birth weight (P = .010). No explanation was found for the effect of prenatal smoking on obstructive sleep apneas.

Conclusion. Prenatal smoking by mothers correlated with an increase in frequency and length of obstructive apneas and a decrease in birth weight of their infants. The infants were under greater risk for obstructive apnea if both parents smoked. Explanations for our results are unknown to us, but these findings may be of interest in the study of infant breathing behavior and epidemiological characteristics of sudden infant death syndrome.
Postoperative Respiratory Compromise in Children With Obstructive Sleep Apnea Syndrome: Can It Be Anticipated?
Authors: Rosen Gerald M. , Muckle Robert P. , Goding George S. , Mahowald Mark W. , Ullevig Connie
Published: December 2021

Objective. The aim of this research was to describe the postoperative respiratory complications after tonsillectomy and/or adenoidectomy (T and/or A) in children with obstructive sleep apnea syndrome (OSAS), to define which children are at risk for these complications, and to determine whether continuous positive airway pressure (CPAP) is an effective strategy for dealing with these complications.

Methods. The data for this study were gathered through a retrospective chart review of all children 15 years of age or younger with polysomnographically (PSG) proven OSAS who had a T and/or A at Hennepin County Medical Center between January 1985 and September 1992. Particular attention was paid to factors that contributed to the OSAS, postoperative respiratory complications, and intervention strategies for dealing with these complications.

Results. The charts of 37 children with OSAS documented by preoperative PSG who later had a T and/or A were reviewed retrospectively. Ten of these children had significant postoperative respiratory compromise secondary to OSAS that prolonged their hospital stay from 1 to 30 days and caused symptoms ranging from O2 desaturation <80% to respiratory failure. These children were younger and had significant associated medical problems that contributed to or resulted from their OSAS in addition to large tonsils and adenoids. The associated medical problems included craniofacial anomalies, hypotonia, morbid obesity, previous upper airway trauma, cor pulmonale, and failure to thrive. The children with postoperative respiratory complications also had more severe apnea on their preoperative PSG. One child had a uvulopalatopharyngoplasty (UPPP) in addition to the T & A. Taken together, the history, physical and neurological examination, and the PSG were able to identify successfully the children who subsequently developed respiratory compromise secondary to OSAS after a T and/or A. Nasal continuous positive airway pressure (CPAP) and bilevel CPAP was used successfully to manage the preoperative and/or postoperative upper airway obstruction in five of these children.

Conclusions. Based on these findings, overnight observation is recommended with an apnea monitor and oximeter for patients undergoing a T and/or A who have OSAS and meet any of the following high-risk clinical criteria: (1) <2 years of age, (2) craniofacial anomalies affecting the pharyngeal airway particularly midfacial hypoplasia or micro/retrognathia, (3) failure to thrive, (4) hypotonia, (5) cor pulmonale, (6) morbid obesity, and (7) previous upper airway trauma; or high-risk PSG criteria: (1) respiratory distressindiex (RDI) >40 and (2) SaO2 nadir <70%; or undergoing a UPPP in addition to the T and/or A. Nasal CPAP/bilevel CPAP can be used to manage the preoperative and/or postoperative upper airway obstruction in patients with OSAS undergoing a T and/or A.
Age-Related Response to Lidocaine-Prilocaine (EMLA) Emulsion and Effect of Music Distraction on the Pain of Intravenous Cannulation
Authors: Arts S. E. , Abu-Saad H. H. , Champion G. D. , Crawford M. R. , Juniper K. H. , Ziegler J. B. , Fisher R. J.
Published: December 2021

Objective. To compare the efficacy of a local anesthetic cream and music distraction in reducing or preventing pain from needle puncture (intravenous cannulation) in children. A secondary aim was to examine the influence of age on the pain report and behavior and on the therapeutic outcome.

Methodology. Children aged 4 to 16 years (N = 180) who were to undergo surgery under general anesthesia via intravenous cannulation were randomly allocated to one of three interventions. The comparison of lidocaine-prilocaine emulsion (EMLA, Astra) and a placebo emulsion was double-blind. Stratification by age group (4 to 6, 7 to 11, 12 to 16) ensured an equal number of children (20) in each intervention/age group category. A global assessment of the behavioral reaction to the procedure was made by the principal investigator, taking into account vocal, verbal, facial, and motor responses. The child was asked to assess pain severity on the Faces Pain Scale (FPS) and a visual analogue toy (VAT). The scales were applied conservatively as ordinal scales: FPS 0 to 6; VAT 0 to 10.

Results. Children who received lidocaine-prilocaine emulsion reported less pain (mean FF5 score = 1.42) compared with placebo emulsion (mean FPS score = 2.58) and with music distraction (mean FPS = 2.62). There was a highly significant therapeutic effect (P < .001) on the self-report and behavioral scores. Younger children, regardless of intervention, reported significantly more pain than the older children (mean FPS scores: 2.85, 2.33, 1.43 for age groups 4 to 6, 7 to 11, and 12 to 16 respectively; P < .001). The superiority of the local anesthetic emulsion was maximal in the youngest age group (4 to 6) almost eliminating pain-related behavior, and multiple regression analysis confirmed significant age and treatment effects and revealed interaction between therapeutic effect and age. Although a trend favoring the active emulsion was evident in the older children (7 to 11, 12 to 16) the differences were not significant. The pain scores were influenced by the type (gauge) of cannula, but this did not affect the conclusion regarding therapeutic and age effects. There was no influence of sex, experience with venipuncture, or whether the child was anxious on arrival in the operating room.

Conclusions. The results show that lidocaine-prilocaine emulsion is highly effective in preventing pain from venipunctures in young children the group in most need of prevention.
Infant Sleep Position and Risk for Sudden Infant Death Syndrome: Report of Meeting Held January 13 and 14, 1994, National Institutes of Health, Bethesda, MD
Authors: Willinger Marian , Hoffman Howard J. , Hartford Robert B.
Published: December 2021

Objective. To evaluate the current knowledge on the relationship between infant sleep position and sudden infant death syndrome (SIDS), and to determine how the information can be used to guide further activities in the United States.

Methods. Data from international vital statistics, epidemiologic studies of SIDS risk factors, and studies of outcomes of public health interventions that advocated nonprone sleeping to reduce the risk for SIDS were discussed at a meeting held by the National Institute of Child Health and Human Development (NICHD) with cosponsorship from the National Institute on Deafness and Other Communication Disorders (NIDCD), and the National Center for Health Statistics (NCHS) on January 13, and 14, 1994.

Results. Trends in postneonatal mortality and SIDS rates from 1980 through 1992 were evaluated for Australia, Britain, New Zealand, the Netherlands, Norway, Sweden, and the United States. All of the countries that experienced a rapid decline in prone sleeping also had reductions of approximately 50% in their SIDS rates. Postneonatal mortality rates dropped as well, with the reduction in SIDS being the primary contributor to the reported declines. The major behavioral change in all targeted populations was in sleep position. No significant changes were observed in the proportion of parents who smoked cigarettes, or in breast-feeding. Preliminary data from population-based studies showed there were no reported adverse outcomes associated with a change to side or back sleep position, such as an increase in deaths due to aspiration or in apparent life-threatening events.

Conclusion. The overwhelming opinion of the assembled experts was that the evidence justified greater effort to reach parents with the American Academy of Pediatrics' recommendation that healthy infants, when being put down to sleep, be positioned on their side or back.
Video-Assisted Thoracoscopic Surgery for Patent Ductus Arteriosus
Authors: Burke Redmond Paul
Published: December 2021

Therapeutic options for the treatment of patent ductus arteriosus (PDA) continue to evolve. Gross and Hubbard reported the first surgical interruption in 1939.1 Transcatheter occlusion was achieved by Portsmann et al in 1971,2 and indomethacin therapy for premature newborns was described in 1976.3 Although preliminary results have been reported for several transcatheter PDA devices, none currently have Food and Drug Administration approval. Transcatheter coils are being placed in many institutions,4 and some patients are awaiting the availability of transcatheter devices. In an effort to reduce surgical trauma, advanced endoscopic imaging technology has been adapted for use in pediatric cardiothoracic surgery, enabling an interruption of the PDA with a minimally invasive transthoracic technique.5
Hereditary Sensory Neuropathy Manifesting as Possible Child Abuse
Authors: Makari George S. H. , Carroll James E. , Burton Edward M.
Published: December 2021

Because child abuse occurs frequently and leads to repeated trauma if unrecognized, pediatricians are acutely aware of nonaccidental injury. On occasion, an uncommon disease is manifested in a way that suggests child abuse as a possible explanation of trauma. We report on two siblings with hereditary sensory neuropathy. One of these two children was removed from the home because of suspected child abuse. It is important to recognize hereditary sensory and autonomic neuropathies (HSAN) as a cause of repeated trauma to prevent unnecessary family intervention for suspected child abuse.

CASE REPORTS

PATIENT 1

A 5-year-old Hispanic girl was removed from her home after hospitalization for second degree burns over 15% of her body.
FORMER BLUE CROSS CHIEF DECLINES TO TESTIFY
Authors: L. J. F.
Published: December 2021

Joseph P. Gamble, who led the Washington area Blue Cross plan down a financially disastrous path during the 1980s, said yesterday he would answer no questions from the Senate subcommittee looking into the management of the troubled insurance giant...

Gamble, who retired as chief executive officer of the National Capital plan in November, led the company into an ill-fated diversification strategy during the 1980s that led to more than $ 100 million in losses...

In six years, Gamble alone ran up $447,000 in travel expenses, and travel for him and two other top executives topped $ 1 million, the probe found.
Letter to the Editor
Authors: Turner Ronald B.
Published: December 2021

The American Academy of Pediatrics Committee on Infectious Diseases recently published a revised statement regarding the use of ribavirin for treatment of respiratory syncytial virus (RSV) infections.1 The new statement specifically recommends that patients at high risk for complications of their RSV infection by virtue of underlying disease or with severe disease as indicated by blood gas analysis be treated with ribavirin. This is a change from the previous statement that acknowledged the lack of consensus and did not explicitly recommend ribavirin in these situations.
Kernicterus in a Full Term Infant
Authors: Penn Anna A. , Enzmann Dieter R. , Hahn Jin S. , Stevenson David K.
Published: December 2021

Neonatal jaundice can represent a benign physiologic process or be the harbinger of serious illness with associated severe neurotoxicity. The neurological manifestations of kernicterus, a condition resulting from the deposition of unconjugated bilirubin in the central nervous system, are rarely seen in modern neonatal care, but jaundice, which reflects elevated serum bilirubin levels, is one of the most common findings in the neonatal period.1 More than half of all term infants will develop some neonatal jaundice and at least 6% will have a serum bilirubin concentration above 12.9 mg/dL.2 The appropriate treatment of hyperbilirubinemia is currently a topic of much debate in pediatrics, particularly treatment of full term infants without risk factors for hemolytic disease.3,4
Apparent Insatiability: An Unrecognized Manifestation of Food Intolerance in Breast-Fed Infants
Authors: Ducharme Francine M. , Rousseau Elisabeth , Seidman Ernest G. , Chad Zave
Published: December 2021

Recognized manifestations of food allergy in infants include atopic dermatitis, urticaria, colic, gastroenteropathy, allergic rhinitis, asthma, and anaphylaxis.1 Recently, sleep disturbance was added to this list.2 We present two exclusively breast-fed siblings in whom the cardinal manifestation of food intolerance was apparent insatiability. To our knowledge, voracity has never been reported as a manifestation of food sensitivity. Further, confronted with an apparently healthy and well-growing infant, most clinicians would tend to dismiss maternal concerns regarding their infant's feeding behavior. This attitude may not only delay diagnosis, but also prolong maternal sleep deprivation associated with insatiable breast-fed infants who have unrecognized food intolerance.
Letter to the Editor
Authors: Harrington Madeline
Published: December 2021

Wiswell et al, in their article "Circumcision in Children Beyond the Neonatal Period," (December 1993, Pediatrics), found a substantial (7%) complication rate. For this reason, they recommend that physicians "be more proactive in recommending neonatal circumcision." By this, they presumably mean that more neonates should be circumcized despite a complicated neonatal course (the reason that 32% of patients in their study were not circumcized as neonates) or that parents should be more strongly encouraged to choose neonatal circumcision (55% were not circumcized of parental choice).
Letter to the Editor
Authors: Harrison Helen
Published: December 2021

The parents who drafted "The Principles For Family-Centered Neonatal Care"1 have all spent considerable time in the neonatal intensive care unit (NICU). Most of us are parents of two or more premature babies. We are familiar with NICU families of all backgrounds through our work in support organizations, disability rights groups, and ethics committees. Our university educations may have made us better able to understand and articulate the issues, but they did not significantly alter our experience in the NICU.
Recent and Intended Drug Trafficking Among Male and Female Urban African-American Early Adolescents
Authors: Li Xiaoming , Feigelman Susan
Published: December 2021

Objective. To investigate associations between recent and intended involvement in drug trafficking and perceptions of the social environment among high-risk urban African-American youths.

Methods. A multicomponent risk assessment survey was conducted among a convenience sample of 351 African-American youths 9 through 15 years of age residing in low-income communities. Both univariate analysis and logistic regression were performed to examine the association of youths' perceived social environment with recent and intended involvement in drug trafficking.

Results. Drug selling or delivering in the previous 6 months was reported by 6% of the youths; 12% expected to engage in these activities in the next 6 months. There was a strong association between drug trafficking and other high-risk behaviors, including drug use. Among both genders, perceptions that neighbors, friends, or family members were involved in drug trafficking were correlated with recent or intended drug trafficking. For boys, personal economic needs had a strong association with drug trafficking. For girls, personal feelings were more important correlates of intended involvement.

Conclusions. Efforts aimed at both drug-trafficking prevention and intervention need to be community-based and multifaceted. Programs should address the youths' perceived social environments and consider gender differences regarding correlates of drug-trafficking involvement.
The Role of Carnitine Supplementation in Valproic Acid Therapy
Authors: Kelley Richard I.
Published: December 2021

Carnitine is a simple, vitamin-like compound that transports long-chain fatty acids into mitochondria. Despite its essential role in human nutrition and metabolism, carnitine engendered relatively little medical interest until the description in the 1970s of human disorders in which muscle or systemic levels of carnitine were markedly depressed and in which clinical improvement followed treatment with carnitine. Since then, carnitine has enjoyed a remarkable rise in popularity as an aid to everything from common muscle fatigue to treatment of specific inborn errors of metabolism. Nowhere has the popularity of carnitine been more evident than in the treatment of children taking valproic acid, which causes in some children a depression of free carnitine levels.
Why are Children Hospitalized? The Role of Non-Clinical Factors in Pediatric Hospitalizations
Authors: Goodman David C. , Fisher Elliott S. , Gittelsohn Alan , Chang Chiang-Hua , Fleming Craig
Published: December 2021

Objective. Pediatric medical discharge rates vary widely across hospital service areas, beyond differences explained by chance or disease incidence alone. This study examines the relationship between the characteristics of local medical services and the likelihood of hospitalization.

Design. Small area and population-based regression analysis.

Setting. The 72 hospital service areas of Maine, New Hampshire, and Vermont.

Study population. The 589 290 (1989) children of Maine, New Hampshire, and Vermont < 15 years of age with 120 806 discharges during 1985 through 1989.

Measurement and main results. Using logistic regression and controlling for community income, we found that children residing in zip codes with high per capita bed supply (4.0/1000) had 9% more discharges (odds ratio: 1.09; 99% confidence interval: 1.07, 1.11) compared with children in areas with low per capita bed supply (1.9/1000). Children living 30 minutes from the nearest hospital had 15% fewer medical discharges (odds ratio: 0.849; confidence interval: 0.830, 0.867) than those living in a zip code with a hospital. Residence in one of the three academic medical center hospital service areas resulted in 32% fewer discharges (odds ratio: 0.68; confidence interval: 0.66, 0.70). Similar and statistically significant(P < .01) results were noted for the most common nonperinatal diagnostic categories: asthma/bronchitis (diagnostic related group = 98) and gastroenteritis (diagnostic related group = 184). No effect was noted for femur fracture, a condition for which admission rates equal disease incidence.

Conclusions. The supply and character of medical care are important influences on the likelihood of hospitalization for pediatric medical conditions for which outpatient alternatives are available.
Evaluation of a Rapid Diagnostic Test for Respiratory Syncytial Virus (RSV): Potential for Bedside Diagnosis
Authors: Krilov Leonard R. , Barone Stephen R. , Harkness S. Hella , Lipson Steven M. , Kaplan Mark H. , Ciamician Zarui
Published: December 2021

Objective. Rapid detection of respiratory syncytial virus (RSV) infection can assist clinicians in decisions regarding antiviral therapy with ribavirin as well as instituting infection control measures. The Abbott TestPack RSV is a rapid RSV detection immunoassay that can be performed on respiratory secretions in 20 to 30 minutes without special laboratory equipment The purpose of this study was to evaluate housestaff performance of the TestPack RSV at bedside as compared with laboratory testing of aliquots of the same specimen by tissue culture inoculation, direct fluorescent antibody (DFA) testing, and TestPack RSV.

Methods. During the 1991 through 1992 RSV season, 137 nasopharyngeal aspirates or washes obtained from pediatric patients < 4 years of age suffering from acute respiratory disease were assayed by the Food and Drug Administration-approved TestPack RSV as well as conventional tube culture and DFA testing.

Results. 66 of 137 (48%) specimens were positive for RSV as defined by: isolation and DFA-positive (n = 48) and DFA testing positive with negative culture (n = 18); blocking assay experiments using TestFack RSV confirmed culture-negative DFA-positive specimens as positive in 8/8 instances in which material for retesting was available. Using these definitions, the sensitivity and specificity for the assays were: housestaff TestPack RSV: 92%, 93%; laboratory TestPack RSV: 97%, 98%; virus isolation: 72%, 100%.

Conclusion. From these data, it appears that the TestPack RSV EIA in the field setting is reliable, although laboratory confirmation of results is important.
Efficacy of Albuterol in the Management of Bronchiolitis
Authors: Gadomski Anne M. , Lichenstein Richard , Horton Lisa , King James , Keane Virginia , Permutt Thomas
Published: December 2021

Objective. To examine the efficacy of albuterol (0.15 mg/kg per dose) in the management of bronchiolitis.

Design. Randomized, double-blind, placebo-controlled outpatient clinical trial utilizing four study groups: nebulized albuterol, nebulized saline, oral albuterol, and oral placebo.

Setting. Pediatric emergency department and outpatient clinic at University of Maryland in Baltimore.

Patients. Eighty-eight infants (median age 5.5 months) being treated for their first episode of wheezing were randomly assigned to nebulized albuterol (n = 22), nebulized saline (n = 23), oral albuterol (n = 19), oral placebo (n = 24).

Interventions. The nebulized groups received two nebulizations 30 minutes apart, whereas the oral groups received one oral dose.

Main outcome measures. Respiratory and heart rates, clinical score, oxygen saturation (Spo2), and the infant's state, ie, asleep, awake, or feeding, were recorded at baseline and at 30 and 60 minutes after treatment

Results. Randomization produced equivalent groups in terms of demographics and baseline measures. There were no statistically significant differences in any outcomes among the four treatments, except for oral albuterol, which produced an increase in heart rate (15 beats per minute, P = .005). No differences in the need for additional treatment or hospitalization were observed. Change in the state of the infant during the trial had significant effects on respiratory rate and clinical score.

Conclusions. Albuterol is as effective as oral placebo in the management of bronchiolitis. Past studies supporting the use of albuterol did not control for effects of change in state of the infant and did not use a truly inactive placebo group. This study underscores the importance of these design components in measuring the efficacy of albuterol in infants.
WHAT'S IN A NOM?
Authors: L. J. F.
Published: December 2021

The French, who sometimes claim to have invented civil rights, are free at last to decide what first names they may give their children. No longer will their choice be subject to the whims of a junior official in the local mairie of the commune in which their child is born and registered, who until now has been able to reject any name deemed "contrary to the interests of the child."

Under a law dating from the 11th Germinal of the year XI of the French Revolution (in fact, April 1st 1803, but not intended as an April fool's joke), parents were obliged to choose their child's name from one of the various authorised calendars of names of Catholic saints, revolutionaries or historical figures who were real, not mythical, and had lived before the Middle Ages. Achille, Nestor and Vercingetorix were all right; Jupiter and Juno were not.

The law was supposed to ensure that French babies were given French names and to protect them from ridiculous or obscene ones. Yet, as so often when bureaucrats know better, the ridiculous is what appeared. For boys, Chien (dog), Injurieux (insulting) and Fou (mad) were acceptable. Ordinary Breton and Basque names were, until relatively recently, forbidden. Girls could be called Porcaire (piggy), but not Sue-Ellen.
Which Dogs Bite? A Case-Control Study of Risk Factors
Authors: Gershman Kenneth A. , Sacks Jeffrey J. , Wright John C.
Published: December 2021

Objective. Dog bites cause an estimated 585 000 injuries resulting in the need formedical attention yearly and children are the most frequent victims. This study sought to determine dog-specific factors independently associated with a dog biting a nonhousehold member.

Methods. A matched case-control design comprising 178 pairs of dogs was used. Cases were selected from dogs reported to Denver Animal Control in 1991 for a first-bite episode of a nonhousehold member in which the victim received medical treatment. Controls were neighborhood-matched dogs with no history of biting a nonhousehold member, selected by modified random-digit dialing based on the first five digits of the case dog owner's phone number. Case and control dog owners were interviewed by telephone.

Results. Children aged 12 years and younger were the victims in 51% of cases. Compared with controls, biting dogs were more likely to be German Shepherd (adjusted odds ratio (ORa) = 16.4, 95% confidence interval (CI) 3.8 to 71.4) or Chow Chow (ORa = 4.0, 95% CI 1.2 to 13.7) predominant breeds, male (ORa 6.2, 95% CI 2.5 to 15.1), unneutered (ORa = 2.6, 95% CI 1.1 to 6.3), residing in a house with ≥1 children (ORa 3.5, 95% CI 1.6 to 7.5), and chained while in the yard (ORa = 2.8, 95% CI 1.0 to 8.1).

Conclusions. Pediatricians should advise parents that failure to neuter a dog and selection of male dogs and certain breeds such as German Shepherd and Chow Chow may increase the risk of their dog biting a nonhousehold member, who often may be a child. The potential preventability of this frequent public health problem deserves further attention.
TIME TO THROW IN THE TOWEL?
Authors: L. J. F.
Published: December 2021

England must take the credit—or blame—for the reinvention of boxing. The sport was a popular part of the Roman games but had vanished by the 5th century. It returned some 1200 years later, when bare-fist prizefights began to be held in and around London. With help from the Marquess of Queensberry, boxing spread around the world, making money for a considerable number of boxing promoters and a smaller number of boxers.

It is appropriate, then, that the British Medical Association should be actively involved in examining the sport. In its latest report, The Boxing Debate, which was issued last week, it repeats its call for a ban on boxing and asks for an independent inquiry into its safety.

The briefest reading of the report should persuade even boxing's proponents of the need for an inquiry. In its appendix the report prints abstracts of recent research on what happens to boxers after they have been battered in the ring.

For professional boxers, several studies make unpleasant reading. One using computerised tomography found 87 per cent of boxers, in a sample of 18, showed evidence of brain damage. Another records that 15 out of 19 young boxers register as impaired on a battery of neuropsychological tests.

Particularly disturbing are three studies which show that changes found in the brains of ex-boxers are immunochemically similar to those seen in Alzheimer's disease. That raises the possibility that even boxers who retire from the ring healthy may pay the price in middle age with early onset of Alzheimer's disease.
Recombinant Human Erythropoietin in the Treatment of the Anemia of Prematurity: Results of a Double-Blind, Placebo-Controlled Study
Authors: Meyer Michael P. , Hann F. Mary , Sive Alan A. , Moller Geoffery , Malan Atties F. , Meyer Jill H. , Commerford Anita , Jacobs Peter
Published: December 2021

Objective. To assess the efficacy of recombinant human erythropoietin (rHuEpo) in the treatment of the anemia of prematurity.

Methodology. A double-blind, placebo-controlled study was conducted on 80 preterm infants (≤32 weeks; postnatal age, 2 to 8 weeks; central hematocrit ≤35%). Patients were randomly assigned to receive subcutaneous rHuEpo (Eprex, 600 U/kg per week) or an equivalent volume of placebo, for up to 6 weeks. All patients received supplements of vitamin E (25 IU) and iron (3 mg/kg per day). The iron supplement was increased if declining serum ferritin measurements were noted.

Results. Treatment and placebo groups did not differ significantly with respect to mean gestational age, birth weight hematocrit, or reticulocyte count at study entry. Fewer transfusions were administered to those receiving erythropoietin (7 compared with 21; P = .002). Compared with the placebo group, the infants receiving rHuEpo had a higher mean hematocrit (32.3 ± 4% vs 29.3 ± 6.2%; P = .014) and absolute reticulocyte count (223 ± 73 vs 124.9 ± 73 x 109/L; P < .001) at the end of the study. The mean neutrophil count was not significantly reduced at study exit (P = .8), nor at any other period during the trial in the rHuEpo group. Intercurrent events (mostly infections) were not increased in the treatment group, although there was one case of sudden infant death syndrome at age 4 months.

Conclusions. Using a dose of rHuEpo of 600 U/kg per week, this study has shown a clear reduction in the requirement for blood transfusion in preterm infants.
Care of the Child With Tympanostomy Tubes: A Visual Guide for the Pediatrician
Authors: Isaacson Glenn , Rosenfeld Richard M.
Published: December 2021

More than 2 million tympanostomy tubes are placed annually in the United States, primarily in children with chronic or recurrent otitis media refractory to nonsurgical management (J.S. Reilly, personal communication, 1994). Traditionally, the operating otolaryngologist has had the responsibility of caring for these patients, including: confirming middle ear disease, assuring tube patency, controlling refractory otorrhea, and managing complications such as tympanic membrane perforation or cholesteatoma. In response to pressures from a changing health care system, pediatricians are less able to refer children back to the otolaryngologist for routine tube surveillance, and must therefore perform it themselves, often with incomplete instrumentation and training.

An approach is presented here for the care of the child with tympanostomy tubes based on the authors' combined experience with thousands of intubated children, and on available information from the pediatric and otolaryngic literature. With appropriate postoperative surveillance and follow-up care, the morbidity from tympanostomy tubes can be minimized. Although there are other ways of achieving the same goals, these time-honored methods are safe and effective. Because this is a visual guide, photographs are liberally interspersed to clarify and reinforce the written material.

NORMAL TUBE APPEARANCE

There are hundreds of different tube designs and materials and at least five different potential insertion sites in the tympanic membrane. This bewildering array of devices can be reduced to two general types: short-term tubes (intended to remain in the eardrum for 8 to 15 months) and long-term tubes (intended to remain in the eardrum > 15 months) (Fig 1A and B).
Infant Walker-Related Injuries: A Prospective Study of Severity and Incidence
Authors: Chiaviello Christine T. , Christoph Richard A. , Bond G. Randall
Published: December 2021

Objective. To determine the incidence and significance of walker-related injuries in infants.

Methods. During a 3-year, 8-month period, all infants who were brought to the University of Virginia Pediatric Emergency Department with a walker-related injury were prospectively studied. During the emergency department visit demographic and epidemiologic information were recorded. The annual incidence of walker-related injuries occurring in infants <1 year of age that resulted in a hospital emergency department visit was calculated from the home zip codes of the injured patients and from the population of infants <1 year of age living in Charlottesville and in Albemarle County.

Results. Sixty-five patients were enrolled in the study. The age distribution ranged from 3 months to 17 months, with 95% younger <1 year old. Mechanisms associated with walker-related injuries included stairway falls in 46 infants (71%), tip-overs in 14 infants (21%), falls from a porch in 2 infants (3%), and burns in 3 infants (5%). These injuries predominantly involved the head and neck region (97%), with few injuries to the extremities (6%) and trunk (3%). Although the majority of injuries were minor, significant injuries occurred in 19 infants (29%). These injuries included skull fracture, concussion, intracranial hemorrhage, full-thickness burns, c-spine fracture, and death. After excluding the burned patients, all the serious injuries resulted from falls down stairs. The annual incidence of injuries occurring in infants <1 year of age, related to the use of walkers, and resulting in an emergency department visit was 8.9/1000, and for serious injuries was 1.7/1000.

Conclusions. The incidence and significance of infant walker-related injuries in infants are unacceptably high.
Kernicterus in Premature Infants: Current Prevalence and Relationship to NICHD Phototherapy Study Exchange Criteria
Authors: Watchko Jon F. , Claassen Diana
Published: December 2021

Objective. This study was undertaken to determine the current prevalence of kernicterus in premature neonates and to relate the occurrence of kernicterus to 1) the categorization of the infant as "at risk" by National Institute of Child Health and Human Development (NICHD) Phototherapy Study exchange transfusion criteria, and 2) the clinical management of the infant's hyperbilirubinemia.

Design. Retrospective review of postmortem and clinical records.

Setting. Magee-Womens Hospital, a University of Pittsburgh Medical Center affiliated hospital with approximately 10 000 deliveries per year and a Level III Neonatal Intensive Care Unit with about 1400 admissions annually.

Subjects. All neonates autopsied between January 1, 1984 and June 30, 1993 who were <34 weeks gestation and who lived at least 48 hours; a total of 81 infants.

Results. Three infants had kernicterus resulting in a prevalence rate of 4%. These cases included: 1) a 33-week newborn with nonimmune hydrops and a peak bilirubin of 26 mg/dl; 2) a 25-week newborn with asphyxia, hyaline membrane disease, grade IV intraventricular hemorrhage, necrotizing enterocolitis, meconium peritonitis, sepsis, prolonged acidosis, and a peak bilirubin of 11.3 mg/dl; and 3) a 24-week newborn with asphyxia, hyaline membrane disease, grade III intraventricular hemorrhage, and a peak serum bilirubin of 18.5 mg/dl. Of the remaining 78 infants who did not have kernicterus, peak bilirubin ranged from 3.6 to 22.5 mg/dl and 56% had bilirubin levels greater than that suggested as a criterion for exchange transfusion by NICHD Phototherapy Study guidelines; yet all but three were managed with phototherapy alone.

Conclusions. We conclude that kernicterus is currently an uncommon event in preterm infants, even when bilirubin levels are allowed to rise above those previously thought to place the premature infant at risk.
ACETAMINOPHEN OVERDOSE AS A SUICIDAL GESTURE: A SURVEY OF ADOLESCENTS' KNOWLEDGE OF ITS POTENTIAL FOR TOXICITY
Authors: Myers Wade C. , Otto Terrance A. , Harris Elaine , Diaco Daniel , Moreno Anthony
Published: December 2021

Acetaminophen is a popular nonprescription analgesic that is often taken in overdose by adolescents during suicidal gestures. The authors hypothesized that most adolescents are naive about the toxic and lethal potential of acetaminophen in overdose. A one-page, 12-item questionnaire was administered to 169 high school students to evaluate their perceptions and knowledge in this area. Whereas only 22% of the sample underestimated the dose of acetaminophen necessary to cause harm, 40.5% underestimated the potential lethality of acetaminophen in overdose. Moreover, 17% of the sample did not believe one could ingest enough acetaminophen to cause death. The lack of knowledge about acetaminophen's potential dangerousness, its widespread availability, and an absence of early symptoms of hepatotoxicity make this medication highly dangerous to those adolescents who take it in overdose during parasuicidal behavior.
Infant Sleep Position and Sudden Infant Death Syndrome Risk: A Time For Change
Authors: Hunt Carl E.
Published: December 2021

I fully support a comprehensive professional and public intervention campaign in the US to establish supine as the standard sleep position. Although other preventive health objectives can be included, the emphasis needs to be clearly focused on sleep position. Achieving the lowest possible prone prevalence rate in the US is thus the first goal of this new campaign.

The second and equally important goal of the new campaign should be to utilize this opportunity to maximum advantage to enhance our knowledge regarding the epidemiological risk factors causally related to SIDS and their interactions, and the interactions between epidemiological and biological risk factors. In addition to quantifying changes in infant mortality and in infant sleep position, we will also need to characterize both the supine and the persistent prone infant groups in regard to all of the putative epidemiological risk factors for SIDS. This campaign can thus enhance our understanding of the epidemiological risk factors for SIDS as long as a significant decrease in prone prevalence can be achieved.