bluuebunny/crossref_metadata_2025 huggingface dataset:
Health Counseling for Adolescents: What They Want, What They Get, and Who Gives It
Authors: Joffe Alain , Radius Susan , Gall Marilyn
Published: December 2021

To determine the extent of health counseling received by college freshmen from their primary health care providers, 362 students answered questions regarding 15 health topics. Internists provided more counseling than pediatricians and family/general practitioners about smoking and alcohol use, more than pediatricians about drug use and heart disease prevention, and more than family/general practitioners about weight control and nutrition. Pediatricians exceeded family/general practitioners in counseling about weight control and nutrition but did not exceed internists in any areas. For 11 of 15 topics, more than 75% of students reported receiving no counseling. Women were counseled for stress and contraception more frequently than men. Overall, topics most often discussed by physicians were exercise, nutrition, and breast self-examination. The topics most frequently requested by students were exercise, stress (women), depression, weight control (women) and sexually transmitted diseases (men). These data suggest that adolescents receive little health counseling from personal physicians, especially regarding topics leading to great morbidity and mortality for this age group. Pediatricians, especially, must increase the extent of counseling if they are to meet the American Academy of Pediatrics' goal of providing care to adolescents and young adults.
Carbamazepine: An Alternative Drug for the Treatment of Nonhereditary Chorea
Authors: Roig M. , Montserrat L. , Gallart A.
Published: December 2021

Five patients with a moderate to severe degree of nonhereditary chorea were successfully treated with standard anticonvulsant doses of carbamazepine. In two cases, the cause of chorea was related to a streptococcal infection. In another patient, the involuntary movements appeared seven days after severe head injury. The cause in the remaining two patients could not be determined with certainty, despite extensive laboratory investigations. Improvement began within four to 15 days after the initiation of therapy. No side effects were noticed in four patients throughout treatment (3 months to 36 months). In one patient, the medication had to be discontinued after 17 days, because of an allergic cutaneous rash. In view of our results, we propose that carbamazepine be considered as an alternative drug for the treatment of nonhereditary chorea.
Prophylactic Indomethacin for Prevention of Intraventricular Hemorrhage in Premature Infants
Authors: Bandstra Emmalee Setzer , Montalvo Berta M. , Goldberg Ronald N. , Pacheco Irma , Ferrer Pedro L. , Flynn John , Gregorios Jocelyn B. , Bancalari Eduardo
Published: December 2021

The impact of early prophylactic use of intravenous indomethacin on the incidence and severity of periventricular-intraventricular hemorrhage and patent ductus arteriosus in 199 oxygen-requiring premature infants (≤1300 g birth weight) was prospectively investigated. The trial was controlled, the infants were randomized, and the investigators were unaware of the group assignments. Patients with minimal (grade I) or no periventricular-intraventricular hemorrhage determined by prestudy echoencephalography were randomized within two birth weight subgroups (500 to 899 and 900 to 1300 g) to receive either prophylactic indomethacin (n = 99) or an equal volume of saline-vehicle placebo (n = 100). The first dose (0.2 mg/kg) was given within 12 hours of delivery and two subsequent doses (0.1 mg/kg) were administered at 12 hourly intervals. Prophylactic indomethacin significantly reduced the incidence of grades II to IV periventricular-intraventricular hemorrhage. Intraventricular hemorrhage was half as common in infants given prophylactic indomethacin as in control infants (23% v 46%, P < .002). The reduction was manifested in both birth weight subgroups. Results of this study also confirmed a lower incidence of clinically significant patent ductus arteriosus in infants who received prophylactic indomethacin in contrast to those who received placebo (11% v 42%, P < .001). No significant differences were found between treatment and control groups in the duration of oxygen therapy, mechanical ventilation, or hospitalization or in the incidence of pneumothorax, chronic lung disease, sepsis, necrotizing enterocolitis, retinopathy of prematurity, or death. Early prophylactic indomethacin initiated within 12 hours of delivery is effective in reducing the incidence of intraventricular hemorrhage as well as clinically significant patent ductus arteriosus in very low birth weight premature infants.
Very Low Birth Weight Infants at 8 and 11 Years of Age: Role of Neonatal Illness and Family Status
Authors: Hunt Jane V. , Cooper Bruce A. B. , Tooley William H.
Published: December 2021

The intellectual and educational status of 108 children with very low birth weight (≤1,500 g), born from 1965 to 1978, was evaluated and tested on standard tests (eight children with severe handicaps were excluded) at 8 years of age. Fifty-seven were further evaluated at 11 years of age. Six categorical outcomes were defined a priori, based on the Wechsler Intelligence Scale for Children-Revised IQ and discrepancies between Verbal and Performance scores and Bender Gestalt Test score. Proportions at 8 years of age were: 4.6% very low IQ (below 70), 13.9% low IQ (70 to 84), and, for those with IQ greater than 84, 12.0% language disability, 12.0% performance disability, 21.4% visual-motor disability, and 36.1% normal. Learning disabilities, determined by discrepancies between IQ and Wide Range Achievement Test scores, included 16.7% of all children. Outcome proportions at 11 years of age were essentially comparable to those at 8 years of age; outcome constancy was present in 52.6%. Ratings of neonatal illness and parent education level strongly influenced the likelihood of outcome at 8 years of age. When ratings were dichotomized (ie, low v high neonatal illness and low v high parent education), the level of neonatal illness primarily influenced the likelihood of normal outcome, whereas the level of parent education influenced the degree of severity of the disability.
Surfactant Replacement Therapy for Severe Neonatal Respiratory Distress Syndrome: An International Randomized Clinical Trial
Authors:   Collaborative European Multicenter Study Group
Published: December 2021

In a randomized multicenter trial, involving the collaboration of eight European neonatal intensive care units, the efficacy of replacement therapy with a new surfactant preparation (Curosurf) was tested in 146 patients with severe neonatal respiratory distress syndrome. Criteria for entry included birth weight 700 to 2,000 g, age when treated two to 15 hours, and requirement of artificial ventilation with Fio2 ≥ 0.6. The babies were treated with a single large dose of surfactant (200 mg/kg) at a median age of nine hours (range two to 15 hours). Average Fio2 before treatment was the same (0.80) for both surfactant-treated patients and control patients. Babies receiving surfactant showed, within five minutes, a dramatic improvement of oxygenation as reflected by a nearly threefold increase of the Pao2/Fio2 ratio. Six hours after randomization, the Pao2/Fio2 ratio still showed a 98% improvement in surfactant-treated patients compared with controls (P < .001), and statistically significant differences in favor of the treated babies persisted until 48 hours after randomization, when surviving control infants began to recover. Treatment with surfactant decreased neonatal (≤28 days) mortality from 51% to 31% (P < .05). Compared with control babies, the surfactant-treated group also had a decreased incidence of pulmonary interstitial emphysema (23% v 39%; P < .05) and pneumothorax (18% v 35%; P < .05). The percentage of survivors without bronchopulmonary dysplasia in the treated group was more than twice that of the control group (55% v 26%; P < .001). Treatment with this surfactant appears to effectively improve lung function and short-term outcome in infants with severe respiratory distress syndrome.
Neck Breathing: A Form of Voluntary Respiration for the Spine-Injured Ventilator-Dependent Quadriplegic Child
Authors: Gilgoff Irene S. , Barras Donna M. , Jones Michelle Sellers , Adkins Hazel V.
Published: December 2021

Children with respirator-dependent quadriplegia because of C-2 spinal cord injuries are now surviving the acute stages of their injury. The major cause of mortality and morbidity in the chronic stage is due to respiratory complications. Surveillance, 24 h/d, is the best way to prevent accidental disconnection of respirator equipment from the patient and its inherent catastrophic consequences. The constant risk of disconnection adds tension to the home environment and takes away from the patient any degree of independence or privacy. Because of this, an alternative method of respiration using neck accessory muscles was developed to restore a patient-controlled, voluntary system of respiration. This method, neck breathing, is described in detail in seven children varying in age from 3 years to 16 years 3 months. All seven patients had complete paralysis of the intercostal muscles and the diaphragm. An eighth patient who was unable to learn the technique is also described. Neck breathing is also compared to glossopharyngeal breathing, an alternative method of respiration developed during the polio era.
Growth in Children With Cerebral Palsy Fed Via Gastrostomy
Authors: Rempel Gina R. , Colwell Sarah O. , Nelson Richard P.
Published: December 2021

Growth characteristics of 57 children with feeding gastrostomies attending the cerebral palsy clinic at a regional medical facility were evaluated. All children had severe neuromotor and orofacial involvement and mental retardation. More than 90% of the patients were less than fifth percentile for height and weight, and 80% were underweight for height before gastrostomy tube placement. Following gastrostomy, 33% remained underweight for height and 21% became overweight for height. The majority of children remained at less than the fifth percentile for height and weight. Improvement in linear growth was much less common than improvement in weight. Children with gastrostomies placed in the first year of life were most likely to exceed the fifth percentile for height and weight. The mechanisms of growth retardation in children severely affected by cerebral palsy are not known, but poor nutrition is thought to be the major contributor. Gastrostomy feeding in children severely affected by cerebral palsy can improve nutritional status but does not eliminate growth retardation. The importance of growth and adequate nutrition in reducing morbidity in children with severe neuromotor involvement remains to be established.
d-Penicillamine and Retinopathy of Prematurity
Authors: LAKATOS LAJOS
Published: December 2021

To the Editor.—

The letter to the editor by Johnson et al1 and studies by others regarding vitamin E prophylaxis for retinopathy of prematurity suggest that further research into the prevention of retinopathy of prematurity should not be limited to vitamin E.

On the basis of clinical observations we reported that d-penicillamine treatment in the neonatal period was associated with a marked decrease in the incidence of severe retrolental fibroplasia among the very low birth weight infants.2
Changing Profile of Congenital Heart Disease
Authors: BENSON D. WOODROW , Moller James , Fyler Donald C. , Fixler David E.
Published: December 2021

In the past 20 years, considerable change has occurred in the profile of congenital heart disease regarding both diagnosis and treatment. The profile has changed from older to younger patients; the essence of this change has been from pediatric to infant to neonatal cardiology. There has been a shift from palliative to more definitive surgical procedures and a change from invasive (cardiac catheterization) to noninvasive (echocardiography) diagnostic methods. The profile has changed from definitive surgical treatment limited to simple lesions to surgical treatment of the most complex lesions.

There has been steady improvement in the recognition of cases of congenital heart disease. Of all children admitted to hospitals for treatment of congenital heart disease, the portion less than three days of age has increased from 24% in 1969 to 1972 to 33% in 1982 to 1986.
Ten-Year Study of Pediatric Drownings and Near-Drownings in King County, Washington: Lessons in Injury Prevention
Authors: Quan Linda , Gore Edmond J. , Wentz Kim , Allen Jill , Novack Alvin H.
Published: December 2021

The factors associated with submersion events among <20-year-old persons that occurred in King County from 1974 to 1983 were studied to focus prevention efforts. Near-drowning (n = 103) and drowning (n = 96) victims were identified from medical examiners' reports, paramedics' reports, and hospital discharge registers. Annual incidence was 5.5; the mortality rate was 2.6 per 100,000 children. Although preschool-aged children had the largest incidence (12.8), followed by older adolescents (4.9), adolescents had the largest case fatality rate, 77%. Lake and river victims had the largest incidence, mortality, and case fatality rate; swimming pools, the smallest case fatality rate (25%). A total of 89% of all victims had absent or no supervision; victims supervised by lifeguards had a 42% case fatality rate. Prior seizures were part of the history of 7.5% of all victims; 25% of fatal submersions by adolescents were associated with alcohol. Bathtub submersions were associated with child abuse in three of 16 preschool-aged children and epilepsy in four of five older children. Certain age groups and sites combined had the greatest incidence: preschool-aged children in swimming pools, infants in bathtubs, teenagers in lakes and rivers. Incidence decreased in public and semipublic pools coincident with fencing regulations. These findings suggest prevention strategies: extending fencing requirements to private pools, discouraging alcohol consumption during water sports, changing bathing practices of epileptics, and improving lifeguard efficacy.
Intentional Banding
Authors: JOHNSON CHARLES F.
Published: December 2021

Banton et al have called attention to banding of children's appendages in their description of six new cases. By emphasizing recognition and treatment of this unusual malady, they inadvertently diminished the importance of considering a nonaccidental cause, in certain instances.

The possibility of intentional injury was not suggest in cases 5 and 6, which involved banding in infants by fabric filaments from a known object—mittens. In case 2, the source of the fiber was said to be "apparently from an item of clothing." In cases 1, 3, and 4, the constrictions were caused by hairs.
Haemophilus influenzae Type b Polysaccharide Vaccine: An Efficacy Study
Authors: Harrison Lee H. , Broome Claire V. , Hightower Allen W.
Published: December 2021

The Haemophilus influenzae type b polysaccharide vaccine was licensed for use in the United States in April 1985. Postlicensure case-control efficacy studies have yielded markedly different estimates of efficacy, leading to contradictory recommendations to practicing physicians. To obtain additional information about the efficacy of the vaccine, we studied cases of invasive Haemophilus influenzae type b disease ascertained through active surveillance in areas with a total population of 34 million. We enrolled children 24 to 59 months of age who did not attend day-care centers. (Data from our day-care study have been published elsewhere.) For each case child, as many as three 24- to 59-month-old control children were chosen from a roster of acquaintances supplied by the child's parent. Conditional logistic regression was used, and vaccine efficacy was estimated to be 62% (95% confidence interval = 0%, 85%), which did not change significantly after adjusting for age and parental smoking, variables that were significantly different for case and control children. Results of this study support our previous finding of a positive protective efficacy, albeit lower than the efficacy of 90% found in children 18 to 71 months of age in the Finnish prelicensure trial.
Periodic Breathing in Preterm Infants: Incidence and Characteristics
Authors: Glotzbach S. F. , Baldwin R. B. , Lederer N. E. , Tansey P. A. , Ariagno R. L.
Published: December 2021

The prevalence and characteristics of periodic breathing in preterm infants were measured by 24-hour impedance pneumograms in 66 preterm infants before discharge from the nursery. Four periodic breathing parameters (percentage of periodic breathing per quiet time, number of episodes of periodic breathing per 100 minutes of quiet time, mean duration of periodic breathing, and longest episode of periodic breathing) were compared to data available from healthy term infants and from term infants who subsequently died of sudden infant death syndrome (SIDS). Periodic breathing was found in all preterm infants studied and mean periodic breathing parameter values (12.0%, 8.6 episodes, 1.2 minutes, and 7.3 minutes, respectively) in our preterm population were substantially higher than values from healthy term infants and SIDS victims. Most periodic breathing parameters decreased significantly in infants studied at 39 to 41 weeks' postconceptional age compared with earlier postconceptional age groups. No relationship was found between central apneas of ≥15 seconds' duration and postconceptional age or any periodic breathing parameter. Periodic breathing is a common respiratory pattern in preterm infants that is usually not of pathologic significance. Associations between elevated levels of periodic breathing and respiratory dysfunction or SIDS should be made with caution.
Otitis Media in Children With Learning Disabilities and in Children With Attention Deficit Disorder With Hyperactivity
Authors: Adesman Andrew R. , Altshuler Lisa A. , Lipkin Paul H. , Walco Gary A.
Published: December 2021

A retrospective study was conducted to compare history of middle ear disease children with an attention deficit disorder with hyperactivity (ADD-H) and children with a learning disability. Of 138 children evaluated in a child development clinic, learning disability without ADD-H was diagnosed in 45 (29 boys, 16 girls; mean age = 9.5 years) and ADD-H without learning disability was diagnosed in 21 (17 boys, 4 girls; mean age = 8.5 years). Based on parental report, children with ADD-H had significantly more complaints of earaches during the preceding 3 months and significantly more ear infections during the preceding year. Specifically, no between-group differences were observed for total number of ear infections since birth, extended antibiotic therapy, tympanostomy tube placement, or recent hearing problems. Although middle ear disease in preschool children has repeatedly been linked to later language deficits, this study suggests that middle ear disease in school-age children may also be associated with hyperactivity and/or inattention, independently of learning disability.
Children, Adolescents, and Television
Authors:   Committee on Communications
Published: December 2021

In 1984 the American Academy of Pediatrics Task Force on Children and Television issued a statement1 that cautioned pediatricians and parents about the potential for television to promote violent and/or aggressive behavior and obesity. The influence of television on early sexual activity, drug and alcohol use and abuse, school performance, and perpetuation of ethnic stereotypes was also stressed. Advances in our understanding of the effects of television on children have prompted this update of the Academy's policy.

In 1989 the average child in the United States still spent more time watching television than performing any other activity except sleeping. According to recent Nielsen data,2 children aged 2 to 5 years view approximately 25 hours of television per week, children aged 6 to 11 years watch more than 22 hours per week, and adolescents 12 to 17 years watch 23 hours of television per week. Although the amount of commercial television viewed by children has declined since 1980, the most recent estimates of television viewing do not include the use of video cassette recorders. Therefore, the amount of time that children in our country spend in front of the television set has probably not decreased significantly in the past 8 years.

Television's influence on children is a function of the length of time they spend watching and the cumulative effect of what they see. By the time today's child reaches age 70, he or she will have spent approximately 7 years watching television.3 Therefore, television may displace more active experience of the world.
Dexamethasone Therapy for Bacterial Meningitis in Infants and Children
Authors:   Committee on Infectious Diseases
Published: December 2021

BACKGROUND

Bacterial meningitis affects an estimated 15 000 infants and children in the United States each year. The case-fatality rates for these patients are from 5% to 10%; as many as 20% to 30% of survivors have long-term sequelae, the most common of which is hearing impairment.1 The reported incidence of hearing loss after meningitis has ranged from 5% to 20% of patients, depending on the selection of patients, techniques used to assess hearing, and etiology.2-5 In 1972 to 1977, Dodge and co-workers2 documented hearing loss in 31% of patients with Streptococcus pneumoniae meningitis, 10% with Neisseria meningitidis meningitis, and 6% with Haemophilus influenzae meningitis. Bilateral sensorineural hearing impairment occurred in 14%, 10%, and 3%, respectively. Newer antimicrobial agents with superior bactericidal activity in cerebrospinal fluid have not reduced morbidity and case-fatality rates compared with conventional therapy.

The pathophysiologic events believed to contribute to adverse outcome from bacterial meningitis include alteration of cerebral capillary endothelial cells that comprise the blood-brain barrier, cytotoxic and vasogenic cerebral edema, and increased intracranial pressure.6 These events can lead to decreased cerebral perfusion pressure with a resultant diminution in cerebral blood flow causing regional hypoxia and focal ischemia of brain tissue.

Because of its anti-inflammatory effects, corticosteroid therapy has been evaluated in experimental meningitis and in infants and children with meningitis. Dexamethasone produced significant reductions in intracranial pressure, brain edema, and lactate concentrations in cerebrospinal fluid in experimental H influenzae and S pneumoniae meningitis.7,8 In addition, the administration of dexamethasone was associated with decreased concentrations of prostaglandin E2 in cerebrospinal fluid and lowered mortality and clinically evident neurologic sequelae in rabbits with experimental pneumococcal meningitis.9
Prediction Rules for Selective Radiographic Assessment of Extremity Injuries in Children and Adolescents
Authors: McConnochie Kenneth M. , Roghmann Klaus J. , Pasternack Joel , Monroe David J. , Monaco Liberatore P.
Published: December 2021

To assess the potential for selective use of roentgenography in evaluating extremity injuries, prediction rules were developed based on prospective observations for 617 injured children and adolescents examined in our Emergency Department (phase 1) and tested on 601 examined 1 year later (phase 2). Logit analysis produced best-fitting statistical models for phase 1 data with significant (P < 0.05) direct effects of gross signs, point tenderness, activity not routine, swelling moderate or severe, time from injury <6 hours, and pain with motion for upper extremity injuries; and, for lower extremity injuries, not knee injury, activity not routine, point tenderness, and foot injury. Prediction rules developed in phase 1 performed equally well when tested on phase 2 injuries. Data from both phases were combined, therefore, in analysis that produced risk estimates. For all injury types (ie, for injuries with all possible combinations of presence or absence of these findings), risk for fracture was derived. For upper extremity injuries, with a threshold risk for fracture of 20% used to select specific injury types for roentgenography, prediction rule outcomes were 18.1% of roentgenograms avoided and 5.3% of fractures missed. For lower extremity injuries, using a threshold risk of 10% to select injury types for roentgenography, outcomes were 25.8% of roentgenograms avoided and 5.3% of fractures missed. Alternative prediction rules allowed still greater roentgenogram avoidance, although missed fractures also increased. Risk of adverse functional outcome from missed fractures appeared small. Annual national cost savings from the elimination of 18.1% of upper and 25.8% of lower extremity roentgenographic evaluations was estimated at $103 million.
Primary Care: The Future for Pediatric Education
Authors: Alpert Joel J.
Published: December 2021

There is a continuing crisis in primary care, characterized by inadequate numbers of appropriately trained primary care physicians and the failure to mount an effective and consistent graduate educational program for primary care. This paper reviews the history of the primary care crisis; revisits the definition of primary care; and, through identification of critical issues, presents a primary care educational agenda for the 1990s. Pediatrics is at a crossroads regarding primary care, as powerful social and economic forces are impacting on today's major pediatric care problems.

Before the second World War there were more than 300 primary care physicians available for each 100 000 of our population. Today the ratio is 75 for 100 000. This is despite the fact that a shortage of 50 000 physicians 10 years ago no longer exists. The majority view is that a physician surplus of 70 000 will be present by the early 1990s.1 Whether there is a surplus is subject to interpretation and the surplus may end up as nonexistent. Moreover, the availability of primary care physicians varies with geographic location, and even a single figure for this nation provides a distorted picture. The shortage is especially serious in inner cities and in many rural areas. In addition, the use of overall numbers assumes that all primary care physicians are appropriately trained in the general disciplines.

For the past century, physicians have cared for patients usually as family physicians. Today, however, the generalist has been replaced by the specialist. Is this a function of financial rewards and society's needs and values or the educational experience?
Bacteremia With Otitis Media
Authors: Schutzman Sara A. , Petrycki Stephen , Fleisher Gary R.
Published: December 2021

To investigate the occurrence and outcome of bacteremia associated with otitis media, charts were reviewed from patients who were 3 to 36 months of age, had temperatures ≥39°C, and were diagnosed with isolated clinical otitis media. A total of 2982 patients were identified. Blood cultures were obtained from 1666 (56%). Of the 1666 patients, who had blood drawn for cultures, 50 (3.0%) had bacteremia. These included 39 with Streptococcus pneumoniae, 4 with Haemophilus influenzae, 2 with Neisseria meningitidis, 3 with Salmonella species, and 2 with Staphylococcus aureus. The incidence of bacteremia increased at higher temperatures, being 1.9% at temperatures ≤40°C and 5.0% at temperatures >40°C. Younger children were more likely to have bacteremia; 3.7% ≤12 months of age, 2.4% 13 to 24 months of age, and 1.9% 25 to 36 months of age had blood culture results that were positive (not significant). Reevaluation of the 50 bacteremic patients showed that 9 patients had continued fever, 3 patients had persistent bacteremia, pneumonia developed in 1 patient, and meningitis developed in 1 patient. It was concluded that (1) 3% of young febrile children with otitis media have bacteremia at the time of evaluation, a rate comparable to that previously reported in children with no focus of infection; (2) the incidence of bacteremia increases at higher temperatures; and (3) most febrile children with otitis media do well. The clinician must therefore weigh the potential benefit of drawing a blood culture to identify children at risk for complications against the inherent cost, inconvenience, and discomfort.
Controlled Trial of a Home and Ambulatory Program for Asthmatic Children
Authors: Hughes Daniel M. , McLeod Marjorie , Garner Barry , Goldbloom Richard B.
Published: December 2021

Care of asthmatic children is often episodic and more therapeutic than preventive. A 2-year randomized, controlled trial involving 95 children measured the impact of a comprehensive home and ambulatory program for pediatric asthma management using objective outcome measures. Interventions for the study group during the first year included 3-month clinic visits, education, and home visits by a specially trained research nurse. Control subjects continued to receive regular care from a family physician or pediatrician. Eighty-nine subjects (93%) completed the study. Study subjects had less school absenteeism than control subjects (10.7 vs. 16.0 days, P = .04) and showed significantly better small airway function after 1 year. Asthma severity improved in 13 study subjects and worsened in 5. The reverse was true for control subjects. Study subjects exhibited better metered aerosol technique than control subjects (P = .0005). Fewer days were spent in hospital by the study subjects admitted compared with control subjects (3.67 vs 11.2 days, P = .02). After 1 year, more study than control families (72.1% vs 33.1%, P = .006) reported that their asthmatic child took responsibility for the asthma management. The intervention failed to reduce exposure to secondhand smoke or to household pets. There were no significant differences in medical visits, theophylline levels, or records of asthma symptoms. One year after discontinuing the intervention, a marked "washout" effect was observed. Comprehensive ambulatory programs of childhood asthma management can improve objective measures of illness severity but must be sustained.
Race, Culture, and Ethnicity
Authors: PACHTER LEE M.
Published: December 2021

To the Editor.—

In a recent article published in Pediatrics regarding cosleeping in a community sample of 2- to 3-year-old children,1 Madansky and Edelbrock reported that cosleeping was more common among nonwhite families and that this might reflect a "subcultural practice." Putting aside for the moment the question of what is meant by "subculture," I feel that the use of "white" and "nonwhite" or "black" as cultural categories requires some discussion.

There is a distinction that has to be made between the concepts of "race" and "culture."
Immunologic Defects in Patients With Refractory Sinusitis
Authors: Shapiro Gail G. , Virant Frank S. , Furukawa Clifton T. , Pierson William E. , Bierman C. Warren
Published: December 2021

Sixty-one patients with chronic sinusitis who were referred for an allergy evaluation were evaluated for immunologic competence including assessment of quantitative serum immunoglobulin levels, IgG subclass levels, and response to pneumococcal and Haemophilus influenzae vaccines. In addition to chronic sinus disease, recurrent otitis media and asthma exacerbation were common problems in this group. Five patients had an elevated age-adjusted IgE level and 22 patients had positive prick tests to one or more environmental inhalants; these findings suggest an allergic component in this subgroup. Twelve additional patients had highly reactive intradermal tests to common environmental allergens, which also may be clinically significant for underlying atopy. Eleven patients had low immunoglobulin levels, 6 had low immunologlobulin levels and vaccine hyporesponsiveness, and 17 had poor vaccine response only. Thus, 34 of 61 patients with refractory sinusitis had abnormal results on immune studies, with depressed IgG3 levels and poor response to pneumococcal antigen 7 being most common. In addition to allergy, immunologic incompetence may be an important etiologic factor in patients with chronic, refractory sinusitis.
Comparison of the Attitudes of Health Care Professionals and Parents Toward Active Treatment of Very Low Birth Weight Infants
Authors: Lee Shoo K. , Penner Pauline L. , Cox Margaret
Published: December 2021

Although pediatricians and neonatal nurses influence parents' treatment decisions, little is known about their attitudes toward active treatment of very low birth weight (VLBW) infants (<1500 g) and how they compare with parental attitudes. A survey of all 50 pediatricians in Newfoundland (72% response), all 53 neonatal intensive care nurses at the Janeway Child Health Centre (73.6% response), parents of all 144 traceable VLBW infants (72.2% response), and parents of 25 randomly selected normal term infants (60% response), born in Newfoundland between 1983 and 1987, revealed significant differences in attitudes among parents, nurses, and pediatricians about whether active treatment should be offered to potentially severely handicapped VLBW infants. Most parents of both VLBW and normal term infants (>80%) agreed, pediatricians were divided, whereas most nurses (79.5%) objected. Both pediatricians and nurses tended to overestimate (P < .05) the morbidity, mortality, and costs of care of VLBW infants. There was a direct correlation (P< .05) between a negative attitude toward saving VLBW infants and a negatively false perception of neonatal morbidity, mortality, and costs. All groups favored a role for parents and physicians in treatment decisions and objected to a role for regulatory bodies. Pediatricians and nurses also favored a role for nurses and hospital ethics committees but parents disagreed. While most nurses (71%) believed it was unethical to save potentially severely handicapped infants, few pediatricians (36.9%) agreed. Only 27.8% of pediatricians and 10.3% of nurses would seek court intervention if they disagreed with a parental decision not to actively treat a potentially handicapped infant. The results indicate a need for regular updating of physicians and nurses about neonatal outcomes, for increased cognizance of parental desires, and for physicians to be actively involved in treatment decisions.
Prediction of Developmental Outcome Using a Perinatal Risk Inventory
Authors: Schemer Albert P. , Sexton Miriam E.
Published: December 2021

An effective perinatal developmental screening that predicts developmental outcome of high-risk neonates is currently not available. One hundred twenty-five high-risk infants were evaluated prior to discharge from the neonatal intensive care unit using a newly developed perinatal risk inventory, family status index, and abbreviated neurobehavioral assessment scale. All infants had been evaluated using the Bayley Mental and Motor scales or the Stanford-Binet. They were also evaluated by a pediatrician, audiologist, and ophthalmologist. Fifteen infants had been evaluated using 9-month Bayley Scales of Infant Development, 74 had been evaluated using the Bayley at 9 and 18 months, and 36 children had been assessed using the Stanford-Binet at 36 months. The total score of the perinatal risk inventory demonstrated a significant correlation with the infants' last score on the Bayley and Stanford-Binet (r = -.55, P < .001). The abbreviated neurobehavioral assessment scale correlated with the infants' IQ and developmental quotient score (r = .3, P < .001); the family status index did not correlate well with the developmental outcome. Using a score of 10 on the perinatal risk inventory provided a sensitivity of 0.76, specificity of 0.79, positive predictive value of 0.475, and negative predictive value of 0.929. Twelve of the 13 infants with cerebral palsy were identified as being potentially developmentally abnormal prior to discharge. It appears that it is possible to predict the developmental outcome of high-risk neonates using a perinatal risk inventory.
Cardiac Sequelae of Kawasaki Disease in Japan: Statistical Analysis
Authors: Nakamura Yosikazu , Fujita Yasuyuki , Nagai Masaki , Yanagawa Hiroshi , Imada Yoshio , Okawa Sumio , Kawasaki Tomisaku , Kato Hirohisa
Published: December 2021

The proportions of Kawasaki disease patients with cardiac sequelae in Japan were analyzed using nationwide survey data from the 6½-year period July 1982 through December 1988. Of 46 864 cases of Kawasaki disease reported in the surveys, 7637 or 16.3% had cardiac sequelae such as dilation or stenosis of coronary arteries, myocardial infarction, and valvar lesions 1 month on more after onset. The prevalence of cardiac sequelae was particularly high in males, infants younger than 1 year, and children older than 5 years of age. In sequential observation, there was no correlation between the prevalence of cardiac sequelae and periods of high or low incidence of the disease. The prevalence of cardiac sequelae overall declined steadily over the observation period, perhaps as a consequence of increasing use of intravenous gamma globulin. However, children older than the age of 5 years manifested increasing prevalence of cardiac sequelae over the observation period, probably as a result of lower rates of intravenous gamma globulin administration.
"Crack Kids": Not Broken
Authors: ZUCKERMAN BARRY , FRANK DEBORAH A.
Published: December 2021

Reports in the lay press based on anecdotal evidence have resulted in a rush to judgment about the impact of in utero exposure to illicit drugs, particularly cocaine, on the health, behavior, and development of America's children.1 Children with a history of prenatal cocaine exposure, labeled "crack kids," are portrayed in the media as inevitably and permanently damaged. An article on Rolling Stone Magazine (October 18, 1990) stated that these babies are "like no others, brain damaged in ways yet unknown, oblivious to any affection." An article in the New York Times reported that "the parents and researchers say a vast majority of children exposed to significant amounts of drugs in the womb appeared to have suffered brain damage that cuts into their ability to make friends, know right from wrong, control their impulses, gain insight, concentrate on tasks, and feel and return love."
Unusual Manifestation of Stevens-Johnson Syndrome Involving the Respiratory and Gastrointestinal Tract
Authors: Edell Dean S. , Muelenaer Andre A. , Majure Marc , Davidson James J.
Published: December 2021

There are many recognized acute complications of Stevens-Johnson syndrome: however, long-term sequelae involving the respiratory and gastrointestinal tracts are exceedingly rare. We present an 8-year-old girl who developed esophageal stricture and chronic lung disease while recovering from Stevens-Johnson syndrome and discuss these complications with possible mechanisms for their occurrence.
Exercise Assessment of Cardiac Function in Children and Young Adults Before and After Bone Marrow Transplantation
Authors: Larsen Ranae L. , Barber Gerald , Heise Charles T. , August Charles S.
Published: December 2021

Cardiac toxicity is a potential complication of bone marrow transplantation because recipients frequently receive cardiotoxic chemotherapy and/or irradiation before transplantation. Most studies indicate that transient cardiac toxicity occurs within weeks of transplantation, but few studies have evaluated either cardiac status before or late after transplantation.

Cardiac performance was assessed via cycle ergometry in 20 children and young adults before transplantation and 31 other children and young adults after transplantation. Mean survival time in the group post-transplantation was 3.9 years with a range of 11 months to 12.1 years. Left ventricular size and shortening fraction at rest were assessed via echocardiography. Data were compared to those of 70 healthy subjects from our laboratory.

Patients before and after transplantation had normal oxygen consumptions and cardiac indices at rest. During exercise, however, patients treated for cancer both before and after bone marrow transplantation had reduced exercise times, reduced maximal oxygen consumptions, and reduced ventilatory anaerobic thresholds. Cardiac reserve, as judged by the response of the cardiac output during exercise, was reduced severely. There were no significant differences between the groups tested before and after transplantation. Patients who had been treated for aplastic anemia, who had received less intensive therapy before transplantation, performed significantly better than did patients treated for cancer. Despite these findings, only four patients had abnormalities by echocardiography.

In conclusion, before transplantation patients with oncologic diagnoses had serious limitations in exercise performance, most likely as a result of the effects of the cardiotoxic therapy given as part of their conventional cancer therapy. Long-term survivors of bone marrow transplantation also had similar abnormalities. Since the same patients were not studied before and after transplantation, one cannot draw definite conclusions about the effect of the transplantation itself upon cardiac function. However, exercise testing is a sensitive, noninvasive method of assessing patients at risk for cardiac dysfunction secondary to potentially cardiotoxic agents.
Ingestion of Cylindrical and Button Batteries: An Analysis of 2382 Cases
Authors: Litovitz Toby , Schmitz Barbara F.
Published: December 2021

During a 7-year period, 2382 cases of battery ingestion were reported to a national registry. Button cells were ingested by 2320 of these patients; 62 patients ingested cylindrical cells. These cases are analyzed to reassess current therapeutic recommendations, hypotheses about battery-induced injury, and strategies for prevention and intervention. Hearing aids were the most common intended use of ingested cells (952 cases, 44.6%); and in 312 (32.8%) of these cases, the battery actually was removed by a child from the child's own aid.

Overall, 9.9% of patients were symptomatic. Two children experienced severe esophageal injury following the ingestion of large diameter cells and required repeated dilatation. In this series and in prior reports, most batteries which lodged in the esophagus and caused esophageal injury were large diameter (20 to 23 mm). However, neither battery diameter nor symptom occurrence could be used to detect all patients with esophageal battery position.

Outcome was not affected by battery discharge state, but was influenced by chemical system. Lithium cells, with their larger diameters and greater voltage, were associated disproportionately with adverse effects. Mercuric oxide cells were substantially more likely to fragment, compared with other chemical systems. No clinical evidence of mercury toxicity occurred in this series, although one patient demonstrated minimal elevation of blood mercury levels. In this series and 10 prior reports, all patients with elevated blood mercury levels had ingested batteries which fragmented and showed evidence of radio-opaque droplets in the gut. Special monitoring may be advisable for individuals who have ingested 15.6-mm-diameter mercuric oxide cells.

Ipecac was administered in 37 cases of button cell ingestion, causing battery expulsion in only one patient. Retrograde battery movement from the stomach to the esophagus necessitating emergent endoscopic retrieval occurred as a complication of ipecac administration in another patient. The use of endoscopic and surgical intervention declined more than fivefold during the study period. Endoscopic retrieval success was a function of battery location, with batteries in the esophagus more readily retrieved than those in more distal gastrointestinal locations (90.0% vs 46.7%, respectively). A current management protocol is presented advocating a noninvasive approach for most cases of button cell ingestion where an esophageal position is excluded. Manufacturers are urged to provide more securely fastened, child-resistant battery compartments on hearing aids as well as other battery-powered products in household use.
Neurotoxicity of Lorazepam in a Premature Infant
Authors: CRONIN CATHERINE M. G.
Published: December 2021

To the Editor.—

Recently, I have observed several cases of stereotypic movements following injection of lorazepam in premature infants and wish to alert my colleagues to a potential cause of neurotoxicity.

Case 1

CASE REPORTS

A male neonate was born in a peripheral hospital at 24 weeks gestation. Apgar scores were 2 at 1 minute and 6 at 5 minutes. He weighed 680 g and was transferred to a tertiary care institution at 20 hours of life.
Neonatal Hyperbilirubinemia Associated With Glucose-6-Phosphate Dehydrogenase Deficiency in Sephardic-Jewish Neonates: Incidence, Severity, and the Effect of Phototherapy
Authors: Kaplan Michael , Abramov Ayala
Published: December 2021

Glucose-6-phosphate dehydrogenase (G-6-PD) deficiency is frequently associated with neonatal hyperbilirubinemia, and sometimes kernicterus, often in the absence of any identifiable trigger or hematological evidence of hemolysis. The aim of this study was to compare the incidence and severity of, and the effect of phototherapy on, jaundice in G-6-PD-deficient vs G-6-PD-normal neonates in the Sephardic-Jewish community. Healthy term newborns, born to mothers of families stemming from geographic areas known to be "at risk" for G-6-PD deficiency, were screened for the condition and surveyed for hyperbilirubinemia. Seventy-five G-6-PD-deficient neonates formed the study group, while 266 neonates with normal levels of the enzyme formed the control group. Neonates with any other identifiable cause for jaundice were excluded. Phototherapy was commenced when the serum bilirubin levels reached 16 mg/dL (274 µmol/L) or more, and it was discontinued at 12 mg/dL (205 µmol/L) or less. Hyperbilirubinemia developed in 27 (36%) of the deficient neonates (serum total bilirubin >13.9 mg/dL [238 µmol/L]), compared with 50 (18.8%) of control neonates (P = .002), while 20 (26.7%) of the study group required phototherapy, compared with 31 (11.7%) of control neonates (P = .002). Two neonates in the study group required exchange transfusion (serum bilirubin >20 mg/dL [342 µmol/L]), vs 0 in the control group (not significant). Further analysis was performed on male neonates only: despite a tendency for the hyperbilirubinemia to behave differently with regard to peak bilirubin levels, age at the time of the peak, duration of phototherapy, and rate of bilirubin decrease during phototherapy, these differences failed to attain statistical significance. Values for hematocrit and reticulocyte count did not show evidence of overt hemolysis. Routine daily clinical evaluation and use of phototherapy according to the above criteria made it possible to keep the need for exchange transfusion to a minimum and to prevent kernicterus in this population.