bluuebunny/crossref_metadata_2025 huggingface dataset:
THE FEMINIZATION OF POVERTY
Authors: Student
Published: December 2021

Dr. Halfdan Mahler, Director-General of the World Health Organization [said] in many cultures women were the underprivileged: girls often received less food than boys, a pattern passed on by mothers who gave themselves less food than their husbands; girls often received less in the way of formal education than boys, since they were needed by mothers to help in the collection of water, preparation of food, and house and horticultural work—school learning being anyway irrelevant to becoming in turn a mother. Unemployment among women around the world was far higher than among men. Dr. Mahler summarized the position as "the feminization of poverty," by legislation, constitution, and ideology.
Evaluation of the Pediatric Patient for Liver Transplantation
Authors: Zitelli Basil J. , Malatack J. Jeffrey , Gartner J. Carlton , Urbach Andrew H. , Williams Laurel , Miller Joanne W. , Kirkpatrick Beverly
Published: December 2021

In a 36-month period from 1981 to 1984, 209 pediatric patients were evaluated for liver transplantation. The purpose of the evaluation was to assess the severity and progression of the disease, anatomical suitability for transplantation, and psychosocial stability and to initiate family education. Of the 209 patients evaluated, 85 (41%) underwent transplantations and 64 (75%) survived at least 12 months. Thirty-four (16%) patients were not considered candidates for transplantation. The mean waiting period increased from 80.3 days to 232 days. Of 174 patients considered for transplantation, 41 (24%) died prior to surgery. A formal evaluation for liver transplantation permitted appropriate selection of candidates and provided education for informed consent. We also stress the need for greater participation in pediatric organ donation.
Graft Versus Host-Like Illness in a Child With Phenobarbital Hypersensitivity
Authors: Knutsen Alan P. , Shah Manoj , Schwarz Kathleen B. , Tsai Cheng C.
Published: December 2021

A child in whom a phenobarbital hypersensitivity drug reaction developed which consisted of fever, a prunitic desquamating erythrodermic rash, alopecia, icterus, protein-losing enteropathy, myositis, and nephritis, is described. Laboratory studies demonstrated eosinophilia, elevated serum IgE, and elevated T suppressor/cytotoxic cells in the peripheral blood. Findings from biopsy specimens of skin and jejunum suggested a cellmediated pathogenesis, and lymphoproliferative studies of the patient's mononuclear cells revealed a positive response to phenobarbital. The clinical findings and laboratory studies suggested an autoimmune cell-mediated hypersensitivity reaction triggered by phenobarbital.
Metoclopramide Effect on Faltering Milk Production by Mothers of Premature Infants
Authors: Ehrenkranz Richard A. , Ackerman Barbara A.
Published: December 2021

Metoclopramide treatment has been shown to augment milk production by stimulating prolactin secretion in women in whom lactational insufficiency develops after a full-term pregnancy. The effect of metoclopramide therapy in 23 women who were delivered of premature infants (birth weight 1,314 ± 115 g, gestational age 30.4 ± 0.7 weeks) and who were having difficulty maintaining milk production with milk expression was evaluated. Each woman had noted a gradual decrease in the total daily volume of expressed milk during the first several weeks of lactation. Maternal metoclopramide therapy was started at a mean of 32.0 ± 3.7 days postpartum, after a review of diet and milk expression technique and an increase in the number of expressions per day failed to increase milk production. Daily milk production increased significantly from 93.3 ± 18.0 mL/d to 197.4 ± 32.3 mL/d between the first and seventh day of therapy. This increase was associated with significantly increased basal serum prolactin levels, from 18.1 ± 3.3 ng/mL to 121.8 ± 21.5 ng/mL. Although milk expression resulted in a variable increase in serum prolactin levels prior to metoclopramide treatment, milk expression did not produce any additional prolactin response in the treated women, with mean basal levels of 157.8 ± 15.4 ng/mL v mean peak levels of 144.5 ± 12.2 ng/mL. No major side effects were reported by the women, and no untoward effects were noted in the infants fed milk expressed while their mothers were being treated with metoclopramide. After treatment with metoclopramide, 15 of the 23 women were able to successfully maintain lactation, were breast-feeding at the time their infants were discharged from the hospital, and continued to breast-feed afterward. These data suggest that the increased daily milk production seen with metoclopramide treatment is related to a significant increase in the basal prolactin level, and they demonstrate that metoclopramide treatment can permit a successful breast-feeding experience in women who deliver prematurely and have difficulty maintaining lactation.
Aluminum Intoxication in a Child: Treatment With lntraperitoneal Desferrioxamine
Authors: Warady Bradley A. , Ford Douglas M. , Gaston Charlotte E. , Sedman Aileen B. , Huffer William E. , Lum Gary M.
Published: December 2021

We report the successful chelation of aluminum and the clinical resolution of severe aluminum intoxication in an infant receiving chronic peritoneal dialysis through the use of intraperitoneal desferrioxamme. Following the introduction of desferrioxamine, urine and dialysate fluid aluminum levels exceeded those noted without the chelating agent, thus demonstrating enhanced removal of aluminum. As a result of therapy, plasma and bone aluminum levels decreased markedly, and previously noted histomorphometric abnormalities on bone biopsy resolved. Clinically, the aluminum-associated osteomalacia and microcytic hypochromic anemia completely reversed. Moderate developmental delay has also improved slightly but persists. Our experience suggests that intraperitoneal chelation therapy with desferrioxamine may be helpful to reverse aluminum intoxication in children with chronic renal failure. However, limited exposure to aluminum should remain a primary goal.
Bone Marrow Transplantation for Children With Acute Leukemia and Down Syndrome
Authors: Rubin Charles M. , O'Leary Maura , Koch Penelope A. , Nesbit Mark E.
Published: December 2021

Four children with acute leukemia and Down syndrome received high-dose cyclophosphamide therapy and total body irradiation in preparation for bone marrow transplantation. Skin and mucous membrane toxicity was pronounced. Furthermore, three children died during the immediate posttransplantation period of infectious and hemorrhagic pulmonary complications. One patient had hematologic recovery and is surviving disease-free 1 year following transplantation. These preliminary observations are in agreement with previous data suggesting that children with Down syndrome are at higher risk for toxicity, pneumonitis, and, possibly, death following administration of intensive therapy for leukemia in comparison with children without Down syndrome. Improvements in the management of these children in the future will depend upon a better understanding of the biologic and pathophysiologic aspects of Down syndrome and additional clinical experience.
Intracranial Hemorrhage During Extracorporeal Membrane Oxygenation in Neonates
Authors: Cilley Robert E. , Zwischenberger Joseph B. , Andrews Alice F. , Bowerman Richard A. , Roloff Dietrich W. , Bartlett Robert H.
Published: December 2021

Intracranial hemorrhage is a complication of extracorporeal membrane oxygenation for the treatment of neonatal respiratory failure. A retrospective review of 35 neonates treated with extracorporeal membrane oxygenation was performed; ten had intracranial hemorrhage. Infants with intracranial hemorrhage had lower birth weights and were gestationally younger than infants with intracranial hemorrhage. Eight of eight neonates of less than 35 weeks' gestational age sustained intracranial hemorrhage. Six died immediately after extracorporeal membrane oxygenation was stopped. Two lived less than 1 year. Two of 27 neonates older than 34 weeks' gestational age sustained intracranial hemorrhage. One child is normal, the other died at 18 months of age. Based on the results of this study, the risk of intracranial hemorrhage appears low in neonates of greater than 34 weeks' gestational age who undergo extracorporeal membrane oxygenation treatment for severe respiratory failure. The use of extracorporeal membrane oxygenation, as it is presently performed, is contraindicated in neonates of less than 35 weeks' gestational age because of the risk of intracranial hemorrhage.
Neurologic/Behavioral Syndrome Associated With Ingestion of Chloride-Deficient Infant Formula
Authors: KALEITA THOMAS A.
Published: December 2021

To the Editor.—

Six consecutively examined children (five boys, one girl) exposed to Neo-Mull-Soy formula have demonstrated consistent symptomatology, suggesting the existence of a distinct neurologic/behavioral syndrome relating to its use. Two of these children were found to have hypochloremic metabolic alkalosis reported elsewhere.1 All six children had failure to thrive, including arrest of head circumference in four. The children were examined between 5 and 6 years of age, and four had been followed longitudinally for at least 2 years.
Changing Spectrum of Serious Child Abuse
Authors: HANSON KAREN J.
Published: December 2021

To the Editor.—

Child abuse and neglect is receiving considerable attention in both the scholarly and popular press. The acknowledgment of this problem, however, represents an admission of social failure, and explanations frequently serve as displacement mechanisms, value justifications, or support for agendas unrelated to child abuse and neglect. In an area currently receiving widespread media attention, it is crucial that research used to justify policy recommendations be clearly conceptualized, well supported by the data, and rigorously critiqued, both inhouse and in the public arena.
Child Abuse
Authors: GOLDSON EDWARD
Published: December 2021

To the Editor.—

As a member of the Child Advocacy Team at the Children's Hospital in Denver and one who also knew Henry, I was very pleased to read Dr Ray E. Helfer's commentary (Pediatrics 1985;76:993-997). I can say that I am in agreement with many of the issues raised and with the priorities established. Nevertheless, I feel a sense of concern in that I wonder whether several more basic and perhaps more difficult issues were omitted.
Substance Abuse by Teenagers
Authors: FELDMAN VIRGINIA
Published: December 2021

To the Editor.—

Pediatrics is to be commended for its recent articles keeping the problem of teenage alcohol abuse before the pediatrician's eye.1,2 Schwartz et al1 concluded that "pediatricians should play an active role in educating patients and their parents about alcohol." Unfortunately, alcohol education by physicians is at the stage car safety education was ten years ago—we know the scope of the problem but have few studies to show us how to effectively guide or change behavior in our daily office practices.
Failure of Trimethoprim/Sulfamethoxazole As Prophylactic Therapy of Gram-Negative Sepsis in Pediatric Patients With Cancer
Authors: WALD ELLEN R.
Published: December 2021

In Reply.—

Esquembre et al report an experience with the failure of trimethoprim/sulfamethoxazole (TMP/SMX) as prophylactic therapy in pediatric patients with cancer. This occurred during the second to third year after chemoprophylaxis was instituted as a routine method of therapy. Antimicrobial resistance to TMP/SMX has been reported previously in adults with malignancies who were receiving chemoprophylaxis1 and has likewise been noted among isolates of Escherichia coli in developing countries.2 However, resistance to TMP/SMX did not occur as a clinical problem either at Children's Hospital of Pittsburgh or at the National Cancer Institute during a similar time period.3,4
Live Attenuated Varicella Vaccine Use in Immunocompromised Children and Adults
Authors: Gershon Anne A. , Steinberg Sharon P. , Geib Lawrence ,   the National Institute of Allergy and Infectious Diseases Varicella Vaccine Collaborative Study Group
Published: December 2021

Live attenuated varicella vaccine has been administered to 307 children with leukemia in remission and to 86 healthy adults. The vaccine was well tolerated and immunogenic. The major side effect in leukemic children receiving maintenance chemotherapy was development of a vaccine-associated rash. Vaccinees in whom a rash developed were potentially somewhat infectious to others about 1 month after immunization. Vaccination was not associated with an increase in the incidence of herpes zoster or in relapse of leukemia. Vaccination provided excellent protection against severe varicella. It was associated with a significantg decrease in the attack rate of chickenpox following an intimate exposure to varicella-zoster virus, conferring about 80% protection in leukemic children. The cases of breakthrough varicella that occurred were mild. Thus, the vaccine may either prevent or modify varicella in high-risk individuals. It may also have use for prevention of nosocomial varicella.
Cardiorespiratory Function in 16 Full-Term Infants With Sudden Infant Death Syndrome
Authors: Southall D. P. , Richards J. M. , Stebbens V. , Wilson A. J. , Taylor V. , Alexander J. R.
Published: December 2021

Twenty-four-hour tape recordings of ECG and breathing movements from 16 term infants (≥37 weeks' gestation) who subsequently died of sudden infant death syndrome (SIDS) were compared with recordings from surviving infants from the same populations. Apneic pauses of varying durations, periodic and regular breathing patterns, heart and respiratory rates during regular breathing were measured. Only one of 16 full-term infants with SIDS had findings outside the range of age-matched control infants (an excess of periodic breathing patterns and an absence of regular breathing). When the first recordings of each of infants who died of SIDS, except one who had cyanotic episodes prior to death, were compared to recordings of survivors (six for each case) closely matched for age, gestation, and weight at birth, no differences in breathing patterns or heart or respiratory rates during regular breathing could be demonstrated. These particular measurements of cardiorespiratory function were, therefore, unable to identify the majority of full-term infants at risk for SIDS.
Factors Related to the Age of Attainment of Nocturnal Bladder Control: An 8-Year Longitudinal Study
Authors: Fergusson D. M. , Horwood L. J. , Shannon F. T.
Published: December 2021

The age of attainment of nocturnal bladder control was studied in a birth cohort of New Zealand children. By 8 years of age, but all 3.3% of children had attained such control, but because some children had relapsed subsequent to the attainment of control, 7.4% of children had nocturnal enuresis. It was estimated that from 5 years of age onward between one half to two thirds of children experiencing nocturnal enuresis did so as a result of failure to attain nocturnal control and the remaining children had secondary or onset enuresis. Factors predictive of the age of attainment of nocturnal bladder control were a family history of enuresis, the child's developmental level at 1 and 3 years of age, and the child's early sleeping patterns. The age of attainment of bladder control was unrelated to a broad range of psychosocial factors including family social and economic background, family life-event measures, changes in parents in the family, and residential changes. These results favor the view that the etiology of primary enuresis is mainly biologic and that psychosocial factors play little role in this aspect of bed-wetting.
Elevated Lead Levels in Children With Nonorganic Failure to Thrive
Authors: Bithoney William G.
Published: December 2021

Every child with failure to thrive has at least one organic medical disease: malnutrition. It is well documented that lead and other heavy metals are absorbed more readily in the presence of both malnutrition and iron deficiency anemia. Malnutrition and lead exposure tend to be found in the same population groups. Furthermore, lead poisoning is correlated with many of the identical intellectual and behavioral deficits demonstrated in children suffering from nonorganic failure to thrive. Because of these facts, whole blood lead levels were determined for 45 children with nonorganic failure to thrive and 45 age-, race-, and socioeconomically matched comparison subjects. Children with failure to thrive had a lead level of 22.67 ± 10.29 (µg/dL (mean ± SD); for control children, it was 14.33 ± 5.42 (P < .001). Children with failure to thrive were more frequently anemic (P < .0001), a possible lead effect, and had higher free erythrocyte protoporphyrin levels. Children with failure to thrive were developmentally delayed on the Denver Developmental Screening Test (unblinded observation) with high failure rates in both language (P < .001) and gross motor skills (P < .02). Although failure on the Denver Developmental Screening Test within the failure to thrive group was not linearly correlated with lead level, any such effects may have been masked by the effects of malnutrition and failure to thrive per se. A number of authors have suggested that lead levels formeriy thought to be inconsequential are clinically toxic. Lead levels in the 15- to 20-µg/dL range interfere with heme synthetase activity and the synthesis of CNS neurotransmitters. Increased lead levels, malnutrition, and iron deficiency are all potentially etiologic in the developmental disabilities ascribed to failure to thrive. Pediatricians should screen all at-risk children with failure to thrive for elevations in lead levels, developmental delay, and iron deficiency. Given that malnutrition per se is synonymous with failure to thrive and may result in increased lead absorption, pediatricians should immediately take steps to ensure adequate caloric intake in children with failure to thrive. The treatment of such biomedical problems as elevated lead levels, malnutrition, and iron deficiency may ameliorate some of the behavioral, cognitive, and interactive deficits observed in nonorganic failure to thrive. Parenting difficulties observed in families with children who fail to thrive may be exacerbated by the child.
Circumcision Debate
Authors: WISWELL THOMAS E.
Published: December 2021

In Reply.—

I wholeheartedly concur with the gist of Dr Cohen's letter. Circumcision, as performed in this country, is a painful, traumatic event. In his superb monograph, Wallerstein1(135-144) discusses the seemingly incongruous approach to newborn circumcision pain. Many believe that there is no pain felt by infants undergoing the procedure. As recently as 4 years ago, a neurosurgeon acquaintance of mine told me that he believed his own son would feel no pain while being circumcised—"he isn't myelinated yet."
Interaction of Dietary Pudding With Phenytoin
Authors: JANN MICHAEL W. , BEAN JOHNNIE , FIDONE GEORGE S.
Published: December 2021

To the Editor.—

Patient compliance with use of anticonvulsant medication is necessary to achieve seizure control. In nonambulatory, mentally retarded epileptic patients, phenytoin tablets (Dilantin Infatabs, Parke Davis) are often crushed and mixed with various semisolid foods to mask their taste and to enhance compliance. At our facility, phenytoin tablets were customarily mixed with vanilla pudding prior to patient administration.

From our routine therapeutic drug-monitoring program, several patients were observed to have low therapeutic serum concentrations despite seemingly adequate phenytoin dosages.
Shigella and Child Abuse
Authors: SMITH RICHARD D. , MCNAMARA JOHN J. , LADD MARYANNE
Published: December 2021

To the Editor.—

Chronic Shigella vulvovaginitis has occasionally been described in children.1-4 Although frequently asymptomatic, approximately 50% of patients have a sanguinous vaginal discharge that, at times, has been confused with gonorrhea. Most authors believe that the etiology of the infection is fecal contamination of the vagina from improper hygiene of the perineum. However, in a substantial percentage of culture-proven cases of Shigella vulvovaginitis, there have been no simultaneous or preceding gastrointestinal symptoms and cultures of the stool and/or rectum were negative.
Dyslipoproteinemia and Migraine
Authors: GLUECK CHARLES J.
Published: December 2021

In Reply.—

Because the anatomic, biochemical, epidemiologic, nutritional, genetic, and clinical genesis of atherosclerosis is in childhood,1,2 it is important to consider models for sampling in childhood for the dyslipoproteinemias. At a minimum, I would recommend a family history-triggered high-risk strategy with sampling of all children whose parents had sustained premature (≤age 60 years) myocardial infarction, angina, cerebrovascular accident, or peripheral vascular disease.1,2 Second, all children with known parental dyslipoproteinemia should be sampled, as should all children with parental history of essential hypertension gout/hyperuricemia, and/or diabetes.
Guanosine Triphosphate Cyclohydrolase I Deficiency: Early Diagnosis by Routine Urine Pteridine Screening
Authors: Naylor Edwin W. , Ennis David , Davidson A. George F. , Wong Lawrence T. K. , Applegarth Derek A. , Niederwieser Alois
Published: December 2021

A deficiency of hepatic guanosine triphosphate cyclohydrolase I is reported in a 4-month-old infant in whom positive results on a Guthrie phenylketonuria test in the neonatal period were found. Because of the significantly elevated serum phenylalanine levels a diagnosis of classical phenylketonuria was made, and dietary therapy was started. Urinary pteridine screening for cofactor variants, however, revealed extremely low levels of both neopterin and biopterin. This suggested the possibility of guanosine triphosphate cyclohydrolase I deficiency and led to additional confirmatory assays. Repeat urine, serum, and CSF pteridine profiles, combined with tetrahydrobiopterin-loading studies and the assay of guanosine triphosphate cyclohydrolase I activity in a liver biopsy, confirmed the defect. It is significant to note that the diagnosis was made before the onset of major clinical symptoms. This case illustrates the need for routine cofactor variant screening of all infants in whom hyperphenylalaninemia is diagnosed in the neonatal period.
Familial Reye-Like Syndrome: A Presentation of Medium-Chain Acyl-Coenzyme A Dehydrogenase Deficiency
Authors: Taubman Bruce , Hale Daniel E. , Kelley Richard I.
Published: December 2021

A 20-month-old girl with a family history of two siblings who died of an encephalopathy diagnosed as Reye syndrome presented to an emergency room in hypoglycemic coma and was found to have medium-chain acyl-coenzyme A dehydrogenase deficiency. The salient clinical and biochemical features of this newly described inborn error of fatty acid metabolism are described and contrasted to those of classical Reye syndrome. Important clues that should lead the clinician to suspect this disorder, methods of diagnosis, and appropriate acute and long-term therapy are also discussed.
Nonsurgical Management of Children With Recurrent or Unresectable Fibromatosis
Authors: Raney Beverly , Evans Audrey , Granowetter Linda , Schnaufer Louise , Uri Antonia , Littman Philip
Published: December 2021

At The Children’s Hospital of Philadelphia, since 1971, six children 3 months to 17 years of age with fibromatosis have been treated with a combination of vincristine, actinomycin D, and cyclophosphamide (VAC). The first three patients also received radiation therapy (5,500 rads). Locally recurrent tumors developed in four of the children after previous operative removal; the other two had tumors that could not be removed initially. The tumors arose in the neck (three patients), pelvis (two patients), or foot (one patient). In the three patients treated with VAC alone, complete disappearance of tumor was confirmed at second operation in two, and greater than 75% shrinkage on CT scans occurred in the third, all at 4 to 6 months after VAC was started. In two of the three patients who received VAC plus radiation therapy, complete disappearance of tumor occurred at 13 and 16 months; the third had no response. Five of the six patients are free of recurrent fibromatosis at 1, 2, 4, and 11 years after VAC was begun; the sixth has required multiple operations during the last 6 years. We conclude that combination chemotherapy with VAC can produce regression of fibromatosis in some children with recurrent or unresectable lesions. The administration of VAC should be considered for children with fibromatosis in whom operative removal is not feasible, would prove mutilating, or is unlikely to produce long-term control of the disease.
Contralateral Pneumothoraces in the Newborn: Incidence and Predisposing Factors
Authors: Ryan C. Anthony , Barrington Keith J. , Phillips Harold J. , Finer Neil N.
Published: December 2021

A prospective study was performed to ascertain the incidence of, and risk factors for, the developmént of a contralateral pneumothorax in 32 neonates with respiratory distress, without evidence of pulmonary hypoplasia, who had an initial unilateral air leak requiring pleural drainage. The mean postnatal age of occurrence of the first pneumothorax was 31.04 hours (range 0.1 to 92 hours); a subsequent contralateral pneumothorax developed in 14 infants (44%) at a mean postnatal age of 61.5 hours (range 8 to 106 hours). Thirteen of the 14 infants with a subsequent contralateral pneumothorax had pulmonary interstitial emphysema visible on the chest radiograph taken immediately after drainage of the first pneumothorax, compared with eight of the 18 infants without a contralateral pneumothorax (P <.005). Other factors significantly associated with a contralateral pneumothorax were alveolar-arterial oxygen gradient (P <.01) and FiO2 (P < .005), both measured one hour after the pneumothorax, and gestational age (P < .05). Multivariate discriminant function analysis did not usefully add to the predictive power of pulmonary interstitial emphysema alone. Infants with pulmonary interstitial emphysema at the time of an initial unilateral pneumothorax are at significant risk for the development of a contralateral pneumothorax.
Buffy Coat Transfusions in Neonates With Sepsis and Neutrophil Storage Pool Depletion
Authors: Wheeler J. Gary , Chauvenet Allen R. , Johnson Christine A. , Block Steven M. , Dillard Robert , Abramson Jon S.
Published: December 2021

A randomized study was initiated in neonates with neutropenia (absolute peripheral neutrophil count <1,500/µL) and suspected bacterial infection. Twenty infants with proven infection were enrolled, nine of whom had depletion of bone marrow stores of maturing neutrophils (≤ 7% metamyelocyte, band and mature forms per 100 nucleated cells). These nine were randomized to receive 15 mL/kg of either buffy coat transfusions (group 2) or plasma and blood products (group 3). The remaining 11 (group 1) were observed. Peripheral neutrophil counts were monitored to determine the neutrophil response to transfusions. There were ten of 11 patients in group 1, two of four in group 2, and two of five in group 3 who lived at least seven days. No complications of transfusion were noted. No difference in the rate of peripheral neutrophil increase was found among the three groups. The study was stopped when it became clear that sufficient numbers of patients could not be entered into the study, in a reasonable period of time, to prove or disprove a clinically significant improvement in outcome. Although in vitro testing of the buffy coat preparations showed normal function in three of four cases, the clinical quality of the buffy coats may have been inadequate because of poor availability of whole fresh blood less than 24 hours old. The role of neutrophil transfusions in these patients remains unclear.
Familial Right Thoracic Stomach
Authors: HUBERT BRUCE C. , TOYAMA WILLIAM M.
Published: December 2021

Hiatal hernia reportedly occurs in about one in 1,000 infants.1 Failure of fusion of the dorsal mesentery and the developing stomach probably accounts for the widened esophageal hiatus. A continuum then exists that ranges from a small loculus of gastric mucosa in the chest (partial thoracic stomach) to a complete herniation of the stomach into the thoracic cavity. This abnormality has rarely been reported in infancy and, almost always, the hernia has been reported in the left thoracic cavity.2-4 A familial occurrence in infants in successive generations has never been previously reported.

CASE REPORTS

K.C., a 2-month-old white boy, was admitted to the Marshfield Medical Center because of a progressive increase in postprandial vomiting.
Head Start: Making a Popular Program Work
Authors: BESHAROV DOUGLAS J. , HARTLE TERRY W.
Published: December 2021

Head Start, the federal government's preschool program for low-income children, is one of the nation's most popular domestic initiatives. In 1980, President Carter praised it as "a program that works." President Reagan included Head Start in the "safety net" and has presided over a substantial funding increase.

Head Start began in 1965 as a 6-week summer experiment in using child development services to improve the future prospects of disadvantaged children. It quickly became a full year program. Now, 20 years old, it serves about 450,000 children, at an annual cost of more than $1 billion.

The program's popularity is based on the widespread impression that it lifts poor children out of poverty by improving their learning ability and school performance.
Tobacco Use by Children and Adolescents
Authors:   Committee on Adolescence
Published: December 2021

Cigarette smoking is the chief single avoidable cause of death in our society and the most important health issue of our time.1

Despite increased public awareness of the long-term morbidity associated with the initiation of cigarette smoking during childhood and adolescence, the 1979 US Surgeon General's report on the health consequences of smoking estimated that 6 million teenagers smoke, and there are another 100,000 youngsters less than 13 years of age who smoke.2 In 1979, the National Institute of Education reported a fivefold increase in the number of smokers between junior high school- and senior high school-aged students.3 In 1983, Johnston et al4 found that 21% of high school seniors were regular daily smokers. Although there has been a general decline of cigarette smoking among male adolescents, there has been no parallel decline in the rate of cigarette smoking among young women, particularly those 17 and 18 years of age (J. A. Califano, Jr, unpublished remarks, 1968, 1974, 1979). Young women who use oral contraceptives are at higher risk of cardiovascular complications if they smoke. Among women who smoke during pregnancy, there is increased risk of poor fetal growth, spontaneous abortion, fetal death, and neonatal death.5,6

In addition to the use of cigarettes, the use of "smokeless tobacco," eg, chewing tobacco and snuff, is becoming more common among young people, particularly rural youth. It is estimated that between 10% and 20% of high school students use smokeless tobacco.7 Its use has been associated with leukoplakia, oral cancer, tooth abrasion, and loss of teeth.8
Applesauce and Isoniazid
Authors: ABERNATHY ROSALIND S.
Published: December 2021

To the Editor.—

Notterman et al (Pediatrics 1986;77:850-852) reported about an 8-month-old infant who absorbed crushed isoniazid in applesauce poorly both during treatment for tuberculous meningitis and later in pharmacokinetic studies. A second child exhibited a less severe malabsorption. The authors state that "Children should not be treated with untested ad hoc preparations of drugs. Common practice and textbook recommendations based on such practice may be seriously misleading."

I believe that is an unjustified condemnation of a longstanding practice.
Applesauce and Isoniazid
Authors: NOTTERMAN DANIEL A.
Published: December 2021

In Reply.—

Abernathy indicates that she has achieved favorable results with chemotherapy of tuberculosis using a crushed isoniazid tablet admixed with a teaspoon of applesauce, jelly, or jam (flavor not specified). Citing historical controls, she also implies that the generally favorable response to antituberculous therapy in children supports the use of isoniazid preparations that have not undergone rigorous pharmaceutical scrutiny, including tests of gastrointestinal absorption.

In our study,1 the isoniazid was mixed with a tablespoon of applesauce rather than a teaspoon as used by Abernathy.
Thumb-Sucking Debate
Authors: MACKENZIE ELLEN P.
Published: December 2021

To the Editor.—

I practiced pediatrics for 14 years before I switched specialties to psychiatry, which I have practiced (both adults and children) for the past 21 years. Therefore, I have double reason to be perturbed by the article on aversive taste treatment in Pediatrics (1986;78:174-176), which is apparently offered as the voice of "Experience and Reason." To contradict this study of seven children from three families, I offer my experience since 1944 and the reasons for what I recommend.
Thumb-Sucking Debate
Authors: FRIMAN PATRICK C. , BARONE VINCENT J. , CHRISTOPHERSON EDWARD R.
Published: December 2021

In Reply.—

In the course of Dr MacKenzie's considerable clinical experience, she has established some strong opinions about thumb sucking and a method for its treatment. We have been treating thumb sucking for more than 10 years1 and have only recently subjected our method to an empirical analysis. Prior to conducting our analysis, we did an extensive library search for empirical studies on the etiology and treatment of thumb sucking. We did not find any data-based references for the inevitability of a "power struggle" between thumb-sucking children and their parents, for the primary prevention of thumb sucking, or for the efficacy of long-term supportive visits to the pediatrician for thumb sucking.
Why I Have Difficulty Being Enthusiastic About Recommending That Children Wear Helmets on Bicycles
Authors: CIASTKO ALLEN R.
Published: December 2021

To the Editor.—

Dr Weiss in his study of bicycle helmet use in Pediatrics (1986;77:677-679) makes a plea to pediatricians and family physicians to advocate bicycle helmet use based on the frequency and severity of head injuries reported in other studies of bicycle accidents. Unfortunately, most studies quoted either reviewed bicycle injuries in isolation from other types of injury or were national death report statistics which represent only the tip of the iceberg (ignoring relative morbidity statistics).
Fetal Abuse and Neglect: An Emerging Controversy
Authors: Landwirth Julius
Published: December 2021

Advances in fetal medicine have expanded opportunities for protection of fetal health and intrauterine management of an increasing number of fetal disorders. The legal rights and duties of parents to provide necessary medical treatment for the child may extend to the prenatal period. Resolution of the conflict between the rights of the fetus to be born healthy and the pregnant woman's right of privacy is difficult and controversial. It is suggested that intrusion into a woman's individual fundamental rights for the potential benefit of her fetus should be permissible only in narrowly defined circumstances.
SUCCESSFUL MANAGEMENT OF PROTRUSION OF THE TONGUE IN A FIVE-YEAR-OLD ENGLISH BOY (1805)
Authors: C. T. E.
Published: December 2021

The following case report published in 1805 describes the successful treatment of a markedly protruding tongue in a young boy. The method is so simple that one wonders whether the author has not omitted something in the history.

On Thursday, May 24, 1804, Ralph Heighington, five years old, was admitted into the Sunderland Dispensary. He had been much distressed with worms, and for this complaint he was put under my charge. He had every appearance of scrofula, such as ophthalmia tarsi, and marks under the chin from scrofulous sores, etc.; but what chiefly attracted my attention was his tongue, which was so much enlarged in length, breadth, and thickness, that it hung out of his mouth considerably below the chin. It had a very disgusting appearance. The upper part of it was rugose, and indented with a few longitudinal fissures. The dentes incisores were gone; and the few remaining molares were much diseased, and ready to drop out. He could not utter a single syllable, but appeared to understand everything I said to him. The tongue began to swell before he was a year old; and increased so rapidly, as to prevent him from learning to speak a word. By the use of a few vermifuge medicines, a large quantity of worms were expelled, and, with them, all the concomitant symptoms disappeared. The tongue remained still much the same, being protruded without the mouth about three inches. The more he endeavoured to pull it within his lips, the further it appeared to be protruded. I thought it expedient to ... push back the tongue, and shut the mouth; but the moment he withdrew his hand, it burst without the mouth, the same as before. I ordered the tongue to be returned into the mouth, and retained there by means of a silk handkerchief, which was passed below the chin, and the ends firmly fastened at the crown of the head. By this means the jaws were kept perfectly close together. At first he appeared very uneasy, but being relieved occasionally, by taking off the handkerchief for a few minutes, and replacing it again, he was enabled to bear it; and, in the course of five weeks, the tongue became of the natural size and appearance, and he could pronounce several short words very distinctly. By these means, a perfect cure was effected.
Pneumatic Otoscopy in Healthy Full-Term Infants
Authors: Cavanaugh Robert M.
Published: December 2021

Pneumatic otoscopy was performed on 81 healthy full-term babies during the first 72 hours of life and at routine well-baby follow-up visits. Only 14 of 115 (12%) of the eardrums visualized during the first three days of life moved briskly to insufflation as compared with 29 of 65 (44%) and 50 of 71 (71%) by 3 weeks and 10 weeks of age, respectively. A pink color was noted in 38 of 115 (33%) and redness in five of 115 (4%) of the eardrums examined during the first 72 hours of life, whereas 64 of 71 (90%) of the tympanic membranes appeared gray by age 10 weeks. Tympanic membrane dullness, decreased light reflex, and diminished translucence, occurred in greater than 90% of the infants during the first three days of life and declined to 26% or less by 4 months of age. The data suggest that limited mobility, changes in color, poor luster, and relative opacity of the tympanic membrane occur in healthy neonates and may reflect physiologic changes unique to the newborn period.
Pulse Oximetry: An Alternative Method for the Assessment of Oxygenation in Newborn Infants
Authors: Jennis Michael S. , Peabody Joyce L.
Published: December 2021

Continuous monitoring of oxygenation in sick newborns is vitally important. However, transcutaneous Po2 measurements have a number of limiations. Therefore, we report the use of the pulse oximeter for arterial oxygen saturation (Sao2) determination in 26 infants (birth weights 725 to 4,000 g, gestational ages 24 to 40 weeks, and postnatal ages one to 49 days). Fetal hemoglobin determinations were made on all infants and were repeated following transfusion. Sao2, readings from the pulse oximeter were compared with the Sao2 measured in vitro on simultaneously obtained arterial blood samples. The linear regression equation for 177 paired measurements was: y = 0.7x + 27.2; r = .9. However, the differences between measured Sao2 and the pulse oximeter Sao2 were significantly greater in samples with > 50% fetal hemoglobin when compared with samples with < 25% fetal hemoglobin (P < .001). The pulse oximeter was easy to use, recorded trends in oxygenation instantaneously, and was not associated with skin injury. We conclude that pulse oximetry is a reliable technique for the continuous, noninvasive monitoring of oxygenation in newborn infants.
Need for Large Sample Sizes in Randomized Trials
Authors: HENNEKENS CHARLES , BURING JULIE E.
Published: December 2021

Prevention is an area of relevance and concern to all health professionals, in particular, pediatricians. This concept encompasses primary prevention of disease (such as diphtheria, pertussis, tetanus, and poliomyelitis) among healthy individuals as well as secondary prevention or the reduction in risks of complications, recurrences, or mortality among those already affected. It is unlikely that a new measure will have as dramatic an effect as did the poliomyelitis vaccine, a prevention measure, which reduced the incidence of paralytic disease in the vaccinated group more than 50% compared with children given placebo. Analogously, virtually none of the new therapeutic measures of promise is likely to have as clear-cut an effect as did penicillin, which decreased mortality from pneumococcal pneumonia approximately sixfold (from about 95% to 15%).
Pediatric Lead Poisoning in 1987: The Silent Epidemic Continues
Authors: LANDRIGAN PHILIP J. , GRAEF JOHN W.
Published: December 2021

Great gains in the understanding and control of childhood lead poisoning have been made since this disease was first diagnosed in the early years of this century. Efforts of pediatricians, public health officials, and enlightened regulators have brought about substantial reductions in the lead content of paint, food, milk, water, air, and, most recently, gasoline. Significant decreases in children's blood lead levels and in the incidence of lead poisoning have resulted. Few American pediatricians trained in the past decade have ever seen a child with the coma, papilledema, and convulsions of acute lead encephalopathy.

Despite these advances, the silent epidemic of childhood lead poisoning is not yet over. It is particularly well now that we function in this manner because some of the important issues that we are dealing with at this time are items that cannot be completed by this date. We will depend upon the new Executive Committee and new Executive Board to carry these issues to completion.

Last year, I spoke to you with a great deal of concern about our problems in medical liability. I expressed a conviction that an independent research on this subject could contribute to a real resolution of the problem. We have pursued this plan during the year and I can tell you now that, at the instigation of the Academy, the Institute of Medicine of the National Academy of Sciences has held a feasibility study and a planning meeting during this year. This has lead to the formation of a proposal for the research that is now waiting only for the funding to proceed.
Pulse Oximetry in Very Low Birth Weight Infants With Acute and Chronic Lung Disease
Authors: Ramanathan Rangasamy , Durand Manuel , Larrazabal Carlos
Published: December 2021

With improved survival of very low birth weight infants, the incidence of bronchopulmonary dysplasia has significantly increased. Pulse oximetry appears to be an adequate alternative to transcutaneous Po2, for continuous arterial oxygen saturation (Sao2) monitoring in neonates; however, its usefulness has not been very well documented in very low birth weight infants. We studied 68 patients with birth weight < 1,250 g; 44 neonates had respiratory distress syndrome and 24 had bronchopulmonary dysplasia. Using a Nellcor N-100 pulse oximeter, we compared transcutaneous oxygen saturation with simultaneous arterial samples analyzed for Sao2 (range 78% to 100%) using an IL 282 co-oximeter. Fetal hemoglobin was measured in 66 patients. We also evaluated the accuracy of transcutaneous Po2 in reflecting arterial Po2 in patients with bronchopulmonary dysplasia. Over a wide range of Po2, Pco2, pH, heart rate, BP, hematocrit, and fetal hemoglobin, linear regression analysis revealed a close correlation between pulse oximeter values and co-oximeter measured Sao2 in patients with acute (r = .88, Y = 19.41 + 0.79X) and chronic (r = .90, Y = 9.72 + 0.92X) disease. Regression analysis of transcutaneous v arterial Po2 in infants with bronchopulmonary dysplasia showed an r value of .78. In addition, in these patients with chronic disease, the mean difference between pulse oximeter Sao2 and co-oximeter measured Sao2 was 2.7 ± 1.9% (SD); whereas the mean difference between transcutaneous and arterial Po2 was -14 ± 10.7 mm Hg.

Our findings indicate that pulse oximetry can be used reliably in very low birth weight infants with acute and chronic lung disease, for Sao2 values greater than 78%. This technique is more advantageous than transcutaneous Po2 in infants with bronchopulmonary dysplasia. Additional studies are needed to evaluate the performance of the pulse oximeter in tiny infants with Sao2 values < 78%.
DO WE PROTECT PATIENTS OR RELATIVES?
Authors: Student
Published: December 2021

Patients should be encouraged to ask for information they want, but not have it forced upon them. Someone dying may, early in the illness, feel the need for less information than is required later on. The young usually need more information than the old, but generalisations are to be mistrusted. Relatives are to be listened to courteously but the plea "You won't tell him will you, he couldn't stand it" is often to be translated as "You won't tell him will you? I don't think I can handle it."
INFORMED CONSENT IN CLINICAL TRIALS
Authors: Student
Published: December 2021

What arguments are there for and against full informed consent? In favour is the need to respect another's right to self-determination. Also, information about the trial will improve the patient's knowledge and understanding of his illness and treatment. And some doctors might consider it worthwhile to involve patients when decisions are made, while others might merely be trying to protect themselves from unwelcome publicity. Indeed, informed consent may be chiefly a legalistic device to pass on to the patient unpleasant responsibilities that should have been the physician's.
Prolonged Mechanical Ventilation and Intracranial Hemorrhage: Impact on Developmental Progress Through 18 Months in Infants Weighing 1,200 Grams or Less at Birth
Authors: Bozynski Mary Ellen A. , Nelson Michael N. , Matalon Terence A. S. , O'Donnell Karen J. , Naughton Patricia M. , Vasan Ushanalini , Meier Werner A. , Ploughman Lynn
Published: December 2021

In this prospective, longitudinal study, the relative impact of intracranial hemorrhage and prolonged mechanical ventilation on developmental progress during the first 18 months of life of infants weighing 1,200 g or less at birth was examined. A total of 159 surviving infants were divided into two groups: infants with and those without intracranial hemorrhage. These groups were then subdivided into groups of infants receiving prolonged mechanical ventilation (> 21 days) and those mechanically ventilated for 21 days or less, thus creating four subgroups. Group 1 (intracranial hemorrhage and prolonged mechanical ventilation) and group 3 (intracranial hemorrhage and no prolonged mechanical ventilation) showed no statistically significant differences for severity of intracranial hemorrhage, persistence of yentriculomegaly, or presence of periventricular leukomalacia. A repeated-measures analysis of variance demonstrated a main effect for prolonged mechanical ventilation on outcome as measured by the Bayley Mental Development Index and Bayley Psychomotor Development Index at 4, 8, 12, and 18 months of age (corrected for prematurity). Forward stepwise regression revealed prolonged mechanical ventilation to be the best predictor of Bayley indexes at all ages except 4 months of age, for which the Psychomotor Development Index was best predicted by length of hospitalization. No main effect for intracranial hemorrhage was demonstrated, but the motor performance of infants with intracranial hemorrhage declined significantly with age. By contrast prolonged mechanical ventilation was associated with uniformly poor performance at every age and serves as a powerful marker for poor developmental progress during the first 18 months of life in infants weighing 1,200 g or less at birth.