bluuebunny/crossref_metadata_2025 huggingface dataset:
The Introduction of Human Immunodeficiency Virus Into the North Carolina Pediatric Population
Authors: Grant Cameron , McKinney Ross E. , Weedy Chris , Katz Samuel L. , Wilfert Catherine M.
Published: December 2021

The authors reviewed the means by which human immunodeficiency virus (HIV) seropositivity was acquired for the 134 seropositive children seen at Duke University Medical Center prior to September 1990. Perinatal transmission occurred in 111 (83%) and blood product transmission in 15 (11%). Of the 108 mothers (there were three sets of siblings) responsible for perinatal transmission, 44 (41%) had acquired their infection while residing in North Carolina. Intravenous (IV) drug use by the mother or her sexual partner was the significant risk factor for maternal infection in 91 (84%) of the total cases and in 38 (86%) of the 44 women infected in North Carolina. The proportion of women who acquired their HIV infection from a sexual partner who was an IV drug user was significantly greater for mothers who were resident in North Carolina when infected compared with mothers infected elsewhere (P < .001). On the basis of admissions to drug treatment programs during the 1990 fiscal year, cocaine is the predominant IV drug used in North Carolina. Admissions to cocaine abuse programs occurred throughout the state, and mothers who acquired HIV infection from IV drug use were more likely to live in counties with a higher frequency of cocaine abuse treatment.
Back Transporting Infants From Neonatal Intensive Care Units to Community Hospitals for Recovery Care: Effect on Total Hospital Charges
Authors: Phibbs Ciaran S. , Mortensen Lynn
Published: December 2021

Many neonates are referred to neonatal intensive care units (NICUs) for specialized care far from their parents' residence. This distance can add to the stress of the parents and reduce the contact of the parents with their newborn. Small studies have found that back transporting these neonates to hospitals closer to their homes is safe and cost-effective. Despite these findings, the reluctance of many insurers to pay for back transports prevents or delays many back transports. Insurers may not consider the findings of the previous studies to be conclusive, given that the comparisons were between small numbers of neonates back transported and neonates who remained in tertiary care, and the potential for differences in severity of illness between the groups is significant. In this study the effect on hospital charges of back transports was examined by comparing the charges for care in community hospitals with what these charges would have been in a tertiary care center. The advantage of this method is that it avoids case-mix differences between the groups and thus minimizes the potential for small-sample bias. Data were collected for all back transports from a NICU to non-tertiary care centers (n = 90) for a 9-month period. We were able to obtain the itemized bills for the care at community hospitals for 42 of these patients. Each bill was recalculated using the charges for the NICU to determine potential for savings. The average charges for recovery care were about $6200 lower at the community hospital than they would have been at the NICU. When the charges for the back transport are subtracted (mean = $1603), the average net savings are $4,600. These savings are even larger ($6163) for neonates who stayed at the community hospital for more than 7 days.
Decreased Thymus Size on Chest Radiography: A Sign of Pediatric Human Immunodeficiency Virus Infection?
Authors: MEYERS ALAN , PEPE NICHOLAS , CRANLEY WILLIAM , MCCARTEN KATHLEEN
Published: December 2021

The early diagnosis of infection with the human immunodeficiency virus (HIV) in infancy is clinically important but remains problematic in the asymptomatic child born to an HIV-infected mother. In addition, many such women are unaware of their HIV infection until their child manifests symptomatic HIV disease. Nonspecific signs of pediatric HIV infection, such as generalized lymphadenopathy, hepatosplenomegaly, or persistent thrush, may be important in alerting the clinician to consider the possibility of HIV infection in the child whose history of HIV risk is unknown. We report one such sign which may be evident on plain chest radiography.

The pathology of the thymus gland in pediatric acquired immunodeficiency syndrome has been described by Joshi and colleagues,1-3 who have reported precocious involution with marked reduction in thymus size and weight.
Variability in Head Circumference Growth Rate During the First 2 Years of Life
Authors: Jaffe M. , Tal Y. , Hadad B. , Tirosh E. , Tamir A.
Published: December 2021

The head circumference (HC) curves were plotted for a group of 415 healthy full-term babies over the first 2 years of life. Two hundred ten (51%) of the cohort demonstrated HC variability, defined as an HC acceleration or deceleration of at least 1 centile curve for at least 2 months. Of these, the deceleration pattern was predominant (80.9%), and also frequently permanent (87%). The HCs of 3 (1.42%) of 210 infants with HC variability ended up with a deviation of 2 standard deviations or more from the mean. The onset of HC transition occurred from the mean age of 1.3 months, and the new curve had stabilized by age 13 months In 95% of the study group. Parallel changes occurred In body weight and body length In approximately 48% of the total cohort, but more frequently in the variable-HC group. The clinical interpretation of these findings is discussed.
Value of Cranial Ultrasound and Magnetic Resonance Imaging in Predicting Neurodevelopmental Outcome in Preterm Infants
Authors: van de Bor Margot , den Ouden Lya , Guit Gerard L.
Published: December 2021

In this prospective study, cranial ultrasound was performed to detect periventricular-intraventricular hemorrhage and periventricular leukomalacia in 33 preterm infants of less than 32 weeks' gestation. At 44 weeks postmenstrual age magnetic resonance imaging was performed to detect the stage of myelination. Neurodevelopmental outcome was assessed at 3 years of age in 31 children (2 children died in the first year of life). Significant correlations were found between neurodevelopmental outcome and ultrasound findings (χ2 = 32.8; P < .0001) and stage of myelination (χ2 = 20.5; P < .0005). To establish the criterion with the best predictive factor, multiple regression analysis was performed with outcome as dependent variable and periventricular-intraventricular hemorrhage, periventricular leukomalacia, and stage of myelination as independent variables. It appeared that the detection of periventricular leukomalacia with ultrasound showed the best predictive factor for neurodevelopmental outcome. Routine magnetic resonance imaging at 44 weeks postmenstrual age should not be performed just for the purpose of predicting neurodevelopmental outcome more reliably.
Effect of an Exchange Transfusion on Plasma Antioxidants in the Newborn
Authors: Lindeman J. H.N. , Lentjes E. G.W.M. , Houdkamp E. , van Zoeren-Grobben D. , Schrijver J. , Berger H. M.
Published: December 2021

The effect of an exchange transfusion on antioxidants in the plasma of newborns with rhesus hemolytic disease was studied. The antioxidant concentrations in donor blood were similar to normal adult values except for the lower vitamin C concentrations. Exchange transfusion decreased the newborns' iron and ferritin levels and increased their ceruloplasmin and transferrin (primary antioxidants) concentrations and latent iron-binding capacity. The changes in secondary antioxidant concentrations were variable; uric acid and thiols were stable, vitamin C and bilirubin fell, and vitamin E rose. The total peroxyl-radical trapping capacity of the secondary antioxidants did not change significantly. The fall in levels of thiobarbituric acid reactive substances, an index of lipid peroxidation, was related to the lower levels present in the donor blood. Exchange transfusion rapidly produced variable changes in the concentrations of prooxidant and antioxidant substances in plasma and may thus influence free radical metabolism in the newborn.
Comparison of the Causes and Consequences of Prematurity and Intrauterine Growth Retardation: A Longitudinal Study in Southern Brazil
Authors: Barros Fernando C. , Huttly Sharon R.A. , Victora Cesar C. , Kirkwood Betty R. , Vaughan J. Patrick
Published: December 2021

A cohort of 5914 liveborns (99% of the city births) was followed up to the age of 4 years in Pelotas, southern Brazil. Besides the perinatal evaluation, the cohort children were examined again at mean ages of 11, 23, and 47 months. During each visit the children were weighed and measured and information on morbidity was collected. Also, multiple sources of information were used for monitoring mortality throughout the study. Of the babies with known gestational age, 9.0% were classified as intrauterine growth-retarded and 6.3% as preterm. Excluding those of unknown gestational age, 62% of low birth weight babies were intrauterine growth-retarded and 36% were preterm. Intrauterine growth retardation was statistically associated with maternal height, prepregnancy weight birth interval, and smoking, whereas preterm births were associated with maternal prepregnancy weight and maternal age. Preterm babies had a perinatal mortality rate 13 times higher than that of babies of appropriate birth weight and gestational age and 2 times higher than that of intrauterine growth-retarded babies. Infant mortality rates presented a similar pattern, with the differentials being more pronounced during the neonatal than in the postneonatal period. In the first 2 years of life intrauterine growth-retarded children were at almost twice the risk of being hospitalized for diarrhea compared with appropriate birth weight, term children, while preterm children experienced only a slightly greater risk. For pneumonia, however, both groups of children were hospitalized significantly more than appropriate birth weight, term children. In terms of growth, despite their earlier disadvantage, preterm children gradually caught up with their appropriate birth weight, term counterparts. This catch-up occurred primarily between mean ages 23 and 47 months. Intrauterine growth-retarded children, however, exhibited no such catch-up. Indeed, their average monthly growth rates between measurements were always lower than those of children in the other two groups.
DNA Diagnosis of Central Nervous System Infection by Mycoplasma pneumoniae
Authors: Narita Mitsuo , Matsuzono Yoshihiro , Togashi Takehiro , Kajii Naofumi
Published: December 2021

A nested polymerase chain reaction method for the detection of Mycoplasma pneumoniae was devised and applied to clinical samples. This system could detect 5 to 50 fg of the DNA from M pneumoniae and did not amplify the DNA from Mycoplasma genitalium. With this method, the sequence of this organism was detected successfully in cerebrospinal fluid samples from four of six patients and in serum samples from three of four patients with clinically and serologically confirmed mycoplasmal central nervous system infection. This strongly suggested the direct invasion of this organism into the central nervous system and the concomitant occurrence of mycoplasmaremia. The nested amplification method is considered to be simple, rapid, and sensitive without the use of radioisotopes, thereby being highly applicable as a useful tool in routine clinical laboratories for the preliminary detection and diagnosis of mycoplasmal Infections, particularly in extrapulmonary cases.
Concave Hymenal Variations in Suspected Child Sexual Abuse Victims
Authors: Kerns David L. , Ritter Mary L. , Thomas Ronald G.
Published: December 2021

The purpose of this study was to describe and analyze the characteristics of, and the clinical correlates to, concave hymenal variations in a large number of suspected child sexual abuse victims. Thirteen hundred eighty-three female child and adolescent suspected sexual abuse victims were comprehensively evaluated. Photocolposcopy was used for the anogenital examinations. Concave hymenal variations were found in 174 patients (12.6%). Sixty-one (35.1%) were anterior. Of these, 40 (65.6%) were curved and smooth, and 21 (34.4%) were angular and/or irregular. One hundred (57.5%) were posterior/lateral. Of these, 33 (33%) were curved and smooth, and 67 (67%) were angular and/or irregular. Thirteen patients (7.5%) had multiple hymenal concavities. Posterior/lateral location was associated with penile-vaginal contact (P = .004), penetration (P = .006), stranger perpetrator (P = .032), hymenal rim narrowing (P < .001), and posterior fourchette abnormality (P = .049). Angular and/or irregular features were associated with penile contact (P = .005), vaginal contact (P = .035), penile-vaginal contact specifically (P < .001), penetration (P = .046), abnormal general physical examination (P = .018), and hymenal rim narrowing (P < .001). Logistic regression analysis demonstrated that age-specific prevalence trends for posterior/lateral (P < .001) and angular and/or irregular (P = .011) concavities were consistent with acquired anatomic findings. An interobserver exercise with five "blinded" raters evaluating photographs of 49 patients showed significant agreement among observers in sorting posterior/lateral and angular concavities into the diagnostic categories "suggestive of trauma" and "trauma." Multiple lines of evidence support the hypotheses that concavity characteristics of posterior/lateral location, angular contour, and rim irregularity are associated with prior hymenal trauma.
Managed Care
Authors: SAPIN SAMUEL O.
Published: December 2021

To the Editor.—

The recent report in Pediatrics1 of a random survey of American Academy of Pediatrics Fellows, titled "Barriers to Pediatric Referral in Managed Care Systems" paints a picture of managed care with brushstrokes which are much too broad. Managed care is an extremely heterogeneous entity and the authors of the report do not emphasize sufficiently the fact that pediatricians in certain types of managed care systems practice with no barriers to appropriate referrals for subspecialty or inpatient care.
Managed Care
Authors: LAWS HARRY F.
Published: December 2021

To the Editor.—

The publication of an article in the February 1992 issue of Pediatrics by Cartland and Yudkowski1 gravely concerns me, because it seems to reflect a conclusion unsubstantiated by factual information. I am referring specifically to the implication that the managed care system limits necessary access to pediatrics subspecialty and inpatient care. The authors present data that support a limitation of access within a managed care system, but their anecdotal stories fail to convince me that all these referrals were "necessary."
Managed Care
Authors: CARTLAND JENIFER D. C. , YUDKOWSKY BETH K.
Published: December 2021

In Reply.—

Dr Robbins' criticism of our paper1 essentially makes two points. First, Dr Robbins criticizes the evaluation of physicians' perceptions of managed care systems because, he feels, these perceptions are largely self-serving. (We presume that Dr Robbins does not criticize the whole field of survey research.) Second, Dr Robbins is concerned that the reported perceptions are not validated by patient-level analysis.

As mentioned repeatedly in the paper, the survey was designed to measure perceptions. Whether these perceptions are self-serving cannot be determined by the research tools that we used, or by any others that we know of.
Serum Enzyme Monitoring in Asthma Patients
Authors: PRESS SHIRLEY , LIPKIND REINA S.
Published: December 2021

To the Editor.—

We read with interest the article by Maguire et al entitled "Cardiotoxicity During Treatment of Severe Childhood Asthma."1 Many of the symptoms that these asthmatic patients exhibited are similar to the manifestation of acute myocarditis, ie, tachycardia, elevated CPK-MB levels, electrocardiogram abnormalities, in addition to their severe respiratory distress. In our study of seven children with acute myocarditis, two of them had an initial diagnosis of status asthmaticus.2 Do the authors feel that it is possible that some of the children in their study may in retrospect have had myocarditis that responded to the treatment of severe status asthmaticus?
Community-Based Evaluation of the Effect of Breast-Feeding on the Risk of Microbiologically Confirmed or Clinically Presumptive Shigellosis in Bangladeshi Children
Authors: Ahmed Faruque , Clemens John D. , Rao Malla R. , Sack David A. , Khan M. R. , Haque Emdadul
Published: December 2021

To assess the association between breast-feeding and the risk of microbiologically confirmed or clinically presumptive shigellosis, the authors performed a case-control analysis of Bangladeshi children younger than 3 years of age who were followed up for 1 month after exposure to Shigella in their residential neighborhoods. Two hundred sixty-nine cases with culture-confirmed shigellosis (n = 119) or clinically presumptive shigellosis (culture-negative dysentery, n = 150) were compared with 819 controls without Shigella diarrhea or other invasive diarrheal illnesses. The odds ratio relating breast-feeding to confirmed or presumptive shigellosis, adjusted for potentially confounding variables, was 0.48 (95% confidence interval = 0.32 to 0.72; P < .001), suggesting a substantial protective effect. The protective association decreased with age but was still significant during the third year of life; appeared to be directly related to the degree of stunting and was equivalent for confirmed and presumptive shigellosis. Notably, the protective association remained substantial against episodes due to Shigella which were resistant to at least one of the antibiotics customarily used for treatment of Shigella diarrhea (age-adjusted odds ratio = 0.40; 95% confidence interval = 0.22 to 0.74; P < .01). These data suggest that breast-feeding confers a high level of protection against shigellosis throughout the first 3 years of life, especially among nutritionally compromised children, and thereby underscore the importance of promotion of breast-feeding as a central component of Shigella control programs in less developed settings.
Abraham Jacobi Award Address, April 14, 1992 The Medical Home: Pediatric Practice and Child Advocacy in the 1990s
Authors: Sia Calvin C. J.
Published: December 2021

It is with the deepest humility that I accept the Abraham Jacobi Award from the American Medical Association (AMA) and the American Academy of Pediatrics. Dr Jacobi represented the best in pediatrics, a practitioner in New York in 1853, Professor of Diseases of Children at New York Medical College in 1859, Chairman of the AMA Section Council on Pediatrics, founder and president of the American Pediatrics Society, and president of the American Medical Association. He was perhaps best known as a child advocate. Dr Jacobi believed that physicians should take an active interest in public policy. At an early age he was, and remained throughout his life, what would now be termed a "troublemaker." He actively pursued legislation for women and children in Albany, the state capitol, and in Washington, DC. Throughout his long and productive life, he felt comfortable only when championing a good cause.1-4 It is truly an honor to receive an award bearing his name.

Before I begin my address, I would like to pay personal tribute to my dear wife Kathie, who has stood by me for 40 years throughout my shortcomings as a husband and father, as I pursued my interest in organized medicine as a child advocate. She has suffered through long waits for late dinners because of my practice or meetings, the yardwork that was never done because of office or hospital emergencies, and cared for our family alone while I attended meetings on the mainland. I would also like to honor my mentor, the late Dr Irvine McQuarrie, who "fathered" me during my first year of pediatrics residency in Hawaii.
Effect of Maternal Hypertension on Neonatal Neutropenia and Risk of Nosocomial Infection
Authors: Mouzinho Ana , Rosenfeld Charles R. , Sanchez Pablo J. , Risser Rick
Published: December 2021

Neonatal neutropenia occurs in ∼50% of newborns delivered by women with pregnancy-induced hypertension. It is thought to be transient, independent of birth weight and gestational age, and unassociated with significant risks, including infection. It recently was suggested that neonatal neutropenia occurs primarily in smaller, younger neonates, is related to the severity of pregnancy-induced hypertension, and importantly, may be associated with an increased risk for nosocomial infection. We examined these points in a large inborn population in consecutive years, performing retrospective (n = 110, 1989) and prospective (n = 151, 1990) studies in low birth weight (≤2200 g) neonates delivered by women with pregnancy-induced hypertension. Overall, 40% to 50% of neonates studied developed neonatal neutropenia, and they were younger and smaller (P < .01) than non-neutropenic neonates. In the prospective study, neutropenic neonates were more likely to have mothers with severe pregnancy-induced hypertension (P < .001), and the incidence of neonatal neutropenia was primarily among neonates <30 weeks of gestation and <1500 g birth weight, ∼80% vs 35% to 45% in older, larger neonates or infants (P < .001). Although nosocomial infection occurred more frequently among the group of neutropenic neonates in the prospective study (P < .02), the incidence was similar to that in matched non-neutropenic controls delivered of normotensive women. Thrombocytopenia (<100 000/mm3) was not more frequent in neutropenic neonates. Although neonatal neutropenia occurs in 40% to 50% of low birth weight neonates from pregnancies complicated by pregnancy-induced hypertension, this primarily reflects an incidence of 80% among neonates <30 weeks gestation. There is no apparent increased risk for development of nosocomial infection or thrombocytopenia.
Neonatal Genital Prolapse
Authors: BAYATPOUR MAHIN , PHELPS HOPE , MCCANN JOHN , HARRIS TONI
Published: December 2021

Neonatal vaginouterine prolapse is a rare condition. The problem usually occurs at birth or during the first few days of life. A high percentage of the reported cases have been associated with congenital spinal defects, occult or otherwise. The treatment has been primarily surgical or through the use of a pessary.

In this report we present a case of a newborn who was treated conservatively with a simple digital reduction procedure. Follow-up at six and twelve months showed no evidence of a recurrence.

Although previously reported in the obstetric, gynecologic, and surgical literature, no cases of neonatal vaginouterine prolapse have appeared in the general pediatric literature.
Meconium and Tracheal Aspiration
Authors: DENK LARRY
Published: December 2021

To the Editor.—

I thank Drs Wiswell and Henley for their article on meconium aspiration sydnrome (MAS).1 They have provided helpful data on a subject that requires further elucidation. I think they could have emphasized further the benefits of suctioning by pointing out the following statistics derived from their study: 12 (9.0%) of 133 newborns not suctioned developed MAS, whereas only 24 (3.9%) of the 608 newborns who were suctioned developed MAS.

My training and subsequent practice have been to intubate and suction all newborns with thick meconium, and all newborns with any type of meconium who have not yet cried.
Meconium and Tracheal Aspiration
Authors: REYNOLDS DAVID W.
Published: December 2021

To the Editor.—

Based on a retrospective analysis of neonates born at Walter Reed Army Medical Center from 1985 through 1989 with meconium-stained amniotic fluid (MSAF), Drs Wiswell and Henley conclude that all such newborns should have their tracheas suctioned immediately after birth.1 This study was undertaken primanly to address the recommendation of Cunningham et al that intratracheal aspiration be reserved for babies requiring positive pressure resuscitation.2

Although Wiswell and Henley found a significantly higher incidence of meconium aspiration syndrome (MAS) in all nonsuctioned neonates (12/133) compared with all suctioned neonates (24/608), this was clearly not true for babies with thin meconium.
Does Denver II Produce Meaningful Results?
Authors: JOHNSON KATHERINE L. , ASHFORD LINDA G. , BYRNE KAREN E. , GLASCOE FRANCES PAGE
Published: December 2021

To the Editor.—

We commend Frankenburg et al for their efforts to revise the Denver Developmental Screening Test.1 The authors have wisely incorporated suggestions from many researchers who conducted validity studies on older versions of the measure.2-5 As a consequence, the Denver II appears to be substantially improved, particularly in its measurement of language. This is quite important because the more prevalent developmental disabilities share language deficits as a common characteristic.

Yet despite its manny improvements, the Dennver II is clearly unnfinished adn unready for marketing.
Does Denver II Produce Meaningful Results?
Authors: FRANKENBURG WILLIAM K.
Published: December 2021

In Reply.—

We are grateful to Johnson et al for raising the issue of validity of the Denver II. It has offered us an opportunity to clarify the purpose and use of the Denver II. One must consider two kinds of validity. The first type of validity is the degree to which an instrument measures that which it purports to measure. As the authors have stated, the Denver II presents norms of development of specific skills just as growth curves present growth norms.1
Caveats on Abdominal Central Venous Pressure Measurement
Authors: TONG TIMOTHY K.
Published: December 2021

To the Editor.—

I applaud the important study done by Lloyd et al on the "Accuracy of Central Venous Pressure Measurement From the Abdominal Inferior Vena Cava"1 Those of us who help take care of critically ill children know too well the risks and technical difficulties of establishing internal jugular and central venous lines in children.

The authors report that the intra-abdominal venous pressure closely reflects that of the intrathoracic venous pressure. They offer the caveat that this may not be accurate in patients with an obstruction to the inferior vena cava by a thrombus or extrinsically by a tumor.
Temperament and the Psychobiology of Childhood Stress
Authors: Boyce W. Thomas , Barr Ronald G. , Zeltzer Lonnie K.
Published: December 2021

This paper provides a conceptual overview of recent research on the developmental psychobiology of childhood stress. We propose that the construct of temperament can be regarded as an organizing principle in children's responses to environmental adversity, and we review three physiologic "windows" through which such responses can be usefully examined. It is concluded that individual differences between children in their psychobiologic reactivity to stressors may constitute an important and novel point of departure for future studies of stress and childhood morbidity.
Individual Differences in Response to Stress
Authors: Lewis Michael
Published: December 2021

Observation of newborns and infants reveals individual differences in reactivity to stress. A measurement system based on threshold, dampening, and reactivation is described to assess these individual differences in the newborn period and thereafter. The three features are independent and, therefore, represent different aspects of reactivity. There is some evidence for stability of individual differences in reactivity between birth and 2 months of age. This stability is more apparent for infants who were highly reactive as newborns. The role of dispositional factors of reactivity, their stability, and the effects of the environment are discussed.
Vagal Tone: A Physiologic Marker of Stress Vulnerability
Authors: Porges Stephen W.
Published: December 2021

Vagal tone is proposed as a novel index of stress vulnerability and reactivity with applications in all branches of medicine, and with particular value in pediatrics. The paper proposes a model emphasizing the role of the parasympathetic nervous system and particularly the vagus nerve in mediating homeostasis and defining stress. Measurement of cardiac vagal tone is proposed as a method to assess on an individual basis both the stress response and the vulnerability to stress. The method monitors the neural control of the heart via the vagus (ie, vagal tone) as an index of homeostasis. The method provides a standard instrument with statistical parameters that are comparable between patients and throughout the life span. This noninvasive method will allow the assessment of the stressful impact of various clinical treatments on the young infant and permit the identification of individuals with vulnerabilities to stress.
INTRODUCTION
Authors: HAGGERTY ROBERT J.
Published: December 2021

The William T. Grant Foundation supports eight consortia, each devoted to a specific issue, and each consisting of ten to twenty members from a Variety of scientific disciplines. Our purpose is to provide a forum for discussion of ideas, research, and conceptual and theoretical bases of that research to individuals who work in related areas, but who might not under other circumstances have easy communication with each other, especially in the preliminary stages of the development of their research projects. By the time national meetings occur, projects are of necessity completed, and there is no chance for modification using an interdisciplinary approach.

We have been very pleased with this device to bring research workers of different disciplines together. The newest of these consortia is devoted to the Developmental Psychobiology of Stress and includes pediatricians, psychologists, and anthropologists who work on both human and animal models. This group moved promptly in their first meeting to bring together a talented group of researchers from different disciplines; the results of their research are presented in this supplement. They well exemplify the advances that have been made in recent years in methodology to study mind-body interactions in infants and older children. Methodologic barriers in the past have limited research on stress in humans. It is stimulating and exciting to see that these barriers are beginning to be overcome, and that research such as is presented here is illuminating this exciting new field. It has enormous application to pediatric practice and child health in the future.
Oral Ketamine Premedication to Alleviate the Distress of Invasive Procedures in Pediatric Oncology Patients
Authors: Tobias Joseph D. , Phipps Sean , Smith Bruce , Mulhern Raymond K.
Published: December 2021

This study prospectively evaluated the efficacy of oral ketamine in alleviating procedure-related distress in pediatric oncology patients. Ketamine (10 mg/kg) was administered orally to 35 children and adolescents, ranging in age from 14 months to 17 yeas (mean = 6.5 years). Procedure-related distress was evaluated by using parent/clinician ratings and the Observational Scale of Behavioral Distress (OSBD-R). Eighty-seven percent of children were sedated within 45 minutes. Clinician and parent ratings were similar, with 77% rating procedural distress as low (0 to 3). The OSBD-R scores were low throughout all phases of the study. Although this study was neither randomized nor placebo-controlled, statistical comparison of the OSBD-R scores of the patients who received oral ketamine with those of historical controls (from a study previously performed at the same institution but using intravenous midazolam) showed significantly less distress (P < .001) during the procedure in children who received oral ketamine. Additionally, OSBD-R scores of the patients who received oral ketamine were significantly lower (P < .001) during all phases than those of the saline placebo group in the other study. No cardiorespiratory side effects related to ketamine were noted. The majority of patients showed recovery from sedation within 2 hours following the procedure. In conclusion, oral ketamine effectively alleviated procedure-related distress in pediatric oncology patients.
Acute Pancreatitis in a 12-Year-Old Girl After an Erythromycin Overdose
Authors: BERGER THOMAS M. , COOK WALTER J. , O'MARCAIGH AENGUS S. , ZIMMERMAN DONALD
Published: December 2021

A variety of drugs including certain antibiotics have been implicated in causing acute pancreatitis.1 So far, there have been three reported cases in adults in which erythromycin was identified as a possible cause of acute pancreatitis.2-4 We report the first case of erythromycin-induced acute pancreatitis in childhood. We suggest a possible pathophysiological mechanism based on the known motilin agonist properties of erythromycin.

CASE REPORT

A 12-year-old girl was brought to the Emergency and Trauma Unit, with acute, crampy abdominal pain and vomiting. These symptoms had started 1 hour earlier, approximately 30 minutes after the deliberate ingestion of 20 tablets of erythromycin (Erythromycin Base Filmtab, 250 mg, Abbot Laboratories, Pharmaceutical Products Division, North Chicago, IL) after an argument with her parents and her boyfriend.
The Proper Role of β2-Adrenergic Agonists in the Treatment of Children with Asthma
Authors: FURUKAWA CLIFTON T. , KEMP JAMES P. , SIMONS F. ESTELLE R. , TINKELMAN DAVID C.
Published: December 2021

β-Adrenergic agonist therapy was associated with increased asthma mortality when high-potency isoproterenol was used in the United Kingdom in the 1960s, and when the β-agonist fenoterol was used increasingly in New Zealand in the 1970s.1-3 Recently, a Canadian epidemiologic study reported an increased risk of death with regular use of β-agonists, particularly fenoterol.4 Fenoterol may be uniquely less safe than other β-agonists because of a greater cardiotoxic potential due to less β2 specificity (than terbutaline) and a greater relative dose per actuation.5 The concerns about the safety of β-agonists are linked intimately with the concerns about their effectiveness in asthma therapy.
Issues in State Newborn Screening Programs
Authors: CLAYTON ELLEN WRIGHT
Published: December 2021

These are heady times for newborn screening. Articles in the medical literature and speakers at grand rounds urge us to test babies for disorders, including cystic fibrosis,1 biotinidase deficiency,2 and medium-chain acyl coenzyme A dehydrogenase deficiency.3 States are expanding the batteries of tests they perform. My own state of Tennessee just began testing neonates for galactosemia this year. And this is no doubt just the beginning. New techniques are being developed that will make it possible to look for a host of genetic characteristics using microscopic amounts of blood. We soon may be able to discern many conditions and characteristics of our children.
Impact of Childhood Asthma on Health
Authors: Taylor William R. , Newacheck Paul W.
Published: December 2021

In 1988, the National Health Interview Survey contained a supplemental questionnaire on childhood conditions that included asthma. The authors used these data from 17 110 households to determine the disease burden resulting from asthma and to determine the functional status of children with and without asthma by linking information from the core and supplemental questionnaires. The prevalence of asthma in children younger than 18 years of age in the United States as reported by an adult in the household was 4.3% in 1988 and was 3.2% in 1981, the last time a comparable questionnaire was used in the National Health Interview Survey. The difference between the prevalences of asthma was statistically significant (95% confidence interval for the difference was 0.7% to 1.5%). An estimated 2.7 million children younger than 18 years were reported by an adult in the household to have had asthma in the past year. The added burden of illness experienced by children with asthma compared with children without asthma was an additional 10.1 million days missed from school, 12.9 million contacts with medical doctors, and 200 000 hospitalizations. Almost 30% of children with asthma had some limitation in activity, compared with only 5% of children without asthma. A greater proportion of black children experienced more severe functional disability and had more frequent hospitalizations than white children with asthma. Ten percent of children with asthma had severe disease as measured by frequency of bother and limitations in function; these children accounted for 35% of hospitalizations for asthma and 77% of the days in the hospital. Ultimately, measures of the impact of disease on health become important tools to evaluate the effectiveness of prevention and treatment.
Hyperactivity in School-Age Boys and Subsequent Risk of Injury
Authors: Davidson Leslie L. , Taylor Eric A. , Sandberg Seija T. , Thorley Geoffrey
Published: December 2021

Hyperactive boys between 6 and 8 years of age, identified through systematic population-based screening of a community in London, were compared prospectively with a nonhyperactive control group to determine whether they were at greater risk of sustaining injuries. The study sample was drawn from 1296 completed parent and teacher questionnaires. Hyperactive groups were designated in three ways (parental report, teacher report, and combined parent and teacher report). Injuries were assessed by reviewing the medical records of the five emergency departments serving the community. Although boys with conduct problems did sustain more injuries than control subjects, no relationship between hyperactivity and injury was found. Similarly, when milder injuries were excluded from the analysis, the association remained negative. The absence of an association could not be accounted for by differential parental protectiveness of boys designated hyperactive. This study, which has a power of .80 to determine an increase in the relative risk of injury of 1.5, found no effect for hyperactive behavior in boys. Hyperactive behavior is probably not a risk factor for injury; if it is, it exerts a modest effect, less than 1.5, therefore accounting for less than 4% of injuries to school-aged boys.
Population-Based Study of the Incidence, Complexity, and Severity of Neurologic Disability Among Survivors Weighing 500 through 1250 Grams at Birth: A Comparison of Two Birth Cohorts
Authors: Robertson Charlene M.T. , Hrynchyshyn Gregory J. , Etches Philip C. , Pain Kerrie S.
Published: December 2021

Mortality and incidence, complexity, and severity of early childhood neurodevelopmental disability are reported for two cohorts of preterm infants of 500 through 1250 g birth weight. Comparing 1978-1979 (cohort 1) and 1988-1989 (cohort 2), 1-year survival improved from 82 (36%) of 226 to 197 (67%) of 291. Cohort 1 survivors were heavier and more mature than cohort 2 survivors (1047 g vs 930 g, 29.6 vs 27.3 weeks). Parental demographic variables were similar. The incidence of specific disabilities with greater than 97% follow-up to 1.5 years adjusted age did not change: cerebral palsy, 14 (17%) vs 20 (10%); vision loss, 5 (6%) vs 9 (5%); mental retardation, 9 (11%) vs 13 (7%); hearing loss, 3 (4%) vs 7 (4%); and convulsive disorders, 2 (2%) vs 3 (2%). The overall number of disabled children (17 [21%] vs 30 [15%]), complexity of disability (≥2 disabilities per child: 11 [13%] vs 10 [5%]), and severity of disability (projected dependency: 6 [7%] vs 10 [5%]) did not differ between cohorts 1 and 2. The cerebral palsy prevalence, based on neonatal survival, dropped from 157 per 1000 to 93 per 1000. Analysis by birth weight-specific categories in 250 g increments did not alter results, but disability rates were highest for those of lowest weight. In contrast to other reports this population-based North American study from a well-developed perinatal regional program reports no increase in incidence, complexity, or severity of disability in preterm infants weighing 500 through 1250 g at birth.
`Guidelines' Versus the Legal Standard of Care and Screening for Polycythemia
Authors: REYNOLDS DAVID
Published: December 2021

To the Editor.—

Belated thanks to the Academy for acknowledging the fact that almost nothing in medicine is certain. Beginning in June 1991, all committee reports are accompanied by a paragraph recognizing that alternative management strategies may be appropriate and that the opinions expressed do not constitute standards of medical care.

The first part of this qualification accepts the fact that each clinical encounter is unique. Decision making based on an attitude of patient uniformity demeans the human nature of the patient and his or her family as well as the physician.
Bereavement
Authors: PANOSH WANDA K.
Published: December 2021

To the Editor.—

I applaud the Academy's insightful report on "The Pediatrician and Childhood Bereavement."1 Despite training culminating in board certification in Pediatrics and Internal Medicine, I received no effective formal guidance in the area of grief and bereavement. Only since the sudden death of my 7-year-old son and the painful readjustment my family has been forced to undergo since, has it been obvious how deficient we physicians are in this area of caring. Thus I would like to add the following comments:
European Surfactant Trial: Questions About the Protocol
Authors: SPEER CHRISTIAN P. , GEFELLER OLAF
Published: December 2021

In Reply.—

We appreciate Dr Deichsel's interest in the Randomized European Multicenter Trial of Surfactant Replacement Therapy1 and welcome the opportunity to clarify the points raised in his letter. Although we agree with Dr Deichsel that protocol violations are a pervasive problem in any clinical trial, we feel puzzled by his line of reasoning. Why does he argue that "a remark on the loopholes which inevitably occur during the conduct of a trial with intensive care patients" is missing? The correct observations that 35% of the patients in the multiple-dose group required only one surfactant dose and the 25th percentile of the distribution o the total time of exposure to oxygen in the same group is as high as 26 hours leads him to the strange conclusion that only protocol violations in our trial could explain this discrepancy.
Sleeping Position and Sudden Infant Death
Authors: BARNESS LEWIS A. , GILBERT-BARNESS ENID
Published: December 2021

To the Editor.—

The recognition by the Academy1 that altering the recommendation for the sleeping position of infants may lower the incidence of sudden infant death may help decrease the diagnosis of sudden infant death syndrome as one of us (E. G.-B.) reported in 19892 and as Professor John Emery reported in 1968.3 In addition, recognition of other possible causes of sudden infant death,4 eg, beds and bedding, overlying, metabolic diseases, child abuse, and felicide will further help to limit the diagnosis of Sudden Infant Death Syndrome, essentially a diagnosis of unknown cause made by exclusion.
Research in Behavioral-Developmental Pediatrics: New Frontiers and Elusive Boundaries
Authors: Shonkoff Jack P. , Kennell John H.
Published: December 2021

As an academic discipline, behavioral pediatrics has eluded simple definition. For some, it encompasses the study and management of variations in normative behavior from the newborn period through adolescence. Others prefer the designation "developmental pediatrics" or "developmental psychobiology," and focus primarily on the effects of significant illness, disability, or physiological dysfunction on children and their families. Increasingly, a more inclusive, integrated agenda has been advocated (ie, "behavioral-developmental pediatrics") to address the dynamics of human adaptation within a wide variety of contexts, including those related to biological as well as cultural or socioeconomic variation.

Rooted originally in practical problem-solving and advocacy, contemporary behavioral-developmental pediatrics is evolving into a recognized scientific and clinical discipline. This evolution is reflected in a growing participation in rigorous empirical research, as well as in the pragmatic application of a maturing data base to the care of children and their families. Behavioral-developmental pediatrics encompasses such diverse interests as the promotion of healthy lifestyles, the prevention of injury and developmental dysfunction, the provision of anticipatory guidance and early intervention, therapeutic counseling, and the care of children with chronic health impairment or disability. In each of these areas, child behavior and development are viewed increasingly through a wide-angle lens, to ensure inclusion of the contributions of both nature and nurture.

BOUNDARIES AND TENSIONS

Like other rapidly growing academic disciplines that are inherently multidisciplinary, the broad scope of behavioral-developmental pediatrics often makes its boundaries difficult to define. Generally speaking, a boundary serves as a marker of territorial limits. As such, it demarcates differences and establishes where one domain ends and the other begins.
Conceptual and Methodological Issues for Behavioral Pediatrics Research
Authors: Finney Jack W. , Brown George W. , Syme S. Leonard
Published: December 2021

Three prescriptions are made to improve behavioral pediatrics research: (1) Focus behavioral pediatrics on preventive research from environmental and social perspectives. (2) Ground research questions more extensively within a conceptual framework. (3) Enhance research quality with reliable, valid measurement. Conceptual and methodological improvements in research will facilitate integration of the multidisciplinary, multimethodological, and multitheoretical scope of behavioral pediatrics and further its contributions to science.
Fitness, Activity, and Sports Participation in the Preschool Child
Authors:   Committee on Sports Medicine and Fitness
Published: December 2021

A sedentary lifestyle has been linked to the development of coronary artery disease, hypertension, diabetes mellitus, obesity, and other chronic diseases of adulthood. Although these conditions are predominantly diseases of adulthood, they are thought to be lifelong processes with their origins in childhood. The promotion of physical activity in early childhood may be important as the initial step in developing lifelong habits that may help forestall future chronic illness. Although some children may be too sedentary, others are participating in training programs and competitive sports that are inappropriate for the preschool age group. Guidelines for fitness and sports participation for preschool children younger than 6 years must be based on a careful consideration of the physical fitness needs as well as the unique developmental requirements and limitations of this age group.

LEVELS OF CHILDHOOD FITNESS

The results of recent national physical fitness testing of school-aged children have raised the concern that we are in the midst of a youth fitness crisis. It is clear from these studies that school-aged children have more body fat and weight than children had 20 years ago.1,2 However, because of the lack of comparable physical fitness tests done in the past, it has been difficult to determine if there has been a decline in physical fitness. Although national surveys, such as the National Children and Youth Fitness Study, have determined norms for field test measures of physical fitness in school-aged children, no such data exist for children younger than 6 years. In addition, it is unknown whether there has been any change in the level of physical fitness of preschool children in recent years.
Earrings: A Source of Bloodborne Infections?
Authors: WALSON PHILIP D. , BRADY MICHAEL T.
Published: December 2021

To the Editor.—

We recently became aware of a practice which has potential for transmission of bloodborne diseases: sharing of nonsterilized earrings. Both young adult-aged children of one of us (P. W.) confided that they had shared earrings with friends. Although both children were aware of the risks associated with the sharing of needles and sexual activity, neither associated sharing earrings with any health risk. Questioning of other adolescents and young adults revealed that this practice may be widespread.