bluuebunny/crossref_metadata_2025 huggingface dataset:
Motor Vehicle Occupant Injuries to Children in Crash and Noncrash Events
Authors: Agran Phyllis A. , Dunkle Debora E.
Published: December 2021

The mechanisms and severity of nonfatal injuries to children in crash and noncrash situations were compared: 82 children (15%) were involved in noncrash events and 466 (85%) were involved in crash events. Younger children (0 to 4 years of age) were more likely to be injured in a noncrash incident. The mechanism of injury was significantly different; 45% of the children injured in a noncrash event were ejected in contrast to 5% of the children injured in a crash event. Although more severe injuries were sustained in crashes, most of the children who were ejected in a noncrash event sustained at least moderate injuries. Use of restraint systems, door lock mechanisms, and appropriate passenger seating locations in the motor vehicle are three simple measures that could attenuate or eliminate noncrash injury.
A Comparison Study of Parental Adaptation Following a Child's Death at Home or in the Hospital
Authors: Lauer Mary E. , Mulhern Raymond K. , Wallskog Joyce M. , Camitta Bruce M.
Published: December 2021

Mothers and fathers of 37 deceased pediatric oncology patients were interviewed 3 to 28 months after their child's death. Twenty-four of these families had participated in a formal Home Care Program for dying children, whereas the remaining 13 families had children who died in the hospital. Parental adaptation following the home care experience appeared to be more favorable than following terminal care and death in the hospital. Specifically, the parents who had cared for their terminally ill child at home displayed more positive adjustment patterns as indexed by their perception of how the child's death had affected their marriage, social reorientation, religious beliefs, and views on the meaning of life and death. Ratings given by parents providing home care indicated a significant reduction in guilt during the home care experience which was maintained at 6 and 12 months following the child's death. In contrast, parents who did not provide home care reported intensified feelings of guilt during their child's terminal hospitalization which were unresolved at one year after the child's death. The results are discussed in terms of the practical and emotional benefits that may be derived from a family's voluntary choice of home care for dying children.
Dexamethasone and Salbutamol in the Treatment of Acute Wheezing in Infants
Authors: Tal Asher , Bavilski Chanan , Yohai David , Bearman Jacob E. , Gorodischer Rafael , Moses Shimon W.
Published: December 2021

Thirty-two infants, aged 1 to 12 months, hospitalized with acute wheezing, were studied. They were randomly divided into four treatment groups of eight patients each. The treatments were intramuscular dexamethasone or placebo (double-blind), and salbutamol (oral and inhaled), or none (open), in all four possible combinations. The study was carried out as a randomized block design with eight blocks of four infants each, matched by age and clinical score. Average daily improvements, as reflected by changes in the clinical score and length of hospital stay, was essentially the same for infants treated with placebo, salbutamol alone, and dexamethasone alone. However, combined salbutamol-dexamethasone treatment resulted in more than twice the rate of improvement of the other treatments. The difference was statistically highly significant (P < .01). Furthermore, the response of this combined treatment was observed within 24 hours; none of the ten infants in whom there was no significant improvement within 48 hours and neither of the two patients who developed respiratory failure received the combined salbutamol-dexamethasone treatment. A potentiating effect of corticosteroids on the β-adrenergic responsiveness is a possible explanation for the advantage of this combined treatment in the management of acute wheezing in infancy.
Is Stuttering an Illness?
Authors: PRESTON E. NOEL
Published: December 2021

The letter from the Medical Care Foundation Peer Review Panel was a plaintive one. "[Insurance Company] has requested we review this claim and give an opinion as to whether stuttering is an illness. If you cannot make a decision on this claim, any suggestions regarding which specialty to send it to would be helpful." The envelope that brought me this letter contained claims forms, rejection notices, appeals, denials of appeals, medical statements, further denials, a flurry of intraoffice memos to and from different levels of the insurance company's hierarchy, and finally a demand from the patient that the matter be submitted to Peer Review for a decision.
Foster Care Children
Authors: SCHOR EDWARD L.
Published: December 2021

In Reply.—

Demb's perspective is an important one and merits discussion. I agree that children entering foster care do so with some degree of preexisting emotional disturbance. One would be surprised to find otherwise, given the neglect and abuse that prompt their placement, although there has been little published about this aspect of child abuse. Viewing this issue from a residential foster care facility would tend to exaggerate the truth of this conclusion. However, as Sokoloff1 has noted <20% of placements are for manifest difficulties of the children themselves; others2 have found an even lower proportion.
Foster Care Children
Authors: SCHOR EDWARD L.
Published: December 2021

In Reply.—

I would like to thank Dr Madden for his praise of my article. I concur with his and Sokoloff's concern that existing Medicaid reimbursement schedules pose a potential deterrent to the provision of appropriate health care to foster children.1 This appears to be the case in Maryland.2

As outlined in the final paragraph of my article,3 the medical professional services that foster children require are extensive and time consuming. It is for that reason that i have some reservations about the recommendation of the American Academy of Pediatrics4 that foster children be cared for by the same health care provider as the foster family.
Conjunctivitis-Otitis Syndrome
Authors: BODOR FRANK F.
Published: December 2021

In Reply.—

I wish to thank Whitson for his comments on my paper. I apologize for omitting to state the total number of patients with purulent conjunctivitis under subtitle "Patients, Methods, and Materials," as it was stated in the abstract. During the study period, a total of 132 patients with purulent conjunctivitis (including those associated with otitis media) was seen in the office. I might add here that many of these patients were visiting the office because of other symptoms, and that in these cases the diagnosis was made as a result of an active search for purulent conjunctivitis.
Febrile Neonates
Authors: VOORA S. , SRINIVASAN G. , LILIEN L. D. , YEH T. F. , PILDES R. S.
Published: December 2021

In Reply.—

Jenista et al1 found nonpolio enterovirus infection in 83% of febrile infants in the first month of life during July through October 1981 and suggested that some of the febrile neonates in our study2 also may have had enteroviral infection. Our study of fever was limited to full-term newborns in the first four days of life and we found no seasonal variation in incidence of fever. For 1979 v 1980 incidence of fever was: January, 0 v 5; February, 0 v 3; March, 0 v 11; April, 5 v 4; May, 8 v 7; June, 2 v 7; July, 3 v 2; August 5 v 3; September 7 v 7; October, 6 v 5; November, 5 v 0; December, 6 v 0.
A Computerized System for Continuous Physiologic Data Collection and Analysis: Initial Report on Mean Arterial Blood Pressure in Very Low-Birth-Weight Infants
Authors: Adams M. Abby , Pasternak Joseph F. , Kupfer Barry M. , Gardner Thomas H.
Published: December 2021

A system for continuous measurement and analysis of mean arterial blood pressure (MABP) by microcomputer is presented. The system allows prolonged recording and maintenance of fine detail by sequential evaluation and storage of up to 3,600 data points per hour. Fifteen preterm appropriate-for-gestational-age (AGA) infants weighing ≤1,500 g (very low birth weight) who were free of pulmonary and neurologic disease were monitored continuously from birth to 5 days of age. MABP was recorded via an umbilical arterial catheter with a pressure transducer and module interfaced with the microcomputer. Software was developed to analyze this stored data rapidly. MABP was found to correlate significantly with gestational age from 3 to 15 hours of age (P < .05). Significant correlation was rare after 20 hours of age. MABP increased as a function of postnatal age in 11 infants. This increase was greater (0.31 to 0.54 mm Hg/h) for the least mature infants (27 to 29 weeks of gestation). The increase for the most mature infants (31 to 32 weeks of gestation) was low (0 to 0.24 mm Hg/h), and in three infants a small negative slope was seen. The steep rise in MABP during the first 40 hours of life in the least mature infants may be due to the perfusion requirements of extrauterine life. These pressures may be at or near the threshold for rupture of immature vascular beds such as are found in the subependymal germinal matrix and thus predispose to intraventricular hemorrhage.
Distance Running Improves Fitness in Asthmatic Children Without Pulmonary Complications or Changes in Exercise-Induced Bronchospasm
Authors: Nickerson Bruce G. , Bautista Daisy B. , Namey Marla A. , Richards Warren , Keens Thomas G.
Published: December 2021

The effect of a distance running program was studied in 15 children with severe chronic asthma. Following a 6-week control period, the subjects ran four days a week for 6 weeks. The distance was increased gradually to 3.2km. Clinical status and need for treatment did not change. Episodes of exercise-induced bronchospasm were readily reversed. Fitness improved as measured by the distance run in 12 minutes (P <.005). Resting pulmonary function did not change. Exercise-induced bronchospasm following a bicycle ergometer stress test under comparable conditions did not change. Ventilatory muscle strength, measured as the maximal inspiratory pressure, and endurance, measured as the sustainable inspiratory pressure, were at a high level initially and did not change. It is concluded that distance running is safe and can increase the fitness of asthmatic children who are receiving adequate therapy.
Acute Lower Respiratory Tract Illnesses in Cali, Colombia: A Two-Year Ambulatory Study
Authors: Berman Stephen , Duenas Alvaro , Bedoya Alvaro , Constain Victor , Leon Saul , Borrero Isabella , Murphy James
Published: December 2021

A surveillance system for acute lower respiratory tract illnesses was implemented February 1977 in five neighborhood health clinics. Of the 1,229 patients with an illness identified during the 25 months from Feb 1, 1977 to Feb 28, 1979, there were 38 with croup, 451 with tracheobronchitis, 339 with bronchiolitis, and 401 with pneumonia. Forty-two percent of the illnesses occurred in children less than 1 year of age and 66% occurred in children less than 2 years of age. A viral infection was diagnosed in 20% of the patients by viral cultures and/or fourfold rises in complement fixation antibody titers in acute and convalescent sera. A viral agent was identified in 29% of patients with croup, 20% with tracheobronchitis, 22% with bronchiolitis, and 17% with pneumonia. Four viral agents, respiratory syncytial virus (RSV) adenovirus, parainfluenza viruses, and influenza viruses accounted for 94% of the cases associated with a viral infection. RSV was associated with 9% of the cases, adenovirus with 6.8%, parainfluenza with 2.1%, and influenza with 1.3%. These four viral agents had slightly different clinical patterns. The majority of RSV infections were diagnosed in children less than 2 years of age with bronchiolitis or pneumonia. Yearly outbreaks of RSV were noted during periods corresponding to RSV peaks in northern temperate climates. Adenoviral infections occurred most frequently in children between 1 and 5 years of age with tracheobronchitis or pneumonia in association with high fever. Parainfluenza viral infections were usually associated with tracheobronchitis and pneumonia. Influenza infections usually occurred in older children with pneumonia associated with high fever, headache, and myalgias. Bacteremias were identified in four patients with lower respiratory tract infections. Twenty percent of children with moderate or severe malnutrition and an acute respiratory illness were bacteremic. Three of the four children with moderate or severe malnutrition, pneumonia, and fever greater than 38.9°C had a positive blood culture. There were 17 children seen who required hospitalization and three subsequent deaths in this group.
Association of Genital Mycoplasmas with Exudative Vaginitis in a 10 Year Old: A Case of Misdiagnosis
Authors: Waites K. B. , Brown M. B. , Stagno S. , Schachter J. , Greenberg S. , Hemstret G. P. , Cassell G. H.
Published: December 2021

A 10-year-old girl with a 1-year history of lower genitourinary tract symptoms suggestive of bacterial infection but with numerous negative urine cultures was referred to the University of Alabama urology clinic after empirical treatment with multiple antibiotics failed to resolve her symptoms. An extensive urologic evaluation revealed no structural or physiologic abnormalities, but an exudative vaginitis was noted and large numbers of Ureaplasma urealyticum and Mycoplasma hominis were isolated from the lower genital tract. Cultures for Chlamydia, viruses, and routine bacterial pathogens were negative. After initiation of tetracycline therapy, symptoms resolved and subsequent cultures for mycoplasmas were negative. In addition, a seroconversion was noted for M hominis but not for U urealyticum. Chlamydia serology was negative. It was later learned that the patient had been sexually molested just prior to the onset of symptoms. This case illustrates the necessity of early consideration of a mycoplasmal etiology in the patient with persistent genitourinary symptoms and no obvious bacterial pathogen, or in the patient whose condition is refractory to routine antibiotic therapy.
Campylobacter jejuni-Associated Hemolytic-Uremic Syndrome in a Mother and Daughter
Authors: Chamovitz Bruce N. , Hartstein Alan I. , Alexander Steven R. , Terry Annie B. , Short Priscilla , Katon Ronald
Published: December 2021

A mother and daughter with Campylobacter jejuni-associated hemolytic-uremic syndrome (HUS) are discussed. The mother was hospitalized with bloody diarrhea and HUS; C jejuni was isolated from her stool. The 2-year-old daughter had been admitted five days prior to her mother with HUS following a three-day prodrome of vomiting and diarrhea. Multiple stool cultures were negative for enteric pathogens; however, cultures were not obtained until the eighth hospital day and after antibiotic therapy. Extensive investigation failed to identify another cause for the diarrheal illness or HUS in our patients. Indirect immunofluorescent antibody titers for C jejuni were 1:32 and 1:16 for the mother and daughter, respectively. An asymptomatic 9-month-old son had C jejuni isolated from his stool and had an immunofluorescent antibody titer of 1:64. Three other family members were asymptomatic, stool-culture negative, and had immunofluorescent antibody titers ≤ 1:4. The susceptibility to develop HUS following an enteric antigenic stimulus is illustrated by the patients presented. The need for systematic investigation of all HUS cases for potential susceptibility markers, as well as an exhaustive etiologic search, is emphasized.
Prevention of Chronic Hepatitis B Virus Infection from Mothers to Infants in the United States
Authors: CHIN JAMES
Published: December 2021

Transmission of hepatitis B virus (HBV) from mothers who either have an acute HBV infection or who are chronic hepatitis B surface antigen (HBsAg) carriers to their infants has been well documented.1-3 In countries where HBV is hyperendemic, transmission from carrier mothers to their infants has been estimated to be the cause of 20% to 40% of all chronic HBV carriers in the population. Such transmission might account for as many as 50 million chronic HBV carriers throughout the world.

Most HBV infections in infants are asymptomatic. Infected infants who develop antibody to HBsAg (anti-HBs) are presumably immune for life and are not believed to be at any increased risk of subsequent liver disease.
Italian Surgeons Can Be Intimidated by Facts
Authors: LONGO GIORGIO , SIMON GIORGIO , TAMBURLINI GIORGIO , VIOLINO MARCO
Published: December 2021

To the Editor.—

In 1977 at the Children Hospital of Trieste we evaluated the use of antibiotics in the hospital wards. The most impressive finding was the common use of antibiotics for routine prophylaxis before surgical interventions.1

This tendency was recognizable in all surgical wards (stomatology, otorhinolaryngology, and general surgery) and its quantitative aspects were very similar to those reported by Kesler et al.2 The problem of inappropriate use of antibiotics, especially in the surgical wards, has been recognized as a major concern in hospital care and many remedies have been proposed and tested: use of predetermined therapeutic protocols, medical audit on antibiotic usage, mandatory written requests for certain antibiotics, introduction of automatic "stop order," mandatory references to literature before prescribing, etc.3
Treatment of Choking
Authors: DAY RICHARD L. , DUBOIS ARTHUR B.
Published: December 2021

In Reply.—

We thank Dr Eigen for noting that our paper on choking1 showed just how (as asserted by Heimlich and others) back blows might be harmful in the emergency treatment of severe choking. In the same issue, there is a review by Heimlich,2 and there is also a report by Greensher and Mofenson,3 which advises back blows as the first maneuver to save a choking child and expresses fear that a child's abdominal organs could be injured by abdominal thrusts.
Growth and Development of Infants Weighing Less Than 800 Grams at Birth
Authors: Bennett Forrest C. , Robinson Nancy M. , Sells Clifford J.
Published: December 2021

A prospective study of infants weighing <800 g at birth and cared for in a single neonatal intensive care unit between 1977 and 1980 was conducted. Neonatal mortality was 80%; neurodevelopmental outcome was assessed in 16 of the 18 survivors. Mean birth weight for these 16 was 730 g; mean gestational age was 26 weeks. Perinatal asphyxia, respiratory distress, apnea, mechanical ventilation, and chronic pulmonary disease were commonplace. Symptomatic intracranial hemorrhage, seizures, sepsis, or meningitis did not occur in survivors. Of the 16 infants, 13 (81%), including all three with birth weight <700 g, were without major CNS handicaps and were developing appropriately at 6 months to 3 years of age. Only one of the 16 had clearly subnormal mental development. None had a major visual or hearing impairment. Apgar scores at one and five minutes were significantly related to outcome; apnea, mechanical ventilation, and chronic pulmonary disease were not. These data suggest that a remarkably hopeful outcome is possible for the few survivors of extremely low birth weight.
Ligation of Patent Ductus Arteriosus in Premature Infants: Importance of Accurate Anatomic Definition
Authors: Fleming William H. , Sarafian Lynne B. , Kugler John D. , Nelson Robert M.
Published: December 2021

The aortic arch anatomy of the premature infant may not be as simple to determine as the anatomy of an older child. A case of a premature infant who had inadvertent ligation of the left pulmonary artery during attempted ligation of a patent ductus arteriosus is described. On the fourth day following the initial operation, the patient underwent successful surgery to remove the pulmonary artery ligature and to ligate the persistent patent ductus arteriosus. A lung scan on the seventh day following removal of the pulmonary artery ligature showed normal perfusion of both lungs. Six months later, the child's growth, development, and chest roentgenogram were normal.
Dust-Free Bedrooms in the Treatment of Asthmatic Children with House Dust or House Dust Mite Allergy: A Controlled Trial
Authors: Murray Andrew B. , Ferguson Alexander C.
Published: December 2021

Twenty asthmatic children with prick tests positive for house dust or house dust mites were allocated to two groups that were matched for severity. One group was provided with zippered vinyl covers for pillows, mattresses, and box springs, and instructions for making the bedroom as easy to keep clean as a hospital ward; the other group was not. At the end of a 1-month study period, there was a marked and statistically significant difference in symptoms and signs of asthma between the two groups. Those with a dust-free bedroom had fewer days on which wheezing was observed, medication was given, or an abnormally low peak expiratory flow rate was recorded. Bronchial tolerance to aerosolized histamine significantly improved in the group whose bedrooms had been modified. A dust-free bedroom diminishes bronchial irritability and is a practical and effective method for decreasing asthma in children with house dust or house dust mite allergy.
Retrolental Fibroplasia: Further Clinical Evidence and Ultrastructural Support for Efficacy of Vitamin E in the Preterm Infant
Authors: Hittner Helen Mintz , Godio Louis B. , Speer Michael E. , Rudolph Arnold J. , Taylor Martha M. , Blifeld Cindy , Kretzer Frank L.
Published: December 2021

To further evaluate the efficacy of oral vitamin E in preventing the development of severe retrolental fibroplasia (RLF) in very low-birth-weight infants, 100 infants treated with 100 mg/kg/d of vitamin E (dl-α-tocopheryl acetate) were compared with 75 infants treated with 5 mg/kg/d of vitamin E (dl-α-tocopherol) in the same nursery during the previous year. All 175 infants weighed ≤1,500 g at birth and required supplemental oxygen. A total of 120 infants (69 treatment; 51 control) survived ≥ 10 weeks. Multivariate analysis of the control population identified five risk factors (P ≤ .10): gestational age, level and duration of oxygen administration, intraventricular hemorrhage, sepsis, and birth weight. When multivariate analysis was applied to both control and treatment groups, the severity of RLF was found to be significantly reduced in infants given the treatment dose of vitamin E(P = .003). Ultrastructural analyses of 58 pairs of whole-eye donations from high-risk infants surviving less than 10 weeks suggest that the initial morphologic event is gap junction increases between the plasma membranes of adjacent spindle cells of the vanguard retina. Such extensively gap junction-linked spindle cells are apparently removed from the vasoformative process as early as 4 days of life, forming a barrier to further normal vascular development and triggering retinal and vitreal neovascularizations approximately 8 weeks later. These events are maximally suppressed by elevated plasma vitamin E levels in infants ≥27 weeks gestational age.
Otitis Media and Compliance
Authors: MAYES LINDA C. , PERRIN JAMES M.
Published: December 2021

To the Editor.—

The recent study of otitis media by Schwartz et al,1 has basic methodologic problems that call into question the validity of the conclusions. The first relates to the definition of otitis media with effusion (OME). Criteria in the study have not been validated, and (more importantly) only 60% of the diagnoses of OME were confirmed by tympanometry. Did the other 40% really have OME? Would analysis using only children whose diagnosis was confirmed by tympanometry have led to the same results?
Otitis Media and Compliance
Authors: SCHWARTZ RICHARD H. , RODRIGUEZ WILLIAM J. , GRUNDFAST KENNETH M.
Published: December 2021

In Reply.—

The analysis of our data by Mayes and Perrin is certainly appreciated. First, in answer to their inquiry about diagnosis, Schwartz diagnosed the otitis media in each case, using both pneumatic otoscopy and tympanometry. Though Schwartz' accuracy in diagnosis could be questioned, we feel that his diagnostic skills are at least as good as those of any other investigator who has reported on the management of otitis media.

Second, as for the problem of changing denominators, we are grateful to Mayes and Perrin for pointing out the confusion between the table and the text.
Carboxyhemoglobin Concentration in Fetal Cord Blood
Authors: BUREAU MICHEL A.
Published: December 2021

In Reply.—

Huch et al give very valuable comments about the limitations of the IL 282 Co-oximeter (IL Instrumentation Laboratory) for measurements of carboxyhemoglobin (HbCO) in fetal blood. They mentioned the problems of interference between oxyhemoglobin (HbO2) and HbCO of fetal blood on the multiwavelength analysis of spectrophotometers such as the IL 282 Co-oximeter. For practical purposes the method used overestimates the fetal HbCO but not maternal HbCO and therefore the ratio of fetal/maternal HbCO is falsely increased.
Measles in the Future?
Authors: HEALY C. E. , CLINIC WELBORN
Published: December 2021

To the Editor.—

I am concerned about measles immunization in that most studies show up to a 5% failure rate with the current immunization practice, at least as measured by the hemagglutination-inhibition (HI) technique. Some of these children might be protected by neutralizing antibodies or cellular (lymphocytic)-mediated immunity, but the extent and duration of this immunity, if any, is unknown. HI immunity is apparently permanent. The end result of the current immunization practice will be a large pool of hundreds of thousands and eventually, millions of adults, who will be susceptible to measles.
Parents' Time Is Worth Money
Authors: RICHARDSON DOUGLAS
Published: December 2021

To the Editor.—

I was delighted to see Donn's letter about the cost effectiveness of home management of bronchopulmonary dysplasia.1 Such contributions are vital in helping to curb the rapidly rising costs of neonatal intensive care. However, his economic analysis is flawed. By tacit assumption, he omits any consideration of the opportunity costs to the parents. To omit this presumes that the parents' time is worth little or nothing, as we often seem to indicate by the long patient waiting times in our offices.
Neonatal Seizures
Authors: COEN RONALD W.
Published: December 2021

To the Editor.—

Seizures are a clinical sign that disturbances have or are continuing to occur in the CNS.1 It is important to determine the etiology of a seizure for the purpose of both treating the infant and for predicting later development. Several studies have shown that seizures associated with asphyxia, trauma, infection, and brain anomalies result in fewer normal outcomes than those associated with hypocalcemia, subarachnoid hemorrhage, or even an unknown etiology.2 Experimental evidence suggests that seizures per se have a detrimental effect on the immature brain.
Treatment of the Choking Child
Authors: GREENSHER JOSEPH , MOFENSON HOWARD C.
Published: December 2021

In Reply.—

The comments by Hoffman are well taken and his analysis of the data presented by Day et al1 in their article deserves consideration. In addition to Hoffman's observation on acceleration of a foreign body from a back blow it should be noted that the acceleration measurements by Day et al were done with the accelerometer on the external surface of the neck. To validate the assumption that downward acceleration of a supraglottic foreign body would result from a back blow requires acceleration measurements performed upon the foreign body itself.
Doppler Debate Continued
Authors: BEJAR RAUL , MERRITT T. ALLEN , COEN RONALD W. , MANNINO FRANK , GLUCK LOUIS
Published: December 2021

To the Editor.—

We wish to answer the negative and often inappropriate responses generated by our commentary.1 As stated clearly, we do not oppose the transcutaneous Doppler technique; we intended only to discuss the technical problems inherent in continuous wave Doppler transducers and the interpretations made from indirect "measurements of cerebral blood flow" (CBF) and patterns of pulsatile blood flow. Most of the technical problems described in our commentary probably can be avoided by using two-dimensional, range-gated, pulsed Doppler ultrasonography.
If Too Much of a Good Thing Is BAD, Is Too Much of a Bad Thing BPD?
Authors: Cassady George
Published: December 2021

The report by Poets and Sens1 in this issue clearly shows that raising the criteria required for endotracheal intubation and intermittent mandatory ventilation (ET/IMV) in an entire community population of vulnerable, very low birth weight (VLBW) infants reduces bronchopulmonary dysplasia (BPD). Outcomes in all live-born infants with birth weights of between 500 and 1499 g from the German state of Lower Saxony, cared for in tertiary centers (comparable to level III neonatal intensive care units [NICUs] in this country) as well as in community centers (level II NICUs), from 1992 through 1994 were examined. No apparent price was paid for this improvement in pulmonary outcome.
Does Supine Sleeping Cause Asymmetric Heads?
Authors: Hunt Carl E. , Puczynski Mark S.
Published: December 2021

A relationship between PWS and supine sleeping is theoretically plausible. Additional studies are necessary, however, to confirm that the incidence of appropriately defined PWS has increased, and that the magnitude and timing of this increase are consistent with the magnitude and timing of increasing supine prevalence. The recommended strategy to prevent any risk for PWS is to rotate the head position during supine sleeping and to use the prone position for supervised awake time. With the combined efforts of primary care physicians and parents, therefore, orthotic devices such as soft helmets or rigid head bands (The Wall Street Journal, Midwest edition. February 23, 1996) should rarely, if ever, be necessary, and surgery for PWS should never be necessary.
The Management of Opioid and Benzodiazepine Dependence in Infants, Children, and Adolescents
Authors: Yaster Myron , Kost-Byerly Sabine , Berde Charles , Billet Carol
Published: December 2021

As physicians and nurses, we have a fundamental obligation to manage pain and relieve patient suffering as a crucial element of our professional commitment to patient care.1,2 These are not merely lofty ideals; effective pain management produces a myriad patient benefits including reduced morbidity and mortality, early mobilization, and shortened hospital stay.3

Historically, children were undertreated for pain and for painful procedures because of the common wisdom that children neither responded to, nor remembered, painful experiences to the same degree that adults did. This is simply untrue. We now know that even neonates experience pain and that all children, even the critically ill, respond to noxious stimuli with biochemical and physiologic stress responses that if untreated can lead to increased patient morbidity and mortality.4,5
Letter To The Editor
Authors: Poets Christian F.
Published: December 2021

The data presented by Johnson et al suggest that the recommendation to place infants on their back or side, issued by the American Academy of Pediatrics in 1992, has so far had very little effect on the way parents put their infants to sleep. This is particularly disappointing as recent data from Europe and New Zealand demonstrate that child care practices can indeed be influenced very effectively. For example, in Avon, United Kingdom, the proportion of infants usually sleeping in the prone position fell from 59% in 1988 to 2% in 1992.
Letter To The Editor
Authors: Kattwinkel John , Brooks John , Keenan Maurice E. , Malloy Michael , Willinger Marian
Published: December 2021

Drs Johnson et al present some evidence to suggest that the national "Back to Sleep" campaign in the United States may not yet be effective—at least in parts of Michigan. Data being collected by the National Institutes of Health from a wider national sample are somewhat more optimistic, with a reduction of prone sleeping from 73% before the 1992 AAP recommendation to 43% just prior to launching the "Back to Sleep" campaign in June 1994 (M. Willinger, personal communication).
Lumbar Puncture in Meningitis?
Authors: Boyer Kenneth M. , Gotoff Samuel P.
Published: December 2021

Wiswell et al1 assert that "if lumbar punctures (LPs) are omitted as part of the early neonatal sepsis evaluation, the diagnosis of bacterial meningitis occasionally will be delayed or missed completely." They call into question a study from our institution as well as several others2-5 that have recently concluded that cerebrospinal fluid (CSF) examination is not indicated in asymptomatic neonates with antepartum risk factors for infection." We would like to raise for discussion the semantics of Dr Wiswell's assertion and the data upon which it is based.
Thyroid Screening for Early Discharged Infants
Authors: Saslow Judy G. , Post Ernest M. , Southard Carol A.
Published: December 2021

Objective. As neonatal discharge before 24 hours of life becomes commonplace, the rejection of congenital hypothyroidism (CH) screening specimens obtained too early has created the need for numerous additional tests. We sought to determine whether the specimens obtained before 24 hours could be used safely.

Methods. During a 31-day period we measured thyrotropin in all thyroid-screening specimens that had been obtained before 24 hours. We also examined the early specimens from every infant diagnosed in New Jersey with CH during 1993 or 1994.

Results. Among the 663 specimens, those obtained at or before 12 hours and those from infants with birth weights less than 2500 g had too many low thyroxine results to be useful. Among the 515 specimens obtained at more than 12 to 24 hours from newborns weighing 2500 g or more, 37 (7%) had low thyroxine levels and 12 (2.3%) had thyrotropin levels of 20 µIU/mL (mU/L) or higher. Four hundred seventy-one of the 515 infants had subsequent specimens obtained at more than 24 hours, and none of the results were abnormal. There was no child weighing more than or equal to 2500 g who was diagnosed with CH in 1993 and 1994 whose specimen obtained at 24 hours or less was normal.

Conclusions. Accepting specimens obtained at more than 12 to 24 hours from infants weighing 2500 g or more would have resulted in more than the usual number of false-positive results but no false-negative results. This would have decreased the requests for additional specimens by more than 90%.
Effects of In Utero Substance Exposure on Infant Neurobehavior
Authors: Napiorkowski Beata , Lester Barry M. , Freier M. Catherin , Brunner Susan , Dietz Laura , Nadra Andrea , Oh William
Published: December 2021

Objective. This study had two objectives: (1) to assess infant behavior by using the NICU Network Neurobehavioral Scale (NNNS), an assessment designed specifically for prenatally drug-exposed infants; and (2) to control for the effects of polydrug use involving alcohol, marijuana, and cigarettes on the neurobehavioral status of the newborn infant.

Methods. The subjects and controls in this study were full-term infants of appropriate gestational age with no medical problems. At 1 to 2 days of age, 20 infants exposed to cocaine, alcohol, marijuana, and cigarettes; 17 infants exposed to alcohol and/or marijuana and cigarettes; and 20 drug-free infants were evaluated by using the Neonatal Intensive Care Unit Network Neurobehavioral Scale. The data were reduced to reflect clinically defined categories of neurobehavioral function and were analyzed by using analysis of variance and X2 statistics.

Results. Cocaine-exposed infants showed increased tone and motor activity, more jerky movements, startles, tremors, back arching, and signs of central nervous system and visual stress than unexposed infants. They also showed poorer visual and auditory following. There were no differences in how the examination was administered to cocaine-exposed and nonexposed infants. Reduced birth weight and length were also observed in cocaine-exposed infants.

Conclusions. Differences attributable to cocaine-exposed infants were related to muscle tone and motor performance, following during orientation, and signs of stress. However, cocaine-exposed infants were not more difficult to test, nor did they require an alteration in the examination. Both neurobehavioral patterns of excitability and lethargy were observed. Findings may have been due to the synergistic effects of cocaine with alcohol and marijuana.
Prevalence of Juvenile Chronic Arthritis in a Population of 12-Year-Old Children in Urban Australia
Authors: Manners Prudence J. , Diepeveen Dean A.
Published: December 2021

Objective. To conduct a cross-sectional, community-based, point prevalence study of inflammatory joint disease and other rheumatic disorders in 12-year-old children in a metropolitan community.

Methods. After completion of a pilot study of 816 10-year-old children, a cross-sectional prevalence study was performed 2 years later on a randomized sample of 2241 12-year-old children (including the cohort from the pilot study) from a community of approximately 221 700 children aged 12 years or younger, with 17 300 children aged approximately 12 years. A rheumatologic examination was performed on each child by a single observer after perusal of completed questionnaires from parents and children.

Results. Three of 816 children in the pilot study were shown to have juvenile chronic arthritis (JCA), fulfilling the criteria of the European League Against Rheumatism for the diagnosis of JCA. Only 1 of 3 had a previous diagnosis of JCA. The prevalence was 3.7 per 1000. Of 2241 children examined 2 years later, 89% returned two questionnaires (one completed by the parent and one by the child). At examination, 38 swollen joints were identified in 32 children. Nine children were identified with JCA, of whom 7 had not had previous diagnoses. No questions from the questionnaires identified the 7 children with previously undiagnosed JCA. The point prevalence of JCA in this community was 4.0 per 1000. Although the children with newly diagnosed cases tended to have mild disease, it was associated with significant morbidity and the potential for serious morbidity.

Conclusions. This is the first reported prevalence study of JCA in which case ascertainment was based on clinical examination by a rheumatologist of children within a community. The prevalence of 4.0 per 1000 was significantly higher than the accepted prevalence of 0.6 to 1.1 per 1000. A study based on known cases would have significantly underestimated the true prevalence of JCA in this community, with 7 of 9 cases being previously undiagnosed. Questionnaires were not effective in identifying children with undiagnosed JCA, clinical examination supported by a history from the parent and child providing the only reliable means of diagnosis. It is possible throughout the world that the numbers of undiagnosed cases of JCA significantly exceed the numbers of known cases, with the true prevalence being significantly higher than the levels currently accepted.
MOTHERS WHO MURDER THEIR CHILDREN
Authors: L. J. F.
Published: December 2021

Goodby My Little Ones by C. Hickey, T. Lighty, and J. O'Brien, Onyx Books, 1996. This recent book, and the three others listed below, should be read by every pediatrician who is in the apnea monitoring business!

It describes in detail the confession, trial, and conviction of "Mrs H," who murdered her five children. Two of these cases were reported by Dr A. Steinschneider in 1972, and formed the basis for the hypothesis of sleep apnea as a cause of sudden infant death syndrome (SIDS) (Pediatrics, 1972). This article started the apnea monitoring "rage" that continues today. The effectiveness of this monitoring in preventing deaths remains unproven despite extensive studies.

OTHER BOOKS ON THE SAME SUBJECT:

Sleep My Child, Forever by John Coston

Mommie's Little Angels by Mary Lou Cavenaugh

Precious Victims by Don W. Weber and Charles Bosworth, Jr
Espaço público e gestão da segurança urbana
Authors: Maciel Wellington Ricardo Nogueira
Published: December 2021

Em muitas cidades no mundo as administrações municipais têm construído mecanismos de segurança com o intuito de reativar os usos públicos do espaço urbano. Em Fortaleza, Ceará, Brasil, a gestão do Prefeito Roberto Cláudio (2017-2020) criou o Programa Municipal de Proteção Urbana que instituiu as células de proteção comunitária (torres de observação, drones, câmeras de vigilância e patrulhamento miliar ostensivo, com guarda municipal e polícia militar circulando em bicicletas e motos) em lugares com altas taxas de criminalidade. Este artigo discute as transformações ocasionadas por esse modelo de “proteção de proximidade” no bairro Jangurussu, território da periferia da cidade que concentra o maior número de mortes de adolescentes. A metodologia baseia-se em pesquisa documental, observação do cotidiano do bairro e entrevistas semiestruturadas com jovens que utilizam o Centro Urbano de Cultura, Arte, Ciência e Esporte (Cuca), localizado nas proximidades da torre de observação, para saraus, festas de reggae e apresentações de rap. Os resultados desta pesquisa sugerem que a territorialização militarizada da política de segurança urbana, em vez de favorecer, contribui para enfraquecer os usos intensos do espaço urbano ao inibir e controlar a presença dos jovens no raio de ação da torre de observação.
Marcadores sociais da diferença na experiência escolar de jovens estudantes negras
Authors: Soares Cristiane Barbosa , Bonetti Alinne de Lima
Published: December 2021

Analisamos os marcadores de gênero e raça presentes nas experiências de jovens estudantes negras de uma escola da rede pública. Para tanto, utilizamos a abordagem etnográfica a fim de compreender como tais marcadores operam no processo de construção das subjetividades das jovens negras. Com isso, questões sobre identidade, representatividade e resistências surgiram se inter-relacionando no processo de construção das subjetividades, o que evidenciou a emergência dos marcadores de gênero e de raça nas dinâmicas estabelecidas no contexto escolar. A partir dessa leitura, depreendemos que as experiências dos sujeitos que transitam no contexto escolar reforçam a importância da escola no processo de construção das subjetividades.
Coloración de tejas de caucho y plástico reciclado y su respuesta opto-térmica
Authors: Sanchez Amono Maria Paz , Sulaiman Halimi Cristina , Alchapar Nohelia Liliana , Gaggino Rosana , Correa Cantaloube Erica Norma
Published: December 2021

La eficiencia energética consiste en lograr un menor consumo de energía frente a una misma prestación. La distinta cantidad de radiación solar que es reflejada o absorbida se debe al color de la superficie. Las tejas desarrolladas en esta investigación son de color negro, por tener partículas de caucho en su composición, que contienen negro de humo. Los colores oscuros tienen una absortividad solar mayor, por lo tanto, se analizó la alternativa de colorear las tejas con colores claros, para reducir la absorción de radiación solar. El objetivo es evaluar distintas posibilidades técnicas para la coloración de tejas a partir de la incorporación de pigmentos, y determinar el rendimiento energético. Para la fabricación, se incorporaron óxidos, masterbatch, caucho y polietileno de color. Se realizaron experiencias variando sus dosificaciones y para la determinación del comportamiento termo-físico de las tejas se testearon propiedades ópticas (albedo y emisividad) y temperatura superficial de 2 unidades muestrales -una teja coloreada en verde y una en negro-. El grupo con mejores resultados fue el número 3, donde se mezcla el caucho negro, el polietileno verde y el masterbatch. Al comparar el desempeño termo-físico de tejas recicladas color verde en relación a tejas color negro, se observó un comportamiento más eficiente en las tejas de color verde. Se registraron incrementos en el nivel de albedo del 11% y disminuciones de temperatura superficial superior a 8°C.
Pesaje de vehículos en movimiento en puentes de un claro con número limitado de sensores
Authors: Agüero Barrantes Pablo , Lobo Aguilar Sergio , Christenson Richard E
Published: December 2021

En las economías emergentes, la implementación de la Gestión de Infraestructura del Transporte es una necesidad imperante. Con el propósito de utilizar de la forma más eficiente posible los limitados recursos disponibles, la tecnología surge como un aliado estratégico en dicho objetivo. Con el fin de preservar los pavimentos y puentes, diferentes metodologías han sido desarrolladas para la detección de vehículos con sobrepeso. En el presente artículo se presenta la implementación y validación del pesaje de vehículos en movimiento mediante la instrumentación de un puente en servicio ubicado en Costa Rica, con una cantidad reducida de sensores. Se utilizó el enfoque basado en áreas de influencia de ondas de respuesta de deformaciones unitarias. Dada la distribución de los sensores, minimizando los requisitos de instrumentación, se utilizaron dos tipos de deformación unitaria: horizontal y cortante. Dos camiones de calibración fueron utilizados como referencia y luego se procedió a estimar el peso del tráfico aleatorio, para confrontar dichos resultados con los datos de la estación de pesaje estática más cercana.
Phyllopertha horticola Linné - Pest in blueberry plantations in the Mărişel area (Cluj County)
Authors: HULUJAN Ionuţ Bogdan , FLORIAN Teodora , BUNESCU Horia
Published: December 2021

Phyllopertha horticola Linné (Coleoptera: Scarabaeidae) is one of the most common phytophagous beetles in Central Europe. In 2020 the blueberry growers from the Mărişel area reported the presence of a new beetle that attacked the fruit’s flowers and leaves. The species was identified at the University of Agricultural Sciences and Veterinary Medicine in Cluj-Napoca as the garden chafer. In the following year, the plants attacked by the garden beetle were monitored in the blueberry plantation in the Mărişel area. For monitoring the garden chafer, three rows of land were randomly selected in each plot with intervals of 20 plants per row. Each plant was analyzed individually and the number of adult beetles reported on the plant was noted. The observations were made between June and July 2021. In the Elliot variety, the share of plants reported with adults of Phyllopertha horticola Linné was between 50% and 60%, the average being 55%. Regarding the maximum number of adults/plant, it was between 6 specimens (raw 1) and 9 adults/plant (raw 2). In the Bluecrop variety, the share of plants with adults of the monitored species was between 10% and 45%, with an average per variety of 25%.
Effect of Cooking and Freezing on Levels of pesticides residues in Local Fresh Fish
Authors: ALABOUDI Akram Rishan , ALMASHHADANY Dhary Alewy , JARRAH Bashar Suleiman
Published: December 2021

Pesticides are an important part of pests controlling strategies. Misuse of such chemicals has been linked to pollution of various environments and toxicities that lead to various health conditions and diseases. Importance of healthy and non-contaminated fish for human diet is essentially required. Samples of 14 local fresh fish (tilapia, grey mullet, and cat fish) were analyzed for seven pesticides (endosulfan, heptachlor, malathion, chlorpyrifos, bifenthrin, deltamethrin, and fenoxycarb) using liquid chromatography with tandem mass spectrometry (LC-MS/MS). Heat processing applied for positive samples by two different cooking method (roasting at 79 °C for 10 min and frying at 210 °C for 40 min) have influenced the levels of studied pesticides and significantly reduced their levels by 53-95%. Freezing preservation of contaminated fish at -70 °C for one month only reduced the level of the pesticides by 6-30%, however, final reduced levels were not below recommended maximum residue limit values.