bluuebunny/crossref_metadata_2025 huggingface dataset:
Can Clinical Judgment Detect Children with Speech-Language Problems?
Authors: GLASCOE FRANCES P.
Published: December 2021

In Reply.—

Screening primarily on the basis of parents' concerns is clearly cost-effective. If a pediatrician implemented the Academy's policy of standardized developmental screening at each of the 12 well-child visits scheduled between 0 and 5 years of age on a sample of 100 patients followed up from birth, administrations of 1200 tests are required. Eight hundred administrations are needed before the group reaches 24 months of age. Only 12% of parents whose children were younger than 24 months of age had concerns about their child's speech and language such that screening only in response to concerns reduces the numbers of tests from 800 to 96—a substantial savings in time and expense.
Should Promethazine Be Available Without Prescription?
Authors: ROSEFSKY JONATHAN B.
Published: December 2021

To the Editor.—

In a recent issue of Pediatrics, G. B. Hickson et al1 urged caution in permitting over-the-counter use of promethazine because of its possible association with rare side effects. A major reason underlying the concern about promethazine has been that it is technically a member of the phenothiazine class of compounds. However, it should not be identified mistakenly with antipsychotic phenothiazines like chlorpromazine. Promethazine is an antihistaminic phenothiazine and is categorized as one of the H1-receptor antagonist type of antihistamines.
Lateralization of Brain Lesions Following Extracorporeal Membrane Oxygenation
Authors: Mendoza Julita C. , Shearer Loretta L. , Cook Larry N.
Published: December 2021

The cranial ultrasound and computed tomography scan films of 180 patients who underwent extracorporeal membrane oxygenation were reviewed. Sixteen patients were considered to have moderate to severe brain lesions. Of these, 6 were ischemic and 10 were hemorrhagic. Five (83.3%) of the 6 ischemic lesions involved the right side and only 1 ischemic injury occurred on the left. Seven (70%) of the 10 hemorrhagic lesions occurred solely or predominantly on the side opposite the carotid ligation and 3 were found on the same side as the ligation. One patient suffered a right temporal hemorrhage following cannulation of the left common carotid artery. There was no predominance of brain lesions for either side when both hemorrhagic and ischemic lesions were combined. These observations implicate alterations in cerebrovascular hemodynamics accompanying carotid ligation and reperfusion in the path ogenesis of central nervous system lesions associated with the extracorporeal membrane oxygenation procedure. It is suggested that systematic classification of brain lesions associated with extracorporeal membrane oxygenation be made to get a better understanding of their pathology.
Antibody Responses to Influenza B Viruses in Immunologically Unprimed Children
Authors: Levandowski Roland A. , Regnery Helen L. , Staton Eldridge , Burgess B. Gail , Williams Michael S. , Groothuis Jessie R.
Published: December 2021

The cocirculation in several parts of the world of influenza viruses B/Yamagata/16/88 and B/Victoria/2/87, which are genetically and antigenically divergent, has prompted the question of whether immunization with one viral antigen is sufficient for protection against both strains. Twenty-three high-risk infants and young children were immunized with a commercial trivalent influenza vaccine containing the antigens of influenza virus B/Yamagata/16/88. When antibodies against influenza viruses B/Yamagata/16/88 and B/Victoria/2/87 were determined, increases developed uniformly to both in the sera of primed children previously exposed to influenza virus B/Victoria/2/87 by immunization or infection. Antibodies against B/Yamagata/16/88 developed in the sera of unprimed children with titers similar to those of the primed children. However, antibodies to B/ Victoria/2/87 were not detected in the sera of the unprimed children. These data suggest that children with out appropriate immunologic priming may not be protected against an infection with a B/Victoria/2/87 strain after vaccination with a B/Yamagata/16/88 strain. Immunization with more than one influenza B virus strain may be desirable in some high-risk pediatric patients if divergent influenza B viruses circulate.
Improved Support for Children with Disabilities
Authors: CROCKER ALLEN C.
Published: December 2021

Meeting the special expenses associated with health and habilitative services for a child who has significant chronic illness or disability can be very challenging for a family. Our present system of health insurance is diverse, fragmented, and frequently inadequate, confronting families with disqualifications per preexisting conditions, waiting periods, restricted benefits, copayments, ceilings, and out-of-pocket expenses. Although many problems are involved, one scheme that has had considerable stability and relatively broad benefits is enrollment in Medicaid. Specific family financial eligibility requirements limit Medicaid to those with low incomes. Interstate variations in eligibility are substantial, and many families have difficulty understanding and negotiating the system.
Ureteropelvic Junction Obstruction as a Cause for Intermittent Abdominal Pain in Children
Authors: BELMAN A. BARRY
Published: December 2021

Two or three times each year children are seen by the Urology Service at Children's Hospital, Washington, DC, who have a history of intermittent, severe midabdominal pain associated with vomiting due to intermittent ureteropelvic junction obstruction. These symptoms may have been on-going for years. The following case history serves as a typical example.

CASE REPORT

A 6-years-old boy was referred to the Urology Service from the Gastrointestinal Service where he had been sent by his primary physician. He had a 1-year history of episodic abdominal pain occurring one to two times per month initially, but becoming more frequent during the past few months.
In Reply: Neuroleptic Malignant Syndrome
Authors: JOSHI PARAMJIT , COYLE JOSEPH T. , CAPOZZOLI JOSEPH
Published: December 2021

We appreciate the letter of Dr Edwards, which draws attention to the potential risk of antiemetics for causing neuroleptic malignant syndrome (NMS). As we indicated in our article, the mechanism of action shared by drugs that cause NMS is blockade of brain dopamine receptors. Antiemetics, commonly used in pediatrics, such as prochlorperazine maleate and metoclopramide, act by blocking central dopamine receptors and have a propensity for precipitating acute extrapyramidal symptoms, ie, dystonic reaction. Dehydration is a frequent complication of recurrent vomiting in children, that is an indication for prescribing antiemetics.
Congenital Glaucoma
Authors: SPAETH GEORGE L.
Published: December 2021

I recently have seen three very disturbing cases. All of them were quite similar. They all involve missed cases of congenital glaucoma.

Congenital glaucoma (trabeculodysgenesis) is a very rare disease. However, it is not difficult to diagnose; and when diagnosed promptly, it is not difficult to treat successfully. When the diagnosis is missed, however, and the optic nerves become atrophic due to the glaucomatous disease, the consequent blindness is irreversible. Because of the obvious signs that occur in children with congenital glaucoma, and because the treatment so often can be effective, blindness from congenital glaucoma should be almost nonexistent in a country such as the United States.
In Reply: Coughing and Bed Sheet Wrapping
Authors: LAVIGNE JOHN V. , DAVIS A. TODD
Published: December 2021

A 93% success rate in 90 patients in 12 hours, without relapse, is indeed impressive; there are very few procedures reported in the psychological literature that report such a remarkable success rate.

Cohlan et al note the phrases "little or no deceit" and "some punishment" were used in the article posing an alternative to the bedsheet wrapping technique they espouse. Perhaps we were not careful enough in our wording, and these phrases should be clarified. With the dictionary defining deceit as "making a person believe as true something that is false," we should have reported "no deceit."
In Reply: Breast-Feeding and Infectious Illness, Power and Confidence Intervals
Authors: JEKEL J. F. , RUBIN D. H. , LEVENTHAL J. M. , KRASILNIKOFF P. A. , WEILE B.
Published: December 2021

The issues raised by Hopkinson in her letter in this issue are important questions. Hopkinson doubted that our findings are applicable to the United States, because the overall rate of initiating breast-feeding is different from Denmark. We suggested that our findings could be applied to middle class populations in the US because breast-feeding rates in Denmark are similar for this group, but we stated ". . . nor can they be extrapolated to rural or poor urban populations in developed nations." By not making a distinction between different groups within the US or other industrialized nations, Hopkinson unnecessarily limits the potential implications of our study.
Risk of Seizures After Measles-Mumps-Rubella Immunization
Authors: Griffin Marie R. , Ray Wayne A. , Mortimer Edward A. , Fenichel Gerald M. , Schaffner William
Published: December 2021

To evaluate the risks of seizures and other neurologic events following measles-mumps-rubella (MMR) or measles-rubella (MR) immunization, a retrospective cohort study was conducted among 18 364 Tennessee children enrolled in Medicaid who received MMR or MR immunizations in their first 3 years of life. One hundred children had seizures at some time between immunization and 36 months; there were no encephalopathies during this period. Four children had febrile seizures in the 7 through 14 days following MMR or MR immunization compared with 72 in the interval 30 or more days following MMR or MR immunization yielding a relative risk (95% confidence interval) of 2.1 (0.7 to 6.4). Although not statistically significant, this increase in febrile seizures in the 7- through 14-day interval following MMR immunization is coincident with the occurrence of fever following MMR immunization and is consistent with reports of other investigators.
NOCTURNAL CORTISOL, THYROID STIMULATING HORMONE, AND GROWTH HORMONE SECRETORY PROFILES IN DEPRESSED ADOLESCENTS
Authors: Kutcher Stan , Malkin Dina , Silverberg Jay , Marton Peter , Williamson Peter , Malkin Aaron , Szalai John , Katic Marco
Published: December 2021

Twelve depressed adolescents and 12 controls matched for age, sex, Tanner stage, time of menstrual cycle (females), weight, and time of year assessed were studied over 3 nights. Measurements for cortisol, thyroid stimulating hormone, and growth hormone were made on serum collected at 10 p.m., 12 midnight, 1 a.m., 2 a.m., 3 a.m., 4 a.m., and 6 a.m. in eight pairs and every 20 minutes from 8 p.m. to 7 a.m. in four pairs. Cortisol secretion did not significantly differentiate the groups. Thyroid stimulating hormone secretion was significantly elevated in the depressed group at one time point. Growth hormone secretion significantly differentiated the two groups at most time points, and the depressed adolescents significantly hypersecreted growth hormone (area under the curve). Implications for the diagnosis, etiology, and treatment of adolescent depression are discussed.
Social Environment and Vulnerability of Low Birth Weight Children: A Social-Epidemiological Perspective
Authors: MCGauhey Peggy J. , Starfield Barbara , Alexander Cheryl , Ensminger Margaret E.
Published: December 2021

This study examined the impact of low birth weight on children's health and assessed the influence of the social environment on various aspects of health in low birth weight and normal birth weight children. Data on 8661 children aged 2 through 11 from the 1981 Child Health Supplement of the National Health Interview Survey provided strong evidence for two major conclusions: (1) Low birth weight children in high-risk social environments are at increased for poor health outcomes compared with comparable normal birth weight children. This vulnerability was found across all age groups, suggesting that the effects of low birth weight are long-lasting. The poor health outcomes for low birth weight children in high-risk social environments were found for all seven aspects of child health status studied: excessive bed days, restricted-activity days, and school-loss days; school failure, low school-ranking, behavior problems, and maternal perception of child health status as fair/ poor. (2) The mechanism of risk was complex and differed by birth weight group. Whereas certain combinations of individual risk factors protected normal birth weight children from several adverse outcomes, none for low birth weight children were identified. However, low birth weight children in low-or moderate-risk social environments were not at greater risk for poor outcomes compared with comparable normal birth weight children. This study underscores the importance of a healthy social environment for children who are already at high risk for poor health outcomes by virtue of being low birth weight.
EARLY ASTHMA ONSET: CONSIDERATION OF PARENTING ISSUES
Authors: Mrazek David , Klinnert Mary D. , Mrazek Patricia , Macey Terri
Published: December 2021

This report examines the relationship between early parental behavior and the later onset of asthma in a cohort of 150 children who were genetically at risk for developing asthma. Judgments of both parenting problems and maternal coping were made during a home visit when the infant was 3 weeks old. A clinical interview with the mother was developed and reliably coded. The sample was divided into two groups based on the presence or absence of concerns about coping and parenting. During the following 2 years, the respiratory status of the children was monitored. Four categories of respiratory status were defined: (1) asthma: (2) recurrent infectious wheezing; (3) a single isolated wheezing episode; or (4) no wheezing. Early problems in coping and parenting were associated with the later onset of asthma (p < 0.001). Furthermore, parents of children who developed asthma were more likely to have been having difficulties at the 3-week visit than those whose children developed infectious wheezing (p < 0.005).
Wilderness Medicine for Children
Authors: Gentile Douglas A. , Kennedy Barbara C.
Published: December 2021

Wilderness travel with children requires special preparation and places extra demands on parents. However, it also affords unique opportunities. Parents and children interact in a setting distant from the stresses of work and school. Isolated from the distractions of television and modern life, children experience new environments and participate in activities that enrich their lives and often provide valuable lessons. Physicians can encourage and facilitate such activities by providing guidelines and recommendations for wilderness safety. In the wilderness as with general health care, prevention provides the best means of coping with potential difficulties.
EDUCATIONAL TIDBITS
Authors: L. J. F.
Published: December 2021

Of an estimated 46 million students enrolled in elementary and secondary schools in fall 1989, about 12 percent were at private schools. More than half of private school students attend Catholic schools, while about a third are enrolled in other religious schools. Nonsectarian schools account for 14 percent of the private-school population. Most private school students are enrolled in elementary school, while a sixth attend private high school. About a third attend private schools that combine elementary and secondary.
Safety Practices and Living Conditions of Low-Income Urban Families
Authors: Santer Lisa J. , Stocking Carol B.
Published: December 2021

Injuries remain the leading cause of mortality in children and disproportionately affect poor children. Prior injury prevention efforts have neglected the injury prevention needs of these children. One hundred thirty-three care givers of medically indigent urban children younger than 6 years old were interviewed regarding living conditions, previous injuries, and safety practices and knowledge. Functional smoke detectors and fire extinguishers were present in 75% and 27% of homes, respectively. Few respondents, regardless of previous poisoning experience, were cognizant of ipecac, had it in their homes, or had a good response to a possible poisoning. Few homes had locked storage space, and most hazards were stored suboptimally. While the frequency of the use of automobiles was low, rides in a variety of vehicles were common with 63% of children who usually were restrained inadequately. Additionally, 89% of children aged 35 to 59 months and 6% of those younger than 3 years old sometimes bathed without adult supervision. These findings indicate the dramatic need for injury prevention programs focused on low-income urban families. Specific concerns include exposure to fires and burns, falls, hazardous travel conditions, dangerous chemical, choking, and drowning. Lack of information and isolated care givers may result in poor supervision and responses to injury of these children. We suggest potential interventions in each area.
Creatine Kinase Isoenzyme BB Concentrations in the Cerebrospinal Fluid of Newborns: Relationship to Short-term Outcome
Authors: De Praeter Claudine , Vanhaesebrouck Piet , Govaert Paul , Delanghe Joris , Leroy Jules
Published: December 2021

Creatine kinase brain isoenzyme (CK-BB) was determined in cerebrospinal fluid of 150 neonates by a newly developed immunoenzymatic assay. Newborns with a documented neurologic disorder (intraventricular hemorrhage, postasphyxial encephalopathy, central nervous system infection, or persistent periventricular intraparenchymal echodensities) showed markedly higher concentrations of immunoreactive CK-BB than did the normal newborns or those with subarachnoid hemorrhage. In neonates with seizures the data suggest that the underlying neurologic disorder accounts for the higher CK-BB values and not the seizures per se. High concentrations of CK-BB in the neonatal period were followed by poor short-term outcome.
Autistic and Dysphasic Children. I: Clinical Characteristics
Authors: Tuchman Roberto F. , Rapin Isabelle , Shinnar Shlomo
Published: December 2021

Autism and dysphasia are behaviorally defined disorders of higher cerebral function which in preschool children share the common core symptom of impairment of language. In this study we describe the clinical characteristics of 314 autistic and 237 dysphasic nonautistic children evaluated by one child neurologist. There was no significant difference between autistic and dysphasic children in gestational age, birth weight, or prevalence of associated medical disorders, all of which were infrequent, although a positive history of resuscitation or ventilatory support was more common in dysphasic than autistic children (P = .03). As a group autistic children are more likely than dysphasic children to have language subtypes affecting central processing and formulation, a family history of psychiatric disorders and autism, and a history of regression of language and behavior. After excluding 12 girls with autistic symptoms who met the clinical criteria for Rett syndrome, we found that there was no significant difference in the number of autistic and dysphasic children with an abnormal sensorimotor examination. Girls with autism were more likely than boys to have severe mental deficiency (38% of autistic girls vs 23% of boys) (P = .012) and a motor deficit (27% vs 11%) (P = .0009).
Autistic and Dysphasic Children. II: Epilepsy
Authors: Tuchman Roberto F. , Rapin Isabelle , Shinnar Shlomo
Published: December 2021

In a previously described population of 314 autistic and 237 dysphasic nonautistic children, after exclusion of 12 autistic girls with Rett syndrome, 14% (42 of 302) of autistic children and 8% (19 of 237) of dysphasic children had epilepsy (P = .03). The major risk factors for epilepsy were severe mental deficiency and the combination of severe mental deficiency with a motor deficit. In autistic children without severe mental deficiency, motor deficit, associated perinatal or medical disorder, or a positive family history of epilepsy, epilepsy occurred in 6% (10 of 160) which was analogous to the 8% (14 of 168) found in similar dysphasic nonautistic children. The language subtype of verbal auditory agnosia is associated with the highest risk of epilepsy in autistic (41%, 7 of 17) and dysphasic (58%, 7 of 12) children. The higher percentage of epilepsy in autistic girls, 24% (18 of 74) compared with boys 11% (25 of 228) (P = .003), is attributed to the increased prevalence of cognitive and motor deficit in girls. Once the risk attributable to associated cognitive and motor disabilities is taken into account, there is no difference in the risk of epilepsy between autistic and nonautistic dysphasic children.
Experience of an Interdisciplinary Pediatric Pain Service
Authors: Shapiro Barbara S. , Cohen David E. , Covelman Kenneth W. , Howe Carol J. , Scott Sam M.
Published: December 2021

This article is a report of our experience with an interdisciplinary pain service in a large tertiary care pediatric hospital. During the first 2 years of operation, we received 869 consultations and referrals from more than 19 hospital divisions. Postoperative pain was the most frequent reason for consultation (56% of patients). Patients with pain related to cancer and sickle cell disease comprised 25% of the consultations. The remaining patients had a wide variety of primary diagnoses and causes of pain. We calculated the time spent by pain service physicians in direct patient care. The majority (63%) of physician time was spent with a small number of patients (17%). Most of these patients had pain that was unrelated to surgery, cancer, or sickle cell disease, and many posed dilemmas in diagnosis and treatment. Physician time was correlated directly to the use of psychologic and physical therapies for the pain, involving multiple team members. This experience supports the demand for an interdisciplinary pain service in a tertiary care children's hospital. A significant amount of physician time is necessary to provide patient care and to maintain a team approach, however, and pediatricians and other health care professionals who aim to implement such services should be cognizant of the time required.
The Ethics of Accepting Gifts from Pharmaceutical Companies
Authors: Margolis Lewis H.
Published: December 2021

How physicians respond to the promotional activities of the pharmaceutical industry is the subject of ongoing debate and controversy. This paper postulates that the acceptance of gifts in virtually any form violates fundamental duties of the physician of nonmaleficence, fidelity, justice, and self-improvement. The medical community must articulate this position clearly, and it should act accordingly.
Population, Income, and Ecological Correlates of Child Pedestrian Injury
Authors: Braddock Mary , Lapidus Garry , Gregorio David , Kapp Mary , Banco Leonard
Published: December 2021

Pedestrian injury is a significant health problem among urban children. This study is an analysis of the role of population, income, and ecological factors in the occurrence of child pedestrian collisions. One hundred and ninety-eight motor vehicle collisions occurring in Hartford, Connecticut involving pedestrians younger than 15 years old were reported to police during 1986 through 1987. Collision locations were abstracted from police reports and assigned a census tract. Census tracts were classified as "high frequency" (8+ collisions), "moderate frequency" (3 to 7 collisions), or "low frequency" (0 to 2 collisions). High-frequency census tracts had greater proportions of children and of nonwhite residents than moderate- or low-frequency tracts. They also were characterized by high proportions of households headed by females living below the poverty line. High-frequency tracts had a greater number of children per acre than moderate or low tracts. Children per acre had the strongest association with collision frequency (R = .72) and remained the most consistent when other variables were controlled. The number of children per acre is a potentially useful predictor of census tracts at risk for child pedestrian collisions. This may be useful in developing focused prevention strategies within an urban environment.
Is There an Association Between Hemangioma and Syndromes With Dysmorphic Features?
Authors: Burns A. Jay , Kaplan Lawrence C. , Mulliken John B.
Published: December 2021

Most vascular birthmarks can be categorized, based on clinical and cellular criteria, as either (1) a hemangioma, or (2) a malformation, or (3) a macular stain. Macular stains are commonly seen in newborns, and they consist of faint vascular stains of the glabella, eyelids, and nuchal region called "nevus flammeus," "stork bite," "salmon patch," etc. Unfortunately, the term "hemangioma" is frequently applied to all three types of cutaneous vascular lesions. Usually, these disparate vascular anomalies are listed in association with various malformative syndromes and are generically labeled "hemangioma." This study attempts to define accurately the specific vascular anomalies seen in children born with syndromes with dysmorphic features. This review of five standard textbooks of genetics showed that the majority of vascular anomalies reported in syndromic newborns are not hemangiomas. Rather, they are macular stains, and the vast majority of these fade with time. Congenital telangiectasias and other vascular malformations (capillary, lymphatic, venous, arterial, and combinations thereof) also occur in association with dysmorphic syndromes. contrast, hemangioma, the most common neonatal tumor, is seen only incidentally with rare dysmorphic conditions. Specifically, hemangioma was found to occur only in association with midline (sternal, abdominal) clefting, right-sided aortic arch coarctation, and with a constellation of sacral and genitourinary defects.
Infants at High Risk for Sudden Infant Death Syndrome??? Have They Been Identified???—A Commentary
Authors: KRONGRAD EHUD
Published: December 2021

The article by Steinschneider and Santos in this issue of Pediatrics,1 is one in a series2-6 in which a relatively new technique of on-line recordings of cardiorespiratory function is used. This technique has been used mainly during home monitoring of infants considered to be at high risk for sudden infant death syndrome (SIDS). It allows for objective on-line recording of cardiorespiratory anomalies and their correlation with parental observation. The authors have monitored 155 siblings of infants who died of SIDS, whom they considered to be epidemiologically at risk. Many alarms were reported for both apnea and bradycardia. Many parents felt a need to stimulate the infants or to provide cardiopulmonary resuscitation, either because of monitor alarms or because they perceived clinical changes in respiratory pattern, color, or behavior, which they believed to be of a life-threatening nature.
Maternal Phenylketonuria
Authors:   Committee on Genetics
Published: December 2021

Prior to newborn screening and the availability of dietary treatment for phenylketonuria, most patients with classic phenylketonuria developed profound mental retardation and rarely reproduced.1,2 Newborn screening for phenylketonuria has been routinely available throughout the United States for approximately 25 years. Many infants who were identified as having elevated blood phenylalanine concentrations received dietary treatment. In most cases they have attained normal intelligence. A significant number of women who are no longer being treated have entered or are approaching their reproductive years. When diet is discontinued, elevated blood phenylalanine concentrations and other biochemical changes of classic phenylketonuria again become evident.

Children born to mothers whose blood phenylalanine concentrations exceed 0.6 mM (10 mg/dL) have an extremely high incidence of microcephaly and mental subnormality due to the teratogenic effects of phenylalanine and its metabolites.1-8 The incidence of other congenital anomalies, such as congenital heart defects, is also increased. When blood phenylalanine concentrations are less than 0.6 mM(10 mg/dL), the effect on offspring appears to be less severe and less constant. The outcome of such pregnancies is being investigated in a collaborative study sponsored by the National Institutes of Health.1,7 Additional data will become available soon.

All women with persistent phenylalanine elevations should be counseled prior to pregnancy about the possible adverse effect of their condition on their offspring. These women should also be counseled about the risk that their child might have phenylketonuria (approximately 1/120). Reproductive options should be discussed.

Women who decide to proceed with pregnancy should be advised that dietary treatment may improve the outcome for their child.2-4,7-9
Midazolam-Fentanyl Sedation
Authors: YASTER MYRON , NICHOLS DAVID G. , DESHPANDE JAYANT K. , WETZEL RANDALL C.
Published: December 2021

In Reply.—

We can not disagree more with Dr Traynor. Multiple studies have repeatedly demonstrated that children are rarely treated for pain or for painful procedures even when their discomfort and anguish is obvious.1,2 Providing analgesia, amnesia, and sedation should be priorities of medical and surgical care and are hardly of "dubious" benefit. Indeed, the callousness and disregard displayed by many physicians to their patient's pain is shocking. Indeed, it is not at all surprising that patients with cancer, as an example, describe the horrors of their treatment as much worse than the disease itself.
Sucrose as an Analgesic for Newborns
Authors: SCHOEN EDGAR J.
Published: December 2021

To the Editor.—

Blass and Hoffmeyer1 are to be congratulated for documenting the simple noninvasive use of a sucrose-flavored pacifier to relieve pain in newborns. In well-controlled studies they showed that not only did this benign therapy decrease distress during blood collection for routine newborn screening, but it also reduced crying more than 50% during circumcision. Earlier work by Blass and others indicated that a pacifying stimulus as well as oral sucrose relieves pain2-4 and that this analgesic effect is mediated through opiate pathways.5-7
Corporal Punishment
Authors: NERSESIAN WILLIAM
Published: December 2021

To the Editor.—

The article "Hypovolemic Shock in a Child as a Consequence of Corporal Punishment"1 prompted me to reflect on several points. In their discussion and summarizing sentence, it is clear that the authors oppose any form of corporal punishment. I am concerned that this conclusion is based solely on the perceived risks (adverse effects, as evidenced in this anecdotal report) of physical punishment with no attempt to examine or study any potential benefits of physical punishment.
Corporal Punishment
Authors: FLETCHER JAMES L.
Published: December 2021

To the Editor.—

Expecting the worst, I read with interest the article, "Hypovolemic Shock in a Child as a Consequence of Corporal Punishment," in the April issue of Pediatrics.1 My concern was not disappointed. I rejoiced, of course, that the little girl in the case report recovered from the effects of her severe paddling (ie, beating). The article raises in a biased fashion very troublesome issues, however.

Hardly anyone in organized or academic medicine speaks of public morality anymore.
Corporal Punishment
Authors: MAY RONALD B. , BEAL DOUGLAS W.
Published: December 2021

In Reply.—

Dr Nersesian quite correctly points out that there are no controlled long-term studies to determine the beneficial effects of physical punishment. He also sets down a list of criteria to be met prior to the use of physical punishment. These criteria are well thought out and an excellent guide to a parent who feels that physical punishment is necessary. He is also correct in his assumption that the authors are generally opposed to corporeal punishment; however, our position is not based on this one case alone.
Methsuximide-Induced Movement Disorder
Authors: DOOLEY JOSEPH , CAMFIELD PETER , BUCKLEY DAVID , GORDON KEVIN , WIRRELL ELAINE , CAMFIELD CAROL
Published: December 2021

To the Editor.—

A recent article in Pediatrics reported that methsuximide improved seizure control, without serious adverse effects, in 15 of 25 children with intractable epilepsy.1 We subsequently added methsuximide to the treatment regimen of a 17-year-old boy who was already taking valproate, clobazam, and intermittent lorazepam and paraldehyde for uncontrolled seizures. His seizures remained uncontrolled, but 24 days after the initiation of methsuximide he developed orofacial dyskinesia and akathesia, while receiving 450 mg per day (11.3 mg/kg/d).
Methsuximide-Induced Movement Disorder
Authors: TENNISON MICHAEL , GREENWOOD ROBERT , MILES MICHAEL
Published: December 2021

In Reply.—

We appreciate comments of Dooley et al and hope that our paper will stimulate further interest in this often overlooked drug. That methsuximide could induce a movement disorder is not totally unexpected. Other antiepileptic drugs occasionally have been associated with dyskinetic movements. All treatments have a risk-to-benefit ratio and may be inappropriate for a given patient in a given circumstance; this does not diminish the value of the drug for other patients.

We do not feel that it has been proved clearly that the movements are due to methsuximide.
Randomized Trial of Comprehensive Prenatal Care for Low-Income Women: Effect on Infant Birth Weight
Authors: McLaughlin F. Joseph , Altemeier William A. , Christensen Myra J. , Sherrod Kathryn B. , Dietrich Mary S. , Stern David T.
Published: December 2021

The effect of comprehensive prenatal care on birth weight was examined using a prospective randomized design. A total of 428 pregnant women were randomly assigned to comprehensive prenatal care (n = 217) or standard prenatal care (n = 211). Comprehensive care was provided by a multidisciplinary team of nurse-midwives, social workers, a nutritionist, paraprofessional home visitors, and a psychologist. Standard prenatal care consisted of medical care provided by obstetric residents. Multiple regression analysis using behavioral, demographic, and medical variables showed a strong relationship between the set of predictors and birth weight. Comprehensive care was related to higher birth weights for primiparous but not multiparous mothers. Separate analyses of variance for primiparas and multiparas similarly showed a favorable effect of comprehensive care on birth weight for primiparous but not multiparous mothers.
Randomized European Multicenter Trial of Surfactant Replacement Therapy for Severe Neonatal Respiratory Distress Syndrome: Single Versus Multiple Doses of Curosurf
Authors: Speer Christian P. , Robertson Bengt , Curstedt Tore , Halliday Henry L. , Compagnone Daniele , Gefeller Olaf , Harms Karsten , Herting Egbert , McClure Garth , Reid Marc , Tubman Richard , Herin Peter , Noack Gerd , Kok Joke , Koppe Janna , van Sonderen Loekie , Laufkötter Edgar , Köhler Wolfgang , Boenisch Herbert , Albrecht Klaus , Hanssler Ludwig , Haim Michaela , Oetomo Sidarto B. , Okken Albert , Altfeld Peter C. , Groneck Peter , Kachel Walter , Relier Jean-Pierre , Walti Herve
Published: December 2021

There is now convincing evidence that the severity of neonatal respiratory distress syndrome can be reduced by surfactant replacement therapy; however, the optimal therapeutic regimen has not been defined. This randomized European multicenter trial was designed to determine whether the beneficial effects of a single large dose of Curosurf (200 mg/kg) in babies with severe respiratory distress syndrome (arterial to alveolar oxygen tension ratio ∼0.10) could be enhanced by using multiple doses of surfactant. Preterm neonates (birth weight 700 to 2000 g) with severe respiratory distress syndrome requiring artificial ventilation with fraction of inspired oxygen ≥0.6 were randomized into two groups at an age of 2 to 15 hours. Both groups received the usual dose of Curosurf(200 mg/kg) immediately after randomization. In neonates randomized to receive multiple-dose treatment, two additional doses of Curosurf (100 mg/kg each) were instilled into the airways (12 and 24 hours after the initial dose) provided that the patients still needed artificial ventilation with fraction of inspired oxygen >0.21. In both groups (single dose: n = 176, multiple doses: n = 167) there was a rapid improvement in oxygenation as reflected by a threefold increase in arterial to alveolar oxygen tension ratio within 5 minutes after surfactant instillation (P < .001), and peak inspiratory pressure and mean airway pressure could be reduced significantly during the first 6 hours after surfactant treatment. In addition, ventilatory requirement (peak inspiratory pressure, ventilatory efficiency index) was reduced in the multiple-dose group 2 to 4 days after randomization (P < .05 to .01). Sixty-five percent of the patients randomized to the multiple-dose regimen and 68% of the single-dose group needed supplemental oxygen 12 hours after the first treatment. Analysis of 28-day outcome data showed a reduction of the incidence of pneumothorax in the multiple-dose group (9% vs 18%, P < .01). The primary end point, of combined incidence of mortality and bronchopulmonary dysplasia, was 33% in the single-dose group and 27% in the multiple-dose group (P = .08). Mortality at 28 days was reduced from 21% in the single-dose group to 13% in the multiple-dose group (P < .05 by logistic regression). It is concluded that treatment with multiple doses of surfactant is more effective than single-dose treatment in severe neonatal respiratory distress syndrome, further reducing pneumothorax mortality.
Long-term Treatment of Severe Familial Hypercholesterolemia in Children: Effect of Sitosterol and Bezafibrate
Authors: Becker M. , Staab D. , Von Bergmann K.
Published: December 2021

Seven prepubertal children (age range 5.3 to 10.8 years) with severe heterozygous familial hypercholesterolemia (serum cholesterol concentration 416 ± 85 mg/dL and low-density lipoprotein [LDL] cholesterol concentration 360 ± 90 mg/dL) were first treated by dietary Intervention, second by sitosterol (3 x 2 g/d), and third by bezafibrate (2 x 200 mg/d). Each treatment period lasted 3 months. Subsequently, a treatment combining half the dose of sitosterol and bezafibrate was administered for the following 24 months. Diet alone reduced total and LDL cholesterol values by 4.5% (not significant) and 6.6% (P < .05), respectively. Sitosterol lowered total and LDL cholesterol values by 17% (P < .05) when compared with diet alone. Compared with sitosterol, bezafibrate produced a more pronounced effect on total and LDL cholesterol values (-18% and -28%, P < .05), and high-density lipoprotein cholesterol concentration increased significantly from 48 mg/dL to 55 mg/dL Combined treatment with half the dose each of sitosterol and bezafibrate was as effective as the higher dose of bezafibrate, and reduction averaged almost 40% and 50% for total and LDL cholesterol values; this lipid-lowering effect persisted for the next 24 months. Laboratory safety parameters and physical examination revealed no obvious side effects. This study indicates that the combination of sitosterol (3 x 1 g/d) plus bezafibrate (1 χ 200 mg/d) is an alternate, acceptable, safe, and effective therapeutic approach for treatment of severe hypercholesterolemia in children with high-risk familial hypercholesterolemia.
Burning of a Neonate due to a Pulse Oximeter: Arterial Saturation Monitoring
Authors: SOBEL DANIEL B.
Published: December 2021

Monitoring of arterial hemoglobin saturations by pulse oximetry has become a fixture in neonatal and pediatric intensive care units, operating rooms, and in other hospital settings. Use with extremely premature neonates is especially beneficial because of their immature skin development and vulnerability to topical damage—whether due to chemicals, tape, or temperature.1,2 This report documents a case of a burn due to a presumed shorting of a pulse oximeter probe cable in an extremely premature neonate.

CASE REPORT

The patient was a 690-g Hispanic female neonate born prematurely at approximately 25 weeks' gestation with respiratory distress syndrome requiring mechanical ventilation and supplemental oxygen.
Chemotherapy for Tuberculosis in Infants and Children
Authors:   Committee on Infectious Diseases
Published: December 2021

Active tuberculosis is diagnosed in more than 1100 children annually in the United States. The therapy for patients with tuberculosis has undergone major changes during the past decade, including demonstration of the efficacy of multidrug, short-course chemotherapy for pulmonary tuberculosis in adults.1 At least nine studies of 6-month antituberculosis chemotherapy have demonstrated comparable results in children.2-10 The purpose of this statement is to give revised recommendations for treatment of tuberculosis in infants and children. These recommendations have been formulated in collaboration with the Division of Tuberculosis Elimination of the Centers for Disease Control and the American Thoracic Society.

MICROBIOLOGIC RATIONALE FOR TREATMENT

Laboratory observations of Mycobacterium tuberculosis and clinical therapy trials have led to a hypothesis concerning the populations of tubercle bacilli and the actions of various antimycobacterial drugs and drug combinations.11,12 Mycobacteria replicate slowly, can remain dormant for prolonged periods, and can be killed by drugs only during replication. In the host, bacilli live in several sites: open cavities, closed caseous lesions, and within macrophages. Each site contains bacilli with a different population size, metabolic activity, and rate of replication. Open cavities, which are rare in infants and children, have the largest number of mycobacteria. Naturally occurring drug-resistant mutants of M tuberculosis occur within large bacterial populations even before chemotherapy is started. The number of drug-resistant mutants is proportional to the size of the mycobacterial population; thus, they are common in open cavities, but less common in caseous lesions and within macrophages. Mutants naturally resistant to two drugs are virtually nonexistent.
Ibuprofin Safety
Authors: LORIN MARTIN I.
Published: December 2021

In Reply.—

Dr Rosefsky contends that ibuprofen has a relatively good safety record, both in children as well as in adults. However, because for most children it is questionable whether or not fever needs to be treated at all, I contend that the change to a newer, more expensive, and more toxic drug is not justifiable. This is not to say that ibuprofen is not an acceptable or useful drug, but only that it should not be used for simple or routine antipyresis while a safer agent is available.
Location of Port-Wine Stains and Likelihood of Complications
Authors: TAN OON TIAN , MORELLI JOSEPH , STAFFORD TIMOTHY J.
Published: December 2021

In Reply.—

We were interested to read Dr Lueder's comments regarding the incidence of glaucoma in patients with PWS in the trigeminal distribution. While we agree that the incidence of 7% in our study appears to be low, we also feel that the incidence of 24% he mentions in his letter may be rather high. It is our impression that the incidence of glaucoma is somewhere in between. One reason for the low incidence being reported in our study is the fact that only those who had already had the diagnosis made of glaucoma were included in our study.
Home Visitation Investment
Authors: OLDS DAVID L. , KITZMAN HARRIET
Published: December 2021

In Reply.—

We agree with Dr Sissman that greater attention needs to be paid to the costs and financial returns that society can expect from an investment in home visitation. Our group is working on an empirical report that addresses this topic. Unfortunately, there is virtually no published evidence on the cost-savings that might be produced by an investment in home visitation per se, although there are several reports on the cost effectiveness and cost benefits of home visitation when it is combined with other services.1-3
The Anser System
Authors: GLASCOE FRANCES PAGE
Published: December 2021

In Reply.—

How likely is it that users of the Anser System will spend what is a considerable amount of time collecting information from teachers, parents, and children, but stop short at drawing any conclusions from the findings? It is the central and everyday task of physicians to marshall data and then form judgments about the nature of the problem and interventions. The Anser System may help Pediatricians gather descriptions about children. But, it leaves the inescapable process of determining just what their difficulties are entirely to chance, whim, or idiosyncrasy.
Perineal Confusion
Authors: EMANS S. JEAN
Published: December 2021

To the Editor.—

The recent study by Drs Kellogg and Parra1 is clearly important in documenting the prevalence of the "linea vestibularis" in the normal neonate. However, this structure is not previously "undescribed," John McCann and colleagues2 described an "avascular midline area" in the posterior fourchette in 25.6% of prepubertal girls selected for nonabuse. In this study, the possibility that some of these lines were caused by labial adhesions was not reported separately. In a study not published at the time of your article, Berenson and colleagues3 found a midline avascular area in 4% of a younger group of girls.
Questions on ECMO Study
Authors: SCANLON JOHN W.
Published: December 2021

To the Editor.—

The remarkable study by O'Rourke et al1 about extracorporeal membrane oxygenation (ECMO) for persistent pulmonary hypertension undoubtedly will generate considerable discussion about the investigators' creative and novel approach both to the ethics of informed consent and to the methods of research design.

I have one simple question. If their entry selection criteria produced an 85% likelihood of dying, why did only 40% of conventionally treated controls die? Superficially it would seem either that their criteria were inaccurate or that care substantially improved after 1983.
A Different View of Surfactant Development
Authors: KATTWINKEL JOHN
Published: December 2021

To the Editor.—

Dr Lucey has praised the neonatology profession for finally "getting it right" in its recent development of surfactant therapy for neonatal respiratory distress syndrome.1 Although, in some respects, I agree that we have done it better than in the past, I believe there needs to be an opposing view presented to his uniformly rosy assessment.

Yes, we do have a "therapy which we know works and is safe," and which was an international joint product of research groups, industry, and the Food and Drug Administration.
Primary Care Physicians' Knowledge About Diphtheria-Tetanus-Pertussis Immunizations in Preterm Infants
Authors: Langkamp Diane L. , Langhough Rebecca
Published: December 2021

Preterm infants often receive their diphtheria-tetanus-pertussis (DTP) immunizations on a delayed schedule or in reduced dosage. Since primary care physicians (PCPs) immunize many preterm infants, the purpose of this study was to describe PCPs' knowledge about the use of DTP immunizations in preterm infants. Among the 479 PCPs who completed the questionnaire, 84% of pediatricians and 60% of family physicians correctly identified chronologic age as a criterion for initiating DTP immunizations in preterm infants. However, nearly 45% of PCPs linked this with other criteria such as a minimum weight requirement. Family physicians' answers differed from the recommendations more often than pediatricians' answers. The answers of pediatricians and family physicians who completed residency >20 years ago differed from the recommendations more often than those who completed training ≤20 years ago. The answers of PCPs with fewer than five preterm infants in their practices differed from the recommendations more frequently than the answers of those with five or more preterm infants in their practices. Educational interventions are needed to bring PCPs' knowledge and practices into compliance with the American Academy of Pediatrics recommendations concerning DTP immunizations for preterm infants.