bluuebunny/crossref_metadata_2025 huggingface dataset:
Prenatal Diagnosis for Pediatricians
Authors:   Committee on Genetics
Published: December 2021

This statement is for the pediatrician who may be called upon to care for the child with a birth defect or genetic disorder. The involved family may wish to know and may benefit from methods that convert probability statements about recurrence risks into facts about the fetus. Many families will find knowledge and choice better than chance.

Rapid advances in technology have prompted the Committee on Genetics to retire the June 1980 statement and to prepare a new one. The purpose of this revised statement is to inform the pediatrician about the current status of antenatal diagnosis as it relates to genetic and family counseling in clinical practice.

The pediatrician may be called upon to help address questions about the natural history of the disorder under consideration and the possibility of intrauterine treatment. Prenatal diagnosis can give information that may improve the outcome of pregnancy and can be helpful to the obstetrician in the management of labor and delivery. The availability of prenatal diagnosis gives couples options they might not otherwise have, including termination of an affected pregnancy or preparation for the birth of an abnormal child. This enables many couples to have children, when without this information they would have chosen to be childless.

The techniques currently in use or under investigation for prenatal diagnosis include (1) fetal tissue sampling: amniocentesis, chorionic villus sampling, percutaneous umbilical blood sampling, precutaneous skin biopsy, and other organ biopsies; (2) fetal visualization: ultrasound, fetoscopy, magnetic resonance imaging, and radiography; and (3) maternal serum α-fetoprotein screening.

INDICATIONS FOR FETAL TISSUE SAMPLING
In Reply: Neonatal Prevalence of Anti-Human Immunodeficiency Virus Antibodies in California
Authors: NICHOLAS STEPHEN W. , SONDHEIMER DIANE L. , WILLOUGHBY ANNE , HOFF RODNEY
Published: December 2021

The preliminary data from the California survey of heelstick samples from newborns indicate a lower rate of HIV seroprevalence in childbearing women than was reported for Massachusetts and New York. It is also interesting that the rate for California female military recruits matches that of childbearing women.

The lower HIV seroprevalence rates in California women compared with East Coast states raises important questions about differing patterns of HIV transmission to women in the two areas. Regional stratification of the statewide rates, especially for inner-city neighborhoods, should provide relevant data for understanding these patterns.
In Reply: Fire Setting and Klinefelter Syndrome
Authors: MILLER MARVIN , SULKES STEPHEN
Published: December 2021

We echo our previous message that Klinefelter syndrome should be considered in any boy with antisocial behavior including fire setting and aggression toward others. The antisocial behavior often improves with testosterone therapy. This is the second case that we have received from the readers of Pediatrics, and we would like to know whether others have seen such individuals.
NutraSweet Overdosage
Authors: BUTCHKO HARRIETT H. , STRATHMAN IRVIN
Published: December 2021

This letter is prompted by a call from a pediatrician attending a child who had ingested 50 Equal tablets containing NutraSweet brand sweetener (aspartame). This physician expressed concern about treatment for this "overdose." Although aspartame is a food additive and not a drug, comprehensive information regarding aspartame is readily available in both Poisindex and Drugdex.

Aspartame is a dipeptide of aspartic acid and the methyl ester of phenylalanine. Extensive studies have shown that aspartame is metabolized to its constituent amino acids and methanol in the gastrointestinal tract, which are then absorbed and metabolized in the same way as when they are derived from common everyday foods.
TRENDS IN COCAINE ADDICTION
Authors: Student
Published: December 2021

The National Institute on Drug Abuse estimates that two million to three million Americans abused cocaine in 1985. . .[A current] estimate is that at least three million Americans abuse the drug, and 40 percent of them use crack, the powerfully addictive, smokable form of cocaine.

"There has been a major decrease in use among the affluent and educated and a substantial increase in use by the young, poor and uneducated," [an expert said].
VITAMIN C-INDUCED ANEMIA IN PREMATURE INFANTS
Authors: Student
Published: December 2021

The evidence provided by our studies suggests that ascorbic acid therapy places the erythrocytes of premature infants at risk of oxidative damage. . . The significance of these findings to the routine management of premature infants remains to be determined.
"CRACK" BABIES
Authors: Student
Published: December 2021

They can't be cuddled like normal babies. Often their arms and legs, even their necks are rigid. They don't fall into normal sleep patterns. They cry incessantly. . .It is distressing to return the babies to mothers for whom drugs remain the dominant feature of life. Such a mother may be indifferent to her child or abusive when its cries irritate her. The babies are not easy to care for; they lack normal responsiveness. We may see that baby back in the emergency room severely battered. Then the hunt begins for a foster home.
PARENTHOOD II
Authors: Student
Published: December 2021

Growing numbers of middle-aged Americans whose children have grown up and gone off, or those who assumed they would soon have an empty nest, are leaving the porch light on for offspring who are returning home to stay well into their 20s and 30s. . . It's like Parenthood II.

Rising housing costs and beginning pay rates that have not gone up as fast as those of more experienced workers have been identified as two major causes of this trend. But recent research suggests an even more important explanation: Young Americans are in fact having difficulty growing up, many are spoiled by their parents' affluence and unwilling to go out on their own and settle for less.
BLOOD BANKS FACING HUNDREDS OF AIDS SUITS
Authors: L. J. F.
Published: December 2021

Blood bank officials in the United States are sounding an alarm because they are facing hundreds of lawsuits from people stricken with AIDS after receiving transfusions.

Issue of Screening Test

The suits generally involve transfusions received before mid-1985, when blood banks started using a screening test that detects antibodies to the AIDS virus in the blood. The central legal issue involves negligence: before the screening test was entirely in place, were the blood banks negligent in their efforts to keep the virus out of the blood supply?

The blood banks. . . say the AIDS threat was not fully understood immediately and it was not always clear that the tests would be reliable. Moreover, they say it was often impractical to move more rapidly.

While the test has made the nation's blood supply much safer, Federal experts at the Centers for Disease Control in Atlanta estimate that 12,000 people now living in the United States have been infected with the AIDS virus in blood transfusions. Of these, 2,170 adults and 177 children have developed AIDS so far.
DON'T JUST STAND THERE!
Authors: Student
Published: December 2021

Americans tend to feel it is better to do something rather than not to do anything."I call them the `Godsakers," said the English Dr. Fry. "`For God's sake do something.'"
MOTHER FIGHTS TO RUIN THE TASTE OF POISON
Authors: L. J. F.
Published: December 2021

On March 6, a mother in Oregon watched a public television report about British companies that were discouraging children from eating poisonous household products by lacing them with Bitrex, the world's bitterest flavoring agent.

The woman, Lynn Tylczak, who has two small children and lives in Albany, 60 miles south of Portland, began a letter-writing campaign that is focusing attention on poison prevention. She may also be speeding Bitrex's journey to supermarket shelves in products like detergents, nail-polish removers, rodenticides and antifreeze.

"Mrs. Tylczak has already achieved a certain victory by bringing national attention to this issue," said Linda Golodner, executive director of the National Consumers League in Washington. "She has shown that a single consumer can make a difference."

Now she is encouraging manufacturers to add Bitrex to their products by sharing with them letters of support that are sent to her group, the Poison-Proff Project (4384 S.E. Ermine Street, Albany, Ore. 97321).

`A Very Promising Area'

Consumer and safety organizations in the United States are beginning to notice. On May 5, the National Safety Council, a 13,000-member public-service organization, called on manufacturers to use Bitrex in all appropriate household products.

"Bitrex is the most bitter substance known to man," according to the Merck Index.

In 1982, some British companies began using Bitrex in household products to deter inquisitive children, but the practice did not grow until two years ago, when the Royal Society for the Prevention of Accidents endorsed its use.
OFF THE GROUND
Authors: L. J. F.
Published: December 2021

In assessing most events, much can depend on your point of view. Consider this: The U.S. Air Force recently announced in a short news release that a Midgetman missile, under development since 1983 and making its first test flight, was "successfully launched" from Vandenberg Air Force Base on the central California coast.

"However," the release continued, "at approximately 70 seconds into the launch an anomaly occurred in stage II causing the range safety officer to initiate the command destruct sequence." Meaning: The missile blew up. That's successful?
CLASSY SNEAKERS
Authors: Student
Published: December 2021

If you so much as mention [the word "class"], you're accused of promoting class distinctions, while every minute of every day every magazine on our newsstands is selling us class privilege and class status—in our ears, in our food, in our houses. Think of the social significance of the kind of sneakers you buy!
ALL MEDICAL DECISIONS ARE VALUE-LADEN
Authors: Student
Published: December 2021

Medicine as we have come to know it will be radically altered by the recognition that it is essentially an evaluative enterprise. [This shift in thinking will influence] the most routine, day-to-day decisions, decisions that must be made coutless times a day in the personal clinical relationship as well as in governmental and institutional policy decisions.
HETEROGENEOUS POPULATION
Authors: Student
Published: December 2021

LWB is part of the complex interactions of such factors as prenatal growth retardation, prematurity, complications of labor and delivery, congenital malformations, and adverse prenatal and postnatal social and psychological influences. These factors cannot be separated easily to show separate impacts.
Intraventricular Hemorrhage in Preterm Infants: Declining Incidence in the 1980s
Authors: Philip Alistair G. S. , Allan Walter C. , Tito Alison M. , Wheeler Louise R.
Published: December 2021

Ultrasound has been routinely used since late 1979 to diagnose periventricular-intraventricular hemorrhage in infants whose gestational age was 34 weeks or less. During the years 1980 to 1987 the ultrasound scans were interpreted by one person, and a steady decline in incidence of periventricular-intraventricular hemorrhage was observed. Both for infants of 34 weeks or less and for very low birth weight (<1500 g) infants, periventricular-intraventricular hemorrhage incidence decreased, respectively, from 34% and 39% in 1980 to 1981 to 19% and 25% in 1986 to 1987. This decrease was confined to true intraventricular hemorrhages, which decreased from 22% in 1980 to 1981 to 7% in 1986 to 1987 for infants of ≤34 weeks' gestation. These results were not influenced by a change in the distribution of birth weights or gestational ages of the infants evaluated nor by a change in the inborn to outborn ratio. The incidence of periventricular-intraventricular hemorrhage was lower in infants born by cesarean section than those delivered vaginally, but the decrease could not be attributed to an increased number of deliveries by cesarean section. Although there were undoubtedly changes in neonatal care during this time period, no planned intervention occurred. It was concluded that pharmacologic intervention studies must be interpreted with caution.
Cerebral Blood Flow Velocity Changes in Preterm Infants After a Single Dose of Indomethacin: Duration of Its Effect
Authors: Van Bel Frank , Van de Bor Margot , Stijnen Theo , Baan Jan , Ruys Jan H.
Published: December 2021

Indomethacin decreases cerebral blood flow velocity and blood flow in the preterm infant. The duration of this negative effect has not been established. Cerebral blood flow velocity was evaluated in 24 preterm infants with symptomatic patent ductus arteriosus before and during the first 12 hours after a single intravenous dose of indomethacin, 0.1 mg/kg. Cerebral blood flow velocity was estimated by serial Doppler investigations of the anterior cerebral arteries. Indomethacin administration led to an instantaneous decrease of peak systolic flow velocity, temporal mean flow velocity, and end-diastolic flow velocity of the anterior cerebral arteries in all infants, which was maximal between 2 and 40 minutes after indomethacin administration and was followed by a more sustained recovery of all velocities to baseline values. Temporal mean flow velocity was not different from pre-indomethacin values at 3 hours after the administration. It is concluded that indomethacin can impact the cerebral circulation of the preterm infant for at least 2 hours. This may have consequences in preterm infants with unstable hemodynarnics and pulmonary function.
Deep Venous Thrombosis Complicating Myelomeningocele: Report of Three Cases
Authors: Bernstein Mark L. , Esseltine Dixie , Azouz E. Michel , Forbes Patricia
Published: December 2021

Deep venous thrombosis is a frequent, well-recognized complication of spinal cord injury. Patients with myelomeningocele often have similar weakness of the lower extremities. Following orthopedic surgery, they may also be immobilized at a time when they are hypercoagulable. In addition, as with patients with spinal cord injury, patients with myelomeningocele are prone to urinary tract infection, which may cause local inflammation in the pelvic veins. For the first time, three patients with myelomeningocele complicated by deep venous thrombosis are described. The differential diagnosis (deep venous thrombosis vs osteomyelitis vs fracture) is also discussed in a child with myelomeningocele and a warm, swollen leg, as are the diagnostic methods available. Finally, the issue of antithrombotic prophylaxis in patients with myelomeningocele who are to undergo extensive orthopedic surgery is discussed.
ASCERTAINMENT BIAS IN FOLLOW-UP STUDIES
Authors: Student
Published: December 2021

Parents who have not come to terms with their child's disability may tend to avoid situations where that disability is highlighted. . .The Disability rate [in ex-premature children] amongst those "easy" [to follow-up] was only 4% but amongst the "difficult" [to follow-up] it was 35%. . . .
Necrotizing Otitis Externa During Induction Therapy for Acute Lymphoblastic Leukemia
Authors: Wolff Lawrence J.
Published: December 2021

In three children who were receiving acute lymphoblastic leukemia induction therapy and were severely neutropenic, necrotizing otitis externa developed. Two patients had a probing maneuver to their ear canal. Pseudomonas aeruginosa was isolated in heavy growth from the external canal of three patients and other tissues of one patient. Staphylococcus aureus was cultured from the ear canal and tissues of one patient and Streptococcus faecalis from the ear canal of another patient. Necrotizing otitis externa resolved in two patients after 2 weeks of intravenous antibiotics, debridement, and resolution of neutropenia. One patient required prolonged intravenous antibiotics and several surgical procedures. The occurrence of necrotizing otitis externa in children with acute lymphoblastic leukemia and severe neutropenia, the association of Gram-positive cocci with necrotizing otitis externa, and the importance of protecting anatomic barriers like the external ear canal in immunocompromised patients are emphasized.
Respiratory Distress Syndrome and Intracranial Hemorrhage: Cause or Association? Inferences From Surfactant Clinical Trials
Authors: LEVITON ALAN , VANMARTER LINDA , KUBAN KARL C. K.
Published: December 2021

Among preterm newborns, those with respiratory distress syndrome are at increased risk of intracranial hemorrhage. Three hypotheses have been offered as explanation for this association.

In the biology hypothesis, respiratory distress syndrome in one way or another increases the risk of intracranial hemorrhage. Variations on this hypothesis incorporate specific adverse effects of respiratory distress, such as grunting (ie, increased intrathoracic pressure leads to increased cranial intravascular pressure), impaired cerebral blood flow, and acidosis.

In the second hypothesis, treatment of respiratory distress increases the risk of intracranial hemorrhage. For example, rapid infusion of buffer for treatment of acidosis was once thought to influence the risk of bleeding into the brain, although substantiation has not been provided.
Williams Syndrome
Authors: GREENBERG FRANK
Published: December 2021

How we have come to an understanding of Williams syndrome as a multisystem disorder is reminiscent of the seven blind men and the elephant. Cardiologists such as Williams et al and Beuren described the cardiovascular manifestations of the condition, particularly supravalvular aortic stenosis, in 1961. Earlier, Fanconi et al and others reported cases of idiopathic hypercalcemia of infancy primarily from an endocrinologic point of view. In 1963, Black and Carter described the association of the two conditions with a set of dysmorphic facial features which, unfortunately, has been labeled `elfin' facies. The syndrome was described further in the 1970s by Jones and Smith. In 1978, because of the work of Bennett et al, the behavioral phenotype began to become known.
Colic or Milk Allergy
Authors: TAUBMAN BRUCE
Published: December 2021

In the article by Drs Lothe and Lindberg, they purport to examine the relationship between infant colic and cow's milk protein allergy. However, the majority of the infants they studied did not fit the definition of infants with colic. The authors claimed the definition they used for their study corresponded to that of Wessels et al, Carey, and Schmitt. Yet, each of these physicians defined the syndrome of infant colic as excessive crying in "otherwise healthy" infants.
Status Epilepticus
Authors: AICARDI JEAN , CHEVRIE JEAN-JACQUES
Published: December 2021

Concerning the article by Maytal and colleagues and the accompanying editorial by Freeman, we have also found that the mortality and morbidity of cryptogenic status epilepticus has decreased considerably since our 1970 paper. Likewise, the incidence of acquired hemiplegia in France has become low during the same period. Contrary to Maytal et al, however, we believe that better and earlier control of convulsive status has played a role in this decrease. There is considerable evidence that convulsive seizures can produce brain damage, irrespective of the cause of attacks.
CRYOTHERAPY FOR ONE OR BOTH EYES FOR INFANTS WITH RETINOPATHY OF PREMATURITY?
Authors: Student
Published: December 2021

Until [more information concerning outcome in the CRYO-ROP trial are available]. . . caution suggests presuming that the treatment outcome and side effect correlations might be high and counsels the surgeon to treat only one eye in moderatly severe ROP, treating both eyes only as the severity rises well above the minimum threshold defined in the CRYO-ROP study.
TALE OF THREE CITIES
Authors: Student
Published: December 2021

Hospitalization accounts for a large proportion of the expenditures for child health care, and differences in the rate of hospitalization may produce important variations in the cost of that care. We studied the rates of hospitalization in Boston, Rochester (N.Y.), and New Haven (Conn.) in 1982.

We assigned the risk of hospitalization in Rochester a score of 1.00. Boston children were hospitalized at more than twice the rate of Rochester children for most medical diagnostic categories (relative risk, 2.65; 95 percent confidence interval, 2.53 to 2.78), and the rate for the New Haven group was intermediate (relative risk, 1.80;95 percent confidence interval, 1.68 to 1.93).
NOW THAT WE HURT WHERE IT REALLY COUNTS, SOMETHING MAY HAPPEN—AT LAST
Authors: Student
Published: December 2021

Facing at least $5 billion in employee medical costs this year, many automobile industry executives acknowledge that their efforts to control costs have failed, and they are calling for drastic changes in the way the nation pays for health care.
MORE DEBATE AND MORE EVIDENCE NEEDED
Authors: Student
Published: December 2021

Taking decisions about life sustaining treatment can be stressful for health professionals, whose training may have included little if any clinical ethics and health care law. House officers and nurses are often reported to be confused about what sort of care should be provided, and doctors' and patients' views of whether or not the patient should be resuscitated may conflict.

In view of our medical conservatism perhaps we need a wider debate about life sustaining protocols. Taking part should be not only actual and potential patients but also the many groups who staff hospitals. One difficulty is the lack of research into the processes and effects of life sustaining treatment and its withdrawal on all concerned. If institutional protocols catch on they should be evaluated even if they seem obviously beneficial.
FETUS ABUSE
Authors: L. J. F.
Published: December 2021

ROCKFORD, Ill., May 3 (AP)—A woman who was found to have used cocaine during her pregnancy, even hours before giving birth, has been convicted by a Juvenile Court judge here of prenatal child abuse and neglect.

The verdict. . .placed the child, now 3 months old, in the care of social workers pending a hearing. . .to determine whether custody should eventually be restored to the mother, who has been participating in a drug treatment program.
PRODUCER DID NOT HAVE TO WARN OF POSSIBLE HARM CAUSED TO FETUS
Authors: L. J. F.
Published: December 2021

SEATTLE, May 17 (AP)—A federal jury today cleared Jim Beam Brands of negligence for not stating on its whisky labels that alcohol consumption by pregnant women could cause birth defects in their children.
DECISION MAKING FOR HANDICAPPED NEWBORNS
Authors: Student
Published: December 2021

—67 percent would not want doctors to do everything possible to treat a handicapped newborn. 21 percent disagreed.

—86 percent would want to refuse treatment for a newborn infant if he or she was likely to survive with severe handicaps.
COMMERCE REARS ITS HEAD
Authors: Student
Published: December 2021

One of every six American doctors now advertise and those who do spend an average of $8000 a year on newspaper, magazines, television and radio ads.
Persistent Bacteremia Due to Coagulase-Negative Staphylococci in Low Birth Weight Neonates
Authors: Patrick Christian C. , Kaplan Sheldon L. , Baker Carol J. , Parisi Joseph T. , Mason Edward O.
Published: December 2021

During a 6-month period in 1987, 13 low birth weight neonates without indwelling central intravascular catheters had persistent (positive blood cultures for ≥6 days) coagulase-negative staphylococcal bacteremia despite adequate antibiotic therapy. Daily blood cultures remained persistently positive for a mean of 13 days (range 6 to 25 days). This group of infants was compared with other low birth weight infants with similar birth weights and nonpersistent coagulase-negative staphylococcal bacteremia, defined as two or more positive blood cultures accompanied by supporting clinical manifestations of sepsis. During this period, coagulase-negative staphylococcal represented 29% of all bacteremias, and 33% of coagulase-negative staphylococcal bacteremias were persistent. Other than soft tissue abscesses, none of the infants with persistent coagulase-negative staphylococcal bacteremia had a defined focus of infection. Abdominal distention (P= .001) and thrombocytopenia (P<.03) occurred significantly more frequently in the patients with persistent coagulase-negative staphylococcal bacteremia than in those with nonpersistent bacteremia. Of the 13 patients with persistent coagulase-negative staphylococcal bacteremia, 2 received methicillin and 11 received vancomycin. No antibiotic tolerance to either antibiotic could be demonstrated. Serum concentrations of vancomycin far exceeded the minimum bactericidal concentration in all cases in which vancomycin was prescribed. No in vitro differences could be demonstrated between persistent and nonpersistent coagulase-negative staphylococcal strains for slime production, biotype, proteins from modified whole cell lysates developed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis, and opsonophagocytosis by adult neutrophils in the presence of pooled human sera. Additionally, plasmid profile analysis and phage typing revealed no common strain causing the persistent bacteremia. The pathogenesis of persistent coagulase-negative staphylococcal bacteremia in low birth weight neonates without intravascular catheters remains obscure.
IN BRITAIN, DAMAGED BABIES HAVE A RIGHT TO DIE IN PEACE AND DIGNITY
Authors: Student
Published: December 2021

Britain's first "right to die" case, concerning a severely brain damaged baby, reached the court of appeal... whose final judgment read: "I direct that leave be given the hospital authorities to treat [the baby] in such a way that she may end her life and die peacefully with the greatest dignity...[The judge] left it to her carers to decide what course of action would cause her least suffering.
"MULTIPLE-COMPARISONS" PROBLEM
Authors: Student
Published: December 2021

Often investigators report many P values in the same study. The expected number of P values smaller than 0.05 is 1 in 20 tests of true null hypotheses; therefore the probability that at least one P value will be smaller than 0.05 increases with the number of tests, even when the null hypothesis is correct for each test. This increase is known as the "multiple-comparisons" problem...One reasonable way to correct for multiplicity is simply to multiply the P value by the number of tests. Thus, with five tests, an orignal 0.05 level for each is increased, perhaps to a value as high as 0.25 for the set. To achieve a level of not more than 0.05 for the set, we need to choose a level of 0.05/5 = 0.01 for the individual tests. This adjustment is conservative. We know only that the probability does not exceed 0.05 for the set.
HOW VERSUS WHY
Authors: Student
Published: December 2021

One tendency that accompanies a preoccupation with technique is for discourse relating to it (technique) to displace questions as to whether or not it should be pursued at all. That is, "how" questions displace "why" questions.
YELLOW SKIN A BETTER PREDICTOR?
Authors: Student
Published: December 2021

If kernicterus develops in an infant due to high serum bilirubin, low reserve albumin, and acidosis, bilirubin acid will also be deposited in the skin. In consequence, it seems possible that the yellow colour of the skin is correlated with that of the brain, to the extent that bilirubin deposition in the skin has occurred by precipitation of bilirubin acid. If so, the intensity of the yellow colour of the skin may be a somewhat better predictor of brain damage than the serum bilirubin concentration and measurement of the colour of the skin may theoretically be of clinical utility.
THERE'S NO BUSINESS LIKE MED BUSINESS
Authors: Student
Published: December 2021

Researchers at the—University Medical Center in—, have patented a new method of preventing jaundice in newborn babies...Dr—and Dr—received patent 4,831,024.
Drug Screening
Authors: MILMAN DORIS H.
Published: December 2021

To the Editor.—

The Committee on Adolescence and its adjunctive committees' recently published statement (Pediatrics 1989;84:396-398) concerning drug screening, of signal importance in its subject and obviously earnest in its intent, is somewhat disappointing in its content. With respect to the points made as recommendations, only the first is unexceptionable; the rest appear to be illogical, or self-contradictory, or poorly stated, or aimed at reconciling irreconcilable differences among the various participants, or all of the above.
Cyclosporine A for the Treatment of New-Onset Insulin-Dependent Diabetes Mellitus
Authors: Chase H. Peter , Butler-Simon Nancy , Garg Satish K. , Hayward Anthony , Klingensmith Georgeanna J. , Hamman Richard F. , O'Brien Donough
Published: December 2021

It is not known whether early immunosuppresive treatment can preserve long-term endogenous insulin secretion in subjects with insulin-dependent diabetes mellitus. In the present study, clinical remissions during the first year and C-peptide production for 3 years were followed after 43 subjects with newly diagnosed insulin-dependent diabetes mellitus were randomly assigned to a cyclosporine A treatment group for 4 months or to a control group. Of the six cyclosporine A-treated subjects who had remissions, five were 19 years of age or younger, compared with two of the four in the control group. C-peptide production was present in 98% of all subjects after 4 months, in 88% after 1 year, and in 43% after 3 years. There were no significant differences in numbers of subjects with C-peptide production or in mean hemoglobin A1 levels, between cyclosporine A-treated and control subjects after 3 years. Cyclosporine A treatment of subjects with newly diagnosed insulin-dependent diabetes mellitus for a period of 4 months does not have the ability to preserve residual β-cell function.
Screening for Anxiety and Depression in an Adolescent Clinic
Authors: Smith Mark Scott , Mitchell Jeff , McCauley Elizabeth A. , Calderon Rosemary
Published: December 2021

The Spielberger State-Trait Anxiety Inventory (STAI) and the Children's Depression Inventory (CDI) were administered to 228 consecutive adolescent clinic patients and provisional physician diagnoses were compared with test scores obtained in 205 valid replies. The age range was 10 to 17 with a mean ± SD of 14.3 ± 1.8 years. Racial distribution was 176 white, 21 black, 4 Asian, and 4 other. The provisional diagnoses were categorized as follows: medical diagnosis only, 140; psychiatric diagnosis only, 45; and combined medical/psychiatric diagnosis, 20. Mean scores ± SD for the entire study population were STAI-State 41.1 ± 10.9, STAI-Trait 41.3 ± 11.8, and CDI 10.1 ± 8.3. Odds ratios showed that patients with only a psychiatric diagnosis had higher STAI scores than those with only a medical diagnosis and those with a combined medical/psychiatric diagnosis; patients with only a psychiatric diagnosis and those with a combined medical/psychiatric diagnosis had higher CDI scores than those with only a medical diagnosis. The medical records of 30 patients in the medical diagnosis category with high STAI and CDI scores were reviewed; of 140 patients with medical diagnoses, screening detected 15 patients (10.7%) who warranted further intervention for psychiatric disorders.
Negative Clinical Trials in Cystic Fibrosis Research
Authors: Pattishall Edward N.
Published: December 2021

The statistical power of 61 negative clinical trials of therapeutic regimens in patients with cystic fibrosis published from 1977 through 1988 was reviewed and the ability of the investigations to detect small, medium, and large standardized differences was calculated. Small, medium, and large standardized differences were defined as ratios of 0.2, 0.5, and 0.8, respectively, of the observed difference compared with the standard deviation. The average numbers (±SD) of patients in the treatment and control groups were 14.3 ± 6.9 and 14.5 ± 7.9, respectively. None of the studies had 80% power to detect a small or medium standardized difference and only 4 of the reports had 80% statistical power to detect a large standardized difference. The variability of cystic fibrosis causes a decrease in the standardized difference, making it more difficult to demonstrate statistical significance. Statistical power of negative clinical trials reported in the literature deserves more attention from investigators as well as physicians who treat patients with cystic fibrosis.
Longitudinal Study of Adverse Reactions Following Diphtheria-Tetanus-Pertussis Vaccine in Infancy
Authors: Long Sarah S. , Deforest Adamadia , Smith David Gary , Lazaro Carlos , Wassilak Steven G. F. ,   Pennridge Pediatric Associates
Published: December 2021

A prospective study of immunogenicity and adverse effects of 1553 doses of diphtheria and tetanus toxoids and whole cell pertussis vaccine (DTP) was performed in 538 children observed longitudinally from 2 months to 20 months of age. Subjects were randomized to the standard four-dose immunization schedule or to a three-dose schedule (with a saline injection substituted for DTP at 6 months of age). The three-dose schedule could not be recommended on the basis of serologic data. Compliance for completing a clinical observation form in the 48 hours following injections was >99%. Fever, local reactions, or adverse behavioral effects were described in association with 96% of DTP doses and 36% of placebo injections. Contraindications to DTP immunization developed in 3% of study children. No convulsion, hypotonic hyporesponsive episode, encephalopathy, or temperature >40.5°C occurred. Behavioral and local imflammatory effects occurred maximally in the first 6 hours following vaccine but fever peaked later. There was no interrelationship between occurrence of local reaction and fever. Data suggest that age has more effect on the type and rate of adverse clinical events than does vaccine dose number. Existing antibody levels to vaccine components, lot of vaccine, breast-feeding, or gestational age did not affect rate or type of clinical reactions. Neither occurrence of reactions nor the use of acetaminophen affected antibody response to vaccine.
Immunization of Children With Acute Lymphoblastic Leukemia With Live Attenuated Varicella Vaccine Without Complete Suspension of Chemotherapy
Authors: Arbeter Allan M. , Granowetter Linda , Starr Stuart E. , Lange Beverly , Wimmer Robert , Plotkin Stanley A.
Published: December 2021

A total of 44 children with acute lymphoblastic leukemia were immunized against chickenpox with the Oka/Merck strain live attenuated varicella vaccine. Of these children, 24 continued oral chemotherapy with 6-mercaptopurine during the immunization period and 20 had suspension of all chemotherapy for 1 week before and 1 week after the vaccine. Seroconversion, as determined by the detection of fluorescent antibody to membrane antigens, occurred in 91% and did not differ between patients continuing 6-mercaptopurine from those in whom chemotherapy was suspended. Fever and/or rash occurred in less than one third of vaccinated children. Unexpected reactions occurred in two vaccinated children, one from each group, both of whom had low absolute lymphocyte counts (<750/µL) on the day of immunization. Vaccine-induced immunity appeared effective in preventing or modifying chickenpox after exposure to natural disease.
Cost-Effectiveness Analysis in Pediatric Practice
Authors: PANTELL ROBERT H. , BERWICK DONALD M.
Published: December 2021

The physician's first responsibility is to the patient: to apply appropriate current medical knowledge to treat and prevent illness and to assure that risks and harm from intervention are less than those of the untreated disease. Physicians have a stake in society, as well, however, and this implies prudent use of health care dollars. New medical technologies can sometimes simultaneously improve individual health status and reduce costs to society, but more often new technologies pose a dilemma for physicians and society. Health benefits come with a price tag. The benefit to the individual patient results in more costs in an already overburdened health care budget.
A Belated Randomized Control Trial
Authors: CHALMERS THOMAS C.
Published: December 2021

When medical scientists and/or practitioners are asked to comment on an article that may have already created a controversy of both a scientific and ethical nature in the public press, the temptation is irresistible to abandon the language of scientific articles and to call a spade a spade. I bow to that irresistible temptation. A plague on all houses except those who reported and conducted the study in this issue of Pediatrics.1

When the study in question was designed and executed (1985 to 1988), an extremely difficult situation had been created by others. An elaborate, expensive, and potentially both effective and dangerous new technology had been allowed to proliferate without the gathering of reliable information about its relative efficacy and safety.
The Extracorporeal Membrane Oxygenation Debate
Authors: CLARK REESE H. , KINSELLA JOHN P. , MCCURNIN DONALD C. , NULL DONALD M. , DELEMOS ROBERT A.
Published: December 2021

To the Editor.—

We read with interest the recent article by Dworetz et al.1 We agree with the authors' conclusions that controlled studies to assess the merits of alternative strategies for the management of critically ill neonates are necessary.

The authors have carefully presented the limitations of their report including the retrospective nature of the study, the restrictive selection criteria used, and the small number of patients. However, the authors did not include the number of inborn vs outborn infants, the age of patients at the time of entry into the "study," and the specific diagnoses of the patients meeting ECMO criteria.
Infants and Children With Acquired Immunodeficiency Syndrome: Placement in Adoption and Foster Care
Authors: PLOTKIN STANLEY A. , WENDER ESTHER B.
Published: December 2021

In Reply.—

In fact, the AIDS Task Force recommends that adoptive and foster parents have the right, if they so wish, to obtain the result of an human immunodeficiency virus test on a prospective adopted child. If Dr Dix will reread the statement, he will find the following.

"In response to the legitimate need for preplacement HIV testing of the infant or child in areas of high prevalence of HIV infection in childbearing women, procedures should be established by foster care and adoption agencies in collaboration with health care facilities, to accomplish the following.
Tone and Reflex Development Before Term
Authors: Allen Marilee C. , Capute Arnold J.
Published: December 2021

The evolution of tone and reflexes from 25 weeks postmenstrual age (gestational age plus chronologic age) to term in a population of 42 surviving infants is described. The infants were born in 1983 at the Johns Hopkins Hospital, had birth weights <1300 g, were examined weekly until neonatal intensive care unit discharge, and did not develop cerebral palsy. Lower-extremity flexor tone was first detectable at 29 weeks postmenstrual age by the popliteal angle and heel to ear maneuvers. Flexor tone, recoil, and hyperreflexia were all noted 2 to 3 weeks earlier in the lower extremities (33 to 35 weeks) than in the upper extremities (35 to 37 weeks). Hip tone (35 to 37 weeks) followed knee flexor tone, but preceded shoulder tone (37 to 38 weeks). Trunk tone on ventral suspension emerged closer to term (36 to 40 weeks), and more than half of infants evaluated at term continued to demonstrate head lag when pulled to sitting position. The emergence of the primitive and pathologic reflexes reflects (both in timing and pattern) the evolution of tone: development of the reflexes in the lower extremities precedes that of those in the upper extremities, and development of the distal reflexes precedes that of the proximal. Maturation of tone, deep tendon reflexes, pathologic reflexes, and primitive reflexes occurs in an orderly, sequential manner, with a well-defined pattern: caudocephalad (lower extremities to upper extremities) and centripetal (distal to proximal).
Intellectual and Adaptive Functioning in Individuals With Down Syndrome in Relation to Age and Environmental Placement
Authors: Brown Frank R. , Greer Margaret K. , Aylward Elizabeth H. , Hunt Hurshell H.
Published: December 2021

The cognitive and adaptive capacities of 130 individuals with Down syndrome were investigated as a function of age and environmental placement. Intellectual deterioration occurred whether individuals resided at home or in an institutional setting. Social/adaptive deterioration also occurred but with the least decline for those individuals who resided in institutional settings.
Population-Based Study of the Developmental Outcome of Children Exposed to Chloride-Deficient Infant Formula
Authors: Willoughby Anne , Graubard Barry I. , Hocker Anita , Storr Carla , Vietze Peter , Thackaberry Joan M. , Gerry Mary Ann , McCarthy Mary , Gist Nancy F. , Magenheim Mark , Berendes Heinz , Rhoads George G.
Published: December 2021

In 1978 and 1979 a large number of US children were fed chloride-deficient soy-based infant formula. A representative sample of such children was identified in a southern county through a mailing to the homes of 3639 first- and second-grade children in the public schools. Of the 2329 (64%) who responded, 56 reported use of deficient formula and were invited to have developmental testing by one of four study psychologists at their school. Of the 310 users of other soy formulas, 112 were selected for testing as matched controls on the basis of their sex, feeding history, age, birth weight, and socioeconomic status (as indicated by school attended). After exclusions and refusals, 42 children who used deficient formula and 66 control children were tested using the McCarthy Scales of Children's Abilities. Examiners were unaware of the child's history of formula use. The mean General Cognitive Index was 102.8 in those using deficient formula and 105.4 in controls. After adjustment for demographic differences the children who used chloride-deficient formula were found to average 4.9 points less than the controls (P = .04, 1-tailed). The largest difference was in the Quantitative subscale (P = .005). These data show a statistically significant although small effect of chloride-deficient formula on the long-term developmental outcome of exposed children; however, further study of these results is needed for full confirmation.
Screening for Biotinidase Deficiency in Newborns: Worldwide Experience
Authors: Wolf Barry , Heard Gregory S.
Published: December 2021

Between January 24, 1984, and December 31, 1988, 29 screening programs for biotinidase deficiency in newborns were established in 12 countries, and 4 396 834 newborns were screened. The worldwide incidence is based on screening programs in Australia, Austria, Canada, Italy, Japan, Mexico, New Zealand, Scotland, Spain, Switzerland, The United States, and West Germany. Biotinidase deficiency was detected in 72 newborns; 32 had profound biotinidase deficiency (<10% of mean normal activity level) and 40 had partial deficiency (10% to 30% of mean normal activity level). The combined incidence of profound and partial deficiency was 1 case per 61 067 live births (1:49 500 to 1:79 544; 95% confidence interval), the estimated frequency of the recessive allele was 0.0040, and the frequency of heterozygosity was estimated to be 1:123. Profound deficiency occurred in 1 per 137 401 live births (1:109 300 to 1:211 200), and partial deficiency in 1 per 109 921 live births (1:86 600 to 1:159 700). Most available parents of children with profound and partial deficiency had biotinidase activity levels intermediate between zero and mean normal activity levels. Six children with profound dificiency were symptomatic at, or soon after, the time of diagnosis; no infant with partial deficiency has become symptomatic, but little is known about the natural history of infants with partial deficiency. Most children whose biotinidase deficiency was detected by newborn screening were white, one was black, and one Hispanic; biotinidase deficiency has not been detected in Oriental children. Although 8 pilot programs have terminated, 21 will continue either indefinitely or until predetermined targets are reached, and 3 new programs were scheduled to begin in January 1989. Each state, region, and country must decide whether screening for biotinidase deficiency should be added to its existent program based on the various advantages of screening, the incidence, the availability of resources, and priorities.
Dietary Protein Source and Plasma Lipid Profiles of Infants
Authors: Tseng Emily , Potter Susan M. , Picciano Mary Frances
Published: December 2021

Total cholesterol and triglyceride concentrations were measured in plasma samples taken at 4 and 8 weeks of age from 40 full-term infants who had been fed either human milk or one of three formulas containing casein-to-whey ratios of 82:18, 66:34, or 50:50 to investigate whether dietary protein influenced the development of plasma lipid profiles. Infants fed the formula with the casein-to-whey ratio of 82:18 had significantly higher plasma cholesterol levels at both 4 and 8 weeks of age compared with other groups of infants (P < .05). Infants fed the high-casein formula also showed an increase in plasma cholesterol levels with time (P < .001). Plasma triglyceride concentrations decreased as concentration of casein decreased (P < .05) among the formula-fed groups and increased with time. Infants fed human milk had plasma triglyceride concentrations similar to those infants who had been fed the 82:18 formula at 4 weeks of age; however, triglyceride concentrations eventually fell and were similar to those concentrations in infants who had been fed the 50:50 formula at 8 weeks of age. Results indicate that constituent lipids of human milk or formulas were not determining factors for changes observed in plasma cholesterol levels and triglyceride concentrations among groups. Since formulas differed only in proteins and their constituent amino acids, further investigation of the impact of dietary protein (amino acids) on development of blood lipid profiles in infants is warranted.
Assessment of Temperament in the Toddler Age Group
Authors: Oberklaid Frank , Prior Margot , Sanson Ann , Sewell Jill , Kyrios Michael
Published: December 2021

We used the Toddler Temperament Scale with large representative samples of younger (mean age = 20.5 months; N = 1188) and older (mean age = 35.4 months; N = 1360) Australian toddlers. There were significant sex differences on 6 of the temperament dimensions for the young group, and on 5 of the 9 dimensions for the older group. Older boys were also more likely to be categorized clinically as having a "difficult" temperament and less likely to have an "easy" temperament.

Each group was divided into quartiles according to socioeconomic status. For the younger toddlers there were significant differences in 3 of 9 temperament dimensions, and for the older group there were significant differences in 7 of 9 dimensions. Groups with higher socioeconomic status had temperament ratings which were more likely to make them easier to manage, and to be categorized clinically as having an easy temperament, but toddlers with low socioeconomic status were more likely to have a difficult temperament. There were significant differences in temperament dimension scores between Australian toddlers and those studied in an American setting.

These results indicate that toddler temperament ratings differ according to age, sex, social class, and cultural context. Great caution needs to be taken in interpreting individual temperament profiles utilizing comparison data obtained from different sociocultural settings. Future temperament "norms" may need to specify characteristics of the group of children from which they were derived to allow more valid comparisons.