bluuebunny/crossref_metadata_2025 huggingface dataset:
Cardiorespiratory Recordings From Infants Dying Suddenly And Unexpectedly at Home
Authors: Meny Robert G. , Carroll John L. , Carbone Mary Terese , Kelly Dorothy H.
Published: December 2021

Objective. Little is known about the mechanism of death during sudden infant death. To study the mechanism, we obtained data on six infants who died while on a memory-equipped cardiorespiratory monitor.

Methods. Waveforms of respiration and heart rate trend were available for five infants; an alarm log only was available for the sixth. These printouts were reviewed with attention to mechanism and time to death.

Results. All infants were born prematurely; autopsies reported the cause of death as sudden infant death syndrome in three cases and bronchopulmonary dysplasia in the others. Bradycardia, which played a more prominent role than central apnea, was preceded by tachycardia in two deaths. Resuscitation occurred within 1 minute in four cases; no response to alarms occurred in the other two cases, apparently because the parents were desensitized by prior meaningless alarms. Five patients died within 20 minutes, whereas one death due to sudden infant death syndrome was prolonged.

Conclusion. Bradycardia is an important feature in all six of these infant deaths. Although its etiology is unknown, hypoxemia or obstructive apnea may precede bradycardia. Home monitors equipped to detect these possible antecedents will yield further insight into sudden infant death.
An Evaluation of Autonomic Nervous System Function in Patients With Prader-Willi Syndrome
Authors: DiMario Francis J. , Dunham Barbara , Burleson Joseph A. , Moskovitz Jay , Cassidy Suzanne B.
Published: December 2021

Objective. Prader-Willi syndrome (PWS) is a complex multisystem genetic disorder in which many cardinal features may have a neurologically based patho-physiology involving both the central and peripheral components of the autonomic nervous system. Autonomic nervous system function was studied noninvasively in a group of subjects with PWS and control subjects to determine whether autonomic nervous system dysfunction exists as part of the PWS.

Design/setting. This cross-sectional study was performed in the neurophysiology laboratory at a tertiary care facility.

Methods. Evaluation included anthropometric measurements and calculation of a body mass index (BMI). Simultaneous electrocardiography and serial recordings of pulse rate and systolic/diastolic mean arterial blood pressures during orthostatic maneuvers were taken. Pupillary response to the instillation of dilute pilocarpine and measurements of plasma norepinephrine at rest and after standing were also obtained. Results were analyzed using two-tailed t tests, Fisher exact test, analysis of variance, and analysis of covariance adjusting for age, gender, and BMI.

Patients. There were 14 subjects with PWS (8 female, 6 male; aged 4 to 40 years, mean age 16 years) and 8 control subjects (4 female, 4 male; aged 5 to 37 years, mean age 19 years).

Results. Abnormal findings were obtained only in subjects with PWS. Analysis of covariance adjusting for age, gender, and BMI revealed a trend for subjects with PWS to have lower resting diastolic blood pressure (P < .09) and significantly less change in diastolic blood pressure after standing (P < .02). Subjects with PWS had significantly greater BMI than did control subjects (P < .001), which correlated significantly with all pulse rate measurements where the greater the BMI the higher the pulse rate at rest (r = .25, P < .04) and the lower the pulse rate after arising from lying to standing at both 15 and 30 seconds (r = .17, P < .1; r = .55, P < .08 respectively). Pupillary constriction of 2 mm or more was seen in 7 of 14 subjects with PWS and in no control subjects (P < .004). The 30:15 R-R interval ratio was abnormal in 6 of 14 subjects with PWS and in no control subjects (P < .03).

Conclusions. These results suggest that patients with PWS have a detectable underlying autonomic dysfunction characterized principally by diminished parasympathetic nervous system activity.
Simultaneous Technique for Acuity and Readiness Testing (START): Further Concurrent Validation of an Aid for Developmental Surveillance
Authors: Sturner Raymond A. , Funk Sandra G. , Green James A.
Published: December 2021

Study objective. A brief (8-minute) procedure, now called Simultaneous Technique for Acuity and Readiness Testing or START, has been shown to be efficacious for predicting developmental outcomes and a cost-effective screen for visual acuity. The objective of the two studies reported here was to examine the ability of this procedure to predict concurrent developmental outcome by using a new simplified scoring system.

Design. A prospective design was used. Subjects were screened using START, and then samples were stratified on the basis of developmental screening results (START in study 1 and the revised Denver Developmental Screening Test and a shortened version of the Minnesota Child Development Inventory in study 2) into subsamples (n = 118 and 120) which were administered the standard criterion test (McCarthy Scales of Children's Abilities in one cohort and the Stanford-Binet in the other).

Setting. Prekindergarten registration for a rural school system in North Carolina.

Subjects. Two county-wide cohorts of preschool children (n = 352 and 362).

Measurements and main results. Results for prediction of the McCarthy outcomes were as follows: sensitivity, 0.76; specificity, 0.99; predictive value, 0.81; underreferral, 1.3%; overreferral, 1.0%; and percent agreement, 98%. Prediction of Stanford-Binet results was as follows: sensitivity, 0.94; specificity, 0.83; predictive value, 0.22; underreferral, 0.3%; overreferral, 16%; and percent agreement, 84%. Most of the overreferrals for the Stanford-Binet were in the clinically important borderline category.

Conclusion. These results provide further support for the concurrent validity of START. The results illustrate how routine health procedures can be restructured to obtain clinically useful data on specific child developmental functioning.
Parents' Responses to Vaccine Information Pamphlets
Authors: Clayton Ellen Wright , Hickson Gerald B. , Miller Cynthia S.
Published: December 2021

Objective. To assess parents' knowledge and opinions about immunizations and immunization practices before and after introduction of vaccine information pamphlets.

Research design. Telephone questionnaire administered to parents whose children received immunizations in the preceding week.

Setting. Six private pediatric practices in Nashville area and resident continuity clinic at Vanderbilt University Medical Center.

Participants. Parents whose children were scheduled to receive immunizations were asked to participate. Interviews were completed with 177 parents whose children received immunizations before and 156 parents after pamphlets were introduced. These two groups of parents had similar demographic characteristics.

Results. Parents who received vaccine information pamphlets learned more about vaccines (2.38 facts/parent after vs 1.18/parent before vaccine information pamphlets, z = -6.28, P < .0001) and were more eager to obtain immunizations for their children (76% vs 38%, χ2 = 47.24, P < .001). Receipt of pamphlets did not make parents significantly more likely to report side effects from vaccines (63% after vs 55% before, NS) but tended to make them less likely to turn to non health care providers for information (58% after vs 69% before, χ2 = 3.73, P = .06). Parents who received pamphlets, however, said more often that they received too much information (20% vs 4%, χ2 = 14.9, P < .001).

Conclusions. Vaccine information pamphlets enhanced parents' knowledge and acceptance of immunizations. There is room for further improvement.
Blowing Away Shot Pain: A Technique for Pain Management During Immunization During Immunization
Authors: French Gina M. , Painter Eileen C. , Coury Daniel L.
Published: December 2021

Objective. To study the effect of an active distraction technique on pain in preschool children receiving diphtheria, pertussis, and tetanus immunization.

Design. Randomized, unblinded controlled study.

Setting. Columbus Public Health Department Immunization Clinics.

Participants. One hundred forty-nine 4- to 7-year-old children.

Intervention. Children were taught to blow out air repeatedly during the injection, as if they were blowing bubbles.

Results. Children who were taught to blow out air during their shots had significantly fewer pain behaviors (P < .04) and demonstrated a trend toward lower subjectively reported pain (P = .06). There was no significant difference in the nurse or parent visual analog scale scores.

Conclusions. A simple distraction technique can be effective in helping children cope with the pain of immunization. The use of such a technique to relieve the pain and distress associated with even a brief painful procedure should be encouraged.
LAYING DOWN THE LAW ON INDIRECT COSTS
Authors: L. J. F.
Published: December 2021

The office of Management and Budget (OMB) has finally issued new rules limiting indirect-cost payments. The new rules will cost universities about $100 million a year, according to one spokesperson for an association of university administrative officers.
ALL-GIRL CLASSES TO HELP GIRLS KEEP UP WITH BOYS
Authors: L. J. F.
Published: December 2021

A wealth of research shows that girls are largely shortchanged in traditional classrooms, particularly in math and science, where boys tend to dominate discussion, receive more of their teachers' time and wring the self-confidence from girls who enter school equal in achievement and attitude but leave with lower test scores and diminished dreams.

In response to that research, which shows girls scoring generally lower on standardized tests—there is a 50-point gap on the math S.A.T.—and avoiding advanced math and science classes, three California schools are segregating girls in some classes ...

The pilot was so popular that the program was expanded this year to include two math and two science classes for both freshman and sophomore girls.

It is the public schools, however, that could face legal challenges and the loss of state or federal money by offering segregated instruction.
The Wonder Years
Authors: Grace Ted W. , Patrick Kevin
Published: December 2021

Lexicographers have always been troubled by words without precise meaning, like adolescence. Because it originates from the Latin word adolescere, meaning to grow up, one might assume that it includes anyone who is not a grown-up. However, grown-up means adult, and adult comes from the Latin word adultus, which is the past participle of the word adolescere. So anyone who is not an adolescent is an adult, and vice versa. Although such circular reasoning might serve the interests of politicians well, it gives epidemiologists, health statisticians, and members of the practice community serving this group gastric acidity. Unfortunately, when terms with imprecise meanings are used, no one else knows "what you chose it to mean!"
Health Care Reform and the Special Needs of Children
Authors: Perrin James M. , Bloom Sheila R. , Kahn Robert S. , Davidson Stephen , Guyer Bernard , Hollinshead William , Richmond Julius B. , Wise Paul H. , Walker Deborah Klein
Published: December 2021

Health care reform may well address many of the needs of children and adolescents, offering greater emphasis on prevention and providing insurance to the large number of US children currently uninsured. Yet key public health and community health service programs essential to the well being of children and adolescents have gained little attention in the current national health care reform debates. Most discussions focus on insurance and cost containment and fail to address other systemic barriers to health care. Insurance alone will not solve the health problems faced by children and adolescents.

SPECIAL NEEDS OF CHILDREN AND ADOLESCENTS

Addressing the health risks that children and adolescents face requires combining public and private efforts and community-oriented and personal care services.
Childhood Lead Poisoning in the '90s
Authors: Piomelli Sergio
Published: December 2021

Lead is an extremely toxic metal: even a single atom of lead, once in the human body, binds to a protein and induces some damage; the greater the exposure, the more serious the effects. Lead has no physiological function; any amount of body lead reflects environmental pollution.1

In the 1990s, in the United States, is lead poisoning a devastating environmental threat to our children or is childhood lead poisoning a threat of the past? Probably neither of these statements is correct. It may be worthwhile to look at the current situation in detail.

In the 1970s, before efforts were made to reduce environmental lead, common effects in children of the widespread environmental contamination with lead were encephalopathy and even death.
Lymphadenitis as the Dominant Manifestation of Kawasaki Disease
Authors: Stamos Julie Kim , Corydon Kathleen , Donaldson James , Shulman Stanford T.
Published: December 2021

Kawasaki disease (KD) is an acute febrile illness primarily affecting infants and young children. Its importance relates to the fact that 20% to 25% of untreated patients develop coronary abnormalities that can lead to myocardial infarction or even to death.1 KD is a leading cause of acquired heart disease in children in many regions, including the United States.2 Because there are no specific diagnostic tests for KD, the diagnosis is established by the presence of fever and four of five criteria without other explanation for the illness: (1) nonexudative conjunctival injection; (2) oral mucosal changes; (3) changes of the peripheral extremities; (4) rash, primarily truncal; and (5) cervical lymphadenopathy.
Letter to the Editor
Authors: Holberg Catharine J , Duncan Burris , Ey John
Published: December 2021

We would like to thank Dr Heery for his comments on our paper "Exclusive Breast-Feeding for at Least 4 Months Protects Against Otitis Media."1 The first finding he mentions refers to a decrease in the mean number of otitis media (OM) episodes with increasing duration and exclusivity of breast-feeding. Dr Heery is correct that this part of the analysis did not control for other potential risk factors. We had preferred to give the actual mean number of otitis media episodes by breast-feeding status (Table 2), which most clearly expresses the data in its raw form, rather than deriving predicted or adjusted means, which are more removed from the data.

See table in the PDF file
Throat Cultures
Authors: Wald Ellen R.
Published: December 2021

I read with great interest the article entitled "Duration of Positive Throat Cultures for Group A Streptococci After Initiation of Antibiotic Therapy" by Snellman et al.1 The study involved 47 patients in whom streptococcal pharyngitis was diagnosed, who were randomly selected to receive three different antimicrobial regimens with a varying number of doses before the performance of a repeat throat culture. The degree of positivity of the persistently positive cultures (1+, 2+, or 3+) was not shown.
Letter to the Editor
Authors: Snellman Leonard W. , Stang Howard J. , Johnson Dwight R. , Kaplan Edward L.
Published: December 2021

We appreciate Dr Wald's interest in our article1 and the opportunity to respond to some of her comments.

Patients in our study were not treated with a varying number of doses before the performance of a repeat throat culture, but had a throat culture performed before each of the first four doses of oral antibiotic if treated with oral penicillin or erythromycin. The initial and three subsequent throat cultures were performed at intervals similar to those patients treated orally if patients were treated with intramuscular benzathine penicillin G.
ACADEME GETS LESSONS FROM BIG BUSINESS
Authors: L. J. F.
Published: December 2021

PITTSBURGH—Like many other academics, Richard Florida used to stand before his public-policy classes at Carnegie Mellon University here and lecture students who silently copied every word.

But after a weeklong seminar in "Total Quality Management" at Xerox Corp. this past summer, Prof. Florida has a new style: He sits with his legs crossed in the corner of the classroom, listening and doodling. While he draws, the students, whom Prof. Florida considers his "customers," plan the course, design the syllabus, run the classes and even suggest their own grades.

Prof. Florida is practicing a controversial new brand of education. He says he believes that by treating students as customers and allowing them to choose what they want to learn, he is making them better thinkers, superior problem-solvers and more employable graduates.

"We're setting up an educational system here that's totally geared to meeting customer requirements," he says. "We've got to serve these customers if we're going to survive."
MINNESOTA TAKES CONTROVERSIAL STEPS TO REFORM HEALTH CARE
Authors: L. J. F.
Published: December 2021

When Minnesota legislators last spring passed health legislation that included a tax on health care providers, many physicians thought the state had gone too far. As the state begins to implement the law, however (physicians will begin paying the tax in 1994), those same physicians are realizing that their troubles may have just begun.

The tax is only one part of a larger health reform package that promises to change the way Minnesota physicians practice. Under the law, for example, the state will assign physicians to some patients. The law also requires the state to develop practice parameters and controls on technology...

Beginning in 1994, physicians will pay a 2% income tax on their gross revenues. The tax, which will not be levied on Medicare or Medicaid services or on physicians employed by managed care providers, will help pay for health insurance for the state's approximately 400,000 uninsured.

Many physicians opposed the legislation because it will cut into their pay...

And to achieve its goal of reducing health care costs by 10% a year for five years, the state will develop and implement practice parameters in an attempt to avoid ineffective treatment.
THE VA IS THE LARGEST HEALTH CARE SYSTEM IN THE USA
Authors: L. J. F.
Published: December 2021

What would the chances for congressional approval of President Clinton's health care plan be if Americans peered into the future and discovered that:

Over half of the patients (55%) in the plan with routine medical problems wait three hours or longer, sometimes all day, to be seen for a few minutes by an over-worked doctor struggling with increasing numbers of patients and piles of government forms, regulations, controls and policy directives...

The VA is the largest health care system, public or private, in the U.S. and one of the largest in the world. It operates 171 medical centers with 80,000 beds; 362 out-patient and community clinics with 23 million patient visits annually...

VA is the quintessential government bureaucracy: administratively officious and laden with red tape and regulatory minutiae destructive to both quality patient care and staff conduct. Three volumes of the U.S. Code (title 38) and a full volume of the Code of Federal Regulations, plus scores of volumes of federal personnel and other policy restrictions, govern each VA employee's every move. Thousands of pages provide detailed descriptions of medical conditions, degrees of disability and potential eligibility for pension benefits and free health care.
Providing Comprehensive Health Care to Children With Chronic Illness
Authors: Jessop Dorothy Jones , Stein Ruth E. K.
Published: December 2021

Objectives. To test whether a program of outreach and comprehensive health care for children with chronic disorders provides more complete care and reduces unmet health needs compared with traditional care.

Design. A pretest-posttest randomized control trial.

Setting. An inner-city municipal teaching hospital.

Sample. Two hundred nineteen systematically enrolled mothers of children with diverse chronic physical health conditions.

Interventions. A comprehensive outreach program, Pediatric Home Care (PHC), contrasted with Standard Care.

Measurements and Results. Nine elements of comprehensive care established in the literature as components of a basic package of care for those with chronic conditions. The PHC intervention addressed gaps in services and improved both the acquisition and maintenance of elements of comprehensive care.

Conclusions. These data suggest mechanisms through which comprehensive care programs may contribute to the improvement in psychological and social outcomes previously reported for those in the PHC intervention.
Outcome of Very Low Birth Weight Infants: Multiple Gestation Versus Singletons
Authors: Leonard Carol H. , Piecuch Robert E. , Ballard Roberta A. , Cooper Bruce A. B.
Published: December 2021

Objective. Multiple gestation infants are overrepresented in intensive care nurseries, and have been reported to have greater morbidity than singletons. A cohort of very low birth weight infants was examined to determine outcome of premature infants based on gestation type (multiple or single) and hypothesized that at this low birth weight, the outcome of the groups would be similar.

Method. The sample was composed of all infants with birth weights ≤1250 g born in a 10-year period (September 1977 through September 1987). Ninety-two percent (n = 364) of the infants discharged were seen at 1 year of age, and 73% (n = 249) were observed to school age. Morbidity was assessed by neurodevelopmental examinalions and standard developmental tests.

Results. At 1 year of age and at school age, there were no differences in neurologic or neurosensory outcome between multiple gestation and single gestation infants. Logistic regression analyses were performed on the school age data, using cognitive outcome as the dependent variable and gestation type, birth weight, gestational age, intracranial hemorrhage, chronic lung disease, and a social risk factor as predictor variables. Gestation type was not associated with cognitive outcome at school age. Social risk factors and chronic lung disease showed an association with cognitive outcome at school age.

Conclusions. Multiple gestation was not related to increased morbidity in this very low birth weight group. The developmental outcome of all infants with birth weights ≤1250 g in this study was related to medical and social risk factors. These findings were consistent for a large group of infants over a 10-year period.
Alteration in the Proportion of CD4 T Lymphocytes in a Subgroup of Human Immunodeficiency Virus-Exposed-Uninfected Children
Authors: Gesner Matthew , Papaevangelou Vana , Chen Song-He , Moore Tiina , Krasinski Keith , Borkowsky William , Kim Mimi
Published: December 2021

Objective. The age-related changes in the proportion of CD4 and CD8 lymphocytes in human immunodeficiency virus (HIV)-seronegative children born to HIV-infected mothers (seroreverters) were compared with the changes in these lymphocyte subsets in children born to seronegative women to assess a possible effect of exposure to HIV without infection.

Design. There were 146 seroreverter and 72 seronegative children. The median CD4 and CD8 percentages for each of these two groups of children were compared retrospectively at 3-month intervals from birth through 27 months and at a tenth interval for the time beyond 27 months. The weighted average of the within-subject rate of change of CD4 and CD8 percentages were also compared between the two groups. Finally, for each subject, the proportion of the subject's CD4 percentage assays which were <10th percentile of the entire study population (30%) was calculated, and the distributions of the subject-specific proportions were then compared between the seronegative and seroreverter groups using the Wilcoxon rank sum test. The proportion of CD8 assays <10th percentile (12%) or >90th percentile (26%) were also computed for each subject, and the distributions of the proportions were compared similarily.

Results. The median CD4 percentage for seroreverter children was lower than that for the seronegative children at every interval from birth through 27 months and for the last interval for values obtained at greater than 27 months, although the comparison was statistically significant only at the 4- to 6-month period. The weighted average of the within-subject rate of change of CD4 percentage was -0.09 and -3.0 per year (P .04), and of CD8 percentage was 1.3 and 1.0 (P = .67), for the seroreverter and seronegative children, respectively. There were significantly more children in the seroreverter group than in the seronegative group who had repeated assays in which the CD4 percentage was <10th percentile for age (P <.00005). In addition, there was a subset of 10 seroreverter children (6.8%) who had CD4 percentages <30% on >50% of their assays, as compared with only one (1.4%) seronegative child. The proportion of CD8 assays <10th percentile or >90th percentile were not significantly different between the two groups of children.

Conclusions. The CD4 proportions were persistently lower in the seroreverter than in the seronegative population, although only reaching statistical significance in 1 of 10 3-month intervals. This finding may be due to a subgroup of seroreverter children who have persistently low CD4 lymphocyte percentages.
Evaluation of Recurrent Pediatric Syncope: Role of Tilt Table Testing
Authors: Strieper Margaret J. , Auld Debbie O. , Hulse J. Edward , Campbell Robert M.
Published: December 2021

Objective. To determine the current practice and effectiveness of evaluating recurrent syncope in pediatric patients, and to establish the role of tilt table testing in the evaluation.

Design. Retrospective analysis of 54 pediatric patients with the history of syncope referred to cardiologists. Group I consisted of 27 patients examined without tilt table testing group II consisted of 27 patients whose examination included tilt table testing.

Results. Group I had an average of 5.4 studies and group II, 6.6 studies performed per patient. Studies included chest radiograph (16 vs 13), electrocardiogram (24 vs 27), echocardiography (21 vs 27), 24-hour electrocardiogram (14 vs 16), transtelephonic monitor (7 vs 8), electrophysiology study (1 vs 3), complete blood cell counts (11 vs 12), chemistries (10 vs 11), thyroid function test (3 vs 3), neurology consult (12 vs 6), electroencephalogram (12 vs 5), and head computed tomographic scan (5 vs 3). Of the 298 non-tilt studies, the results of only 5 (1.6%) were abnormal. Diagnoses were made in 5 (18.5%) of 27 group I patients (Wolff-Parkinson-White syndrome, 1; conversion reaction, 2; hyperventilation, 1; migraines, 1), whereas diagnosis was made in 27 (100%) of 27 group II patients (neurocardiogenic syncope, 25; conversion reaction, 2).

Conclusion. An extensive workup is not routinely indicated in syncopal patients with a history consistent with neurocardiogenic syncope. Tilt table testing performed early in the evaluation will increase the probability of a diagnosis, and will often prevent the need for further extensive, expensive anxiety-producing tests.
SLASH AND BURN TIME
Authors: L. J. F.
Published: December 2021

Modern Healthcare magazine will report in its coming issue that 27% of the hospitals it talked with this year are cutting their work forces, some by as much as 24%. Church-affiliated and investor-owned facilities are the toughest cutters. Support staff and middle managers are primary targets. Only 7% of the hospitals plan to add staff.
Risk of Injury From Baseball and Softball in Children 5 to 14 Years of Age
Authors:   Committee on Sports Medicine and Fitness
Published: December 2021

Baseball is one of the most popular sports in the United States, with estimates of 4.8 million children 5 to 14 years of age participating annually in organized and recreational baseball and softball. Interest in and fascination with the sport have grown since the beginning of the 20th century, but it was not until 1965 that the issue of "Little League elbow" raised concern about the safety of the game. Recently, highly publicized catastrophic impact injuries from contact with a ball or bat have raised new safety concerns. These injuries provided the impetus for this review of the safety of baseball for 5- to 14-year-old participants. The discussion focuses principally on baseball, but softball is considered in accord with the availability of relevant literature. This statement mainly concerns injuries during practices and games in organized settings; players and bystanders also can be injured in casual play.

The term Little League elbow was used in 1965 to denote radiologic evidence of fragmentation of the medial epicondylar apophysis and osteochondrosis of the head of the radius and capitellum.1,2 Subsequent studies of children 12 years old and younger3,4 have found a substantially lower incidence of abnormalities than originally described.1,2 Early detection and intervention seem to permit the complete resolution of symptoms and underlying structural abnormalities.5 More serious abnormalities become more common after the age of 13 years.6-8 The role that repetitive throwing in 5- to 14-year-old children may play in the evolution of elbow overuse injuries at an older age remains to be determined.
Letter to the Editor
Authors: Beach Roberta K.
Published: December 2021

Joseph Nicolosi's letter offers an opportunity to emphasize an important point made in the American Academy of Pediatrics' statement on "Homosexuality and Adolescence." The acknowledgment and understanding of one's sexual identity and sexual orientation is a developmental process that occurs gradually throughout adolescence and young adulthood. Confusion about sexual orientation is not unusual during adolescence, and the Committee on Adolescence agrees that professionals should avoid prematurely labeling an adolescent as gay. The role of the health professional is to offer sensitive and nonjudgmental support as the adolescent explores his or her developing sexual identity.
Parents' Versus Physicians' Values for Clinical Outcomes in Young Febrile Children
Authors: Kramer Michael S. , Etezadi-Amoli Jamshid , Ciampi Antonio , Tange Susan M. , Drummond Keith N. , Mills Elaine L. , Bernstein Mark L. , Leduc Denis G.
Published: December 2021

Objective. To compare how parents and physicians value potential clinical outcomes in young children who have a fever but no focus of bacterial infection.

Methods. Cross-sectional study of 100 parents of well children aged 3 to 24 months, 61 parents of febrile children aged 3 to 24 months, and 56 attending staff physicians working in a children's hospital emergency department. A pretested visual analog scale was used to assess values on a 0-to-1 scale (where 0 is the value of the worst possible outcome, and 1 is the value for the best) for 22 scenarios, grouped in three categories according to severity. Based on the three or four common attributes comprising the scenarios in a given group, each respondent's value function was estimated statistically based on multiattribute utility theory.

Results. For outcomes in group 1 (rapidly resolving viral infection with one or more diagnostic tests), no significant group differences were observed. For outcomes in groups 2 (acute infections without long-term sequelae) and 3 (long-term sequelae of urinary tract infection or bacterial meningitis), parents of well children and parents of febrile children had values that were similar to each other but significantly lower than physicians' values for pneumonia with delayed diagnosis, false-positive diagnosis of urinary tract infection, viral meningitis, and unilateral hearing loss. For bacterial meningitis with or without delay, however, the reverse pattern was observed; physicians' values were lower than parents'. In arriving at their judgment for group 2 and 3 scenarios, parents gave significantly greater weight to attributes involving the pain and discomfort of diagnostic tests and to diagnostic error, whereas physicians gave significantly greater weight to attributes involving both short- and long-term morbidity and long-term worry and inconvenience. Parents were significantly more likely to be risk-seeking in the way they weighted the attributes comprising group 2 and 3 scenarios than physicians, ie, they were more willing to risk rare but severe morbidity to avoid the short-term adverse effects of testing.

Conclusions. Parents and physicians show fundamental value differences concerning diagnostic testing, diagnostic error, and short- and long-term morbidity; these differences have important implications for diagnostic decision making in the young febrile child.
Early Prediction of the Development of Microcephaly After Hypoxic-Ischemic Encephalopathy in the Full-Term Newborn
Authors: Cordes Isabel , Roland Elke H. , Hill Alan , Lupton Brian A.
Published: December 2021

The development of microcephaly after significant hypoxic-ischemic cerebral injury in the full-term newborn has major prognostic significance. However, the onset of microcephaly in this context may be delayed more than 12 months.

Objectives. To determine whether serial head circumference measurements and decreased rate of head growth in asphyxiated full-term newborns during the first few months of life may predict the development of eventual microcephaly.

Methodology. Serial head circumference measurements at 4, 8, and 18 months of age were obtained in 54 full-term newborns who had acute, hypoxic-ischemic encephalopathy. The rate of head growth was determined on the basis of changes in head circumference ratios which are calculated as follows: actual head circumference/mean head circumference for age x 100%. Head circumference ratios were correlated with severity of newborn encephalopathy and outcome at 18 months.

Results. A decrease in head circumference ratios of >3.1% between birth and 4 months of age was highly predictive of the eventual development of microcephaly before 18 months (sensitivity 90%, specificity 85%).

Conclusions. These data demonstrate that serial head circumference measurements during the first 4 months of life and calculation of decreased rate of head growth in full-term newborns with hypoxic-ischemic encephalopathy may predict microcephaly before its actual occurrence.
Treatment of Acute Childhood Diarrhea With Homeopathic Medicine: A Randomized Clinical Trial in Nicaragua
Authors: Jacobs Jennifer , Gloyd Stephen S. , Gale James L. , Jiménez L. Margarita , Crothers Dean
Published: December 2021

Objective. Acute diarrhea is the leading cause of pediatric morbidity and mortality worldwide. Oral rehydration treatment can prevent death from dehydration, but does not reduce the duration of individual episodes. Homeopathic treatment for acute diarrhea is used in many parts of the world. This study was performed to determine whether homeopathy is useful in the treatment of acute childhood diarrhea.

Methodology. A randomized double-blind clinical trial comparing homeopathic medicine with placebo in the treatment of acute childhood diarrhea was conducted in León, Nicaragua, in July 1991. Eighty-one children aged 6 months to 5 years of age were included in the study. An individualized homeopathic medicine was prescribed for each child and daily follow-up was performed for 5 days. Standard treatment with oral rehydration treatment was also given.

Results. The treatment group had a statistically significant (P < .05) decrease in duration of diarrhea, defined as the number of days until there were less than three unformed stools daily for 2 consecutive days. There was also a significant difference (P < .05) in the number of stools per day between the two groups after 72 hours of treatment.

Conclusions. The statistically significant decrease in the duration of diarrhea in the treatment group suggests that homeopathic treatment might be useful in acute childhood diarrhea. Further study of this treatment deserves consideration.
Extracorporeal Membrane Oxygenation for Refractory Septic Shock in Children
Authors: Beca John , Butt Warwick
Published: December 2021

Objective. To review demographic data and outcome of children who received extracorporeal membrane oxygenation (ECMO) for refractory septic shock.

Method. Review of medical charts of nine children receiving ECMO for culture-proven refractory septic shock treated in a multidisciplinary pediatric intensive care unit.

Results. Median age was 12 years and median weight was 45 kg. Median inotrope requirements (µg/kg per minute) before ECMO were dopamine, 15; dobutamine, 12.5; epinephrine, 4; and norepinephrine, 3.5. Four children received two inotropes concurrently, and five received three or more. All nine patients had severe respiratory failure; eight had evidence of other organ system dysfunction, with six having five or more organ system dysfunctions. Median PRISM score was 27. Median duration of ECMO was 137 hours. Within 24 hours of starting ECMO, 7 of 9 children had all inotropes stopped. Four patients died and five survived, all of whom are leading normal lives.

Conclusion. In this small group of children with probably fatal septic shock, ECMO was successfully supported the circulation and 5 of the 9 children survived. We suggest that septic shock should not be considered a contra-indication to ECMO.
Noninvasive Monitoring of Oxygenation in Infants and Children: Practical Considerations and Areas of Concern
Authors: Poets Christian F. , Southall David P.
Published: December 2021

Objective. To review the technical principles of transcutaneous Po2 (tcPo2) monitors and pulse oximeters and to discuss methodological and practical issues related to the use of these devices in infants and children.

Design. Literature review and summary of personal experience.

Results. tcPo2 measurements are influenced by skin thickness, sensor temperature, amount of contact gel used, and state of peripheral perfusion. The average in vivo response time to a rapid decrease in Pao2 is approximately 16 seconds. Sensitivity to both hypoxemia (Pao2 < 50 mm Hg) and hyperoxemia (Pao2 > 80 to 100 mm Hg) is approximately 85%. Pulse oximeters require careful sensor placement (to avoid optical shunts) and adequate pulse pressures (> 20 mm Hg). They are prone to movement artifact. There are considerable differences in bias and precision between different brands, resulting, for example, in quite different upper alarm limits required to detect hyperoxemia reliably. The normal range of oxygen saturation measured by pulse oximetry, measured with one brand of pulse oximeter (Nellcor) during regular breathing, is 95% to 100% in preterm infants and 97% to 100% in full-term infants and children.

Conclusions. Because both devices have their specific shortfalls, they should ideally be used in combination, particularly in critically ill preterm neonates. Where this is not feasible or necessary, clinicians must be aware of the limitations of the device they are using.
REPORT CARDS: SOME SAY THERE MUST BE A BETTER WAY
Authors: L. J. F.
Published: December 2021

Despite decades of improvements in education, report cards have hardly changed; educators see them as necessary evils that add little to a student's education but fear. Increasingly, though, some schools are trying new ways of communicating with parents that can reduce violence at home and actually enhance learning.

In Attleboro, report cards now include a warning to parents not to let their frustration over grades turn into violence. In Baltimore, middle-school students earn "improvement points" and compete against themselves, not their peers.

Setting Their Own Goals

A school in Manhattan, Kan., has replaced report cards with triangular parent-student-teacher conferences in which the children set their own educational goals and then assess how well they have done ...

While scattered schools around the country are experimenting with alternatives to the report card—portfolios of work, evaluations by the teacher or parent conferences—report cards remain the most important communication between school and home in a vast majority of schools ...

The biggest problems arise when parents overreact. Child advocates in several cities say that when report cards are issued, reports of child abuse go way up. The National Committee for Prevention of Child Abuse, a group in Chicago, has a national awareness campaign, with advertisements that read, "Stop the Report Card Reflex."
Summary of the Urologic Section
Authors: Kaplan William E.
Published: December 2021

A meeting of the Section on Urology of the American Academy of Pediatrics was held in conjunction with the annual meeting of the American Academy of Pediatrics in Washington, DC, October 30 through November 1, 1993. This meeting continues to be the most significant scientific program for pediatric urology. Two hundred ninety-three abstracts were submitted worldwide, and the competition was fierce for the 91 accepted podium and poster presentations. Chairperson, Casimir F. Firlit, MD, PhD, of North-western University Medical School and Children's Memorial Hospital in Chicago, IL, presided over the meeting. The papers that were presented at this meeting and that are of interest to the practicing pediatrician are summarized in this article according to topic.

URETEROPELVIC JUNCTION OBSTRUCTION

This group of papers investigated both clinical management of ureteropelvic junction obstruction as well as some basic research concerns, all to determine what is the best method of management for newborns and young children with ureteropelvic junction obstruction. Early diagnosis by prenatal ultrasonography has only complicated decision-making processes relative to appropriate therapy. The combination of research protocols to evaluate the effects of obstruction as well as appropriate methods of management were presented.

Thomas et al, from Leeds, determined that the renal pelvic diameter measured on a 16- to 24-week fetus could help to determine ultimate renal function. If the in utero ultrasonograph revealed a renal pelvic diameter of >15 mm, impaired renal function was the determination. However, those kidneys that had a renal pelvic diameter <5 mm would have normal renal function even though hydronephrosis would be present at the time of birth.
Staffing Patterns for Patient Care and Support Personnel in a General Pediatric Unit
Authors:   Committee on Hospital Care
Published: December 2021

The mission of a pediatric inpatient unit, no matter how large or small, whether in a private or public hospital, is to provide optimum, age-appropriate care for each patient and to lend sensitive and understanding support to his or her family. The key to success in achieving this mission is the quality and commitment of the personnel on the unit. If the skills and the dedication are present and there is flexibility in staffing assignments, the desired patient care outcomes will be inevitable.
Screening Infants and Young Children for Developmental Disabilities
Authors:   Committee on Children With Disabilities
Published: December 2021

Early identification of children with developmental disabilities can lead to treatment or amelioration of the severity of a disability and its impact on the functioning of the child and family. Because developmental screening is a process that selects those children who will receive the benefits of more intensive evaluation, or of treatment, all infants and children should be screened for developmental disabilities, otherwise some may be denied access to needed care. Successful early identification of developmental disabilities requires the pediatrician to be skilled in the use of screening techniques and of developmental surveillance, to actively seek parental concerns about development, and to create linkages with available resources in the community. Because community systems vary from one locality to another and may change over time, the physician's information must be updated on a regular basis. Children and families are best served when the primary pediatrician providing health supervision services collaborates with the tracking and intervention services available in the community.
Letter to the Editor
Authors: Davis Deborah J.
Published: December 2021

I appreciate Dr Clark's comments about my article entitled "How aggressive should delivery room cardiopulmonary resuscitation be for extremely low birth weight neonates?" Dr Clark points out a regrettable discrepancy between the text and Fig 1; the text should have indicated that there were 62 neonates born during the study period who weighed 501 to 750 g. Of these, 58 had active intervention defined as resuscitative efforts at least to the level of intubation and ventilation if needed.
Sexuality Education in Schools
Authors: Choi Y. Sammy
Published: December 2021

Sexuality education in the United States has been addressed recently by the official American Academy of Pediatrics (AAP) publication, "School Health: Policy and Practice" prepared by the AAP Committee on School Health.1 In the section on school and sexuality education, the AAP has endorsed the recommendations published in 1991 by the Sex Information and Education Council of the United States (SIECUS)2 which is part of the National Coalition to Support Sexuality Education, a coalition of organizations that support the goal that all children and youth receive sexuality education by the year 2000.
Letter to the Editor
Authors: Marks Melvin I. , Hall Caroline B.
Published: December 2021

Dr Zucker's letter describes concern about the American Academy of Pediatrics (AAP) Committee on Infectious Diseases statement on the use of ribavirin for the treatment of respiratory syncytial virus (RSV) infections (Pediatrics 1993;92:501-504).

The Committee developed its recommendations on the basis of the available placebo-controlled prospective double-blind studies. Although these studies contained relatively small numbers of patients, they were controlled and prospective, and all showed a favorable response. The variable course of RSV illnesses and the relatively low mortality rates make clinically meaningful end-points difficult to define and quantitate.
Prenatal Genetic Diagnosis for Pediatricians
Authors:   Committee on Genetics
Published: December 2021

Pediatricians may be called upon to counsel a family in which prenatal diagnosis is being considered or in which there is a fetus with a genetic disorder. In some settings, the pediatrician may be the primary resource for counseling the family. More frequently, counseling may already have been provided by a clinical geneticist and/or obstetrician. However, because of a previous relationship with the family, the pediatrician may be called upon to review this information and to assist the family in the decision-making process. The pediatrician should be familiar with the principles of prenatal genetic diagnosis and know how to apply them to specific problems in genetic counseling, diagnosis, and management in clinical practice. At the same time, pediatricians should be familiar with resources available in their region for obtaining information about whether and how a specific disorder can be diagnosed and when and where to refer patients for prenatal genetic diagnosis. The technology of prenatal diagnosis is changing rapidly, and genetic consultants can assist pediatricians in the appropriate utilization and interpretation of the diagnostic tests that are available.