bluuebunny/crossref_metadata_2025 huggingface dataset:
Human Immunodeficiency Virus Infection in Childhood, Adolescence, and Pregnancy: A Status Report and National Research Agenda
Authors: Nicholas Stephen W. , Sondheimer Diane L. , Willoughby Anne D. , Yaffe Sumner J. , Katz Samuel L.
Published: December 2021

During the first half of this decade, much new information about the acquired immunodeficiency syndrome (AIDS) became available, including landmark reports of the syndrome in children from Oleske et al, Rubinstein et al, and Scott et al; descriptions of AIDS in pregnancy by Wetli et al, Rawlinson et al, and Minkoff et al; and discovery of the agent that causes AIDS, the human immunodeficiency virus (HIV, formerly called HTLV-III/LAV).

The first sets of health guidelines pertaining to HIV-infected children and adolescents in school, day-care and foster care settings were published by the American Academy of Pediatrics' Committee on Infectious Diseases in March 1986 and 1987. In 1987, the Surgeon General's Workshop on Children With HIV Infection and Their Families provided the first comprehensive set of recommendations relevant to the provision of pediatric and obstetrical care to infected mothers, infants, children, and adolescents. Most recently, during February 1988, the Secretary of Health and Human Services formed the Secretary's Work Group on Pediatric HIV Infection and Disease that consisted of members from each of the health and human services agencies, including the Social Security Administration and the Health Care Financing Administration. The broad mandate of this group was to make recommendations to facilitate the removal of barriers to care, treatment, and financial burdens of children and adolescents with HIV infection and their families.

In contrast, HIV infection has not received sufficiently widespread attention from the obstetric, pediatric, or adolescent research communities. The uneven geographic distribution of the disease; its associated social, legal, and ethical complexities; and the lack of sufficient research monies all have contributed to this problem.
Ethical Issues in Preventive Pediatrics
Authors: DOXIADIS SPYROS A.
Published: December 2021

During the last 20 years there has been an increasing interest in many aspects of medical ethics. This is not surprising, because continuously advancing medical knowledge and technology have given to the medical profession new powers over life and death. These have created many dilemmas that were nonexistent as recently as the 1950s and the 1960s. The advances and the dilemmas drew into the field of medicine other sciences and disciplines such as philosophy and law. They also stimulated the interest of the wider public, which, rightly, wanted to participate more actively in all matters and decisions affecting their health and ultimately their lives.
Impact of Rock Lyrics and Music Videos on Children and Youth
Authors:   COMMITTEE ON COMMUNICATIONS
Published: December 2021

Rock music has undergone dramatic changes since its introduction 30 years ago and is an issue of vital interest and concern for parents and pediatricians.

Rock music lyrics have become increasingly explicit during the last two decades—particularly with reference to sex and drugs. Some lyrics communicate potentially harmful health messages. These lyrics are of special concern in today's environment, which poses unprecedented threats to the health and well-being of adolescents, including pregnancy, drug use, acquired immunodeficiency syndrome (and other sexually transmitted diseases), accidents, and suicide.

The American Academy of Pediatrics (AAP) strongly opposes censorship. According to the Federal Communications Commission, the public owns the airways, which are leased back to radio and television stations that are obligated to produce programming in the public's best interest. Good taste and self-regulation by consumers, media, and the music industry would be appropriate and effective solutions.

The AAP, therefore, recommends that:

1. The public, and parents in particular, be made aware of sexually explicit, drug-oriented, or violent lyrics on records and tapes.

2. Broadcasters and the music industry be encouraged to demonstrate good taste and self-restraint in decisions regarding what is produced and allowed to be broadcast.

3. Rock performers be reminded that they can serve as positive role models for children and teenagers.

4. The AAP and other concerned organizations encourage parents to take a more active role in monitoring music to which their children are exposed.

5. Local coalitions of pediatricians, educators, and parents discuss the effects of the media on children and teenagers.

6. Research concerning the impact rock music has on the behavior of adolescents and preadolescents be developed and supported.
Breast-Feeding and the Working Mother: A Profile
Authors: Ryan Alan S. , Martinez Gilbert A.
Published: December 2021

Based on a survey of a nationally representative sample of new mothers, this study compares the incidence and duration of breast-feeding among mothers who were employed full-time outside the home with those not employed. Results indicated that the same proportion of mothers (55%) who were employed full-time as those not employed reported breast-feeding their infants in the hospital. Working full-time seemed to have a substantial impact on breast-feeding duration. Only 10% of full-time employed mothers breast-fed their infants at 6 months of age compared with 24% of those not employed. Analyses of breast-feeding by demographic characteristics indicated that in-hospital breast-feeding was relatively high among mothers who were not working outside the home and who were 30 years of age and older, in high family income groups, college educated, white, and living in the Mountain or Pacific region of the United States. Breast-feeding patterns among white and black mothers showed that a relatively high incidence of in-hospital breast-feeding was reported by black mothers who returned to work full time. Many more blacks than whites who were working full time were in those demographic subgroups that reported the highest incidence of breast-feeding: mothers who were 25 years of age and older, in highincome groups, and college educated. Ways to increase the level of breast-feeding among employed mothers are outlined.
Zinc Supplementation in Infants With a Nutritional Pattern of Failure to Thrive: A Double-Blind, Controlled Study
Authors: Walravens Philip A. , Hambidge K. Michael , Koepfer Debbie M.
Published: December 2021

The objective of this study was to determine whether zinc deficiency is one of the factors involved in nutritional failure to thrive in infants and toddlers. Participants were selected on the basis of anthropometric criteria, particularly a decline in weight velocity preceding changes in length gains. The investigation was designed as a double-blind, randomized, pair-matched, controlled study of dietary zinc supplementation of 6 months' duration. Anthropometric data were collected at 0, 1, 3, and 6 months. Twenty-five pairs of infants completed the project. When compared with placebo-treated control children, the zinc-supplemented group (combined sexes) and the supplemented boys showed significant improvements in standard deviation scores for weight for all three intervals, the largest differences occurring for the 0- to 3-month interval (P ≤ .0001). The zinc-supplemented girls demonstrated a trend toward improvements in changes in standard deviation scores for weight (P = .056). There were no differences in length gains for either boys or girls. This improvement in weight gains after zinc supplementation demonstrates that mild zinc deficiency can be one of the etiologic factors in nutritional failure to thrive during infancy.
Sickle Cell Trait and Competitive Athletics: Is There a Risk?
Authors: Pearson Howard A.
Published: December 2021

The gene for sickle hemoglobin has a nearly global distribution, occurring with great frequency in Africa (and from there to the Western Hemisphere), southern Europe, the Mideast, and parts of the Indian subcontinent. In the homozygous state, homozygosity for sickle cell genes (sickle cell anemia) produces great concentrations of sickle hemoglobin [HbS] within the RBCs, usually >90%. Such large concentrations of HbS are associated with spontaneous sickling under physiologic conditions in vivo that result in severe hemolytic anemia and vasooclusive complications that compromise and threaten health, and even survival.

In contrast, the heterozygous state, designated sickle cell trait, is associated with only 30% to 40% HbS in the RBCs, most of the remainder being normal adult hemoglobin (HbA). These relatively small concentrations of HbS are not associated with in vivo sickling.
Steroid Treatment of Laryngotracheitis: A Meta-Analysis of the Evidence From Randomized Trials
Authors: Kairys Steven W. , Olmstead Elaine Marsh , O'Connor Gerald T.
Published: December 2021

The use of adrenocorticoids to reduce the morbidity associated with laryngotracheitis (croup) remains controversial despite ten published reports of randomized trials involving 1,286 patients. To determine whether, viewed in aggregate, these studies demonstrate a significant benefit of steroid treatment for this disorder, a meta-analysis of the nine methodologically satisfactory trials was performed. Clinical improvement 12 and 24 hours posttreatment and incidence of endotracheal intubation were evaluated. For each end point, an estimate of the overall effect was obtained by calculating a typical odds ratio and 95% confidence interval. This analysis indicates that the use of steroids in children hospitalized with croup is associated with a significantly increased proportion of patients showing clinical improvement 12 hours (odds ratio = 2.25, 95% confidence interval = 1.66, 3.06) and 24 hours (odds ratio = 3.19, 95% confidence interval = 1.70, 5.99) posttreatment and a significantly reduced incidence of endotracheal intubation (odds ratio = 0.21, 95% confidence interval = 0.05, 0.84). Higher initial doses of steroid (≥125 mg of cortisone or ≥100 mg of hydrocortisone) were associated with a larger proportion of patients improved 12 hours posttreatment than was seen with lower doses. These results support the use of steroids in the treatment of hospitalized children with croup and, in the absence of a randomized clinical trial of sufficient size, provide the most reliable estimate of the impact of steroid therapy on the morbidity associated with croup. In addition, the results of this meta-analysis may be used to estimate the number of subjects who would be required to conduct a randomized clinical trial of steroids for the treatment of croup.
Human Immunodeficiency Virus and Artificial Feeding
Authors: PLOTKIN STANLEY A.
Published: December 2021

Dr Halsey has brought to my attention that a sentence in the human immunodeficiency virus (HIV) infection control statement (AAP News, September 1988) and perinatal statement (Pediatrics 1988;82:941-944) might be misinterpreted as advocating artificial feeding for HP/-infected infants in developing countries. It was our intention to advocate the use of artificial feeding by HIV-infected mothers only in the United States and other developed countries where safe water and hygienic practices are the norm. In other countries, the advantages of breast milk outweigh the possible risk of transmission to the newborn.
IN YOUR NEIGHBORHOOD: A MODERN CHILD CARE CENTER
Authors: Esbenshade John F.
Published: December 2021

The "Little Ponies" day care center, located at Clos de Cheval d'Argent 1, has 60 beds for children, 30 in the infant section and 30 in the "large" section. It is open from Monday through Friday from 7:30 am to 6:30 pm and is closed on legal holidays.

Charges are fixed by the French Community Council. They are determined by parental income and range from 50 to 400 F ($1.25 to $8) per day.

The center is directed by a nurse and our little ones are taken care of and directed by early childhood specialists. Further, several times each week a medical consultation for the kids is provided by a pediatrician attached to each day care center.

Maintenance staff assures perfect upkeep of the buildings and material.

Meals are prepeared at the center by a cook: light breakfast at 9:00, lunch at 11:00, snack at 3:00. As for the menus, they are made up by the nurse-director and the pediatrician in collaboration. Special diets are prepared as needed and scrupulously followed according to the request of the parents or the family doctor. Formula is also prepared at the center, except if it is a special one.

When welcoming parents and child in the morning, the nurse or child care worker in charge asks parents for useful information about the baby: has he slept well . . . when did he eat. . . ? Note is made of everything unusual that might be mentioned, and of any special treatments or diets that might need to be followed.

During the day, numerous stimulating activities are organized: games on the floor on foam pads, cushions to climb over, drawing, crafts. . . . Games, of course, are adapted to the age of the little ones and take place in well-separated areas in the sections for infants and toddlers.

In the evening, when the parents come to pick up their children, they are informed about any useful information about the behavior of their baby during the day.
Prevention of Hepatitis B Infection in Newborns Through Mass Screening and Delayed Vaccination of All Infants of Mothers With Hepatitis B Surface Antigen
Authors: Schalm Solko W. , Mazel J. Adriaan , de Gast Gijsbert C. , Heijtink Rudolf A. , Botman Meindert J. , Bänffer John R. J. , Cerards Leo J. , Zwijnenberg John , Fetter Willem P. F. , Nuijten Ad S.M. , Wladimiroff Yuriy W. , Christiaens Godelieve C.M.L.
Published: December 2021

Beginning in 1982 all pregnant women undergoing prenatal routine blood analysis in three large city hospitals and one large rural area were tested for hepatitis B surface antigen (HBsAg). Infants of all HBsAg-positive mothers received hepatitis B immunoglobulin (HBIg), 0.5 mL/kg of body weight within two hours of birth and, after randomization, 10 µg of hepatitis B vaccine either at 0, 1, 2, and 11 months of age (schedule A) or at 3, 4, 5, and 11 months of age (schedule B). A second injection of HBIg (1 mL) was given to infants on schedule B at 3 months of age. Blood samples were obtained at 3, 6, 11, 12, 24, and 36 months. In a two-year period, 28,412 pregnant women were tested for HBsAg; screening efficiency varied between 85% and 98%. The overall prevalence of HBsAg was 0.8%, with a marked variation between urban centers (2.2%) and the rural area (0.3%). Vaccinations were received by 180 of 193 infants of HBsAg-positive mothers (90 on schedule A and 90 on schedule B). Concentrations of hepatitis B surface antibody less than 10 IU/L were observed in nine instances in five children from group A and in seven instances in six children from group B. Four hepatitis B viral infections (two HBsAg carriers, two who underwent antihepatitis B core seroconversions) were recorded in group A v one infection (antihepatitis B core seroconversion) in group B. The protective efficacy of the program (screening plus passive immunization and delayed vaccination) was 94%. The estimated cost of preventing one case of hepatitis B infection in neonates was $3,000 (US currency). It is concluded that screening all pregnant women for HBsAg can be introduced effectively at reasonable costs in a country with a low prevalence of HBsAg and a high proportion of home deliveries. Delayed active vaccination starting at 3 months of age may be an effective and, for reasons of high compliance and low cost, attractive alternative to early active vaccination.
SCIENTISTS FOR HIRE
Authors: Student
Published: December 2021

Megacorporate industry has not only penetrated the universities, but seduced leading scientists from pursuit of knowledge for the world to pursuit of another million dollars for themselves. Molecular biologists now found their own companies and become millionaires their discoveries just one more commodity in the market. Scientists are becoming as Brecht's Galileo predicted, "a race of intelligent dwarfs who can be hired for anything."
Cardiovascular Fitness in Children With Asthma Correlates With Psychologic Functioning of the Child
Authors: Strunk Robert C. , Mrazek David A. , Fukuhara Jolene T. , Masterson Jim , Ludwick Susan K. , LaBrecque John F.
Published: December 2021

Abnormalities in fitness in asthmatic children are assumed to derive from illness severity. We studied 90 children with moderately severe to severe but stable asthma for (1) fitness levels using bicycle ergometry, (2) measures of asthma severity, (3) clinician's impression of child (Child Global Assessment Scale), and (4) mother's rating of child's behavior (Child Behavior Checklist). Fitness values ranged from 15% to 120% of normal values for age, sex, and body surface area: 48% were abnormal (<2 SD below mean) and 5% were borderline (1 to 2 SD below mean). Associations between levels of fitness and medical and psychologic criteria were tested using regression analyses. Of the 11 medical variables used to define the severity of asthma, recent exacerbation of disease, forced expiratory volume in 1 second, and specific airway conductance together accounted for 8.1% of the variability in the workload ratios (ie, R2 = 0.081). The importance of the psychologic factors in determining the variability in the workload ratios was tested after the importance of the medical variables had been considered: Child Global Assessment Scale accounted for a significant amount of variability, improving the R2 to 0.180 (an increase to 0.100, P = .003). These data suggest that, within the spectrum of disease presented by the patients in this study, adjustment to the disease is at least as important as severity of disease in determining fitness.
Tin-Protoporphyrin in the Management of Children With Crigler-Najjar Disease
Authors: RUBALTELLI FIRMINO F. , GUERRINI PIETRO , REDDI ELENA , JORI GIULIO
Published: December 2021

The Crigler-Najjar disease is a rare disorder originally described in 1952 and characterized by a severe unconjugated hyperbilirubinemia appearing in the first days of life and persisting throughout life. In 1969, Arias et al proposed to subdivide such patients into two groups. The first group (Crigler-Najjar disease type 1) consisted of the most severely jaundiced infants in whom bilirubin encephalopathy developed resulting in death, usually within the first year of life, and whose plasma bilirubin level did not decrease during treatment with phenobarbital. Their bile was described as virtually colorless and appeared to contain only a trace amount of bilirubin, all in the unconjugated form. In the second group (Crigler-Najjar disease type 2), bilirubin conjugates were detected in normally yellow bile. In these patients, the unconjugated hyperbilirubinemia was less severe and encephalopathy was absent.
Changing Epidemiology of Mumps and Its Impact on University Campuses
Authors: Sosin Daniel M. , Cochi Stephen L , Gunn Robert A. , Jennings Charles E. , Preblud Stephen R.
Published: December 2021

The reported incidence of mumps has declined dramatically since licensure of the live attenuated mumps vaccine in the United States in 1967, particularly in young children. Because administration of the vaccine was not widely practiced during the first decade it was available, there is now a cohort of teenagers and young adults who are relatively underimmunized. Reported mumps cases in this cohort increased substantially during 1986 to 1987. Mumps outbreaks at three Illinois universities, from which 123 clinical cases were reported between September 1986 and May 1987, were investigated. Meningeal involvement was reported in 17% of case-patients, orchitis occurred in 19% of 64 men, 6% of patients were hospitalized, and direct health care costs were estimated at $264 per case and more than $32 000 for the three outbreaks combined. The risk of mumps illness was greater for students <20 years of age (relative risk [RR] = 2.1, 95% confidence interval [CI] = 1.4, 3.1); students residing in dormitories (RR = 2.7, 95% CI = 1.6, 4.6); and out-of-state students (RR = 1.8, 95% CI = 1.0, 3.0). Because the available data suggest that mumps in college-aged persons is due chiefly to a failure to vaccinate susceptible persons, colleges and universities should become one major focus of mumps prevention activities to reduce susceptibility in this high-risk population.
Neonatal Vocal Cord Paralysis Following Extracorporeal Membrane Oxygenation
Authors: Schumacher Robert E. , Weinfeld Irvin J. , Bartlett Robert H.
Published: December 2021

Five cases of unilateral vocal cord paralysis/ paresis were diagnosed following extracorporeal membrane oxygenation for newborn respiratory failure. All were right sided and transient in nature. None of the five patients had other findings commonly associated with vocal cord palsy. The extracorporeal membrane oxygenation procedure requires surgical dissection in the carotid sheath on the right side of the neck, an area immediately adjacent to both the vagus and recurrent laryngeal nerve. It is speculated that vocal cord paralysis in these infants was acquired as a result of the extracorporeal membrane oxygenation cannulation. Although the vocal cord paralysis resolved in all cases, two patients had difficult courses after extracorporeal membrane oxygenation. Therefore, laryngoscopic examination should be considered for patients after extracorporeal membrane oxygenation.
Clinical and Nutritional Consequences of Lactose Feeding During Persistent Postenteritis Diarrhea
Authors: Penny Mary E. , Paredes Patricia , Brown Kenneth H.
Published: December 2021

In a double-blind prospective trial, 64 children, 3 to 36 months of age, who had diarrhea for at least 14 days were randomly assigned to receive either a milkbased diet containing 6 g/kg of body weight per day of lactose or the same diet in which the lactose was >95% prehydrolyzed withβgalactosidase. Clinical and nutritional outcomes were compared. The groups were similar at the start of the study. Four of 33 patients (12.1%) in the lactose group were considered to have treatment failure because of excessive purging with or without refusal to accept the diet, compared with 1 of 31 patients (3.2%) in the hydrolyzed lactose group (P = .20). Among successfully treated boys, fecal excretion was initially similar, but on days 3 to 5 of the trial the lactose group purged a mean 74.4 g/kg per day (95% confidence limits 17.8, 131.0) compared with 42.0 g/kg per day (95% confidence limits 11.4, 72.6) in the hydrolyzed lactose group (P < .01). Diarrhea stopped within 30 hours of hospital admission in 11 children in the hydrolyzed lactose group (35.5%) compared with 1 child in the lactose group (3.3%) (P < .001). Fecal excretion of carbohydrate, nitrogen, and energy was significantly greater in the lactose group (P < .01), but there were no significant differences in fat excretion or in incremental weight change during hospitalization. Feeding lactose-containing nonhuman milk as the sole nutrient source to children with persistent diarrhea resulted in substantially greater purging which was sufficiently severe to increase the risk of dehydration in these children.
CHILDREN UNDER SIEGE
Authors: Student
Published: December 2021

In southern Africa twenty-five children die every hour from the effects of war, not only from the brutality of war itself but also from malnutrition and disease resulting from breakdown of communications and health services and loss of food production. And the plight of children in the region is growing worse, according to a report prepared by experts for the United Nations Children's Fund, UNICEF.
Annual Summary of Vital Statistics—1988
Authors: Wegman Myron E.
Published: December 2021

Data for this article, as in previous reports, are drawn principally from Monthly Vital Statistics Report, published by the National Center for Health Statistics (NCHS). US data for 1988 come from the NCHS annual summary and are estimates by place of occurrence, based upon a count of all certificates received in state offices between two dates, 1 month apart, regardless of when the event occurred. Mortality data by cause and age, however, come from the Current Mortality Sample, a systematic 10% sample of those certificates. For the United States as a whole, the estimates, with few exceptions, have proved to be close to the subsequent final figures. There are considerable variations in some states, however, because provisional figures are by place of occurrence.

Advance final reports for births, deaths (including infant deaths), marriages, and divorces provide more detail on items like age, sex, race, education, and certain indices of health care. These reports are by place of residence for births and deaths but marriages and divorces are by place of occurrence.

Careful attention should be paid to differing denominators in text and tables. For overall rates, like the birth rate or death rate, the standard denominator is 1000 total population. In instances in which more refined analysis is possible, other denominators are used, such as 100 000 for cause of death data. The particular denominator is indicated in each table.

The international data come from the annual Demographic Yearbook and the quarterly Population and Vital Statistics Report, both published by the Statistical Office of the United Nations, which has also been kind enough to provide directly more recent data reported by various countries.
Defining Successful Performance Among Pediatric Residents
Authors: Altmaier Elizabeth M. , McGuinness Gail , Wood Peggy , Ross Randall R. , Bartley James , Smith Wilbur
Published: December 2021

The pediatric literature has documented a growing attention to defining the nature and quality of residency training. The critical incident technique, a method widely accepted in industrial settings, was used in this study to determine attitudes and behaviors deemed critical for successful performance of residents in a pediatric training program. Structured interviews with 17 senior teaching faculty produced descriptions of resident behavior that were classified into the following mutually exclusive categories: commitment to learning, clinical judgment, communicating medical information, recognition ion of limits, professional behavior, interpersonal skills with patients, and dealing with emergency situations. Only 30% of the critical incidents obtained from the faculty were related to criteria traditionally used to select and evaluate residents, such as knowledge and technical skills, while the remaining incidents were noncognitive in nature. The results of this study have implications for the evaluation and selection of residents and suggest that pediatric program directors and faculty must give attention to the means by which noncognitive skills are fostered in residents.
Introital Diameter as the Criterion for Sexual Abuse
Authors: HEGER ASTRID , EMANS S. JEAN
Published: December 2021

During the past decade, interest in the medical diagnosis of the sexually abused child has dramatically increased. Sexual abuse of children is not a recent phenomenon, but in a society reluctant to believe that children are abused, medical professionals have often been placed in the position of being asked to validate the disclosure from the child solely on the basis of medical evidence.

In response to this pressure, physicians have attempted to establish standards of diagnosis by developing objective medical criteria. The legal system, accustomed to a general increase in medical knowledge and technology, has come to expect medical evidence to support an increasing number of cases of sexual abuse.
Replacing the Work of Pediatric Residents: Strategies and Issues
Authors: Honigfeld Lisa , Perloff Janet , Barzansky Barbara
Published: December 2021

Nine hospital pediatric departments that had either discontinued or reduced their residency programs were examined to determine how services were maintained. Hospital location, preferences of community physicians and hospital staff, and the availability of other types of personnel influenced the choice of staff to replace residents. Moonlighters were used in more than half of the study hospitals, with increased responsibilities for nurses as the second most frequently used strategy. The addition of full-time attending staff, neonatal specialists, and family practice residents was used by one third of the study hospitals. All but one hospital used more than one type of personnel to do residents' work. Some substitution methods seem more stable than others, but all situations in which the staff available was barely able to provide necessary services appear unstable. Physicians generally agreed that residents are the optimal hospital staff provider.
Young Adults With Special Health Care Needs: Prevalence, Severity, and Access to Health Services
Authors: McManus Margaret A. , Newacheck Paul W. , Greaney Ann M.
Published: December 2021

Health care needs of disabled young adults and access to care are analyzed using the 1984 National Health Interview Survey, a nationally representative sample of 10 394 randomly selected noninstitutionalized young adults aged 19 to 24. In 1984, 1.4 million young adults (almost 6%) suffered from disabilities. The leading cause of disability was diseases of the musculoskeletal system and connective tissue. Young adults living in poverty, in households where the family reference person had less than a high school education, and who were male were at elevated risk of disability. Disabled young adults made almost three times as many physician contacts and were hospitalized for close to six times as many days as nondisabled young adults. One of every 5 disabled young adults was uninsured in 1984. Forty-one percent of disabled Hispanic 19- to 24-year-olds and 51% of disabled young adults of other races were uninsured compared with 19% of whites and blacks. Research and financing policy implications are discussed.
Daytime Urinary Frequency
Authors: ROBSON LANE M. , LEUNG ALEXANDER K. C.
Published: December 2021

To the Editor.—

Zoubek et al1 reported on "Extraordinary Urinary Frequency" in children. This problem is likely more frequent than is appreciated presently. During the 14-month period from May 1989 through to June 1990, we observed 10 children with this problem. The Table shows the clinical data on these children. All 10 children had a previously normal daytime voiding pattern, a normal physical examination, and a negative urine culture. Seven of the ten children were boys.
Excess Injury Mortality Among Children in the United States: Comparison of Recent International Statistics
Authors: Williams Bret C. , Kotch Jonathan B.
Published: December 2021

Using data from the National Center for Health Statistics and the World Health Organization, child injury death rates in the US were compared to those of Canada, England and Wales, France, Netherlands, and Norway. Except for the 1981 Canadian figure, overall US childhood injury mortality was greater than childhood injury mortality rates of all countries studied during each year from 1980 to 1986. Injury mortality steadily declined in most other countries, whereas the US rate appears to be increasing. Attention to specific causes reveals that much of the difference is explained by motor vehicle injuries and homicide, but in every childhood age group US death rates due to drowning, firearms, homicide, poisoning, and fire are among the highest. Excess US injury mortality is largely attributable to deaths among children younger than 5 and older than 14 years of age, the most vulnerable groups in all countries. Especially high rates among US minorities account for little of the observed differences; for many injuries, the mortality rate of US nonblacks is several times those reported by the comparison nations. Behavioral strategies are inadequate to deal with excess death rates of this magnitude. Limiting exposure through regulation of handguns, greater use of public transportation, and affordable and accessible day care are among the measures that should be implemented.
Children With Special Needs in England and Wales: The Care of Hearing Impairment, Myelomeningocele, and Adolescent Pregnancy
Authors: Goodwin Shirley
Published: December 2021

Services for children with special needs in England and Wales are described briefly, with attention to the services provided by the National Health Service, local authorities, the social security system, and voluntary organizations. For illustrative purposes, particular reference is made to children with hearing impairments and myelomeningoceles. A separate account is given of the provision for pregnant adolescents, again addressing services provided by all major sources of assistance.
Increasing Incidence of Varicella Hospitalizations in United States Army and Navy Personnel: Are Today's Teenagers More Susceptible? Should Recruits Be Vaccinated?
Authors: Gray Gregory C. , Palinkas Lawrence A. , Kelley Patrick W.
Published: December 2021

Hospital records for 10 687 United States Army and Navy adult varicella (chickenpox) admissions were reviewed. Annual hospital admission rates for varicells increased more than fourfold in the active-duty army during 1980 to 1988 and more than 18-fold among active-duty navy enlisted personnel during 1975 to 1988. Fifty-seven percent of vanicella admissions occurred in the most junior military members, aged 17 to 20. More than half of the total vanicella admissions occurred in personnel with less than a year of military service. Multivariate analysis of the navy data confirmed increasing time-related trends of risk, suggesting a national temporal trend of increased vanicella susceptibility in US teenagers and young adults. Administering a safe and effective vanicella vaccine to army and navy recruits could prevent more than 7260 hospital-bed days during the first year of use.
Breast-feeding and Diarrheal Morbidity
Authors: Popkin Barry M. , Adair Linda , Akin John S. , Black Robert , Briscoe John , Flieger Wilhelm
Published: December 2021

This study used a unique longitudinal survey of more than 3000 mother-infant pairs observed from pregnancy through infancy. The sample is representative of infants from the Cebu region of the Philippines. The sequencing of breast-feeding and diarrheal morbidity events was carefully examined in a longitudinal analysis which allowed for the examination of age-specific effects of feeding patterns. Because the work controlled for a wide range of environmental causes of diarrhea, the results can be generalized to other populations with some confidence. The addition to the breast-milk diet of even water, teas, and other nonnutritive liquids doubled or tripled the likelihood of diarrhea. Supplementation of breast-feeding with additional nutritive foods on liquids further increased significantly the risk of diarrhea; most benefits of breast-feeding alone on in combination with nutritive foods/liquids became small during the second half of infancy. Benefits of breast-feeding were slightly greater in urban environments.
Delayed Detection of Coarctation in Infancy: Implications for Timing of Newborn Follow-up
Authors: Ward Kent E. , Pryor Robert W. , Matson James R. , Razook Jerry D. , Thompson Webb M. , Elkins Ronald C.
Published: December 2021

During a recent 5-year period, 74 patients younger than 6 months of age were diagnosed with coarctation of the aorta. Coarctation was correctly diagnosed in only 22% of patients prior to referral despite readily apparent femoral pulse abnormalities in 86%. Infants whose symptoms were detected between 5 and 14 days of age were significantly more ill than infants outside this age range and had a high mortality rate (25%). The number of associated cardiac defects was not related to the severity of clinical illness in this group, suggesting that closure of the ductus arteriosus is the primary determinate of disease severity. Observations in two patients suggested that a detectable pulse discrepancy occurs between 3 and 5 days postnatally. Upper extremity hypertension was found commonly in infants after 5 days of age despite the presence of congestive heart failure. Earlier detection of coarctation in the newborn requires a diligent cardiovascular and peripheral pulse examination between 3 and 7 days of life, upper extremity and lower extremity blood pressure measurement, and a high index of suspicion.
`Ivory Tower' Fellowship Statement Challenged
Authors: NEWPORT MARY T.
Published: December 2021

I have a number of questions related to the "Statement on Pediatric Fellowship Training" by the Federation on Pediatric Organizations.

The article did not list the authors of the statement. How many participants were involved in the development of this statement, what was the composition of the group, and, in particular, how many were subspecialists who practice clinical medicine in nonacademic settings?

The statement noted, with regard to the goals of training fellows, that "perhaps most important, graduates of regular and advanced training programs should be prepared to initiate independent research and to compete for peer-reviewed research funding."
Reducing Night Waking in Infancy: A Primary Care Intervention
Authors: Adair Robin , Zuckerman Barry , Bauchner Howard , Philipp Barbara , Levenson Suzette
Published: December 2021

Approximately 25% of infants wake regularly at night and need help in resettling. The purpose of this study was to implement and evaluate a brief intervention to prevent such night waking. The study used a prospective cohort design with historical controls. Information from the control group was collected at the 9-month visit. The intervention group was enrolled at the 4-month visit. The intervention consisted of information about sleep-onset associations, completion of a sleep chart, and discussion about sleep with the pediatrician. The outcome was also measured at the 9-month visit. To obscure the purpose of the study, the outcome questionnaire for both groups addressed feeding and sleeping. One hundred twenty-eight (74%) of 172 eligible infant-parent pairs comprised the control group and 164 (74%) of 222 the intervention group. The majority of families were white, married, and well-educated. The groups were similar with regard to sociodemographic variables and factors thought to be related to night waking such as current breast-feeding, thumb/pacifier sucking, maternal isolation, and parental perception of difficult child. At 9 months of age, the intervention infants were reported to experience 36% less night waking per week compared with those in the control group (2.5 vs 3.9 wakings per week, P = .02). Frequent night waking was twice as common in control infants (27% vs 14%, P =.01). It is concluded that this pediatric intervention can help parents reduce night waking in infants.
Light and Retinopathy of Prematurity: Does Retinal Location Offer a Clue?
Authors: Fielder Alistiar R. , Robinson Judith , Shaw David E. , Moseley Merrick J. , Ng Yin K.
Published: December 2021

Nursery illumination has been implicated in the pathogenesis of retinopathy of prematurity (ROP), although the results of recent studies are conflicting. The data base for this article is a prospective ROP study on 607 infants of birth weight ≤1700 g including 35 larger siblings from multiple births when 1 infant fulfilled the birth weight criteria. Retinopathy commences preferentially in the nasal retina of the most immature neonate and is less likely to develop, or its onset is delayed, in the superior and inferior regions. These findings cannot be fully accounted for by regional vascular and neuroanatomical variations. Radiometric and physiological evidence suggests that the very immature neonate, most at risk of developing severe ROP,receives the greatest retinal irradiance. Furthermore, ROP commences in the areas of the retina receiving the highest light dose, and its onset is either retarded or inhibited in the darker retinal regions. Further studies are required to determine whether early exposure to light is a factor in the development of ROP. If a causal relationship is proven, here at least is one modality that can easily and immediately be controlled.
Maternal Avoidance of Eggs, Cow's Milk, and Fish During Lactation: Effect on Allergic Manifestations, Skin-Prick Tests, and Specific IgE Antibodies in Children at Age 4 Years
Authors: Sigurs Nele , Hattevig Gunnar , Kjellman Bengt
Published: December 2021

Two matched groups of children with a family history of atopy/allergy were observed from birth. In one group (n = 65) the mothers had a diet free from eggs, cow's milk, and fish during the first 3 months of lactation, whereas the mothers in the other group (n = 50) had a normal diet. Atopic/allergic manifestations, skin-prick tests, and specific IgE antibodies to egg white and cow's milk during the first 18 months of life have been reported previously. At 4 years of age the children underwent a clinical examination, skin-prick tests, and determination of specific IgE antibodies in serum against certain food and inhalant allergens. Both the cumulative incidence and the current prevalence of atopic dermatitis were significantly lower in the group of children whose mothers had adhered to a hypoallergenic diet during lactation, whereas all other atopic manifestations were similar. The number of children with positive skin-prick tests and specific IgE antibodies did not differ significantly, but the number of positive skin-prick tests and specific IgE antibody reactions in serum was significantly lower in the children of mothers adhering to the diet, indicating a milder degree of sensitization in these children.
Prevalence of Radiographic Evidence of Paint Chip Ingestion Among Children with Moderate to Severe Lead Poisoning, St Louis, Missouri, 1989 Through 1990
Authors: McElvaine Michael D. , Matté Thomas D. , Binder Sue , DeUngria Estilita G. , Copley Charles G.
Published: December 2021

Although experts once believed that ingesting chips of lead-based paint was the major cause of lead poisoning among children, conventional wisdom now holds that lead-contaminated dust and soil are the major routes of exposure. Data from a Childhood lead-poisoning treatment clinic were examined to assess the frequency with which children ingest paint chips. For this study, the reports on abdominal radiographs of 90 children with moderate to severe lead poisoning who had received their first chelation treatment during 1989 or 1990 were reviewed. According to a radiologist's evaluation, 13 of 90 abdominal radiographs (14%; 95% confidence interval [CI] 7% to 22%) showed evidence of paint chip ingestion. Of 46 children with blood lead levels ≥ 55 µg/dL, 12 (26%) had radiographs that showed paint chips, whereas only 1 (2%) of 44 children with blood lead levels <55 µg/dL had such radiographs (prevalence ratio = 11.5; 95% CI 1.6 to 84.6). The actual proportion of children with moderate to severe lead poisoning who have consumed leaded-paint chips is likely to be higher than this estimate based on radiographic evidence. While lead-contaminated dust is a major source of lead exposure, ingestion of leaded-paint chips clearly remains an important source of exposure among children with moderate to severe lead poisoning.
Suppurative Group A β-Hemolytic Streptococcal Infections in Children
Authors: Rathore Mobeen H. , Barton Leslie L. , Kaplan Edward L.
Published: December 2021

Group A β-hemolytic streptococci (GABHS) have once again become an important cause of serious suppurative disease in children. A 100% increase in the rate of GABHS bacteremia and an increased frequency in GABHS bacteremia in previously healthy children were observed in 1989 through 1990 compared with 1984 to 1988. Streptococcal isolates were characterized and patient demographic data were tabulated from children hospitalized with GABHS suppurative infections in 1989 through 1990. The differences in clinical manifestations and strains of GABHS were examined in patients with bacteremia, with or without focal site of infection, and in those with focal infections without bacteremia. Bacteremic children were significantly younger and had higher white blood cell counts at admission. No patient had a toxic shock-like syndrome. Although no specific strain was associated with suppurative infections, serum opacity reaction-negative organisms were more frequently associated with focal infections without bacteremia. The data suggest that GABHS may have become more virulent. Physicians should consider GABHS as an important cause of serious suppurative infection in children.
Fatal Intentional Salt Poisoning Associated with a Radiopaque Mass
Authors: DOCKERY W. KEITH
Published: December 2021

Intentional poisoning has become recognized more widely as a form of child abuse in recent years.1 Many substances have been reported as the agents used, including common table salt (sodium chloride).2-5 However, there is very little published information on the manifestations of salt poisoning when it is administered in large quantities in the undissolved, crystallized form. A case of fatal salt poisoning is reported which emphasizes two characteristics of crystallized salt that have not been described previously and which emphasizes once again that poisoning in young children may be a form of child abuse.

Case Report

A 5-year-old girl was brought to a local emergency department with seizures and hypernatremia.
FATAL CANICOLA FEVER WITH AUTOPSY FINDINGS
Authors: LEROY ELIE P. , GOLDMAN ALBERT , GOLDIN MILTON , BOLONIK SAMUEL J.
Published: December 2021

A fatal case of canicola fever in a six year old child is presented. The clinical laboratory and anatomic findings are briefly discussed. A brief review of the literature is made.
BUTANOL-EXTRACTABLE IODINE IN THE SERUM OF INFANTS
Authors: MAN EVELYN B. , PICKERING DONALD E. , WALKER JAMES , COOKE ROBERT E.
Published: December 2021

The difference between SPI and BEI in blood from the umbilical cord or from infants is no greater than the difference noted in the blood of adults. The average differences, SPI-BEI, in both are 0.4 to 0.5 gamma %.

SPI and BEI of cord blood do not differ significantly from those of the mother's blood taken during delivery and, therefore, cannot be used to measure the BEI of the infant during the first weeks of life. In contrast the concentrations of fatty acid and cholesterol of the serum from cord blood was only about one-third as great as that of maternal blood.

In the first days of life SPI and BEI rise sharply. In 12 of 13 infants 2 to 6 days old the BEIs were between 7.0 and 11.7 gamma %, values indicative of hyperthyroidism in adults.

Data on children from birth to 16 years of age suggest that the normal range may remain higher than that of adults for as long as seven years.
CHEMICAL GROWTH IN MAN
Authors: FORBES GILBERT B.
Published: December 2021

From midfetal life to the period of young adulthood, chemical growth, as regards Na, K and H2O, proceeds in a manner which conforms to the differential growth equation, y = bxk.

Equations of this general form have been derived for each of the chemical constituents in question, from which mean total body content can be calculated for any normal subject of given body weight.

Retentions of Na, K and H2O resulting from normal growth can be anticipated by means of these equations.