bluuebunny/crossref_metadata_2025 huggingface dataset:
Increased Prevalence of Ventricular Septal Defect: Epidemic or Improved Diagnosis
Authors: Martin Gerard R. , Perry Lowell W. , Ferencz Charlotte
Published: December 2021

The Baltimore-Washington Infant Study is an ongoing case-control study of congenital cardiovascular malformations in infants in whom the clinical diagnoses have been confirmed by echocardiography, catheterization, surgery, or autopsy. An increase in the prevalence of ventricular septal defects was detected in 1,494 infants with congenital cardiovascular malformations between 1981 and 1984. The prevalence of congenital cardiovascular malformations increased from 3.6 to 4.5 per 1,000 live births (P<.025) and the prevalence of ventricular septal defect increased from 1.0 to 1.6 per 1,000 live births (P< .001). The increase in ventricular septal defects accounted for the total increase in congenital cardiovascular malformations. The prevalence of isolated ventricular septal defect increased from 0.67 to 1.17 per 1,000 live births (P<.001). The prevalence of ventricular septal defect with associated coarctation of the aorta, patent ductus arteriosus, atrial septal defect, and pulmonic stenosis did not change. The prevalence of ventricular septal defect diagnosed by catheterization, surgery, and autopsy did not change; however, defects diagnosed by echocardiography increased from 0.30 to 0.70 per 1,000 live births (P<.001). It is concluded that the reported increase in prevalence of ventricular septal defect is due to improved detection of small, isolated ventricular septal defects and that there is no evidence of an "epidemic."
Normative Arm and Calf Blood Pressure Values in the Newborn
Authors: Park Myung K. , Lee Da-Hae
Published: December 2021

Indirect BP measurement was obtained in the right upper arm in 219 healthy newborn infants with the Dinamap monitor and was compared with values obtained from the calf to establish normative BP values and to help establish a diagnosis of hypertension and coarctation of the aorta in the newborn. There were 174 Mexican-Americans (79.5%), 33 whites (15.0%), and 12 blacks (5.5%). The width of the BP cuff was selected to be 0.4 to 0.5 times the circumference of the extremities. Three supine position readings of BPs and heart rate were obtained from each site and were averaged for statistical analyses. Mean arm BP values (±SD) of the neonate less than 36 hours of age were 62.6±6.9/38.9± 5.7 mm Hg (48.0±6.2 mm Hg). Neonates older than 36 hours had slightly but significantly (P<.05) greater values (4 to 6 mm Hg) than did infants younger than 36 hours of age. Active neonates had values 6 to 10 mm Hg greater than quiet neonates (P<.05). BP values in the calf obtained with the same-sized cuff were almost identical with those obtained from the arm. Differences in consecutively obtained arm and calf BPs (arm values minus calf values) were 1.1±7.7 mm Hg systolic, -0.01 ± 6.2 mm Hg diastolic, and 0.9 ±6.9 mm Hg mean pressures. Mean heart rate (±SD) of neonates less than 36 hours of age was 129.4± 13.2 beats per minute and that of neonates older than 36 hours of age was 139.4± 14.1 beats per minute. These results show the following: (1) arm BPs and calf BPs using the same-sized cuff are almost identical with mean values of approximately 65/ 41 mm Hg (50 mm Hg) in neonates one to three days of age, (2) arm BP of 75/49 mm Hg (59 mm Hg) or greater is in the hypertensive range, and (3) calf BPs that are less than arm BPs by mean + 1 SD (6 to 9 mm Hg) necessitate a thorough investigation for coarctation of the aorta.
Health Care of Physicians' Children
Authors: Wasserman Richard C. , Hassuk Bruce M. , Young Paul C. , Land Marshall L.
Published: December 2021

In anecdotal reports, problems have been cited in the health care of physicians' children, but no systematic study of this issue has been attempted. Pediatricians in a community of high physician density were interviewed to determine whether and how the health care of physicians' children differs from that of children of equivalent socioeconomic status. Of the community's 33 pediatricians, 94% responded to items in a 45-minute structured interview, for which test-retest reliability was demonstrated. Systematic differences in the care of physicians' children included delayed help seeking and increased self-referral to specialists by parents, and poor documentation of psychosocial history, less detailed instruction giving, and a reluctance to discuss problem behavior by pediatricians. Reasons cited by pediatricians for these problems included inappropriate assumptions concerning the medical knowledge of the physician's family, confusion between the roles of healer and help seeker, and embarrassment about discussing personal issues with colleagues. Pediatricians and physician parents need to become aware of and communicate about the potential for problems in the health care of physicians' children.
Fear of Obesity Among Adolescent Girls
Authors: Moses Nancy , Banilivy Mansour-Max , Lifshitz Fima
Published: December 2021

The perceptions concerning weight, dieting practices, and nutrition of 326 adolescent girls attending an upper middle-class parochial high school were studied in relation to their body weight. Underweight or overweight students were those with greater than 10% body weight differential for height. The high school students reported an exaggerated concern with obesity regardless of their body weight or nutrition knowledge. Underweight, normal weight, and overweight girls were dieting to lose weight and reported frequent self-weighing practices. As many as 51% (n = 60) of the underweight adolescents described themselves as extremely fearful of being overweight and 36% (n = 43) were preoccupied with body fat. A distorted perception of ideal body weight was documented, particularly among the underweight students; the greater the underestimation of perceived ideal body weight, the greater the actual deficit in ideal body weight for height of the students (r = .73; P < .001). Normal weight and overweight girls had better concordance between their actual and perceived ideal body weight for height. The frequency of bingeing and vomiting behaviors was similar among the three weight categories. The data suggest that fear of obesity and inappropriate eating behaviors are pervasive among adolescent girls regardless of body weight or nutrition knowledge.
Duration of Pediatric and Internal Medicine Practice in Oregon
Authors: SCHUNK GEORGE J. , OSTERUD HAROLD T.
Published: December 2021

This study was prompted by the perception that there were few pediatricians older than 60 years of age in the state of Oregon who were practicing primary care pediatrics. The hypothesis that there was a high practice attrition rate of primary care pediatricians was suggested by this observation. This could be the result either of early retirement or career change.

Data concerning attrition rates in medical specialties are sparse. Manpower studies of the medical profession have described the entry of students into medicine and the entry of young physicians into medical practice but have not offered information regarding the exit from practice or the frequency of career changes.
Malnutrition and Growth Retardation in Newborn Infants
Authors: MILLER HERBERT C. , JEKEL JAMES F.
Published: December 2021

Pediatricians in the United States recognize growth and development as a distinguishing feature of their specialty. They have demonstrated their concern for growth retardation and malnutrition in all age groups, but they have been misguided in diagnosing these two conditions in newborn infants. It is said that the Denver birth weight chart, sanctioned by the American Academy of Pediatrics and the American College of Obstetrics and Gynecology, is the standard most widely used in this country for diagnosing intrauterine growth retardation in newborn infants. The contributions to our understanding of intrauterine growth retardation by Lubchenco and her colleagues are well recognized, but there is need for expansion of present knowledge.
Status Epilepticus: It's Not What We've Thought or Taught
Authors: FREEMAN JOHN M.
Published: December 2021

Status epilepticus has been defined as `seizures so severe as to constitute a fixed and lasting condition." Prevention of status epilepticus is one of the reasons given for administering anticonvulsant drugs to children. Because status epilepticus is widely believed to be capable of producing neurologic deficit, seizures are believed to require emergency treatment to prevent status epilepticus that might cause brain damage.

However, when was the last time you saw a child with status epilepticus who died or had residual encephalopathy? Certainly, there was the child who nearly drowned; the drowning caused both damage to the brain and status epilepticus. I would attribute the residual brain damage to the drowning, not to the status epilepticus.
ORPHAN TRAINS
Authors: Student
Published: December 2021

What were these children like, these waifs who hustled New York City streets or lived in squalid orphanages with names like Home for the Friendless? What was it like to have been one of the more than 100,000 urban ragamuffins scooped up, put on trains and shipped to strange new lives on Midwestern farms [in] an exceedingly ambitious child-aid operation, the Orphan Trains. Starting in 1854 and continuing for the next 75 years, the Children's Aid Society, later joined by other agencies, took whole trainloads of children from vermin-infested city slums to new tomorrows in the heartland. The first participants and the majority of those to come later were from New York.

Once arrived, they were lined up to be picked over by townspeople. Younger ones were adopted by families; older ones taken in and educated in return for work, and the unchosen shipped to the next town. One historian observed that not since the Children's Crusade in the 13th century had there been such a movement of children over such vast distances.
APPEALS COURT AFFIRMS VERDICT THAT BENDECTIN DOES NOT CAUSE BIRTH DEFECTS
Authors: L. J. F.
Published: December 2021

Cincinnati, OH.—In a major ruling today the U.S. Court of Appeals for the Sixth Circuit, Cincinnati, upheld a jury verdict that Bendectin does not cause birth defects in a case involving approximately 1,150 plaintiffs. ...

There have been 22 jury verdicts of judgments in favor of Merrell Dow Pharmaceuticals Inc. in cases alleging the drug was responsible for birth defects including this trial which consolidated approximately 1,150 plaintiffs. Four trial verdicts currently stand in favor of individual plaintiffs which Merrell Dow believes are reflections of sympathy for the children. The company is taking appropriate steps to reverse these verdicts and obtain rulings in its favor.
ALL CONVICTED IN E-FEROL TRIAL
Authors: L. J. F.
Published: December 2021

Two former drug company executives and a drug company were convicted ... of conspiring to market an unapproved, misbranded drug linked to the deaths of 38 infants.

Jurors deliberated 12½ hours over three days before reaching a verdict in the case, which began Aug. 8 in U.S. District Court.

Found guilty of conspiracy were Larry K. Hiland, former president of O'Neal, Jones & Feldman Pharmaceuticals in Maryland Heights; Ronald M. Carter, former president of Carter-Glogau Laboratories Inc., of Glendale, AZ.; and the Carter-Glogau Company.

O'Neal, Jones is now called O'Neal Inc.; Carter-Glogau is now called Retrac Inc.
COMPULSORY SCIENCE AND MATH?
Authors: Student
Published: December 2021

"Why should we allow 13-year-old children to decide whether they will or will not study science and mathematics?" . . . "We compel children to learn to read, after all." As things stand, he added, only 15 percent of American high school students study physics, only 30 percent study chemistry and only 55 percent study algebra.
Half-Dose Immunization for Diphtheria, Tetanus, Pertussis: Response of Preterm Infants
Authors: Bembaum July , Daft Andrea , Samuelson Joel , Polin Richard A.
Published: December 2021

The American Academy of Pediatrics currently recommends administering full-dose diphtheria, tetanus, pertussis, (DTP) vaccine to preterm infants, beginning at 2 months' chronologic age. Many physicians, however, continue to administer DTP vaccine at a reduced dosage in an attempt to lessen side effects. This study was designed to quantitate the immune response of 20 preterm infants immunized with half-dose DTP vaccine and to determine the nature and extent of side effects. Control subjects were 25 preterm infants immunized with full-dose vaccine. Although 96% of infants who received a full dose were able to mount a serologic response to pertussis after a second dose of DTP, 45% of infants who received a half dose were unable to mount a similar immune response to pertussis even after a third dose of DTP and required a full-dose (fourth dose of DTP) vaccine to better ensure protection. Serologic responses to diphtheria and tetanus were similar in the two groups. The incidence of side effects in preterm infants receiving both full-dose and half-dose DTP was less than that seen in a full-term population. Thus, the physician caring for the preterm infant should adhere to the American Academy of Pediatrics' recommendation for the immunization of preterm infants and offer full-dose DTP vaccine at the routine time intervals of 2, 4, 6, and 15 or 18 months' chronologic age to ensure adequate protection.
Heavy Cocaine Use by Adolescents
Authors: Smith Deborah E. , Schwartz Richard H. , Martin David M.
Published: December 2021

Adolescents are susceptible to becoming cocaine users. Twenty-eight teenagers in a drug rehabilitation program were identified as heavy cocaine users and questioned about their experiences. They reported family conflict leading to running away (86%), school drop-out (24%) and delinquent behaviors such as stealing (96%) and vandalism (57%). Cocaine use started at 14 years for 21%, with progression from onset to at least weekly use within eight weeks (54%). Side effects included sleep disturbance (18%) and tolerance to cocaine (25%). Withdrawal was characterized by cocaine craving up to one month later (93%). The majority (96%) were polydrug abusers. Possible causes of teen substance abuse are discussed, and the importance of prevention is emphasized.
MOTHER-TO-CHILD TRANSMISSION OF HIV INFECTION
Authors: L. J. F.
Published: December 2021

271 children born to HIV-infected mothers in 8 European centres are being followed up from birth in a multicentre, collaborative study. By June, 1988, 45% had been followed for over 1 year: 10 had developed AIDS or AIDS-related complex, all by the age of 9 months, of whom 5 had died. 22 other children had symptoms or signs suggestive of HIV infection; of these, 12 had immunological abnormalities, 9 of whom were infected. 5 children had problems not related to HIV, including 3 neonatal deaths. The other 234 children are immunologically normal and clinically well. The median age of antibody loss was 10.3 months, although I did not lose antibody until over 18 months. None lost antibody and then became and remained seropositive. Of 100 children followed for more than 15 months, 19 had persistent antibody, and 5 were antibody-negative but presumed to be infected because of virus isolation or antigen detection; these children were clinically and immunologically normal. The estimated vertical transmission rate was 24%.
Guidelines for the Determination of Brain Death in Children
Authors: NARKEWICZ RICHARD M.
Published: December 2021

In 1986, a task force was impaneled consisting of representatives from a number of legal and medical disciplines, including two representatives from the American Academy of Pediatrics, to examine the issue of brain death in children. This consortium developed a consensus report which was published in Pediatrics (1987;80:298-300). This report, however, does not represent Academy policy and should not be construed as such. This material has been referenced subsequently, most recently in the August (1988) issue of Pediatrics, with the inference that it represents the Academy's position. In summary, the guidelines issued by the Task Force have provided the medical and legal communities with useful information on a sensitive issue, but it should be reiterated that they do not represent an official policy of the American Academy of Pediatrics.
Extracorporeal Membrane Oxygenation and Right-Sided Brain Lesions
Authors: ORR RICHARD A. , DALTON HEIDI J.
Published: December 2021

We want to commend Schumacher et al on their attempt to study the risks involved with carotid artery ligation. However, we have a major concern about the statistical methods used in this article. First, the authors compared two groups of infants (extracorporeal membrane oxygenation v nonextracorporeal membrane oxygenation) with regard to lateralizing abnormalities on the EEG using the one-tailed Fisher exact test and demonstrated statistically significant differences between the two in the incidence of attenuation, slowing, and diffuse abnormality with a unilateral emphasis (table 4). It is worth noting that the P value for the diffuse abnormality when using the one-tailed Fisher exact test actually calculates to be .06, demonstrating no significant difference.
Chest Pain in an Adolescent: Think of Cocaine!
Authors: SCHWARTZ RICHARD H.
Published: December 2021

Results of a prospective study of causes of chest pain in children and adolescents was published in the September issue of Pediatrics. Five pediatricians, from two Philadelphia teaching hospitals, prospectively evaluated 407 pediatric patients whom they saw in their emergency rooms because of chest pain. I was disappointed because the authors did not mention the cause being seen increasingly frequently in adolescents, that related to smoking cocaine "freebase." I was particularly surprised at the omission because Dr Selbst, the first author of the paper, recently coauthored a case report of a 16-year-old boy with chest pain secondary to cocaine use.
In Reply: Chest Pain in an Adolescent: Think of Cocaine!
Authors: SELBST STEVEN M.
Published: December 2021

Our failure to mention cocaine abuse in the discussion of chest pain was an oversight. Previously, I reported the case of an adolescent who visited our emergency department with acute, severe chest pain caused by cocaine abuse. This teenager was seen long after completion of our study of 407 children with chest pain, even after our manuscript was first drafted. We were surprised by his findings and by the fact that no others like him had been seen during our 1-year study period.
In Reply: The Anencephalic Controversy
Authors: LANDWIRTH JULIUS
Published: December 2021

In reminding us of the need for precision in the application of clinical classifications, Dr Coulter and Ms Quinn offer, albeit inadvertently, a glimpse through the proverbial looking glass at the much larger approaching controversy to which the "anencephalics as donors" issue is prologue. From the narrow perspective of organ procurement policy, it is indeed tempting to ask whether the distinction between anencephaly and hydranencephaly is more than a fine neuropathologic nuance.
Klinefelter Syndrome and Fire-Setting Behavior
Authors: EBERLE ANDREA J.
Published: December 2021

The description by Miller and Sulkes of fire-setting behavior in four individuals with Klinefelter syndrome attracted my attention because I recently found an additional case.

An 18-year-old boy was seen by his family physician because of the sudden onset of violent temper outbursts and suicidal thoughts. He set fire to a neighbor's house and stole a car. There were no previous behavior problems, but he was developmentally delayed, required speech therapy, and learned slowly.
In Reply: Klinefelter Syndrome and Fire-Setting Behavior
Authors: MILLER MARVIN E. , SULKES STEPHEN
Published: December 2021

We appreciate the comments of Dr Eberle that provide further anecdotal experience for an association between Klinefelter syndrome and fire-setting behavior. In addition, her observation and Sorenson's observations which she notes provide additional evidence that testosterone may be helpful in individuals with Klinefelter syndrome who have fire-setting behavior or other antisocial behavior including stealing and violence toward others.

We have also seen an additional individual with variant Klinefelter syndrome, similar to Dr Eberle's patient.
Is Hypaque Dangerous?
Authors: SCHLECHTER ROBERT , BESSERMAN ABRAHAM
Published: December 2021

Concerning the use of diatrizoate sodium (Hypaque) in abdominal CT scans described by Kane et al (Pediatrics 1988;82:11-15), we agree that there is certainly much to be gained from CT scanning in blunt abdominal trauma. We question the routine use of diatrizoate sodium in an injured child predisposed to gastric distention and vomiting. This is particularly dangerous when he or she is prone and restrained and close observation at the bedside is not possible. Solid organ injuries are well demonstrated without contrast, and injury to a viscus can be evaluated clinically and by routine roentgenographic procedures.
In Reply: Is Hypaque Dangerous?
Authors: CRONAN JOHN J. , DORFMER GARY S.
Published: December 2021

Drs Schlechter and Besserman have raised an interesting point concerning the use of diatrizoate sodium in abdominal trauma CT scans. We believe strongly that it is important to obtain excellent bowel opacification in order that injuries to the bowel can be delineated. Without bowel opacification, CT has little possibility of actually being able to discern mesenteric injuries, bowel hematomas, and areas of bowel laceration.

Diatrizoate sodium is an ideal medium in this need because it provides excellent bowel opacification even in the setting of slowed bowel motility achieving a rapid transit time.
In Reply: Ethical Basis for Repealing Religious Exemptions From Child Abuse Statutes
Authors: WElL WILLIAM B.
Published: December 2021

The letter from Dr Jecker presents an important and cogent basis for repeal of the religious exemption laws that are part of child abuse and neglect legislation in many states, including my own. Whereas her discussion focuses on the issues from the viewpoint of the rights and duties of parents, the American Academy of Pediatrics and its Committee on Bioethics tended to view the problem more in terms of the rights or interests of the child. Dr Jecker is, however, correct in pointing out that the AAP statement did not outline the formal ethical arguments that formed the basis of their statement.
In Reply: Intrapartum Asphyxia and Cerebral Palsy
Authors: FREEMAN JOHN M. , NELSON KARIN B.
Published: December 2021

Dr Hermansen makes several points that do not contradict our paper and then he makes a leap in logic that does. We agree with him that there is some correlation, although a weak one, between pH and one-minute Apgar scores and that there is not much evidence that pH predicts long-term neurologic dysfunction. In fact, Dijxhoorn and co-workers found that pH does not explain most neurologic dysfunction even within the neonatal period. Ruth and Raivio, in the first birth cohort study of the predictive value of pH and other measures of neonatal acid-base balance, reported that none of these measures was better than, or even as good as, the Apgar score in predicting neurologic status at 1 year.
MOTHERHOOD DEVALUED
Authors: Student
Published: December 2021

The value of "motherhood" has become a platitude, but it has so little moral force that, all over the country, we are forcing mothers to put their infants in day care so they can take jobs at the minimum wage. What does it say about our priorities that we feel it's more important for these women to flip hamburgers or clean hotel rooms than to care for their babies?
A LASTING IMPRESSION
Authors: Student
Published: December 2021

For relatives, the last few days and weeks they live with their loved ones may be the time, out of decades of a relationship, they remember best. The good times are forgotten and overtaken by the events of the last few hours. As members of the caring team it is our responsibility to ensure that these memories are as positive as possible. To do this it is necessary to look and listen and be sensitive to the needs of others.
NO TEAM PLAYER
Authors: Student
Published: December 2021

In 1927, the story goes, a Detroit secretary burst excitedly into her boss's office and cried, "Mr. Smith! A man has just flown across the Atlantic all by himself!" Smith engrossed in reports did not respond.

She tried again: "Mr. Smith, you don't understand—all by himself a man has flown the Atlantic!" This time he looked up. "All by himself a man can do anything," he said, "When a committee flies the Atlantic, let me know."
POLITICIANS (AND, LET'S FACE IT, DOCTORS) LIKE A QUICK FIX
Authors: Student
Published: December 2021

There is. . .a persisting paradox throughout the recent history of infant mortality rate analysis: the dominant effect exerted by social and economic factors continue to intrude, yet so often health service solutions to the problems are sought. Further significant improvements in infant mortality will be largely determined by social policy; the pity is that any such changes in policy will exert their effect slowly, making evaluation difficult. In sociological terms it is delayed gratification—a concept of little appeal to politicians.
Adverse Reactions to Diphtheria, Tetanus, Pertussis-Polio Vaccination at 18 Months of Age: Effect of Injection Site and Needle Length
Authors: Ipp Moshe M. , Gold Ronald , Goldbach Morton , Maresky David C. , Saunders Norman , Greenberg Saul , Davy Till
Published: December 2021

Adverse reactions after diphtheria, pertussis, tetanus, polio vaccination at 18 months of age were investigated in three groups: 74 children injected in the deltoid muscle with a 16-mm (5/8-in) needle, 64 in the anterolateral thigh with a 16-mm needle, and 67 in the anterolateral thigh with a 25-mm (1-in) needle. No significant differences in systemic reactions were observed. Severe pain occurred in 30.5% of the groups injected in the thigh compared with only 8.1% of the group injected in the arm (P < .001). Children vaccinated in the thigh had decreased movement of the extremity significantly more often than those injected in the arm (49.9% v 25.6%, P < .005), and two thirds of the former limped for 24 to 48 hours. Redness and swelling were observed more often after injection in the arm than in the thigh (58.1% v 26.7%, P < .0005). The only effect of changing needle length in the groups injected in the thigh was the occurrence of more redness and swelling in children vaccinated with the 16-mm needle compared with the 25-mm needle. Overall, parents rated more reactions as moderate to severe among children injected in the thigh than among children injected in the arm (64.2% v 37.9%, P < .001). The deltoid muscle appears to be the preferred site for administration of diphtheria, pertussis, tetanus, polio vaccine at 18 months of age.
Vasopressin Levels and Pediatric Head Trauma
Authors: Padilla Guadalupe , Leake John A. , Castro Robert , Ervin M. Gore , Ross Michael G. , Leake Rosemary D.
Published: December 2021

The syndrome of inappropriate secretion of antidiuretic hormone is associated with head trauma; however, there are no reports concerning vasopressin levels in pediatric patients with head trauma. Urine vasopressin in eight children (mean ± SEM, age 7.5 ± 1.6 years, range 1 to 15 years) was measured by radio-immunoassay during their hospitalization for head trauma. Urine vasopressin values for ten healthy children (mean age 5.4 ± 1.3 years) and for eight children hospitalized for systemic antibiotic treatment of infections (age 5.9 ± 1.8 years) also were obtained. Urine vasopressin, urine and serum sodium concentration and osmolality, urea nitrogen, creatinine, and fluid intake were measured within 24 hours of admission and daily for the following two days. For the first three days following head trauma, mean urine vasopressin levels in pediatric patients with head trauma were increased (P < .05) compared with those of healthy children. Despite fluid restriction to 85% of maintenance level, 25% of patients with head trauma exhibited the clinical syndrome of inappropriate secretion of antidiuretic hormone (hyponatremia, increased urinary sodium, diminished serum osmolality, and urine osmolality greater than serum osmolality). Urine osmolality greater than 800 mosm/kg was associated with markedly increased urine vasopressin levels (200 to 1,650 pg/mL); children with this finding may be at particular risk for the syndrome of inappropriate secretion of antidiuretic hormone without restrictive water intake.
Neonatal Pulse Oximetry: Accuracy and Reliability
Authors: Hay William W. , Brockway Julia M. , Eyzaguirre Mario
Published: December 2021

Pulse oximetry has gained widespread use in neonatal oxygen monitoring. However, because specific morbidity in neonates has been related to abnormal levels of oxygen partial pressure (Pao2), it is essential to demonstrate that pulse oxygen saturation values (Spo2) are highly accurate and reflect with precision the simultaneous Pao2. In this report, data is presented that describe the accuracy of the Ohmeda Biox 3700 pulse oximeter. Spo2 was highly correlated with arterial blood oxygen saturation (r = .99) measured on arterial (catheter) blood using a two-wavelength Radiometer OSM2 Hemoximeter. When compared with Pao2, Spo2 values of 92% ± 3% (mean ± range) excluded all of the measured Pao2 values less than 45 mm Hg and greater than 100 mm Hg. Spo2-tcPo2 (transcutaneous Po2) and Spo2-Pao2 (catheter or percutaneous arterial Po2) correlations showed that bronchopulmonary dysplasia, percutaneous arterial sampling, and nipple feeding skewed the tcPo2 but not the Pao2 correlations with Spo2, indicating that Spo2 is not sensitive to peripheral factors that affect tcPo2. Spo2-Pao2 correlation was not affected by gestational age. A high degree of accuracy of Spo2 values and Spo2 prediction of normal appearing Pao2 values are defined by these results.
THEOPHYLLINE AND SCHOOL PERFORMANCE
Authors: L. J. F.
Published: December 2021

After review of the clinical literature, FDA has concluded, in agreement with its Pulmonary-Allergy Drugs Advisory Committee, that there is insufficient data to state that theophylline produces an adverse effect on the school performance of children. However, the agency encourages further well-controlled studies on this subject.

Agency Review

Because of questions about the methodology used in these studies and the statistical interpretation of the results, in October 1987 FDA's Pulmonary-Allergy Drugs Advisory Committee reviewed all the studies and made recommendations to the agency.

In accordance with the recommendations of this committee and after further agency review, FDA concludes that the present data do not support the conclusion of an adverse effect of theophylline on the performance of school children.

However, consistent with the recommendations of the Advisory Committee, further well-controlled studies are needed. Such studies should include welldefined psychological parameters and be carried out by individuals familiar with the best psychological tests available. The goal of these studies should be to clarify whether any association exists between theophylline and learning behavior or school performance.
Hemoglobin FM-Fort Ripley: Another Lesson From the Neonate
Authors: GLADER BERTIL E.
Published: December 2021

In this issue of Pediatrics, Priest and co-workers have described a new fetal hemoglobin abnormality (Hb FM-Fort Ripley) which causes neonatal methemoglobinemia. Methemoglobin is the form of hemoglobin in which iron is oxidized (Fe3+) instead of reduced (Fe2+), and in this state hemoglobin does not transport oxygen. Methemoglobin normally accounts for less than 1% of the total hemoglobin, although small amounts of hemoglobin continually are being oxidized by exogenous and endogenous agents (including oxygen itself). Elevated methemoglobin levels occasionally occur in pediatric patients, and when this happens they are due to one or more of the following causes: exposure to chemicals that oxidize hemoglobin iron (eg, nitrates, nitrites, aniline derivatives); hereditary deficiency of methemoglobin reductase (also known as cytochrome b5 reductase), an erythrocyte enzyme that normally reduces methemoglobin; transient red blood cell deficiency of methemoglobin reductase, a normal neonatal event that persists until 3 to 4 months of age; the inheritance of an M hemoglobin, such as Hb FM-Fort Ripley.
Recombinant Erythropoietic Growth Factors as an Alternative to Erythrocyte Transfusion for Patients With "Anemia of Prematurity"
Authors: CHRISTENSEN ROBERT D.
Published: December 2021

Erythrocyte transfusion is a commonly used treatment in neonatal medicine. This was illustrated by Blanchette and Zipursky who tabulated the transfusions given to preterm infants at the Hospital for Sick Children. They reported that in the first 6 weeks of life 90% of patients received at least one transfusion and nearly 50% of patients received cumulative transfusions in excess of their total circulating RBC mass. During the first 2 weeks of life most transfusions given to preterm infants are for the purpose of replacing blood withdrawn for laboratory tests. However, after that time transfusions are usually given for an anemia that is not attributable to blood withdrawal, nutritional deficiencies (vitamin E, iron, folate, etc) or genetic abnormalities.
Taurine and Auditory System Maturation
Authors: PERLMAN MAX
Published: December 2021

The question of whether the amino acid taurine is essential for infant nutrition is still being reviewed because of insufficient evidence in humans that dietary taurine deficiency has adverse effects that are prevented or corrected by its administration. The only empirical evidence that taurine is essential is the finding of abnormal electroretinograms in eight children maintained with long-term parenteral nutrition without taurine. Electroretinograms appeared normal in three of four of them when taurine was added to their parenteral solutions. The ambivalence of nutritionists about taurine was expressed recently, perhaps unintentionally, in a consensus statement made by the European Society of Paediatric Gastroenterology and Nutrition: "The amino acid content of the (dietary) protein should not fall below that of breast milk."
POVERTY AND VERY LOW BIRTH WEIGHT INFANTS IN DC
Authors: Student
Published: December 2021

The single largest contributor to infant mortality in the District of Columbia, and elsewhere in the United States, is immaturity. In the district the dead newborns are not simply those born a little too early; they are extraordinarily premature, babies weighing less than 2 pounds 4 ounces at birth. The cause of their premature birth is not known. It is not just teenage pregnancy, poor maternal nutrition, infectious disease, cigarette smoking, drug abuse or alcohol—although each of these is statistically associated with an increased risk for early delivery. The major common factor repeatedly identified is poverty. It is apparent that the overriding influences on infant mortality are social and cultural, not medical.
Radon Exposure: A Hazard to Children
Authors:   COMMITTEE ON ENVIRNOMENTAL HAZARDS
Published: December 2021

BACKGROUND

In December 1984, a construction engineer who lived in Boyertown, PA, triggered radiation monitors while entering the Limerick nuclear power plant near Philadelphia. He had not been contaminated by radioactive materials at the plant; therefore, his home in nearby Berks County was tested. The concentration of radon gas there was 2,700 pCi/L of air, a level much higher than had ever been measured in a residence in the United States. In January, the engineer, his wife, and their two small children were advised to leave the home immediately. The family had been exposed to radiation levels more than 50 times the annual occupational limit for uranium miners. Radon levels in an adjacent house were low but were extremely high in other nearby houses. This region of the country, known as the Reading Prong, which encompasses parts of Pennsylvania, New Jersey, and New York, has geologic deposits of low-grade uranium ore.

Radon gas, a relatively common natural indoor air pollutant is a radioactive decay product of uranium. Radon and its decay products have been shown to increase the risk of lung cancer in underground miners. More recently, radon has been recognized to be widespread in homes in the United States. An estimated 13,000 lung cancer deaths per year may be attributed to residential exposure to radon gas. In this statement the hazards of exposure to radon and its decay products, known as radon progeny or radon daughters, are reviewed.

NATURE AND SOURCES OF RADON

Radon is a colorless, odorless, inert radioactive gas.
Residency Training and Child Abuse
Authors: JOHNSON CHARLES P.
Published: December 2021

The special pediatric practice issue of Pediatrics was an appropriate forum for the articles by Dubowitz and Chastain et al and the response by Morrow. In all three commentaries, various aspects of pediatric residency training were discussed, whereas the need for a "supplement" represented the overload of continuing education of the practitioner.

Dubowitz suggested that there is a need for additional pediatric residency training in child maltreatment. Chastain et al questioned pediatricians about perceived increases in adolescent medicine skills acquired since the Task Force on Pediatric Education called for more emphasis on adolescent medicine during residency training.
In Reply: Residency Training and Child Abuse
Authors: MORROW GRANT
Published: December 2021

The results of the questionnaire referred to in Dr Johnson's letter point out several interesting aspects of residency training in child abuse. First, when a program offers an effective educational experience in an area, the residents will be interested and will participate in an active way. Second, program directors should ask for input from the residents about the quality and extent of their training program so that departments can make thoughtful decisions about rotations in their individual programs. Whether the director can respond to residents' wishes depends to a great extent on how much flexibility there is in a program as determined by elective or selective time.
Late-Onset Hearing Loss
Authors: NIELD TOM , RAMOS ANGELA D. , WARBURTON DAVID
Published: December 2021

The findings of Hendricks-Munoz and Walton concerning the incidence of sensorineural hearing loss in infants with persistent pulmonary hypertension (persistent fetal circulation) substantiate our findings that, in some cases, the loss appears to be of delayed onset and progressive. We would, however, like to point out that delayed-onset sensorineural loss is not limited to infants with persistent pulmonary hypertension, because four of the 11 infants we reported did not have persistent pulmonary hypertension. Therefore, serial audiologic evaluations should also be done for any infant with significant respiratory failure requiring prolonged mechanical ventilation with resultant chronic lung disease.
Newborn Screening for Sickle Cell Disease and Other Hemoglobinopathies
Authors: WETHERS DORIS , PEARSON HOWARD , GASTON MARILYN
Published: December 2021

Hemoglobinopathies represent one of the major health problems in the United States and constitute the most common genetic disorders in some populations. Sickle cell disease (SS, SC, S-β-thalassemia) alone affects about one in 400 American black newborns, as well as persons of African, Mediterranean, Asian, Caribbean, Middle Eastern, and South and Central American origins.

For the past 20 years, the medical profession has known that children with sickle cell anemia have an increased susceptibility to severe bacterial infection, particularly due to Streptococcus pneumoniae. The risk of major infection and death posed by this organism is greatest in the first 3 years of life and can occur as early as 3 months of age. In fact, this infection may be the first clinical manifestation of disease. The infection can be fulminant, progressing from the onset of fever to death in a matter of hours, and the case fatality rate is reported as high as 30%.

In addition, acute splenic sequestration, another acute catastrophic event, contributes to early mortality in children with sickle cell anemia and may occur as early as 5 months of age.

It has been proposed that early diagnosis to identify infants with major sickle hemoglobinopathies, who have a high risk of early mortality and morbidity, is essential to institute appropriate ongoing care and effective measures of prophylaxis and intervention. Early diagnosis of hemoglobinopathies should be in the newborn period.

Even though the technology to screen infants in the newborn period has been available for the past 15 to 20 years, screening has not received widespread acceptance.
PROGRAM EFFECTS ON DECREASING MORBIDITY AND MORTALITY
Authors: Grover Ranjeet
Published: December 2021

Our experience demonstrates that the diagnosis of sickle cell disease at birth along with early intervention can reduce mortality among identified patients. However, accurate screening of newborns in the absence of a comprehensive follow-up program is of limited value.

Our experience with trait follow-up indicates that couples at risk should be sought both by testing the parents of trait newborns and by testing the mothers in the prenatal period.

Our recommendations are that programs for sickle cell screening of newborns should be structured on the basis of clearly defined goals and should ensure the following services: a newborn screening laboratory under strict quality control with backup facilities for special test procedures and interpretation of test results; an efficient and effective mechanism for recall of infants with presumptively positive results and referral of patients with the sickle cell disease diagnosis; treatment centers with a high standard of medical care to provide comprehensive care to patients with sickle cell disease and their families; skilled genetic counseling for the families of newborns with sickle cell disease and trait, including the information available concerning prenatal diagnosis for couples at risk; broadbased and ongoing education for professionals, paraprofessionals, and the public at large to enhance their understanding and cooperation; means to evaluate the effectiveness and success of the program in achieving the goals set forth.
Newborn Experience in the Cooperative Study of Sickle Cell Disease
Authors: Gill Frances M. , Brown Audrey , Gallagher Dianne , Diamond Steven , Goins Eleanor , Grover Ranjeet , Lubin Bertram , Moore Gloria , Gaston Marilyn H.
Published: December 2021

In 1978, the National Heart, Lung, and Blood Institute of the NIH initiated a large-scale, multiinstitutional collaborative study to investigate the clinical course of sickle cell disease from birth to death. Twenty-three institutions participate in the cooperative study, of which 19 have pediatric components. Newborn screening is performed in 18 institutions. Centers are located along the east coast, and in the South, the Midwest, and California. Both rural and urban populations are represented in the study. This Cooperative Study of Sickle Cell Disease has been described in detail.

MATERIALS AND METHODS

Newborn screening began in late 1978, and patient entry began in 1979. Between late 1978 and August 1986, 633 infants were found to have a hemoglobin pattern of FS and 326 were found to have FSC. A major effort was made to enroll these infants with sickle cell disease in the cooperative study. Other infants whose diseases were not diagnosed by screening but referred to the centers were also enrolled. From these two sources a total of 600 infants less than 6 months of age had been enrolled in the study as of August 1986. Diagnoses were established by cellulose acetate and citrate agar gel electrophoreses or by isoelectric focusing studies.

The children have been followed up regularly at the study centers. Visits are scheduled for the ages of 2, 4, 6, 9, 12, 15, 18, 21, and 24 months and twice yearly thereafter. During the visits an interval history is obtained, a complete physical examination is performed, and developmental state is assessed.
Prophylaxis With Oral Penicillin in Children With Sickle Cell Anemia: A Randomized Trial
Authors: Gaston Marilyn H. , Verter Joel I. , Woods Gerald , Pegelow Charles , Kelleher John , Presbury Gerald , Zarkowsky Harold , Vichinsky Elliott , Iyer Rathi , Lobel Jeffrey S. , Diamond Steven , Holbrook C. Tate , Gill Frances M. , Ritchey Kim , Falletta John F.
Published: December 2021

Children with sickle cell anemia have an increased susceptibility to bacterial infections, especially to those caused by Streptococcus pneumoniae. We therefore conducted a multicenter, randomized, double-blind, placebo-controlled clinical trial to test whether the regular, daily administration of oral penicillin would reduce the incidence of documented septicemia due to S pneumoniae in children with sickle cell anemia who were younger than 3 years of age at the time of entry. The children were randomly assigned to receive either 125 mg of penicillin potassium (105 children) or placebo (110 children) twice daily. The trial was terminated 8 months early, after an average of 15 months of follow-up, when an 84% reduction in the incidence of infection was observed in the group treated with penicillin, as compared with the group given placebo (13 of 110 patients v 2 of 105; P = .0025). There were no deaths from pneumococcal septicemia in the penicillin-treated group but three deaths from the infection occurred in the placebo group. On the basis of these results, we conclude that children should be screened in the neonatal period for sickle cell hemoglobinopathy and that those with sickle cell anemia should receive prophylactic therapy with oral penicillin by 4 months of age to decrease the morbidity and mortality [SEE FIGURE IN SOURCE PDF.] associated with pneumococcal septicemia. (Previously published in N Engl J Med 1986;314:1593-1599.
APPROACHES TO SCREENING
Authors: Harris Mary S. , Eckman James R.
Published: December 2021

Georgia's newborn screening program for hemoglobinopathies has been evolving for more than 23 years. The program began in 1964 with the screening of infants at 6 months of age and progressed to the full-scale implementation of a statewide hemoglobinopathy newborn screening program in 1980.

The program functions as a cooperative effort with several major components: two tertiary care centers, a community-based clinic, and the state public health department. The tertiary care centers consist of the Augusta Comprehensive Sickle Cell Center affiliated with the Medical College of Georgia and the Georgia Sickle Cell Center at Grady Hospital affiliated with Emory University School of Medicine. These two centers are responsible for patient care, education, and research. The community component consists of the Sickle Cell Foundation of Georgia, which is responsible for counceling clients with sickle cell trait, community education, and notification of parents of infants with normal test results. The state component consists of the Georgia Department of Human Resources, which is responsible for program administration and primary laboratory testing.

The program components coordinate their services through a voluntary organization known as the Georgia Sickle Cell Task Force. The organization consists of representatives from agencies and organizations actively involved in the provision of services for patients with sickle cell disease. The members of this organization work together to ensure an efficient service network for education, testing, counseling, patient management, program monitoring, and evaluation.

Georgia's screening program can best be described as a targeted, voluntary, mandatory screening program, which means that, unless the mother objects to having her infant tested on religious grounds, infants in 13 ethnic groups are automatically tested because they are considered at risk (African, Arabian, Central American, Greek, Maltese, Hispanic, Indian, Portuguese, Puerto Rican, Sardinian, Sicilian, South American, and Southern Asian).