bluuebunny/crossref_metadata_2025 huggingface dataset:
Quality of Mother-Infant Attachment and Pediatric Health Care Use
Authors: Harris Emily S. , Weston Donna R. , Lieberman Alicia F.
Published: December 2021

The relationship between infant pediatric care use in the first year of life and the quality of mother-infant attachment at 1-year of age was examined. Fifty-six mother and infant pairs were classified by the Ainsworth Strange Situation procedure as securely (n = 17) or anxiously attached (n = 39). Pediatric records for the first 12 months of life were reviewed for frequency and type of visit, diagnoses, treatment, and symptoms prompting the care visit. Anxiously attached infants used acute care services (walk-in and emergency room) significantly earlier and more often than infants with a secure attachment. Use of acute care services began at a mean age of 3.8 months for the anxiously attached infants compared with 6.5 months for the securely attached. Differences in utilization persisted through the year. Mean acute care use in the anxiously attached infants was 3.6 visits compared with 1.9 visits for the securely attached. Acute care use was associated with a variety of common infant illnesses in both groups. In contrast, there was no difference in the use of well-baby care (mean 6 visits). Utilization and attachment status were independent of birth or prenatal difficulties. High cumulative use of pediatric care during the first year of life may identify infant and mother pairs who ho are experiencing strain in their interactions and relationship. Early recognition would provide an opportunity for comprehensive assessment and preventive intervention in the pediatric setting.
Acute Thyroxine Ingestion in Pediatric Patients
Authors: Lewander William J. , Lacouture Peter G. , Silva J. Enrique , Lovejoy Frederick H.
Published: December 2021

During a 1-year period, 15 cases of acute thyroxine (T4) overdose with documented serum T4 concentrations were studied. All patients were <5 years of age and 80% were boys. All were examined within 1 to 6 hours of ingestion and all were asymptomatic. Estimated dose ingested in 10 patients ranged from 1.5 to 8.8 mg (0.1 to 0.73 mg/kg). Three patients with initial T4 serum concentrations >75 µg/dL manifested signs of toxicity within 12 to 48 hours (fever, tachycardia, hypertension, and/or agitation) that resolved within 24 to 60 hours. The mean elimination half-life of T4 in 7 patients with multiple serum concentrations was 2.8 ± 0.4 days, whereas the mean elimination half-life of triiodothyronine was 6 ± 1.7 days. It was concluded that (1) the majority of acute pediatric T4 overdoses are not severe and may be managed on an outpatient basis, (2) the absence of early clinical manifestations does not preclude delayed onset of toxicity that may be better predicted by initial T4 concentrations, and (3) the elimination half-life of T4 is shorter and the elimination half-life of triiodothyromine is longer than with therapeutic doses.
Selected Midline Defect Associations: A Population Study
Authors: Khoury Muin J. , Cordero José F. , Mulinare Joseph , Opitz John M.
Published: December 2021

Using data from the population-based Metropolitan Atlanta Congenital Defects Program, the association of seven relatively common and easily ascertainable groups of midline defects was studied. These defects were neural tube defects (575 patients), oral clefts (633 patients), omphalocele (141 patients), esophageal atresia/tracheoesophageal fistula (88 patients), imperforate anus (151 patients), conotruncal heart defects (289 patients), and diaphragmatic hernia (75 patients). Known syndromes were excluded from the analysis. Of 1743 infants with at least one midline defect, 86 (4.9%) had at least a second midline defect, and 9 (0.5%) had two additional midline defects. Pairwise analysis of the seven defects shows that, although most midline defects tend to be statistically associated with other midline defects, specific combinations of midline defects are seen. For example, neural tube defects are more strongly associated with cleft lip with or without cleft palate than with cleft palate alone; imperforate anus is more strongly associated with spina bifida than with anencephaly or encephalocele. Moreover, some combinations of defects are not observed (eg, neural tube defect and conotruncal heart defect, clefts and diaphragmatic hernia, omphalocele and esophageal atresia/tracheoesophageal fistula). These data point to the need for further refinement in the study of the association of midline defects in terms of embryologic and pathogenetic mechanisms because most midline defects tend to occur as an isolated defect, some midline defects occur with nonmidline defects (such as limb defects), and specific associations among midline defects are observed.
Axillary Arterial Monitoring of Pediatric Patients
Authors: Lawless Stephen , Orr Richard
Published: December 2021

Use of the axillary artery for hemodynamic monitoring has gained acceptance in critically ill adults. However, there is little information concerning the safety and complications of such catheters in the pediatric population. Sixteen pediatric patients who had axillary lines placed for pressure monitoring were evaluated for neurologic and vascular function, by comparing the arm with the axillary line with the contralateral arm. There were no major complications during axillary artery monitoring. After decannulation, systolic blood pressure did not differ between arms. In a pediatric critical care environment with skilled ongoing nursing care, the axillary artery can be used as a site for intraarterial monitoring in pediatric patients without a detrimental effect on concurrent or future blood pressure monitoring.
Hypercalciuric Hypophosphatemic Rickets, Mineral Balance, Bone Histomorphometry, and Therapeutic Implications of Hypercalciuria
Authors: Chen C. , Carpenter T. , Steg N. , Baron R. , Anast C.
Published: December 2021

A 14-year-old Turkish boy had severe rickets that had been clinically evident since he was 2 years of age. When he was 5 years of age, he had normal serum calcium and phosphorus levels and increased alkaline phosphatase activity. Treatment with modest dosages of vitamin D (5000 U/d for 3 weeks) resulted in hypercalcemia. At 10 years of age, high-dose vitamin D (40 000 U/d) plus phosphorus (1.1 g/d) therapy for 20 days resulted in symptomatic nephrolithiasis. When, 14 years of age, he had normocalcemia, hypophosphatemia, increased alkaline phosphatase activity, and normal circulating parathyroid hormone concentration. Levels of 25-hydroxyvitamin D were normal but those of 1,25-dihydroxyvitamin D were markedly increased. Rickets and osteopenia were evident on radiographs, and osteomalacia was present on trabecular bone obtained at biopsy. Balance study results showed increased intestinal absorption of calcium and phosphorus, hypercalciuria, and increased urinary phosphorus excretion. This patient manifests an unusual form of hypophosphatemic rickets in which hypercalciuria is a cardinal feature. In contrast with most varieties of hypophosphatemia, this disorder is characterized by appropriately increased production of 1,25-dihydroxyvitamin D in response to hypophosphatemia. It is recommended that urinary calcium excretion be assessed in all patients with hypophosphatemic rickets so that appropriate therapy will be instituted.
Symptomatic Mitral Valve Prolapse in Children and Adolescents: Catecholamines, Anxiety, and Biofeedback
Authors: Smith Mark Scott , Doroshow Carol , Womack William M. , Tenckhoff Lore , Stamm Stanley , Pertik Maria
Published: December 2021

It has been proposed that symptomatic mitral valve prolapse may be associated with a hyperadrenergic state and/or increased anxiety. To test this hypothesis, Spielberger State-Trait Anxiety (STAI) scores and 24-hour urinary catecholamine collections were gathered from 11 children and adolescents without mitral valve prolapse, 6 with asymptomatic mitral valve prolapse, and 14 who had chest pain (some with additional symptoms of shortness of breath, palpitations, and fatigue). STAI scores and catecholamine excretion values were not significantly different between groups. Ten symptomatic patients were randomly assigned to either eight sessions of skin temperature biofeedback with daily home practice of relaxation-mental imagery techniques or an attention-placebo condition. Change in 24-hour urinary catecholamine excretion values and STAI scores from baseline to end of treatment did not differ significantly between treatment and placebo conditions. Although not evident at the end of treatment, a significant decrease in chest pain was found in the biofeedback group at 6-month follow-up evaluation. In summary, results of this study did not show evidence of increased sympathetic tone or levels of anxiety in symptomatic pediatric patients with mitral valve prolapse. A behavioral treatment program using biofeedback and relaxation-mental imagery techniques was associated with decreased chest pain at 6-month follow-up.
CONGENTITAL MYOTONIC DYSTROPHY
Authors: L. J. F.
Published: December 2021

The clinical features of 14 neonates with congenital myotonic dystrophy were retrospectively reviewed. These babies represent all the new cases of congenital myotonic dystrophy seen in the department since 1982. Twelve babies were referred because of either difficulties in diagnosis or difficulties in the management of their respiratory problems. Of the 14 babies, 13 had birth asphyxia, 11 were premature, and four had intrauterine growth retardation. Ten babies required artificial ventilation from birth. Abnormalities on chest radiography included thin ribs (n = 9) and raised right hemidiaphragms (n = 5). Recurrent episodes of collapse and consolidation of the lungs secondary to poor swallowing occurred in all ventilated babies. All babies ventilated for longer than four weeks died of respiratory complications before the age of 15 months. One baby was successfully extubated after diaphragmatic plication, but he died a few months later. Duration of ventilation was the best guide to prognosis.
Family History Evaluation as a Predictive Screen for Childhood Hypercholesterolemia
Authors: Griffin Timothy C. , Christoffel Katherine K. , Binns Helen J. , McGuire Patricia A. ,   The Pediatric Practice Research Group
Published: December 2021

A study was conducted to evaluate the efficacy of family history factors as screening criteria for childhood hypercholesterolemia. When they were seen for routine care at one of eight office practices, 1005 prepubertal children underwent random serum cholesterol determinations. Parental and grandparental histories of cardiovascular risk factors and atherosclerotic complications prior to 55 years of age were also obtained. Of the initial group, 274 children had total cholesterol levels ≥175 mg/dL, and 175 of these children returned for retesting after an overnight fast. A total of 88 children were found to have low-density lipoprotein-cholesterol (LDL-C) values ≥90th percentile for age and sex. Maternal and paternal histories of hypercholesterolemia were significantly associated with elevated LDL-C (odds ratio = 7.3 and 2.9, respectively), but had extremely low sensitivities (0.09, 0.15) despite modest positive predictive values (0.42, 0.22). Grandparental histories of sudden death, peripheral vascular disease, and gout were associated with elevated LDL-C, but sensitivities and positive predictive values for all of these factors were less than 0.22. Family history factors most commonly recommended as criteria for cholesterol screening in children did not identify half of all the children with elevated LDL-C and did not selectively identify the most severely affected children. Adding information concerning the presence of childhood obesity did not result in appreciable improvement in LDL-C detection beyond that achieved by family history factors alone. It was concluded that if thorough identification of young children with elevated LDL-C is desired, inclusive population screening rather than a family history-based strategy would be the most effective approach.
Retrospective and Prospective Identification of Unpublished Controlled Trials: Lessons From a Survey of Obstetricians and Pediatricians
Authors: Hetherington Jini , Dickersin Kay , Chalmers Iain , Meinert Curtis L.
Published: December 2021

Investigations in which statistically significant differences between treatment groups have not been observed are less likely than others to be reported in scientific journals. In clinical research, this selective suppression of "negative" results may lead to the adoption of ineffective or hazardous treatments. In an attempt to obtain information about unpublished trials in perinatal medicine, letters were sent to 42 000 obstetricians and pediatricians in 18 countries. As a result, we were notified of 395 unpublished randomized trials. Only 18 of the trials had been completed more than 2 years before the survey, a period during which at least 2300 reports of perinatal trials had been published. Of the 395 unpublished trials, 125 had ceased recruitment within the 2 years prior to the survey, 193 were actively recruiting at the time of the survey, and 59 were about to begin recruitment. It was concluded that publication bias will not be addressed successfully by attempts to obtain information about unpublished trials retrospectively. However, since the response rate to our request for details about ongoing and planned trials was good, prospective registration of trials at inception appears to be a feasible approach to reducing publication bias and its adverse consequences. An additional merit of prospective registration of clinical trials is that it should reduce unnecessary duplication (as opposed to necessary replication) in research and promote more effective collaboration.
Report of the Task Force on Circumcision
Authors:   AAP TASK FORCE ON CIRCUMCISION
Published: December 2021

Properly performed newborn circumcision prevents phimosis, paraphimosis, and balanoposthitis and has been shown to decrease the incidence of cancer of the penis among US men. It may result in a decreased incidence of urinary tract infection. However, in the absence of well-designed prospective studies, conclusions regarding the relationship of urinary tract infection to circumcision are tentative. An increased incidence of cancer of the cervix has been found in sexual partners of uncircumcised men infected with human papillomavirus. Evidence concerning the association of sexually transmitted diseases and circumcision is conflicting.

Newborn circumcision is a rapid and generally safe procedure when performed by an experienced operator. It is an elective procedure to be performed only if an infant is stable and healthy. Infants respond to the procedure with transient behavioral and physiologic changes.

Local anesthesia (dorsal penile nerve block) may reduce the observed physiologic response to newborn circumcision. It also has its own inherent risks. However, reports of extensive experience or follow-up with the technique in newborns are lacking.

Newborn circumcision has potential medical benefits and advantages as well as disadvantages and risks. When circumcision is being considered, the benefits and risks should be explained to the parents and informed consent obtained.
Exericise and the Asthmatic Child
Authors:   Section on Allergy and Immunology,   Section on Diseases of the Chest
Published: December 2021

Airway obstruction often develops in children with asthma after physical exertion. This exerciseinduced bronchoconstriction on asthma is not limited to children with asthma but also occurs in children with allergic rhinitis without clinically necognizable asthma. Typically, 5 to 8 minutes of vigorous exercise is sufficient to make the child short of breath, and symptoms of coughing, chest tightness, and wheezing begin shortly afterward. Chest pain, shortness of breath, and/on chest tightness may be the only complaints. Usually, within ½ to 1 hour, the episode subsides spontaneously. Some children appear to also have a delayed (4 to 12 hours) response to exercise, with the same symptoms that were present immediately after exercise.

The severity of such an attack of exercise-induced asthma depends on many factors. Children with poorly controlled asthma may have increased airway obstruction with trivial exercise such as walking or climbing a flight of stairs. The severity of obstruction at the onset of exercise may contribute as well, because an attack that begins with partially obstructed airways may end with more obstructed airways. The cold, dry ambient air significantly increases obstruction, as do many industrial pollutants, particularly sulfur dioxide. Both reactivity and obstruction may worsen with or after a viral infection on with allergen exposure, so that an asthmatic child's response to exercise may vary dramatically from day to day.

The exercise itself is an important variable but is individualized. Strenuous exercise increases the severity of the asthma and a short, intense effort may induce exercise-induced asthma as well as a longer, less intense effort.
Amenorrhea in Adolescent Athletes
Authors:   COMMITTEE ON SPORTS MEDICINE
Published: December 2021

A minority of female athletes participating in ballet, gymnastics, distance running, rowing, and cycling, as well as other sports activities, occasionally experience menstrual and associated physiologic changes. Women competing in the sports of ballet and gymnastics have been reported to have a particularly increased incidence of primary and secondary amenorrhea, decreased bone density, stress fractures, and symptoms of anorexia nervosa. Results of several studies have indicated decreased levels of circulating estrogen as well as other metabolic changes.

Research designed to determine the etiology of the amenorrhea and the associated changes has shown mixed results.

Low body fat cannot be linked in a causative fashion to hormonal changes or decreased levels of circulating estrogen. Early studies linking minimum body fat and menarche, as well as maintenance of regular menstrual cycles, have not been replicated. However, measurement of percentage of body fat may be helpful in assessing the nutritional status of athletes.

Ballet and gymnastics are perceived by some to be activities that are stressful psychologically. Although stress has been shown to cause amenorrhea, studies to date have not demonstrated the presence of significantly increased levels compared with agematched girls not participating in ballet and gymnastics.

Some authors have postulated that tall, thin athletes who may be genetically at risk for delayed maturation are naturally attracted to these sports. Some of the delays may relate to preselection. However, no evidence currently exists proving a definite relationship between preselection and the physiologic changes in these athletes.

There is an increased emphasis by athletes, coaches, judges, and spectators on a slender physique for female gymnasts and ballet dancers.
In Reply:Office-Based Medication Dispensing
Authors: SHEA DANIEL W.
Published: December 2021

The statement was developed by the Committee on Practice and Ambulatory Medicine (of which I was then chairman) with the approval and support of the American Academy of Pediatrics' Executive Board. It was designed to respond to the needs of the membership for direction and guidance in this area of practice activity. Establishing organizational policy on an issue such as this for which there are no hard data requires a consensus building process where expert opinion is solicited, competing views are evaluated, and a thoughtful position is fashioned. Our committee, at all times, sought substance, fairness, and balance in formulating the content of this statement.
In Reply: Supplemental Security Income Benefits for Children
Authors: FOX HARRIETFE B.
Published: December 2021

Mr Stein's letter speaks to a serious access problem because SSI eligibility in most states guarantees disabled children not only financial assistance but Medicaid coverage as well. Having recently completed a federally funded study of disabled children's access to SSI and Medicaid benefits, I am well aware of the various obstacles to these children's eligibility.

Federal law establishes that children who suffer from a physical or mental impairment equal in severity to one that would prevent an adult from working are to be considered disabled for purposes of SSI eligibility.
In Reply: Thrombocytopenia and Pediatric Patients With AIDS
Authors: BURNS EDWARD R. , ELLAURIE MAADHAVA , RUBINSTEIN ARYE
Published: December 2021

Based upon newly analyzed data, we agree with Dr Weinblatt's well-made point that HIV disease cannot be solely attributed to autoimmune destruction on the basis of elevated levels of platelet-associated IgG. In a recent prospective study of 38 infants and children with HIV infection monitored for as many as 9 years, we demonstrated that, using elevated platelet-associated IgG levels to detect AIDS thrombocytopenia, the sensitivity is 93% but the specificity is 13%. However, when combined with the finding of large circulating platelets as measured by increased mean platelet volume, the specificity is increased to 90%.
Mortality Rates
Authors: BABSON S. GORHAM
Published: December 2021

We are fortunate to receive Myron Wegman's annual summary of vital statistics in the December issue of Pediatrics. This valuable information is not readily available to the pediatrician.

I am somewhat discomforted by the emphasis continually made by health authorities and lay press on the United States' unfavorable international position in its infant mortality rate of 10.4 per 1000 live-born infants—now 19th in relation to other advanced countries for 1986. However, eight of these countries have less than 100 000 births each year, and most of them have relative ethnic homogeneity.
In Reply: Treatment of Bacillus Infections
Authors: FEDER HENRY M.
Published: December 2021

Dr Barson suggests that vancomycin should be used as empiric therapy for serious systemic and central nervous system Bacillus species infections pending susceptibility test results. This suggestion is based on the recent publication by Weber et al who reported that 54 strains of Bacillus cereus were susceptible to both vancomycin and chloramphenicol and that 35 strains on non-cereus Bacillus species were all susceptible to vancomycin; however, 14% of these 35 strains were resistant to chloramphenicol. Thus, chloramphenicol may be a poor choice for empiric therapy.
MALPRACTICE MONSTER
Authors: Student
Published: December 2021

Before we can persuade doctors to adopt standards of quality care, we must slay the medical-malpractice monster. Medical professionals should be held accountable for negligence and incompetence, but not for disappointment and grief over events no one can predict or control.
SQUEAKY WHEEL GOT THE GREASE
Authors: Student
Published: December 2021

The millions of dollars for Tylenol investigations [in 1982] yielded little beyond the probability that some lone crackpot had tampered with a few boxes of the pain reliever. . . . By comparison 634 Americans had been stricken with AIDS by October 5, 1982. Of these, 260 were dead. There was no rush to spend money, mobilize public health officials, or issue regulations that would save lives.
Early Detection of Delayed Myelination in Preterm Infants
Authors: van de Bor Margot , Guit Gerard L. , Schreuder Anneke M. , Wondergem John , Vielvoye G. Jan
Published: December 2021

Myelination of the central nervous system can be demonstrated with magnetic resonance imaging. The influence of periventricular-intraventricular hemorrhage and periventricular leukomalacia on cerebral myelination was studied using magnetic resonance imaging. The subjects were 33 preterm infants of less than 30 weeks' gestation studied at 44 weeks' postmenstrual age: 11 infants with periventricular-intraventricular hemorrhage, 7 with periventricular leukomalacia, and 15 without periventricular-intraventricular hemorrhage or periventricular leukomalacia. There were no differences in mean gestational age and birth weight between the three groups. However, infants without periventricular-intraventricular hemorrhage or periventricular leukomalacia had significantly less respiratory distress syndrome. At 44 weeks postmenstrual age, infants with periventricular leukomalacia had a significantly delayed myelination pattern (stage M2) in comparison with infants without periventricular-intraventricular hemorrhage or periventricular leukomalacia and infants with periventricular-intraventricular hemorrhage (stages M3 and M4). The latter two groups had myelination stages that were similar to those of healthy term infants at 44 weeks' postmenstrual age. The results demonstrate that periventricular leukomalacia causes delayed myelination of the cerebrum, whereas periventricular-intraventricular hemorrhage does not.
Brain Death in the Newborn
Authors: Ashwal Stephen , Schneider Sanford
Published: December 2021

The clinical courses of 18 preterm and term infants less than 1 month of age in whom brain death was diagnosed were retrospectively reviewed. Clinical diagnosis was determined neurologically and included (1) coma, (2) apnea, manifested by inability to sustain respiration, and (3) absent brainstem reflexes. Electroencephalograms were performed in all patients; 17 patients had adequate cerebral blood flow as estimated by radionuclide imaging. The results indicate that (1) neurodiagnostic tests such as electroencephalograms and radionuclide scanning reconfirmed clinically determined brain death in only one half to two thirds of patients; (2) electrocerebral silence in the absence of barbiturates, hypothermia, or cerebral malformations during 24 hours was confirmatory of brain death if the clinical findings remained unchanged; (3) absence of radionuclide uptake associated with initial electrocerebral silence was associated with brain death; (4) term infants clinically brain dead for 2 days and preterm infants brain dead for 3 days did not survive despite electroencephalogram or cerebral blood flow status; and (5) phenobarbital levels > 25 µg/ mL may suppress electroencephalographic activity in this age group. The findings suggest that determination of brain death in the newborn can be made solely by using clinical criteria. Confirmatory neurodiagnostic studies are of value because they can potentially shorten the period of observation.
Growth of Vegetarian Children: The Farm Study
Authors: O'Connell Joan M. , Dibley Michael J. , Sierra Janet , Wallace Barbara , Marks James S. , Yip Ray
Published: December 2021

To examine the effects of a vegetarian diet on child growth, height and weight data of 404 vegetarian children aged 4 months to 10 years who lived in a collective community in Tennessee were studied. Height for age, weight for age, and weight for height were compared with the US growth reference. Birth weights, infant feeding patterns, and parental heights were also evaluated in relation to growth. Most of the height for age, weight for age, and weight for height (n = 833) were within the 25th and 75th percentiles of the US growth reference. The mean height for age and weight for age, however, were slightly less than the median of the reference population. For different age groups, the mean height ranged from 0.2 to 2.1 cm and the mean weight ranged from 0.1 to 1.1 kg less than the reference median. The largest height difference was observed at 1 to 3 years of age and may be partly the result of intrinsic irregularities in the US growth reference at those ages. By 10 years of age, children from The Farm averaged 0.7 cm and 1.1 kg less than the reference median, representing only 0.1 and 0.3 SD from the reference. Thus, these children have adequate attained growth, even though it was modestly less than that of the reference population.
Feeding and Temperament as Determinants of Early Infant Crying/Fussing Behavior
Authors: Barr Ronald G. , Kramer Michael S. , Pless I. Barry , Boisjoly Christiane , Leduc Denis
Published: December 2021

In the first 3 months of life, crying and fussing in normal infants tend to increase until 6 weeks of age and decrease progressively thereafter. To determine whether feeding choice and early infant temperament are predictors of early crying, 374 healthy, full-term infants were observed prospectively from birth to 6 weeks of age. Feeding choice and sociodemographic characteristics were ascertained in the first few days postpartum. Parents completed a 17-item early infant temperament questionnaire at 2 weeks of age and a 24-hour behavior diary for 8 days at 6 weeks of age. Initially breast-fed infants cried and fussed more frequently throughout 24 hours compared with those who were formula fed, and increased frequency and duration of crying and fussing were predicted by "more difficult" temperament. Furthermore, a different pattern of crying and fussing within the day was found for infants who were changed from breast- to formula feeding. However, according to stepwise multiple regression models, daily duration of crying/ fussing was significantly predicted only by the temperament score (but not initial feeding choice), which accounted for 7% of the variance. Frequency of crying/ fussing were predicted only by socioeconomic status, temperament, and feeding frequency, which accounted for 12% of the variance. Breast- or formula feeding at 6 weeks of age was independently associated with crying/ fussing only during the evening. It was concluded that early infant temperament predisposes to early crying and fussing but is of limited use as a clinical predictor. Later crying/fussing behavior is not predicted by initial feeding. However, the pattern of duration of crying/fussing appears to change following a change from breast to formula, which may account for the presumed effectiveness of this maneuver.
"CRACK" NEONATES AND THEIR MOTHERS
Authors: Student
Published: December 2021

"This is very unfulfilling. You stay up nights with these babies trying to keep them alive, and you realize there's an unacceptable home situation they're going to, without a caring set of parents," said [a neonatologist].

The absence of maternal feeling among some crack users is chilling.

Recently, in the middle of the night [the neonatologist] was called into the hospital nursery to resuscitate a one-pound, three-ounce baby, 14 weeks premature, the offspring of a habitual crack user in her late teens.

"When I told the mother, (the baby) was critically ill, she said, `I was going to get an abortion, but I was too busy,' " said [the doctor].

"I said, `Do you want to touch your baby? Your baby is dying.' The only thing she said is, `What time is breakfast?' " The young woman vanished right after her meal.
Moebius Sequence and Prenatal Brainstem Ischemia
Authors: GOVAERT PAUL , VANHAESEBROUCK PIET , DE PRAETER CLAUDINE , FRÄNKEL URLIEN , LEROY JULES
Published: December 2021

Congenital nonprogressive (bilateral) facial palsy and external ophthalmoplegia are essential clinical features for the diagnosis of Moebius syndrome. One century after its initial thorough description, the precise delineation and pathogenesis of the syndrome still remain obscure. Heuristic hypotheses concerning the latter have been put forward. Three major theories of etiology remain valid: primary brainstem nuclear hypoplasia, secondary brainstem nuclear degeneration, and brainstem atrophy secondary to muscular defect. None of these theories easily explains why, apart from cranial nerve dysfunction, the Moebius syndrome is frequently a part of oral-limb deficiency anomaly syndromes.
Acute Splenic Sequestration in a 2-Month-Old Infant With Sickle Cell Anemia
Authors: PAPPO ALBERTO , BUCHANAN GEORGE R.
Published: December 2021

Acute splenic sequestration crisis is a potentially fatal complication of sickle cell anemia. It is characterized by acute splenic enlargement, with trapping of erythrocytes, causing increasing anemia and the potential for circulatory failure. The development of newborn screening programs aimed at identifying children with clinically significant hemoglobinopathies, combined with early parental education and careful follow-up, has decreased the overall mortality due to acute splenic sequestration crisis and other complications during the early years of life. The purpose of this paper is to report the case of an 8-week-old infant with sickle cell anemia and acute splenic sequestration crisis.
In Reply: Early Language Milestone Scale and Language Screening
Authors: WALKER DEWEY D. , GUGENHEIM SUSAN , DOWNS MARION , NORTHERN JERRY L.
Published: December 2021

We welcome a critique from our Denver friend and colleague, with his long experience in validating screening tests. No criticism of the DDST as a developmental screen was intended in our article. We merely wanted to make the point Dr Frankenburg himself has so succinctly stated that "outcome measures . . . such as syntax and articulation problems, are not even ascertained with the DDST test. . . ." The justification for our proposal that a language screening test like the ELM be used is, indeed, that the DDST is not a comprehensive language screen, as Dr Frankenburg concedes.
Growth of Children With Cerebral Palsy
Authors: HARUDA FRED
Published: December 2021

The article by Rempel et al (Pediatrics. 1988;82:857-862) highlights the importance of the central nervous system's normal growth and development. The syndrome of hemiatrophy secondary to a hemispheric brain injury at birth is well recognized by pediatric neurologists. The fact that the children in the study by Rempel et al did not all thrive with adequate nutrition suggests that, in children with cerebral palsy, with bilateral cerebral injuries, their lack of somatic growth may be thought of as "bilateral hemiatrophy," the injury to each hemisphere resulting in contralateral hemiatrophy.
Growth of Children With Cerebral Palsy
Authors: FIDONE GEORGE S.
Published: December 2021

Careful perusal of the article by Rempel et al has caused us to question the validity of the growth measurements that form the basis for the study's conclusions. Of the 57 patients reported, 21 were examined by one of the authors; 14 others had their data "reviewed in the care facility in which they resided" or were obtained by telephone contact with caretakers; data regarding the remaining 22 were culled from hospital records. Nowhere are the height or weight methods of measurement specified.
In Reply: Growth of Children With Cerebral Palsy
Authors: NELSON RICHARD P. , REMPEL GINA , COLWELL SARAH O.
Published: December 2021

Dr Haruda suggests that deficient somatic growth in children with severe cerebral palsy may be the consequence of "bilateral hemiatrophy." This concept is an attractive potential cause, but basic physiologic mechanisms remain elusive.

The validity of linear growth measurements in our study is at issue in Dr Fidone's correspondence. All measurements of children obtained in this study were performed by several trained staff of the cerebral palsy service at Gillette Children's Hospital. We acknowledge the difficulties in securing reliable measurement in children with skeletal deformity, but the large majority of children were young and did not have fixed contractures.
GERBER = BRISTOL MYERS = MEAD JOHNSON
Authors: L. J. F.
Published: December 2021

For decades, the $1.6 billion infant formula industry in the U.S. has billed itself as the pediatric community's "helpful ally."

But now, aided by No. 2-ranked Bristol-Myers Co., Gerber Products Co. is staging an end-run around the physician's office to respond to what it sees as "mothers' growing influence and independence" in choosing formulas.

As expected, Gerber yesterday unveiled its Gerber Baby Formula at a news conference in New York. The formula . . . will be put on the market in September . . . Gerber will devote scant effort to wooing pediatricians, who have traditionally recommended infant formula to mothers.

Instead, the Fremont Mich.-based baby food maker is unleashing its 600-member sales force on supermarkets and is launching a multimillion dollar print and television campaign.
Milk Intolerance in Children With Persistent Sleeplessness: A Prospective Double-Blind Crossover Evaluation
Authors: Kahn A. , Mozin M. J. , Rebuffat E. , Sottiaux M. , Muller M. F.
Published: December 2021

From July 1986 to July 1988, 146 children less than 5 years of age were referred by their physicians to our university sleep clinic for continual waking and crying during sleep hours. For 85 children (58.2%), the sleeplessness was attributed to inappropriate sleep habits. For 17 children (11.6%), no explanation was found for the sleep difficulties in spite of an extensive workup. Their median age at referral was 13.5 months (range 2.5 to 29 months). Their persistent sleeplessness was tentatively attributed to an undiagnosed intolerance to cow's milk. Cow's milk was excluded from their diet. In 15 children sleep normalized after 5 weeks (range 4 to 6 weeks). As seen from the parents' logs, the median time needed by the children to fall asleep decreased from 15 minutes (range 15 to 60 minutes) to 10 minutes (range 10 to 15 minutes, P = .001). The number of complete arousals decreased from 5 (range 1 to 12) to less than 1 per night (range 0 to 2) (P = .001). Total sleep time per 24 hours increased from 5.5 hours (range 3 to 8.5 hours) to 13.0 hours (range 10 to 14.5 hours, P = .001). Sleep normalized in one child who continued to receive no cow's milk only after the hydrolyzed hypoallergenic diet was discontinued. In every child, a double-blind crossover challenge was conducted involving a control diet containing no cow's milk and a diet containing cow's milk. The challenge induced the reappearance of insomnia and agitated behavior in all except one child. The child's initial sleep difficulties were retrospectively attributed to inappropriate sleep habits. To confirm the need to maintain the exclusion diet, double-blind crossover challenges with cow's milk were repeated with 10 children. Challenges were done between 16 and 22 months of age in 7 children and between 25 and 57 months of age in 3 children. The types of reactions observed were comparable with those seen previously, with the exception of that seen with a 57-month-old girl. She showed no sleeplessness during the challenge and was allowed a normal diet. At 24 months of age (range 15 to 50 months), 14 children were still being treated with the exclusion diet. Occasional sleepless nights were observed following accidental reintroduction of cow's milk in the diet. The observation that most insomniac infants respond successfully to changes in sleep routine and to behavioral approaches is supported by this study. Only the most persistent cases, those not responding to other forms of treatment, should be considered potential candidates for the diagnosis of food intolerance. An exclusion diet, managed with competent medical supervision, could bring the family long awaited relief within a few weeks. The diagnosis can then be confirmed by a milk challenge test.
NATIONAL DAY OF PRAYER
Authors: Barness Lewis A.
Published: December 2021

A national day of prayer has been recognized as a part of our country's heritage since it was declared by the Continental Congress in 1775.... Officially it is the first Thursday of every May; this year it falls on May 5.

We could trust the spirit of President Abraham Lincoln who, in despair, said, "I have been driven many times upon my knees by the overwhelming conviction that I had nowhere else to go."

This is the anxiety felt by 13-million American children who are "Poorest in a Land of Plenty," title given a film produced by the National Council of Churces, to be introduced on Mother's Day, May 14 (NBC, 1 pm). The NCC's statistics show that "One out of every five children in America is poor; among 20 industrialized nations the USA has the third highest infant mortality rate; among industrialized nations only the USA and South Africa fail to provide comprehensive health care for children and pregnant women.
Distribution of Antibodies to a Causative Agent of Exanthem Subitum (Human Herpesvirus-6) in Healthy Individuals
Authors: Yoshikawa Tetsushi , Suga Sadao , Asano Yoshizo , Yazaki Takehiko , Kodama Hiroshi , Ozaki Takao
Published: December 2021

The transfer of IgG antibodies to a causative agent of exanthem subitum (human herpesvirus-6) from mother to infant was examined with an indirect immunofluorescence assay. Of 20 mothers, 85% had the antibody more than 1:10, and the significantly higher level of the antibody was found in the cord blood with a positive rate of 95%. A mean ratio of cord blood to maternal antibody titer was 1.63. A total of 301 sera from healthy individuals was examined for the age-specific prevalence of antibody to the virus. In the first 2 months of life, 87% of infants had the antibody; the positive rate and the level of antibody decreased during the first 6 months of life with the lowest positive rate of 6% at 4 to 5 months of age. After 6 months of age, they increased gradually and reached the highest level at 1 year of age with the positive rate of 86%. From 2 years of age, the prevalence of the antibody was almost stable (69% to 76%) and similar to those in adolescents and adults.
Gross and Fine Motor Development in 45,X and 47,XXX Girls
Authors: Salbenblatt James A. , Meyers Deborah C. , Bender Bruce G. , Linden Mary G. , Robinson Arthur
Published: December 2021

Neuromuscular deficits have been described in 47,XXY and 47,XYY boys, but gross and fine motor development of girls with sex chromosome aneuploidy has not been extensively studied. Twenty-one propositae, 8 to 19 years of age, identified through newborn screening to be 45,X, 47,XXX, or 45,X mosaic, and 11 control girls were evaluated by a physical therapist unaware of their genetic constitution. The Bruininks-Oseretsky Test of Motor Proficiency (BOTMP) was administered, and the quality of neuromuscular function was determined. The 45,X and 47,XXX propositae exhibited both gross and fine motor dysfunction, with 12 of 15 BOTMP composite scores below the 10th percentile. The clinical assessment confirmed the BOTMP findings, with 13 propositae exhibiting dysfunctional sensory-motor integration. A delay in the age of independent walking confirmed the consistency of motor developmental dysfunction throughout time. Sex chromosome mosaics were more similar to control girls. The gross and fine motor delays were frequently associated with a moderate to severe language dysfunction which adversely affected classroom performance. Regular developmental assessments of children with sex chromosome aneuploidy, including sensory-motor integration, should assist in the identification of early developmental delays and permit appropriate intervention.
Three-Wheel and Four-Wheel All-Terrain Vehicle Injuries in Children
Authors: Dolan Margaret A. , Knapp Jane F. , Andres Jody
Published: December 2021

In January 1988, sales of new three-wheel all-terrain vehicles (ATVs) were banned in the United States because of the high incidence of injury associated with their use, especially by children. Four-wheel ATVs remain on the market. A retrospective review of all ATV injuries seen in a level I pediatric trauma center was conducted to compare the nature and severity of injuries in three-wheel vehicles with those associated with four-wheelers. A total of 36 ATV injuries were seen from April 1986 to August 1988. All patients were < 16 years of age; 72% were ≤12 years of age. Of the patients, 56% were boys; 44% were girls. Although 56% of incidents involved three-wheelers, a larger number of more serious injuries, defined as the presence of indicators of injury severity (eg, death, Injury Severity Score ≥10, intensive care unit admission, or need for surgery), involved four-wheel vehicles. A total of 15 injuries occurred in 1987; 12 injuries, including the first death involving an ATV at the pediatric trauma center, occurred in the 7 months since the sales ban. Immature judgment and/or motor skills were the most common factors contributing to injury. Existing information regarding injuries involving three-wheel ATVs is supported by our data, according to which it is suggested that four-wheel vehicles may be dangerous in the hands of immature or unskilled operators < 16 years of age. Injury prevention efforts should be directed at prohibiting any ATV use by persons < 16 years of age.
Health Insurance Status of Young Adults in the United States
Authors: McManus Margaret A. , Greaney Ann M. , Newacheck Paul W.
Published: December 2021

Sociodemographic and health characteristics of young adults who are uninsured, publicly insured, and privately insured were examined using the 1984 National Health Interview Survey. The results indicated that 26% of 19 to 24-year-old persons had no health insurance protection, 65% were privately insured, 7% were publicly insured, and 1% had both private and public coverage. Young adults at greatest risk for being uninsured were male, Hispanic and black, poor and near-poor, unemployed, high school dropouts, living with others, and residing in the South and West. All young adults predictably lose or change health insurance as they move from dependence to independence. It was concluded that greater use of new and existing transitional insurance options should be offered as well as targeted educational and communication strategies to assure that all young persons enter adulthood with some basic insurance protection.
Body Proportionality and Head and Length `Sparing' in Growth-Retarded Neonates: A Critical Reappraisal
Authors: Kramer Michael S. , McLean Frances H. , Olivier Marielle , Willis Diana M. , Usher Robert H.
Published: December 2021

Despite the popular current distinction between "proportional" and "disproportional" intrauterine growth retardation, it has never been shown that variation in body proportions is greater among growth-retarded than nongrowth-retarded infants of the same birth weight, nor that proportionality is distributed bimodally among growth-retarded infants. Based on a cohort of 8719 neonates born between 1980 and 1986 of mothers with concordant (± 7 days) menstrual dating and early ultrasound estimates of gestational age, we used a continuous measure of birth weight for gestational age to define four study groups: nongrowth retarded (n = 5163) and mild (n = 411), moderate (n = 226), and severe (n = 147) intrauterine growth retardation. Compared with non-growth-retarded infants of the same gestational age, growth-retarded infants had substantially lower lengths, head circumferences, and proportionality ratios, and the magnitude of the deficits increased significantly with increasing degrees of growth retardation. When the comparison was based on birth weight rather than gestational age, however, growth-retarded infants had slightly but significantly greater lengths and head circumferences, with increased variability in body proportions, but no evidence of the bimodality that would characterize two distinct subtypes. The analysis suggests that proportionality among intrauterine growth-retarded infants represents a continuum, with progressive disproportionality as severity of growth retardation increases. Moreover, despite evidence of some "sparing," the absolute magnitudes of the deficits in length and head growth remain substantial.
Medication Dosages During Pediatric Emergencies: A Simple and Comprehensive Guide
Authors: TENDLER CRAIG , GROSSMAN SUSAN , TENENBAUM JUDITH
Published: December 2021

Drug dosing during life-threatening pediatric emergencies is a source of stress for most physicians and nurses. This can be attributed to the lack of standardized drug doses for most pediatric medications, thus requiring time-consuming calculations with small margins of error. Anxiety may be further heightened by the infrequent occurrence of pediatric emergencies, resulting in a staffs limited experience with such crises. In an effort to reduce the potential for error and anxiety during administration of these pediatric critical care drugs, a majority of the major medical centers are currently using medication tables. Many prototypes have been published in the literature, but most require calculations and are incomplete in their content.