bluuebunny/crossref_metadata_2025 huggingface dataset:
Varicella Hepatitis or Reye's?
Authors: Partin Jacqueline S. , Partin John C. , Schubert William K.
Published: December 2021

We read the article, "Varicella Hepatitis Without Neurologic Symptoms or Findings", by Ey, Smith and Fulginiti (Pediatrics 67: 285, 1981) with some distress. It seems unfortunate that so many reports on Reye's-like illnesses are being published using data based on unproven diagnoses. Although the etiology of the disease remains unknown, perhaps agreement could be reached on cliagnostic criteria.

During the period from December 1978 to May 1980, we studied 80 cases of Reye's disease. Thirty-three had a varicella prodrome; 28 of these were clinical grade 1.
Letters to the Editor
Authors: Fulginiti Vincent A. , Ey John L. , Smith Sandra M.
Published: December 2021

We thank Drs Partin and Schubert for their commentary on our report. We anticipated this type of reaction to our findings, hence our discussion in the body of our report.

The issue is clear. Is there an entity, varicella hepatitis, that is distinct from what some call stage I (or 0) Reye's syndrome? Neither our data nor the data in the above letter answer the question clearly. It is clear that there are children who have varicella with vomiting and associated liver enzyme elevations.
Bruises and Child Abuse
Authors: Collins Edward W.
Published: December 2021

It was gratifying to see the article on hypersensitivity vasculitis seen as suspected child abuse by Waskerwitz et al.1 As the pediatrician member of a multidisciplinary child abuse team we have seen several cases that initially seemed to be child abuse and subsequently were determined to be a nontraumatic medical problem. One such case was a 6-week-old infant who had hyperpigmented bands on each forearm that were initially diagnosed as post-traumatic hyperpigmentation by the first dermatologist consulted.
Adolescent Suicide Attempts Following Elective Abortion: A Special Case of Anniversary Reaction
Authors: Tishler Carl L.
Published: December 2021

Pregnancy continues to be a common occurrence among adolescents, often producing psychosocial stress. This report describes two female adolescent patients who, following elective abortion, attempted suicide on the approximate date the fetus would have been born had it come to term. Recognition of adolescents who are emotionally vulnerable and at high risk for self-destructiveness may be beneficial in the management and follow-up of such patients.
Risk Factors for Child Abuse: Methodologic Standards in Case-Control Studies
Authors: Leventhal John M.
Published: December 2021

To determine whether the findings of case-control studies of risk factors for child abuse may have been biased because of inattention to scientific principles of research design, 22 case-control studies were reviewed investigating either of two risk factors: (1) prematurity or low birth weight of the abused child or (2) young maternal age of the mother of the abused child. Each study was examined to determine compliance with seven methodologic standards that would minimize bias or distortion of the results. No study satisfied all seven standards. Two standards, choice of a specific control group and adjustment for differences in clinical and demographic susceptibility factors, most often affected the results. Studies complying with both of these standards indicated that prematurity or low birth weight is not a risk factor for abuse and that young maternal age at the birth of the abused child is likely to be a risk factor. Few studies complied with the standard concerned with avoidance of detection bias; this failure may have a major effect on the direction of the results of certain studies. Previous case-control studies of child abuse have important methodologic flaws that can affect the validity of the results. The standards presented should be helpful in planning methodologically rigorous studies.
Variation on a Theme by Fenner: The Pathogenesis of Chickenpox
Authors: Grose Charles
Published: December 2021

In a study exemplifying both brevity in experimental design and brilliance in execution, Fenner1 delineated the pathogenesis of the acute exanthems. He lumped together the human diseases of smallpox, chickenpox, measles, and rubella because of similarities in clinical presentation after a relatively long incubation period, even though etiologically these diseases are caused by a diverse group of DNA and RNA viruses (poxvirus, herpesvirus, paramyxovirus, and togavirus, respectively). The animal model that he selected was the murine virus infection called mousepox or infectious ectromelia. Inasmuch as the natural route of infection is through minute abrasions in the skin, Fenner inoculated the test animals in either the foot or pinna with small doses of mousepox.
Apparent Inverted Tandem Duplication May Result from Parental Paracentric Inversion
Authors: McGee John P. , Cranin Debra Ann , Hoegerman Stanton F. , Hoegerman Georgeanne
Published: December 2021

Strain et al1 described a retarded malformed young man with an abnormal chromosome 14 which they diagrammed as 14 pter→q31::q31→q21. They stated that G-banded chromosomes of both parents were normal and interpreted the proband's abnormal 14 as a de novo inverted tandem duplication.

We wish to propose an alternate mechanism which could account for both the origin of the proband's abnormal chromosome and the three miscarriages in six pregnancies experienced by the proband's mother. One of the proband's parents may be heterozygous for a paracentric inversion with breakpoints occurring within 14q24.1 and 14q32.3 or at any two other points between them equidistant from 14q31 (see figure 2 of Strain et al).
Oral Chloromycetin
Authors: Kauffman Ralph E.
Published: December 2021

The recent study by Yogev et al1 nicely demonstrates that therapeutic concentrations of chloramphenicol in serum and CSF are achieved following oral administration of chloramphenicol palmitate. However, the authors' pharmacokinetic interpretation of their data is open to question. The apparent longer half-life and higher mean peak and trough serum concentrations most likely reflect greater bioavailability and prolonged absorption of the oral dosage form compared to the intravenous preparation rather than a difference in elimination half-life.
Developmental Language Disability As a Consequence of Prenatal Exposure to Ethanol
Authors: Shaywitz Sally E. , Caparulo Barbara K. , Hodgson Elizabeth Susan
Published: December 2021

Two pre-school-aged patients with a history of prenatal exposure to ethanol had abnormal head size and developmental delay. Both children were strikingly similar in physical appearance, behavior, and cognitive dysfunction. Facial features were typical of fetal alcohol syndrome. Head circumference >97th percentile without hydrocephalus and no evidence of prenatal or postnatal growth failure were unusual for ethanol teratogenicity. Each child had a similar pattern of verbal and behavioral dysfunctions characterized by (1) marked hypervigilence, (2) distractability, and (3) cognitive confusion manifested as anxiety and behavioral disorganization. It is suggested that a history of prenatal exposure to ethanol associated with (1) large head circumference, (2) facial features of fetal alcohol syndrome, and (3) early developmental delay, particularly in language acquisition, and impaired modulation of attention and arousal may represent a possible new effect of alcohol teratogenicity.
Otitis Media During Early Life: How Hazardous to Development? A Critical Review of the Evidence
Authors: Paradise Jack L.
Published: December 2021

In a number of recent reports1-3 developmental impairments of a lasting nature have been attributed to prolonged or repeated episodes of otitis media occurring during the first one to three years of life. The impairments described include intellectural and learning difficulties,1,2,4-8,10-13 impaired speech and language,3,5,8,9,11-13 and disturbed behavior.7,8 In some of the reports1,12 the impairments have been referred to as permanent or irreversible.

These reports, having appeared in publications directed respectively to physicians,2-4,6,8-13 speech-language-hearing professionals,1-3,5 educators,11 and psychologists,7,12 and in some instances having been cited in widely disseminated professional and lay news media (reference 14; Newsweek, June 14, 1976, p 47; New York Times, Dec 26, 1978, p C2) quite naturally have aroused broad anxiety and concern. The reports also have served to provide the impetus, or the justification, not only for aggressive casefinding programs, but also, in infants and children with recognized middle-ear effusions, for early recourse to aggressive modes of treatment, most often in the form of myringotomy and tympanostomy tube insertion.

The purpose of the present report is to review critically the body of evidence on which the supposed relationship between early otitis media and later developmental impairments is based.

DISEASE PROCESS

In the typical case of acute otitis media, pus fills the middle-ear cavity. Sooner or later the infection begins to subside—with or without the help of antimicrobial drugs—and the initially purulent middle-ear liquid changes in character, coming to resemble serum, mucus, or even glue. With continued healing the Eustachian tube gradually recovers its ventilatory function, and the middle-ear liquid eventually is resorbed, or drains, and becomes replaced by air.
Does Lead at Low Dose Affect Intelligence in Children?
Authors: Needleman Herbert L. , Bellinger David , Leviton Alan
Published: December 2021

Ernhart et al, on the basis of their own follow-up data and an incorrect critique of a single study, find reason to question the entire literature documenting the adverse effects of low levels of lead. They assert that, if effects exist, they are minimal. To reach this sweeping conclusion, they contradict or ignore the findings of the earlier study by Perino and Ernhart, misread a table from the one study they single out for criticism, and draw debatable conclusions from their own data.

We conclude by calling the readers' attention to this sentence: "While the effects of subclinical lead intoxication may not be noted in the individual cases seen in a pediatric clinic, analysis of group data indicate quite clearly (emphasis added) that performance on an intelligence test is impaired."
Prophylactic Antibiotics in Pediatric Surgery
Authors: Kesler Richard W. , Guhlow Linda J. , Saulsbury Frank T.
Published: December 2021

The frequency and appropriateness of prophylactic antibiotic use in children less than 6 years of age who received surgery were examined. Antibiotics were prescribed for 62% of children who had surgery, and prophylaxis was the sole reason for antibiotic use in 73% of the patients. Prophylactic antibiotics were administered inappropriately with respect to timing or duration to 42% of the children receiving preoperative prophylaxis, 67% receiving intraoperative prophylaxis, and 55% receiving postoperative prophylaxis. Thus, prophylaxis alone is the major indication for antibiotic use in pediatric surgical patients, and prophylactic antibiotics are frequently administered inappropriately.
49th Annual Meeting, Oct 24-26, 1980
Authors: Gonzales Edmond T.
Published: December 2021

The Section on Urology of the American Academy of Pediatrics met in session in conjunction with the 49th Annual Meeting of the Academy in Detroit. Several areas of interest to the urologist and the pediatrician were discussed, and they included: hypospadias, urodynamic assessment of obstruction, vesicoureteral reflux, the management of urinary infection in children, cryptorchidism, and testicular neoplasms. This brief report is an attempt to summarize pertinent aspects of these topics that would be of help and interest to the practicing pediatrician.

HYPOSPADIAS

Until fairly recently, the emphasis in hypospadias surgery was on functional reconstruction, and a subglanular meatus was felt to be satisfactory. However, newer techniques,1-3 improved suture materials and the popularization of optical magnification have recently allowed for more cosmetically normal reconstructions. Of interest during this year's discussion of hypospadias was the observation that all authors stressed the potential and desirability of achieving a cosmetically normal, glanular meatus. In fact, three of the four papers discussed the reconstruction of distal hypospadias—a meatus at the coronal margin with little or no chordee. In the past, parents were advised that surgery was unnecessary for these mild lesions because there was no limitation of function. Wacksman4 described a modification of a meatal-based skin flap for reconstruction of these lesions with a low complication rate—no fistulae and one meatal stenosis in 15 procedures.

One of the limiting factors in encouraging the reconstruction of a mildly hypospadiac, but functionally satisfactory urethral meatus, is the need for several days of indwelling catheterization and the risk of surgical complications—fistulae and strictures.
Correlation Between Blood Ammonia Concentration and Organic Acid Accumulation in lsovaleric and Propionic Acidemia
Authors: Coude F. X. , Ogier H. , Grimber G. , Parvy Ph. , Dinh D. Pham , Charpentier C. , Saudubray J. M.
Published: December 2021

Hyperammonia has been reported in several disorders of branched chain amino acid metabolism including propionic, isovaleric, methylmalonic acidemia, and β-ketothiolase deficiency.1 Nevertheless the true incidence of hyperammonemia and its variation during the course of these diseases are not yet well known. The purpose of this study was to compare the blood ammonia concentrations and the concomitant serum organic acid accumulation in patients with propionic and isovaleric acidemia.

MATERIALS AND METHODS

Seven patients with propionic acidemia have been studied. The diagnosis was usually made during the first episode of the disease by gas chromatography. It was always confirmed by the direct measurement of propionyl coenzyme A (CoA) carboxylase activity in fibroblasts.2
Letters to the Editor
Authors: Lemons James A.
Published: December 2021

Drs Minoli and Moro's response to our controlled prospective study of transpyloric and intermittent gavage feeding states that the nature of our study did not permit the demonstration of the major advantage of transpyloric feedings, ie, ability to administer large volumes of formula. Our study was controlled in that we attempted to achieve 120 kcal/kg/day intake by 10 days of age in both groups of babies fed either by intermittent gastric gavage or the transpyloric route. This was achieved without a difference in complication rate by either method of feeding.
Occlusive Lesions of Cardiac Conducting Tissue Arteries in Sudden Infant Death Syndrome
Authors: Anderson Kenneth R. , Hill Robert W.
Published: December 2021

Cardiac conducting tissue from the hearts of 40 victims of sudden infant death syndrome was examined microscopically by serial section. In five hearts there was marked narrowing of the major artery supplying the atrioventricular node. In another there was similar narrowing of the artery supplying the sinus node. The arterial lesions were focal and characterized by cellular intimal thickening which severely narrowed the vessel lumen. This arterial anomaly may be a contributory factor in the pathogenesis of some cases of sudden infant death.
Dilation in Neonates: A Protocol
Authors: Caputo Anthony R. , Schnitzer Robert E. , Lindquist Thomas D. , Sun Shyen
Published: December 2021

A protocol for safe and effective dilation in the nursery is presented. This combination has been utilized in numerous nurseries in Newark, NJ and at several institutions around the county. No side effects have been noted after three years of continuous use.
BARTHOLMAEUS METLINGER ON THE CARE OF THE NEWBORN INFANT (1473)
Authors: C. T. E.
Published: December 2021

On December 7, 1473, Günther Zainer of Augsburg printed Bartholomaeus Mettlinger's (?-1491) book entitled Ein Regiment der Jungen Kinder.1 This book has two distinctions: it was the first pediatric text to be printed in the vernacular; and the first of its kind to contain an illustration.

Metlinger drew heavily from the Arabic physicians, indeed some of his chapters are copied almost verbatim from Rhazes. He also leaned heavily on the writings of Hippocrates and Galen in preparing his book.2

His suggestions for the immediate care of the newborn infant were as follows:

After the child is born the midwife shall cover his fingers with rose or other honey, put it in the child's mouth in such a manner that it covers the jaws, gums and tongue so that if there is any to be dissolved it will be dissolved. Then the navel should be cut four fingers long and tied both on the side of the child and that of the mother so that it does not bleed. Then one should sprinkle the child with finely pulverized salt but not the mouth, nostrils or face. It is good to mix the salt with equal parts of powdered rose, wild marjoram and whortleberry flowers. Averroëes and Avicenna are of the opinion that salt bites and that the child should be rubbed with acorn oil. Such salting or anointing cleans and strengthens the external members so that the child may be handled with the least care whether it be cold or hot, severe or mild [weather].
Persistence of Antibody After the Administration of Influenza Vaccine to Children with Cancer
Authors: Sumaya Ciro Valent , Williams Thomas E.
Published: December 2021

Children with cancer who received an intramuscular injection of inactivated split or whole bivalent (A/New Jersey/76-A/Victoria/75) influenza virus vaccine during the fall of 1976 were tested up to 18 months later for the persistence of antibody. Titers of antibody [Unknown]10 to influenza A/New Jersey/76 virus were present in the sera of 34 children two weeks after immunization. The geometric mean titer was 40.0. Eighteen months later a titer [Unknown]10 was present in 13 (38%) children; the geometric mean titer was 8.5. Of 36 children with a titer of antibody [Unknown]10 to A/Victoria/75 virus two weeks after immunization, 34 still had a detectable titer in the later examination. The geometric mean titer declined from 65.3 to 25.6. Titers of antibody to B/Hong Kong/72 virus (not included in the vaccine) remained relatively stable. In 11 children the usual chemotherapy was discontinued during the study. The shorter persistence of antibody to A/New Jersey/76 virus, in contrast to that of the other two influenza viruses tested, was associated with a lack of prior exposure to the virus and the absence of subsequent natural infection with this virus or an antigenicaily related subtype. The potential effect of cancer chemotherapy on the persistence of antibody levels is unclear.
Skull Roentgenograms in Pediatric Head Trauma: A Vanishing Necessity?
Authors: Ferry Peggy C.
Published: December 2021

"Doctor, my child fell off his bicycle and was knocked out for a few minutes. What should I do?"

"Dr Ferry, this is the pediatric resident in the emergency room. I have just examined an 8-year-old boy who fell off the monkey bars at school and was unconscious for five minutes. He is fine now. Should I order skull roentgenograms? Or a computed tomography (CT) scan? Should he be admitted for observation?"

Pediatric head trauma continues to present a mangement dilemma. The above questions are not uncommon, and with advances in neuroradiologic technology, major questions frequently arise concerning the necessity for skull roentgenograms or, more recently, a CT head scan.
High-Frequency Ventilation: Panacea or Problem?
Authors: DeLemos Robert A. , Null Donald M. , Meredith Keith S.
Published: December 2021

It is apparently an axion of medicine that "new" must be better. Thus, the introduction of a fascinating innovation in respiratory care, high-frequency oscillatory ventilation, has unleashed a storm of interest unparalleled in neonatal medicine. Although the techniques of high-frequency oscillatory ventilation are complex and the complications often unforeseen and hazardous, demands for experimental ventilators have exceeded the manufacturers' capacities to produce them.

As with any new medical procedure, high-frequency oscillatory ventilation must be viewed in an appropriate perspective. Current management of infants with respiratory distress syndrome is extremely successful with many major medical centers reporting survival rates exceeding 90% and a low incidence of residual lung disease.
Transient Erythroblastopenia
Authors: Davis Deborah , Gordon John
Published: December 2021

We read with interest the article by Dickerman1 on transient erythroblastopenia. On March 18, 1981, a 28-month-old male of Croatian-French Canadian descent was admitted to this hospital with progressive pallor and fatigue of two weeks' duration. His history was otherwise normal with the exception of a hospital admission for croup 2½ months previously. His hemoglobin count at that time had been 12 gm/100 ml.

Physical examination revealed a quiet pale boy with moderate tachypnea. He had shotty cervical adenopathy and a mild flow murmur and tachycardia. Findings from the rest of the examination were normal.
Oral Albuterol in the Treatment of Childhood Asthma
Authors: Rachelefsky Gary Stuart , Katz Roger Merril , Siegel Sheldon Colman
Published: December 2021

The efficacy, safety, tolerance, and bioequivalence of albuterol (a relatively selective β2-adrenergic drug) was evaluated in 20 asthmatic children (6 to 14 years of age). The study was divided into two phases: a single-blind multiple-dose treatment with placebo and three separate weekly treatments with 2, 4, and 6 mg of albuterol (tablets or syrup) administered four times a day; and a double-blind crossover period comparing 4-mg albuterol tablets to syrup and placebo. Patients recorded daily diaries and were seen weekly. Theophylline, isoproterenol, and/or epinephrine was administered as needed. In phase 1, the 4- and 6-mg albuterol doses were superior with the latter causing more side effects. In phase 2, a 4-mg dose of albuterol was superior to placebo. The syrup formulation was superior to tablets when extra medications (P < .01) and six-hour change in pulmonary function were evaluated; the maximum effect of the 4-mg syrup dose was reached at four hours and lasted for six hours whereas the effect of the tablet peaked at two hours and was minimal after five hours. Heart rate changes from base line were greater with syrup. Four milligrams of albuterol syrup (2 mg/5 ml) four times a day is the preferred dose for the asthmatic child 6 to 14 years of age.
Diagnosis of Acute Interstitial Nephritis: Is a Kidney Biopsy Necessary?
Authors: Somekh E. , Fried D. , Hanukoglu A. , Raviv U.
Published: December 2021

Several weeks after reading the interesting article, "Acute Interstitial Nephritis in Children: A Report of 13 Cases and Review of the Literature" (Ellis D, Fried WA, Yunis EJ, et al: Pediatrics 67:862, 1981), a 10-year old girl was admitted to our Department with a history of five days' fever [100.1 to 100.2 F (37.8 to 37.9 C)], progressive fatigue, anorexia, diffuse abdominal pain, and vomiting. The mother noticed, one day prior to her admission, a decreased urinary output.
Maple Syrup Smell in the Intensive Care Unit
Authors: Lin Angela E.
Published: December 2021

The article on maple syrup urine disease (Clow CL, Reade TM, Scriver CR: Outcome of early and long-term management of classical maple syrup urine disease. Pediatrics 68:856, 1981) has prompted me to report our neonatal intensive care unit's experience with an "outbreak" of maple syrup odor.

Baby girl M. was the 1,730-gm product of a 32-week gestation of a 29-year-old white mother. Pregnancy was uncomplicated except for premature labor.
A FEW PROVERBS ABOUT CHILDREN AND CHILDHOOD
Authors: C. T. E.
Published: December 2021

The literature of almost every country is replete with proverbs about children and childhood.1 Those listed below are just a few from the literature of the West.

1. Childhood often holds a truth in its feeble fingers, which the grasp of manhood cannot retain, and which it is the pride of utmost age to recover—Ruskin

2. Childhood shows the man, as morning shows the day—Milton

3. Childhood and youth see the world in persons—Emerson

4. Childhood is the sleep of reason—Rousseau

5. Children are very nice observers, and they will often perceive your slightest defects—Fénelon

6. Children have more need of models than of critics—Joubert

7. Children should have their times of being off duty, like soldiers—Ruskin

8. Children sweeten labours, but they make misfortunes more bitter—Bacon

9. How little is the promise of the child fulfilled in the man—Ovid
Effect of High School Students' Knowledge of Child Development and Child Health on Approaches to Child Discipline
Authors: Johnson Charles F. , Loxterkamp David , Albanese Mark
Published: December 2021

Because there is an association between the lack of knowledge of normal child development, high and unrealistic expectations for a child's performance, and child abuse, a questionnaire about normal child development, child health maintenance, child discipline aspects of childrearing, and child development was given to a representative sample of high school students in Iowa. Though high school students in Iowa rank high in academic performance, the results of this study indicated that students in grades 9 through 12 had a poor knowledge of child development and child health maintenance. Students whose highest probability of response to a child discipline problem was either to punish or abuse knew less about child development and child health maintenance than their peers. Boys at all grade levels knew less about child development and child health maintenance and were more likely to choose punishment and abuse than girls. Though the causes for child abuse are multifactorial and complex, there is a need to guarantee that all who are at risk for parenthood be informed about child development, child health maintenance, and child discipline to minimize the effects that ignorance of these factors may have on their approaches to discipline and their potential for child abuse.
Intraoral Findings and Anomalies in Neonates
Authors: Jorgenson Ronald J. , Shapiro Steven D. , Salinas Carlos F. , Levin L. Stefan
Published: December 2021

Examinations of the oral cavities of 2,258 neonates demonstrated a high frequency of gingival and palatal cysts (of the newborn), leukoedema, and median alveolar notches. Alveolar lymphangiomas, ankyloglossia, and commissural lip pits were seen relatively frequently; several other conditions were seen rarely. A difference in the frequencies between the races or sexes was documented for most of the conditions.
Detection of Seizure Activity in the Paralyzed Neonate Using Continuous Monitoring
Authors: Goldberg Ronald N. , Goldman Steven L. , Ramsay R. Eugene , Feller Rosalyn
Published: December 2021

In experimental animals neurologic damage may occur during seizure activity whether the seizure is accompanied by motor activity and hypoxemia or whether the animal is paralyzed and normoxemic. These findings suggest that it may be important to detect seizure activity in the paralyzed neonate. Nine infants who were mechanically ventilated and paralyzed with pancuronium had their condition diagnosed as seizure activity. Vital signs were continuously monitored and six infants had either oxygen saturation or transcutaneous oxygen measured during seizure activity. For the group as a whole, rhythmic fluctuations in vital signs, cardiac rhythm, and oxygenation occurred every four minutes (range one to seven minutes) and lasted two minutes (range one to four minutes). In seven patients whose seizures were not accompanied by cardiac arrhythmias the following mean increases were noted: systolic arterial blood pressure, 15 mm Hg (range 7 to 36 mm Hg); heart rate, ten beats per minute (-11 to 30/min); oxygen saturation, 12% (range 4% to 20%); and transcutaneous oxygen, 31 mm Hg (range 14 to 45 mm Hg). Seizures in the two patients with cardiac arrhythmias were accompanied by a decrease in systolic arterial blood pressure of 27 mm Hg (range 15 to 40 mm Hg) and in oxygen saturation of 24% (range 20% to 28%). The presence of rhythmic fluctuation in vital signs and oxygenation should alert the physician to the possibility of seizure activity in the paralyzed neonate.
Mortality and Morbidity of 500- to 1,499-Gram Birth Weight Infants Live-born to Residents of a Defined Geographic Region Before and After Neonatal Intensive Care
Authors: Horwood Sargent P. , Boyle Michael H. , Torrance George W. , Sinclair John C.
Published: December 2021

All very low-birth-weight infants live-born to residents of an urban southern Ontario county were studied before (1964 to 1969) and after (1973 to 1977) the introduction of neonatal intensive care. Mortality at hospital discharge decreased from 89.4% to 77.6% among infants whose birth weights were 500 to 999 gm and from 37.6% to 22.8% among infants with birth weights of 1,000 to 1,499 gm. The families of 121/150 (81%) and 134/151 (89%) of all children from the two cohorts who were discharged from the hospital alive were surveyed. At follow-up 7/121 (6%) and 4/134 (4%) had died. Major damage was reported for 13/121 (11%) and 18/134 (13%) of the children. Neonatal intensive care was associated with a significant reduction in mortality but there has not been a significant change in morbidity.
The Bannayan Syndrome: An Autosomal Dominant Disorder Consisting of Macrocephaly, Lipomas, Hemangiomas, and Risk for Intracranial Tumors
Authors: Higginbottom Marilyn C. , Schultz Paul
Published: December 2021

The Bannayan syndrome is a disorder consisting of macrocephaly, alterations of linear growth, and benign mesodermal hamartomas—primarily lipomas and hemangiomas. The purpose of this report is to present a family with the Bannayan syndrome, confirming the genetic etiology of the disorder and demonstrating that affected individuals are at risk for developing intracranial neoplasms. This report brings to seven the number of cases reported in the literature.
Management of Asthma—A Correction
Authors: Weinberger Miles
Published: December 2021

In the paper "Management of Asthma," table 1 presents the theophylline dose for short-term therapy of acute symptoms when serum concentrations will not be monitored.1 The data from which these recommendations were derived have subsequently been published.2 Unfortunately, it is now apparent that there is an error in the data of table 1. Safer dosage recommendations are presented in the Table.

As stated in "Management of Asthma," even these doses may cause minor side effects in some patients, and higher doses may be needed for optimal effect in others but should be guided by measurement of serum theophylline concentration.
Letters to the Editor
Authors: Klein Louis D.
Published: December 2021

I find the commentary by St. Geme (Pediatrics 68:734, 1981) to be most disturbing. It is an hysterical plea without factual basis: it is inappropriate and divisive for St. Geme to promote his own interests (ie, pediatricians) at the cost of depreciating others. I can sympathize with his pleas for pediatricians to take a more active role in matters pertaining to the general health and welfare of children. However, he calls attention to several other issues that obscure and confuse his message.
School Absence: A Problem for the Pediatrician
Authors: Weitzman Michael , Klerman Lorraine V. , Lamb George , Menary Jean , Alpert Joel J.
Published: December 2021

Children who are frequently or persistently absent from school tend to perform poorly in school and are likely to drop out before graduation from high school. Excessive school absence has significant implications in terms of maladaptive behavior, wasted opportunities, and future unemployment and welfare costs. Epidemiologic information about this problem suggests that physical and mental health problems of students or their families are the sole or contributing cause of this behavior in more than 50% of cases. Excessive school absence may signal such health problems as poor coping with or management of chronic illness, masked depression, teenage pregnancy, substance abuse, inappropriate responses to minor illnesses, or severe family dysfunction. School absence patterns appear to be a readily available, easy-to-use marker of childhood dysfunction which lends itself to screening large numbers of children for unmet health needs. Attention to this area of child behavior as part of routine health care will frequently uncover previously unrecognized health problems in children and their families.
Histochemical Diagnosis of Hirschsprung Disease
Authors: Huntley Carolyn Coker , Shaffner Louis deS. , Challa Venkata R. , Lyerly Anne D.
Published: December 2021

A histochemical staining technique for detection of acetylcholinesterase (AChE) in rectal suction biopsies was compared with the presence or absence of ganglion cells in full-thickness or suction biopsies for the diagnosis of Hirschsprung disease (HD) in infants and children. Biopsies from 55 of 58 children were adequate for both the AChE assay and routine pathologic examination for ganglion cells. Two patterns of AChE staining were noted. With pattern A, prominent nerve fibers staining for AChE were seen throughout the muscularis mucosa and the lamina propria. With pattern B, similar fibers were seen only in the muscularis mucosa and the areas of lamina propria that were immediately adjacent. No "false-negative" AChE staining reactions were found in patients with HD. No "false-positive" reactions showing pattern A were found. This pattern was diagnostic for HD. Three false-positive reactions were found showing pattern B in patients with conditions other than HD. Among 22 patients with HD, 19 were males and three were females. Pattern A occurred in all age groups and in both sexes. Pattern B in patients with HD was seen exclusively in male infants 1 month of age or less. Experience suggests that the AChE staining of rectal suction biopsies is an excellent screening test for HD in infants and children. If pattern B is encountered, however, the specimen should be examined by routine pathologic techniques for the presence of submucosal ganglion cells.
Polydrug- and Methadone-Addicted Newborns: A Continuum of Impairment?
Authors: Chasnoff Ira J. , Hatcher Roger , Burns William J.
Published: December 2021

Two groups of infants born to drug-addicted mothers were evaluated in a prospective controlled study and compared with a third control group. Group I infants (N = 39) were born to mothers on well-controlled low-dose methadone maintenance. Group II infants (N = 19) were born to polydrug-abusing mothers, and group III infants (N = 27) were born to control mothers who had no history or evidence of drug abuse. All three groups were matched for maternal factors that might affect neonatal outcome. Group I infants were significantly smaller than control infants for all growth measurements and had a significantly smaller head circumference than group II infants. Utilizing the Brazelton Neonatal Behavioral Assessment Scale, group I infants showed more depression of interactive behaviors and state controls than group II infants, who in turn were more depressed than group III infants. The effects of nonnarcotic drugs on intrauterine growth and neonatal behavior appear to place the polydrug-addicted newborn in an intermediate zone of deficit between normal and opiate-addicted newborns.
PEDIATRIC PSYCHOPHARMACOLOGY
Authors: Haggerty Robert J.
Published: December 2021

The Journal of the American Academy of Child Psychiatry, the official publication of the American Academy of Child Psychiatry, has a new image (8½x11 inches), now comes out six rather than four times per year, and is now published by the Williams & Wilkins Co. In addition, the journal is putting together issues or special sections on specific topics. Pediatric psychopharmacology is the subject of the January 1982 issue, with five papers. Pediatricians as well as child psychiatrists should read these articles. Pediatricians prescribe a lot of drugs for behavior problems. But as this section points out, no cures can be expected yet. Perhaps the most important point is that specific medications have been found to influence specific syndromes and/or metabolic pathways. As a result they may have their greatest impact as a stimulus for the study of the biologic basis of some behaviors, ". . .with the ultimate aim of developing a rational rather than empirical psychopharmacology." Pediatricians are often therapeutic enthusiasts and this series of articles presents a solid, but realistically sober view of the value of drugs in behavior problems today. The journal is a good place for pediatricians to begin their education in children's behavioral problems.
Newborn Cerebellar Size
Authors: Birnholz Jason C.
Published: December 2021

The cerebellum can be visualized ultrasonically in preterm and full-term newborn infants. A cross-sectional area measurement of the central portion of the vermis correlated with gestational age (r = .98) when growth was normal (N = 51). Central vermian area was decreased in small-for-date newborn infants (N = 10) but was normal in large for date (diabetic pregnancy) subjects (N = 6). Ultrasonic cerebellar visualization and central vermian area measurement may be extended antenatally as an additional measurement of fetal brain growth.
Dysuria in Adolescent Girls: Urinary Tract Infection or Vaginitis?
Authors: Demetriou Efstratios , Emans S. Jean , Masland Robert P.
Published: December 2021

Dysuria is a common presenting complaint of adolescent girls. Because physicians often assume a bacterial urinary tract infection (UTI) is present, the patient may be treated with antibiotics without thorough evaluation. In previous studies only half of adult women complaining of dysuria had bacteriuria with greater than 105 organisms per milliliter.1,2 Vaginitis,3,4 vulvitis,3 Neisseria gonorrhoeae,5 Chlamydia trachomatis,6-9 and bacteriuria with less than 105 organisms per milliliter1,2,9 are responsible for the symptoms in many of the remaining subjects. A recent study in adult women found that a history of external dysuria (pain felt as the urine passes over the inflamed vaginal labia) suggested vaginal infection, whereas a history of internal dysuria (pain felt inside the body) suggested bacterial UTI.4
Letter to the Editor
Authors: Russell George , Reid J. Anne , Sutherland Hamish W. , Stowers John M.
Published: December 2021

Concerning hypertrichosis pinnae in babies of diabetic mothers, Rafaat1 is by no means the first to observe this phenomenon. We have long used this sign in assessing infants of diabetic mothers.2 It was first described by Akerren3 and later emphasized by Eklund et al.4
Doubtful of Compliance
Authors: Allen William R. , Bunce Harvey
Published: December 2021

The article by Schwartz et al1 describes an investigation of the effect of compliance with antibiotic therapy on the occurrence of middle ear effusion after acute otitis media. The authors imply that the return of three (or two) positive urine specimens indicates pharmacologic compliance. However, as stated by the authors "no attempt was made to confirm that the urine specimens were actually collected on the specified days." It is possible that all urine was collected on a single day.
Letter to the Editor
Authors: Shaywitz Sally E. , Caparulo Barbara K. , Hodgson Elizabeth Susan
Published: December 2021

We thank Miller, Valente, and Farber for the interest they show in our report. All three letters raise a basic question—that of what implications can be drawn from diagnostic labels. Thus, while certain diagnostic labels do present implications about etiology, natural course and response to treatment, others, unfortunately, do not, and serve, more appropriately, as tools that only describe a set of developmental or physical findings. For example, while the term cerebral gigantism describes a certain group of children who seem to share characteristics, it would not be correct to invoke cerebral gigantism as an explanation or etiology for the overgrowth that is seen in these patients.
Current Trends in the Incidence of Neural Tube Defects
Authors: Windham Gayle C. , Edmonds Larry D.
Published: December 2021

To verify and investigate the reported decline of neural tube defects (NTDs) in the last decade, data from three different sources were examined: the Birth Defects Monitoring Program (BDMP), composed of newborn discharge diagnoses; the population-base Metropolitan Atlanta Congenital Defects Program (MACDP); and the National Center for Health Statistics (NCHS), whose data include only live births. Although the three systems use different methods of ascertaining cases, all data bases showed a decreasing trend in NTD rates, with annual percent decreases of 3.1% for NCHS, 5.7% for BDMP, and 7.7% for MACDP. The decrease was noted in all variables examined: race, sex, and birth status for each defect. NTD rates appear to be declining more rapidly in females than in males. Further, the rate among stillborn infants decreased more than the rate among liveborn infants. The exclusion of stillbirths in the NCHS data may contribute to its low rate of decline for female anencephalics. Data from England showed a larger average annual decrease (10.6%) than did data from the United States. Although reasons for the overall decline are not verifiable, a variety of explanations are suggested for this decline and for the difference in NTD rate decline noted between live births and stillbirths. The overall decline in NTD rates should be investigated with respect to etiology; recognition of the decline is useful for planning and evaluating health care programs.
XERO QUOTE
Authors: Barness Lewis A.
Published: December 2021

It is sobering to reflect that a three minute television commercial for a food product costs about the same amount of money as most University Nutrition Departments in Great Britain have for their annual research budgets.
Management of Fractures in Hemophilia
Authors: Wolff Lawrence J. , Lovrien Everett W.
Published: December 2021

Nine patients with hemophilia A suffered 16 fractures. Four patients had severe hemophilia (factor VIII < 1%) and five had moderate or mild hemophilia (factor VIII between 4% and 25%). Two patients developed skeletal pseudotumors after their fractures. One patient developed neurapraxia. Fractures in hemophiliacs should be treated promptly with 25 units/kg/day of factors. Fractures of the upper limb should be maintained at this dose for seven days; lower extremity fractures should be treated with factor for 14 days. Orthopedic management should be the same as used for nonhemophiliacs. Skeletal pseudotumors should be managed with prolonged factor administration and immobilization until radiographic evidence of healing occurs.
WORKING MOTHERS
Authors: Meir Golda
Published: December 2021

There are mothers who work only when they are forced to .... But there is a type of woman who cannot remain home for other reasons. In spite of the place which her children and her family take up in her life, her nature and being demands something more; she cannot divorce herself from a larger social life. She cannot let her children narrow her horizon. And for such a woman, there is no rest .... This eternal inner division, this double pull, this alternating feeling of unfulfilled duty—today toward her family, the next day toward her work—this is the burden of the working mother.
SINGULAR RECOVERY OF A FIVE-YEAR-OLD ENGLISH BOY FROM A VIOLENT ACCIDENT (1829)
Authors: C. T. E.
Published: December 2021

The case report below gives evidence that children can survive a severe accident. Even more surprising was this child's ability to survive the depleting therapy so commonly used during the early part of the nineteenth century. To The Editor of THE LANCET: Master Y., aetatis five, a healthy child, was negligently crossing the road...at the time a heavy two-wheel cart was approaching at a rapid pace, and which he did not perceive. He was, in consequence, thrown down by the horse, and placed beneath the wheel, which passed over his body at about the situation of his epigastrium. This fact was attested by four persons, present at the time.... The child was stunned at the moment, and taken to his home, which was close at hand. I was immediately sent for and found him crying perfectly sensible, and complaining of acute pain, which was increased considerably on pressure, just beneath the floating ribs of the left hypochondrium, with considerable tenderness also over the upper part of the abdomen. After very careful examination, I found he was free from dislocation and fracture. His right cheek was grazed, and his shoulder, &c. bruised, but he complained of no pain on pressure of any part of his spinal column, the whole course of which I examined attentively. From the nature of the accident, I should have suspected this, à priori, to have been the seat of injury, but I was led to a more minute inquiry respecting its state, by noticing an involuntary discharge of urine shortly after my arrival.
Nonsteroidal Anti-inflammatory Drugs and the Treatment of Neonatal Sepsis Due to Group B Streptococci
Authors: Cherry James D. , Barrett Cynthia T.
Published: December 2021

Although group B streptococci are highly susceptible to penicillin and other antimicrobial agents the mortality in early onset disease approaches 50%. Very little is known about the precise pathophysiology of group B streptococcal sepsis and its attendant hematologic, hemodynamic, and immunologic abnormalities. The cause of death in babies is usually shock that is unresponsive to conventional restoration of vascular volume and pharmacologic pressor agents.

The findings reported by Short and colleagues in this issue of Pediatrics1 utilizing the suckling rat model of group B streptococcal sepsis are notable. However, caution is necessary in analyzing the results. A strong plea must be made to discourage haphazard human trials with nonsteroidal anti-inflammatory drugs prior to additional confirmatory studies in the rat group B streptococcal sepsis model, and the performance of similar experiments in larger animal model systems.
Position Statement 1982
Authors:   Joint Committee on Infant Hearing
Published: December 2021

Early detection of hearing impairment in the affected infants is important for medical treatment and subsequent educational intervention to assure development of communication skills.

In 1973, the Joint Committee on Infant Hearing Screening recommended identifying infants at risk for hearing impairment by means of five criteria, and suggested follow-up audiologic evaluation of these infants until accurate assessments of hearing could be made (AAP Newsletter Supplement, October 1973). Since the incidence of moderate to profound hearing loss in the at-risk infant group is 2.5% to 5.0%, audiologic testing of this group is warranted. Acoustic testing of all newborn infants has a high incidence of false-positive and false-negative results and is not universally recommended.

Recent research suggests the need for expansion and clarification of the 1973 criteria. This 1982 statement expands the risk criteria and makes recommendations for the evaluation and treatment of the hearing-impaired infant.

I. IDENTIFICATION

A. Risk criteria

Factors that identify those infants who are at risk for having hearing impairment include the following:

1. Family history of childhood hearing impairment

2. Congenital perinatal infection (eg, cytomegalovirus, rubella, herpes, toxoplasmosis, syphilis)

3. Anatomic malformations involving the head or neck (eg, dysmorphic appearance including syndromal and nonsyndromal abnormalities, overt or submucous cleft palate, morphologic abnormalities of the pinna)

4. Birth weight < 1,500 gm

5. Hyperbilirubinemia at level exceeding indications for exchange transfusion

6. Bacterial meningitis, especially Haemophilus influenzae

7. Severe asphyxia which may include infants with Apgar scores of 0 to 3 or who fail to institute spontaneous repiration by ten minutes and those with hypotonia persisting to 2 hours of age