bluuebunny/crossref_metadata_2025 huggingface dataset:
Defecation Dynamics
Authors: SCHMITT BARTON D.
Published: December 2021

To the Editor.—

The recent article by Loening-Baucke et al helps our understanding of defecation dynamics. However, her recommendation that "children with encopresis should have their rectal sensation and their ability to defecate balloons evaluated" (p 678) seems like diagnostic overkill.

1. What are normal values for these tests?

2. Will such testing change the diagnosis or etiology? Couldn't the inability to relax the external sphincter during defecation be a consequence of chronic stool holding (due to either painful bowel movements or harsh toilet training) rather than a cause of stool holding? How do you know the children were cooperative during this test?
DECLINE IN MORBIDITY OF LOW BIRTH WEIGHT SURVIVORS NOT YET SHOWN
Authors: Student
Published: December 2021

Hundreds of "follow-up studies" have been published since the early days of neonatal intensive care, and each represents a considerable cost in terms of time and resources. It is unfortunate that only a mere handful of these are based on geographically defined populations since [meaningful] comparisons . . . can only be made through such studies. To date these show that there has been no real change in the level of morbidity among low birthweight survivors. The "important reduction in morbidity," which we would all welcome, is yet to be demonstrated.
Socioeconomic Differentials and Neonatal Mortality: Racial Comparison of California Singletons
Authors: Gould Jeffrey B. , Davey Becky , LeRoy Susan
Published: December 2021

The median family income of the zip code of maternal residence was used to estimate the presence and determine the extent of socioeconomic differentials in the neonatal mortality rates of a cohort of 401,399 white and of 66,577 black Californian singletons born from 1982 to 1983. The neonatal mortality rate in the white infants increased from 3.99 in mothers residing in zip codes with a median family income >$25,000 to 12.1 for mothers residing in zip codes with a median family income <$11,000. With decreasing socioeconomic status there was also a significant increase in the percentage of white infants weighing less than 2,500 g (percentage of low birth weight increased from 3.75 to 8.33) and weighing less than 1,500 g (percentage of very low birth weight increased from 0.56 to 1.46). When the source of the socioeconomic difference in white neonatal mortality was partitioned, 77.4% was due to deterioration in the birth weight distribution and 22.6% to deterioration in birth weight-specific mortality rates. For the black cohort, the neonatal mortality rate increased from 5.9 in the most, to 9.0 in the least affluent strata. Although decreasing residential median family income was associated with an increase in the percent low birth weight (8.19 v 12.86), the percentage of very low birth weight was not significantly different (1.59 v 2.10). When the source of the differential in black neonatal mortality was partitioned, only 29% was due to deterioration of the birth weight distribution, whereas 71% was secondary to less favorable birth weight-specific mortality rates. These findings support the usefulness of zip code median family income to estimate socioeconomic differentials in neonatal mortality and justify the importance of California's statewide program to decrease low birth weight.
Knowledge and Concerns About Acquired Immunodeficiency Syndrome and Their Relationship to Behavior Among Adolescents With Hemophilia
Authors: Overby Kim J. , Lo Bernard , Litt Iris F.
Published: December 2021

The knowledge and concerns regarding acquired immunodeficiency syndrome (AIDS) and their relationship to certain behaviors among adolescents with hemophilia, a pediatric risk group with human immunodeficiency virus (HIV) antibody positivity rate as high as 70% to 90%, are described. Information was obtained from 26 patients, 13 to 19 years of age, through the use of a confidential self-administered questionnaire and a semistructured interview. In general, subjects demonstrated a high level of factual knowledge regarding the cause, natural history, transmission, and prevention of AIDS. Despite this, participants frequently behaved in ways that were potentially harmful to themselves and others. Specifically, although aware of the importance of using condoms, sexually active adolescents with hemophilia were not practicing safe sex. Restriction in the use of heat-treated clotting factor because of concerns about AIDS was also frequently reported. Professionals providing AIDS education and counseling for these individuals need to be cognizant of the concerns and social skills of this population; they should focus not only on factual information but also on the social and situational pressures confronting these teenagers, which may be more immediate determinants of their behavior and well-being. As AIDS continues to spread into the general population, these findings have relevance to AIDS education and health policy efforts aimed at all adolescents.
POLITICIANS SHOULD MEET STANDARDS, TOO
Authors: L. J. F.
Published: December 2021

I read with interest the article concerning the New York panel that wants to have physicians take competency tests for relicensure.

I welcome this effort and would encourage this with one qualification: that our elected officials, especially those at the state and federal levels, have some basic education before governing similar to that required of physicians before practicing medicine. We cannot begin to practice medicine until we have gone through years of rigorous, demanding preparatory education, then must pass competency tests (board exams).

Our elected officials, however, have no such requirements. I would suggest that these elected officials have some basic education in governing and be required to maintain a certain grade-point average before they are permitted to run for office. They should be required to take competency tests concerning world history, economics, human relations, and world affairs. Politicians also should not be exempt from recertification. Certainly, world politics have changed as much or more than anything in the field of medicine.
Brain Lesions and Extracorporeal Membrane Oxygenation
Authors: SHORT BILLIE LOU
Published: December 2021

There are several disturbing statements in the paper by Schumacher et al. The paper is entitled "Right-Sided Brain Lesions. . ." but only eight patients who happened to have right-sided lesions after extracorporeal membrane oxygenation were discussed. The authors implied that intracranial hemorrhages were unusually distributed, with a unique predominance of right-sided lesions. What were the findings in the other 61 patients treated at the University of Michigan? Were there no left-sided or bilaterally distributed lesions in that population? How many infants had neuroimaging studies other than cranial sonography performed to document the presence of intracranial lesions? How can he infer that there is a predominance of right-sided lesions when the authors did not include the acute neurologic, neuroimaging, or followup data in the whole population treated.
OPINION IS NOT GOOD ENOUGH
Authors: Student
Published: December 2021

Clinical freedom is dead, and no one need regret its passing. Clinical freedom was the right-some seemed to believe the divine right—of doctors to do whatever in their opinion was best for their patients. In the days when investigation was non-existent and treatment as harmless as it was ineffective the doctor's opinion was all that there was, but now opinion is not good enough. If we do not have the resources to do all that is technically possible then medical care must be limited to what is of proved value, and the medical profession will have to set opinion aside.

Clinical freedom died accidentally, crushed between the rising cost of new forms of investigation and treatment and the financial limits inevitable in an economy that cannot expand indefinitely. Clinical freedom should, however, have been strangled long ago, for at best it was a cloak for ignorance and at worst an excuse for quackery. Clinical freedom was a myth that prevented true advance. We must welcome its demise, and seize the opportunities now laid out before us.
In Reply: SI Unit Dangers
Authors: ROBERTS ROBERT J.
Published: December 2021

Although the original Committee statement was correct, the two errors pointed out by Dr Perlman were introduced and not caught in the final galley proof reading.

Dr Perlman's point is well-taken and reiterates the Committee's conclusion that drug dosing should continue to be reported in mass units to avoid the possibility of dosing errors. We agree with Dr Perlman and will continue to vigorously oppose this potentially confusing and certainly unnecessary conversion.
TECHNIQUES AND EFFICACY OF SCREENING
Authors: Guthrie Robert
Published: December 2021

The story of newborn screening for inborn errors of metabolism begins with the ideas expressed by Archibald Garrod in 1902. He published a paper called "The Incidence of Alkaptonuria, A Study in Chemical Individuality," in which he showed insight into the inheritance of specific chemical defects in metabolism. This was before any knowledge of enzymes or metabolism existed and was soon after the discovery of Mendel's laws of inheritance. The application of Mendel's laws of inheritance in the human organism was pioneered by Garrod. He originated the phrase "inborn errors of metabolism" that is still used today.

Forty years later, Beedle and Tatum performed their Nobel prize-winning work with the mold Neurospora to demonstrate the "one gene-one enzyme" hypothesis. One of their associates, the late Dr David Bonner, later published a series of papers concerning the case of one auxotroph of Neurospora with two amino acid requirements for isoleucine and valine. This double requirement was found to be due to "internal inhibition": the accumulation of the precursor to one branch-chained amino acid, isoleucine, blocked the conversion of another branch-chained precursor to its amino acid, valine. This phenomenon of "internal inhibition" demonstrated in Neurospora was a prelude to more recent insight into human errors of metabolism, such as phenylketonuria (PKU).

Bickel's publication in 1953 of a dietary treatment for PKU led to a great deal of interest in early treatment of PKU. There were many attempts to set up urine screening programs using the ferric chloride reagent that Folling used in discovering the disease in 1934.
Cellulose Acetate/Citrate Agar Electrophoresis of Filter Paper Hemolysates From Heel Stick
Authors: Schedlbauer Lewis M. , Pass Kenneth A.
Published: December 2021

In 1965, New York State Public Health Law 2500-a was enacted, mandating the screening of all newborns for phenylketonuria. The law was amended in 1974 to include testing for six other conditions, one of which is homozygous sickle cell disease. Originally, all screening was done in four semiautonomous laboratories located in Erie County (Buffalo), Onondaga County (Syracuse), New York City, and Albany County (Albany). These laboratories were set up to receive, test, and report results of all specimens in their respective regions of the state. Between 1981 and 1985, all screening was centralized at the Wadsworth Laboratories of the New York State Health Department in Albany, where in 1986 the newborn screening laboratory tested more than 288,000 specimens. Hemoglobin is screened with the two-tier procedure of Garrick et al: alkaline electrophoresis on cellulose acetate followed by acid electrophoresis on citrate agar.

METHODS/PROCEDURES

The average daily volume of the New York State Newborn Screening Program is 1,200 specimens, but the number of specimens can range from 800 to 3,000 per day. Specimens are collected from infant blood obtained by heel stick on Schleicher and Schuell 903 filter paper. Medical personnel are advised to collect the specimen when the infant is three to five days of age and before any planned transfusion is administered. The specimens are air dried and mailed to the laboratory within 24 hours of collection.

When received in the laboratory accessioning unit, the specimens are examined to determine their suitability for testing. Specimens are screened for sickle hemoglobin only if there is sufficient blood on the filter paper and the date of collection to date of laboratory receipt is less than 14 day.
REVIEWS OF LAY LITERATURE ON CHILD CARE: WHAT PARENTS ARE READING
Authors: Glascoe Frances P. , Moore William R. , Henderson James , Martin Elaine D.
Published: December 2021

Considering development to have multivariate determinants, the authors address child-care issues from womb to adolescence. Parents' roles include controller and arranger of the environment and instructor and guide; identical across parents' gender. Management methods depend on applied behavioral theory, usually reinforcement and punishment. These evolve with the developing child, and are designed to be preventive, instructive, and corrective. Detailed advice is given on a range of child-rearing topics such as immunizations, illnesses, thumbsucking, diaper changing, and toilet training. The social context includes consideration of parents' vulnerabilities, the effects of divorce, sibling rivalry, and the needs of exceptional children. Parents are assisted in finding needed resources and there are no presumptions of family structure or material resources. The reading level is moderate, the book well-organized; thorough and systematic in its coverage of a diverse range of topics. It is indexed in detail. The authors assume no prior knowledge of child-care. Medical content was rated as excellent.
FINE IN AN INFANT DRUG CASE
Authors: Student
Published: December 2021

St. Louis, Jan. 21 (AP)—A pharmaceutical company has been fined $115,000 and a former executive sentenced to six months in a work-release program for marketing an unapproved drug linked to the death of 38 premature babies.

The sentences were imposed Friday by Judge Clyde Cahill of Federal District Court here, which had jurisdiction in the case because the company, O'Neal, Jones & Feldman Pharmaceuticals, now called O'Neal Inc., is based in the St. Louis suburb of Maryland Heights.

O'Neal was the sole distributor of E-Ferol Aqueous Solution, used for treatment of retrolental fibroplasia, a disease that can cause blindness in premature infants exposed to too much oxygen.

The product, which was never tested by the Food and Drug Administration, was introduced in 1983 and recalled in 1984, after reports of infant deaths associated with its use.

The executive who was sentenced Friday is James B. Madison, a 68-year-old former O'Neal vice president for operations, who had pleaded guilty to wire fraud and mislabeling. In addition to the six months in a work-release program, Judge Cahill sentenced him to three years' probation and ordered him to contribute $10,000 to a charity that helps children.

O'Neal, which had pleaded guilty to charges including mail fraud and failure to obtain approval of a new drug application, was ordered to pay $125,000 in court costs in addition to the $115,000 fine.

The sentences were handed down one day after Judge Cahill imposed a $130,000 fine on the drug's now-defunct manufacturer, Carter-Glogau Laboratories of Glendale, Ariz. Its former president, Ronald M. Carter, and O'Neal's former president, Larry K. Hiland, were sentenced to six months in prison by Judge Cahill, who ordered them to contribute $65,000 each toward research on drug safety.

Carter-Glogau, Mr. Carter and Mr. Hiland had all been convicted of conspiracy, marketing and unapproved drug and misbranding the drug.

The two companies and their insurers have reached settlements totaling millions of dollars with the families of children treated with the drug.
Passive Smoking by Asthmatics: Its Greater Effect on Boys Than on Girls and on Older Than on Younger Children
Authors: Murray Andrew B. , Morrison Brenda J.
Published: December 2021

In 415 nonsmoking asthmatic children who were seen consecutively, asthma symptoms were more severe if the mother was a smoker than if she was a nonsmoker. This applied to both sexes but was more marked in boys than in girls. There were also other indications that sons were the more severely affected: the forced expiratory volume at 1 second, the forced expiratory flow rate during the middle half of the forced vital capacity, and the provocation concentration of histamine needed to result in a 20% decrease in the forced expiratory volume at 1 second were significantly decreased only in the sons, and lung function test results were significantly less in sons than in daughters of mothers who smoked. When the 415 children were stratified according to age, lung function improved significantly with increasing age in the children of nonsmokers; in children of smokers, by contrast, symptoms and lung function test results became progressively worse. As well, there was a correlation between these indications of asthma severity and the number of years the child had been exposed to the mother's smoke. It appeared that, compared with girls, boys were more sensitive to passive smoking, and that its adverse effect increased with age and with duration of exposure.
QUO VADIS?
Authors: Student
Published: December 2021

There are growing concerns, among physicians and others in the US, about the impact of [present] policies on medical care costs, on the commercialisation of medicine, and on physician autonomy. As a result of the new market-oriented policies, physicians in the US are now the most litigated-against, second-guessed, and paperwork-laden physicians in western industrialised democracies. Physicians' day-to-day clinical decisionmaking—commonly referred to as clinical freedom—is increasingly subject to review and appoval by "case managers" working for employers, insurance carriers, and government financed and regulated professional review organisations. Malpractice suits and administrative costs are multiplying. The growing adversarial relationship with private and public payers and loss of physican autonomy are closely related to the growing view that medical care should be treated like any other private business.
DRUG USE DECLINES IN U.S. HIGH SCHOOLS
Authors: L. J. F.
Published: December 2021

The nation's high school seniors are using fewer drugs than any class since 1975, a report from the National Institute on Drug Abuse showed.

Researchers said they were particularly encouraged by results showing a drop in cocaine use for the second year in a row, and the beginnings of a reversal in the soaring use of crack, an inexpensive, refined form of cocaine.

However, the war against drugs is far from over, with more than half of all students using an illegal substance at least once before graduating, said Charles R. Schuster, NIDA director. Moreover, drug use remains at a very high level among high school dropouts, he said.

The survey polled 16,300 high school seniors from 135 schools nationwide.
Educational Outcomes and Illness Behaviors of Participants in a Child-Initiated Care System: A 12-Year Follow-up Study
Authors: Lewis Charles E. , Lewis Mary Ann
Published: December 2021

Young adults who participated as children in a study of child-initiated care from 1972 to 1974 and their parents were studied again in 1986. More than 80% of all parents were located and interviewed. Of the 260 young persons located, 71% responded to a questionnaire. Although there was no significant association between being a frequent user of health care in either 1972 to 1973 or 1973 to 1974 and use of care 12 years later, girls who were consistently frequent care users in both school years had a similar pattern of use as young women in 1986. Frequent users as children and young adults had a greater prevalence of headaches and stomachaches, but at both ages boys were less likely to seek care when faced with complaints or perceived health problems. A significant association was found between consistently frequent care use as a child and subsequent academic problems as a young adult. The importance of identifying children with chronic complaints (unrelated to physical causes) and helping them to deal with the true sources of their distress are emphasized by the data.
LIMITATION OF LEARNING BY EXPERIENCE
Authors: Student
Published: December 2021

We should be careful to get out of an experience only the wisdom that is in it—and stop there, lest we be like the cat that sits on a hot stove lid. She will never sit down on a hot stove lid again—and that is well; but also she will never sit down on a cold one anymore.
WHO IS LOST TO FOLLOW-UP?
Authors: Student
Published: December 2021

The belief that impaired infants are more likely to continue in follow-up is. . .not supported. The infant's developmental status significantly influenced loss to follow-up only between the 18-to 36-month time interval. Here, more babies in the dubious (vs abnormal) category withdrew.

In general our findings suggest that environmental characteristics exert the major effect on dropout rates in high risk infants and their controls.
CONSENT: IN RESEARCH AND IN DAILY PRACTICE
Authors: Student
Published: December 2021

It is arguably the case that informed consent requirements have affected human research more deeply than they have the practice of clinical medicine, and that this is so at least in part because informed consent in research has been mandated and monitored by federal controls and regulations that link funding for research to consent procedures. However, it is doubtful that. . . adding review of consent forms to the tasks of utilization review committees would have the same level of impact on clinical medicine as the institutional review board system has had on human research. Institutional review boards are a system of prior, rather than after-the-fact, review they are concerned solely with questions of research ethics; and they are in a position to address questions of voluntariness and competency in a way utilization committees could not.
Unconventional Remedies Used for Patients With Juvenile Arthritis
Authors: Southwood Taunton R. , Malleson Peter N. , Roberts-Thomson Peter J. , Mahy Marguerite
Published: December 2021

While attending arthritis youth camps, 53 patients with juvenile arthritis from Australia (31 patients), New Zealand (4 patients), and Canada (18 patients) completed individual questionnaires concerning their treatment. Between 1 and 8 unconventional remedies (mean 2.6) had been used by 37 (70%) of the patients. The most commonly used unconventional remedies were copper bracelets (68%), diet (43%), and patent medicines (38%). The potential dangers of unconventional remedy use in children are illustrated by three case reports. Professionals caring for patients with juvenile arthritis should be aware that most of them will probably use unconventional remedies at some time.
Prolonged Maternal Fluid Supplementation in Breast-Feeding
Authors: Dusdieker Lois B. , Stumbo Phyllis J. , Booth Brenda M. , Wilmoth Rosemary N.
Published: December 2021

A randomized, crossover study design was used to evaluate the effect of prolonged maternal fluid supplementation on the milk supply of breast-feeding women. A total of 19 well-nourished women whose infants were solely breast-fed and thriving were enrolled when their infants were 90 to 120 days of age. Of this group, 15 women consumed at least a 25% increase in fluids above baseline for 7 days. Mean daily milk production was 767 ± 178 mL for the baseline period and 744 ± 138 mL for the increased fluid period. There was no significant change in milk production between baseline and increased fluid periods. No significant linear relationship between the percentage increase in fluid intake and percentage change in milk production was found.
Predicting Risk for Bronchopulmonary Dysplasia
Authors: DUNN MICHAEL S.
Published: December 2021

As technology and understanding have progressed, allowing perinatologists to save smaller and increasingly immature neonates, there has been an increase in the number of premature neonates requiring prolonged support with assisted ventilation and supplemental oxygen. The term bronchopulmonary dysplasia (BPD) was originally applied to relatively large preterm neonates undergoing a predictable sequence of change from severe respiratory distress syndrome to severe chronic obstructive lung disease.1 This typical pattern is frequently not seen in the ventilator- or oxygen-dependent preterm neonates found in today's neonatal intensive care units. The term BPD is still, however, commonly applied to the condition of prolonged (ie, >28 days) supplemental oxygen dependence in the premature baby.2,3
More on Meconium Aspiration
Authors: WISWELL THOMAS E.
Published: December 2021

In Reply.—

I am intrigued by Dr Karlowicz's proposal that vigorous babies may be insidiously aspirating swallowed meconium. He states it is "imperative" to remove meconium-stained fluid from the stomachs of depressed neonates. Although it seems reasonable that an infant could regurgitate and aspirate meconium-stained gastric contents, I am unaware of any reports which support this conjecture.

Most standard neonatology, perinatology, and pediatric textbooks do not recommend "emptying" the stomach to prevent aspiration. Furthermore, the few resources recommending gastric suctioning do not reference any investigations or anecdotal reports supporting the procedure.
The National Immunization Program of the Netherlands
Authors: Verbrugge Hans P.
Published: December 2021

After a brief explanation of the immunization policy in the Netherlands, the national immunization program is described, with special attention given to coupling of the municipal population records with a computerized database of individual immunization records at the provincial level. The Dutch program achieves coverage rates greater than 90% for all routine immunizations. Participation in the program is free of charge to every child living in the country up to the age of 13 years, but there is no obligation or requirement to be immunized. Financing of the program is also discussed.
Children With Special Needs in the Netherlands: Impaired Hearing, Adolescent Pregnancy, and Myelomeningocele
Authors: Verbrugge Hans P.
Published: December 2021

In the Netherlands, treatment and management of children with special needs is characterized by the absence of financial barriers to care and the existence of a number of specialized services. For hearing-impaired children, there are special audiologic centers and special schools. Adolescents at risk of unintended pregnancy are protected through education and a dedicated system of family planning clinics. Children with multiple handicaps, such as those associated with myelomeningocele, face greater difficulties but still have an array of services available to them at little or no cost. Families are sheltered from excessive expense through social insurance.
Long-Bone Fractures in Young Children: Distinguishing Accidental Injuries From Child Abuse
Authors: Thomas Susan A. , Rosenfield Nancy S. , Leventhal John M. , Markowitz Richard I.
Published: December 2021

While testifying in child abuse cases, physicians have been frustrated by the lawyer who asks, "Doctor, how did this injury happen?" The medical records and radiographs of 215 children younger than the age of 3 with fractures evaluated by a pediatric service during a 5-year period were retrospectively reviewed in an attempt to elucidate the mechanism of childhood fractures. Based on these reviews, two clinicians and two pediatric radiologists rated the likelihood that the fracture was either accidental or due to child abuse. Long-bone fractures were strongly associated with abuse. This report focuses on the 39 children with either humeral or femoral fractures. Fourteen children had humerus fractures. Eleven were considered to be the result of child abuse, and 3 the result of accidents. The latter 3 were supracondylar elbow fractures in children who fell from a tricycle, a rocking horse, or downstairs. Humerus fractures other than supracondylar fractures were all found to be due to abuse. There were 25 femur fractures. Nine were found to be from abuse, 14 were found to be from accidents, and 2 could not be rated. Sixty percent of femur fractions in infants younger than 1 year of age were due to abuse. Although it is taught that femur fractures in young children are inflicted unless proven otherwise, in this study it was found that femur fractures often are accidental and that the femur can be fractured when the running child trips and falls.
Initial Medical Evaluation of an Adopted Child
Authors:   COMMITTEE ON EARLY CHILDHOOD, ADOPTION AND DEPENDENT CARE
Published: December 2021

Providing health care for adopted children always has been a significant part of pediatric practice, and pediatricians have provided services in different areas of the adoption process for many years. Recent changes in adoption prompt a reevaluation of the pediatrician's role in managing the medical care of adopted children and their families.

There has been a gradual shift from viewing adoption as a childless couple's opportunity to find an infant to focusing on the needs of the child first by placing children within families who can help them realize their fullest potential. Increasingly, adoption agencies work with older children and special needs children who have physical handicaps, emotional problems, or chronic medical illness. Private adoptions are often arranged outside of agencies, sometimes with open discussions between birth and adoptive parents. In addition, there are now more than 10 000 international adoptees entering this country each year. The pediatrician must be equipped to evaluate the special needs of all these children and to help their new families integrate them into the family unit.

This statement addresses the initial medical evaluation of adoptive children who may have acute and long-term medical, psychological, and developmental problems because of their genetic, emotional, cultural, psychosocial, and/or medical backgrounds.

Prior to adoption, or at the time of entry into the family, the pediatrician should begin a careful medical assessment of the child and should counsel the family appropriately regarding adoption issues. Pediatricians should be alert to the following potential problems:
Cerebroelectrical Depression Following Surfactant Treatment in Preterm Neonates
Authors: Hellström-Westas Lena , Svenningsen Nils W. , Bell Angela H. , Skov Liselotte , Greisen Gorm
Published: December 2021

During surfactant treatment of respiratory distress syndrome, 23 premature newborns were investigated with continuous amplitude-integrated electroencephalography (cerebral function monitors). Simultaneously, arterial blood pressure and transcutaneous blood gas values were recorded. A short(<10 minutes) but significant decrease in cerebral activity was seen in almost all neonates immediately after the surfactant instillation, in spite of an improved pulmonary function. In 21 of 23 neonates, a transient fall in mean arterial blood pressure of 9.3 mm Hg (mean) occurred coincidently with the cerebral reaction. Neonates in whom intraventricular hemorrhage developed tended to have lower presurfactant mean arterial blood pressure (P> .05), but they had a significantly lower mean arterial blood pressure after surfactant instillation (P < .05). No other differences were found between neonates in whom intraventricular hemorrhage developed and those without intraventricular hemorrhage. The present findings demonstrate that an acute cerebral dysfunction may occur after surfactant instillation. In some vulnerable neonates with arterial hypotension and severe pulmonary immaturity,the fall in mean arterial blood pressure may increase the risk of cerebral complications and could be related to an unchanged rate of intraventricular hemorrhage after surfactant treatment.
Fluoxetine/Norfluoxetine Concentrations in Human Milk
Authors: BURCH KELLY J. , WELLS BARBARA G.
Published: December 2021

Drug therapy for mothers with postpartum depression is complicated by the need to consider the effect of drugs taken by the mother on the nursing infant. In many cases abrupt weaning of the infant is prescribed so that drug therapy may begin, but this may precipitate conflicting feelings of guilt and cause hormonal upset in the mother, both of which may exacerbate the mood disorder. Traditional antidepressants are excreted in human milk, and the effects of these drugs on the infants of nursing mothers are unknown.1 Most of the tricyclic antidepressants have autonomic side effects that may affect both milk
Universal Hepatitis B Immunization
Authors:   Committee on Infectious Diseases
Published: December 2021

HEPATITIS B DISEASE AND EPIDEMIOLOGY

In the United States 200 000 to 300 000 acute infections with hepatitis B virus (HBV) occur each year.1,2 More than one million persons in the United States have chronic HBV infection, and approximately 4000 to 5000 persons die each year from HBV-induced chronic liver disease and hepatocellular carcinoma. Although HBV infections occur during childhood and adolescence, the full impact of these infections is not recognized until many years later when chronic liver disease and hepatocellular carcinoma may develop. The incidence of HBV infection increases rapidly during adolescence, with higher rates among blacks than among whites (Fig 1).3 Although rates vary by region, sex, and race, between 3.3% and 25% of all persons have had HBV infection by 25 to 34 years of age. The likelihood of becoming chronically infected with HBV varies inversely with the age at which infection occurs. HBV transmitted from hepatitis B surface antigen (HBsAg)-positive mothers to their newborns results in HBV carriage for up to 90% of infants. Between 25% and 50% of children infected before 5 years of age become carriers, whereas only 6% to 10% of acutely infected adults become carriers. It is estimated that more than 25% of carrier infants will die from primary hepatocellular carcinoma or cirrhosis of the liver, with most of these deaths occurring during adult life.

HBV infection occurs more commonly in certain populations, including Pacific Islanders, Alaskan Natives, immigrants from countries in which infection is highly endemic, persons who require multiple transfusions of blood or blood products, and persons with high-risk lifestyles, including intravenous drug abuse and contact with multiple sexual partners.
NUTRITIONAL QUALITY OF MILK THERMALLY MODIFIED TO REDUCE ALLERGIC REACTION
Authors: TOMARELLI R. M. , LINDEN ELIZABETH , BERNHART F. W.
Published: December 2021

Rat growth experiments have demonstrated that the impairment of the nutritional quality of milk by the heat treatment required for the preparation of a hypoallergenic product is a result of a destruction of vitamins. Young rats fed heat-treated milk fortified with minerals and all the usual vitamins with the exception of vitamin B12 grow at a suboptimal rate. The addition of liver powder or of a vitamin mixture containing vitamin B12 to the heat-treated milk results in a growth rate equal to that of rats fed unheated milk. The addition of aureomycin to the heat-treated diet, with or without vitamin B12 does not increase the growth rate.
Q-T INTERVAL DURING ACTIVE AND INACTIVE RHEUMATIC FEVER
Authors: FINKEL SIDNEY , BALDWIN JANET S.
Published: December 2021

The Q-Tc in 79 normal children ranging in age from 2 to 12 years was found to be 0.418 with a standard deviation of 0.016.

The Q. Tc was studied in 208 children ranging in age from 3 to 13 years during active rheumatic fever and chorea. One hundred nineteen of these patients were subsequently followed in the cardiac clinics. The P-R interval was studied simultaneously, and observation were made in regard to the presence or absence of resultant organic heart disease.

A significant number of patients showed prolongation of the Q-Tc value during the acute illness, far more so in those with rheumatic carditis than with polyarthritis or chorea alone. During the inactive phase, a number of patients maintained a prolonged Q-Tc value.

The Q-Tc value in patients with rheumatic fever is an additional laboratory aid which may help in determining the presence of active carditis. The prolongation of the Q-Tc value in polyarthritis and in chorea in the absence of other clinical findings should suggest further observation for the possible presence of a mild carditis. However, in evaluating patients whose Q-Tc is above normal and in whom the presence of active carditis is otherwise questioned, consideration must be given to the fact that the Q-Tc has been found to exceed the upper limit of normal in some normal children.

These findings show that, following active rheumatic fever, in some patients the Q-Tc value may remain prolonged over long periods of time in the absence of any manifest clinical activity or change in the cardiac status of the patient. Therefore it is the opinion of the authors that when careful evaluation over a period of time shows no other clinical or laboratory evidence of rheumatic activity, the sole finding of a Q-Tc remaining above normal range should not be considered as indicative of persistence of active carditis.
SULFOBROMOPHTHALEIN SODIUM EXCRETION TEST AS A MEASURE OF LIVER FUNCTION IN PREMATURE INFANTS
Authors: OBRINSKY WILLIAM , DENLEY MALCOLM L. , BRAUER RALPH W.
Published: December 2021

In normal adults, following a single intravenous injection of BSP, the logarithmic decline of plasma BSP levels is rectilinear. In patients with hepatic disease, the plotted values are curvilinear with flattening of the curve, or "saturation," occurring at high plasma BSP concentration. The use of the excretion curve provides a dynamic representation of the hepatic uptake of dye throughout the test, avoids the theoretic objections to the 45 minute test, and obviates the necessity for plasma volume determinations.

Thirty-five healthy prematures of varying age and weight were the subjects of a study of liver function by the bromsulphalein excretion test. As measured by the BSP excretion test, there is progressive maturation of liver function with age in prematures which does not necessarily correlate with weight. The excretion curves obtained in prematures 18 to 28 hours of age resemble those of older patients with severely impaired hepatic function. Clearance of dye in these subjects is slow throughout the test. With increasing age there is a gradual change in the pattern of the curves characterized by the appearance of the initial sharp slopes coincident with rapid dye removal. "Saturation," or flattening of the curves, persists until a later age and takes place at progressively lower plasma levels. This biphasic pattern is apparent in the prematures over 4 days of age. The normal adult pattern is not attained until about 6 to 8 weeks although the 45 minute retention values become normal at three weeks.

The gradual development of normal excretion curves in premature infants may be explained by the progressive maturation of the anatomic and physiologic factors involved in the mechanism of BSP clearance. The increasing size of the capillary network in the liver that occurs with advancing age in effect increases hepatic blood flow and exposes a greater volume of blood in the sinusoids to the activity of the liver. The appearance of the initial sharp slopes, representing rapid dye removal, probably results from this increasing vascularity and possibly from maturation of the hepatic uptake mechanism. The continuance of the biphasic character of the curves probably results from inability to excrete the dye efficiently into bile.
ADRENAL CORTICAL HYPERFUNCTION IN CHILDHOOD
Authors: ROSE ELIZABETH KIRK , ENTERLINE HORATIO T. , RHOADS JONATHAN E. , ROSE EDWARD
Published: December 2021

An additional case of adrenal cortical hyperfunction occurring in a boy aged 3 8/12 years is reported. The clinical features included bulimia, obesity, hypertension, hirsutism, personality change, osteoporosis and intermittent neurologic manifestations. The urinary excretion of 17-ketosteroids and corticoids was increased. There was no genital dystrophy or impairment of glucose tolerance. Marked temporary improvement followed partial bilateral resection of the enlarged adrenals. The patient died 10 months after operation, following exposure to epidemic parotitis, as a result of massive hemorrhage from ulceration of the esophagus. Necropsy showed bilateral nodular adrenal cortical hyperplasia limited to the fascicular and reticular zones. Bilateral rests of adrenocortical cells were found in the rete testis. No Crooke's changes or adenomata were found in the basophile cells of the anterior pituitary.
OBSTRUCTION OF DUODENUM IN THE NEWBORN INFANT DUE TO ANNULAR PANCREAS
Authors: SHAPIRO DANIEL J. , DZURIK FRANK J. , GERRISH EDWIN W.
Published: December 2021

Four cases of duodenal obstruction in the neonatal period caused by an annular constricting pancreatic ring are reported. These cases and the five others previously reported by different authors have been reviewed. Criteria were not found in this group of cases by which a definite preoperative diagnosis could be made. The etiology, embryology and treatment of this condition in infants have been discussed.
Serious Respiratory Tract Disease Caused by Respiratory Syncytial Virus: Prospects for Improved Therapy and Effective Immunization
Authors: Chanock Robert M. , Parrott Robert H. , Connors Mark , Collins Peter L. , Murphy Brian R.
Published: December 2021

On this felicitous occasion we honor Dr Saul Krugman for his many contributions to the study and control of a wide variety of important pediatric viral diseases. In preparing our remarks we found it difficult to identify a major pediatric viral pathogen upon which Saul had not left his mark. One of the few that escaped, for reasons unknown, is respiratory syncytial virus (RSV). Since RSV is the major pediatric respiratory tract viral pathogen, we thought this agent might pique his interest. Those of us studying RSV need all the help we can receive from biomedical scientists of Saul's caliber. What follows is a summary of current efforts to develop improved therapy and effective immunoprophylaxis for this elusive respiratory tract viral pathogen. IMMUNITY TO RSV DISEASE The mechanisms by which the immune system protects the respiratory tract against RSV infection and disease are not completely understood. However, it is clear that infection (or reinfection) induces resistance in the upper respiratory tract that is neither complete nor long lasting.1,2 The situation is some-what more favorable in the lower respiratory tract, where infection (or reinfection) induces more substantial and more durable resistance to disease. As a consequence, cumulative immunity from multiple reinfections protects older children and adults against the more serious forms of disease involving the lower respiratory tract such as bronchiolitis and pneumonia. Resistance to RSV infection in the upper respiratory tract appears to be mediated primarily by local secretory IgA antibodies, which explains the transitory nature of immunity in this region.3
Prospects for Control of Hepatitis B Virus Infection: Implications of Childhood Vaccination and Long-term Protection
Authors: Stevens Cladd E. , Toy Pearl T. , Taylor Patricia E. , Lee Thomas , Yip Hoo-Yi
Published: December 2021

Hepatitis B vaccine has been recommended for high-risk individuals in the United States for more than a decade. This targeted strategy, however, has failed to control hepatitis B virus (HBV) infection. Universal immunization is being considered as an alternative approach, in particular the inclusion of hepatitis B vaccine with routine childhood vaccinations. Data presented herein demonstrate a high degree of efficacy for hepatitis vaccine with hepatitis B immune globulin in preventing perinatal HBV infection in newborns. Immune response to vaccine was dependent in part on the dose administered, with some enhancement of response if the infant was older at the time of initial injection or if the booster dose was given later. Long-term follow-up showed persistence of vaccine-induced antibody for 5 to 10 years in 90% of immunized infants and adults. Only 3% to 5% of these high-risk individuals had serologic evidence of an HBV infection. None of the infections had been symptomatic and none resulted in a chronic HBV carrier state. Thus, immune responses and efficacy of hepatitis B vaccine in infants were excellent, and immunity and protection against clinically significant HBV infection persisted for at least 5 to 10 years, features essential to success of a program of universal childhood immunization against HBV
On-Lap Travel: Still a Problem in Motor Vehicles
Authors: Agran Phyllis F. , Winn Diane G. , Castillo Dawn N.
Published: December 2021

National observational studies indicate that infants who are not restrained in child safety seats (CSSs) in motor vehicles are usually riding on the lap of another occupant. This study was undertaken to determine the conditions under which children travel on-lap. The extent to which injuries would be reduced if these children were restrained in CSSs was also examined. Data were taken from a multihospital monitoring system for pediatric occupant injuries and from the coroner's office in a single urban county (1980 through 1989). One hundred ten children younger than 1 year of age evaluated in the monitored emergency departments after involvement in a crash had been traveling on-lap. On-lap travel did not appear to result from overcrowding. Eighty-eight percent were riding in vehicles with five or fewer occupants; 83% were in the front seat; 58% sustained injury; 22% of those evaluated were hospitalized; and 15% sustained intracranial injury. A 30% reduction in overall injury, a 75% reduction in hospitalization, and a 69% reduction in intracranial injury were projected for those riding on-lap, had they been restrained in CSSs. Applying national rates of on-lap travel (16.8%) to National Highway Traffic Safety Administration estimates of the number of infants injured in crashes each year indicates that approximately 2218 of these children would be on the lap of another passenger. Substantial savings in terms of injury and associated costs can be realized if children traveling on-lap were in CSSs. Parent education as well as strict enforcement of CSS laws must be implemented. Parents must be convinced that this practice of travel in vehicles is not protective and, in fact, poses a significant risk for injury.
Television Viewing and Pediatric Hypercholesterolemia
Authors: Wong Nathan D. , Hei Thomas K. , Qaqundah Paul Y. , Davidson Dennis M. , Bassin Stanley L. , Gold Kurt V.
Published: December 2021

Cholesterol screening for children is recommended currently only for those with a family history of premature coronary heart disease or hyperlipidemia. The authors report on a pediatric-office-based cholesterol screening program where the predictive values of family history indicators were evaluated along with reported television viewing, physical activity, and dietary habits in 1081 children (aged 2 to 20 years, mean 7.4 ± 3.6 [SD] years). Eight percent of these children had a total cholesterol value of 200 mg/dL or higher; 53% of such children reported watching 2 or more hours of television daily compared with 34% of children with lower cholesterol levels. Multivariate analyses revealed that excessive television viewing was the strongest predictor for a child to have a cholesterol value of 200 mg/dL or higher, with relative risks of 2.2 for 2 to 4 hours of television viewing per day (P < .01) and 4.8 for children watching more than 4 hours/day, when compared to those watching less than 2 hours/day (P < .01). In contrast, a positive family history of a high cholesterol level was only modestly associated with an increased probability of having a high cholesterol level (relative risk 1.6, P < .05), and a history of premature myocardial infarction in a parent or grandparent was not associated with a child's cholesterol level. Excessive television viewing was found to be associated with certain dietary and physical activity habits and may prove to be a useful, global marker for several life-style factors predisposing children to hypercholesterolemia.