bluuebunny/crossref_metadata_2025 huggingface dataset:
High-Frequency Ventilation and Tracheal Injuries
Authors: WISWELL THOMAS E. , CLARK REESE H. , CORNISH J. DEVN
Published: December 2021

To the Editor.—

We read with interest the study of Mammel et al.1 However, we wish to address several aspects of the report regarding the design of the investigation, their interpretation of the results and of other reports, and the conclusions they make.

First, we take exception to the title itself. Unfortunately, many pediatricians and neonatologists do not make any distinction between the various types of nonconventional, high-frequency ventilators. High-frequency ventilation is a generic term encompassing several very different modalities of ventilation including high-frequency positive pressure ventilation, high-frequency flow interruption, high-frequency jet ventilation, and high-frequency oscillatory ventilation.
Tactile/Kinesthetic Stimulation Effects on Preterm Neonates
Authors: FIELD TIFFANY
Published: December 2021

In Reply.—

In response to Saigal and Whyte, we would agree that there are some methodologic weaknesses in our study. Indeed, we acknowledged these as caveats in our paper. But we will try to clarify the "perplexing problems" raised by Saigal and Whyte.

First, Saigal and Whyte suggest that they did not understand our stratification procedure. Because matching infant-for-infant on critical variables is virtually impossible with neonates in a neonatal intensive care unit (NICU), stratification is used as a close-to-matching process.
Questions About Early Enteral Feeding Study
Authors: LA GAMMA EDMUND F.
Published: December 2021

In Reply.—

Response to Edwards and Johnson: From a statistical perspective, we are aware of the potential risk of false-negative results based on a straight forward power analysis of the data we presented. However, due to the number of known, and perhaps greater number of unknown, variables, the level of complexity, and the diversity of clinical approaches to the medical problems in critically ill neonates, we sought to execute our protocol during an 8-month period of "stable staffing and management approaches."
Childhood Upper Respiratory Tract Infections: To What Degree Is Incidence Affected by Day-Care Attendance?
Authors: Fleming David W. , Cochi Stephen L. , Hightower Allen W. , Broome Claire V.
Published: December 2021

Risk factors for acute upper respiratory tract disease in childhood were evaluated in a population-based sample of the Atlanta metropolitan area. Mothers from 449 households containing 575 children less than 5 years of age were selected by random-digit dialing and questioned about upper respiratory tract infection and ear infection occurring in their children during the preceding 2 weeks. Household demographic and socioeconomic characteristics, maternal smoking history and child day-care attendance and breast-feeding information were also obtained. For children less than 5 years of age, the reported incidence of upper respiratory tract infection was 24%, and of ear infection, 6%. Controlling for the other variables measured, day-care attendance was associated with a significantly increased risk of both illnesses. For upper respiratory tract infection, increased risk was present for all children attending day care (P = .02, odds ratio = 1.6), whereas for ear infection, risk could be demonstrated only for full-time attendees (P = .005, odds ratio = 3.8). Maternal smoking was a second independent risk factor for a child's having upper respiratory tract infection (odds ratio = 1.7, P = .01). Thirty-one percent of all upper respiratory tract infection among day-care attendees and 66% of all ear infections among full-time day-care attendees were attributable to day-care attendance. Given the proportion of children in day care, 9% to 14% of the total burden of upper respiratory tract disease in this population was day care related. As use of child day-care facilities has increased, this specific exposure has become a major factor contributing to transmission of acute upper respiratory tract disease in childhood.
Health Services Use by Children Enrolled in a Hospital-Based Primary Care Clinic: A Longitudinal Perspective
Authors: Fosarelli Patricia D. , DeAngelis Catherine , Mellits E. David
Published: December 2021

The use of a hospital-based primary care clinic for health maintenance and illness care and use of the emergency room were monitored for 3 years for 293 children who had been enrolled in the clinic as infants. Infrequent users of one facet of care were infrequent users of other facets of care, and they remained so for all 3 years. The same trends were noted for frequent users. Children who used the clinic for health maintenance infrequently were more likely to have registered in the clinic after 2 months of age and to demonstrate consistently infrequent use throughout the 3 years. Children who used the clinic for illness care infrequently were more likely to have at least two siblings and to demonstrate consistently infrequent use. Children who used the emergency room infrequently were likely to have been consistently infrequent users for emergencies and illness throughout the 3 years. Conversely, those who used the clinic frequently for health maintenance were more likely to have registered before 1 month of age, to have multiple chronic conditions, and to demonstrate consistently frequent use for maintenance throughout the 3 years. Frequent users for illness came were more likely to have none or one sibling, multiple chronic conditions, and to demonstrate consistently frequent use for illnesses. Finally, children who used the emergency room frequently were likely to have multiple chronic conditions and to demonstrate sustained frequent use throughout the 3 years. These results suggest that patterns of use are established as early as the first year of life.
Deafness: Ever Heard of It? Delayed Recognition of Permanent Hearing Loss
Authors: Coplan James
Published: December 2021

Records of approximately 1,000 children seen for evaluation of developmental delay during the period July 1979 to December 1985 were reviewed; 46 children with permanent hearing loss were identified. Age at diagnosis of deafness and factors contributing to delay in diagnosis were sought. Mean age at diagnosis of profound congenital deafness was 24 months. Lesser degrees of congenital hearing loss were not diagnosed until 48 months of age. High-risk medical history or physical anomalies associated with embryologic abnormalities of the auditory system that should have triggered a prompt search for deafness went unheeded in most instances. In 40% of subjects, the author was the first to diagnose hearing loss. For two thirds of this subgroup, audiologic referral was prompted by medical, physical, or developmental findings rather than clinically evident hearing loss during physical examination. Adherence to specific historical, physical, or developmental risk criteria, regardless of the examiner's subjective impression of how well the child seems to hear, would have permitted the timely diagnosis of hearing impairment in all children in this series.
Judicial Involvement and Conduct Problems of Fathers of Infants Born to Adolescent Mothers
Authors: Elster Arthur B. , Lamb Michael E. , Peters Laura , Kahn James , Tavaré Jane
Published: December 2021

Data were obtained from retrospective review of 191 patient records to determine the extent and types of conduct problems among fathers of infants born to adolescent mothers. Ninety-eight fathers (51%) reported having committed a legal offense prior to the pregnancy. This rate appears substantially greater than rates of arrests of adolescents in the general population. When paired data for couples were analyzed, there was great similarity for severity of offense. Fathers, however, had committed more severe crimes than their partners. Male offenders came from families of lower socioeconomic status backgrounds and more single-parent families and were less frequently employed or in school (or graduated) than nonoffenders. They also had been more involved with various other problem behaviors, such as a previous pregnancy, drinking behavior, and behavior problems at school. There was a clustering of problem behaviors among offenders suggesting psychosocial maladjustment prior to the pregnancy. Our results suggest an association between fatherhood and delinquency among partners of adolescent mothers. It appears that these fathers form a heterogeneous group. Although some young fathers may be well adjusted, others have significant psychologic problems.
Tocopherol Efficacy and Safety for Preventing Retinopathy of Prematurity: A Randomized, Controlled, Double-Masked Trial
Authors: Phelps Dale L. , Rosenbaum Arthur L. , lsenberg Sherwin J. , Leake Rosemary D. , Dorey Frederick J.
Published: December 2021

To test the efficacy and safety of vitamin E in preventing retinopathy of prematurity, 287 infants with birth weights of less than 1.5 kg or gestational ages of less than 33 weeks were enrolled within 24 hours of birth in a randomized, double-masked trial of IV, followed by oral, placebo v tocopherol (adjusted to plasma levels of 3 to 3.5 mg/dL). In the 196 infants completing ophthalmic follow-up, tocopherol did not prevent retinopathy of prematurity of any stage (28% placebo treated v 26% tocopherol treated) or moderately severe retinopathy of prematurity (8% placebo treated v 11% tocopherol treated). Cicatricial sequelae were not significantly different (1/97 placebo treated v 3/99 tocopherol treated), with one placebo-treated infant and one tocopherol-treated infant having retinal detachments. Among all 232 infants examined, those treated with tocopherol had more retinal hemorrhage than placebo-treated infants (8/121 placebo treated v 16/111 tocopherol treated), and retinal hemorrhage correlated positively (P < .01) with plasma levels of tocopherol after the first 2 weeks of age. Prospective monitoring of morbidity including late-onset sepsis, necrotizing enterocolitis, etc revealed no differences between groups except that grades 3 and 4 intraventricular hemorrhage occurred more frequently in infants weighing less than 1 kg at birth who had received tocopherol (14/42, 33%) v those who had received placebo (4/43, 9%) (P < .02). Our data do not support the use of tocopherol for prophylaxis against retinopathy of prematurity in premature infants and suggest that IV tocopherol treatment starting on day 1 may increase the incidence of hemorrhagic complications of prematurity, particularly in infants with birth weights of less than 1 kg.
Influenza: A Shot or Not?
Authors: Hall Caroline Breese
Published: December 2021

Few viruses have acquired over decades such notoriety as influenza and such interesting sobriquets as "Lady Influenza," "The Last of the Great Plagues," "The Spanish Flu," and "Blitz Katarrh." Each year, sages convene to predict the Lady's itinerary and wardrobe, her antigenic cloak for the next season's debut and to thus pick the comparable components for the vaccine. Each fall, reminders and recommendations for immunization are issued, and sentinels across the country pronounce her pace to physicians, public, and press.

Despite this annual concern and cost, the vaccine against influenza is poorly used. Less than 20% of those recommended for yearly immunization receive the vaccine, and in children the estimates are as low as 1% to 7%. Influenza vaccine, thus, has the dubious distinction of being associated with the lowest compliance rate of any recommended vaccine in pediatrics.
Comparison of Self-Hypnosis and Propranolol in the Treatment of Juvenile Classic Migraine
Authors: Olness Karen , MacDonald John T. , Uden Donald L.
Published: December 2021

In a prospective study we compared propranolol, placebo, and self-hypnosis in the treatment of juvenile classic migraine. Children aged 6 to 12 years with classic migraine who had no previous specific treatment were randomized into propranolol (at 3 mg/kg/d) or placebo groups for a 3-month period and then crossed over for 3 months. After this 6-month period, each child was taught self-hypnosis and used it for 3 months. Twenty-eight patients completed the entire study. The mean number of headaches per child for 3 months during the placebo period was 13.3 compared with 14.9 during the propranolol period and 5.8 during the self-hypnosis period. Statistical analysis showed a significant association between decrease in headache frequency and self-hypnosis training (P = .045). There was no significant change in subjective or objective measures of headache severity with either therapy.
Are You Overlooking Fractures of the Mandibular Condyle?
Authors: MYALL ROBERT W. T. , SANDOR GEORGE K. B. , GREGORY CRYSTAL E. B.
Published: December 2021

Fractures of mandibular condyle may be overlooked because attention is often focused on readily apparent soft tissue injury such as lacerations and abrasions. Clinical and radiographic signs are often subtle, but the injuries caused by rapid deceleration and listed in Table 2 will serve to alert the pediatrician to the possibility of such fractures. All children in these circumstances should be carefully examined for dental occlusion and the preauricular area palpated to help formulate a clinical diagnosis. Additional evidence is gained from the finding of deviation or limitation of the jaw upon opening or edema in the preauricular area. If any of these yield abnormal findings, a good quality series of mandibular radiographs will be needed to confirm the diagnosis. Overlooking a condylar fracture may commit a child to unsightly facial asymmetry, marked malocclusion, or ankylosis requiring invasive surgery for correction. Consultation with an oral and maxillofacial surgeon or other interested specialist should be sought while the patient is still in the emergency room.
WHEN DO WE HAVE "SUFFICIENT" EVIDENCE?
Authors: Student
Published: December 2021

[In a recent] report, one of the signatories ... apparently having second or third thoughts considered the evidence "falls far short of proof"—an implication that we can measure distance from an absolute called proof. This lust for "absolute" proof represents a view of science that is mistaken, dangerously so, since it interferes with two types of endeavour: translating scientific evidence into public health policy and pursuing research into the social causation of illhealth.
A MUCH-NEEDED NEW MEDICAL TERM IS BORN
Authors: Student
Published: December 2021

A slip of the typewriter has created a term which fills a need. "Clinical gudgement" is obviously derived from "gudgeon"—a gullible person, or, from the fish of that name, one who will swallow anything (Shorter Oxford English Dictionary, 1968). The term must refer to the practice of making clinical decisions on shaky or absent evidence; the complement, in fact, to the more familiar term. How about a "gudgement of the month" award?
EFFECTS OF LIMITED HEARING ON THE DEVELOPMENT OF SPEECH IN CHILDREN UNDER THREE YEARS OF AGE
Authors: HUIZING HENK C. , POLLACK DOREEN
Published: December 2021

Natural development of speech elements in acoustically handicapped children has been proved possible provided that the limited hearing is detected at a very early age by new testing procedures. It is achieved under clinical conditions by the use of individual hearing aids which provide auditory stimulation from the age of 2 years, or even earlier, upwards. Special treatment is necessary and training of the parents plays an important part. If a listening function is not established at an early age, there is the danger that children with limited hearing will ignore sound or will actually find it annoying. Future success is dependent on the hard of hearing child's being educated together with the normal speaking children, with the reservation that he will need special arrangements for speech therapy and speech reading. New specifications should be made concerning the admission of acoustically handicapped children into special schools and the considerations mentioned above should be applied.
SYNDROME OF OVARIAN AGENESIS (CONGENITALLY APLASTIC OVARIES)
Authors: SILVER HENRY K.
Published: December 2021

A proved case of the syndrome of ovarian agenesis, short stature, multiple congenital abnormalities and high urinary gonadotropins in a 2 year, 8 month old female is presented.

Congenital anomalies included webbed neck, abnormalities of the feet, a moderate degree of cubitus valgus and defects of the vertebrae.

Only slight retardation of epiphyseal development was present by the fourth year of life.

Because of the marked variations in the levels of urinary gonadotropins in this patient, it is suggested that more than one assay should be performed in a preadolescent girl before it is concluded that the gonadotropins are not increased.
CONGENITAL STIPPLED EPIPHYSES
Authors: FORD G. DAVID , SCHNEIDER MARTIN , BRANDON JAMES R.
Published: December 2021

Two infants, one full term and the other premature, presented symptoms of "congenital stippled epiphyses" (dysplasia epiphysialis punctata, chondrodystrophia calcificans congenita). The outstanding characteristics of the entity are the presence of multiple, discrete, dense calcifications in many cartilaginous epiphyses and apophyses. The diagnosis, necessarily, rests upon roentgenographic examinations.
FIBROUS STERNOMASTOID TUMOR OF INFANCY
Authors: GRUHN JOHN , HURWITT ELLIOTT S.
Published: December 2021

A case of sternomastoid tumor of infancy is described which presented clinically as a neck mass without torticollis and simulated a neoplasm.

Four aspects of the problem are discussed: (1) the relationship of tumor and torticollis; (2) the etiology and pathogenesis; (3) the differential diagnosis from sarcoma; and (4) the treatment.

Prophylactic resection of the mass to exclude a possible malignant tumor or to prevent the subsequent development of torticollis, is not justified, since in about 80% of cases spontaneous regression occurs without sequelae.

The institution of passive neck exercises over a period of several months during and following degression of the mass may contribute to a decreased incidence of deformities.
PRODUCTION OF CONGENITAL DEFECTS IN THE OFFSPRING OF PREGNANT MICE TREATED WITH CORTISONE
Authors: FRASER F. CLARKE , FAINSTAT T. D.
Published: December 2021

It has been shown that cortisone, injected into pregnant female mice, will produce cleft palate and other congenital malformations in the resulting young. The incidence of cleft palate varies according to the genetic constitution of the treated mice, the dosage of cortisone used and the gestational stage at which treatment is begun.
CLINICAL OBSERVATIONS ON TRICHOCEPHALUS TRICHIURUS (WHIPWORM) INFESTATION IN CHILDREN
Authors: JUNG RODNEY C. , BEAVER PAUL C.
Published: December 2021

Of about 2000 hospitalized children whose stools were examined routinely, 18% were infested with Trichocephalus trichiurus. The heavy infestations (over 30,000 eggs/ cc.), which consistently produced diarrhea and dysentery, were most common in children 2 to 4 years of age. A significant correlation existed between worm-burden and incidence of amebiasis.

A successful technic for the treatment of trichocephaliasis is described. The importance to the clinician of measuring worm burden is emphasized.
ATRESIA OF THE INTRAHEPATIC BILE DUCTS
Authors: AHRENS EDWARD H. , HARRIS RUTH C. , MACMAHON H. EDWARD
Published: December 2021

Case histories of four patients with atresia of the intrahepatic interlobular bile ducts are reviewed. Three of the four also had anomalies of the extrahepatic bile ducts. All had secondary biliary cirrhosis. The course of disease was distinguished by a relatively long life span, all patients surviving more than three years and one remaining alive at five years. Generalized skin xanthomatosis occurred in all patients, together with a marked and characteristic elevation of the serum lipids.

There was no indication on postmortem examination that intrahepatic bile ducts had developed and then become obliterated. The evidence presented in this study suggests that absence of interlobular bile ducts is a developmental anomaly, and that the embryologic development of biliary epithelium is normally independent of the growth of hepatic trabeculae.
SPECIAL REVIEWS
Authors: HAMMON W. McD.
Published: December 2021

AMONG a large group of neurotropic viral infections of man, poliomyelitis is currently of greatest importance to pediatricians of most countries. In all areas of the temperate and tropical zones where surveys have been made, poliomyelitis infection rates, as measured by the neutralization test, are approximately the same as those for rubeola or other common acute infectious diseases of childhood. In many countries the fatal and paralytic cases assume considerable importance in pediatric practice and, above all, in public interest and demand for control, In many tropical and subtropical areas, however, paralytic rates are reputedly low, and this disease is not recognized as a problem of any importance.

In some areas of the world other neurotropic viruses assume an importance equal to or greater than that of poliomyelitis. Epidemics of these other viruses may occur at intervals as frequent as those of poliomyelitis epidemics or at longer or shorter intervals, but when epidemics do occur they are occasionally of major proportions. Outbreaks of Japanese B encephalitis have occurred principally in children in the past 15 years in Japan, Okinawa and certain other Far Eastern areas. Western equine encephalitis virus has been responsible for important outbreaks in children in the central valley areas of California, and the St. Louis virus has also been responsible for local outbreaks involving principally children in the western United States. These viruses are all members of the arthropod-borne group of viral encephalitides.

Epidemic parotitis, although not usually listed among the neurotropic viruses, has come to occupy a more and more important position as the serologic tests for its diagnosis have received more widespread use in the diagnosis of cases of the nonbacterial meningoencephalitides.
School Performance and Theophylline
Authors: WEINBERGER MILES , LINDGREN SCOTT , JOAD JESSE
Published: December 2021

To the Editor.—

Dr Rachelefsky and his colleagues reported, first in USA Today (Dec 2, 1986, p 1) and later in Pediatrics (1986;78:1133-1138) that theophylline adversely affected school performance. Specifically, they stated, "Teachers said kids couldn't sit still, they weren't remembering as well, they were acting up, and their handwriting had changed" (USA Today). They concluded that "the short-term administration of theophylline to asymptomatic asthmatic children not receiving oral bronchodilators can adversely affect school performance and behavior" (Pediatrics).
Gift to a Litigious Society
Authors: GARSON ARTHUR
Published: December 2021

In Reply.—

I sincerely appreciate the letter from Dr Sapire and his colleagues because it permits me to reemphasize the conclusion of my article "None of the suggested management strategies for these patients should be taken as an absolute rule because there may be differences of opinion among various pediatric cardiologists. Nonetheless . . . a great deal of consideration should be given to these patients." There certainly is room for disagreement on the verapamil issue, as well as other points in the article.
Escherichia coli O157:H7 as the Predominant Pathogen Associated With the Hemolytic Uremic Syndrome: A Prospective Study in the Pacific Northwest
Authors: Neill Marguerite A. , Tarr Phillip I. , Clausen Carla R. , Christie Dennis L. , Hickman Robert O.
Published: December 2021

During a 12-month period, 14 patients with the hemolytic uremic syndrome were identified in a prospective study of enteric pathogens associated with this disorder. Of the 12 patients with a diarrheal illness preceding the onset of hemolytic uremic syndrome, fecal Escherichia coli O157:H7 was detected in seven (58%), all of whom had bloody diarrhea. Half of the siblings of these patients had concurrent nonbloody diarrhea. No source for infection with this organism was identified. Enteric infection with E coli O157:H7 occurs in the majority of cases of hemolytic uremic syndrome following diarrheal illness in the Pacific Northwest and may represent a previously overlooked cause of hemolytic uremic syndrome in other locales. Evaluation of all cases of hemolytic uremic syndrome for enteric pathogens should routinely include cultures for E coli O157:H7 until results of additional studies clarify the distribution of agents associated with hemolytic uremic syndrome in different geographic regions. These findings may provide new opportunities for the design of therapeutic and preventive strategies in this disorder.
Conversion Reactions in Children as Body Language: A Combined Child Psychiatry/Neurology Team Approach to the Management of Functional Neurologic Disorders in Children
Authors: Maisami Mohammad , Freeman John M.
Published: December 2021

Conversion reactions in children represent a form of "body language," a plea for help in a child who has no alternative method of communicating stress. Although conversion reaction may take many forms, this report focuses on those presenting as neurologic dysfunction. The parallel evaluation and treatment of these symptoms by a child psychiatry/pediatric neurology team has demonstrated success in removing the symptom while simultaneously evaluating the underlying stress. Unnecessary medical tests have been avoided and perpetuating factors have been eliminated. Continued family treatment has emphasized health rather than disease and seems to have prevented recurrence.
Neisseria meningitidis Bacteremia in Children: Quantitation of Bacteremia and Spontaneous Clinical Recovery Without Antibiotic Therapy
Authors: Sullivan T. Dennis , LaScolea Leonard J.
Published: December 2021

The relationship between the magnitude of bacteremia due to Neisseria meningitidis and the clinical diagnosis was determined for 43 children who had fever in the presence or absence of focal signs of infection. Bacteremia was quantitated by the previously described procedure using heparinized blood (0.2 to 1.0 mL). Additionally, blood was cultured by means of the radiometric Bactec technique. Seventeen patients had meningitis, 12 had meningococcemia, 13 had unsuspected or "occult" bacteremia, and five had other diagnoses. "Occult" bactermia was diagnosed initially in four patients, but subsequently meningitis was diagnosed. All 13 patients with 500 or more organisms per milliliter had meningitis or meningococcemia in contrast to 12 (55%) of 22 patients with less than 500 organisms per milliliter (P ≤ .0035). Only 18 (42%) of these patients bacteremic with N meningitidis presented with petechiae or purpura. All 13 children with occult bacteremia were sent home after blood cultures were obtained; six of the 13 received a regimen of oral amoxicillin for otitis media. At reexamination (interval 16 to 119 hours) four had meningitis, seven were clinically improved (afebrile, negative blood culture, without invasive disease), and two were still mildly febrile with negative blood culture. Three of these bacteremic children experienced spontaneous clinical and bacteriologic resolution without antibiotic treatment. This has not been previously reported.
Day-Care Center Exclusion of Sick Children: Comparison of Opinions of Day-Care Staff, Working Mothers, and Pediatricians
Authors: Landis Suzanne E. , Earp Jo Anne L. , Sharp Michael
Published: December 2021

Day-care center staff are often faced with the decision of whether to send sick children home. Some pediatricians may question the criteria used by day-care centers to exclude children who have mild infectious illnesses. To determine whether there is a consensus on illness policy, we asked day-care center staff, mothers, and pediatricians which sick children in day care should be excluded. Randomly selected day-care center staff, mothers, and pediatricians in three North Carolina counties completed self-administered questionnaires. We asked how combinations of temperature and symptoms that occur with common childhood infections should affect the staff's decisions to "call the parent for immediate pickup." Response rates were 302 of 347 staff (87%), 134 of 200 mothers (67%), and 69 of 80 pediatricians (86%). A temperature of 37.2° to 37.7°C (99° to 99.9°F) was considered a fever by 35% of staff, 24% of mothers, and 6% of pediatricians (P < .01). At every level of elevated temperature from 37.2° to 38.9°C (99° to 102°F), day-care center staff were more likely to request immediate pickup than mothers or pediatricians (P < .01). For each of eight symptoms and for all three groups of respondents, the addition of a temperature of 37.8°(100°F) increased the proportion of children sent home (P < .01). Day-care center staff, mothers, and pediatricians differ in their reported exclusionary practices for ill day-care children. Public health practitioners should continue to educate all groups in terms of the epidemiology of common infections in day-care centers; communities should consider designing alternative child-care arrangements for mildlyillchildren.
Child Health and the 1987 Nobel Peace Prize
Authors: HANSON LARS Å.
Published: December 2021

The Nobel Peace Prize for 1987 was awarded to Dr Oscar Arias, President of Costa Rica. Almost all of the comments referring to this have related to Dr Arias' peace plan for Central America. This important peace plan was probably a significant factor for the Nobel Committee but not the only argument for awarding the prize to the foremost representative of the remarkable country of Costa Rica. I proposed the nomination of Dr Arias for the last 5 years and a major reason was his accomplishments in Costa Rican child health.

Costa Rica is located between Panama and Nicaragua.
Too Much Lead, Too Little Iron
Authors: CLARK MARGARET
Published: December 2021

In Reply.—

We appreciate the work of Carraccio et al which confirms our findings that the anemia found in children with lead poisoning results from coexistent iron deficiency. The discrepancy between the two studies concerning the predictive value of blood lead in elevations of erythrocyte protoporphyrin bears further exploration. What is striking, however, is that in both series more than 50% of the variability in erythrocyte protoporphyrin remains unexplained. Now the public health focus is on detecting children with low blood lead levels—before even subtle CNS damage has occurred.
Residency Training in Management of Child Abuse
Authors: MORROW GRANT
Published: December 2021

To state that the specialty of pediatrics has undergone changes in the past 25 years would be a monumental understatement. New therapies and new diseases, as well as new societal ways of looking at children's needs, have stressed both training programs and practice. In the early 1960s, C. Henry Kempe shocked the pediatric world by defining the problem of child abuse. In the intervening time, leaders in the field of pediatrics have stressed the need to add more experience in recognizing and managing psychosocial problems of children to our training programs. In 1975, Dr Robert V. Haggerty and his colleagues formulated the concept of "the new morbidity" referring to the multiple psychosocial problems confronting children in our society.
In Defense of Retaining Ipecac Syrup as an Over-the-Counter Drug
Authors: LITOVITZ TOBY
Published: December 2021

The occurrence of ipecac toxicity following chronic ipecac abuse is now well established in the medical literature, usually following self-administration by bulimic patients. In this issue of Pediatrics, Sutphen and Saulsbury1 identify chronic intentional ipecac administration by a parent to a child as another form of abuse leading to ipecac poisoning. In two prior reports (in abstract form) four additional pediatric victims who survived were identified.2,3 Additionally, a fatality following chronic ipecac administration to a 4-year-old child (again Munchausen syndrome by proxy) was reported to the American Association of Poison Control Centers 1987 National Data Collection System.4
Cognitive and Motor Differences Among Low Birth Weight Infants: Impact of Intraventricular Hemorrhage, Medical Risk, and Social Class
Authors: Lewis Michael , Bendersky Margaret
Published: December 2021

The independent impacts of severe intraventricular hemorrhage, other common medical complications of prematurity, and socioeconomic status on the development in the second year of life of 32 low birth weight subjects were explored. Outcome measures included standard tests of mental and motor development, an evaluation of language competence, and an assessment of information processing ability in a habituation/recovery paradigm. Partial correlations indicated that intraventricular hemorrhage influences cognitive and motor development independently of the other predictor variables. Socioeconomic status predicted language ability and recovery of attention to a novel stimulus independent of the other predictors. Medical complications other than intnaventnicular hemorrhage also made an independent contribution to the variance in language outcome. Implications of these findings are discussed.
DR JOHN BROWN OF EDINBURGH ON THE DANGERS OF GIVING LAUDANUM TO CHILDREN (1858)
Authors: C. T. E.
Published: December 2021

John Brown, M.D. (1810-1882), remarkable for his close and accurate clinical observations, was the author of a three-volume collection of essays entitled Horae Subsecivae (i.e."leisure hours"). Many consider these essays to be among the greatest of humanistic essays on medicine published during the 19th century.

Brown in his warning below stressed the terrible consequences of dosing children with laudanum.

There is another practice which I must notice, and that is giving children laudanum to make them sleep, and keep them quiet, and for coughs and windy pains. Now, this is a most dangerous thing. I have often been called in to see children who were dying, and who did die, from laudanum given in this way. I have known four drops kill a child a month old; and ten drops one a year old. The best rule, and one you should stick to, as under God's eye as well as the law's, is never to give laudanum without a doctor's line or order. (Brown was directing his comments to parents).
Nocturnal Hypoventilation in Children With Nonprogressive Neuromuscular Disease
Authors: Heckmatt J. Z. , Loh L. , Dubowitz V.
Published: December 2021

Eight patients between 4 and 24 years of age with nonprogressive neuromuscular disease sought medical attention because of severe nocturnal hypoventilation. There were two types of findings: subacute with progressive early morning headaches and daytime drowsiness and acute with ventilatory failure and cor pulmonale. Seven patients were ambulant. Seven were successfully treated with either a cuirass negative pressure ventilator or a positive pressure ventilator via a tracheostomy. The ventilatory assistance was only used at night and resulted in rapid resolution of early morning symptoms and a return to full daytime activity. One patient died as a result of an intercurrent respiratory infection before respiratory support could be given. It is important to be aware of this potentially life-threatening complication in patients with an otherwise good prognosis and of the benefit to be derived from active treatment.
Childhood Dermatomyositis: Serial Microvascular Studies
Authors: Silver Richard M. , Maricq Hildegard R.
Published: December 2021

Childhood dermatomyositis is an inflammatory condition affecting the skin and muscles that is often associated with a small vessel vasculopathy. According to previous retrospective studies, it is suggested that the severity of the vasculopathy is related to the course of the disease. Sequential in vivo nailfold microscopy was used to assess the frequency and the degree of vasculopathy in nine children with dermatomyositis. The degree of morphologic changes in the nailfold capillary bed was shown to correlate with the clinical course. The technique of nailfold capillaroscopy may prove to be a clinically useful, noninvasive means of early prognosis.
Genital Lichen Sclerosus Mistaken for Child Sexual Abuse
Authors: JENNY CAROLE , KIRBY PHILIP , FUQUAY DIANE
Published: December 2021

Because of heightened awareness about sexual abuse, it is important for physicians to differentiate between genital lesions associated with abuse and those associated with "natural" disease processes.

Lichen sclerosus is a disease of the skin most often found in the vulvar and perianal areas of postmenopausal women. It is less commonly seen in prepubertal female children and premenopausal adult women. Cases of lichen sclerosus have also been reported on the male genitalia, and it is an uncommon cause of phimosis in boys.

One of the clinical manifestations of lichen sclerosus is cutaneous bleeding causing lesions resembling "blood blisters" or bruises.
In Reply: α-Fetoprotein Normal Values
Authors: GALE GORDON B. , O'CONNOR DENNIS , CHU JEN-YIH
Published: December 2021

We would like to thank Caglar et al for providing further information about normal values of α-fetoprotein in neonates and infants. Although the number of serum α-fetoprotein values in the premature neonate is still limited, the table referred to by them further illustrates that normal values in neonates and infants are different from adult normals. The values vary with both gestational age and postnatal age of the infants. Physicians who interpret α-fetoprotein values in neonates and infants need to keep this information in mind.
Renal Glycosuria in Pyelonephritis
Authors: TRACHTMAN HOWARD , KAHN RONALD
Published: December 2021

Standard pediatric nephrology textbooks do not include acute pyelonephritis in the differential diagnosis of renal glycosuria. Recently, we encountered a 9-month-old girl who had fever up≤39.4°C(103°F) for five to six days. On the sixth day of her illness, a Chemstrip urinalysis was performed and demonstrated the presence of 2+ pyuria, 1+ protein, 1+ hematuria, and 4+ glycosuria. A simultaneous blood glucose concentration was 107 mg/ dL. A repeat urinalysis, done 32 hours after a feeding, confirmed the presence of renal glycosuria, a concurrent serum glucose of 129 mg/dL, pyuria, minimal hematuria, and proteinuria.
IATROGENIC EPIDEMIC OF VERY LOW BIRTH WEIGHT NEONATES?
Authors: Student
Published: December 2021

In England and Wales the number of liveborn low birthweight babies (less than 2500 gm) progressively rose by 16% between 1981 and 1986. One factor, but not the only one, contributing towards the increased number of live births of extremely small babies is a more vigorous policy towards resuscitation at birth of babies who, before the era of intensive care might have been classed as miscarriages or abortions, even though they showed signs of life at birth.
Parental Administration of Chemical Agents: A Cause of Apparent Life-Threatening Events
Authors: Hickson Gerald B. , Altemeier William A. , Martin Elaine D. , Campbell Preston W.
Published: December 2021

Nine infants with apparent life-threatening events that occurred as a result of poisoning by a caretaker are described. These episodes were characterized by apnea plus some combination of color change, choking or gagging, and abnormal muscle tone. Five of the infants responded to vigorous stimulation, and four required cardiopulmonary resuscitation. Most poisonings (seven infants) were detected by a urine drug screen. Medications detected included acetaminophen, amphetamine, benzodiazepines (two infants), cocaine, codeine, meperidine (two infants), Methadone, phenobarbital, and phenothiazines (three infants). Four infants received two or more drugs. Most perpetrators of the poisonings were mothers (seven) and five of the parents admitted administering the various agents. Reasons for the poisonings included an apparent attempt to harm an infant, the need to sedate a fussy infant, or a gross misunderstanding of the potential risk of various agents to infants. Because no history of drug administration was elicited at the time of hospital admission, six infants might have been discharged with a diagnosis of apnea of infancy had not an attempt been made to investigate the possibility of poisoning. These cases suggest that poisoning by a caretaker should be added to the differential diagnosis of any infant brought to medical attention because of an apparent lifethreatening event and that urine drug screening should be considered in the evaluation.
Nursing Perspective
Authors: Earles Ann
Published: December 2021

Newborn screening may be the single most important recent advance in the treatment of sickle cell disease. However, the efficacy of newborn screening depends on adequate patient education, counseling, and follow-up medical care. In large part, it is the nurse's responsibility to ensure that these follow-up services are provided.

The Northern California Comprehensive Sickle Cell Center at Children's Hospital, Oakland, has a regional newborn hemoglobinopathy screening program that identifies approximately 15 newborns with sickle cell disease annually. Obstetrical nurses collect an umbilical cord blood sample from all babies born at the ten participating institutions. Samples are sent to the reference hemoglobinopathy laboratory at Children's Hospital, and diagnostic results are available within 1 week of birth.

When a diagnosis of sickle cell disease is made, the genetic counselor discusses the case with the sickle cell nurse coordinator and physician. The responsible private physician and obstetrician are personally notified. In most cases, the family receives a telephone call from the genetic counselor approximately 1 week after the birth. An appointment is then made in the next week for laboratory confirmation of diagnosis and initiation of counseling. At the confirmation appointment, the family and patient are introduced to the sickle cell nurse coordinator, and a comprehensive sickle cell clinic appointment is made for the following week. At this appointment, a "new family letter" introducing the rest of the sickle cell staff is reviewed with the family by the nurse, and a copy is given to the family. This letter outlines the comprehensive services available to patients and contains information to familiarize them with our particular clinical services and policies.
DROWNING DRUG RESEARCH
Authors: L. J. F.
Published: December 2021

A woman files a lawsuit against a pharmaceutical company, claiming that her baby's birth defects were caused by the use of one of the company's products, a contraceptive gel. The Food and Drug Administration earlier had reviewed the data concerning the product, and concluded that it was safe. The scientific evidence notwithstanding, an appellate court awarded the woman $4.7 million. Stories such as the outcome of Wells v. Ortho Pharmaceutical Corp. have of course become routine news today. Not so familiar to the public, however, is the effect such lawsuits are having on pharmaceutical innovation in the U.S.

The discounting of medical evidence in court is only one of the problems that has inhibited medical research and testing, according to a report released by the American Medical Association. "The Impact of Product Liability on the Development of New Medical Technologies" argues that research and testing of vaccines, contraceptives and other medical therapies are in a state of paralysis because of the explosion of product-liability litigation. . .
REVIEWS OF LAY LITERATURE ON CHILD CARE: WHAT PARENTS ARE READING
Authors: Glascoe Frances P. , Moore William R. , Henderson James , Martin Elaine D.
Published: December 2021

Caplan F, ed. The First Twelve Months of Life: Babies Growth Month by Month. 3rd ed. New York, NY: Bantam; 1984; list price $4.95 (#14 on the 1988 bestseller list of books on child care of the Ingram Book Co, distributors of trade books).

Covering prenatal and infant development, the author relies on a multivariate theory of development in which the parents' roles include controller of environments, model of ideal behavior, nurturer, and instructor. Parents have identical roles. Management methods are generally behavioral and include positive reinforcement, both social and tangible, as well as punishment. Methods are designed to be preventive, corrective, and instructive. Specific practices in child-rearing and development are covered in detail and are based on empirical studies. The author is sensitive to parents' needs and fears and addresses other social issues such as environmental pressures, but not the needs of exceptional children. Intact families and material resources are presumed. The text is wellorganized, and development is detailed in month-by-month charts, photographs, and descriptions. It is moderately difficult to read. The medical content was rated as excellent with the exception of the outdated immunization schedule.
PRESIDENT OF BRITAIN'S PAEDIATRIC ASSOCIATION SPEAKS OUT
Authors: Student
Published: December 2021

In a human race whose desire for life is almost universal there is something vaguely presumptuous and self righteous about a self styled group which arrogates to itself the title "Pro-Life" and by implication categorizes those whom it chooses to condemn as "Anti-Life."
Genetic and Environmental Determinants of Growth in Mexican-Americans
Authors: Martorell Reynaldo , Mendoza Fernando S. , Castillo Ricardo O.
Published: December 2021

Height and weight data from the Mexican-American portion of the Hispanic Health and Nutrition Examination Survey (HHANES) are shown for children of ages 2 to 17 years and compared with data for non-Hispanic white children from the second National Health and Nutrition Examination Survey and with the National Center for Health Statistics (NCHS) reference curves. Differences in stature between the Hispanic Health and Nutrition Examination Survey and the reference populations were minor prior to adolescence and could be entirely attributed to the greater poverty of Mexican-Americans. However, differences increased during adolescence (ie, median stature was less than the 25th percentile of the NCHS reference population at 17 years of age) and, in contrast with earlier ages, were independent of poverty. Similar growth patterns were observed in samples of upper-class subjects from Mexico and Guatemala. Nonetheless, the extent to which the short stature of Mexican-American adolescents is genetic is unclear because there is an apparent time trend toward greater stature in the Mexican-American population. In conclusion, the NCHS reference curves are appropriate growth standards for preadolescent Mexican-American children. Whether they are valid for Mexican-American adolescents remains unclear.
INFANT FORMULA MAKERS REPENT (UNDER PRESSURE)
Authors: Student
Published: December 2021

[New York] state's Supplemental Nutrition Assistance Program now serves 61,500 low-income women, infants and children. Companies that produce infant formula—and overcharged for it—have promised an $18 million rebate. Together with $43 million in state funds, an additional 4,000 women and children can be served this year.
RETINOPATHY OF PREMATURITY BUFFS PLEASE NOTE
Authors: Student
Published: December 2021

The term "angiogenic disease" has been proposed for. . .conditations in which an abnormality of capillary growth is a principal pathologic feature and in which there is a possibility that therapeutic control of the abnormal growth might eliminate or ameliorate other manifestations of the disease.
Plasma Aluminum Measurements in Term Infants Fed Human Milk or a Soy-Based Infant Formula
Authors: LITOV RICHARD E. , SICKLES VIRGINIA S. , CHAN GARY M. , SPRINGER MARY A. , CORDANO ANGEL
Published: December 2021

Aluminum is the most abundant metal in the earth's crust. There is a constant environmental exposure to this element because it is ubiquitous. Under usual conditions, dietary aluminum has not been shown to have any deleterious effects because aluminum is poorly absorbed and readily excreted in the urine. However, aluminum may be a health concern in patients with compromised kidney function and those receiving total parenteral nutrition. Aluminum, if retained, results in an increase in the concentration of body aluminum.

There has been some recent interest in the exposure of infants to aluminum, especially in those infants with immature or impaired renal function.