bluuebunny/crossref_metadata_2025 huggingface dataset:
Medical Care and Preterm Infants of Normal Birth Weight
Authors: Paneth Nigel , Wallenstein Sylvan , Kiely John L. , Snook Curtis P. , Susser Mervyn
Published: December 2021

Preterm infants of normal birth weight (born before 37 completed weeks of gestation and weighing more than 2,250 g) experience a neonatal mortality risk almost four times higher than do term infants in the same weight range. In an analysis of the effect of hospital level of birth on neonatal mortality, such preterm normal weight infants were found to experience higher mortality if born outside of a Level 3 (tertiary care) center. For all singleton infants in this weight-gestation category born in New York City maternity services during a 3-year period (N = 23,257), the relative mortality risk for Level 1 births (compared with Level 3) was 1.72 (P < .01) and for Level 2 births 1.47 (P < .05). The excess mortality at Level 1 and Level 2 units was almost entirely due to a more than twofold higher death rate in black infants born in these units. Several potentially confounding socioeconomic, demographic, and biologic variables entered into a logistic regression model could not account for the higher mortality rates for black infants born in Level 1 and Level 2 units. Among black infants born at Level 1 units, deaths in preterm normal birth weight infants were less likely to occur in a receiving tertiary care center than were either deaths in low birth weight infants or deaths in term normal weight infants, suggesting that the need for special care of preterm normal birth weight infants is underestimated in some hospitals without newborn intensive care units.
Components of Attention, Methylphenidate Dosage, and Blood Levels in Children With Attention Deficit Disorder
Authors: Sebrechts Marc M. , Shaywitz Sally E. , Shaywitz Bennett A. , Jatlow Peter , Anderson George M. , Cohen Donald J.
Published: December 2021

In this study we analyzed some of the cognitive components that may constitute attention deficit disorder. It consisted of a double-blind, drug-placebo study of 12 children being treated with three doses of methylphenidate and placebo. Results of an attentional test battery, teacher and parent ratings, and blood levels of methylphenidate are reported. In general, performance was best with 0.6 mg/kg of methylphenidate (the highest dose tested) and worst with placebo. It is argued that no single test provides a complete assessment of attentional deficits and that methylphenidate can improve performance by affecting the allocation of cognitive resources to a task.
Views of Graham Challenged
Authors: CHRISTOFFEL KATHERINE K. , JAFFE DAVID , LISTERNICK ROBERT , TANZ ROBERT , ZIESERL EDWARD , DAVID RICHARD , ESTERLY NANCY , MCLONE DAVID , SMITH ALICE
Published: December 2021

To the Editor.—

George Graham's recent commentary on poverty and nutrition lambasts the public policy that supports food supplementation for poor women and children.1 His challenge, he argues, is based on lack of a scientific basis for the policy. We believe his position is both wrong and dangerous, and that it is based on faulty logic.

Dr Graham's argument is also rather difficult to follow. It is so rambling, emotional, and sarcastic in tone that it was a challenge to these readers to understand why the editors of Pediatrics agreed to publish the piece.
Impact of Revaccinating Children Who Initially Received Measles Vaccine Before 10 Months of Age
Authors: Stetler Harrison C. , Orenstein Walter A. , Bernier Roger H. , Herrmann Kenneth L. , Sirotkin Barry , Hopfensperger Dan , Schuh Ruth , Albrecht Paul , Lievens Alan W. , Brunell Philip A.
Published: December 2021

Two hundred fifty-four infants who had received measles vaccine at <10 months of age were revaccinated at ≥15 months of age, and their immune responses were compared with 129 control infants who received their first doses of measles vaccine at ≥15 months of age. Sera were collected at the time of revaccination (study infants) or primary vaccination (control infants), 3 weeks, and 8 months later and tested for antibody by hemagglutination inhibition (HI), enzymelinked immunosorbent assay (ELISA), and cytopathic effect neutralization (CPEN). Of the 121 study infants who were initially HI negative, 116 (95.9%) made HI antibody 3 weeks postrevaccination compared with 126 (99.2%) of 127 control infants (P = 0.19). Of the 63 study infants with no initial detectable antibody by any of the three tests, 14 (22.2%) had a measles-specific IgM response 3 weeks postrevaccination compared with 37 of 50 (74.0%) randomly chosen control infants. By 8 months after revaccination, the 121 initially HI-negative study infants were significantly less likely to have detectable HI antibodies than control infants (52.1% v 97.6%) (P < .001). However, 96.7% of these 121 study infants had detectable neutralizing antibody 8 months postrevaccination, an antibody thought to correlate best with protection. This study confirms the altered immune response to revaccination in infants first vaccinated prior to 10 months of age; however, the data suggest that most of these infants were successfully primed and are probably protected after revaccination.
Sexually Transmissible Infectious Agents in Sexually Active and Virginal Asymptomatic Adolescent Girls
Authors: Bump Richard C. , Sachs Larry A. , Buesching William J.
Published: December 2021

Sixty-eight sexually active and 52 virginal adolescent girls were evaluated for six sexually transmissible infectious agents: Gardnerella vaginalis, Ureaplasma urealyticum, Mycoplasma hominis, Chlamydia trachomatis, Trichomonas vaginalis, and Neisseria gonorrhoeae. There were significant differences between sexually active and virginal girls with respect to the prevalence of isolation of U urealyticum (75% v 33%, P < .005),M hominis (27% v 10%, P < .05), and C trachomatis (19% v 2%, P < .025) but not for G vaginalis (34% v 17%, P = .09). N gonorrhoeae and T vaginalis were isolated exclusively from sexually active girls, but their low prevalence (6% and 9%, respectively) made the difference statistically insignificant (P = .2 and .06, respectively). Race, current v previous sexual activity, multiple sexual partners, oral contraceptive use, and concurrent isolation of another organism did not identify those at increased risk for chlamydial isolation. Such girls were significantly more likely to have inflammatory Papanicolaou smears (36% V 10%, P < .05) and excessive WBC in their vaginal secretions (50% v 19%, P = .05). The data support the contention that C trachomatis, N gonorrhoeae, and T vaginalis are organisms that are predominantly acquired via sexual routes. Significant nonsexual modes of transmission are supported by the data for the genital mycoplasmas and G vaginalis. Finally, a history of sexual activity in an adolescent female warrants specific diagnostic testing for Chlamydia.
Longitudinal Evaluation of a Statewide Network of Hospital Programs to Improve Child Passenger Safety
Authors: Colletti Richard B.
Published: December 2021

As a project begun in 1979 to improve child passenger safety, a statewide network of hospital-based car safety seat rental and education programs was implemented by a coalition of volunteers, nurses, physicians, and state agencies. A car safety seat program was established at every hospital delivering newborns. To evaluate the effectiveness of this network of programs, 1,846 newborns (87% of hospital discharges) were observed at discharge at ten hospitals during 33 observation studies from 1979 to 1984. Mean correct car safety seat usage increased from <21% in 1979 to 82% in 1984. Concurrently, use of the dangerous lap or arms position decreased from 70% preprogram to 6% postprogram, and incorrect car safety seat usage decreased from 28% to 3%. In addition 1,597 children from 0 to 3 years of age were observed at an annual county fair from 1982 to 1984. Use of either a vehicle seat belt alone or car safety seat with harness and seat belt increased from 34% in 1982 to 67% in 1984. Car safety seat and seat belt misuse occurred in 42% of infants <1 year of age and 20% of children 1 to 3 years of age. These findings suggest that a network of hospital-based car safety seat rental and education programs is an effective means of improving the passenger safety of newborns, infants, and young children.
ERRATUM
Authors: Cole Cynthia H.
Published: December 2021

There is a new typographical error in the "corrected" theophylline dosage printed on page 813 in the November 1985 (vol 76, No. 5) issue of Pediatrics concerning theophylline dosage in The Harriet Lane Handbook.

The correct dosage for infants 6-52 weeks old should be 0.2 x age in weeks + 5.0 (not 1.2 x age in weeks + 5.0).
Tardive Dyskinesia: A Concern for the Pediatrician
Authors: SINGER HARVEY S.
Published: December 2021

Antipsychotic drugs, such as the phenothiazines (chlorpromazine, fluphenazine, thioridazine), butyrophenones (haloperiodol), and diphenylbutylpiperidines (pimozide) are used in children and adolescents to treat a variety of clinical entities including psychoses, tics, behavior disorders, and movement problems. Because virtually all of these drugs have a potential to affect body movements and posture, they have also been termed neuroleptics.1 Most physicians are aware of the more common acute extrapyramidal side effects of these drugs, such as oculogyria, pseudoparkinsonism, dystonia, and restlessness (akathisia). Despite the widespread use of neuroleptics, however, little is known about the long-term neurologic consequences of such treatment. Of particular concern, based originally on data in adults, is the risk of severe and persistent tardive dyskinesia developing in persons receiving neuroleptic therapy.
Early Indicators of Self-Destruction in Childhood and Adolescence: A Survey of Pediatricians and Psychiatrists
Authors: Fine Paul , McIntire Matilda S. , Fain Pamela R.
Published: December 2021

This paper reports a comparison of pediatricians' and psychiatrists' opinions about screening for children and adolescents at risk for self-destruction. Fifty-nine percent of the members of the Nebraska Chapter of the American Academy of Pediatrics and 69% of the members of the Nebraska District Branch of the American Psychiatric Association completed questionnaires containing selected early indicators for self-destruction and programs for suicide prevention. Principal findings were that pediatricians placed less emphasis than child psychiatrists on major depressive disorder, younger pediatricians placed more emphasis than psychiatrists on psychosocial indicators, physicians from both groups said they usually hospitalize attention-seeking self-destructive children, and pediatricians from smaller communities expressed less confidence in referral to psychiatrists but more confidence in community-based programs. Findings suggest that a small group of children and adolescents at risk for eventual suicide may not be identified as early as the more obvious larger groups of individuals who are accident prone, who ingest toxic substances, and who come from violent families. General indicators of risk for self-destruction include substance abuse, psychosocial problems, and minor depression. Factors indicating more specific risk for suicide include escalating stress, family enmeshment, and major mental illness, particularly major depressive disorder. Postgraduate education, instruments for discriminate screening, and balanced programs for suicide prevention are suggested to improve care.
Age of Diphtheria, Tetanus, and Pertussis Immunization of Special Care Nursery Graduates
Authors: Vohr Betty R. , Oh William
Published: December 2021

Diphtheria, tetanus, and pertussis (DTP) immunization data were collected on 103 special care nursery graduates in our neonatal follow-up clinic to determine whether DTP immunization schedules were significantly delayed relative to recommendations of the American Academy of Pediatrics (2, 4, and 6 months for DTP 1, 2, and 3, respectively). An inverse correlation was found between birth weight and immunization for first, second, and third DTP (r = 0.319, P < .01; r = .205, P < .05; and r = .236, P < .05, respectively). We subsequently conducted a mail survey to determine the DTP immunization policy present in effect in 25 neonatal intensive care units in the United States and Canada. The survey indicates that procedural approaches remain markedly heterogeneous, and 10 of 25 (40%) units have no existing policy for implementation of DTP immunization. These data suggest that special care nursery populations are at potential risk for pertussis, which requires a conscious implementation of DTP immunization by the special care nursery, the follow-up clinic personnel, and the primary care physician.
Driving Safety and Adolescent Behavior
Authors: Brown Richard C. , Sanders Joe M. , Schonberg S. Kenneth
Published: December 2021

Accidents, and mainly automotive accidents, are currently the leading cause of mortality and morbidity among young people. Understanding and addressing the issue of automotive accident prevention requires an awareness of the multiple psychodynamic, familial, and societal influences that affect the development and behavior of adolescents. Risk-taking behavior is the product of complex personal and environmental factors. As pediatricians, we have the obligation and the opportunity to improve the safety of our youth who drive and ride. This opportunity is available to us not only in our roles as counselors to youth and families, but also as we serve as role models, educators, and agents for change within our communities.
Rehydration
Authors: MACLEAN WILLIAM C.
Published: December 2021

To the Editor.—

The recent well-done study by Santosham et al1 seems to be mistitled, "Oral Rehydration Therapy for Acute Diarrhea in Ambulatory Children in the United States. . ." Rehydration was not studied. The average gain in weight in the first 24 hours of fluid therapy was 1% or less and indicated that dehydration was generally absent. The investigators studied the situation as it exists in the United States, ie, well-nourished, generally well-hydrated children with diarrhea.
Impact of Selected Diagnosis-Related Groups on Regional Neonatal Care
Authors: Lagoe Ronald J. , Milliren John W. , Baader Marilyn J.
Published: December 2021

The evaluation and reimbursement of hospital use by means of diagnosis-related groups (DRGs) may have a major impact on the utilization of regional neonatal care. Medicare has already implemented the DRG system and other payors, including Medicaid, Blue Cross, and commercial insurance, are also considering adopting it. Under this approach, neonates are assigned to one of seven DRGs, each of which is reimbursed at a relatively fixed rate. An evaluation of hospital utilization by neonates focused on three of these DRGs in four regional neonatal systems located in Upstate New York. Calendar year 1983 data indicated that Level III, II, and I neonatal facilities generated substantially different mean stays for these DRGs in the four regions. The ranges of mean stays between Level III and Level I facilities were greatest for DRGs involving neonates who died or were transferred and those with extreme immaturity and/or respiratory distress syndrome. Federal length of stay and cost standards for these categories failed to address the different utilization experience of these levels of care. The analysis suggests that, as additional payors adopt DRGs, the standards relating to neonatal care must be modified.
Presence of Respiratory Viruses in Middle Ear Fluids and Nasal Wash Specimens From Children With Acute Otitis Media
Authors: Chonmaitree Tasnee , Howie Virgil M. , Truant Allan L.
Published: December 2021

During a 28-month period, 84 children with acute otitis media were studied by viral and bacterial cultures of middle ear fluid and viral cultures of nasal lavage fluid. Viruses were isolated from the middle ear fluid of 17 (20%) patients. Evidence of viral infection was demonstrated by positive viral cultures of middle ear fluid and/or nasal lavage fluid in 33 (39%) patients. Rhinovirus in one patient and influenza b virus in another were the only pathogens isolated. Influenza virus, enterovirus, and rhinovirus were the most common viruses found in middle ear fluids. Parainfluenza virus, adenovirus, and respiratory syncytial virus were found less often. In 82% of cases, the virus isolated from middle ear fluid was also isolated from nasal lavage fluid, but only 44% of viruses found in nasal lavage fluid were also found in middle ear fluid. Mixed bacterial and combined viral-bacterial infections were common. Only 15% of patients had no pathogen isolated from middle ear fluids. Using tissue culture techniques, we demonstrated that enterovirus and rhinovirus are also common middle ear pathogens. Our data reemphasize the significance of viruses as etiologic agents of acute otitis media and propose several questions regarding the viral-bacterial interactions and the types of viruses involved in the pathogenesis of the disease.
Fluoride Supplementation
Authors:   Committee on Nutrition
Published: December 2021

This statement reviews the rationale for the use of fluoride supplements for infants and children. The concept of fluoridation of water supplies as an effective and cost-beneficial method of reducing caries prevalence in the general population is strongly supported. In the absence of an adequately fluoridated water supply, fluoride supplements should be given to all children. This should begin at about 2 weeks of age; the dosage will depend on the concentration of fluoride in the local water supply. Fluoride-containing dentifrices are an important source of topical fluoride, but it is essential that parents be aware of the danger of excessive fluoride intake and that they teach their children to avoid swallowing toothpaste.
Halifax and the Precipitate Birth of Pediatric Surgery
Authors: Goldbloom Richard B.
Published: December 2021

Several years ago, while attending the annual music festival in Marlboro, VT, I had the good fortune to renew acquaintanceship with Dr Robert Gross, who was living nearby in retirement. When I had been a Senior Medical Resident at Children's Hospital Medical Center in Boston in 1951, Dr Gross was Chief of Surgery and was justifiably regarded as the leading pediatric surgeon of his era. The textbook on pediatric surgery, which he had co-authored years earlier with his predecessor, Dr William Ladd, was considered the authoritative reference on the subject. In those days, we medical residents did not have too much contact with the senior surgeons, and we were certainly overawed by Dr Gross. Thus, I was amazed that some 25 years later Dr Gross seemed to remember that I had moved from Montreal to Halifax a few years earlier.

"I suppose you know," he said, "that Halifax was the birth place of pediatric surgery as a specialty."

This announcement came as a revelation, and on subsequent inquiry, I discovered that it was also news to fellow pediatric Haligonians, both medical and surgical. Dr Gross informed me that the seminal event was the great Halifax Explosion of 1917—a tragedy whose anniversary is still marked annually in Halifax.

On December 6, 1917, a French munitions ship, the Mont Blanc collided with the Norwegian vessel, Imo, in the narrows of Halifax harbor. There resulted the most powerful man-made explosion in history prior to the detonation of the first atomic bomb at Hiroshima. Almost 2,000 men, women, and children were killed and 9,000 were injured, including 199 who were blinded.
Second or Subsequent Remission With a Disease-Free Survival of 5 Years or Longer in Acute Lymphocytic Leukemia of Childhood: Results of a National Survey
Authors: Musgrave Stanley , Dickerman Joseph D. , Land Vita J.
Published: December 2021

A national survey was conducted to determine the number of children with acute lymphocytic leukemia who have survived 5 years or longer in their second or subsequent remission. Seventy-two such patients were identified. The clinical and laboratory characteristics of these patients as well as their therapy are described. It is concluded that long-term second or subsequent remission may occur more frequently than previously appreciated.
An Unusual Ocular Finding Associated With Chromosome lq Deletion Syndrome
Authors: WRIGHT LINDA L. , SCHWARTZ MARCIA F. , SCHWARTZ STUART , KARESH JAMES
Published: December 2021

To the Editor.—

We report an unusual ocular finding associated with the chromosome lq deletion syndrome in a full-term black girl for whom there was no family history of congenital anomalies, fetal wastage, consanguinity, or drug ingestion. The infant was overtly microcephalic (third percentile) with a sloping forehead, metopic sutures open to the brow, and a large posterior fontanel. She had a low anterior hair line, depressed nasal bridge, bulbous nose, thin down-turned lips, prominent philtrum, malformed ears, and a webbed neck.
Vitamin E: What Should We Do?
Authors: NEWPORT MARY T.
Published: December 2021

To the Editor.—

Regarding the report of the American Academy of Pediatrics Committee on Fetus and Newborn concerning vitamin E and the prevention of retinopathy of prematurity (Pediatrics 1985;76:315-316), we are very concerned about the strong statement made in the final sentence that "the committee regards prophylactic use of pharmacologic vitamin E as experimental and cannot recommend that high doses of vitamin E be given routinely to infants weighing less than 1,500 g ....."

First, could you define "pharmacologic vitamin E," ie, what vitamin E levels are considered to be pharmacologic by the committee, and do "sufficient" or "physiologic" levels, which are terms used by some authors in this area, fall into this category?
Simultaneous Sudden Infant Death Syndrome in Twins
Authors: Smialek John E.
Published: December 2021

Nine cases of twin infants dying suddenly and simultaneously are described, two of which the author examined personally. A review of this phenomenon described in other literature is also presented. It is hoped that increased awareness of this phenomenon will decrease the profound suspicions of both lay and professional persons that the deaths were due to criminal instrumentality.
Amounts of Fluoride in Self-Administered Dental Products: Safety Considerations for Children
Authors: Heifetz Stanley B. , Horowitz Herschel S.
Published: December 2021

With the increased use of various fluoride preparations for caries prevention, all dental personnel should know their potential toxicity and the margins of safety associated with their use. An understanding of the body's mechanisms for handling fluoride provides a rational basis for assessing the possible risks of excessive fluoride ingestion. Five to 10 g of sodium fluoride is considered a certainly lethal dose for a 70-kg adult. One quarter of the certainly lethal dose can be ingested without producing serious acute toxicity and is known as the safely tolerated dose. Comparisons of certainly lethal and safely tolerated doses for commonly used fluoride agents and procedures show that they can be applied with little or no risk of adverse acute effects, as long as they are used judiciously. If their use is abused, there is a risk of illness or even death. If amounts of fluoride close to the certainly lethal dose are ingested, the speed of initiating proper treatment is critical for survival. Vomiting should be induced, if it is not spontaneous; fluoride-binding liquids, such as milk or liquid or gel antacids, administered; and the patient taken to the nearest hospital for emergency care. Frequent ingestion of low but excessive quantities of fluoride during the period of tooth formation can lead to dental fluorosis. Particular concern is warranted for the ingestion of fluoride-containing toothpastes by young children and the inappropriate use of dietary fluoride supplements in communities with sufficient fluoride already present in drinking water. Parents should brush the teeth of preschool children or, at the very least, dispense only small amounts of toothpaste for them (a pea-sized portion). Dentists and physicians should know the fluoride concentration of a patient's water supply before prescribing fluoride supplements. Fluoride preparations should be dispensed in appropriate quantities; labeled with suitable cautionary statements; packaged, when appropriate, with child-proof closures or in tear-proof materials; and stored in safe locations. Practitioners should use only Food and Drug Administration or American Dental Association approved products, use recommended methods for their delivery, know their toxicity, and be familiar with emergency measures for treating accidental overdosages. The risk of adverse effects is small when fluorides are used judiciously.
Calcium-Regulating Hormones and Minerals From Birth to 18 Months of Age: A Cros-Sectional Study. II. Effects of Sex, Race, Age, Season, and Diet on Serum Minerals, Parathyroid Hormone, and Calcitonin
Authors: Specker] B. L. , Lichtenstein P. , Mimouni F. , Gormley C. , Tsang R. C.
Published: December 2021

The influence of sex, race, age, season, and diet (cow's milk formula v human milk) on serum minerals and calcium-regulating hormones in infants less than 18 months of age is described in this study of 198 infants. No sex differences were observed in calcium, magnesium, phosphorus, parathyroid hormone, or calcitonin concentrations. Black infants had decreased serum phosphorus concentrations compared with white infants. There was a decrease in serum ionized calcium and phosphorus levels with age. During winter, there were significant increases in serum calcium and magnesium and decreases in serum phosphorus, parathyroid hormone, and calcitonin levels. Formula-fed infants had increased serum phosphorus and decreased ionized calcium concentrations compared with infants fed human milk. Thus, race, age, season, and diet appear to exert significant effects on serum minerals and calcium-regulating hormones in infancy. Interpretation of these mineral and hormone concentrations in normal or diseased states should be based on normative data specific to race, age, season, and diet.
Acetylation Phenotype and Hepatotoxicity in the Treatment of Tuberculosis in Children
Authors: Martinez-Roíg A. , Camí J. , Llorens-Terol J. , de la Torre R. , Perich F.
Published: December 2021

We studied the relationship between acetylation phenotype and the appearance of biochemical and clinical signs of liver damage in 73 tuberculous children treated with isoniazid and rifampin. No significant differences were found with respect to the distribution of acetylation phenotype between tuberculous patients and a control group consisting of 256 children. Hepatotoxicity manifested in 27 cases (37%), of which only five (7%) had clinical signs. Application of the Fisher exact probability test did not show a relationship between acetylation phenotype and hepatotoxicity.
Guidelines for the Pediatric Cancer Center and Role of Such Centers in Diagnosis and Treatment
Authors:   Section on Oncology-Hematology
Published: December 2021

GUIDELINES FOR PEDIATRIC CANCER CENTERS

The pediatric cancer center cannot be defined simply in terms of restriction by diagnosis and age group. It implies a multidisciplinary approach by a team of pediatric, surgical, radiologic, nursing, and paramedical specialists. The care of the pediatric oncology patient should be coordinated by a trained pediatric oncologist in a center that includes the following facilities and capabilities: (1) pediatric oncology nursing care in a specific area; (2) a pediatric intensive care unit; (3) pediatric radiologist and radiologic services that include lung tomography, computed axial tomography, ultrasonography, and angiography; (4) hematopathologic laboratory services capable of doing cell marker studies; (5) laboratories for the routine provision of drug levels; (6) blood cell component therapy; (7) a pharmacy familiar with antineoplastic agents; (8) clinical pharmacology services; (9) protective isolation; (10) personnel familiar with pediatric total parenteral nutrition techniques; (11) radiotherapist familiar with pediatric oncology problems and radiotherapy equipment which includes cobalt-60 or an accelerator with nominal beam energy of 6 meV or greater; (12) rapid section studies and operating room consultation at any time; (13) a multidisciplinary tumor board or its equivalent; (14) surgeons specializing in pediatric oncology; and (15) trained oncology social workers.

ROLE OF CENTERS IN DIAGNOSIS AND TREATMENT

Each year cancer is discovered in about 6,000 children in the United States. Fifty percent of these cancers are curable when the diagnostic and therapeutic techniques available today are instituted promptly. There are many reasons, some beyond any physician's control, for the failure to realize this potential cure rate, but among recognized factors are late detection, misdiagnosis, and inappropriate treatment.
Chance and Ventricular Septal Defect
Authors: NEWMAN THOMAS B.
Published: December 2021

In Reply.—

I expected that Dr Nora might respond to my paper, and I appreciate the opportunity to address his thoughtful comments.

Dr Nora and I are in agreement on several points: that there is a large element of chance in the etiology of congenital heart defects, that the "rough approximations" for multifactorial inheritance he used in the past are wrong and should be abandoned, that continued vigilance is essential to identify new teratogens and genetic syndromes, and that parents should not feel guilty about congenital heart defects in their offspring.
Constipation
Authors: CHEN DOOLEY , SULLIVAN BRADLEY
Published: December 2021

To the Editor.—

Among the frequently encountered problems of a general or referral pediatrician are constipation and/or encopresis. We recently had a patient who presented with a chief complaint of increased stooling pattern, the cause of which may be an acceptable addition to the therapeutic modalities applied to constipated children.

A 10-year-old boy, previously in good health, was brought in because his stool pattern had changed in the past 4 months. He was an individual who, prior to the change, went unnoticed as to his bowel habit.
Phototherapy Effect on the Incidence of Patent Ductus Arteriosus in Premature Infants: Prevention With Chest Shielding
Authors: Rosenfeld Warren , Sadhev Shashi , Brunot Verlaine , Jhaveri Ramesh , Zabaleta Ignacio , Evans Hugh E.
Published: December 2021

Patent ductus arteriosus is common among premature neonates, especially those with birth weights less than 1,500 g. In vitro, room light inhibits the contraction of immature piglet's ductal rings. Because phototherapy is used frequently from the first days of life to treat jaundice in preterm neonates, we compared the occurrence of patent ductus arteriosus among premature infants exposed to this intense light source with those whose chests were shielded. Seventy-four babies with respiratory distress syndrome were randomly assigned to either a treatment group (chest shielded with aluminum foil while on phototherapy, 36 babies) or control group (no shield, 38 babies). All were on radiant warmers, received mechanical ventilation for respiratory distress syndrome, and phototherapy (Air Shields model PTU 78-1) from day 1 of life. Irradiance was maintained at >4.0 µW/cm2/nm in all cases. Although both groups had similar birth weights, gestational ages, severity of respiratory distress syndrome, intravenous fluid intake, and duration of phototherapy, the incidence of patent ductus arteriosus was significantly less in the shield group (shield 11/36 v No shield 23/38; P = .009). Patent ductus arteriosus murmurs developed in shielded patients at a later date, they required less vigorous treatment (ie, indomethacin), and they had shorter hospitalizations (74 v 85 days; P < .05). The significant reduction of patent ductus arteriosus with shielding suggests that phototherapy may play a role in the occurrence of patent ductus arteriosus in premature infants. Shielding may be a practical method to decrease this common complication should this initial observation be confirmed.
Ten-Year Course of Early-Onset Weber-Christian Syndrome With Recurrent Pneumonia: A Suggestion for Pathogenesis
Authors: Sorensen Ricardo U. , Abramowsky Carlos R. , Stern Robert C.
Published: December 2021

A surviving 10-year-old boy with infant-onset systemic Weber-Christian syndrome is reported. He has had recurrent episodes of fever, aseptic panniculitis, and pneumonia. Although corticosteroid therapy has succeeded, colchicine and non-steroidal anti-inflammatory drugs have failed to abort or prevent acute episodes. The persistent leukocytosis (even during remission), the recurrent episodes of fever with associated increase in the acute phase reactants, and the failure of the nonsteroidal anti-inflammatory drugs leads us to propose that this form of Weber-Christian syndrome reflects an inborn error in the regulation of the inflammatory response. Systematic investigation of this hypothesis could yield important information on the normal regulation of inflammation and could lead to a rational therapeutic approach to this puzzling and usually devastating illness.
Efficacy of Computer-Assisted Management of Respiratory Failure in Neonates
Authors: Carlo Waldemar A. , Pacifico Lucia , Chatburn Robert L. , Fanaroff Avroy A.
Published: December 2021

We modified an algorithm for mechanical ventilation of infants with respiratory distress syndrome to create an interactive user-friendly computer program. To determine the effectiveness of this computer program, we evaluated the correction of deranged arterial blood gases in three groups of neonates: group I, treated before the introduction of the computer into the nursery; group II, managed by pediatric residents with the guidance of the computer program; group III, treated after the introduction of the computer into the nursery but managed without consideration of the computer output. Arterial blood gas values improved more frequently in the neonates managed with computer consultation (group II, 65/75, 87%) than in both control groups (group I, 37/57, 65%, P < .005; and group III, 46/63, 73%, P < .05). Furthermore, increases in ventilatory support in the presence of normal arterial blood gas values occurred only in patients managed without computer guidance. In a teaching institution, more effective care of neonates with respiratory failure may be facilitated by computer-assisted management of mechanical ventilators.
Sudden Infant Death Syndrome in a Twin: A Comparison of Sibling Histories
Authors: Kahn A. , Blum D. , Muller M. F. , Montauk L. , Bochner A. , Monod N. , Plouin P. , Samson-Dollfus D. , Delagree E. H.
Published: December 2021

To determine possible characteristics of infant victims of sudden death, we examined 114 items related to the pre- and postnatal histories of 42 pairs of twins one of whom died of sudden infant death syndrome (SIDS) leaving a surviving sibling. Interviews with the parents were conducted after the occurrence of SIDS, and the data were checked with records held by gynecologists and pediatricians. To evaluate the specificity of any factors, we studied a control group of 42 age- and sex-matched pairs of twins, both of whom survived the first year of life. Only 11 of 114 characteristics were significantly related to SIDS: future victims had a smaller weight and height at birth, stayed longer in the nursery, and followed a moving object with their eyes, had head control, and smiled at a later age than their surviving siblings. They also fatigued more often during feeding (11/42) and had reduced arm and neck tonus (9/42). They were described as longer sleepers than their surviving siblings. During sleep, some SIDS twins, but no surviving twin, were found to be cyanotic at least once or pale (4/42) and were repeatedly covered with abundant sweat (8/42). In the control group of normal twins, the occurrence of most of these characteristics was found with a frequency comparable to that seen in the SIDS infants; the specificity of these characteristics is thus considered doubtful. The mean birth weight and height were significantly greater in the control group, and no control infant had an episode of cyanosis or pallor or repeated episodes of profuse sweating observed during their sleep. It is concluded that, if further research validates the occurrence of night hyperhydrosis in some future SIDS victims, this symptom could be a clinical risk factor.
Haemophilus influenzae Type b Colonization in Household Contacts of Infected and Colonized Children Enrolled in Day Care
Authors: Li Karl I. , Dashefsky Barry , Wald Ellen R.
Published: December 2021

Strategies for management of children attending day-care facilities after a case of Haemophilus influenzae type b disease are controversial. The success of chemoprophylaxis in preventing subsequent cases has been variable. Failure of rifampin prophylaxis as currently recommended may result from usage limited to direct contacts of the index patient. This prospective study was designed to ascertain the extent of colonization in household contacts of colonized children attending day-care facilities with an index case of H influenzae disease. Outer membrane protein analysis was used to determine similarity between strains isolated from contacts and index patients. Of children attending six day-care facilities, 15% were colonized with subtypes of H influenzae identical with those of their respective index patients, and 7% of children were colonized with different subtypes. Colonization with identical outer membrane protein subtypes in children from day-care homes was more frequent than in the larger day-care centers (91% v 8%, P < .00001). Within families of children with identical outer membrane protein subtypes, 25% of household members (17% of parents and 44% of siblings) were colonized despite lack of direct contact with the index patients. This colonization rate was comparable to that of household contacts of index patients (26%). Among household contacts of index patients, especially siblings, colonization with H influenzae tended to be lower if the patient attended day care than if the patient did not attend day care (17% v 73%; P = .05 for siblings). We have found that household contacts of colonized day-care children are a reservoir of H influenzae. It is not known whether these colonized secondary contacts may serve as a source of H influenzae infection for susceptible day-care children; the need for prophylaxis in these secondary contacts is undetermined.
Revised First Aid for the Choking Child
Authors:   Committee on Accident and Poison Prevention
Published: December 2021

Aspiration of a foreign body is a common hazard in infancy and childhood. In the last 5 years, there has been a great effort to educate the public on the prevention of choking due to accidental inhalation of foods or small objects by children. Concomitantly, there has been a campaign to teach the first aid measures essential for evaluation and treatment of choking.

LITERATURE REVIEW

Much of the existing data on treating the choking child has been anecdotal. In 1981, the Committee on Accident and Poison Prevention of the Amencan Academy of Pediatrics reviewed the available literature; the Committee recommended that a foreign body in the upper airway be considered an immediate threat to life and that such a foreign body required urgent removal.1 In addition, the Committee recognized the effectiveness of natural coughing and recommended that, if a choking child could breathe and was able to speak and/or cough, all maneuvers were unneccessary and potentially dangerous. If the choking child could not breathe, cough, or make a sound, a series of back blows and chest thrusts was recommended. The Committee recommendations resulted in a spirited controversy concerning the most effective management of the choking child.2-6

At the July 1985 National Conference on Standards and Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiac Care, the American Heart Association, American College of Cardiology, and the American Red Cross convened a panel on Management of Foreign Body Airway Obstruction to review and revise the past recommendations. The panel recommended use of the abdominal thrust—the Heimlich maneuver—as the exclusive method of treating foreign body airway obstruction for adults and children older than 1 year.
The Pediatric Intensivists' Viewpoint
Authors:   PEDIATRIC INTENSIVE CARE NETWORK OF NORTHERN AND CENTRAL CALIFORNIA,   PEDIATRIC INTENSIVE CARE NETWORK OF SOUTHERN CALIFORNIA
Published: December 2021

To the Editor.—

Dr Joseph W. St Geme, Jr, has expressed an understandable concern about the direction of the field of pediatrics, with particular emphasis on the "subspecialty" movement.1 He voices discomfort about the growing number of subspecialists and sees a potential surfeit of "special care hospital subspecialist" competing with and draining clinical opportunities from the sphere of the general pediatric specialist. We do not seek to minimize the challenge to the general pediatrician to retain a meaningful place in the care of the hospitalized child.
Cardiorespiratory Patterns Occurring in Infants During and After Recovery From Respiratory Tract Infection
Authors: Southall D. P. , Stebbens V. A. , Alexander J. R. , Cardle C. M. , Cogswell J. J.
Published: December 2021

During and after respiratory tract infections in 29 hospitalized infants, 12 cardiorespiratory measurements were performed on 24-hour recordings of ECG and respiratory activity. These measurements were compared with similar data obtained from 110 age-matched control infants without infection. Respiratory and heart rates during the state of regular breathing were increased during infection, as compared with recordings made after recovery. The numbers of short apneic pauses 3.6 to 6.0 seconds and >6.0 to 12.0 seconds in duration, together with the duration of the overall longest apneic pause per recording, were reduced during infection compared with after recovery. The total durations of periodic breathing and of periodic apnea per recording were also reduced during infection compared with after recovery. These effects were consistent in 27 of the 29 cases, but in two, periodic breathing levels during infection exceeded the 90th percentile in age-matched controls and were reduced after recovery. Measurements made after recovery tended to conform more closely to values in the control infants. None of the 29 infants studied subsequently died or suffered chronic respiratory problems. This study suggests that prolonged apneic pauses or increased numbers of short pauses are not usually a consequence of respiratory tract infection in normal infants.
Antacid and Formula Effects on Gastric Acidity in Infants With Gastroesophageal Reflux
Authors: Sutphen James L. , Dillard Vivian L. , Pipan Mary E.
Published: December 2021

A variety of peptic diseases are treated with antacids. Antacid dose requirements for young children have not been extensively evaluated. Moreover, the effects of formula feedings on antacid requirements are also unknown. We have investigated the effects of antacids and formula feedings on gastric acidity in infants less than 1 year of age. Small formula feedings of 15 mL/kg per feeding significantly improve antacid buffering of 0.5 mL/kg per dose of standard magnesium-aluminum hydroxide antacids.
Congenital Microcephaly Due to Vascular Disruption: In Utero Documentation
Authors: Hughes Helen E. , Miskin Murray
Published: December 2021

Death in utero of one member of a monozygotic twin pair has been associated with vascular disruptive phenomena in the surviving twin. It has been hypothesized that this event initiates clot formation in the surviving twin with consequent necrosis of tissues distal to the occluded vessels. This case report describes onset in utero of multicystic encephalomalacia and microcephaly in a surviving twin whose brain appeared normal on ultrasound scanning before death of the cotwin at 21 weeks' gestation. The case provides further support for the hypothesized pathogenetic sequence and illustrates the importance of reviewing all prenatal ultrasound scans in infants with congenital microcephaly.
Transient Neonatal `Athyreosis' Resulting From Thyrotropin-Binding Inhibitory Immunoglobulins
Authors: Connors Matthew H. , Styne Dennis M.
Published: December 2021

Recognition of transient forms of neonatal hypothyroidism is difficult because of the urgency of thyroxine treatment. In the present report the first child born to a mother with Graves' disease developed transient hyperthyroidism during the newborn period. The mother underwent radioactive iodine treatment and was maintained euthyroid on l-thyroxine. Two subsequent children were detected by newborn thyroid screen to have low thyroxine and markedly elevated serum thyrotropin (TSH) levels. Technetium 99 metastable and iodine 123 scans at 22 days of age showed the second child to be athyreotic. The third child was not scanned. All three children were nongoitrous at birth. Patients 2 and 3 had continuous TSH suppression with thyroxine therapy for 3 and 4 years. Thyroid function measurements after discontinuation of therapy for 8 weeks were normal, and both children had normal 123I thyroid scans. The mother was found to have potent TSH-binding inhibitory immunoglobulin (TBII) levels in her serum (85.5%). A fourth child with low thyroxine and elevated TSH was born to a mother on a regimen of l-thyroxine for hypothyroidism. 99mTc scan at 26 days of age showed no thyroid tissue and was normal at 3 months. TBII activity was 35% in the maternal serum and absent in the infant's serum. The above laboratory and clinical data are compatible with the blocking nature of TBII, resulting in transient newborn hypothyroidism and an athyreotic appearance on scan. The TBII measurement can be a useful predictor of neonatal hypothyroidism as well as confirm the transient nature of the disease in newborns.
Hypercalciuria, Hyperphosphaturia, and Growth Retardation in Children With Diabetes Mellitus
Authors: Malone John I. , Lowitt Saul , Duncan John A. , Shah Shirish C. , Vargas Alfonso , Root Allen W.
Published: December 2021

The role of hypercalciuria and hyperphosphaturia in the growth retardation of children with diabetes mellitus was investigated in 157 children with diabetes whose mean height was less than that of 37 nondiabetic siblings of similar age (P < .025). Hyperglycemia, hypercalciuria, and hyperphosphaturia were assessed coincident with the height measurement of each child in a cross-sectional suvey. The distribution of height percentiles of the children with diabetes was skewed to the left with 61% at or below the 50th percentile. Eleven percent of the insulin-dependent children with diabetes mellitus were shorter than would be anticipated by a normal distribution of the 157 children. The duration of diabetes (hyperglycemia) had the greatest influence upon the children's height. Children with diabetes were shorter than the nondiabetic subjects by the fourth year of hyperglycemia, and this difference in height became statistically significant after 7 years or more of diabetes. The degree of hypercalciuria and hyperphosphaturia was more closely associated with reduced height in children with diabetes than was the degree of hyperglycemia, although the renal wastage of calcium and phosphorus seemed to be the result of glucosuria. Because hypercalciuria and hyperphosphaturia impair growth in nondiabetic children, they may also play an important role in the poor growth of children with diabetes mellitus.
Cardiovocal Syndrome
Authors: POLANER DAVID M. , BILLET AMY L. , RICHARDSON MARK A.
Published: December 2021

To the Editor.—

We were interested in the recent report of Condon et al (Pediatrics 1985;76:22-25) of two cases of cardiovocal or Ortner's syndrome. We are following a patient with paralysis of the recurrent laryngeal nerve secondary to cardiomegaly not from intrinsic congenital heart disease but from high output failure caused by massive hepatic hemangiomatosis.

The patient was a 4,150-g girl born at term to a 22-year-old gravida 2, para 2 mother whose pregnancy was complicated only by mild pregnancy-induced hypertension. Several small (less than 5 mm) cutaneous hemangiomata were noted at birth. During the next several weeks, the mother noted that the infant fed poorly at one- to two-hour intervals and that she became diaphoretic during feeding.