bluuebunny/crossref_metadata_2025 huggingface dataset:
Premature Sexual Activity as an Indicator of Psychosocial Risk
Authors: Orr Donald P. , Beiter Mary , Ingersoll Gary
Published: December 2021

Although unprotected premature sexual activity is associated with well-defined biologic risks of sexually transmitted disease and pregnancy, the concomitant psychosocial risks are less well documented. The strength of association (odds ratio) of coital status with other risk behaviors and feelings was examined in 1504 junior high school students. Among the 12 through 16-year-old students, 63% of the boys and 36% of the girls were nonvirginal (had had intercourse at least once). The proportion of sexually experienced boys and girls increased with age. Nonvirginal boys and girls were significantly (P < .001) more likely than their virginal cohorts to engage in other activities considered risky. The odds ratios for nonvirginal youth ranged from 3.5 for girls having used drugs other than alcohol or marijuana, to 10.4 for girls having used marijuana. Nonvirginal boys and girls were also at significantly greater risk for engaging in minor delinquent acts and having school problems. Nonvirginal girls (but not boys) were 6.3 times more likely to report having attempted suicide. The strength of associations with feelings was weaker. Nonvirginal girls were at slightly greater risk for reporting feeling lonely, feeling upset, and having difficulty sleeping. A significant proportion of the students reported sexual experience and ever use of alcohol or marijuana (45% of boys, 27% of girls). There were strong age effects so that by age 15 years, 63% of the boys and 50% of the girls reported experience with both activities. The data suggest that early sexual experience among adolescents is associated with other potentially health-endangering behaviors and that the syndrome of problem behaviors is important in this age group.
Elevated Plasma Aluminum Levels in Normal Infants Receiving Antacids Containing Aluminum
Authors: Tsou V. Marc , Young Rose M. , Hart Michael H. , Vanderhoof Jon A.
Published: December 2021

Aluminum toxicity is a documented cause of encephalopathy, anemia, and osteomalacia. Excretion is primarily renal; therefore, patients with renal insufficiency are at risk for aluminum accumulation and toxicity. This has been demonstrated in uremic children treated with aluminum-containing antacids. The purpose of this study was to determine whether plasma aluminum levels were elevated in infants with normal renal function during prolonged aluminum-containing antacid use. Ten study infants (mean age = 5.8 months), who had been receiving antacids for at least 1 week, were compared with 16 control infants (mean age = 9.8 months) not receiving antacids. The study patients consumed 123 ± 16 mg/kg per day (mean ± SEM) of elemental aluminum for an average of 4.7 weeks. Their plasma aluminum level (37.2 ± 7.13 µg/L) was significantly greater than that of the control group (4.13 ± 0.66 µg/L) (P < .005). It is concluded that plasma aluminum levels may become elevated in infants with normal renal function who are consuming high doses of aluminum-containing antacids. The safety of antacids containing aluminum should not be assumed and they should be used judiciously in infants, with careful monitoring of the aluminum dose and plasma level.
Methsuximide for Intractable Childhood Seizures
Authors: Tennison Michael B. , Greenwood Robert S. , Miles Michael V.
Published: December 2021

Methsuximide was added to the therapeutic regimens of 25 children with intractable epilepsy. In 15 patients the drug was well tolerated and resulted in a 50% or greater reduction in seizure frequency. No serious or irreversible adverse effects were seen. Methsuximide is frequently overlooked and may be an effective adjunctive antiepileptic for children with intractable seizures.
Changing Immunization Referral Patterns Among Pediatricians and Family Practice Physicians, Dallas County, Texas, 1988
Authors: Schulte Joann M. , Bown Geri R. , Zetzman Marion R. , Schwartz Benjamin , Green H. Gordon , Haley Charles E. , Anderson Ron J.
Published: December 2021

Family practice physicians and pediatricians in Dallas County, Texas, were surveyed to determine how recent vaccine price increases have changed immunization referral patterns. A total of 73% of responding physicians referred some pediatric patients for immunization in 1988. Public health clinics were the largest referral source with more responding pediatricians (84.4%) referring patients than did responding family practitioners (66.5%). Referrals to the clinics were most often made when patients were unable to afford immunizations in a private practice setting. Between 1979 and 1988, the number of responding pediatricians and family practitioners making immunization referrals increased by 193% and 391%, respectively. The percentages of children referred for immunization increased by 693% during the same decade. It was suggested by our survey of Dallas County physicians that a new influx of patients are using public sector immunizations, potentially creating additional financial stress for public health programs. In addition, this shift to the public sector may undermine the health departments' ability to provide new vaccines or protect greater numbers of children with immunization.
Neuroleptic Malignant Syndrome: Life-Threatening Complication of Neuroleptic Treatment in Adolescents with Affective Disorder
Authors: Joshi Paramjit T. , Capozzoli Joseph A. , Coyle Joseph T.
Published: December 2021

Neuroleptic malignant syndrome (NMS) is an uncommon, potentially fatal side effect of neuroleptic treatment characterized by hyperthermia, rigidity, rhabdomyolysis, and delerium. In recent clinical studies of adults it was suggested that affective disorder is a risk factor for the development of neuroleptic malignant syndrome. The cases of two adolescents with neuroleptic malignant syndrome who were treated with neuroleptic therapy because of psychotic symptoms in association with primary affective disorders are reported. The occurrence of these cases, as well as the observations in adults, suggests that attention to the primary psychiatric diagnosis is important in neuroleptic usage and that physicians should be vigilant to the occurrence of neuroleptic malignant syndrome in the pediatric population.
Public Disclosure of Private Information About Victims of Abuse
Authors:   Committee on Child Abuse and Neglect
Published: December 2021

This Policy Statement was retired May 2005.

Media publication of information about child abuse victims and their families may be detrimental to the victims. This is particularly true in cases of sexual abuse, but it may be just as serious in some cases of physical abuse or neglect. Many states lack laws that restrict publicity concerning the identity of child abuse victims and their families. As a result, serious harm to children can occur, not only at the time of the trial or hearing, but when subsequent stories appear years later.

The American Academy of Pediatrics recommends that all states adopt laws to prevent public disclosure of information that identifies victims of child abuse. The laws should grant courts the discretion to take one or more of the following measures during hearings of alleged civil or criminal child abuse/neglect: (1) exclude the public and media from a proceeding during the testimony of the child victim; (2) exclude the public (but not the media) from an entire proceeding; and (3) use pseudonyms in court records for the child victim and his or her family members.

Criteria by which the need for such protective measures should be judged include (1) the likelihood of identification of the child victim to the public if the protective measure is not taken; (2) the nature of the conduct that is the basis for the proceeding; (3) the child victim's age and level of maturity; (4) the desires of the child victim; and (5) in cases in which a family member is the defendant, the need to protect the family from publicity to encourage the resolution of family problems.
Diagnostic Imaging of Child Abuse
Authors:   Section on Radiology
Published: December 2021

The concept of child abuse as a medical entity has its origins in the radiologic studies of the pediatric radiologist Dr John Caffey, as well as many other specialists in the field of diagnostic imaging. When all cases of child abuse and neglect are studied, the incidence of physical alterations documentable by diagnostic imaging is relatively small. However, imaging studies are often critical in the infant and young child with evidence of physical injury, and they also may be the first indication of abuse in a child who is seen initially with an apparent natural illness. As most conventional imaging studies performed in this setting are noninvasive and entail minimal radiation risks, recommendations regarding imaging should focus on examinations, which provide the highest diagnostic yield at acceptable costs.

SKELETAL IMAGING

Although skeletal injuries rarely pose a threat to the life of the abused child, they are the strongest radiologic indicators of abuse. In fact, in the young infant, certain radiologic abnormalities are sufficiently characteristic to allow a firm diagnosis of inflicted injury in the absence of clinical information. This fact mandates that imaging surveys performed to identify skeletal injury be carried out with the same level of technical excellence utilized in examinations routinely performed to evaluate accidental injuries. The "body gram" or abbreviated skeletal surveys have no place in the imaging of these subtle, but highly specific bony abnormalities.

In general, the radiographic skeletal survey is the method of choice for skeletal imaging in cases of suspected abuse. Modern pediatric imaging systems commonly use special film, cassettes, and intensifying screens to minimize exposure.
Statement on Pediatric Fellowship Training
Authors:   Federation of Pediatric Organizations
Published: December 2021

The following statement was adopted by the Federation of Pediatric Organizations in February, 1990. The Federation consists of the following pediatric organizations: Ambulatory Pediatric Association, American Academy of Pediatrics, American Board of Pediatrics, American Pediatric Society, Association of Medical School Pediatric Department Chairmen, Association of Pediatric Program Directors, Society for Pediatric Research.

The Federation supports the concept that "the principal goal of fellowship training should be the development of future academic pediatricians." Graduates of pediatric fellowship programs usually work in academic centers with significant time set aside for research. Some fellowship-trained pediatricians, particularly neonatologists, allergists, and neurologists, may not work in hospitals or ambulatory settings that are associated closely with academic programs. Fellowship-trained pediatricians in all settings should be encouraged to continue their interest in research to add to the body of pediatric knowledge. To achieve the goal of training pediatric scientists, the following guidelines for fellowship education are recommended:

1. Upon completion of a pediatric fellowship, the trainee should be proficient in clinical care, teaching, and research. Fellowship training should prepare a pediatrician to care for children with complex illnesses within his/her area of special expertise and to serve as a consultant for the general pediatrician. In addition, the fellowship-trained pediatrician should be responsible for the education of pediatric residents and the continuing education of practicing pediatricians. For this reason, fellowship training should include interpersonal skills and pedagogical techniques.

2. Research training should begin as soon as possible; premedical students, medical students, and pediatric residents should be encouraged strongly to participate in meaningful research, and research activities should be carried out throughout fellowship training.
Phenytoin (Dilantin) Prescribing Practices Among Long Island, NY Pediatricians
Authors: MCABEE GARY , ATLURU VIJAYA , CARACCIO THOMAS , MOFENSON HOWARD
Published: December 2021

To the Editor.—

A recent increase in phenytoin (PHT) toxicity in children prompted us to investigate prescribing practices of pediatricians in Long Island, NY. Questionnaires, consisting of 18 questions regarding the use, kinetics, and side effects of PHT, were sent to 603 pediatricians. There were 97 respondents (16%). Of the respondents, 29% originally prescribed PHT themselves (n = 76 = number who responded to question). The mean number of children treated per month was 2.3 (range 1 to 12).
Early Intubation and MAS
Authors: TRAVERSE LIONEL D.
Published: December 2021

To the Editor.—

I was particularly interested by the article by Wiswell et al, entitled "Meconium Aspiration Syndrome: Have We Made a Difference?"1 because it is one of the few articles that has addressed issues of direct interest for the "trenches paediatrician." I would like to propose the following comments to the authors.

Intubation of a newborn, by an experienced and trained person, is a benign gesture. Except for the occasional vagal stimulation and very transient bradycardia associated, and the potential trauma to cords (which in good hands is probably easy to avoid), I am not aware of any medium- or long-term sequelae of intubating an infant once or twice.
Encopresis Caused by Mother's Stoma
Authors: DE VOS ILSE , MESSER ANTHONY P. , WOLTERS WILLEM H. G.
Published: December 2021

To the Editor.—

We read the very interesting case report in Pediatrics1 about the boy who became extremely anxious and refused to go to the toilet after he saw a horrifying television commercial about a toilet. This led to constipation. We have an experience that corroborates this observation and smartly exposes the underlying mechanism.

A 5-year-old girl who had a severe defecation problem for 2 years was brought to our hospital. She persistently refused to go to the toilet or to use a potty.
Can Clinical Judgment Detect Children With Speech-Language Problems?
Authors: Glascoe Frances P.
Published: December 2021

Pediatricians often rely on clinical judgment derived from observation or parental concern to identify children with developmental problems. The less popular but recommended alternative is to repeatedly administer standardized screening tests. Such tests are time consuming but, unlike clinical judgment, have known detection rates. Preliminary research concerning clinical judgment showed that clusters of parental concerns related to their childrens' performances on screening tests. In the present study, previous research was refined by assessment of the meaning of parents' concerns about their childrens' speech-language development. In this study of 157 families seeking pediatric care, 72% of children whose speech-language screening yielded positive results had parents who were concerned about their speech-language development. Of children with negative screening results, 83% had parents with no concerns about their speech-language development. Although standardized screening tests should be used occasionally in the developmental surveillance process, the findings show that the problems of most children with developmental problems were detected through clinical judgment based on parental concern.
Selenium in Pediatric Nutrition
Authors: Litov Richard E. , Combs Gerald F.
Published: December 2021

Se is an essential nutrient that provides antioxidant protection in concert with vitamin E. Several selenoproteins have been identified, but only one, SeGSHpx, has a known function, that of neutralizing toxic hydroperoxides. Plasma Se concentration, being responsive to changes in Se intake, is the most practical and widely used measure of nutritional Se status. The plasma Se concentrations of the majority of healthy infants and children fall within the range of 50 to 150 µg/L. Although SeGSHpx activity measures the metabolically functional form of Se, the lack of a standardized analytical method has limited its usefulness as an index of nutritional Se status. Se deficiency was first observed in animals, but it is now recognized to occur in humans. Two human diseases associated with severe nutritional Se deficiency have been reported from China: a juvenile cardiomyopathy named Keshan disease and a chondrodystrophy named Kaschin-Beck disease. Long-term TPN, which provides negligible amounts of intrinsic Se, has been demonstrated in some cases to result in biochemical and clinical impairment. Although there are no consistent signs and symptoms characteristic of TPN-associated Se deficiency, in addition to the low blood selenium levels, some patients will experience leg muscle pain and altered serum transaminase and creatine kinase activities. These manifestations of Se deficiency usually take years to develop.

Recent information about the amount of dietary Se needed to maximize plasma SeGSHpx activity in adult men has allowed for better estimates of the Se requirement for humans. Recommended daily dietary allowances published recently by the National Academy of Sciences have been revised for infants and children in this paper by making appropriate adjustments for the protein requirements of these age-groups. These recommended intakes for Se can generally be met by consuming adequate amounts of cereals, meat, eggs, dairy products, human milk, and infant formula, which are good sources of highly available Se and are of low risk of providing excess amounts of Se. Suboptimal Se intakes by pregnant women may predispose their infants to low Se status at birth, which in turn may affect the infants' ability to maintain adequate Se status during the first few months of life. In those situations where protein intake is restricted, such as in phenylketonuria and maple syrup urine disease, Se-supplemented formulas should be used. The most critical situation for Se supplementation is in pediatric patients receiving long-term TPN therapy. When supplementing with Se, consideration must be given to the amount and form of Se to be used; with long-term TPN therapy, plasma Se levels should be monitored.
Sweeteners, Flavorings, and Dyes in Antibiotic Preparations
Authors: Kumar Ashir , Weatherly Mark R. , Beaman Dana C.
Published: December 2021

Even though a variety of adverse effects caused by sweeteners, flavorings, and dyes in susceptible individuals have been reported, there is no good single reference with information about these substances in pediatric antimicrobials. Data on sweeteners, flavorings, and dyes in 91 antimicrobial preparations were collected. Sucrose was present in 74 (85%) of 87 preparations, followed by saccharin in 30 (34%) preparations. Mannitol, lactose, and sorbitol were each present in 7 preparations. None of the preparations were free of sweeteners. Thirty-four (37%) of 91 preparations did not specify the flavoring content. While cherry was the most common flavoring used, there were 25 other flavorings. Thirteen different dyes and coloring agents were used in these antimicrobials. Red dye no. 40 was present in 45% of preparations. Tables detailing sweeteners, flavorings, and dyes in different groups of antimicrobials (amoxicillin, ampicillin, cephalosporins, erythromycin, penicillins, sulfonamides, and others) and adverse effects reported with these inert ingredients are presented. These tables should be helpful to physicians in selecting an antimicrobial containing a different sweetener and/or dye when an adverse reaction occurs.
VACTERL Association With High Prenatal Lead Exposure: Similarities to Animal Models of Lead Teratogenicity
Authors: LEVINE FRED , MUENKE MAXIMILIAN
Published: December 2021

The VACTERL association is one of the more common patterns of multiple malformations in children, with an incidence of approximately 1.6 cases per 10 000 live births.1 The pattern of defects consists of vertebral anomalies (found in 70% of patients), anal atresia with or without fistula (80%), cardiac defect (50%) with ventricular septal defect being most common, tracheoesophageal fistula (70%), renal anomalies (53%), and limb anomalies (65% with radial anomalies and 23% with lower extremity defects).2

The definition of the VACTERL association as a distinct entity is based on the finding that its constituent anomalies are associated in a nonrandom manner.1,3,4
Serious Error
Authors: JAIN LUCKY , VIDYASAGAR DHARMAPURI , RAJU TONSE N. K.
Published: December 2021

To the Editor.—

The paper by Ware et al concerning the follow-up of survivors from a surfactant trial1 contains a serious error in Table 5 regarding the source of surfactants in our studies.2 As clearly stated in our abstract, we used Surfactant TA (Tokio Akita Inc, Tokyo, Japan) in the initial trial,3 and a surfactant material, now named Survanta (Abbott Laboratories, North Chicago, IL), in the later multicenter trial.4 These surfactant materials were derived from bovine lung and not from therapeutic abortions, as stated in Table 5 of report by Ware et al.
Secular, Means What?
Authors: SHAW ANTHONY
Published: December 2021

To the Editor.—

I am puzzled by the statement, "No secular change in survival occurred during the study," in the abstract of the excellent article by Morris et al.1 I wonder whether the authors are leaving open the question of whether a change in survival might occur in a more religious setting.
Judging the Validity of Developmental Screening Tests
Authors: CUNNINGHAM ROBERT DANA
Published: December 2021

To the Editor.—

In judging the validity of developmental screening tests, there is frequent difficulty in obtaining the ideal "gold standard" by which to judge the screening instrument. For example, while it is useful to know how the Denver Developmental Screening Test compares with the Stanford-Binet when attempting to identify children with mental retardation at 3 years of age, perhaps it is even more useful to know how the screening test compares with the Stanford-Binet in predicting which 3 year olds will go on to become labeled as mentally retarded at 6 years of age, a time when IQ scores are more stable and school systems are more likely to make special services available.
Follow-up of Infants Treated With Extracorporeal Membrane Oxygenation for Newborn Respiratory Failure
Authors: Schumacher R. E. , Palmer T. W. , Roloff D. W. , LaClaire P. A. , Bartlett R. H.
Published: December 2021

Follow-up studies were conducted to assess the medical and developmental outcome of 92 infants treated with extracorporeal membrane oxygenation at the University of Michigan. Of 118 near-term (>34 weeks' gestation) infants who received extracorporeal membrane oxygenation, 103 (87%) were surviving and available for follow-up at between 1 and 7 years of age. Ninety-two of these children were seen on at least one occasion. Each visit included a history and physical examination, an evaluation by a physical therapist, and developmental testing by a pediatric psychologist. Medical outcome during year 1 found 31% of the children rehospitalized, primarily with respiratory illness. Outpatient-treated lower respiratory tract illness was seen in an additional 31% of the children. New or nonstatic neurologic problems were noted in 6% of the children. Abnormal growth during year 1 occurred in 26% of the children. At last clinic visit 16% of the children exhibited moderate-to-severe neurologic abnormalities, and 8% had moderate-to-severe cognitive delay. Sensorineural hearing loss occurred in 4% of children. Nine percent of the children were receiving speech and language therapy; screening tests showed that an additional 6% had speech and language delay. Overall, at last visit 16 (20%) of the children exhibited some type of handicap. A review of the literature on follow-up studies of non-extracorporeal membrane oxygenation-treated infants with persistent pulmonary artery hypertension produced an impairment rate of 18.5%. Outcome post-extracorporeal membrane oxygenation appears similar to that seen in less ill cohorts of infants treated with more "conventional" therapy. Long-term follow-up of all such infants remains essential.
Pulmonary Mechanics in Preterm Neonates With Respiratory Failure Treated With High-Frequency Oscillatory Ventilation Compared With Conventional Mechanical Ventilation
Authors: Abbasi Soraya , Bhutani Vinod K. , Spitzer Alan R. , Fox William W.
Published: December 2021

Pulmonary mechanics were measured in 43 preterm neonates (mean ± SD values of birth weight 1.2 ± 0.3 kg, gestational age 30 ± 2 weeks) with respiratory failure who were concurrently randomly assigned to receive conventional mechanical ventilation (n = 22) or high-frequency ventilation (n = 21). The incidence of bronchopulmonary dysplasia was comparable in the two groups (high-frequency ventilation 57%, conventional ventilation 50%). Pulmonary functions were determined at 0.5, 1.0, 2.0, and 4.0 weeks postnatal ages. Data were collected while subjects were in a nonsedated state during spontaneous breathing. These sequential data show similar patterns of change in pulmonary mechanics during high-frequency ventilation and conventional mechanical ventilation irrespective of gestational age, birth weight stratification, or bronchopulmonary dysplasia. There was no significant difference in the pulmonary functions with either mode of ventilation during the acute phase (≤4 weeks) of respiratory disease. When evaluated by the clinical diagnosis of bronchopulmonary dysplasia, the pulmonary data suggested a less severe dysfunction in the high-frequency oscillatory ventilation-treated bronchopulmonary dysplasia group compared with the conventional mechanical ventilation-treated group. These results indicate that high-frequency oscillatory ventilation in preterm neonates does not reduce the risk of acute lung injury; however, the magnitude of the pulmonary dysfunction in the first 2 weeks of life merits a reevaluation.
Attention Deficit Disorder With and Without Hyperactivity: Clinical Response to Three Dose Levels of Methylphenidate
Authors: Barkley Russell A. , DuPaul George J. , McMurray Mary B.
Published: December 2021

The response of 23 children with attention deficit disorder (ADD) with hyperactivity (+H) and 17 children with ADD without hyperactivity (-H) to three doses of methylphenidate (5, 10, and 15 mg twice a day) was evaluated in a triple-blind, placebo-controlled crossover design using parent and teacher ratings of behavior, laboratory tests of ADD symptoms, and behavioral observations during academic performance. Results indicated that the children with ADD+H were rated as having more pervasive behavioral problems at home and more pervasive and severe conduct problems at school than the children with ADD-H. Laboratory tests found the children with ADD+H to be impaired in behavioral inhibition and vigilance whereas children with ADD-H were more impaired in the consistent retrieval of verbally learned material Drug effects were noted on the parent and teacher ratings and on most laboratory measures, with all three doses typically producing significant changes but rarely differing among themselves in effectiveness. The groups were not found to differ significantly on any measures in their response to methylphenidate. However, more children with ADD-H were clinically judged as having either no clinical response (24%) or responding best to the low dose (35%) of medication. In contrast, most ADD+H (95%) children were judged to be positive responders and most were recommended to receive the moderate to high dose (71%).
Behavioral Management of Psychogenic Cough: Alternative to the "Bedsheet" and Other Aversive Techniques
Authors: Lavigne John V. , Davis A. Todd , Fauber Robert
Published: December 2021

The treatment of persistent psychogenic cough, a potentially debilitating condition among pediatric patients, can pose diagnostic and treatment dilemmas. Its treatment by the use of a procedure called reinforced suggestion technique was described previously. The use of an alternative procedure relying upon parental and self-monitoring of coughing and either social or material rewards for decreasing rates of coughing is presented.
Parental Presence During Procedures in an Emergency Room: Results From 50 Observations
Authors: Bauchner Howard , Waring Chris , Vinci Robert
Published: December 2021

This report describes the physician-parent-child encounter during an invasive medical procedure in a pediatric emergency department. Fifty children underwent venipuncture or intravenous cannulation performed by 22 physicians and 6 nurses. The median age of the children was 12 months. Parents remained with their children during 31 (62%) of the 50 procedures. Parents were more likely to stay if they had previously stayed when this child (P = .05) or another (P = .02) had undergone a procedure. Parental decision to stay was not related to parental age, gender, race, marital status, or level of education, nor to the residents' age, gender, or level of training. Only 43% of the parents who did stay were given that option by the residents, and of those who did not stay 37% reported that physicians asked them to leave. Nonverbal cues by the residents, such as pulling the curtain closed or turning their back toward parents, were noted in 58% of the encounters in which parents did not stay. The residents and nurses indicated that parents should stay with their child for the following procedures: laceration repair, 66%; venipuncture, 58%; intravenous cannulation, 48%; arterial blood sampling, 32%; suprapubic aspiration, 20%; and lumbar puncture, 14%. In the emergency room studied, it appears that for venipuncture and intravenous cannulation, the majority of parents stay with their children. Parental decision to stay or leave is frequently made without discussion with the physician.
Ten Years of Extracorporeal Membrane Oxygenation: Neurodevelopmental Outcome
Authors: Hofkosh Dena , Feldman Heidi M. , Thompson Ann E. , Nozza Robert J. , Kemp Susan S. , Bowen A'Delbert
Published: December 2021

Of the 87 survivors of extracorporeal membrane oxygenation over a 10-year period, 67 participated in a follow-up study which included neurologic examination (n = 67), cognitive testing (n = 67), and audiologic assessment (n = 33). Matched control subjects for those older than 5 years were also evaluated. Outcome was defined as normal for cognitive scores ≥85 and normal neurologic examination results, suspect for cognitive scores 70 through 84 or nonfocal neurologic findings such as hypertonia/hypotonia, and abnormal for cognitive scores <70 or abnormal neurologic examination results. Of the 10 school-aged children studied, 9 were normal and there were no differences in mean cognitive scores between subjects and controls (IQ subjects = 109 ± 12 [SD], IQ controls = 107 ± 13). For preschoolers aged 2.7 through 4.11 years, the mean cognitive score was 91 ± 11 and 7 (70%) were normal. For infants 6 through 30 months, the mean cognitive score was 101 ± 22 and 27 (57%) were normal. A total of 7 children (21% of those studied) had abnormal audiologic assessments. Three children demonstrated mild high-frequency and 4 moderately severe high-frequency sensorineural hearing loss which was bilateral in 3 and of undetermined laterality in 1. Abnormal neurodevelopmental outcome was significantly associated with cerebral infarction and chronic lung disease. Outcome was not related to demographic or perinatal variables, illness severity prior to extracorporeal membrane oxygenation, or underlying diagnosis. Neurodevelopmental outcome among survivors of extracorporeal membrane oxygenation in this series is consistent with previous reports of morbidity among neonates with severe respiratory failure treated conventionally.
Protracted Mononucleosis-like Illness Associated with Acquired Cytomegalovirus Infection in a Previously Healthy Child: Transient Cellular Immune Defects and Chronic Hepatopathy
Authors: Marshall Gary S. , Starr Stuart E. , Witzleben Camillus L. , Gönczöl Eva , Plotkin Stanley A.
Published: December 2021

Ordinarily, severe disease due to acquired cytomegalovirus (CMV) infection does not occur in immunocompetent children. We describe a previously healthy boy who acquired primary CMV infection at approximately 2 years of age and experienced a 2-year-long debilitating multisystem illness from which he ultimately recovered. Clinical features of this illness included fatigue, poor weight gain, pallor, unexplained fever, musculoskeletal complaints, drenching night sweats, lymphadenopathy, and massive hepatosplenomegaly. Laboratory abnormalities included elevated erythrocyte sedimentation rate, lymphocytosis, and elevated immune complex levels. Cellular immune function was impaired during the illness but was demonstrably normal during convalescence, and there was no other evidence for a known immunodeficiency state. Immunoblot analysis showed enhanced antibody response to a 66-kd infected cell protein after symptomatic recovery. Despite consistently normal indices of hepatic function, liver enlargement persisted after other symptoms had resolved. Liver biopsy demonstrated a mononuclear cell portal tract infiltrate with fibrosis, but CMV could not be demonstrated directly in this tissue. Primary CMV infection has not been reported previously to cause the persistent symptoms seen in this child.
Reflections on the HIFI Trial
Authors: BRYAN A. CHARLES , FROESE ALISON B.
Published: December 2021

Mechanical ventilators have only two functions: to provide a flux to eliminate carbon dioxide from those who will not or cannot breathe and to establish an adequate gas-exchanging volume to reduce shunting. The concept of volume recruitment to reduce shunting goes back at least to Mead and Collier in 1959,1 who showed that without periodic inflations there was a progressive fall in compliance during prolonged mechanical ventilation. Much of the subsequent history of mechanical ventilation in acute lung disease has really been the search for better methods of volume recruitment. The lung has to be inflated past the pressure at which atelectatic lung begins to open and be maintained above its closing pressure (that pressure below which alveoli and airways start to close again).
The Social Filter Effect of Informed Consent in Clinical Research
Authors: THONG Y. H. , HARTH S. C.
Published: December 2021

Few would disagree with the moral principle of respect for individual autonomy in the conduct of clinical research.1-3 After all, self-determination and informed choice are the cultural norms of free societies. Rather, it is the legal and regulatory provisions of the informed consent doctrine that have caused the most difficulties. Some 25 years after the promulgation of this doctrine,4,5 many problems remain with its practical implementation.

The doctrine of informed consent has four essential components. 6-8First, there must be full disclosure of risks and benefits and the therapeutic alternatives. Second, the information must be provided in writing in an easily comprehensible form, but given the intermix of medical terminology and legal jargon, this is easier said than done.9
Managing Hemangiomas
Authors: HURVITZ CAROLE , ALKALAY ARIE
Published: December 2021

To the Editor.—

We read with interest the article, "Management of Alarming Hemangiomas in Infancy: A Review of 25 Cases" by Enjolras et al, in the April, 1990 issue of Pediatrics. We note that all three patients with liver hemangiomas died. We would like to draw your attention to two articles that we have published with regard to treatment of life-threatening hemangiomas with cyclophosphamide.1,2

In our series of four patients, the very large intrahepatic tumor resistant to prednisone in one infant who also had congestive heart failure completely resolved with two courses of cyclophosphamide.
Pierre Robin Sequence Management
Authors: GIVAN DEBORAH C. , BULL MARILYN J. , SADOVE A. MICHAEL , BIXLER DAVID , HEARN DIANE
Published: December 2021

In Reply.—

We thank Dr Brooks for emphasizing our central point that oximetry alone is inadequate for evaluating these children. The data we used for analysis of these patients and for assessing the nature of their apnea were data collected from tracings taken during sleep time to minimize the artifact that Dr Brooks points out. To improve the accuracy of our interpretation, pulse data from the oximeter and heart rate from the cardiotachometer are compared constantly.
Turner Syndrome and Partial Anomalous Pulmonary Venous Drainage
Authors: NOONAN JACQUELINE A.
Published: December 2021

To the Editor.—

In a recent report, Moore et al1 reported that 3 of 12 patients with karyotype XO had partial anomalous pulmonary venous return with an intact atrial septum. In 1984, I presented a poster at the Southern Genetics Meeting which reported three patients with Turner syndrome who had partial anomalous pulmonary venous return demonstrated by cardiac catheterization. An additional infant with aortic atresia was noted at postmortem to have premature closure of the foramen ovale and partial anomalous pulmonary venous return.
Turner Syndrome and Partial Anomalous Pulmonary Venous Drainage
Authors: KIRBY WILLIAM C.
Published: December 2021

In Reply.—

We certainly agree with Dr Noonan's comments regarding the association of partial anomalous venous drainage (PAPVD) and Turner's syndrome. We also have anecdotal information about several additional patients with Turner syndrome and PAPVD. Knowledge of such patients does not define further the overall incidence of these venous anomalies in the population of patients with 45,XO karyotype.

Our study demonstrates that patients with only a single anomalous pulmonary vein may have quite subtle clinical findings.
Temperature and Total White Blood Cell Count as Indicators of Bacteremia
Authors: Jaffe David M. , Fleisher Gary R.
Published: December 2021

This study was designed to quantify more precisely the accuracy of magnitude of rectal temperature and total white blood cell (WBC) count as indicators of bacteremia in children with an obvious focal bacterial infection. A total of 955 children, aged 3 to 36 months, who had rectal temperature ≥39.0°C and were seeking care at either of two urban pediatric emergency departments had blood drawn for culture; 885 had blood drawn for WBC count. Twenty-seven had bacteremia. Various combinations of temperature and WBC count were selected to construct receiver-operating-characteristic curves by plotting sensitivity vs false-positive rate (1 - specificity). The receiver-operating-characteristic curve of WBC count provided significantly better diagnostic information than the curve for temperature increments above 39.0°C. Each increment of 0.5°C led to large decrements in sensitivity and false-positive rates. At a WBC count cutoff of 10 000/mm3, the sensitivity was 92% while the false-positive rate was 57%. Using this cutoff point, the clinician could have avoided performing 368 of 955 blood cultures and missed only 2 of 26 children with bacteremia. Receiver-operating-characteristic curves combining WBC count and temperature increments above 39.0°C provided no better diagnostic information than that of WBC count at a temperature cutoff of 39.0°C. It is concluded that increments in temperature above 39.0°C provided additional diagnostic specificity for bacteremia only at the expense of unacceptable decreases in sensitivity. Total WBC count provided better information. A WBC count cutoff of 10 000/mm3 increased specificity with minimal decrease in sensitivity. Receiver-operating-characteristic curve analysis allows selection of cutoff criteria by individual practitioners based on the prevalence of bacteremia in their communities and on the perceived risks of bacteremia.
Polymorphonuclear Leukocyte Function in the Preterm Neonate: Effect of Chronologic Age
Authors: Usmani Shaista S. , Schlessel Jerrold S. , Sia Concepcion G. , Kamran Shahid , Orner Shahnaz D.
Published: December 2021

In this study, effect of chronologic age on polymorphonuclear leukocyte (PMN) chemiluminescence and random and chemotactic motility was evaluated in 38 stable preterm neonates of less than 32 weeks' gestation during the first month of life. Chemiluminescence and random and chemotactic motility of PMNs from preterm neonates were first evaluated at mean postnatal age of 9.8 days and then weekly for an ensuing 21-day period. For comparison, one blood sample was obtained for PMN functions from 14 healthy term neonates younger than 72 hours of age and seven normal adults. On day 1 PMN chemiluminescence and random and chemotactic motility values in preterm neonates were significantly lower (P < .001) compared with those in term neonates and PMN function values of term neonates were significantly lower (P < .001) than those of adults. Although initial PMN chemiluminescence and random and chemotactic motility values in preterm neonates were depressed, subsequent values on days 7, 14, and 21 increased significantly (P < .002). On day 21 (mean postnatal age of 30.8 days) no differences existed in chemiluminescent activity and random motility between preterm and term neonates; chemotactic motility in preterm neonates, however, remained impaired. Mean cumulative age (gestational age at birth plus postnatal age) of preterm neonates on day 21 of study was 32.5 weeks, suggesting that chronologic age has more effect on maturational changes in PMN functions than gestational age.
Serum Vitamin D Metabolites and Bone Mineralization in Young Children With Chronic Low to Moderate Lead Exposure
Authors: Koo Winston W.K. , Krug-Wispe Susan K. , Steinchen Jean J. , Tsang Reginald C. , Succop Paul A. , Bornschein Robert L. , Berger Omer G.
Published: December 2021

One hundred five children (49 male, 99 black) with known lead exposure indices from birth and adequate nutrient intake of calcium, phosphorus, and vitamin D were studied at 1 of 3 ages (21, 27, or 33 months) to determine the effects of chronic low to moderate lead exposure on circulating concentrations of vitamin D metabolites and bone mineral content as determined by photon absorptiometry. Univariate multiple regression analyses showed no direct relationship of blood lead levels to vitamin D metabolites or bone mineral content. Structural equation analyses which took into account potential covariates of age, season, race, and sex showed estimated declines in serum concentrations of total calcium (from 9.72 to 9.61 mg/dL), phosphorus (from 5.4 to 4.67 mg/dL), and 25-hydroxyvitamin D (from 27.24 to 25.8 ng/mL) and estimated increases in concentrations of parathyroid hormones (from 73.03 to 83.14 µL Eq/mL), 1,25-dihydroxyvitamin D (from 62.39 to 62.69 pg/mL), and bone mineral content (from 222.66 to 234.91 mg/cm) over the observed range of average lifetime blood lead concentrations (4.76 to 23.61 µg/dL, geometric mean 9.74 µg/dL). However, the only statistically significant effect of average lifetime blood lead concentration was that for phosphorus, and the multivariate test of the combined effects of lead on these six outcomes was not statistically significant (P = .2). It is concluded that significant alterations in vitamin D metabolism, calcium and phosphorus homeostasis, and bone mineral content are not present in children whose nutritional status is adequate and who experience low to moderate lead exposure.
Acute Lobar Nephronia: A Review
Authors: RATHORE MOBEEN H. , LUISIRI ATCHAWEE , BARTON LESLIE L.
Published: December 2021

Acute lobar nephronia was described by Rosenfield et al1 in 1979. Subsequently, numerous reports2-5have appeared in the radiologic literature. Also called acute focal bacterial nephritis, this newly defined condition has only recently been described in the pediatric literature.6,7 Because of the focal nature of acute lobar nephronia, it may be confused with an intrarenal abscess. This is especially true when the usual imaging techniques used to investigate urinary tract infections are applied. Acute lobar nephronia is an acute, nonsuppurative renal infection that represents progression of acute pyelonephritis. Because of major differences in the management of acute lobar nephronia and intrarenal abscess, it is important to distinguish these two conditions.
Testing for Maternal Drug Abuse: How Much Is Enough?
Authors: MAYNARD EDWARD C.
Published: December 2021

To the Editor.—

In their recent statement on drug-exposed infants,1 the Committee on Substance Abuse discourages universal screening for perinatal drug abuse, citing concern that "the harm vs the benefits of "labeling" the infant and/or the mother are not known." Just how widely we should be testing for perinatal drug abuse remains unclear, however; recent data from our institution suggest that even with broad screening criteria we are missing most cases of perinatal drug abuse.
Career Satisfaction in Pediatrics
Authors: BOSLEY WARREN
Published: December 2021

To the Editor.—

It would be interesting to see what Dr Simon (Pediatrics. 1990;86:488)1 will write in about 15 years, but I doubt that I shall be here to read it.

You are familiar, I am sure, with surveys of the degree of satisfaction among physicians that have been published occasionally in the past 35 years—Medical Economics, for one, and the study by Jim Schunk2 most recently. Pediatrics does not come off too well. Because the number of "satisfied" pediatricians, especially those in practice, has remained at about 65%, one can predict that Dr Simon will have different thoughts.
Carnitine Deficiency
Authors: KAHLER STEPHEN G.
Published: December 2021

To the Editor.—

I read with interest the report by Treem and Stanley concerning carnitine deficiency in an infant with cystic fibrosis (Pediatrics. 1989;83:993-997). The hypothesis that renal loss of carnitine can be due to tubular defects induced by secondary hyperparathyroidism is plausible.

The finding of no carnitine in the urine in the recovery phase is unprecedented in my experience. The control values reported do not include 0. I would expect to find urine carnitine concentrations in the normal range, when the plasma level was normal.
Carnitine Deficiency
Authors: TREEM WILLIAM R.
Published: December 2021

In Reply.—

The absence of carnitine in the urine during the recovery phase of secondary carnitine deficiency is unusual as pointed out by Dr Kahler. During this time the infant was being treated with a high carnitine diet (formula plus beef broth) and was regaining weight lost during his acute illness. Because values of urine and plasma carnitine were random spot samples and not obtained with the infant fasting, the discrepancy between a normal plasma total carnitine and zero urinary excretion may have been somewhat artifactual.
Turner Syndrome
Authors: LEVIN SOLOMON E. , HARRISBERG JEFF , KELLY ALLAN
Published: December 2021

To the Editor.—

We read with great interest the study of Moore et al1 in which they suggest that there may be a significant association of 45,X Turner syndrome and partial anomalous pulmonary venous drainage. We recently encountered a further case with this association lending support to their contention.

Our patient was noted at birth to have the phenotypic features of Turner syndrome together with lymphedema. Chromosomal analysis confirmed the Karyotype 45 X0. At 4 months of age a diagnosis of coarctation of the aorta was made when her femoral pulses became impalpable.
Urinary Tract Infections
Authors: ROSCELLI JOHN D.
Published: December 2021

To the Editor.—

The recent article by Crain et al1 on urinary tract infections (UTIs) in febrile infants younger than 8 weeks of age covers many important features of urinary tract infections in young infants. It confirms data suggesting that uncircumcised males have an increased incidence of positive urine cultures. It confirms that infants may have positive urine cultures in the absence of a positive urinalysis. The study also demonstrates, again, that some infants with positive urine cultures can have positive blood cultures.