bluuebunny/crossref_metadata_2025 huggingface dataset:
Letter to the Editor
Authors: Reichelderfer Thomas E. , Dorst John P.
Published: December 2021

Frye refers to the sentence in the next to the last paragraph of our article1 which states that the new zinc cent "will cost 49 cents as compared to 99 cents for the bronze penny."

Those of us in the military who drilled with the Springfield rifle, which weighs 9.6 pounds, often thought that after a period of time the decimal point dropped out. So did ours. The sentence should have read, ".49 cents as compared to .99 cents."
Letter to the Editor
Authors: Kenny John D.
Published: December 2021

Our data cannot be interpreted to support the use of free bilirubin determinations in a clinical setting. It is difficult to determine how Wennberg and Ahlfors used acidosis and free bilirubin to make a 60% correct prediction of kernicterus when we supplied very little acid-base information. Perhaps they interpreted our data to suggest that acidosis only occurred in the infants listed in table 4 of the paper. In fact, the 30 autopsied infants on whom our observations are based had very similar degrees of acidosis (Table).
Zinc Toxicity
Authors: Tasic Velibor , Gordova Alexandra , Delidzhakova Maria , Kozhinkova Nada
Published: December 2021

The report of Zimmerman et al1 strongly offers us the hypothesis for defect of mammary zinc secretion leading to secondary acrodermatitis in premature breast-fed infants. The validity of their study is in the prospective measurement of the breast milk zinc concentrations during lactation.

We have also observed a premature infant who had the characteristic skin lesions along with failure to thrive and diarrhea, although the infant was exclusively breast fed, and his family history was negative.
Eisenberg Defended
Authors: Maisels M. Jeffrey
Published: December 2021

I have read Mittleman's letter1 commenting on the thoughtful article by Leon Eisenberg.2 I am surprised and dismayed that you were prepared to dignify this litany of invective by publishing it in your correspondence columns. Eisenberg's restrained reply was admirable—your decision to publish the letter was not.
The Proper Evaluation of Bone Age
Authors: Chan Tak-Sek
Published: December 2021

The proper evaluation of bone age in children has long been neglected in pediatric publications. For example, the 1979 edition of Nelson's Textbook of Pediatrics still carried scanty information which dated back to 1943. Similarly, the other major pediatric textbooks provided no references later than 1962. Greulich and Pyle's hand-and-wrist atlas of 1959, commonly used by radiologists today, is also outdated, for children of this generation do mature earlier than those of the last generation did.
Chronic Alveolar Hypoventilation Secondary to Macroglossia in the Beckwith-Wiedemann Syndrome
Authors: Smith Dean F. , Mihm Frederick G. , Flynn Michael
Published: December 2021

Chronic upper airway obstruction has been shown to cause secondary reversible pulmonary hypertension. Many pathophysiologic processes can produce such obstruction. A 3-month-old child with Beckwith-Wiedemann syndrome who manifested chronic upper airway obstruction secondary to macroglossia is reported. Early recognition and therapy of airway compromise may decrease morbidity and mortality in this syndrome and others in which macroglossia is present.
Multiple Microaerophilic Streptococcal Lung Abscesses After Orthodontic Treatment
Authors: Stern Robert C. , Berkowitz Robert J. , Shurin Susan B. , Sorensen Ricardo U. , Haaga John R.
Published: December 2021

An immunocompetent 12-year-old boy developed multiple microaerophilic streptococcal lung abscesses after application of orthodontic bands ("braces"). The dental work was done in the supine position. The data suggest that the patient aspirated the organisms and, possibly, flecks of dental cement, during orthodontic treatment. "Rubber dams" should be used to help prevent aspiration in children who receive dental work in the supine position. When a rubber dam cannot be used, as with orthodontic treatment, physicians should advise patients who are at risk for developing pulmonary infection (eg, patients with neuromuscular diseases which compromine cough and/or gag, cystic fibrosis, sickle cell anemia, primary immunodeficiency, etc) to have this dental work, including orthodontic treatment, performed in the erect position.
Promoting Successful Breast-Feeding
Authors: Naylor Audrey J.
Published: December 2021

I was pleased to read the Policy Statement "The Promotion of Breast-Feeding."1 While the final conclusions and recommendations are commendable, there are two recommendations within the text of the section "Influencing the Choice" that are questionable and warrant comment.

First, there is the advice that "discharge packs should be given only at the discretion of the attending physician or at the request of the mother." Since "the mother" is not specifically defined as one who has already made an informed choice to formula feed, the phrase presumably includes both those who are breast-feeding and those who have chosen to use formula.
The Bomb and Babies
Authors: Adelman Raymond , Metcalf Mary , Halsted Crystie C.
Published: December 2021

Pediatricians, perhaps more than most physicians, are daily involved with preventive medicine. As we give immunizations, provide anticipatory guidance, or aid new mothers in breast-feeding, we are acting on our commitment to foster the growth and development of children into healthy, productive adults. A threat looms over us, however, that would negate in minutes all of our efforts— the threat of "the last epidemic," the threat of a nuclear war. The medical consequences of nuclear war and the ineffectiveness of any medical response have been well described.1,2
Improvement of Phagocytosis and Nitroblue Tetrazolium Reduction After Exchange Transfusions in Two Preterm Infants with Severe Septicemia
Authors: De Curtis M. , Vetrano G. , Romano G. , D'Antonio F. , Paludetto R. , Ciccimarra F.
Published: December 2021

Vain et al1 have recently reported that the use of the exchange transfusion (ET) with fresh blood in addition to antibiotics and other supportive care therapies, had brought about a decreased mortality in a series of ten newborn infants suffering from severe septicemia with sclerema. They ascribe this effect more to the removal of endotoxins and the improvement of perfusion and tissue oxygenation than to the enhancement of an inflammatory response on the basis of two factors. First, although fresh blood transfusions are postulated to increase humoral immunity depending on the opsonic activity of blood from the donors, many patients had failed to show a significant clinical response after receiving large fresh blood transfusions; but after ET with blood from the same donors a clear improvement had been obtained.
Atavistic Postgraduate Courses
Authors:   Student
Published: December 2021

It is hard to escape an unsettling impression given by the prominent-lecturer format used in postgraduate medical courses: this form of teaching is a throw-back to the preliterate mode of communication of ideas. Anthropologists point out the emotional force that can be harnessed by the spoken word in societies that depend on the oral tradition. Authoritative figures who transmit information in this way exert considerable power over groups of listeners; the oral style of communication by leaders encourages group feeling and keeps alive in the individual listener the childhood sense of dependence.
PURGING SUGAR-PLUMS FOR CHILDREN, AN ENGLISH PROPRIETARY MEDICATION ADVERTISED IN 1705
Authors: C. T. E.
Published: December 2021

Patent, or proprietary, medicines for children were frequently advertised in early eighteenth century English and American newspapers. A typical example is the following published in the Flying Post, 1-3 January 1705.

Purging sugar-plums for children, and others of nice palates, nothing differing in taste, colour, etc. from sugar-plums at the confectioners, having been experienced by thousands to sweeten and purify the blood to admiration, kill worms, cure the green-sickness in maids, pale looks in children, rickets, stomach pains, King's-Evil, scurvies, rheumatisms, dropsies, scabs, itch, tetters [skin disease] etc., good in all cases, where purging is necessary, doing all that is possible to be done by a purging medicine, being the cheapest, safest, and pleasantest purge in the world, fit for persons of all ranks, ages and sexes. Price 1s. the box, to be had only at Mr. Spooner's at the Golden Half-Moon in Buckle-Street in Goodmans-fields near White-Chapel, with directions.
Neonatal Nurse Clinicians
Authors:   COMMITTEE ON FETUS AND NEWBORN
Published: December 2021

The Committee on Fetus and Newborn is cognizant of the increased employment of neonatal nurse clinicians in expanded roles to render intensive care to critically ill neonates. The Committee supports the role of these practitioners. In view of the fact that neonatal nurse clinicians are members of a team rendering sophisticated neonatal intensive care, the Committee strongly recommends the following guidelines:

1 Supervision by the physician in charge of the neonatal intensive care unit in the delivery of pediatric medical care.

2. Participation in the delivery of neonatal intensive care as a member of the neonatal team.

3. Specific training in, and a demonstrated ability to perform, skill-related activities prior to the performance of the activities.

4. Coverage by malpractice liability insurance which recognizes the expanded role of the neonatal nurse clinician.

5. Adequate training of the neonatal nurse clinician for the educational component of the neonatal nurse clinician role.

6. Responsibility for obtaining continuing education to update and revise knowledge, skills, and technologic and therapeutic modalities.

7. Documentation of completion of formal education training as a neonatal nurse clinician.

8. Development of the neonatal nurse clinician role so that growth, advancement, and satisfaction can occur.

9. Regulation of the neonatal nurse clinician/ house officer ratio so as not to detract from house officer preparation and development.
The Sudden Infant Death Syndrome and Apnea/Obstruction During Neonatal Sleep and Feeding
Authors: Steinschneider Alfred , Weinstein Steven L. , Diamond Earl
Published: December 2021

Respiratory observations made during nutritive feeding and a complete daytime nap within the first week of life on ten newborns who subsequently were victims of sudden infant death syndrome (SIDS) were compared with normative data based on 1,301 infants of comparable ages. Measurements were obtained of all apneic pauses and/or transient respiratory obstructive events at least two seconds in duration. A statistically significant increased number of future SIDS victims were found to have an unusual amount of apnea/obstruction episodes during nutritive feeding when compared with the normative group. Future SIDS victims, as a group, also had an increased frequency of apneic pauses during sleep. Furthermore, all SIDS victims demonstrated either an unusual amount of apnea/obstruction during nutritive feeding or apneic pauses during sleep. None of the airway obstruction measures during sleep differentiated the SIDS infants from the normative group. These results are consistent with the general hypothesis that prolonged apnea or airway obstruction is part of the pathophysiologic process resulting in SIDS and those hypotheses implicating unstable respiratory activity during sleep as well as apnea and pharyngeal/laryngeal dysfunction induced by liquid stimulation of the upper airway. They are also compatible with the growing body of evidence indicating that factors that predispose an infant to SIDS originate in the perinatal period.
Prevention of Children's Psychosocial Disorders: Myth and Substance
Authors: Rutter Michael
Published: December 2021

A critical appraisal of primary prevention of children's psychosocial disorders indicates that our knowledge on this topic is limited and that there are few interventions of proven value. Nevertheless, there are possibilities for effective prevention. Myths associated with unwarranted claims for the value of prevention are reviewed in terms of unproven assumptions that: (1) prevention cuts costs; (2) prevention in childhood will improve adult health; (3) improved living standards will reduce mental illness; (4) sensible interventions can only be beneficial; (5) providing people with information leads to preventive action; (6) the main issue in prevention is implementing what we know; (7) the best approach is to tackle the basic cause; and (8) the crucial issue is to identify that one basic cause. Principles of causation are discussed and a model of causative influences is used to consider potentially effective primary prevention policies with respect to those directed at (a) individual predisposition; (b) ecologic factors; (c) influences on opportunity and situation; and (d) current stresses and strengths. It is concluded that a good deal is known about risk factors and the areas in which primary prevention might be effective, but that less is known concerning precisely how to intervene in order to bring about the desired results. There is a potential for effective primary prevention but, so far, it remains largely unrealized.
A Cluster of Cases of Reye Syndrome Associated with Chickenpox
Authors: Hurwitz Eugene S. , Goodman Richard A.
Published: December 2021

In the spring of 1980, four confirmed and three possible cases of Reye syndrome, each associated with a chickenpox prodromal illness, were identified in Las Cruces, NM. One patient, a 5-year-old girl, died. Cases tended to occur in one section of the community, among children attending two of the 16 elementary schools. A telephone survey of parents with school-aged children (6 to 9 years old) suggested that a significantly greater attack rate of chickenpox occurred in children attending those two schools. Based upon this survey and the expected distribution of chickenpox among children less than 15 years of age, the incidence of Reye syndrome following chickenpox infection in the county in which Las Cruces is located was estimated to be 2.5/10,000 cases of chickenpox; these data reveal a four- to ninefold greater incidence of Reye syndrome than that following influenza B infections, which was previously estimated based upon a cluster of five cases in a county in Michigan. Additional investigations of Reye syndrome clusters are needed in an effort to identify and study suspected risk factors and to better define the relationship between Reye syndrome and viral infections.
Practices and Attitudes Toward Breast-Feeding Among Medical Professionals
Authors: Lawrence Ruth A.
Published: December 2021

The results of a mail survey conducted among pediatricians, obstetricians, family practitioners, and nurses, and results of an adjunct survey conducted among hospital administrators are presented. According to the findings, breast-feeding is advocated by physicians; however, the topic is not always initiated, so the mother is influenced by other sources. Supplementary foods and vitamins are advocated to varying degrees and not necessarily in keeping with present knowledge about nutrition. Physicians are willing to counsel mothers regarding problems with breast-feeding and feel that further physician encouragement is necessary for more breast-feeding or longer breast-feeding. Mothers should have an opportunity during pregnancy, while they are in the hospital, and postnatally to learn as much as they can about feeding methods. The obstetrician can initiate earlier discussion with the mother on feeding methods and can assume a more aggressive role in initiating this discussion. In the hospital, a mother who chooses to breast-feed can be assisted in having a successful breast-feeding experience by spending as much time as possible with her infant starting with the period immediately following birth. Postnatally, physicians can encourage successful breast-feeding and breast-feeding of longer duration by not encouraging the early initiation of supplements and solid foods. The increasing trend in breast-feeding can best be facilitated by these positive actions taken by physicians, nurses, and health care facilities.
Life Events and Childhood Morbidity: A Prospective Study
Authors: Beautrais A. L. , Fergusson D. M. , Shannon F. T.
Published: December 2021

The relationship between family life events and rates of childhood morbidity was studied prospectively in a birth cohort of New Zealand children during the period from ages 1 to 4 years. Family life events were associated with increased risk of medical consultation and hospital attendance for illness of the lower respiratory tract, gastroenteritis, accidents, burns, scalds, and accidental poisoning. In addition, children from families experiencing large numbers of life events had an increased risk of hospital admission for suspect or inadequate care. The correlation between life events and rates of child morbidity persisted when a series of measures of family social and economic background was taken into account statistically. Possible explanations of the role of family life events in the development of childhood morbidity are discussed.
Methylphenidate Treatment of Hyperactive Children: Effects on the Hypothalamic-Pituitary-Somatomedin Axis
Authors: Schultz Frederick R. , Hayford John T. , Wolraich Mark L. , Hintz Raymond L. , Thompson Robert G.
Published: December 2021

To further define the influence of methylphenidate on the growth hormone-somatomedin axis and prolactin secretion, serum growth hormone and prolactin concentrations were assessed over 24 hours and in response to provocative stimuli. The nine hyperactive subjects were all studied during methylphenidate therapy and after drug discontinuation. Diurnal patterns of growth hormone and prolactin concentrations were assessed using an ambulatory, continuous blood withdrawal procedure to ensure that activity, caloric intake, and sleep patterns mimicked normal schedules. No significant difference in integrated concentration of growth hormone, fasting somatomedin concentration, or prolactin integrated concentration was detected between subjects receiving or not receiving methylphenidate. There was a significant increase in peak growth hormone response to arginine stimulation among subjects receiving methylphenidate therapy; however, this appeared to correlate with acute methylphenidate administration. These data do not support the hypothesis that growth defects in hyperactive children treated with methylphenidate are caused by alteration in the hypothalamic-pituitary-somatomedin axis.
Infant Respiratory Illness and Indoor Air Pollution from a Woodburning Stove
Authors: HONICKY RICHARD E. , AKPOM C. AMECHI , OSBORNE J. SCOTT
Published: December 2021

With the increasing cost of fossil fuel, woodburning stoves have become popular as a primary source of residential heating. In New England alone, the number of homes with woodburning stoves doubled in the 5-year period 1976 to 1981; it is estimated that two thirds of all New England homes use wood for some energy.1 Cooper2 reported that 51% of the respirable (< 2.5µm) air-pollutant particulates (35 µg/m3) in a Portland, Oregon residential area were from residential wood combustion sources. A family furnace burning 0.5 x 106 BTU of natural gas per day replaced by a woodburning stove of 50% efficiency would emit between 10 to 1,000 times more carbon monoxide, benzopyrene, and respirable particulates than other residential fuels.
Help Needed on Hot Water Burns
Authors: FELDMAN KENNETH W.
Published: December 2021

To the Editor.—

Tap water scald burns present a serious, yet highly preventable, injury to children. They can be most easily prevented by reduction of home water heater temperature to safe levels. In order to protect a maximum number of children, efforts have been made to convince the US Consumer Product Safety Commission (CPSC) to modify water heater industry policy. In February 1981, the US Consumer Product Safety Commission rejected a petition requesting a maximum setting of 130°F on new water heaters for home use.
Evaluation of Hypocalcemia with a Highly Sensitive, Homologous Radioimmunoassay for the Midregion of Parathyroid Hormone
Authors: Mallette L. E. , Wilson D. P. , Kirkland J. L.
Published: December 2021

The diagnosis of hypoparathyroidism by radioimmunoassay of serum parathyroid hormone (PTH) has been hampered by lack of an assay system sensitive enough to allow discrimination between low and normal values. A new assay for human PTH that has improved sensitivity has been developed. It uses an homologous antiserum (against the human hormone) and uses a carboxy-terminal fragment of bovine PTH as tracer to provide an assay monospecific for the midregion of PTH. Immunoreactive PTH (iPTH) was detectable in 25/27 normal children and borderline detectable in the other two. The pediatric normal range was slightly lower than that previously established in adults. Among patients with secondary hyperparathyroidism and normal renal function, iPTH was 3- to 8-fold elevated in those with rickets, and 1.3- to 2.0-fold above normal in those with more acute forms of hypocalcemia. Twelve patients with hypoparathyroidism were studied. iPTH was undetectable in seven with permanent total hypoparathyroidism, and was borderline detectable in five, including four neonates who proved to have transient hypoparathyroidism. In these four patients, iPTH became detectable as the requirements for supplemental calcium decreased. Measurement of iPTH with an adequately sensitive assay may be useful in the diagnosis and management of pediatric hypocalcemia.
Floor Furnace Burns to Children
Authors: Berger Lawrence R. , Kalishman Summers
Published: December 2021

Three children with grid-like second-degree burns of their extremities from contact with floor furnace registers prompted an examination of this thermal hazard. Average temperature of the gratings was 294°F (146°C), with a range of 180° to 375°F (82.2° to 191°C). All of the furnaces tested were positioned at the entrance to bedrooms and had so little clearance that it was impossible to walk around them without contact with their surface. Infants and toddlers are at particular risk: 1 or 2 seconds of exposure would be expected to produce a serious burn. Suggestions for preventing burns from floor furnaces include turning them off when young children are at home; installing barrier gates to prevent children from coming in contact with the registers; and developing a surface coating or replacement grate with less hazardous thermal properties.
Feeding the Low-Birth-Weight Infant: II. Effects of Taurine and Cholesterol Supplementation on Amino Acids and Cholesterol
Authors: Rassin David K. , Gaull Gerald E. , Järvenpää Anna-Liisa , Räihä Niels C. R.
Published: December 2021

Plasma and urine concentrations of taurine were consistently lower in preterm infants fed unsupplemented formula than those observed in the infants fed human milk or formulas supplemented with taurine alone or with taurine plus cholesterol. Such supplementation of formula restored plasma and urine concentrations of taurine to those observed in the infants fed human milk. Taurine was the only amino acid that was present at lower concentrations in the infants fed unsupplemented formula than in those fed human milk. The other acidic and neutral amino acids were present in higher concentrations in the formula-fed infants than in the group fed human milk either during the early weeks of the study (serine, glutamine, glycine, alanine, tyrosine, and methionine) or consistently higher during the entire study (threonine, glutamate, citrulline, valine, isoleucine, leucine, and phenylalanine). Supplementation of formula with taurine plus cholesterol did not appear to have any effect on the amino acid concentrations in the plasma and urine, other than that on taurine itself. Plasma total cholesterol concentration decreased during the fifth to the 12th postnatal weeks of life in all feeding groups. It then returned to the concentrations found during the first and third postnatal weeks in all feeding groups except in the infants fed formulas supplemented with taurine plus cholesterol which had a greater decrease.
Moxalactam Treatment of Serious Infections Primarily Due to Haemophilus influenzae Type b in Children
Authors: Kaplan Sheldon L. , Mason Edward O. , Kvernland Sally J. , Loiselle Elaine M. , Feigin Ralph D.
Published: December 2021

Thirty-eight children completed therapy with moxalactam for a variety of non-CNS infections. Haemophilus influenzae type b (seven ampicillin-resistant strains) was the etiologic agent for 32 children. Doses of moxalactam ranged from 113 to 200 mg/kg/d in three or four divided doses administered parenterally. All children with infections due to H influenzae type b had excellent responses to moxalactam therapy. Children treated for infections due to other agents also responded satisfactorily to moxalactam therapy. Moxalactam concentrations in joint and pleural fluids greatly exceeded the minimal bactericidal concentrations of moxalactam for H influenzae type b. Adverse reactions included neutropenia, eosinophilia, thrombocytosis, and transient elevation of transaminase levels. Moxalactam administered parenterally, at a dose of 113 to 150 mg/kg/d in three or four divided doses is effective therapy for serious infections in children due to H influenzae type b and selected other organisms.
Marshall-Smith Syndrome: Two Case Reports and a Review of Pulmonary Manifestations
Authors: Johnson John P. , Carey John C. , Glassy Frank J. , Paglieroni Teresa , Lipson Mark H.
Published: December 2021

Two patients with the Marshall-Smith syndrome are described. Both had significant and fatal respiratory distress attributable to this condition. Congenital, functional, and acquired abnormalities of the respiratory tract are described in nine of the 11 case reports in the literature and are characteristic of this syndrome as well as a primary cause of failure to thrive and death in these patients. Unusual immunologic findings in one of our two patients are the first to be reported in the Marshall-Smith syndrome. Quantitation of immune function in other patients with this condition will be helpful in determining the significance of these results. It is hoped that the etiology of the syndrome will be discovered as more cases are recognized and reported by pediatricians caring for infants with failure to thrive, advanced bone age, and chronic respiratory symptomatology.
Language Development in a Group of Very Low-Birth-Weight Children Whose Postauricular Myogenic Response Was Tested in Infancy
Authors: Holmes Nan , Conway M. J. , Flood L. , Fraser J. G. , Stewart Ann
Published: December 2021

A new instrument for the detection of the postauricular myogenic (PAM) response was used to test the hearing of 106 infants weighing ≤1,500 g when they were aged 1 to 21 months. Eighty-eight infants showed a positive response at 60 dB hearing level (HL) (normal). The other 18 did not respond; four were found to have sensory neural hearing loss and another six had conductive loss due to secretory otitis media. Of the 106 children, 90 aged 2 years or more (mean 27 months) were living in the United Kingdom, and their language development was assessed. It was normal in 67/75 children whose PAM response had been normal in infancy. The remaining eight children with normal PAM responses in infancy, had language delay. All eight children had problems that were thought to account for the delay, including three with mental retardation, three with cerebral palsy, and two whose families did not speak English. Language development was normal in 11/15 children tested whose PAM responses had been found to be abnormal, including all six whose secretory otitis media had been diagnosed and treated at the time of the PAM test. Delay in language development was found in 3/4 children with sensory neural hearing loss who were available for testing and in one child with overall developmental delay. It is concluded that a positive PAM response at 60 dB HL in infancy indicated hearing adequate for the development of normal speech in otherwise normal children among a group of infants at high risk of hearing loss.
Cerebral Blood Flow
Authors: AHMANN PETER A. , DYKES FRANCINE D. , LAZZARA ANTHONY , WILCOX W. DEAN , CARRIGAN TIMOTHY , GIDDENS DON P.
Published: December 2021

To the Editor.—

Doppler ultrasound assessment of flow velocity in cerebral vessels in neonates has generated intense interest since the technique was originally applied to the preterm infant by Bada et al.1 The value and indication both as a research tool and useful clinical tool have yet to be defined. We have been using a range-gated, pulsed Doppler instrument with a specially designed transducer for the past 18 months and would like to add some comments to those of Bejar et al2 and Volpe et al3 concerning Doppler ultrasound, pulsatility index, patent ductus arteriosus effects on cerebral flow, and autoregulation.
Should Screening Programs Be Perfect?
Authors: MITCHELL MARVIN L.
Published: December 2021

In Reply.—

Wyatt makes two points regarding the vulnerability of newborn screening programs but only one, in my opinion, has serious implications. With regard to the first, that the pitfalls might be used as an excuse to curtail screening programs seems unlikely. The overwhelming evidence accumulated from all programs involved in neonatal screening indicates that despite the occasional missed case, without such programs, the damage to children and their families would have been incalculable. Faced with this evidence few would have the temerity to attempt to discredit the value of screening programs or limit their involvement in health care.
Live Attenuated Varicella Vaccine: The KMcC Strain in Healthy Children
Authors: Arbeter Allan M. , Starr Stuart E. , Weibel Robert E. , Neff Beverly J. , Plotkin Stanley A.
Published: December 2021

The KMcC strain of live, attenuated varicella-zoster virus vaccine was studied in healthy children as a preliminary step toward varicella vaccine studies with this strain in children with leukemia. Forty-three children were immunized: 26 with the 40th passage vaccine and 17 with the 50th passage. Studies included surveillance for clinical reactivity, oropharyngeal excretion of vaccine virus, viruria, and viremia. Antibody responses were assayed by fluorescent antibody to membrance antigens and immune adherence hemagglutination. Cell-mediated immune responses were assayed by lymphocyte proliferation to varicella-zoster virus specific antigens. There was 100% seroconversion to the KMcC passage 40 and 50 vaccines (by fluorescent antibody to membrane antigen assay). Every child studied developed in vitro lymphocyte proliferation to varicella-zoster virus antigens. Papular skin lesions, probably vaccine related, occurred in 31% of the 40th passage vaccinees but in only 6% of the 50th passage vaccinees. The 50th passage KMcC strain vaccine is sufficiently immunogenic and safe to initiate clinical studies with leukemia patients.
Human Growth Hormone Treatment of Children with Growth Failure and Normal Growth Hormone Levels by Immunoassay: Lack of Correlation with Somatomedin Generation
Authors: Plotnick Leslie P. , Van Meter Quentin L. , Kowarski A. Avinoam
Published: December 2021

Children with growth failure, normal growth hormone responses to stimulation tests, and low somatomedin levels are being recognized with increasing frequency. Sixteen patients, aged 2 to 17 years, with these findings were studied. When treated with human growth hormone, the mean plasma somatomedin-C levels of these patients increased from 0.19 ± 0.05 (SD) U/mL to 2.29 ± 1.11 U/mL (P < .001) and mean growth velocity increased from 3.6 ± 1.6 (SD) cm/yr to 7.4 ± 2.9 cm/yr at 8 months of treatment (P < .001). The effect of human growth hormone therapy on the whole group was statistically significant, but the effect on individuals was highly variable. There was no correlation between magnitude of the increase in somatomedin-C and growth response (r = .26, NS). Thus, the long-term growth-promoting effect of human growth hormone therapy in this group of patients could not be predicted from the magnitude of the somatomedin-C responses.
Timing of Elective Hypospadias Repair in Children
Authors: Schultz Janet R. , Klykylo William M. , Wacksman Jeffery
Published: December 2021

Psychological concerns for the timing of medical procedures on children result from the longstanding realization that events and behavioral patterns of childhood have wide-ranging effects on the later behavior of the adult. A review of the literature regarding the effects of surgery on psychological development is presented. Particular reference is made to the impact of genitourinary surgery with specific emphasis on the repair of hypospadias, a congenital anomaly affecting 1:250 to 1:400 live male births. Studies of adults who underwent hypospadias repair as children suggest that they are psychologically different from their peers who did not have this surgery. Specifically, as adults they frequently have sexual difficulty despite erectile competence and they generally occupy less responsible, less competitive, and less independent professions than similarly intelligent cohorts. These findings imply that the experience of hypospadias or its surgical repair may in some way affect psychological development. By examining these experiences in light of emotional and cognitive development and the emergence of body image and sexual identity, predictions for psychologically optimal timing of surgery are made. Importance of the role of the family in the psychological outcome and a discussion of surgical considerations are also provided.
Growth and Development of Full-Term Nonasphyxiated Small-for-Gestational-Age Newborns: Follow-up Through Adolescence
Authors: Westwood Michael , Kramer Michael S. , Munz Diane , Lovett Joan M. , Watters Gordon V.
Published: December 2021

Previous studies of growth and development in small-for-gestational-age (SGA) infants have been plagued by several methodologic defects, including a lack of control for socioeconomic status and parental height and an inability to distinguish among the effects of prematurity, neonatal asphyxia, and intrauterine growth retardation. An attempt has been made to overcome these defects in a study of 33 full-term, nonasphyxiated small-for-gestational-age neonates born between 1960 and 1966 and 33 matched control infants of normal birth weight. The infants were followed up and compared for physical growth and sexual, neurologic, and cognitive development at ages 13 to 19 years. Significant deficits in height, weight, and head circumference were found among the SGA cohort, even after statistical adjustment for differences in socioeconomic status and parental height. Sexual development and bone age were not delayed in the SGA group, however, indicating that the deficits in growth are permanent. On neurologic and cognitive testing, the SGA group had trends toward lower scores but scores were well within the normal range. It is concluded that full-term nonasphyxiated SGA infants have an impaired potential for physical growth, but a good prognosis for neurologic and cognitive development. Previous findings of more severe cognitive deficits are attributed to a failure to distinguish the effects of isolated intrauterine growth retardation from effects due to asphyxia.
Special Responsibilities: The Role of the Pediatrician and the Goals of Pediatric Education
Authors: Starfield Barbara
Published: December 2021

Pediatricians provide care to a minority of US children. To some extent this may be a result of organizational features of their practice. This review of the literature suggests that the practice of pediatrics has some attributes of primary care but in other respects it resembles a subspecialty. Pediatricians serve well as a longitudinal source of care for children who identify them as their regular source. As a group, however, pediatricians are not as accessible and available as they might be, probably do not uniformly provide the comprehensive care that they should, and could serve more adequately as coordinators of care. Concern about the extent to which the training of pediatricians addresses the achievement of the attributes of primary care and stresses the recognition and management of primary care problems should stimulate academicians and practitioners to develop a combined and concerted approach to these problems.
Annual Meeting of the Section on Pediatric Urology
Authors: GONZALES EDMOND T.
Published: December 2021

The Section on Urology of the American Academy of Pediatrics met in association with the 50th annual meeting of the Academy in New Orleans. Several topics of interest to both pediatricians and pediatric urologists were discussed. Inasmuch as members are unable to attend subspecialty sessions when they occur simultaneously with other scheduled programs, this summary is prepared to offer an overview of the content of the meeting of our Section. Readers interested in a specific topic should feel free to contact the senior author of papers of special interest to them.

The meeting was organized into topic-oriented sessions including hypospadias, reconstructive surgery, anomalies of the testis and scrotum, myelodysoplasia, principles of urinary undiversion, ureteral obstruction and techniques to assess the severity of obstruction, urinary incontinence, and vesicouretenal reflux. Miscellaneous papers of interest to both pediatricians and pediatric urologists were also discussed. This summary will focus on those papers of mutual interest to urologists and pediatricians.

HYPOSPADIAS

Several years ago, the Sections on Urology and Child Development issued a position paper on timing for elective genital surgery in children.1 This paper suggested that, for psychological reasons, surgery at less than 1 year of age was preferable. However, for technical reasons, especially regarding hypospadias repairs, surgery was often best delayed until 2 years of age.

More recently, Manley and Epstein2 reported a series of very young infants undergoing major hypospadias reconstructions (as young as age 6 months), with no apparent technical difficulty, no increase in complications, and lessened postoperative anxiety. Two papers at this meeting addressed this topic of current concern.
Breast-Feeding and Infections
Authors: MICK ANN FAY , GROSSMAN LINDSEY K.
Published: December 2021

To the Editor.—

Frank et al,1 comparing incidence and severity of respiratory illness in breast-fed v bottle-fed babies, reach an interesting and reasonable sounding conclusion: that breast-feeding in their study population appeared to protect babies from serious morbidity, but not from respiratory illness per se. The authors do not, however, address in their discussion the fact that 93% of the parents of bottle-fed babies were smokers, whereas only 38% of the breast-fed babies' parents were (table 1 in their paper; these numbers are statistically significant [P < .001 by χ2 test with Yeats' correction]).
Breast-Feeding and Infections
Authors: PROBER CHARLES G. , BACHRACH LAURA K.
Published: December 2021

To the Editor.—

The recent article by Frank et al1 describes the relative incidence of respiratory infections and the morbidity of these infections among breast-fed v bottle-fed infants. The authors note that breast-feeding was associated with trends toward decreased morbidity from these infections in the first 3 and 6 months of life and significantly fewer episodes of pneumonia and bronchiolitis in the first 6 months (P < .05). The authors imply that if their findings are confirmed by others, "a better explanation of the potential benefits of breast-feeding can be offered to parents."
Capitation Adjustment for Pediatric Populations
Authors: Fowler Elizabeth J. , Anderson Gerard F.
Published: December 2021

Objective. The objective of this study is to assess the predictive performance of current claimsbased capitation adjustment methods for pediatric populations. Medicaid programs and other insurers may increasingly use these systems for capitation rate setting, physician profiling, and other purposes.

Methods. Five leading models, a demographic model, ambulatory care groups, ambulatory diagnostic groups, diagnostic cost groups, and payment amounts for capitated systems, were tested by using use and expenditure data for children enrolled in the Maryland Medicaid program and a private nonprofit health maintenance organization in Minnesota. The models were tested at the individual level by using multiple regression methods and at the group level by using split-half validation to create both random and nonrandom groups. One of the nonrandom groups was created to represent children with chronic conditions.

Results. The findings indicate that although each of the alternative methods offers an improvement over a demographic model, significant underpayment remained for high-risk children, regardless of the capitation adjustment method used.

Conclusions. It is concluded that children with chronic conditions would probably remain at risk for discrimination in a competitive health care market under all models tested. Limitations associated with current alternatives suggest the need for further research in the area of pediatric capitation adjustment methods.
Ceftriaxone Choledocholithiasis
Authors: Robertson Frank M. , Crombleholme Timothy M. , Barlow Sarah E. , Verhave Menno , Brown Daniel
Published: December 2021

Ceftriaxone is a broad-spectrum, third-generation cephalosporin. The formation of biliary sludge and cholelithiasis after ceftriaxone administration has been reported and is thought by many to be a benign process.1-3 Despite this, cholecystectomy has been performed in symptomatic patients who have received ceftriaxone.3,4 This complication of ceftriaxone therapy is not widely appreciated in the gastroenterology and surgical literature. We report the documented case of ceftriaxone choledocholithiasis.

CASE REPORT

A 9-year-old boy who 4 weeks before admission was treated for open head trauma was referred for evaluation of abdominal pain and cholelithiasis. The patient sustained a comminuted, depressed skull fracture of the left frontal area with underlying cerebral laceration from being kicked in the head by a horse.
Bilirubin Problem—The Debate Continues
Authors: Newman Thomas B. , Klebanoff Mark A. , Maisels M. Jeffrey
Published: December 2021

Given that the Oregon Chapter of the American Academy of Pediatrics (AAP) has passed a resolution requesting that the Academy's practice parameter on hyperbilirubinemia1 be revised because it is too aggressive, we appreciate the letter from Drs Seidman and Stevenson,2 who suggest that it is not aggressive enough. Drs Seidman and Stevenson express reservations about both the practice parameter and some of the studies on which it was based. Because we were involved with some of those studies, we would like to add our comments to the excellent response to their letter by Dr Robertson.3
A Randomized Trial of the Effect of Dust Control on Children's Blood Lead Levels
Authors: Lanphear Bruce P. , Winter Nancy L. , Apetz Leslie , Eberly Shirley , Weitzman Michael
Published: December 2021

Objective. Dust control is recommended as one of the cornerstones of controlling childhood lead exposure; however, the effectiveness of dust control has not been demonstrated for children who have low to mild elevations in blood lead (ie, less than 25 µg/dL). The objective of this study was to determine whether dust control, as performed by families, had an effect on children's blood lead levels and dust lead levels in children's homes.

Design. Randomized, controlled trial.

Setting. Community-based trial in Rochester, NY.

Participants. One hundred four children, 12 to 31 months of age at baseline.

Intervention. Families and children were randomized to one of two groups. Families of children in the intervention group received cleaning supplies, information about cleaning areas that are often contaminated with lead, and a cleaning demonstration. Families in the control group received only a brochure about lead poisoning prevention.

Outcome Measures. Baseline measurements of lead in blood, house dust, soil, water, and paint were taken from both groups. Seven months after enrollment, a second blood lead assay was obtained, and lead levels in household dust were measured. The main outcome measures were change in blood lead levels and dust lead levels by treatment group.

Results. The median blood lead level of children enrolled in the study was 6.7 µg/dL (range, 1.7 to 30.6 µg/dL). There was no significant difference in the change of children's blood lead levels or dust lead levels by treatment group. The median change in blood lead levels among children in the intervention group was -0.05 µg/dL compared with -0.60 µg/dL among those in the control group. There also was no significant difference in the change of dust lead by group assignment, although there was a trend toward a significant difference in the percentage of change in dust lead levels on noncarpeted floors, which was greater among houses in the intervention group.

Conclusions. These data suggest that an intervention that consists only of providing cleaning supplies and a brief description of dust control is not effective at reducing blood lead levels among urban children with low to mild elevations in blood lead levels at a 7-month followup.
Efficacy of Glucose-based Oral Rehydration Therapy
Authors: Gavin Norma , Merrick Nancy , Davidson Bruce
Published: December 2021

Objective. This article reviews and synthesizes evidence in the published literature on the safety and efficacy of oral rehydration therapy (ORT) among young children with pediatric gastroenteritis in developed nations.

Methodology. We searched the literature for randomized, controlled trials comparing the safety and efficacy of ORT with intravenous (IV) rehydration treatment and/or oral rehydration solutions (ORSs) of different sodium content. We combined the failure rates of each set of studies in statistical meta-analyses and conducted tests of homogeneity of treatment effect over all the studies and for subgroups of children defined by the trial type, the sodium content of the ORS, and the setting of care. We also conducted a multivariate logistic regression on the probability of failure to determine the relative importance of these factors, controlling for other characteristics of the trials. Other outcomes were also tabulated and discussed. These include the relative incidence of hypernatremia and hyponatremia induced by treatment; weight gain; the volume, frequency, and duration of diarrhea; for inpatient trials, the length of stay; and for outpatient trials, rates of hospitalization.

Results. The evidence suggests that among pediatric patients with gastroenteritis in developed countries, failure of ORT, defined as the need to rehydrate children intravenously, is infrequent. We found a combined overall ORT failure rate of 3.6%. We found no statistically significant difference in failure rates by trial type or the sodium content of the ORS. However, we did find some supporting evidence for a lower failure rate among children treated in outpatient settings. In addition, compared with patients rehydrated intravenously, pediatric patients treated with ORT were not found to be at higher risk of iatrogenic hypernatremia or hyponatremia. The evidence from the literature fails to show a consistent trend in favor of either high-or low-sodium solutions for rehydration of pediatric patients.

Conclusions. There seems to be a great potential for improving the medical treatment of children with acute gastroenteritis by the greater use of ORT.