bluuebunny/crossref_metadata_2025 huggingface dataset:
Annual Summary of Vital Statistics—1981
Authors: Wegman Myron E.
Published: December 2021

Data for this article, as in previous reports, are drawn principally from the Monthly Vital Statistics Report, published by the National Center for Health Statistics. The international data come from the 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 more recent data. Except for mortality data by cause and age, which are based on a 10% sample, all the US data for 1981 are estimates by place of occurrence based upon a count of certificates received in state offices between two dates, one month apart, regardless of when the event occurred. Experience has shown that for the country as a whole the estimate is very close to the subsequent final figures. There are, however, considerable variations in a few of the states, particularly in comparing data by place of occurrence with data by place of residence. State information should be interpreted cautiously.
Prolonged Apnea and Cardiac Arrhythmias in Infants Discharged from Neonatal Intensive Care Units: Failure to Predict an Increased Risk for Sudden Infant Death Syndrome
Authors: Southall D. P. , Richards J. M. , Rhoden K. J. , Alexander J. R. , Shinebourne E. A. , Arrowsmith W. A. , Cree J. E. , Fleming P. J. , Goncalves A. , Orme R. L'E.
Published: December 2021

Twenty-four hour recordings of respiratory wave form and ECG were made on low-birth-weight and/ or premature infants within one week of discharge from eight neonatal intensive care units. Eight infants (0.7%) had episodes of apnea >30 seconds in duration, all of which were accompanied by bradycardia <100 beats per minute; 25 infants (2.3%) had a total of 36 apneic episodes between 20 and 30 seconds in duration, 29 of which were accompanied by bradycardia ≤100 beats per minute; and 19 infants (1.7%) had episodes of bradycardia ≤50 beats per minute without prolonged apnea (as shown by a lack of breathing movement). Five infants had ventricular premature beats (including one with ventricular tachycardia). Eleven infants had supraventricular premature beats (including two with supraventricular tachycardia and one with preexcitation). Four infants had both supraventricular and ventricular premature beats. Two infants had preexcitation. Eleven infants who underwent 24-hour recordings died. Five infants were victims of sudden infant death syndrome. One infant death was sudden and unexpected and was attributed to bronchopneumonia. Two deaths were associated with congenital heart disease and three were associated with major cerebral disorders. None of the six babies who died suddenly and unexpectedly had apnea ≥20 seconds, bradycardia ≤50 beats per minute, or cardiac arrhythmias on their 24-hour recordings.
ON THE INJURIOUS EFFECT OF THE BABY CARRIAGE ON THE PHYSICAL DEVELOPMENT OF THE YOUNG (1880)
Authors: C. T. E.
Published: December 2021

On November 10, 1880, Dr. Henry H. Smith of Philadelphia read a paper before the Philadelphia County Medical Society in which he condemned the use of the baby carriage as follows:

The advocates of the use of baby-carriages contend that they are beneficial by keeping an infant longer in the fresh air than can be done when it is carried by a nurse, who soon becomes fatigued.

This is certainly not true in many instances, as a woman who is not strong enough to carry an infant, even if it weighs twenty-five pounds, is physically unfitted for her duty as a nurse. Such an objection is very apt to be raised by the nurses themselves, and should be regarded with suspicion by the mother. Often it is evidence of laziness or a fondness for flirtation or talking, as may be noted at any time in our parks or squares, and especially in Rittenhouse Square, where many nurses of wealthy children can be daily seen amusing themselves by the hour, totally regardless of the infant, who may be likewise seen with its head hanging out over the side of the carriage, so as to compress the veins of the neck and induce a certain degree of congestion of the brain, if it is not found in some equally-improper and injurious attitude likely to result in curvature or caries of the spine, the origin or exciting cause of which it is subsequently difficult to recognize.

Another evil liable to ensue from the constant use of the baby-carriage is the jarring and concussion of the delicate brain and spinal cord of the infant, created by bouncing the carriage over gutters or up and down the curbstones of our sidewalks....

The baby-carriage mania has now reached that point in Philadelphia that an infant and a coach appear to be inseparable, and, though the cost of a baby-carriage is quite an item in the expenses of the nursery, "few there are so poor as not to do it reverence." Of course, it is admitted that there may be instances where the use of a baby-carriage occasionally by a child able to walk a little, or where the carriage permits a poor, tired mother to obtain for herself a little relaxation whilst keeping her baby in its carriage in the Park, or in the case of feeble children or those recuperating from an attack of illness, is advantageous: but, as a general rule, the anatomical and physiological facts just alluded to may be deemed as sufficient to induce physicians to give attention to the abuse of a custom that is by no means the result of necessity in the case of infants or those under twelve months of age.
The Scope of Nursing Practice in Level III Neonatal Intensive Care Units
Authors: Harper Rita G. , Little George A. , Sia Concepcion G.
Published: December 2021

A structured, timed, telephone survey to determine the scope of nursing practice in level III neonatal intensive care units revealed that the staff/head nurse and neonatal nurse clinician/specialist now are responsible for a wide variety of sophisticated skills and procedures, which were heretofore usually performed by a physician. This study has broad implications for educational as well as service activities and indicates a need to change physician and nurse expectations and education accordingly.
Prediction of Child Abuse in an Ambulatory Setting
Authors: Rosenberg Norman M. , Meyers Sheila , Shackleton Nancy
Published: December 2021

A prospective random study was performed on 476 patients, up to 2 years of age, by full-time registered nurses in the emergency room. The parent (caretaker) and child were assessed in an effort to predict child abuse. The incidence of abuse rose from 2.5% to 15.2% if one or more abnormal features were present in parent or child (P < .0003). Abuse developed in 19% of unkempt children and 28% of children with abnormal bruises, burns, or bites. The incidence of abuse increased to 42% (P < .002) when these factors were present together. An unkempt child with an abnormal parenting pattern had a 30% chance of being abused (P = .007).
Diarrhea in Breast-Fed and Non-Breast-Fed Infants
Authors: Cushing Alice H. , Anderson Linda
Published: December 2021

During the first year of life a group of babies was prospectively observed for diarrhea and for fecal carriage of heat-labile toxigenic bacteria, with or without colonization factor, and rotavirus. Approximately half of the babies were breast-fed for the first six months of life. There was no difference between groups (breast-fed vs non-breast-fed) in number of babies who had diarrhea during any two-month period. Nor was there any difference between groups in the number of babies who had diarrhea while carrying toxigenic bacteria, with or without colonization factor. Secretory antibody to toxin was found in 37% of colostrum and milk samples. There was a small but insignificant difference in the number of babies who had diarrhea when they carried toxigenic bacteria depending on the presence of antibody in the breast milk they received.
Group A Streptococcal Meningitis
Authors: Murphy Daniel J.
Published: December 2021

A retrospective record study of six cases of meningitis caused by group A β-hemolytic Streptococcus is presented. Associated findings included otitis media, pharyngitis, and erysipelas. All patients survived their infections despite major complications including seizures, shock, coma, renal failure, and hepatitis. Two patients had neurologic sequelae. Group A Streptococcus causes a severe form of bacterial meningitis in apparently healthy children.
Foster Care Children
Authors: DEMB HOWARD B.
Published: December 2021

To the Editor.—

After reading Schor's article "The Foster Care System and Health Status of Foster Children" (Pediatrics 1982;69:521) I wished that there was one point he would have made more clearly. Namely, that the population of children coming into foster care has a high incidence of psychopathology, much of it rather severe. A corollary point should also be made, ie, that the quantity and quality of psychopathology produced by the fact of entering foster care is minimal by comparison to the nature and extent of the psychopathology already present in these children when they come into foster care.
Creatinine Excretion
Authors: HARKAVY KENNETH L.
Published: December 2021

To the Editor.—

The data presented by Sutphen1 are interesting, but they do not speak to the conclusions that are drawn in the paper. If urine creatinine excretion is supposed to reflect body muscle (protein) mass, why wasn't creatinine excretion expressed as milligrams per kilogram of actual weight v actual weight? Inspection of the Table suggests the correlation would not be nearly as good. His results do support the conclusion that larger infants have more protein but variation with malnutrition or maturation is unevaluated.
Conjunctivitis-Otitis Syndrome
Authors: NERSESIAN WILLIAM S.
Published: December 2021

To the Editor.—

Bodor's report1 concerning conjunctivitis-otitis syndrome concludes that 73% of patients with purulent conjunctivitis concurrently had otitis media. He also remarks that in families with more than one child, 47% of siblings were affected simultaneously or within a one-month period. If valid, these data certainly add to our knowledge concerning bacterial conjunctivitis; however, I believe the study contains some flaws which seriously affect its credibility.

First, and most important, the study did not examine all patients with purulent conjunctivitis who were seen during a 1-year period.
Conjunctivitis-Otitis Syndrome
Authors: WHITSON ROBERT K.
Published: December 2021

To the Editor.—

The recent article by Bodor1 is an excellent discussion of a clinical syndrome virtually unrecognized in standard textbooks. However, his article does not clearly indicate the frequency of associated otitis media in patients with eye symptoms only, nor does it discuss treatment and outcome in patients with the conjunctivitis-otitis syndrome. Because of the apparent association between conjunctivitis and otitis in young children, I started a study in my private pediatric practice to determine the frequency of this association.
Consultants to Schools
Authors: SPRUNGER LEWIS W. , BOYCE W. THOMAS , DUNCAN BURRIS
Published: December 2021

To the Editor.—

Recent studies1,2 have shown that children use school systems' health care resources to address their problems of both "new" and "old" morbidity. Because schools generally do not provide primary health care, such children may be less than adequately served. Wright and Vanderpool3 have proposed that pediatricians make increased efforts to bolster schools' involvement with and understanding of child health issues by serving as consultants. This appears to be one rational strategy to follow while we continue to strive to make comprehensive primary health care universally available to children.
Risk Factors for Necrotizing Enterocolitis in Infants Weighing More Than 2,000 Grams at Birth: A Case-Control Study
Authors: Wilson Rickey , del Portillo Madeline , Schmidt Emmet , Feldman Roger A. , Kanto William P.
Published: December 2021

A retrospective case-control study of necrotizing enterocolitis (NEC) was conducted among infants weighing >2,000 g at birth. Twenty-three infants met the NEC criteria for inclusion in the study; 12 weighed 2,001 to 2,500 g at birth and 11 weighed >2,500 g at birth. Hypoglycemia occurred in 7/12 (55%) infants weighing 2,001 to 2,500 g and in 4/35 (11%) control subjects (P < .02). In infants weighing >2,500 g at birth, polycythemia (occurring in 7/12 study infants (58%) and 5/32 (16%) control infants) and respiratory distress (3/11 study infants (27%) and 0 control subjects) were significantly associated with NEC (P < .02). Larger infants with a history of perinatal stress and/or physiologic immaturity are likely to be at greater risk for NEC than their normal counterparts.
Physiologic Stress Reduction by a Local Anesthetic During Newborn Circumcision
Authors: Wiliamson Paul S. , Williamson Marvel L.
Published: December 2021

To evaluate the effectiveness of the dorsal penile nerve block in reducing the stress of circumcision upon newborns, physiologic measurements in 30 healthy full-term infants (including transcutaneous oxygen levels, crying time, heart rate, and respiratory rate) were monitored continuously before, during, and after the operation. Infants receiving the dorsal penile nerve block with lidocaine (1% Xylocaine) (N = 20) experienced significantly less stress, as evidenced by smaller decreases in transcutaneous oxygen pressure levels, less time spent crying, and smaller increases in heart rate, than infants circumcised in an identical manner without anesthetic (N = 10). No complications resulted from injection of the local anesthetic or from the circumcision procedure itself. Inasmuch as dorsal penile nerve block has a low complication rate, is simple to learn, and adds little time or expense to the overall procedure, and if it proves to be as effective clinically as the physiologic data indicate, the dorsal penile nerve block should be considered for every infant undergoing circumcision.
Oculocardiac Reflex in Near Miss for Sudden Infant Death Syndrome Infants
Authors: Kahn André , Riazi Jalil , Blum Denise
Published: December 2021

To gain insight into the role of the vagus nerve in sudden infant death syndrome (SIDS), 180 infants ranging in age from 1 to 66 weeks were examined with respect to cardiac response to ocular compression. There were 35 near-miss infants, 76 normal siblings of SIDS victims, and 69 normal control infants. Asystoles within the control group ranged from 0.3 to 1.8 seconds. Ten of 35 (28%) near-miss infants and 10/76 (13%) siblings had asystoles >2.0 seconds when first tested. When statistically compared, the near-miss infants were significantly different from both the control infants and the siblings (Kruskal-Wallis procedure: P < .01, and P < .05, respectively). It is concluded that in the first year of life a significant number of near-miss infants have an exaggerated cardiac response to ocular compression. Furthermore, the presence of prolonged asystoles in certain siblings indicates that vagal hypersensitivity, as manifested by ocular compression, may be, in part, hereditary.
Corticoresistant Nephrotic Syndrome Associated with T-Cell Deficiency in Two Sisters
Authors: Tabin René , Guignard Jean-Pierre , Gautier Emile , Dubrit Micheline , Jeannet Michel , Golaz Jean , Moretta Lorenzo
Published: December 2021

The coexistence in two sisters, born to related parents, of a corticoresistant nephrotic syndrome, lymphopenia, an immune deficit, short stature, and photophobia is described. The immune deficit is mainly cellular; studies of lymphocyte markers demonstrate a pronounced deficiency of T lymphocytes and Fc-µ receptorbearing cells. It is suggested that a thorough examination of number and function of T cells should be performed in patients with a familial corticoresistant nephrotic syndrome and recurrent infectious episodes before considering immunosuppressive treatment.
Sleep and Bedtime Behavior in Preschool-Aged Children
Authors: Beltramini Antonio U. , Hertzig Margaret E.
Published: December 2021

Age stage-specific changes in patterns of sleep and bedtime behavior were examined in 109 normally developing preschool-aged children who were the subjects of the New York Longitudinal Study of Temperament and Development. The data were derived from information abstracted from interviews conducted with parents about the behavior of their children in daily life situations at 1, 2, 3, 4, and 5 years of age. The following age trends were found: older children were significantly more likely to exhibit a prolongation of bedtime routine, insist on sleeping with the light on, take a treasured object to bed, request parental attention after being told good night, and experience delays in falling asleep than were younger children. The frequency of occurrence of night awakening was not different at the different age levels examined, although older children were significantly more likely to experience nightmares. The fathers of older children were significantly more likely to participate in bedtime routines, and older children were also significantly more likely to share a bedroom with a sibling. No sex differences were found.
Diagnosis of III-Defined Pulmonary Infiltrates by Lateral Decubitus Chest Radiography
Authors: Faerber Eric N. , Darling Donald B. , Leonidas John C.
Published: December 2021

The lateral decubitus chest radiograph is a useful procedure in the evaluation of ill-defined pulmonary densities that may simulate infiltrates. This procedure, although described previously in the radiologic literature, has not been in frequent use. The procedure assists diagnosis in patients who are not able to take a deep inspiration due to personal limitations and in young children who are not able to cooperate fully.
Evaluation of the Pertussis Components of Diphtheria-Tetanus-Pertussis Vaccine
Authors: Murphy M. Dianne , Rasnack Jeane , Dickson Harold D. , Dietch Marc , Brunell Philip A.
Published: December 2021

The adjuvant and antigen components of the pertussis fraction of diphtheria-tetanus-pertussis (DTP) vaccine were evaluated. Four preparations of DTP vaccine composed of either whole cell (Wc) or extracted (E) pertussis antigen combined with either an aluminum phosphate (Ph) or alum (Al) adjuvant were compared. Local reactions were similar in all four vaccines after the first two immunizations but were significantly increased in incidence and severity following the third immunization with vaccine WcPh. This appeared to be due to the Ph adjuvant rather than the antigen component. Febrile reactions were experienced more often (P = .0009) and with higher temperatures (P = .0001) with the WcPh vaccine following the first immunization. This appeared to be due to the Wc component. Comparing the pooled Wc groups with the pooled E groups revealed a greater febrile response in the Wc group after both the first (P = .0008) and the second (P = .03) immunization. Local reactions appear temporally and etiologically to be distinct from febrile reactions. The pooled Wc antigen group produced a higher geometric mean titer than the pooled E antigen group (P = .05). Serologic responses, with respect to geometric mean titer, were not significantly different among the individual vaccines. This study suggests that the combination of whole cell and aluminum phosphate, which is currently in use in the United States, is probably not the optimal formulation for pertussis vaccine.
Cancer Mortality Following Cardiac Catheterization: A Preliminary Follow-up Study on 4,891 Irradiated Children
Authors: Spengler Robert F. , Cook David H. , Clarke E. Aileen , Olley Peter M. , Newman Alice M.
Published: December 2021

A retrospective cohort study was conducted on the risk of radiation-induced cancer mortality following cardiac catheterization. The study included 4,891 children with congenital heart disease who were assessed by cardiac catheterization during 1946 to 1968 at The Hospital for Sick Children, Toronto. The cohort was matched against the Ontario cancer death file from 1950 to 1975. The average period of follow-up was 13 years and more than 66,000 person-years have been accrued from the cohort. No deaths from breast cancer or thyroid cancer were identified. Five cancer deaths were observed and compared with 4.8 expected deaths based on Ontario cancer death rates. The five cancer deaths resulted from three leukemias, one Wilms' tumor, and one unspecified nervous system tumor. The preliminary findings did not demonstrate a significant leukemia risk arising from diagnostic cardiac catheterizations. Continued follow-up of this cohort is required to evaluate the risk of breast and thyroid cancers which can occur more than 20 years following radiation exposure.
Cow's Milk Proteins Cause Infantile Colic in Breast-Fed Infants: A Double-Blind Crossover Study
Authors: Jakobsson Iréne , Lindberg Tor
Published: December 2021

Sixty-six mothers of 66 breast-fed infants with infantile colic were put on a diet free from cow's milk. The colic disappeared in 35 infants; it reappeared on at least two challenges (cow's milk to mother) in 23 infants (35%). A double-blind crossover trial with cow's milk whey protein was performed in 16 of these 23 mothers and infants. Six infants had to be taken out of the study for various reasons; of the remaining ten infants, nine reacted with colic after their mothers' intake of whey protein-containing capsules. Sequential analysis showed a high correlation between infantile colic in breast-fed infants and their mothers' consumption of cow's milk protein. A diet free of cow's milk is suggested for the mothers as a first trial of treatment of infantile colic in breast-fed infants.
A Minicomputer-Based Perinatal/Neonatal Telecommunications Network
Authors: Bostick James S. , Hsiao Henry S. , Lawson Edward E.
Published: December 2021

A minicomputer-based telecommunications network has been developed to link all of the state's nine tertiary neonatal intensive care units in order to provide information on availability of neonatal and maternal beds. The information is updated automatically on computer terminals located in each neonatal intensive care unit every two hours by a complete system poll (350 polls per month). This information has been found to be accurate 95% of the time. Through a computer simulation, this network is shown to provide a significant reduction (P < .0005) in the number of referral telephone calls, and thus the time, required to locate a bed within the state for obstetric or pediatric patients needing transfer. In addition, this network has provided a data base to aid in local, regional, and statewide planning for perinatal facilities. A 6-month summary of the data indicated that for 16% of the system polls, less than two neonatal intensive care units could accept outside referrals, demonstrating frequent severe statewide restrictions for care of high-risk patients. The total operating budget for the most recent fiscal year was less than $25,000, which is far less than that of manual 24-hour central telephone operator systems providing similar services. This telecommunications network is a cost-effective answer to the common problem of limited regional perinatal resources.
Aspirin Consumption and Severity of Reye's Syndrome
Authors: STARKO KAREN M.
Published: December 2021

In Reply.—

The Center for Disease Control,1 the Committee on Infectious Diseases of the American Academy of Pediatrics,2 and The Food and Drug Administration,3 have concluded that the studies conducted in Arizona,4 Michigan,5 and Ohio6 indicate that a statistically significant association exists between Reye's syndrome (RS) and salicylate use. Reasons for this association being false, such as case-control misclassification, the influence of confounding variables (fever, headache) etc, have been addressed by these groups. Although concerns have been raised regarding these factors, none has been shown to account for the association.
Doppler-Pulsatility Index
Authors: BATTON DANIEL G. , HELLMANN JONATHAN , MAISELS M. JEFFREY
Published: December 2021

To the Editor.—

The determination of cerebral blood velocity in the newborn infant using transfontanel Doppler ultrasound has been discussed in detail in two recent commentaries.1,2 Whereas the use of the Doppler effect to determine blood velocity is well accepted, it is apparent that considerable controversy exists regarding the ability of this technique to measure cerebral blood flow in the neonate.1,2 In particular, the hemodynamic significance of the pulsatility index (PI) remains unclear.

It has been suggested that the PI reflects cerebral vascular resistance based on the assumption that, as resistance is altered, primarily diastolic, and not systolic, blood velocity will change.
Vaginal Hygiene of Girls Seen in Well Child Care Visits
Authors: LE CHINH T. , YU KYO L. , TRIMMER MARILEE
Published: December 2021

To the Editor.—

Pediatricians and nurse practitioners often find that the vaginal hygiene of female infants seen in routine well-baby visits is inadequate. Fecally stained secretions are often found in the intracoitus, labial folds, or groin of these children. During a two-month period, we prospectively surveyed mothers seen in our offices for their knowledge of adequate hygiene practices for female infant genitalia.

We specifically asked the mothers to demonstrate how they routinely wiped their baby girls' perineal and vaginal areas after "a messy diaper."
Superior Vena Cava Syndrome in Childhood: Report of Ten Cases and Review of the Literature
Authors: Issa Philip Y. , Brihi Emile R. , Janin Yves , Slim Michel S.
Published: December 2021

Experience with ten children with superior vena cava obstruction is reported. Five patients had non-Hodgkin's lymphoma, two had Hodgkin's disease, two had benign lesions, and one patient was suspected on clinical and radiologic basis to have a lymphoma. The clinical situation at presentation was often critical and required rapid treatment. Radiotherapy and/or chemotherapy were used initially as lymphoma was the most frequent cause of obstruction. Urgent thoracotomy was resorted to when treatment failed. Survival with no evidence of disease for more than 5 years was observed in three children: one had a cystic lymphangioma, another had a mediastinal abscess, and the third had a Hodgkin's lymphoma. Review of the literature from 1951 to 1976 revealed that only 24/150 children reported with superior vena cava obstruction syndrome had mediastinal tumors; the remainder developed the obstruction after surgical procedures on the heart or vena cava.
Decreased Bone Mineral Content in Small-for-Gestational-Age Infants Compared with Appropriate-for-Gestational-Age Infants: Normal Serum 25-Hydroxyvitamin D and Decreasing Parathyroid Hormone
Authors: Minton Stephen D. , Steichen Jean J. , Tsang Reginald C.
Published: December 2021

Bone mineral content was determined by photon absorptiometry, adapted for use in neonates, in 23 small-for-gestational-age (SGA) infants of 31 to 42 weeks of gestational age, for 12 weeks. At birth, term SGA infants had lower bone mineral content than term appropiate-for-gestational-age (AGA) infants; postnatal increase in bone mineral content was slow and lagged significantly behind that of term AGA infants. Preterm SGA infants had bone mineral content that was similar to that of preterm AGA infants at birth; postnatal bone mineral content was similar to that of preterm AGA infants, but was decreased compared with the expected intrauterine bone mineral content. Serum 25-hydroxyvitamin D concentrations and parathyroid hormone levels were the same for SGA and AGA infants. Serum 25-hydroxyvitamin D concentrations decreased slightly with postnatal age and remained within normal limits. Serum parathyroid hormone concentrations decreased in both SGA and AGA infants and reached undetectable levels at 10 to 12 weeks of age.
Endocarditis in High-Risk Neonates
Authors: Oelberg David G. , Fisher David J. , Gross Donald M. , Denson Susan E. , Adcock Eugene W.
Published: December 2021

The clinical spectrum of neonatal endocarditis, including bacterial and nonbactenal types, is examined in five case reports that were drawn from nursery experiences over a recent 2-year period. In contrast to previous reports of 100% mortality from neonatal endocarditis, one patient survived. Changing heart murmur and hematuria were most frequently associated with bacterial and nonbacterial endocarditis in four of the five cases. Pulmonary hypertension, thrombocytopenia, and coagulopathy were also associated with nonbacterial endocarditis. Echocardiograms were performed on four of the patients; only one was suggestive of endocarditis. Staphylococcus aureus was isolated from both cases of bacterial endocarditis, including the single survivor. Thus, it is suggested that the initial antibiotic coverage of any neonate with the clinical syndrome of sepsis, hematuria, and a heart murmur include antistaphylococcal coverage for the possibility of bacterial endocarditis.
Bile Ascites During Infancy: Diagnosis Using Disofenin Tc 99m Sequential Scintiphotography
Authors: So Samuel K. S. , Lindahl Julie A. , Sharp Harvey L. , Cook Anthony M. , Leonard Arnold S.
Published: December 2021

Bile ascites or peritonitis in infancy is a rare condition that is usually caused by spontaneous perforation of the extrahepatic tree. Recently, an infant with bile ascites from a spontaneously ruptured choledochal cyst was treated. The use of Disofenin Tc 99m sequential scintiscanning was found to be an effective, rapid, and noninvasive preoperative tool in the demonstration of a bile leak. Disofenin Tc 99m scintiscanning may be the best and most informative method currently available in the preoperative diagnosis of bile ascites.
Evaluation of a Residency Training Program in Behavioral Pediatrics
Authors: Phillips Sheridan , Friedman Stanford B. , Smith Jean , Felice Marianne E.
Published: December 2021

The impact of behavioral training upon first-year residents was evaluated by assessing attitudes with regard to 15 clinical "entities," including behavioral disorders, physical disorders, and "mixed" disorders. Each entity was rated at four times: beginning of the year, start of the behavioral rotation, end of the rotation, and end of the year. Multiple-choice questions were also included to assess knowledge regarding behavioral pediatrics. Data were collected from 37 residents, from 1977 to 1980. For behavioral disorders and mixed disorders, residents' self-reported competence increased with regard to diagnosis, management, advising parents, and knowledge of resources. Further, the greatest change occurred during the 2-month rotation. In contrast, change in perceived competence for physical disorders was not specific to the rotation but, rather, increased evenly over the year. Ratings of faculty and housestaff interest remained constant across testing points, and residents'"desire to learn more" and prediction of "future relevance" showed a slight decrease over time, for all disorders. Knowledge regarding behavioral pediatrics increased significantly from the beginning of the year to the start of the rotation, and also during the rotation. These data demonstrate that changes in residents' perceived competence are directly related to their rotation experience, and suggest that behavioral issues can be introduced successfully during the first year of residency training.
Circumcision: The Effect of Information on Parental Decision Making
Authors: MAISELS M. JEFFREY , HAYES BARBARA , CONRAD SARAH , CHEZ RONALD A.
Published: December 2021

Circumcision, a surgical procedure of debatable medical value, is performed on more than 80% of male infants in the United States.1-3 Although there are numerous documented complications of the surgery,4 parents are rarely informed adequately about the operation or its risks.5,6 We speculated that if parents were given more complete and objective information about the procedure, some might elect not to have their sons circumcised. This study was designed to test this hypothesis.

METHODS

During a 3-month period, 104 mothers seen in our prenatal clinic at 30 to 34 weeks of gestation were randomly assigned to receive, or not to receive, written information about circumcision.
Kernicterus Reexamined
Authors: TURKEL SUSAN BECKWITT , MILLER CAROL A. , GUTTENBERG MARTA E.
Published: December 2021

In Reply.—

Ours was a retrospective, controlled study of the clinical-pathologic correlates of kernicterus. Cases with kernicterus at autopsy were matched by gestational age, weight, and length of survival with paired control infants. The same neuropathologist was responsible for the initial processing and diagnosis of all the cases.

On review, we found the expected histologic features of toxic bilirubin encephalopathy in only two of 32 cases with characteristic gross bilirubin staining at autopsy. Spongy change was found in no predictable anatomic location in the remaining cases.
Measles in the Future?
Authors: FULGINITI VINCENT A.
Published: December 2021

In Reply.—

The conservative figure for seroconversion after live measles virus vaccine administered at 15 months of age is given as "at least 95%."1 In many of the actual studies seroconversion, when tested by sensitive serologic techniques, is actually higher, 97% to 100%.2-4 To our knowledge, no one has studied, comprehensively, a large group of nonreactors to determine whether: (1) they are genetically incapable of responding, (2) they will respond to a second dose, or (3) they are actually immune but not detected by the tests employed.
Parents' Time Is Worth Money
Authors: DONN STEVEN M. , GLASSANOS MARIANNE R.
Published: December 2021

In Reply.—

Richardson has raised several issues not fully addressed in our initial report which deserve careful consideration.

We certainly agree that there may be opportunity costs to the parents. However, our program is offered selectively and would not be available to families if it imposed economic hardship that would jeopardize infant or family well-being. Of course, certain costs of child rearing are assumed by every parent choosing to have a child and most working mothers do tend to take some time from work after the birth of the child.
Treatment of the Choking Child
Authors: HOFFMAN JEROME R.
Published: December 2021

To the Editor.—

The continuing controversy regarding best management of foreign body obstruction of the upper airway was given fairly significant coverage in your July 1982 issue. Although the position paper of the Committee on Accident and Poison Prevention of the American Academy of Pediatrics1 presents the conventional bias shared by other authoritative groups such as the American Heart Association and the National Academy of Sciences-National Research Council, it does not present the rationale for its position.
Is the "Therapeutic Orphan" About to Be Adopted?
Authors: Coté Charles J. , Kauffman Ralph E. , Troendle Gloria J. , Lambert George H.
Published: December 2021

In this issue of Pediatrics, the Committee on Drugs (COD) has examined the continued problem of the "unapproved" use of "approved" medications in pediatrics.1 This commentary will expand on the issues that have restricted drug research in children and describe current initiatives to facilitate and encourage such research to achieve the necessary drug labeling to reduce unapproved uses of medications in children.

BACKGROUND

Physicians who treat infants and children frequently prescribe medications that have never been approved by the Food and Drug Administration (FDA) for pediatric patients; unfortunately, many drugs are released without labels for pediatric use and often with pediatric disclaimers.
Histiocytic Necrotizing Lymphadenitis With Autoimmune Phenomena and Meningitis in a 14-Year-Old Girl
Authors: Debley Jason S. , Rozansky David J. , Miller Michael L. , Katz Ben Z. , Greene Marianne E.
Published: December 2021

Histiocytic necrotizing lymphadenitis, also known as Kikuchi-Fujimoto disease, is a disorder of lymph nodes originally described by Kikuchi1 and Fujimoto2 in 1972. Since 1982 this disorder has been increasingly recognized in the United States and worldwide, with the most extensive analyses of the disease presented by Dorfman et al.3-5 There has been little discussion of this entity in the pediatric literature.

The most common presentation of necrotizing lymphadenitis includes fever and painless cervical lymphadenopathy. Patients may also present with weight loss, nausea, vomiting, diarrhea, chills, or diaphoresis. On occasion, myalgias, arthralgias, malar or butterfly rash, hepatomegaly, and splenomegaly have been noted.3
Use and Abuse of the Apgar Score
Authors:   Committee on Fetus and Newborn, American Academy of Pediatrics,   Committee on Obstetric Practice, American College of Obstetricians and Gynecologists
Published: December 2021

This is a revised statement published jointly with the American College of Obstetricians and Gynecologists that emphasizes the appropriate use of the Apgar Score. The highlights of the statement include: (1) the Apgar Score is useful in assessing the condition of the infant at birth; (2) the Apgar score alone should not be used as evidence that neurologic damage was caused by hypoxia that results in neurologic injury or from inappropriate intrapartum treatment; and (3) an infant who has had "asphyxia" proximate to delivery that is severe enough to result in acute neurologic injury should demonstrate all of the following: (a) profound metabolic or mixed acidemia (pH <7.00) on an umbilical arterial blood sample, if obtained, (b) an Apgar score of 0 to 3 for longer than 5 minutes, (c) neurologic manifestation, eg, seizure, coma, or hypotonia, and (d) evidence of multiorgan dysfunction.
Letter To The Editor
Authors: Wiswell Thomas E. , Baumgart Stephen , Gannon Catharine M. , Spitzer Alan R.
Published: December 2021

Dr Escobar rightly concludes that more research is needed concerning the performance of lumbar punctures (LPs) in neonates at risk for sepsis. He warns of accepting a blanket recommendation of performing LPs in all these infants. As the risks for long-term complications from the procedure are extraordinarily low, we wonder what "unfortunate events" he fears from such a recommendation.

In regard to the possibility that clinicians may not have recorded symptoms, we carefully reviewed the entire medical records, including both physicians' and nurses' notes.
Does Quality of Care Affect Rates of Hospitalization for Childhood Asthma?
Authors: Homer Charles J. , Szilagyi Peter , Rodewald Lance , Bloom Sheila R. , Greenspan Peter , Yazdgerdi Susan , Leventhal John M. , Finkelstein Dianne , Perrin James M.
Published: December 2021

Background. Hospitalization rates for childhood asthma are three times as high in Boston, Massachusetts, as in Rochester, New York; New Haven, Connecticut, rates are intermediate. We undertook this study to determine how care for children admitted for asthma varies across these communities.

Methods. We performed a community-wide retrospective chart review. We reviewed a random sample of all asthma hospitalizations, from 1988 to 1990, of children 2 to 12 years old living in these communities (n = 614). Abstracted data included demographics, illness severity, and treatment before admission.

Results. Compared with Rochester children, Boston children were less likely to have received maintenance preventive therapy (inhaled corticosteroids or cromolyn [odds ratio (OR), 0.4 (0.2, 0.9)]), acute "rescue" therapy (oral corticosteroids [OR, 0.2 (0.1, 0.4)]), or inhaled betaagonist therapy [OR, 0.5 (0.3, 1.0)]. A larger proportion of admitted asthmatic patients in Boston (34%) were in the least severely ill group—oxygen saturation 95% or above—compared with patients in Rochester (20%).

Conclusions. The quality of ambulatory care, including choice of preventive therapies and thresholds for admission, likely plays a key role in determining community hospitalization rates for chronic conditions such as childhood asthma.
NURSE PRESCRIBING—WHAT NEXT?
Authors: L. J. F.
Published: December 2021

. . . The Medicinal Products: Prescribing by Nurses Act (1992) is in existence, permitting certain groups of nurses prescribing rights for a limited formulary of products. Why should the nursing profession be seeking prescribing rights? Meeting chairman Dr Graham Burton (Zeneca) identified the trend to increasing specialization of the nurse's role, and that many more nurses undertake postgraduate research in their chosen specialization, leading to an increased amount of clinical responsibility in practice.
Alcohol Misuse and Adolescent Sexual Behaviors and Risk Taking
Authors: Fergusson David M. , Lynskey Michael T.
Published: December 2021

Objective. The aims of this study were to examine the associations between alcohol misuse and measures of early onset sexual activity and sexual risk-taking behaviors during adolescence and the extent to which any association between these two sets of behaviors could be explained by common risk factors that predisposed individuals to both outcomes.

Method. Data were gathered during the course of a 16-year longitudinal study of a birth cohort of 953 New Zealand children and included: (1) self-report measures of early onset sexual activity (before the age of 16 years), multiple partners (three or more), and unprotected intercourse during the interval from 15 to 16 years; and (2) prospectively measured risk factors, including social background, childhood adversity, novelty seeking, and affiliations with delinquent peers.

Results. Adolescents who reported misusing alcohol had odds of early onset sexual activity, multiple partners, and unprotected intercourse that were 6.1 to 23.0 times those of young people who did not misuse alcohol. After adjustment for common or correlated risk factors, the adjusted odds ratios between alcohol misuse and early onset sexual activity and unprotected intercourse were reduced but remained statistically significant. However, no significant association between alcohol misuse and multiple partners was found after adjustment for common or correlated risk factors.

Conclusions. Much of the apparent association between alcohol misuse and teenage sexual activity and risk taking seems to arise through the influence of common family, individual, and peer factors. However, alcohol misuse may also place teenagers at greater risk of initiating early onset sexual intercourse and engaging in unprotected intercourse.
Safety and Efficacy of High-dose Rhesus-Human Reassortant Rotavirus Vaccines-Report of the National Multicenter Trial
Authors: Rennels Margaret B. , Glass Roger I. , Dennehy Penelope H. , Bernstein David I. , Pichichero Michael E. , Zito Edward T. , Mack Michael E. , Davidson Bruce L. , Kapikian Albert Z. ,   United States Rotavirus Vaccine Efficacy Group
Published: December 2021

In the January 1996 article titled "Safety and Efficacy of High-dose Rhesus Human Reassortant Rotavirus Vaccines—Report of the National Multicenter Trial" (Rennels et al. Pediatrics, 1996:97:7-13), the Acknowledgments section on page 12 included an incorrect location for one member of the United States Rotavirus Vaccine Efficacy Group, and another member was inadvertently omitted.

The correct list should include: Stephen Fries, MD, Boulder Medical Center, Boulder, CO; and Hervey Froehlich, MD, Kaiser Permanente Medical Office, Fresno, CA.
Estéticas de (re)existencia
Authors: Manrique Garcia Diana
Published: December 2021

El presente artículo presenta algunas de las expresiones organizativas rituales de la comunidad Itonama en la Amazonia boliviana, donde las danzas y la espiritualidad manifiesta en ellas, se erige como parte de una ética colectiva de cuidado. En ellas el cuerpo femenino cobra protagonismo y hace uso de estas expresiones estéticas, para en una lógica multitemporal reinventarse e interpelar el sistema colonial- moderno, patriarcal, capitalista. La ritualidad en su diversidad de formas, emerge como un lugar político de decisión e incidencia, que favorece la reinvención de las subjetividades femeninas atravesadas por múltiples interseccionalidades.
Drug Overdose Deaths in the United States, 1999–2020
Authors: Hedegaard Holly , Miniño Arialdi , Spencer Merianne Rose , Warner Margaret
Published: December 2021

This report uses the most recent data from the National Vital Statistics System (NVSS) to update statistics on deaths from drug overdose in the United States, showing rates by demographic group and by specific types of drugs involved (such as opioids or stimulants), with a focus on changes from 2019 to 2020.
Approximating Expensive Distance Metrics
Authors:   Montana State Universtiy, Pryor Elliott , Stouffer Nathan ,   Montana State Universtiy
Published: December 2021

Computing the distance between point a and point b is typically considered to be very easy. However, there are times when computing a distance can take significant computation time; we call these expensive distance metrics. Suppose we have some expensive distance metric and we need to compute the distances between a bunch of points. This paper explores a method that to reduce the number of queries to the distance metric and the effect on clustering. The authors find that total run time can be reduced while only inducing small inaccuracies in clustering output.
E-agriculture Framework for Improving Agricultural Productivity among the Smallholder Farmers in Rural Kenya
Authors: IRERI Daisy Mbucu , AWUOR Mzee , OGALO James
Published: December 2021

The economy of Kenya depends mainly on agriculture where smallholder farming has a significant role as it employs 65 percent of the work force and contributes 32 percent of Kenya’s GDP. However, the agricultural industry in Kenya is currently facing difficulties in low productivity. The rural areas have the largest concentration of poverty and food insecurity. Majority of the farming activities in Kenya are on small scale and the problems of these farmers are multifaceted including sub-divisions and small farm sizes, leading to diseconomies of scale and low productivity. The goal of this research was to develop and validate an E-agriculture Framework for Improving Agricultural Productivity among the Smallholder Farmers. Descriptive research design was used. The study was carried out in South Eastern Kenya. The target population comprised 224 meteorological staff, 421 agricultural extension officers, 208 ICT personnel and 3,833 farmers. Data was collected using self-administered questionnaires, observation and interviews and analyzed using SPSS. The study found that challenges faced farmers were cost, illiteracy and ICT skills among others. Further, the study established that farmers required specific information such as soil management, pest management etc., for mainly improving their productivity. The researcher proposed an e-agriculture framework for improving agricultural productivity through promoting innovative use of ICT tools to bridge the distance between the farmers and the research communities. The proposed e-framework could be used by government policy makers and stakeholders on ICT on agricultural services in other developing countries to implement policies that speeded up the use of ICT on agricultural information.
The Influence of foliar fertilization on different soybean genotypes
Authors: NEGREA Adrian , REZI Raluca , RUSU Teodor , URDĂ Camelia , SUCIU Vasilena
Published: December 2021

Soybean is one of the most important leguminous crops due to its high oil and protein content with a significant role in nutrition. Micronutrients for soybean growth and development are very important and foliar fertilization is used to overcome environmental stress and help soybean plants to fill their nutritive needs. The research was carried out in 2020 by the Soybean Breeding Laboratory from the Agricultural Research and Development Station in Turda, Romania. Foliar fertilization had both positive and negative effects for 1000-grain weight and yield however, quality traits do not seem to be influenced by applying supplement of microelements during the vegetation period. The research suggests that genotype is the determining factor in the efficiency of foliar fertilization. In this sense, the present experiment will continue to bring answers regarding the effects of foliar fertilizers on some soybean genotypes.