bluuebunny/crossref_metadata_2025 huggingface dataset:
Long-term Effect of Inhaled Corticosteroids on Growth Rate in Adolescents With Asthma
Authors: Merkus Peter J.F.M. , Quanjer Philip H. , van Essen-Zandvliet Elisabeth E.M. , Kerrebijn Karel F. , Duiverman Eric J. , van Houwelingen Hans C.
Published: December 2021

Background. Growth in stature in asthmatic adolescents may be delayed compared to normals as a result of treatment with inhaled corticosteroids (CS) or because of a delay in puberty. However, growth rates in asthmatic children have never been studied when treatment with CS was randomized and when growth was compared with that of matched healthy control subjects.

Objective. To assess the long-term effect of CS treatment on growth rates in asthmatic adolescents.

Methods. Participants were 40 asthmatic teenagers (mean age 12.8 years) who received randomized treatment with 0.2 mg of albuterol (salbutamol) with either placebo three times a day (BA + PL) or 0.2 mg of budesonide three times a day (BA + CS) for a median period of 22 months in a double-blind controlled study. Growth rates were compared with those of 80 control subjects who were matched for sex, age, height, and duration of follow-up.

Results. Growth rates in male patients, but not in female patients, were significantly less than in control subjects (P < .05), a finding consistent with a delay of puberty due to asthma. The mean difference (95% confidence interval) in growth rates between patients treated with BA + PL and their controls was -0.70 (–1.62, 0.22) cm/y; that between patients treated with BA + CS and their controls was -0.44 (–1.25, 0.37) cm/y. The observed mean (SEM) case-control difference between treatment groups was + 0.27 (0.58) cm/y in favor of BA + CS.

Conclusion. Growth retardation observed in adolescents with asthma may be due to a delay in puberty but not to the prescription of 0.6 mg of budesonide daily.
Attitudes of Mothers, Doctors, and Nurses Toward Neonatal Intensive Care in a Developing Society
Authors: Wainer Stephen , Khuzwayo Harriet
Published: December 2021

Background. The ethical allocation of scarce resources is a major challenge for physicians working in the developing world. Guidelines currently employed by health care workers in the developed world may be considered impractical or inappropriate in the "Third World."

Objective. To gain insight into the attitudes of doctors, nurses, and mothers of recent neonatal intensive care unit (NICU) survivors toward the utilization and withdrawal of life support in the context of a developing society.

Design. Descriptive cohort study.

Participants. Thirty-three doctors, 20 nurses, and 70 mothers of recent NICU survivors. The cohort of mothers surveyed were predominantly unmarried, poorly educated, and either unemployed or still at school.

Results. In response to hypothetical scenarios, mothers exhibited very conservative attitudes toward withdrawal of life support compared to caregivers. Only 2.9% (2/70) of mothers would contemplate any degree of life support withdrawal for infants with probable "moderate" handicap compared with 51.0% (26/51) of the medical staff. One mother (1.4%, 1/70) accepted the concept of withdrawal of life support where extremely poor outcome was anticipated, compared with 85% (45/53) of the caregivers. Doctors and nurses exhibited very utilitarian attitudes toward NICU resource allocation, with emphasis directed toward avoidance of significant handicap. The majority of these caregivers considered the anticipated burden of the handicapped child in the society to be a major factor in the justification of their decision.

Conclusion. The nonideal conditions under which doctors and nurses work in developing nations mandate resource allocation to be an integral component of NICU care.
Which Is the Most Appropriate Dosage of Liposomal Amphotericin-B (AmBisome) for the Treatment of Fungal Infections in Infants of Very Low Birth Weight?
Authors: DA SILVA L. PEREIRA , AMARAL J. M. VIDEIRA , FERREIRA N. CORDEIRO
Published: December 2021

To the Editor.—

Lackner et al1 report on the excellent efficacy and lack of toxicity of 1 to 5 mg/kg per day of liposomal Amphotericin-B (AmBisome) administered to two infants of very low birth weight with disseminated fungal infection.

We agree with the authors when they say that success in the treatment of two cases does not allow extrapolation of the same therapeutic schedule to an infants with identical multisystemic immaturity.

We would like to report two cases from our own clinical experience with distinct characteristics.
Hepatitis B Virus Infection in Honolulu Students
Authors: Pon Eugene W. , Ren Hexuan , Margolis Harold , Zhao Zixian , Schatz Gary C. , Diwan Arwin
Published: December 2021

Objectives. To determine hepatitis B virus (HBV) carrier and infection rates and HBV epidemiology in Honolulu students.

Design. Cross-sectional survey.

Setting. Honolulu public elementary, intermediate, and high schools.

Patients. A volunteer sample of 4936 students from 43 Honolulu schools.

Main outcome measures. HBV carrier rate (presence of hepatitis B surface antigen) and infection rate (presence of either hepatitis B surface antigen, antibody to hepatitis B surface antigen, antibody to hepatitis B core antigen, or any combinations of these) by school grade, ethnicity, and place of birth.

Results. Eighty-three (1.68%) students were identified as HBV carriers, and a total of 353 (7.15%) students had serologic evidence of infection. Infection rates increased from elementary school age to high school age, more so in Asian/Pacific Island-born students. The prevalence of infection was higher in Asian/Pacific Island-born students than in those born in the United States. The majority of infected Hawaiian-born students were first-generation Asian/Pacific Island Americans.

Conclusions. Horizontal transmission of HBV occurs in Honolulu school-age children. HBV immunization of all infants in Hawaii, not just those born to carrier mothers, is necessary to reduce HBV transmission in Hawaii.
MAKING MONEY BY MAKING BABIES
Authors: L. J. F.
Published: December 2021

The State of New York may be eager to attract new business, but there's one kind of inflow it would do well to avoid. According to state health officials, New York is fast becoming "the surrogate-parenting capital of the nation."

New York accounts for some 40 percent of the several thousand surrogate parenting contracts signed so far in the nation, and the number is rising ...

At least 17 state legislatures have decided it's harmful commerce, and forbidden it. So have Germany, France, Britain and a slew of other countries. But not New York . . . That's why advertisements like this one appear in New York newspapers:

Married or single women with children needed as surrogate mothers for couples unable to have children. Conception to be by artificial insemination. Please state your fee. Contact ...

For those who want children, infertility can be a tragedy. Allowing this kind of commerce, however, would be a greater one.
Addressing Concerns of Pediatric Trainees Caring for Patients With Human Immunodeficiency Virus Infection
Authors:   TASK FORCE ON PEDIATRIC AIDS
Published: December 2021

Since the recognition of the human immunodeficiency virus (HIV) as the cause of HIV infection and the acquired immunodeficiency syndrome (AIDS), studies have determined that the risk of infection to the health care worker through occupational exposure is extremely low. However, the perception of risk can have potential psychologic consequences for health care workers providing medical care to HIV-infected patients. What is it that makes caring for HIV-infected patients an unsettling emotional experience? While occupational risks accompany all work, physicians have in the recent past perceived themselves with little vulnerability to a devastating disease. Medical professionals at the turn of the century had alarmingly high rates of mortality from tuberculosis, and today, if not immunized, they are at increased risk for hepatitis B. HIV infection carries formidable biologic and social consequences that contribute to the psychologic stress that may accompany caring for infected patients.

Because H1V-infected patients are dealt with extensively in tertiary centers, there are significant implications for resident and medical student training, especially in urban locales where the rate of HIV infection is high.

The emotional risks of caring for patients with HIV infection have had scant documentation, but there is growing evidence for concern. A study of 250 residents in New York City documented that 19% of pediatric residents and 36% of medical residents had needle-stick exposure to HIV in 1986. A 1988 study of 294 pediatric residents in 11 New York City programs revealed that 205 of the residents (69.7%) had been stuck with a blood-contaminated needle on 588 separate occasions. While there was considerable concern expressed by residents over acquiring HIV, more than half did not want to know whether they were HIV seropositive.
Complication of Intranasal Midazolum
Authors: LUGO RALPH A. , FISHBEIN MARK , NAHATA MILAP C. , LININGER BARBARA
Published: December 2021

The recent article by Theroux et al on the use of intranasal midazolam was interesting. The purpose of this letter is to share our experience regarding a complication associated with the use of this drug.

The need for an ideal sedative for pediatric patients undergoing diagnostic and short surgical procedures is well established. In the past 5 years, the literature is replete with reports on the efficacy, ease of administration, and tolerance of intranasal midazolam. Currently, our group is also evaluating the efficacy of intranasal midazolam in pediatric patients (aged 2 to 12 years) undergoing upper endoscopy. Soon after beginning enrollment, however, it became apparent that intranasal midazolam causes intense burning, irritation, and lacrimation on instillation into the nares.
ROUTINE DISCHARGE EXAMINATION OF BABIES: IS IT NECESSARY?
Authors: L. J. F.
Published: December 2021

The Maternity Services Advisory Committee recommended a routine neonatal discharge examination in 1985. However, this has not been generally accepted and the 1989 report of the joint Working Party on Child Health Surveillance recommended only a repeat examination of hip stability on discharge or within 10 days after birth. This altered recommendation was partly a response to the welcome trend towards early discharge which makes it increasingly difficult to ensure that a second examination is carried out. Moss et al addressed this problem with an audit assessing the value of the second neonatal examination. The examination, performed on 97.3% of 1795 newborn infants, was done on the day of discharge on 1428 infants (79.6%). Because of early discharge, 38.5% of babies were examined on or before day 2, the median time of the discharge examination being 4 days of age. The second examination uncovered previously undetected problems in 63 infants (3.6%). However, 49 abnormalities were minor, such as superficial infection and jaundice not requiring phototherapy; in seven babies the abnormality was not new and should have been detected by the first examination. Only seven infants had a new or potentially important abnormality: jaundice, a transient heart murmur, a distended abdomen which resolved spontaneously, and—most significantly—dislocatable hips in four infants. An important finding was therefore detected in only 0.5% of second examinations. The study concluded that a full second examination cannot be justified, but a test for hip stability should be performed.

The Hall report discusses the key role of parents in the detection of defects but stresses that some defects are unlikely to be recognised even by the most astute parents and require a special search by health professionals. In this category congenital dislocation of the hip and congenital heart disease require special consideration.
Factors Affecting Left Ventricular Mass in Childhood: The Muscatine Study
Authors: Malcolm Donald D. , Burns Trudy L. , Mahoney Larry T. , Lauer Ronald M.
Published: December 2021

Objective. To examine the contribution of age, body size, and blood pressure to left ventricular mass (LVM) in childhood and develop a population-based reference of normative LVM data.

Methods. Age, sex, height, weight, and auscultatory systolic and diastolic blood pressures were measured and an echocardiogram was performed to estimate LVM in 904 normal children, aged 6 to 16 years, in Muscatine, IA. Pearson product-moment correlation coefficients were determined to describe the degree of linear association between LVM and age, body size, and blood pressure. Age-sex-, weight-sex-, and height-sex-spedfic Z scores were determined for LVM, age, weight, height, and blood pressure. Sex-specific LVM prediction equations were derived using weighted-least-squares regression analysis.

Results. A strong positive linear association of LVM with age, weight, height, Quetelet index, and systolic and diastolic blood pressure was demonstrated. Z scores for eight different LVM quintile patterns revealed that age, height, weight, and blood pressure each exert an independent influence on LVM in children. Sex-specific predicted M-mode LVM and upper limits of the 90% prediction intervals based on age and height are presented.

Conclusion. Since age, height, weight, and blood pressure may each exert an independent influence on LVM in children, each factor must be considered when interpreting LVM in childhood. While age, sex, and height are unalterable, both weight and blood pressure can be modified. Thus the pathologic contribution of excess weight and blood pressure ought not be masked by statistical adjustments in reference values for LVM. Sexspecific values of LVM and the 90% and 95% prediction intervals of LVM that do not factor out the effects of obesity or blood pressure are presented. These provide the upper-limit reference values of LVM for the evaluation of children in whom increased LVM is suspected.
Pediatric Workforce Statement
Authors:   Committee on Careers and Opportunities
Published: December 2021

Developing accurate forecasts for physician workforce needs is an extraordinarily difficult task. In 1980 the Graduate Medical Education National Advisory Committee (GMENAC) completed a comprehensive workforce study. Based on estimates of growth of the number of pediatricians, GMENAC predicted a potential excess of 4950 pediatricians by 1990.1 The American Academy of Pediatrics (AAP) studied the report and issued a response in 1981 that questioned many elements in the model.2 However, the Academy was concerned that an excess number of pediatricians would be produced by the 1990s, and a statement published in 1985 and revised in 1987 recommended government and academic policies ensuring the production of pediatricians of the highest quality, but in fewer numbers.3

Subsequent to the 1987 statement, consistent evidence has pointed to shortages of pediatricians rather than the projected surplus in all regions of the country. A 1990 survey of residency program directors provided the strongest empirical evidence to date that the supply of new pediatricians is not meeting the demand.4

In 1990, the Council on Graduate Medical Education (COGME) contracted with the consulting firm of Abt Associates, Inc to reexamine the adequacy of physician workforce supply. The resulting report, commonly referred to as the Abt report, contends there would be an even greater oversupply of peditricians than projected in the 1980 GMENAC report.5 The AAP concerns with this report's methodology and conclusions were strongly voiced to the COGME and in the literature.6,7 Subsequent to the Abt Report, the COGME published a report which emphasizes a growing shortage of practicing generalists (ie, general pediatricians, general internists, and family physicians) and calls for an increase in the percentage of residents who complete a 3-year training program in the generalist specialties.8
Questions About Electrographic Seizures in Newborns
Authors: SCHELLER JOSEPH M.
Published: December 2021

To the Editor.—

The study by Scher et al in the January issue of Pediatrics1 on electrographic neonatal seizures is an important addition to the neonatal seizure database. However, there are some aspects of the study that I find problematic. First, the study calculates the incidence (prevalence) of electrographic seizures for that patient population without providing details about which patients were included and excluded. Did any newborns who were suspected of having seizures not have electroencephalograms (EEGs)? Were any newborns suspected of having seizures treated with anticonvulsants before the EEG was performed? If the answer to either of these questions is yes, the reported incidence may not be accurate.
Prevention of Fetal Alcohol Syndrome
Authors: SHOEMAKER F. WELLS
Published: December 2021

To the Editor.—

The American Academy of Pediatrics (AAP) policy statement on fetal alcohol syndrome (FAS) in the May issue Pediatrics1 makes several errors of omission and, I believe, of naivete. The report cites an incidence figure of 1.9 per 1000 live births and a corresponding annual cost estimate of $320 million from a 1987 report by Abel and Sokol. 2 The report ignores, however, the 1991 reports3 by the same two distinguished authors in which they revised their estimates downward sixfold to 0.3 per 1000, and the cost estimate to $70 million.
Acellular and Whole-Cell Pertussis Vaccines as Booster Doses: A Multicenter Study
Authors: Englund Janet A. , Decker Michael D. , Edwards Kathryn M. , Pichichero Michael E. , Steinhoff Mark C. , Anderson Edwin L.
Published: December 2021

Objective. To compare the safety and immunogenicity of a variety of acellular (AC) and whole-cell (WC) pertussis vaccines combined with diphtheria and tetanus toxoids.

Methods. Standard enrollment and reaction forms were used at five sites, and serologic evaluation was performed at a single site. Nine AC (Massachusetts Public Health Laboratories, Biocine Sclavo recombinant pertussis toxoid [PT], Connaught/BIKEN, Lederle three-component, Biocine Sclavo recombinant three-component, SmithKline Beecham three-component, Porton three-component, Takeda-Wyeth, and Connaught multicomponent), and three WC (Connaught Laboratoties, Lederle Laboratories, and Massachusetts Public Health Laboratories) were studied. All AC contained varying concentrations of PT; some vaccines also contamed filamentous hemagglutinin (FHA), pertactin, and/or agglutinogens.

Results. Two hundred forty children, aged 16 to 21 months and 4 to 6 years, were enrolled at five sites. Significantly less fever, redness, swelling, pain, limp, and use of pain medication were noted following AC compared with WC. Significant increases in antibody to PT were seen following all vaccines. Significant rises in FHA antibody were seen following all WC and the seven AC that contained FHA. Postbooster PT antibody levels were similar among the AC groups, regardless of the amount of PT administered (between 3.5 and 25 µg per dose). The dose of FHA did not affect PT antibody response. Infants primed with WC who were boosted with a monocomponent PT vaccine did not manifest a significant antibody response to FHA.

Conclusion. The rate of adverse reactions was not a function of the number of antigens or the antigen quantity in the acellular vaccines, and antibody responses following AC were similar or better than antibody responses following WC. These results support the further evaluation of these vaccines in a larger National Institute of Allergy and Infectious Diseases-sponsored study in infants.
The "88% Saturation Test": A Simple Lung Function Test for Young Children
Authors: Wagner Carol L. , Brooks John G. , Pratt Kimberly , Richter Susan E. , Phelps Dale L.
Published: December 2021

Objective. The 88% saturation test (88%-SAT) was developed as an alternative to standard spirometry for those young children unable to perform standard forced expiratory maneuvers. In adults, this test revealed rapid desaturation in those persons with a history of asthma when compared with healthy control subjects. Similar findings in children were tested.

Setting. Tertiary care hospital.

Patients. Thirty-three former premature infants (28.3 ± 2.3 weeks gestation), aged 5 to 7 years, who were participating in a follow-up study, were enrolled in this study.

Design. The study compared the 88%-SAT with standard spirometry and respiratory health characteristics ascertained through a parental questionnaire. The 88%-SAT consists of continuous measurement of hemoglobin saturation by pulse oximetry (Sao2) while the subject breathes a nonhumidified 12% oxygen and nitrogen mixture for 10 minutes or until Sao2 decreases to 88%, whichever occurs first. Abnormal 88%-SAT was defined as a decrease of Sao2 to 88% within the 10-minute period, and abnormal spirometry was defined using standardized values.

Results. Of the 20 children who successfully completed both spirometry and the 88%-SAT, 10 had normal spirometry results and did not desaturate to 88%, and 5 had abnormal spirometry and 88%-SAT results. Four children did not desaturate during the 88%-SAT, but had abnormal spirometry results, and one child had abnormal 88%-SAT results, but normal spirometry.

Ten additional children completed the 88%-SAT, but not standard spirometry. Three children were unable to complete either test. Of those 30 children tested, 7 (23%) had a history of reactive airways disease, and all 7 had abnormal 88%-SAT results. The 88%-SAT had greater sensitivity (100% vs 75%) and specificity (87% vs 63%) than spirometry in identifying children with known reactive airways disease.

The mean McCarthy general cognitive index (GCI) of the group performing both spirometry and the 88%-SAT (n = 20) achieved a mean (± SD) GCI of 96.2 ± 16.7, and the group (n = 30) that completed the 88%-SAT had a mean (± SD) GCI of 75.2 ± 26.3 (χ2 P < .012). The 10 children able to perform only the 88%-SAT had a mean GCI (± SD) of 72.8 ± 26.9, and the 3 children unable to perform either test had a mean GCI (± SD) of 63 ± 11.

Conclusions. Our data suggest that the 88%-SAT may be more effective than spirometry for identifying reactive airways disease in young, uncooperative, or developmentally delayed children. The dry air of the hypoxic inspired gas may function as an airway challenge, leading to decreased oxygenation in patients with reactive airways.
Potential Impact of Linking an Emergency Department and Hospital-Affiliated Clinics to Immunize Pre-School-Age Children
Authors: Bell Louis M. , Lopez Nereida I. , Pinto-Martin Jennifer , Casey Rosemary , Gill Frances M.
Published: December 2021

Objective. To determine whether the use of an urban pediatric emergency department (ED) to immunize pre—school-age children would result in an improvement in the percentage fully vaccinated by the end of the second year of life.

Design. A retrospective cohort study of two groups: (1) 100 consecutive children (ED group) enrolled at one of two hospital-affiliated primary care clinics were chosen from the ED patient logs if their second birthday occurred in the 12 months prior to November 1990; and (2) 91 age-matched control children (control group) were chosen at random from the same hospital-affiliated clinics' enrollment logs without regard to ED use. The health care provided during the first 2 years of life for each group was compared.

Results. The mean number of visits to the ED in the first 2 years of life by the ED group was significantly greater than that of the control group (2.9 [SD] ± 2.5 vs 1.1 ± 1.4; P < .001) during the first 2 years of life. In 67% of ED visits, children would have been well enough to receive a vaccination. Both groups had similar types and numbers of visits to the primary clinics. For example, the ED group had 10 ± 5 visits by age 2 years compared with the control group, which had 9 ± 4 visits. There was no significant difference in actual immunization percentages achieved in the clinic, with 62% of the ED group having received four diphtheria, pertussis, and tetanus vaccinations; three oral poliovirus vaccinations; and one measles, mumps, and rubella vaccination by age 2 compared with 69% of control children. There were more missed vaccination opportunities during clinic visits in the ED group (7.4 vs 4.6 per 100 clinic visits; P < .01). If immunizations were offered in the ED to those children who needed them, immunization percentages would have been increased an average of 20% compared with percentages achieved in the clinic alone.

Conclusion. Routine vaccinations in the ED would significantly increase immunization percentages in children enrolled in two hospital-affiliated clinics. Close linkage and coordination between the ED and hospital-affiliated clinics may improve preventive health care in urban children who use EDs.
Comparison of Liquid and Dried Blood for Neonatal Hemoglobinopathy Screening: Laboratory and Programmatic Issues
Authors: Papadea Christine , Eckman James R. , Kuehnert Rachel S. , Platt Allan F.
Published: December 2021

Objectives. To compare laboratory and programmatic issues in neonatal hemoglobin screening in two systems using either liquid cord blood or heel puncture blood dried on filter paper (DB) to determine the accuracy of hemoglobin phenotype; the collection rate of cord blood versus DB; and the types of and reasons for errors.

Methods. Cord blood samples for 6904 newborns were analyzed by electrophoresis in a large hospital laboratory. DB samples on the same cohort were analyzed by isoelectric focusing in a state public health laboratory.

Results. Interlaboratory concordance was 99.4% for 6904 matched specimen pairs, which included 27 disease and 596 carrier phenotypes. In 42 pairs, discordances for potential disease phenotypes occurred with cord blood samples. Errors involving carrier phenotypes occurred in 15 cord blood samples and 14 DB samples. Inconclusive results requiring repeat testing occurred more often in the cord blood testing system (92) than in the DB system (23). Clerical transcriptions and limitations of the techniques accounted for most laboratory errors. Noncompliance in sample collection occurred more frequently with cord blood (181) than DB (86).

Conclusions. Both systems are subject to errors, but are equally reliable for neonatal hemoglobinopathy screening.
Predictors of Early Grade Retention Among Children in the United States
Authors: Byrd Robert S. , Weitzman Michael L.
Published: December 2021

Background. Despite increasing concerns regarding school readiness, little is known about child health correlates of early school failure among the general child population. The results of this study, conducted to investigate health and social factors associated with early grade retention in a nationally representative sample of children in the United States, are reported here.

Design. Analyses of data derived from interviews with parents of 9996 children ages 7 to 17 years who participated in the Child Health Supplement to the 1988 National Health Interview Survey.

Main Outcome Measures. History of repeating kindergarten or first grade.

Results. Nationally, 7.6% of children repeated kindergarten or first grade. In a logistic regression model, factors independently associated with increased risk of grade retention were: poverty [Odds Ratio (OR) 1.7, 95% confidence interval (CI) 1.4, 2.1], male gender (OR 1.5, CI 1.3, 1.9), low maternal education (OR 1.4, CI 1.1, 1.8); deafness (OR 1.9, CI 1.4, 2.6), speech defects (OR 1.7, CI 1.1, 2.6), low birth weight (OR 1.6, CI 1.2, 2.2), enuresis (OR 1.6, CI 1.1, 2.2), and exposure to household smoking (OR 1.4, CI 1.1, 1.7). High maternal education (OR 0.6 CI 0.4, 0.9) and residence with both biological parents at age 6 years (OR 0.7, CI 0.6, 0.9) were independently associated with a decreased risk of retention. Recurrent otitis media, black race, and low maternal age, although associated with early grade retention in bivariate analyses, were not independently associated with grade retention in a model that controls for these other factors and for the age cohort of the child. Although omitted from the above predictive model because of uncertainty about its temporal relation to early grade retention in this dataset, behavior problems at the time of interview have a strong independent association (OR 1.9, CI 1.5, 2.5) with prior early retention.

Conclusions. This is the first study that uses national data to investigate how health and social factors individually and collectively contribute to early grade retention. It demonstrates that early retention is common, that a number of extremely common child health problems are independently associated with it, and that the magnitude of the heightened risk associated with these problems is similar to that of many of the well-recognized and difficult to change family and social risk factors for early retention. The successful implementations of Pub L 99-457 (The Education for All Handicapped Children Act Amendments of 1986) services in communities nationwide, and the improvement in the educational performance of large numbers of children will be facilitated by pediatricians' advocacy and surveillance for problems that place children at risk for educational failure, and by effective referral to and collaboration with nonpediatric child and family services.
Penicillin- and Cephalosporin-Resistant Streptococcus pneumoniae: An Emerging Microbial Threat
Authors: Leggiadro Robert J.
Published: December 2021

Recent reports from South Africa,1 Spain,2 Hungary,3 Texas,4-6 and Memphis7,8 document an increasing incidence of penicillin-resistant Streptococcus pneumoniae infections in children. The emergence of penicillin-resistant pneumococci that also demonstrate decreased susceptibility to extended-spectrum cephalosporins presents an even greater clinical challenge.6-9 This commentary reviews recent developments in the epidemiology, identification, and management of penicillin- and cephalosporin-resistant pneumococcal disease in children.

Pneumococcal susceptibility to penicillin is defined as a minimal inhibitory concentration (MIC) <0.1 µg/mL. Intermediate (relative) penicillin resistance is defined as an MIC from 0.1 to 1.0 µg/mL and high-level resistance as an MIC >1.0 µ/mL. Pneumococcal penicillin resistance is mediated by alterations in penicillin-binding proteins involved in cell wall synthesis.10
Prevention of Periventricular Hemorrhage
Authors: Reynolds E. Osmund R. , Meek Judith
Published: December 2021

Cerebral periventricular hemorrhage (PVH) of preterm neonates can be defined as hemorrhage arising in the germinal layer that may rupture into the ventricles or provoke hemorrhagic parenchymal infarction.

PVH has been a major focus of attention for perinatologists since the 1970s and 1980s when studies by computed tomography and echosonography showed that it was very common in neonates who were of very low birth weight (< 1500 g) or born very preterm (< 33 weeks gestation). Up to 50% of such neonates were affected and the prevalence in survivors was about one in three.1,2

As well as being an important cause of death, PVH has been a significant cause of neurodevelopmental impairment in surviving neonates.3
Sepsis + C-Reactive Protein
Authors: Philip Alistair G. S.
Published: December 2021

Pourcyrous et al are to be congratulated for their careful analysis of C-reactive protein (CRP) in the setting of suspected neonatal infection.1 They were able to evaluate a large number of babies with positive blood cultures. Their approach, using an initial CRP and repeat levels at 12 and 24 hours later, is one that I have been advocating for some time,2,3 when used in conjunction with leukocyte counts.

See table in the PDF file

As the authors note, I observed that infants with group B streptococcal (GBS) infection evaluated within 12 hours of delivery may initially have normal CRY levels,4 that rise within 24 hours.
Using Mass Media to Reduce Adolescent Involvement in Drug Trafficking
Authors: Romer Daniel
Published: December 2021

Objective. Drug trafficking among adolescents is a newly recognized high-risk behavior that seems to be involving large numbers of youths. Strategies to prevent and/or alter this behavior must be developed and evaluated. In view of the high exposure of adolescents to the mass media, interventionists seeking to reduce adolescent risk behavior have increasingly employed the media in their efforts to reduce adolescent risk behaviors in general. However, not all risk behaviors may be amenable to change as a result of this approach. Therefore, before utilizing this approach to address adolescent drug trafficking, it is important to investigate previous efforts targeting related risk behaviors.

Results. Mass media campaigns against the use of drugs have been common in the US and seem to have played a role in reducing consumption of both legal and illegal drugs. The most effective messages seem to focus on the risks of drug use and the social disapproval that attends use. The mass media may increase the influence of these antidrug messages by changing the social climate surrounding drug use.

Conclusions. The mass media may be a particularly effective way to reach adolescents and their parents in communities in which adolescent drug trafficking is prevalent and to unite the institutions that could influence adolescents against involvement in the drug trade. However, intervention efforts must also contend with the economic incentives of the drug trade in poor, central-city communities.
African-American Youth: Drug Trafficking and the Justice System
Authors: Leviton Susan , Schindler Marc A. , Orleans Renee S.
Published: December 2021

Objective. To examine the role of the legal system in adolescent drug trafficking.

Methods. Descriptive and analytic review of the literature and relevant legislation.

Findings. Utilization of young adolescents by drug "kingpins" in drug trafficking is a new practice that is highly advantageous to the employer for several legal and economic reasons. From the perspective of the drug kingpins, juveniles are particularly useful in drug trafficking because they work for lower wages. Further, even if the youth are arrested, the juvenile justice system enables their rapid return for continued service in the drug trade. From the perspective of the youth, drug trafficking offers one of the few economic opportunities available to them. Further, the numbers suggest a tremendous racial disparity in the juvenile justice system.

Conclusions. The mutual advantages to both employer and employee of using youths in drug trafficking increases the likelihood that this new practice will continue to flourish and with increasingly young children. Effective prevention and treatment interventions will need to be multifaceted, addressing the economic, educational, and social issues that have permitted the rapid emergence of adolescent drug trafficking. Finally, further investigation of the apparent racial disparities is necessary.
Antenatal Formula Advertising: Another Potential Threat to Breast-feeding
Authors: Howard Cynthia R. , Weitzman Michael , Lawrence Ruth , Howard Fred M.
Published: December 2021

Breast-feeding is vitally important to the health and well being of infants throughout the world. The Department of Health and Human Services has identified improved breast-feeding rates as part of the national health and disease prevention objectives for the year 2000. These objectives state that 75% of women will initially breast-feed their infants and 50% will still be breast-feeding at 5 to 6 months.1 Breast-feeding is recognized as the optimal way to nourish most newborns by the American Academy of Pediatrics (AAP), the American College of Obstetricians Gynecologists, and the World Health Organization.2-4 Additionally, the Institute of Medicine of the National Academy of Sciences recommends breast-feeding for all infants in the United States under ordinary circumstances and states that exclusive breast-feeding is the preferred method of feeding for normal full-term infants from birth to age 4 to 6 months.5
Children's Memory for a Salient Medical Procedure: Implications for Testimony
Authors: Merritt Kathy Ann , Ornstein Peter A. , Spicker Brenda
Published: December 2021

Objective. Protecting sexually abused children hinges on their ability to remember and report events surrounding alleged incidents of abuse. This study was designed to provide information on young children's memory and recall of stressful experiences.

Methodology. Children's memory for features of a voiding cystourethrogram (VCUG) experience were examined because this invasive procedure is similar in many respects to incidents of sexual abuse. The recall performance of 24 3- to 7-year-olds was assessed immediately after the VCUG and after a delay of 6 weeks using a hierarchically structured interview protocol including both open-ended and more specific questions. To assess correlations between recall performance and distress, behavioral and physiological indicators of distress were measured during the procedure.

Results. The children remembered 88% of the component features of the VCUG experience at the initial assessment and 83% after 6 weeks. Behavioral and salivary cortisol measures indicated that the children were distressed during the procedure. Although several of the behavioral measures were correlated negatively with the amount of recall, levels of salivary cortisol did not predict the children's recall performance.

Conclusion. The findings suggest that, under some conditions, young children can provide accurate and detailed reports of personally experienced distressful events.
MORE MANAGED HEALTH-CARE SYSTEMS USE INCENTIVE PAY TO REWARD "BEST" DOCTORS
Authors: L. J. F.
Published: December 2021

What It Takes to Be Rated a Good Doctor

Here are some of the more than 20 quality standards used by U.S. Healthcare Inc. to determine what level of incentive payments family practitioners, pediatricians and internists will receive for delivering high quality medical care.

• How easy is it to make appointments for checkups?

• How long is the waiting time in a doctor's office?

• How much personal concern does a doctor show for patients?

• How readily can patients obtain follow-up test results?

• Would patients recommend their doctor to others?

• Do doctors provide regular immunizations for children? Breast-cancer checks for women? Colon-cancer checks for men?

• What percent of a doctor's patients transfer to another physician's care each year?
CALCULATORS DO IMPROVE SAT MATH SCORES
Authors: L. J. F.
Published: December 2021

Will permitting the use of calculators artificially increase SAT math test scores?

A. Not at all, so they should be allowed.

B. Yes, so they should be banned.

C. Only marginally, so they should be allowed—but scores should be adjusted to offset the effect.

The folks who run the Scholastic Aptitude Test, which will allow the use of calculators during the college entrance examination starting next year, initially said the correct answer was A. Critics insisted the right answer was B. Now, after a field test on calculator use involving 200,000 students last spring, the testing service has disclosed that C is their answer.
Is Neonatology Being Abandoned by the RRC and General Pediatrics
Authors: Harper Rita G. , Dweck Harry , Yellin Paul B. , Cassady George , Little George , Kleinman Leonard , Korones Sheldon , Yoon Jing J.
Published: December 2021

The neonatal grapevine seems to be growing with vigor these days. Fed by the rumor that there will be a new proposal by the Residency Review Committee (RRC) to limit the time of critical care training that pediatric house officers receive, the vine is sprouting with amazing vitality. "Critical care exposure" is reported to be limited to 5 of the 33 months of training that the house officers receive including the time spent in the neonatal intensive care unit (NICU), the pediatric intensive care unit, and the transplant service.
CLINTON OFFICIAL DEFENDS PLAN FOR VACCINES
Authors: L. J. F.
Published: December 2021

Trying to allay concerns expressed by members of Congress and by drug company executives, a Clinton Administration official said today that the Government would not waste money or vaccine in a new program to inoculate millions of children from low-income families.

Drug company executives and some lawmakers have criticized the Administration's plan, saying the Government was trying to buy far more vaccine than would be needed to immunize children eligible for the free shots under the program. ... Congress has set aside $460 million for the project this year.

The Administration plans to store much of the vaccine at a Federal warehouse in Burlington, NJ. She said the Government would manage distribution of the vaccine under a contract with Federal Express of Memphis, TN.

Dr. R. Gordon Douglas, Jr., president of the vaccine division of Merck & Company, said, "A federally operated megawarehouse for storage and shipping of up to 80 percent of this nation's pediatric vaccines is a public health crisis in the making."

At a congressional hearing on May 18, Senator Dale Bumpers, Democrat of Arkansas, said he doubted that the warehouse would be ready to ship vaccines by Oct. 1, when the program is supposed to begin.

"GSA's track record has been an unmitigated disaster as long as I can remember," the senator said, "I don't have very much confidence in GSA."
The Effectiveness of Parent Counseling in Managing Colic
Authors: Carey William B.
Published: December 2021

Colic, or excessive crying in young infants, continues to be described typically in pediatric textbooks as being of uncertain cause and as having no generally satisfactory solution. Despite this confusion and pessimism, much is now known about predisposing factors and successful management. The paper by Wolke, Gray, and Meyer in this issue of Pediatrics (Excessive infant crying: a controlled study of mothers helping mothers) makes a significant further contribution to understanding the interactional nature of the problem and the effectiveness of parent counseling about infant management in reducing the amount of crying.

Researchers now usually define colic as >3 hours a day of irritability, fussing, and crying on >3 days in any 1 week (and perhaps also for 3 weeks or more) during the first 3 or 4 months of life in an infant who is otherwise healthy and well fed.1
THE NURSE PARADIGM
Authors: L. J. F.
Published: December 2021

Because one of the most revolutionary parts of health care reform in America is bound to be the burgeoning role that nurses will play, including providing many of the services that were once confined to physicians. Their new prominence will benefit patients—and raise some new questions about the importance of tender loving care and the economic value of medical services.

Exhibit A in what the president of Columbia-Presbyterian Medical Center in New York City calls "a major paradigm shift" is that hospital's decision to give its nurse practitioners admitting privileges, further blurring the line between what doctors do and what nurses can.

Dr. William T. Speck, the president of Columbia-Presbyterian, says that, in his hospital, which is both a prominent teaching and research center and the health care nucleus of a sprawling urban area, giving nurse practitioners more authority simply made good sense.
Letter to the Editor
Authors: Wiswell Thomas E.
Published: December 2021

Doctors Anderson and Schwarz have misinterpreted the data from our recent report.1 We found an increasing number of circumcisions among older boys precisely at the time the circumcision frequency rate was increasing among neonates. We suspect the increases in both populations was due to several factors—the 1989 Ad Hoc Statement on Circumcision and the general increased awareness of the potential health benefits of the procedure.

I am astounded that these physicians have stated there are no other countries in the western world with a rise in the rate of neonatal circumcision.
FLORIDA APPROVES MEASURE ON RIGHT TO BREAST-FEED IN PUBLIC
Authors: L. J. F.
Published: December 2021

TALLAHASSEE, Fla., March 3—In an action that is being hailed by women's and health groups as an important symbolic victory, the Florida Legislature has enacted what is apparently the first state measure guaranteeing women the right to breast-feed their children in public.

By a unanimous vote, the Florida Senate on Tuesday passed a bill that amends the state's statutes on indecent exposure, lewd and lascivious behavior and obscenity to exempt and protect nursing mothers from arrest or harassment by law-enforcement or private security officials.

The bill also endorses breast-feeding as the preferred method of nurturing an infant and condemns "the vicious cycle of embarrassment and ignorance" and "archaic and outdated moral taboos" surrounding the practice.

The measure has been praised by organizations like La Leche League, a breast-feeding advocacy group, which describes it as the first instance in the nation of a state's codifying support for breast-feeding.
Serum and Bile Bilirubin Pigments in the Differential Diagnosis of Crigler-Najjar Disease
Authors: RUBALTELLI FIRMINO F. , NOVELLO ANTONELLA , ZANCAN LUCIA , VILEI MARIA TERESA , MURACA MAURIZIO
Published: December 2021

Objective. To differentiate between Crigler-Najjar (CN) disease types 1 and 2.

Design. The patterns of serum bilirubins, bile pigment composition, and phenobarbital response were studied.

Patients. Three infants, affected by high serum unconjugated bilirubin concentrations, previously classified as type 1 CN.

Methods. Serum and bile bilirubin pigment composition, both before and after phenobarbital (PB) treatment, were determined by alkaline methanolysis and high-pressure liquid chromatography. PB was given for at least 3 weeks by oral administration (5 mg/kg bw per day).

Results. No diconjugated bilirubin was found either before or after PB treatment in the serum of the three studied infants. In two patients traces of monoconjugated bilirubin were detected before PB therapy, and the ratio of conjugated/total bilirubin (percent) was increased by the PB response. In the third patient, traces of monoconjugated bilirubin appeared only after PB administration. However, the serum unconjugated bilirubin concentration decreased significantly only in the second patient, following the second cycle of PB treatment, leading to the diagnosis of type 2 CN. The analysis of the methyl ester derivatives of bile pigments was also performed on bile samples obtained in two patients by Entero-Test (R) both before and after PB treatment. An absolute increment in monoesterified bilirubin concentration was found after PB administration, although the percent concentration increased in one case and decreased in the other. No diesterified bilirubin was detected in the bile samples.

Conclusions. The present results show that in types 1 and 2 CN disease it is possible to detect traces of monconjugated but not diconjugated bilirubin both in serum and in bile. Whereas PB treatment is effective in slightly increasing the serum monoconjugated bilirubin concentration even in type 1 CN disease, the diagnosis of type 1 or 2 is based on finding a substantial decrease of serum unconjugated bilirubin following PB administration.
An Infant in a Car Seat on a Washing Machine: Epidural Hematoma
Authors: HULKA FRIEDA , PIATT JOSEPH
Published: December 2021

Desperate parents resort to imaginative and sometimes dangerous improvisations to pacify a crying infant. One measure that has actually received physician endorsement in popular parenting publications is to set the inconsolable baby, often suffering from colic, in a car seat on an engaged clothes dryer or washing machine. The warmth, rhythmic noise, and vibration together have the desired soporific effect. As the following case report illustrates, placement of car seats on vibrating elevated surfaces can have life-threatening side effects as well.

CASE REPORT

A 7-month-old male was brought by ambulance to the emergency room after suffering an apparent seizure.