bluuebunny/crossref_metadata_2025 huggingface dataset:
Erythropoietin—Not Yet a Standard Treatment for Anemia of Prematurity
Authors: Wilimas Judith A. , Crist William M.
Published: December 2021

In this issue of Pediatrics, Shannon and coworkers report that the frequency and volume of red cell transfusions administered to premature infants can be decreased by using recombinant human erythropoietin (r-HuEPO). We believe that the most important contribution of this study may relate as much to its design—that is, the application of clearly defined transfusion guidelines—as to the efficacy of r-HuEPO in this setting.

In this randomized, controlled multicenter trial, 157 infants weighing <1250 g at birth received either r-HuEPO or placebo. These infants (mean age = 24 days) had received an average of 3.5 transfusions before their enrollment. During the study, packed red blood cell transfusions were given according to criteria developed by the investigators.
Clinical Trial of Glucose-Oral Rehydration Solution (ORS), Rice Dextrin-ORS, and Rice Flour-ORS for the Management of Children With Acute Diarrhea and Mild or Moderate Dehydration
Authors: Molina Susana , Vettorazzi Carolina , Peerson Janet M. , Solomons Noel W. , Brown Kenneth H.
Published: December 2021

Objective. To assess the effects of glucose (G)-oral rehydration solution (ORS), rice dextrin (RD)-ORS, and rice flour (RF)-ORS on fluid intake, rapidity of rehydration, and stool output of children with acute diarrhea and mild or moderate dehydration.

Methods. The study was a randomized, double-masked clinical trial. One hundred forty-six male infants, ages 3 to 36 months, were randomly assigned to one of three treatment groups. Clinical evaluations and fluid balances were conducted every 2 to 4 hours for 48 hours. Principal outcome variables were ORS consumption, recovery of hydration status, and fecal output.

Results. The groups were similar at admission with regard to age, nutritional status, history of the current episode, and clinical status. There were no differences in ORS consumption by treatment group during any period of study. During the first 6-hour period, patients in group RF had less stool output (16 ± 14 g/kg/body weight) than those in group G (22 ± 20 g/kg) or RD (21 ± 19 g/kg; P < .05). After 12 hours of hospitalization, there were no differences by treatment group. Recovery of hydration status, changes in serum sodium and potassium, and duration of diarrhea in the hospital were similar in all three groups.

Conclusion. There was a 24% to 27% reduction in stool output during the first 6 hours of treatment among children who received RF-ORS compared with those who received G-ORS or RD-ORS, but this effect did not persist after the first 12 hours of therapy. Because this difference was of small magnitude and limited duration, it has minor clinical importance. Thus, we conclude that the three solutions had similar efficacy for children with acute, watery diarrhea and mild or moderate dehydration.
Condom Availability for Youth
Authors:   Committee on Adolescence
Published: December 2021

The medical consequences of adolescent sexual activity are a national health concern, highlighted by unintended pregnancy and sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome (AIDS). Health promotion goals for teenagers include postponement of sexual activity until psychosocial maturity and consistent use of condoms by those who do engage in sexual intercourse.

Although designing effective strategies to accomplish these goals remains a challenge, increased condom use is a realistic, achievable objective. The national public health agenda to reduce HIV transmission emphasizes the need to facilitate condom use as a method of disease prevention. Condom availability programs in schools are receiving widespread attention as a potential strategy to increase condom use by sexually active adolescents. Pediatricians are being asked for advice by school boards and community groups. This statement reviews the pertinent issues related to condom availability in schools and provides recommendations for use in responding to requests for advice.

Background

Sexual behavior of American adolescents has been studied for the past generation. Trend analysis shows increasing rates of sexual intercourse among young people over the past 20 years.1-3 Middle to late adolescence is now the average time for initiation of sexual intercourse. The 1992 Centers for Disease Control and Prevention national school-based Youth Risk Behavior Survey (YRBS) of 11 631 students in grades 6 through 12 reported that 54% of all high school students were coitally experienced, with 39% having had coitus in the 3 months before the survey. 4,5 Forty percent of 9th graders reported having sexual intercourse, a percentage that increased to 72% in 12th graders.
The Use of Cranial CT Scans in the Triage of Pediatric Patients With Mild Head Injury
Authors: Davis Robert L. , Hughes Michael , Gubler K. Dean , Waller Patti L. , Rivara Frederick P.
Published: December 2021

Objective. Recent evidence suggests that patients with a normal cranial CT scan after head injury can be safely discharged home from the emergency department. However, supporting data from previous studies has relied on incomplete patient follow-up. We utilized a statewide comprehensive hospital abstract reporting system (CHARS) to assess whether children with normal CT scans after head injury subsequently developed intracranial sequelae in the month following their initial injury.

Design. Retrospective case-series study, with comprehensive statewide follow-up for 1 month.

Setting. The emergency department of a Level 1 Trauma Center in Seattle, Washington.

Participants. All children (n = 400) with head injury, Glasgow Coma Score of 13 to 15, and initial normal CT scan seen over a 4.5-year time period. All were matched against CHARS to evaluate admissions within 30 days after emergency department disposition. For readmissions, International Classification of Diseases (9th revision) discharge and procedure information was collected. All children were also matched against the state death files.

Results. Four children were readmitted for neurologic reasons within 1 month following injury. One child on coumadin for heart disease developed a symptomatic subdural hematoma 5 days after head injury, requiring neurosurgical drainage. One child developed a symptomatic hemorrhagic contusion 3 days after injury, requiring observation only. Two children were readmitted 1 day after injury for concussive symptoms; both were discharged home after observation only. There were no deaths among the study population.

Conclusions. Among children with a normal cranial CT scan after mild head injury, delayed intracranial sequelae requiring intervention are extremely uncommon. In otherwise stable patients, a normal cranial CT scan can identify patients to be safely discharged from the emergency department, and would be more cost-effective than 1 to 2 days of hospital observation.
JUNK SCIENCE JUNKED
Authors: L. J. F.
Published: December 2021

It took a decade, but in a California courtroom this month science finally beat the plaintiffs' lawyers. The Ninth Circuit Court of Appeals dismissed the notorious Bendectin case.

This was the lawsuit brought by the parents of two children who said their sons' birth defects were caused by the anti-morning sickness drug that the mothers took during their pregnancies. The dismissal is a giant step toward returning sanity to our out-of-control tort liability system.

In a unanimous opinion filed on January 4, a three-judge panel ruled that the science offered up by the plaintiffs' experts was inadequate. The court pointed out that none of their findings had been published in scientific journals or offered up for peer review.

The court didn't mince words. "Bendectin litigation has been pending in the courts for over a decade," Judge Alex Kozinski's scathing opinion reads, "yet the only review the plaintiffs' experts' work has received has been by judges and juries, and the only place their theories and studies have been published is in the pages of federal and state reporters."

Or as we would put it, the aim of this case wasn't a search for truth and justice but a search for deep pockets.
"Topical Steroid Holiday"
Authors: Hepburn David , Morelli Joseph , Weston William L.
Published: December 2021

Daily use of low-potency topical steroids is a frequently observed pediatric prescribing pattern.1 Many clinicians believe such a strategy is safe because low-potency topical steroids usually do not suppress levels of plasma cortisol or produce systemic side effects. However, daily use of low-potency steroids may result in suppression of plasma cortisol levels.1-4

Suppression of plasma cortisol levels after use of topical steroids has been observed in a biphasic pattern. There is suppression within 2 weeks of starting daily therapy, then recovery to normal despite continued use, then suppression again after 4 to 6 weeks of daily therapy.2,3
Surfactant Therapy: More Evidence of Effectiveness
Authors: Averell Carlyne
Published: December 2021

In the August 1993 issue of Pediatrics Horbar et al1 reported an 8% decrease in mortality of 601 to 1300 preterm neonates after the introduction of surfactant therapy at eight neonatal intensive care units (NICUs) in the Neonatal Research Network. Even after adjusting for perinatal risk factors and time trend, a 27% reduction in the risk of death was found among infants for whom surfactant treatment was available (adjusted odds ratio = 0.73; 95% confidence interval: 0.55, 0.95).
AMERICAN HOSPITAL ASSOCIATION FAULTS PERFORMANCE OF JCAH
Authors: L. J. F.
Published: December 2021

The American Hospital Association (AHA) declared a "crisis of confidence" in the Joint Commission on Accreditation of Health-care Organizations, which accredits most of the nation's hospitals.

The AHA said its 5,000 member hospitals are so frustrated by the Commission's performance that more than ten of its state chapters are considering alternatives. Defections could lead to the Commission's collapse, said Richard Davidson, president of the AHA.

The AHA's unusual public criticism comes as the Joint Commission scrambles to revamp its procedures to respond to vast changes under way in the US health-care system. It also comes amid growing demands by consumers and employers for accountability among health-care providers.

The Commission inspects most of the nation's hospitals every three years as part of its accrediation process. Hospitals must be accredited to receive Medicare reimbursements for treating the elderly.

At a press conference in Chicago, officials of the AHA said its members have expressed broad concerns about the quality of the agency's inspections and the costs of the services. In addition, they said a "relentless marketing of education programs" and other products aimed at helping hospitals prepare for the surveys has clouded the Joint Commission's mission with conflicts.
INTERNATIONAL LACTATION CONSULTANT ASSOCIATION ANNOUNCES 1996 MANUSCRIPT COMPETITION
Authors: Auerbach K. G.
Published: December 2021

The International Lactation Consultant Association is sponsoring a competition designed to identify outstanding manuscripts relating to human lactation or breast-feeding in 1996. Authors may enter one of two categories: a Literature Review competition or a Research Paper competition. The winner in each category will receive $500 (US currency); winning manuscripts will be published in the Journal of Human Lactation. Entrants need not be members of the International Lactation Consultant Association. Students are encouraged to enter.

Competition in the Research Paper competition is open to published or unpublished authors; the Literature Review competition is limited to currently unpublished authors. The postmark deadline for entry in the 1996 competition is January 5, 1996.

To obtain guidelines for submitting a manuscript for consideration in the competition, send a self-addressed (and stamped if US) envelope to:
Developmental Outcome as a Function of the Goodness of Fit Between the Infant's Cry Characteristics and the Mother's Perception of Her Infant's Cry
Authors: Lester Barry M. , Boukydis C. F. Zachariah , Garcia-Coll Cynthia T. , Peucker Mark , McGrath Margaret M. , Vohr Betty R. , Brem Francine , Oh William
Published: December 2021

Objective. To determine whether the "goodness of fit" between infant cry characteristics and the mother's perception of the cry is related to developmental outcome at 18 months of age.

Design. This was a prospective, longitudinal study from birth to 18 months performed in a blinded manner.

Setting. The study was conducted in a maternity hospital, including normal and special care nurseries and a laboratory for developmental follow-up.

Patients. The 121 term and preterm infants and their mothers were selected to meet medical criteria.

Measurement. Acoustic analysis of 1-month infant cry and the mother's perception of the same cry was used to divide subjects into four groups representing matches and mismatches between infant cry characteristics and maternal cry perception. Primary outcome measures of cognitive, language, motor, and neurologic outcome were administered at 18 months. Caretaking environment measures were also recorded.

Results. Statistically significant (P < .05) findings showed that matched groups scored higher on measures of language and cognitive performance than infants in the mismatch groups, with a particular advantage for infants in the matched group in which mothers accurately perceived the higher-pitched cries of their infants. There were no differences between the groups in biologic or sociodemographic factors. Group differences were observed in social support and maternal self-esteem.

Conclusions. Matches and mismatches between infant cry characteristics at 1 month and the mother's perception of the cry are related to cognitive and language outcome at 18 months in term and preterm infants. This relation is probably due to transactional processes in which developmental outcome is affected by the clarity of the infants' signals and by the ability of the mother to accurately perceive her infant's signals. The mother's ability to read her infant's cues may be affected by factors such as social support and self-esteem.
Skateboard Injuries
Authors:   Committee on Injury and Poison Prevention
Published: December 2021

Skateboarding has resurged and so have its associated hazards and injuries. There are an estimated 8 million skateboarders now in the United States.1 Pediatricians informed about skateboard activities in their areas can help prevent needless injuries to children and adolescents.

During the last skateboard injury epidemic, the annual incidence of injuries peaked at 150 000 in 1977 and subsequently decreased to 16 000 in 1983. It is likely that this decrease in injuries was primarily related to decreased skateboard activity and not to improved safety conditions. With increased popularity the number has risen, with an estimated 56 435 injuries being treated in emergency departments in 1992.1 In addition, an estimated 1900 hospitalizations occurred due to skateboard-related injuries during this period. The vast proportion of admissions were from head injuries.2

Analysis of Consumer Product Safety Commission data from 1991 indicates the following salient features of the current outbreak of skateboard injuries during this period3:

• 95% involved skateboarders younger than 25 years; 61% involved 5- to 14-year-olds;

• 87% of victims were male;

• 74% of injuries involved the extremities—usually fractures of radius and ulna, 21% to the head and neck, and 5% to the trunk;

• severe injuries (intracranial, internal) were uncommon, moderate injuries (long bone fractures) were most common, and deaths occurred almost always from collisions with motor vehicles;

• younger victims incurred a higher proportion of head and neck injuries than older victims—head injury occurred in 75% of the victims in the 0- to 4-year-old age group, 50% in the 5- to 9-year-old group, and 15% in the 10- to 19-year-old category;

• head injuries in the older age groups were more severe because of collisions with motor vehicles; and

• helmets designed for skateboarding are seldom worn but will protect skateboarders from serious head injury; data on the protective value of elbow pads, knee pads, and wrist guards are inconclusive; they may reduce injury severity. The use of bicycle or hockey helmets has not been evaluated.4,5
Making the "Rochester" Criteria Look Good!
Authors: Young Paul C.
Published: December 2021

Jaskiewicz and colleagues inflate the difference in the risk of serious bacterial infections (SBI) in febrile infants between their low risk and "not low risk" groups by including as an outcome variable infants who clearly have SBIS at the time of enrollment. For example, they use the presence of soft tissue infections on physical examination as both an exclusion criteria from the low risk category and as a diagnostic finding for an SBI. This seems a fundamentally flawed concept even if one considers a paronychia to be a "serious" bacterial infection.
The Management of Febrile Infants by Primary-Care Pediatricians in Utah: Comparison With Published Practice Guidelines
Authors: Young Paul C.
Published: December 2021

Objective. To determine primary-care pediatricians' management of febrile infants and compare them with published practice guidelines.

Design. Case scenarios were sent to 194 primary-care pediatricians in Utah, describing three febrile infants, ages 21 days, 60 days, and 20 months, corresponding to the three age groups: 0 to 28 days; 29 to 90 days, and 91 days to 36 months for which the guidelines suggest different strategies.

Results. Ninety-four pediatricians responded (response rate, 48%). Compliance with the guidelines was 39% for the 21 day old, 9.6% for the 60 day old, and 75% for the 20 month old. No respondent followed the guidelines for all three infants. Performance of tests to determine if an infant was low risk varied from 3%, for a stool white cell examination in a febrile 2 month old with diarrhea, to 75% for a complete blood count in a 20 month old with a temperature of 40°C. Compliance did not differ between private and academic practitioners. Those in practice less than 5 years (n = 22) were more likely than those with more experience to follow the guidelines for the 21 day old but not the other two infants.

Conclusion. Primary-care pediatricians in Utah manage febrile infants with fewer laboratory tests and less hospitalization than recent practice guidelines developed by an expert panel of academic specialists suggest.
Unintentional Perineal Injury in Prepubescent Girls: A Multicenter, Prospective Report of 56 Girls
Authors: Bond G. Randall , Dowd M. Denise , Landsman Ira , Rimsza Mary
Published: December 2021

Objective. To determine the pattern of perineal injuries and frequency of hymenal involvement resulting from unintentional trauma in prepubescent girls.

Design. Prospective, multicenter. Observation by skilled observers. Determination of the circumstance and physical pattern of injury, with specific attention to the hymen.

Setting. Children's emergency department or acute care clinic.

Patients. Tanner stage 1 girls presenting with acute perineal injury. Criteria for unintentional injury: observation of the event or knowledge of the girl's engagement in a risky activity (eg, biking or climbing monkey bars) immediately before the injury.

Results. Fifty-six girls were evaluated. Age range: 1 to 12 years (median, 6 years; mean, 6.2 years). Associations: bicycle, 39%; other outdoor injuries, 25% (climbing apparatus, straddling an object, and falls); indoor injuries, 36% (straddling furniture and falls). Most injuries were minor. In each group the labia minora was the most frequent structure involved. The majority of injuries were anterior or lateral to the hymen. However, in 34% some or all of the injuries were posterior to the hymen. Thigh injuries were observed only in older children engaged in bicycle riding or outdoor play. In only one patient was the hymen involved. That patient was a 2 year old who fell outdoors, at a park, abducting her legs in a splits-type mechanism. She had a pinpoint abraded area on the hymenal surface at three o'clock. Otherwise, no unique pattern of injury was associated with age or circumstance of injury.

Conclusions. Hymenal injuries are rarely the result of unintentional injury. The presence of a hymenal injury should suggest sexual abuse. Involvement of other perineal structures was commonly associated with unintended injury. Given the limited resources for prevention, the relative infrequency of perineal injuries and the minor nature of most of these injuries, significant preventive efforts are not justified.
US SETS RULES ON AU PAIRS
Authors: L. J. F.
Published: December 2021

The Clinton Administration issued new regulations today for the nation's 10,000 foreign in-home child-care workers that set new standards for those who care for children under 2 years old. ... the rules also require families employing the au pairs to pay them a weekly stipend of $115, up from the current $100 ...the agency will require that an au pair caring for children have at least 6 months' experience or training in infant care ... The new regulations bar au pairs from caring for children under 3 months old. To reinforce the educational aspects of the program, the regulations require au pairs to take at least 6 hours of college credit courses. Families must pay up to $500 for education for an au pair ...
CONGRESSIONAL STUDY QUESTIONS VALUE OF OUTCOMES RESEARCH
Authors: L. J. F.
Published: December 2021

The 320-page report, "Identifying Health Technologies that Work: Searching for Evidence," by the Office of Technology Assessment, has significant implications for both researchers and health policy makers ...

The Office of Technology Assessment found that the hopes for effectiveness research are not misplaced, but they have been overly optimistic and often misdirected, the report concludes. It will not necessarily reduce health care costs significantly ... The analysis of large databases ... has proved not to be a particularly useful tool in providing valid, believable answers about comparative effectiveness. The report suggests that experimental research based on randomized, controlled trials might provide more valid results.

Clinical practice guidelines themselves came under fire in the Office of Technology Assessment report because of how they are developed and disseminated. Simply issuing them to physicians often has no effect, and unless they promote "extremely compelling" practices or are issued by credible organizations, they may have the unintended effects as clinicians try to circumvent them ...

The report is available for $20 from the US Government Printing Office. S/N 052-003-01389-4. Call 202/512-1800.
Invasive Fungal Dermatitis in the ≤1000-Gram Neonate
Authors: Rowen Judith L. , Atkins Jane T. , Levy Moise L. , Baer Susan C. , Baker Carol J.
Published: December 2021

Objective. In 1991, we noted the emergence amongst our extremely low birth weight neonates of a new clinical entity, invasive fungal dermatitis, characterized by erosive, crusting lesions and a high rate of subsequent systemic fungal infection. We sought to define this condition and examine potential risk factors.

Methods. Sixteen neonates with invasive fungal dermatitis were seen during a 2-year period in three Baylor College of Medicine affiliated intensive care nurseries. Seven were confirmed cases, with skin biopsy evidence of invasion beyond the stratum corneum. Nine had a consistent clinical course and a positive potassium hydroxide examination of skin scrapings or isolation of fungi from skin or systemic cultures. Three controls were matched to each case by hospital, date of admission, and birth weight Data was collected by retrospective chart review.

Results. Invasive fungal dermatitis occurred in 5.9% of at-risk infants. Case patients had a mean birth weight of 635 g and developed skin lesions at a mean age of 9 days (range, 6 to 14). Candida albicans was the most commonly implicated pathogen, but other Candida species, Aspergillus, Trichosporon beigelii, and Curoularia were also seen. Disseminated infection occurred in 69%, all due to Candida sp. Case patients were significantly more premature than controls (mean gestation, 24.4 vs 25.9 weeks) and were more likely to be delivered vaginally (81% vs 50%). Postnatal steroids were administered to cases (81%) more often than controls (46%). Case patients had more prolonged hyperglycemia (as assessed by insulin administration) than controls (mean 4.3 vs 2.0 days).

Conclusions. Invasive fungal dermatitis is a disease of the smallest, most immature neonates and is associated with vaginal birth, steroid administration, and hyperglycemia. We speculate that the skin serves as a portal of entry for colonizing fungal species and may thus lead to disseminated infection. Methods to improve skin barrier function may be useful in preventing this disorder.
Neonatal Pulmonary Mechanics and Oxygenation After Prophylactic Amnioinfusion in Labor: A Randomized Clinical Trial
Authors: McEvoy Cindy , Sardesai Smeeta , Macri Charles , Paul Richard , Durand Manuel
Published: December 2021

Objective. Amnioinfusion has been reported to improve the perinatal outcome of pregnancies complicated by decreased amniotic fluid volume, but detailed information on its possible adverse effects on neonatal pulmonary mechanics and oxygenation is not available.

Study design. We evaluated 42 infants with birth weights of 2600 to 4320 g and gestational ages of 36 to 44 weeks, who were born to mothers enrolled in a prospective, randomized trial of amnioinfusion for oligohydramnios in labor. Maternal entry criteria were gestational age 36 weeks or older, estimated fetal weight more than 2500 g, oligohydramnios defined as an amniotic fluid index of 5 cm or less, and a normal fetal heart rate pattern. Evaluation of pulmonary mechanics and oxygen saturation (SaO2) was done with the infants breathing room air between birth and day 3 of life. Transpulmonary pressure, flow, and tidal volume were recorded simultaneously, and pulmonary resistance and lung compliance were calculated. SaO2 was measured for 30 minutes with the Nellcor N-200 oximeter and IBM computer oximetry software.

Results. Evaluation of the data revealed no significant difference between the two groups for tidal volume, lung compliance, pulmonary resistance, or work of breathing. There were no differences between the two groups in the number of desaturation episodes or in percent of desaturations to less than 90%, 85%, or 80% SaO2.

Conclusion. Prior studies have shown amnioinfusion to improve perinatal outcome. Our findings demonstrate that amnioinfusion for oligohydramnios in labor does not adversely affect neonatal pulmonary mechanics or oxygenation.
Acute Isoniazid Neurotoxicity in an Urban Hospital
Authors: Shah Binita R. , Santucci Karen , Sinert Richard , Steiner Phillip
Published: December 2021

Objectives. To describe the presentation and treatment of acute isoniazid (INH) neurotoxicity appearing at an inner-city municipal hospital.

Design. Case series.

Participants. Seven patients (eight patient visits) with an age range of 5 days to 14.9 years.

Results. At our institution, no children appeared with acute INH neurotoxicity in the period 1985 through 1990, whereas seven patients were treated from 1991 through 1993. This paralleled the rise in the number of children with tuberculous infection and disease seen at our institution, from an average 96 per year to 213 per year during these two time periods. All seven patients were receiving INH daily for tuberculosis (TB) prophylaxis. Accidental ingestion (five episodes) and suicidal attempts (three episodes) accounted for these visits. The total amount ingested range from 14.3 to 99.3 mg/kg (mean, 54 mg/kg). All but one patient presented with afebrile seizures. One patient presented twice with seizures. Acute INH neurotoxicity was not suspected on the first admission; however, when readmitted 4 weeks later with another seizure, the diagnosis of acute INH neurotoxicity was made.

Intervention. Intravenous pyridoxine was used in five episodes. Because it was not a stocked item in our pediatric emergency cart (as well as at another hospital, necessitating a transfer of a patient with refractory seizures to our hospital), the average delay was 5.8 hours (range, 1.3 to 13 hours) before it was given. Two patients with refractory seizures failed to respond to anticonvulsants, and their seizures were controlled only after parenteral pyridoxine.

Conclusions. We have seen an increased incidence of acute INH neurotoxicity because of the resurgence of TB in New York City. Others as well may see a similar rise based on local trends in TB infection and disease. Acute INH toxicity should be suspected in children presenting with seizures with or without fever. In patients with a known access to INH, seizures should be considered to be caused by INH toxicity unless proved otherwise. Parenteral pyridoxine, the specific antidote for INH-induced refractory seizures, should be readily available in every emergency department in the areas similarly experiencing increasing trends of TB.
Buffered Lidocaine: Analgesia for Intravenous Line Placement in Children
Authors: Klein Eileen J. , Shugerman Richard P. , Leigh-Taylor Kate , Schneider Carol , Portscheller Dawn , Koepsell Thomas
Published: December 2021

Objectives. To evaluate the effectiveness of intradermal buffered lidocaine as analgesia before intravenous line (IV) placement in children.

Methods. This was a randomized clinical trial undertaken in the emergency department (ED) of a regional children's hospital. Participants were children 8 to 15 years old, seen in the ED and in need of IV lines. They were enrolled by three ED nurses. Participants were randomized to receive either intradermal buffered lidocaine or no analgesia. Before placement of the IV line, patients recorded the amount of pain they were in (baseline pain) on a visual analog pain scale. The primary outcome measure was amount of pain caused by the initial IV attempt, even if that attempt was unsuccessful. This was recorded by the participant on a visual analog scale. Demographic characteristics, the number of attempts to successful placement, and the time required to place the IV line were also recorded. Differences in pain of initial IV attempt and time to place the IV line were evaluated with the Mann-Whitney U test. Differences in success of IV line placement were evaluated with the χ2 test.

Results. Fifty-nine patients completed the study. Thirty received buffered lidocaine, and 29 received no analgesia before IV line placement. There was no significant difference between the two groups with regard to baseline pain or demographic characteristics. The median level of pain of the initial IV attempt as measured by the visual analog scale was 2.3 in the buffered-lidocaine group and 4.4 in the no-lidocaine group. Thirty-three percent of patients in the lidocaine group and 28% percent in the no-lidocaine group required more than one IV attempt. The median time to IV line placement was 10 minutes in the lidocaine group and 6 minutes in the no-lidocaine group.

Conclusions. Use of intradermal buffered lidocaine is an effective way to diminish the pain of IV line placement in children 8 to 15 years of age. There was no difference in IV success rate in this study; however, larger numbers of patients would be required to detect statistically significant differences. We recommend the routine use of intradermal buffered lidocaine for analgesia before IV line placement in older children in all but emergent situations.
THE DIETARY RECOMMENDATIONS OF THE AMERICAN ACADEMY OF PEDIATRICS
Authors: Gaul G.
Published: December 2021

The AAP cannot logically embrace two contradictory positions put forward by their 1992 Committee on Nutrition: 1) recommending 30% of energy from fat but 2) not one percentile less. Although a population nutrient goal of 30% of energy from fat is reasonable for adults, because ingestion of this amount of energy from fat will not jeopardize their growth, this guideline developed from studies of adults (mostly males) does not and should not apply to children. Because this goal was recommended for children by the 1992 Committee on Nutrition it is obvious that, if implemented, some children will be at risk for growth failure. The pediatricians in Canada have solved this problem by recommending a tapering decrease of fat intake from 50% of energy from fat at age 2 years to 30% by the time of the conclusion of linear growth (ie, adolescence) (11).
Screening for Retinopathy of Prematurity—A Problem Solved?
Authors: Flynn John T. , Sola Augusto , Good William V. , Phibbs Roderic H.
Published: December 2021

In the United States there are about 4 million births annually,1 of which about 10% are premature. The percentage of premature births has increased over the last decade2 and every year there are >20 000 infants whose birth weight is 1250 g or under who survive beyond 28 days of life.3 An additional 32 000 surviving infants weigh between 1251 and 1500 g at birth. Both birth weight strata contain, by all that we know about the disease, infants at the highest risk for the development of retinopathy of prematurity (ROP). If infants of these birth weights are to be examined by ophthalmologists competent to perform indirect ophthalmoscopy on these tiny prematures, an average of 6 times during the period of highest susceptibility for the development of threshold ROP4 disease—32 to 40 weeks postconceptional age5,6—then we are talking about ±300 000 such examinations per year in the neonatal intensive care units across this country.
Does Hunger Cause Obesity?
Authors: Dietz William H.
Published: December 2021

Both hunger and obesity occur with an increased frequency among poorer populations in the United States.1-6 Because obesity connotes excessive energy intake, and hunger reflects an inadequate food supply, the increased prevalence of obesity and hunger in the same population seems paradoxical. Although a variety of environmental, social, behavioral, or physiologic mechanisms could cause both problems independently, an alternative possibility is that hunger and obesity are causally related. The following case report supports this hypothesis.

CASE REPORT

A.B. (not her real initials) was a 7-year-old African American girl first brought to the Weight Control Program of the Boston Floating Hospital in December 1992.
Fatal Intramuscular Bleeding Misdiagnosed as Suspected Nonaccidental Injury
Authors: Wetzel Randall C. , Slater Anthony J. , Dover George J.
Published: December 2021

The syndromes of child abuse or non-accidental injury (NAI) are readily recognized. The frequency of NAI requires that it be considered in any child who has been, or appears to have been, traumatized. Nevertheless, great care must be exercised to avoid the parental anxiety and stress that may result from the mistaken diagnosis of child abuse.1 Many conditions mimic NAI, and even well-described ones may be overlooked due to their present rarity.

CASE REPORT

This 10-week-old female infant was comatose, hypotensive, with poorly perfused extremities, and had received cardiopulmonary, resuscitation (CPR). She was the first-born child of a 24-year-old Hispanic mother and a 32-year-old Jewish father.
Inhaled Nitric Oxide Treatment for Stabilization and Emergency Medical Transport of Critically Ill Newborns and Infants
Authors: Kinsella John P. , Schmidt Jeffrey M. , Griebel Jeff , Abman Steven H.
Published: December 2021

Stabilization and transport of critically ill newborns and infants is a vital component of regionalized care. With the advent and proliferation of new therapies for the management of severe hypoxemic respiratory failure, emergency medical transport to tertiary care centers increasingly requires novel transport innovations. Inhaled nitric oxide (NO) therapy has been used in the management of severe persistent pulmonary hypertension of newborns (PPHN) and of hypoxemic respiratory failure in older pediatric patients.1-5 We report the use of inhaled NO therapy during transport in six patients with critical hypoxemia. This report describes a practical approach to stabilization and transport of critically ill newborns and infants using inhaled NO.
Injuries Associated With Infant Walkers
Authors:   Committee On Injury And Poison Prevention
Published: December 2021

Infant walkers, or baby walkers, generally consist of a wheeled base supporting a rigid frame that holds a fabric seat with leg openings and usually a plastic feeding/play tray. The two basic types of walkers include the X frame, in which the steel support bars form an X, and the circular frame, in which the support bars rise vertically from the circular base to the tray. The device is designed to support a preambulatory infant, with feet on the floor, and allow mobility while the infant is learning to walk. Some walkers are equipped with bouncing mechanisms, activity toys, or locking devices that keep them from moving, and some fold flat for storage.

Estimated annual sales of walkers are over 3 million.1(pp72-86) Studies have found that between 55% and 92% of infants between 5 and 15 months of age use walkers.2-6 Parents give various reasons for using walkers-to keep the infant quiet and happy, to encourage mobility and promote walking, to provide exercise, and to hold the infant during feeding.4,5,7 One third of parents in one study used walkers because they believed that walkers would keep their infant safe.5

According to the National Electronic Injury Surveillance System (NEISS) of the United States Consumer Products Safety Commission (CPSC), 25 000 children, almost all between the ages of 5 and 15 months, were treated in hospital emergency departments in 1993 for injuries associated with the use of infant walkers, at an estimated cost of $90 000 000 annually.1(pp72-86),8 Eleven deaths occurred during the years 1989 through 1993.8
Mitral Valve Prolapse and Athletic Participation in Children and Adolescents
Authors:   Committee on Sports Medicine and Fitness
Published: December 2021

Mitral valve prolapse (MVP) is generally a benign condition characterized by the protrusion of the mitral valve leaflets into the left atrium during systole. The prevalence of MVP in individuals under the age of 18 years is estimated to be 5% but is higher in those with Marfan's syndrome and other collagen vascular disorders.1 A midsystolic nonejection click with or without a late systolic murmur is the auscultatory hallmark of this syndrome. The diagnosis of MVP in children and adolescents should be based primarily on auscultatory findings and not on minor echocardiographic findings.1

The prognosis in children and adolescents with isolated MVP appears to be excellent and complications are rare. In 553 children, aged 15 days to 18 years, who were involved in studies with a follow-up period of 6 to 9 years, the following were reported: subacute bacterial endocarditis (one case), cerebral vascular accidents (two cases), migraine headaches (four cases), and chest pain (12 cases).2,3 Only four cases of sudden death have been reported in patients younger than 20 years of age.1-4

In a study of 103 patients with MVP, 16% were found to have premature ventricular beats during exercise electrocardiography (ECG) (exercise test).3 Thirty-eight percent were found to have premature ventricular contractions (PVCs) on 24-hour ECG (Holter) monitoring. This study, however, does not report the true prevalence of dysrhythmias because all these subjects had been referred to a pediatric cardiologist for evaluation. It is likely that these reported numbers are high because asymptomatic patients are less often referred.
A Note of Caution About the Continuous Use of Colorimetric End-Tidal CO2 Detectors in Children
Authors: Bhende Mananda S. , LaCovey David
Published: December 2021

Colorimetric end-tidal CO2 (ETCO2) detectors (Easy Cap, Nellcor Inc, Hayward, CA) are extremely useful in determining the position of the endotracheal tube (ETT) in the airway and have been validated in animals, children, and adults.1-6 They have not been labelled for use in children weighing 15 kg because of their large dead space of 38 mL.1-3

We have demonstrated in numerous studies that the ETCO2 detector accurately verifies the ETT position in infants weighing >2 kg with spontaneous circulation.1-3
Are You Interested in Telephone Triage Research?
Authors: Poole Steven R.
Published: December 2021

In the fall of 1993, we described our 5-year experience in providing after-hours telephone triage and advice for patients of private pediatricians in metropolitan Denver (The After-Hours Program).1 In the year since our report, we have come to recognize a rapidly growing interest in large scale programs that offer centralized after-hours pediatric telephone triage and advice provided by well-trained nurses using standardized guidelines. In the past year our program has expanded to serve approximately 165 pediatricians throughout Colorado (95% of Denver private pediatricians and 75% of Colorado private pediatricians).
MINNESOTA UNIVERSITY DOCTOR IS CONVICTED OF FALSIFYING DATA IN DRUG STUDY
Authors: L. J. F.
Published: December 2021

MINNEAPOLIS, Aug. 7—A nationally known child psychiatrist has been convicted by a Federal jury of falsifying data in a $250,000 drug study at the University of Minnesota.

Dr. Barry Garfinkel, who is widely respected for his work on suicide among teen-agers, was found guilty on Thursday after a two-week trial in which a former assistant testified that he had told her to "make up" data. The verdict makes him one of the few American scientists ever convicted of a crime in connection with a study of an experimental drug regulated by the Food and Drug Administration.

Dr. Garfinkel, 46, was accused of falsifying reports during a study of Anafranil, an anti-depressant that he tested from 1986 to 1989 on patients with obsessive-compulsive disorders. His research was part of a national study to prove that Anafranil was safe and effective enough to be sold in the United States ...

Prosecutors admit it is rare to seek criminal charges against a scientist in such a case. Since 1978, only 24 doctors, including Dr. Garfinkel, have been convicted of crimes involving tests of new drugs, said Mark Brown, the associate chief counsel for the Food and Drug Administration, which oversees all such research.
Neonatal Immunization: Response to Haemophilus influenzae Type b-Tetanus Toxoid Conjugate Vaccine
Authors: Kurikka Sari , Käyhty Helena , Peltola Heikki , Saarinen Leena , Eskola Juhani , Mäkelä P. Helena
Published: December 2021

Objective. To study the immunogenicity and tolerability of Haemophilus influenzae type b (Hib) conjugate vaccine administered in the neonatal period.

Design. Hib capsular polysaccharide (PS)-tetanus toxoid conjugate vaccine (PRP-T) was given to 120 neonates at 2 days of age, followed by PRP-T or the Hib PS vaccine at 4 months and a PRP-T booster at 14 months. Their anti-Hib PS concentrations were compared with those in children receiving PRP-T at 2 and 4 months or at 4 months.

Results. No serious adverse reactions were noted. The geometric mean concentration of anti-Hib PS at the age of 2 days was 0.34 µg/mL and at 4 months was 0.12 µg/mL. This was significantly more than the concentration in unimmunized infants at this age and 3.5 times more than expected, taking into account the natural decay of transplacentally acquired antibodies. Such a response was not seen in infants with a high (greater than 3.0 µg/mL) neonatal antibody concentration. The PRP-T vaccine given at 4 months elicited an antibody response in all infants and Hib PS in 62%, indicating immunologic priming. At 14 months a higher percentage of the infants who had received PRP-T at 2 days and 4 months than of those who had received PRP-T at 4 months only had anti-Hib PS concentrations greater than 0.15 µg/mL. All infants responded well to the booster at 14 months. There was no evidence of immunologic tolerance.

Conclusions. Neonatal immunization with PRP-T was safe and well tolerated in Finnish infants, and it would be worthwhile to further study its effects in higher risk populations.
Carbon Dioxide Protects the Perinatal Brain From Hypoxic-Ischemic Damage: An Experimental Study in the Immature Rat
Authors: Vannucci Robert C. , Towfighi Javad , Heitjan Daniel F. , Brucklacher Robert M.
Published: December 2021

Background and Objective. Clinical investigations suggest that premature infants who require mechanical ventilation from respiratory distress syndrome are at increased risk for periventricular leukomalacia if hypocapnia occurs during respiratory management. The question remains as to the contribution of hypocapnia to hypoxic-ischemic brain damage and whether or not hypercapnia is neuroprotective.

Methods. Seven-day postnatal rats underwent unilateral common carotid artery ligation followed thereafter by exposure to systemic hypoxia with 8% oxygen (O2) combined with either 0, 3, 6, or 9% carbon dioxide (CO2) for 2.5 hours at 37°C. Survivors underwent neuropathologic examination at 30 days of postnatal age, and their brains were categorized as follows: 0 = normal; 1 = mild atrophy; 2 = moderate atrophy; 3 = atrophy with cystic cavitation <3 mm; 4 = cystic cavitation >3 mm of the cerebral hemisphere ipsilateral to the carotid artery ligation. The width of the ipsilateral hemisphere also was determined on a posterior coronal section and compared with that of the contralateral hemisphere to ascertain the severity of cerebral atrophy/cavitation. Data were analyzed by linear models.

Results. CO2 tensions averaged 26, 42, 54, and 71 mm Hg in the 0, 3, 6, and 9% CO2 exposed animals, respectively, during systemic hypoxia. Blood O2 tensions during hypoxia were not different among the four groups and averaged 34.7 mm Hg. Neuropathologic results showed that 30/38 (79%) rats exposed to 3% CO2 showed either no or mild brain damage compared with 13/33 (39%) controls (0% CO2). Cystic cavitation occurred in only four CO2 exposed rat pups compared with 14 controls (P = .001). At 6% CO2 exposure, all of 20 rat pups showed either no damage or mild atrophy compared with controls (P < .001); and at 9% CO2 exposure, 19/23 (83%) rat pups showed no or mild damage compared with controls (P < .001). The data also showed that the greatest reduction in brain damage occurred in immature rats exposed to 6% CO2 with slightly less protection at 9% CO2 (P = .012), the latter comparable with the severity of brain damage sustained by animals inhaling 3% CO2. Analyses of coronal width ratios at each CO2 exposure provided results comparable with those of the gross neuropathology scores.

Conclusions. The results indicate that in an immature rat model normocapnic cerebral hypoxia-ischemia is associated with less severe brain damage than in hypocapnic hypoxia-ischemia and that mild hypercapnia is more protective than normocapnia. The findings in an experimental model merit further animal investigations as well as a clinical reappraisal of the ventilatory management of sick newborn human infants.