bluuebunny/crossref_metadata_2025 huggingface dataset:
Phenytoin-Induced Choreoathetosis in Infancy: Case Reports and a Review
Authors: Krishnamoorthy K. S. , Zalneraitis E. L. , Young R. S. K. , Bernad P. G.
Published: December 2021

Three cases of choreoathetosis which developed during phenytoin therapy in children less than 2 years of age are described. The most striking clinical manifestations included the sudden onset of restlessness and agitation with superimposed choreoathetosis. None of these children had toxic levels of phenytoin in the blood. Discontinuation of phenytoin resulted in prompt cessation of the symptoms. Phenytoin-induced choreoathetosis should be a diagnostic consideration in children with a preexisting CNS insult who manifest violent choreoathetosis during therapy for seizure control. This consideration is especially pertinent in the pediatric intensive care unit, where other more common causes of agitation could be misdiagnosed.
Desquamative Interstitial Pneumonia and Antigen-Antibody Complexes in Two Infants with Congenital Rubella
Authors: Boner Attilio , Wilmott Robert W. , Dinwiddie Robert , Jeffries Donald J. , Matthew Duncan J. , Marshall William C. , Mowbray James F. , Pincott John R. , Rivers Rodney P.
Published: December 2021

Desquamative interstitial pneumonia was observed in two infants with the late-onset congenital rubella syndrome. In both infants this unusual lung disease was associated with circulating immunoglobulin M complexes and interstitial pulmonary deposits of IgM by immunofluorescence. Both infants had IgG deficiency. The first child recovered with a reduction in IgM complex levels and synthesis of rubella-specific IgG. The second infant died during the acute phase of his illness at which time there were high serum concentrations of IgM complexes and slightly increased levels of IgG complexes. Delayed maturation of the immune response in congenital rubella may predispose to persistent antigenemia and pulmonary deposition of rubella antigen-containing IgM complexes resulting in an acute form of interstitial pneumonia.
Myocardial Calcification in a Neonate Following Open Chest Cardiac Compression
Authors: BISSET GEORGE S. , HIRSCHFELD STEPHEN S. , FISCHER WILLIAM W. , FARRIS KENNETH D.
Published: December 2021

Massive myocardial calcification remains an unusual roentgenographic finding in the neonate.1-5 The only three previously reported cases of radiographic demonstration of this occurrence were believed to be secondary to myocardial infarction.1-5 Several features of this case report make it unusual, particularly from an etiologic standpoint. CASE REPORT A 13-day-old black male infant born at 40 weeks of gestation was referred for evaluation of respiratory distress. On physical examination, the patient had signs of congestive heart failure, associated with absent femoral pulses. Two-dimensional echocardiography revealed severe coarctation of the thoracic aorta, D-transposed great vessels, and single ventricle and tricuspid atresia. The initial arterial blood gaas tensions revealed: pHH 7.39, Pco2 20 torr, and Po2 91 torr.
Azarcón and Empacho
Authors: ACKERMAN ALAN , RODMAN DOROTHY
Published: December 2021

To the Editor.—

We were pleased to see the case report concerning azarcó-related lead poisoning from the treatment of empacho.1 Since the time Bose et al composed their paper (September 1982), several new pieces of information have become available.

1. Additional cases of azarcó poisoning have been confirmed in Michigan-four cases, Wisconsin—one case, and California—ten cases.2-4 In several of these cases, other children in the extended family have either died of seizures after receiving azarcón in Mexico—one case5 or had been chelated for lead poisoning several years previously, although no source of lead had been identified—one case.3
A Potential Mechanism of Pathogenesis for Early Posthemorrhagic Hydrocephalus in the Premature Newborn
Authors: Hill Alan , Shackelford Gary D. , Volpe Joseph J.
Published: December 2021

Ventricular dilation is common following intraventricular hemorrhage. Neuropathologic studies have demonstrated that chronic posthemorrhagic hydrocephalus most commonly is a result of an obliterative arachnoiditis in the posterior fossa or is due to obstruction of flow of CSF within the ventricular system. Recent use of ultrasound scanning has demonstrated the occurrence of ventricular dilation within days of intraventricular hemorrhage (prior to the expected time of development of arachnoiditis). In the case described, serial realtime ultrasound scans demonstrated small mobile particles within dilated ventricles seven days following intraventicular hemorrhage. There was no obstruction of CSF flow within the ventricular system. Thus, in this case, ventricular dilation may have been secondary to plugging of arachnoid villi by the small particulate matter and, as a consequence, decrease in CSF reabsorption.
DTP-Associated Reactions: An Analysis by Injection Site, Manufacturer, Prior Reactions, and Dose
Authors: Baraff Larry J. , Cody Christopher L. , Cherry James D.
Published: December 2021

Local and less serious systemic reactions are frequent following immunization with diphtheria-tetanus-pertussis (DTP) vaccine. The effects of injection site, manufacturer, previous reactions, and dosage reduction upon subsequent reactions to DTP immunization were investigated. Local reactions, notably pain and swelling, were less common when the immunization was given in the buttocks than in the thigh. No injection site was consistently associated with lower systemic reaction rates. There was no significant difference in the rate of more serious reactions by vaccine manufacturer. Differences in rates of less serious reactions by manufacturer were observed but seemed to be related to vaccine lot differences rather than the specific vaccines. In a subset of 772 children, in whom data regarding sequential reactions were available, it was noted that all three reactions investigated—local redness, temperature ≥39°C, and persistent crying longer than one-half hour—were two to three times more frequent on a subsequent immunization when present on a prior vaccination than if not present on a prior vaccination than if not present previously. One hundred children received a half dose of DTP vaccine because of a less serious reaction associated with prior immunization. In all instances, they had significantly less serious local reactions as well as notable differences in temperature, drowsiness, and persistent crying.
Routine Screening of Newborns for Cystic Fibrosis: Not Yet
Authors: HOLTZMAN NEIL A.
Published: December 2021

Laboratory tests that look good on the "drawing board" often turn out to have limited usefulness in routine practice.1 This problem is particularly troublesome when tests that are capable of detecting patients with overt disease are used to screen apparently healthy populations. In that situation, false-negative and false-positive tests occur with unexpected frequency.2 Yet pressure for screening—including the passage of laws mandating it—sometimes precedes the validation of new tests.3 The compulsion to apply new techniques without adequate validation extends beyond screening; hence the term, "technological imperative." The American Academy of Pediatric's Task Force on Genetic Screening called attention to this problem several years ago, echoing the words of a Committee of the National Academy of Sciences3,4:
Acute lngestions of Thyroid Hormones
Authors: Lehrner Lawrence M. , Weir Michael R.
Published: December 2021

Although thyroid medications are commonly prescribed, there are only nine case reports describing the consequences of acute excessive ingestion of thyroid hormones. Two additional cases are presented and the prior nine cases are reviewed. The potential for toxicity is discussed in relationship to the cellular mechanisms of action of thyroid hormones. Although the potential for toxicity is low, the following therapy is recommended to decrease further the toxic potential: (1) lavage and activated charcoal to decrease absorption, (2) cholestyramine to decrease enterohepatic circulation (3) prednisone and/or propylthiouracil to decrease conversion of thyroxine to triiodothyronine, and (4) propranolol to block metabolic effects. If symptoms of toxicity develop, then attempts to remove thyroid hormones should be undertaken using exchange transfusion.
Neonatal Exchange Transfusions Complicated by Transfusion-Induced Malaria
Authors: Shulman Ira A. , Saxena Sunita , Nelson Janice M. , Furmanski Martin
Published: December 2021

Two neonates who became infected with Plasmodium vivax subsequent to exchange transfusion are described. This complication of neonatal exchange transfusion is unusual in that only two other similar cases have been reported to the Centers for Disease Control. Although malaria is an unusual complication, it should be kept in mind when considering the differential diagnoses of fever following neonatal exchange transfusion. The risk of transfusion-induced malaria may be increasing due to the influx of immigrants from areas endemic for malaria. Careful blood donor selection and blood donor education may minimize this risk.
Breast Milk Iodide: Reassessment in the 1980s
Authors: Gushurst Colette A. , Mueller Jennifer A. , Green James A. , Sedor Frank
Published: December 2021

In addition to iodized salt, the American diet is inadvertently supplemented with iodine from other foods, such as bread and cow's milk. The iodine content of breast milk has not been assessed recently in this country. Sixty-one samples of breast milk from 37 women were analyzed for iodide content using an iodide-selective electrode method. Mean breast milk iodide level on initial samples for this population was 178 µg/L (range 29 to 490 µg/L), about four times the recommended daily allowance for infants. Iodide levels in breast milk did not correlate with the age of the infant (ie, stage of lactation). There was a significant correlation between the iodide level in the breast milk and dietary iodine as estimated by a food frequency questionnaire, and iodized salt intake was significantly related to the iodide content of the breast milk.
Vitamin E and Necrotizing Enterocolitis
Authors: Finer Neil N. , Peters Kathrine L. , Hayek Zamir , Merkel Cheryl L.
Published: December 2021

Although vitamin E has been shown to reduce the incidence of severe sequelae from retrolental fibroplasia, there have been recent suggestions that its use may be associated with an increased incidence of necrotizing enterocolitis (NEC). A review was made of experience with vitamin E, both intramuscular and oral, and NEC over a 4½-year period. Of 418 infants of birth weight less than 1,500 g admitted during this period, 28/209 infants who had received vitamin E had definite NEC (13.4%) compared with 12/209 who had not received vitamin E (5.74%, χ2 = 7.07, P = .008). For infants of birth weight less than 1,250 g, 16/103 infants who received vitamin E developed NEC v 1/159 who had not (χ2 = 21.1, P < .001); the incidence of NEC was not significantly different between the two groups for infants with birth weight between 1,250 to 1,500 g. The early mortality (< seven days) for infants with birth weight of 1,500 g or less was significantly greater for those who had not received vitamin E (43.5% v 13.8%, χ2 = 44.9, P < .001), most probably a reflection of the omission of this drug for the most critically ill infants in this retrospective review. The incidence of NEC was not different for infants with birth weight of 1,500 g or less who received intramuscular vitamin E compared with control infants from the same period. For those infants for whom serum tocopherol levels were available, no infant who developed NEC and who had received only oral vitamin E had a serum tocopherol level of greater than 3.5 mg/100 mL. The increased incidence of NEC appeared to be associated with an oral dose of 200 mg of vitamin E of the currently available hyperosmolar preparation. In an effort to reduce serious eye sequelae from retrolental fibroplasia, infants with birth weight less than 1,250 g who require oxygen should receive either parenteral vitamin E or a low osmolar oral preparation within 12 hours of birth.
The Transected Urachus: An Unusual Cause of Neonatal Ascites
Authors: HEPWORTH RANDALL C. , MILSTEIN JAY M.
Published: December 2021

Neonatal ascites may arise from a number of different causes.1,2 The purpose of this report is to describe an unusual iatrogenic cause of neonatal urinary ascites.

The patient was a 3-day-old white male infant born by precipitous vaginal delivery. His Apgar scores were 7 and 9 at one and five minutes, respectively, and birth weight was 3,147 g. Initially, the infant was noted to have hypoglycemia, which resolved with oral feeding, as well as transient tachypnea and temperature instability, which resolved spontaneously. The physical examination was otherwise normal.

On the second day of life, the patient became jaundiced and had recurrent temperature instability, hypoglycemia, and seizure activity.
Kawasaki Disease and an Unusual Primary Infection with Epstein-Barr Virus
Authors: KIKUTA HIDEAKI , MIZUNO FUMIO , OSATO TOYORO , KONNO MUTSUKO , ISHIKAWA NOBUYOSHI , NORO SHIN-ICHI , SAKURADA NORIO
Published: December 2021

To the Editor.—

Kawasaki disease (acute febrile mucocutaneous lymph node syndrome, MCLS)1 has been increasingly encountered throughout Japan. Furthermore, this syndrome has also been identified in other countries.2 We previously suggested that this particular disease may be closely associated with an abnormal immune response to Epstein-Barr virus (EBV).3 To obtain more information, further investigations were carried out on another group of 45 Japanese patients (27 boys and 18 girls; mean age of 2.3 years) that satisfied the criteria for a definite diagnosis of MCLS.3
Survival and Morbidity of Our Smallest Babies: Is There a Limit to Neonatal Care?
Authors: COHEN RONALD S. , STEVENSON DAVID K. , ARIAGNO RONALD L. , SUNSHINE PHILIP
Published: December 2021

To the Editor.—

We recently reported an improved outcome for infants with birth weight in the 751-to 1,000-g range; the prognosis for infants weighing 750 g or less at birth was equivocal.1 Since the publication of this report, further interesting data on the very low-birth-weight infants cared for in the Stanford University Hospital Intensive Care Unit have become available. We would like to add these data to those already published.

In the original paper,1 we reported a 28% neonatal mortality for 751-to 1,000-g birth weight infants born during 1977 to 1980.
Breast-Feeding and Illness
Authors: CUNNINGHAM ALLAN S.
Published: December 2021

To the Editor.—

Holmes et al1 underestimated the association between breast-feeding and lowered illness rates. A separate comparison for their subgroup of more serious illnesses (lower respiratory tract infection, acute otitis media, gastroenteritis, meningitis—table 3) shows the following: For maternal education ≤11 years there were 53 such illnesses per 100 formula-fed infants (28 illnesses/53 infants) compared with 13 illnesses per 100 breast-fed infants (3/23), a fourfold excess. For maternal education ≥12 years formula-fed infants had 42 illnesses per 100 infants (raw data: 30 illnesses/71 infants) whereas the breast-fed infants had 27 illnesses per 100 infants (raw data: 28/104).
Cerebral Concussion in Children: Assessment of Injury by Electroencephalography
Authors: Mizrahi Eli M. , Kellaway Peter
Published: December 2021

An examination was made of 967 initial and follow-up electroencephalograms of 371 children with clinically diagnosed cerebral concussion to determine whether the EEG could provide an objective measure of injury. For each patient, the degree and distribution of EEG abnormalities, as well as their rate of resolution, were correlated with the severity of clinically assessed injury. A close relationship was found between the severity of both initial and longitudinal EEG disturbances and the clinically suspected grade of concussion. Serial EEGs of individual patients showed a similar relationship between time elapsed since injury and degree of abnormality. The rate at which the sequence of EEG resolution took place varied in direct relation to the severity of concussion. It was concluded that the initial EEG and the rate and degree of resolution of EEG abnormalities, together with the time elapsed since injury, can provide objective and reliable information to the clinician for the establishment of the diagnosis and assessment of severity of cerebral concussion in children.
Hemodynamic Response to High-Frequency Ventilation in Infants Following Cardiac Surgery
Authors: Vincent Robert N. , Stark Ann R. , Lang Peter , Close Richard H. , Norwood William I. , Castaneda Aldo R. , Frantz Ivan D.
Published: December 2021

The hemodynamic response to high-frequency ventilation was compared with conventional ventilation in six infants following cardiac surgery. While undergoing high-frequency ventilation, adequate gas exchange was maintained in all infants. High frequency ventilation allowed a reduction of peak ventilatory pressure at the airway opening by 19%, and peak tracheal pressure by 42%. No clinically important changes in heart rate, systemic and pulmonary arterial pressure, cardiac index, or systemic and pulmonary vascular resistance were noted when high-frequency ventilation was compared with conventional ventilation.
Congenital Hydranencephaly/Porencephaly Due to Vascular Disruption in Monozygotic Twins
Authors: Jung Jack H. , Graham John M. , Schultz Nancy , Smith David W.
Published: December 2021

Monozygotic twinning has been associated with a variety of vascular disruptive defects including congenital hydranencephaly/porencephaly. Data involving 24 cases of congenital hydranencephaly/porencephaly associated with twinning are reported. In these cases, the finding of a preponderance of monozygotic twins and the common association of a deceased co-twin support the hypothesis of a vascular disruptive etiology. These defects are presumed to be secondary to embolic phenomena or thromboplastin release from the deceased co-twin to the survivor via the vascular interconnections of a conjoined monochorionic placenta. In all cases of hydranencephaly/porencephaly, a careful examination of the placenta and membranes for evidence of a deceased co-twin is warranted prior to providing recurrence risk counseling.
Fatal Acute Splenic Sequestration at 4 Months of Age
Authors: Walterspiel Juan N. , Rutledge Joe C. , Bartlett Bryan L.
Published: December 2021

A patient with homozygous sickle cell anemia is the youngest known to have died from acute splenic sequestration crisis. A cord blood screening program might have prevented this infant's death.
Effect of Isoproterenol Inhalation on Airway Resistance in Chronic Bronchopulmonary Dysplasia
Authors: Kao Lily C. , Warburton David , Platzker Arnold C. G. , Keens Thomas G.
Published: December 2021

The effects of isoproterenol inhalation on pulmonary mechanics in ten infants with bronchopulmonary dysplasia (BPD), aged 41 ± 1 (SE) weeks postconception, with gestational age at birth 30 ± 1 weeks, and birth weight 1,590 ± 200 g were studied. The infants had: (1) hyaline membrane disease requiring mechanical ventilation in the first five days of life, (2) mechanical ventilation and/or FIO2 greater than 30% for at least 30 days, and (3) stage III or IV radiographic changes. Thoracic gas volume, airway resistance, and specific airway conductance were measured in an infant body pressure plethysmograph during quiet breathing. Dynamic pulmonary compliance was measured using an esophageal balloon. These infants with BPD had greater airway resistance, lower specific airway conductance, and lower dynamic pulmonary compliance than 16 normal control infants (age 40 ± 1 weeks postconception). In the infants with BPD, measurements were obtained before and ½, 1, 2, and 6 hours after the administration of isoproterenol aerosol 0.1% inhalation or saline aerosol placebo, five breaths by slow inflation of the lungs with an anesthesia bag. Within 30 minutes after isoproterenol inhalation, airway resistance decreased 28% ± 5% and specific airway conductance increased 53% ± 15%. Thoracic gas volume and dynamic pulmonary compliance did not change. There were no changes following administration of the placebo. Isoproterenol inhalation is associated with rapid short-term improvement in airway resistance and specific airway conductance in infants with BPD.
Management of Hepatic Hemangioendotheliomas of Infancy by Transarterial Embolization: A Report of Two Cases
Authors: JOHNSON D. H. , VINSON A. M. , WIRTH F. H. , PRESBERG H. J. , HARKINS G. , Nuss D. , WALBURGH C. E. , RAFF J. C.
Published: December 2021

Hepatic hemangioendotheliomas are uncommon vascular tumors which present as abdominal masses, unexplained jaundice, bleeding disorders, or congestive heart failure.1-3 Death often results from congestive heart failure despite appropriate treatment with digoxin and diuretics.4 Verification of hepatic vascular malformations rests on selective angiography,5 hepatic scintigraphy,6 computed tomography,7 and abdominal ultrasonography.8

Successful treatment of heart failure depends on elimination of the malformation's left-to-right shunt and its adverse cardiac effects. Present theapeutic recommendations for symptomatic patients remain divided. Treatment options include surgical excision of localized lesions,9 hepatic artery ligation,10 radiation,11 and glucocorticoid therapy12,13, often combinations of these programs are used.
Principles of Treatment of Disabled Infants
Authors:   Joint Policy Statement
Published: December 2021

Discrimination of any type against any individual with a disability/disabilities, regardless of the nature or severity of the disability, is morally and legally indefensible.

Throughout their lives, all disabled individuals have the same rights as other citizens, including access to such major societal activities as health care, education, and employment.

These rights for all disabled persons must be recognized at birth.

NEED FOR INFORMATION

There is a need for professional education and dissemination of updated information which will improve decision-making about disabled individuals, especially newborns. To this end, it is imperative to educate all persons involved in the decision-making process. Parents should be given information on available resources to assist in the care of their disabled infant. Society should be informed about the value and worth of disabled persons. Professional organizations, advocacy groups, the government, and individual care givers should educate and inform the general public on the care, need, value, and worth of disabled infants.

MEDICAL CARE

When medical care is clearly beneficial, it should always be provided. When appropriate medical care is not available, arrangements should be made to transfer the infant to an appropriate medical facility. Consideration such as anticipated or actual limited potential of an individual and present or future lack of available community resources are irrelevant and must not determine the decisions concerning medical care. The individual's medical condition should be the sole focus of the decision. These are very strict standards.

It is ethically and legally justified to withhold medical or surgical procedures which are clearly futile and will only prolong the act of dying.
Floor Furnace Burns
Authors: BERGER LAWRENCE , KALISHMAN SUMMERS
Published: December 2021

In Reply.—

We appreciate Grossman's sharing his ingenious device to prevent burns from floor furnaces. Another physician-engineer, Dr. William Green, has also created a device to prevent burns from floor furnaces (Figure).

All such constructions require a fair amount of carpentry skill, and carry with them their own hazards of falls, broken dowels, and entrapment. For these reasons, we urge parents to install gates or keep the furnace turned off when infants or toddlers are in the home.
Child Abuse: Parenteral Hydrocarbon Administration
Authors: SAULSBURY FRANK T. , CHOBANIAN MICHAEL C. , WILSON WILLIAM G.
Published: December 2021

The recognized spectrum of child abuse and neglect has expanded enormously since the original description of the battered child syndrome by Kempe et al, in 1962.1 In addition to physical abuse, we now realize that sexual abuse and nutritional neglect, as well as emotional abuse and neglect of children are problems of considerable magnitude.

Another form of child abuse reported with increasing frequency is the intentional poisoning of children. Although this form of child abuse was mentioned by Kempe et al1 in their original report, it has only recently received more recognization and attention. Because of several unique characteristics, some authors2-4 favor considering intentional poisoning as a distinct subgroup of child abuse.
Upper Extremity Burns from Woodstoves
Authors: YANOFSKY NORMAN N. , MORAIN WILLIAM D.
Published: December 2021

Twenty-one woodstove-related burns of the hand and forearm in preschool-aged children were reviewed concerning nature and mechanism of injury, treatment, and clinical course. Two distinct patterns of injury were seen: with infants less than 14 months of age, burns occurred almost exclusively when the child touched the stove intentionally, unable to distinguish it from another piece of furniture; in older children burns were always "accidental."

[See figure in the PDF file]

Most burns epithelialized spontaneously with surgical intervention and without functional disability. Protective devices are available and could prevent childhood burns from woodstoves.
Unstable Diabetes and Unstable Families: A Psychosocial Evaluation of Diabetic Children with Recurrent Ketoacidosis
Authors: White Kimberly , Lee Kolman Mary , Wexler Phyllis , Polin Gail , Winter Robert J.
Published: December 2021

To investigate the physical and psychological factors associated with labile diabetic control, 30 children and adolescents with recurrent diabetic ketoacidosis were included in a retrospective longitudinal review covering an 8-year period. The details of the ketoacidosis episodes and the psychosocial characteristics of the patient and his family were summarized from the medical record. Only a minority of the ketoacidosis episodes were overtly and solely related to intercurrent illness or poor compliance. A majority of the subjects studied lived in families with substantial psychosocial dysfunction, including chronic unresolved interpersonal conflict, inadequate parenting, father not in home, financial stress, and lack of family involvement with the diabetes. Many of the children displayed behavioral and personality problems. In most of these 30 cases, there was evidence that these dysfunctions existed prior to the onset of diabetes. These psychosocial problems were not immediately apparent in many instances, thus requiring more comprehensive psychosocial assessment and involvement by a social worker and/or a psychologist. Ongoing emotional support and counseling were instrumental in reversing the pattern of recurrent ketoacidosis, in coordination with care by all members of the diabetes team. The findings from this experience suggest that recurrent ketoacidosis warrants prompt evaluation from a psychosocial as well as a physical perspective.
Marital Adjustment to Chronic Childhood Illness: A Critique of the Literature
Authors: Sabbeth Barbara F. , Leventhal John M.
Published: December 2021

Thirty-four studies of marital adjustment were selected from the literature on family adjustment to chronic childhood illness. Studies were reviewed to determine whether divorce rates were elevated or marital adjustment was poorer compared with that of families of healthy children. Of 23 studies reporting divorce rates, only six used a group of families without a chronically ill child for comparison. These studies showed no significant differences in the divorce rates between groups. Of 23 studies of marital adjustment, 83% investigated marital distress. Four of seven studies with comparison groups showed that marital distress was increased in parents of chronically ill children. Other areas of marital adjustment, such as communication, decision-making, and role flexibility, have received almost no attention by researchers. It is questioned whether divorce or distress is an adequate indicator of marital adjustment in general. Further studies are needed to understand the relationships between divorce, distress, and other important areas of marital adjustment to chronic childhood illness.
Relationship of Family Life Events, Maternal Depression, and Child-Rearing Problems
Authors: Fergusson D. M. , Horwood L. J. , Shannon F. T.
Published: December 2021

The relationship between maternal reports of child-rearing problems, family life events, and maternal depressive symptoms was studied in a birth cohort of children in New Zealand. Rates of child-rearing problems showed a steady increase with both increasing levels of family life events and maternal depressive symptoms. Log-linear modeling of the results suggested that the apparent correlation between family life events and reports of child-rearing problems was mediated by the effects of maternal depression so that women subject to large numbers of adverse life events suffered increased rates of depression and in turn reported higher rates of problem behavior in their children. There was no significant correlation between family life events and reports of child-rearing problems when the effects of maternal depressive symptoms were taken into account. The findings tend to suggest that the previously reported association between family life events and child-rearing problems arises because life events provoke depressive symptoms in women and in turn this alters the way in which they perceive or evaluate their children's behavior.
Chiamydia trachomatis Infection in Sexually Active Adolescents: Prevalence and Risk Factors
Authors: Chacko Mariam R. , Lovchik Judith C.
Published: December 2021

The prevalence of Chlamydia trachomatisgenital infection was studied in a sexually active urban Baltimore adolescent population. Possible risk factors such as age, past history of sexually transmitted disease, number of sexual partners, contact with sexually transmitted disease, oral contraceptive use, and concomitant gonococcal infection were also evaluated. The prevalence of chlamydial infection in the 280 adolescents studied was 26%: 35% in male adolescents, 27% in pregnant female adolescents, and 23% in nonpregnant female adolescents. Chiamydia was almost three times as prevalent as gonorrhea in the same population. Age, past history of sexually transmitted disease, oral contraceptive use, and concomitant gonorrhea were not significantly associated with chlamydial infection. However, multiple current sexual partners, contact with sexually transmitted disease, genitourinary symptoms, and cervical ectopy were significantly associated with chlamydial infection. Testing for chlamydial infection in sexually active urban teenagers is recommended for those with genitourinary symptoms, those with cervical ectopy, or those who are contacts of persons with sexually transmitted disease. Considering the reservoir of infection in the asymptomatic female adolescents, screening for chlamydial infections in family planning clinics warrants consideration.
Unreliability of Radiographic Diagnosis of Septic Hip in Children
Authors: Volberg Frank M. , Sumner Thomas E. , Abramson Jon S. , Winchester Patricia H.
Published: December 2021

The radiographs of 19 pediatric patients with aspiration-proven bacterial infections of the hip were analyzed. The hip radiograph was abnormal in all neonates showing lateral subluxation. The radiograph was negative in eight of ten children more than 1 year of age. It is emphasized that children with suspected septic hip require immediate joint aspiration regardless of radiographic findings.
Care of Infants with Myelomeningocele
Authors: LIPTAK GREGORY S. , MASIULIS BARBARA S.
Published: December 2021

To the Editor.—

The article by Gross et al1 on the management of newborns with meningomyelocele is outrageously misleading. The reader unfamiliar with children who have meningomyelocele would believe, after reading this paper, that half of these children (48%) can be expected to have such a wretched existence that they should not be allowed to live. The authors imply that this 48%, who were given supportive care only, would have poor "quality of life" with "suffering," poor "intellectual prognosis," and bad "potential for human relationships."
Job Satisfaction and Stress Among Neonatologists
Authors: Clarke Thomas A. , Maniscalco William M. , Taylor-Brown Susan , Roghmann Klaus J. , Shapiro Donald L. , Hannon-Johnson Catherine
Published: December 2021

Neonatology is reputed to be a stressful pediatric subspecialty. To quantify objectively this stress and to assess the factors involved, a questionnaire was mailed to neonatologists in the northeastern United States. Ninety-six (70%) replied. A five-point scale was used to determine the level of satisfaction with neonatology as a career and the level and type of stress experienced at work. Almost all neonatologists experienced stress at work: 34% moderately severe and 16% very severe stress. Open-ended questions indicated that the major causes of stress were excessive work load, eg, on call too often or calls at night; problems in patient care, especially dealing with infant death; and staff disagreements, especially nurse or housestaff conflicts. Twenty percent of those surveyed suffered a stress-related illness in the previous 5 years. One sixth of the neonatologists were either moderately or very dissatisfied with their career. Major dissatisfactions were: too much work, especially managing many sick patients; lack of resources, including inadequate salary; too much stress at work; and administrative demands. Job satisfaction was derived from patient care, teaching, intellectual stimulation, and research. Altering subspecialty had been considered at some time by 58% (15% very seriously). This study confirms that neonatology, in the eyes of those who practice it, is a highly stressful career. It also suggests that job stress is a greater problem than job dissatisfaction.
Nonsexual Transmission of Sexually Transmitted Diseases: An Infrequent Occurrence
Authors: Neinstein Lawrence S. , Goldenring John , Carpenter Sarah
Published: December 2021

Sexually transmitted diseases occur in epidemic numbers in the United States today. Nonsexual transmission of these diseases is rarely an issue in adults. However, when the same diseases are found in children, the tendency of pediatricians and other health care practitioners has been to believe the mode of transmission is asexual. A review of gonorrhea, Chiamydia trachomatis, herpes genitalis, condyloma acuminata, Trichomonas vaginalis, syphilis, chancroid, and granuloma inguinale infections has been made to address the issue of nonsexual transmission of sexually transmitted diseases. Nonsexual transmission of these infections is an infrequent occurrence and when they affect the prepubertal child, sexual abuse must be highly suspected.
Antibody Production Following Immunization with Diphtheria and Tetanus Toxoids in Children Receiving Chemotherapy During Remission of Malignant Disease
Authors: Kung F. H. , Orgel H. A. , Wallace W. W. , Hamburger R. N.
Published: December 2021

Twenty-seven children with various childhood malignancies who were in clinical remission and receiving maintenance chemotherapy were given diphtheria-pertussis-tetanus (DPT) immunizations. Antidiphtheria and antitetanus titers were drawn before and 1 month after immunization. Only one child had no antibody response to either antigen. Two other children failed to develop any detectable antitetanus antibody titer but did mount a normal antibody response to inactivated diphtheria antigen. In fact, most children made good antibody responses to both immunizing antigens, irrespective pective of the nature of their disease or of the treatment given. These results show that children receiving longterm chemotherapy should not be denied the protection afforded by immunization with nonliving vaccines.
Diabetes Mellitus During Pregnancy and the Risks for Specific Birth Defects: A Population-Based Case-Control Study
Authors: Becerra Jose E. , Khoury Muin J. , Cordero Jose F. , Erickson J. David
Published: December 2021

Although the excess risk for birth defects among children of mothers with diabetes mellitus is well documented, there are few data concerning the risk for specific malformations. In the Atlanta Birth Defects Case-Control Study, those risks for malformations were evaluated. The population-based study included 4929 live and stillborn babies with major malformations ascertained by the Metropolitan Atlanta Congenital Defects Program in the first year of life born to residents of Metropolitan Atlanta between 1968 and 1980. The study also included 3029 nonmalformed live babies who were frequency-matched to case babies by race, period of birth, and hospital of birth. The relative risk for major malformations among infants of mothers with insulin-dependent diabetes mellitu (n = 28) was 7. (5% confidence interval [CI]1.9, 33.5) compared with infants of nondiabetic mothers. The relative risks for major central nervous system and cardiovascular system defects were 15.5 (95% CI = 3.3, 73.8) and 18.0 (95% CI = 3.9, 82.5), respectively. The absolute risks for major, central nervous system, and cardiovascular system malformations among infants of diabetic mothers were 18.4, 5.3, and 8.5 per 100 live births, respectively. Infants of mothers with gestational diabetes mellitus who required insulin during the third trimester of pregnancy were 20.6 (95% CI = 2.5, 168.5) times more likely to have major cardiovascular system defects than infants of nondiabetic mothers. The absolute risk for infants of this group of diabetic mothers was 9.7%. No statistically significant differences were found among infants of mothers with gestational diabetes mellitus who did not require insulin during pregnancy. These results suggest a stronger association than previously reported between maternal diabetes mellitus and specific categories of major malformations and implicate gestational diabetes mellitus as a risk factor for major cardiovascular system defects.
Hypermagnesemia and Intestinal Perforation Following Antacid Administration in a Premature Infant
Authors: BRAND JOSEPH M. , GREER FRANK R.
Published: December 2021

Antacid therapy is widely used prophylactically in pediatric intensive care units to prevent stress ulcers. It has also been used in the medical management of gastric bleeding in newborn infants.1,2 Complications of antacid therapy in the newborn infant have included hypotonia, asymptomatic hypermagnesemia without hypocalcemia, as well as aluminum-hydroxide bezoar formation.1-3 This is the first report in which a severe degree of these complications of magnesium-containing antacids is described that includes hypermagnesemia with hypocalcemia and in which a strong case is made against the use of antacid therapy in the treatment of gastric bleeding in very low birth weight infants.
Immunizations to the Deltoid Region
Authors: BERGESON PAUL S.
Published: December 2021

To the Editor.—

Ipp and coworker1 should be congratulated for their brief but brilliant piece of work regarding the use of the deltoid, rather than the thigh, for diphtheria-pertussistetanus and polio immunizations in children 18 months of age and older. The observation of lesser pain and fewer severe reactions when deltoid injections compared with thigh injections are used is important. Reducing reactions to immunizations is abundantly logical as an aid to furthering the interventional immunization effort.
Jitteriness in Full-Term Neonates: Prevalence and Correlates
Authors: Parker Steven , Zuckerman Barry , Bauchner Howard , Frank Deborah , Vinci Robert , Cabral Howard
Published: December 2021

The prevalence and correlates of jitteriness were evaluated in a sample of 936 healthy full-term infants. Jitteriness was seen in 44% of this sample: 23% were classified as mildly jittery, 8% as moderately jittery, and 13% as extremely jittery. Jitteriness was seen most commonly in infants who were sleepy or active and least commonly in infants who were quietly wakeful during the neonatal examination. Jittery infants were more likely to be difficult to console when crying (P < .01) and less visually alert (P < .001) than were nonjittery infants. Jitteriness was seen more commonly in slightly smaller (P < .05) and shorter (P < .001) infants, in those more than 12 hours old (P < .01), and in those not exposed to general anesthesia (P < .05). In an expanded sample of 1054 healthy and sick full-term infants, jitteriness was observed more commonly in neonates who had been exposed prenatally to maternal marijuana use (P < .01), but not to cocaine use (P = .1), and whose mothers had a positive postpartum urine assay for marijuana (P < .05) or cocaine (P = .06). The magnitude of these drug effects, however, was small. These findings have important implications for the early parent-infant relationship, pediatric practice, and future research.
Acquired Immunodeficiency Syndrome Transmission: Changes in Knowledge and Behaviors Among Teenagers, Massachusetts Statewide Surveys, 1986 to 1988
Authors: Hingson Ralph , Strunin Lee , Berlin Beth
Published: December 2021

Despite substantial progress, adolescents remain at high risk for human immunodeficiency virus (HIV) infection. Two independent random digit dial statewide Massachusetts surveys of 16- to 19-year-old persons conducted August through September 1986 and 1988 revealed that the proportion of teenagers who had discussed acquired immunodeficiency syndrome (AIDS) in schools increased from 52% to 82%. Knowledge about how AIDS is transmitted was also significantly higher in 1988. The proportion of teenagers using drugs other than alcohol and marijuana declined from 13% to 9%, and intravenous drug use declined from 1% to 0.1%. At the same time, among sexually active teenagers, the proportion who reported changes in sexual behavior to avoid AIDS increased from 16% to 34%. The proportion who adopted condom use to avoid AIDS increased from 2% to 19%. However, the overall proportion of teenagers who reported sexual intercourse in the past year increased significantly from 55% to 61%. In 1988, among sexually active teenagers, 37% never used condoms and 33% used them only some of the time. Of all respondents, 18% reported unprotected sex with more than one partner in the previous year, and 3% reported unprotected sex with intravenous drug users. Although mass media and school education may increase knowledge and stimulate some teenagers to change behavior, for others more personal forms of counseling may be needed. The effects of increasing physician counseling warrant special study. Teenagers who had spoken to physicians about AIDS were much more likely to have adopted condom use to avoid HIV exposure. However, although 80% of adolscents saw a physician in the past year, only 13% were counseled about AIDS.
Decreased Cardiac Output in Infants of Mothers Who Abused Cocaine
Authors: van de Bor Margot , Walther Frans J. , Ebrahimi Mahmood
Published: December 2021

Cocaine increases the level of circulating catecholamines by blocking the catecholamine reuptake receptors. The effect of intrauterine cocaine exposure on cardiac output was studied in 15 full-term newborn infants whose mothers used cocaine during pregnancy. A total of 22 healthy nonexposed full-term infants served as a control group. On the first day of life, cardiac output (183 ± 12 vs 235 ± 13 mL/kg per minute, mean ± SD; P < .05) and stroke volume (1.3 ± 0.1 vs 1.9 ± 0.1 mL/kg, mean ± SD; P < .005) were lower and arterial blood pressure (60 ± 2 vs 41 ± 2 mmHg, mean ± SD; P < .001) higher in the infants exposed to cocaine. On day 2, cardiac output, stroke volume, and mean arterial blood pressure were similar, probably because of the gradual excretion of cocaine and its metabolites by the infant. It was speculated that an increase in plasma norepinephrine levels is responsible for the cardiovascular effects of intrauterine cocaine exposure.
Pediatric Problems in a Suburban Shelter for Homeless Families
Authors: Bass Joel L. , Brennan Patricia , Mehta Kishor A. , Kodzis Sally
Published: December 2021

The experience of an affiliation between a hospital-based clinic and a family shelter is presented. The medical implications of family shelter residence include special issues related to the spread of infectious diseases, particularly to the neonate. Preentry medical evaluation revealed that a large proportion of children and their parents had one or more medical problems. Of 67 children screened before entrance, 3% had Giardia lamblia detected in the stool. In addition to carriage of enteric pathogens, the range of pediatric problems encountered included a variety of acute and chronic medical conditions, unmet primary care needs, and developmental and school difficulties. Fifty-eight percent of shelter residents were found to be "medically homeless." Formal liaison between a hospital-based clinic and a family shelter was found to be an effective way to promote a healthy environment in the family shelter and to provide needed medical services to shelter families.
What Constitutes Adequate Oxygenation?
Authors: Dudell Golde , Cornish J. Devn , Bartlett Robert H.
Published: December 2021

In an attempt to avoid the substantial risks of pulmonary injury associated with the use of high ventilator pressures and high oxygen concentrations, physicians often ask such questions as "What is the optimal Pao2?" and "What treatment should be used to achieve an optimal Pao2?" Although the intent to minimize secondary, ventilator-induced lung injury is laudable, any attempt to provide a fixed numeric response to this query is misguided not only because the oxygen requirements and clinical circumstances of our patients vary, but because the Pao2 is a particularly poor indicator of these needs.

An example is the large full-term neonate admitted to a newborn intensive care unit from the delivery room with obvious tachypnea and an arterial Po2 of 60 mm Hg in room air. Is this Pao2 acceptable? A more appropriate question may be whether the infant's "oxygenation" is adequate. But what is "oxygenation"? If by this vaguely applied term we mean the partial pressure of oxygen in the arterial blood, and if we define the acceptable limits for this parameter as being between 50 and 80 mm Hg, as is often done, then the answer must clearly be in the affirmative. If, on the other hand, we take oxygenation to mean the balance between the rate of oxygen delivery to the tissues and their rate of oxygen consumption, then we must admit that we cannot know on the basis of the information provided by the Pao2 alone.

Oxygen delivery is determined by the concentration o hemoglobin in the blood, its oxygen saturation, the rate at which this blood is circulated to the tissues (generally, the cardiac output), and the efficiency with which the oxygen is "unloaded" from hemoglobin to the tissues.
Retrocardiac Pneumomediastinum: Radiographic Finding and Clinical Implications
Authors: Rosenfeld David L. , Cordell Charles E. , Jadeja Naren
Published: December 2021

Fourteen neonates with posterior mediastinal air collections (retrocardiac pneumomediastinum) are described. In the majority of the infants (13 of 14), the mediastinal air developed as a complication of assisted ventilation. It is suggested that the retrocardiac pneumomediastinum represents air trapped in a potential space in the mediastinum posterior to the heart and not within the pulmonary ligament. The collections have a variable shape and size and rarely may produce a tension phenomenon elevating the posterior, inferior portion of the heart off of the diaphragm. There was a strong association of retrocardiac pneumomediastinum with other manifestations of extraalveolar air, including pulmonary interstitial emphysema (13 of 14 infants), pneumothorax (1 of 14 infants), dissection of air into the soft tissues of the neck (10 of 14 infants), and pneumoperitoneum (5 of 14 infants).