bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictors of Failure of High-Frequency Oscillatory Ventilation in Term Infants With Severe Respiratory Failure
Authors: Paranka Michael S. , Clark Reese H. , Yoder Bradley A. , Null Donald M.
Published: December 2021

Objective. To identify clinical factors in term neonates with severe respiratory failure that predict which neonates are unlikely to respond to high-frequency oscillatory ventilation (HFOV).

Design. This was a retrospective review of patient charts and medical records.

Patients. We studied 190 newborns treated with HFOV between July 1985 and December 1992. All patients were at least 35 weeks' estimated gestational age and had severe respiratory failure, defined as arterial to alveolar oxygen ratio (a/A ratio) of less than 0.2 or the need for peak inspiratory pressure greater than 35 cm H2O on conventional ventilation.

Results. Of the 190 patients, 111 (58%) responded to HFOV (HFOV responders), and 79 (42%) were placed on extracorporeal membrane oxygenation (ECMO) after HFOV failed to improve gas exchange (nonresponders). The two groups were similar in gender and birth weight. Factors associated with failure of HFOV to produce a sustained improvement in gas exchange were a diagnosis of congenital diaphragmatic hernia and more severe respiratory compromise as assessed by admission blood gas. Stepwise logistic regression analysis showed that a diagnosis of congenital diaphragmatic hernia/lung hypoplasia (CDH/LH) and the a/A ratio at initiation of and after 6 hours of HFOV were the only significant independent predictors of the need for ECMO. Among all the patients, the presence of CDH/LH or an initial a/A ratio of 0.05 or lower yielded a sensitivity of 74% and specificity of 77% in correctly identifying neonates in whom HFOV failed to produce a sustained improvement in oxygenation. When neonates with CDH/LH were excluded from analysis, the most significant predictor of failure of HFOV was the a/A ratio after 6 hours of HFOV. In neonates without CHD/LH, a 6-hour a/A ratio of 0.08 or lower discriminated responders from nonresponders (ie, treatment with ECMO) with a sensitivity of 77% and specificity of 92%.

Conclusions. In our patients, the presence of CDH/LH, severe respiratory failure (a/A ratio 0.05 or lower) at initiation of HFOV, and lack of improvement in oxygenation (a/A ratio 0.08 or lower after 6 hours of HFOV) were associated with failure of HFOV and treatment with ECMO. This information should help other centers to identify neonates who are at the greatest risk for requiring ECMO support and thus allow prompt transfer to an ECMO center.
Bacillus Calmette-Guérin Complications in Children Born to HIV-1-Infected Women With a Review of the Literature
Authors: O'Brien Katherine L. , Ruff Andrea J. , Louis Marie Albert , Desormeaux Julio , Joseph Delourdes Jules , McBrien Maureen , Coberly Jacqueline , Boulos Reginald , Halsey Neal A.
Published: December 2021

Objective. To compare the risk of complications following Bacillus Calmette-Guérin(BCG) vaccination among children by maternal and infant HIV-1 infection status as part of an investigation of an outbreak of BCG complications.

Methods. A nonconcurrent cohort study of BCG complications among 125 infants born to HIV-1 seropositive and 166 infants born to HIV-1 seronegative mothers was conducted in Cité Soleil, Haiti. Infants were examined at regular intervals until 15 months of age, and complications from BCG were documented. An investigation of BCG vaccination practices was conducted.

Results. Mild or moderate complications occurred among 16 of 166 (9.6%) infants born to HIV-1 seronegative mothers compared with 4 of 13 HIV-1-infected infants (30.8%, P = .04) and 10 of 75 (13.3%, P = .39) uninfected infants born to HIV-1-infected mothers. No serious complications were noted. The outbreak of complications was associated with administration of 2.0 to 2.5 times the recommended dose of BCG vaccine.

Conclusions. This and five other cohort studies indicate that there may be a small increased risk of complications following BCG vaccination among HIV-1-infected children, but the reactions are usually mild and the risk does not outweigh the benefits of BCG vaccination in populations at high risk of tuberculosis during infancy and childhood.
Resuscitation of Neonates with the Laryngeal Mask Airway—A Caution
Authors: Brimacombe Joe , Gandini D.
Published: December 2021

We would like to report our experience with the laryngeal mask airway (LMA) for neonatal resuscitation. The LMA was used in neonates with apnea or heart rate <100 min-1 who had no evidence of meconium aspiration. The LMA was inserted using the standard technique with the cuff fully deflated and then inflated with 2 to 5 mL air.1 It was then held in place manually and connected to a pediatric Mapleson F circuit. Intermittent positive-pressure ventilation or continuous positive airway pressure was administered until respiration was established.
Child Abuse Law
Authors: Frader Joel
Published: December 2021

Pediatrics deserves congratulations for publishing the article by Clark1 on decisions to withdraw or withhold medical treatment in pediatrics. Clark is right to point out the disturbing discrepancy between federal and state standards on this important matter. A number of other important points deserve emphasis.

First, the American Academy of Pediatrics (AAP) policy statement, "Guidelines on Forgoing Life-Sustaining Medical Treatment,"2 developed by its Committee on Bioethics, was published earlier this year. Although guidelines do not constitute a standard of medical care, they do provide a useful approach that pediatricians might follow when faced with these difficult situations.
Direct Comparison of Sn-Mesoporphyrin, An Inhibitor of Bilirubin Production, and Phototherapy in Controlling Hyperbilirubinemia in Term and Near-Term Newborns
Authors: Kappas Attallah , Drummond George S. , Henschke Claudia , Valaes Timos
Published: December 2021

Background. Sn-mesoporphyrin (SnMP) is a potent inhibitor of bilirubin production. In our previous studies a single dose (6 µmol/kg birth weight) significantly moderated hyperbilirubinemia and reduced phototherapy (PT) time by >75% when administered within 24 hours of birth to preterm infants.

Objective. To directly compare the efficacy of SnMP and PT for controlling hyperbilirubinemia in term and near-term infants.

Methods. Two randomized, sequentially analyzed trials (Study I: male term infants; Study II: infants of both sexes and gestational age [GA] 245-265 days) were conducted. SnMP (6 µmol/kg birth weight) or PT (Phillips F20T12/BB lamps) was administered to paired infants according to strict criteria of plasma bilirubin levels and age. Time of enrollment and closure of cases and crossover, if necessary, of SnMP infants to PT or all infants to exchange transfusion were precisely defined in each pair. SnMP or PT was considered superior if the time between enrollment and closure of the case was reduced by >24 hours over the alternative treatment or if crossover had occurred.

Results. None of the 44 SnMP-treated infants required supplemental PT. Of the 22 pairs of term infants enrolled in Study I, SnMP proved superior to PT in 20 and equal in two. Of the 20 pairs of near-term infants enrolled in Study II, SnMP was superior in 12 and PT in two; six were tied. Two SnMP-treated infants were unpaired. The PT-treated infants in Study I required an average of 33 hours of treatment; those in Study II, 48 hours. None of the enrolled infants required exchange transfusion or interruption of breast-feeding.

In both studies, times between case enrollment and closure were reduced by >30 hours in SnMP compared with PT infants; requirements for additional days of medical observation and bilirubin measurements were also significantly less in SnMP infants.

Conclusion. A single dose of SnMP entirely supplanted the need for PT in jaundiced term and near-term newborns and significantly reduced medical resource use to monitor hyperbilirubinemia.
Information Processing and Developmental Assessments in 3-Month-Old Infants Exposed Prenatally to Cocaine
Authors: Mayes Linda C. , Bornstein Marc H. , Chawarska Katarzyna , Granger Richard H.
Published: December 2021

Objective. To determine the effect of prenatal cocaine exposure on 3-month infant information processing and developmental assessments.

Methods. One hundred and eight infants, 61 cocaine-exposed and 47 controls, participated at 3 months of age in an infant-control habituation and novelty responsiveness procedure and in a developmental assessment using the Bayley Scales of Infant Development both administered by experimenters blind to the drug exposure status of the infant.

Results. Compared to the non-drug-exposed group, infants exposed prenatally to cocaine were significantly more likely to fail to start the habituation procedure and, for those who did, significantly more likely to react with irritability early in the procedure. The majority of infants in both groups reached the habituation criterion, and among those who did there were no significant difference between cocaine and non-cocaine-exposed infants in habituation or in recovery to a novel stimulus. Infants who were cocaine-exposed showed comparatively depressed performance on the motor (Psychomotor Developmental Index) but not the mental (Mental Developmental Index (MDI)) scales of the Bayley. These results obtained for habituation and Bayley MDI controlling for both perinatal and sociodemographic factors.

Conclusions. Differences in reactivity to novelty but not in information processing between cocaine-exposed and non-cocaine-exposed infants suggest that the effects of prenatal cocaine exposure may be on arousal and attention regulation rather than early cognitive processes.
Inter-Hospital Transport of Neonatal Patients on Extracorporeal Membrane Oxygenation: Mobile-ECMO
Authors: Heulitt Mark J. , Taylor Bonnie J. , Faulkner Sherry C. , Baker Lorrie L. , Chipman Carl W. , Harrell James H. , VanDevanter Stephen H.
Published: December 2021

Objective. To describe the equipment, personnel requirements, training, management techniques, and logistic problems encountered in the design and implementation of a mobile extracorporeal membrane oxygenation (ECMO) program.

Design. This is a report of a technique for the transport of patients on ECMO and a description of our retrospective case series.

Settings. The study was conducted at a regional referral children's hospital and ECMO unit.

Patients. Thirteen neonatal medical patients with acute respiratory failure were transported with mobile-ECMO.

Results. Over a 24-month period, we transported 13 neonatal patients with mobile-ECMO. The reason for transport with mobile-ECMO was inability to convert from high-frequency ventilation (4 of 13), patient already on ECMO (1 of 13), and patient deemed too unstable for conventional transport (8 of 13). Eleven of the 13 patients were transported from other ECMO centers. Of the 13, 9 survived. No major complications during transport were reported for any of the patients. Follow-up data were available on all nine survivors of neonatal mobile- ECMO. Eight of these had normal magnetic resonance imaging scans of the brain; the ninth had a small hemorrhage in the left cerebellum.

Conclusion. Our limited series shows that patients can be safely transported with mobile-ECMO. This program does not replace the early appropriate transfer for ECMO-eligible patients to an ECMO center.
Noninvasive Investigation of Infantile Hepatic Hemangioma: A Case Study
Authors: Bruce Suzanne , Downe Lyn , Devonald Katherine , Ellwood David
Published: December 2021

A preterm infant presented with high-output cardiac failure. Color Doppler imaging of the liver revealed a large hepatic hemangioma. Pulsed-wave Doppler of the proximal aorta was used to monitor non-invasively the reduction in flow through the arteriovenous malformation in response to steroid therapy. The hemangioma resolved completely by 7 weeks of age.
PROFIT LEVELS STAGNATING AT HOSPITALS
Authors: L. J. F.
Published: December 2021

Profit margins at most hospitals across the country declined or stagnated last year, reflecting growing pressure on them to reduce costs. And health care executives said many hospitals would be under even greater pressure in 1995 if Congress enacted proposals that would slash spending for medical care for the elderly and the poor.

At investor-owned hospitals, the outlook is brighter, because many of them have moved aggressively to merge and cut costs. Profit at these hospitals has risen in the 1990s.
Why Supplemental Security Income Is Important for Children and Adolescents
Authors:   Committee on Children With Disabilities
Published: December 2021

The Supplemental Security Income (SSI) program for children is an important part of the federal government's social benefits program for children with special needs. The SSI program is a nationwide program administered by the Social Security Administration (SSA) that does the following:

• provides monthly cash payments based on family income,

• qualifies the child for Medicaid health care services in many states, and

• assures referral of SSI child beneficiaries into the state Title V Children With Special Health Care Needs program's system of care.

The SSA considers a child to be disabled if:

• the impairment-physical or mental, or chronic medical condition-is as severe as a condition that would keep an adult from working,

• the condition is expected to last a long time or is life threatening, and

• the child is unable to engage in the everyday activities that most children the same age can do.

Congress implemented the children's component of the SSI program in 1974 in recognition that disabled children who live in low-income households are among the most disadvantaged of all Americans and therefore deserve special assistance. The cost of caring for a child with special needs is an especially heavy burden for families with limited resources. The intent of the SSI program is to reduce the additional deleterious environmental effects that a low family income can have on the growth and development of the disabled child and thereby help these children become self-supporting members of society.

The SSI program provides cash benefits.
Letters to the Editor
Authors: Walker Marsha
Published: December 2021

I read with interest the report by the Provisional Committee for Quality Improvement and Subcommittee on Hyperbilirubinemia (Pediatrics 1994;94:558-565) entitled, "Practice Parameter: Management of Hyperbilirubinemia in the Healthy Term Newborn." I wish to make a couple of comments on jaundice and the breast-fed newborn. It was gratifying to see recommendations discouraging the interruption of breast-feeding and eliminating the use of supplemental water or dextrose and water in this situation. Many jaundiced breast-fed newborns simply need more breast milk, ie, more feedings and a check to see that the newborn is swallowing milk at breast.
ON WAITING LIST BEFORE BIRTH
Authors: L. J. F.
Published: December 2021

In May 1991, an ultrasound examination revealed that a 17-week fetus had a potentially fatal heart malformation. Thirteen weeks later, doctors at the University of Pittsburgh put the fetus on a list of patients awaiting human hearts for transplant.

At 35 weeks, when the fetus was mature enough to live outside the womb, the baby was delivered and became the world's youngest heart transplant patient. But the baby died when she was 3 1/2 months old...

Last year, there were just 71 heart transplants in babies in the United States, and 18 percent to 37.5 percent of babies die before a heart can be found. So, Dr. Frager said, in listing a fetus before it was even mature enough for a transplant, the doctors "wanted to give their patient a leg up."
Adverse Outcomes of Bacterial Meningitis in School-Age Survivors
Authors: Grimwood Keith , Anderson Vicki A. , Bond Lyndal , Catroppa Cathy , Hore Robyn L. , Keir Eddie H. , Nolan Terry , Roberton Don M.
Published: December 2021

Objective. To determine the outcomes of bacterial meningitis in school-age survivors.

Design. Prospective cohort study.

Setting. Teaching pediatric hospital.

Children. During 1983 through 1986, 158 meningitis survivors, ages 3 months to 14 years, treated at a single center were enrolled. Between 1991 and 1993, 130 children, 82% of the original cohort, were evaluated at a mean age of 8.4 years and a mean of 6.7 years after their meningitis.

Outcome measures. Blinded neurologic, neuropsychologic, audiologic, behavior, and socio-demographic assessments were compared with those from grade- and sex-matched control children. Multivariate analyses adjusted for age at testing and socio-demographic variables.

Results. There was a systematic increase in risk of abnormality or poorer functioning for children with meningitis, compared with control children, across all categories tested, which was significant for fine motor function, Intelligence quotient (IQ) scores, and tests of school behavior, neuropsychologic function, and auditory figure-ground differentiation. Eleven children who had experienced meningitis (8.5%) had major deficits (IQ <70, seizures, hydrocephalus, spasticity, blindness, or severe to profound hearing loss); a further 24 (18.5%) cases and 14 (10.8%) control children had minor deficits (IQ 70 to 80, inability to read, mild to moderate hearing loss, abnormalities in speech discrimination, or school behavior problems). Overall, children who had meningitis were at greater risk (26.9%) for disability. Children with acute neurologic complications had more adverse outcomes than those with uncomplicated meningitis and control children (39% vs 18% vs 11%, respectively).

Conclusions. One in four school-age meningitis survivors has either serious and disabling sequelae or a functionally important behavior disorder, neuropsychologic or auditory dysfunction adversely affecting academic performance. As a group, survivors function less well than their classroom peers, and risk is greatest for, but not confined to, those who had acute neurologic complications. All survivors require careful follow-up, at least until school age.
Passive Smoke Exposure and Otitis Media in the First Year of Life
Authors: Ey John L. , Holberg Catharine J. , Aldous Michael B. , Wright Anne L. , Martinez Fernando D. , Taussig Lynn M. ,   Group Health Medical Associates
Published: December 2021

Objective. This study examined, in a health maintenance organization population of children, the associations between parents' smoking and otitis media (OM) in their children while controlling for other known risk factors.

Methods. Healthy newborns (1246) in a large health maintenance organization were enrolled at birth, and 1013 (81%) were followed prospectively for the first year of life. Their medical records were reviewed for the diagnosis of otitis media. Information on risk factors for recurrent OM (ROM) was collected, including a number of variables related to parental smoking.

Results. After controlling for other known risk factors for ROM including gender, day care, other siblings in the home, parental history of hay fever, and method of feeding, it was found that heavy maternal smoking of 20 or more cigarettes per day was a significant risk factor for ROM but not for nonrecurrent otitis. Heavy maternal smoking was associated with a threefold risk for ROM if the infant weighed less than the mean at birth (3.5 kg) after controlling for other risk factors. No association was found with paternal smoking.

Conclusions. Heavy maternal smoking is a significant risk factor for ROM in the first year of life. This smoking effect seems to be stronger among infants of lower birth weight.
Unrecognized Human Immunodeficiency Virus Type 1 Infection in a Cohort of Transfused Neonates: A Retrospective Investigation
Authors: Lieb Loren E. , Mundy Thomas M. , Goldfinger Dennis , Pepkowitz Samuel H. , Brunell Philip A. , Caldwell M. Blake , Ward John W.
Published: December 2021

Objective. To retrospectively identify unrecognized human immunodeficiency virus type 1 (HIV-1) infection among a cohort of children transfused as neonates before donated blood was routinely screened for HIV-1 antibody.

Methods. Records at a large, private, metropolitan hospital were reviewed to identify children who were transfused as neonates between January 1980 and March 1985 and discharged alive from the hospital. Multiple data sources were used to locate these children. Parents or guardians were contacted, and their children were offered HIV-1 antibody testing and physical examination.

Results. Of the 775 children identified as having received transfusions during the project period, 644 (83%) were located, and 443 (69%) were evaluated for HIV-1 infection. Among those evaluated, 33 (7%) had antibody to HIV-1, including 14 whose infections had not been previously diagnosed. At the time of enrollment, 13 children infected with HIV-1 were asymptomatic an average of 63 months after transfusion.

Conclusion. HIV-1 antibody testing should be considered for all children, regardless of clinical status, who were transfused before routine blood donor screening was implemented in March 1985, particularly in areas with a high incidence of acquired immunodeficiency syndrome during those years.
Cardiopulmonary Evaluation of Exercise Tolerance After Chest Irradiation and Anticancer Chemotherapy in Children and Adolescents
Authors: Pihkala Jaana , Happonen Juha-Matti , Virtanen Kari , Sovijärvi Anssi , Siimes Martti A. , Pesonen Erkki , Saarinen Ulla M.
Published: December 2021

Objective. The aim of the study was to evaluate the cardiopulmonary exercise tolerance in children and adolescents after chest irradiation and anticancer chemotherapy.

Methods. We studied 30 subjectively asymptomatic patients aged 8 to 25 years treated for pediatric malignancies with chest irradiation (XRT) ± chemotherapy. The median interval since XRT was 7 (range, 2 to 13) years. The median XRT dose for mediastinum and/or lungs was 2550 (range, 1000 to 5100) cGy. The median cumulative dose of anthracyclines was 250 (range, 0 to 480) mg/m2. Cardiac function and exercise tolerance were evaluated by electrocardiography, echocardiography, radionuclide cineangiography, and exercise test with gas exchange analysis.

Results. The patients differed from normal controls in systolic indices of myocardial function. In echocardiography, the left ventricular contractility was abnormal in 14/30 patients. In radionuclide cineangiography, the left ventricular ejection fraction was subnormal in 6/30 patients, and in 9/30 patients the rise in ejection fraction during exercise was inadequate (<5%). In exercise testing, the mean (±SD) maximum workload attained was 2.7 (±0.7) watts/kg, and the mean (±SD) maximum oxygen consumption was 35.4 (±9.7) mL/min/kg. Both variables were <80% of predicted values in 11 patients.

Conclusions. XRT and anticancer chemotherapy very often lead to late cardiopulmonary toxicity and impaired exercise tolerance. Although in most cases this toxicity seemed to be mild and subclinical, the long-term clinical sequels merit further evaluation.
Children's Health: Racial and Ethnic Differences in the Use of Prescription Medications
Authors: Hahn Beth A.
Published: December 2021

Objectives. Although racial and ethnic differences in the use of hospital and physician services have been well established, research has not examined the relationship between minority status and the use of prescription medications for children with some access to the health care system. This study examines differences in probability and number of prescribed medications by race and ethnicity, and whether the differences remain if socioeconomic factors, indicators of need, and number of physician visits are taken into account.

Methods. Using data from the 1987 National Medical Expenditure Survey, multivariate regression analysis was used to examine the probability of receiving a prescription medication and number of medications for two samples of children, ages 1 to 5 (N = 1347) and ages 6 to 17 (N = 2155).

Results. Descriptive statistics indicate that compared with white children, black and Hispanic children are less likely to receive a prescribed medication and have on average, fewer medications. The multivariate results of this analysis show that those differences persist, depending on age group of the child, after adjusting for socioeconomic factors, health conditions, and number of physician visits.

Conclusions. The relationship between racial and ethnic status and the use of prescription medication mirrors other types of services, such as physician visits, and affirms that minorities receive fewer services than whites.
Fluoride Supplementation for Children: Interim Policy Recommendations
Authors:   Committee on Nutrition
Published: December 2021

The Committee on Nutrition of the American Academy of Pediatrics (AAP) last issued a statement in 1986 on the topic of fluoride supplementation for children. The recommendations made at that time recently have been reassessed because of what seems to be an increased incidence of dental fluorosis in children living in the United States. Dental fluorosis appears during tooth formation and is caused by excessive fluoride ingestion, which leads to enamel protein retention, hypomineralization of the dental enamel and dentin, and disruption of crystal formation. The effect is cosmetic only, ranging from barely perceptible white striations or specks to confluent areas of pitting or brownish gray staining. Teeth affected by fluorosis seem to continue to be resistant to dental caries.

The main sources of fluoride include fluoridated water, foods or drinks reconstituted or prepared with fluoridated water, dentifrices, and fluoride supplements. Water is not fluoridated to a uniform level throughout the United States, and young children ingest significant but variable amounts of fluoride while brushing their teeth with fluoride-containing toothpaste. Because both of these sources of fluoride are difficult to control, attention has been directed again at the dosage of fluoride supplements to attempt to prevent dental fluorosis.

In January 1994, a Dietary Fluoride Workshop sponsored by the American Dental Association was convened to address the issue of dental fluorosis. Although children can receive substantial amounts of fluoride from beverages and dentifrices, the experts at this workshop thought the only source of fluoride that could be easily altered was the supplement prescribed by physicians and dentists.
The Role of Schools in Combatting Substance Abuse
Authors:   Committee On Substance Abuse
Published: December 2021

The use of alcohol, tobacco, and other illegal drugs remains at disturbingly high levels among American teenagers. As the physical, social, and psychological "home away from home" for most children and adolescents, schools should assume a leadership role in substance abuse prevention, identification, intervention, and referral. Furthermore, schools are encouraged to develop comprehensive policies to ensure that they are free of tobacco, alcohol, and other drugs.
Kernicterus in a Full-Term Infant: The Need for Increased Vigilance
Authors: Moneit William
Published: December 2021

I read the article, "Kernicterus in a Full-Term Infant," in the June 1994 issue of Pediatrics, and wish to comment on the conclusions drawn by Penn et al.

On the point of follow-up care after infants are discharged at 24 hours of life or sooner: I have found it to be good clinical practice to bring these infants into the office for their first examination at 3 days of life. The number of times that I have seen problems with newborns and especially those born to first time mothers are countless.
Ultrasound Screening for Dysplasia of the Hip
Authors: Harcke H. Theodore , Walter Robert S.
Published: December 2021

The three-part study of ultrasound screening in Norway by Rosendahl et al is a well conducted study and is valuable because it adds to our knowledge about sonographic hip screening in the newborn. Readers must be careful not to generalize from this study that ultrasound has no role in detecting developmental dysplasia of the hip (DDH). It has been our contention that universal newborn screening by ultrasound is impractical and results in overtreatment.1 This paper supports our position but concludes that 2 weeks of age is a better time for screening.
HEADED FOR THE 36-HOUR WEEK AND A DOCTOR SHORTAGE
Authors: L. J. F.
Published: December 2021

...Newly graduated doctors in Britain's health service, who work over 70 hours a week in hospital apprenticeships, endorsed legally capping their workweek at 56 hours. The government has pledged to cut junior physicians' 83 hour weekly maximum in stages.
The Role of Parents in the Detection of Developmental and Behavioral Problems
Authors: Glascoe Frances Page , Dworkin Paul H.
Published: December 2021

Objective. The success of early identification of children with developmental and behavioral problems is influenced by the manner in which pediatricians elicit, recognize, and select clinical information and derive appropriate impressions. Parents are ready sources of clinical information, and they can be asked to provide two broad types of data: appraisals, including concerns, estimations, and predictions; and descriptions, including recall and report. The purpose of this article is to help pediatricians make optimal use of clinical information from parents to increase the accuracy of clinical judgment in detecting children with developmental and behavoral problems.

Design. Review of 78 research articles and tests relying on parent information from pediatric, psychological, and education literature.

Results and Conclusion. There are several formats for eliciting parental information that are superior in terms of accuracy and ease of evocation. Specifically, parents' concerns and good-quality standardized parent report measures such as the Child Development Inventories capitalize best on parents' observations and insights into their children. In combination, these two types of parental information offer an effective method for the early detection of behavioral and developmental problems in primary-care settings.
Province-Based Study of Neurologic Disability of Children Weighing 500 Through 1249 Grams at Birth in Relation to Neonatal Cerebral Ultrasound Findings
Authors: Aziz Khalid , Vickar David B. , Sauve Reginald S. , Etches Philip C. , Pain Kerrie S. , Robertson Charlene M. T.
Published: December 2021

Background. Adverse neurodevelopmental outcome in premature infants is more common in the presence of certain ultrasonographically detectable intracranial lesions. Present nomenclature and classifications of parenchymal changes in preterm infants of varying gestations have led to some confusion. Descriptive definitions may be clinically useful. Regionalized perinatal and neonatal care enables population-based studies of these lesions and subsequent outcomes.

Methods. Two- to 3-year outcomes of neonates weighing 500 through 1249 g born in Alberta to Alberta residents during 1987 through 1990 were reviewed in relation to neonatal cerebral ultrasound lesions. Odds ratios and confidence limits for disability were calculated.

Results. Of 960 live births in this weight group, 669 (70%) survived to 1 year adjusted age; 646 (96.6%) were assessed at follow-up, and 80 (12.4%) of these were disabled: cerebral palsy, 8.7%; vision loss, 2.9%; hearing loss, 1.3%; epilepsy, 0.6%; mental retardation, 4.8%; more than one disability per child, 3.6%; and projected dependent disability, 1.4%. Lesions considered to be predictive of disability on ultrasound (excluding germinal layer hemorrhage) were found in 79 (11.8%), parenchymal lesions in 63 (9.4%) of 1-year survivors: intraventricular hemorrhage (IVH) (n = 59), persistent or transient cerebral ventriculomegaly (n = 50), persistent or transient intraparenchymal periventricular echodensity (n = 29), and cystic periventricular leukomalacia (n = 7). All lesions except isolated IVH were associated with adverse outcome; 37% of disabled children, 61% of multiply disabled children, and all children projected to become dependently disabled had parenchymal lesions with or without IVH. Triple lesions of IVH, cerebral ventriculomegaly, and intraparenchymal periventricular echodensity gave an odds ratio for disability of 50. Transient lesions had significant risk.

Conclusions. This province-based study provides a descriptive scheme of serial neonatal cerebral ultrasound lesions and outcome considered useful for clinicians caring for newborns of lowest gestational ages. The overall incidence of parenchymal lesions was lower than frequently reported. Combinations of lesions were linked to increased incidence, complexity, and severity of childhood disability.
Prolonged Episodes of Hypoxemia in Preterm Infants Undetectable by Cardiorespiratory Monitors
Authors: Poets Christian F. , Stebbens Valerie A. , Richard David , Southall David P.
Published: December 2021

Objective. To determine whether episodes of prolonged hypoxemia occur without prolonged apneic pauses (≥20 seconds) and without bradycardia (pulse rate, ≤100 beats per minute) in apparently well preterm infants.

Methods. Long-term recordings of arterial oxygen saturation as measured by pulse oximetry (SpO2), photoplethysmographic (pulse) waveforms from the oximeter, and breathing movements were performed in 96 preterm infants (median gestational age at birth, 34 weeks; range, 28 to 36 weeks) who were breathing room air. Recordings started at a median age of 4 days (range, 1 to 60 days).

Results. During a median duration of recording of 25 hours, 88 episodes in which SpO2 fell to 80% or less and remained there for 20 seconds or longer were identified in 15 infants. The median duration of these prolonged desaturations was 27 seconds (range, 20 to 81 seconds). In 73 episodes (83%), SpO2 continued to fall to 60% or less. Twenty-three desaturations were associated with prolonged apneic pauses and 54 with bradycardia; 19 of these were associated with both apnea and bradycardia. Thirty desaturations (34%; 10 infants) occurred without bradycardia and without prolonged apnea.

Conclusions. These results indicate that a proportion of apparently well preterm infants exhibit episodes of severe prolonged hypoxemia unaccompanied by prolonged apneic pauses or bradycardia. Such episodes, therefore, would be difficult to detect if only breathing movements and heart rate are monitored. Indications for the use of oxygenation monitors in preterm infants should be reconsidered.
Decreased Carbon Dioxide Sensitivity in Infants of Substance-Abusing Mothers
Authors: Wingkun Janet G. , Knisely Janet S. , Schnoll Sidney H. , Gutcher Gary R.
Published: December 2021

Objective. To determine whether there is a demonstrable abnormality in control of breathing in infants of substance-abusing mothers during the first few days of life.

Methods. We enrolled 12 drug-free control infants and 12 infants of substance abusing mothers (ISAMs). These infants experienced otherwise uncomplicated term pregnancies and deliveries. The infants were assigned to a group based on the results of maternal histories and maternal and infant urine toxicology screens. Studies were performed during quiet sleep during the first few days of life. We measured heart rate, oxygen saturations via a pulse oximeter, end-tidal carbon dioxide (ET-CO2) level, respiratory rate, tidal volume, and airflow. The chemoreceptor response was assessed by measuring minute ventilation and the ET-CO2 level after 5 minutes of breathing either room air or 4% carbon dioxide.

Results. The gestational ages by obstetrical dating and examination of the infants were not different, although birth weights and birth lengths were lower in the group of ISAMs. Other demographic data were not different, and there were no differences in the infants' median ages at the time of study or in maternal use of tobacco and alcohol. The two groups had comparable baseline (room air) ET-CO2 levels, respiratory rates, tidal volumes, and minute ventilation. When compared with the group of ISAMs, the drug-free group had markedly increased tidal volume and minute ventilation on exposure to 4% carbon dioxide. These increases accounted for the difference in sensitivity to carbon dioxide, calculated as the change in minute ventilation per unit change in ET-CO2 (milliliters per kg/min per mm Hg). The sensitivity to carbon dioxide of control infants was 48.66 ± 7.14 (mean ± SE), whereas that of ISAMs was 16.28 ± 3.14.

Conclusions. These data suggest that ISAMs are relatively insensitive to challenge by carbon dioxide during the first few days of life. We speculate that this reflects an impairment of the chemoreceptor response.
Evaluation of a Portable Infrared End-Tidal Carbon Dioxide Monitor During Pediatric Interhospital Transport
Authors: Bhende Mananda S. , Karr Valerie A. , Wiltsie Drew C. , Orr Richard A.
Published: December 2021

Purpose. Critically ill children often require endotracheal intubation before transport to a tertiary care center. Correct endotracheal tube (ETT) placement (trachea versus esophagus) and maintenance during transport are of the utmost importance. We evaluated a portable, qualitative, infrared end-tidal carbon dioxide monitor during transport of critically ill children.

Methods. Fifty patients, ages 1 day to 19 years (median, 1 year), weighing 1.6 to 70 kg (median, 10 kg) who were intubated and transported by ground ambulance (n = 25) or rotorcraft (n = 25) were enrolled. ETT position was confirmed by physical examination, arterial blood gas or pulse oximetry, and sometimes by a chest radiograph. The instrument was attached, and readings were obtained before and during transport by transport nurses or respiratory therapists who also completed a brief questionnaire about the monitor. A moving bar indicator with a light-emitting diode display on the instrument indicates the presence of expired carbon dioxide.

Results. All three esophageal tube positions and 48 of 50 tracheal tube positions were correctly identified (sensitivity, 96%; specificity, 100%; positive predictive value, 100%; and negative predictive value, 60%). There were two false-negative results: in one case, there was instrument malfunction because of blood backing up into the tubing because of traumatic intubation, and in the second case, the patient had a chest tube that was leaking air. The device was evaluated as "too large" (30 of 50), "hard to secure" (25 of 50), and "not convenient" (29 of 50). Tube kinking was a problem (n = 7) when used in small infants in isolettes. The instrument was considered helpful in assuring ETT position when clinical evaluation was not possible because of noisy conditions.

Conclusions. We conclude that this carbon dioxide monitor was useful during transport of critically ill children in confirming ETT position. Further improvements in this noninvasive technology might be helpful in making the device more practical for use during interhospital transport.
Low Levels of Selenium in Mothers and Their Newborns in Pregnancies With a Neural Tube Defect
Authors: Güvenç Hüseyin , Karataş Fikret , Güvenç Müzehher , Kunç Şeref , Aygün A. Denizmen , Bektaş Sirri
Published: December 2021

Objective. Very few data are presented in the literature about selenium (Se) in human fetal development. The aim of this paper was to study the relationship between maternal and neonatal Se status and neural tube defects (NTDs).

Patients and methods. Serum and hair samples were obtained from 20 nonpregnant women, 32 healthy mothers with normal newborns, and 28 mothers who had a newborn with NTD, and their newborns at delivery. Serum Se levels, as ng/mL, and hair Se levels, as µg/g, were determined on a Perkin-Elmer 1000 spectrophotometer (United Kingdom) by fluorometry.

Results. The mean maternal serum and hair Se concentrations in the NTD group (42.9 ± 1.75 ng/mL, 277 ± 7.73 ng/g, respectively) were significantly lower than those of the control healthy mothers (50.2 ± 2.35 ng/mL, 300 ± 6.10 ng/g, respectively) and the nonpregnant women (58.1 ± 3.12 ng/mL, 315 ± 7.64 ng/g, respectively). A significant decrease in concentrations of Se in serum and hair was observed in newborns with a NTD (26.0 ± 1.55 ng/mL, 181 ± 3.71 ng/g, respectively) compared with healthy newborns (32.6 ± 1.70 ng/mL, 204 ± 4.43 ng/g, respectively).

Conclusions. Maternal Se deficiency during pregnancy was thought to be one of the factors responsible for NTDs. However, the lowered serum and hair Se concentrations may be secondary manifestations of an abnormal pregnancy and did not contribute to its production. More studies on maternal Se status during the antenatal period, especially early gestation and neonatal Se status including normal newborns and NTD infants, are needed.
A Prospective, Controlled Evaluation of Home Chemotherapy for Children With Cancer
Authors: Close Pamelyn , Burkey Edith , Kazak Anne , Danz Patricia , Lange Beverly
Published: December 2021

Objectives. Infusion of chemotherapy at home provides an alternative to hospitalization for children with cancer. Few programs of pediatric home chemotherapy have been described or evaluated. The purpose of this work was to compare prospectively chemotherapy in the hospital to chemotherapy at home with respect to billed medical charges, out-of-pocket expenses, and quality of life.

Methods. Eligibility criteria for home therapy were defined. Parents and nurses were trained. Billed charges, loss of wages, out-of-pocket expenses, medical outcome, and quality of life of 14 patients for one course of chemotherapy in the hospital were compared with those for an identical course at home.

Results. Daily charges for chemotherapy were $2329 ± 627 in the hospital and $1865 ± 833 at home; out-of-pocket costs, $68 ± 31 and $11 ± 6, respectively; and loss of income, $265 ± 233 and $67 ± 107, respectively. Patients' independence, well-being, appetite, mood, and school work were significantly better at home, and parental time at work and with the family was greater.

Conclusion. Administration of selected chemotherapy at home results in lower billed charges, reduced expenses, reduced loss of income for parents, and a more satisfying lifestyle for patients and parents.
Congenital Nonobstructive, Nonhemolytic Jaundice: Effect of Tin-Mesoporphyrin
Authors: Rubaltelli Firmino F. , Dario Cinzia , Zancan Lucia
Published: December 2021

Tin-protoporphyrin (SnPP) and tin-mesoporphyrin (SnMP) have been proposed for the treatment of Crigler-Najjar (CN) disease type 1;1,2 in fact, both drugs moderate the hyperbilirubinemia to some extent.1,2 These compounds bind to heme oxygenase far more avidly than does heme itself, thus blocking access of the natural substrate to the binding site of the enzyme and inhibiting heme degradation and bilirubin production.3-5 Because these synthetic compounds do not contain iron and thus cannot bind oxygen, they cannot be oxidatively transformed into bilirubin by the enzyme heme oxygenase and therefore remain intact until they are excreted.

Recently, SnPP was administered to a 2.5-month-old girl,1 and two 17-year-old boys were successfully treated with two cycles of prolonged SnMP therapy.2
Letter to the Editor
Authors: Kattwinkel John
Published: December 2021

I can offer the following in response to Dr Rosenbloom’s letter:

Although the concept of a "hired gun" may be distasteful to most of us, it is not necessarily bad. If a witness is well prepared, restricts testimony to issues about which he/she is truly an expert, and testifies responsibly, there is no ethical or moral reason that such a person should not do so frequently and effectively. In fact the conscientious expert witness can make a valuable contribution to maintaining and improving the quality of medical care.
Injury Prevention Counseling by Pediatricians: A Benefit-Cost Comparison
Authors: Miller Ted R. , Galbraith Maury
Published: December 2021

Objectives. The American Academy of Pediatrics believes that health education, through office-based counseling, can contribute to childhood injury prevention. This report extends previously published work on the effectiveness of primary care-based counseling and compares the costs and estimated monetary value of the benefits of safety counseling targeting children ages 0 to 4 years.

Methods. We estimate the savings achievable with comprehensive childhood injury prevention counseling organized around the three Framingham Safety Surveys used in The Injury Prevention Program (TIPP) developed by the American Academy of Pediatrics. We verify the estimated savings by comparing them with the effects of pediatrician counseling from separate analyses of the most fully evaluated interventions—in child motor vehicle occupant injuries, burns, and falls.

Results. TIPP pediatrician injury counseling sessions between the ages of 0 and 4 years can achieve estimated savings of $880 per child or $80 per visit. If all 19.2 million children ages 0 to 4 years completed TIPP, we estimate that $230 million would be saved annually in medical spending, and injury costs would decline $3.4 billion. Each dollar spent on TIPP childhood injury prevention targeting children ages 0 to 4 years returns nearly $13.

Conclusion. TIPP pediatrician injury counseling is a cost-effective method of preventing childhood injuries and should be more widely adopted.
INCREASED SERUM PHOSPHOLIPASE A2 ACTIVITY IN MALAWIAN CHILDREN WITH FALCIPARUM MALARIA
Authors: Vadas P , Taylor TE , Chimsuku L
Published: December 2021

Malaria is a multisystem disease with a mortality rate of 5 to 30% even with optimal treatment. Earlier studies have shown increased circulating levels of TNF in the plasma of patients as an independent predictor of severe or fatal disease. TNF has already been shown to facilitate the release of proinflammatory enzyme phospholipase A2 from various cells in vitro. Because both TNF and PLA2 are increased in patients with septicemia and because TNF levels are already shown to be increased in patients with malaria, the authors studied the relationship between TNF levels, severity of disease, and PLA2 activity.

Seventy-five children (age 3 months to 10 years) with severe malaria due to Plasmodium falciparum and 34 controls (age 2 to 5 years) taking part in the malaria survey at a school in the same region in Malawi were included in the study. The children were afebrile and aparasitemic. Many of these children had cerebral malaria with coma. Twenty patients had uncomplicated falciparum malaria and 55 had cerebral malaria. Ten of them (all with cerebral malaria) died. In addition to examining the children, particularly for neurological status, laboratory studies obtained included the blood count, hematocrit, leukocyte count, thick blood smears for quantitative evaluation of parasitemia, and measurement of PLA2 activity.

Mean plasma PLA2 activity in 34 healthy controls was 424 U/mL, whereas in the 75 patients with malaria the mean value was 53 804 U/mL. In the 45 children who were available for follow-up 1 month later after treatment the mean plasma PLA2 activity was 2546 U/mL. The high mean plasma level was not different between children with cerebral malaria and those with uncomplicated malaria. However the PLA2 activity in 28 children with profound coma was much higher than in other patients with malaria. The initial plasma PLA2 activity was predictive of outcome. Patients who had levels higher than 60 000 U/mL had a higher mortality rate (33%) compared with those with values less than 60 000 U at (8.3%). There was also a significant correlation between TNF and plasma PLA2 activity. Pretreatment serum PLA2 activity also correlated with the intensity of parasitemia. The cerebral spinal fluid PLA2 activity was not elevated even in those patients with severe malaria.

The biological role of this observation is unclear. However, selective inhibition of PLA2 may be a new target for future therapy because PLA2 is proinflammatory enzyme.