bluuebunny/crossref_metadata_2025 huggingface dataset:
TIPP—The First Ten Years
Authors: Bass Joel L.
Published: December 2021

In April 1983 the American Academy of Pediatrics (AAP) officially launched the first major nationwide drive by a national medical association to prevent injuries: TIPP (The Injury Prevention Program). TIPP was introduced officially at the spring meeting of the AAP in Philadelphia by Surgeon General C. Everett Koop, who stated that "Accidents, poisonings, and injuries have emerged as one of the greatest threats to our children's health."1

TIPP had its origin in three state projects funded by the Title V—Maternal and Child Health Program in California, Massachusetts, and Virginia. Each one of these state programs had developed injury prevention strategies for practitioners.
The Pediatrician's Role in Helping Children and Families Deal with Separation and Divorce
Authors: Yablin Bernard A.
Published: December 2021

The Psychosocial Committee is to be commended for its report on the pediatrician and divorce in the July issue of Pediatrics.

I would like to add the following:

The role of the pediatrician should extend well beyond the divorce and immediate adjustment process.

Firstly, there should be greater involvement between both the pediatrician and the Family Court system to help prevent misplacement of the child in custody decisions. (I believe that various groups within the American Academy of Pediatrics are already working with judicial/legal groups to bring to them a greater knowledge of child development and mental health).
Letters to the Editor
Authors: Stein Martin T.
Published: December 2021

The American Academy of Pediatrics Committee on Psychosocial Aspects of Child and Family Health appreciates Dr Yablin's comments on our recent statement, The Pediatrician's Role in Helping Children and Families Deal with Separation and Divorce (Pediatrics 1994;94:119-121).

He is correct when he points out that pediatricians have a potentially beneficial role during the child custody decision process. Too often these crucial decisions for the children and family are guided by lawyers without input from professional child advocates—either pediatricians, psychologists, or psychiatrists.
Medical "Experts" for Hire!
Authors: Schrager Gloria O.
Published: December 2021

Recent experiences as a medical expert in malpractice cases have made me increasingly disheartened by the damage done to innocent colleagues by members of our own profession. We tend to inveigh against malpractice lawyers as our adversaries, but they could accomplish very little without the full cooperation and enthusiastic support of medical consultants. The following case illustrates several abuses that I believe are important to bring to the attention of the medical community.

A full-term female neonate was born by normal spontaneous delivery after an uncomplicated pregnancy.
TEXTBOOK COMPLIANCE COMMISSION
Authors: L. J. F.
Published: December 2021

In 1988 education author Harriet Tyson wrote A Conspiracy of Good Intentions: America's Textbook Fiasco. It tells a chilling tale. "California," says Tyson, "has a special [textbook] ‘compliance commission’ that checks for compliance with all the social issues that are being pursued by special interest groups including feminists, a black power advocate, environmentalists, family values advocates and the like. The compliance commission counted how many female lead characters there are in the textbook, how many blacks and Chicanos appear in pictures, and so on."

If the head counts didn't come out to their liking, the textbook either had to be rewritten or it would be rejected.
Carbohydrate Absorption From Fruit Juice in Young Children
Authors: Smith Melanie M. , Davis Michael , Chasalow Fred I. , Lifshitz Fima
Published: December 2021

Objective. To compare carbohydrate absorption following ingestion of apple juice and white grape juice in 28 healthy children.

Design. Randomized, double-blind crossover study.

Setting. Outpatient pediatric clinic at Maimonides Medical Center.

Participants. A total of 18 healthy infants (mean age 6.3 months) and 10 toddlers (mean age 18.0 months), representing those ages when juice is first introduced (6 months) and when juice comprises a large portion of the diet (18 months).

Methods. Breath hydrogen (H2) testing was performed after age-specific servings of white grape juice or apple juice, 4 and 8 ounces respectively, were consumed. These portions provided approximately 1 g of fructose per kg of body weight. Breath H2 responses of >20 ppm were considered positive, indicating incomplete absorption of fruit juice carbohydrates.

Results. In the combined age groups, carbohydrate malabsorption occurred more frequently after apple juice consumption (54%) than after white grape juice (19%; P < .001). Significant differences in area under the breath H2 curve (AUC) were also found between the two juices in both age groups. Among toddlers, the differences between the mean peak breath H2 responses were significant (48 ppm after apple juice consumption compared with 12 ppm after white grape juice; P < .001). These differences were not significant in the infant group. Significant differences (P < .05) were seen between the two age groups after consumption of apple juice; the toddlers exhibited a greater number of positive breath H2 responses and higher peak responses compared with the infants. Data from the children who drank both juices showed significant differences in peak breath H2 responses after consumption of apple juice compared with white grape juice (P < .005).

Conclusions. The study demonstrated less carbohydrate malabsorption following ingestion of white grape juice compared with apple juice in healthy 6- and 18- month-old children.
THE VIEW FROM COLUMBIA-PRESBYTERIAN MEDICAL CENTER: Is This Really the Future?
Authors: L. J. F.
Published: December 2021

Emerging as hospitals' most promising source of new patients are clinics like Columbia-Presbyterian Eastside, which, in health care jargon, are called "centers," lest potential patients confuse these gleaming outposts with conventional clinics that cater to the poor and uninsured. To attract middle-class patients wary of leaving their protected blocks, the city's huge hospitals are branching out to ethnic enclaves, upscale New York neighborhoods, affluent suburban communities, and even distant American expatriate communities in Eastern Europe.

Four months ago, Columbia-Presbyterian created a satellite in Moscow and more centers are planned for Warsaw, Prague, St. Petersburg, Budapest, and possibly Beijing.

"Our feeling is that there will be no hospitals in the future," said Dr. William T. Speck, president of Columbia-Presbyterian. "And probably, in the next 10 or 20 years most of the activity will take place in a center or maybe even in homes."

At Columbia-Presbyterian, the top executives are already mulling over what to do with the huge Washington Heights hospital as it empties out to the satellites.

"Hospitals are going to get smaller and smaller and maybe the hospitals might turn into something else," Dr. Speck said. "Perhaps a gymnasium or a flower shop."
Myelin in SIDS: Assessment of Development and Damage using MRI
Authors: Lamont Phillipa , Sachinwalla Toos , Pamphlett Roger
Published: December 2021

Objective. Abnormalities of myelin that have been reported in Sudden Infant Death Syndrome (SIDS) include a delay in development and focal lesions presumed to be secondary to hypoxia. Magnetic resonance imaging (MRI) gives excellent images of white matter and can be used to map the progress of myelination and to demonstrate focal lesions. It was the aim of this study to determine whether any MRI abnormality of myelin could be detected in the brains of SIDS compared to control infants.

Methods. The brains of 28 SIDS and 14 control infants were fixed in formalin and scanned with MRI. The proton density, T2-weighted, and inversion recovery scans were assessed for the presence of focal white matter lesions. The amount of myelin in 26 sites was measured in the proton density scans, using a densitometer. The amount of myelin present could be assessed in 21 of 26 sites.

Results. In 15 of 21 sites the amount of myelin for age was the same in SIDS and controls. In three sites the rate of myelination was greater in SIDS than control and in another three sites the amount of myelin for age was greater in SIDS than control infants, but these differences were not seen in infants aged less than 8 months. No focal abnormalities of white matter were seen in either SIDS or control infants.

Conclusions. The development of white matter in brains of SIDS infants less than 8 months old is the same as in controls, and in older SIDS infants white matter development may be slightly advanced compared to controls. No hypoxic changes can be seen in SIDS white matter on MRI.
Sudden Infant Death Syndrome and Subsequent Siblings
Authors: Hunt Carl E.
Published: December 2021

Siblings of a prior SIDS victim are at increased risk for SIDS. Documented monitoring is cost-effective in siblings of prior SIDS infants,4 but cost has not yet been studied in any other infant groups. Although the clinical effectiveness of home infant monitoring has not yet been established for any infant group, documented monitoring is a technological advance that will play a critical role in determining whether home monitors can prevent infants from dying of SIDS. The importance of the Steinschneider study4 is therefore related not only to its role in clarifying the cost-effectiveness of documented monitoring in subsequent siblings, but also to its emphasis on the overall clinical usefulness of documented monitoring.
Antenatal Formula Advertising
Authors: Lane Daniel M.
Published: December 2021

The criticism of antenatal formula advertising by Howard et al1 regrettably reflects how ignorant many pediatricians are about breast-feeding in the community setting. Having been involved in infant nutrition studies on a face-to-face basis for more than 10 years,2 our experience indicates that formula advertising plays an insignificant role in reducing the frequency of breast-feeding among new mothers. Most information about infant nutrition is provided to American mothers through hospitals' prenatal classes run by Departments of Obstetrics.
Letters to the Editor
Authors: Howard Cynthia R. , Howard Fred M. , Lawrence Ruth A.
Published: December 2021

We thank Dr Lane for his comments. We agree that formula advertising is probably not the most important influence on a mother's choice of how to feed her infant. Infant feeding decisions are complicated encompassing cultural beliefs, family structure, health, and cost considerations. We believe physicians, whenever possible, should encourage breast-feeding but recognize that the family's final decision must be supported.1-3 Additionally, we agree that pediatricians have less influence in that decision than do obstetricians.
Letters to the Editor
Authors: Williams Robert K.
Published: December 2021

Use of the laryngeal mask airway (LMA) has grown considerably over the past few years in both adults and children.1,2 The LMA may have special benefits in the management of severe airway problems and the American Society of Anesthesiologists have incorporated its potential use into its algorithm on management of the difficult airway.3 Recently, its use in resuscitation of neonates has been advocated.4,5

I have used the LMA in my practice of pediatric anesthesia and have generally been pleased with its performance in spontaneously breathing patients under general anesthesia.
Letters to the Editor
Authors: Clark Frank
Published: December 2021

I appreciate the opportunity to respond to Dr Frader's comments. In particular, I would like to address his third concern. The last thing I would want is to add any further confusion to this issue.

First, Dr Frader correctly notes that the origins of the 1984 Federal Child Abuse Amendments (FCAA) are different than the various state child abuse and neglect reporting statutes. The FCAA were explicitly passed to provide the substantive legal foundation upon which the Department of Health and Human Services could issue replacement regulations for the original Baby Doe rules.1
EXPOSURE TO ALTERNATING HYPOXIA AND HYPEROXIA CAUSES SEVERE PROLIFERATIVE RETINOPATHY IN THE NEWBORN RAT
Authors: L. J. F.
Published: December 2021

Exposure to variable hyperoxia has recently been shown to be much more effective at producing proliferative retinopathy in the newborn rat than exposure to constant hyperoxia. To incorporate a more clinically relevant oxygen-exposure paradigm in our studies, we have now used a cycle between 50 and 10% oxygen and have compared its effects with those found using new exposures to the previously used 80/40% cycle. Starting at birth and continuing for 14 days, rats were exposed to environments that cycled between 50 and 10% oxygen or 80 and 40% oxygen every 24 hours. After exposure, some rats were killed for assessment of retinal vascular development. Others were removed to room air for 4 days before killing and evaluation for the presence of abnormal neovascularization—a clinical consequence believed to be promoted by termination of oxygen therapy. The 50/10% cycle resulted in greater retardation of retinal blood vessel development during oxygen than that found in the 80/40% exposure group. After 4 days post exposure in room air, the incidence of preretinal neovascularization was 97% in the 50/10% rats and 72% in the 80/40% group. Clearly, the overall amount of oxygen the subjects receive is less critical than other parameters of its administration in producing proliferative retinopathy. Also, the range of variation (40% in both cases) is not the controlling characteristic. Our results suggest that consistency of oxygen level and avoidance of hypoxic levels should be important concerns in neonatal oxygen therapy.
Epidemiologic Pictures of Kawasaki Disease in Japan: From the Nationwide Incidence Survey in 1991 and 1992
Authors: Yanagawa Hiroshi , Yashiro Mayumi , Nakamura Yosikazu , Kawasaki Tomisaku , Kato Hirohisa
Published: December 2021

Objective. Since 1970, twelve nationwide epidemiologic surveys of Kawasaki disease (KD) have been conducted throughout Japan every two years to describe KD in Japan. By the end of 1992, a total of 116 848 cases were reported. This paper summarizes the statistical analysis of the latest survey for the 2-year period from January 1991 through December 1992.

Method. A questionnaire form and diagnostic guidelines for KD were sent to all pediatric departments of hospitals with 100 or more beds throughout Japan and information was obtained on patients with KD diagnosed during the 2-year period from January 1991 through December 1992.

Results. The summary of the results is: 1) the number of patients reported was 11 221 (6604 males and 4617 females; male/female ratio = 1.43) with a yearly incidence rate of 90 per 100 000 children <5 years old; 2) the monthly number of patients was higher in winter and summer, although the monthly difference was not marked; 3) age-specific incidence rates showed a unimodal peak at 1 year of age; 4) the proportion of patients with a family history of KD in a sibling was 1%; 5) the proportion of recurrent patients was 3%; 6) the proportion of patients with cardiac sequelae 1 month after disease onset was 13%; and 7) the number of patients who died was 9, which conforms to 0.08% of total patients.

Conclusion. The incidence rates of KD in Japan are ten times higher than those reported in western countries and almost constant over 6 years. The descriptive epidemiology of the disease, which supports the infection theory, does not change for years.
Safety and Immunogenicity of PRP-T Combined with DTP: Excretion of Capsular Polysaccharide and Antibody Response in the Immediate Post-Vaccination Period
Authors: Miller Melanie A. , Meschievitz Carlton K. , Ballanco Gerard A. , Daum Robert S.
Published: December 2021

Objective. To evaluate whether combining Haemophilus influenzae type b capsular polysaccharide covalently linked to tetanus toxoid (PRP-T) and diphtheria-tetanus-pertussis (DTP) in one syringe produced a vaccine that was safe and immunogenic.

Design. Randomized clinical trial.

Setting. Suburban New Orleans pediatric population.

Participants. Convenience sample of 150 healthy infants.

Methods. Enrollees were randomized to receive DTP and PRP-T in one injection (Group 1), DTP and PRP-T separately (Group 2), or DTP and H influenzae type b capsular saccharide coupled to a nontoxic variant of diphtheria toxin, CRM197, (HbOC) separately (Group 3) at 2, 4, and 6 months of age. All infants received oral polio vaccine at 2 and 4 months of age. Parents were instructed to record side effects on a standardized form after each vaccine administration. Blood was drawn before each immunization and at 7 months of age; an additional blood and a urine specimen was obtained 2 to 3 days after one of the vaccination visits. Serum was assayed for H influenzae anticapsular antibody (anti-PRP), anti-pertussis toxoid, anti-fimbrial hemagglutinins, anti-diphtheria and anti-tetanus toxoid antibodies, and antibody to polio viruses. Urine was assayed for H influenzae type b capsular polysaccharide.

Results. The rate of occurrence of fever did not differ significantly between groups. Local swelling and erythema occurred more often at the administration site in Group 1 infants than at the DTP administration sites of infants in Groups 2 and 3 after the first and second vaccinations. The mean concentration of all antibodies we assayed did not differ significantly when Group 1 and 2 infants were compared. HbOC recipients (Group 3) had lower mean anti-H influenzae anticapsular antibody and higher mean anti-diphtheria and anti-tetanus antibody concentrations after two and three doses compared with Group 1 and Group 2 infants. No group had a significant change in mean anti-PRP antibody concentration 2 to 3 days after vaccination with any dose. After vaccination, antigenuria occurred less frequently in Group 1 infants (54%, 78%, and 72% in Groups 1, 2, and 3, respectively, P < .01).

Conclusions. Combining PRP-T and DTP produced a combination vaccine associated with a slight increase in the rate of erythema and swelling but with similar immunogenicity of the vaccine components and oral polio vaccine.
TWIN WHO SURVIVED SEPARATION SURGERY IS DEAD
Authors: L. J. F.
Published: December 2021

...She died at 1 am after her lung problems had worsened.

No relatives were at the hospital when she died.

...The bill for Angela's medical care has exceeded $1 million at Children's Hospital alone.
Contribution of Asphyxia to the Induction of Hearing Impairment in Jaundiced Gunn Rats
Authors: Silver Sarah , Kapitulnik Jaime , Sohmer Haim
Published: December 2021

Objectives. This study was designed to determine whether asphyxia contributes to the induction of hearing impairment during neonatal jaundice.

Methods. Asphyxia was induced in jaundiced and nonjaundiced Gunn rats on postnatal days 1 (low bilirubin levels) and 10 (elevated bilirubin levels). Auditory nerve-brainstem evoked response thresholds were assessed in 21- and 28-day and 3-month-old rats.

Results. Asphyxia by itself or jaundice by itself did not lead to any type of hearing impairment. However, the combination of both high plasma bilirubin levels and asphyxia in 10-day-old rats but not in 1-day-old rats was accompanied by a progressive hearing loss in these rats.

Conclusions. The contributory effect of asphyxia on neonatal jaundice may have important clinical relevance if asphyxia, for example, respiratory distress, accompanies neonatal jaundice.
Effects of Early Dexamethasone Therapy on Pulmonary Mechanics and Chronic Lung Disease in Very Low Birth Weight Infants: A Randomized, Controlled Trial
Authors: Durand Manuel , Sardesai Smeeta , McEvoy Cindy
Published: December 2021

Objective. To determine the changes in pulmonary mechanics before and during early dexamethasone therapy, and to evaluate the effect of dexamethasone on the duration of mechanical ventilation in very low birth weight (VLBW) ventilator-dependent infants at risk for chronic lung disease (CLD).

Methods. A prospective randomized trial was conducted. Forty-three patients (birth weight 600 to 1500 g, gestational age 24 to 32 weeks) who failed to be weaned from the respirator at 7 to 14 days of age were enrolled; 23 infants received a 7-day course of dexamethasone (0.5 mg/kg/day intravenously for 3 days, 0.25 mg/kg/day for 3 days, and 0.1 mg/kg/day for 1 day), and 20 patients were in the control group. At similar mean airway pressure (MAP) and fractional inspired oxygen concentration (FiO2), respiratory system mechanics were measured before and on days 2, 5, and 7 of the study. Airway pressure, flow and tidal volume (VT) were recorded and only mechanical breaths were analyzed. Respiratory compliance (Crs) and respiratory resistance (Rrs) were calculated by two factor least mean square analysis.

Results. Eighty-three percent of infants in the dexamethasone group and 90% in the control group received surfactant in the first 24 hours of life. There was a significant increase in Crs and VT in the dexamethasone group as compared with the control group (P < .001). No major changes in Rrs were observed. Dexamethasone therapy significantly decreased FiO2 and MAP P < .001) and facilitated successful weaning from mechanical ventilation. In addition to a shorter duration of mechanical ventilation (P < .01), the occurrence of CLD (FiO2 > 0.21 at 36 weeks of corrected gestational age, chest radiograph changes) was significantly decreased in the dexamethasone group (P < .01). Except for a transient increase in blood pressure and serum glucose, there were no significant differences in infection rates, intraventricular hemorrhage, or retinopathy of prematurity. Thirteen patients in the control group received dexamethasone at a later age.

Conclusions. Our findings indicate that: 1) early dexamethasone therapy in VLBW infants markedly improves respiratory compliance and tidal volume, reduces FiO2 and MAP requirements, and facilitates extubation in these infants; 2) early dexamethasone therapy reduces the duration of mechanical ventilation and decreases CLD (at 28 days and 36 weeks) in a population of VLBW infants largely treated with surfactant.
Bilirubin Guidelines are a Setback!
Authors: Rabinovitz Jeffery J. , Washburn Earl R.
Published: December 2021

Our hearts sunk when we read "Practice Parameter: Management of Hyperbilirubinemia in the Term Newborn," which appeared in the October 1994 issue of Pediatrics.1 This document represents a terrible setback for those who wish to manage healthy, jaundiced infants in a more conservative and less invasive manner than had been traditional 20 years ago.

The algorithm presented describes a detailed and rigorous thought process that should be considered when treating any jaundiced infant, and we applaud this.
Use of a Single Solution for Oral Rehydration and Maintenance Therapy of Infants With Diarrhea and Mild to Moderate Dehydration
Authors: Cohen Mitchell B. , Mezoff Adam G. , Laney D. Wayne , Bezerra Jorge A. , Beane Bernadette M. , Drazner Dana , Baker Ray , Moran J. Roberto
Published: December 2021

Objective. To compare the efficacy of two commonly used solutions in the rehydration of infants with mild to moderate dehydration caused by acute diarrhea in the United States.

Design and setting. Double-blind, parallel-group, randomized study performed at Children's Hospital Medical Center.

Patients. Sixty infant boys (≤2 years old), with mild (≤5%) or moderate (6 to 9%) dehydration caused by acute diarrhea of less than 1 week's duration were included in the study.

Interventions. Infants were randomly assigned to receive treatment with either a glucose-based oral rehydration solution (ORS) (Pedialyte, Ross Laboratories, Columbus, OH) or a rice syrup solids-based ORS (Infalyte, Mead Johnson Nutritional Group, Evansville, IN). After rehydration was achieved, patients entered a maintenance phase during which, in addition to a maintenance ORS, breast milk or a soy-based formula was offered infants older than 1 year were also given a lactose-free diet.

Outcome measures. Rehydration was judged clinically. Infants remained on a metabolic bed during the study in to separate and quantitate urine and stool output. Therefore, in addition to clinical outcome, we compared intake, output and apparent absorption and retention of fluid, sodium, and potassium between groups.

Results. All patients were successfully rehydrated using an ORS without the use of intravenous fluids. No differences were detected between treatment groups in time to rehydration, percentage of weight gain after rehydration, consumption of ORS to achieve rehydration, or stool output. However, the apparent sodium absorption (net intake less fecal output) was greater in the Infalyte group than the Pedialyte group during the first 24 hours.

Conclusion. The two maintenance oral electrolyte solutions (Pedialyte and Infalyte) most commonly used in the United States are effective as rehydration solutions for infants with mild to moderate dehydration. We speculate that a strategy for oral rehydration therapy in the United States, based on the use of a single solution during the rehydration and maintenance phase, might gain additional acceptance by practicing pediatricians and family physicians.
MANAGEMENT STRATEGIES HAVE LITTLE IMPACT ON FINANCIAL PERFORMANCE OF RURAL HOSPITALS
Authors: L. J. F.
Published: December 2021

Management strategies adopted in response to a changing hospital market apparently have little impact on the financial performance of rural hospitals in the United States, concludes a study supported by the Agency for Health Care Policy and Research (HS05998). Stephen S. Mick, PhD, of the University of Michigan, and colleagues examined the effect of thirteen management strategies on the financial performance of a national sample of 797 US rural hospitals from 1983 to 1988. Examples of these strategies are group purchasing; multihospital, HMO, or nursing home affiliation; and adoption of outpatient services either inside or outside of the hospital service area.

The researchers found no widespread or consistent connection between a hospital's strategic action and positive financial performance ... The researchers conclude from these findings that implementing strategic activities may not be sufficient for rural hospitals to maintain viable networks of acute care facilities in rural areas ...
Older Children and Adolescents Living With Perinatally Acquired Human Immunodeficiency Virus Infection
Authors: Grubman Samuel , Gross Elaine , Lerner-Weiss Nancy , Hernandez Myriam , McSherry George D. , Hoyt Laura G. , Boland Mary , Oleske James M.
Published: December 2021

Objective. To describe the clinical, immunologic, and psychosocial characteristics of children living with perinatally-acquired human immunodeficiency virus (HIV) infection beyond the age of 9 years.

Methods. This is a descriptive cohort study of 42 surviving perinatally infected children older than 9 years followed at the Children's Hospital Acquired Immunodeficiency Syndrome (AIDS) Program (part of a university-based inner city medical center) as of June 1993. The study is based on medical record data of clinical, immunologic, and psychosocial parameters.

Results. The cohort includes 20 boys and 22 girls with a mean age of 136 months. The mean age at diagnosis of HIV infection was 88 months, and 59.5% were asymptomatic at the time of diagnosis. Currently, after a mean follow-up period of 48 months from diagnosis, 23.8% remain asymptomatic, 19.1% have non-AIDS-defining HIV-related symptoms, and 57.1% have AIDS; 85.7% of the cohort did not develop HIV-related symptoms until after 48 months of age (late-onset prolonged survivors). There was an average annual decline of 71.4 CD4+ cells/µL in the cohort from the ages of 7 to 16 years, and 21.4% have a current CD4+ lymphocyte count of greater than 500 cells/µL, 28.6% between 200 and 500 cells/µL, and 50% less than 200 cells/µL; 76% are orphaned as a result of maternal death, with the majority of the cohort (60%) cared for by extended family members. Disclosure of diagnosis has occurred in 57.1%. The vast majority of the cohort (76%) are attending regular school, with the remainder in special education.

Conclusions. Although close to one quarter of the children and adolescents ages 9 to 16 years living with perinatally acquired HIV infection described in this cohort remain asymptomatic and have a relatively intact immune system, the remainder are living with significant HIV-related symptoms, many of which are chronic in nature and have an impact on daily living. The children in this cohort had both significant immunologic deterioration and symptomatic disease progression during the mean follow-up period of 48 months from the time of diagnosis with HIV infection.
INTERNATIONAL LACTATION CONSULTANT ASSOCIATION ANNOUNCES 1996 MANUSCRIPT COMPETITION
Authors: Auerbach K. G.
Published: December 2021

The International Lactation Consultant Association is sponsoring a competition designed to identify outstanding manuscripts relating to human lactation or breastfeeding in 1996. Authors may enter one of two categories: a Literature Review competition or a Research Paper competition. The winner in each category will receive $500 (US currency); winning manuscripts will be published in the Journal of Human Lactation. Entrants need not be members of the International Lactation Consultant Association. Students are encouraged to enter.

Competition in the Research Paper competition is open to published or unpublished authors; the Literature Review competition is limited to currently unpublished authors. The postmark deadline for entry in the 1996 competition is January 5, 1996.

To obtain guidelines for submitting a manuscript for consideration in the competition, send a self-addressed (and stamped if US) envelope to:
Latex Hypersensitivity in Children: Clinical Presentation and Detection of Latex-Specific Immunoglobulin E
Authors: Kwittken Pamela L. , Sweinberg Sharon K. , Campbell Donald E. , Pawlowski Nicholas A.
Published: December 2021

Objective. To better understand the clinical characteristics, diagnosis, and possible prevention of immediate hypersensitivity reactions to latex in a hospitalized, pediatric patient population.

Methods. We performed a retrospective case analysis of the first 35 patients with latex allergy evaluated by our service over a 2-year period at our institution. Characteristics of patients and clinical reactions were analyzed and the presence of latex-specific immunoglobulin E was assessed using in vitro methods. In a limited group of

Objective. To better understand the clinical premedication with steroids and antihistamines was evaluated for the prevention of latex allergic reactions.

Results. The majority of our patients had life-threatening reactions. In previous reports, most pediatric patients underwent reactions in the perioperative period and belonged to two well-recognized "high-risk" patient groups (spina bifida and genitourinary malformations). In our series, 21 patients (60%) had reactions outside of the operating room setting, and 14 patients (40%) had primary diagnoses outside of the previously recognized "high-risk" groups. Many patients had a history of multiple surgical procedures, and a history of a surgical procedure in the first year of life was very common. A pre-existing clinical history of latex allergy was present in only 18 of the 35 patients, and a severe or life-threatening allergic reaction was the presenting feature of latex allergy in 11 of the 35 patients. Using in vitro assays, we were able to detect latex-specific immunoglobulin E in the sera of all but two of our patients. Latex gloves and latex-containing intravenous sets were common triggers for reactions. When exposure to latex occurs systemically, as through an intravenous line, premedication with steroids and antihistamines may fail to protect against anaphylaxis.

Conclusions. Our experience indicates that the incidence of latex hypersensitivity in children is increasing, that the circumstances (patient profile, hospital location, route of exposure) in which life-threatening reactions may occur are more broad than previously reported, and that a better understanding of both environmental sources of latex antigens and host responses to latex exposure are needed for improved prevention of serious reactions.
Acute Isoniazid Neurotoxicity in an Urban Hospital
Authors: Shah Binita R. , Santucci Karen , Sinert Richard , Steiner Phillip
Published: December 2021

In the last 5 months, we have treated two more patients, girls ages 12 and 16, both receiving daily INH therapy for TB prophylaxis, who ingested INH in suicide attempts. One was admitted with status epilepticus and coma and the other with vomiting and abdominal pain.
Prospective Evaluation of Complications of Dorsal Penile Nerve Block for Neonatal Circumcision
Authors: Snellman Leonard W. , Stang Howar J.
Published: December 2021

Objective. To evaluate the complications of the dorsal penile nerve block (DPNB) when used for routine neonatal circumcisions.

Methods. All male newborns born in a community hospital between November 1, 1989 and August 31, 1990, and circumcised after DPNB were evaluated. Questionnaires were completed at the time of hospital discharge and at a health supervision visit 2 weeks later.

Results. Questionnaires were returned for 491 (85%) eligible patients. The only complication of DPNB found was bruising at the site of injection in 54 patients (11%). All bruising had resolved by the 2-week visit, and none was thought to have any clinical significance.

Conclusion. DPNB is a safe method of decreasing the pain and stress of neonatal circumcision.
Telephone Calls to an Infectious Diseases Fellow
Authors: Cotton Mark F.
Published: December 2021

Objective. There is no information on the impact and nature of telephone calls directed to subspecialists. The main objective was to document prospectively all calls directed to a first-year infectious diseases fellow, to determine their content, origin, educational value, and time allocation.

Results. Three hundred fifty-nine calls were received over a 71-day period from March 24 through May 20, 1992. The mean number of daily calls was 5.1 ± 3.3. Mean time per call was 7 ± 5.4 minutes. Cumulatively, 41.7 hours were spent responding to telephone calls. The subgroup with the most calls (44.3%) was from pediatricians in practice. Seventy percent of calls were for advice about case management. Forty percent of calls were considered educational to the fellow.

Conclusions. This study confirms the importance of the infectious disease subspecialist as a resource for primary care physicians.
Cardiac Dysrhythmias and Sports
Authors:   Committee on Sports Medicine and Fitness
Published: December 2021

This Policy Statement was retired October 2008.

Sudden unexpected death during athletic participation is the overriding consideration in advising individuals with dysrhythmias about participation in sports. The incidence of sudden death is 1 to 2 per 200 000 athletes per year and approximately 12 per year in US high school athletes.1 Between 5 and 22% of these deaths occur during sports or physical activities that include basketball, racquetball, jogging, football, soccer, and golf.2 The remainder occur during sedentary activities.2 Another potential risk for the athlete with a dysrhythmia is injury to self or others from syncope or near syncope while playing sports.

The leading cause of sudden unexpected cardiac death is hypertrophic cardiomyopathy.1 A dysrhythmia of ventricular or supraventricular origin may be a significant factor in the sudden unexpected death of these individuals.1 Myocarditis is also a cause of sudden cardiac death. Severe dysrhythmia may be a prominent feature of myocarditis even in the absence of significant cardiac dysfunction.1 This diagnosis should be considered in an individual who has a recent sudden onset of a symptomatic dysrhythmia.3 Ventricular dysrhythmias with exercise are a potential cause of death in individuals with arrhythmogenic right ventricular dysplasia (a rare muscle disorder of the right ventricle).1

Sudden death resulting from dysrhythmia can occur with exertion or excitement in individuals who have hereditary syndromes that include prolongation of the QTc interval.3 Sudden death has also been associated with mitral valve prolapse (rarely) and with Wolff-Parkinson-White syndrome.3

MEDICAL HISTORY

The patient's medical history is of critical importance. Dysrhythmias may be episodic and not apparent at the time of physical examination.
False Allegations of Sexual Touching
Authors: Kaplan Jeffrey
Published: December 2021

I read "False Allegations of Sexual Touching by Physicians in the Practice of Pediatrics" in the November 1994 issue with great interest. The final sentence is the point I wish to emphasize: "In our zeal to help and protect abused patients, the potential for the victimization of innocent pediatricians must be appreciated and minimized." I have personally witnessed more than one practitioner who suffered trial by the press (one doctor was vindicated of a felony charge, he later took his own life).
Letters to the Editor
Authors: Rosendahl Karen , Markestadt Trond
Published: December 2021

We thank Drs Harcke and Walter for their valid comments. We agree that ultrasound has an important role in the detection of developmental dysplasia of the hip (DDH), as we also stated in the conclusion of the paper,1 but we are still uncertain with regard to the use of ultrasound in screening for DDH. In our study universal or selective ultrasound screening possibly had an effect in reducing the rate of late DDH as compared with just clinical screening.1
ADMINISTRATIVE COSTS IN U.S. HOSPITALS
Authors: L. J. F.
Published: December 2021

Background. Previous estimates of administrative costs in U.S. hospitals have been based on figures in California, and nationwide extrapolation has been controversial. If the costs of bureaucracy are high, major policy reforms may yield substantial savings.

Methods. We obtained detailed data on hospital expenses for fiscal year 1990 from reports submitted to Medicare by 6400 hospitals. We calculated each hospital's administrative costs by summing expenses in the following Medicare cost-accounting categories: administrative and general, nursing administration, central services and supply (excluding the purchase cost of supplies), medical records and library, utilization review, and the salary costs of the employee benefits department. We classified costs in most other categories as clinical. Some small categories of expenses (e.g., gift shop) were excluded from both our clinical and administrative groupings, and for others (e.g., plant operations), a proportional share was allocated between the two groupings.

Results. Nationwide, administration accounted for an average of 24.8 percent of each hospital's spending in fiscal 1990. Average hospital administrative costs ranged from 20.5 percent in Minnesota to 30.6 percent in Hawaii. Administrative salaries accounted for 22.4 percent of the average hospital's salary costs. Administrative costs were similar in states with high and low rates of enrollment in health maintenance organizations (HMOs).

Conclusions. Hospital administrative costs in the United States are higher than previous estimates and more than twice as high as those in Canada. Greater enrollment in HMOs, with more competitive bidding by hospitals for managedcare contracts, an important element of proposed managed-competition health care reforms, does not seem to lower hospital administrative costs. N Engl J Med. 1993;329:400-3.
EFFECT OF REACTIVE OXYGEN SPECIES ON THE ERYTHROCYTE CALCIUM-PUMP FUNCTION IN PROTEIN-ENERGY MALNUTRITION
Authors: Okunade W. G. , Olorunsogo O. O.
Published: December 2021

Marasmus is felt to result from a diet that is fairly equally deficient in protein and in calories. In contrast, kwashiorkor is usually explained as being caused by a diet deficient more in proteins than in calories. This explanation for kwashiorkor has been questioned by Golden and Ramdath,1 who suggested that the pathogenesis could be better explained by an imbalance between the quantity of free oxygen radicals and scavengers of those free oxygen radicals. The authors of this paper took anemia as one of the usual clinical features of kwashiorkor and attempted to verify this hypothesis by measuring "the presence of non-heme iron and endogenous products of lipid peroxidation in the erythrocyte membranes of normal and kwashiorkor subjects and assessed the susceptibility of the membranes to exogenously generated reactive oxygen species." The extent of lipid peroxidation in the erythrocytes of kwashiorkor subjects was three times that found in erythrocytes of normal subjects. The erythrocytes from kwashiorkor subjects were much more susceptible to oxidative stress than were the erythrocytes from normal subjects and the oxygen free radicals reduced the erythrocyte calcium-pump function in kwashiorkor subjects to a greater extent than in normal subjects. These findings lend support for the hypothesis of the pathogenesis of kwashiorkor proposed by Golden and Ramdath.
$45 MILLION MALPRACTICE VERDICT
Authors: L. J. F.
Published: December 2021

... A Fairburn family has been awarded $45 million after their son had to have his hands and legs amputated following an HMO's decision to have him treated at a hospital 42 miles from his home.

On March 26, 1993, Lamona Kaye Adams called the company's emergency line about 3:50 a.m. to report that her 6-month-old son, James, was moaning, panting, limp, and running a 104-degree temperature.

After telling her to place the child in a tepid bath, the emergency line nurse checked with a doctor and directed that the child be taken to Scottish Rite Hospital, north of Atlanta. Kaiser Permanente receives a 15% discount for patients at Scottish Rite.

On the way to Scottish Rite, James' heart stopped. He was revived with CPR at another hospital, but circulation ceased to his extremities and he developed gangrene. A blood infection was later diagnosed.

During a nine-day trial in Fulton State Court, Kaiser's lawyers contended that it would have made no difference if James had been sent to the nearest emergency room.

"Our issue is quality," said the Kaiser Permanente medical director for Georgia. "Quality pediatric care was most available at Scottish Rite."

But the Adamses' lawyer called the case an example of what happens when cost-conscious managed-care providers try to cut corners.
Hired Guns and Malpractice Cases
Authors: Rosenbloom Arlan L.
Published: December 2021

I have just read Gloria Schrager's letter in the February issue on medical expertise and John Kattwinkel's reply. My own experience as an expert for both plaintiffs and defendants is littered with examples of "hired guns" testimony by our colleagues. Those of us who have been appalled by this behavior and would be willing to sign contributions about offensive experiences might be able to make a difference. Certainly the lawyers' services will find these articles and would be able to eventually discover who the author was talking about.
WOMEN AND MALARIA—SPECIAL RISK AND APPROPRIATE CONTROL STRATEGY
Authors: Rueben R.
Published: December 2021

The factors that make pregnant women particularly vulnerable to morbidity and mortality with falciparum malaria and their relationship to current control strategies are reviewed. Pregnant women, particularly during their first pregnancy, are at greatest risk of severe falciparum malaria in areas of high and continuous malaria transmission and under conditions of unstable malaria in which they do not develop protective immunity. The author recommends chemoprophylaxis with chloroquine for pregnant women living in holoendemic and hyperendemic areas of Africa and Papua, New Guinea. Chloroquine is safe, but drug resistance has increasingly limited its utility, distribution is a formidable problem. In rural areas where poorly developed health care system are better developed and malaria transmission is less intense, the emphasis should be on early diagnosis and treatment. Women are potentially the key to the implementation of malaria control programs, yet recent studies indicate that underprivileged women frequently do not attend malaria clinics and are often missed in projects with passive surveillance. Additional research and community interventions are needed to enable women with malaria to obtain treatment and to involve them in malaria control measures at the village level.
Accelerated Idioventricular Rhythm: A Benign Arrhythmia in Childhood
Authors: MacLellan-Tobert Susan G. , Porter Co-burn J.
Published: December 2021

Objective. To determine whether accelerated idioventricular rhythm (AIVR) is benign in pediatric patients.

Methods. The records were reviewed of all patients younger than age 15 years who had been diagnosed with a ventricular arrhythmia between 1976 and 1991.

Results. AIVR was diagnosed in 12 patients, ages 1 day to 15 years (mean, 8.9 years). In 3 patients the arrhythmia was discovered on ambulatory electrocardiographic monitoring after presentation with syncope or presyncopal symptoms. One patient had palpitations. The remaining diagnoses were made during routine examinations or at postoperative follow-ups for congenital heart disease. The AIVR rate ranged from 90 to 150 beats per minute. The rate was within 10 beats per minute of the preceding sinus rate in 11 patients. Echocardiograms were normal in 8 patients. Two patients had double-outlet right ventricles; 1 had repair of the tetralogy of Fallot; and 1 had abnormal ventricular septal motion. Seven patients were taking antiarrhythmia medication without control of the AIVR at presentation. Patients were followed for a mean of 68.4 months (range, 31 to 191 months). All patients were alive and asymptomatic, with normal activity at the last follow-ups.

Conclusions. Complete resolution of AIVR may not occur. However, AIVR seems to be a benign arrhythmia. Treatment was not effective in controlling the arrhythmia and is likely unnecessary.
HMOs AND THE NEW HEALERS
Authors: L. J. F.
Published: December 2021

The illness: a pulled muscle.

The health plan's recommendations: A massage and a potion of healing herbs, including minced palmetto berries and chopped valerian root.

The patient's reaction: "Taking valerian root was a lot easier than some heavy prescription which might have knocked me on my tail," says Skip Dane, a professor at Brigham Young University in Provo, Utah, whose recent injury came about when he was lifting weights.

Clearly, this isn't your parents' health plan ...

... Treatments once scorned by the medical establishment (and still viewed warily by many doctors) are gaining coverage from health-maintenance organizations, insurance companies, and health alliances.
Recombinant Tissue Plasminogen Activator Treatment in Two Infants With Fulminant Meningococcemia
Authors: Zenz Werner , Muntean Wolfgang , Gallistl Siegfried , Zobel Gerfried , Grubbauer Hans M.
Published: December 2021

Fulminant meningococcemia defines a life-threatening disease with acute onset, severe septic shock, and progressive hemorrhagic necrosis of the skin. Despite advances in intensive care, the case fatality rate of this disease is still between 30% and 50%.1-5

Disseminated intravascular coagulation (DIC) with deposition of fibrin and histologically demonstrable widespread microvascular thromboses contributes significantly to the pathogenesis.6-9 Impairment of fibrinolysis caused by elevation of plasminogen activator inhibitor 1 (PAI-1), the physiologic inhibitor of tissue plasminogen activator, is part of these clotting abnormalities and has prognostic significance; the extent of elevation of PAI-1 is correlated to the development of shock, renal impairment, and mortality.10,11