bluuebunny/crossref_metadata_2025 huggingface dataset:
Otitis Media in Early Childhood and Cognitive, Academic, and Classroom Performance of the School-Aged Child
Authors: Roberts Joanne Erwick , Burchinal Margaret R. , Collier Albert M. , Ramey Craig T. , Koch Matthew A. , Henderson Frederick W.
Published: December 2021

The relationship between the occurrence of otitis media during the first 3 years of life and cognitive, academic, and classroom performance during the third year of elementary school was evaluated in 44 socioeconomically disadvantaged children. The children attended a research day-care program where their otitis media experience and psychoeducational development were documented prospectively from birth. No significant relationship was found between otitis media in early childhood and performance on tests of verbal intelligence or academic achievement in the third year of school. The number of days of otitis media before 3 years of age was significantly correlated with teachers' ratings of children's attentional behavior in the classroom, however. Children with more early otitis media tended to be rated as less task oriented and less able to work independently than children with less otitis media. This was an exploratory study of a small number of children. Further study of the potential association is needed.
In Reply: Streptococcal Pharyngitis Study
Authors: REDD STEPHEN C. , FACKLAM RICHARD R. , COHEN MITCHELL L.
Published: December 2021

We appreciate the interest in our study expressed by Drs Read and Beekman. We agree that positive and negative predictive values of a test depend not only upon the sensitivity and specificity of the test but also the prevalence of the disease in the population studied. In contrast to the beliefs of Read and Beekman, however, we believe that these results are applicable to the usual pediatric practice. To understand our position, it is necessary to examine the effects of prevalence on positive and negative predictive values.
Sports Injuries in a High School
Authors: McLain Larry G. , Reynolds Scott
Published: December 2021

A 1-year study was undertaken investigating all sports injuries at a large high school. A total of 1283 student athletes participated in sports and suffered 280 injuries for an overall injury rate of 22%. The largest injury rate was in football (61%) followed by girls and boys gymnastics, wrestling, and boys basketball. Five sports had no injuries—boys' tennis, golf, boys' and girls' swimming, and girls' water polo. Severity of injury was measured by number of days lost per injury. Girls' track had the greatest number of days lost per injury (320) followed by girls' basketball, girls' cross country, boys' track, and boys' wrestling. Sprains and strains accounted for 57% of all injuries. Of the injured athletes, 87 were seen by a physician and only 5 athletes required surgery. The small number of serious injuries requiring surgery suggests that a motivated and competent pediatrician can play an integral role as a team physician.
Mortality in Children and Adolescents With Sickle Cell Disease
Authors: Leikin Sanford L. , Gallagher Dianne , Kinney Thomas R. , Sloane Desirée , Klug Panpit , Rida Wasima
Published: December 2021

A study of the natural history of sickle hemoglobinopathies was begun in March 1979. By August 1987, a total of 2824 patients <20 years of age were enrolled. There have been 14 670 person-years of followup. Seventy-three deaths have occurred. Most of the deaths were in patients with hemoglobin SS. The peak incidence of death was between 1 and 3 years of age, and the major cause in these young patients was infection. Cerebrovascular accidents and traumatic events exceeded infections as a cause of death in patients > 10 years of age. There was limited success in identifying risk factors for death. Comparison of this study's overall mortality of 2.6% (0.5 deaths per 100 person-years) with previous reports indicates improvement of survival in US patients <20 years of age with sickle hemoglobinopathies. This improvement is most likely due to parental education and counseling about the illness and the early institution of antibotics in suspected infections.
FOALS ARE GETTING HELP
Authors: L. J. F.
Published: December 2021

KENNETT SQUARE, Pa.—Nearly as rare as the colt that grows up to be a racing champion is the birth of twin foals. Yet a tiny and brave filly and her weaker twin brother grow stronger every day here in an intensive care unit for newborn horses.

Established in 1983 and directed . . . by Dr. Wendy E. Vaala, a . . . veterinarian, the University of Pennsylvania's intensive care unit for foals was built. . . . It is one of only seven such units in the country, and they have led to the development of a new specialty in veterinary medicine—equine neonatology.

Recipes for formula fed to foals were borrowed from those used at the University of Pennsylvania Hospital in Philadelphia. The intensive care unit uses ultrasound equipment, heart monitors and other devices commonly used in human neonatal medicine. Treatments for infections, poisoning, ulcers, birth defects, even difficult births were adopted from human medicine. . . . But there are no incubators. . . .The foals are too active.
CORPORATE BOTTOM LINE—PATIENTS SEEN PER HOUR
Authors: Student
Published: December 2021

Imaginary conversation at a corporate HMO: Doctor X, we love you here, but you're seeing only 4.2 patients an hour. We'd like you to see 7.2. I can't do that, my standards will fall, I'll miss things. It wouldn't be fair to the patient. Well, hate to tell you, we got a guy out there who's willing to do it.
Adolescents With Special Health Needs: Prevalence, Severity, and Access to Health Services
Authors: Newacheck Paul W.
Published: December 2021

The health care needs of disabled adolescents are examined using data from a nationally representative sample of 15 181 randomly selected adolescents aged 10 to 18 years from the 1984 National Health Interview Survey. More than 6% of adolescents, or nearly 2 million nationwide, suffered some degree of disability or limitation in their usual activities in 1984. The leading causes of disability were mental disorders and respiratory diseases. Adolescents living in poverty and in households where the adult members had completed little formal education exhibited increased risk of disability. Disabled adolescents were shown to have three times as many physician contacts annually and spend nine times as many days hospitalized as their nondisabled counterparts. One in every seven adolescents with a disability was found to be uninsured—exposing their families to extreme financial risks. The great cost of insurance was cited as the primary reason for absence of coverage for 70% of all adolescents without coverage. Public policy implications of these results are discussed.
Pediatric Procedures: Do Parents Want to Watch?
Authors: BAUCHNER HOWARD , VINCI ROBERT , WARING CHRISTINE
Published: December 2021

Invasive medical procedures, such as venipuncture or obtaining intravenous access, may be frightening and painful experiences for children and their parents. It is our experience that many pediatricians request that parents not be present during these procedures. A review of the medical literature revealed no information about parental preference with regards to these procedures. The purpose of this study was to determine whether parents prefer to be present when their children undergo venipuncture or intravenous placement.

METHODS AND RESULTS

The study was conducted during a 2-month period in the pediatric emergency department at Boston City Hospital. All parents, except those with a critically ill child who required immediate medical attention, were eligible for the study.
DATA-DREDGING IS DANGEROUS
Authors: Student
Published: December 2021

Extrapolation results to future patients based on hypotheses not specified a priori is dangerous and should be avoided until the results can be confirmed by future studies.
Improving Access to Health Services for Adolescents From Economically Disadvantaged Families
Authors: Newacheck Paul W.
Published: December 2021

An analysis of the health status and health care utilization patterns of poor and nonpoor adolescents was conducted using a sample of 22 792 adolescents 10 to 18 years of age from the 1983 and 1984 National Health Interview Surveys. The results indicate that adolescents from families with incomes below the poverty level were three times as likely to be reported in only fair or poor health status and were 47% more likely to suffer from disabling chronic illnesses than adolescents from families with incomes above the poverty level. Use of inpatient hospital services was similar for adolescents from poor and nonpoor families when health status was controlled. However, adolescents from poor families were 35% more likely than those from nonpoor families to have waited 2 or more years between physician contacts. In addition, poor adolescents made 13% fewer physician contacts on an annual basis when compared with nonpoor adolescents. Substantial differences in utilization rates were found when poor adolescents were disaggregated according to whether they were covered by Medicaid. Those with Medicaid coverage used physician services at rates similar to nonpoor adolescents, whereas those without Medicaid coverage lagged substantially behind. Based on the conclusion that Medicaid is effective in reducing barriers to needed services, strategies for expanding Medicaid eligibility to additional low-income adolescents are discussed.
Cigarette Smoking-Associated Changes in Blood Lipid and Lipoprotein Levels in the 8-to 19-Year-Old Age Group: A Meta-Analysis
Authors: Craig Wendy Y. , Palomaki Glenn E. , Johnson A. Myron , Haddow James E.
Published: December 2021

In this meta-analysis it was demonstrated that, when compared with nonsmokers of similar age, smokers in the 8- to 19-year-old age group have significantly higher serum levels of triglyceride (+11.8%), very-low-density lipoprotein (VLDL)-cholesterol (+12.4%) and low-density lipoprotein (LDL)-cholesterol (+4.1%) and significantly lower serum levels of high-density lipoprotein (HDL)-cholesterol (-8.5%) and total cholesterol (-3.7%). All of these smoking-associated changes are in the same direction as those found in adults, with the exception of total cholesterol levels, which are significantly increased in adult smokers. The extent to which mean triglyceride, LDL-cholesterol, and HDL-choles-terol levels are shifted is significantly greater in the 8-to 19-year-old smokers than in adult smokers. The changes in mean total cholesterol levels among smokers in both age groups represent only the net shifts in the lipoprotein fractions and are therefore likely to be a less sensitive indicator of the possible lipid-related excess coronary artery disease risk in smokers.
Bicycle Helmets
Authors:   Committee on Accident and Poison Prevention
Published: December 2021

Bicycling has become extremely popular in the last 5 years. There were an estimated 88 million cyclists in the United States in 1988.1 In addition to providing efficient transportation, bicycling can afford an enjoyable form of aerobic exercise. It is not without hazards, however. In 1985, there were more than 500 000 emergency room visits and 1300 deaths attributable to bicycles.2 Many of those injured on killed were children and adolescents. The most common cause of death (70% to 80% of cases) and the leading cause of disability from bicycling is head injury.3,4 One third of injured bicyclists treated in emergency room have head injuries, as do two thirds of those admitted to the hospital.5-7 The majority of bicycle crashes involving children do not involve cars. Most children are injured falling from their bicycles on colliding with fixed objects.

The manufacture of relatively low-cost, light-weight bicycle helmets capable of protecting against much of this head injury has been accomplished because of recent technological advances. Voluntary impact standards have been developed by the Snell Memorial Foundation and the American National Standards Institute (ANSI), and helmets meeting these standards have a label (Snell or ANSI) affixed to the helmet. Studies in Australia8 and England9 have clearly demonstrated the efficacy of helmet use, and a recent study in Seattle showed that helmets reduced the risk of head injury by 85% and of brain injury by 88%.3 Despite this, helmets are used by less than 5% of child bicyclists. Reasons for nonuse have varied, but generally are thought to be due to a lack of awareness of the problem, peer pressure, and a lack of availability of helmets at many retail outlets where bicycles are purchased.
Errors, Gaps, and Misconceptions in the Disease-Related Knowledge of Cystic Fibrosis Patients and Their Families
Authors: Henley Lesley D. , Hill Ivor D.
Published: December 2021

A cross-sectional survey was conducted among 60 families with a child with cystic fibrosis to assess their medical knowledge of the illness. A 63-item, multiple-choice test with acceptable psychometric properties was administered to 60 mothers, 54 fathers, 29 siblings (aged 10 to 23 years), and 18 patients (aged 9 to 22 years). Parents and patients correctly answered approximately three quarters and siblings two thirds of all items. Family members were most knowledgeable about general cystic fibrosis facts, physiotherapy, gastrointestinal symptomatology and treatment, and anatomy. They were less well-informed about respiratory symptomatology and treatment and nutrition. Parental knowledge of genetics and reproductive risks was mediocre, and that of patients and siblings was poor. Knowledge of terminology was uniformly low. Social class was a significant predictor of parental knowledge. If left uncorrected the misconceptions, gaps, and errors in family members's knowledge of cystic fibrosis identified in this study could result in inadverent noncompliance in treatment of the patient.
Butterfly-Shaped Mark: A Variant Form of Nevus Flammeus Simplex
Authors: Metzker Aryeh , Shamir Raanan
Published: December 2021

A red-violet, rhomboid-shaped mark on the sacrum of 25 children is described. It is recognized, for the first time, as a part of the nevus flammeus simplex distribution; it is less common than the erythema nuchae or the facial salmon patch. It has the tendency to disappear more slowly than other forms of nevus flammeus simplex. No further investigations seem indicated.
Predicting Risk for Bronchopulmonary Dysplasia: Selection Criteria for Clinical Trials
Authors: Sinkin Robert A. , Cox Christopher , Phelps Dale L.
Published: December 2021

Early identification of neonates in whom bronchopulmonary dysplasia is most likely to develop permits appropriate enrollment into clinical trials testing early intervention therapies for the prevention or treatment of bronchopulmonary dysplasia. Analysis of 160 neonatal intensive care unit survivors to 28 days revealed that supplemental oxygen requirement at 28 days could be predicted by a logistic regression including (1) birth weight, gestational age, 5-minute Apgar score, and peak inspiratory pressure at 12 hours for 12-hour-old neonates and (2) birth weight, gestational age, peak inspiratory pressure at 12 hours, and mean airway pressure at 10 days for 10-day-old neonates. These two regression analyses were applied prospectively to three new data sets totaling 238 neonates to test their predictive ability. Neonates were classified into low-, moderate-, or high-risk groups on the basis of their predicted probability of requiring oxygen supplementation at 28 days; low = probability of <25%, moderate = probability of 25% to 75%, and high = probability >75%. Although these populations were demographically distinct from the original group, the regression analyses performed well. The regression analysis for 12 hours of age classified 125 neonates at low risk of whom 9% required supplemental oxygen at 28 days, and the regression analysis for 10 days classified 141 neonates at low risk of whom 7% required supplemental oxygen. The 12-hour regression analysis classified 80 neonates at moderate risk of whom 33% required supplemental oxygen at 28 days and the 10-day regression analysis classified 49 neonates at moderate risk of whom 24% required supplemental oxygen. The 12-hour regression analysis classified 33 neonates at high risk of whom 64% required supplemental oxygen, and the 10-day regression analysis classified 48 neonates at high risk of whom 75% required supplemental oxygen. A graphic presentation of these two regression analyses permits easy bedside prediction of a neonate's risk of requiring supplemental oxygen at 28 days at the time of enrollment for clinical preventive or therapeutic trials for bronchopulmonary dysplasia and facilitates the calculation of required sample sizes.
Child Abuse
Authors: DE JONG ALLAN R. , ROSE MIMI
Published: December 2021

In Reply.—

We thank Dr Smith for his interesting perspective regarding screening for child abuse. We had hoped our article would help physicians focus on the verbal evidence of abuse and show how insensitive the physical evidence is in predicting which child had been abused sexually. To apply the principles of sensitivity and specificity to the assessment of child abuse or sexual abuse, we must have a gold standard which characterizes these problems. Neither a child protective services decision nor a legal determination of "no proven abuse" can be used as a gold standard, unless we can accept a "gold standard" made of iron pyrite.
Reviews of Lay Literature in Child-Care: What Parents Are Reading
Authors: GLASCOE FRANCES PAGE , MOORE WILLIAM O. , BAUMGAERTEL ANNA
Published: December 2021

L. Canter, L. Hausner. Homework without Tears. New York: Harper & Row Publishers, 1987; list price $7.95 (No. 30 on the 1990 bestseller list of books on child care from Ingram Book Co., distributor of trade books).

This text offers parents some solid advice about children and homework, including: establishing an appropriate study area, working with teachers, time management, task analysis, test preparation and independent completion of work. The authors wander onto shaky ground when they suggest that parents should not help children learn concepts and when they fail to mention that a child's need for assistance with homework may be indicative of significant trouble with school work and learning problems. Accordingly, parents are not directed toward psychoeducational evaluations, tutors or other resources. Further, they are not helped to acquire insight into their child's feelings about school, developmental readiness for various academic activities, self-concept, peer pressure, or the impact of different kinds of educational experiences (e.g., self-versus teacher-directed activities, private versus public schools, large versus small classes, etc.). Despite these weaknesses, the book contains many helpful suggestions and fills a void in the offerings on child-care by focusing specifically on homework issues.
Household Magnetic Fields and Childhood Leukemia: A Critical Analysis
Authors: Michaelson Sol M.
Published: December 2021

For the past two decades, considerable interest and concern have been expressed, particularly in the lay media, over the hazards of exposure to the electric and magnetic fields from high-voltage transmission lines, electric appliances in the home, and video display terminals. Laboratory research and observations on human populations indicate that electric fields from these sources do not constitute a health hazard to humans or animals. There are reports, however, of an apparent association between magnetic fields and cancer or leukemia in selected populations. The quality of these reports and the validity of the conclusions, however, are questionable.

Nevertheless, these studies have generated considerable public anxiety. This is exemplified by an article published in the New Yorker magazine (July 1990). The author relates in graphic detail accounts of a suspected cancer cluster on a single street in a community in Connecticut. Resources for this investigative report were largely second-hand accounts from newspapers and personal interviews with small nuclei of residents that suggested a relationship with exposure to electric and magnetic fields from a nearby electric substation. This article fanned the fires of public concern about electric and magnetic field-induced health dangers despite the fact that state and local health officials emphasized there was no evidence to confirm a connection. Almost weekly discussions in newspapers and magazines and on television, as well as the publicity given to a forthcoming Environmental Protection Agency report, have exacerbated the concern.

ENVIRONMENTAL FACTORS

Humans are exposed to a wide variety of natural and artificial electromagnetic fields. The predominant natural magnetic field is the earth's static magnetic field, which has a strength of about 0.5 G. Electric power is transmitted as direct current and/or as alternating current (AC) at 50 or 60 Hz.
Bilirubin Toxicity: The Problem Was Solved a Generation Ago
Authors: VALAES TIMOS
Published: December 2021

The article by Newman and Maisels1 in the current issue of Pediatrics is the latest in their crusade to prove that the prevailing management of neonatal jaundice is of unproven efficacy, probably risky, definitely wasteful of resources, and, therefore, should be changed.2-6 There is no doubt that the status of neonatal jaundice has been reduced to that of an "expensive nuisance." It is very common, but, in the great majority of the cases, it is not accompanied by any other clinical or laboratory abnormality, has no diagnostic value, and disappears in a few days without sequelae. The current status of neonatal jaundice contrasts with the respect and fear it generated in the past.
The Diaper Controversy
Authors: SUTTON MARIANNE B.
Published: December 2021

In Reply.—

We would like to thank Dr Newman for her personal and amusing comments about parenting and diapers. We agree that parents should decide which type of diapers suit their family's needs. We nevertheless feel that pediatricians should be prepared to discuss diapering options with parents and help them to make educated personal choices in much the same way a pediatrician would give advise on child rearing.
PRESIDENT'S ADDRESS
Authors: BEAVEN PAUL W.
Published: December 2021

IT IS now, 21 years since the American Academy of Pediatrics was founded. It is not inappropriate at this time to call attention to this significant anniversary of our birth. In June 1930, at Detroit, its organization was completed and officers were elected. A year later, the first annual meeting was held in Atlantic City. It was made clear at that time that pediatricians were now convinced that a society was needed whose principal objective would be not solely to promote social and scientific needs of its members, but which would exist primarily to promote child welfare. The means by which this major objective would be gained would be to raise the standards of pediatric education and pediatric research; to encourage better pediatric training in medical schools and hospitals; to promote scientific contributions to pediatric literature; and to relate the private practice of pediatrics to the larger field of the welfare of all children. The society should cooperate with others whose objectives were similar, but would he the democratic forum for pediatric thought and endeavor.

Following is a quotation from the constitution adopted at the first meeting:

"The object of the Academy shall be to foster and stimulate interest in pediatrics and correlate all aspects of the work for the welfare of children which properly come within the scope of pediatrics. The Academy shall endeavor to accomplish the following purposes: to maintain the highest possible standards of pediatric education in medical schools and hospitals, in pediatric practice, and in research; ... to maintain the dignity and efficiency of pediatric practice in its relationship to public welfare; to promote publications and encourage contributions to medical and scientific literature pertaining to pediatrics."
UNILATERAL PARALYSIS OF THE DIAPHRAGM IN THE NEWBORN INFANT DUE TO PHRENIC NERVE INJURY, WITH AND WITHOUT ASSOCIATED BRACHIAL PALSY
Authors: SCHIFRIN NATHAN
Published: December 2021

The literature on diaphragmatic paralysis in the newborn infant due to phrenic nerve injury is reviewed. Four additional cases are described. Fluoroscopic as well as roentgenographic examination of the chest is urged in the diagnosis of thoracic pathology in the newborn period.

Stimulation of the phrenic nerve is believed to be an aid in determining the prognosis. If the diaphragm contracts one can infer that the nerve is intact below the level of stimulation and that the diaphragm has not undergone atrophy of disuse, and that the muscle fibers are capable of contraction when adequately stimulated. Failure of the diaphragm to contract means that the nerve has been compromised below the level of stimulation or that the muscle fibers of the diaphragm are too atrophic to contract. The prognosis in the latter cases must be guarded.
CHRONIC EOSINOPHILIA DUE TO VISCERAL LARVA MIGRANS
Authors: BEAVER P. C. , SNYDER C. H. , CARRERA G. M. , DENT J. H. , LAFFERTY J. W.
Published: December 2021

Three cases of chronic extreme eosinophilia with granulomatous lesions in the liver have been studied. A larval nematode observed in sections from the liver of one patient has been identified either as Toxocara canis or Toxocara cati, common cosmopolitan ascarids of dogs and cats; available evidence favors the former.

The term visceral larva migrans is proposed for this type of parasitism, known in animals but not previously described in humans. It is related to better known cutaneous larva migrans, in that both are usually caused by infective stage larvae of nematode parasites of other animals. Man being an abnormal host, either has unfavorable tissue reactions or otherwise fails to provide stimuli for usual tissue migration and development of the parasite. As a result, larvae remain active for variable periods in various tissues. Similar but less severe and less prolonged reactions occur when the larvae of normal nematode parasites of man invade the tissues of a hyperimmune individual.

Visceral larva migrans is usually a relatively benign disease, characterized chiefly by sustained eosinophilia, pneumonitis and hepatomegaly, and probably is due both to direct tissue damage by migrating larvae and to allergic responses to their products. Its severity varies with the number of larvae in the tissues and the immune or allergic state of the infected individual.
DUPLICATIONS OF THE ALIMENTARY TRACT
Authors: GROSS ROBERT E. , HOLCOMB GEORGE W. , FARBER SIDNEY
Published: December 2021

The term "duplication" should be used when describing those spherical or tubular structures found along the alimentary tract whose walls contain well-developed muscular layers and whose lining is a mucosa similar to that of some part of the alimentary tract. They should not be confused with mesenteric lymphatic cysts, or anomalies arising from a Meckel's diverticulum.

Symptoms produced by these lesions usually vary according to their location, their size, and the type of fluid secreted by their mucosa.

Duplications should almost invariably be removed, even though they are incidentally discovered and have not as yet given rise to symptoms. The pitfalls met with surgical treatment of these lesions are discussed. In this series, cases treated prior to 1940 carried fatality rates which were quite high; in the 20 cases treated in the last four years there have been no deaths.

Sixty-eight examples of duplications from one institution are briefly listed; 45 of these have not appeared in the literature before. This amount of material coming from one hospital would seem to indicate that these abnormalities must occur with sufficient frequency to warrant the attention of pediatrician, roentgenologist, and surgeon so that they can be recognized promptly and treated suitably.
THERAPEUTIC MEASURES PROMOTING RECOVERY FROM THE PHYSIOLOGIC DISTURBANCES OF INFANTILE DIARRHEA
Authors: DARROW DANIEL C.
Published: December 2021

ALTHOUGH the improvements in fluid therapy have seemed to result largely from recent clinical observations, actually the fundamental ideas were developed by research on experimental animals in laboratories of physiology, biochemistry, pharmacology and clinical medicine. In many aspects, the progress has depended on laboratory work using physiologic and biochemical methods but applied with a point of view arising from clinical experience. The opportunities for this type of research came largely with full-time medicine in clinical departments.

I was led to the use of potassium in fluid therapy by studies which were carried out on experimental animals throughout a period of 10 years in association with Drs. Yannet, Harrison and Miller. We had the excellent technical assistance of Miss Carey, Miss Coville and Mr. lannucci and Mr. Barringham. During these years, the knowledge of the metabolism of water and electrolyte was advancing rapidly under the leadership of Gamble, Van Slyke, Peters, Loeb, Hastings, Fenn, Adolph, Butler, Homer Smith, and Newburg to mention only a few. In 1945, I summarized this knowledge of body water and electrolytes as related to clinical problems. Through the courtesy of Dr. Park, I came to Baltimore on VJ day to work for 60 days with the facilities of the pediatric department at Johns Hopkins. The study of diarrhea was made possible by the nurses, the resident, Dr. Govan, the head of the laboratory, Dr. Kaydi, and a superb technician, Mrs. Radcliffe. Through Hansen's generosity, Flett, Pratt, Wiese, Alice Gamble and I later extended these observations in Texas. We were able to show that deficiency of potassium occurs in diarrhea, that potassium may safely be used parenterally or orally and that improved results follow its use.
TRENDS
Authors: COLLINS-WILLIAMS C.
Published: December 2021

ACCIDENTS, at the present time, are one of the principal causes of death, particularly among children. In Canada approximately 1,500 children die each year as the result of accidents, a mortality greater than that due to the 10 acute infectious diseases of childhood combined. During the five year period 1942-46 inclusive, in Canada, accidents stood in eighth place as a cause of death during the first year of life, in third place during the second year, and in first place during each year after infancy up to the fifteenth birthday. During the same period, 21% of the deaths between the first and fifteenth birthdays were due to accidents.

In this age of preventive medicine when our chief purpose as physicians is the prevention of morbidity and mortality, we, as pediatricians, cannot neglect this extremely important phase of child care. In any campaign to reduce the number of accidents, there are three ways in which the physician can play an important part. Firstly, the general public must be made aware of the seriousness of the situation and must be educated in the ways in which they, as citizens and parents, can help to reduce accidents. Secondly, the medical profession, working through its associations and publications, must stimulate all physicians to a concerted effort to reduce the number of accidents. Finally, and most important, the physician must concentrate on an educational program for his own private patients. A few words from the physician who looks after the child will do more to impress parents than will reams of propaganda published by someone unknown to them.
Treatment of Infants with Acute Diarrhea: What's Recommended and What's Practiced
Authors: Bezerra Jorge A. , Stathos Theodore H. , Duncan Burris , Gaines John A. , Udall John N.
Published: December 2021

In 1985, the American Academy of Pediatrics (AAP) published a policy statement on the treatment of infants with acute diarrhea complicated by mild to moderate d ehydration. To determine how closely physicians in the United States follow the AAP's treatment guidelines, a questionnaire was sent to 457 pediatricians and 360 family practitioners. The questionnaire presented a hypothetical infant with acute diarrhea complicated by mild to moderate dehydration and included questions regarding the number of such patients seen yearly, length of time used to rehydrate the infant, and how formula or solids are introduced following rehydration. Complete responses were received from 53% of pediatricians and 40% of family practitioners. The number of patients with acute diarrhea seen per year did not affect physician's treatment. Pediatricians and family practitioners responded similarly to most questions. Contrary to the AAP's guidelines to rehydrate in 4 to 6 hours, 62% of responding physicians extend the rehydration period to 12 to 24 hours. Also contrary to the AAP's recommendations, 62% of pediatricians and family practitioners use a lactose-free formula. The majority of responding physicians do follow the AAP's treatment guidelines to initiate feedings with diluted formula. Significantly more pediatricians than family practitioner advance to a full-strength formula within 1 day (P = .011). Fewer than 50% of physicians polled started solids within 24 hours as suggested by the AAP. Overall, the findings suggest that very few pediatricians and family practitioners follow all aspects of the AAP's treatment guidelines for infants with acute diarrhea complicated by mild to moderate dehydration.
ECMO and Sepsis. If Differences Could Be Due to Chance Alone, Are Trends Worth Discussing?
Authors: WEISS MARC G.
Published: December 2021

The authors of the study on ECMO and sepsis1 have made a fundamental error in reaching their conclusion. Their data show a .06 probability that the survival difference between the groups is due to chance alone. As stated in their methods, the authors considered P < .05 to be significant. Hence, the only conclusion supported by the data presented is that there is no difference in survival between ECMO and standard therapy in sepsis. The authors, instead, discussed a "trend" toward improved survival, as if their study indeed showed a difference.
Statement on Cholesterol
Authors:   Committee on Nutrition
Published: December 2021

Increased blood cholesterol levels have been found to be a risk factor for coronary vascular disease in adult populations, and the reduction of cholesterol levels in adults decreases the risk. Because no comparable studies have been carried out in childhood populations, the significance of cholesterol as a risk factor for coronary vascular disease must be inferred from less direct evidence. It is also important to note that a number of other factors including cigarette smoking, hypertension, obesity, and diabetes mellitus are important in their causative relationship to atherosclerotic vascular disease. A family history of premature coronary vascular disease is also a risk factor for early onset coronary vascular disease.

The American Academy of Pediatrics (AAP) last published its recommendations regarding dietary fat and cholesterol in 19861 and suggested indications for cholesterol testing in children and adolescents in 1989.2 Very recently the Expert Panel on Blood Cholesterol Levels in Children and Adolescents of the National Cholesterol Education Program (NCEP), in a comprehensive report, recommended that all children and adolescents eat a diet that on average contains no more than 30% of total calories from fat, less than 10% of total calories from saturated fat, and less than 300 mg of cholesterol per day.3 The panel recommended screening blood cholesterol levels only in those children and adolescents whose risk of developing coronary vascular disease as adults could be identified by family history or by the coexistence of several risk factors. In this statement the earlier recommendations of the AAP are reviewed in the context of the recent NCEP report and provide current guidelines regarding dietary fat and cholesterol, cholesterol screening, and management of elevated blood cholesterol levels in children.
Access to Emergency Medical Care
Authors:   Committee on Pediatric Emergency Medicine
Published: December 2021

More than 60 000 children seek emergency care each day in the United States. However, inequities in our present health care system often preclude the prompt and appropriate access to emergency care necessary to treat these infants, children, and young adolescents—hereafter referred to as children. Several important obstacles exist. (1) As of 1990, there were more than 12 million uninsured American children.1 (2) Many children are declared uninsurable because of chronic illnesses, disabling conditions, or other preexisting conditions. (3) Although emergency departments are required to evaluate all patients who seek care, it is well known that lack of insurance can serve as an obstacle to prompt access to, transport to, and treatment at appropriate-level emergency and critical care facilities. (4) There is not yet universal availability and appropriate use of the 911 access number.2 (5) The extent to which pediatrics is included in the educational and training content of paramedic and basic emergency medical technician programs has been shown to be less than adequate.3,4 (6) Finally, children have special needs, requiring services not always available in every hospital. Therefore, the obstacles to prompt access are magnified at a critical time for the child seeking emergency care.

Several recent developments have increased the recognition and understanding of the unique emergency medical care needs of children.
Temperature Measurement—Gold Standard
Authors: FREED GARY L. , FRALEY J. KENNARD
Published: December 2021

In Reply.—

We thank Dr Weiss for his insightful comments regarding the controversial issue of a "gold standard" in temperature assessment. However, the purpose of our paper was not to define a gold standard, nor to judge the acceptability of conventional methods of temperature assessment. Rather, we attempted to place a new technology in perspective with currently accepted methods. While Dr Weiss raises some important points about the adequacy of rectal, oral, or axillary temperatures, we feel our work provides useful "clinical" information for practitioners who struggle to decide between methods of temperature assessment.
Temperature Measurement
Authors: ALEXANDER DAVID , TERNDRUP THOMAS
Published: December 2021

To the Editor.—

In the March 1992 issue of Pediatrics, Freed and Fraley published an article entitled, "Lack of Agreement of Tympanic Membrane Temperature Assessments with Conventional Methods in a Private Practice Setting."1 This study concluded that the FIRST Temp thermometer was unreliable, compared with conventional methods of temperature-taking in the private pediatric setting. I would like to raise two methodologic concerns which may have influenced their results. Under "Methods," the authors state that their tympanic thermometer provided a choice of two modes: "tympanic" and "surface," They further state that the tympanic mode was used for all temperature measurements.
Short-term Effects of Feed Composition on Sleeping and Crying in Newborns
Authors: Oberlander Tim F. , Barr Ronald G. , Young Simon N. , Brian Jessica A.
Published: December 2021

To determine whether the composition of feedings would affect newborn behavior independently of the act of feeding itself, 53 two- to three-day-old normal newborns were randomly assigned to receive an extra feeding of water, carbohydrate (lactose), or balanced formula 3 hours after their usual early morning feeding. Previous studies in adult humans and animals, and a single study in human newborns, have indicated that more sleep might be expected following the carbohydrate feed compared with the water and balanced-formula feeds because of recruitment of centrally mediated serotonergic systems. Behavioral effects were assessed for 40 minutes postfeeding by direct observation of the newborn's states (quiet, active, and indeterminate sleep; drowsiness; non-cry wakefulness; and fret/cry). Feed composition did affect behavior, and the effects were fairly specific to particular newborn states. Non-cry wakefulness and drowsiness were unrelated to the presence or type of nutrients, but they tended to occur soon after the meal in all groups. Crying was increased in water-fed newborns relative to both carbohydrate- and formula-fed newborns. Sleeping showed specific patterns of change in all three groups. Sleep duration was increased in the balanced-formula group compared with the water group throughout the observation period. Contrary to the prediction, sleeping duration in carbohydrate-fed newborns never exceeded that of formula-fed newborns; rather, it resembled that of water-fed newborns early in the postprandial period, but formula-fed newborns later. These effects could not easily be explained by potential confounding factors such as handling, volume ingested, caloric intake, or plasma glucose concentration. The results confirm that variations in the composition of a single meal can affect newborn behavior in the postprandial period and that these effects vary over time. Predictions of more sleep in the carbohydrate vs balanced-formula groups were not confirmed, implying that serotonergic systems are less important than other putative mechanisms. The results suggest that typical variations in feeding composition have implications for the understanding of early newborn behavior, mother-infant interaction, and clinical disturbances in newborn state.
Guidelines for Prevention of Group B Streptococcal (GBS) Infection by Chemoprophylaxis
Authors:   Committee on Infectious Diseases and Committee on Fetus and Newborn
Published: December 2021

BACKGROUND

For two decades streptococci classified serologically as Lancefield group B Streptococcus agalactiae (GBS) have been a leading cause of perinatal infections. In neonates and young infants these infections include congenital pneumonia, sepsis, or meningitis; in pregnant women they include urinary tract infection, chorioamnionitis, early postpartum endometritis, postcesarean section febrile morbidity, and—less frequently—pelvic thrombophlebitis or endocarditis. Although the incidence varies somewhat by geographic region, 12 000 infants and 50 000 pregnant women in the United States are estimated to develop GBS-associated morbidity or mortality annually.1 Overall mortality for early-onset (less than 7 days of age) and late-onset (7 days to 3 months of age) infant disease is approximately 15% and 10%, respectively.2-4 Gestational age significantly correlates with mortality among early-onset cases and is approximately 25% to 30% in preterm infants and 2% to 8% in term infants. Thus, every year approximately 1 600 infants die and an equal number have permanent neurologic sequelae following meningitis.1 This substantial GBS-associated perinatal mortality and morbidity make prevention strategies imperative. Among proposed strategies, including chemoprophylaxis and immunoprophylaxis, only intrapartum maternal chemoprophylaxis has been evaluated for safety and efficacy.

EPIDEMIOLOGY

GBS are frequently harbored in the genitourinary and lower gastrointestinal tracts of adults. When sensitive culture methods are used for their detection (ie, antibiotic-containing or selective broth media) and both lower vaginal and anorectal sites are sampled, GBS are found in 15% to 40% of pregnant women.5-8 Direct plating of swabs from body surfaces onto solid media or sampling of the cervix as a single genital tract site fails to identify as many as 50% of women who are culture-positive for GBS.4
Introduction
Authors: SCHEIDT PETER C. , KESSEL SAMUEL S.
Published: December 2021

An effort to improve the health of children must consider challenges to a healthy body, mind, and spirit. It must recognize the importance of the family, community, and environment. Consequently, the very nature of pediatrics has evolved from a primary focus on acute care and the treatment of infectious disease to one of promoting health, preventing disease, and optimizing development. Clinicians and researchers concerned with children and adolescents increasingly acknowledge the importance of behavior as a determinant and an outcome of health and disease. Indeed, the major causes of morbidity and mortality of childhood and adolescence (injuries, suicide, sexually transmitted disease, and others) are primarily related to behavior. Spurred by the recognition of these behaviorally related threats to children and youth, health agencies are directly and increasingly confronted with the urgency to study, understand, and modify behavior as it influences and interacts with physical health.

In response to this urgency, the National Institute of Child Health and Human Development and the Maternal and Child Health Bureau jointly sponsored a conference on Research in Behavioral Pediatrics in Columbia, MD, on May 22 to 24, 1989. The purposes of the conference were (1) to identify directions and approaches that are likely to be productive for future research in behavioral pediatrics; (2) to stimulate increased research activity and successful competition for support; and (3) to increase interdisciplinary collaborative research efforts within the field of behavioral pediatrics.

The planning committee developed an agenda to present and explore models for behavioral pediatric research that could serve to define challenges and approaches for the field.