bluuebunny/crossref_metadata_2025 huggingface dataset:
Levothyroxine Poisoning
Authors: WHITE J. DOUGLAS , LITOVITZ TOBY L.
Published: December 2021

To the Editor.—

We read the recent report by Lehrner and Weir1 of acute levothyroxine ingestions with concern. Advocacy of an aggressive approach disregards their own cases as well as the medical literature,2-5 Which contains at least seven cases of acute excessive ingestion of levothyroxine (five of which were overlooked by the authors). These reports repeatedly emphasize "a striking discrepancy between the high concentrations of active hormones and the minor clinical symptoms"4 and "the benign course after massive ingestion of levothyroxine."5
Significance of Growth Modulators in Human Milk
Authors: Gaull Gerald E. , Wright Charles E. , Isaacs Charles E.
Published: December 2021

Human milk contains growth modulators of potential clinical importance to the neonate. Evidence from animal and cell culture models as well as ancillary evidence about their stability and the way some of them are processed for secretion suggest they are probably physiologically significant. Their presence in human milk does not by itself establish their importance; however, it is useful to explore their potential functional roles. Growth modulators present in human milk include: EGF, NGF, certain enzymes, and taurine.
Absorption of Protein and Protein Fragments in the Developing Intestine: Role in Immunologic/Allergic Reactions
Authors: Walker W. Allan
Published: December 2021

An important adaptation of the gastrointestinal tract to the extrauterine environment is its development of a mucosal barrier against the penetration of proteins and protein fragments. To combat the potential danger of invasion across the mucosal barrier the newborn infant must develop within the lumen and on the luminal mucosal surface an elaborate system of defense mechanisms which act to control and maintain the epithelium as an impermeable barrier to the uptake of macromolecular antigens. As a result of a delay in the maturation of the mucosal barrier, newborn infants are particularly vulnerable to pathologic penetration by harmful intraluminal substances. The consequences of altered defense are susceptibility to infection and the potential for hypersensitivity reactions and the formation of immune complexes. With these reactions comes the potential for developing life-threatening diseases such as necrotizing enterocolitis, sepsis, and hepatitis. Fortunately, "nature" has provided a means for passively protectecting the "vulnerable" newborn against the dangers of a deficient intestinal defense system, namely human milk. It is now increasingly apparent that human milk contains not only antibodies and viable leukocytes but many other substances that can interfere with bacterial colonization and prevent antigen penetration.
Determinants of Mother-Infant Interaction in Adolescent Mothers
Authors: Levine Lauren , Coll Cynthia T. Garcia , Oh William
Published: December 2021

Mother-infant interactions of adolescent and nonadolescent mothers are compared, and the impact of maternal age, ego development, education, and child care support on these interactions is examined. Thirty primiparous, white, lower- to middle-class mothers (half ≤17 years) and their healthy full-term infants (8 months) were studied. Interactions were videotaped during face-to-face interactions and teaching sessions. Child care support and ego development were assessed. During face-to-face interactions, only one difference was found between adolescent and nonadolescent mothers: nonadolescent mothers showed more positive affect toward infants. During teaching, nonadolescent mothers talked more, showed more positive affect toward infants, and demonstrated tasks more often. Individual differences during face-to-face interactions were more related to mothers's ego development and support whereas teaching interactions were mostly associated with maternal age. Thus, maternal age was a stronger predictor of interactive style during teaching. This may partially explain noted cognitive deficits in infants of teenage mothers. However, individual differences among all mothers in ego development, education, and support were significantly related to interactions. Thus, teenage mothers with less education and support and lower ego development may represent a higher risk subgroup of adolescent mothers providing less optimal care-giving environments for their infants.
Management of the Newborn with Myelomeningocele: Time for a Decision-Making Process
Authors: Charney Edward B. , Weller Susan C. , Sutton Leslie N. , Bruce Derek A. , Schut Luis B.
Published: December 2021

The relationship between time of surgical intervention and eventual outcome was examined in 110 newborns with myelomeningocele. Numerous earlier reports have cited a significant increase in mortality and morbidity associated with delay of surgery beyond 48 hours. Within the study population of infants, 52 infants (47%) had "early" surgery within the first 48 hours of life, 32 infants (29%) had "delayed" surgery between 3 and 7 days of age, 12 infants (11%) had "late" surgery between 1 week and 10 months of age, and 14 infants (13%) never had surgery by parental decision. Survival rates were similar between those with early, delayed, or late surgery as 92%, 94%, and 100%, respectively, were alive at age 10 months. Also, no significant association existed between time of surgery and development of ventriculitis, developmental delay, or worsening of paralysis. From these observations, it is concluded that there is no urgency in surgical intervention for the initial management of newborns with myelomeningocele. Rather, there is time for comprehensive discussions, counseling, and emotional support for those parents in need of a decision-making process before establishing consent for or against surgical management of their newborn.
Relationship of Prolonged Pharmacologic Serum Levels of Vitamin E to Incidence of Sepsis and Necrotizing Enterocolitis in Infants with Birth Weight 1,500 Grams or Less
Authors: Johnson Lois , Bowen Frank W. , Abbasi Soraya , Herrmann Nira , Weston Marian , Sacks Linda , Porat Rachel , Stahl Gary , Peckham George , Delivoria-Papadopoulos Maria , Quinn Graham , Schaffer David
Published: December 2021

The incidence of culture-proven neonatal sepsis and necrotizing enterocolitis (NEC) in preterm infants maintained at pharmacologic (mean 5.1 mg/dL ± 1.45 SD) serum vitamin E levels for long periods was prospectively studied as part of a double-masked clinical trial of the effect of prophylactic vitamin E v placebo treatment on the development and course of retinopathy of prematurity (ROP). Within a few days of birth, 914 preterm infants were enrolled in the study; 545 (275 placebo-treated infants, 270 vitamin E-treated infants had birth weight of 1,500 g or less. A significant difference in incidence of neonatal sepsis (17 placebo-treated infants, 37 vitamin E-treated infants) and NEC (18 placebo-treated infants, 32 vitamin E-treated infants) was observed among infants who had been treated for eight or more days and who had developed neither sepsis nor NEC before that time. The association of vitamin E treatment with increased incidence of disease was much higher with sepsis than with NEC. The most likely reason for these observations is a pharmacologic serum vitamin E-related decrease in oxygen-dependent intracellular killing ability which results in a decreased resistance to infection in preterm infants. The data suggest that, if this occurs, it is clinically significant only in the more immature infants. In view of the known variability of absorption of oral vitamin E and the association between high serum vitamin E levels and increased incidence of sepsis and late-onset NEC reported here, it can be concluded that serum vitamin E levels must be monitored when supplemental vitamin E is administered to premature infants, especially those with birth weight 1,500 g or less. The risk-benefit ratio of long-term treatment using vitamin E at high serum levels should be clearly assessed.
Long-Term Protective Immunity of Recipients of the OKA Strain of Live Varicella Vaccine
Authors: Asano Yoshizo , Nagai Takao , Miyata Takao , Yazaki Takehiko , Ito Shigemitsu , Yamanishi Koichi , Takahashi Michiaki
Published: December 2021

In spite of close contacts with patients who had varicella, 101 of 106 (95%) healthy and sick children (142 of 147 (97%) exposures of these children) who had received the OKA strain of live varicella vaccine 7 to 10 years earlier were protected against the disease completely. Among them, 37 of 38 (97%) vaccine recipients who received immunologic testing had varicella-zoster virus (VZV) antibodies tested by fluorescent antibody to membrane antigen method with a geometric mean titer of 1:9.3, and 37 of the 38 (97%) showed positive skin reaction to varicella-zoster virus antigen with erythema (mean diameter 13.4 mm). These findings were compared with those for 29 children who had contracted typical varicella 7 to 10 years earlier, whose seropositive rate was 100% with a geometric mean titer of 1:10.5, and 97% of whom (28/29) had positive skin reaction with mean diameter of 12.9 mm. These results indicate that the vaccine-induced protective immunity persists for approximately one decade and is almost equal to the long-term immunity following natural infection.
Auditory Nerve and Brainstem Responses in Newborn Infants with Hyperbilirubinemia
Authors: Nakamura Hajime , Takada Satoshi , Shimabuku Roberto , Matsuo Masafumi , Matsuo Tamotsu , Negishi Hirokuni
Published: December 2021

To assess early bilirubin toxicity, a study was made of auditory brainstem responses in relation to total bilirubin levels as well as unbound bilirubin levels in 56 hyperbilirubinemic infants (total bilirubin ≥15.0 mg/dL) and 24 infants who did not have jaundice. The latencies of wave I at 85 dB HL (hearing level) in hyperbilirubinemic infants were significantly greater than those in the control group. The latencies of wave I and V in hyperbilirubinemic infants with unbound bilirubin levels ≥1.0 µg/dL (group C) were greater than those in the control group and in the hyperbilirubinemic infants with unbound bilirubin levels <0.5 µg/dL (group A) and with unbound bilirubin levels <1.0 µg/dL (group B). There were no significant differences of the wave I-V interpeak latency between the control infants and the hyperbilirubinemic infants. Thirty of the 80 infants showed prolonged peak latencies (greater than the mean ± 2 SD for the control infants) of wave I and/or V in one or both ears. The incidences of the prolonged peak latencies in group B (42%) and group C (89%) were significantly greater than that in the control group (12%). The serial determinations of auditory brainstem responses in infants treated with exchange transfusions revealed that the prolonged peak latencies before exchange transfusion improved at 48 and 96 hours after the procedure for wave I, and at 24, 48, and 96 hours after the procedure for wave V. The interpeak latency of wave I-V did not change with exchange transfusion. These results suggest that the auditory nerve is reversibly damaged in the infants with hyperbilirubinemia, and, in particular, the abnormal auditory brainstem response recordings are more closely related to the unbound bilirubin level than the total bilirubin level.
Neuropsychological Sequelae of Childhood Cancer in Long-Term Survivors
Authors: Copeland Donna R. , Fletcher Jack M. , Pfefferbaum-Levine Betty , Jaffe Norman , Ried Hubert , Maor Moshe
Published: December 2021

In order to assess the effects of various cancer treatments on neuropsychological functioning, 74 long-term survivors of childhood cancer were examined. A comprehensive battery of tests was administered to two CNS treatment groups (irradiated and nonirradiated leukemia and lymphoma patients) and a control group (solid tumor and Hodgkin disease patients receiving no CNS treatment). The CNS-irradiated group obtained lower scores than the other two groups, with significant differences in visual-motor and fine motor skills, spatial memory, and arithmetic achievement resulting in significant differences in IQ scores (VIQ, PIQ, FSIQ). The results are discussed in relation to: (1) the effects of CNS irradiation on cognitive development; (2) the specificity of these effects; and (3) the relationship of age at diagnosis to treatment effects. It is concluded that although there is a general lowering of scores after CNS irradiation, the effect is most pronounced for nonlanguage skills. Age at diagnosis was less important than the type of treatment, with CNS irradiation reducing performance regardless of when cancer was diagnosed. There were indications that children with any type of cancer diagnosed before age 5 years are more likely to have some cognitive difficulties.
Provision of Related Services for Children with Chronic Disabilities
Authors:   Committee on Children with Disabilities
Published: December 2021

The term "related services" is defined in Public Law 94-142, the Education for All Handicapped Children Act of 1975, as follows:

. . . related services means transportation, and such developmental, corrective and other supportive services (including speech pathology and audiology, psychological services, physical and occupational therapy, recreation, and medical and counseling services, except that such medical services shall be for diagnostic and evaluation purposes only) as may be required to assist a handicapped child to benefit from special education, and includes the early identification and assessment of handicapping conditions in children.

Under PL 94-142, all handicapped children are to have available to them "a free, appropriate, public education which includes special education and related services to meet their unique needs." Such services are to be provided at no cost to the child or family in conformity with an Individual Education Plan.

PROBLEMS

In the implementation of PL 94-142, the physician's role in providing related services has been narrowly defined as meaning:

. . . services provided by a licensed physician to determine a child's medically related handicapping condition which results in the child's needs for special education and related services.

This definition fails to recognize the physician's potential role in the supervision, program planning, medical management, and monitoring process.

According to the definition, the physician's role in the delivery of related services has become limited to diagnosis. Little physician input is sought on treatment-related issues. As a result, the delivery and coordination of related services have posed a serious problem.1,2
Effect of Sleep State and Position on the Incidence of Obstructive and Central Apnea in Infants
Authors: Orr William C. , Stahl Monte L. , Duke James , McCaffree Mary Anne , Toubas Paul , Mattice Cynthia , Krous Henry F.
Published: December 2021

Sixty-four infants with a history of apnea were studied to determine the effects of sleeping position and sleep state (rapid eye movement [REM]) v (nonrapid eye movement [NREM]) on the occurrence of central and obstructive apneas. All-night polysomnographic studies were conducted on each infant, and the spontaneous occurrence of central and obstructive apneic events was determined in the prone, supine, and side positions. Sleeping position did not significantly affect the rate or duration of central or obstructive apneas. Furthermore, neither central nor obstructive apneic episodes were significantly altered by sleep state. These data suggest that, in spite of an ostensible predisposition to upper airway obstruction in the supine position and during rapid eye movement sleep, neither sleeping position nor sleep state appears to affect the rate of duration of apneic events.
Hyperresponsiveness of Cough Receptors in Patients with Bronchial Asthma
Authors: Mitsuhashi Masato , Mochizuki Hiroyuki , Tokuyama Kenichi , Morikawa Akihiro , Kuroume Takayoshi
Published: December 2021

The hyperresponsiveness of cough receptors was evaluated using the acetic acid inhalation test in healthy adults, patients with bronchial asthma, and children with or without cough. The concentration of acetic acid inducing cough was more than 20% in all 16 healthy adults and 18 children in the control group. There were two groups of asthmatic patients: Those in group 1 showed normal response to more than 20% acetic acid (n = 46), and those in group 2 showed a sensitive reaction to less than 10% (n = 11). Mean age was 9.0 ± 4.2 years in group 1 and 15.1 ± 7.6 years in group 2 (statistical significance, P < .001). Six of 11 asthmatic patients in group 2 were classified as nonallergic asthmatics, whereas only five of 46 patients in group 1 were nonallergic (P < .01). Bronchoconstriction was not induced in any case, in spite of the production of cough. It is suggested that the hyperresponsiveness of individual cough receptors without the stimulation of irritant receptors be evaluated.
Diet-Related Knowledge, Skill, and Adherence Among Children with Insulin-Dependent Diabetes Mellitus
Authors: Lorenz Rodney A. , Christensen Nedra K. , Pichert James W.
Published: December 2021

The dietary adherence of a sample of 97 patients with insulin-dependent diabetes mellitus has been quantitatively described. Now, in an effort to understand the poor dietary aherence found, diet-related knowledge and skill and their relationship to dietary adherence among 90 diabetic children have been studied. Diet-related competencies assessed were the ability to: (1) recall the personal diet plan, (2) correctly fill one's plate from a buffet, with the diet plan in hand, and (3) choose an appropriate meal from a restaurant menu. Adherence to the diet was assessed by unobtrusive observations at meals. Error rates on the three tests of knowledge and skill were .21, .28, and .51, respectively. The mean error rate at mealtime was .35, only slightly higher than the error rate for filling a plate when the children knew they were being tested. In a multiple regression analysis, age (r = .37) and sex (R = .48) were associated with adherence to the diet plan. Ability to choose correctly from a menu, duration of diabetes, and ability to correctly fill a plate from a buffet also entered the regression equation (R = .54). The data suggest that many children did not possess the knowledge and skill required for good dietary adherence, regardless of motivation. Health educators may underestimate the complexity of the behaviors expected of chronically ill patients.
Effect of Cost-Sharing on the Use of Medical Services by Children: Interim Results from a Randomized Controlled Trial
Authors: Leibowitz Arleen , Manning Willard G. , Keeler Emmett B. , Duan Naihua , Lohr Kathleen N. , Newhouse Joseph P.
Published: December 2021

Health care expenditures of 1,136 children whose families participated in a randomized trial, The Rand Health Insurance Experiment, are reported. Children whose families were assigned to receive 100% reimbursement for health costs spent one third more per capita than children whose families paid 95% of medical expenses up to a family maximum. Outpatient use decreased as cost-sharing rose for a variety of use measures: the probability of seeing a doctor, annual expenditures, number of visits per year, and numbers of outpatient treatment episodes. Hospital expenditures did not vary significantly among children insured with varying levels of cost-sharing. Episodes of treatment for preventive care were as responsive to cost-sharing as episodes for acute or chronic illness. The results give no reason not to insure preventive care as liberally as care for acute illness.
The Rand Health Insurance Experiment for Children
Authors: HAGGERTY ROBERT J.
Published: December 2021

Results of the Rand Health Insurance Experiment (the largest controlled trial of the impact of different amounts of copayment for child health services ever conducted) published in this issue of Pediatrics1 are a cause for concern among pediatricians. Two questions are posed by these studies. First, is the use of child health services price dependent or, in other words, do children use less health care if there is more out-of-pocket cost? The answer is yes, but mainly for office visits, not hospitalizations, for older children. This finding does not surprise most pediatricians. Most goods and services in our society are sensitive to price.
Cost of Varicella Epidemic
Authors: MILLER PATTI J. , LANDRY SANDRA , SEARCY MARY ANN , HUNT ELLA , WENZEL RICHARD P.
Published: December 2021

To the Editor.—

Nosocomial airborne transmission of varicella has been documented.1,2 The disease is characterized by an incubation period of ten to 21 days with infectivity beginning at approximately one day before the onset of rash.3 On June 27, 1984, a pediatric resident at the University of Virginia Medical Center who was known to be susceptible to chickenpox examined an 18-month-old black male infant with papular, vesicular lesions on his face, upper extremities, back, and groin.
Circulatory Changes in Newborn Lambs with Experimental Polycythemia: Comparison Between Fetal and Adult Type Blood
Authors: Fouron Jean-Claude , Bard Harry , Riopel Lise , de Muylder Xavier , Van Ameringen Marie-Reine , Urfer François
Published: December 2021

Hemodynamic effects of increased hematocrit were compared in two groups of newborn lambs. In the first group (fetal type blood), exchange transfusions were carried out using packed red blood cells obtained from newborn lambs within one to two hours after birth. In the second group (adult type blood), the same procedure was carried out using adult sheep blood. In both groups, hematocrit values ranging between 70% and 80% were reached. The increase in hematocrit caused a decrease in cardiac output due to an increase in peripheral resistance. Pulmonary resistance increased more than systemic resistance. However, the increase in pulmonary resistance was significantly greater in the polycythemic newborn lambs with adult blood. A right-to-left shunt through a patent ductus or a foramen ovale was noted in six of the eight lambs included in this group. On the other hand, none of the seven polycythemic newborn lambs with fetal blood developed signs of right-to-left shunting. It is concluded that during neonatal polycythemia, the level of hematocrit is not the sole factor responsible for the hemodynamic changes observed. Other unknown influences related either to the red cells or the plasma must impinge upon the pulmonary circulation to alter vascular resistance.
Assessing Children's Blood Pressure—Considerations of Age and Body Size: The Muscatine Study
Authors: Lauer Ronald M. , Burns Trudy L. , Clarke William R.
Published: December 2021

Blood pressure was assessed in 4,207 children, aged 5 to 18 years, examined in the schools of Muscatine, Iowa during 1981. Overall, 69.9% of the age-sex-specific quintiles and height-sex-specific quintiles of systolic blood pressure were identical. In only 1.0% of children did these quintiles differ by more than one. Children whose blood pressure was in the highest quintile for both age and height were more obese than their peers. Those whose blood pressure was high for age but not for height were proportionately taller and heavier than their age peers. Children whose blood pressure was high for height but not for age were older, shorter, and lighter. Thus, having precocious levels of blood pressure for age during childhood is associated with excessive body weight or precocious height, whereas having high blood pressure for height but not for age is associated with being short for age. The latter suggests that age may be a factor independent of height and weight affecting blood pressure level in childhood. These relationships of body size and age to blood pressure must be considered when evaluating children's blood pressure levels in the clinical setting, and a technique for doing so is presented.
A CHALLENGE TO RUDENESS
Authors: Student
Published: December 2021

On the subject of manners for children, many adults believe that the opposite of `polite' is `creative.' Poor little mannerly children, they think—how suppressed and inhibited they must be. Actually, the opposite of `polite' is `rude.' If you think rude children are better off emotionally than well-behaved ones, you are in luck, because there are so many of them around . . ." With these words, the inimitable Miss Manners throws down her impeccably white glove in the cause of civilizing the world in one generation.
PARENTS' RIGHT TO DECIDE
Authors: Student
Published: December 2021

Dave and Debbie Bailey, a couple in Orange, Calif., were given 45 minutes to decide the fate of the 20-ounce infant that had just been born to them 16 weeks prematurely. Knowing that most such infants die eventually, and that half of the survivors suffer some handicap, they tearfully resolved to let nature take its course. But their doctor obtained a court order to continue treatment to keep the infant alive at any cost. As Andrew Malcolm of The Times reported, the hospital's ethics committee backed the doctor in every respect except allowing the parents to believe their choice would be decisive. . . .

No baboon heart could have been implanted in Baby Fae if her parents had denied consent. Why should not the Baileys have had the same veto over the rescue of their child? . . . Like Procrustes, who stretched or cut his guests to fit a single-size bed, public policy seems to accord all infants an absolute right to life, not just by divine will but by all conceivable medical heroics. Parents can be given too much choice, but none at all seems too little.
Symptomatic Gastroesophageal Reflux Following Gastrostomy in Neurologically Impaired Patients
Authors: Mollitt Daniel L. , Golladay E. Stevers , Seibert Joanna J.
Published: December 2021

Utilizing the sequence of contrast radiography, gastric technetium scintigraphy, and 24-hour pH probe, 30 of 46 (65%) neurologically impaired patients, referred for feeding gastrostomy, were demonstrated to have gastroesophageal reflux and underwent a Nissen fundoplication and gastrostomy. There was no evidence of reflux in the remaining 16 (35%) and a gastrostomy alone was performed. Four infants (aged 2 to 13 months) subsequently developed progressive vomiting from 2 to 8 months following gastrostomy placement. Repeat evaluation documented postoperative reflux in three. All four underwent a Nissen fundoplication with relief of their symptoms. Gastroesophageal reflux following gastrostomy may have been produced by an alteration in anatomy or progressive neurologic dysfunction. In all likelihood, however, it was present but undetected preoperatively. An antireflux procedure was required following gastrostomy in 25% of neurologically impaired patients with an initial negative reflux evaluation. Additionally, primary fundoplication in this group was associated with 10% incidence of recurrent symptoms. The high incidence of postoperative reflux, as well as the morbidity associated with gastrostomy in face of gastroesophageal reflux, warrants careful follow-up of the brain damaged patient with feeding gastrostomy.
MALABSORPTION OF KNOWLEDGE
Authors: Student
Published: December 2021

Scientists, including those who speak most eloquently to the public, are continually saying "We must known more." This is true, of course, but the muted conviction that this in itself will save us is false. Knowledge does not automatically order itself in human terms, and if this is true of science generally, it is all the more true of the sciences of human behavior. More startling, and contrary to the workaday beliefs of most scientists, knowledge does not even always accumulate, in the simplest, additive sense. A few years ago a colleague of mine came back from a conference on information retrieval where one of the speakers argued (using, of course, calculation) that for some of the knowledge unearthed by scientists of the past, it would be cheaper to rediscover it than to retrieve it. Imagine, if you will, the wave of uneasy movement that might have rippled through the graves of dead scientists at that argument: For some, the work to which they devoted their lives was not merely wrongheaded—this they were prepared for—it was, even when right, never absorbed in the body of human knowledge.
Oral Rehydration Therapy for Acute Diarrhea in Ambulatory Children in the United States: A Double-Blind Comparison of Four Different Solutions
Authors: Santosham Mathuram , Burns Barbara , Nadkarni Vinay , Foster Stephan , Garrett Steven , Croll Larry , O'Donovan J. Crosson , Pathak Radha , Sack R. Bradley
Published: December 2021

Oral rehydration solutions containing 50 to 90 mmol/L of sodium have recently been recommended for the treatment of diarrhea in both hospitalized and ambulatory children in the United States. Few data are available, however, from ambulatory US children. Therefore, we conducted a randomized double-blind study comparing the use of four different oral rehydration solutions with differing concentrations of sodium, glucose, and base. Ambulatory children less than 2 years of age with acute diarrhea (N = 140) were randomly chosen to receive solutions containing sodium at 90 (solution A), 50 (solution B), and 30 mmol/L (solutions C and D). All oral rehydration solutions contained 20 g/L of glucose except solution D which contained 50 g/L of glucose. Solution A contained bicarbonate as its base source whereas the other three contained citrate. All but three (98%) children were treated uneventfully according to the study protocol, and there were no differences among groups in measurements of clinical outcome. It was concluded that in ambulatory US children, oral rehydration solutions containing 90, 50, or 30 mmol/L of sodium can be used safely for the treatment of mild acute diarrhea and that citrate is as efficacious as bicarbonate in the correction of acidosis.
Demographic Analysis of Childhood Pedestrian Injuries
Authors: Rivara Frederick P. , Barber Melvin
Published: December 2021

Factors in a child's living environment and socioeconomic background that contribute to the risk of pedestrian injury were studied. In 1982, in the city of Memphis, there were 210 pedestrian injuries among children aged 0 to 14 years, a rate of 138/100,000 children. The injured child was most often male, with mean age of 7.3 years; the child was usually struck while crossing the street between intersections, most commonly during the hours from 2 to 7 PM. Pedestrian injuries occurred in 81 of the 142 census tracts in the city. Compared with census tracts without reported injuries, these tracts had twice the percentage of nonwhite population, lower household incomes, more children living in female-headed house-holds, more families living below the poverty level, and greater household crowding (all differences significant at P < .01). The single variable of crowded housing per acre best predicted the number of injuries per acre in multiple regression analysis. A group of children who are at high risk of pedestrian injury through increased exposure in the environment was identified. As with many other types of injuries, modification of external factors—in this case, traffic engineering modifications—seems to be the most practical solution.
Atypical Bacterial Infections Explained by a Concomitant Virus Infection
Authors: Dagan Ron , Hall Caroline B. , Menegus Marilyn A.
Published: December 2021

Because both viral and bacterial infections are common during early childhood, dual infections are not unexpected. However, the clinical manifestation of such combined infections may be, difficult to interpret, and they are often misdiagnosed as "atypical bacterial infection." Five patients with concomitant viral-bacterial infections are described. In all five cases, virus detection enabled the physicians to better understand an otherwise puzzling clinical presentation. In view of the recent progress in rapid viral diagnoses and the potential of antiviral drugs, the possibility of dual infection should be investigated more often.
Home Phototherapy Treatment of Neonatal Jaundice
Authors: Eggert Larry D. , Pollary Rodney A. , Folland David S. , Jung August L.
Published: December 2021

A home phototherapy program for healthy, term newborns with hyperbilirubinemia (n = 62) was implemented, and results were compared prospectively with a group of term neonates who met enrollment criteria but were treated in-hospital (n = 55). The purpose of the study was to prospectively assess the feasibility, safety, and effectiveness of home phototherapy in treating uncomplicated neonatal jaundice. Infants were required to be greater than 24 hours old and to weigh at least 2,270 g (5 lb). Enrolling physicians were instructed to select infants whose clinical diagnoses and bilirubin levels allowed an adequate margin of error for a trial of home phototherapy and whose parents were capable of managing the added responsibilities of home therapy. At the time the phototherapy equipment was delivered and set up in their home, parents received extensive instruction, including how to record pertinent ongoing data on a home flow sheet. Serum bilirubin levels were measured at least daily. The preponderant diagnosis listed by enrolling physicians was "physiologic jaundice." No parent reported significant complications, and no infant required rehospitalization. Bilirubin levels decreased as rapidly in the home group as in the hospitalized control group, and duration of treatment averaged 2.8 days. About $18,000 was saved by treating these 62 infants at home compared with in-hospital costs in our community. We found home phototherapy to be a feasible, safe, and effective alternative to in-hospital phototherapy for otherwise healthy, jaundiced infants with motivated and capable parents.
Double-Blind Clinical Trial of Calf Lung Surfactant Extract for the Prevention of Hyaline Membrane Disease in Extremely Premature Infants
Authors: Kwong Melinda S. , Egan Edmund A. , Notter Robert H. , Shapiro Donald L.
Published: December 2021

A prospective, double-blind, controlled trial was conducted to determine whether instillation of an exogenous surfactant into the lungs before the first breath could prevent hyaline membrane disease. The surfactant is calf lung lipid extracted from saline lung lavage. Entry was limited to infants who were 24 to 28 weeks' gestation, who were born at Children's Hospital of Buffalo, and whose mothers had not received betamethasone for more than 24 hours before birth. Treated infants received 3 mL (90 mg) of calf lung surfactant extract instilled into their trachea before the first breath; control infants received 3 mL of normal saline. A prospective scoring system and respiratory support variables were used to compare the groups. At 48 hours of age, only two of 14 calf lung surfactant extract-treated infants (14%) had hyaline membrane disease compared with seven of 13 control infants (54%) (P = .033). Inspired oxygen, mean airway pressure, ventilator rate and ventilator efficiency index were also lower in the treated group during the first 48 hours of life (P < .01 to P < .001). Calf lung surfactant extract instillation at birth appears to be an effective material and method of preventing hyaline membrane disease in extremely premature infants.
"Inactive" Ingredients in Pharmaceutical Products
Authors:   Committee on Drugs
Published: December 2021

Pharmaceuticals often contain agents that have a variety of purposes including improvement of the appearance, bioavailability, stability, and palatability of the product. Excipients frequently make up the majority of the mass or volume of oral and parenteral drug products. These pharmaceutical adjuvants are usually considered to be inert and do not add to or affect the intended action of the therapeutically active ingredient.

Some 773 chemical agents have been approved by the Food and Drug Administration for use as inactive ingredients in drug products.1 Inasmuch as these compounds are classified as "inactive," manufacturers are not presently required to list them on the product label. These ingredients are used for a variety of different purposes (Table 1). Because of the large number of these agents and their frequency of use, practicing physicians have recently become concerned about their possible physiologic effects. The increasing number of reports of adverse effects associated with pharmaceutical excipients2 has led to professional and consumer organizations formally requesting the FDA (Food and Drug Administration) to require complete disclosure on the product label of all substances contained in pharmaceuticals. Problems encountered with "inactive" ingredients, include the following.

ADVERSE EFFECTS OF PHARMACEUTICAL EXCIPIENTS

Benzyl Alcohol

This antimicrobial agent is commonly used as a preservative in many injectable drugs and solutions. A number of neonatal deaths and severe respiratory and metabolic complications in infants have been associated with use of this agent.3-5 In a controlled study, intraventricular hemorrhage, metabolic acidosis, and increased mortality were positively correlated with substantial benzoic acid and benzyl alcohol levels in neonates.6
School-Aged Children With Motor Disabilities
Authors:   Committee on Children With Disabilities
Published: December 2021

Pediatricians are commonly asked to evaluate school-aged children with motor deficits and to participate in the writing of a prescription for physical and/or occupational therapy that is deemed necessary to remediate and/or treat the disability. In the majority of states, physical therapy services are available only through a physician's prescription. Occupational therapy services, on the other hand, are generally available in nonhospital settings (such as in schools) without physician-written prescriptive orders. The problem is as follows: Many of the therapeutic programs developed for the motor-impaired child have not been subjected to careful, scientific evaluations; therefore, it is necessary for the pediatrician to be aware of those therapeutic modalities that have and have not received scientific scrutiny and, also, be cognizant of those that are generally regarded as helpful.1 Furthermore, the physician should be able to help the parents and educators understand what can and cannot be accomplished by a therapy program. 2,3

The first responsibility of the physician is to provide an accurate diagnosis, if possible, and to ensure that the child does not have a progressive disability. The spectrum of static disorders ranges from dyspraxia (clumsiness) to cerebral palsy.4 In addition to the primary neuromotor disorder, all potential associated problems such as learning disabilities, emotional difficulties, and epilepsy must be identified and treatment programs recommended. If the parents, educator, and physician agree that the child's motor difficulties are interfering with his or her educational program, then by law (Public Law 94-142)5 a physical and/or occupational therapy program might be considered to provide assistance in the student's educational endeavors.
Smoking and Asthma
Authors: PEDREIRA FRANK
Published: December 2021

In Reply.—

We thank Dr Berkowitz for his thoughtful response to our paper in the March 1985 issue of Pediatrics. Our study was not designed to address the problem of smoking effect on asthma.

However, a number of investigations have shown that atopic individuals may develop wheezing after exposure to tobacco smoke.1-4 Moreover, several studies have demonstrated that cigarette smoke can cause bronchoconstriction and associated decrease in lung function.5-7 These studies support the clinical impression of Dr Berkowitz that children with asthma will "have less problems if their parents stop or decrease their amount of cigarette smoking."
Childhood Sarcoidosis Manifesting as Juvenile Rheumatoid Arthritis
Authors: Lindsley Carol B. , Godfrey William A.
Published: December 2021

Sarcoidosis in childhood may manifest primarily as arthropathy and uveitis, mimicking juvenile rheumatoid arthritis. The characteristic appearance and course of the inflammation at these sites, particularly the uveitis, is often a major clue to correct diagnosis. These children generally do not have the fulminant systemic manifestations such as pulmonary disease usually ascribed to sarcoidosis.
Girls With Attention Deficit Disorder: A Silent Minority? A Report on Behavioral and Cognitive Characteristics
Authors: Berry C. A. , Shaywitz S. E. , Shaywitz B. A.
Published: December 2021

A sample of girls and boys with attention deficit disorder (ADD) were examined for within-group sex differences and compared with control boys and girls on historical, behavioral, and cognitive characteristics. Profiles of essential and secondary features of ADD support the Diagnostic and Statistical Manual of Mental Disorders nosology for ADD with and without hyperactivity as clinically distinct subtypes of ADD, with the girls and boys with ADD with hyperactivity exhibiting attentional, behavioral, and cognitive impairments, and the children with ADD without hyperactivity exhibiting deficits along an attentional/cognitive axis. Management problems and antisocial behaviors were correlates of hyperactivity, and increased impulsivity was not associated with attentional deficits in the absence of hyperactivity. Within the ADD with hyperactivity group, the girls demonstrated more severe cognitive impairments, particularly in the area of language function, were younger at the time referral for medical attention, and tended to come from families of lower socioeconomic status. Disruptive, uncontrolled behaviors were more frequent among the boys with ADD with hyperactivity. The girls with ADD without hyperactivity demonstrated poorer self-esteem and were significantly older than the boys with ADD without hyperactivity at referral. Girls in both ADD with and without hyperactivity groups were more likely to suffer peer rejection than their male counterparts. The results of this study suggest that girls with ADD may be underidentified and that cognitive deficits have a more prominent role in the identification of girls, whereas behavioral disturbances increase the likelihood of identification for boys.
Foster Care for Child Maltreatment. II. Impact on School Performance
Authors: Runyan Desmond K. , Gould Carolyn L.
Published: December 2021

At least 150,000 children currently reside in foster care in the United States because of child maltreatment. Nearly 15% of all confirmed maltreatment reports record foster care as one of the acute interventions. Yet, the impact of foster care has been largely unexamined. We conducted a historical cohort study of the impact of foster care on subsequent school performances for 114 children placed in foster care because of maltreatment. A comparison cohort was constituted of 106 maltreated children who were similar in age, race, sex, and year of diagnosis but who were left in their homes after report. School records were reviewed for 96 of the foster care children and 69 of the home care children. School attendance had improved for both groups at the time of follow-up nearly 8 years later. Children in school at the time of report who were then placed in foster care missed an average of 15.6% of the school year prior to the report compared with missing only 3.48% of the most recent school year. The children from the comparison group missed an average of 8.5% of the school year prior to their index maltreatment report and 7.2% of their most recent year in school. Forty-four percent of the foster care group achieved average or above average grades on follow-up compared with the passing rate for the home care group of 32% (P = .17). The foster care children were more likely to receive special education services. Overall, both groups were doing poor work in school an average of 8 years after maltreatment report. There appears to be no evidence for a significant rehabilitative effect of foster care as measured by subsequent school performance.
TV and Adolescents
Authors: STRASBURGER VICTOR C.
Published: December 2021

To the Editor.—

We applaud the publication of the Zuckerman and Zuckerman1 article on television and children. It is a subject that has received sparse attention in the pediatric literature. We would like to comment briefly on two important omissions.

1. Adolescents are not specifically mentioned. Although the Zuckermans do mention concerns about violence, stereotyping, decreased school performance, and poor health attitudes, additional areas of concern are the effect of television on adolescents' world-view, their use of alcohol, and their sexual activities.
1984 Milk-Feeding Patterns in the United States
Authors: Martinez Gilbert A. , Krieger Fritz W.
Published: December 2021

This paper presents results of surveys conducted continuously during a period of years to assess the trend in the incidence of breast-feeding. From 1955 to 1984, questionnaires were mailed to a large nationally representative sample of mothers to determine the use of various milks for feeding infants during the first 6 months of life. Data from these surveys demonstrated the resurgence of breast-feeding both in incidence and duration through 1982. From 1982 through 1984, these increases continued but at a markedly reduced level.
Routine Quantitative Blood Cultures in Children With Haemophilus influenzae or Streptococcus pneumoniae Bacteremia
Authors: Bell Louis M. , Alpert Gershon , Campos Joseph M. , Plotkin Stanley A.
Published: December 2021

The potential clinical value of quantitative blood cultures determined by a commercially available lysis-direct plating method was studied in 50 children with either Haemophilus influenzae or Streptococcus pneumoniae bacteremia. The magnitude of bacteremia correlated with the severity of the infection; patients with ≥100 colony-forming units per milliliter were significantly more likely to have meningitis (P < .01, χ2 = 7.5). On the other hand, all patients with S. pneumoniae bacteremia with colony counts lower than 15 colony-forming units per milliliter had "occult bacteremia" with no focus of infection. The data suggest that patients with higher levels of bacteremia have more severe disease. Quantitative blood culture results may be helpful in identifying which children are at risk for invasive disease.
Spermatic Cord Torsion: Diagnostic Limitations
Authors: Stoller Marshall L. , Kogan Barry A. , Hricak Hedvig
Published: December 2021

To distinguish spermatic cord torsion from other intrascrotal pathology, scrotal ultrasound and radionuclide scanning have been highly recommended on the basis of both clinical and experimental studies. We review the data from six patients in whom ultrasound or nuclear medicine examination was misleading. We emphasize that history, physical examination, and urinalysis remain the cornerstones of the diagnosis of spermatic cord torsion. Scrotal ultrasound and nuclear medicine scans are useful adjuncts and are reassuring when in agreement with the clinical picture. However, they are not 100% sensitive or specific, and a negative study should not prevent emergency operative exploration of a clinically suspicious lesion.