bluuebunny/crossref_metadata_2025 huggingface dataset:
Determinants of Fetal Growth and Body Proportionality
Authors: Kramer Michael S. , Olivier Marielle , McLean Frances H. , Dougherty Geoffrey E. , Willis Diana M. , Usher Robert H.
Published: December 2021

Previous studies of fetal growth and body proportionality have been based on error-prone gestational age estimates and on inappropriate comparisons of infants with dissimilar birth weights. Based on a cohort of 8719 infants with validated (by early ultrasonography) gestational ages and indexes of body proportionality standardized for birth weight, potential maternal and fetal determinants of fetal growth and proportionality were assessed. Maternal history of previous low birth weight infants, pregnancy-related hypertension (particularly if severe), diabetes, prepregnancy weight, net gestational weight gain, cigarette smoking, height, parity, and fetal sex were all significantly associated with fetal growth in the expected directions. Consistent with previous reports, maternal age, marital status, and onset or total amount of prenatal care had no significant independent effects. Fetal growth ratio (relative weight for gestational age), pregnancy-related hypertension, fetal sex, and maternal height were the only significant determinants of proportionality. Infants who were growth-retarded, those with taller mothers, those whose mothers had severe pregnancy-related hypertension, and males tended to be longer and thinner and had larger heads for their weight, although these variables explained only a small fraction of the variance in the proportionality measures. Among infants with intrauterine growth retardation, gestational age was not independently associated with proportionality (in particular, late term and postterm infants did not tend to be more disproportional), a finding that does not support the hypothesis that earlier onset of growth retardation leads to more proportional growth retardation. The results raise serious questions about previous studies of proportionality, particularly those suggesting a nutritional etiology for proportional intrauterine growth retardation. They also emphasize the importance of controlling for degree of growth retardation, maternal stature, and pregnancy-related hypertension in evaluating the prognostic consequences of proportionality for mortality, morbidity, and functional performance.
Physical Development and Medical History of Children Who Were Treated Antenatally With Corticosteroids to Prevent Respiratory Distress Syndrome: A 10- to 12-Year Follow-up
Authors: Smolders-de Haas H. , Neuvel J. , Schmand B. , Treffers p. E. , Koppe J. G. , Hoeks J.
Published: December 2021

Potential side effects of antenatal administration of corticosteroids to prevent neonatal respiratory distress syndrome were studied in 10- to 12-year-old children whose mothers had participated in a randomized, double-blind, placebo-controlled trial of betamethasone. The children had a general physical examination; parents were interviewed about the medical history of their child with special attention to infectious diseases; growth data were collected; and a developmental neurological examination, an ophthalmological examination, and a lung function test were conducted. In the corticosteroid group significantly more hospital admissions because of infectious diseases during the first years of life were reported. On the other variables no differences between the corticoid and the placebo groups were found.
Nifedipine Poisoning in a Child
Authors: Wells Thomas G. , Graham Charles J. , Moss M. Michele , Kearns Gregory L.
Published: December 2021

A 14-month-old child ingested approximately 800 mg (70 mg/kg) of nifedipine. When first examined, the child was unresponsive, markedly hypotensive, and hyperglycemic. According to electrocardiographic results, there was a third-degree atrioventricular block that rapidly progressed to cardiac arrest. Following successful cardiopulmonary resuscitation, mechanical ventilation and resuscitation with intravenous normal saline, calcium chloride and dopamine were required to restore perfusion, reverse metabolic acidosis, and stabilize vital signs. Complications related to nifedipine intoxication included the development of pulmonary edema and possible infarction in the posterior parietal and occipital lobes associated with cortical blindness and the development of seizures with an abnormal electroencephalogram. The patient recovered without clinically apparent residua. Massive nifedipine overdose in infants represents a potentially life-threatening event that requires prompt medical attention. Reported cases of nifedipine intoxication were reviewed and therapeutic interventions Received for publication Jan 23, 1989; accepted Aug 16, 1989. were discussed.
Distinguishing Sepsis From Blood Culture Contamination in Young Infants With Blood Cultures Growing Coagulase-Negative Staphylococci
Authors: Geme Joseph W. St , Bell Louis M. , Baumgart Stephen , D'Angio Carl T. , Harris Mary Catherine
Published: December 2021

Coagulase-negative staphylococci represent the most common cause of serious nosocomial infection in many intensive care nurseries. However, these organisms are also common blood culture contaminants. To determine the value of quantitative blood cultures in distinguishing sepsis from culture contamination, we reviewed records of all infants in our nurseries who had peripheral blood isolates of coagulase-negative staphylococci during a 3-year period. Twenty-three episodes of sepsis were identified in 21 infants, and 10 infants had blood culture contamination. Colony counts from the initial peripheral blood culture were significantly different for the two study groups (P < .001). In 9 of 23 episodes of sepsis, the initial peripheral blood culture grew >100 colony-forming units (cfu) per mL. In the other 14 episodes, the initial culture yielded ≤50 cfu/mL. All 10 infants with culture contamination had colony counts of <50 cfu/mL, and in 9 the initial peripheral blood culture grew <20 cfu/mL. Infants with sepsis, including those with colony counts of ≤50 cfu/mL, were significantly more likely to have a central catheter or an abnormal hematologic value or both (P < .05). Infants who lacked these clinical features were more likely to have contamination. We conclude that quantitative blood cultures in conjunction with specific clinical information may distinguish sepsis from culture contamination with coagluase-negative staphylococci in young infants. In addition, low colony-count growth should not be ignored as contamination in this high-risk population.
Subdural Effusion and Its Relationship With Neurologic Sequelae of Bacterial Meningitis in Infancy: A Prospective Study
Authors: Snedeker Jeffrey D. , Kaplan Sheldon L. , Dodge Philip R. , Holmes Sandra J. , Feigin Ralph D.
Published: December 2021

One hundred thirteen infants, aged 1 to 18 months, were screened systematically and serially using transillumination for the presence of subdural effusion during acute bacterial meningitis due to Haemophilus influenzae type b, Streptococcus pneumoniae, or Neisseria meningitidis. Effusion developed in 44 (39%) of the patients during the course of treatment. Young age, rapid onset of illness, low peripheral white blood cell count, and high cerebrospinal fluid levels of protein and bacterial antigen were associated with a higher likelihood of developing effusion. Although patients with effusion were more likely to have neurologic abnormalities both at the time of admission and at completion of therapy, and were more likely to have seizures during the course of treatment, there was no greater incidence of seizures, hearing loss, neurologic deficits, or developmental delay on long-term follow-up (median follow-up interval 5.5 years) in patients with effusion. Specific invasive therapy is not indicated in infants with meningitis and subdural effusion who are otherwise improving.
Infant Mortality: A Practical Approach to the Analysis of the Leading Causes of Death and Risk Factors
Authors: Dollfus Catherine , Patetta Michael , Siegel Earl , Cross Alan W.
Published: December 2021

The analysis of infant mortality data provides an opportunity for developing preventive strategies to improve this indicator of a population's health. All infant deaths in North Carolina during a 5-year period (1980 through 1984) were analyzed using the International Classification of Diseases, 9th revision (ICD-9), and a system for linked birth and death records that allows the analysis of birth certificate information on deaths. Causes of death were aggregated based on common etiology such as prematurity or obstetric-related conditions rather than the more traditional organ system taxonomy of the ICD-9 codes. Analyses were carried out separately for very low birth weight (≤1500 g), moderately low birth weight (1501 through 2500 g), and normal birth weight (>2500 g) babies. Maternal characteristics identified from the birth certificate were also compared with the different causes of death. Prematurity-related conditions accounted for 37.5% of all deaths, ranking far above the 17.4% for congenital anomalies and 12.9% for sudden infant death syndrome. For normal birth weight babies, sudden infant death syndrome ranked first, followed by congenital anomalies and nonperinatal infections. For the moderately low birth weight babies, congenital anomalies ranked first, with sudden infant death syndrome second and prematurity-related conditions third. For the very low birth weight babies, prematurity-related conditions accounted for nearly 70% of the deaths, with obstetric conditions and congenital anomalies ranking second and third, respectively. Maternal risk factors identified an overrepresentation of nonwhite, unmarried, and young teenage mothers and mothers with less than adequate prenatal care. This system for analyzing infant deaths provides an opportunity to devise preventive strategies by identifying common underlying conditions, such as prematurity, that account for a high proportion of deaths.
Should Promethazine in Liquid Form Be Available Without Prescription?
Authors: Hickson Gerald B. , Altemeier William A. , Clayton Ellen W.
Published: December 2021

Promethazine, available by prescription only since its introduction in 1946, has been widely used for pediatric patients because of its antihistaminic, antiemetic and sedative properties. Recently, it's makers have sought Federal Drug Administration approval to introduce two liquid over the counter allergy/cold/cough products containing promethazine as an active ingredient. Although millions of doses have been administered, promethazine use has not been free of risk. Promethazine has been reported to cause significant sedation, agitation, hallucinations, seizures, dystonic reactions, and possibly apparent life-threatening events or sudden infant death syndrome. The impact of these relatively uncommon adverse reactions on children would be minimal if parents would use over the counter promethazine only for appropriate indications and only in children greater than 2 years of age. However, according to results of research evaluating the use of various over the counter medications by families for their children, promethazine will be used inappropriately. Both its over the counter status, implying a certain margin of safety, and its formulation as a syrup, providing ease of administration, should increase its use in all age groups including that by children less than 2 years of age who may be most vulnerable to the adverse reactions associated with the drug's use.
Relative Efficacy of Long-Acting Stimulants on Children With Attention Deficit-Hyperactivity Disorder: A Comparison of Standard Methylphenidate, Sustained-Release Methylphenidate, Sustained-Release Dextroamphetamine, and Pemoline
Authors: Pelham William E. , Greenslade Karen E. , Vodde-Hamilton Mary , Murphy Debra A. , Greenstein Jonathan J. , Gnagy Elizabeth M. , Guthrie Karen J. , Hoover Michele D. , Dahl Ronald E.
Published: December 2021

Twenty-two children with attention deficit-hyperactivity disorder underwent a double-blind, placebo-controlled, crossover evaluation of the efficacy of standard methylphenidate twice a day and comparable doses every morning of a sustained-release preparation of methylphenidate (SR-20 Ritalin), a sustained-release form of dextroamphetamine (Dexedrine Spansule), and pemoline. The children were participating in a summer treatment program in which they engaged in recreational and classroom activities. Dependent measures include evaluations of social behavior during group recreational activities, classroom performance, and performance on a continuous performance task. Results revealed generally equivalent and beneficial effects of all four medications. Dexedrine Spansule and pemoline tended to produce the most consistent effects and were recommended for 10 of the 15 children who were responders to medication. The continuous performance task results showed that all four medications had an effect within 2 hours of ingestion, and the effects lasted for 9 hours. The implications of these results for the use of long-acting stimulant medication in children with attention deficit-hyperactivity disorder are discussed.
Sucrose and Delinquency: Behavioral Assessment
Authors: Bachorowski Jo-Anne , Newman Joseph P. , Nichols Sharon L. , Gans Dian A. , Harper Alfred E. , Taylor Steve L.
Published: December 2021

In this study, a double-blind challenge design was used to evaluate the hypothesis that sucrose ingestion may compromise the behavioral performance of juvenile delinquents. Subjects were 58 white delinquents, 57 black delinquents, and 39 white nondelinquents. The behavioral assessment included tasks that are relevant to delinquency and that might be expected to be disrupted following sucrose ingestion. The results provide no evidence that sucrose ingestion impairs the performance of juvenile delinquents. In fact, the results of several analyses indicated that the sucrose breakfast was associated with improved performance. In additional analyses the effect of sucrose on particular subgroups of juvenile delinquents was evaluated. Statistical interactions indicated that the performance of delinquents rated as more behaviorally disturbed benefited from sucrose ingestion, whereas those delinquents with less pronounced behavior problems tended to show impaired performance following a sucrose-loaded breakfast. These results indicate that simple statements regarding the effects of sucrose ingestion on behavior are likely to be misleading and highlight the need to consider individual difference variables when investigating the effects of sucrose on juvenile delinquents.
Rapid Loading of Critically III Patients With Carbamazepine Suspension
Authors: Miles Michael V. , Lawless Stephen T. , Tennison Michael B. , Zaritsky Amo L. , Greenwood Robert S.
Published: December 2021

To determine the rate and factors that affect carbamazepine absorption, six patients being treated in the pediatric intensive care unit for frequent seizures received loading doses (7.4 to 10.4 mg/kg) of carbamazepine suspension by either nasogastric or nasoduodenal tube. Carbamazepine serum concentrations were determined 15, 30, 60, 120, and 480 minutes after administration by fluorescence polarization immunoassay. One patient who had an ileus did not attain therapeutic concentrations (> 4.0 mg/L). The other five patients with normal gastrointestinal function achieved mean serum concentrations at 1 hour and 2 hours of 4.3 mg/L and 7.3 mg/L, respectively. Delayed gastric emptying and concurrent enteral feedings appear to slow the absorption of carbamazepine. No adverse effects were observed. Rapid loading with carbamazepine suspension appears to be a useful alternative for the management of critically ill pediatric patients who are experienced frequent seizures.
The Total Costs of Ultrasonography Summary
Authors: BAILLE MICHAEL D.
Published: December 2021

To the Editor.—

In a recent article, Sheih et al.1 suggest that renal ultrasonography may provide a simple and cost-effective tool for screening large populations for renal abnormalities. However, two additional cost factors need to be taken into consideration. First, there is the cost of the further evaluation of the 595 patients (of 635) who did not need surgery. At a minimum they had another ultrasonographic examination. Second, the authors imply that the 50 patients who underwent surgery were saved from the cost of treatment of renal failure.
The Total Costs of Ultrasonography Summary
Authors: SHEIH CHUNG-PIN , LIN CHING-YUANG
Published: December 2021

In Reply.—

In our article, we reported on 645 renal abnormalities found in 132 686 school children screened through the use of renal ultrasonography. Of those with renal abnormalities, 50 patients had surgically correctable lesions. The other 595 cases have been examined fully to establish the correct diagnosis and the prevalence of renal abnormalities in school children. However, in this study, the cost to benefit ratio was determined by total expense to number of surgically treatable diseases.
Is It a New Syndrome or Due to Overstimulation in the ICU?
Authors: PERLMAN JEFFREY , VOLPE JOSEPH J.
Published: December 2021

In Reply.—

We appreciate the interest in our recent article that identified a previously unrecognized movement disorder in infants with bronchopulmonary dysplasia. We suspect from Dr Cole's comments that she can confirm some of our observations. However, her use of imprecise language makes it difficult to draw such a conclusion decisively. We refer to language such as "frantic movement," "disorganization in the motor system," "attempt to re-organize," "attempt to defend themselves from a stressful environment," "overtaxed autonomic system," "behavioral disorganization," "tongue thrusting... a learned behavioral response to stress," and "autonomic disorganization."
Antacid Poisoning
Authors: DEB SIDDHARTHA
Published: December 2021

To the Editor.—

Dr J. Brand and Dr F. Greer's discussion of a case of hypermagnesemia and intestinal perforation following antacid administration in a premature infant1 can be misleading to physicians who may need to use antacids for treating their patients. The patient in consideration was receiving 18 mL/kg/d of antacids. This is equivalent to more than a liter of antacids per day for an average adult weighing 60 kg.

The management of bleeding of the upper gastrointestinal tract would include the use of H2 receptor blocking agents and usually 2 to 4 mL of antacids or more per kg per day to keep the gastric pH value above 5. Hence, the complications in the baby discussed are secondary to massive overdosage and toxicity of the antacids and to not following routine antacid administration.
Familial Liability to Intrauterine Vascular Impairments
Authors: HENNEKAM RAOUL C. M. , HOFSTEE NIEK
Published: December 2021

To the Editor.—

In 1987 in Pediatrics, Stevenson and co-workers discussed the hypothesis that neural tube defects may be produced by inadequate nutrient supply to the rapidly growing neural folds due to primary vascular abnormalities.1 Recently, we found another family which may support this hypothesis (Figure).

The proposita (Figure, III, 2) was a 5-month-old second-born child of healthy nonconsanguineous parents. The pregnancy and delivery were uneventful. Birth weight was 3630 g (75th percentile), length was 50 cm (50th percentile), and skull circumference 36 cm (75 percentile).
Familial Liability to Intrauterine Vascular Impairments
Authors: STEVENSON ROGER E.
Published: December 2021

In Reply.—

Families such as the one reported by Hennekam and Hofstee provide the initial evidence that congenital anomalies produced through vascular pathogenesis may have a heritable basis. This evidence conflicts with the prevailing view that vascular pathogenesis implies environmental causation and, hence, a negligible recurrence risk.

Exclusive claim to any pathogenetic mechanism producing human anomalies must not be assigned to any etiology, heritable or environmental, at this point in our understanding of human development.
Cognitive and Behavioral Sequelae of Mild Head Injury in Children
Authors: Bijur Polly E. , Haslum Mary , Golding Jean
Published: December 2021

Data from a longitudinal study of 13 000 British children were used to assess the sequelae of mild head injury 1 to 5 years after injury. One hundred fourteen children with parental reports of mild head injury treated with ambulatory care or admission to hospital for one night were compared with 601 children with limb fractures, 605 with lacerations, 136 with burns, and 1726 children without injury. Scores at age 10 were adjusted for intelligence, aggressive and hyperactive behavior at age 5, sex, socioeconomic status, and six other social factors. Children with head injuries were statistically indistinguishable from uninjured children on all outcomes except teacher's report of hyperactivity. After control of hyperactivity at age 5 and the social and personal factors, the head-injured children's mean hyperactivity score was four tenths of a standard deviation above that of the uninjured children. Children with lacerations and burns scored as badly or worse on measures of intelligence, mathematics, reading, and aggression as the children with head injuries. The small magnitude of the hyperactivity association coupled with the overall negative results suggests that mild head injury in school-aged children does not have an adverse effect on global measures of cognition, achievement, and behavior 1 to 5 years after injury.
Routine Admission Urinalysis Examination in Pediatric Patients: A Poor Value
Authors: Mitchell Nancy , Stapleton F. Bruder
Published: December 2021

The urinalysis has long been considered an important screening test for hospitalized children. The value of the admission urinalyses, required by hospital bylaws, was assessed for detecting urinary tract disease in children admitted to a day-care unit or impatient medical or surgical services during the months of June and November 1987. Of 2695 admissions, urinalyses were considered essential for diagnosis or therapy in 543 patients (excluded from analysis). In the remaining 2152 patients eligible for screening, urinalyses were obtained in 145 (30%) of day-care unit and 587 (35%) of inpatient admissions. The results of 149 (20%) of screening urinalyses were abnormal (23% abnormal in inpatient and 10% abnormal in day-care unit admissions). The numbers of urinalyses with abnormal results were similar in surgical and medical admissions and between the months of June and November. Pyuria (90 patients) and hematuria (66 patients) were the most common abnormalities in initial urinalyses. Follow-up urinalyses and other diagnostic studies were obtained in 38% of patients with abnormal admission urinalysis results. In subsequent urinalyses, 58% showed persistent abnormalities; however, most subsequent abnormal results were not pursued with additional tests. Urinary tract infections were diagnosed in 6 patients. No other additional diagnoses were determined. The cost of initial urinalyses and subsequent diagnostic studies in these 732 patients during the 2 months was $23 465. The cost per diagnosis of urinary infection was $3911. It is concluded that when hospital bylaws require routine urinalyses at the time of admission, this requirement is frequently ignored and, in addition, abnormal results are often unappreciated or not pursued. In the medical center studied, this screening test was costly and had little apparent benefit in detecting renal disease.
Semipermeable Dressing and Transepidermal Water Loss in Premature Infants
Authors: Vernon Hazel J. , Lane Alfred T. , Wischerath Linda J. , Davis Jonathan M. , Menegus Marilyn A.
Published: December 2021

Within the first days of life, 10 infants, of 32 weeks' gestational age or less, began 2 weeks of treatment with a semipermeable wound dressing over a small area of skin. The effects of the dressing on transepidermal water loss and cutaneous microflora were evaluated. Transepidermal water loss from the semipermeable dressing-treated skin was significantly less than that from the untreated skin immediately after placement of the dressing (8.1 ± 1.8 g/m2 · h-1 vs 17.7 ± 3.5 g/m2 · h-1, P < .0001). The normal accelerated skin maturation process that occurs in these infants continued beneath the semipermeable dressing. The number of gram-negative bacilli or other bacteria did not increase beneath the semipermeable dressing beyond that seen on the untreated site. Malassezia furfur was found only on the control site, never beneath the semipermeable dressing. According to results of this preliminary study, a semipermeable dressing can be safely used in premature infants and the use of a semipermeable dressing may decrease the excessive transepidermal water loss associated with prematurity.
Diabetes Mellitus in Patients With Cystic Fibrosis: Effect on Survival
Authors: Reisman J. , Corey M. , Canny G. , Levison H.
Published: December 2021

Patient data obtained from the cystic fibrosis clinic of the Hospital for Sick Children (Toronto, Canada) over the period 1977 to 1988 were analyzed to compare the diabetic and nondiabetic cystic fibrosis patients. The pulmonary function, nutritional status, and survival data for 713 patients who attended the clinic over the 11-year period are reported. Insulin-dependent diabetes was found to exist in 37 (5.2%) of 713 patients. The patient age at time of diabetes diagnosis ranged from 2 to 34 years, with a mean ± SD of 20.0 ± 7.4 years. Patients who died in both the diabetic and nondiabetic groups had worse pulmonary and nutritional status than the surviving patients, but there were no significant differences between the diabetic and nondiabetic groups in those who died or in those who remained alive. Survival analysis showed a similar prognosis in the diabetic and nondiabetic groups. It is concluded that cystic fibrosis patients with diabetes are, for their age, not different from patients without diabetes with respect to pulmonary function, nutritional status, and survival.
Genital Findings in Prepubertal Girls Selected for Nonabuse: A Descriptive Study
Authors: McCann John , Wells Robert , Simon  , Voris Joan
Published: December 2021

This project was designed to collect normative data on the genital anatomy from a sample of nonabused prepubertal girls. A total of 114 girls between the ages of 10 months and 10 years were examined and photographed with a colposcope. After screening for the onset of puberty and the possibility of undetected abuse, 93 subjects remained. Examination techniques included a supine labial separation approach, a supine labial traction method, and a prone knee-chest position. Common genital findings included erythema of the vestibule (56%), periurethral bands (50.6%), labial adhesions (38.9%), lymphoid follicles on the fossa navicularis (33.7%), posterior fourchette midline avascular areas (25.6%), and urethral dilation with labial traction (14.9%). The hymenal orifice opened more frequently during the knee-chest (95.2%) and the labial traction (90.5%) methods than with the supine separation (79.3%) approach. Hymenal findings included mounds (33.8%), projections (33.3%), and "septal remnants"/midline hymenal tags (18.5%). Intravaginal findings of vaginal ridges (90.2%) and rugae (88.7%) were found primarily through the labial traction approach. The cervix was visualized without the use of a speculum in 69% of the children during the knee-chest examination. Unusual findings included posterior fourchette friability (4.7%), anterior hymenal clefts (1.2%), and notches of the hymen (6%). One child had an imperforate hymen (1.2%) and 2 (2.5%) had hymenal septa. A vaginal discharge was detected in 2 (2.6%) and a foreign body in 1 (1.3%). Tables that include the vertical and horizontal hymenal orifice diameters by age group and by method are presented.
Midazolam-Fentanyl Intravenous Sedation in Children: Case Report of Respiratory Arrest
Authors: Yaster Myron , Nichols David G. , Deshpande Jayant K. , Wetzel Randall C.
Published: December 2021

Children undergoing diagnostic or therapeutic procedures are often frightened and uncooperative. This fear may be exacerbated by parental anxiety, by separation from parents, and by pain or the anticipation of pain from the procedure itself. To achieve satisfactory sedation and analgesia, various drugs administered alone and in combination have been recommended using either an oral,1 intramuscular,2-5 intravenous,6-8 or a rectal9,10 route of administration. Although each has some purported advantage, none of the drugs or techniques that are currently available are absolutely safe or completely reliable.11-14 Because of this concern for safety and efficacy, many children experiencing procedure-related pain are often inadequately treated with analgesics and are immobilized primarily by physical restraint.
Letter to the Editor
Authors: Higgins Sarah S. , Hardy Christian E. , Higashino Stanley M.
Published: December 2021

The points outlined by Rosenberg and Kisson in their Letter-to-the-Editor regarding our CPR study are interesting comments that reflect personal views and biases associated with their experience with this problem.

Their first point mentions that our survival data following CPR attempts exceeds that which is in the literature. We acknowledged that in our literature review. However, our study demonstrated a 46% reported survival statistic.

The second point regarding the potential for parents to initiate CPR erroneously was not indicated as an issue by any of the respondents in our study.
Perinatal Drug Abuse
Authors: Silber Tomas J. , D'Angelo Lawrence J.
Published: December 2021

Chavkin and Kandall forcefully point out that a growing number of adolescent and young adult women who use drugs and alcohol during their pregnancy are indeed untreated.1 A contributory factor to this situation is the fact that their drug use had not been detected prior to the pregnancy. A new way of thinking is needed to deal with this problem. In the same issue of Pediatrics, one recognized leader in the field of substance abuse after another alert us to the need for a critical reconsideration of the American Academy of Pediatrics' Committee recommendations on screening.2,3
A Pediatrician's Personal Reflections on Varicella
Authors: Gospe Sidney M.
Published: December 2021

Primary varicella infection in adults is uncommon, and the severity of this typically childhood illness can be significant. The use of varicella-zoster immune globulin (VZIG) to modify infection in either susceptible adults or compromised hosts who have been exposed to varicella is recommended.1

It is estimated that approximately 4% of the urban adult population is susceptible to varicella infection2; however some hospital worker screening studies have indicated slightly higher rates.3,4 This figure would suggest that of the approximately 1650 individuals embarking on a career in pediatrics each year,5 66 of them would be at risk for contracting chickenpox either during their residency or early in their years of practice.
The UCLA-University of Utah Epidemiologic Survey of Autism: Prenatal, Perinatal, and Postnatal Factors
Authors: Mason-Brothers Anne , Ritvo Edward R. , Pingree Carmen , Petersen P. Brent , Jenson William R. , McMahon William M. , Freeman B. J. , Jorde Lynn B. , Spencer Mary J. , Mo Amy , Ritvo Anne
Published: December 2021

In a recent epidemiologic survey conducted in Utah, 241 autistic patients (DSM-III criteria) were found. Medical records of 233 autistics were surveyed for the presence of 36 potentially pathologic prenatal, perinatal, and postnatal factors. These results were compared with those of an identical survey of 62 of their nonautistic siblings, with the results of four previously published surveys, and with normative data. No potentially pathologic factor or group of factors occurred significantly more frequently among the autistic patients. Also, previous observations of significant differences in the occurrence of certain factors in the histories single vs multiple siblings with autism were not confirmed, with the exception of increased viral-type illness during gestation in single-incidence cases. Thus, the etiology of the brain pathology that characteristically disrupts normal development and produces the syndrome of autism remains obscure. Other data from the epidemiologic survey, however, suggest that the role of genetic factors needs to be explored further.
Safety and Immunogenicity of Haemophilus influenzae Type b Oligosaccharide-CRM197 Conjugate Vaccine in Infants Aged 15 to 23 Months
Authors: Madore Dace Viceps , Johnson Cynthia L. , Phipps Donna C. , Myers Martin G. , Eby Ronald , Smith David H. ,   Pennridge Pediatric Associates
Published: December 2021

A total of 268 infants aged 15 to 23 months received one dose of a vaccine composed of Haemophilus influenzae type b oligosaccharides covalently linked to the nontoxic diphtheria toxin variant CRM197 (HbOC; HibTITER). Side effects associated with vaccination were infrequent, transient, and mild. One month after a single vaccination, the anti-H influenzae type b capsular polysaccharide antibody concentration rose from a geometric mean prevaccination level of 0.20 µg/mL to 13.77 µg/mL. Of these infants, 99% had a postvaccination level greater than or equal to 1.00 µg/mL, a level associated with long-term protection. The immune response was long-lived: all of the children who were monitored 17 to 27 months after vaccination had concentrations greater than or equal to 1.00 µg/mL. The anti-H influenzae type b capsular polysaccharide antibody generated was predominantly of the IgG isotype and IgG1 subclass. The immune sera had bactericidal activity in vitro and conferred passive protection in the infant rat meningitis model.
Substance Abuse Education in Pediatrics
Authors: Adger Hoover , McDonald Eileen M. , DeAngelis Catherine
Published: December 2021

Historically, physicians have received little formal education related to alcohol or other drug abuse and dependence. A survey of all pediatric programs in the United States was conducted to assess the current status of alcohol/drug education in pediatrics. At the medical student and residency training levels, only 44% and 40% of programs, respectively, required any formal instruction, and only 27% and 34%, respectively, offered an elective for medical students or residents. Although most respondents endorsed the inclusion of both required and elective alcohol and drug education in the curriculum, few programs that did not include it already had a future plan for it. Major impediments identified were curriculum time constraints (86% medical student level, 68% resident level) and the lack of a qualified instructor (55% medical student level, 50% resident level). The survey results suggest a strong need for development of faculty and structured alcohol and drug abuse educational plans specific to pediatrics.
Real-Time Ultrasound and Color-Doppler Imaging in Pulmonary Sequestration
Authors: NEWMAN BEVERLEY
Published: December 2021

Pulmonary sequestrations are congenital masses of aberrant, nonfunctioning pulmonary tissue that usually do not connect with the bronchial tree and derive their arterial blood supply from systemic vessels, most often the distal thoracic or upper abdominal aorta. The majority of sequestrations are intralobar and contained within the visceral pleura of the normal lung; these usually have their venous drainage to the pulmonary venous system. Extralobar sequestrations have a separate pleural covering and usually drain to systemic veins or the portal venous system.1-3 Patients most often come to clinical attention with repeated respiratory infections.2 The sequestered segment is usually visualized radiographically as a nonaerated opacity at the medial lung base, more often left-sided.
Prehospital Care for Victims of Submersion
Authors: BUSHORE MARTHA
Published: December 2021

In this issue of Pediatrics is a study1 that represents a milestone in the growth and development of Emergency Medical Services for Children systems. Linda Quan and co-workers provide us with a study of victims of submersion who were less than 20 years of age and who received care during a 10-years interval in an Emergency Medical Services unit and required hospitalization or died. Because the majority of these submersions occurred in the urban setting of King Country with the rapid response of Emergency Medical Services units and reliable recording of cardiopulmonary resuscitation (CPR) data, the study results are impressively complete.
Improving Access to Health Care for Children, Youth, and Pregnant Women
Authors: NEWACHECK PAUL W.
Published: December 2021

Twenty-five years ago it seemed that America was on the verge of universal health care coverage.1 A large and growing number of workers and their dependents had gained employer-based health insurance coverage.2 Medicaid and Medicare were enacted to serve the needs of those who did not work—notably the poor and the elderly. Direct service programs, such as community health centers, maternal and infant care projects, and children and youth projects, were also established in the mid-1960s to serve low-income families. At the time, it appeared that this pluralistic approach to financing health care was leading to universal access to health care.
Practical Significance of Lactose Intolerance in Children: Supplement
Authors:   Committee on Nutrition
Published: December 2021

Since the Committee on Nutrition issued its first statement on "The Practical Significance of Lactose Intolerance in Children" in 1978,1 there have been a few interesting clinical advances in our knowledge of the digestion of lactose. We suggest that the original statement be reviewed to provide a framework for the information presented here.

Lactose is a disaccharide that is present in almost all mammalian milks. It is digested in the small bowel by the lactase located on the brush border of the enterocyte. On digestion, lactose is broken down into two components, glucose and galactose. If lactose is not digested or is digested minimally, the intact sugar moves into the large bowel where it is fermented by enteric bacteria. This fermentation produces acids, carbon dioxide, methane, and hydrogen, and usually results in borborygmi and abdominal discomfort. Lack of digestion of lactose results in an increased number of solute particles in the large bowel with a concomitant increase in osmotic pressure. It has been suggested that the diarrhea associated with lactose intolerance occurs when the capacity of the bacteria to metabolize carbohydrate in the colon has been exceeded.2 Consequently, there is a flow of fluid into the lumen of the bowel with a resultant watery, fermentative diarrhea. These clinical signs and symptoms represent lactose intolerance, a condition that results from malabsorption and lack of digestion of lactose.

There are two useful clinical tests for lactose malabsorption. One test measures the increase in the concentration of glucose in blood following administration of a load of lactose (1 g/kg up to 50 g/kg, equivalent to a liter of milk).
Bacterial Flora of "Normal" Sinuses
Authors: Brook Itzhak
Published: December 2021

To the Editor.—

I read with interest the study by Arruda et al1 concerning the recovery of organisms from maxillary sinuses. The authors were able to isolate bacteria from 6 (29%) of the 21 patients with normal maxillary sinus radiographs. These findings support our earlier observation in which we recovered aerobic and anaerobic bacteria in uninfected maxillary sinuses.2 The colonization of the sinus cavity with oral flora may explain the chain of events that lead to infection.
Bacterial Flora of "Normal" Sinuses
Authors: Arruda L. Karla , Solé Dirceu , Weckx L. M. , Naspitz Charles K. , Mimica Igor M.
Published: December 2021

In Reply.—

In our opinion, the nonsterility of the normal maxillary sinuses has not been resolved completely, in part because of the obvious difficulties in performing maxillary sinus punctures in healthy individuals. We have recovered high titers of bacteria in sinus aspirates of 28.6% of our patients with normal maxillary sinus x-rays. However, all the children in our study had chronic tonsillitis and/or adenoids enlargement, and therefore our results only apply to children with those underlying conditions.
Access to Medical Care for Children and Adolescents in the United States
Authors: Wood David L. , Hayward Rodney A. , Corey Christopher R. , Freeman Howard E. , Shapiro Martin F.
Published: December 2021

To evaluate access to health care for American children and adolescents, a telephone survey of a national random sample of households was conducted in which 2182 children 17 years or younger were studied. Approximately 10% had no medical insurance; 10% had no regular source of care; and 18% identified emergency rooms, community clinics, or hospital outpatient departments as their usual site of medical care. Children who were uninsured, poor, or nonwhite were less likely to have seen a physician in the past year (P < .001), and uninsured children were less likely to have up-to-date immunizations. Logistic regression analyses revealed that poor, uninsured, or nonwhite children less frequently had a regular source of care; more frequently used emergency rooms, community clinics, and hospital outpatient departments as their regular providers; and more frequently encountered financial barriers to health care. Low-income or nonwhite children had much less access to care compared with children from more affluent or white families, independent of insurance status or health status.
Transbronchial Biopsies in Children After Heart-Lung Transplantation
Authors: Scott John P. , Higenbottam Tim W. , Smyth Rosalind L. , Whitehead Bruce , Helms Peter , Fradet Guy , De Leval Marc , Wallwork John
Published: December 2021

Sixty transbronchial biopsies have been performed in eight children after heart-lung transplantation. The selection of fiber-optic bronchoscope or a small (4 mm; 30 cm) rigid bronchoscope was made according to the size of endotracheal tube required at surgery. If the endotracheal tube was size 7.5 or greater, a fiber-optic bronchoscope was used, whereas if the endotracheal tube size was below 7, a rigid bronchoscope was used. For the diagnosis of lung rejection, the histology of biopsies revealed a sensitivity of 91% and specificity of 69% (similar to the result in adults). The histology also distinguished lung infection from rejection. Complications included three pneumothoraces and two clinically significant episodes of hemorrhage, one of which led to a cardiorespiratory arrest, which may have been caused by hypoxia. As a result, arterial oxygen saturation is now monitored during the procedure using a pulse oximeter.
Impact of Intrauterine Growth Retardation and Body Proportionality on Fetal and Neonatal Outcome
Authors: Kramer Michael S. , Olivier Marielle , McLean Frances H. , Willis Diana M. , Usher Robert H.
Published: December 2021

Previous prognostic studies of infants with intrauterine growth retardation (IUGR) have not adequately considered the heterogeneity of IUGR in terms of cause, severity, and body proportionality and have been prone to misclassification of IUGR because of errors in estimation of gestational age. Based on a cohort of 8719 infants with early-ultrasound-validated gestational ages and indexes of body proportionality standardized for birth weight, the consequences of severity and cause-specific IUGR and proportionality for fetal and neonatal morbidity and mortality were assessed. With progressive severity of IUGR, there were significant (all P < .001) linear trends for increasing risks of stillbirth, fetal distress (abnormal electronic fetal heart tracings) during parturition, neonatal hypoglycemia (minimum plasma glucose <40 mg/dL), hypocalcemia (minimum Ca <7 mg/dL), polycythemia (maximum capillary hemoglobin ≥21 g/dL), severe depression at birth (manual ventilation >3 minutes), 1-minute and 5-minute Apgar scores ≤6, 1-minute Apgar score ≤3, and in-hospital death. These trends persisted for the more common outcomes even after restriction to term (37 to 42 weeks) births. There was no convincing evidence that outcome among infants with a given degree of growth retardation varied as a function of cause of that growth retardation. Among infants with IUGR, increased length-for-weight had significant crude associations with hypoglycemia and polycythemia, but these associations disappeared after adjustment for severity of growth retardation and gestational age. Increased length-for-weight and head circumference-for-weight, however, were associated with slightly increased risks of stillbirth and fetal distress, respectively, even after adjustment. It is concluded that IUGR, especially when severe and regardless of cause, is an important determinant of numerous adverse metabolic and asphyxic fetal and neonatal outcomes. Disproportionality is a proxy for severe IUGR and carries little or no additional risk.
Development and Validation of an Index for Scoring Baseline Respiratory Disease in the Very Low Birth Weight Neonate
Authors: Palta Mari , Gabbert Debra , Fryback Dennis , Widjaja Indra , Peters Mary Ellen , Farrell Philip , Johnson Janis ,   Other Members of the Severity Index Development and Validation Panels and of the Newborn Lung Project
Published: December 2021

An accurate description of the population at risk for neonatal chronic lung disease is clearly of prime importance for comparative studies and the planning of interventions. Attempts to explain variations in chronic lung disease rates in such studies have been compromised by lack of a way of estimating the severity of the initial pulmonary disease as a risk factor. Therefore, a severity index was developed for use in very low birth weight (<1501 g) neonates. Special emphasis was placed on applicability of the index in the multicenter observational setting. Development followed a clinician panel approach, with the resulting index designed to capture clinical judgment of severity. The index was validated prospectively on neonates in a neonatal intensive care unit, and retrospectively using charts from nine hospitals nationwide. Correlations of the index with clinical judgment in the two samples were .95 and .93, respectively. In an additional validation the index combined with birth weight correctly predicted oxygen dependence status at 30 days in 36 of 42 neonates consecutively admitted to five neonatal intensive care units (P = .002). Birth weight and the severity index contributed about equally to the prediction, and therefore they seem to represent partly independent components of baseline propensity for prolonged oxygen dependence.
Screening for Neuroblastoma at 3 Weeks of Age: Methods and Preliminary Results From the Quebec Neuroblastoma Screening Project
Authors: Tuchman Mendel , Lemieux Bernard , Auray-Blais Christiane , Robison Leslie L. , Giguere Robert , McCann Mark T. , Woods William G.
Published: December 2021

A large neuroblastoma screening study was recently started in the province of Quebec, Canada. This project, a collaboration between the Quebec Network for Genetic Medicine and the University of Minnesota, is studying the impact of screening infants for the preclinical detection of neuroblastoma on the population-based mortality caused by this tumor. All infants born in Quebec during a 5-year period will be screened twice, at 3 weeks and at 6 months. Urinary homovanillic acid and vanillylmandelic acid determination from dried filter paper samples is used for screening. Initial qualitative screening is done by means of thin-layer chromatography with confirmatory quantitative screening by gas chromatography-mass spectrometry (GC-MS). During the initial 6 months of 3-week screening, 41 673 neonates (92% compliance rate) were screened and 10.6% of them were tested also by GC-MS. Nine of these neonates had positive results on two GC-MS tests and were referred for evaluation to rule out the presence of neuroblastoma. Four had the tumor, 1 had a calcified adrenal gland, and 4 had no tumor detected. Three additional neonates had clinical diagnosis of neuroblastoma before they reached the screening age of 3 weeks. A neuroblastoma that did not secrete homovanillic acid or vanillylmandelic acid was diagnosed clinically in 1 additional patient who tested negative by screening.