bluuebunny/crossref_metadata_2025 huggingface dataset:
In Reply: Atherosclerosis
Authors: KWITEROVICH PETER O.
Published: December 2021

In his letter, Dr Mauer has expressed concern that my prior commentary constituted a "disservice to science" and "closes the book" on future hypothesis testing.

My commentary was written in response to a previous commentary by Dr Mauer. I was concerned that Dr Mauer's comments, namely, "The significance of serum cholesterol levels as an independent variable could not be definitely assigned" and "there are no available data on children," were misleading. At the very least, the pediatrician deserved a detailed review of the literature and a careful exposition of the cholesterol hypothesis.
School Performance and Theophylline
Authors: RACHELEFSKY GARY S. , WO JULIE , ADELSON JUDIH , MICKEY M. RAY , SPECTOR SHELDON L. , KATZ ROGER M. , SIEGEL SHELDON C. , ROHR ALBERT S.
Published: December 2021

In Reply.—

Drs Weinberger, Lindgren, and Joad's comments are appreciated, and they raise a number of questions about our report of the adverse effects of theophylline. We appreciate their concerns, and we hope the following satisfies them.

Because the manuscript was published in Pediatrics and reported by the staff of USA Today, we will concern ourselves with the peer-reviewed published paper.

The study was randomized and double blinded; the investigators, the children, the teachers, and the parents had no way of knowing whether the children were on theophylline or not, and there was no prior experience with theophylline titration.
Gift to a Litigious Society
Authors: SAPIRE DAVID W. , WOLF WENDY J. , CASTA ALFONSO
Published: December 2021

To the Editor.—

The article by Dr Garson1 impacts significantly on all physicians who treat children with cardiac dysrhythmias. We recognize that Dr Garson is an authority in the diagnosis and management of cardiac rhythm disorders in children, and we agree with his view that arrhythmia therapy can be potentially hazardous. However, we do take exception to the format and presentation of the information in this article.

By using the term "medicolegal" in the title, a potential red flag is raised to attract the attention of tort lawyers who might justifiably believe they can use this information for their own purposes.
Purulent Tendon Sheath Infection
Authors: FISCHEL DAVID R.
Published: December 2021

To the Editor.—

We recently cared for a young patient who had a rather unusual infection. Review of the standard pediatric literature and a Medline search yielded no other descriptions of this particular entity. Therefore, I am submitting a description of this child's examination and treatment in order to share this with other pediatricians who may have already encountered or who may in the future encounter a similar clinical problem.

Five days before this child's admission, the babysitter of this 12-month-old caucasian girl reported to the infant's mother that the child would not bear weight on her left foot and would not walk.
Drug Prescribing in Pediatrics: Challenges for Quality Improvement
Authors: SOUMERAI STEPHEN B. , ROSS-DEGNAN DENNIS
Published: December 2021

Pharmacoepidemiology and quality of care have become highly visible topics in geriatric medicine circles of late—due in part to research suggesting that there are important adverse effects of commonly used medications in elderly patients (eg, falls and fractures of the hip).1 Relatively less attention has been focused on patients at the other end of the age spectrum—children and adolescents. Although their exposure to medications is less than in older patients, pediatric drug prescribing is not an insignificant concern. In one longitudinal study of 222 children,2 the average number of medication courses received was 8.5 during the first 5 years of life.
Daytime Urinary Frequency
Authors: BLOOM DAVID A. , SEDMAN AILEEN , ZOUBEK JERI
Published: December 2021

In Reply.—

We missed the paper by Leung and Robson, and appreciate the chance to learn of it. It should be included in the definitive bibliography for extraordinary frequency. Certainly, as they say, the problem is more prevalent than recognized generally.

The enuresis and urgency would have disqualified 3 of their 10 patients from our series. The pH of 5 in half of their patients was of interest. We didn't, off hand, know the normal pH range of children in a urology clinic.
Human Immunoglobulins for Intravenous Use: Comparison of Available Preparations for Group B Streptococcal Antibody Levels, Opsonic Activity, and Efficacy in Animal Models
Authors: Givner Laurence B.
Published: December 2021

Currently available human immunoglobulin preparations for intravenous use (IVIGs) are being used (with antibiotics) by some physicians for therapy of sepsis in newborns. Most neonatal sepsis and/or meningitis in this country is caused by group B Streptococcus (GBS), and most of these cases are due to type III GBS (III-GBS). The killing of III-GBS in vitro is dependent on specific IgG antibody. Adequate serum levels of specific III-GBS antibody protect the exposed newborn from the development of invasive disease. Therefore, III-GBS was used as a model to evaluate the activity of three IVIG preparations available for clinical use. Specific antibody levels, in vitro opsonophagocytic killing, and protective efficacy in animal models revealed differences in activity for III-GBS between the three IVIG preparations as well as between IVIG lots from the same manufacturer. Furthermore, it was found that the effect of IVIG using one of the assay methods may not reliably predict activity obtained using the other assays. These data document the inability to predict functional activity against a specific pathogen such as GBS on the part of a lot of IVIG chosen at random. In view of these findings and of the limited data evaluating clinical efficacy, IVIG cannot be recommended at this time for use in the therapy of infectious diseases such as neonatal sepsis.
Methods for Evaluating the Protective Activity of Intravenous Immunoglobulins for Neonatal Pathogens: Entanglement or Encouragement?
Authors: BAKER CAROL J. , EDWARDS MORVEN S.
Published: December 2021

Reducing neonatal mortality is a goal common among health care workers. However, the means by which to achieve this goal may engender debate and cause confusion. It is inherently attractive to consider human immunoglobulin prepared for intravenous use as an adjunct to therapy for neonatal sepsis, especially in those preterm infants who have the highest incidence and mortality. Before we embark on difficult and costly clinical trials to determine the efficacy of intravenous immunoglobulin (IVIG) as adjunctive therapy, however, two hurdles must be surmounted. Commercial preparations of IVIG must be proved to be safe in neonates and there must be the promise that their benefit will outweigh both risk and cost.
Temperature Measurement—Gold Standard
Authors: WEISSE MARTIN E.
Published: December 2021

To the Editor.—

I would like to comment on the article by Freed and Fraley in the March 1992 issue of Pediatrics.1 I have no argument with their study design and in fact applaud them for using Altman and Bland's method of analysis. Their conclusions, as written, are correct, that the tympanic thermometer "is unreliable compared with conventional methods of temperature determination." The three issues that I would like to raise are: (1) the relative accuracy of rectal and tympanic temperatures in predicting core temperature, (2) rectal temperature as the "gold standard," and (3) axillary thermometry as an acceptable conventional method of clinical temperature.
The Use of Sodium Bicarbonate in Neonatal Resuscitation: Help or Harm?
Authors: HEIN HERMAN A.
Published: December 2021

Those who cannot remember the past are condemned to repeat it.

George Santayana

The Life of Reason

Sodium bicarbonate has long been used in neonatal resuscitation, and recommendations for its use are currently included in guidelines issued as a part of a national program to improve neonatal resuscitation.1 Given our relatively long experience using sodium bicarbonate in neonatal resuscitation, one might assume that the early experimental data on which usage was predicated were extensive and compelling and that modern data continue to support its use.

Sodium bicarbonate was first commercially produced in the late 1950s, and soon thereafter, its use in premature neonates became commonplace, not for treating neonatal asphyxia per se, but rather as a therapy designed to prevent azotemia, hypoglycemia, and elevations in serum potassium levels as well as for correcting metabolic acidosis (the socalled Usher regimen).2
Compartment Syndrome Following Intraosseous Infusion
Authors: VIDAL R. , KISSOON N. , GAYLE M.
Published: December 2021

Cannulation of an intraosseous (IO) site allows rapid access to the vascular space under emergency conditions. With increasing acceptance of this technique, some of its complications are now being fully appreciated. We present a case of a child who developed compartment syndrome and had a lower extremity amputation after infusion of fluids through an IO needle inserted in the proximal tibia. This case is presented to highlight the precautions that may prevent compartment syndrome. Additional emphasis is placed on early recognition and aggressive treatment of compartment syndrome to preserve function in the affected limb.

CASE REPORT

A 1-month-old infant with fever and irritability was treated at a community hospital.
Suprapubic Aspiration of Urine in Very Low Birth Weight Infants
Authors: BARKEMEYER BRIAN M.
Published: December 2021

The incidence of urinary tract infection in the neonatal period is higher in preterm than in term infants.1 These are typically late-onset infections occurring after 72 hours of age.2 Because the signs of urinary tract infection in neonates are nonspecific, a safe and effective way of sampling urine for culture such as suprapubic aspiration is essential. Although previous studies have demonstrated the efficacy of this procedure in term and preterm infants, the preterm infants studied previously were undoubtedly larger than those very low birth weight infants cared for in today's neonatal intensive care units, inasmuch as survival rates for these small infants have increased.1,3
SEX DIFFERENCES IN THE INTERACTION BETWEEN TEMPERAMENT AND PARENTING
Authors: Bezirganian Sophia , Cohen Patricia
Published: December 2021

Temperament and parent-child relationships were measured in a random sample of 776 children followed over a 10-year period. The goal was to determine whether temperament evolves differently for boys versus for girls, and if so, whether parenting influences gender-specific development. Gender-specific parenting effects on the evolution of difficult temperament were found: low effects were not present. A possible explanation for these findings is proposed. The contribution of these findings to understanding biology-environment interactions in causing sex differences in development is discussed.
Prenatal Marijuana Exposure and Neonatal Outcomes in Jamaica: An Ethnographic Study
Authors: Dreher Melanie C. , Nugent Kevin , Hudgins Rebekah
Published: December 2021

Objective. To identify neurobehavioral effects of prenatal marijuana exposure on neonates in rural Jamaica.

Design. Ethnographic field studies and standardized neurobehavior assessments during the neonatal period.

Setting. Rural Jamaica in heavy-marijuana-using population.

Participants. Twenty-four Jamaican neonates exposed to marijuana prenatally and 20 nonexposed neonates.

Measurements and main results. Exposed and nonexposed neonates were compared at 3 days and 1 month old, using the Brazelton Neonatal Assessment Scale, including supplementary items to capture possible subtle effects. There were no significant differences between exposed and nonexposed neonates on day 3. At 1 month, the exposed neonates showed better physiological stability and required less examiner facilitation to reach organized states. The neonates of heavy-marijuana-using mothers had better scores on autonomic stability, quality of alertness, irritability, and self-regulation and were judged to be more rewarding for caregivers.

Conclusions. The absence of any differences between the exposed on nonexposed groups in the early neonatal period suggest that the better scores of exposed neonates at 1 month are traceable to the cultural positioning and social and economic characteristics of mothers using marijuana that select for the use of marijuana but also promote neonatal development.
FLUOXETINE TREATMENT OF CHILDREN AND ADULTS WITH AUTISTIC DISORDER AND MENTAL RETARDATION
Authors: Cook Edwin H. , Rowlett Randall , Jaselskis Catherine , Leventhal Bennett L.
Published: December 2021

An open trial of pharmacological treatment with fluoxetine, ranging from 20 mg every other day to 80 mg per day, led to a significant improvement in Clinical Global Impressions ratings of Clinical Severity in 15 of 23 subjects with autistic disorder and 10 of 16 subjects with mental retardation. Six of 23 patients with autistic disorder and 3 of 16 patients with mental retardation had side effects which significantly interfered with function, consisting predominantly of restlessness, hyperactivity, agitation, decreased appetite, or insomnia. Double-blind studies of the efficacy of pharmacological agents that potently inhibit 5-IIT uptake in the treatment of mental retardation coexisting with Axis I psychiatric disorders (especially obsessive-compulsive disorder) and autistic disorder are warranted.
Zidovudine and Didanosine Combination Therapy in Children With Human Immunodeficiency Virus Infection
Authors: Husson Robert N. , Mueller Brigitta U. , Farley Maureen , Lewis Linda L. , Balis Frank M. , Brouwers Pim , Butler Karina M. , Jarosinski Paul , Pizzo Philip A. , Woods Lin , Goldsmith Jonathan C. , Avramis Vassilios I. , Church Joseph A. , Kovacs Andrea , Ono Janice , Rasheed Suraiya , Venzon David
Published: December 2021

Objective. Zidovudine and didanosine are both beneficial for the treatment of human immunodeficiency virus (HIV) infection in children. Because disease progression and toxicity often limit their long-term use as single agents, new approaches to using nucleoside analogues are necessary to improve current antiretroviral therapy.

Design. We conducted a phase I-II study to evaluate the tolerance, pharmacokinetics, and antiviral activity of the combination of zidovudine and didanosine in children with HIV infection. Sixty-eight children who were either previously untreated or who had manifested hematologic toxicity on full-dose zidovudine were enrolled. Eight dose combinations were studied in the previously untreated children, with doses of zidovudine ranging from 90 to 180 mg/m2 every 6 hours and doses of didanosine ranging from 90 to 180 mg/m2 every 12 hours.

Results. Fifty-four previously untreated HIV-infected children were enrolled in this part of the study, of whom 49 remained in the study for a minimum of 24 weeks. For children with previous zidovudine-related hematologic toxicity, three dose levels with zidovudine at 60 mg/m2 every 6 hours orally and didanosine ranging from 90 to 180 mg/m2 every 12 hours orally were used. A total of 14 children were enrolled in this part of the study, and 12 remained on therapy for at least 24 weeks. No evidence of new or enhanced toxicity was observed in either group. After 24 weeks, the median CD4 cell count for all patients increased from 331 to 556 cells/mm3 (P = .01). For the previously untreated group, the median increase in CD4 counts was from 386 to 726 cells/mm3 (P = .003). The median p24 antigen concentration (in those with a detectable level at baseline) decreased from 95 to <31 pg/mL (P < .001). The geometric mean titer of HIV in plasma decreased from 83.1 to 2.7 tissue culture infectious doses/mL (P = .001).

Conclusions. The combination of zidovudine and didanosine was well-tolerated at doses as high as those used in single agent therapy. Potent in vivo antiviral activity was observed. Combination therapy with nucleoside analogues may be an important approach to optimizing the use of these agents in the treatment of HIV infection.
Interconception Care: A New Role for the Pediatrician
Authors: Klerman Lorraine V. , Reynolds David W.
Published: December 2021

The infant mortality rate continues to be higher in this country than in many other industrialized nations.1 Federal, state, and local governments have responded by spending large amounts of money on attempts to reduce the infant mortality rate, and expert groups, task forces, and commissions have issued reports on the subject.2-4 Until recently, however, there seemed little that the primary care pediatrician—as distinct from the neonatologist—could do about this problem, because approximately two thirds of infant deaths occur in the neonatal period (before the 28th day of life and often before the neonate leaves the hospital). But this situation should change as attention is increasingly shifted from what can be done after the baby is born to what can be done before the baby is conceived.
Primary Care Pediatricians
Authors: DeSpirito Anthony P. , Brotherton Sarah E.
Published: December 2021

Lately, the relatively low proportion of physicians who practice primacy care medicine has concerned many, yet exact figures are lacking, given the variation in the methods used for calculation. To this end, we recently surveyed US pediatric residency programs about their residents who finished training in 1992. This was accomplished through the aid of many of the program directors and of members of the Board of Directors of the American Academy of Pediatrics. Through our correspondence, 60% of the programs provided the following information: approximately 55% of graduating residents were planning to enter pediatric practice directly and 42% were planning to enter a subspecialty fellowship.
THIS FEDERAL HEALTH PLAN WORKED TOO WELL
Authors: L. J. F.
Published: December 2021

Before okaying any plan that attempts to increase access to health care while harnessing costs, congress ought to re-examine the government-funded End-State Renal Disease program. It shows that per-treatment costs can be controlled by setting limits on what providers are paid, but controlling the volume is vastly more complex...

A program that initially served 11,000 people today serves 165,000 and is expected to soon have 300 000 beneficiaries...

First year costs were $229 million and reached $1 billion by 1977. In 1991, the program cost $6.6 billion.

Even so, efforts by Medicare, which administers the program, to control perpatient costs have been a great success. Administrators capped the reimbursement rate early and steadfastly refused to raise it—not even to compensate for inflation. Twice the rate was lowered. Thus, the cost in constant dollars of a dialysis treatment has fallen 61%—$54 from $138...

Today dialysis patients are older and sicker, and people over age 65 form the fastest growing group of new users. Among the aged beneficiaries are people in a persistent vegetative state and nursing-home residents who go to dialysis centers on stretchers...

In Britian it is rare for anyone over age 55 to go on dialysis, largely because the British health-care system contains an implicit bias against providing dialysis for any kidney patient with multiple serious disorders, which elderly patients almost always have. As a result, for every million people in Britain, 154 are on dialysis; in the U.S., 539 people out of every million are on dialysis.
Summary of Major Changes in the 1994 Red Book: Report of the Committee on Infectious Diseases
Authors: Peter Georges
Published: December 2021

The 1994 edition of the Red Book was recently published by the American Academy of Pediatrics (AAP), providing the most recent recommendations and guidelines for prevention, control, and treatment of infectious diseases in infants and children.1 These recommendations and guidelines are based on information available through 1993 and replace those given in the 1991 Red Book. To aid physicians and other health care professionals in assimilating new recommendations and information into their practices, a summary of major changes is given in the Red Book. This summary, with minor changes, is reprinted here. Subsequent recommendations of the AAP are published as Committee statements in AAP News and Pediatrics. In keeping with the current 3-year intervals between editions of the Red Book, the next edition is anticipated no later than 1997.

Major changes in recommendations and related information in the 1994 Red Book are summarized as follows:

1. Immunization recommendations. The schedules for routine immunization, including changes in recommendations for Haemophilus influenzae type b, hepatitis B, measles, and oral polio vaccines have been revised. In view of the increasing complexity of the immunization recommendations for infants and children, particular attention should be given to the comments and footnotes in these schedules. In addition, because licensure of new vaccines and revised recommendations after publication of the Red Book will result in continuing changes, the Committee anticipates the publication of an updated immunization schedule each year in the interval before the next edition of the Red Book is published.

2. Guidelines on active immunization.
IT'S A SELLER'S MARKET FOR NURSE PRACTITIONERS
Authors: L. J. F.
Published: December 2021

Nurse Practitioners: Nurse practitioners (NPs), who have nine to 24 months of education beyond an RN and some of whom have masters degrees, are allowed in some states to work "in collaboration" with physicians, consulting with them only as necessary. Other states require advanced practice nurses to work with varying degrees of physician supervision. There are about 25,000 NPs in practice, and the American Nurses Association says there are four job openings for every certified nurse practitioner. Their median income is in the $40,000 range.
METERED-DOSE INHALER ADHERENCE IN A CLINICAL TRIAL
Authors: Kamada Alan
Published: December 2021

Self-reporting and canister weight overestimate compliance and a subset of patients who deliberately dump medication prior to follow-up visits was identified.
EFFECT OF 22 MONTHS OF TREATMENT WITH INHALED CORTICOSTEROIDS AND/OR BETA-2- AGONISTS ON LUNG FUNCTION, AIRWAY RESPONSIVENESS, AND SYMPTOMS IN CHILDREN WITH ASTHMA
Authors: Kamada Alan
Published: December 2021

Inhaled corticosteroids are important in the long-term treatment of childhood asthma.
In Reply: Scalding Water Temperatures
Authors: GREENSHER JOSEPH
Published: December 2021

The observations by Lukefahr and Ezekiel regarding scald burns and the potentially harmful recommendations by some manufacturers of automatic dishwasher detergent brands are well taken.

The American Academy of Pediatrics has supported changes in building codes to stipulate that water heaters be set at safe temperature levels (125 to 130°F) when installed and model state legislation was drafted requiring all water heaters leased or sold to be preset at 120°F. Manufacturers' acceptance and adherence is anticipated.
Occupational Health and Safety Issues for Child-Care Providers
Authors: Calder Judith
Published: December 2021

This paper reviews the occupational health and safety issues for child-care providers. Specifically, it answers the following questions: Who are the care givers? What are their risks of occupational illness and injury? What are the risks to children from care givers? Who pays to reduce the risk? What future research is needed to identify potential risks to and strategies for this work force and their clients?

WHO ARE THE CARE GIVERS?

Out-of-home child care is provided in two ways: in child-care centers (larger facilities designed especially for the care of children) and in family day-care homes. Persons who obtain day care know the care givers personally. They are the people who make it possible for parents to be dependable, productive, and worry-free employees or students. More importantly, they are the ones entrusted to care for children for as much as 50 hours a week. Parents expect their children to be safe, treated with respect, and nurtured in ways that are specific, familiar, and compatible with the family's child-rearing beliefs. Parents also expect care givers to be adroit in addressing their concerns as well as their children's. Despite all of this personal interaction, few parents are aware of the characteristics of the child-care work force, the conditions under which they work, and their impact on quality child-care services.

The Child-Care Employee Project (CCEP), a national non-profit resource organization devoted to addressing adult needs associated with child care, developed a profile of child-care workers by compiling and examining data on center-based child care as part of the National Child-care Staffing Study (NCCSS).1
Letter to the Editor
Authors: Duggan Christopher , Kleinman Ronald E.
Published: December 2021

Several aspects of Jacobs et al's study of homeopathic medicines cines in the treatment of childhood diarrhea deserve further comment.1 It is known that nutritional management of acute diarrhea can have a large impact on duration of illness; specifically, the timing and composition of the introduction of foods after rehydration can have a major impact on stool output and length of illness.2,3 As a result, clinical trials of acute diarrhea in which treatment groups are fed the "child's normal diet" (as was the case in this report) or the "standard hospital diet" are subject to major confounding effects, ie, was the change in stool output due to the intervention under study or a dietary factor not measured or taken into account?
Gastrointestinal Maturation and Motility Patterns as Indicators for Feeding the Premature Infant
Authors: Lebenthal Emanuel
Published: December 2021

The Koenig et al study1 showed different effects of two-thirds concentration feeding compared with one-third concentration in relation to shorter mean time of onset and longer duration of fed response. The different motility response can be related to availability of regulatory mechanisms. Similar studies of individual food component,26 eg, glucose, triglyceride, and casein hydrolysate, disrupted fasting activity but had differing effects on the duration of fed activity and the increase of contractile activity. Glucose followed by peptides then lipids caused the greatest increase in contraction and duration of fed activity.26 It is assumed that each group of nutrients induces the secretion of different peptide hormones that may be responsible for the fed pattern of motility. It is suggested that the feeding releases gastrin and cholecystokinin27 that in return change the pattern of motility activity to the fed pattern. When a protein feeding was given intraduodenally both cholecystokinin and pancreatic polypeptide were released in large quantities and the intestinal motility changed to fed pattern.27 Peptide YY is also released in large quantities after both a large protein and fatty meal.28 The main question that the Koenig et al study1 raises is how the concentration, volume, and presence of the feed in the stomach or duodenum affect the release of regulatory gut peptides and gastrointestinal hormones. In addition it is important to know how the ontogeny of gut hormones and regulatory peptide can be manipulated by changing the mode, content, concentration, and volume of feeding.

Available fat, carbohydrate, and protein in the premature diet might be important in modifying the developmental pattern of intestinal and pancreatic enzymes as well as affecting gastric emptying.
THE VALUE OF BED REST DURING PREGNANCY QUESTIONED
Authors: L. J. F.
Published: December 2021

Physicians recommend bed rest for one of every five pregnant women for at least 1 week and occasionally for 2 months or more. Yet, the high costs and unproven effectiveness of bed rest for preventing or treating pregnancy complications argue against its widespread use, according to the Low Birthweight Patient Outcomes Research Team (PORT)...

The medical literature does not offer enough evidence to recommend bed rest at home or in the hospital to prevent first-trimester spontaneous abortion...
TIPP—The First Ten Years
Authors: Bass Joel L.
Published: December 2021

The following is an addendum to the Commentary entitled "TIPP—The First 10 Years," written by Joel L. Bass that appeared in the February 1995 issue of Pediatrics on page 274:

In addition to sponsoring the 1988 revision of TIPP, Sandoz Pharmaceuticals Corporation also provided an educational grant for the 1994 TIPP revision.
The Effect of Bronchopulmonary Dysplasia on Growth at School Age
Authors: Vrlenich Laura A. , Bozynski Mary E. A. , Shyr Yu , Schork M. Anthony , Roloff Dietrich W. , McCormick Marie C.
Published: December 2021

Objective. To determine the effect of bronchopulmonary dysplasia (BPD) on growth at school age.

Design. A prospective cohort study.

Methods. The sample included 406 children selected from a reconstructed cohort of infants of very low birth weight previously enrolled in a multisite, randomized, controlled clinical trial. The children were contacted at 8 to 10 years of age. Height, weight, and head circumference (HC) were measured. Possible confounders including sociodemographic data, and neonatal factors were also recorded.

Results. The children in the BPD group were significantly smaller in weight (z score, -0.50 ± 1.19 SD vs -0.06 ± 1.30 SD) and HC (z score, -1.41 ± 1.32 SD vs -0.63 ± 1.62 SD) than those without BPD. However, after controlling for cofounders (using analysis of covariance), no significant differences were demonstrated between the two groups. Power analyses showed that a difference of at least 0.43 z score units could have been detected. The previously documented associations between BPD and suspected confounders were reconfirmed.

Conclusions. Significant differences were noted between children with and without BPD for weight and HC but not height. When possible confounders were taken into account, the differences were no longer appreciated. Thus, the previously reported poor growth in children with BPD may have been related to other factors and not necessarily to BPD.
Steroids and Asthma
Authors: Shapiro Gail G.
Published: December 2021

It is impossible to read about asthma in the 1990s without being informed that it is an inflammatory disease and that all but the mildest cases require anti-inflammatory therapy for optimal management.1 Bronchoalveolar lavage studies document the influx of inflammatory cells and the upregulation of inflammatory cytokines in bronchial washings of patients with chronic asthma.2 Biopsy specimens confirm an inflammatory cell accumulation and the destructive change to the epithelium that one would expect from this insult.3

The pathophysiology of asthma would seem to justify the use of corticosteroids for its management. A single dose of prednisone can be shown to decrease inflammatory leukotrienes while there is a concomitant increase in forced expiratory volume in 1 second.4
FOLLOW-UP OF ASTHMA FROM CHILDHOOD TO ADULTHOOD: INFLUENCE OF POTENTIAL CHILDHOOD RISK FACTORS ON THE OUTCOME OF PULMONARY FUNCTION AND BRONCHIAL RESPONSIVENESS IN ADULTHOOD
Authors: Segal Allen T.
Published: December 2021

FEV1 in adults with asthma was significantly predicted only by the childhood level of FEV1. The presence of bronchial responsiveness in adulthood was significantly predicted by the female gender and the degree of bronchial responsiveness in childhood. The degree of bronchial responsiveness in adulthood was only weakly related to the initial degree of responsiveness in childhood.
Response to Dr Smith
Authors: Eaton Antoinette Parisi
Published: December 2021

I am pleased to have the opportunity to comment on Dr Smith's article. He has shared with us collaborative approaches to the organization and delivery of health care that have been used in the Dallas inner city to break down structural and cultural barriers to health care at the community level. In the June 1994 issue of Pediatrics, Albert Scheiner points out that "Ninety-five percent of pediatric health care is provided in the community .... All community practice settings are home ground for the family and the child and provide opportunities for a continuity of care experience that is family-centered and that includes such concepts as child advocacy, disease prevention, and health promotion."1

Dr Smith aptly points out that rapidly evolving changes in the health care system and health care financing can provide an opportunity to accomplish many of the positive changes for children that pediatricians long have sought. I would like to share some thoughts about how we create the health care, education, and research components of the new community pediatrics. New kinds of collaboration will be critical to developing these components, and such collaboration will challenge all of us to partner with institutions and individuals with whom in the past we may have been unfamiliar or even uncomfortable.

Because it is always good to define our terms, let us take as a starting point Haggerty's definition of community pediatrics,2 which captures the essence of the Dallas program. Says Haggerty:

Community pediatrics seeks to provide a far more realistic and complete clinical picture by taking responsibility for all children in a community, providing preventive and curative services, and understanding the determinants and consequences of child health and illness, as well as the effectiveness of services provided.
PEOPLE WANT MORE INFORMATION FOR HEALTH CHOICES, SURVEY FINDS
Authors: L. J. F.
Published: December 2021

Most people would like to have more information to help them choose hospitals, doctors, and health care plans, a new survey by Louis Harris and Associates has found.

Many large employers already receive reports from health maintenance organizations and other health plans on how satisfied their members are. Many employers and health plans also collect appraisals of doctors and hospitals by patients. But such reports are not often shown to the consumers themselves, company benefits executives say.

In the Harris survey, which was commissioned by Towers Perrin, a benefits consulting firm, 66% said they would like to see report cards for hospitals, 58% said they would like to see consumer ratings of physicians, and 52% wanted ratings for health plans.

The telephone survey of 1081 people was weighted to reflect all United States heads of households or spouses age 21 or older. The margin of error was plus or minus 3 percentage points. Most were employees of large companies, which other surveys have shown are most likely to offer choices of health plans.
Blood Pressure Ranges in Premature Infants: II. The First Week of Life
Authors: Hegyi Thomas , Anwar Mujahid , Carbone Mary Terese , Ostfeld Barbara , Hiatt Mark , Koons Anne , Pinto-Martin Jennifer , Paneth Nigel
Published: December 2021

Objective. To examine the arterial blood pressure in the first week of life in a healthy premature population.

Design. Population-based cohort study.

Setting. Three intensive care nurseries in central New Jersey.

Patients. Premature infants with birth weights less than 2000 g.

Main Outcome Measures. We documented daily maximum and minimum systolic and maximum and minimum diastolic blood pressures during the first 7 days of life. To examine the effects on these ranges of blood pressure of specific risk factors likely to affect blood pressure, we identified four groups of infants: (1) healthy infants without any of the major risk factors (n = 193); (2) infants who were mechanically ventilated but free of any of the other conditions (n = 225); (3) infants with histories of maternal hypertension or preeclampsia (n = 38); and (4) infants with low Apgar scores (less than 3 at 1 minute and less than 6 at 5 minutes) regardless of the presence of other conditions (n = 86).

Results. Blood pressure increased steadily in the first week of life in all four groups. There was no relationship between any of the four blood pressure variables, or trends in blood pressure over time, with birth weight, gender, or race. Regression equations (based on all infants with available data) for blood pressure ranges by day of life revealed that the maximum systolic blood pressure increased by 2.6 mm Hg/d, the minimum systolic blood pressure increased by 1.8 mm Hg/d, the maximum diastolic blood pressure increased by 2.0 mm Hg/d, and the minimum diastolic blood pressure increased by 1.3 mm Hg/d.

Conclusions. Infants with birth asphyxia and ventilated infants had significantly lower systolic and diastolic blood pressures than healthy infants.
Long-term Aspirin Therapy for Hepatopulmonary Syndrome
Authors: Song Jin Young , Choi Jung Yun , Ko Jun Tae , Bae Eun Jung , Kim Ho Sung , Noh Chung Il , Yoon Yong Soo
Published: December 2021

It is well known that arterial hypoxia can occur with chronic liver disease in adults as well as children.1-3 The clinical syndrome of hypoxia in association with liver disease has been called hepatopulmonary syndrome (HPS) or intrapulmonary vasodilative disease.3,4 In its classic form, HPS is a triad of abnormal arterial oxygenation, hepatic dysfunction, and pulmonary vascular dilation. The primary underlying disease of the hepatobiliary system is mainly liver cirrhosis or other chronic liver disease.4,5 The hypoxia is caused by either right-to-left shunting through arteriovenous connections within the lungs or a ventilation-perfusion imbalance caused by diffuse vasodilation of pulmonary arteries at the precapillary and capillary levels.1-3
Brain Injury in a Healthy Child One Year After Periureteral Injection of Teflon
Authors: Borgatti Renato , Tettamanti Alberto , Piccinelli Paolo
Published: December 2021

This report presents the case of a previously healthy 6-year-old girl who had an ischemic injury corresponding to the territory perfused by the lateral branches of the lenticulostriate arteries of the middle cerebral artery. Stroke in childhood is rare, and the specific causes are identified in only half the cases. Our patient was carefully studied for any hereditary or acqired risk Factors for stroke, but we found only one, an endoscopic injection of Teflon performed 1 year before to correct vesicoureteral reflux. This suggests the risk of potential migration of Teflon particles to the brain, here they can block the microcirculation.
THE HIGH-AFFINITY IMMUNOGLOBULIN E (IgE) RECEPTOR (FcεRI) MEDIATES IgE-DEPENDENT ALLERGEN PRESENTATION
Authors: Hopp Russell
Published: December 2021

Low numbers of monocytes with highaffinity IgE receptors and bound-specific IgE, attracted to the late-phase response target area (skin, nose, or lungs) may be a prime cell for the initiation of further Type I immediate and Type I late-phase responses (referred to as T cell mediated, delayed response, in this paper).
LOWER AIRWAY INFLAMMATION DURING RHINOVIRUS COLDS IN NORMAL AND ASTHMATIC SUBJECTS
Authors: Szefler Stanley J.
Published: December 2021

Rhinoviral colds are associated with a bronchial mucosal lymphocytic and eosinophilic infiltrate that may be related to changes in airway responsiveness and asthma exacerbations.
VIRAL INFECTION POTENTIATES THE INCREASE IN AIRWAY BLOOD FLOW PRODUCED BY SUBSTANCE P
Authors: Kobayaski Roger H. , Kettlehut Brett
Published: December 2021

Purpose of the Study. Substance P is a tachykinin found in the airways of many animals, including humans. Tachykinins may induce inflammation, increase blood flow, increase mucus secretion, and induce bronchoconstriction. The purpose of this study was to determine whether viral infections might enhance blood flow produced by substance P.

Methods. Male F344 rats were intranasally inoculated with Sendai virus or sterile viral growth media. Airway blood flow was measured by an ingenious microsphere method. Substance P or histamine was injected to determine effects on baseline airway blood flow; subsequently inhibition of neutral endopeptidase: phosphoramidon (NEP, 2.5 mg/kg) and angiotensin-converting enzyme: captopril (ACE, 2.5 mg/dL) were injected to determine whether they (inhibitors) modulate substance P increases in pulmonary vasculature blood flow.

Results. Viral infection magnified the increase in airway blood flow evoked by substance P, but histamine did not. Both NEP inhibitor and ACE inhibitor potentiated the increase in substance P-induced airway blood flow. Therefore, this may be a possible mechanism for exaggerated substance P-induced airway blood flow.

Reviewers' Comments. This is an elegant, well-thoughtout series of experiments which help shed additional light on the mechanisms of viral-induced airway obstruction. Viral infections may potentiate tachykinin-mediated airway obstruction by disturbing the intricate interplay among mediators; in this case, the downregulation of NEP and ACE. Previous studies have shown that other agents such as tobacco smoke (J Appl Physiol. 1993;74:2537-2542) may cause tachykinin-mediated inflammation. These studies help us understand the mechanisms of airway inflammation and may help us develop effective therapeutic interventions.
CHRONOTHERAPY OF ASTHMA WITH INHALED STEROIDS: THE EFFECT OF DOSAGE TIMING ON DRUG EFFICACY
Authors: Sachs Martin I.
Published: December 2021

The single daily administration of inhaled triamcinolone at 3:00 pm has no increased systemic effects and produces similar improvement in efficacy variables to QID administration.
PREVALENCE AND INCIDENCE OF VERTICALLY ACQUIRED HIV INFECTION IN THE UNITED STATES
Authors: Maguire Peter , Goldsobel Alan
Published: December 2021

These results provide a basis for estimating medical and other resource needs for HIV-infected women and their children and for measuring the impact of interventions to reduce vertical transmission of HIV.
INFLUENCE OF HOST GENOTYPE ON PROGRESSION TO ACQUIRED IMMUNODEFICIENCY SYNDROME AMONG CHILDREN INFECTED WITH HUMAN IMMUNODEFICIENCY VIRUS TYPE 1
Authors: Church Joseph A.
Published: December 2021

The specific factors that determine the clinical course in individual patients with HIV infection are yet to be precisely defined. Variable virus subtypes are likely to produce different clinical pictures. This article documents that host factors, such as HLA genotype, are also important in clinical outcome. The relative importance of host versus viral characteristics is as yet undetermined.
K5 = Diastolic Pressure
Authors: Alpert Bruce S. , Marks Lloyd , Cohen Myron
Published: December 2021

The Report of the Second Task Force on Blood Pressure Control in Children—19871 has served as the "reference standard" for normal blood pressure (BP) on children from age 3 through 18. The authors recommended that for children from 3 to 12 years old the 4th Korotkoff sound (K4) be utilized to determine diastolic BP. In reviewing that document, we find that this was chosen not because of a well-demonstrated correlation of K4 with measured diastolic BP, but because KS values were not always obtained in the databases from which the final analyses were performed.
The Prenatal Visit
Authors: Grylack Lawrence J.
Published: December 2021

I would like to expand upon the AAP statement entitled "The Prenatal Visit" made by the AAP Committee on Psychosocial Aspects of Child and Family Health1 by discussing another facet: the prenatal visit made by the neonatologist to a high-risk obstetric inpatient. As obstetricians, pediatricians, and patients have become more aware of the value of this visit, I have gained more experience with the process and would like to present the standard components of that interaction.
Pediatrics electronic pages http://www.pediatrics.org
Authors: HORBAR JEFFREY D. , SACK JOHN
Published: December 2021

Pediatrics electronic pages, the official on-line journal of the American Academy of Pediatrics, will appear on the World Wide Web beginning in January 1997. This Internet publication represents a commitment by the Academy to provide its members and other health professionals with access to a state-of-the-art electronic information tool in the field of pediatrics. In partnership with HighWire Press of Stanford University, the Academy will strive to develop this new medium of scientific communication to meet the needs of both clinicians and scientists. The Internet has the potential to transform scientific communication; its impact may be as profound as the invention of the printing press.
Ultrasonographic evaluation of the median nerve: normal and variant anatomy and
appearance
Authors: Nulle Kitija , Jaudzema Aija
Published: December 2021

The median nerve is a mixed sensory and motor nerve that innervates part of the
flexor muscles in the anterior compartment of the forearm and muscles in the lateral
part of the hand; palmar cutaneous and digital cutaneous nerves branch from the median
nerve, which provides sensory innervation to the skin on the radial side of the palm.
Also, the median nerve is an object of interest because neuropathy of the median nerve
at the level of the carpal tunnel is the most common entrapment neuropathy which
increases dramatically in patients with diabetes. Neuromuscular ultrasound provides
extensive diagnostic information and has proved itself as a useful complementary test to
electrodiagnostic examinations in cases involving median nerve neuropathy. It often
happens that the cause of nerve entrapment and neuropathy are variants of several
anatomical structures along the course of the median nerve. It is important to be aware
and report such anatomical variations of the median nerve in order to avoid damaging the
nerve during surgical treatment. Despite the frequently documented abnormalities in the
pathway of the brachial plexus and the median nerve, the anatomical variations are
unusual to see and are rarely reported. Moreover, there are variations that do not fit
under any of the classifications described in the literature.
Pewarisan Hak Atas Tanah dalam Perkawinan Antar Negara
Authors: Hidayati Taufika , Pasaribu Yusuf Hanafi
Published: December 2021

The phenomenon of inter-state marriage in Indonesia has an influence on legal actions in it, especially the issue of children born and having dual citizenship after Law Number 12 of 2006 concerning Citizenship was passed by the Government. This study aims to measure the extent to which children born from these marriages get inheritance rights with underage positions. In addition, what is the legal status based on Law Number 1 of 1974 concerning Marriage and Law Number 5 of 1960 concerning Land regarding the position of land inheritance rights. This study uses an empirical normative method, which combines legal research methods that not only view law as a prescriptive (determining) and applied scientific discipline, but also descriptive (explaining) based on the reality of legal developments in society. The results of this study indicate that children born from inter-state marriages who have dual citizenship and are still minors are entitled to land inheritance rights in the form of property rights provided that the child must choose Indonesian citizenship at the age of 18 (eighteen) years based on the laws and regulations. valid invitation.Fenomena perkawinan antar negara di Indonesia memberi pengaruh dalam perbuatan hukum di dalamnya, terutama persoalan anak yang lahir dan memiliki kewarganegaraan ganda setelah Undang-undang Nomor 12 Tahun 2006 tentang Kewarganegaraan disahkan oleh Pemerintah. Penelitian ini bertujuan untuk mengukur sejauh mana anak yang dilahirkan dari perkawinan tersebut mendapat­kan hak waris dengan kedudukan masih di bawah umur. Selain itu bagaimana status hukumnya berdasarkan Undang-undang Nomor 1 Tahun 1974 tentang Perkawinan dan Undang-undang Nomor 5 Tahun 1960 tentang Pertanahan terhadap kedudukan hak waris tanah. Penelitian ini menggunakan metode normatif empiris, yaitu melakukan penggabungan metode penelitian hukum yang tidak hanya memandang hukum sebagai disiplin ilmu yang bersifat preskriftif (menentukan) dan terapan, namun sekaligus bersifat deskriptif (memaparkan) yang didasarkan pada kenyataan perkembangan hukum di masyarakat. Hasil penelitian ini memberikan petunjuk bahwa anak yang dilahir­kan dari perkawinan antar negara yang berkewarganegaraan ganda dan masih di bawah umur berhak atas hak waris tanah berupa hak milik dengan ketentuan anak tersebut harus memilih kewarganegaraan Indonesia pada saat usianya 18 (delapan belas) tahun berdasarkan peraturan perundang-undangan yang berlaku.