bluuebunny/crossref_metadata_2025 huggingface dataset:
Interleukin-6: A Sensitive Parameter for the Early Diagnosis of Neonatal Bacterial Infection
Authors: Buck Christian , Bundschu Julia , Bartmann Peter , Pohlandt Frank , Gallati Harald
Published: December 2021

Objective. Early recognition is important for the successful treatment and outcome of neonatal infections. As interleukin-6 (Il-6) plays a critical role in the induction of C-reactive protein (CRP) synthesis in the liver, it was hypothesized that this cytokine could be detected earlier in blood than the CRP during the course of bacterial infection.

Design. In a prospective study of 298 newborns who were admitted to the nursery unit, CRP levels, blood cell count with differential, and Il-6 levels were determined at the time of admission and 24 hours after admission. Seventy-six newborns were excluded from the study because of incomplete or incorrect blood sampling.

Results. The remaining 222 newborns were assigned to one of five groups: 11 newborns with blood culture-positive sepsis (sensitivity of Il-6 on admission 73%), 15 newborns with clinical sepsis (sensitivity of Il-6 on admission 87%), 41 newborns with infection (sensitivity of Il-6 on admission 68%), and 54 newborns without clinical and laboratory evidence of infection (specificity 78%). The remaining 101 newborns were defined as a mixed group because the diagnosis of neonatal infection could not clearly be made. Seventy-five percent of infected newborns had negative Il-6 levels 24 hours after admission. Of the 18 infected newborns with negative Il-6 levels on admission, 10 newborns had elevated CRP levels, suggesting that Il-6 was already negative because of the short half-life of Il-6. Sensitivity of Il-6 in CRP-negative newborns on admission was 100% in newborns with blood culture-positive and clinical sepsis. Il-6 was more sensitive than CRP in infected newborns on admission (73% vs 58%).

Conclusion. Il-6 is a sensitive parameter for diagnosing neonatal bacterial infection. The combination of CRP and Il-6 seems to be the ideal tool for the early diagnosis of neonatal infection.
The Role of Aversive Bittering Agents in the Prevention of Pediatric Poisonings
Authors: Rodgers George C. , Tenenbein Milton
Published: December 2021

The use of bittering agents as "aversives" has been advocated as a possible method of preventing toxic ingestions in children. The most commonly recommended agent, denatonium benzoate (Bitrex, Bitter Safe, and other brand names) is a chemical related to lidocaine. It was developed initially as a possible local anesthetic but was found to have an unpleasant and bitter taste at as low as 50 ppb in liquid products. Because of this property it has been used for many years as a denaturant for alcohol to prevent ingestion. It has been suggested that denatonium benzoate would be effective in preventing a significant number of pediatric ingestions if it were widely used as an aversive agent in potentially toxic products found in the home.
SCREENING FOR ALL NEWBORNS URGED FOR SICKLE-CELL DISEASE
Authors: L. J. F.
Published: December 2021

WASHINGTON, April 27—Issuing new guidelines for diagnosing and treating sickle-cell disease, a Federal panel recommended today that all newborns be screened for the blood condition, regardless of race.

The expert panel, which spent two years studying what is known about sickle-cell disease, said that although the disorder was most prevalent in African-Americans, looking for it only in blacks would miss too many other children who should be treated.

"Even though the rate of sickle-cell disease is lower in some populations than in others, sickle-cell disease can and does occur in almost all racial and ethnic groups," said Dr. Jeanne A. Smith of Harlem Hospital Center in New York, cochairman of the 13-member panel that drafted the guidelines...

The new guidelines were endorsed by several medical groups, including the American Academy of Pediatrics, the American Nurses Association, the National Medical Association and the National Association for Sickle Cell Disease...

Copies of the sickle-cell treatment guidelines for newborns and infants, in versions for doctors and health workers, as well as for parents, can be obtained by writing to Sickle Cell Disease, A.H.C.P.R. Publications Clearinghouse, PO Box 8517, Silver Spring, MD 20907, or calling (800) 358-9295.
HEALTH CARE CONTRAPTION
Authors: L. J. F.
Published: December 2021

You could almost hear the jaws dropping when Ira Magaziner, the White House's guru at guruing, said over the weekend, "The government is going to set standards, guarantee high-quality, affordable care, and then get out of the way."

As any of the health care reformers who used to gather at Jackson Hole could tell you, a lot of what's already wrong with the medical economy arises from Washington's habit of creating entitlements while trying to conceal from taxpayers how much they really cost...

The whole Clinton health care scheme advances behind a phalanx of euphemism aimed at muddying up what's really going on here. It would spawn huge new bureaucracies, but these will travel under the alias "purchasing alliance." Price controls are subsumed under the MBAish-sounding "global budgets," and the taxes that would finance the thing are called "premiums"...

It's odd to see people who are so obviously far behind the rest of the world's learning curve. In Sweden, Germany and most other serious places they're pulling U-turns and beginning to dismantle their expensive welfare bureaucracies...
Experience With the Illuminated Endotracheal Tube in the Prevention of Unsafe Intubations in the Premature and Full-Term Newborn
Authors: Heller Richard M. , Heller Toni W.
Published: December 2021

Objective. To determine whether an endotracheal tube modified by incorporation of a fiberoptic strand in the wall and connected to a light source could be safely and reliably positioned in premature and full-term newborns using transdermal siting of a bright spot on the skin at the suprastemal notch of the chest wall.

Methods. All newborns in the Vanderbilt Neonatal Intensive Care Unit who were candidates for intubation by established clinical criteria, who were not already intubated, were candidates for the study. We defined optimal placement of the endotracheal tube to be one with the tip of the tube below the first thoracic vertebral body and no less than 0.5 cm above the carina or at T-4 (if the carina could not be seen on the radiograph). A light source was connected to the fiberoptic strand and the endotracheal tube positioned so that a circle of light was visible on the skin of the chest wall at the suprasternal notch.

Results. In all 22 placements, the tube tip was below the larynx and above the canina. In 20 of the placements, the position was optimal between T-1 and T-4, whereas in the other 2 the tube tip was high between the larynx and the thoracic inlet.

This system required that an endotracheal tube 0.5 mm smaller than usually used be utilized because of the slight increase in outer diameter due to the fiberoptic strand. Conventional suction catheters were used in this study.

Conclusions. This study has shown that the illuminated endotracheal tube is a reliable device for accurate positioning in premature and full-term newborns using transdermal siting of a bright spot on the skin at the suprasternal notch.
Outcome and Cost of Open- and Closed-Chest Cardiopulmonary Resuscitation in Pediatric Cardiac Arrests
Authors: Sheikh Azad , Brogan Thomas
Published: December 2021

Objective. The dismal survival rates of cardiac arrest in children managed with conventional closed-chest cardiopulmonary resuscitation (CC-CPR) have renewed interest in the use of open-chest CPR (OC-CPR). We determined the efficacy of the early use of OC-CPR in children after cardiac arrest.

Methods. A retrospective review of emergency medical services (EMS) and hospital records revealed 27 children who were brought to the emergency department under CPR after blunt trauma.

Results. Twelve children had CC-CPR and 15 children underwent OC-CPR. Prehospital resuscitation and transport of both groups of children was excellent by current standards, and OC-CPR was performed within 5 minutes of arrival in the emergency department. CPR was successful with restoration of spontaneous circulation in 17% of children after CC-CPR, whereas 20% of children had restoration of spontaneous circulation after OC-CPR. This difference was not statistically significant. None of the children regained consciousness or survived to discharge. The hospital charges for patients who underwent OC-CPR were significantly higher (P = .005). Less than 30% of the hospital charges were reimbursed in both groups.

Conclusions. OC-CPR does not improve survival in children who sustain cardiac arrest and receive CPR for more than 20 minutes in the field. Under these circumstances OC-CPR is an expensive and futile procedure to undertake.
THE OLD SHELL GAME
Authors: L. J. F.
Published: December 2021

Pressure to ration will be greatest in alliances that indude cities. Inside an alliance, everyone pays the same rate—"community rating"—for health care (page 227), and the premiums collected have to cover everyone's needs, including the AIDS patient, the assault victim, and the $158,000 low-birth-weight baby. People will figure out that you pay the highest premiums and get the least health care in affiances that include inner cities.

Moreover, the bill shifts medical costs now paid by the federal government, including a large part of Medicaid, onto the alliances. The brunt will be borne by urban alliances. For example, the bill halts Medicaid payments to the chronically ill and subsidies to urban hospitals that treat the poor (pages 802, 812).

Reductions in federal spending are called "savings" by the Clinton administration, but the costs are just shifted from the federal budget to the regional alliances, which must pay for everyone's health needs out of local premiums. For example, the $4.9 billion annual cost of caring for 387,450 chronically ill New York City residents will be shifted from Medicaid to local premiums.
Parents With Human Immunodeficiency Virus Infection: Perceptions of Their Children's Emotional Needs
Authors: Niebuhr Virginia N. , Hughes Janice R. , Pollard Richard B.
Published: December 2021

Objective. To investigate the likelihood of patients who have human immunodeficiency virus/acquired immunodefidency syndrome (HIV/AIDS) being parents and to identify concerns of these parents about their children.

Design. A survey was conducted of parental status, demographics, perceptions of social/emotional needs of self and one's children. Responses were analyzed for demographic differences.

Participants. A total of 242 patients from the university HIV/AIDS clinics completed the survey.

Main outcome measures. Parental status, number, and ages of children, parental concerns about their children related to their own HIV/AIDS.

Results. Nearly one third (31.8%) of the sample of HIV/AIDS patients were parents, and three fourths (76%) of the female patients were mothers. Slightly more than one third of these were married, and these were not predominantly families who also had infected children. The percentage of women in the parent subsample (40.8%) was higher than the percentage of women in the overall patient sample (16.7%). Only half of the parents reported that their children >4 years of age knew of their diagnosis. Two thirds of the parents reported they believed their children did not need to talk to someone about their parent's health, and nearly half of the parents reported that they did not need help dealing with their children concerning issues related to AIDS.

Conclusion. The percentage of HIV/AIDS patients who are parents is high, and parental status and emotional needs of parents and their children will likely become an increasingly important issue. Many questions are raised by our findings. Should we be concerned that many parents have been unable to talk to their children about their own health? Should we help parents acknowledge that their children may need some outside help to cope?
Criteria for Exchange Transfusion in Jaundiced Newborns
Authors: Ahlfors Charles E.
Published: December 2021

Objective. A widely published set of exchange transfusion criteria lowers critical bilirubin concentrations when the serum albumin falls to <2.5 g/dL. Although acknowledging the role of bilirubin-albumin binding in bilirubin neurotoxidty, this approach may inadvertently produce two critical bilirubin concentrations. This study investigates using the bilirubin/albumin ratio instead of the single albumin concentration to eliminate this potential ambiguity in the criteria.

Design and participants. The bilirubin/albumin ratio was defined as a reliable indicator of bilirubin-albumin binding if the frequency curves of specific unbound bilirubin concentrations are normally distributed functions of the ratio. Therefore the bilirubin/albumin ratios at which the unbound bilirubin reached 10, 15, and 20 nmol/L were determined by the peroxidase method in 35 well full-term, 10 ill full-term, and 19 ill preterm neonates. The frequency curves for each unbound bilirubin concentration plotted against the bilirubin/albumin ratio were tested for normality.

Results. The frequency of each unbound bilirubin concentration was a normally distributed function of the bilirubin/albumin ratio. Furthermore, the mean ratio at which each unbound bilirubin occurred did not differ significantly among the groups of neonates.

Conclusion. The bilirubin/albumin ratio is a simple, nonambiguous way of incorporating the serum albumin concentration into exchange transfusion criteria.
Hereditary Pancreatitis in the Children of West Virginia
Authors: Hunt John A. , Chertow Bruce S. , Elitsur Yoram
Published: December 2021

Hereditary pancreatitis is the second most common cause of chronic pancreatitis in children.1 In this entity, pancreatitis is clustered in families and inherited throughout the generations, involving many family members. The disease is transmitted as an autosomal dominant trait which is not sex-linked and has limited penetrance.1 Unfortunately, the etiology of this familial disease is unknown. The most common symptom in hereditary pancreatitis is recurrent attacks of abdominal pain due to repeated episodes of acute pancreatitis, which later may result in exocrine and/or endocrine pancreatic insufficiency. In cases in which pancreatic histology had been reported, normal pancreatic tissue was replaced by diffuse fibrosis and chronic inflammation.2
Bovine Surfactant in Full-Term Neonates With Adult Respiratory Distress Syndrome-like Disorders
Authors: Gortner L. , Pohlandt F. , Bartmann P.
Published: December 2021

Kammash and co-workers described the effects of natural surfactant (BLSE) in full-term neonates1 suffering from adult respiratory distress syndrome (ARDS)-like disorders.2 Due to paucity of further published data,3 we would like to confirm the aforementioned studies by our observations in neonates. Full-term newborns were eligible for the pilot trial, if severe ARDS-like disorder was diagnosed: Fio2 0.9 to 1.0 for Pao2 >50 mm Hg; peak inspiratory pressure (PIP) 35 cm H2O for Paco2 50 mm Hg.
HMOS—ANOTHER ROADBLOCK FOR ALZHEIMER'S DRUG
Authors: L. J. F.
Published: December 2021

The first Cognex auguries are not promising. These signs of resistance come from two of the nation's largest HMOs, Northern California Kaiser Permanente and the Group Health Cooperative of Puget Sound. Northern California Kaiser has already decided to ban Cognex from its formulary...

Cognex is expected to cost about $1,300 to $1,500 annually per patient, and this does not include the costs of blood tests and physician visits required to guard against side effects. Against this Kaiser argues that Cognex helps only some victims of Alzheimer's Disease; the gain is not very great in many patients; and some who take Cognex suffer liver toxicity that the HMOs would have to treat. So from an HMO's point of view, Cognex is not "cost-effective," the magic mantra of HMO health care. But for anyone who's aware of the living hell in which many Alzheimer's patients and their families live, this argument does not wash...

Americans still expect their doctors to put patients' interests first. As the Cognex incident at the two major HMOs shows, that expectation need not be satisfied in HMO health care. Mr. Clinton, his health reform, and the American people can only benefit if the president takes specific measures to ensure that patients' expectations and HMO reality are congruent.
Video Game-Related Seizures: A Report on 10 Patients and a Review of the Literature
Authors: Graf William D. , Chatrian Gian-Emilio , Glass Stephen T. , Knauss Thomas A.
Published: December 2021

Objective. To further describe the features, postulated pathophysiology, treatment, and outcome of seizures occurring while playing or watching video games (video game-related seizures (VGRS)).

Design. We evaluated retrospectively 10 patients with VGRS seen by us and reviewed 25 reported cases.

Results. The 35 patients ranged in age from 1 to 36 years (mean: 13.2); and 26 subjects (74%) were male. Eight individuals (29%) had prior infrequent nonfebrile seizures, 4 (11%) had febrile convulsions, and 2 (6%) had a family history of epilepsy. VGRS consisted of generalized tonic-clonic seizures in 22 of 35 individuals (63%); absences in 2 (6%); simple partial seizures in 6 (19%); complex partial seizures in 4 (11%); and other manifestations in 4. Neurologic examination and computed tomographic and magnetic resonance imaging scans were normal. Electroencephalograms demonstrated generalized or focal, interictal or ictal epileptic patterns in 11 of 21 patients (52%) and photoparoxysmal responses in 17 of 32 (53%). Eleven of 15 individuals (73%) treated with video game (VG) abstinence alone, 3 of 6 who received anticonvulsants but played VGs, and 7 of 12 treated with combined VG abstinence and anticonvulsants had no further seizures.

Conclusions. We postulate that a special convulsive susceptibility of selected neurons in striate, peristriate, infratemporal, and posterior parietal cortices to particular visual stimuli plays a major role in VGRS. VG abstinence is the treatment of choice of VGRS. Anticonvulsant medication is suggested only for those individuals who continue to play VGs or suffer from seizures triggered by other, unavoidable visual stimuli, or from unprovoked attacks.
Does a Condom-Promoting Strategy (the Swiss STOP-AIDS Campaign) Modify Sexual Behavior Among Adolescents?
Authors: Hausser Dominique , Michaud Pierre André
Published: December 2021

Objective. To measure sexual behavior changes (especially the use of condoms) among adolescents after 5 years of a population-based acquired immunodeficiency syndrome prevention strategy at the national and regional level.

Design. Two comparative cross-sectional surveys by self-administered questionnaires were conducted in 1987 and 1990.

Setting. Two similar samples of 16- to 19-year-old apprentices. The two samples, 1987 (n = 1359) and 1990 (n = 817), are comparable in terms of sex, age, profession, and location.

Results. The percentage of boys who say they are sexually active has remained the same (75%) and has slightly increased among younger girls (65% to 75%, NS). The average number of partners has remained steady for boys and girls. Regular use of any contraceptive device has remained steady among girls (75%) and increased among boys (1987, 38%; 1990, 54%; P < .001). In 1987 as well as in 1990, the condom was the most widely used method (>90%), followed by the pill (50%), withdrawal (20%), and chemicals (5%). Rates were about the same for both sexes. Rates of irregular use of condoms increased among boys and girls (P < .01); regular use of condoms increased among boys (22% to 34%, P < .01) and girls (10% to 27%, P < .001); use of the pill has slightly decreased.

Conclusions. During a 5-year period, the Swiss "STOP-AIDS" campaign and local interventions had had no real effect on the rate of sexual activity of apprentices but had had a positive effect on the use of contraception and condoms. The prevention strategy should (and will) be maintained in the future.
Pediatric Clerkship Performance in Diverse Community Clinical Settings
Authors: Kurlandsky Lawrence E. , Potts Michael , Kumar Ashir
Published: December 2021

Objective. To determine whether multiple and diverse clinical settings and resources in a pediatric clerkship result in satisfactory performance by medical students and affect their choice of a pediatric residency after graduation.

Design. Retrospective study 1985 through 1990.

Setting. Medical students in a pediatric clerkship in a medical school that is part of a land grant university where the clinical curriculum is conducted in six geographically distinct communities.

Main outcome measure. (1) Three performance criteria including: multiple choice final examination score, clinical performance evaluations by preceptors, and formal evaluation of patient written records. (2) Students matching with a pediatric or combined internal medicine/pediatric residency.

Results. Of 499 students 92.8% successfully passed all three criteria with no statistically significant differences between communities. A smaller percentage of students (15.2%) (community range, 6 to 18.5%) entered straight or combined pediatric residencies, whether or not a pediatric residency was present in the community.

Conclusions. Medical students can achieve satisfactory competency in pediatric clerkships offered in diverse clinical settings, and choose pediatric residency training whether or not they are exposed to a pediatric residency during their clerkship. A problem-based learning curriculum does not hinder selecting pediatrics as a career choice.
Altered Blood Pressure Reactivity in Adolescent Diabetics
Authors: Newkumet Kathleen M. , Goble Monica Martin , Young Reuben B. , Kaplowitz Paul B. , Schieken Richard M.
Published: December 2021

Objective. We examined hemodynamic responses to a variety of physiologic stimuli in 14 normotensive adolescents with type I diabetes and 45 healthy controls to determine whether structural vascular changes contribute to a reduced vasodilator capacity in adolescent diabetics. We asked, in adolescents with type I diabetes: (1) Are structural vascular changes present? (2) Are changes in the systemic vascular bed reflected in abnormal blood pressure regulation? and (3) Is abnormal vascular reactivity associated with either diabetes duration or control?

Methodology. Diabetic subjects were outpatients treated at the Medical College of Virginia, ages 13 to 18 years. Diabetes duration averaged 7.5 years. Each subject underwent an echocardiogram, dynamic and isometric exercise testing, and forearm plethysmography.

Results. Compared to controls, diabetic subjects had (1) higher systolic and diastolic blood pressure during dynamic and handgrip exercise, (2) decreased forearm vasodilator capacity in response to ischemia, and (3) an increased aortic peak velocity. Group diastolic filling abnormalities were found, but these did not persist after adjustment for heart rate. The following variables were related to both diabetes duration and control (average glycosylated hemoglobin): (1) diastolic blood pressure during dynamic exercise, (2) resting forearm vascular resistance, and (3) forearm vascular reactivity. In addition, diabetes duration correlated with isometric exercise diastolic blood pressure, and diabetes control correlated with resting diastolic blood pressure.

Conclusion. In young diabetics we found that (1) abnormalities of the resistance vessels of the forearm may be present, (2) the degree of vascular change is related to diabetes duration and control, and (3) aortic distensibility may be impaired.
Nitric Oxide Synthase Is Deficient in the Aganglionic Colon of Patients With Hirschsprung's Disease
Authors: Bealer John F. , Natuzzi Eileen S. , Buscher Cori , Flake Alan W. , Adzick N. Scott , Harrison Michael R. , Ursell Philip C.
Published: December 2021

Objectives. The cause of Hirschsprung's disease is unknown but defects in nonadrenergic, noncholinergic innervation could prevent relaxation of aganglionic colon in patients with this disease. Nonadrenergic, noncholinergic nerves induce relaxation by using nitric oxide synthase to produce the smooth muscle relaxant nitric oxide (NO). In this study we asked whether aganglionic colon in patients with Hirschsprung's disease is deficient in NO synthase-containing nerves.

Methodology. Using the tetrazolium blue dye method of demonstrating nicotinamide adenine dinucleotide phosphate-diaphorase enzymes, we examined eight colon specimens (four aganglionic and four ganglionic) from patients with Hirschsprung's disease for the presence of NO synthase. We further quantified NO synthase enzyme activity in these eight specimens by using the [3H]arginine-to-[3H]citrulline conversion assay.

Results. The nicotinamide adenine dinucleotide phosphate-diaphorase staining showed that aganglionic colon contained less NO synthase than ganglionic colon. This NO synthase deficiency was located primarily in the nerves of the circular muscle layer of the colon. In addition, there was a striking difference in the NO synthase enzyme activity between aganglionic and ganglionic colon as measured by the [3H]arginine-to-[3H]citrulline conversion assay. Total NO synthase activity, as measured by this assay, was found to be less in aganglionic than in ganglionic colon. When the total activity was divided into its four known isoforms, aganglionic colon was noted to be striking deficient in the isoform derived primarily from nerves.

Conclusion. We conclude that aganglionic colon is deficient in NO synthase-containing nerves. This deficiency could prevent smooth muscle relaxation in the aganglionic colon of patients with Hirschsprung's disease.
NATION'S DOCTOR—SURGEON GENERAL
Authors: L. J. F.
Published: December 2021

The office of Surgeon General has off and on been slated for termination. But that was before Ronald Reagan's Surgeon General, the patriarchal, independent-minded C. Everett Koop, emerged from obscurity to become the telegenic evangelist of the AIDS crisis. Tolerated by the Reagan White House as a bargain-priced diversion from its own lassitude on AIDS, Koop demonstrated how the office could be used for mass education by a public health champion with a rhetorical flair. In TV parlance, the Surgeon General became the "nation's doctor." Koop's visibility was enhanced when he exercised the long-neglected right of Public Health Service officers to deck themselves out in navy-cut gold-braided uniforms.
SURGICAL INNOVATION UNDER SCRUTINY
Authors: H. B.
Published: December 2021

Although assessment of any new operation begins with observational studies, only controlled studies can form the basis of any decision-making. Studies must be controlled to eliminate the bias that is hard to avoid when a surgical innovator records his own good results. Uncertainty is illustrated by laparoscopic cholecystectomy and hernia repair . . . Surgeons seek to legitimize their enthusiasm by comparing personal results, in cases chosen by themselves and operated on by experienced consultant surgeons committed to the task . . . Laparoscopic cholecystectomy takes longer than conventional open surgery and, although the patient stays in hospital for less time afterwards and postoperative pain is reduced, the only certainty is that more operations have been done on a younger cohort of patients and at a higher cost than previously, a great challenge to cost-containment schemes.
Ribavirin. Red Book Committee Recommendations Questioned
Authors: Wald Ellen R. , Dashefsky Barry
Published: December 2021

The new guidelines provided by the Committee on Infectious Diseases of the American Academy of Pediatrics on the Use of Ribavirin in the Treatment of Respiratory Syncytial Virus Infection (RSV) are perplexing and prompt concern: "Ribavirin treatment is recommended for the following patients hospitalized with RSV lower respiratory tract disease: a. infants at high risk for severe or complicated RSV infection, including those with complicated congenital heart disease (including pulmonary hypertension); those with bronchopulmonary dysplasia, . . ."1,pp502-503 The accompanying qualifier that "the recommendations in this statement do not indicate an exclusive course of treatment or procedure to be followed"1,p501 is important but insufficient to dampen the effect of the Committee's decision to change its former stance of merely urging consideration of the use of ribavirin for patients at high risk for complications2 to an unequivocal recommendation to do so.
Recommended Timing of Routine Measles Immunization for Children Who Have Recently Received Immune Globulin Preparations
Authors:   Committee on Infectious Diseases
Published: December 2021

Passively acquired antibody can block replication of live viral vaccines and subsequent active immune responses.1-3 The persistence of transplacentally acquired maternal measles antibodies can interfere with the response to measles vaccine in some infants up to 12 months of age.4,5 Simultaneous or prior administration of immune globulin administered through the intramuscular or intravenous route has a similar blunting or blocking effect on the host response to certain live virus vaccines.1,6,7 The American Academy of Pediatrics previously recommended a 3-month interval after administration of immune globulin before parenteral administration of live viral vaccines, including measles, mumps, and rubella vaccines (MMR). This recommendation was based on the half-life of passively administered immune globulin and data from individuals who received low doses of immune globulin.2 However, immune globulin is now used in larger doses for treatment or prevention of several diseases, 8 necessitating a lengthening in the interval between use of immune globulin and the administration of certain live virus vaccines.

INTERFERENCE WITH MEASLES IMMUNIZATION

In a recent study high doses of immune globulin interfered with the response to measles immunization for more than 3 months.1 Children who received bacterial polysaccharide immune globulin (BPIG), a product under clinical evaluation, in a dose of 0.5 mL/kg (80 mg of IgG per kilogram) intramuscularly had reduced measles antibody response when measles vaccine was given as long as 5 months after administration of BPIG (Figure). The measles antibody concentrations (pen gram of protein) in BPIG were similar to concentrations found in preparations of immune globulin (IG) for intramuscular administration, specific immune globulin preparations (eg, VZIG, HBIG, and TIG), and immune globulin for intravenous administration (IGIV).
Freezing With Chicken Juice
Authors: Warner F. Jack
Published: December 2021

I read with interest the method of anesthetizing the skin before any pain was inflicted (Pediatrics. November 1993).1 I have been using ethyl chloride spray for more than 30 years to do the same thing. We call it "chicken juice" for those who are "chickens" and can't stand pain. It becomes instantly effective with no waiting period. There is no pam with using a needle directly through semifrozen skin. This is very acceptable to the children and even some adults.
Barriers To Use of Oral Rehydration Therapy
Authors: Reis Evelyn Cohen , Goepp Julius G. , Katz Scott , Santosham Mathuram
Published: December 2021

Objective. To identify potential barriers to the use of oral rehydration therapy (ORT) by pediatric practitioners.

Design. Cross-sectional, anonymous, self-administered survey of physicians' ORT knowledge, attitudes, and practice.

Setting. A national continuing medical education conference.

Participants. One hundred four general pediatricians primarily in private practice (66%) who completed training after 1980 (76%).

Measurements and results. Most respondents (83%) reported that ORT plays an important role in their management of dehydration. However, compliance with guidelines from the American Academy of Pediatrics for use of oral therapy is limited: 30% withhold ORT in children with vomiting or moderate dehydration, 50% fail to advise prompt refeeding, and only 3% advise use of a spoon or syringe. The degree of importance of ORT in physicians' practice was negatively associated with reported lack of convenience of ORT administration in the practice setting (P < .001), support staff preference for intravenous versus ORT (P < .001), need for additional training of support staff to implement ORT (P < .01), and likelihood of reimbursement for intravenous versus ORT (P = .07). Notably, degree of importance of ORT was not associated with physician ORT knowledge.

Conclusion. Efforts to improve use of ORT should be expanded beyond physician education and focus on such barriers as support staff limitations and financial constraints.
Association of Pulmonary Inflammation and Increased Microvascular Permeability During the Development of Bronchopulmonary Dysplasia: A Sequential Analysis of Inflammatory Mediators in Respiratory Fluids of High-Risk Preterm Neonates
Authors: Groneck Peter , Götze-Speer Bettina , Speer Christian P. , Oppermann Martin , Eiffert Helmut
Published: December 2021

Objectives. Bronchopulmonary dysplasia (BPD) of preterm neonates is associated with an increased recruitment of inflammatory cells into the airways. To evaluate further the role of inflammation in the pathogenesis of BPD, tracheobronchial aspirate fluid of neonates with birth weight <1200 g (n = 59) was sequentially analyzed in a prospective study.

Methods. Tracheobronchial aspirate fluid was assessed for chemotactic activity, neutrophil cell count, concentrations of elastase-α1-proteinase inhibitor and activity of free elastase, concentrations of chemoattractants (complement component C5-derived anaphylatoxin, leukotrien B4, interleukin-8), and albumin concentrations as well as α1-proteinase inhibitor activity. The secretory component for immunoglobulin A was used as reference protein. Only specimens without evidence of microbiological colonization were studied.

Results. In neonates with prolonged respiratory disease (BPD-risk neonates, n = 24, fraction of inspired oxygen ≥ 0.3 and/or peak inspiratory pressure ≥ 16 cm H2O at day 10 postnatal age, birth weight 892 ± 36 g, gestational age 27.2 ± 0.3 weeks) chemotactic activity, cell count, concentrations of the chemoattractants complement component C5-derived anaphylatoxin, leukotriene B4, interleukin-8, as well as levels of elastase-α1-proteinase inhibitor were significantly higher at day 10 and/or day 15 of postnatal age compared with neonates without chronic pulmonary disease (total n = 35; day 10, n = 11; day 15, n = 8). There was no difference in free elastolytic activity. Concentrations of albumin as well as α1-proteinase inhibitor activity were higher in BPD-risk patients on day 15, indicating an increased pulmonary leak.

Conclusion. We conclude that preterm neonates at risk for the development of BPD show an enhanced inflammatory reaction in the lungs and an associated increase in pulmonary microvascular permeability. We speculate that inflammation may play an important role in the pathogenesis of BPD.
PUBLIC HEALTH'S MOST WANTED
Authors: Snowe Robert J.
Published: December 2021

See table in the PDF file
LORENZO'S OIL AND ADENOLEUKODYSTROPHY
Authors: L. J. F.
Published: December 2021

The new movie "Lorenzo's Oil" tells how the parents of a child with a rare illness overcame indifference in the medical establishment and, by themselves, invented a cure.

The message is that medical science has become detached from the needs of those it serves, but that individuals can leap bureaucratic impediments to find new cures with their own faith and efforts ...

According to the movie and the account of the parents, Augusto and Michaela Odone of Fairfax, Va., they refused to accept doctors' advice that there was no hope for their son, Lorenzo, after they were told in 1984 that he was suffering from a rare hereditary disease known as adenoleukodystrophy ...

... they defied the medical establishment's pessimism, read obscure medical journals and figured that a mixture of two natural oils, known as erucic and oleic acids, would correct an important symptom of the disease ...

Dr. Rizzo began the first pilot study of the oil in August 1987. Six of 8 boys in the study deteriorated rapidly. The other two seemed to stabilize for a time, but one has now had a relapse and investigators have lost contact with the other.

In a study by Dr. Hugo Moser of Johns Hopkins University School of Medicine, 70 children with the rapidly progressing disease used the oil from the time of their first symptoms until they lost sight and movement. The oil, Dr. Moser concluded, "did not make any difference."

Dr. Moser said that so far he had seen no evidence that Lorenzo's disease could be prevented in boys who were otherwise destined to get it ...
Oxidation of Proteins in Neonatal Lungs
Authors: Gladstone Igor M. , Levine Rodney L.
Published: December 2021

Objective. To develop a method capable of quantifying the oxidative modification of proteins in pulmonary fluid obtained during routine suctioning of neonates receiving ventilation, thus providing an integrated assessment of antioxidant defenses.

Design. Consecutive sample of neonates receiving ventilation.

Setting. Neonatal intensive care unit.

Patients. Twenty-six neonates receiving ventilation with a gestational age of 24 to 42 weeks, from whom 246 samples were collected and analyzed.

Measurements and results. The carbonyl content in the lavage samples was measured by reaction with 2,4-dinitrophenylhydrazine followed by high-pressure liquid chromatography. Oxidation of proteins caused introduction of carbonyl groups into the side chains of the protein, providing a convenient and relatively specific marker of oxidative damage. On the first day of life, the initial protein-bound carbonyl for each neonate was usually low and consequently was not significantly related to birth weight, gestational age, or initial ventilatory requirements. Examination of the changes in pulmonary protein carbonyl in the first days of life revealed correlations of interest. In the first day of life, four neonates whose average inspired oxygen were <40% showed no increase in carbonyl content, whereas four neonates whose inspired oxygen was >40% showed an average increase in carbonyl of 51% (P < .001). Also, the need for ventilation >3 days was correlated with elevated carbonyl in those first 3 days. The carbonyl content averaged over the first 3 days was 0.13 ± 0.02 mol carbonyl/mol protein for the eight neonates receiving ventilation < 72 hours, whereas the nine needing longer ventilation had a carbonyl content of 0.28 ± 0.03 mol carbonyl/mol protein (P < .05). Seven neonates were treated with dexamethasone because of ventilator dependence at 14 days of age. In these neonates, treatment was associated with a 50% reduction in carbonyl content within 48 hours (P < .02).

Conclusions. Oxidative damage to pulmonary proteins can be quantitated in samples obtained during routine suctioning of neonates receiving ventilation. The amount of oxidatively modified protein may provide a quantitative assessment of oxygen toxicity and of pulmonary antioxidant defenses.
Doppler-Derived Systolic Pulmonary Artery Pressure in Acute Neonatal Respiratory Distress Syndrome
Authors: Seppänen Marko P. , Kääpä Pekka O. , Kero Pentti O. , Saraste Markku
Published: December 2021

Objective. To determine the course of systolic pulmonary artery pressure (PAP) in association with ductal shunting and cardiac output (CO) in preterm neonates.

Design. During the acute phase of respiratory distress syndrome (RDS) with and without surfactant treatment, serial Doppler ultrasound examinations were performed at the ages of 2, 12, 24, 48, and 72 hours in 51 neonates with RDS and 21 healthy, preterm controls. Twenty-eight of the distressed neonates received two or four doses of synthetic exogenous surfactant at intervals of 12 hours. Measurements of hemodynamic variables in these neonates were performed before and after 8 hours following surfactant treatments. PAP was estimated by the Doppler method from the maximal tricuspid regurgitant flow velocity. Doppler ultrasound was also used to determine simultaneously CO, and the direction and magnitude of the ductal shunting.

Results. The PAP was initially at the same level, but remained significantly higher in distressed than in healthy, preterm control neonates between the ages of 12 to 48 hours. The systolic systemic arterial blood pressures did not differ between the distressed and control neonates, but increased gradually during the study period. Consequently, the ratio of systolic pulmonary and systemic pressure was also higher in neonates with RDS than in controls during the first day of life. Bidirectional ductal shunting disappeared in all neonates studied after 2 days of life. Significant left-to-right shunting through the ductus arteriosus persisted more frequently in distressed neonates, especially those with surfactant treatment, than in control neonates during the study period, and more often caused the need for medical or surgical closure. Doppler-derived CO remained stable throughout the study in the distressed neonates, being significantly higher in surfactant-treated neonates than nontreated distressed neonates or healthy controls at 72 hours of life.

Conclusions. The data of the present study confirms that the postnatal decrease in PAP is delayed in acute RDS. Further, significant patent ductus arteriosus shunting persists longer in RDS and may contribute to elevated CO during the resolution of the disease.
THE VACCINE SCAPEGOAT
Authors: L. J. F.
Published: December 2021

Cynics argue that the reason Bill and Hillary Clinton pistol-whipped the drug industry over vaccine prices just days before the State of the Union was to intimidate the rest of U.S. industry into silence oven the tax-laden economic proposal. And the reason cynicism like this is coming back into vogue is that the Clintons, as elsewhere, had so transparently demagogued the vaccine issue, leaving huge and obvious parts of the immunization problem unmentioned ...

A more honest explanation of the problem at least would have mentioned both the famous liability suits that pushed up the cost of vaccines and the government bureaucracy's own failed efforts to immunize the poor.

That brings us to the second widely known reason that so many children don't receive the proper immunizations: The bureaucracy can't figure out how to get the job done. Any child in any state can receive free vaccines at a public-health clinic paid for by state and federal money. So why don't more parents respond? One large reason is that the public system is very inconvenient.

Before they will administer a vaccination, many public-health clinics require a physician's referral or a complete physical. They don't phone with a reminder that it's time again for the shots. And, like the department of motor vehicles, their hours often aren't convenient for working parents ....

So yes, there's a problem, but clearly it's about something more complicated than just price. The President's answer is to spend $300 million to "improve outreach efforts" and hire more staff for the public clinics.
INFANT BONDING AND GUILTY MOTHERS
Authors: L. J. F.
Published: December 2021

In "Mother-Infant Bonding: A Scientific Fiction," just published by Yale University Press, Diane E. Eyer examines mother-infant bonding, one theory that turned out to have a short but influential life span, roughly the 1970's.

Bonding managed to have a major impact despite slender evidence for its existence: a study by the original researchers of only 28 mothers, analogies from studies of mother-offspring attachment and rejection in nonhuman mammals as well as interpretations drawn from the behavior of infants in pathological situations. Though the early research has largely been dismissed, the theory of bonding continues to have an impact.

"One of the things I wanted to see," Ms. Eyer said in a recent interview about her work, "was how research that was so patently untrue was so credible to so many people. I didn't expect to find villains, but it was clear that medicine was benefiting more than women were" ...

Ms. Eyer does not argue that all child-rearing experts offer scientifically indefensible advice, simply that consumers of the advice should be skeptical of the science it's based on and treat it more like religion—and therefore a question of belief—than as absolute truth.
Emergency Medical Services for Children: The Report From the Institute of Medicine
Authors: Weinberg Joseph A. , Medearis Donald N.
Published: December 2021

The scope and complexity of the problems posed by attempting to provide emergency medical services for children (EMS-C) are great. Of the 90 million emergency department visits in the United States each year, one third, or 30 million, are by children. Many of these are due to injury. In 1990, 266 000 injured children were admitted to hospitals; > 20 000 children died of injuries in 1988 and many more were disabled permanently. In addition to this human cost, the monetary cost of childhood injuries has been estimated to be $7.5 billion annually.1

Most emergency department visits by children, however, are for illnesses, many of which may be serious, such as asthma, pneumonia, or bacterial meningitis.
Poststreptococcal Reactive Arthritis and Silent Carditis: A Case Report and Review of the Literature
Authors: Schaffer Frederick M. , Agarwal Ravinder , Helm Jutta , Gingell Robert L. , Roland J. Michael A. , O'Neil Kathleen M.
Published: December 2021

Between 1984 and 1988, a resurgence of acute rheumatic fever (ARF) was reported in several pediatric centers.1-3 During the same time, pediatric cases,4-6 and, recently, adult cases6 of poststreptococcal reactive arthritis (PSRA) have been reported. Although several of these patients had or developed multisystemic manifestations,4,5 none of these cases fully adhered to the guidelines of the revised Jones criteria.7 Thus, these individuals were given the diagnosis of PSRA or poststreptococcal rheumatic syndrome (PSRS) rather than ARF.4-6,8-10

One of the leading causes of acquired pediatric heart disease in North America is carditis of ARF,3 and severe cases can result in congestive heart failure, the need for valve replacement, or death.11
Reimbursement for Medical Foods for Inborn Errors of Metabolism
Authors:   Committee on Nutrition
Published: December 2021

Inborn errors of amino acid metabolism such as phenylketonuria, maternal phenylketonuria, maple syrup urine disease, homocystinuria, methylmalonic acidemia, propionic acidemia, isovaleric acidemia and other disorders of leucine metabolism, glutaric acidemia type I and tyrosinemia types I and II, and urea cycle disorders are rare diseases that are treatable by diet. Treatment might include the restriction of one or more amino acids, the restriction of total nitrogen, or the supplementation of specific substances. Untreated, these diseases culminate in severe mental retardation or death.

Once diagnosis is confirmed, treatment of amino acid and urea cycle disorders must be carefully monitored by a physician with expertise in metabolic diseases. Special medical foods, commercially available, are indispensable for the active, ongoing treatment of diagnosed amino acid and urea cycle disorders. Special medical foods would, if used as the sole dietary source, represent a hazard to affected and healthy children. US Public Law (Publ L) 100-290 defines the term medical food as ". . . a food which is formulated to be consumed or administered enterally under the supervision of a physician and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements, based on recognized scientific principles, are established by medical evaluation."1

After passage of Publ L 100-290, many states provided funding for these products through Medicaid, and most states offered assistance through Crippled Children's and Women, Infant, and Children's programs. Some states now have laws mandating private insurance coverage for special medical foods.

It is the position of the American Academy of Pediatrics that special medical foods that are used in the treatment of amino acid and urea cycle disorders are medical expenses that should be reimbursed.