bluuebunny/crossref_metadata_2025 huggingface dataset:
Changes Made to Orders Placed by Overnight Admitting Residents on Teaching Rounds the Next Day
Authors: Chiel Laura , Freiman Eli , Yarahuan Julia , Parsons Chase , Landrigan Christopher P. , Winn Ariel S.
Published: December 2021

OBJECTIVES

Increased focus on health care quality and safety has generally led to additional resident supervision by attending physicians. At our children’s hospital, residents place orders overnight that are not explicitly reviewed by attending physicians until morning rounds. We aimed to categorize the types of orders that are added or discontinued on morning rounds the morning after admission to a resident team and to understand the rationale for these order additions and discontinuations.

METHODS

We used our hospital’s data warehouse to generate a report of orders placed by residents overnight that were discontinued the next morning and orders that were added on rounds the morning after admission to a resident team from July 1, 2017 to June 29, 2018. Retrospective chart review was performed on included orders to determine the reason for order changes.

RESULTS

Our report identified 5927 orders; 538 were included for analysis after exclusion of duplicate orders, administrative orders, and orders for patients admitted to non-Pediatric Hospital Medicine services. The reason for order discontinuation or addition was medical decision-making (n = 357, 66.4%), change in patient trajectory (n = 151, 28.1%), and medical error (n = 30, 5.6%). Medical errors were most commonly related to medications (n = 24, 80%) and errors of omission (n = 19, 63%).

CONCLUSIONS

New or discontinued orders commonly resulted from evolving patient management decisions or changes in patient trajectory; medical errors represented a small subset of identified orders. Medical errors were often errors of omission, suggesting an area to direct future safety initiatives.
Round Table Discussion
Authors: GRULEE CLIFFORD G. , ELAM JAMES O.
Published: December 2021

1. The following equipment was described:

A. A tracheotomy inhalator for administering humidified oxygen, with optional use of positive pressure.

B. Modifications in the respirator collar and headpiece to accommodate the tracheotomy patient.

2. A scheme of treatment which distinguishes between ventilatory deficiency and alveolar deficiency in poliomyelitis was mentioned.

3. The oximeter is useful in determining the indications for oxygen therapy, and artificial respiration and, in some instances, tracheotomy.

4. The bulbar patient with excessive mucus accumulation in the tracheobronchial tree may require frequent bronchoscopic aspiration. Removal of mucus by suction catheter should be limited to brief intervals.

5. The administration of oxygen to the respirator patient before and during the time the respirator ports are open for 5 minute intervals prevents hypoxic insults.

6. Patients may be liberated from the respirator as rapidly as is physiologically expedient on the basis of oximetry.

7. The respirator tends to produce hyperventilation when the arbitrary pressures are used. This may be prevented by adjusting the pressure on the basis of measured respiratory minute volume.

8. Following excessive ventilation in the respirator the patient becomes uncomfortable by sudden reduction in the respirator pressure apparently because his respiratory center has become adjusted to a low arterial CO2 tension. Hence the patient's comfort is not a satisfactory index of normal ventilation in the respirator.
PHYSIOLOGIC STUDIES ON THE CARDIOVASCULAR STATUS OF NORMAL NEWBORN INFANTS (WITH SPECIAL REFERENCE TO THE DUCTUS ARTERIOSUS)
Authors: Adams Forrest H. , Lind John
Published: December 2021

Physiologic studies, including cardiac catheterization, electrocardiography, and determination of heart volume have been performed on eight newborn infants with normal cardiovascular status, ranging in age from 7 hours to 14 days. The two most interesting results of these studies were the finding of right ventricular and pulmonary hypertension of moderate degree, and a significantly barge left to right shunt of blood through the ductus arteriosus after the third day of life.[See Table II in Source Pdf]
CONGENITAL CORONARY ARTERIOVENOUS FISTULA
Authors: Gasul Benjamin M. , Arcilla Rene A. , Fell Egbert H. , Lynfield Joshua , Bicoff J. Pedro , Luan Lawrence L.
Published: December 2021

Five patients with congenital coronary arteriovenous fistula communicating with the right ventricle are presented. Case 5, a 3-week-old infant, represents the youngest patient to be diagnosed and studied, in the literature. The clinical features, hemodynamics and angiocardiographic findings are analyzed.

Two major types of fistula affecting the coronary arterial system are recognized. In coronary arteriovenous fistula the functional disturbance consists of a left-to-right shunt, and a diastolic overloading of the left heart chambers and of the right heart chambers into which the fistula opens. In coronary arterio-systemic fistula the altered hemodynamics are essentially those of an internal fistula confined to the systemic circulation. A postulate regarding the nature of the blood flow through the various types of fistulae is given, and this is correlated with the phonocardiographic and hemodynamic findings.

The diagnosis should be strongly suspected on the basis of a loud, superficial and continuous cardiac murmur localized in an area atypical for a patent ductus arteriosus. If the continuous murmur is maximal at the pulmonary area, it is extremely difficult to differentiate this anomaly from a patent ductus arteriosus and/or aortic-pulmonary septal defect. Phonocardiographic demonstration of a louder diastolic than systolic component is very suggestive of a coronary arteriovenous fistula communicating with the right ventricle.

The roentgenologic and electrocardiographic findings are not specific. Cardiac catheterization is not diagnostic, although when correlated with the clinical picture it may strongly suggest the diagnosis.

Angiocardiography, particularly retrograde aortography, is diagnostic. The information obtained from the various methods used is discussed. Dilatation of the ascending aorta demonstrated by angiocardiography was a constant finding in our series. Its pathogenesis is discussed, and its importance as a differential sign in the angiocardiogram against the diagnosis of ventricular septal defect is stressed. The differential diagnosis by retrograde aortography between coronary arteriovenous fistula into the right ventricle and ruptured aortic sinus of Valsalva into the same chamber is discussed and illustrated.

While this anomaly is compatible with longevity, the potential complications to which the patient with it may be subjected and the relative innocuousness of corrective surgery without the need for hypothermia or cardiopulmonary bypass, demonstrated in previous reports and in our series, make us believe that surgery should be considered in practically all cases of fistula of the coronary arterial system.
ENVIRONMENTAL FACTORS AFFECTING HUMAN DEVELOPMENT, BEFORE AND AFTER BIRTH
Authors: Knobloch Hilda , Pasamanick Benjamin
Published: December 2021

The relationship of socioeconomic factors to pregnancy experience and later neuropsychiatric functioning was investigated by a series of retrospective and anterospective epidemiologic studies.

The studies demonstrated an increased amount of brain damage in the lower socioeconomic strata, where a higher incidence of complications of pregnancy and a greater number of babies with low birth weights are found.

In 992 infants examined at 40 weeks of age, pregnancy experience, birth weight and later physical status were the only major factors which could explain group differences in developmental quotients.

The studies further indicated that the relatively small amount of variability found in infancy could be explained largely by the presence of damage to the central nervous system, and supported the view that at this period of life social factors affect the psychologic level of integration primarily through biologic mechanisms. Later, during the preschool period, the direct influence of the sociocultural forces on the psychologic performance becomes manifest.
GASOLINE ADDICTION IN CHILDREN
Authors: Easson William M.
Published: December 2021

The cases of two boys addicted to gasoline are presented in detail. In a review of previously reported cases and these two cases, certain etiologic factors appear to be constant.
IMMUNOHEMATOLOGIC OBSERVATIONS ON ERYTHROBLASTOTIC INFANTS. I. DIAGNOSIS AND PROGNOSIS
Authors: STURGEON PHILLIP
Published: December 2021

With the use of the described developing test and other technics in immunohematologic observations on red blood cells and sera from untreated neonatal infants suspected of having erythroblastosis, it has been possible to make a specific diagnosis and to obtain data which will contribute to a more accurate prognosis than has been possible heretofore.

The AB serum, saline, and blocking tests as described lack the specificity and sensitivity of the direct developing tests for diagnosis; but when used alone, if the results are positive, they are of some value in the estimation of prognosis.
THE LIVER IN JUVENILE WILSON'S DISEASE
Authors: Silverberg Mervin , Gellis Sydney S.
Published: December 2021

Twelve cases of juvenile Wilson's disease are reviewed. Eight presented with hepatic manifestations, and six of these showed a predominance of liver symptomatology throughout their entire illness. It appears that this type of onset is not uncommon when the disease begins in the pre-adolescent period. In childhood, chronic liver disease of unknown etiology should always be screened for Wilson's disease. Careful examination for Kayser-Fleischer rings should repeatedly be made. The finding of cupruria, aminoaciduria without glycosuria or albuminuria, and decreased blood uric acid levels are strongly suggestive of Wilson's disease. Punch biopsy of the liver with visualization of copper by means of an improved modification of the histo-chemical rubeanic acid method or Howell's newer histo-chemical method, or determination of copper content as well as histochemical analysis of liver obtained by surgical biopsy appear to be the only reliable methods at present for proof of diagnosis. [See Table III in Source Pdf.]
ANEURYSMAL MALFORMATION OF THE GREAT VEIN OF GALEN CAUSING HEART FAILURE IN EARLY INFANCY
Authors: Gomez Manuel R , Whitten Charles F. , Nolke Anthony , Bernstein Jay , Meyer John Stirling
Published: December 2021

Five cases of heart failure, resulting from a cerebral arteriovenous fistula and aneurysm of the great vein of Galen, are reported. In two infants the diagnosis was made roentgenographically; one improved after arterial ligation. In four cases, autopsy demonstrated the anomalous vessels and dilatation or hypertrophy of the heart. In three cases there was spongy necrosis of the brain. The pathogenesis of heart failure seems to be related to an enormous increase of the intake of the right atrium and ventricle. The cerebral damage seems to be due to ischemia caused by shunting of blood toward the veins bypassing the capillary network. Early diagnosis can be made by auscultation of the head and cerebral arteriography in infants who develop heart failure. Treatment is discussed.
Letters to the Editor
Authors: LOWE CHARLES U.
Published: December 2021

The observation that many normal children develop yellow-colored skin and apparent hypercarotenemia during a period from approximately 6 to 18 months of age is an observation that is partially documented in the pediatric literature. There is some experimental evidence that this happens in most normal children. For example, Clausen and McCoord (J. Pediat., 13:635, 1938) noted: "The average level of plasma carotenoids rises from about 20 units per 100 ml at birth to about 100 units at 18 months, and falls to a constant level of about 90 units by the fifth year.
Muscular Hypertrophy of the Esophagus: Report of a Case with Involvement of the Entire Esophagus
Authors: Blank Eugene , Michael Thomas D.
Published: December 2021

Hypertrophy of the muscular wall of the entire esophagus was found in a 2-year-old girl who had been wheezing and vomiting since early infancy.
FURTHER OBSERVATIONS OF A PATIENT WITH HYPERGLYCINEMIA
Authors: Childs Barton , Nyhan William L.
Published: December 2021

Observations of a patient with hyperglycinemia have been extended. The patient, who has been subsisting on a low protein diet, has shown some improvement in the clinical manifestations though he has failed to grow. Loading experiments have increased the list of amino acids capable of inducing ketosis and symptoms in the patient to five: leucine, isoleucine, valine, threonine, and methionine. Eleven other amino acids have been similarly tested and were found to be beneficial, reducing the toxicity of the five ketogenic amino acids. Blood levels of the amino acids have been measured under a variety of circumstances. When given alone, the toxic amino acids were found to accumulate in the blood. Such accumulations were less striking when the nonketogenic amino acids were given together with the ketogenic ones. The patient has been benefitted by a diet low in protein which has been supplemented by the innocuous amino acids.
A FOLLOW-UP STUDY OF CHILDREN OF LOW BIRTH WEIGHT AND CONTROL CHILDREN AT SCHOOL AGE
Authors: Robinson Nancy M. , Robinson Halbert B.
Published: December 2021

A comprehensive follow-up of survivors of matched groups of low- and mature-birth-weight infants born in Wake County, North Carolina, was carried out when the children were approximately 8 to 10 years old. The sample included 92 who had weighed more than 2,500 gm at birth, 102 with birth weights of 1.501-2,500 gm, and 33 who had weighed 1,500 gm or less. Covariance techniques were utilized to hold background factors constant in some of the analyses. A higher proportion of the tiniest infants had sustained major physical defects (24% vs. 2-3% in other groups). This group was significantly smaller in weight and head size, and tended to come from more disadvantaged socioeconomic backgrounds. Extensive comparisons of data from physical and psychological examinations, social histories, and school reports tended to find only a few significant differences among the groups, all of which were probably related more closely to social background than to birth weight per se. The data indicate that, aside from physical size and major physical defects, social class assumes much more importance than does birth weight in determining a child's developmental prognosis.
RUMINATION AND GROWTH FAILURE IN MALE FRATERNAL TWIN
Authors: Hollowell Joseph G. , Gardner Lytt l.
Published: December 2021

Observations on a male infant with the rumination syndrome and growth failure are presented. The infant's twin sister did not exhibit rumination. The rumination and growth failure in the male twin began concurrently with intense marital conflict and anxiety in the family environment. Hospitalization of the male and mothering by the nursing staff strikingly reversed his growth failure. With aid from multiple sources a more suitable family environment was established, the father returned to the home, and psychiatric assistance was provided. Special attention was given to the male twin during and after the hospitalization. During this time the female twin's linear growth and weight increments began to decelerate, so that by age 2 3/12 years both twins were of comparable size. At age 3 4/12 years both were slightly above the 3rd percentile for linear growth.

Possible explanations for the findings are presented and the subject of rumination in infants is reviewed. These cases offer further evidence that growth failure associated with certain types of disordered family environments may be psychosomatic in origin.
DEXAMETHASONE IN THE TREATMENT OF ACUTE BACTERIAL MENINGITIS: THE EFFECT OF STUDY DESIGN ON THE INTERPRETATION OF RESULTS
Authors: Belsey Mark A. , Hoffpauir Calvin W. , Smith Margaret H. D.
Published: December 2021

Low doses of dexamethasone (4.8 mg per meter squared of body area per day) were compared to a placebo as an adjunct to a standardized antimicrobial treatment of acute bacterial meningitis in 102 infants and children. In attempting to ensure an equal risk of complications and sequelae in the two treatment groups, we matched the patients by age, state of consciousness, and etiologic agent; analysis was based on 86 matched patients. Complications occurred in 8 patients in the dexamethasone treated group and in 18 of the placebo group; the complications were milder in the dexamethasone group. However, these results must be tempered by the observation that nearly all complications occurred among patients who had an elevated level of CSF-COT on admission or evidence of meningitis existing for several days before hospitalization; both factors have been noted previously to be associated with increased risk of complications. Since our results reflect differences that were inherent in the groups at the outset, we must conclude that we have not demonstrated that low doses of dexamethasone have any significant effect on the course or outcome of acute bacterial meningitis.
RECTAL THERMOMETER-INDUCED PNEUMOPERITONEUM IN THE NEWBORN
Authors: Greenbaum Edward I. , Carson Merle , Kincannon William N. , O'Loughlin Bernard J.
Published: December 2021

Two cases of pneumoperitoneum of the newborn caused by perforation of the rectum by a rectal thermometer are presented. The infants presented with symptoms of respiratory distress and cyanosis associated with vomiting and abdominal distention. The literature on the subject is reviewed. Only seven such cases have been reported to date, and the mortality approximates 70%. The single most important factor affecting prognosis appears to be the state of maturity at the time of reparative surgery. Of five mature infants operated on within 24 hours of symptoms, four have survived and have done well. We strongly advocate caution in the use of rectal thermometers, and we would suggest that axillary temperatures or flexible rectal probes be used whenever possible.
GROWTH PATTERN OF PREMATURELY BORN INFANTS
Authors: GLASER KURT , PARMELEE ARTHUR H. , PLATTNER E. B.
Published: December 2021

One hundred sixty-three prematurely born infants were observed from birth to 8 months of age. Their growth progress was recorded at regular intervals and evaluated in detail as to the pattern of the weight, length, head circumference and sitting height increment. Variations conditioned by differences in race, sex and birthweight were analysed. A comparison of these premature infants with normal full term infants was made. The data were evaluated statistically and graphically.
Effects of Vitamin C on Osteogenesis Imperfecta
Authors: Kurz Diann , Eyring Edward J.
Published: December 2021

Biochemical and clinical effects of vitamin C on children with osteogenesis imperfecta have been documented. There is a significant drop in serum zinc correlated with ascorbate ingestion (25 to 50 mg/kg/day). This tendency contrasts to the trend in normal controls which is upward. Family members behave either like the affected child or normally whereas control families show only the expected increases.

Incidence of fracturing drops with chronic vitamin C ingestion. While encouraging this observation is not well controlled. Larger groups of patients must be observed before arriving at firm conclusions.
Recurrence of Skin Disease in a Nursery: Ineffectuality of Hexachlorophene Bathing
Authors: Gehlbach S. H. , Gutman L. T. , Wilfert C. M. , Brumley G. W. , Katz S. L.
Published: December 2021

An outbreak of streptococcal and staphylococcal skin disease was discovered in a full-term nursery after the discontinuation of bathing infants with hexachlorophene. The epidemic was only temporarily controlled by conventional means and recurred despite reinstitution of hexachlorophene bathing. Measures that decreased infants' exposure to visitors and hospital personnel and enforced aseptic techniques in the nursery were more important than use of hexachlorophene soap in achieving and maintaining control.
Report of the Ad Hoc Task Force on Circumcision
Authors: Thompson Hugh C. , King Lowell R. , Knox Eric , Korones Sheldon B.
Published: December 2021

There is no absolute medical indication for routine circumcision of the newborn. The physician should provide parents with information pertaining to the long-term medical effects of circumcision and noncircumcision, so that they make a thoughtful decision. It is recommended that this discussion take place before the birth of the infant, so the parental consent to the surgical procedure, if given, will be truly informed.

A program of education leading to continuing good personal hygiene would offer all the advantages of routine circumcision without the attendant surgical risk. Therefore, circumcision of the male neonate cannot be considered an essential component of adequate total health care.
Who will monitor access?
Authors: Haggerty Robert J.
Published: December 2021

Access to health care is a necessary but not sufficient step toward quality health services. Once society has guaranteed equity of access by removal of financial barriers, the question arises, "Should society monitor such access and, if so, who should do it?" One can argue that for adults, when most barriers to care–financial, geographical, and cultural–are reduced, if one still does not use the services, it is his (her) own business, as long as he (she) is not a threat to others; and this decision should not be intruded upon. Even with this view there are dissenters; but, for children, the issue is more clear.
Erythromycin's Effect on Theophylline Blood Level
Authors: Cummins Leo H. , Kozak Peter P. , Gillman Sherwin A.
Published: December 2021

Recently we have been performing serum theophylline determinations in our office, using a Waters high-pressure liquid chromatography unit and a simplified micromethod.1

Theophylline determinations done on patients who were receiving bronchodilators orally around the clock and who had problems with vomiting resulted in a surprising association of high theophylline levels in some patients receiving erythromycin. Several of these patients had serum theophylline determinations prior to starting erythromycin. The serum theophylline determination was repeated because of vomiting and the theophylline levels were significantly elevated (Table I).
Early-Onset Pneumococcal Sepsis in Newborn Infants
Authors: Bortolussi Robert , Thompson Theodore R. , Ferrieri Patricia
Published: December 2021

Five infants with pneumococcal sepsis presented with respiratory distress and clinical signs of infection in the first day of life. Although there was no apparent epidemiological relationship among the patients, four of the five were seen within a 12-month period. Pneumonia, prolonged rupture of fetal membranes, and prematurity were features in these patients. Three infants died, two within 12 hours of diagnosis. Streptococcus pneumoniae was isolated from the vagina of three of the mothers; in two, the serotype was identical to that recovered from their infants. Clinical features of neonatal pneumococcal sepsis are similar to those of early-onset group B streptococcal infection. Like the group B Streptococcus, S. pneumoniae acquired from the maternal vagina is a potential life-threatening pathogen in the newborn period.
Prospective Study of Maternal and Infantile Infection with Chlamydia trachomatis
Authors: Hammerschlag Margaret R. , Anderka Marlene , Semine Deborah Z. , McComb Dorothy , McCormack William M.
Published: December 2021

We examined the prevalence of chlamydial infection in a population of pregnant women and observed their infants to determine the risk of development of ocular or respiratory infection. We examined endocervical and serum specimens from 322 pregnant women for Chlamydia trachomatis and chlamydial antibody. The cultures were obtained at the first prenatal visit. Six (2%) of the women were infected with C trachomatis. Chlamydial antibody was present in the genital secretions of 47% and 73% of the serum samples. The six infants born to infected women, 61 infants born to women who were culture-negative, but local antibody-positive, and 28 control infants born to culture-negative, antibody-negative women were followed for up to six months. Four of six infants born to infected women developed chlamydial infection: two developed culture-positive conjunctivitis, one had asymptomatic nasopharyngeal infection, and one infant developed pneumonitis. Three of 61 infants born to mothers who were culture-negative and local antibody-positive developed conjunctivitis due to C trachomatis. None of the 28 control infants developed chlamydial infection. Most (79%) of the infants had chlamydial antibody in their serum at 2 to 4 weeks of age. The correlation between maternal and infant serum antibody titer was r=0.71 suggesting that antibody was placentally transferred.
Diagnostic Ramifications of Repeated Plasma Cholesterol and Triglyceride Measurements in Children: Regression Toward the Mean in a Pediatric Population
Authors: Morrison John A. , Laskarzewski Peter , deGroot Ido , Kelly Kathe A. , Mellies Margot J. , Khoury Philip , Glueck Charles J.
Published: December 2021

To assess the diagnostic ramifications of the phenomenon of regression toward the mean for plasma cholesterol and triglyceride in a pediatric population group, two sequential plasma cholesterol and triglyceride measurements were made six weeks or more apart (visits 1 and 2), in children from the Cincinnati Lipid Research Clinic, Princeton school study group. In 326 children with plasma cholesterol ≥205 mg/dl (the 95th percentile) at visit 1, mean plasma cholesterol fell 10.5 mg/dl at visit 2 (P <0.1). Only 58%, 188 of these 326 children with cholesterol ≥205 mg/dl at visit 1, had levels ≥205 at visit 2. In 180 children with plasma triglyceride ≥125 mg/dl at visit 1 (the 95th percentile), only 31% had levels ≥125 at visit 2. These marked shifts toward less extreme values for cholesterol and triglyceride at a second sampling of children initially at the extremes of the distribution reflect, in part, the phenomenon of regression toward the mean, and argue for at least a second and preferably a third resampling of all children initially above some "cutpoint" for cholesterol and triglyceride. Failure to repetitively retest before making diagnostic conclusions or contemplating therapeutic interventions could result in misdiagnosis, unnecessary treatment programs, and overestimation of treatment efficacy.
Neonatal Signs as Predictors of Cerebral Palsy
Authors: Nelson Karin B. , Ellenberg Jonas H.
Published: December 2021

Signs of neonatal neurologic dysfunction, recorded in approximately 40,000 infants, were evaluated prospectively for their ability to predict later motor handicap. Tenfold to 33-fold increases in risk of cerebral palsy (CP) were observed in surviving children with any one of the following characteristics: birth weight less than 2,000 gm, head circumference more than 3 SD above or below the mean, five minute Apgar score of 3 or less, diminished activity or diminished cry lasting for more than one day, thermal instability, need for gavage feeding, hypotonia or hypertonia, single or multiple apneic episodes, or hematocrit less than 40%. Of worse portent, with relative risks exceeding 50, were neonatal seizures or Apgar scores of 3 or less at ten minutes or later. These characteristics were also markers of considerable risk of early death. For 0.5% of surviving infants, an overall impression of abnormality of brain function during the nursery period was recorded by the attending physician; there was a 99-fold increase in CP among these children.
The Pediatric Examination of Educational Readiness: Validation of an Extended Observation Procedure
Authors: Levine Melvin D. , Oberklaid Frank , Ferb Thomas E. , Hanson Margaret A. , Palfrey Judith S. , Aufseeser Cary L.
Published: December 2021

The Pediatric Examination of Educational Readiness (PEER) is a standardized observation system for use by health care professionals. It combines a prekindergarten physical examination with a neurodevelopmental and behavioral assessment. The PEER was field tested on 386 children, of whom 22% revealed a "definite concern" in one area of development or behavior, 8% in two, and 14% in three or more areas. (A concern was a finding that required direct intervention, continuing surveillance or further evaluation.) Children with multiple areas of concern were found to have lower teacher rating scores at the end of kindergarten than those with isolated or no concerns. An observation procedure, such as the PEER, can be a productive part of the pediatric assessment of children entering kindergarten.
There's a Demon in Your Belly: Children's Understanding of Illness
Authors: Perrin Ellen C. , Gerrity P. Susan
Published: December 2021

Knowledge of how children come to understand the processes of causation, prevention, and treatment of illness is needed to help health professionals and educators in their work with children. Healthy children attending kindergarten through eighth grade were asked a series of standardized questions about illness, and their responses were scored on a scale corresponding to Piaget's theoretical framework of cognitive development. Children's responses varied widely at all ages, but there was a consistent systematic progression in their understanding of illness-related concepts with age. Kindergarten children typically understand illness causation as quite magical, and/or as the consequence of their transgression of rules. At fourth grade, children believe all illness to be caused by germs whose very presence is sufficient to make a child sick. The complexity of the mechanisms that must interrelate to cause illness is not understood until eighth grade at the earliest. At approximately 12 or 13 years of age children begin to understand that there are multiple causes of illness, that the body may respond variably to any or a combination of agents, and that host factors interact with the agent to cause and cure illness. This sequence in the development of understanding about illness parallels conceptual development in other content areas such as physical causality, although it seems to lag a bit. The delineation of the concepts typical of children at each developmental stage, as provided in this paper, will help to guide educational efforts and future research.
Two Cases of Dipylidiasis (Dog Tapeworm Infection) in Children: Update on an Old Problem
Authors: Hamrick Harvey J. , Drake W. Rodwell , Jones H. Michael , Askew Anne Preston , Weatherly Norman F.
Published: December 2021

Children in households with dogs and cats may become infected with the dog tapeworm more frequently than suspected. Because of age-appropriate hand-to-mouth exploration, young infants and toddlers, through contact with fleas on pets, floors, and furnishings, are particularly susceptible. Knowledge of the life cycle of this animal parasite and the manner in which children acquire and demonstrate infection can lead to early diagnosis and effective treatment.
Personnel in Neonatal Pediatrics: Assessment of Numbers and Distribution
Authors: Merenstein Gerald B. , Rhodes Philip G. , Little George A.
Published: December 2021

There has not been an accurate assessment made of the number of practicing neonatologists, attrition rate of neonatalogists, or geographic distribution of neonatologists; therefore, a telephone survey was conducted to assess these issues. The basic conclusion of this study is that numbers and distribution of neonatologists, as well as ratio to patient population, are not deficient or disproportionate when analyzed on a nationwide basis.
Oliguria and Tolazoline Pharmacokinetics in the Newborn
Authors: Ward Robert M. , Daniel Catherine H. , Kendig James W. , Wood Mary A.
Published: December 2021

Tolazoline treatment of neonates has been reported since 1965. Dosages increased from pulse doses of 1 to 2 mg/kg to continuous infusions of 10 mg/kg.h before neonatal plasma tolazoline concentrations were measured. We developed a microassay for tolazoline and determined neonatal distribution volume, 1.61 ± 0.21 L/ kg, and disposition rate constant (β), 0.0027 ± 0.005 min-1 (mean ± SEM). Half-life (y) ranged from 1.47 to 41.25 (median =4.43) hours and correlated inversely with urine output (x); y (h) = -0.46 + 7.63/x (mL/kg.h), r = .61, P < .05. The highest plasma tolazoline concentration in a neonate was 20.3 mg/L. Lethal tolazoline concentrations in lambs ranged from 21.8 to 56.8 mg/L. Initial tolazoline concentrations during infusions and after 1- to 2-mg/kg pulse doses ranged from 0.35 to 2.3 mg/L and PaO2 increased ≥15 mm Hg in 64% of 14 treatments. The average neonatal pharmacokinetics predict that each 1 mg of tolazoline HC1 per kilogram pulse dose will increase the plasma concentration of tolazoline base by 0.5 mg/L. The plasma concentration should remain constant with infusion dose increments of 0.16 mg of tolazoline HC1 per kilogram per hour for every 1.0-mg/kg loading dose. Tolazoline dose requirements for specific patients will vary, especially with renal dysfunction. Reduced tolazoline doses were used to treat two patients, concentrations remained constant, and PaO2 was maintained. Tolazoline doses derived from neonatal kinetics are less than current infusion doses and may avoid high concentrations.
Dynamics of Infant Feeding: Mothers, Professionals, and the Institutional Context in a Large Urban Hospital
Authors: Winikoff Beverly , Laukaran Virginia Hight , Myers Deborah , Stone Richard
Published: December 2021

A multidimensional approach was taken to understand the constraints to breast-feeding in a large municipal hospital. Data were collected through direct observation, chart review, and questionnaires to patients and staff. Breast-feeding had not yet begun within 24 hours postpartum in 37% of women who wanted to breast-feed. Chart review revealed that at hospital discharge no woman was breast-feeding exclusively: only 16% of infants had ever been breast-fed and all of these also had been formula fed. The most common reason for the use of supplementary formula and early weaning was the mother's perception or anticipation of insufficient milk. The existing procedures communicated the message to patients that the health care providers expected women to bottle-feed. Some practices that prevented successful breast-feeding were prolonged and/or unnecessary separation of mother and infant, routine provision of infant formula, confusion about drug contraindications for breast-feeding, and inconsistent identification of breast-feeding infants. Staff knowledge about breast-feeding management was inadequate, and staff underestimated mothers' interest in breast-feeding. Recommendations to facilitate breast-feeding include a revision of routines and procedures as well as provision of staff education and expansion of patient education.
Children With Influenza A Infection: Treatment With Rimantadine
Authors: Hall Caroline Breese , Dolin Raphael , Gala Christine L. , Markovitz David M. , Zhang Yu Qin , Madore Paul H. , Disney Frank A. , Talpey William B. , Green John L. , Francis Anne B. , Pichichero Michael E.
Published: December 2021

Treatment with rimantadine of influenza in children and the potential development of resistance in clinical isolates associated with therapy have not been previously studied. We compared rimantadine to acetaminophen therapy in a controlled, double-blind study of 91 children with influenza-like illness. Of 69 children with proven influenza A/H3N2 infection, 37 received rimantadine and 32 received acetaminophen for five days. Children receiving rimantadine showed significantly greater reduction in fever and improvement in daily scores for symptoms and severity of illness during the first three days. Viral shedding also diminished significantly during the first two days but subsequently increased such that by days 6 and 7 the proportion of children shedding virus, as well as the quantity of virus shed, was significantly greater in the rimantadine group. During the seven-day study, of the 22 children in the rimantadine group with serial isolates tested, ten (45.5%) had resistant isolates compared with two (12.5%) of those with serial isolates in the acetaminophen group (P < .03). Thus, of the total 37 children in the rimantadine group, 27% were found to have resistant isolated compared with 6% in the total group receiving acetaminophen (P < .04). Furthermore, the mean inhibitory concentration of rimantadine increased with time in the rimantadine group (r = .4, P = .002) but not in the acetaminophen group. Rimantadine therapy, thus, appears to be significantly more effective than acetaminophen in ameliorating the clinical signs and symptoms of influenza in children. Treatment with rimantadine was also associated with increased viral shedding after the medication was discontinued and with the development of resistance in the clinical isolates, the significance of which is unknown.
Long-Term Follow-up of Children With Congenital Central Hypoventilation Syndrome
Authors: Oren Joseph , Kelly Dorothy H. , Shannon Daniel C.
Published: December 2021

The long-term clinical course of six patients with congenital central hypoventilation syndrome is described. During the neonatal period, the patients had prolonged apneas and hypoventilation, in the absence of cardiac, pulmonary, or neuromuscular disease. After an initial period of respirator dependency, they became able to sustain normal gas exchange while awake. During sleep, however, profound hypoventilation developed, and tracheostomy and mechanical ventilation were required. Ventilatory responses to hypercapnia and hypoxia were depressed or absent and did not improve with time. One patient was able, at 2 years of age, to breathe spontaneously during sleep with only moderate hypoventilation. The others, now 4 to 14 years of age, still need ventilatory support during sleep. Complications, such as cardiac failure and hypoxic seizures, mostly occurred early in the course and resolved with correction of insufficient mechanical ventilation. Speech acquisition was possible with the use of a special stoma plug. All patients were managed at home, and with appropriate support, the parents were able to provide safe ventilatory care with low morbidity and no mortality.
Neonatal Anesthesia
Authors:   Committee on Fetus and Newborn,   Committee on Drugs,   Section on Anesthesiology,   Section on Surgery
Published: December 2021

In the past, some practicing physicians have advocated withholding anesthetic or analgesic agents from neonates undergoing surgical procedures. The rationale expressed for such practice is that some neonates undergoing surgery are often so unstable that the risk of an anesthetic agent is too great to justify the possible benefit of pain relief. An analogy may be drawn to the adult patient with major trauma who must undergo life-saving surgery in whom anesthesia is reduced or withheld because of the fear of worsening an already compromised physiologic homeostasis.1 Also cited in support of this practice is the impression that nerve pathways are not sufficiently myelinated to transmit painful stimuli or that neonates do not have sufficiently integrated cortical function to recall painful experiences.

There is an increasing body of evidence that neonates, including those born preterm, demonstrate physiologic responses to surgical procedures that are similar to those demonstrated by adults and that these responses can be lessened with anesthetic agents.2-6 Other studies have suggested that stability of variables such as blood pressure, heart rate, and oxygenation is important in reducing complications such as intraventricular hemorrhage or pulmonary hypertension.7,8 There is also increasing evidence that neonatal cortical function is far greater than previously thought9,10 and some suggestion that short-term behavior may be affected by prior painful stimuli.11,12

The Committee on Fetus and Newborn, The Committee on Drugs, the Section on Anesthesiology, and the Section on Surgery believe that local or systemic pharmacologic agents now available permit relatively safe administration of anesthesia or analgesia to neonates undergoing surgical procedures and that such administration is indicated according to the usual guidelines for the administration of anesthesia to high-risk, potentially unstable patients.
Academic Achievement in Children Ten to 12 Years After Haemophilus influenzae Meningitis
Authors: Feldman Heidi M. , Michaels Richard H.
Published: December 2021

Academic achievement by 23 children 10 to 12 years after treatment of Haemophilus influenzae meningitis was assessed using individually administered standardized tests, review of school transcripts, and parent and teacher questionnaires. The children's performance was compared with (1) their own performance in a previous study 6 to 8 years after the illness; (2) the performance of 23 similarly aged siblings in the previous study, a comparison which served to age match subjects and sibling controls; and (3) the performance of 11 of those similarly aged siblings retested in the current study. Subjects scored in the average range on all measures. Scores were comparable to results 4 years previous in four of six academic measures, with minor deterioration in reading single words and decoding nonsense words. There were no differences between subjects in the current study and control subjects from the previous study, except in decoding nonsense words, and no differences between subjects and control subjects in the current study, except in paragraph reading accuracy. Scholastic grade point averages and scores on parent and teacher behavior problem-rating scales showed no group differences. Subjects used more school-based remedial services, although the trend did not achieve statistical significance. Parents reported spending more time with subjects than with control subjects helping with homework. These findings suggest that children who have recovered from meningitis due to H influenzae can maintain scores and grades comparable to their siblings as they progress to middle school. Their academic success may involve more school and family support to compensate for the mild differences in intelligence quotient and neuropsychologic testing found in the previous study.
Age Limits of Pediatrics
Authors:   Council on Child and Adolescent Health
Published: December 2021

The purview of pediatrics includes the physical and psychosocial growth, development, and health of the individual. This commitment begins prior to birth when conception is apparent and continues throughout infancy, childhood, adolescence, and early adulthood, when the growth and developmental processes are generally completed. The responsibility of pediatrics may therefore begin with the fetus and continue through 21 years of age. There are special circumstances (eg, a chronic illness and/or disability) in which, if mutually agreeable to the pediatrician, the patient, and when appropriate the patient's family, the services of the pediatrician may continue to be the optimal source of health care past the age of 21 years.
Benign Epilepsy of Childhood and Gowers's Statements
Authors: FREEMAN JOHN M.
Published: December 2021

In Reply.—

Mea Culpa! One should always go back to the original citation as indicated by Drs Bouma and Peters. Fortunately, Gower's statement would have supported both our thesis and my favorite dictum "All that's new is rarely true, and all that's true is rarely new." The authors' speculation about treating for a short period of time (3 to 6 months) is equally as valid as ours not to treat. What is needed are studies and a rethinking of the prevalent concept that all epilepsy should be treated for 2-4 years or more.
Bronchoalveolar Lavage for Diagnosis of Pneumonia in the Immunocompromised Child
Authors: Frankel Lorry R. , Smith David W. , Lewiston Norman J.
Published: December 2021

Seven children with immunocompromised states were referred to the pediatric bronchoscopy service for evaluation of pneumonia. Flexible fiberoptic bronchoscopy accompanied with bronchoalveolar lavage was performed in all seven of these children. A definitive diagnosis was made for six of these seven patients. The diagnosis included Pneumocystis carinii in three, Candida albicans in two, and cytomegalovirus in one. There were no complications associated with the procedure. Flexible fiberoptic bronchoscopy with bronchoalveolar lavage should be considered early in the evaluation of the immunocompromised child with pneumonia.
Milk Production by Mothers of Premature Infants
Authors: Hopkinson Judy M. , Schanler Richard J. , Garza Cutberto
Published: December 2021

Milk volume, day of initiation of pumping, duration and frequency of milk expression, and length of night rest interval were evaluated for the first month postpartum in 32 healthy, nonsmoking women (ages 20 to 38 years) who delivered at 28 to 30 weeks' gestation. Early milk volumes were related negatively to the delay between delivery and the initiation of milk expression (r = -.48, P < .02). Average milk volumes at 2 weeks and 4 weeks postpartum were 493 ± 330 and 606 ± 369 mL/d (mean ± SD), respectively, and were not related to the absolute frequency or duration of pumping or to night rest interval. Volume changes between weeks 2 and 4 postpartum were correlated with the absolute frequency (r = .49, P < .01) and duration of pump use (r = .42, P < .05) during this interval and with changes in frequency (r = 0.56, P < .002) or duration (r = 0.49, P < .05) between the first 2 and the second 2 weeks postpartum. Optimal milk production was associated with five or more milk expressions per day and pumping durations that exceeded 100 min/d.
Pyoderma Gangrenosum as a Manifestation of Leukemia in Childhood
Authors: Gilman Andrew L. , Cohen Bernard A. , Urbach Andrew H. , Blatt Julie
Published: December 2021

Pyoderma gangrenosum is an uncommon skin lesion often associated with autoimmune diseases. A clear association between leukemia and pyoderma gangrenosum in adults has been established. Two cases of pyoderma gangrenosum in children with leukemia in whom it may be an initial finding are presented.
Report of the Task Force on Pertussis and Pertussis Immunization—1988
Authors: Cherry James D. , Brunell Philip A. , Golden Gerald S. , Karzon David T.
Published: December 2021

Pertussis (whooping cough) is an endemic and epidemic disease due to Bordetella pertussis. The disease has been and still is a major cause of morbidity and mortality in young children throughout the world. The World Health Organization estimates that 600,000 deaths due to pertussis occur yearly; virtually all of these deaths occurred in unimmunized infants.1 In the United States, pertussis has been successfully controlled by the routine mass immunization of infants and children. In the prevaccine era, there were 115,000 to 270,000 cases of pertussis and 5,000 to 10,000 deaths due to the disease each year.2 During the last 10 years, there have been 1,200 to 4,000 cases and five to ten deaths per year.3-6

Unfortunately, the control of pertussis by immunization has not enjoyed sustained international success because of controversy relating to vaccine reactions and effectiveness. Since 1982 this controversy has been a problem in the United States. Most pediatricians as well as a large number of parents are aware of the present pertussis vaccine controversy; however, few understand the facts. This controversy involving the media, political and legal sectors, and the scientific community is a major threat to our present immunization program and the future control of pertussis in the United States7-11 ("20/20," ABC News, Feb 5, 1985; "DPT: Vaccine Roulette," National Broadcasting Co, Date, 1982; Democrat and Chronicle, Rochester, NY, March 8-12, 1987, p 1; The Fresno Bee, Dec 2-3, 1984, p 1; Dec 5, 1987, p B14). Because of this, a task force on pertussis and pertussis vaccine was created by the Executive Board of the American Academy of Pediatrics to review the problem.