bluuebunny/crossref_metadata_2025 huggingface dataset:
Jaundice, Terminating Breast-Feeding, and the Vulnerable Child
Authors: Kemper Kathi , Forsyth Brian , McCarthy Paul
Published: December 2021

Jaundice is the most commonly treated condition of otherwise well newborns. Although recommended treatments are thought to be safe and effective, the impact of jaundice and therapy on maternal attitudes and behavior is unknown. It was hypothesized that, in contrast to comparison mothers, mothers of jaundiced infants would be more likely to stop breast-feeding in the first month of life, have more separation difficulties with their infant, and be greater users of health care. Both groups of mothers were surveyed in the hospital and 1 month after discharge. Mothers were eligible if their infants were born at Yale-New Haven Hospital after February 1987 and were in the regular nursery. Jaundiced infants had a total serum biirubin concentration ≥205 mmol/L (12 mg/dL); control infants were not jaundiced. Of those who agreed to participate, 84% (85/101) of mothers of jaundiced infants and 80% (124/155) of control mothers completed the 1-month questionnaire. There were no substantial differences between the control and jaundiced groups, respectively, with regard to maternal age (29.1 years vs 29 years) education (66% vs 60% some college), or race (86% vs 82% white). Breast-feeding was more common in the jaundiced group (61% vs 79%, P < 05). By 1 month, more mothers of jaundiced infants had completely stopped breast-feeding (19% vs 42%,P < .01). They were more likely to have never left the baby with anyone else (including the father) or left the baby at most one time for less than 1 hour (15% vs 31%, P < .05). Although they reported a similar number of infant health problems in the first month of life (35% vs 27%, control vs jaundiced group), mothers of jaundiced infants were more likely to take the baby for more than two well-child checkups (6% vs 17%, P < .05), more than one sick visit (9% vs 19%, P = .05), and any emergency room visit (2% vs 11%, P < .05) (not including visits for bilirubin measurements). These results suggest that jaundice and current therapies for it may increase the risk for premature termination of breast-feeding and for development of the vulnerable child syndrome.
PRACTICAL EPIGRAM OF APGAR SCORE
Authors: Butterfield Joseph
Published: December 2021

Despite the value of the [Apgar] scoring system, experience has shown that it may be difficult to memorize the categories that make up the score and that [some] medical personnel are not familiar with it. The purpose of this communication is to describe an epigram (Figure) which embodies the basic components of the scoring system and implements its application. [SEE TABLE 1 IN SOURCE PDF.]

The epigram has not altered the essence of the Apgar scoring system. . . . It does afford a means of remembering it easily. This has been an effective adjunct in expanding the use of the Apgar Score in this medical center, and it may be of value to those physicians who are interested in furthering the employment of this scoring system in their hospitals.
Severity of Necrotizing Enterocolitis: Influence on Outcome at 2 Years of Age
Authors: Walsh Michele C. , Kliegman Robert M. , Hack Maureen
Published: December 2021

The long-term outcome of very low birth weight (VLBW) infants with necrotizing enterocolitis has been reported to be similar to that of other VLBW infants. To examine the influence of disease severity on outcome, the growth and neurodevelopment of survivors of necrotizing enterocolitis were evaluated when the babies were 20 months' corrected age. Between 1975 and 1983, 1506 VLBW infants were admitted to the hospital, and necrotizing enterocolitis developed in 84 (5.6%). Forty infants (48%) survived to be 20 months' corrected age, and complete follow-up data were available for 36. Survivors were classified by modified Bell's criteria into four groups by increasing severity of disease; 13 had mild necrotizing enterocolitis (stage IIA, IIB), and 23 had severe necrotizing enterocolitis (stage IIIA, IIIB). The 36 survivors were compared with 766 surviving VLBW infants without necrotizing enterocolitis. There were no perinatal or socioeconomic differences between groups. Compared with infants with stage II necrotizing enterocolitis at 20 months, infants with stage III necrotizing enterocolitis had a higher rate of subnormal body weight (39% vs 15%) and subnormal head circumference (30% vs 0%). Thirty-three percent of necrotizing enterocolitis survivors had significant neurodevelopmental impairment; the majority of impaired infants (10 of 12) were survivors of stage III necrotizing enterocolitis. These findings highlight the importance of continued evaluations for medical and neurodevelopmental sequelae.
Aid to the Evaluation of Therapeutic Studies
Authors: Reisch Joan S. , Tyson Jon E. , Mize Susan G.
Published: December 2021

Physicians are often faced with conflicting recommendations from therapeutic studies. An evaluation form is proposed to facilitate the evaluation of the quality of therapeutic studies and the resulting treatment or management recommendations in any area of medicine. Twelve major topics for evaluation include sample size determination, randomization, selection of control group(s), "blinding," and support for treatment recommendations. Emphasis is placed on study design and performance rather than data analysis. Thirty-four primary criteria based on accepted research standards are designated as most important, and examples from the literature are provided to illustrate their use. The form provides a comprehensive set of well-accepted standards of research in a format that encourages detailed, consistent, and thoughtful evaluation of therapeutic studies. The evaluation form is recommended as a tool for physicians who wish to develop and exercise skill in evaluating therapeutic studies.
Abnormal Patterns of Pulmonary Neuroendocrine Cells in Victims of Sudden Infant Death Syndrome
Authors: Gillan John E. , Curran Carmel , O'Reilly Eileen , Cahalane Seamus F. , Unwin Anthony R.
Published: December 2021

Ventilatory dysfunction has become the main focus of current research in sudden infant death syndrome (SIDS). This has been correlated with structural abnormalities in the carotid body and respiratory nuclei of the brainstem. In recent studies, the denervating effect of asphyxial brainstem dysfunction on the pulmonary neuroendocrine cells, which probably function as chemoreceptors, was demonstrated and prompted the following study. The pulmonary neuroendocrine system was evaluated in 25 victims of SIDS and 20 control infants, ranging in age from 3 weeks to 7 months and 1 to 12 months, respectively. The pulmonary neuroendocrine cells were stained by the Churukian-Schenk method and the neuroendocrine cell-positive airway values expressed as a percentage of the total number of airways. The range of positive airway values for victims of SIDS was 2% to 97% with a median of 73%. In contrast, the range for the control infants was 1% to 44% with a median of 25.5%. The SIDS victims' percentage was significantly greater than the control infants' percentage (P< .0001). The number of pulmonary neuroendocrine cells in positive airway was also increased among SIDS victims compared with control infants. The altered plumonary neuroendocrine cell pattern could be attributable to either brainstem dysfunction or chronic hypoxia. These explanations are not, however, mutually exclusive of one another; in fact, it is possible that both mechanisms may be operative.
Lessons From Long-Term Survivors of Childhood Cancer
Authors: Komp Diane M.
Published: December 2021

Facing another birthday, it's not always easy to agree with Browning. New technical information mushrooms even as my grey-crowned synapses burn out. Authority and tradition, the twin domains of the experienced, are under fire as patriarchal, paternalistic, imperialistic, and whatever else fails to satisfy modern sensabilities. It surely looks as if the game is to the swift and the young. Yet my birthday this year was graced by an experience that younger clinicians cannot yet savor.

As I answered the phone's ring, I heard, "This is a voice from your past; this is Freddie" (Names have been altered to protect privacy). Although I have not seen him for 10 years, the voice was unmistakable. How can you forget the voice of the first patient with leukemia you were able to tell that he was cured? He was also the first of my longterm survivors of cancer to father children and provide me with "grandchildren" to brag about. My first "grandchildren" are already teenagers and there have been dozens more born since then to other patients who are long-term survivors of cancer.

Freddie and two other patients participated with their families in the last grand rounds I gave at my former academic post. He was seen first 20 years ago with leukemia as a teenager with a high white blood cell count and hyperuricemia. He is now 36 years old and a coal miner. At the time of his marriage, in his town only the mines provided employment with health benefits for someone with a prior history of malignancy.
Internationally Adopted Children and Cytomegalovirus
Authors: BARTON LESLIE L. , FRIEDMAN ALLAN D.
Published: December 2021

We read with interest the article by Hostetter et al in Pediatrics and the companion article in American Journal of Diseases of Children. Although we agree with the need for careful history taking, physical examination, and selected screening laboratory tests for these (and all) children, we cannot agree with the recommendation for routine urine cultures for cytomegalovirus. More than one half of women of childbearing age in upper income groups have seronegative test results and, thus, are at risk for primary infection with cytomegalovirus.
In Reply: Colic or Milk Allergy
Authors: LOTHE LASSE , LINDBERG TOR
Published: December 2021

We fully agree with Dr Taubman that studies of infantile colic should not include infants with the symptoms found in those with cow's milk allergy. None of the infants in our study (Pediatrics 1989;83:262-266) had such symptoms. We also emphasized this in the discussion. We used the term vomiting perhaps erroneously; a more correct word would be "spitting." According to our more than 30-year (T.L.) experience in clinical pediatrics, this spitting phenomenon is common in the age group—especially if the infants have a wish to suck often.
Parents and Steroid Use by Nonathletes
Authors: SALVA PAUL S. , BACON GEORGE E.
Published: December 2021

Anabolic steroid use has received a great deal of attention lately and was the subject of a recent American Academy of Pediatrics' Committee on Sports Medicine report. Other professional associations have also issued position papers as well. All of these statements addressed steroid use by athletes only, implying that athletes are the only segment of the population using them. This simply is not the case. Several studies have shown that 10% to 20% of those who admit to steroid use are not involved in athletics.
ADVERTISEMENTS IN MEDICAL JOURNALS = HIGHER COST OF MEDICATION
Authors: Student
Published: December 2021

[The] function of advertising within learned journals is not to inform but to make possible lower subscription rates for a privileged segment of our population and to support journals in a fashion to which they would otherwise have no opportunity to become accustomed.

It is no doubt true that subscription prices of some journals would be increased without advertising revenue; but this seems as slight a cost as truth has ever incurred. It is not much of a brave new world in which the costs of necessary information for physicians and scientists are made lower by higher prices of medications for the ill and in which impartial truth and shoddy contrivance rub shoulders in the heady atmosphere of intellectual work.
Parental Attitudes and Practices Toward Children as Pedestrians
Authors: Rivara Frederick P. , Bergman Abraham B. , Drake Christiana
Published: December 2021

Community programs to reduce the toll from pedestrian injuries in childhood must include parents as a key element. This study, consisting of a survey questionnaire, was undertaken to provide information concerning current parent attitudes and practices that could be used to guide prevention programs. The survey consisted of 2464 questionnaires from parents of children in grades kindergarten to four in a suburban school district. Although 94% of parents did not believe that 5- to 6- year-old children can reliably cross streets alone, one third of parents allowed kindergarten-aged children to cross residential streets alone and first-grade children to walk alone to school. The presence of speeding traffic or the lack of safe places to walk did not influence parents in limiting their children's crossings. Few (17%) parents believed that children should be taught not to cross alone; one half of parents, including 41% of parents of kindergarten-aged children believed that children should be taught to cross busy streets without traffic lights. According to results of the study, parent expectations for their children's pedestrian skills may be inappropriate and may be a fruitful target for injury-prevention programs.
Phototoxicity of Tin Protoporphyrin, Tin Mesoporphyrin, and Tin Diiododeuteroporphyrin Under Neonatal Phototherapy Conditions
Authors: Fort Farrel L. , Gold Jack
Published: December 2021

Tin metalloporphyrins are being considered as therapeutic agents for neonatal hyperbilirubinemia, and it is possible that concurrent exposure to phototherapy will occur during their use. Euthymic hairless guinea pigs, Crl:IAF(HA)BR, were given daily intraperitoneal injections of tin protoporphyrin (SnPP), tin mesoporphyrin (SnMP), or tin diiododeuteroporphyrin (SnI2DP) for 3 successive days. They were concurrently exposed to ambient light or two different kinds of phototherapy light under conditions similar to that found in neonatal intensive care units. Phototherapy light exposure was for a continuous period of approximately 72 hours following the first injection of metalloporphyrin. The presence or absence of phototoxicity under these conditions was determined by observations for an erythematous response on the back and ears of the guinea pigs. The dosages used were 0.75, 3.75, and 7.5 mg/kg per day of SnPP, 0.075, 0.375, and 0.75 mg/kg per day of SnMP, and 0.9, 4.5, and 9.0 mg/kg per day of SnI2DP. These dosages for each drug were approximately 1 times, 5 times, and 10 times, respectively, the maximum anticipated clinical dosage. At equal multiples of the clinical dosages, SnI2DP was less phototoxic than SnPP, and SnMP was the least phototoxic of the three compounds. SnPP was marginally phototoxic at the lowest dosage. SnMP was phototoxic only at the highest dosage under phototherapy light emitting ultraviolet A irradiation, but when phototherapy light not emitting ultraviolet A irradiation was used, SnMP was not phototoxic. In all cases, the phototoxic response was reversible when the drug and phototherapy treatment were discontinued.
Neuropsychologic Impairment in Children With Sickle Cell Anemia
Authors: Swift Andrea V. , Cohen Morris J. , Hynd George W. , Wisenbaker Joseph M. , McKie Kathleen M. , Makari George , McKie Virgil C.
Published: December 2021

In this study, the neuropsychologic functioning of 21 children with sickle cell anemia and 21 sibling controls, age range 7 through 16 years, with no history of neurologic disease, was examined. Outcome measures included tests of intelligence, constructional praxis, memory, and academic learning. On the Wechsler Intelligence Scale for Children—Revised, the sickle cell group had a mean Full Scale IQ of 77.7 (SD 12.4) compared with 94.3 (SD 11.0) for the control group. The profile of test scores was similar for the two groups, with the sickle cell group scoring significantly lower than the control group on almost all cognitive measures. Both groups showed academic achievement to be commensurate with their measured intellectual ability. These results suggest that subtle but significant and widespread neuropsychologic deficits are associated with sickle cell anemia even in the absence of neurologic complications. When and by what process this neuropsychologic impairment is caused needs to be determined.
Status of Varicella Vaccine for Healthy Children
Authors: STARR STUART E.
Published: December 2021

Many readers of Pediatrics have undoubtedly wondered about the status of varicella vaccine with regard to licensure. After all, Takahashi and colleagues carried out the first clinical trials with live attenuated OKA strain vaccine in 1973, and since then, the vaccine has been studied extensively, with largely favorable results, in both healthy and leukemic children.

In actuality, prelicensing studies were delayed because of the development of unacceptable reactions in leukemic children who received certain lots of vaccine. Rashes occurred more frequently than in earlier studies in which different lots of vaccine were used, and in four children moderately severe disease requiring hospitalization and treatment with acyclovir developed.
Generalized Seizures in an Infant Due to Environmentally Acquired Cocaine
Authors: RIVKIN MICHAEL , GILMORE HERBERT E.
Published: December 2021

The adverse neurologic consequences of cocaine ingestion have been well documented in adults and adolescents. Only a few reports exist in which the neurologic effects of cocaine in infants are described. In each of these cases, the infants acquired the drug from the maternal circulation during gestation, through the act of breast-feeding, or through consumption of breast milk. Reports of infants who ingested cocaine without maternal involvement do not exist. An infant is described in whom generalized tonic-clonic seizures developed after inadvertent ingestion of cocaine in her home. The ramifications of such a clinical appearance on diagnosis and treatment are discussed.
PREP Statement
Authors: ALDEN ERROL R. , Dow JEAN ,   PREP ADVISORY GROUP
Published: December 2021

The following statement was developed by the PREP Advisory Group as part of an effort to inform the Academy membership about plans currently underway for the future of the PREP program.

Planning is still in the early stages, but the Department of Education is enthusiastic about the projected changes, including 12 (instead of 10) issues of Pediatrics in Review, a new section in the journal devoted to practice management, and computerized diagnosis and management problems in addition to the Self-Assessment examination. Some of these changes will be phased in during the next 2 years; the new PREP program will actually be launched in January 1992.

Please "stay tuned"—as plans continue to develop, we will keep the membership informed. In the meantime, if you have questions, comments, or suggestions regarding PREP, we would be happy to hear from you. You may contact PREP, Department of Education, American Academy of Pediatrics, 141 Northwest Point Blvd, Elk Grove Village, IL 60009-0927.
Status Epilepticus—Risks and Treatment
Authors: HARUDA FRED
Published: December 2021

I have one question for Dr Freeman. As a parent, would he allow his son to ride a bicycle or climb on the monkey bars after a first generalized seizure, or after an episode of status epilepticus, without prophylactic medication, knowing that he was at a greatly increased risk to have a second seizure? Would he allow this, knowing that, if the seizure occurred, his child might fall from the bicycle or off the monkey bars and break his neck or have a subdural hematoma?
In Reply: Status Epilepticus—Risks and Treatment
Authors: FREEMAN JOHN M.
Published: December 2021

Dr Haruda's letter deserves a strong reply. His central point is embodied in the last lines.". . .this 25% risk of another seizure, which may have fatal complications, is far too great for me to expect the parents of my patients to accept, and neither would I if I were such a parent. It is my practice to treat seizures."

This response embodies what I term "the Mount Everest" approach to seizures: seizures are treated because they are there.
Drug Screening
Authors: SCHWARTZ RICHARD H. , TSESIS VLADIMIR
Published: December 2021

To the Editor.—

We are writing to express our strong opposition to the recently published American Academy of Pediatrics' (AAP) position paper concerning drug screening of adolescents (Pediatrics 1989;84:396-398). The improved accuracy and widespread use of urine tests for drugs of abuse has been one of the most significant advances in the diagnosis and management of diseases of addiction. Tests for drugs of abuse furnish objective evidence of exposure to illicit drugs—evidence that is difficult or impossible to obtain by any other means.
Psychosocial Characteristics of Homeless Children and Children With Homes
Authors: Bassuk Ellen L. , Rosenberg Lynn
Published: December 2021

A comparison was made of 86 children from 49 homeless Boston families headed by women and 134 children from 81 housed Boston families headed by women. In both groups, the mothers were poor, currently single, and had been receiving welfare payments for long periods. Data were collected from the mothers by personal interview; standardized tests were administered to mothers and children (Denver Developmental Screening Test, Simmons Behavior Checklist, Children's Depression Inventory, Children's Manifest Anxiety Scale, and Child Behavior Checklist. The data indicate that many homeless children and poor children with homes have severe and pressing problems. Among preschool children, a higher proportion of homeless children than poor children with homes had one or more developmental delays (P < .05), although their scores on the Simmons Behavior Checklist were similar. Among school-aged children, the scores of the homeless children were worse than those of the children with homes on the Children's Depression Inventory, Children's Manifest Anxiety Scale, and the Child Behavior Checklist, but only the difference on the Anxiety Scale approached statistical significance (P = .06). Both homeless children and poor children with homes generally had worse scores than most other comparison groups of children. Unless action is taken to improve the lot of all these children, it is likely that many will continue to have significant problems that will seriously hamper their ability to function.
Chronic Conditions, Socioeconomic Risks, and Behavioral Problems in Children and Adolescents
Authors: Gortmaker Steven L. , Walker Deborah K. , Weitzman Michael , Sobol Arthur M.
Published: December 2021

Children with a chronic health condition have long been considered at excess risk for psychosocial morbidity. Despite an increasing prevalence of chronic childhood conditions and heightened concerns for the quality of life of the chronically ill, population-based studies of behavior problems among children with chronic physical conditions are rare. Findings on the epidemiology of behavior problems in a nationally representative sample of 11 699 children and adolescents aged 4 to 17 years in the United States are reported. Data included a 32-item parent-reported behavior problem index, measures of chronic childhood conditions, measures of school placement and performance, and sociodemographic variables. Analyses confirmed that chronic physical conditions were a significant risk factor for behavior problems, independent of sociodemographic variables. Among children these differences were observed across all subscales; among adolescents the largest differences were found for the Depression/Anxiety and Peer Conflict/Social Withdrawal subscales. Rates of extreme behavior problem scores (those in the top 10th percentile) were 1.55 times higher among children with a chronic health condition compared with children without a chronic condition (95% confidence interval 1.29 to 1.86). These independent odds were lowered to 1.44 when covariates for confounding were introduced via a multivariate logistic regression. Other independent risks included the absence of either biologic parent (odds ratio 2.05), male gender (1.53), low vs high family income (1.30), low vs high maternal education (1.51), and young vs old maternal age at childbirth (2.57). Chronic health conditions were also a major risk factor for placement in special education classes and having to repeat grades. Despite evidence for effective interventions, health services for children with chronic conditions—particularly mental health services—remain fragmented, signaling the need for increased attention to behavioral problems and their treatment among all health professionals caring for children.
Persistence of Antibody and Booster Responses to Reimmunization With Haemophilus influenzae Type b Polysaccharide and Polysaccharide Diphtheria Toxoid Conjugate Vaccines in Children Initially Immunized at 15 to 24 Months of Age
Authors: Berkowitz Carol D. , Ward Joel I. , Chung-E-Chiu . , Marcy S. Michael , Gordon Lance , Hendley J. Owen , Meier Kathleen , Marchant Colin D. , McVerry Patrick
Published: December 2021

To evaluate the persistence of antibody after Haemophilus influenzae type b polysaccharide vaccine (PRP) and H influenzae type b polysaccharide diphtheria toxoid conjugate vaccine (PRP-D), a group of 141 infants initially immunized between 15 and 24 months of age were studied 1 year later. One month after immunization with PRP, the mean anti-PRP antibody level was 0.27 µg/mL and 1 year later was 0.29 µg/mL (not significant). In the group immunized with PRP-D, the levels were 1.34 µg/mL and 1.20 µ/mL (not significant), respectively. To evaluate immunogenicity and safety of a booster immunization 1 year after initial vaccination, subjects were randomly assigned to receive saline, PRP, or PRP-D. In addition, 73 age-matched previously unimmunized subjects were vaccinated with PRP or PRP-D. In all groups, adverse reactions were minor and resolved by 48 hours. Subjects receiving booster immunization with PRP or PRP-D had significantly greater antibody responses than children of the same age receiving their first dose of vaccine. The highest antibody levels were achieved in children initially immunized with PRP-D, regardless of whether the booster vaccine was PRP (112.8 µg/mL) or PRP-D (122.0 µg/mL) (not significant). Antibody levels after booster vaccine were significantly lower in those initially given PRP compared with those initially given PRP-D but significantly higher than in age-matched previously unimmunized control subjects (PRP booster 3.16 µg/mL vs control of 0.62 µg/mL [P < .05]; PRP-D booster 12.31 µg/mL vs control 2.31 µg/mL [P < .01]).
Furosemide Effect on Mineral Status of Parenterally Nourished Premature Neonates With Chronic Lung Disease
Authors: Vileisis Rita A.
Published: December 2021

In this study, the effect of prolonged furosemide administration on calcium and phosphorus homeostasis was examined in 16 parenterally nourished very low birth weight infants with chronic lung disease. Patients received one of three different dosages of phosphorus: low, 0.91 ± 0.06 mmol/kg per day; moderate, 1.24 ± 0.02 mmol/kg per day; and high, 1.64 ± 0.06 mmol/kg per day. All furosemide-treated patients had high levels of urinary calcium (12.1 ± 2.2 mg/kg per day), phosphate (19.1 ± 2.7 mg/kg per day), and cyclic 3'5'-adenosine monophosphate (76.8 ± 6.7 nmol/kg per day) excretion, independent of their phosphorus intake. Parathyroid hormone concentrations were high in furosemide-treated patients (0.95 ± 0.15 ng/mL) compared with patients not treated with furosemide and receiving either moderate (0.49 ± 0.05 ng/mL) or low (0.42 ± 0.07 ng/mL) phosphorus intakes. Furosemide administration may lead to secondary hyperparathyroidism.
Could Hypobilirubinemia Be Bad?
Authors: GARBAGNATI ERSILIA
Published: December 2021

To the Editor.—

Recently, M. van de Bor et al1 have attempted to relate the degree of hyperbilirubinemia at birth to later poor neurologic development in a large number of low-birth-weight subjects. However, as occurred in previous studies, this research has taken into account only problems related to bilirubin toxicity without paying any attention to a possible biologic role of this pigment.

Bilirubin is a mysterious substance. It belongs to a large group of compounds, the so-called "bile pigments," that are widely distributed in the animal as well as in the vegetable kingdom.
The Extracorporeal Membrane Oxygenation Debate
Authors: SHORT BILLIE LOU
Published: December 2021

To the Editor.—

I would like to thank Dr Dworetz and associates1 for their concern for the use of retrospective criteria in determining ECMO (extracorporeal membrane oxygenation) entry criteria, a concern that is common to all of us. It should be pointed out that a controlled trial comparing ECMO to hyperventilation was completed at Boston Children's Hospital2 showing an improved survival with extracorporeal membrane oxygenation. Even though the criteria of the Boston study were tested prospectively, a year after that study, we must deal with how to change the criteria to reflect new therapeutic modalities.
More Concerning Asthma and Exercise
Authors: FURUKAWA CLIFTON T. , MURPHY SHIRLEY , Eggleston Peyton , Rachelefsky Gary , Bahna Sami , Fischer Thomas , Katz Roger , Meltzer Eli , Ownby Dennis , Pearlman David , Tinkelman David
Published: December 2021

In Reply.—

Dr Altenburger's letter asks us to go beyond our statement endorsing medical therapy for a child with exercise-induced asthma into a statement about what "schools should" and "should not" do about medications. It has always been difficult for the "little white clinic" to tell "the little red schoolhouse" how to handle health concerns. It should be recognized that in some communities there is very good communication and cooperation and that policy statements cannot assure such good practice.
Acquired Immunodeficiency Syndrome and Adolescence
Authors: PARKER JAMES E.
Published: December 2021

To the Editor.—

Goodman and Cohall1 have provided a valuable survey regarding the adolescent attitude to acquired immunodeficiency syndrome.

In their final paragraph, however, they pose a question which I find disturbing, in that it appears to strike at the very root of medical philosophy. How do we respond to the suggestion that 21% of respondents claimed that they would commit suicide if they had a positive human immunodeficiency virus test? Is this a reason not to test, or should one say "Amen, so be it?" We must recognize that this threat is very real but that it nevertheless constitutes emotional blackmail.
Nonhandicapped Very-Low-Birth-Weight Infants at One Year of Age: Developmental Profile
Authors: Williamson W. Daniel , Wilson Geraldine S. , Lifschitz Marta H. , Thurber Susan A.
Published: December 2021

The developmental profile of 61 very-low-birth-weight infants without major cognitive, motor, or sensory deficits was compared with that of 28 term infants at 1 year chronologic age. The groups significantly differed in two ways on the Revised Gesell Developmental Schedules. First, very-low-birth-weight infants were more likely than term infants to have significant discrepancies between either their fine motor or language abilities and their early problem-solving skills as measured by the Adaptive scale of the Gesell. Second, across all fields of behavior (adaptive, gross motor, fine motor, language, and personal/social), very-low-birth-weight infants scored significantly below term infants. The very-low-birth-weight infant's motor performance significantly correlated with bronchopulmonary dysplasia, intracranial hemorrhage, and number of days spent in the hospital. Language performance significantly correlated with intracranial hemorrhage, birth weight, and sex. These findings underscore the limitations of global developmental scores to describe adequately the developmental performance of very-low-birth-weight infants. Instead, a comprehensive assessment of all fields of behavior is necessary to provide an accurate profile of this high-risk group.
Precursors of Reading Delay: Neurodevelopmental Milestones
Authors: Shapiro Bruce K. , Palmer Frederick B. , Antell Sue , Bilker Stacey , Ross Alan , Capute Arnold J.
Published: December 2021

The relationship between current reading ability and the achievement of early language and motor developmental milestones was evaluated in 240 children, aged 7½ years, whose language and motor achievement had been charted at each well baby visit during the first 2 years of life. Those children whose composite reading score was 6 months behind their chronologic age on the Woodcock-Johnson Psychoeducational Battery were classified as having reading delay. Relationships to reading outcome were assessed for individual infant milestones, for critical screening values, and by statistical techniques that characterized the developmental process rather than single milestones. Significant differences (P < .05) were noted between children with and without reading delays for the following milestones: 4 to 6 words, 7 to 20 words, 50 words, 2-word sentences, and 5 and 8 body parts. The positive predictive value of slower milestone achievement ranged from 0% to 50%. Techniques that focused on the developmental process during the first 2 years (either rate of achievement of neurodevelopmental milestones or order of milestone acquisition) were better able to classify children with reading delay (sensitivity = .73, specificity = .78). Although the language milestone measures did not classify children sufficiently well to be diagnostic, the data served to determine whether a child would be at high risk based on performance rather than historical factors.
Disorders of Attention and Activity Level in a Referral Population
Authors: Accardo Pasquale J. , Blondis Thomas A. , Whitman Barbara Y.
Published: December 2021

Of 614 children referred for an evaluation of hyperactivity and inattention, the 422 (68.7%) who qualified for a diagnosis of attention deficit disorder (ADD) were compared with the 192 (31.3%) who did not. The children with ADD had significantly higher full-scale IQ scores, verbal scores, and parental educational levels. They also had a significantly higher incidence of specific learning disabilities (73.7%). The absence of hyperactivity in children with ADD further exaggerated the differences in learning disability between the two groups. Cognitive limitation, severe parental psychopathology, and child neglect/abuse were significantly higher in the group without ADD. The two groups did not differ in the incidence of parental or child depressive symptomatology, motor diagnoses, language disorders, conduct disorders, and psychosomatic complaints. That only 29 children in whom ADD was absent (4.7% of all referrals) had been given a trial of stimulant medication does not support the presence of a major abuse of such drugs in the community.
Relationship Between Infant Feeding and Infectious Illness: A Prospective Study of Infants During the First Year of Life
Authors: Rubin David H. , Leventhal John M. , Krasilnikoff Peter A. , Kuo H. S. , Jekel James F. , Weile Birgitte , Levee Alice , Kurzon Matthew , Berget Arne
Published: December 2021

Prior studies investigating the relationship between infant feeding and infectious illnesses in developed countries have provided conflicting data about whether breast-feeding protects against common infectious illnesses early in life. These conflicts may in part be due to the failure to consider the following methodologic issues: (1) collecting data prospectively at frequent intervals for active surveillance of the detection of infections and of feeding practices, (2) specifying what is meant by infectious illnesses and breast-feeding, (3) controlling for confounding variables such as social class or presence of siblings in the household, and (4) applying appropriate analytical strategies to a population in which both feeding and exposure to illness change over time. A total of 500 infants born consecutively in a university-affiliated community hospital in Copenhagen, Denmark, were studied prospectively for the first 12 months of life by means of a detailed, monthly, mailed questionnaire that focused on feeding practices and illnesses (overall response rate, 73%). The percentage of infants who were completely or mostly breast-fed decreased from 88% at 1 month to 20% at 12 months of age. After adjustment for major covariates, no statistically significant relationship was found between the type of infant feeding and the incidence of four categories of infectious illnesses: gastroenteritis, upper respiratory illness, otitis media, and lower respiratory illness. The adjusted incidence density ratio for gastroenteritis was 1.067 (95% confidence interval = 0.982, 1.226) and for upper respiratory illnesses 0.984 (95% confidence interval = 0.883, 1.096). These data suggest there is no substantial protective effect of breast-feeding against the occurrence of infectious illnesses early in life in a largely middle class urban population in a developed country.
Psychogenic Seizures in Children and Adolescents: Outcome After Diagnosis by Ictal Video and Electroencephalographic Recording
Authors: Wyllie Elaine , Friedman Diane , Rothner A. David , Luders Hans , Dinner Dudley , Morris Harold , Cruse Robert , Erenberg Gerald , Kotagal Prakash
Published: December 2021

Psychogenic seizures in 21 nonepileptic children and adolescents, aged 8 to 18 (mean 14.5) years, were recorded by means of video recording and electroencephalography. The episodes included thrashing movements, limb jerking, or staring, with unresponsiveness. Ictal and interictal electroencephalograms showed no abnormalities after antiepileptic medication was discontinued. Fifteen patients had psychogenic seizures spontaneously during recording, and six had seizures in response to suggestion and intravenous saline injection. After the video-electroencephalographic evaluation, patients and families were told that the episodes were emotional in origin. All patients but 1 agreed to remain without antiepileptic medication, and 16 patients (76%) agreed to begin psychiatric treatment. At 6 to 66 (mean 30) months' follow-up, 14 of 18 (78%) were free of episodes. These data indicate that the majority of young patients with psychogenic seizures have a good outcome. A firm diagnosis is critical so that the episodes can be classified and emphasized as medically not worrisome, permitting a shift away from antiepileptic medication and toward psychiatric treatment.
Management of Alarming Hemangiomas in Infancy: A Review of 25 Cases
Authors: Enjolras Odile , Riche Marie Claire , Merland Jean Jacques , Escande Jean Paul
Published: December 2021

During the past 10 years, 25 infants with alarming hemangiomas—lesions that impaired important functions and were life threatening, especially when there was visceral involvement—have been treated. A vascular mark was present at birth in 68% of these infants. Visceral hemangiomas were associated with bulky cervicocephalic hemangiomas or with small hemangiomas scattered over the body. Among the 25 infants, 12 had laryngeal hemangiomas, 3 had hepatic hemangiomas, and 1 had gastrointestinal hemangiomatosis. Ocular sequelae, malocclusion, and cutaneous distortion were the most important functional problems. Corticosteroid treatment was used for 23 of 25 infants with alarming hemangiomas. There was a varied treatment response: total failure (30% of the patients); excellent, dramatic, rapid improvement (30% of the patients); and moderate, doubtful response, with the natural course of the disease remaining unaltered (40% of the infants). Arterial embolization, used in 6 infants, gave inconstant results. Cardiac failure, frequently associated with large cutaneous hemangiomas and always seen with hepatic multinodular hemangiomas, required digitalization. In some cases arterial embolization reduced the increased cardiac output. Liver hemangiomas had a high mortality; all 3 infants with hepatic involvement died.
Tentorial Hemorrhage Associated With Vacuum Extraction
Authors: Hanigan William C. , Morgan Andrew M. , Stahlberg Lisa Kokinski , Hiller Janet L.
Published: December 2021

The clinical and radiologic descriptions of three neonates with tentorial hemorrhage after vacuum extraction are reported. All patients were full term, with Apgar scores of 8 or more; one patient experienced fetal distress during delivery. Within 36 hours after birth, the neonates had multiple generalized seizures; computed tomography or magnetic resonance imaging outlined distinctive tentorial hemorrhages with extension over the superior surface of the cerebellum or inferior surface of the occipital lobe. One patient had diffuse hypoxic-ischemic injury, and another had bilateral temporal lobe infarcts. Treatment included medical control of seizures and intracranial hypertension; one patient had surgical evacuation of bilateral subdural hematomas. Follow-up from 1 to 5 years showed significant developmental delays in two patients. These cases demonstrate that the forces generated on the fetal cranium by vacuum extraction are similar to those produced by forceps and result in tentorial laceration, venous rupture, and subdural hemorrhage. Because these hemorrhages may be associated with significant ischemic injury, serial radiologic evaluation is recommended for the detection of persistant structural abnormalities.
Establishing Special Needs Car Seat Loan Program
Authors: Bull Marilyn J. , Stroup Karen Bruner , Stout Janet , Doll Judith P. , Jones Jacqueline , Feller Noreen
Published: December 2021

Car seat loan and rental programs have provided many families with low-cost access to child restraints. When an infant or child is unable to be accommodated in a standard car seat or seat belt owing to physical or medical problems, parents of these children have few, if any available resources. The establishment and operation of a loan program at the Indiana University School of Medicine for children who are medically fragile is reviewed in this article. This program was developed by the Automotive Safety for Children Program at the James Whitcomb Riley Hospital for Children, Indiana University Medical Center, to meet the special transportation needs of children with respiratory, orthopaedic, and other medical and physical difficulties. A summary table is included to highlight restraints that have performed satisfactorily during dynamic crash tests and are used to meet patient transportation needs at Riley Hospital. Guidelines for establishing and maintaining a child restraint loan program for children with special needs are outlined to encourage replication of this effort.
Abnormal Maxillary Sinus Radiographs in Children: Do They Represent Bacterial Infection?
Authors: Arruda L. Karla , Mimica I. M. , Solé D. , Weckx L. L. M. , Schoettler J. , Heiner D. C. , Naspitz C. K.
Published: December 2021

Thirty-three children with chronic tonsillitis and/or adenoid enlargement and without previous diagnosis of sinusitis were studied regarding the bacterial flora of their maxillary sinuses. Puncture of maxillary sinus was performed at surgery (adenoidectomy and/or tonsillectomy) and aspirates were cultured. Streptococcus pneumoniae was isolated from 8 of 12 (66.7%) patients whose x-rays showed completely opacified maxillary sinus. Streptococcus viridans, Streptococcus faecalis, and Staphylococcus epidermidis were recovered from 6 (28.6%) of the 21 patients with normal maxillary sinus radiographs. Bacterial titers were greater than 104 colonies/mL in all but one of the positive cultures. No anaerobic bacteria were isolated. History of bronchial asthma, presence of nasal purulent secretion, elevated blood eosinophils, and elevated serum IgE were found more frequently in children with complete opacification of maxillary sinus. Serum levels of IgG2 were low in 29% of the children, but no correlation was found between low IgG2 levels and positive cultures from maxillary sinus aspirates. We concluded that children with complete radiologic opacification of maxillary sinus had bacterial infection in almost 70% of the cases with symptoms that did not prompt their physicians to consider the diagnosis of sinusitis.
Gas Embolism After Ingestion of Hydrogen Peroxide
Authors: RACKOFF WAYNE R. , MERTON DAVID F.
Published: December 2021

Gas embolism to the portal venous system is a well-recognized radiographic sign in infants with necrotizing enterocolitis. It also has been seen after colonic irrigation with hydrogen peroxide solution.1,2 We present what we believe is the first reported patient with radiographic evidence of portal venous gas embolism after ingestion of hydrogen peroxide solution. This finding is important because gas embolism to the portal venous system after colonic irrigation with hydrogen peroxide has been associated with gangrenous and perforated bowel.1,2

CASE REPORT

A 2-year-old boy ingested an unknown amount of 3% hydrogen peroxide solution. The child was found with foam around his mouth.
Repeated Oral Administration of Activated Charcoal for Treating Aspirin Overdose in Young Children
Authors: VERTREES JULIA E. , MCWILLIAMS BENNIE C. , KELLY H. WILLIAM
Published: December 2021

The data from our two patients indicates that gastrointestinal dialysis with repeated oral doses of activated charcoal may significantly enhance the elimination of overdoses of salicylate in young children. Limited experience precludes precise recommendations, but current evidence suggests that gastrointestinal dialysis should be evaluated further for treating pediatric salicylate intoxication.
An Unlucky Rabbit's Foot?
Authors: RYAN-POIRIER KATHLEEN , WHITEHEAD PETER Y. , LEGGIADRO ROBERT J.
Published: December 2021

The diagnosis of tularemia, a bacterial disease, may not be considered because of its low incidence in the United States. A careful epidemiologic history, however, may offer the necessary clues to diagnosis.1 We describe two cases of tularemia in siblings presumably caused by contact with a rabbit killed by hunting dogs. Of special interest was the use of the rabbit's feet as good luck charms. Although appropriate measures can be taken to prevent this disease, such precautions are either not widely known or not strictly adhered to among those who hunt small game.

CASE REPORTS

An 8-year-old white boy (R. M.) from Memphis was referred to LeBonheur Children's Medical Center for evaluation of persistent fever.
Medical Staff Appointment and Delineation of Pediatric Privileges in Hospitals
Authors:   Committee on Hospital Care
Published: December 2021

Medical staff credentialing, including the delineation of clinical privileges for each staff member, represents a cornerstone in the hospital quality assurance program. The process involves the evaluation and verification of a practitioner's professional competence and conduct based on his/her education and training, previous professional experience, personal background, and peer assessment. Once the practitioner's credentials have been confirmed and approved, clinical privileges are extended by the hospital, matching the practitioner's documented competence and skills with the standards and resources of the institution.

Because of the many significant differences between individual hospitals (ie, size, services provided, geographic location, population served, organization of the medical staff, fiscal and administrative characteristics), no one method for credentialing is universally applicable. The medical staff of each hospital is therefore responsible for establishing its own procedures for credentialing. There are certain elements, however, required in each hospital's credentialing process:

1. It must be thorough, fair, and timely and involve unbiased and good-faith peer review. Any possible malicious use of the peer review process is not acceptable.

2. The etire credentialing process must be clearly described in the medical staff bylaws. Included inn this description should be mechanisms for appeal and guaranteed due process for disputes concerning disciplinary actions and for changes in or revocation of privileges. The medical staff bylaws should also incorporate provisions of the federal Health Care Quality Improvement Act of 1986 as well as reference provisions of applicable state laws, to help achieve or describe available immunities annd protections for the hospital and peer review committee members from various legal liabilities.