bluuebunny/crossref_metadata_2025 huggingface dataset:
Motor Vehicle Accident Trauma and Restraint Usage Patterns in Children Less Than 4 Years of Age
Authors: Agran Phyllis F. , Dunkle Debora E. , Winn Diane G.
Published: December 2021

In a sample of children less than 4 years of age, treated in an emergency room after a motor vehicle accident, 22% were restrained in a child safety seat (improper and proper), 12% were restrained by a vehicle seat belt, and 70% were unrestrained. Trauma and injury patterns related to the various restraint use patterns are described. Most children in safety seats and seat-belted children, if injured, sustained minor contusions, abrasions, or lacerations. Injury among properly restrained children in safety seats was primarily the result of unavoidable mechanisms (eg, flying glass, intrusion). Improper use contributed to injury among safety-seat-restrained children, primarily by allowing the child to hit against the vehicle interior. Seat-belted children also were injured, primarily by hitting against the vehicle interior. Although some of the restrained children were seriously injured, in general, restrained children tended to sustain less serious and fewer injuries than the unrestrained children.
Adenovirus Infections in Young Children
Authors: Edwards Kathryn M. , Thompson Juliette , Paolini Janet , Wright Peter F.
Published: December 2021

The importance of adenovirus in initiating respiratory disease in young children is stressed in this report. The incidence, clinical illness, asymptomatic carriage, and serologic response of acute adenovirus-associated infection are described in a carefully followed cohort of normal children cultured with each episode of febrile respiratory illness. During a 6-year period, 8.2% of 1,416 nasal washings obtained from sick infants and children less than 7 years of age yielded adenovirus. Adenoviruses were isolated from only 1/174 (0.6%) cultures taken from well children. Typing of 98 isolates showed 81% to be types 1 or 2. A ≥ fourfold rise in neutralizing titer was seen in 45/59 (76%) sampled. In a subset of the cohort observed for 2-week periods in a day care setting, 14 of 21 well children (67%) exposed to symptomatic children with adenovirus infection developed febrile respiratory symptoms and shedding of the same serotype within 2 weeks of exposure. This study confirms that adenovirus has a high attack rate and causes significant respiratory disease in young children.
Farm Accidents in Children
Authors: Cogbill Thomas H. , Busch Henry M. , Stiers Gary R.
Published: December 2021

During a 6½ year period, 105 children were admitted to the hospital as the result of trauma that occurred on farms. The mechanism of injury was animal related in 42 (40%), tractor or wagon accident in 28 (26%), farm machinery in 21 (20%), fail from farm building in six (6%), and miscellaneous in eight (8%). Injury Severity Score was calculated for each patient. An Injury Severity Score of greater than or equal to 25 was determined for 11 children (11%). Life-threatening injuries, therefore, are frequently the result of childhood activities that take place in agricultural environments. The most common injuries were orthopedic, neurologic, thoracoabdominal, and maxillofacial. There was one death in the series, and only one survivor sustained major long-term disability. Such injuries are managed with optimal outcome in a regional trauma center. Educational programs with an emphasis on prevention and safety measures may reduce the incidence of farm accidents.
Noisy Toys: A Possible Source of Sensorineural Hearing Loss
Authors: Axelsson Alf , Jerson Tomas
Published: December 2021

This report focuses attention on the widespread availability of toys emitting harmfully loud noises.
Care, Costs, and Health: Reactions to and Reinterpretation of the Rand Findings
Authors: Starfield Barbara , Dutton Diana
Published: December 2021

The reports of Valdez et al1 and Leibowitz et al2 mark the culmination of a landmark effort. Initiated over a decade ago, the Rand Health Insurance Experiment—the most ambitious and expensive randomized controlled trial ever conducted in health services research—was designed to produce estimates of the costs of various forms of national health insurance. Projected estimates of the costs of Medicaid and Medicare had been far too low and health policy experts hoped to obtain information that would prove closer to the mark in the (then) seemingly likely passage of some form of national health insurance.

Although national health insurance has not materialized, the impact of medical care costs on utilization of services and health status is still of great interest. The amount of "cost-sharing" (medical costs paid by patients) has increased dramatically in public insurance programs, and many health policymakers favor increases in private insurance programs. The central question now, however, is how much of the cost burden can be borne by patients without inducing reductions in utilization that are harmful to health.

The two papers1,2 in the May issue of Pediatrics reported on the impact of cost-sharing on children's utilization and health. The basic findings were similar to those for adults. In general, the higher the costs paid by families, the fewer the children receiving medical care and the fewer the services per user. The only exception was hospitalization of children aged 5 to 13, which was largely unaffected by cost-sharing; higher costs did appear to reduce hospitalization of younger children, as well as ambulatory care for children of all ages.
Infant Rash Caused by Paracetamol in Breast Milk?
Authors: MATHESON I. , LUNDE P. K.M. , NOTARIANNI L.
Published: December 2021

To the Editor.—

According to Wilson et at,1 adverse drug reactions in breast-fed infants associated with maternal drug intake are rarely reported. We report such a reaction after paracetamol ingestion by the mother.

The patient was a 2-month-old, healthy, and fully breast-fed girl. Her 34-year-old mother had rheumatoid arthritis and also developed a postpartum borderline psychosis, which was first treated with 2 mg of flupentixol and 100 mg of nortriptyline daily. Later nortriptyline was replaced by 100 mg of desipramine.
Sex, Drugs, Rock `N' Roll: An Introduction
Authors: Strasburger Victor C.
Published: December 2021

Despite their apparent physical health, adolescents frequently engage in behaviors that increase their risk of physical harm, jeopardize their future, and dismay their parents. Among these activities are sexual activity and drug use. This article will summarize data about the current levels of teenage pregnancy and drug use among teenagers and will critique the studies that produce this data. When viewed in perspective, levels of premature sexual activity and drug usage among teenagers may not be quite as alarming as previously thought.
Alcohol, Television, and Teenagers
Authors: Singer Dorothy G.
Published: December 2021

This paper examines alcohol use of young people and their TV viewing habits in terms of hours and kinds of programs watched. Content of TV programs is examined with regard to alcohol use by characters and the effects of such modeling on viewers' habits. Ads for alcoholic beverages in print and on TV are discussed and the results of studies are presented. Recommendations are suggested for the TV industry as well as for viewers in order to minimize the effects of alcohol as a socially desirable and tension-reducing substance.
Counseling the Sexually Active Teenager: Reflections From Pediatric Practice
Authors: Sladkin Kenneth R.
Published: December 2021

Counseling the sexually active teenager is both an important and a difficult undertaking. Due to the increasing rates in adolescent sexual intercourse, pregnancy, and sexually transmitted diseases, it is necessary for all health care professionals to elicit a sexual history from each patient. Being comfortable with one's own sexuality and conveying complete confidentiality are the sine qua non of this type of interview and counseling. Topics that may be covered are contraception, sexually transmitted diseases, sexual intercourse and its place in the adolescent's life, other kinds of sexual expression, and satisfaction with one's sexuality. It is not necessary to have liberal views of sexuality to obtain an adequate history or to provide competent counseling.
Screening for Congenital Hypothyroidism With Specimen Collection at Two Time Periods: Results of the Northwest Regional Screening Program
Authors: LaFranchi Stephen H. , Hanna Cheryl E. , Krainz Patricia L. , Skeels Michael R. , Miyahira Richard S. , Sesser David E.
Published: December 2021

To determine the benefit of collecting two routine specimens to test for congenital hypothyroidism, we examined the results of our newborn screening program during the last 9.5 years. The Northwest Regional Screening Program (NWRSP) performs a primary thyroxine test with thyroid-stimulating hormone determinations on the lowest 10% of dried blood filter paper specimens. An initial specimen is obtained in the newborn period, and a routine second specimen is collected at approximately 4 to 6 weeks of age in all infants born in Oregon and 25% of infants born in Idaho, Montana, Alaska, and Nevada. Between May 1975 and October 1984, 182 infants with primary hypothyroidism were detected from 811,917 infants screened, a prevalence rate of 1:4,461. The routine second specimen led to the diagnosis of 19 infants of 484,604 infants screened, a detection rate of 1:25,505. When infants detected by the second screen were compared with those detected by the first screen, they had higher thyroxine and lower thyroidstimulating hormone concentrations on filter paper and serum specimens. When thyroid scanning was used, all but one infant detected by the second screen had some residual thyroid tissue, whereas 35% of infants detected by the first screen had thyroid aplasia. Skeletal maturation was more likely to be normal in infants detected by the second screen. These infants appear to have milder hypothyroidism due to a later age of onset or slower evolution of thyroid failure. At a cost of $31,881 per infant detected by the second screen, the NWRSP found it cost-effective to obtain a routine second specimen.
Ipecac Administration in Children Younger Than 1 Year of Age
Authors: Litovitz Toby L. , Klein-Schwartz Wendy , Oderda Gary M. , Matyunas Nancy J. , Wiley Scott , Gorman Richard L.
Published: December 2021

The efficacy of ipecac syrup in the induction of emesis and safety of its administration was studied in 105 poison-exposed infants 6 through 11 months of age (study subjects) and compared prospectively with 302 poison-exposed infants and children 12 through 35 months of age who served as age controls. Of the 105 study subjects 101 (96.2%) vomited. The failure of ipecac to induce emesis in six patients (four of 105 study subjects two of 302 age control subjects) is comparable with ipecac failure rates reported elsewhere. The frequency of side effects caused by ipecac syrup did not differ between study and control subjects. There were no serious medical complications resulting from the administration of ipecac syrup. When not readily available at home, ipecac administration was delayed an additional 21.8 minutes if obtained from a pharmacy and 38.4 minutes if obtained from an emergency department. Because of the time delay and the increased health care cost, home rather than emergency department administration of ipecac should be advised. These data demonstrate that ipecac syrup effectively induces emesis and is safe for home administration to poisoned infants 6 to 11 months old.
Cystic Fibrosis and Neuroblastoma
Authors: Moss Richard B. , Blessing-Moore Joann , Bender S. W. , Weibel A.
Published: December 2021

Two cases of coexistent cystic fibrosis and infantile thoracic neuroblastoma are presented. In one patient, neuroblastoma was congenital, and diagnosis of cystic fibrosis was made at 3 months of age; in the other, the diagnosis of cystic fibrosis was made at 7 months of age, preceding that of neuroblastoma by 4 months. In both infants, surgical resection of the tumors have been successful. Recent advances in the genetic aspects of neuroblastoma, including translocation and activation of the oncogene N-myc, are discussed. Current recombinant DNA technology, which can identify translocation of N-myc and allow localization of the cystic fibrosis gene if the translocation occurs near the cystic fibrosis allele, is being applied to these cases.
Lactation Failure Due to Insufficient Glandular Development of the Breast
Authors: Neifert Marianne R. , Seacat Joy M. , Jobe William E.
Published: December 2021

With the present increased incidence of breast-feeding, clinicians need to be prepared to identify and manage problems in lactation. Most problems are related to insufficient knowledge, inappropriate routines, and lack of confidence and are easily managed or prevented by prenatal education, anticipatory guidance, and adequate support. Increasing evidence exists that primary causes of lactation failure also occur and can preclude successful lactation, even among highly motivated women. Three cases are presented in which lactation failure is believed to stem from insufficient glandular tissue within the breasts. Supportive history for this entity include absence of typical breast changes with pregnancy and failure of postpartum breast engorgement to occur. Associated physical findings included a unilateral underdeveloped breast in each woman and palpable patchy areas of glandular tissue in one case. Breast diaphanography, or transillumination, substantiated clinical findings in the two cases in which it was performed. Both multiparous women had a previous unsuccessful breast-feeding experience, whereas the primiparous woman had immediate family members with a history of lactation failure. All three women benefited psychologically from the interpretation that lactation failure was not due to their breast-feeding performance, and each elected to continue nursing long-term despite the need for formula supplement. These cases are presented to emphasize that primary causes of lactation failure do exist and to alert clinicians to the historical and physical findings suggestive of inadequate glandular tissue as an etiology of previously unexplained lactation failure. Preserving the "every woman can nurse" myth contributes to perpetuating a simplistic view of lactation and does a disservice to the small percentage of women with primary causes of unsuccessful lactation.
Munchausen Syndrome by Proxy
Authors: GUANDOLO VINCENT L.
Published: December 2021

In Reply.—

There was an older sibling of the patient reported in "Munchausen Syndrome by Proxy: An Outpatient Challenge." This child's past medical history as disclosed by the mother included numerous allergies, a tonsillectomy/adenoidectomy at an early age, recurrent urinary tract infections during infancy, and chronic bouts of bronchitis and croup. These conditions predated the family's transfer to our office for pediatric care. There were infrequent office visits for minor medical problems in this child during the time that the mother concentrated on the patient described in our report.
Flying, Peanuts, and Crying Babies
Authors: STAFFORD ELISABETH M.
Published: December 2021

To the Editor.—

Guidelines from the American Academy of Pediatrics for injury prevention state that "physicians caring for children should counsel parents in age-appropriate, season-appropriate, locality-appropriate strategies which reduce common serious injuries".1 In keeping with this philosophy, many pediatricians educate parents about foods that may be unsafe for their child at a given age. Yet, there seems to be a substantial number of caretakers whom we obviously have not reached, judging by my observations of travelers feeding peanuts to toddlers on airplanes.
Catheter-Related Infection in Infants Due to an Unusual Lipophilic Yeast—Malassezia furfur
Authors: Long John G. , Keyserling Harry L.
Published: December 2021

Malassezia furfur (Pityrosporum orbiculare, P ovals), a lipophilic yeast that is part of the normal skin flora, causes tinea versicolor but has only rarely been associated with more serious infections. We report five episodes in four infants of catheter-related infection caused by this organism. All episodes occurred in infants who had survived serious neonatal disorders and were receiving prolonged therapy with intravenous fat emulsion. Sudden onset of fever without focal findings was the usual presentation; however, one afebrile patient had recurrent episodes of apnea, bradycardia, and cyanosis. Thrombocytopenia was a prominent finding. Patients were generally treated with amphotericin B. All patients recovered when the colonized catheter was removed or fat emulsion therapy was stopped. The yeast usually grew slowly in blood culture media but grew readily when subcultured onto Sabouraud's medium coated with sterile olive oil. Yeasts were readily identified in all four patients in whom a buffy coat Gram stain was obtained of blood from the central intravenous catheter. M furfur may be a fairly common but unrecognized cause of catheter-related sepsis in infants receiving long-term fat emulsion therapy. This organism should be sought whenever routine blood cultures are negative for bacteria and yeasts are observed in a buffy coat Gram stain.
Changes in Cell Proliferation Kinetics in the Mouse Cerebellum After Total Asphyxia
Authors: Yoshioka Hiroshi , Mino Masahiro , Morikawa Yuji , Kasubuchi Yasuo , Kusunoki Tomoichi
Published: December 2021

This study was undertaken to investigate the effects of neonatal asphyxia on brain development, with special reference to the kinetics of neuronal proliferation by using autoradiography. For 30 minutes, two-day-old suckling mice, Jcl:ICR strain, were put into a chamber which was constantly flushed with 100% CO2 gas. After the exposure to asphyxia, 29% of the mice survived. Cell cycle studies were carried out at two days and at seven days on the external matrix cells, the precursor of the granule cells, at the external granular layer of the cerebellum from CO2-exposed and control mice by 3H-thymidine autoradiography. At two days the generation time of the control mice was about 15 hours, whereas that of the asphyxiated mice was about 17 hours. The prolongation of the generation time in the asphyxiated mice was caused mainly by a delay in the G2 phase. This prolongation was apparent for about five days and there-after growth caught up. These results suggest that neonatal asphyxia has an adverse effect on cerebellar neuronal proliferation that may revert to normal spontaneously in older animals.
Infantile Myofibromatosis
Authors: WISWELL THOMAS E. , SAKAS E. LAWRENCE , STEPHENSON STEPHEN R. , LESICA JOHN J. , REDDOCH SHIRLEY R.
Published: December 2021

We recently cared for an infant with infantile myofibromatosis, a rare condition involving the dermal, visceral, musculoskeletal, and subcutaneous tissues. Most reports of this disorder have appeared in the pathology, cancer, and radiology literature.1-7 We report this case and review this condition in order to familiarize pediatricians with the clinical manifestations, histopathologic features, and prognosis of affected infants.

CASE REPORT

A 2,970-g female infant was born at term to a gravida 2, para 1 woman following an uncomplicated pregnancy. The family history was unremarkable. The infant's initial physical examination revealed a raised, hard, violaceous mass on the left side of the face, measuring 4 x 5 cm and extending from the upper lip to the lower eyelid and involving the nose (Fig 1).
Diffuse Retinopathy Following Measles, Mumps, and Rubella Vaccination
Authors: MARSHALL GARY S. , WRIGHT PETER F. , FENICHEL GERALD M. , KARZON DAVID T.
Published: December 2021

Blindness due to optic neuritis or panretinopathy has been reported as an acute complication of natural measles infection.5 Recently, loss of visual acuity following measles, mumps, and rubella (MMR) vaccination with the fundoscopic changes of optic neuritis has been described.6 We have observed a child with blindness due to diffuse neuroretinitis temporally associated with measles, mumps, and rubella vaccination and the development of a postvaccination measles syndrome.

CASE REPORT

A 16-month-old baby girl presented with acute loss of vision 16 days after routine measles, mumps, and rubella vaccination.

The infant had been previously healthy and developmentally normal. She had received three previous oral polio and diphtheria, tetanus, and pertussis vaccinations without adverse reactions.
Metolazone and Furosemide Therapy for Edema
Authors: ARNOLD WATSON C.
Published: December 2021

In Reply.—

Drs Garin and Richard have presented data that confirm our finding that a combination of furosemide and metolazone is efficacious in inducing a diuresis and natriuresis in children with edema resistant to furosemide alone. They echo valid concerns regarding the safety of combination diuretic therapy.

The increased incidence of complications noted in their experience may have been due to their higher doses of furosemide (5 mg/kg/d). We limited furosemide to 2 to 4 mg/kg/d.
Outbreak of Cryptosporidiosis in a Day-Care Center
Authors: Alpert Gershon , Bell Louis M. , Kirkpatrick Carl E. , Budnick Lawrence D. , Campos Joseph M. , Friedman Harvey M. , Plotkin Stanley A.
Published: December 2021

An outbreak of diarrhea due to infection with Cryptosporidium occurred in a day-care center. During a period of 2 months, 23 of 53 (43%) children attending the day-care center and 15 of 104 (14%) household contacts had diarrhea. Cryptosporidium oocysts were identified in 13 of 20 (65%) symptomatic children tested compared with three of 27 (11%) asymptomatic children (χ2 = 12.56, P < .001). Enteropathogenic bacteria, enteroviruses, rotavirus, and other protozoan parasites were ruled out as the cause of the diarrhea. A history of diarrhea in household contacts was associated with excretion of Cryptosporidium oocysts by the children. Human-to-human transmission of the infection was suggested by the epidemiology.
Classroom Performance and Social Factors of Children With Birth Weights of 1,250 Grams or Less: Follow-up at 5 to 8 Years of Age
Authors: Eilers Betty Lou , Desai Nirmala S. , Wilson Melissa A. , Cunningham M. Douglas
Published: December 2021

Of 43 long-term survivors with birth weights of 1,250 g or less, 33 were compared with peers and school-aged siblings for educational levels and needs. Of the 33 children in school, three (9.1%) were in classes for children with major handicaps, whereas 30 (90.9%) were found to be comparable to their classmates by teachers and/or test scores, but 14 (47%) were receiving remedial instruction to perform at grade level. Of 13 children with school-aged siblings, three required more hours of assistance by specialized teaching staff than their siblings. The group without the need for specialized teaching staff had older mothers and tended to reside in higher socioeconomic households. Overall, our children with birth weights of 1,250 g or less (51.5%) required more special education efforts than the general school population (24.1%), thereby enabling most to compare favorably with their peers.
Phenothiazine-Induced Sleep Apneas and the Opioid System
Authors: KAHN ANDRÉ
Published: December 2021

In Reply.—

Dr Sandyk suggests that the increased number of apneas seen in sleeping infants after the administration of phenothiazine could be related to an increase in endogenous opioids. If validated, this suggestion could be of interest for the understanding of the mechanisms inducing central and obstructive sleep apneas. As suggested naloxone could be tried in case of phenothiazine-induced apneas, but it seems advisable to systematically avoid the administration of phenothiazine-containing drugs to children younger than 2 years of age.
Circumcision and Urinary Tract Infections
Authors: WISWELL THOMAS E.
Published: December 2021

In Reply.—

Dr Cunningham apparently believes that there is no plausible physiologic explanation for the association between a decreased incidence of urinary tract infections and circumcisions as we recently described,1 and that we should seek alternative explanations for our findings. However, we disagree with most of the alternative suggestions and the comments that he has made.

We recently completed a second study evaluating the occurrence of urinary tract infections during the first year of life in more than 400,000 infants.
Salicylate Toxicity Rediscovered
Authors: PEARLMAN LYON N.
Published: December 2021

To the Editor.—

Howrie, Moriarty, and Breit are to be commended for again bringing to the attention of your readers, the fact that oil of wintergreen is a highly toxic susbtance.1 However, I would gently chide them on their statement that its use as a flavoring agent for homemade candy was "a previously unappreciated source" of poisoning. As long ago as 1940, the late W. T. Shirreff and myself2 pointed out that methyl salicylate was frequently used as a liniment and not uncommonly as a flavoring medium in foods.
Don't Do It in Front of the Kids
Authors: ROSENBERG MORTON B. , AHLGREN LAURIE S. , HARRIS BURTON H.
Published: December 2021

To the Editor.—

Our new day-surgery facility includes an architectural plan that allows the parents of patients to remain with their children. Satisfied with the design, we were surprised to discover that frequently when we went to talk to parents after an operation, they were nowhere to be found. An undercover investigation by the hospital security force revealed that the missing parents were almost always in the cafeteria. This was so different from the expected perioperative family hovering that it defied explanation.
Childhood Enuresis: Prevalence, Perceived Impact, and Prescribed Treatments
Authors: Foxman Betsy , Valdez R. Burciaga , Brook Robert H.
Published: December 2021

Childhood enuresis can indicate an underlying problem as benign as developmental immaturity or as serious as urinary tract obstruction. As part of a large population-based study, parents of 1,753 children aged 5 to 13 years were asked about the presence and frequency of enuresis, perceived impact, and physician-prescribed treatments. Enuresis at least once during a 3-month period was reported for 14% of this general population of children. Boys were significantly more likely to experience enuresis than girls (16% v 12%; P < .01). The prevalence of enuresis at least once a week was similar among boys and girls (7% v 6%). Parents reported that more than half of the children are distressed by their enuresis, and two thirds of parents expressed concern. Thirty-eight percent of bed wetters have seen a physician about their condition. More than one third of these children have been treated with a drug. The most commonly recommended regimen in the literature, the bed alarm, was prescribed to only 3% of bed-wetting children who saw a physician.
High-Frequency Ventilation and Tracheal Injuries
Authors: Mammel Mark C. , Ophoven Janice P. , Lewallen Patrick K. , Gordon Margaret J. , Sutton Marylyn C. , Boros Stephen J.
Published: December 2021

Recent reports linking serious tracheal injuries to various forms of high-frequency ventilation prompted this study. We compared the tracheal histopathology seen following standard-frequency, conventional mechanical ventilation with that seen following high-frequency, conventional mechanical ventilation, and two different forms of high-frequency jet ventilation. Twenty-six adult cats were examined. Each was mechanically ventilated for 16 hours. Seven received standard-frequency, conventional mechanical ventilation at 20 breaths per minute. Seven received high-frequency, conventional mechanical ventilation at 150 breaths per minute. Six received high-frequency jet ventilation at 250 breaths per minute via the Instrument Development Corporation VS600 jet ventilator (IDC). Six received high-frequency jet ventilation at 400 breaths per minute via the Bunnell Life Pulse jet ventilator (BLP). A semiquantitative histopathologic scoring system graded tracheal tissue changes. All forms of high-frequency ventilation produced significant inflammation (erosion, necrosis, and polymorphonuclear leukocyte infiltration) in the trachea in the region of the endotracheal tube tip. Conventional mechanical ventilation produced less histopathology than any form of high-frequency ventilation. Of all of the ventilators examined, the BLP, the ventilator operating at the fastest rate, produced the greatest loss of surface cilia and depletion of intracellular mucus. IDC high-frequency jet ventilation and high-frequency, conventional mechanical ventilation produced nearly identical histologic injuries. In this study, significant tracheal damage occurred with all forms of high-frequency ventilation. The tracheal damage seen with high-frequency, conventional mechanical ventilation suggests that ventilator frequency, not delivery system, may be responsible for the injuries.
Kawasaki Syndrome, Reye Syndrome, and Aspirin
Authors: BUSHORE MARTHA
Published: December 2021

In Reply.—

Because the incidence of each of these serious pediatric diseases is low, but the need for prompt recognition and skillful management is essential to optimal outcome, Drs Takahashi and Mason's excellent review and knowledgeable guidance are invaluable to the practicing pediatrician who rarely manages either of these disorders. Our concern that aspirin may interfere with platelet adhesion (when not therapeutically desirable), may increase airway resistance, and may be associated with Reye syndrome should not lead us to discontinue recommending appropriate use of this excellent drug when therapeutic benefit outweighs risk.
School Buses and Seat Belts
Authors: AHRONHEIM GERALD A.
Published: December 2021

To the Editor.—

The epidemic of motor vehicle injuries and fatalities may be no less amenable to control than, say, infectious diseases such as pertussis or measles. As two papers in September's issue of Pediatrics suggest, the task is not necessarily a technical one, such as vaccine development, but a behavioral one analogous to the introduction of effective hygienic practices. In recent decades the majority of North American parents seem to have come to accept clean food and water, as well as childhood immunizations, as normal parts of life.
Supplementation With Human Milk Protein Improves Growth of Small Premature Infants Fed Human Milk
Authors: Rönnholm Kai A. R. , Perheentupa Jaakko , Siimes Martti A.
Published: December 2021

We investigated the influence of human milk protein and medium-chain triglyceride supplementations of human milk feedings on the growth of very low birth weight infants during their first weeks of life. A group of 44 preterm infants with birth weights of less than 1,520 g and a mean gestational age of 30.3 weeks was randomly divided into four groups to receive plain human milk or human milk supplemented with human milk protein (0.9 g/dL), with medium-chain triglycerides (1 g/dL), or with both. The medium-chain triglyceride oil supplementation did not influence the growth of these infants. The infants given supplementary protein gained weight faster during weeks 4 to 6 than those without (18.5 ± 0.7 v 15.1 ± 0.6 g/kg/d; mean ± SEM; P = .001). After 4 weeks of age the infants given supplementary protein had a mean weight gain equal to the mean intra-uterine rate, in contrast to the infants of the other groups, who grew more slowly until age 6 weeks. Furthermore, we found a correlation between serum albumin concentration and weight gain during the seventh week of life (P = .018). The length growth velocity for the infants with protein supplementation was 0.99 ± 0.06 cm/wk (mean ± SEM) and for those without 0.83 ± 0.05 cm/wk (P = .043). There was no difference in growth of head circumference between the groups. We conclude that human milk protein supplementation improves the growth of small premature infants fed human milk, and that the protein concentration of bank milk is insufficient for their adequate growth.
Tactile/Kinesthetic Stimulation Effects on Preterm Neonates
Authors: Field Tiffany M. , Schanberg Saul M. , Scafidi Frank , Bauer Charles R. , Vega-Lahr Nitza , Garcia Robert , Nystrom Jerome , Kuhn Cynthia M.
Published: December 2021

Tactile/kinesthetic stimulation was given to 20 preterm neonates (mean gestational age, 31 weeks; mean birth weight, 1,280 g; mean time in neonatal intensive care unit, 20 days) during transitional ("grower") nursery care, and their growth, sleep-wake behavior, and Brazelton scale performance was compared with a group of 20 control neonates. The tactile/kinesthetic stimulation consisted of body stroking and passive movements of the limbs for three, 15-minute periods per day for a 10 days. The stimulated neonates averaged a 47% greater weight gain per day (mean 25 g v 17 g), were more active and alert during sleep/wake behavior observations, and showed more mature habituation, orientation, motor, and range of state behavior on the Brazelton scale than control infants. Finally, their hospital stay was 6 days shorter, yielding a cost savings of approximately $3,000 per infant. These data suggest that tactile/kinesthetic stimulation may be a cost effective way of facilitating growth and behavioral organization even in very small preterm neonates.
Central Nervous System Involvement in Cat Scratch Disease
Authors: Lewis Donald W. , Tucker Samuel H.
Published: December 2021

Cat scratch disease is a cause of benign regional adenopathy which is rarely associated with CNS complications. Two children with cat scratch disease associated with alterations of mental status and convulsions are presented. One patient had a focal cerebral abnormality on neurologic examination, EEG, and computed axial tomography. The spectrum of CNS involvement is reviewed for this usually benign disease. Prognosis is generally excellent. The pathogenesis of the CNS complications has not been elucidated.
Farm Accidents
Authors: COGBILL THOMAS H. , BUSCH HENRY M. , STIERS GARY R.
Published: December 2021

In Reply.—

We appreciate the interest and comments by Dr Paulson relative to our paper (Pediatrics 1985;76:562-566). In our series of 105 children injured in farm accidents, we reported one mortality (1%) and one child (1%) with major long-term disability. Follow-up ranged from 2 to 80 months based upon review of complete outpatient records in this stable rural population. Serious neurologic and physiologic sequelae were accurately recorded.

We agree with Dr Paulson that a retrospective chart review will underestimate the number of minor disabilities including subtle neurologic, orthopedic, and pulmonary sequelae.
College Measles
Authors: WHITE FORREST P.
Published: December 2021

To the Editor.—

The increase in measles cases on college campuses during the past year brings into question our national policy about measles immunization. Is it correct and comprehensive? Or has our success in eliminating smallpox led us down the garden path of dangerous assumptions?

Conventional wisdom holds that we can eliminate measles just as we did smallpox. Does anybody really think we can reach every village in every remote region of the world to identify every case of measles? Smallpox is a devastating, readily identifiable disease, and vaccination against it leaves a distinctive mark.
Correlates of Low-Level Lead Exposure in Urban Children at 2 Years of Age
Authors: Bellinger David , Leviton Alan , Rabinowitz Michael , Needleman Herbert , Waternaux Christine
Published: December 2021

The blood lead levels of a large number of US preschool children approach the value regarded as the upper limit of normal. To reduce the number of children whose levels increase into the range thought to be toxic, the antecedents and correlates of levels in the 0- to 25-µg/dL range must be identified. In a large longitudinal study of middle and upper-middle class children living in metropolitan Boston, we evaluated how well five sets of variables predicted children's blood lead levels at 2 years of age: environmental lead sources, mouthing activity, home environment/care giving, prior developmental status, and sociodemographic characteristics. A series of bivariate and multivariate analyses indicated that only environmental lead sources and, to a lesser extent, mouthing activity accounted for significant protions of the variance in blood lead levels. Environmental lead sources were not significantly related to the home environment/care-giving variables or to sociodemographic characteristics. The most promising approach for achieving community-wide reductions in children's blood lead levels is reduction in the amount of lead in the proximate environment.
Calcium-Regulating Hormones and Minerals From Birth to 18 Months of Age: A Cross-Sectional Study. I. Effects of Sex, Race, Age, Season, and Diet on Vitamin D Status
Authors: Lichtenstein P. , Specker B. L. , Tsang R. C. , Mimouni F. , Gormley C.
Published: December 2021

The influence of sex, race, age, season, and diet (cow's milk formula v human milk) on the vitamin D and vitamin D-binding protein status in infants less than 18 months of age was investigated in this crosssectional, prospective study of 198 infants. No differences by sex were observed in serum 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, 24,25-dihydroxyvitamin D, or vitamin D-binding protein concentrations. By race, black infants had significantly elevated serum 1,25-dihydroxyvitamin D levels relative to white infants. By age, vitamin D-binding protein concentrations increased with increasing age. By season, serum 25-hydroxyvitamin D concentrations were low in winter, whereas 1,25-dihydroxyvitamin D and vitamin D-binding protein were high in winter compared with summer. By diet, formula-fed infants had higher serum concentrations of all measured vitamin D metabolites and vitamin D-binding protein than human milk-fed infants. Thus, race, age, season, and diet exert, individually or in combination, different and significant effects on vitamin D metabolites; these should be considered in assessing infant vitamin D status.
Coxsackievirus B2 Infection in a Neonate With Incontinentia Pigmenti
Authors: Barson William J. , Reiner Charles Ba
Published: December 2021

Because of the concern for herpes simplex virus infection in the neonate, the presence of neonatal vesiculobullous lesions is a critical finding. However, there are other etiologies for these lesions. A case of a neonate with a vesicular rash and meningoencephalitis which was initially thought due to herpes is presented. The infant was ultimately determined to have incontinentia pigmenti and a concomitant coxsackievirus B2 infection.
Intermittent Testicular Torsion
Authors: Stillwell Thomas J. , Kramer Stephen A.
Published: December 2021

Testicular torsion is the most common cause of acute scrotal pain in prepubertal and adolescent boys and should be foremost in the minds of primary care physicians evaluating these children. Intermittent testicular torsion is a separate entity that should be considered in all young males with a history of scrotal pain and swelling. Acute and intermittent sharp testicular pain and scrotal swelling, interspersed with long intervals without symptoms, are characteristic. Physical findings may include horizontal or very mobile testes, an anteriorly located epididymis, or bulkiness of the spermatic cord from partial twisting. Awareness of this entity and early elective orchiopexy will improve testicular salvage in patients with intermittent testicular torsion.
Genitourinary Injuries Secondary to Break Dancing in Children and Adolescents
Authors: GEARHART JOHN P. , LOWE FRANKLIN C.
Published: December 2021

Trauma to the lower genitourinary tract in children and adolescents has been a rare occurrence. However, with the advent of pediatric trauma centers, more of these injuries are now being seen and evaluated. Although trauma to the genitourinary tract alone is an uncommon cause of death, trauma centers are seeing more children in which decisions regarding the management of the genitourinary tract must be made. Most injuries that have been reported have been secondary to blunt trauma such as straddle injuries, falls, or motor vehicle accidents. Recently, two cases of lower genitourinary tract trauma have been seen associated with the current fad of break dancing.
Relationship Between Bilirubin and Hearing Loss
Authors: GALLAHER KEITH J. , MAISELS M. JEFFREY
Published: December 2021

To the Editor.—

De Vries et al1 describe an interesting association between serum bilirubin levels > 14 mg/dL and sensorineural deafness in low birth weight infants. A similar association (in infants who were exposed to lower serum bilirubin levels) was reported by Bergman et al.2 These results are important because of their potential influence on how we treat these infants, yet they raise certain questions.

The authors classified infants as "high risk" or "low risk" based on the presence of certain "adverse factors," but they do not tell us about the distribution of these factors in the study patients.
Relationship Between Bilirubin and Hearing Loss
Authors: DE VRIES LINDA S.
Published: December 2021

In Reply.—

We were most interested in Gallaher and Maisels' comments on our paper. Although they mention that sensorineural deafness is an unusual event in their experience, they do not provide us with an incidence and also do not mention their method for testing hearing.

Most of our infants, were classified as high risk because they required ventilation for hyaline membrane disease. The ten deaf infants who were high risk and their ten matched controls were all ventilated.
Pathogenesis of Biliary Atresia
Authors: ESTERLY JOHN R.
Published: December 2021

To the Editor.—

The report of biliary atresia in one identical twin is of interest. As the authors' state, the observation suggests that the malformation may be acquired rather than of genetic origin. Many pediatric pathologists consider biliary atresia an acquired defect in a large, but unknown, proportion of affected patients. The evidence to support the hypothesis is circumstantial. Stages of a presumed continuum from mild periportal inflammation and neonatal hepatitis to obstructive atresia have been found at autopsy in patients with the congenital rubella syndrome.2
Henoch-Schönlein Purpura and Human Parvovirus Infection
Authors: LEFRÈRE J. J. , COUROUCÉ A. M. , SOULIER J. P. , CORDIER M. P. , GIRAULT M. C. GUESNE , POLONOCSKI C. , BENSMAN A.
Published: December 2021

To the Editor.—

Human parvovirus is already known to be responsible for aplastic crisis in chronic hemolytic anemia,1 for erythema infectiosum or fifth disease,2 and for arthropathies,3,4 and it has recently been isolated from the serum of patients with vascular purpura.5 We report the case of Henoch-Schonlein purpura associated with human parvovirus infection.

H. T., a 6-year-old girl, without any significant past history, was admitted on March 8, 1985, for joint pain and swelling (wrists, knees, ankles) associated with intense abdominal pain.
Steroid Abuse by Adolescents
Authors: DYMENT PAUL G.
Published: December 2021

In Reply.—

Dr Kwasman has raised an important point, that androgen misuse by athletes is widespread, and this problem should be addressed by pediatricians in their offices when caring for such youth.1 As sports in which muscle strength or size is important are the most likely to be the ones for which the drugs are taken (weight lifting, throwing events in track, football, and muscle building), the physician should discuss this subject with every athlete seen participating in these events.
Sequelae of Acute Bacterial Meningitis in Children Treated for Seven Days
Authors: Jadavji T. , Biggar W. D. , Gold R. , Prober C. G.
Published: December 2021

The sequelae of acute bacterial meningitis in children who were treated with ampicillin or chloramphenicol for seven days during the period January 1979 to June 1983 were assessed prospectively. The 235 patients (117 boys and 118 girls) ranged in age from four days to 18 years (mean 26.4 months). Haemophilus influenzae type b was isolated in 70% of patients, Streptococcus pneumoniae in 20%, and Neisseria meningitidis in 10%. The mortality rate was 6.4%. No relapses occurred. Of the 220 survivors, 171 had neurologic psychometric, audiologic, and ophthalmologic assessments performed for a minimum of 1 year following their illness. One hundred thirty-six (80%) children had no detectable sequelae; 20% had mild to severe handicaps. The frequency of sequelae was greatest among children with S pneumoniae meningitis (57%) and least among children with N meningitidis (0%). The sequelae observed included: sensorineural hearing loss (12.9%), developmental delay (5.3%), speech defect (4.7%), motor defect (3.0%), hydrocephalus (1.7%), and seizure disorder (1%). The frequency of observed sequelae among these patients is similar to that previously reported in children treated for ten to 14 days. Our findings indicate that seven days of intravenous antibiotic therapy is adequate for the treatment of bacterial meningitis in children.
New Disorder of Vitamin B12 Metabolism (Cobalamin F) Presenting as Methylmalonic Aciduria
Authors: Rosenblatt David S. , Laframboise Rachel , Pichette Jeanne , Langevin Pierre , Cooper Bernard A. , Costa Teresa
Published: December 2021

An infant with vitamin B12-responsive methylmalonic aciduria and no homocystinuria or megaloblastic anemia presented with stomatitis, glossitis, convulsions, and developmental delay. Cultured fibroblasts showed defective incorporation of both [14C]5-methyltetrahydrofolate and [14C]propionate into protein by whole cells and a decrease of methionine synthase activity in cell extracts. Despite excessive incorporation of [57Co]cyano-B12 by fibroblasts from the patient, free vitamin B12 was unable to efflux from lysosomes, and, therefore, synthesis of both adenosyl-B12 and methyl-B12 was impaired.
Factors Related to Early Termination of Breast-Feeding in an Urban Population
Authors: Feinstein Joel M. , Berkelhamer Jay E. , Gruszka Mary Ellen , Wong Cynthia A. , Carey Ann E.
Published: December 2021

A prospective study of breast-feeding mothers was undertaken to determine the effect of formula samples and other hospital-related factors on success in breast-feeding. Of the 166 nursing mothers studied for 4 months postpartum, 83% breast-fed for 1 month, 73% for 10 weeks, and 58% for 4 months or longer. Breast-feeding duration was not affected by formula samples given at discharge from the hospital. Factors correlating significantly with improved breast-feeding rates include maternal age, maternal education, nonsmoking, previous breast-feeding, planned pregnancy, initiation of breast-feeding in the first 16 hours, and minimization of formula supplementation in the nursery. Partial breast-feeding (supplementing more than one bottle of formula per day, measured at 1 month postpartum) was associated with shorter breast-feeding duration. This latter effect was minimized by frequent nursing (seven or more times per day), despite formula supplementation.