bluuebunny/crossref_metadata_2025 huggingface dataset:
Virus Burden in Human Immunodeficiency Virus Type 1-Infected Children: Relationship to Disease Status and Effect of Antiviral Therapy
Authors: Srugo Isaac , Brunell Philip A. , Chelyapov Nickolas V. , lsraele Victor , Ho David D. , Alam Masud
Published: December 2021

The human immunodeficiency virus type 1 (HIV-1) was isolated from the plasma and peripheral blood mononuclear cells (PBMCs) from each of 21 infected children. The mean titers in plasma were 7 and 165 tissue culture-infective doses per milliliter in 9 children with asymptomatic (P-1) and 12 with symptomatic (P-2) infection, respectively (P = .0013). Significantly higher viral titers were found in PBMCs obtained from P-2 compared with P-1 children: 1920 vs 25 tissue culture-infective doses per 106 PBMC (P = .0018). In symptomatic patients at least 1 in 520 circulating mononuclear cells harbored HIV-1. No correlation was found between the viral burden and CD4+ lymphocyte counts. A decrease in the HIV-1 titers was noted both in PBMCs and plasma of symptomatic patients treated with zidovudine for 2 to 7 months. It is concluded that symptomatic children harbor a higher amount of the virus in plasma and PBMCs than asymptomatic children. Zidovudine treatment for 2 months or more decreased the amount of HIV-1 in PBMCs and plasma.
Butterfly-Shaped Mark
Authors: METZKER ARYEH , SHAMIR RAANAN
Published: December 2021

In Reply.—

We were delighted to encounter interest in our "Butterfly-Shaped Mark" (BSM), and read Dr Oakes' remarks with interest. Alas, his critical attitude derives mainly from confusion of terminology. A call for an accepted agreement on common terminology is long due.1 When using the term nevus flammeus (a port wine stain), we clearly differentiate it from capillary hemangioma (strawberry hemangioma). We are quite aware of, and quoted accordingly, the occurrence of several capillary hemangiomas with spinal lesions.2
Impact of Very Low Birth Weight Infants on the Family and Its Relationship to Parental Attitudes
Authors: Lee Shoo K. , Penner Pauline L. , Cox Margaret
Published: December 2021

This study tested common assumptions that very low birth weight (VLBW) infants (<1500 g) adversely affected families and that if affected parents could choose again, they would prefer not to save potentially handicapped VLBW infants. A survey of parents, which used a validated impact-on-family questionnaire, was sent to families of all 144 traceable VLBW infants (72.2% response), and families of 25 randomly selected healthy term infants (60% response), born in Newfoundland between 1983 and 1987 (median age 36.5 months, range 12 to 71 months). This revealed that families with developmentally delayed VLBW infants perceived no worse impact on the family than those with healthy term infants. Families with developmentally normal VLBW infants perceived a more positive family impact than the other two groups (P < .05). Most parents of both VLBW and healthy term infants supported saving all infants regard-less of outcome (>80%), believed that parents should be the principal decision makers regarding treatment decisions (>92%), and supported the role of physicians (>59%), but not nurses, ethics committees, or other regulatory bodies, in this decision. For the VLBW group, parental attitudes toward saving VLBW infants were related to their perceptions of family impact (P < .05) but independent of sociodemographic factors or of the developmental normality of the infant. It is concluded that VLBW infants did not adversely affect these New-foundland families or change their attitudes toward saying potentially handicapped infants. In the current debate about whether VLBW infants should be saved, cognizance must be taken of parental desires.
`Typus Edinburgensis' Explained
Authors: LAING I. A. , LYALL E. G. H. , HENDRY L. M. , ELLIS P. M.
Published: December 2021

In 1974, an Edinburgh family was described in which five infants from three generations had a consistently abnormal facial appearance, retarded motor and mental development, and failure to thrive. All died in the first months of life. The eponym "Typus Edinburgensis" was used to label these infants.1 Although at that time no chromosomal abnormality was detected, it was predicted that the advancement of cytogenetic technology might eventually reveal an associated chromosomal abnormality. High-resolution chromosome analysis has now identified a familial reciprocal and apparently balanced translocation between chromosomes 1 and 2 in three members of this family, following detection of an unbalanced karyotype in a neonate with an abnormal phenotype similar to that previously described.
A Matter of Terminology
Authors: RAMOS DE ALMEIDA J. M.
Published: December 2021

To the Editor.—

O2 "saturation" of hemoglobin has been used as a noninvasive, continuous measurement, adjunct to Pao2 and Paco2 invasive measurements, in mechanical ventilation of the newborn. It reflects the relationship between oxyhemoglobin and total hemoglobin and is expressed in percent.1 O2 saturation measurement is safe and useful if kept below 90%, the point where the dissociation curve starts its horizontal alignment.

In medical literature authors invariably use the expression "O2 saturation." This expression is inaccurate.
Questioning Asthma Treatment Study
Authors: MCJUNKIN JAMES E. , STALLO PAMELA S.
Published: December 2021

To the Editor.—

The article "Methylprednisolone Therapy for Acute Asthma in Infants and Toddlers: A Controlled Clinical Trial" by Tal et al1 is interesting, but it does have some weak areas which perhaps the authors can address. First of all, the outcome which seems to be most emphasized in the study, ie, percent admitted, is a fairly weak outcome measure when compared with other more objective measures such as changes in pulmonary function. Note that the decision to discharge was made by the senior resident in charge of the emergency department.
The Future of Primary Care
Authors: MOSCOLA RITAMARIE
Published: December 2021

To the Editor.—

In the article "Primary Care: The Future of Pediatric Education"1 Dr Alpert addresses many issues facing pediatrics. I agree with his list of problems. However, I doubt that the social, economic, and cultural changes he describes will ever occur.

My informal survey of pediatricians in practice is a song of frustration and boredom. The ringing telephone provides the rhythm. How does a patient-physician relationship develop in an environment of missed appointments, 3 AM emergency department visits, and managed care? Many families change physicians whenever employers change health benefits packages.
Reduction of Neonatal Mortality after Multiple Doses of Bovine Surfactant in Low Birth Weight Neonates with Respiratory Distress Syndrome
Authors: Liechty Edward A. , Donovan Edward , Purohit Dilip , Gilhooly Joseph , Feldman Bernard , Noguchi Akihiko , Denson Susan E. , Sehgal Sabitha S. , Gross Ian , Stevens Dennis , Ikegami Machiko , Zachman Richard D. , Carrier Steven T. , Gunkel J. Harry , Gold Alan J.
Published: December 2021

To determine if outcomes of low birth weight neonates with respiratory distress syndrome can be improved by the administration of multiple doses of bovine surfactant, we conducted two identical multicenter, controlled trials, and the results were combined for analysis. Seven hundred and ninety-eight neonates weighing 600 to 1750 g at birth who had developed respiratory distress syndrome within 6 hours of birth were assigned randomly to receive either 100 mg of phospholipid/kg of Survanta, a modified bovine surfactant (n = 402), or a sham dosing procedure (n = 396). Neonates whose respiratory distress persisted could be given up to three more doses, with all doses to be given in the first 48 hours after birth. Dosing was performed by investigators not involved in the clinical care of the neonates; nursery staff were kept blinded as to the treatment assignment. Fewer Survanta-treated neonates died of any cause (18.4% vs 27.3%, P = .002), died of respiratory distress syndrome (9.0% vs 20.3%, P < .001), and either died or developed bronchopulmonary dysplasia due to respiratory distress syndrome (51.2% vs 64.6%, P < .001). Neonates who received Survanta also had greater improvement in their oxygenation and ventilatory status from baseline to 72 hours than did control neonates. Survanta-treated neonates were at lowered risk for developing pulmonary interstitial emphysema (18.6% vs 39.3%, P < .001) and other pulmonary air leaks (11.5% vs 25.9%, P < .001). We conclude that multiple doses of Survanta given after diagnosis of respiratory distress syndrome reduce mortality and morbidity.
Neuropsychological Functioning in Human Immunodeficiency Virus Type 1 Seropositive Children Infected Through Neonatal Blood Transfusion
Authors: Cohen Sarale E. , Mundy Thomas , Karassik Beth , Lieb Loren , Ludwig Dona D. , Ward John
Published: December 2021

The neuropsychological development of 15 human immunodeficiency virus type 1 (HIV-1) seropositive children infected through neonatal blood transfusion was compared with that of a control group of 33 HIV-1 seronegative children who had also received blood transfusions as neonates. Human immunodeficiency virus type 1 infection was identified on the basis of a callback blood testing. Two thirds of the HIV-1-infected children were asymptomatic at time of enrollment in the study of development. The children were administered two psychological batteries approximately 8 months apart. The results indicated that the two serostatus groups did not differ in overall intelligence, even as long as 8 years after HIV-1 infection. Significant group differences, though slight, were found on school achievement and on tasks that require motor speed, visual scanning, and cognitive flexibility. Continued longitudinal study of this cohort will be important in characterizing the evolution of neuropsychological deficits.
Sweden's Experience in Reducing Childhood Injuries
Authors: Bergman Abraham B. , Rivara Frederick P.
Published: December 2021

Why does Sweden have the lowest childhood injury rate of any country in the world? The answer lies in a combination of factors including the special characteristics of Swedish society and an energetic 35-year campaign. Contributing societal characteristics are a small, relatively homogeneous, health conscious, lawabiding population that values children. Key factors in the campaign have been support of trauma surveillance systems and injury prevention research, ensuring safer environments and products through legislation and regulation, and a broad-based safety education campaign using coalitions of existing groups. Emulating the strategies used in the Swedish campaign would markediy reduce the number of US children killed, injured, and disabled from trauma.
Surfactant Proteins and Anti-Surfactant Antibodies in Sera from Infants With Respiratory Distress Syndrome With and Without Surfactant Treatment
Authors: Chida Shoichi , Phelps David S. , Soll Roger F. , Taeusch H. William
Published: December 2021

The presence of surfactant protein antigenemia and of surfactant protein antibodies was determined in serum from surfactant-treated and control infants with respiratory distress syndrome who were enrolled in a prospective randomized clinical trial. The surfactant used for treatment (surfactant TA) contained surfactant proteins (SPs) B and C and no SP-A. Enzymelinked immunosorbent assays (ELISAs) that identify surfactant-associated proteins and ELISAs that identify IgG or IgM directed against surfactant proteins were used to investigate sera from these infants obtained prior to treatment, at 1 week of age, and at 2 months of age. There were no significant differences between average values in the surfactant-treated and control groups at each time period. However, in the control group, averaged results from ELISAs that identify SP-A and that identify IgM antibodies to SP-A or to SP-B,C showed significant differences between pretreatment sera and sera obtained at 1 week of age. No significant differences were noted in averaged results for IgG. Positive ELISA values were more frequently found in the control group than in the surfactant-treated group with regard to SP-A, and IgM against SP-A and SP-B,C in sera from neonates at 1 week of age. No positive ELISA values were found in sera from infants at 2 months of age. It is concluded that some patients with severe respiratory distress syndrome presumably leak surfactant proteins into the circulation and that this induces transient low titers of IgM antibody. This occurrence is decreased with surfactant treatment. Surfactant treatment may reduce leak of surfactant proteins into the vascular space by reducing lung damage.
Tuberculosis in Children 10 Years of Age and Younger: Three Decades of Experience During the Chemotherapeutic Era
Authors: Nemir Rosa Lee , O'Hare Donna
Published: December 2021

The 863 patients, aged 10 years and younger, treated at the Children's Chest Clinic of Bellevue Hospital during three decades (1953 through 1981) clearly indicated the success of antituberculosis therapy. There were no deaths from tuberculosis. Early treatment is associated with a reduction in the serious forms of disease, eg, meningitis, miliary disease, and bone infections, and with preventing death. Medication was well tolerated: only 1.1% of the patients had adverse reactions, all of which were reversible. Consistent compliance with medication of only 62% of patients is a challenge to the medical profession. Only 22.5% of mycobacterial cultures were positive. Long-term follow-up of patients was rewarding: seven pregnancies with healthy mothers and babies, and no reactivation of tuberculosis by later infections, even those such as measles or pneumonia. The severity of disease was related largely to patient's age (3 years and younger) and intimacy of contact, the highest rate being when the mother was the contact. The long-term experience emphasizes the value of early identification, therapeutic compliance, and comprehensive contact tracing in the future elimination of tuberculosis. Prophylactic therapy and close observation should be considered for contacts, especially those exposed to human immunodeficiency virus infections and addicted to drugs.
Passive Smoking Alters Lipid Profiles in Adolescents
Authors: Feldman Joseph , Shenker I. Ronald , Nussbaum Michael , Jacobson Marc S. , Etzel Ruth A. , Spierto Francis W. , Lilienfield David E.
Published: December 2021

Although cigarette smoking is associated with elevation of plasma lipid levels and changes in lipoprotein distribution, it is not known whether passive smoking is associated with an alteration in lipid profiles. The relation between plasma cotinine, a marker of exposure to tobacco smoke, and lipid profiles was studied in healthy adolescents from a suburban New York high school district who were undergoing preparticipation sports physicals. Forty-four percent of the adolescents reported that one or both parents currently smoked. Eleven percent of the adolescents had plasma cotinine concentrations ≥2.5 ng/mL, the level considered indicative of exposure. Adolescents with two smoking parents had significantly higher plasma cotinine concentrations after adjustment for other factors than adolescents whose parents did not smoke. Plasma cotinine concentration ≥2.5 ng/mL was associated with an 8.9% greater ratio of total cholesterol to high-density lipoprotein cholesterol (P < .003) and a 6.8% lower high-density lipoprotein cholesterol (P < .03). These results suggest that passive smoking, like active smoking, leads to alterations in lipid profiles predictive of an increased risk of atherosclerosis.
Fish Oil Treatment of Hyperlipidemia in Children and Adolescents Receiving Renal Replacement Therapy
Authors: Goren Avner , Drukker Alfred , Stankiewicz Halina , Goldstein Robert
Published: December 2021

The effect of 8 weeks of daily oral fish oil supplementation in a dose of 3 to 8 g/d on serum lipid levels was studied in 16 patients, 7 to 8 years of age, who had end-stage renal disease and were receiving renal replacement therapy. Fasting serum cholesterol (CHOL), triglyceride (TG) levels, and lipoprotein profiles were measured before therapy, 8 weeks after fish oil supplementation, and 4 weeks after its cessation. During 8 weeks of treatment the mean serum CHOL level did not change. The mean serum TG level, however, decreased significantly (P < .01) from 236 ± 31 mg/dL to 171 ± 21 mg/dL (27.5%). Four weeks after treatment was stopped, the mean serum TG level returned to a value not significantly different from the pretreatment level (208 ± 30 mg/dL). In a subgroup of 11 excessively hyperlipidemic patients, with serum CHOL and TG levels ≥50% of the 90th percentile for age and sex, the mean serum TG level decreased even more (30.8%), from 286 ± 35 mg/dL to 198 ± 24 mg/dL (P < .01), and the mean CHOL/high-density lipoprotein CHOL ratio decreased from 8.4 ± 1.2 to 7.4 ± 1.3 (P < .05). Blood pressure and platelet counts remained stable during the entire study period. Side effects of the treatment were minimal. These results show that dietary fish oil supplementation reduces serum TG levels in young patients receiving renal replacement therapy and improves their "atherogenic" serum lipoprotein profile.
Infirmary-Style Sick-Child Day Care: Do We Need More Information?
Authors: Furman Lydia
Published: December 2021

At least 8.2 million children younger than the age of 4 years have working mothers.1 More than half of these infants and children receive out-of-home care: approximately 23% attend day-care centers, 37% are in "family day care," 8% are cared for by the mother herself at work, and the remainder are cared for at home by a relative or sitter.1 Illness is a significant and frequent problem for children of parents working out of the home. We know that respiratory illnesses are the most common acute illness among children in the United States,2 and a recent study found that for children younger than the age of 3, the prevalence of medicated respiratory tract infections is lowest in children cared for in their own homes, higher in those receiving "family day care," and highest in those attending child-care centers.3 Children in day-care centers are additionally at greater risk of several other infectious diseases.4-6 The Bureau of National Affairs concluded that on any given day more than 359 000 children younger than the age of 14 with both parents working are too ill to attend school or day care.7 Who is caring for these sick children? Several recent reviews have examined this question in detail.8,9

A variety of patterns of care for sick children of parents working outside the home have evolved. These can be grouped by type of provider and by location of care. Possible care givers include (1) a parent, (2) a familiar care giver who is not the parent, or (3) a trained but unfamiliar health worker.
Hypothyroidism in Otherwise Healthy Hypercholesterolemic Children
Authors: LAVIN ARTHUR , NAUSS ALAN H.
Published: December 2021

Atherosclerosis is the leading cause of death in the United States. Studies in adults have shown that intervention with combined diet and medication can reduce atherosclerotic plaque formation and, as a result, the incidence of symptomatic coronary artery disease.1-4 With a strong tradition of preventive medicine, the pediatric community has begun exploring the prevention of adult atherosclerosis through intervention in childhood. Although issues such as universal vs selective high-risk screening, ideal age for screening and intervention, and treatment regimens remain unresolved and controversial, many preventive cardiology clinics, as well as individual pediatricians, have been screening and treating children.5,6 As part of an initial evaluation of hypercholesterolemic children and prior to any intervention, it is important to determine whether other disease processes are contributing to the child's dyslipoproteinemia.
The Relationship Between Pertussis Vaccine and Brain Damage: Reassessment
Authors:   Committee on Infectious Diseases
Published: December 2021

Administration of pertussis vaccine has been associated temporally with local and systemic reactions, including febrile convulsions. Based on the National Childhood Encephalopathy Study (NCES), a large case-controlled, epidemiologic study in Great Britain, permanent neurological disability (brain damage) has not been considered a common sequela of rare, severe, adverse neurological events temporally related to pertussis immunization. Recently, however, reassessment of this conclusion has been prompted by the following events: a review of the NCES by a workshop convened to make recommendations for a possible future United States study of the association of pertussis vaccination and serious neurological illness,1 a legal decision in Great Britain questioning the findings of NCES;2 further investigations of the role of pertussis vaccine in causation of acute and chronic neurologic illness;3-6 and continuing reassessment of recommendations for pertussis vaccination by national committees in Canada,7 Great Britain,8 and the United States. Recent reviews and editorials also have addressed this and related questions concerning adverse events attributed to pertussis vaccine.9-12

The Committee herein reports its reassessment of the role of pertussis vaccine as a cause of chronic neurological disability. In this review, the term "encephalopathy" is avoided deliberately. Definition of this term is difficult, and its use can be misleading. For example, the NCES study population was children with acute, serious neurological illness, the majority of whom had convulsions lasting 30 minutes or more.13 Thus, in assessing the nature of the relationship between pertussis immunization and neurological events, the term "acute, serious neurological illness" is considered more appropriate than "encephalopathy."
The Status of Acellular Pertussis Vaccines: Current Perspective
Authors:   Committee on Infectious Diseases
Published: December 2021

Clinical studies of component ("acellular") pertussis vaccines have been undertaken in recent years, and several acellular vaccines have been used in Japan for 10 years. The Committee has reviewed these trials and related data and herein provides its assessment regarding the current status of the acellular vaccines and their possible use in the United States.

The pertussis vaccines in current use in the United States are prepared from whole cells of a strain of Bordetella pertussis that is grown in broth medium, harvested by centrifugation, and killed or partially detoxified by heat or by the addition of a chemical agent, such as thimerosal, or by a combination of these methods. In contrast, the acellular vaccines developed in Japan and used in that country since 1981 contain one or more antigens derived from biologically active components of the B pertussis organism.1 An inactivated form of lymphocytosis promoting factor (LPF), also known as pertussis toxin and a variety of other synonyms, is a frequent component of acellular pertussis vaccines, as are filamentous hemagglutinins (FHA). Other constituents included in acellular vaccines are agglutinogens, a term denoting a variety of protein antigens on the surface of the B pertussis organism. Of the agglutinogens, a 69-kd outer membrane protein, when injected into neonatal mice, protects against B pertussis challenge.2 Acellular vaccines also have recently been derived from mutant pertussis toxin molecules prepared with recombinant DNA technology.3

The acellular vaccines produced in Japan have been classified into two types: B type, which contains LPF and FHA in roughly equal amounts; and T type, which contains mostly FHA but some LPF and agglutinogens.1,4
The Use of Dexamethasone in Premature Infants at Risk for Bronchopulmonary Dysplasia or Who Already Have Developed Chronic Lung Disease: A Cautionary Note
Authors: HARKAVY KENNETH L.
Published: December 2021

In Reply.—

The letter-to-the-editor from Dr Frank is a cautionary note about the risks of glucocorticoid therapy for chronic lung disease in infants. These concerns are real and have been enumerated in most papers on the subject. Only one study to date has suggested a long-term benefit (decreased mortality); yet consistently respiratory therapy support is decreased by steroid use. I have performed a limited meta-analysis because all studies have had similar enrollment criteria and treatment regimens. Two lengths of treatment have been compared and the combined data compared with the controls (Table 1).

[See table in the PDF file]

This analysis suggests that there is no major difference in outcome by length of treatment, although short treatment was associated with less hyperglycemia and longer duration of intubation. Comparison of all steroid-treated patients with placebo-treated babies showed treated infants had more hyperglycemia (P < .01 χ2) but an average of 11 fewer days of mechanical ventilation (intermittent mandatory ventilation, ImV). (t test was not done due to lack of raw data; however, difference was significant in each subgroup.)
Strength Training, Weight & Power Lifting, and Body Building by Children and Adolescents
Authors: SHEPHERD ROBERT
Published: December 2021

To the Editor.—

The conclusions1 of the Committee on Sports Medicine concerning this topic are conservative and laudable. However, the definitions of the major lifts described in the article are unclear and possibly misleading.

In the section "Definitions" are mentioned "major lifts,' and `the power clean and the incline and overhead presses.' The article then states, "These lifts involve the use of free weights lifted through the extremes of joint motion in a ballistic rather than a controlled fashion.
Use of Western Blot and Enzyme-Linked Immunosorbent Assays to Assist in the Diagnosis of Lyme Disease
Authors: Rose Carlos D. , Fawcett Paul T. , Singsen Bernhard H. , Dubbs Sharon B. , Doughty Robert A.
Published: December 2021

Without evidence of erythema chronicum migrans, diagnostic confirmation of Lyme disease may be difficult, particularly if there are conflicting laboratory results. Often, for families and physicians, the clinical dilemma is whether fatigue, arthritis/arthralgias, a positive enzyme-linked immunosorbent assay (ELISA), and tick exposure, but no evidence of erythema chronicum migrans, are sufficient to diagnose and treat Lyme disease. Patients with discordant ELISA and Western blot (WB) assay results for Borrelia burgdorferi were studied to determine whether there was sufficient clinical evidence to support a diagnosis of Lyme disease. Of 650 consecutive sera analyzed by ELISA in a laboratory within a 1-year period, 77 were subsequently tested by WB. The clinical data from these patients were then analyzed. The study population was divided into three groups: group 1 (positive ELISA, positive WB), group 2 (positive ELISA, negative WB), and group 3 (negative ELISA, negative WB). Findings included the following: (1) Patients with a strong clinical history of Lyme disease were usually positive by both WB and ELISA (group 1). (2) All patients with erythema chronicum migrans had both positive WB and ELISA tests. (3) Ninety-one percent of group 2 had a rheumatic or inflammatory condition other than Lyme disease. (4) A definite response to antibiotics occurred in 75% of patients wherein both ELISA and WB were positive but in only 11% of cases with a positive ELISA but a negative WB. (5) History of tick exposure and degree of fever were not significantly different among the three serologic groups, and thus they were not diagnostically helpful. It is concluded that (1) positive results from both the WB and ELISA assays provide strong diagnostic support for Lyme disease; and (2) a positive ELISA test, particularly if at a low titer and without a positive WB test, is associated with a lack of clinical features of Lyme disease. Thus, Western blotting is helpful in identifying false-positive ELISA results for Lyme disease.
AN ENGLISH EXPERT'S VIEW OF AMERICAN "INFORMED CONSENT"
Authors: L. J. F.
Published: December 2021

Scientists also feel that overzealous ethical review boards and, in particular, informed consent rules have driven science away.

In the mid-80's, Dr. Richard Peto, a well-known epidemiologist at Oxford University, approached American cardiologists to enlist patients for a study of the drug streptokinase as a treatment for heart attacks. Although the Americans were enthusiastic, in the time that British doctors referred 6,000 patients, only 400 entered from the other side of the Atlantic. He holds consent procedures largely to blame.

"The American documents were three pages of legalistic junk," Dr. Peto said, who had written a single page consent form for British use. "That's not the sort of thing you want to push under someone's nose as he's having a heart attack, terrified, with chest pain, on morphine. You want to tell him about the trial, but you want to be humane."

Although countries in Europe require that researchers discuss a study with potential subjects, the requirement is far less formalized.
PEDIATRICS VANS: HOUSE CALLS FOR THE HOMELESS
Authors: L. J. F.
Published: December 2021

The Children's Health Project, with two mobile medical vans, was created three and a half years ago by the singer and songwriter Paul Simon to give free health care to homeless children in New York City. The vans, which have everything one would find in a regular pediatrician's office, make daily visits to family shelters, shelters for children without families and welfare hotels.

Most patients have common ailments: ear infections, bad colds. Children needing special care are transferred to hospitals.

The project, run by the Children's Health Fund at 919 Third Avenue, near 56th Street, is the largest of its kind in the country. It fills such a gap for the city's roughly 11,000 homeless children that a third van is being added in July. Twenty other cities, including Newark, want to use the project as a model for their own programs.
COMPETITORS' DRUGS BATTLE SEPTIC SHOCK
Authors: L. J. F.
Published: December 2021

Two competitors, Centocor Inc. and Xoma Corp., are seeking clearance from the Food and Drug Administration for an entirely new sort of anti-infection drug...

The new drugs, unlike antibiotics that act upon the bacteria, latch on to toxins made by the bacteria, thus blocking the next biochemical step in the disease process. Both drugs are monoclonal antibodies, proteins that zero in on selected targets in the body. Centoxin is derived from human spleen cells; Xoma's drug, called Xomen E-5, from mouse spleen cells.

... Some estimates... put the combined U.S. and European sales for both drugs at $750 million by the mid-1990s.

One reason for the jumbo market projections is sky-high prices for drugs produced by biotechnology. Centoxin and Xomen-E5 both are expected to cost between $1,500 and $2,500 for a single course of treatment, given by injection.
Critical Limits for Emergency Clinician Notification at United States Children's Hospitals
Authors: Kost Gerald J.
Published: December 2021

Critical results demand rapid patient evaluation, possibly followed by life-saving intervention. A national survey of children's hospitals determined the critical limits used for emergency notification of critical laboratory results. Mean low and high critical limits for children for the tests listed most frequently were as follows (millimoles per liter): glucose, 2.6 and 24.7; potassium, 2.8 and 6.4; calcium, 1.62 and 3.17; and sodium, 121 and 156. For newborns, significantly different (P < .01) critical limits were glucose, 1.8 and 18.2; and potassium, 7.8. Hematology mean critical limits for children included hemoglobin, 69 and 208 g/L; platelets, 53 and 916 x 1O9/L; hematocrit, 0.20 and 0.62 L/L; and white blood cell counts, 2.1 and 42.9 x 109/L. Critical limits for pH were 7.21 and 7.59; for Pco2, 21 and 66 mm Hg; and for Po2, 45 and 124 mm Hg. Important qualitative critical results included blasts on the blood smear and abnormal cerebrospinal fluid findings. In comparison with other medical centers, children's hospitals maintained tighter critical limits for surveillance of renal function, hemostasis dysfunction, and newborn hypokalemia. Use of these results to eliminate outliers can help reduce unnecessary statim notification and improve resource utilization for the acute diagnosis and treatment of critically ill newborns and children.
In Reply: Use and Misuse of Oral Therapy in Diarrhea
Authors: SNYDER JOHN D.
Published: December 2021

I appreciate the chance to clarify what may be a misconception of Dr Kepfer and also others who had read my recent article. The American Academy of Pediatrics Committee on Nutrition recommends that glucose electrolyte solutions be used for rehydration and maintenance therapy for children with acute diarrhea. One such solution is the oral rehydration salt (ORS) solution recommended by the World Health Organization and the United Nations International Children's Emergency Fund, but this solution is not readily available in the United States, as Dr Kepfer notes. However, as mentioned in the introduction to the paper, a number of successful clinical trials of other similar glucose electrolyte solutions have been reported in the United States.
WOMAN TO COLLECT $3.75 MILLION IN DIAPER DETERGENT ACCORD
Authors: L. J. F.
Published: December 2021

ST. LOUIS (July 3 (AP)—A West German chemical company has agreed to pay $3.75 million to a woman who said her leukemia was caused by a detergent used to launder her diapers when she was a baby.

The woman, Fawna Wright, 23 years old, of Mound City, Ill., reached the settlement with the BASF Wyandotte Corporation on Monday. Her lawyers maintained that chemicals in the detergent Loxene might have harmed thousands of infants before it was pulled from the market in the 1960's...

Ms. Wright brought suit in 1985, charging that her illness was caused by chemicals in Loxene that included pentachlorophenol, a substance more widely used as a pesticide and wood preservative...
Prior Approval in the Pediatric Emergency Room
Authors: Glotzer Deborah , Sager Alan , Socolar Deborah , Weitzman Michael
Published: December 2021

Managed-care plans for low-income Americans are widely promoted to improve the quality and control the cost of medical care by reducing unnecessary specialty and emergency room (ER) care through the use of primary care physicians as case managers/gatekeepers. The purpose of this study was to evaluate one element of managed care, gatekeeping prior approval, for children who use the pediatric ER of one urban public hospital. Over a 6-month period, 518 children and adolescents insured under managed-care plans that required authorization from the primary care physician to receive treatment presented to the ER. Of the 385 records reviewed for this study, the majority (87%) received their primary care at community health centers or the hospital's own outpatient clinics. Most ER visits (72%) were made when primary care sites were closed. According to nursing triage assessment, 57% presented with urgent or emergent conditions, and 26% had a history of chronic illness. Nine percent required hospitalization. Although an elaborate system for gatekeeping was established, only 13 (3%) patients' requests for ER care were denied. Of these, 3 were seen in the ER without authorization, 6 received the recommended follow-up, and 4 were not seen in follow-up. Twenty-nine participating primary care sicians (74%) and 19 ER staff (63%) responded to a survey of their experience with and attitudes toward prior approval. For a variety of reasons, the majority of primary care physicians and ER staff found the gatekeeping policies for after-hours visits burdensome and inappropriate. The low denial rate observed was due in large part to physicians' reluctance, because of clinical, ethical, and legal concerns, to deny care to a child who had already been brought to the ER. This study identifies many problems with the design and implementation of prior-approval policies. It appears that the prior-approval requirement has not visibly changed how patients use this emergency room. The study suggests that on-site gatekeeping for children living in poverty will not result in the anticipated benefits in improved care or reduced costs unless primary care alternatives to the ER can be provided at less cost and with equal availability.
Pediatric Interhospital Critical Care Transport: Consensus of a National Leadership Conference
Authors: Day Susan , McCloskey Karin , Orr Richard , Bolte Robert , Notterman Daniel , Hackel Alvin
Published: December 2021

As pediatric interhospital critical care transport has evolved toward a distinct discipline, practitioners in this field have recognized the need for guidelines for transport program development and patient care. At a gathering of medical directors of pediatric transport programs, the following topics were discussed: team composition and transport staffing, training requirements for pediatric and nonpediatric transport teams, goals and design of a transport data base, and medical-legal issues, including the responsibilities of the referring and receiving institutions. Consensus recommendations were made for the major issues in each of these areas. Several questions were raised which may be answered by multiinstitutional studies.
Child Care Options for III Children
Authors: Landis Suzanne E. , Chang Albert
Published: December 2021

Care of ill children who normally attend out-of-home child care programs poses a problem for many working parents, employers, and child care workers. Children cared for in child care centers have an increased incidence of illness and consequently their parents miss work more often compared with children cared for in other child care arrangements. Programs for the care of ill children are discussed to provide the practicing pediatrician with an understanding of the various programs currently or potentially available in the community. The paper ends with a discussion of the various solutions to enhance the economic gains of working parents while serving the need of children for nurturant care.
Recent Declines in Breast-Feeding in the United States, 1984 Through 1989
Authors: Ryan Alan S. , Rush David , Krieger Fritz W. , Lewandowski Gregory E.
Published: December 2021

Ongoing surveys performed by Ross Laboratories demonstrate recent declines both in the initiation of breast-feeding and continued breast-feeding at 6 months of age. Comparing rates in 1984 and 1989, the initiation of breast-feeding declined approximately 13% (from 59.7% to 52.2%), and there was a 24% decline in the rate of breast-feeding at 6 months of age (from 23.8% to 18.1%). The decline in breast-feeding was seen across all groups studied but was greater in some groups than in others. Logistic regression analysis indicates that white ethnicity, some college education, increased maternal age, and having an infant of normal birth weight were all positively associated with the likelihood of both initiating breast-feeding and continuing to breast-feed to at least 6 months of age. Women who were black and who were younger, no more than high school educated, enrolled in the Women, Infants and Children supplemental food program, working outside the home, not living in the western states, and who had an infant of low birth weight were less likely either to initiate breast-feeding or to be nursing when their children were 6 months of age. The factors influencing the decline in breast-feeding were not uniform. There were fewer sociodemograpahic factors associated with the decline in the initiation of breast-feeding than in the decline in prolonged breast-feeding. While the disparity between older and younger mothers in initiating breast-feeding increased, there was an offsetting trend as the disparity associated with parity decreased. The only other significantly changed relationship for initiation of breast-feeding was that the disparity associated with higher income increased significantly: the decline in the rates of breast-feeding among the less affluent was greater than among the more affluent. Many more sociodemographic factors were significantly associated with declines in breast-feeding at 6 months of age. The disparity between those mothers not employed and those employed increased (from an odds ratio of 1.65 in 1984 to 2.43 in 1989). The disparities associated with age and parity both increased over time: the rate of breast-feeding declined more steeply among younger and primiparous mothers than among older and multiparous mothers. Similarly, the declines were greater among those enrolled in the Women, Infants and Children program (compared with those not enrolled), those with less than a college education (compared with some college education), and those not residing in the western region of the United States (compared with those residing in the West). Educational efforts to promote breast-feeding are needed for all pregnant women and should be particularly directed toward the groups who have experienced the most rapid recent decline in the rates of breast-feeding.
Incidence and Correlates of Breast-feeding in Socioeconomically Disadvantaged Women
Authors: Jacobson Sandra W. , Jacobson Joseph L. , Frye Karen F.
Published: December 2021

Although the incidence of breast-feeding has more than doubled in the United States in recent years, this increase has been less evident among blacks and in lower socioeconomic groups. To understand better this lower incidence, cognitive and personality correlates of breast-feeding were examined in two independent lower-class samples: 137 black inner-city mothers and 50 predominantly white mothers. Ego development, depression, and verbal competence were assessed during the first postpartum year. Only 21.9% of the black sample chose to breast-feed, in contrast with 58.0% of the white sample. Although unrelated to depression and social support, breast-feeding was positively associated with ego level and cognitive ability in both samples. Cognitive ability was assessed using the Peabody Picture Vocabulary Test-Revised, which was found to be valid in relation to maternal and infant characteristics for the black socially disadvantaged sample. When compared using multiple regression analysis, the relation of ego maturity to breast-feeding was generally stronger than that of cognitive ability. Women with more ego maturity may breast-feed because of increased feelings of empathy or nurturance or because they are more attuned to current health advisories and able to deviate from community norms to adopt breast-feeding practices more characteristic of the white middle class.
Is a Chest Radiograph Necessary in the Evaluation of Every Febrile Infant Less Than 8 Weeks of Age?
Authors: Crain Ellen F. , Bulas Dorothy , Bijur Polly E. , Goldman Harold S.
Published: December 2021

This study was designed to examine the relationship between respiratory signs and the likelihood of having an abnormal chest radiograph in a sample of febrile infants less than 8 weeks of age. The sample consisted of 242 infants who were admitted during a 3-year period with temperatures ≥38°C (100.4°F) and had a chest radiograph. The house officer recorded the presence of respiratory signs and symptoms including rhinorrhea, tachypnea, cough, rales, wheezes, retractions, and rhonchi.

Each chest radiograph was reviewed independently according to predetermined criteria by a senior radiology resident and an attending pediatric radiologist. Interobserver agreement was 91%. Both observers were blind to the infants' respiratory signs. The chest radiograph interpretations were compared with the presence of respiratory signs. Of the 242 cases, 228 had chest radiographs available for interpretation. Of these, 27 chest radiographs (12%) were identified as abnormal, including 6 where there was initial disagreement as to the presence of an abnormality. Twenty-five (31%) of 80 infants with any respiratory signs had an abnormal chest radiograph, whereas only 2 (1%) of 148 asymptomatic infants did. The sensitivity of respiratory signs was 93% (confidence interval = 76% to 99%). These findings suggest that in the absence of respiratory signs, febrile infants are Unlikely to have an abnormal chest radiograph.
Career Plans of New Pediatricians: Results from a Survey of Residency Program Directors
Authors: Brotherton Sarah E.
Published: December 2021

Directors of pediatric residency programs in the United States, Puerto Rico, and Canada were surveyed regarding plans of graduating residents to determine whether new pediatricians experienced problems finding employment in light of a decreasing growth rate in the child population. Nearly 90% of directors responded, providing information on 1915 residents. Of the 1782 nonmilitary residents in the United States, 815 were entering general pediatric practice and one third (596) were entering subspecialty training. Nearly one half (379) of residents entering general pediatric practice were joining a small group practice, almost one fourth (184) were joining a larger group, 6% (48) were becoming solo practitioners, 7% (57) were joining a health maintenance organization, and nearly 8% (62) were joining a hospital or academic staff. Most residents in the United States experienced no difficulty finding a position and received multiple offers for jobs. Canadian residents were similar to residents in the United States, whereas the postresidency situations of graduates of military and Puerto Rican programs were very different. Despite manpower predictions to the contrary, comments by program directors indicated a demand for general pediatricians. This paper presents only the viewpoint of program directors; whether this perceived need illustrates an avid market for young general pediatricians merits further study.
Breast-Feeding Trends: A Cause for Action
Authors: LAWRENCE RUTH A.
Published: December 2021

Breast-feeding in the United States reached a peak in 1982 after suffering an abysmal decline in the 1940s, 1950s, and 1960s which followed the introduction of the many conveniences afforded by infant formulas. Much effort, energy, and enthusiasm has been poured into the encouragement of women to breast-feed their infants for at least the first 6 months. In 1984, C. Everett Koop, MD, Surgeon General of the United States, said, "We must identify and reduce the barriers that keep women from beginning or continuing to breast-feed their infants."1 A major national effort followed the Surgeon General's Workshop on Breast-feeding and Human Lactation in 1984.2
Can Clinical Judgment Detect Children with Speech-Language Problems?
Authors: CUNNINGHAM ROBERT D.
Published: December 2021

To the Editor.—

In "Can Clinical Judgment Detect Children with Speech-Language Problems?"1 Dr Glascoe suggests that eliciting parental concerns is an effective means of prescreening children for speech-language problems and that prescreening should be done at all office visits. To minimize the number of children that elude detection by the prescreening, Dr Glascoe also suggests that every child should receive a full developmental screening using a standardized test sometime during the preschool years, even if the results of the prescreening are normal.
Causes of Encopresis
Authors: WEINTRAUB DAVID H.
Published: December 2021

To the Editor.—

I was intrigued by Dr Pilapil's comments in his reply regarding the case of stool withholding reported by de Vos et al in the February 1991 issue of Pediatrics.1 It would be pertinent to consider some of the possible byproducts of one element of Pilapil's therapy of his case reported in the April 1990 issue of Pediatrics.2 One must be alert to the possible "anxiety-provoking situation" of exposing this 3-year-old child to the toileting functions of his family.