bluuebunny/crossref_metadata_2025 huggingface dataset:
Triploidy: Case Report of a Live-born Male and an Ethical Dilemma
Authors: FAIX ROGER G. , BARR MASON , WATERSON JOHN R.
Published: December 2021

Triploidy (69 chromosomes) is found in as many as 12% of karyotyped spontaneous first trimester abortuses, but it is rare in live-born infants.1 The longest reported survival of an infant with complete triploidy is seven months.2 Multiple anomalies, poor weight gain, and neurodevelopmental arrest are characteristic of the few reported liveborn infants.2-5 The uniformly dismal outcome of these infants has been considered a contraindication for the use of extraordinary support, eg, mechanical ventilation, once the diagnosis is established. However, ethical issues concerning the treatment of such severely handicapped children are subjects of continuing controversy. The present report describes the course of a male infant with complete triploidy; his survival was artificially prolonged for four months in accordance with parental religious beliefs.
Vitamin K Deficiency in Infancy in Japan
Authors: NAGAO TAKESHI , NAKAYAMA KENTARO
Published: December 2021

To the Editor.—

Lane et al1 reported a case of fatal intracranial hemorrhage in a normal infant who was retrospectively determined to have had vitamin K deficiency. This paper rings the alarm against the tendency toward cessation of routine prophylactic administration of vitamin K at birth for full-term infants. We support this opinion because there are many cases of intracranial hemorrhage due to "idiopathic" vitamin K deficiency in infancy in Japan and this may be related to abandonment of routine vitamin K administration at birth.
Bacterial Flora of Breast-Fed Infants
Authors: ROSE STEPHEN J.
Published: December 2021

To the Editor.—

I read with interest the article on the development of neonatal intestinal flora by Yoshioka et al,1 but found myself at variance with them on several points. Early workers2 described marked differences in the bacterial flora of breast-fed and formula-fed infants with bifidobacteria and lactobacilli predominating in the former group and enterobacteria in the latter. However, the formula then used was a high-solute feed and more recently, other workers3-5 (including myself) have not confirmed these results.
A Believer in Phototherapy
Authors: HEIN HERMAN A.
Published: December 2021

In Reply.—

Rosenbaum's letter provided nothing to change my opinion of the use of phototherapy for healthy, term neonates.

I think you should be advised that the Rocky Mountain Medical Corporation of Greenwood Village, Colorado, is a corporation that sells home phototherapy units.
AAP Periodicity Guidelines: A Framework for Educating Patients
Authors: Strain James E.
Published: December 2021

In 1967 the American Academy of Pediatrics published standards for periodic health supervision visits. In 1972 and 1975, in response to changes in child health needs, the guidelines were revised. The current AAP periodicity guidelines, adopted in 1981, provide for reasonable care and meet the minimum requirements for preventive health services for normal infants, children, and adolescents. Whereas detecting physical defects, evaluating illness, and assessing the child's development are key elements of the periodic visit, parent education is equally important. The educational aspects of a health supervision visit—which consists of interval history, measurements, sensory screening, developmental and behavioral assessment, physical examination, procedures, and anticipatory guidance—are stressed. A prenatal visit is important, particularly for first-time parents. Periodic visits are also valuable for adolescents, who face special concerns such as substance abuse, risk-taking behavior, and problems of sexuality. Often, the pediatrician may be the only professional whose advice and counsel the teenager will accept.
Pacifying Effects of Nonnutritive Sucking on Term and Preterm Neonates During Heelstick Procedures
Authors: Field Tiffany , Goldson Edward
Published: December 2021

Behavioral state, heart rate, and respiration were monitored during heelstick procedures in samples of healthy, term neonates (N = 48) and preterm neonates treated in minimal care (N = 48) and intensive care (N = 48) nurseries. The treated infants who were given pacifiers spent significantly less time fussing and crying during and following the heelstick procedures. Physiologic arousal was monitored in both preterm groups but was attenuated only in the preterm infants who received pacifiers (minimal care group). As similar amounts of sucking were observed in both preterm groups, the inconsistency in treatment effects on behavioral and physiologic arousal was interpreted as a lack of cardiac-somatic coupling in the neonate in intensive care. Results suggest that nonnutritive sucking during heelstick procedures may attenuate behavioral distress in all neonates and physiologic arousal in neonates with less severe postnatal complications.
Basilar Impression in Children
Authors: Teodori Janet B. , Painter Michael J.
Published: December 2021

Ataxia is a common neurologic sign in childhood. Basilar impression due to bony abnormalities of the craniovertebral junction is an uncommon but readily treatable cause of ataxia in children. Two children who had neck stiffness, ataxia, nystagmus, and corticospinal tract signs are described. Basilar impression was recognized only after specific radiologic studies were performed. Both children were treated surgically with good results.
High-Dose Intravenous Immunoglobulin for Severe Platelet Alloimmunization
Authors: BECTON DAVID L. , KINNEY THOMAS R. , CHAFFEE SARA , KURTZBERG JOANNE , FRIEDMAN HENRY S. , FALLETTA JOHN M.
Published: December 2021

The development of platelet alloimmunization is a common and potentially severe consequence in patients who receive frequent platelet transfusions. The use of single-donor pheresis units or human lymphocyte antigen (HLA)-matched platelets to prevent or delay the onset of alloimmunization is often unsuccessful. Once sensitization occurs and refractoriness to platelet transfusions develops, patients are at risk of severe bleeding which may be difficult to manage. There has been no reliably effective therapy for such patients once alloimmunization occurs.

High-dose intravenous (IV) immunoglobulin therapy has been used to treat patients with autoimmune thrombocytopenia,1-4 autoimmune neutropenia,5,6 and posttransfusion purpura.7 Because of its success in these disorders, IV immunoglobulin was given to two patients with hemorrhagic symptoms who were refractory to platelet transfusions because of alloimmunization.
Poverty, Hunger, Malnutrition, Prematurity, and Infant Mortality in the United States
Authors: GRAHAM GEORGE G.
Published: December 2021

In the underdeveloped world it is not difficult to establish cause-and-effect relationships between unemployment and underemployment, poverty, inadequate diets, chronic hunger, undernutrition and malnutrition, low birth weight, high infant and preschool child mortalities, and growth stunting among the survivors.1 Early in the 20th century, when millions of Europe's poor migrated to this country and crowded into inadequate and unsanitary urban settings, such relationships were clearly present.2 Whether the mass migrations, during World War II, of the South's rural poor into the industrial centers of the North created a similar problem is doubtful, as progress was being made simultaneously in the control of diarrheal diseases and other infections, and in assuring the quality, safety, and low cost of our food supply. Trends in infant and child mortality and in the growth of children revealed continued improvement in health and nutritional status.
The Face in Otitis Media
Authors: SHAPIRO GAIL G.
Published: December 2021

In Reply.—

Sharon's impression that children with a specific facies might be more prone to otitis, if true, might mean that there is an association between certain facial growth pattern and aberrant Eustachian tube function. Along the same lines, there is limited evidence and much discussion about the incidence of ear problems being higher in allergic children; their Eustachian tubes are compromised by the changes induced by hypersensitivity reactions in the contiguous area.

As intimated by Sharon, perhaps the sequelae of chronic rhinitis are twofold: facial growth abnormalities and Eustachian tube dysfunction.
The Human Weaning Process
Authors: Whitehead R. G.
Published: December 2021

The weaning process in relation to the nutritional adequacy of human lactation is reviewed. Current trends in breast-feeding, both in industrialized countries and the developing world, are considered, as well as associated changes in weaning practices. Consideration is also given to infant growth patterns in the Western world and how these are being influenced by current dietary practices. The nutritional requirements of babies during the first year of life are discussed, and recent concepts indicating that current estimates might be in excess of physiologic needs are introduced. These theories are of fundamental practical importance in terms of defining the length of time that exclusive breast-feeding remains adequate and determining when the introduction of complementary foods becomes necessary on nutritional grounds. It is emphasized that the weaning process is naturally a lengthy one, lasting many months rather than a few weeks, and that the provision of additional foods need not inhibit a mother's capacity for lactation as long as these feeds are administered in the correct fashion.
Summary-The Weaning Process
Authors: Finberg Laurence
Published: December 2021

Early in this symposium, Räihä (p 136) called attention to the biologic truism that breast-feeding evolved so that the composition of human milk would be optimal for the survival of the species, which must include the mother's survival as well as the infant's. However, optimal for survival in infancy may not be the same as optimal for life in the fifth, sixth, and subsequent decades of modern life. Therefore, as we consider approaches to infant feeding, these considerations, unanswerable at present, should be continuously in our thinking, at no time more than when we consider the weaning period, which, though variously defined, presents the most important nutritional challenge of modern times.

Whitehead has provided us with the news that our understanding of energy requirements for infants is surprisingly imperfect. His data suggest that sole breast-feeding by well-nourished mothers has sufficient calories for optimal growth on the average for 3 months. After this point, the average infant requires another source of calories. This conclusion comes from calculations derived from the National Center for Health Statistics growth curves on the one hand and actual milk production on the other. Although there is room for improvement of the data base, there is certainly a suggestion that weaning should begin at about 3 months of age in the breast-fed infant.

This point is underscored by Underwood, who views weaning as a long-term process in which calories from other foods complement human milk until the infant moves to the family diet. In some societies, such a process may extend over several years, and the presence in human milk of the digestive enzymes amylase and lipase adds an aura of naturalness to such a process.
Infant Bioethics Committees
Authors: DONOVAN EDWARD F.
Published: December 2021

To the Editor.—

The American Academy of Pediatrics Guidelines for Infant Bioethics Committees1 appeared in the midst of increasing public attention on patients such as the Indiana and Long Island Baby Does and in the maze of adopted, invalidated, and newly proposed federal regulations regarding the care of handicapped and otherwise compromised infants. That the AAP guidelines, the Baby Does, and the federal regulations are unrelated events seems unlikely. That the latter two are sufficient justification for the imperfect first is problematic.
Breast-Feeding by Employed Mothers: A Reasonable Accommodation in the Work Place
Authors: Katcher Avrum L. , Lanese Mary Grace
Published: December 2021

A nonprofit voluntary community hospital, the Hunterdon Medical Center, has made a commitment to encourage breast-feeding among employees. In support of this commitment, arrangements were made for time off during the work day for nursing mothers to pump their breasts. An electric breast pump in a suitably accessible location and supportive professional advice were offered. Among those who chose to nurse their babies, it was found that mothers nursed for longer times and were more likely to continue nursing after return to employment when this program was available.
Atrial Flutter in Infancy: Diagnosis, Clinical Features, and Treatment
Authors: Dunnigan Ann , Benson D. Woodrow , Benditt David G.
Published: December 2021

The clinical features and treatment of atrial flutter in eight infants (four male and four female) less than 2 months of age are presented. Atrial flutter was noted during the first week of life in six of the infants and between 6 and 8 weeks of life in the other two infants. Four of the eight infants had associated structural or functional cardiovascular disease, and in three infants a central venous pressure catheter was present in the atrium at the time atrial flutter was diagnosed. Classic flutter waves were apparent on 12-lead ECGs in only two infants. In six infants, flutter waves were not obvious on standard ECGs, but transesophageal electrogram recordings demonstrated the presence of atrial flutter with second degree atrioventricular block. The atrial cycle length during flutter ranged from 135 to 180 ms (mean 149 ms; mean atrial rate 403 beats per minute); there was a 2:1 ventricular response to atrial flutter. Successful termination of atrial flutter was accomplished using three modes of electrical cardioversion in seven of the eight infants: direct curent cardioversion in one, transvenous atrial pacing in one, and transesophageal atrial pacing in five. One asymptomatic infant converted to normal sinus rhythm 24 hours following digoxin administration. One infant had multiple atrial flutter recurrences and required chronic procainamide therapy. In seven of the eight infants, no recurrences have been noted in 6 months to 31/2 years of follow-up. These results demonstrate that atrial flutter may be difficult to diagnose in infants with tachycardia unless transesophageal electrogram recording is utilized for evaluation. In these eight infants, atrial flutter was frequently associated with underlying cardiac disease and/or the presence of central venous pressure catheters in the atrium. Acute treatment with electrical conversion was sufficient in most infants; only one infant required chronic drug therapy to prevent recurrences of atrial flutter.
Aerobic Capacity, Obesity, and Atherosclerotic Risk Factors in Male Adolescents
Authors: Fripp Raymond R. , Hodgson James L. , Kwiterovich Peter O. , Werner John C. , Schuler H. Gregg , Whitman Victor
Published: December 2021

Correlations between aerobic capacity, obesity, and atherosclerotic risk factors were evaluated in adolescents with low-to-moderate levels of physical fitness. Subjects with higher levels of fitness had a more favorable risk profile with decreased body mass index, lower systolic and diastolic blood pressure and plasma triglyceride levels, and higher plasma high-density lipoprotein-cholesterol levels. Simple linear regression analysis revealed an association between body mass index and blood pressure, plasma triglyceride and plasma highdensity lipoprotein-cholesterol. The level of aerobic fitness as determined by exercise duration was also associated with the same atherosclerotic risk factors. However, multiple linear regression analysis demonstrated that body mass index provided the largest explanation, by those variables examined, of the interindividual variance in blood pressure, plasma triglyceride, and high-density lipoprotein-cholesterol. Aerobic fitness contributed only minimally to the variation in these risk factors. These findings suggest that if aerobic conditioning is used to modify atherosclerotic risk factors, it should be accompanied by a reduction in weight in adolescents with low-to-moderate levels of physical fitness.
Social and Familial Factors in the Development of Early Childhood Asthma
Authors: Horwood L. J. , Fergusson D. M. , Shannon F. T.
Published: December 2021

The role of social and familial factors in the development of childhood asthma by age 6 years was studied in a birth cohort of New Zealand children. Rates of asthma varied markedly with the child's sex; boys had twice the rate of asthma as girls. In addition, the factors associated with asthma varied with the child's sex. For boys, wheeze during infancy, early eczema, and parental asthma were all significant risk factors; for girls, the only risk factor was early eczema. Proportional hazards modeling of the data failed to show any significant associations between the development of asthma and a large range of other social and familial factors including breast-feeding, parental smoking habits, pets in the child's family, stress in the family, or family social background. It was concluded that asthma in early childhood appeared to be inherited to some extent, its age of expression was related to the child's sex, and it had a complex interaction with other forms of allergic disease. There was no evidence to suggest that the structure, practices, or dynamics of the child's family played a significant role in the development of asthma for children in this birth cohort.
Asthma and Pneumomediastinum
Authors: ZWERDLING ROBERT G.
Published: December 2021

To the Editor.—

Sturtz's case report and brief review of the literature on spontaneous mediastinal emphysema is interesting.1 However, he neglects to mention what is perhaps the most common cause of this condition in childhood—asthma. Indeed, reports of this complication have occurred over the past 130 years.2-4 Recognition of this fact often results in an understanding of the cause for the pneumomediastinum as well as tipping the clinician off to a possibly undiagnosed but readily treatable condition.
Nonspecific Vaginitis Following Sexual Abuse in Children
Authors: Hammerschlag Margaret R. , Cummings Marinella , Doraiswamy Brinda , Cox Phyllis , McCormack William M.
Published: December 2021

Nonspecific vaginitis, one of the most common causes of vaginitis in adults, is a polymicrobial infection in which vaginal anaerobes act synergistically with Gardnerella vaginalis. The diagnosis is made by examination of the vaginal secretions for clue cells, the development of a fishy odor after the addition of 10% KOH to vaginal secretions, and a vaginal pH greater than 4.5. To determine whether nonspecific vaginitis occurs in sexually abused children, we obtained vaginal washes from 31 abused and 23 nonabused children, 2½ to 13 years of age. A child was considered to have definite nonspecific vaginitis if her wash contained both clue cells and odor; she was considered to have possible nonspecific vaginitis if her wash contained either clue cells or odor. We did not use vaginal pH as a diagnostic criterion because the normal range has not been standardized in prepubertal girls. Possible nonspecific vaginitis (odor only) was found in only 1/23 (4%) of nonabused children. This girl was asymptomatic and findings from her examination were normal. Only one of the 31 abused children had possible nonspecific vaginitis (odor) detected at the initial examination, less than 48 hours after the episode of abuse, whereas 4/31 (13%) developed definite, and 4/31 (13%) possible nonspecific vaginitis at the follow-up visit more than seven days after the episode of abuse or rape. Five of these eight girls developed either a new vaginal discharge or dysuria; three were treated with metronidazole with resolution of their symptoms and reversion of the vaginal wash to normal. These findings suggest that nonspecific vaginitis is uncommon in normal children and that it can be acquired after sexual abuse. Nonspecific vaginitis was the most frequent cause of vaginitis in the abused girls in this study. Examination of a vaginal wash for clue cells and odor should be part of the evaluation of sexually abused girls who develop vulvovaginal symptoms.
Changes in Superior Sagittal Sinus Blood Velocities Due to Postural Alterations and Pressure on the Head of the Newborn Infant
Authors: Cowan Frances , Thoresen Marianne
Published: December 2021

A pulsed Doppler bidirectional ultrasound system has been used to measure alterations in the blood velocities in the superior sagittal sinus of the healthy term newborn infant in response to unilateral and bilateral jugular venous occlusion. These maneuvers were performed with the baby lying in different positions: supine, prone, and on the side (both left and right), the neck flexed or extended, and with the head in the midline or turned 90 degrees to the side (both left and right). Transfontanel pressure was also measured in these positions during occlusions. Results show that turning the head effectively occludes the jugular vein on the side to which the head is turned and that occluding the other jugular vein does not force blood through this functional obstruction. The effect of different forms of external pressure to the head on the superior sagittal sinus velocities was also examined. Alterations in velocities were frequently profound although they varied considerably from baby to baby. This work shows how readily large fluctuations in cranial venous velocities and pressures can occur in the course of normal handling of babies.
Usefulness of Exercise Stress Testing for Prediction of Blood Pressure Trends
Authors: Fixler David E. , Laird W. Pennock , Dana Kent
Published: December 2021

The purpose of this study was to determine whether values of blood pressure during exercise help predict which adolescents are prone to maintain high blood pressure. Dynamic and isometric exercise stress tests were performed on 131 adolescents who had had systolic or diastolic pressures greater than the 95th percentile on three examinations the previous year. Follow-up blood pressures were measured 1 year after the stress testing, and outcomes were classified on the basis of the blood pressure status that year. Stepwise regression analysis was used to examine the association between earlier blood pressures and exercise pressures with outcome pressures. In both male and female adolescents, the average resting systolic pressure on the earlier survey was the best predictor of systolic pressure 2 years later. Blood pressures and heart rates during dynamic and isometric exercise did not significantly contribute to the models' prediction of future systolic or diastolic pressures. The data suggest that exercise stress testing is not a valid method for predicting youths whose blood pressures will remain elevated over the next 1 to 2 years.
Risk Assessment of Ipecac in the Home
Authors: Chafee-Bahamon Claire , Lacouture Peter G. , Lovejoy Frederick H.
Published: December 2021

To determine how frequently parents give ipecac syrup without medical consultation and what complications result from this practice, 8 months of telephone calls to a regional poison center for poisonings of children less than age 6 years (23,790 calls) and 3 years of medical records for children's poisonings from 21 hospitals (516 cases) were studied. The practice of using ipecac syrup without consultation ranged from 0.4% of poison center callers to 6.0% of hospital patients. Of the 137 parents who gave ipecac without consultation, only 4% gave ipecac syrup for a poisoning exposure for which its use was contraindicated. In none of these cases did medical complications such as aspiration, seizures, or gastrointestinal burns result. Hence, the practice of giving children ipecac syrup without medical advice was found to be relatively infrequent and rarely produced complications. The study pointed out the importance of educating parents about products for which ipecac syrup is contraindicated and about occasions when ipecac is unnecessary. In 61% of cases of poisonings, the parent gives ipecac before calling the poison center and learning that the child did not need the Ipecac. The study also suggested that improvements are needed in warning labels of particular products, and revisions and standardization of the labels found on different brands of ipecac syrup are essential for appropriate emergency care.
Prevention of Congenital Rubella Infection: Symposium Summary
Authors: Hinman Alan R.
Published: December 2021

In opening the 1969 conference, Dr Lewis Thomas congratulated the participants on being "assembled to mark the beginning of the end of a major disease." That note of optimism was somewhat tempered by Dr David Sencer in the closing session, when he said that "Eradication will not take place when the vaccine is licensed, but only when the reservoir of susceptibles has been drained by immunization." In the intervening 15 years, much has been learned and done, but much remains to be learned and much more remains to be done. In only a few countries has significant progress been made toward eliminating the problem of congenital rubella infection (by whatever approach). We know congenital rubella infection causes tragic damage throughout the world. We have highly effective and safe vaccines that make this tragedy unnecessary. It now remains for us to fulfill the optimism of 15 years ago by using these preventive measures wisely and widely.
Do Short Children Secrete Insufficient Growth Hormone?
Authors: Zadik Zvi , Chalew Stuart A. , Raiti Salvatore , Kowarski A. Avinoam
Published: December 2021

The 24-hour integrated concentration of growth hormone from 46 children of normal stature was compared with that of 90 short children. Nineteen of the short children had classic growth hormone deficiency by standard pharmacologic growth hormone stimulation tests. Seventy-one children had normal growth hormone responses to stimulation. The mean integrated concentration of growth hormone for children with normal stature (6.6 ± 1.9 ng/mL) was greater than the mean value for those with normal stimulated growth hormone (3.8 ± 2.3 ng/mL) and greater than the mean value for those with growth hormone deficiency (1.6 ± 0.6 ng/mL); differences between groups were all statistically significant (P < .0001). Forty-five percent of children with normal stimulated growth hormone responses had integrated concentration of growth hormone within the range of values for the group with growth hormone deficiency; this finding may provide the explanation for their poor growth. Thus, patients with normal growth hormone responses have a spectrum of spontaneous growth hormone secretion ranging from normal to impaired. Recent reports indicate that children with normal growth hormone responses who have very low integrated concentration of growth hormone may have the potential to improve their growth with growth hormone therapy. Therefore, use of the integrated concentration of growth hormone may be a more effective method than standard pharmacologic stimulation tests for determining which short children are potentially able to respond to growth hormone therapy.
Fifth Versus Fourth Korotkoff Phase
Authors: LONDE SOL
Published: December 2021

It is well known that neither the fourth Korotkoff phase (muffling of sounds) nor the fifth (disappearance of sounds) represent intraarterial diastolic pressure. I agree with Moss1 that whether or not a particular Korotkoff phase reflects true intraarterial pressure is not relevant. What both phases represent is a value for diastolic pressure as determined by the indirect auscultatory method. Clinical measurements should be referred to normal standards established with the same phase used in the determinations.

The question is which is preferable.

Most screening programs in adults and many in children have used the disappearance of sounds for the diastolic criterion because there was much less intraobserver variation.
Health Impact of Measles Vaccination in the United States
Authors: Bloch Alan B. , Orenstein Walter A. , Stetler Harrison C. , Wassilak Steven G. , Amler Robert W. , Bart Kenneth J. , Kirby Cecil D. , Hinman Alan R.
Published: December 2021

As a result of intensive efforts to vaccinate children, measles and its attendant complications of encephalitis and death have declined more than 99% from the prevaccine era. Similarly, subacute sclerosing panencephalitis has declined markedly. Measles vaccine has been demonstrated to be extremely safe, as well as extremely effective. The health and resource benefits due to vaccination against measles during the first 20 years of vaccine licensure have been enormous. In this period it is estimated that vaccination against measles has prevented 52 million cases, 5,200 deaths, and 17,400 cases of mental retardation, achieving a net savings of $5.1 billion. These substantial health and resource benefits of measles vaccination will continue to accrue in the future.
Propylene Glycol Plasma Level
Authors: HALL ALAN H. , BRONSTEIN ALVIN C. , SMOLINSKE SUSAN C. , DOUTRE' WILLIAM H. , KULIG KENNETH W. , RUMACK BARRY H. , SPOERKE DAVID G.
Published: December 2021

To the Editor.—

In reviewing recent publications on hyperosmolality in infants due to the excipient propylene glycol, we detected a major discrepancy between formulas for estimating the propylene glycol plasma level from the osmol gap as presented by Glasgow et al1 and by Fligner et al.2 Both detail similar propylene glycol apparent half-lives (Glasgow et al, 19.3 hours; Fligner et al, 16.9 hours) indicating similarly sloped elimination curves. However, the two predictive formulas give different results using the same osmol gap:

Using 74 mosm/kg as the osmol gap for comparison, Glasgow et al formula (r = .96)1:
Smoking and Asthma
Authors: BERKOWITZ SHELDON
Published: December 2021

To the Editor.—

I want to thank Pedreira and his colleagues1 for providing us with more evidence to convince parents to quit smoking or, at least, not to smoke near their young children. However, although the authors looked at the passive effect of parental smoking on the incidence of lower respiratory tract infections, they did not mention its effect on children with asthma.

It has been my experience that young children with asthma have less problems if their parents stop or reduce their amount of cigarette smoking.
Adolescent Sexuality: Elements and Genesis
Authors: Calderone Mary S.
Published: December 2021

To address the topic of adolescent sexuality and the elements that go into its genesis and evolution, it is necessary to determine when human sexuality, as a body system functioning independently from the human reproductive system, begins to function. In the case of the male, this has been shown by ultrasound technology to be at approximately 17 weeks of gestation, and subsequent developmental stages in both sexes are based on the three primary areas in human development: body, mind, sexuality. Positive aspects of sexual socialization are shown to depend on attitudes of parents, of society, of health and caring professionals, and of the child itself, to whom it is as important a part of its being as are body and mind.

Significant research carried out in different parts of the world on childhood sexuality is cited and discussed with its possible long-term meanings, effects, and possible prevention of the current apparent increase in childhood sexual molestation. The need for a massive paradigm shift on the parts of professionals, parents, and society in viewing, nurturing, and protecting the sexuality of infancy and early childhood is emphasized.
Sex, Drugs, Rock 'N' Roll: Are Solutions Possible?—A Commentary
Authors: Strasburger Victor C.
Published: December 2021

Understanding the demographics of teenage pregnancy and teenage drug abuse is far easier than thinking of solutions to either. Nevertheless, solutions—at least partial solutions—do exist. Several successful programs and their essential components are discussed. Prevention of early teenage drug and sexual experimentation intersect in several key areas: the family, the media, the role of the physician, the appropriateness of prevention, and the need to understand what is normal adolescent behavior. Only when these dual problems are thoroughly understood and their etiologies in adult society are acknowledged will attempts at "solutions" be successful.
Can Fussy Babies Be Spoiled?
Authors: JONES J. ALBRIGHT
Published: December 2021

To the Editor.—

I was disturbed by several aspects of the article by Dr Taubman1 on colic among infants in his practice. I have been in pediatric practice more than 50 years and, therefore, have had my share of babies to test my skill and patience.

It is my understanding that colic means abdominal pain and not just fussiness without a demonstrable cause. And there certainly are a number of causes of colic that can be diagnosed by appropriate studies and a thorough clinical examination.
Bifid Uvula
Authors: EAVEY ROLAND D.
Published: December 2021

To the Editor.—

The recent article on the significance of bifid uvula was very thorough and thoughtful.1 The authors are to be complimented on their ideas and efforts. However, I believe three points should be addressed.

The first is the caveat that "... removal of the adenoids should be avoided because of the risk that hypernasality may develop postoperatively in patients with abnormalities of the palate." This statement rings with a tone of an absolute contraindication to surgery in the face of a bifid uvula.
Annual Summary of Vital Statistics—1984
Authors: Wegman Myron E.
Published: December 2021

Data for this article, as in previous reports,1 are drawn principally from Monthly Vital Statistics Report, published by the National Center for Health Statistics.2-6 The international data come from the Demographic Yearbook7 and the quarterly Population and Vital Statistics Report,8 both published by the Statistical Office of the United Nations, which has also been kind enough to provide directly more recent data. Except for mortality data by cause and age, which are based on a 10% sample, all of the US data for 1984 are estimates by place of occurrence, based upon a count of certificates received in state offices between two dates, 1-month apart, regardless of when the event occurred.
Consistency and Change in the Development of Premature Infants Weighing Less Than 1,501 Grams at Birth
Authors: Ross Gail , Lipper Evelyn G. , Auld Peter A. M.
Published: December 2021

Ninety-four infants with birth weights less than 1,501 g were evaluated on neurologic functioning and mental abilities at 1 year and, again, at 3 to 4 years of age. Results of the examination showed high correspondence in neurologic status and in mental ability between infancy and the preschool period, particularly for children who were diagnosed as clearly normal or abnormal at 1 year. In addition, poorer performance in a test of infant mental ability (which relies primarily on sensorimotor skills), in motor skills, and in neunologic functioning, respectively, were linked to lower IQ, difficulties in expressive language, and articulation deficits at the preschool age. Socioeconomic status predicted 3-year IQ scores and changes in mental ability scores but was not a factor in determining either preschool age neurologic status or changes in neurologic status in the children studied. Socioeconomic status of the children was less predictive of preschool outcome than results of the 1-year examinations.
Committee Statement on Nutrition Corrected
Authors:   Committee on Nutrition American Academy of Pediatrics
Published: December 2021

In Reply.—

It has been called to our attention that there is a typographical error in the Committee on Nutrition statement, "Nutritional Needs of Low-Birth-Weight Infants" (Pediatrics 1985;75:976-986). On p 982, column 2, line 7, the references cited should be 16, 44, and 65. The meaning of the sentence, supported by these references, is that each of the special formulas for premature infants listed in Table 4, Enfamil Premature, SMA "Preemie," and Similac Special Care, has been shown to be associated with adequate growth and metabolic stability.
Percutaneous Endoscopic Gastrostomies in Children
Authors: BENKOV KEITH J. , KAZLOW PHILLIP G. , WAYE JEROME D. , LELEIKO NEAL S.
Published: December 2021

Our ability to maintain the nutritional status of acute and chronically ill children is enhanced by advances in special enteral feedings.1-3 When compared with parenteral nutrition, enteral feedings are accompanied by fewer complications, the ability to deliver large quantities of nutrients, relative ease of administration, and lower cost.2,3 Nasogastric feedings are very manageable for short-term therapy; however, in those patients requiring long-term support, a feeding gastrostomy can offer several advantages.4

Feeding gastrostomies have traditionally been placed via laparotomy under general anesthesia.5

We would like to describe our experience, as pediatric gastroenterologists and endoscopists, in the use of this technique in children.
Academic Hubris
Authors: BERGMAN ABRAHAM B.
Published: December 2021

Envy and pique and vanity, all the passions of self-regard. You could not live long in a society of men and not see them weigh down the rest.

—C.P. Snow in The Masters

I have always liked the word hubris ever since I heard it on my first day of college from a humanities professor as he talked about the ongoing feuds between Sparta and Athens. Professor Arragon of Reed College defined hubris as "stiff-necked." Webster's New World Dictionary1 defines it as "wanton insolence or arrogance resulting from excessive pride." Lewis Thomas2 writes that hubris first turned up in popular English use as a light piece of university slang at Oxford in the late 19th century, with the meaning of intellectual arrogance and insolence.
Prepuce Care
Authors: MALLESON PETER
Published: December 2021

To the Editor.—

In the article by Wiswell et al, "Decreased Incidence of Urinary Tract Infections in Circumcised Male Infants" (Pediatrics 1985;75:901-903), the authors' comment "The parents of uncircumcised male infants were additionally counseled to gently retract the foreskin to allow the easily exposed portion of the glans to be cleaned." As it is generally accepted that the prepuce is adherent to the glans penis and that retracting the foreskin in an infant may traumatize the penis and prepuce, I would wonder whether this advice may have contributed to the increased urinary tract infection rate seen in the uncircumcised male infants.
Prepuce Care
Authors: WISWELL THOMAS E.
Published: December 2021

In Reply.—

In our initial report,1 we counseled parents to cleanse the noncircumcised penis after gentle retraction. We recommended that they wash the foreskin area as they would any part of the infant's body and emphasized that the prepuce should only be pushed back if it could be easily performed, never with any force. If the baby demonstrated any discomfort or if any resistance was felt, gentle retraction should be stopped. This was not an attempt to separate the prepuce.
In Defense of Circumcision
Authors: FINK AARON J.
Published: December 2021

To the Editor.—

Do circumcisions need infant consent? Two northern California mothers seem to think so. They recently brought "landmark" lawsuits on behalf of their circumcised infant sons, alleging, among a number of claims, that the removal of the foreskin is an inhumane act, has no medical basis, is a forcible removal, done with ill will, for traditional, cultural, and religious reasons unrelated to medicine and that the plaintiff is entitled to exemplary and punitive damages.
Circumcision and Urinary Tract Infections
Authors: CUNNINGHAM NICHOLAS
Published: December 2021

To the Editor.—

Wiswell, Smith, and Bass (Pediatrics 1985;75:901-903) reported an association between circumcision and decreased urinary tract infections in infancy. There being no plausible physiologic explanation for such a finding, before we accept any cause and effect relationship and the possible consequence (reversal of the worldwide trend away from routine circumcision of the newborn), we should seek alternative explanations. Several suggest themselves: (1) the two populations, having self-selected themselves (to have or not havecircumcision) differed in some way, socioculturally, in their prenatal habits or in their child-rearing behavior and these differences, not the circumcision, resulted in the discrepancy in incidence of urinary tract infection;
Characterization of Bovine Surfactant for Infants With Respiratory Distress Syndrome
Authors: Taeusch H. W. , Keough K. M. W. , Williams M. , Slavin R. , Steele E. , Lee A. S. , Phelps D. , Kariel N. , Floros J. , Avery M. E.
Published: December 2021

Exogenous surfactant treatment of surfactant-deficient disease states is now under study in a number of centers, using a variety of surfactant preparations. We have chosen one preparation because of its current and potential clinical usefulness, and we have characterized it using selected tests and assays that we thought would be necessary (although not necessarily sufficient) to justify extended clinical use. We found its lipid composition to resemble that of other surfactants derived from lung mince. There is little variation among several batches with regard to lipid composition or surface tension-lowering capability. Morphologic heterogeneity occurs in individual samples of pelleted material studied by electron microscopy. Arterial oxygenation is improved when the material is administered to animals depleted of surfactant. A low molecular weight protein was identified that reacted with antibody that specifically binds nonserum surfactant proteins in a number of animal species (including human and cow). The characteristics of this surfactant preparation should be useful for comparison as newer and simpler products become available.
Changing Patterns of Hospitalization for Children Requiring Surgery
Authors: Perrin James M. , Valvona Joseph , Sloan Frank A.
Published: December 2021

Increasing health care costs have directed public attention to changing rates of hospital care. We examined changes in hospitalization and surgical rates for children during the decade from 1972 to 1981. Total hospitalizations for children younger than 15 years of age increased by only 4% during the decade. For teenagers and young adults (ages 15 to 24 years), hospitalizations declined by 19%. Admissions for surgery declined more for the younger group than for the older one. For children younger than 15 years of age, inpatient tonsillectomies and adenoidectomies (T and A) decreased 43%, representing 58% of the total decline in surgical procedures for this age group. Teaching hospitals continued to provide a sizable proportion of all childhood surgeries and increased their share of both high- and low-technology procedures during the decade. Payment sources varied among procedures. Self-pay varied from a low of 1.6% for T and A to 13.5% for spina bifida. Private insurance or Blue Cross payment varied from 59% for congenital heart disease surgery to 84% for T and A. These data on payments suggest that some children may lack access to some surgical care. Furthermore, insofar as the bulk of payment is from nonfederal sources, changes in hospitalization for surgical procedures will likely come mainly from changing incentives in the private sector.
Acquired Arteriovenous Fistulas of the Scalp in Hemophiliacs
Authors: Gilbert Marvin S. , Capozzi James D. , Forster Alice M.
Published: December 2021

The development of arteriovenous fistulas following multiple intravenous infusions in hemophiliacs has been previously reported. In this report, we discuss two patients in whom arteriovenous fistulas developed following the use of scalp veins as sites of infusion. Because of the rich vascularity of this area and the proximity of the arterial and venous systems we recommend that this site not be used for factor infusion.
Handguns: Risks versus Benefits
Authors: CHRISTOFFEL KATHERINE K. , CHRISTOFFEL TOM
Published: December 2021

THE ISSUE

There are an estimated 40 to 50 million handguns in the United States, with approximately 2 million more being manufactured annually1 (The New York Times, July 9, 1985, p 16). The high prevalence of handgun injury in the United States is unique in all the world and is increasing. Children are among the growing legions of US citizens harmed by the handgun epidemic.2 The effort to control handguns is focussed on developing laws to control their manufacture, importation, purchase, possession, and use. Opponents of these legal approaches claim that gun control endangers constitutional freedoms. When asked, the US Supreme court has consistently rejected that position in favor of the view that the Second Amendment protects a collective, not a personal, right to bear arms.3,4
Dangers of Chicken Soup
Authors: CHU EDWARD
Published: December 2021

To the Editor.—

Chicken soup has long been regarded as a popular treatment for a wide variety of ailments. The 12th century philosopher and physician, Moses Maimonides, extracting from ancient Greek writings, recommended chicken broth for "rectifying corrupted humors,"1 which meant it was good for everything. Recently, chicken soup has again received attention in the medical literature, some of it serious2 and some of it tongue in beak [sic].3-6 The serious study demonstrated a significant increase in nasal mucous velocity following the ingestion of hot chicken soup, suggesting a therapeutic effect in the common cold.
Light and Transcutaneous Po2 Device = Problem?
Authors: TRUEBLOOD DAVID M.
Published: December 2021

In Reply.—

When the sensor in question was reported to the SensorMedics Hot-Line, it was replaced within 24 hours. SensorMedics' standard procedure is to have any reported malfunction or report of less than optimum performance resolved within 24 hours. When the "photosensitive" sensor was returned, it was determined to, indeed, be sensitive to electromagnetic interference, due to the fact that the cable had been subjected to sufficient force to cause the sensor shield to separate from the cable shield.
Low-Dose Testosterone Effect on Somatic Growth
Authors: Rosenfield Robert L.
Published: December 2021

Low-dose testosterone has been found to preserve the growth potential of hypogonadal children requiring anabolic or androgenic therapy. Five girls with Turner syndrome were treated when their chronologic ages were 13 to 14 years and their bone ages were 10.6 to 12.75 years; six hypogonadal boys were treated when their chronologic ages were 11 to 15 years and their bone ages were 10.9 to 14.2 years. Depot testosterone was given as an anabolic agent in an average dose of 28 mg/m2/mo for 6 months to the patients with Turner syndrome and was given to initiate puberty in an average dose of 44 mg/m2/mo for 6 months to the hypogonadal boys. Growth rate doubled on these doses of testosterone, and bone age did not advance disproportionately. Consequently, height potential was preserved. Pubic hair advanced one Tanner stage during the 6-month treatment. Clitoral hypertrophy was observed in only one of the five girls with Turner syndrome and regressed when testosterone therapy was discontinued. Four hypogonadal boys were continued on low-dose testosterone until their bone ages passed 14 years of age and their growth rate waned. Then, the testosterone dosage was increased in increments to 100 to 200 mg/m2/mo. This group reached a height of 100.3 ± 0.8% of the height initially predicted. In addition, all attained an adult height at least 15 percentiles greater than that before therapy. These studies indicate that testosterone in very low doses resembles "anabolic steroids" in that growth is stimulated without an inordinate androgenic effect. Furthermore, these studies show that institution of low-dose therapy in the early teenage years stimulates pubertal growth normally without loss of height potential.
Tenfold Errors in Administration of Drug Doses: A Neglected latrogenic Disease in Pediatrics
Authors: Koren Gideon , Barzilay Zohar , Greenwald Mark
Published: December 2021

We report seven cases of order of magnitude errors in the administration of drugs. The principles typical of this iatrogenic disease are discussed and possible solutions are suggested.