bluuebunny/crossref_metadata_2025 huggingface dataset:
Partial Anomalous Pulmonary Venous Drainage Associated With 45,X Turner's Syndrome
Authors: Moore John W. , Kirby William C. , Rogers William M. , Poth Merrily A.
Published: December 2021

Turner's syndrome has well-described associations with congenital heart disease. Up to one third of patients with karyotype 45,X may have coarctation of the aorta. In addition, patients with hypertrophic cardiomyopathy, septal defects, dextrocardia, and anomalous pulmonary venous drainage have been reported anecdotally. Twenty-one consecutive patients with Turner's syndrome were prospectively evaluated. All patients underwent examination by a pediatric cardiologist, electrocardiogram, chest radiograph, and echocardiogram. Three patients with evidence of right ventricular volume overload had cardiac catheterization. Of 12 patients with karyotype 45,X 3 had partial anomalous pulmonary venous drainage with intact atrial septum. One of the 3 also had moderate aortic stenosis. Two additional patients with 45,X had coarctation of the aorta and bicuspid aortic valve, and 4 other patients had minor cardiac defects. Of 9 patients with mosaic karyotype, 1 had a minor cardiac defect. The observations suggest that there may be a significant association of 45,X Turner's syndrome and partial anomalous pulmonary venous drainage.
Children in Sauna: Cardiovascular Adjustment
Authors: Jokinen Eero , Välimäki Ilkka , Antila Kari , Seppänen Asko , Tuominen Juhani
Published: December 2021

Children's circulatory adjustment to a 10-minute heat stress in a climatic chamber was studied in 61 children and 20 adolescents and young adults. The thermal conditions corresponded to those of an ordinary Finnish sauna bath. In all subjects the rectal temperature and heart rate increased during the heat exposure (P < .001). Systolic and diastolic blood pressures remained unchanged in sauna, but the systolic and especially the diastolic blood pressure decreased (P < .001) in children less than 10 years of age immediately after the heat exposure; two vasovagal collapses developed. Cardiac output increased in all but the less than 5-year-old children (P < .001). This was due to a significant decrease in stroke volume (32.9%) (P < .001) in children less than 5 years old. Stroke volume declined slightly even in the older subjects. These changes indicate that the Finnish sauna bath puts great demands on a child's circulatory regulation. To avoid possible cardiovascular side effects, particularly small children should be supervised carefully during sauna bathing.
Fathers' Hospital Visits to Their Preterm Infants as a Predictor of Father-Infant Relationship and Infant Development
Authors: Levy-Shiff Rachel , Hoffman Michael A. , Mogilner Salli , Levinger Susan , Mogilner Mario B.
Published: December 2021

This short-term longitudinal study assessed the degree to which the frequency of fathers' visits with their preterm infants in the hospital was associated with the quality of ongoing and long-term fathering and infant development. Data on fathering and infant development were collected during the hospital stay, at discharge, at 8 months of age, and at 18 months of age, using both questionnaires and observational schedules. The frequency of visits was significantly correlated with more extensive and positive patterns of fathering at discharge and later periods. It was also associated with more positive perceptions of the infant, as well as with weight gain during hospitalization and psychosocial aspects of later infant development during the first 18 months. The discussion emphasized possible ways in which early paternal contact in the hospital might influence fathers, mothers, and infants. The frequency of paternal visits was highlighted as a variable useful in predicting high-risk parenting.
Improved Outcome in Pierre Robin Sequence: Effect of Multidisciplinary Evaluation and Management
Authors: Bull Marilyn J. , Givan Deborah C. , Sadove A. Michael , Bixler David , Hearn Diane
Published: December 2021

Infants with complications of Pierre Robin sequence are at increased risk of airway obstruction and resultant hypoxia, cor pulmonale, failure to thrive, and cerebral impairment. In an effort to minimize such complications, patients with Pierre Robin sequence were examined prospectively by a multidisciplinary team using polysomnography and continuous oximetry. Obstructive apnea and desaturation occurred in 18 of the 21 patients studied. Four children required only home apnea monitoning, and six required only monitoring and supplemental oxygen. Seven children had lip-tongue adhesion procedures performed, and four required tracheostomy. No patients died. All patients with isolated Pierre Robin sequence had normal development at follow-up except for one child who had experienced a respiratory arrest before referral. With improvements in neonatal intensive care, testing for respiratory assessment, improved surgical and postoperative intervention and home monitoring, the morbidity and mortality for children with Pierre Robin sequence can be reduced markedly.
Growth Hormone Deficiency in an 8-Year-Old Girl With Human Immunodeficiency Virus Infection
Authors: JOSPE NICHOLAS , POWELL KEITH R.
Published: December 2021

Abnormalities of hypothalamic pituitary function have been reported in adult subjects with human immunodeficiency virus (HIV) infection.1-3 However, endocrine studies in children with HIV infection have failed to disclose significant hormonal abnormalities.4 Indeed, children infected with HIV who were growing poorly were found to have opportunistic infections and lower levels of T-helper cells, but normal growth hormone or insulinlike growth factor 1 concentrations.4

Herein we describe an 8-year-old girl with perinatally acquired HIV infection, growth deceleration, and isolated growth hormone deficiency.

CASE REPORT

This 8 ½-year-old female child was referred to the pediatric endocrine clinic for evaluation of growth deceleration.
Is It a New Syndrome or Due to Overstimulation in the ICU?
Authors: COLE JEAN GARDNER
Published: December 2021

To the Editor.—

A recent article by Perlman and Volpe in Pediatrics1 described a new syndrome of movement disorder in infants with severe bronchopulmonary dysplasia. I should like to take issue with these findings and feel that what Perlman and Volpe are describing is actually infants responding behaviorally to an overstimulating environment. This "new syndrome" is, I feel, what Als calls "the consequence of a mismatch of extrauterine environment and the capacity of the central nervous system of the fetal neonate which is adapted for an intrauterine existence"2 to deal with the onslaught of stimulation which it encounters in the noisy, chaotic environment of the average Neonatal Intensive Care Unit.

The behaviors described in the article are seen routinely in preterm infants responding behaviorally to overstimulation.3 These behaviors become learned maladaptive responses to stress. They can be prevented or ameliorated by the provision of a more supportive environment, one which recognizes early signs of behavioral disorganization and responds by reducing the cause of the overstimulation, be it auditory, visual, tactile, or kinesthetic.4-6
Information on Nicotine Abuse
Authors: MOORE JOSEPH C.
Published: December 2021

To the Editor.—

I would like to comment on some information offered in the Committee on Drugs' policy statement, "Transfer of Drugs and Other Chemicals into Human Milk", published in the November 1989 issue of Pediatrics.1 Nicotine is listed as a drug of abuse that is contraindicated during breast-feeding, in the same category as cocaine, heroin, marijuana, phencyclidine 1-(-1-phenylcyclohexyl) piperidine, and amphetamines. Three references are listed; however, none of them provide any good evidence to support a statement with such wide-ranging implications.
Maternal Glucocorticoid Therapy and Reduced Risk of Bronchopulmonary Dysplasia
Authors: Van Marter Linda J. , Leviton Alan , Kuban Karl C. K. , Pagano Marcello , Allred Elizabeth N.
Published: December 2021

Because of substantial clinical and laboratory evidence of the efficacy of glucocorticoids in the treatment of acute pulmonary surfactant deficiency in preterm newborns, we explored the hypothesis that maternal antenatal glucocorticoid receipt is followed by reduced risk of bronchopulmonary dysplasia (BPD). A sample of 223 intubated infants weighing less than 1751 g birth weight provided 76 infants with BPD (defined by both oxygen requirement and compatible chest radiograph) and 147 who had neither BPD characteristic by day 28 of life. When compared to babies who received a complete and timely course of antenatal glucocorticoids, those whose mothers received no glucocorticoids were at prominently increased risk of BPD (odds ratio = 3.0; 95% confidence interval = 1.1, 8.2). Babies whose mothers received a partial course of glucocorticoids were not at increased risk of BPD (odds ratio = 1.3; 95% confidence interval = 0.4, 4.3). Stratification by gender and birth weight at 1 kg showed a benefit of therapy in all strata except that of extremely low birth weight male infants. These data support the hypothesis that maternal antenatal glucocorticoid therapy offers very low birth weight infants protection against BPD.
Enteral Nutrition in Infants With Congenital Heart Disease and Growth Failure
Authors: Schwarz Steven M. , Gewitz Michael H. , See Cynthia C. , Berezin Stuart , Glassman Mark S. , Medow Carol M. , Fish Bernard C. , Newman Leonard J.
Published: December 2021

To determine an effective nutritional regimen for management of growth failure in infants with congenital heart disease and congestive heart failure, the authors studied 19 infants with cardiac anomalies who were not candidates for early corrective surgery. Patients were randomly assigned to one of three feeding groups: group 1 (n = 7) received continuous, 24-hour nasogastric alimentation; group 2 (n = 5) received overnight, 12-hour nasogastric infusions plus daytime oral feedings as tolerated; and group 3 (n = 7) received oral feedings alone. For all patients, commercial infant formula (cow's milk or soy protein) was supplemented to a calorie density of approximately 1 kcal/mL. During a 5.25 ± 0.45 month study period, only group 1 infants achieved intakes > 140 kcal/kg per day (mean = 147 kcal). Serial anthropometric measurements demonstrated that only 24-hour infusions (group 1) were associated with significantly improved nutritional status, when assessed by z scores for weight (P < .01) and length (P < .05). Group 1 infants also showed marked increases in midarm muscle circumference and triceps and subscapular skinfold thicknesses (P < .01, compared with groups 2 and 3). These data suggest that infants with congenital cardiac defects complicated by malnutrition manifest increased nutrient requirements for growth and weight gain. Continuous, 24-hour, nasogastric alimentation is a safe and effective method for achieving both increased nutrient intake and improved overall nutritional status in these infants.
Weight and Dieting Concerns in Adolescents, Fashion or Symptom?
Authors: Casper Regina C. , Offer Daniel
Published: December 2021

Attitudes toward body weight and dieting and the relations of these attitudes to psychological adjustment were investigated in 497 randomly selected adolescents who were in their senior year in one urban and two suburban midwestern high schools. Most students reported feeling physically healthy. Two thirds of female adolescents were preoccupied with weight and dieting compared with only a small number (approximately 15%) of male adolescents. Black female adolescents were found to be less weight- and diet-conscious than white female adolescents. Increased weight and dieting concerns were associated with greater body and self-image dissatisfaction, with a depressed mood, and greater overall symptomatic distress in both male and female adolescents. The fairly common fear of being overweight and thoughts about dieting experienced by contemporary female adolescents, in part, seem to reflect the greater aesthetic value that contemporary society places on thinness for women. Overall, the findings suggest that preoccupation with weight and/or dieting concerns in either male or female adolescents are likely to indicate psychological problems.
EDUCATION: MONEY ISN'T EVERYTHING
Authors: L. J. F.
Published: December 2021

The education establishment and its cheerleaders would have us believe that America is not "investing enough in human capital." But while this rhetorical device has punch, it ignores the facts. Education budgets in the U.S. have never been larger, and they surpass those of virtually every other country. The problem is not in the level of investment, but in the return on that investment...

See table in the PDF file

...This is the usual result of such studies. According to Eric Hanushek of the University of Rochester, of 65 studies on the relationship of expenditures and achievement, only 20% found a positive impact, while 75% found no impact and 5% found negative impact.
Characteristics of Eighth-Grade Students Who Initiate Self-care in Elementary and Junior High School
Authors: Dwyer Kathleen M. , Richardson Jean L. , Danley Kathleen L. , Hansen William B. , Sussman Steven Y. , Brannon Bonnie , Dent Clyde W. , Johnson C. Anderson , Flay Brian R.
Published: December 2021

The purpose of this paper is to examine whether children who care for themselves for longer periods of time are at increased risk of poor grades, truancy, anger, family conflict, stress, risk-taking, and peer influences (in addition to the increased risk of substance use previously reported). Demographic characteristics of eighth-grade students who initiate self-care in junior high school are compared with those initiating self-care in elementary school. Further, increased risks for those initiating self-care in elementary school are examined. Over two thirds of the respondents (67.8%) cared for themselves after school without adult supervision at some time during the week; 23.5% for 1 to 4 hours per week, 15.7% for 5 to 10 hours per week, and 28.6% for 11 or more hours per week. Of those in self-care, 48.5% initiated self-care during elementary school and 51.5% during junior high school. Students who were in the highest category of self-care (≥11 hours per week) vs those in self-care zero hours per week were 1.5 to 2 times as likely to score high on risk-taking, anger, family conflict, and stress, to be more likely to see their friends as their major source of influence, and to attend more parties. The self-reports of academic grades did not differ. The grade of initiation of self-care (elementary vs junior high school) conferred additional risk for drinking alcohol (odds ratio = 1.4), risk-taking tendencies (odds ratio = 1.5), and attending parties (odds ratio = 1.6).
Valproic Acid for the Treatment of Children With Mental Retardation and Mood Symptomatology
Authors: Kastner Ted , Friedman Debra L. , Plummer Alice T. , Ruiz Marilyn Q. , Henning Dana
Published: December 2021

Most researchers agree that there is a high incidence of psychiatric illness among children with mental retardation. Menolascino1,2 found diagnosable psychiatric disorders in 31 of 616 children who were suspected of being mentally retarded. Of this sample, 24.5% were noted to be "emotionally disturbed." Phillips and Williams3 described the results of 100 psychiatric evaluations of children with mental retardation and assigned the following diagnoses: psychotic symptoms, 38%; neuroses, 5%; personality disorders and other nonpsychiatric disorders, 16%; behavior disorders, 26%; transient situational disorders, 2%; and no psychiatric disorder, 13%. Chess4 and Hassibi5 described behavior disorders in a group of 52 children living with their middle class families who were mildly and borderline mentally retarded.
Letter to the Editor
Authors: Strain James E.
Published: December 2021

Dr Simon has captured the essence of pediatrics. The personal satisfaction that comes from the care of children and their families makes pediatrics unique among medical specialties.

Dr Simon is correct in stating that we should all be capable of promoting pediatrics as a career choice for medical students. Often the pediatric resident is in the best position to influence that choice. Students in the third year clinical clerkship consider members of the house staff as their mentors.
SAFE MOTHERHOOD
Authors: L. J. F.
Published: December 2021

In the United States, the US Agency for International Development (USAID) has decided to fund project MotherCare, which is aimed at enhancing the services and educational programme that have a significant impact on maternal and neonatal health and nutrition. The work is being carried out by John Snow Incorporated in Washington DC and will include five projects in different countries to demonstrate the efficacy of various interventions, such as improvements in the nutrition of newborn babies, as well as the prevention and treatment of disorders known to be important to maternal and neonatal mortality and morbidity. The MotherCare project will also introduce research and training initiatives in a number of countries.

For those interested in researching a practical approach to reducing maternal mortality, the Safe Motherhood Operational Research programme is offering funding for government and non-governmental organisations in developing countries.1
Initial Evaluation of Heart Murmurs: Are Laboratory Tests Necessary?
Authors: Smythe John F. , Teixeira Otto H. P. , Vlad Peter , Demers Pierre Paul , Feldman William
Published: December 2021

Heart murmurs, most of them innocent, are the most common reason for referrals to a pediatric cardiologist. In the evaluation of murmurs, the electrocardiogram and echocardiogram are often included. The purpose of this study was to determine the utility of these examinations in the initial assessment of heart murmurs in children and adolescents. In a prospective series of 161 patients, the clinical diagnosis of heart murmurs by a pediatric cardiologist was compared with that obtained after electrocardiogram and echocardiogram (two-dimensional, M-mode, Doppler, and color-Doppler). On the basis of the clinical diagnosis the patients were classified as having "innocent murmur," "pathologic murmur," or "possible pathologic murmur." A total of 161 patients (51% males), aged 1 month to 17 years (median 3.2 years), were studied. After electrocardiogram, no diagnosis was changed. After echocardiogram, the clinical diagnosis of innocent murmur in 109 patients changed in 2 to pathologic (small ventricular septal defect 1, small atrial septal defect 1); pathologic murmur in 46 changed to innocent in 3 and possible pathologic in 2; and possible pathologic in 6 changed to innocent in 3 and to pathologic in 2. The clinical examination by an experienced pediatric cardiologist is an accurate means of assessing newly referred patients with murmurs. The clinical examination had a sensitivity of 96%, specificity of 95%, positive predictive value of 88%, and negative predictive value of 98%. The electrocardiogram, unlikely to disclose any unsuspected heart disease, may assist in reaching the lesion-specific diagnosis when there is underlying pathology. Echocardiography, although diagnostic when heart disease is suspected, is unnecessary in pediatric patients with clinically diagnosed innocent heart murmurs.
Vancomycin-Induced Red Man Syndrome
Authors: Levy Maurice , Koren Gideon , Dupuis Lee , Read Stanley E.
Published: December 2021

A total of 11 cases of red man syndrome collected among 650 children who had received vancomycin in our hospital between 1986 and 1988 (estimated prevalence 1.6%) were retrospectively analyzed. These 11 children were compared with 11 age-matched children who received vancomycin in whom red man syndrome did not develop. Of the patients with red man syndrome, 73%, and of the patients with no reaction, 45.4% received vancomycin for penicillin-resistant Staphylococcus epidermidis-positive cultures, or because of history of penicillin allergy. No difference was observed in the dose per kilogram given to both groups (12.9 ± 3.5 mg/kg per dose in those with red man syndrome vs 12.3 ± 6.9 mg/kg per dose in control childrens. The duration (mean ± standard deviation) of vancomycin infusion was 45.9 ± 16.7 minutes (range 10 to 90 minutes) in patients with red man syndrome and 54.5 ± 7.6 minutes (range 45 to 65 minutes) in the control group (P = .07). In the 5 children with red man syndrome rechallenged with vancomycin, slower infusion rates prevented or reduced the syndrome, which emphasized the fact that the rate of administration is the important determinant of red man syndrome in susceptible cases. Clinically, the syndrome developed at the end of the infusion in most patients, but appeared as early as 15 minutes after initiation of the infusion. It was mostly manifested as a flushed, erythematous rash on the face, neck, and around the ears. Less frequently, the rash was distributed all over the body. Pruritus was usually localized to the upper trunk but was also generalized (2 of 11 children). Associated signs and symptoms were hypotension, watery puffy eyes, tachycardia, respiratory distress, dizziness, agitation, and mild temperature increase. A premature infant with the red man syndrome had skin rash associated with poor perfusion, cold extremities, increased need for oxygen, and severe hypotension. The rash disappeared within 20 minutes (range 5 minutes to 7 hours) after vancomycin infusion was stopped. There was no association between serum vancomycin concentrations and red man syndrome; in both groups of patients therapeutic as well as subtherapeutic concentrations were observed, suggesting that this is an idiosyncratic and not a concentration-dependent phenomenon.
Just Say No!
Authors: FREEMAN JOHN M.
Published: December 2021

A seizure, even a febrile seizure, is terrifying to the family. Seeking reassurance that their child will not die and does not have epilepsy, parents turn to their physician. What is he or she to do?

Often the physician prescribes medication "to prevent further seizures" and then reassures the family that the child will be fine if the medicine is given daily as directed. Both the recommendation and the reassurance are wrong.

A Consensus Development Conference on Febrile Seizures held by the National Institutes of Health in 19801 concluded that they would only "consider" anticonvulsant prophylaxis when the child (1) had abnormal neurologic development, (2) had long or focal seizures, (3) had more than two seizures in 24 hours, (4) had a history of nonfebrile seizures in parent or sibling, or (5) was younger than 1 years of age.
Sex-Specific Dysanapsis and the Effect of Passive Smoking Among Asthmatics
Authors: Murray Andrew B. , Morrison Brenda J.
Published: December 2021

In Reply.—

In view of Dr Kauffmann's suggestion, we reanalyzed our data to find whether the FEF25%-75%/FVC ratio revealed the same sex and age differences as did the FEF25%-75% percent predicted when it was used to assess the severity of asthma. The results were the same. When comparing children of nonsmoking and smoking mothers, the mean FEF25%-75%/FVC ratios were 0.81 vs 0.69 (P = .009) for boys and 0.89 vs 0.83 (P = .54) for girls.
Children Riding in the Back of Pickup Trucks: A Neglected Safety Issue
Authors: Woodward George A. , Bolte Robert G.
Published: December 2021

Motor vehicle-related trauma is the leading cause of death in children in the United States. All states have pediatric restraint requirements for passenger vehicles to help prevent these deaths and injuries. Only a few states, however, possess safety laws or restrictions for passengers who ride in the back of pickup trucks. A retrospective review of medical records for a 40-month period revealed 40 patients whose injuries were a direct result of being a passenger in the cargo area (bed) of a pickup truck. Their injuries and other pertinent data are discussed. Representatives from the Highway Safety Commission of each state were surveyed about their specific highway safety laws. The responses revealed that all states and the District of Columbia have child restraint requirements for passenger automobiles, 34 states have adult restraint laws, but only 17 states have any type of restriction for passengers riding in the back of pickup trucks. Seventy-one percent of the states with pickup truck regulations include only the preschool-age child. Data from the National Highway Traffic Safety Administration concerning pickup trucks and passenger fatality are presented and discussed.
Self-induced Urinary Tract Infection in School-age Boys
Authors: Labbé Jean
Published: December 2021

This study focuses on a consecutive series of 31 boys, aged 5 years 3 months to 14 years 9 months, who had a first diagnosed urinary tract infection. A questionnaire administered after diagnosis revealed that 10 of these boys injected water into their urethra while taking a bath in the few days preceding the onset of infection. Neither presenting symptoms nor urine tests can distinguish self-inflicted infections from infections occurring spontaneously. However, no urinary tract malformations were detected among the boys with a history of urethral manipulation whereas one third of the other 21 boys had anomalies. If these data are confirmed by other studies, complete imaging investigation could then be avoided in such cases. It could also become possible to prevent a number of urinary tract infections in school-age boys by warning parents and children of the serious risks of self-instrumentation.
Dexamethasone Effects on the Hospital Course of Infants With Bronchopulmonary Dysplasia Who Are Dependent on Artificial Ventilation
Authors: Kazzi Nadya J. , Brans Yves W. , Poland Ronald L.
Published: December 2021

A randomized double-blind placebo-controlled trial was conducted to evaluate the effects of enterally administered dexamethasone on the hospital course of infants with bronchopulmonary dysplasia. A total of 23 infants with a birth weight <1500 g who were dependent on artificial ventilation 3 to 4 weeks of age received dexamethasone (n = 12) or saline placebo (n = 11). Dexamethasone (0.5 mg/kg per day) was given in tapering doses for 7 days followed by hydrocortisone (8 mg/kg per day) which was progressively reduced for a total of 17 days of therapy. Infants who received dexamethasone required less oxygen on days 8 and 17 (P < .05) and were more likely to extubate 8 days after therapy than infants in the control group (respectively 8/12 vs 3/11 infants, P < .05; P = .12 after Yates correction). The use of dexamethasone significantly shortened median duration of mechanical ventilation (4 vs 22 days, P < .05) but had no effect on length of oxygen therapy, hospitalization, home oxygen therapy, occurrence and severity of retinopathy of prematurity, rate of growth, and mortality. No significant complications resulted from dexamethasone therapy. Measurements of plasma dexamethasone levels confirmed the absorption of drug from the gastrointestinal tract (23.7 ng/mL in dexamethasone vs 4.6 ng/mL in the control group, P < .05). Dexamethasone administration resulted in short-term improvements in pulmonary function but did not ameliorate the hospital course of infants with bronchopulmonary dysplasia.
Strength Training, Weight and Power Lifting, and Body Building by Children and Adolescents
Authors:   Committee on Sports Medicine
Published: December 2021

Some children and many adolescents use weights to increase strength or enlarge muscles. A smaller number compete in the sports of weight lifting, power lifting, and body building.

DEFINITIONS

Free weights are dumbbells and barbells that are used without the external support of a machine.

Major lifts are lifts used in the sports of weight and power lifting. Also used are the power clean and the incline and overhead presses. These lifts involve the use of free weights lifted through the extremes of joint motion in a ballistic rather than a controlled fashion. They have significant potential to cause injury.1-3 In the clean and jerk, the athlete lifts the barbell in a two-step movement from the floor to the chest and then over the head; the snatch involves the same movement of the barbell performed without interruption with a different technique. The power clean requires raising the barbell from the floor to the shoulders in a two-part maneuver. The dead lift is accomplished by raising the barbell from the floor by straightening the flexed knees. In the squat lift, the athlete holds the barbell behind the head on the shoulders, squats until the thighs are parallel with the floor, and then straightens the legs. In the bench press, the athlete lies supine on a bench, holds the barbell over the chest with the arms extended, lowers the weight to the chest, and then raises it again. The incline press is similar, except that the bench is at a 30° angle.
Injuries in Day Care
Authors: GIELEN ANDREA CARLSON , SMITH GORDON S. , CHAULK PATRICK , GUYER BERNARD
Published: December 2021

To the Editor.—

We believe that there is insufficient evidence to state that "children are at no greater risk of injury in day care settings than in the home environment," as concluded by Rivara et al.1 Because the number of injured children was small (N = 29), it is unlikely that this study could provide accurate age-specific rates or identify rare but serious injuries. Studies of day care environments2,3 suggest that children in day care are exposed unnecessarily to many hazards that have the potential to cause serious injury (eg, unsafe playground surfaces and equipment heights).
Pediatric Emergencies
Authors: WEINBERG JOSEPH A.
Published: December 2021

In Reply.—

Dr DiBona expresses legitimate concern regarding the different classification systems used for pediatric and neonatal units. This concern was shared by the American Medical Association Commission in its deliberations. Discussions were held with the Perinatal Section regarding changing the classification for perinatal care. The pediatric emergencies document was drafted as part of a comprehensive classification of emergency capabilities encompassing multiple disciplines. There were already precedents in trauma, spinal cord injury, burns, and general emergency medicine for level I to the highest level of care.
Are We Becoming a Two-Class Society Based on Neonatal Circumcision?
Authors: SCHOEN EDGAR J.
Published: December 2021

In Reply.—

In 1989, a new American Academy of Pediatrics Task Force on Circumcision updated the earlier reports referred to by Dr Neiberger. The revised statement1 confirmed that there are medical advantages of newborn circumcision as well as disadvantages and affirmed that the decision to circumcise rests with the parents acting with the advice of the physician. The third-party payer should not be able to overrule this decision. Apparently, in Dr Neiberger's city, private insurers pay for newborn circumcision whereas public agencies do not.
Blood Pressure and Intraventricular Hemorrhage in Premature Infants
Authors: PUCCIO V. F. , SOLIANI M.
Published: December 2021

To the Editor.—

We have read with great interest the recently published article by Perry et al.1

The need to define "safe" blood pressure levels in the critically ill premature infants is a central topic in the prevention of intracranial hemorrhage.

However, in Perry's paper maximum systolic blood pressure and maximum mean blood pressure values are much higher than those reported by previously published articles.2-4 High blood pressure values were reported by Lou and Friis-Hansen5 in nine newborns.
Postneonatal Infectious Disease Mortality: The French Situation
Authors: Manciaux M. , Jestin C.
Published: December 2021

Mortality caused by infectious and parasitic diseases represents a limited part of all postneonatal deaths in France, which have been stable for the past decade. This component is worthy of careful analysis because it is at least partially preventable. Statistics are presented and interpreted, with discussion on which disorders should be included in assessing the impact of infection on morbidity and mortality. Figures and international rankings change according to the inclusiveness of the definition chosen. There is need for epidemiologic and statistical research to make comparisons of mortality more clear. Morbidity is also important because of high incidence, frequent hospitalization, and a heavy social cost. Policy and services in France that relate to control and treatment of infection are described, as are shortcomings that call for further efforts.
Behavioral Risk, Emotional Risk, and Child Abuse Among Adolescents in a Nonclinical Setting
Authors: Hibbard Roberta A. , Ingersoll Gary M. , Orr Donald P.
Published: December 2021

In this replication study of adolescents in a nonclinical setting, the prevalence of reported problem behaviors, emotions, and abuse is evaluated, and the impact of abuse on multivariate emotional and behavioral risk is assessed. A total of 3998 students (69%) in a rural midwestern community in grades 7 to 12 participated in the study. Almost 20% of the students reported some form of physical and/or sexual abuse, with more girls than boys reporting sexual abuse (χ2 = 48.5, P < .001). Some problem behaviors (alcohol use) and emotions (trouble sleeping, difficulty with anger) were common among all adolescents and some were strongly associated with a history of abuse (especially, considering or attempting suicide, running away, laxative use, and vomiting to lose weight). Higher emotional and behavioral risk scores among abused students were confirmed. The effects of physical and sexual abuse on risk scores were independent and additive; no interaction was observed. An interaction of gender and sexual abuse on problem behavior was observed, with problem behavior being significantly greater among sexually abused bosultss. The reults confirm increased risk of problem behaviors and negative feelings among abused adolescents when compared with nonabused peers, and better define influences of gender and abuse type on emotional and behavioral risks.
Response to Diet and Cholestyramine in a Patient with Sitosterolemia
Authors: Belamarich Peter F. , Deckelbaum Richard J. , Starc Thomas J. , Dobrin Beth Ellen , Tint G. Stephen , Salen Gerald
Published: December 2021

In this report, an 11-year-old boy with diffuse use tendinous and tuberous xanthomatosis and a plasma sterol concentration of 555 mg/dL, consisting primarily of cholesterol, is described. Three months after changing from an unrestricted diet to a cholesterol-lowering diet, his plasma sterol concentration decreased to 221 mg/dL. Because of the degree and rapidity of his response to diet, sitosterolemia was suspected. According to results of capillary gas-liquid chromatography of his plasma sterols, there was a sitosterol concentration of 31.3 mg/dL (normal <1.0 g/dL), establishing the diagnosis of sitosterolemia. Addition of cholestyramine therpy (8 g/d) to a low sterol diet further lowered his plasma sterol concentration to 73 mg/dL and led to complete regression of all tuberous xanthomata. Tendinous xanthomata regressed at a slower rate. These findings show that the diagnosis of sitosterolemia should be suspected in severely hypercholesterolemic children (total cholesterol >400 mg/dL) whose plasma cholesterol level is highly responsive to dietary manipulation. The rapid and sustained lowering of plasma cholesterol and regression of xanthomata after treatment with diet and cholestyramine suggest that sitosterolemia is a treatable cause of premature atherosclerosis.
Safe Handling of Vaccines
Authors: Casto Daniel T. , Brunell Philip A.
Published: December 2021

The development of safe and effective vaccines for the prevention of infectious diseases associated with high mortality or morbidity is among the most significant accomplishments in medicine. The ultimate goal of eradication of a disease through immunization is an elusive one, having been achieved for only one disease—smallpox. However, a significant reduction in the number of childhood cases of diphtheria, tetanus, pertussis, poliomyelitis, measles, mumps, and rubella has been realized through the use of modern immunizing agents. Recent introduction of vaccines for the prevention of invasive disease caused by Haemophilus influenzae will hopefully provide similar results in the near future.

The success of a vaccine in preventing disease is dependent on both the quality of the immunizing agent and the degree to which it is utilized. Obviously, the safest and most effective vaccine in the world will contribute nothing to the decline of a disease without clinicians' efforts to immunize at-risk individuals and without a willingness on the part of these at-risk individuals (or their parents) to receive the vaccine. This critical issue of vaccine utilization deservingly receives attention in the medical literature with some frequency.1,2 Similarly, the quality of vaccines is frequently addressed in publications concerning aspects such as reactogenicity, immunogenicity, and overall efficacy.3-6 One important factor that can influence efficacy, however, is rarely discussed—how vaccines are handled during shipment and storage.

Discussions concerning preservation of vaccine potency through proper storage and maintenance of the "cold chain" may seem more pertinent to developing countries of the world, where refrigeration is not readily available and exposure of stored product to extreme environmental conditions can be expected.7-9
Medical Guidelines for Day Camps and Residential Camps
Authors:   Committee on School Health
Published: December 2021

Because camp programs differ in many ways, especially in scheduled activities, availability of skilled medical support for the health care staff, and environmental conditions, camp administrators should use the medical guidelines provided in this statement to develop camp-specific protocols for day and residential camps.
28-Day Survival Rates of 6676 Neonates With Birth Weights of 1250 Grams or Less
Authors: Phelps Dale L. , Brown David R. , Tung Betty , Cassady George , McClead Richard E. , Purohit Dilip M. , Palmer Earl A.
Published: December 2021

Survival rates specific for birth weight, gestational age, sex, and race are described for 6676 inborn neonates who weighed less than 1251 g at birth and were born during 1986 through 1987. Overall 28-day survival increased with gestational age and birth weight, from 36.5% at 24 weeks' gestation to 89.9% at 29 weeks' gestation, or from 30.0% for neonates of 500 through 599 g birth weight to 91.3% for neonates of 1200 through 1250 g. The expected birth weight-specific survival advantage for female neonates and black neonates diminished when the data were controlled for gestational age, showing that certain previously reported survival advantages are based on lower birth weight for a given gestational age. Multivariate analysis showed that all tested variables were significant predictors for survival, in order of descending significance: gestational age and birth weight, sex, race, single birth, and small-for-gestational-age status. The powerful effect of gestational age on survival highlights the need for an accurate neonatal tool to assess the gestational age of very low birth weight neonates after birth.
Pediatric Emergency Room Visits: A Risk Factor for Acquiring Measles
Authors: Farizo Karen M. , Stehr-Green Paul A. , Simpson Diane M. , Markowitz Lauri E.
Published: December 2021

In recent years, measles outbreaks have occurred among unimmunized children in inner cities in the United States. From May 1988 through June 1989, 1214 measles cases were reported in Los Angeles, and from October 1988 through June 1989, 1730 cases were reported in Houston. More than half of cases were in children younger than 5 years of age, most of whom were unvaccinated. Of cases of measles in preschool-aged children, nearly one fourth in Los Angeles and more than one third in Houston were reported by one inner-city emergency room. To evaluate whether emergency room visits were a risk factor for acquiring measles, in Los Angeles, 35 measles patients and 109 control patients with illnesses other than measles, and in Houston, 49 measles patients and 128 control patients, who visited these emergency rooms, were enrolled in case-control studies. Control patients were matched to case patients for ethnicity, age, and week of visit. Records were reviewed to determine whether case patients had visited the emergency room during the period of potential measles exposure, which was defined as 10 to 18 days before rash onset, and whether control patients had visited 10 to 18 days before their enrollment visit. In Los Angeles, 23% of case patients and 5% of control patients (odds ratio = 5.2, 95% confidence interval = 1.7, 15.9; P < .01), and in Houston, 41% of case patients and 6% of control patients (odds ratio = 8.4, 95% confidence interval = 3.3, 21.2; P < .01), visited the emergency room during these periods. These data suggest that measles transmission in pediatric emergency rooms played a prominent role in perpetuating these outbreaks. Measles transmission in emergency rooms can be reduced by triage and isolation of suspected cases and by vaccination of eligible patients. Vaccination in emergency rooms provides postexposure prophylaxis and may increase vaccination coverage in the community.
A Difference in Mortality Between Two Strains of Jaundiced Rats
Authors: Stobie Paul E. , Hansen Carl T. , Hailey James R. , Levine Rodney L.
Published: December 2021

Homozygous Gunn rats lack bilirubin glucuronyltransferase, become jaundiced, and often develop kernicterus, thus providing a model for neonatal hyperbilirubinemia. Two new, inbred rat strains that carry the Gunn mutation are described. These were developed by breeding the mutant Gunn gene (j) into the RHA/N and ACI/N strains, producing the new lines, which were designated RHA/N-j and ACI/N-j. Liver assay confirmed the absence of transferase activity in jaundiced rats from both of the new strains, but marked differences in mortality between the strains were observed. The mortality of jaundiced RHA/N-j rats through 8 weeks was the same as that of their nonjaundiced littermates (20%). In contrast, mortality of jaundiced ACI/N-j rats was distinctly greater than that of their nonjaundiced littermates (81% vs 34%, P < .001). Signs of kernicterus such as ataxia were much more frequent in jaundiced ACI/N-j rats than in jaundiced RHA/N-j rats (73% vs 11%, P < .001). Both strains had comparable albumin concentrations through 8 weeks of age. Serum bilirubin concentrations were also comparable, except for a small but significant difference at 20 days of age (ACI/N-j = 294 µmol/L, RHA/N-j = 248 µmol/L, P < .01). Similarly, the bilirubin-to-albumin ratios were comparable except for a significantly higher ratio at 20 days of age in the ACI/N-j rats (ACI/N-j = 0.70, RHA/N-j = 0.51, P < .01). Thus, the RHA/N-j strain is unusual in that the jaundiced animals remain healthy. Conversely, the ACI/N-j animals demonstrate a high incidence of kernicterus with mortality. This dramatic strain difference implies that factors in addition to deficiency of bilirubin glucuronyltransferase are modulating the susceptibility to bilirubin toxicity.
Clinical Manifestations of Primary Herpes Simplex Virus Type 1 Infection in a Closed Community
Authors: Kuzushima Kiyotaka , Kimura Hiroshi , Kido Shinji , Hanada Naoki , Shibata Motohiro , Morishima Tsuneo , Kino Yoichiro
Published: December 2021

The clinical features and the molecular epidemiology of primary herpes simplex virus type 1 (HSV-1) infection among children younger than 3 years of age were investigated in day-care nursery. Serial sera were assayed for anti-HSV-1 glycoprotein B antibody by enzyme-linked immunosorbent assay. Serologic examinations revealed 55 cases of primary HSV infection during the observation period. Fifty-one of them (93%) had typical herpetic gingivostomatitis, showing a high rate of clinically overt infection. Four outbreaks of herpetic gingivostomatitis were observed during the observation period. Forty-one children were infected with HSV-1 in the outbreaks. The rates of infection in the susceptible children were 81%, 73%, 78%, and 100%, respectively, in the four outbreaks. Restriction endonuclease analysis of DNA of isolated HSV revealed that only one strain of HSV-1 had been transmitted among children for a long period.
Individual Differences in Children's Response to Pain: Role of Temperament and Parental Characteristics
Authors: Schechter Neil L. , Bernstein Bruce A. , Beck Arne , Hart Lisa , Scherzer Lawrence
Published: December 2021

Sixty-five families were enlisted in a study exploring factors associated with distress behavior in 5-year-old children receiving diphtheria-tetanus-pertussis immunizations. At a home visit 1 month before the immunization, the following measures were obtained: (1) the Behavioral Style Questionnaire, a measure of temperament; (2) parental self-reports of medically related attributes (eg, "good patient"); (3) parental attitudes toward pain in children and responsiveness to their child's pain; and (4) parental prediction of distress at upcoming immunization. The child's distress behavior during the immunization was evaluated using a modification of the Procedure Rating Scale-Revised and, after the procedure, the child's assessment of his or her pain was elicited using the Oucher. Children's mean Procedure Rating Scale-Revised score was 2.57 of a possible 11. Thirty-one (48%) had low (≤1) and 7 (11%) had high distress scores (≥2 SD above the mean). Factors positively correlated with distressed behavior included more "difficult child" cluster characteristics, the individual temperamental dimension of adaptability, but few parental attitudes and attributes. Parents' predictions of distress were the strongest correlates. These findings document the variation that children demonstrate in response to pain and offer some insight into associated innate and environmental factors. These results imply that treatment strategies derived from parental knowledge and tailored to individual characteristics of the child may be most effective in alleviating pain-related distress in medical settings.
Allergenicity of Orally Administered Immunoglobulin Preparations in Food-Allergic Children
Authors: Bernhisel-Broadbent Jan , Yolken Robert H. , Sampson Hugh A.
Published: December 2021

Passive immunization by the oral administration of immunoglobulin preparations derived from bovine milk, chicken egg, and human sera has been proposed as a method for the prevention and treatment of enteric diseases. However, the allergenic potential of these proteins may be a factor limiting their widespread use for disease prevention. An in vitro study with sera from milk- and egg-allergic children was performed to determine whether these immunoglobulin preparations have allergenic potential. Protein extracts of milk, bovine immunoglobulin, egg white, human immune globulin, and five egg yolk antiviral immunoglobulin preparations were bound to nitrocellulose paper. These preparations were probed for specific IgE binding with sera from milk- and egg-allergic patients. Of 22 milk-hypersensitive patients, 16 had specific IgE binding against the bovine immunoglobulin preparation. Of 28 egg-allergic patients 15 had specific IgE binding against one or more of the egg yolk-derived antiviral chicken immunoglobulins. Control sera were negative against the milk and egg preparations. Western blot analysis confirmed that milk- and egg-allergic patients had IgE-specific antibodies for bovine and chicken immunoglobulin molecules. Therefore, the removal of contaminating proteins from milk and egg antibody preparations would be unlikely to eliminate their allergenic potential. In contrast, sera from milk- and egg-allergic patients displayed no detectable IgE binding to human immunoglobulin preparations. These data indicate that the administration of antibody preparations derived from bovine and chicken sources may lead to severe allergic reactions in milk- or egg-sensitized patients and to sensitization in some nonallergic individuals. On the other hand, it is likely that human immunoglobulin preparations can be administered to such patients with a minimal risk of IgE-mediated reactions.