bluuebunny/crossref_metadata_2025 huggingface dataset:
Genetic Causes of Hydrops Fetalis
Authors: Van Maldergem Lionel , Jauniaux Eric , Fourneau Catherine , Gillerot Yves
Published: December 2021

A series of 1790 fetal and neonatal autopsies performed between 1976 and 1988 were retrospectively investigated for the presence of hydrops. Thirty (5.5%) and 35 (2.8%) cases of hydrops were found in the groups of fetal and neonatal autopsies, respectively. Genetic causes accounted for 35%. A careful search for previously reported genetic causes of fetal hydrops indicated 64 different etiologies. Twenty-one of them were not mentioned in the previous reviews: these include 9 skeletal dysplasias, 5 inborn errors of metabolism, 3 autosomal recessive, 3 autosomal dominant conditions, and 1 chromosomal abnormality
Participation by Pediatricians in Early Intervention: Impetus From Public Law 99-457
Authors: Blackman James A. , Healy Alfred , Ruppert Elizabeth S.
Published: December 2021

Part H of the Individuals with Disabilities Education Act (originally enacted as Public Law 99-457) requires that participating states phase in a system of early intervention services by 1993. By recognizing the importance of good health in the development of infants and toddlers, Congress acknowledged the key role of medical care providers in a comprehensive program for young children with or at risk for developmental delay or dysfunction. National and state surveys of pediatricians suggest limited but growing awareness of this legislation and uncertainty about how they might participate effectively. A chief concern relates to mechanisms of payment for developmental screening and assessment as well as time-demands for participation in interdisciplinary team activities. The American Academy of Pediatrics and its state chapters are responding to requests for information with educational seminars and print materials. Pediatricians can enhance the quality of community support services for children with special needs by participating in planning efforts and by coordinating health care with other aspects of early intervention. Other professionals and parents are looking to pediatricians for leadership and willing participation in the implementation of PL 99-457.
Nutrient Adequacy of Low Fat Intakes for Children: The Bogalusa Heart Study
Authors: Nicklas Theresa A. , Webber Larry S. , Koschak MaryLynn , Berenson Gerald S.
Published: December 2021

Nutritional adequacy is important when diets and dietary alterations are recommended for children. Concern is expressed that low fat intakes may have deleterious effects on growth and development and may be deficient in total calories and essential nutrients. In a study of the effect of variation in percent fat in the diet, a sample of 871 ten-year-olds was stratified according to four different fat intakes: <30% of total kilocalories (kcal), 30% to 35% kcal, 35% to 40% kcal, and >40% kcal. The race/sex distribution was similar within each fat intake group. Fourteen percent of the sample had fat intakes less than 30% of total calories. The amount of calories from breakfast, dinner, and snacks was higher in the children with fat intakes >40% of total calories than those with lower fat intakes. The energy intake of all race/sex groups fell within the recommended range. The low fat intake group was eating 25% less calories than the high fat intake group (1800 kcal vs 2400 kcal). The percentage of calories from carbohydrate, specifically sugar, was greater in the low fat intake group compared with the high fat intake group. Percentage of calories from protein was approximately 13% for all groups. Fiber and starch were the same across all fat intakes. The major fat sources (percentage of total calories), in rank order, in the high fat intake group (>40% kcal) were meats (31%), dairy (16%), fats and oils (10%), and prepared vegetables (10%); whereas in the low fat intake group (<30% kcal) they were dairy (23%), meats (16%), breads (13%), and desserts (12%). Percentage of calories from saturated fat was higher in the high fat intake group (18%) than in the low fat intake group (11%). Interestingly, mean intake of sugar was greater in the low fat intake group (160 g) than in the high fat intake group (129 g). Percentage of total sugar intake in the low and high fat intake groups came from candy (29% vs 21%), beverages (25% vs 19%), and desserts (11% vs 14%). Based on the differences in total caloric intakes, the following is a comparison of the percentage of the high fat intake group vs the percentage of the low fat intake group not meeting the Recommended Dietary Allowances for the following nutrients: vitamins B6 (69% vs 77%), B12 (36% vs 70%), and E (23% vs 55%); thiamin (40% vs 58%), riboflavin (25% vs 45%), and niacin (41% vs 64%). Differences were less dramatic for folacin and iron. Obviously, attention has to be given to overall nutrient adequacy when dietary fat recommendations are made.
Cocaine/Polydrug Use in Pregnancy: Two-Year Follow-up
Authors: Chasnoff Ira J. , Griffith Dan R. , Freier Catherine , Murray James
Published: December 2021

The impact of cocaine on pregnancy and neonatal outcome has been well documented over the past few years, but little information regarding long-term outcome of the passively exposed infants has been available. In the present study, the 2-year growth and developmental outcome for three groups of infants is presented: group 1 infants exposed to cocaine and usually marijuana and/or alcohol (n = 106), group 2 infants exposed to marijuana and/or alcohol but no cocaine (n = 45), and group 3 infants exposed to no drugs during pregnancy. All three groups were similar in racial and demographic characteristics and received prenatal care through a comprehensive drug treatment and follow-up program for addicted pregnant women and their infants. The group 1 infants demonstrated significant decreases in birth weight, length, and head circumference, but by a year of age had caught up in mean length and weight compared with control infants. The group 2 infants exhibited only decreased head circumference at birth. Head size in the two drug-exposed groups remained significantly smaller than in control infants through 2 years of age. On the Bayley Scales of Infant Development, mean developmental scores of the two groups of drug-exposed infants did not vary significantly from the control group, although an increased proportion of group 1 and 2 infants scored greater than two standard deviations below the standardized mean score on both the Mental Developmental Index and the Psychomotor Developmental Index compared with the control infants. Cocaine exposure was found to be the single best predictor of head circumference. Across all infants in the study, a significant correlation between small head size and developmental scores was found. The present study demonstrates that intrauterine drug exposure may place infants at risk for developmental outcome and that head growth after birth may be an important biological marker in predicting long-term development in children exposed in utero to cocaine and other drugs.
The Ricochet of Magic Bullets: Summary of the Institute of Medicine Report, Adverse Effects of Pertussis and Rubella Vaccines
Authors: Howson Christopher P. , Fineberg Harvey V.
Published: December 2021

On July 3, 1991, the National Academy of Sciences' Institute of Medicine (IOM) released a reported entitled, Adverse Effects of Pertussis and Rubella Vaccines,1 in response to a congressional request to review evidence about a set of serious adverse events and immunization with pertussis and rubella vaccines. The request originated in the 1986 National Childhood Vaccine Injury Act (Public Law 99-660), whose primary purpose was to establish a federal compensation scheme for persons potentially injured by a vaccine; Section 312 of Public Law 99-660 called for the IOM review.

Over the course of its 20-month study, the 11-member interdisciplinary committee constituted by IOM to conduct the review examined altogether 18 adverse events for pertussis vaccine—infantile spasms; hypsarhythmia; aseptic meningitis; acute encephalopathy; chronic neurologic (permanent brain) damage; deaths classified as sudden infant death syndrome (SIDS); anaphylaxis, autism; erythema multiforme or other rashes; Guillain-Barré syndrome (polyneuropathy); peripheral mononeuropathy; hemolytic anemia; juvenile diabetes; learning disabilities and hyperactivity; protracted inconsolable crying or screaming; Reye's syndrome; shock and "unusual shock-like state" with hypotonicity, hyporesponsiveness, and short-lived convulsions (usually febrile); and thrombocytopenia—and 4 adverse events for rubella vaccine—acute arthritis; chronic arthritis; radiculoneuritis and other neuropathies; and thrombocytopenic purpura. In conducting its review, the committee recognized that its charge was to focus on questions of causation and not broader topics, such as cost-benefit or risk-benefit analyses of vaccination.

This summary begins with a brief history of events leading to the IOM study, then reviews the methods used by the committee to evaluate the evidence, summarizes the committee's conclusions for these adverse events, and offers directions for future investigation of adverse events in connection with widely used health interventions, such as vaccination.
Fire Hydrant Injuries
Authors: WIDOME MARK D.
Published: December 2021

In Reply.—

I was attracted to the fire hydrant article by Joffe, Torrey, and Baker1 for several unrelated reasons. Aside from my interest in injury prevention, I spent 8 years in college and medical school in West Philadelphia and in Center City Philadelphia. I can appreciate the limited opportunities for Philadelphia's children to escape the Delaware Valley's heat and humidity. But it is in part because I now live and work 100 miles west of Philadelphia, in semirural Hershey, that the most striking thing about Joffe's article is that it is an example of examining a problem with a microscope when a wide-angle lens is called for.
Developmental Toxicants Risk Assessment
Authors: GUZELIAN PHILIP S. , HENRY CAROL J. , FARLAND WILLIAM H. , OLIN STEPHEN S.
Published: December 2021

To The Editor.—

Because of their physical vulnerability and diminutive stature, infants and children often are assumed by the general public and by some health professionals to be more susceptible to the potential toxic effects of the chemicals found in the environment. An analysis based on available data, however, suggests that the answer clearly depends on the substance and the exposure situation. In some cases, there may be no difference at all in the responses of children and adults.
Life, Death, and Parents' Opinions in the Intensive Care Unit
Authors: KAEMPF JOSEPH W.
Published: December 2021

To The Editor.—

I would like to congratulate Shoo K. Lee et al for their thought-provoking article on the parental attitudes toward very low birth weight infants who have been cared for in their neonatal intensive care unit.1 The authors recognize several limitations of their study: (a) small sample size; (b) exclusion of parents of infants who died in the neonatal intensive care unit; (c) exclusion of single parents.

Despite recognizing these limitations, the authors conclude, "Our results indicate that more cognizance must be taken of parental desires in the discussion of whether active treatment should be offered to VLBW infants."
Life, Death, and Parents' Opinions in the Intensive Care Unit
Authors: LEE SHOO , PENNER PAULINE , COX MARGARET
Published: December 2021

In Reply.—

We thank Dr Kaempf for his interest in our paper, and we share his concerns that the study should not be misinterpreted. We also are pleased that Dr Kaempf agrees that more cognizance must be taken of parental desires, but stand by our conclusion that our study supports this view. Dr Kaempf's experience may be different because cultural and socioeconomic differences in different regions may result in different views. However, in both instances, parental desires were taken into consideration.
Risks with Translocation in "Typus Edinburgensis"
Authors: HECHT FREDERICK , HECHT BARBARA K.
Published: December 2021

To the Editor.—

In 1974 Habel1 described five infants in an Edinburgh family with dysmorphic facial features, developmental delay, and early demise. He called the condition "Typus Edinburgensis" and suggested it was due to an undetected chromosome abnormality.

Now, 17 years later, Laing et al2 have studied this Edinburgh family further using high resolution chromosome banding and found a translocation between chromosomes 1 and 2. The "Typus Edinburgensis" results from adjacent segregation of this translocation causing duplication of the segment from 1q42.3 to 1qter and deletion of the segment from 2q37.1 to 2qter.
Publish or Perish
Authors: FULGINTTI VINCENT A.
Published: December 2021

In Reply.—

Dr Sahler's letter to Pediatrics summarizes the dilemma that academic medicine and editors of journals face. It is truly a "chicken and egg" problem, but there is little hope for resolving it in the near future. Academic faculties are very conservative when it comes to changing the "rules" for anything, as evidenced by the slowness with which curricular reform is occurring in this country. Although many have commented on the need to modernize the policies and procedures for the award of tenure, and for academic promotion, the focus for change remains in our faculties and in their promotion and tenure committees, at both the departmental and school or University levels.
Pediatricians Do Matter
Authors: OSKI FRANK A.
Published: December 2021

To the Editor.—

The American Academy of Pediatrics expressed concern when the Mead Johnson Division of Bristol-Myers began a direct advertising campaign to sell their Gerber brand infant formula.

The Academy believed that pediatricians should counsel parents about infant nutrition and choice of formula, and these important nutritional decisions should not be made in response to advertising on television or in the print media.

Marketing surveys validate the concerns of the Academy. The most recent A.C. Nielsen survey (October 22, 1991) indicates that only 56% of the Gerber infant formula that currently is purchased by customers is iron-fortified, as contrasted with 88.2% for SMA, 82% for Similac, and 81.6% for Enfamil.
Iron Syrup Concentration Error
Authors: FIKAR CHARLES R.
Published: December 2021

To the Editor.—

There is an error in the new edition of The Harriet Lane Handbook concerning the concentration of iron in Fer-in-sol syrup.1 The text states that the number of milligrams of elemental iron is 18 milligrams per milliliter. According to the package insert, the concentration is actually 18 milligrams per 5 milliliters.

Children being treated with this iron preparation potentially would be greatly underdosed if the printed information in the handbook is used by a physician in determining a treatment plan for iron deficiency anemia.
Eight-Year School Performance, Neurodevelopmental, and Growth Outcome of Neonates With Bronchopulmonary Dysplasia: A Comparative Study
Authors: Robertson Charlene M.T. , Etches Philip Charles , Goldson Edward , Kyle Janis Mildred
Published: December 2021

Eight-year outcome is reported for three groups of preterm infants with bronchopulmonary dysplasia—group 1 with a birth gestation of ≤31 weeks receiving supplemental oxygen until the equivalent of 36 weeks' gestation, group 2 of the same gestation receiving supplemental oxygen to 28 days postnatal age but not to 36 weeks gestational age, and group 3 with a gestation of ≥32 weeks requiring supplemental oxygen for >28 days—and for an individually matched preterm neonatal comparison group and a term peer comparison group for each bronchopulmonary dysplasia group. The subjects all had parents whose mother tongue was English and were matched for gender, mother's education, and father's socioeconomic status, and in the case of the neonatal comparison groups they also were matched for birth gestation and birth weight. Physical growth and psychoeducational and school performance test scores were similar for the three bronchopulmonary dysplasia study groups with the exception of lower intelligence quotient for those receiving supplemental oxygen for the longest time. Children in groups 1 and 2 had outcome scores similar to those of the neonatal comparison group and significantly below those of their peer comparison groups. On multivariate analysis for group 1 children, 61% of the variance of academic achievement was related to lowest recorded pH, father's socioeconomic status, and lowest recorded Pao2. Compared with the peer groups, the study groups continued to show academic delay when the disabled children were excluded from analysis. Although the duration of pulmonary disease affects outcome, prematurity with and without chronic lung disease, along with adverse social factors, compromises the outcome for low birth weight infants with a history of bronchopulmonary dysplasia who have now reached school age.
Educational Outcome of Neonatal Intensive Care Graduates
Authors: Resnick Michael B. , Roth Jeffrey , Ariet Mario , Bucciarelli Richard L. , Carter Randy L. , Emerson Julia C. , Hendrickson Jo M. , Packer Athol B. , Larsen Janet J. , Wolking William D. , Lucas Mel , Schenck Betty J. , Fearnside Bebe
Published: December 2021

Studies of developmental outcome of neonatal intensive care unit graduates have generally been limited to the first 2 to 3 years of life, with outcome determined by psychometric tests. This study followed neonatal intensive care unit graduates born 1975 through 1983 (n = 457) into the public school system and compared their educational outcomes with those of newborn nursery graduates (n = 656). Outcomes were evaluated by placement in four academic categories: regular classroom, academic problems, speech/language impairment, and major impairment. Educational outcomes for children of both groups were essentially the same. Their placement in the four academic categories were equally affected by nonmedical variables, primarily income (below/above poverty level), race, and sex. Seventy percent of poverty-level children were in one of the three problem categories, compared with 40% of children above poverty level. Neither neonatal intensive care unit treatment nor low birth weight were major predictors of educational outcome. The only clear-cut neonatal intensive care unit effect occurred among children born with sensory or physical impairments. Therefore, in order to reduce poor educational outcomes, follow-up and intervention programs should be targeted primarily to children with diagnosable handicaps and from minority, low-income families.
Lack of Agreement of Tympanic Membrane Temperature Assessments With Conventional Methods in a Private Practice Setting
Authors: Freed Gary L. , Fraley J. Kennard
Published: December 2021

An infrared tympanic membrane thermometer (FIRST temp) said to approximate core temperature accurately is being marketed as a noninvasive, quick, and easy-to-use clinical instrument. The determination of tympanic membrane temperatures by this device was compared with the determination of oral, rectal, or axillary temperatures by a conventional glass thermometer. Subjects were patients of a pediatric group practice in Houston, Texas. FIRST temp and conventional temperature determinations on individual patients were completed within 5 minutes of each other. The presence or absence of otitis media was noted by the examining physician. Agreement between the two methods of temperature determination was assessed by calculating limits of agreement within which 95% (±2 standard deviations) of individual differences would fall. The location of conventional thermometer (oral, rectal, axillary), time interval between the two separate measures, and the presence or absence of otitis media were entered into a multiple regression analysis to determine whether these factors influenced the observed differences between the two methods. A total of 144 patients were enrolled in the study; oral comparisons were obtained in 92 (57%) patients, rectal in 35 (24%), and axillary in 29 (19%). The upper and lower limits of agreement between temperature methods were 1.12°C and 0.89°C and the mean difference was –0.12°C. Regression analysis revealed that only the site of conventional thermometer location (oral, rectal, axillary) was a significant predictor of FIRST temp/conventional differences. Each site had a range of agreement greater than 1.65°C; axillary temperatures had the greatest range (–0.94°C to +1.30°C). Although ease and time reduction with use are attractive properties of the FIRST temp device, these data show that it is unreliable compared with conventional methods of temperature determination.
Girls With Fragile X Syndrome: Physical and Neurocognitive Status and Outcome
Authors: Hagerman Randi J. , Jackson Carey , Amiri Khaled , O'Connor Rebecca , Sobesky William , Silverman Amy Cronister
Published: December 2021

The fragile X syndrome, a common X-linked form of mental retardation and autism, affects females as well as males. Previous work has shown that approximately 35% of heterozygotes (women who carry the fragile X gene) demonstrate cognitive impairment. Thirty-two girls, 18 years or younger, who demonstrate the fragile X chromosome were evaluated and compared with 19 sisters who do not demonstrate the fragile X chromosome. Evaluations included a physical examination, behavioral assessment, and intelligence testing. Significant differences (in intellectual, behavioral, and physical features) were seen between the two groups. Twenty-five percent of fragile X-positive girls had an IQ in the mentally retarded range (IQ < 70) and 28% had an IQ in the borderline range (70 to 84). Prominent ears, shyness, and poor eye contact were significant findings in fragile X-positive girls compared with fragile X-negative girls. Thirty-one percent of the fragile X-positive girls had significant attentional difficulties and most of these girls were successfully treated with stimulant medication. The majority of fragile X-positive girls in this study demonstrated significant behavioral and developmental problems which required identification and appropriate treatment. Pediatricians and health care providers should be aware of the frequency and manner with which fragile X affects females in order to initiate cytogenetic studies and treatment when indicated.
Whole-Body Cesium 137 Activity up to 4 Years After the Chernobyl Reactor Accident in Premature Newborns, Newborns, Infants, and Children
Authors: Koch Hans-Christoph , Burmeister Walther , Georgakopoulou Alexandra , Krämer Anja , Halfmann Kirsten , Hartmann Christiane , Lentze Michael J. , Niesen Mathilde , Knopp Reinhold
Published: December 2021

Cesium 137 activity was measured after the Chernobyl incident in a whole-body radiation counter (4-π-scintillation counter) in 85 premature and mature newborns (group 1), 174 infants and young children up to 2 11/12 years (group 2), and 48 children between 3 and 8 years (group 3) from Bonn (Germany) and surroundings. In 1987 the mean level of radioactivity in group 2, at 3.7 Bq/kg body weight corresponding to a mean radiation exposure of 11 µSv/y, was lower than that of group 1 (5.8 Bq/kg, 17 µSv/y) and 3 (9.4 Bq/kg, 28 µSv/y). Up to 1990 the values of all groups revealed a continuous decrease. The latest measurements showed mean values of 0.5 Bq/kg (1.5 µSy/y) in group 1, 0.6 Bq/kg (1.8 µSv/y) in group 2, and 0.8 Bq/kg (2.4 µSv/y) in group 3. A comparison with present cesium 137 values and determinations at the end of the 1950s and beginning of 1960s, both in adults, showed good agreement. The effective dose-equivalent rates amounted to less than 1% of that from natural radiation exposure. These levels should present no teratogenic risks to the population studied and, while there are theoretical mutagenic risks, the dose is so low that no increase in measurable mutagenic effects should be observed.
Pediatric Organ Donation: The Paradox of Organ Shortage Despite the Remarkable Willingness of Families to Donate
Authors: Morris John A. , Wilcox Todd R. , Frist William H.
Published: December 2021

The 105 pediatric deaths (ages 1 to 16 years) that occurred at Vanderbilt University Medical Center during a 31-month period were reviewed to define the size of the donor pool in the pediatric population and to assess the role of physicians in the procurement of these much-needed organs. Computerized discharge abstracts showed that 57 pediatric patients died without contraindications to organ donation. Manual review of these 57 medical records yielded 46 records suitable for review by Tennessee Donor Services. From this group, 19 eligible donors were identified. All eligible donors died from trauma, intracerebral hemorrhage, anoxic events, or hydrocephalus. Physicians failed to ask one family for permission to donate. All 18 of the families who were asked agreed to donate and organs were successfully procured from all 18 patients. These data suggest that families of pediatric patients are much more willing to agree to donation than the families of adult patients. As a result of this study, a simplified audit process has been developed for hospitals to use in evaluating compliance with required-request legislation.
Lung Involvement in Langerhans' Cell Histiocytosis: Prevalence, Clinical Features, and Outcome
Authors: Ha S. Y. , Helms P. , Fletcher M. , Broadbent V. , Pritchard J.
Published: December 2021

In Langerhans' cell histiocytosis, the prognostic significance of pulmonary disease is controversial. The clinical and radiological features and lung function tests of Langerhans' cell histiocytosis patients presenting to a single tertiary referral center between 1981 and 1987 were reviewed. Age at diagnosis ranged from 2 weeks to 16 years (median 1.7 years) and the male-female ratio was 2.4:1. No child presented with lung involvement alone. In 18 (40%) of 45 patients with multisystem disease there was clinical and/or radiological evidence of lung pathology. Another 6 children (13%) with normal chest roentgenograms had abnormal lung function tests, suggesting subclinical ("occult") involvement. Those with overt lung disease tended to present at a younger than average age (median 0.6 years). The most common functional disturbance was reduced lung or respiratory compliance with reduced lung volumes. Patients with and without lung involvement showed a similar pattern of involvement of other organs, with skin and bone most commonly affected. Of the 45 children with multisystem disease, 38 (84%) survived 2 to 7 years after diagnosis; there was a similar proportion of deaths in children with and without lung involvement. It is concluded that lung involvement occurs in nearly half of young children with multisystem Langerhans' cell histiocytosis but does not adversely affect outcome.
Behavior and Parental Expectations of Child Pedestrians
Authors: Dunne Rosemary G. , Asher Kenneth N. , Rivara Frederick P.
Published: December 2021

Pedestrian injuries remain the most common cause of death from trauma for young school-age children. This study was based on the hypothesis that parents' abilities to accurately assess their children's street-crossing skills vary with the crossing test and age of the children, being less accurate for younger children. Children at three developmental levels (aged 5 through 6, 7 through 8, and 9 through 10 years) and their parents were evaluated on four street-crossing tests and a control vocabulary test. For each test, children's answers were compared to parents' estimates of their children's performance. Parents overestimated the abilities of their 5- through 6-year-olds on all four tests (P < .01). Parents overestimated the abilities of 7- through 8-year-olds on two of the tests (P < .05) and parents accurately assessed the abilities of the 9- through 10-year-olds. On the vocabulary test, parents overestimated their children's performance at all age levels (P < .01). The results support the hypothesis and indicate that parents' expectations for their children's pedestrian skills are least accurate for 5- and 6-year-olds, with the mismatch decreasing as children get older. Inaccurate expectations of children's pedestrian skills may be a fruitful target for injury prevention programs.
National Cholesterol Education Program (NCEP): Highlights of the Report of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents
Authors:   NCEP Expert Panel on Blood Cholesterol Levels in Children and Adolescents
Published: December 2021

Compelling evidence exists that the atherosclerotic process begins in childhood and progresses slowly into adulthood, at which time it leads frequently to coronary heart disease (CHD), the major cause of death in the United States. Despite substantial success in reducing CHD mortality in the past two decades, the disease is still responsible for more than 500 000 deaths annually. About 20% of hospital discharges for acute CHD are for premature disease, ie, in patients younger than 55 years of age. Many of these adults have children who may have CHD risk factors that need attention. Estimates of the annual cost of CHD range from $41.5 to $56 billion.

The Report of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents (which appears as a supplement to this issue of the journal) reviews the evidence that atherosclerosis or its precursors begin in young people; that elevated cholesterol levels early in life play a role in the development of adult atherosclerosis; that eating patterns and genetics affect blood cholesterol levels and CHD risk; and that lowering levels in children and adolescents will be beneficial. Cholesterol is the focus of the report, but other risk factors for atherosclerosis and CHD may originate early in life and should be addressed as well. Specifically, cigarette smoking should be discouraged; hypertension should be identified and treated; obesity should be avoided or reduced; regular aerobic exercise should be encouraged; and diabetes mellitus should be diagnosed and treated.

SIGNIFICANCE OF BLOOD CHOLESTEROL LEVELS IN CHILDHOOD AND ADOLESCENCE
Accuracy of Central Venous Pressure Measuremet From the Abdominal Inferior Vena Cava
Authors: LLOYD THOMAS R. , DONNERSTEIN RICHARD L. , BERG ROBERT A.
Published: December 2021

Central venous pressure measurements in the abdominal inferior vena cava were compared with measurements in the right atrium in 10 infants and 10 children during cardiac catheterization. At end expiration, the mean pressures at these two sites were within 1 mm Hg of each other in all 20 patients, with a mean difference of 0.0 ± 0.36 mm Hg. The abdominal inferior vena cava is a safe and convenient site for measurement of central venous pressure, and our study confirms that such measurements are accurate.
Should Children, Parents, and Pediatricians Worry About Cholesterol?
Authors: LAUER RONALD M.
Published: December 2021

In this issue Arneson et al1 present the results of a survey of Minneapolis pediatricians' attitudes about the significance of cholesterol levels in childhood and the need to measure cholesterol levels in children. Many expressed some skepticism about the predictive value of cholesterol levels for adult cardiovascular disease but despite this, most carried out screening of cholesterol levels in their patients. Most carried out selective screening of cholesterol levels in children with a strong family history of coronary heart disease. About a third of the pediatricians surveyed indicated that they carried out screening of cholesterol levels in all children. There was diversity of view about what levels of cholesterol should be considered as elevated.
Horseback Riding and Head Injuries
Authors:   Committee on Sports Medicine and Fitness
Published: December 2021

This Policy Statement was retired May 2004.

Horseback riding accidents can cause head injuries resulting in death or permanent residual defects. These riding injuries occur most frequently in riders younger than 21 years of age.1 Approximately 20% of injuries in young riders are to the central nervous system.2,3 The majority of these injuries are cerebral contusions, concussions, or skull fractures.3 Use of approved helmets has been associated with a decline in the occurrence of severe head injuries.4

In the early 1980s, numerous organizations (American Horse Shows Association, United States Pony Club, United States Combined Training Association, and the United States Equestrian team) began requiring all competitors to use helmets meeting the United States Pony Club Standard. This standard was developed by the National Operating Committee on Standards for Athletic Equipment.5 In 1988, the American Society for Testing and Materials (ASTM) passed new standards (ASTM F-1163) for equestrian helmets that required helmets to provide a higher level of protection than previous models.6 This is an industry-wide standard that replaces previous standards. As of March 1990, the United States Pony Club required use of these new helmets for all activities.7

New helmets that meet the ASTM standard will be certified by the Safety Equipment Institute (SEI), a compliance organization responsible for certifying industrial products. The SEI seal, containing the date and manufacturer's lot number, must be permanently applied to the inside of the helmet so the buyer will know it is an approved equestrian helmet.7

The American Academy of Pediatrics (AAP) recommends the following steps for preventing and/or lessening the severity of horseback riding-related injuries:
Little League Baseball and Head Injury
Authors: HART EDWARD J.
Published: December 2021

To the Editor.—

"Baseball is far more dangerous than we realize; and for some it may be deadly." (Walters B. "20/20" Television Program. July 12, 1991)

Recently, I have discharged from the hospital a 12-year-old boy whose intracerebral hematoma was sustained while playing Little League baseball and whose injury raises many questions about current safety policies in organized youth baseball.

The boy was struck on the left side of his head by a pitched ball while up at bat; although stunned, he did not lose consciousness and in fact completed the game.
Infimary-Style Sick Child Day Care
Authors: AUERBACK MARVIN L.
Published: December 2021

To the Editor.—

Dr Furman raises a number of issues about potential hazards of hospital-based sick child day care. She is worried about nosocomial infection and the two-way spread of disease between the "healthy ill" in the sick day care program, and the really ill hospital inpatients. So far, I have found practically no real evidence that such a risk exists. Her concern about spread of infection to compromised children (eg, immunosuppressed children) would be true if sick care centers were to be established in tertiary care or university hospitals.
Curmudgeon Strikes
Authors: SILVERMAN JOSEPH A.
Published: December 2021

To the Editor.—

This curmedgeon almost had a GTC SZ1.p487 while reading the September 1991 issue of Pediatrics.

First of all, why use such terms as "mother-neonate pairs" and "primary care providers?"2.p444 Whatever happened to "baby, new-born, doctor, and nurse?"

Second, a co-author of one paper is described by you as not only an MD, and an MPH; he is also a *, ‡, §, ¶, and a #!3.p572 Perhaps Pediatrics should sponsor an appendage contest each year to determine which author has the longest tail!

Third, abbreviations are getting out of hand.
Disposable Diapers vs the Environment
Authors: SEITZ MICHELE L.
Published: December 2021

To the Editor.—

In the August issue of Pediatrics, Sutton, Weitzman, and Howland published a commentary on disposable diapers and the environmental concerns raised by their use.1 They presented a very one-sided argument in favor of cloth diapers and used data from a 1987 article in Consumer Reports (1987;52:510-512) to support their position.

The 1987 price they quoted for using cloth diapers with a laundering service was approximately $26 per month, while the quoted cost for disposables was $84 per month.
A Service Chief Model for General Pediatric Inpatient Care and Residency Training
Authors: Goldmann Donald A. , Nathan David G. , Lovejoy Frederick H. , Andrews Sally M. , Pasternack Sarah
Published: December 2021

Pediatric training programs are faced with rapid, fundamental changes in hospital practice and an increasingly rigorous regulatory and fiscal environment. Traditional models for providing care and teaching students and house officers may not be sufficiently responsive to these challenges. In 1986, the Department of Medicine at Children's Hospital, Boston, reorganized the general inpatient program and implemented a “service chief”system adapted from British hospital “firms.” Three age-based inpatient services (Thomas Morgan Rotch infant/toddler service, Kenneth Daniel Blackfan school-age service, and Charles Alderson Janeway adolescent/young adult service) were created, each headed by an experienced clinician and teacher (service chief). The service chiefs developed age-appropriate curricula, recruited a balanced faculty of generalists and specialists to serve as attending physicians and provide teaching in their areas of expertise, and established strong collaborative relationships with nurse managers on their respective wards. Implementation of the service chief system has been associated with development of faculty esprit de corps,standardized tracking of faculty performance, enhanced supervision and counseling of housestaff, and improved continuity of patient care. Relationships with referring physicians have improved dramatically, as measured by formal satisfaction surveys. Accountability and documentation have been emphasized, and departmental billings have increased sharply. Ongoing quality indicators have been developed, and collaborative patient care,teaching, and quality-improvement projects have been initiated with the nursing staff. Naming the services for distinguished past physicians-in-chief has provided a focus for fund-raising. Although an additional objective of the service chief system was to provide a framework for general pediatric clinical research by housestaff and service faculty, this goal remains largely unrealized. It is concluded that the service chief system is an efficient,effective strategy for providing quality patient care and teaching while meeting the fiscal and administrative burdens of contemporary hospital practice.
Slipped Capital Femoral Epiphysis Without Hip Pain Leads to Missed Diagnosis
Authors: Ledwith Carol A. , Fleisher Gary R.
Published: December 2021

Prompt diagnosis of slipped capital femoral epiphysis (SCFE) is dependent on recognition of variable clinical manifestations. The charts of 116 children and adolescents with SCFE were reviewed to identify characteristics of patients whose diagnosis was initially missed. Missed diagnosis was found in 34 patients (29%). Sixteen of the 34 whose diagnosis was missed had hip pain,while 58 of the 82 whose diagnosis was not missed had hip pain (P =.0157). Of the 34 patients with missed diagnosis, 15 patients had thigh pain. In comparison, of the 82 patients without missed diagnosis, 19 had thigh pain(P = .0241). It is concluded that SCFE is more likely to be missed at the initial visit if hip pain is absent or if thigh pain is present. This review indicates that despite the evidence that patients with SCFE frequently complain of symptoms other than hip pain, the disorder continues to be missed.
Exclusive Breast-Feeding and Weaning: Effect on Serum Cholesterol and Lipoprotein Concentrations in Infants During the First Year of Life
Authors: Kallio Markku J. T. , Salmenperä Leena , Siimes Martti A. , Perheentupa Jaakko , Miettinen Tatu A.
Published: December 2021

The total serum cholesterol concentration of infants was investigated at birth (n = 193) and at the ages of 2 (n = 192), 4 (n = 192), 6 (n = 190), 9 (n= 188), and 12 months (n = 196). Concentrations of cholesterol—very-low-density lipoprotein (VLDL), low-density lipoprotein(LDL), high-density lipoprotein-2 (HDL2), HDL3—and apoprotein B were analyzed in 36 infants at 2, 6, 9, and 12 months of age. Serum cholesterol concentration rose significantly more slowly in the weaned infants compared with exclusively breast-fed infants. The mean difference in total serum cholesterol value between the exclusively breast-fed and weaned infants was largest at ages 2 (0.9 mmol/L, P < .001), 4 (0.6 mmol/L, P < .01), and 6 months (0.5 mmol/L, P < .01). The LDL cholesterol concentration was lower in weaned infants compared with exclusively breast-fed infants at age 2 and 6 months; the mean difference in LDL cholesterol value was 0.9 mmol/L at age 2 months (P < .001)and 0.7 mmol/L at age 6 months (P < .025). Also, the apoprotein B concentration was lower in weaned infants; the mean difference was 24 mg/dL at age 2 months (P < .01) and 30 mg/dL at age 6 months (P< .05). The apoprotein B-LDL cholesterol ratio was stable and similar in both feeding groups through the year. The HDL2 cholesterol concentration was lower in the formula-fed than in breast-fed infants at 2 months of age while the VLDL and HDL3 cholesterol concentrations were independent of the diet. The HDL-LDL cholesterol ratio was higher in formula-fed compared with breast fed infants at 2 and 6 months of age. Thus,low intake of cholesterol and high intake of unsaturated fatty acids modify blood lipid pattern markedly in infancy. Breast-feeding is the natural method of feeding an infant and the cholesterol level with breast-feeding must be considered physiological, so it is to be asked whether artificially made formulas in this respect are sufficient at the moment.
Effects of Microwave Radiation on Anti-infective Factors in Human Milk
Authors: Quan Richard , Yang Christine , Rubinstein Steven , Lewiston Norman J. , Sunshine Philip , Stevenson David K. , Kerner John A.
Published: December 2021

In intensive care nurseries it has become common practice to use microwave thawing of frozen human milk for more rapid accessibility. Twenty-two freshly frozen human milk samples were tested for lysozyme activity, total IgA, and specific secretory IgA to Escherichia coli serotypes 01, 04, and 06. The samples were heated by microwave for 30 seconds at a low- or high-power setting and then reanalyzed. One-mL aliquots of 10 additional human milk samples were micro-waved at low (20°C to 25°C), medium (60°C to 70°C), and high (≥98°C) setting before the addition to each of 1 mL of diluted E coli suspension. E coli growth was determined after 3½ hours of incubation at 37°C. Microwaving at high temperatures (72°C to 98°C) caused a marked decrease in activity of all the tested anti-infective factors. E coli growth at ≥98°C was 18 times that of control human milk. Microwaving at low temperatures(20°C to 53°C) had no significant effect on total IgA, specific IgA to E coli serotypes 01 and 04, but did significantly decrease lysozyme and specific IgA to E coli serotype 06. Even at 20°C to 25°C, E coli growth was five times that of control human milk. Microwaving appears to be contraindicated at high temperatures, and questions regarding its safety exist even at low temperatures.
Lead Toxicity in the 21st Century: Will We Still Be Treating It?
Authors: NEEDLEMAN HERBERT L. , JACKSON RICHARD J.
Published: December 2021

Clinical pediatric practice has not kept pace with the explosive growth in scientific understanding of lead poisoning during the past decade. The report by Glotzer and Bauchner in this issue1 demonstrates the widely differing approaches to treatment of lead toxicity found at many centers. Primary prevention of lead poisoning, the most effective response, continues at a pedestrian pace, even though in the United States we now possess both the knowledge and means to eradicate the disease permanently.

Our understanding of lead's role in human health has changed profoundly during the past five decades. In that period, pediatricians have discarded the
Graft versus Host Disease in Extremely Low Birth Weight Neonate
Authors: FLIDEL ORNA , BARAK YIGAL , LIFSCHITZ-MERCER BEATRIZ , FRUMKIN AZRIEL , MOGILNER BENJAMIN M.
Published: December 2021

To the Editor.—

Graft vs host disease (GVHD) in extremely low birth weight neonates following multiple blood transfusions is probably more frequent than is generally thought.1 Recently, such a case was described by Funkhouser et al.2 We wish to report our experience with an extremely low birth weight neonate with GVHD, presumably induced by blood transfusions. Immunotherapy with rat antilymphocyte monoclonal antibody(Campath 1G) failed to induce any clinical change.

The patient was a boy,
Physician Reimbursement Under Medicaid
Authors: LEE PHILIP R. , NEWACHECK PAUL W.
Published: December 2021

Physician payment under Medicaid has been a cause of growing concern among physicians because of the low levels of reimbursement in relation to private payors and the Medicare program in many states. This is particularly important to physicians caring for children because of the growing dependence of poor children on Medicaid and the evolution of Medicaid policies since the mid 1980s.

Beginning in the mid 1980s Congress began legislating a series of laws that expanded Medicaid eligibility for poor and near poor children. This series of legislation culminated with the Omnibus Budget Reconciliation Acts of 1989 and 1990. These acts required all states to establish minimum Medicaid income eligibility thresholds at 133% of the federal poverty level for children less than 6 years of age and then subsequently to phase-in coverage, 1 year at a time, for all children through 18 years of age with family incomes less than 100% of poverty level.
The Academic Generalist: An Endangered Subspecies?
Authors: HAGGERTY ROBERT J.
Published: December 2021

In Reply.—

Drs Robinson and St. Peter raise an important issue. The General Pediatric Academic Development Program did not exclude projects on health services research; but its main emphasis clearly was by design on research training in clinically related issues, because it is clear that there are many clinical problems in General Pediatrics that have not been studied adequately. The basic research skills that most of the fellows in this program achieved were in epidemiology, biostatistics, and behavioral science, and these are the basic sciences of health sciences research.
Acute Diarrhea Therapy—Suboptimal?
Authors: SIMPSON A. CATHERINE , MCINTYRE LYNN , STE-MARIE MICHELINE
Published: December 2021

To the Editor.—

Snyder1 found that the reported use of glucose-electrolyte solutions by pediatricians was not in accordance with the American Academy of Pediatrics Committee on Nutrition's recommendations on oral rehydration therapy (ORT) for acute diarrhea. To determine actual physician practices, we conducted an audit of diarrhea management, including use of ORT, in the Emergency Room of our pediatric hospital. Our 4-month audit period included an epidemic of viral gastroenteritis, during which we expected to see optimal case management.
`New' Bilirubin Recommendations Questioned
Authors: MERENSTEIN GERALD B.
Published: December 2021

Newman and Maisels are to be congratulated on their diligence in ferreting out information relevant to the evaluation, toxicity, and treatment of neonatal hyperbilirubinemia. Their reviews should be read by all physicians caring for jaundiced newborns so that they can be fully informed of the data now available.1,2

The identification of jaundiced infants can result in the cessation of breast-feeding and the view of the infant as being at increased risk for other illnesses.3,4 This must be balanced against the risk of bilirubin toxicity.

In this issue of Pediatrics, Newman and Maisels5 make recommendations for changes in the evaluation and treatment of jaundiced infants.