bluuebunny/crossref_metadata_2025 huggingface dataset:
Medical Complications of Eating Disorders in Adolescents
Authors: Palla Barbara , Litt Iris F.
Published: December 2021

Anorexia nervosa and bulimia are occurring with increased frequency among adolescents and preadolescents. To determine the range and severity of medical complications encountered in younger anorectic and bulimic patients, we reviewed the medical records of 65 adolescents and preadolescents, aged 10 to 20 years, who were observed in the Eating Disorders Clinic of the Children's Hospital at Stanford. Significant medical instability was present in the majority of our patients. A total of 55% of anorectic patients and 22% of bulimic patients required hospitalization for medical reasons during the study period. Cardiovascular abnormalities were frequent, including bradycardia, prolonged corrected QT intervals, dysrhythmias, and marked orthostatic pulse and BP instability. Hypothermia, with temperatures <35.5°C, was common. Renal abnormalities included pyuria, hematuria, and proteinuria. Electrolyte derangements occurred in patients who vomited or purged. Hypokalemia was most common, but hypocalcemia, hypomagnesemia, and hypophosphatemia were also noted. The majority of our pediatric patients with eating disorders had evidence of physiologic derangement requiring medical intervention. The need for adolescents and preadolescents with eating disorders to receive ongoing medical monitoring in concert with psychiatric treatment and the need for therapists and medical practitioners to become familiar with the potential medical sequelae of eating disorders are underscored by our data.
Life-Saving Therapy for Newborns: A Questionnaire Survey in the State of Massachusetts
Authors: Todres I. David , Guillemin Jeanne , Grodin Michael A. , Batten Dick
Published: December 2021

The attitudes of Massachusetts pediatricians concerning life-saving therapies for newborns were surveyed. The sample was drawn from the membership list of the Massachusetts Chapter of the American Academy of Pediatrics. Of the sample population of 801 physicians, 449 (56%) responded. Three hypothetical cases were presented with treatment options: (1) An infant with Down syndrome and duodenal atresia, (2) an infant with meningomyelocele and microcephaly and, (3) an extremely low birth weight infant of 700 g and 28 weeks' gestation suffering from birth asphyxia. For case 1, 73% of the physicians recommended surgical correction of the duodenal atresia. Of these, 68% would seek a court order if the parents did not consent to surgery. For case 2, 53% of the physicians recommended surgical repair of the meningomyelocele. For case 3, 90% of the physicians recommended continued resuscitation of the infant and referral to an intensive care unit. Religious affiliation and age were factors influencing these clinical recommendations, with Catholic and younger physicians tending to opt for more aggressive medical intervention. The great majority of physicians (93%) indicated that the economic situation of the family should not affect a decision regarding life-saving therapy. A majority (62%) of the physicians approved of infant care review committees with a primary advisory role. Comparison with earlier attitudinal surveys suggests that pediatricians today are more willing to intervene medically on behalf of infant patients than previously.
Corticosteroids for Exacerbations of Asthma: Current Status of the Controversy
Authors: WEINBERGER MILES
Published: December 2021

In 1956, as the result of a multicenter placebo-controlled evaluation, the British Medical Research Council' reported a higher rate of resolution of asthma among hospitalized adults treated with cortisone than among those treated with placebo. However, subsequent trials of corticosterodis for acute exacerbations of asthma have been associated with inconsistent results. A report2 in 1974 showed no effect on asthmatic symptoms or pulmonary function during the first 24 hours of treatment among 45 hospitalized children randomly assigned to receive placebo or parenterally administered corticosteroids, although a small but statistically significant increase in Pao2 was observed. Studies by Kattan et al3 in 1980 and Elbirt et al4 in 1984 further questioned the value of corticosteroids for acute symptoms of asthma in children.
Elemental Mercury Exposure
Authors: SWINEHART LOY T.
Published: December 2021

To the Editor.—

In the article by Hudson et al1 concerning mercury exposure of children of thermometor plant workers, they stated that "this is the first report demonstrating mercury exposure in children of mercury workers." On Sept 28, 1954, a case report of primary mercury poisoning in an infant was presented at a meeting of the North Pacific Pediatric Society, Victoria, British Columbia, Canada. Unfortunately, the case was never submitted for publication.

The patient, a 20-month-old male infant, was referred because of fever, irritability, tremor, and refusal to walk.
Salary or Fee-for-Service
Authors: FERRY JOHN J. , REDLENER IRWIN E.
Published: December 2021

To the Editor.—

That physicians in training were motivated by the method of reimbursement to influence the use of out-patient services by their patients is a noteworthy, albeit not startling, finding (Pediatrics 1987;80:344-350). Our department has struggled with whether to attempt such an experiment to answer the authors' and other questions in recent years. We have not done so because of the strongly held opinions of some faculty members that to use financial incentives during the period of training is inappropriate.
Continuous Auscultation of Heart and Bilateral Breath Sounds
Authors: SCHWARTZ NATHAN , EISENKRAFT JAMES B.
Published: December 2021

To the Editor.—

The frequent determination of vital signs, such as heart rate and bilateral breath sounds, is a mainstay in the care of critically ill infants. Unfortunately, the routine determination of such vital signs involves the manipulation and disturbance of the infant, unnecessary risk of exposure to cold, increased risk of apnea, and infection.1,2 In addition, the frequent disruption of the infant's sleep pattern may take an unaccountable physiologic and psychologic toll. To deal with this common and challenging problem we have devised a simple and inexpensive monitoring device, using readily available supplies, which facilitates the continuous or intermittent evaluation of heart rate and bilateral breath sounds.
Parental Counseling Compared With Elimination of Cow's Milk or Soy Milk Protein for the Treatment of Infant Colic Syndrome: A Randomized Trial
Authors: Taubman Bruce
Published: December 2021

Treating the infant colic syndrome by counseling the parents concerning more effective responses to the infant crying is compared to the elimination of soy or cow's milk protein from the infant's diet in a randomized clinical trial. Because symptoms of vomiting and diarrhea are not part of the infant colic syndrome, infants with these gastrointestinal symptoms were excluded from the study. Dietary changes were accomplished by either feeding the infants a hydrolyzed casein formula or by requiring mothers to eliminate milk from their diets. In phase 1 of the study, the group receiving counseling (n = 10) had a decrease in crying from 3.21 ± 1.10 h/d to 1.08 ± 0.70 h/d (P = .001). The crying in the group that received dietary changes (n = 10) decreased from 3.19 ± 0.69 h/d to 2.03 ± 1.07 h/d (P = .01), a level still greater than twice normal. The decrease in those receiving counseling was faster and greater than that of those given dietary changes (P < .02). In the second phase of the study, group 2 infants were reexposed to cow's milk or soy protein and the parents received counseling. In this phase, counseling again decreased crying significantly from 2.09 ± 1.07 h/d to 1.19 ± 0.60 h/d (P = .05). No infant in the study who improved with changes in his or her diet had a significant increase in crying, with reexposure to soy or cow's milk protein. It is concluded that these data support the theory that for many infants with the infant colic syndrome the crying is a result of parental misinterpretation of infant cries and is not caused by milk protein allergy.
Echocardiographic Assessment of Cardiac Function During Respiratory Syncytial Virus Infection
Authors: Pahl Elfriede , Gidding Samuel S.
Published: December 2021

Respiratory syncytial virus infection has been associated with increased morbidity and mortality in infants with underlying cardiac and pulmonary disease. To understand better the cardiopulmonary interaction in patients with acute respiratory syncytial virus bronchiolitis, we performed M-mode echocardiograms and pulsed Doppler assessment of pulmonary arterial flow in 19 patients with structurally normal hearts during acute illness. Studies were repeated in 11 of these patients following complete recovery. Based on severity of respiratory compromise, patients were grouped into those with severe illness (ten patients) or mild illness (nine patients). Left ventricular dimensions and shortening fraction were used to assess left ventricular function. Right ventricular systolic time intervals and specific Doppler flow velocity measurements were used to assess right ventricular function and elevation of pulmonary artery pressure. Comparisons were made between patients with severe and mild illness and between acute and follow-up studies. No statistically significant differences in left ventricular function, right ventricular systolic time intervals, or Doppler flow measurements were observed. We conclude that in patients with structurally normal hearts, respiratory syncytial virus bronchiolitis is not associated with significant depression of cardiac performance or elevation in pulmonary resistance.
What Does the Cryotherapy Preliminary Report Mean?
Authors: PHELPS DALE L.
Published: December 2021

The dispassionate numbers in the preliminary report of the Multicenter Trial of Cryotherapy for Retinopathy of Prematurity (CRYO-ROP)1 fail to convey the excitement I feel as a physician who now, for the first time, has a tested intervention to offer the infant with serious retinopathy of prematurity. Infants with retinopathy of prematurity at the study's threshold of severity have a 43% incidence of an unfavorable outcome in that eye, eg, retinal detachment or a fold across the macula. Either of these outcomes means severely reduced vision for life. Cryotherapy reduces the chances of an unfavorable outcome to 22%. The preliminary report, however, has left many questions unanswered.
What Is `Significant' and DTP Reactions
Authors: HOFFMAN HOWARD J. , HUNGER JEHU C. , HASSELMEYER EILEEN G. , DAMUS KARLA , PAKTER JEAN , PETERSON DONALD R. , VAN BELLE GERALD
Published: December 2021

In Reply.—

The two letters received in response to our article1 express a diversity of opinion regarding the inferences to be drawn from the findings regarding SIDS and DTP reported from the NICHD SIDS Cooperative Epidemiological Study. In the first instance, Dr Eden suggests that we were too cautious in our concluding statement that: "DTP immunization does not appear to be a significant factor in the occurrence of SIDS." The critical point to be made is that in any study, regardless of the number of subjects included and the care taken in study design and implementation, the most that can be claimed is a statistical result that admits a small probability of exception.
Repeat Throat Cultures?
Authors: WALD ELLEN R.
Published: December 2021

In Reply.—

If patients treated for pharyngitis are symptomatic (with sore throat) at the end of treatment, repeat throat cultures are appropriate. However, if the patient is asymptomatic, routine reculturing is not recommended. The rationale for not performing cultures routinely is that a positive culture from an asymptomatic individual usually identifies a "carrier." Carriers are not thought to be at risk for rheumatic fever, nor are they a source for transmission of the streptococci to their close contacts.
Indian Health Service
Authors: PORVAZNIK JOHN
Published: December 2021

To the Editor.—

In response to the article by Honigfeld and Kaplan (Pediatrics 1987;80:575-578), I would like to make several comments. The Indian Health Service is pleased to see a steady reduction in infant mortality in the general American Indian and Alaskan Native population to a level that is equal to or slightly less (10.2 deaths per 1,000 live births in 1983) than US rates. This progress is largely due to the work of committed professionals who often work under less than optimal circumstances in isolated areas.
Rett Syndrome: Natural History and Management
Authors: Moeschler John B. , Charman Catherine E. , Berg Susan Z. , Graham John M.
Published: December 2021

The clinical findings of seven girls and one woman, 2 to 25 years of age, with Rett syndrome are presented. Previous diagnoses included Prader-Willi syndrome, Angleman syndrome, toxic reaction to pertussis vaccine, CNS dysgenesis, and encephalitis. Rett syndrome has a recognizable neurodevelopmental phenotype without a specific biologic marker, which makes the diagnosis difficult at times. Treatment is largely supportive, and an active parents' association has been helpful to many families.
Outcome for Fetus With Ascites and Cytomegalovirus Infection
Authors: Binder Nancy D. , Buckmaster John W. , Benda Gerda I.
Published: December 2021

The prenatal and neonatal course of a fetus with cytomegalovirus infection and ascites found on ultrasonographic examination at 27 weeks' gestation is reported. The ascites resolved within 4 weeks and the neonate had evidence only of mild congenital cytomegalovirus infection at birth. The factors predictive of the long-term outcome for an infant with congenital cytomegalovirus infection are reviewed. In this case, the finding that signs of significant disease in the fetus do not necessarily correlate with signs of severe congenital infection in the neonate is reported. It is suggested that prospective data are needed to aid in prediction of the course of fetal cytomegalovirus infection.
Aspirin and Reye Syndrome
Authors: ORLOWSKI JAMES P.
Published: December 2021

In Reply.—

It is a pleasure to hear from one of the coauthors of the original article describing Reye syndrome.1 I have to admit to being unaware of the letter to the editor which Dr Baral wrote because its title concealed any relationship to Reye syndrome or aspirin.2 I was also unaware that the tables which did not accompany the original article in the Lancet were still available 25 years later.

I am, however, concerned and confused about some apparent contradictions.
Cocaine Abusers as Mothers
Authors: CHASNOFF IRA J.
Published: December 2021

In Reply.—

I would like to thank Dr Cersonsky for his comments regarding our article (Pediatrics 1987;80:836-838). I certainly agree that the social aspects of a case regarding maternal substance abuse in pregnancy are important in the ultimate prognosis for the exposed child. In our experience with addicted pregnant women, our major work has been pointed toward the importance of early intervention in pregnancy. Unfortunately, the woman reported in this article was not referred to our program, and her physicians never obtained any type of substance abuse history during the pregnancy.
Psychologic Preparation Program for Children Undergoing Acute Appendectomy
Authors: Edwinson Marie , Arnbjörnsson Einar , Ekman Rolf
Published: December 2021

A psychologic preparation program was developed for use prior to emergency surgery in children. The purpose of this study was to determine whether specific information prior to an emergency operation would reduce anxiety. The effect of the preparation program was evaluated with clinical and laboratory procedures. One group of children who received only general verbal information was compared with another group who received specific information. The subjects were 24 patients and their parents. The children were studied at four different clinical units prior to operation, using the Visual Analogue Scale and pulse rate and blood pressure measurements. Stress hormone levels were measured at three of these clinical units. Visual Analogue Scales were administered to parents three times prior to the child's operation. The results were analyzed for within-group differences from one clinical unit to the next and for between-group differences at the various clinical units. The results indicated less anxiety in the children who received specific information. Catecholamine and β-endorphin measurements were not greatly different between the groups.
Otitis Media in Neonatal Intensive Care Unit Graduates: A 1-Year Prospective Study
Authors: Gravel Judith S. , McCarton Cecelia M. , Ruben Robert J.
Published: December 2021

A group of 46 high-risk infants (graduates of a neonatal intensive care unit) and 19 full-term infants were observed prospectively for middle ear status beginning at 40 weeks' postconceptional age. All infants were born to families living in low socioeconomic urban neighborhoods. Pneumootoscopy was used to determine the presence or absence of middle ear effusion during periodic medical and nonmedical visits throughout a 1-year period. Of all infants studied, 91% had at least one episode of otitis media with effusion during the observation interval. There were no differences in the percentages of visits during which high-risk and full-term infants experienced either normal middle ears bilaterally or otitis media with effusion in one or both ears. Furthermore, the age of onset of otitis media with effusion was similar for the two groups of babies. No differences were found between boys and girls in the age of onset for otitis media or in the percentage of visits at which otitis media with effusion was detected. Hispanic infants experienced their initial episode at significantly younger ages than did black infants in the sample. Both groups had similar percentages of visits attributable to otitis media with effusion during the observation period. The results indicate a high incidence among the infants studied and similar otologic courses for neonatal intensive care unit graduates and full-term infants during the first year of life.
Renal Function Correlates of Postnatal Diuresis in Preterm Infants
Authors: Bidiwala Khurshid S. , Lorenz John M. , Kleinman Leonard I.
Published: December 2021

A characteristic pattern of fluid homeostasis occurs in the first week of life in many preterm infants. Initially, urine output is low independent of fluid intake, subsequently a diuresis occurs, and finally urine output begins to vary with intake. Renal clearance measurements were made during each of these three phases to elucidate the renal mechanisms involved. Periods during which the ratio of urine output to fluid intake was ≥1 and urine output was ≥3 mL/kg/h were defined as diuretic. Of 22 preterm infants studied from 12 to 120 hours of age, 17 had at least one period of diuresis. In these infants, urine output, fluid intake rate, output to intake ratio, glomerular filtration rate, and fractional sodium excretion were lowest at 12 to 24 hours of age. During diuresis, urine output tripled without a significant change in fluid intake so that output to intake increased to levels exceeding unity. Diuresis was associated with significant increases in glomerular filtration rate and fractional sodium excretion. By 108 to 120 hours of age, urine output decreased despite an increase in fluid intake. This was accompanied by a decrease in glomerular filtration rate. These results suggest that the initial antidiuretic phase is the result of a low fractional sodium excretion in the face of a low glomerular filtration rate. Subsequently, diuresis and natriuresis occur as a result of abrupt, nonmaturational increases in glomerular filtration rate and fractional sodium excretion. With cessation of diuresis, glomerular filtration rate and fractional sodium excretion decrease and water and electrolyte output begin to vary appropriately with intake.
Hypoxic Arousal Responses in Infants With Bronchopulmonary Dysplasia
Authors: Garg Meena , Kurzner Sharon I. , Bautista Daisy , Keens Thomas G.
Published: December 2021

Infants with bronchopulmonary dysplasia have a high incidence of sudden, unexplained death in the postneonatal period, yet the cause of these deaths is unknown. Frequent episodes of clinically unsuspected arterial oxygen desaturation have recently been described in infants with bronchopulmonary dysplasia. We hypothesized that infants with bronchopulmonary dysplasia who experience frequent episodes of hypoxia may have abnormal arousal responses to these hypoxic episodes. We studied 12 infants with bronchopulmonary dysplasia at 41.4 ± 1.3 weeks postconceptional age. Hypoxic arousal responses were performed during quiet sleep at an inspired oxygen tension of 80 mm Hg for a maximum of three minutes or until arousal occurred. Of 12 infants, 11 (92%) aroused normally to the hypoxic challenge. However, all infants required vigorous stimulation and supplemental oxygen after the initial arousal response. Of 12 infants with bronchopulmonary dysplasia, eight (67%) experienced prolonged apnea with bradycardia, and four of 12 (33%) required brief ventilatory assistance (bag and mask) to restore normal breathing. Abnormal pneumographic findings did not predict the occurrence of these prolonged periods of apnea and bradycardia following hypoxia. We conclude that an abnormal response to hypoxia following arousal may lead to prolonged apnea and bradycardia in infants with bronchopulmonary dysplasia. We speculate that the inability to recover from this hypoxia may result in sudden death in these infants.
Changes in Life-Style After Liver Transplantation
Authors: Zitelli Basil J. , Miller Joanne W. , Gartner J. Carlton , Malatack J. Jeffrey , Urbach Andrew H. , Belle Steven H. , Williams Laurel , Kirkpatrick Beverly , Starzl Thomas E.
Published: December 2021

Sixty-five pediatric patients who received liver transplants between May 1981 and May 1984 were observed for as many as 5 years and examined for changes in life-style. Children were less frequently hospitalized, spent less time hospitalized, required fewer medications, and generally had excellent liver and renal function after hepatic transplantation as compared with their pretransplantation status. Most children were in age-appropriate and standard school classes or were only 1 year behind. Cognitive abilities remained unchanged. Children improved in gross motor function and patients' behavior significantly improved according to parents' perceptions. Enuresis was more prevalent, however, than in the population of children who had not received liver transplants. Parental divorce rates were no greater than those reported for other families with chronically ill children. Overall, objective changes in life-style as well as parents' perceptions of behavior of children appear to be improved after liver transplantation.
Systemic Candidiasis: Cutaneous Manifestations in Low Birth Weight Infants
Authors: Baley Jill E. , Silverman Robert A.
Published: December 2021

The cutaneous manifestations of 18 infants treated for systemic candidiasis during a 3¾-year period were examined. Eight infants, with a mean birth weight of 712 ± 161 g, had a diffuse burn-like dermatitis, usually within the first three days of life. Candida pseudohyphae were identifiable on skin scrapings. A history of a maternal cerclage or intrauterine device complicated by chorioamnionitis was common. A delay in diagnosis or therapy resulted in mortality, whereas promptly treated infants survived. Nine additional infants had monilial diaper rashes, which spread to the trunk and extremities in four infants. These infants were older at the onset of the dermatitis, and all survived the systemic infection. Systemic candidiasis without any cutaneous involvement developed in only one infant. Candidiasis should be more frequently considered, and prompt systemic therapy should be instituted when cutaneous candidiasis occurs within the first few days of life in infants who weigh less than 1,500 g.
Neonatal Staphylococcus epidermidis Right-Sided Endocarditis: Description of Five Catheterized Infants
Authors: Noel Gary J. , O'Loughlin John E. , Edelson Paul J.
Published: December 2021

Coagulase-negative staphylococci are important causes of bacteremia and focal infections in infants hospitalized in neonatal intensive care units. The medical records and echocardiograms of 58 newborns with persistent Staphylococcus epidermidis bacteremia who were hospitalized in the neonatal intensive care unit at The New York Hospital during the past 5½ years were reviewed, and five infants were identified as having S epidermidis right-sided infective endocarditis. These episodes were associated with placement of umbilical venous catheters in the right atrium, slow resolution of bacteremia, and persistent thrombocytopenia. This experience suggests the role of endocardial trauma resulting from the placement of umbilical venous catheters in the pathogenesis of endocarditis. The increasing importance of coagulase-negative staphylococci as a cause of bacteremia in the newborn may explain the emergence of S epidermidis as an important cause of infective endocarditis in the neonatal intensive care unit. These cases underscore the potential severity of S epidermidis infection in the premature newborn.
Resident Stress
Authors: Bergman Abraham B.
Published: December 2021

In the absence of confirmatory evidence, one can only sense that the lives of residents have become increasingly stressful since the late 1950s. Certainly residency stress is receiving more attention in the medical literature.1-4 An excellent conference on stress in pediatric housestaff training sponsored by the Study Group on Pediatric Education and Ross Laboratories was held in 1985.5 Whatever took place in the past, present-day residents carry heavy burdens that materially affect their current performance and future lives. Some of these burdens could and should be lightened. The first step is for medical educators to acknowledge that they exist.

It is neither possible nor advisable to eliminate all stress in residency training; after all, young physicians are being prepared for a taxing marathon race. Attempts should be made, however, to differentiate between useful stress and needless annoyances. Working long hours, behaving effectively in emergencies, dealing with death and dying, managing difficult patients, and coping with the uncertainties of diagnosis and treatment are examples of the first category. For high achievers used to getting As in school, accepting a less than perfect diagnosis, a disease without a treatment, or a mistake that kills is frustrating but must be endured. The annoyances will be discussed later.

GLOBAL CAUSES

Faculty probably can have only limited impact on some of the more global causes of resident stress. It is important, however, that they be recognized and, even more important that residents know that they are recognized. First, there are the normal issues of adult development common to young persons striving to put their personal and professional lives in order.6
National Childhood Vaccine Injury Compensation Act
Authors: SMITH MARTIN H.
Published: December 2021

The past four decades have been years of phenomenal progress in all of medicine, yet in terms of numbers of lives saved or in years of productive lives spared, nothing has equaled the record of preventative pediatrics, specifically, our national immunization program. In the past several years, however, this immunization program has almost fallen into shambles. The sources of this reversal would have been from vaccine liability leading to exorbitant costs or loss of supply of vaccines. In the 1970s and 1980s, a series of crises that were only narrowly averted threatened interruption of the national immunization program.

It is now worthwhile to trace the events of the past several years so that we can review the continuity of the course of events through those years to understand the necessity for the specific resolution of these problems in the form of the National Childhood Vaccine Injury Compensation Act. The American Academy of Pediatrics played a leading and pivotal role in the long struggle to enact this legislation. It is expected that the act should be the means of avoiding any future threats to our national immunization program through loss of supply. Furthermore, and of equal importance, after time for stabilization and experience with its administration, the act should reduce the cost of vaccines. The courts have dealt with the matter of vaccine injury in an irregular and sometimes unpredictable manner. This legislation should provide a more predictable and just outcome for those few who suffer vaccine injuries. Because this is the first major legislation the Academy has undertaken, the membership should be informed of the time involved in promoting passage of this legislation: the costs in hours by the members, officers, and staff, as well as the monetary costs to the Academy.
Twenty-Fifth Anniversary of the National Sudden Infant Death Syndrome Foundation
Authors: BERGMAN ABRAHAM B.
Published: December 2021

When 6-month-old Mark Addison Roe of Greenwich, CT, died suddenly and unexpectedly in October 1958, his parents were told that the cause was "acute bronchial pneumonia." In those days, "it" was called by many names, such as suffocation, overlaying, aspiration, or various forms of pneumonia. The common thread was that all of the terms connoted that parents were either directly, or indirectly, by virtue of failing to secure medical care, responsible for the infant's death.

Mark's death might have been the end of it were it not for the existence of a life insurance policy that his grandparents had bought at the time of his birth.
Acquired Immunodeficiency Syndrome Education in Schools
Authors:   Committee on School Health
Published: December 2021

Aids Education

The AIDS epidemic has been with us for the past 6 years. As of October, 1987, 42,000 total cases of AIDS in persons of all ages have been reported, and the number is predicted to increase to 250,000 cases by 1991. Because no vaccine or cure is available, education offers a reasonable approach to prevention. The American Academy of Pediatrics believes that the nation's schools should immediately initiate AIDS education programs as part of a comprehensive health education plan.

ORGANIZATION OF THE PROGRAM

School Health Advisory Committee

AIDS education programs in the schools should be advocated for and supervised by a school health advisory committee or similar school-related organization in each community.1 The committee for each school or district should consist of the school medical advisor, a community pediatrician and/or public health physician, a school nurse, a health educator, a mental health professional, a school administrator, and a faculty member, a parent, and appropriate community representatives. In smaller school systems, a single school health advisory committee should suffice. These programs should be coordinated by the school medical advisor, school administrators, and school nursing supervisor.

Physician and Nurse Training

Physicians, especially pediatricians and family physicians, and school nurses should receive training about AIDS by participating in educational programs sponsored by regional medical centers, state medical societies, state nursing organizations, public health departments, or organizations such as the state chapters of the American Academy of Pediatrics. Those trained would then: (1) conduct education programs for teachers, school administrators, parent groups, community groups, psychologists and other mental health personnel, and students; (2) assist schools and organizations in the development of educational programs for special groups; (3) review, adapt, and develop educational materials; (4) participate in public panel discussions, including radio and television programs; (5) take part in open discussions between school administrators and staff or between administrators and parents; and (6) facilitate networking among parents, educators, and AIDS support groups.
Physician Reimbursement
Authors: HICKSON GERALD B.
Published: December 2021

In Reply.—

In our study1 in which practice characteristics of residents in a continuity clinic randomized to fee-for-service v salary reimbursement groups were compared, we found that patients enrolled to fee-for-service physicians experienced more well-child care and fewer emergency room visits per patient. However, these observations do not necessarily represent a cause and effect but, rather, may have occurred because fee-for-service reimbursement impacts both outcomes independently. The data also suggested that the higher rate of well-child visits in the fee-for-service group was due to both fewer missed indicated well-child visits and more visits completed in excess of American Academy of Pediatrics' guidelines.2
Day-Care Center Attendance and Hospitalization for Lower Respiratory Tract Illness
Authors: Anderson Larry J. , Parker Robert A. , Strikas Raymond A. , Farrar Jeffrey A. , Gangarosa Eugene J. , Keyserling Harry L. , Sikes R. Keith
Published: December 2021

To identify risk factors associated with hospitalization for acute lower respiratory tract illness, 102 children <2 years of age admitted to four Atlanta metropolitan area hospitals between December 1984 and June 1985 with the diagnosis of lower respiratory tract illness were studied. The most common causative agent associated with illness was respiratory syncytial virus, followed by other respiratory viruses, Haemophilus influenzae, and Streptococcus pneumoniae. The 102 case-patients were compared with 199 age- and sex-matched controls. A parent or guardian for each patient and control was interviewed by telephone regarding demographic data, care outside the home, breast-feeding, previous medical history, allergies, and smoking and illness in household members. Five factors were associated with lower respiratory tract illness in both a univariate analysis and a multiple logistic regression model (P < .05). These factors were the number of people sleeping in the same room with the child, a lack of immunization the month before the patient was hospitalized, prematurity, a history of allergy, and regular attendance in a day-care center (more than six children in attendance). Care received outside of the home in a day-care home (less than or equal to six children in attendance) was not associated with lower respiratory tract illness. The suggestion made by our study and other studies was that for children <2 years of age, care outside of the home is an important risk factor for acquiring lower respiratory tract illness, as well as other infectious diseases, and that this risk can be reduced by using a day-care home instead of a day-care center.
Childhood Physical Fitness Tests: Predictor of Adult Physical Activity Levels?
Authors: Dennison Barbara A. , Straus John H. , Mellits E. David , Charney Evan
Published: December 2021

Regular physical activity has both short- and long-term health benefits in adults. No study has investigated childhood determinants of adult physical activity patterns, however. In a nonconcurrent prospective study, the physical activity levels of 453 young men, 23 to 25 years of age, were compared with their physical fitness test scores as children (10 to 11 years of age and 15 to 18 years of age). The physically active adults had significantly better childhood physical fitness test scores than did the inactive adults. In 224 children, 2 years of fitness test results were available. The risk of physical inactivity in young adulthood was linearly related to the number of low scores on the 548.6-m (600-yd) run and sit-ups tests as children (P < .001). In stepwise multivariate discriminant analysis, the childhood 548.6-m run score was the best discriminator between currently physically active and inactive adults. Reported parental encouragement of exercise, level of education, participation in organized sports after high school, and reported spousal encouragement of exercise also contributed significantly to the discriminant function. These results demonstrate that physical fitness testing in boys facilitates the identification of those at increased risk of becoming physically inactive young adults.
Changes in Oxygen Tension and Effects on Cyclooxygenase Metabolites: III. Decrease of Retinal Prostacyclin in Kittens Exposed to Hyperoxia
Authors: Stuart Marie J. , Phelps Dale L. , Setty B. N. Yamaja
Published: December 2021

The acute phase of oxygen-induced retinopathy is associated with vasoconstriction and occlusion of the retinal vessels. Because this acute vasoobliterative phase could be due to the inhibition in retinal vessels of the production of the potent vasodilator and antithrombotic metabolite prostacyclin, animal experiments were performed to assess this possibility. Eight litters of 27 kittens (four to six days of age) were used. Control kittens were left in room air; hyperoxic kittens were placed in 80% oxygen for 48 hours; recovery kittens were returned to room air for 24 hours following hyperoxic exposure. Following treatments, the animals were killed, retinas isolated, and prostaglandin formation assessed. Retinal tissues produced 6-keto-prostaglandin F1α, prostaglandin F2α, prostaglandin E2, and thromboxane B2, from exogenous arachidonate. A significant (approximately 33%) reduction in retinal 6-keto-prostaglandin F1α (the end product of prostacyclin) was observed both in the hyperoxic and recovery litter mates when compared with controls. Both of the experimental groups also demonstrated a reduction in total retinal prostanoids that paralleled the changes observed in prostacyclin, suggesting that the biochemical effect of hyperoxia on retinal vascular arachidonic acid metabolism occurred at the level of cyclooxygenase. A decrease in the local production of prostacyclin during hyperoxia is consistent with the histologic retinal changes observed during the acute phase of oxygen-induced retinopathy.
Intentional Ipecac Poisoning: Munchausen Syndrome by Proxy
Authors: Sutphen James L. , Saulsbury Frank T.
Published: December 2021

The intentional poisoning of two children with ipecac by their mothers is described. Intractable vomiting and diarrhea were the initial symptoms in both patients. In addition, one patient had clinical and laboratory evidence of skeletal and cardiac myopathy. Both children were subjected to extensive and invasive diagnostic evaluations before the correct diagnosis of chronic ipecac poisoning was made. These cases illustrate the toxic effects of ipecac ingestion and serve to alert physicians to child abuse by ipecac poisoning.
Preventive Care Use by School-Aged Children: Differences by Socioeconomic Status
Authors: Newacheck Paul W. , Halfon Neal
Published: December 2021

Use of ambulatory care services by children from low-income families has increased substantially since the early 1960s. However, in few studies have attempts been made to disaggregate physician visits according to type (eg, preventive v diagnosis and treatment). In this study, receipt of preventive care (including physical, vision, and dental examinations), based on a sample of 16,838 children aged 5 to 16 years from the 1982 National Health Interview Survey, was examined. The results indicate that children in families with incomes below the poverty level, especially those without Medicaid insurance, are much less likely to receive routine preventive care on a timely basis. Poor school-aged children with Medicaid are much more likely to receive timely preventive care than their counterparts without Medicaid coverage. The effectiveness of preventive care for children is discussed and suggestions for improving access to routine preventive care are presented.
Editor's Comment
Authors: M. R. J.
Published: December 2021

This case report illustrates a problem that is more frequently encountered than recognized, particularly with tablets or capsules designed to disguise taste or to avoid dissolution in or irritation of the stomach. Children frequently pass bits of or whole tablets or capsules of medications which have been administered to them, and this undoubtedly may be reflected in apparent ineffectiveness of the drug concerned. Whether this phenomenon is a result of rapid intestinal transit, differences in secretion of HCl or of gastric and/or intestinal digestive enzymes, or some other cause that is operative more frequently in children than in adults is not clear.
Molybdenum Cofactor Deficiency: Another Inborn Error of Metabolism With Neonatal Onset
Authors: BURTON BARBARA K.
Published: December 2021

In Reply.—

Matsuo and co-workers correctly point out that molybdenum cofactor deficiency may present in the neonatal period and, therefore, add yet another disorder to the list of inborn errors of metabolism affecting the neonate. Hypouricemia may be a clue, as noted, and ectopia lentis, as seen in isolated sulfite oxidase deficiency, is an additional important finding. The importance of a careful eye examination in infants suspected of having an inborn error of metabolism is again emphasized.
Ascendancy of the `Black Bottle'
Authors: GREENSHER JOSEPH , MOFENSON HOWARD C. , CARACCIO THOMAS R.
Published: December 2021

In Reply.—

It was not our intent to undermine confidence in syrup of ipecac as a useful and effective means of inducing emesis when indicated, particularly as a home first aid measure. However, it must be recognized that activated charcoal has definite advantages in inactivating larger quantities of ingested substances particularly in circumstances in which the use of syrup of ipecac would no longer be of great benefit. We pointed out that resistance to acceptance of activated charcoal by children limits present use predominantly to emergency departments where compliance can be assured.
Prevention of Lead Poisoning in Children—An Issue for Both Developing and Industrialized Countries
Authors: FAUST DAVID
Published: December 2021

In Reply.—

Should we be correct in reading Dr Guthrie's summary question as a statement that might begin, "It is time that our economic dependence ...," we have but a one word reply: Amen.
Two-Year Follow-up of Infants Enrolled in a Randomized Trial of Surfactant Replacement Therapy for Prevention of Neonatal Respiratory Distress Syndrome
Authors: Dunn Michael S. , Shennan Andrew T. , Hoskins Elizabeth M. , Lennox Kathryn , Enhorning Goran
Published: December 2021

A randomized clinical trial of the use of bovine surfactant for the prevention of neonatal respiratory distress syndrome was completed at our Institution in 1984 (Pediatrics 1985;76:145-153). All infants entering the trial were enrolled in our follow-up clinic and seen at regular intervals for assessment of growth and development, neurologic and sensory status, and incidence of respiratory disease and allergic conditions. Infants have now been followed-up for at least 2 years. Of those infants for whom follow-up is complete, two of 32 (6.3%) surfactant-treated infants died, five (15.6%) had major neurodevelopmental handicaps, and five had minor neurodevelopmental handicaps. In the control group, eight of 33 (24%) infants died, whereas only two (6.1%) survived with major neurodevelopmental handicaps, and four (12.1%) were left with minor handicaps. Except for an increased neonatal death rate in the control group, other differences were not statistically significant. The groups were also comparable in terms of the incidence of late respiratory or allergic disease as assessed by history. Treatment with bovine surfactant at birth of premature infants at high risk for respiratory distress syndrome appears to be safe and of short-term benefit, although no decrease in neurodevelopmental handicap at 2 years' follow-up can be demonstrated.
Hemorrhage, Phenobarbital, and Fluctuating Cerebral Blood Flow Velocity in the Neonate
Authors: Kuban Karl C. K. , Skouteli Helen , Cherer Allen , Brown Elizabeth , Leviton Alan , Pagano Marcello , Allred Elizabeth , Sullivan Kathleen F.
Published: December 2021

Fifty-one sequential intubated babies with birth weights of less than 1,751 were evaluated by serial Doppler ultrasound during the first three days of life. These babies were part of a phenobarbital prophylaxis trial cohort study. Subependymal-intraventricular hemorrhage developed in 17 of the babies. Infants with subependymal-intraventricular hemorrhage, whether or not they received pancuronium or phenobarbital, had coefficients of variation comparable to those of babies without hemorrhage. Coefficient of variation values of the right were comparable to values obtained from the left anterior cerebral artery complex and did not appear to be consistently altered by the presence of subependymal-intraventricular hemorrhage. Coefficient of variation values appeared to be consistently greatest on day 1 and lowest on day 2. In addition, the values overall increased as the number of waves used to determine the coefficient of variation enlarged from five to 20. This phenomena, however, was not seen among pancuronium recipients and suggests that movement artifact may be a determinant of coefficient of variation values. We conclude that, when the best 20 waves are chosen to evaluate the coefficient of variation, no association exists between coefficient of variation values and development of subependymal-intraventricular hemorrhage or administration of phenobarbital.
Variability in 28-Day Outcomes for Very Low Birth Weight Infants: An Analysis of 11 Neonatal Intensive Care Units
Authors: Horbar Jeffrey D. , McAuliffe Timothy L. , Adler Saul M. , Albersheim Susan , Cassady George , Edwards William , Jones Rosamond , Kattwinkel John , Kraybill Ernest N. , Krishnan Venkatesan , Raschko Paula , Wilkinson Andrew R.
Published: December 2021

A retrospective study of all infants weighing 701 to 1,500 g born at 11 neonatal intensive care centers during 1983 and 1984 was performed to determine whether two specific 28-day outcomes, survival and survival without the need for supplemental oxygen, varied among the centers. Survival without the need for supplemental oxygen was chosen as a reflection of infants surviving without chronic lung disease. There were 1,776 live-born infants delivered during the 2-year study period. Of these infants, 85% (1,512) survived 28 days, a range of 80% to 92% at the individual centers. A total of 60% (1,056) of the infants were alive without supplemental oxygen on day 28, a range of 5l% to 70% at the individual centers. Multivariate analysis demonstrated that both survival on day 28 (χ2 = 23.9, P < .01) and survival without supplemental oxygen on day 28 (χ2 = 44.2, P < .0001) varied significantly among centers after the effects of birth weight, gender, and race were taken into account. Female gender, nonwhite race, and increased birth weight were factors associated with improved rates of survival and survival without supplemental oxygen. The magnitude of outcome variation among centers was estimated by using the logistic regression models to predict what the outcomes would be if each center were to treat a standardized population consisting of all 1,776 study infants. Predicted survival rates varied by as much as 15% and the predicted rates for survival without supplemental oxygen varied by nearly 17% between centers with the highest and lowest rates. The differences in outcomes observed at the centers did not correlate with the number of live births at the centers or with the scores on a simple respiratory practices questionnaire. It was concluded that 28-day outcomes for very low birth weight infants vary significantly among different neonatal intensive care centers. Potential sources of this variation include undetected population differences in neonatal disease severity and differences in the techniques of both obstetrical and neonatal care.