bluuebunny/crossref_metadata_2025 huggingface dataset:
Patient Education for Immunizations
Authors: Fulginiti Vincent A.
Published: December 2021

Many physicians and parents consider immunizations routine; as a result, they fail to discuss this important aspect of health care. Parents should be educated about each vaccine and the role it plays in the well-being of their child. To ensure that parents will be able to give informed consent to have their child immunized, the physician should provide information on the nature, prevalence, and risks of the disease; the type of imminization product to be used; expected benefits; risk of side effects; and required follow-up. In addition, the concept of individual immunity as a contribution to community well-being should be discussed. Parents should be apprised of the importance of maintaining accurate immunization records. Verbal communication of this information at the time of vaccination can be reinforced by written documents. One way to verify that parents have understood the information is for the physician to question them at the next office visit.
TIPP Usage
Authors: Krassner Leonard
Published: December 2021

In recent years, physicians have become more concerned about the prevention of childhood soddents. Developed to help physicians teach parents how to avoid unintentional injury, The Injury Prevention Program (TIPP) is significant because anticipatory guidance has now been recognized as being as much a part of routine health supervision as the history and physical examination. The American Academy of Pediatrics' policy statement enclosed with each TIPP package states five goals that deal with major causes of childhood mortality; three can be achieved with a single purchase or action—buying a smoke alarm, buying a bottle of ipecac, and turning down hot water temperathre. TIPP comprises three elements: A parent questionnaire (the Framingbam safety survey) is used to identify at-risk behavior. Safety sheets to be handed out at the next visit reinforce the information provided by the physician in his or her discussion of the questionnaire results. A model counseling schedule suggests how to incorporate the questionnaire aire and safety sheets into an effective office program. By gradually phasing TIPP into an office practice, physicians can become familiar with TIPP materials and integrate it in a controlled manner. The AAP Committee on Accident and Poison Prevention is studying measures to increase the usefulness of TIPP.
Controlled Trial of Dexamethasone in Respirator-Dependent Infants with Bronchopulmonary Dysplasia
Authors: Avery Gordon B. , Fletcher Anne B. , Kaplan Michael , Brudno D. Spencer
Published: December 2021

A randomized trial was conducted of dexamethasone therapy in infants with bronchopulmonary dysplasia who were dependent on respirators and were not progressing clinically despite conventional treatment. Babies were admitted to the study if they had a roentgenogram and clinical diagnosis of bronchopulmonary dysplasia, were 2 to 6 weeks in age, weighed <1,500 g, had made no progress in weaning for the preceding five days, and were free of sepsis, patent ductus arteriosus, and congenital heart disease, and had had no intravenous fat for at least 24 hours. After parental consent was obtained, infants were randomly assigned to control or treatment groups. The study hypothesis was that with steroid treatment, babies could be weaned from the respirator within 72 hours and would show a significant improvement in lung compliance within that time. Sequential analysis exceeded criterion (P < .05) when seven consecutive untied pairs showed weaning with dexamethasone and failure to wean in control infants. Pulmonary compliance improved by 64% in the treated group and 5% in the control group (P < .01). No significant intergroup differences were noted in mortality, length of hospital stay, sepsis, hypertension, hyperglycemia, or electrolyte abnormalities. Study design permits the conclusion that dexamethasone can produce substantial short-term improvement in lung function, often permitting rapid weaning from the respirator, but long-term efficacy and safety must be demonstrated by further investigations.
Phenobarbital and Intraventricular Hemorrhage
Authors: BOYNTON BRUCE R. , MERRITT T. ALLEN
Published: December 2021

To the Editor.—

In their study of the effect of prophylactic phenobarbital on intraventricular hemorrhage, Bedard and coworkers1 utilize a powerful and efficient statistical method known as sequential analysis. In addition to performing the analysis correctly, it is important to describe this method clearly and accurately since it may be unfamilar to nonstatisticians. We believe there are errors in the illustration of the sequential plan (their figure, p 436) that may confuse others who wish to use this experimental design or who are trying to interpret their results.
Is Bovine Milk a Health Hazard?
Authors: Oski Frank A.
Published: December 2021

Whole bovine milk should not be fed to infants during the first year of life because of its association with occult gastrointestinal bleeding, iron deficiency anemia, and cow's milk allergy. The consumption of whole milk after the first year of life should be discouraged because of its potential role in a variety of disorders including atherosclerosis, recurrent abdominal pain of childhood, cataracts, milk-borne infections, and juvenile delinquency.
Weaning Practices in Deprived Environments: The Weaning Dilemma
Authors: Underwood Barbara A.
Published: December 2021

The weaning process varies widely among different cultures as to when the practice is initiated and terminated; in the variety, quality, and quantity of the weaning foods; and in the manner in which the endogenous food is provided. The variations in practices range from providing a food source even before the first breastfeeding to feeding nothing but breast milk for as long as 9 to 12 months, and include feeding from a cupped hand to use of a modern feeding bottle. The advice often given healthy mothers is to breast-feed for as long as possible and compatible with life-style. Most often, when breast-feeding is prolonged, the practice is to provide some complementary food from the early postpartum months onward. However, among some poor traditional societies and in deprived environments, this food may be limited and monotonous in flavor and texture. The monotony of the diet may act synergistically with the consequences of repeated infectious morbidity, and result in chronically depressed appetite and limited acceptance of additional food in quantity and variety at the time when this becomes critical for meeting the nutritional needs of the growing infant. The serious malnutrition prevalent in the 1 to 3 year olds in many deprived environments may have its antecedent etiology in the complementary feeding practices established in the first year of life. Effective interventions to reverse growth faltering of infants reared in deprived environments where breast-feeding is prolonged may require increased attention to providing variety in the weaning diet from at least 4 months onward.
Response of the Gastrointestinal Tract to Premature Weaning in Experimental Animals
Authors: Koldovský Otakar
Published: December 2021

Weaning is an important period in the life of all mammals including the human. During this time the external and internal environment exhibits substantial changes that are in concert under normal conditions. Premature weaning interferes with the development of various functions. Studies demonstrate that premature weaning has immediate and delayed effects. The analysis of the delayed (late) effects of the premature weaning has considerable significance in the advancement of effective preventive medicine.
Neonatal Mortality: Effects of Selective Pediatric Interventions
Authors: Dawodu Adekunle H. , Effiong Charles E.
Published: December 2021

A previous prospective study of neonatal mortality in babies receiving special care at the University College Hospital, Ibadan, revealed that respiratory failure associated with prematurity, perinatal asphyxia, sepsis, and congenital malformations were the major causes of high neonatal mortality. To improve survival, selective measures were taken to improve care of low-birth-weight infants and prevent or treat intrapartum and postnatal hypoxia, metabolic acidosis, hypoglycemia, and hypothermia. A change in the initial antibiotic management of suspected septicemia to the use of cloxacillin and an aminoglycoside was also introduced, based on the current knowledge of etiologic agents and their antimicrobial sensitivities. In the 5-year period (1976 to 1980), the neonatal mortality in babies weighing 2,500 g and more at birth dropped significantly from 1.2% to 0.7% (P < .02). The case fatality rates from birth asphyxia and neonatal sepsis dropped by 48% and 32%, respectively. Despite therapeutic interventions, however, the neonatal mortality in babies with birth weight of 1,000 g or less, 1,001 to 1,500 g, 1,501 to 2,000 g, and 2,001 to 2,499 g remained unchanged at about 82%, 25%, 9%, and 3%, respectively. These results suggest that early identification of infants at risk of developing birth asphyxia or neonatal septicemia and institution of prompt and appropriate management could produce a significant reduction in mortality in infants of normal birth weight. Survival of low-birth-weight infants requires additional high technical, financial, and manpower resources, which most centers in developing countries cannot afford at the present time. Therefore, efforts are probably better concentrated on decreasing the incidence of low birth weight.
Wrongful Life and Wrongful Birth: New Concepts for the Pediatrician
Authors: Coplan James
Published: December 2021

Over the past two decades, numerous suits for damages have been brought against physicians for the injury of wrongful life, or wrongful birth. Within the past 5 years, several precedents have been set that broaden the physician's legal obligation to recognize and act upon foreseeable or potentially recurrent genetic, teratogenic, or chromosomal disorders. These precedents may be expected to affect all physicians, but particularly pediatricians, because of the increased frequency of such disorders in the pediatric population.
Ventilatory Chemosensitivity in Subjects with a History of Childhood Cyanotic Breath-Holding Spells
Authors: Anas Nick G. , McBride John T. , Boettrich Christian , McConnochie Kenneth , Brooks John G.
Published: December 2021

The ability of children with cyanotic breath-holding spells to respond to anger or frustration by voluntary breath-holding for prolonged periods (often to the point of precipitating hypoxic seizure activity) suggested the hypothesis that such children may have a less powerful urge to breathe in the presence of hypoxia and/or hypercapnia than children who do not have breath-holding spells. Because ventilatory chemosensitivity is difficult to measure in infants and young children, this hypothesis was tested indirectly by measuring the ventilatory responses to hyperoxic progressive hypercapnia and to isocapnic progressive hypoxia of seven individuals who had a history of cyanotic breath-holding spells in infancy and 17 control subjects. The mean values for sensitivity to hypoxia and to hypercapnia were not significantly different between the two groups, and the responses of the majority of the subjects with cyanotic breath-holding spells were clearly within the normal range. There were fewer individuals with high-normal ventilatory responses among the subjects with cyanotic breath-holding spells. Although children with cyanotic breath-holding spells may have decreased ventilatory chemosensitivity transiently during infancy or may differ from other children in some other aspect of the control of breathing, the pathogenesis of infantile cyanotic breath-holding spells does not involve a permanently blunted sensitivity to hypercapnia or hypoxia.
Aspiration in Intubated Premature Infants
Authors: Goodwin Salvatore R. , Graves Shirley A. , Haberkern Charles M.
Published: December 2021

A recent study has shown a 77% incidence of tracheal aspiration in children (mean age 13.4 months) who are intubated with uncuffed endotracheal tubes. To determine both the incidence of such aspiration among premature infants and whether continuous positive airway pressure (CPAP) has any preventive effect, 20 tracheally intubated neonates were evaluated for the presence of tracheal aspiration of orally placed Evan's blue dye. The overall incidence of aspiration was 80%. Eighteen of these infants were tested during both 4 cm and 6 cm H2O continuous positive airway pressure, and the incidences of aspiration were 72% and 50%, respectively, which is not a statistically significant difference (P < .17). Ten of these 18 patients were also studied when 2 cm H2O was applied and 60% aspirated. Among all infants who aspirated, compared with those who did not, there was a small but statistically significant decrease in transcutaneous Po2 (P < .05) as well as an increase in respiratory (P < .001) and pulse (P < .01) rates. It is concluded that tracheally intubated neonates frequently aspirate and that clinically useful levels of continuous positive airway pressure are not likely to prevent aspiration.
Munchausen Syndrome by Proxy: An Outpatient Challenge
Authors: Guandolo Vincent L.
Published: December 2021

Primary health care providers are well aware of the physical findings that suggest a child has been intentionally maltreated. Practitioners must also be aware of a more subtle form of child abuse in which the parent victimizes the child by presenting fictitious medical history that initiates a sequence of unnecessary diagnostic and therapeutic interventions. A 4½-year saga of such a case, an example of Munchausen syndrome by proxy in the outpatient setting, is reported.
Renal Clearance of Fluoride in Children and Adolescents
Authors: Spak Carl-Johan , Berg Ulla , Ekstrand Jan
Published: December 2021

Renal function and fluoride excretion have been studied in 38 children. The children were divided into three groups according to their glomerular filtration rate: normal (92 to 136 mL/min/1.73 m2 of body surface area [BSA]), low (< 92 mL/min/1.73 m2 BSA, and super-normal (> 136 mL/min/1.73 m2 BSA). Standard clearance technique with infusion of inulin and p-aminohippuric acid during water diuresis was used. Mean renal fluoride clearance was 45.0 ± 9.8 (SD) mL/min in the group of children with normal glomerular filtration rates and 31.4 ± 8.8 mL/min in the group with low glomerular filtration rates. This difference was statistically significant. There was a close linear relationship between renal fluoride clearance and glomerular filtration rate, urinary flow, and free water clearance. The fractional fluoride excretion did not differ between the groups. About 60% of the filtered fluoride was reabsorbed. No evidence for tubular secretion exceeding the reabsorption could be found. The results suggest that children have lower renal fluoride clearance rates than adults and indicate that a moderate impairment of the renal function could lead to increased retention of fluoride.
Formula Fixed
Authors: BHATIA JATINDER
Published: December 2021

To the Editor.—

We have previously reported1 the loss of calcium and phosphorus from premature infant formulas during simulated feedings. Since the time of that report, one of the products has been reformulated (Similac Special Care 24, Ross Laboratories, Columbus, OH).

Utilizing the procedures used in our study,1 the new formula was studied under simulated conditions (syringe-pump and bolus gavage feeding) using both No. 5 French and No. 8 French polyvinylchloride tubing (Argyle Laboratories, St Louis). Aliquots of formula were obtained (during stirring) before and after each of the feeding studies.
Unconvinced of Value of Antenatal Transfer to Level 3 Intensive Care Units
Authors: SEPKOWITZ SAMUEL
Published: December 2021

To the Editor.—

Paneth et al1 have focused on neonatal deaths occurring at less than 4 hours of age in their extensive analysis of singleton deaths (birth weight 501 to 2,250 g) during 1976 to 1978 in New York City. Despite a well-developed transfer service, 33.6% (655/1948) of all neonatal deaths in this weight category and 42% of all deaths among infants with birth weight less than 1,001 g occurred in the first four hours of life and nearly all occurred in the hospital of birth.
Injuries from Fireworks
Authors: Berger Lawrence R. , Kalishman Summers , Rivara Frederick P.
Published: December 2021

In 1983, there were more than 8,200 victims of fireworks-related injuries treated in US emergency rooms. Half of those injured were children less than 15 years of age, and 11% of the injuries resulted in hospitalization. The eyes are the body part most often injured, followed by hands and fingers. Burns account for the majority of injuries. Every type of fireworks legally available has resulted in serious injury or death. Firecrackers, bottle rockets, and sparklers contribute to the most hospitalizations. States that allow a wide variety of fireworks to be sold for personal use have a rate of fireworks-related fires 50 times greater than states that strictly limit the availability of fireworks. The rate of fireworks-related injuries is more than seven times greater in the less restrictive states.
Effect of Furosemide on the Clinical Course of Transient Tachypnea of the Newborn
Authors: Wiswell Thomas E. , Rawlings James S. , Smith Franklin R. , Goo Elwin D.
Published: December 2021

The effect of furosemide on the course of transient tachypnea of the newborn was evaluated in a controlled, prospective study. Fifty infants with transient tachypnea of the newborn were randomly assigned to control or treatment groups. Those in the treatment group were given furosemide, 2 mg/kg orally, at the time of diagnosis followed by 1 mg/kg 12 hours later if the symptoms persisted. Infants in the control group received a placebo. Compared with infants in the control group, the furosemide-treated group demonstrated no significant difference in the duration of tachypnea nor in the length of hospitalization. It is concluded that oral furosemide, at the doses used in this study, does not significantly affect the clinical course of transient tachypnea of the newborn.
Child Care Workers and Children with Congenital Cytomegalovirus Infection
Authors: PASS ROBERT F. , KINNEY JANET S.
Published: December 2021

Children with congenital cytomegalovirus (CMV) infection shed virus intermittently in saliva and urine for months to years; viruria often persists for five or more years.1 This feature of congenital CMV infection is a problem for institutions such as hospitals and infant developmental centers, as well as for persons who provide care for children with congenital CMV infection. There is concern that these children will transmit CMV to their care givers, who are usually young women in their child-bearing years. Unfortunately, this concern can lead to exclusion of handicapped children with congenital CMV infection from special education programs designed to teach children with motor, hearing or other CNS damage.
Misleading Editorial
Authors: GREENE WILLIAM H.
Published: December 2021

To the Editor.—

In the editorial on the placement of ventilation tubes,1 three articles were referenced as showing controlled studies in which children had unilateral tube placement. In the paper by Kilbey et al,2 54 children between the ages of 4 and 12 years had a grommet placed in one ear and a myringotomy done in the other. In the paper by Lildholdt,3 90 children, between 1 and 10 years of age (average age 4 years), with recurrent suppurative otitis media excluded, were treated with unilateral grommet placement and adenoidectomy.
Interaction Between Digoxin and Commonly Coadministered Drugs in Children
Authors: Koren Gideon
Published: December 2021

Quinidine and digoxin had been coadministered in cardiac patients for several decades before their interaction was reported in 1978. During the last few years, monitoring of increased digoxin serum concentration when several drugs are commonly coadministered with digoxin has led to reports of toxic accumulation of the cardiac glycoside. Because digoxin toxicity is frequently associated with severe morbidity and mortality, close monitoring of clinical and laboratory signs are mandatory whenever the cardiac glycoside is coadministered with quinidine, verapamil, amiodarone, nifedipine, and indomethacin.

Because many of the children receiving a combination of digoxin and interacting drugs are outpatients, it is mandatory to take steps to ensure that toxicity will be detected and treated in its early stages.
Physical Maturity Screening for Participation in Sports
Authors: Kreipe Richard E. , Gewanter Harry L.
Published: December 2021

In an effort to develop screening criteria to allow nonphysicians to detect physically immature boys prior to interscholastic sports competition, 364 male adolescents were studied as part of their group preparticipation health evaluation. Handgrip and self-assessed Tanner stage were measured, in addition to the routine preparticipation health evaluation procedures. Of the 118 boys who were Tanner 3 or less (immature), 103 (87%) had weak grips (< 55 lb [24.9 kg]), and 88 (75%) rated themselves as Tanner 3 or less. Of the 246 boys who were greater than Tanner 3 (mature), 223 (91%) had strong grips (≥55 [24.9 kg]), and 229 (93%) rated themselves as greater than Tanner 3. Six of the 118 immature boys (5%) had both a strong grip and mature self-assessed Tanner stage; three of the 246 mature boys (1%) had both a weak grip and an immature self-assessed Tanner stage. Only 67 of 364 (18%) boys had grips and self-assessed Tanner staging that were discordant. Use of grip strength and self-assessed Tanner staging may obviate the need for physician assessment of Tanner stage for the majority of adolescent boys prior to participation in collision sports.
Contribution of Social and Developmental Factors to Lead Exposure During the First Year of Life
Authors: Dietrich Kim N. , Krafft Kathleen M. , Pearson Douglas T. , Harris Leslie C. , Bornschein Robert L. , Hammond Paul B. , Succop Paul A.
Published: December 2021

The social and developmental correlates of early lead exposure were explored in an interim analysis of data from an ongoing longitudinal investigation in Cincinnati. Regardless of the apparent net availability of lead in the infant's physical environment, parental behavior was still significantly associated with infant blood lead levels. However, this was only the case after infants in the study reached 6 months of age and beyond when prewalking progression and early walking made parental management all the more critical. Future lead screening and abatement programs should include supports for the caretaker-child relationship.
Nephrotic Syndrome Associated with Varicella Infection
Authors: Lin Ching-Yuang , Hsu Hey-Chi , Hung Han-Yang
Published: December 2021

A 4-year-old boy developed nephrotic syndrome following varicella infection. Serologic studies during the early phase of the disease demonstrated a decrease in serum C3, C4, and properdin factor B. Renal biopsy revealed an acute proliferative glomerulonephritis with deposition of immunoglobulins A (IgA) and M, C3, Clq, and varicella virus antigen in the glomerulus, suggesting an immune complex deposition. Ultrastructurally, this suggested a postinfectious immune complex glomerulonephritis. These phenomena suggested that varicella virus antigen antibody complexes were deposited in the glomerulus and activated the classic and alternative pathway of complements, leading to an immune complex glomerulonephritis. During the nephrotic phase, an increase in OKT8 cells and decrease of the OKT4 cells were demonstrated. Two months later, this alteration returned to normal as the renal disease was in remission. This change of lymphocyte subsets during varicella infection may play a role in the pathogenesis of nephrotic syndrome.
Proposed Guidelines on Genetic Engineering
Authors:   Council on Research
Published: December 2021

The American Academy of Pediatrics has become aware of a proposal to National Institute of Allergy and Infectious Diseases (NIAID) that "NIH [National Institutes of Health] prohibit any experimentation involving the transfer of a genetic trait from one mammalian species into the germ cell of another, unrelated mammalian species." An advisory committee rejected this proposal on Oct 29, 1984.

For the record and in any event of further attempts to impose such a prohibition, the Academy, on recommendation of its Council on Research, has the following statement:

Without specific study of the referenced experiments by Dr Ralph Brinster of the University of Pennsylvania, the American Academy of Pediatrics believes that such a blanket prohibition would be scientifically dangerous and detrimental to research efforts into understanding human disease, including cancer, and potentially to the development of new therapies.

There is no true scientific basis for the proposed prohibition. The fact is that a large number of molecular structures, including complex ones, are held in common among the mammalian species. In reality, the species are much more similar than they are different. The species borders that the proposer talks about are a continuum and a blend rather than a sharp demarcation (as is evidenced in cell culture by the ability to fuse cells from many species).

The prohibition would militate against certain possibilities for research and therapy related to inborn errors of metabolism. A gene for the production of an enzyme in one species often makes an enzyme that would produce the same kind of product found in the human.
In Reply: White Blood Cell Transfusions
Authors: CAIRO MITCHELL S.
Published: December 2021

The first question concerning the ratio of suspected to proven neonatal sepsis is a good one. Our ratio was so low because of the strict clinical criteria that we adhered to for patient entry into study. Because we are a tertiary children's hospital and do not have an obstetrical unit attached to our institution, most patients referred to our institution are very critically ill. In our area, the vast majority of neonates for whom sepsis is ruled out are being taken care of at intermediate centers, and I agree that most of the ratios of suspected to proven neonatal sepsis are probably quite high in those centers.
Bone Modulating Factors in Nephrotic Children with Normal Glomerular Filtration Rate
Authors: Freundlich Michael , Bourgoignie Jacques J. , Zilleruelo Gaston , Jacob Allan I. , Canterbury Janet M. , Strauss Jose
Published: December 2021

Factors influencing bone and mineral metabolism were evaluated in 16 children with active nephrotic syndrome and normal glomerular filtration rate. All patients were proteinuric and/or hypoalbuminemic and had elevated serum triglyceride and cholesterol levels. Seven patients had never received or had discontinued glucocorticoid treatment at least 6 months before the study; six patients were receiving prednisone at the time of study. Although all patients were hypocalcemic (serum total or ionized calcium), none was hypomagnesemic. Despite the low serum calcium levels, circulating immunoreactive parathyroid hormone was elevated in only nine of 16. Plasma 25-hydroxyvitamin D was low in all 16 patients, averaging 7.6 ± 1.2 ng/mL for the group. In contrast, levels of 1,25-dihydroxyvitamin D were normal in 12 of 14 patients. Bone mineral content measured by photon absorptiometry averaged 83% and was less than 90% of normal in six of nine patients tested. The findings were not influenced by the recent or concurrent administration of glucocorticoid. The data demonstrate abnormalities of mineral and bone modulation in nephrotic children even in the absence of impaired glomerular filtration rate and irrespective of glucocorticoid therapy. The decrease in serum ionized calcium may be related to an absolute deficiency in 25-hydroxyvitamin D and/or a relative deficiency in 1,25-dihydroxyvitamin D. Undermineralization of bone may result from the low levels of vitamin D metabolites and, in some patients, from an increase in immunoreactive parathyroid hormone. Whether treatment with vitamin D metabolites and/or calcium supplementation will prevent the abnormalities remains to be demonstrated.
Episodes of Apnea and Bradycardia in the Preterm Newborn: Impact on Cerebral Circulation
Authors: Perlman Jeffrey M. , Volpe Joseph J.
Published: December 2021

The effect of episodes of apnea with bradycardia on cerebral circulation was studied during 101 episodes in 15 premature infants. The objectives of the study were to determine whether important alterations occur in cerebral hemodynamics with apnea and bradycardia cardia and whether such alterations relate to systemic hemodynamic events. The transcutaneous Doppler technique was used to measure blood flow velocity in the anterior cerebral arteries. With episodes of apnea complicated by mild-to-moderate bradycardia (heart rate <120 or >80), a decrease in diastolic flow velocity was noted with little or no change in systolic flow velocity. With episodes complicated by severe bradycardia (heart rate <80), the diastolic flow velocity fell to the electronic base line, and a progressive decrease in systolic flow velocity also was observed. Accompanying the changes in cerebral blood flow velocity were similar changes in arterial blood pressure. These data suggest potential deleterious hypoxic-ischemic effects on brain from apnea with severe bradycardia in the preterm infant.
Immunologic Follow-up of Infants Treated With Granulocyte Transfusion for Neonatal Sepsis
Authors: Stegagno Michele , Pascone Roberto , Colarizi Patrizia , Laurenti Francesco , Isacchi Giancarlo , Bucci Giovanni , DE Luca Erminia Carapella
Published: December 2021

The immunologic status and the occurrence of alloimmunization against granulocytes, platelets, lymphocytes, and red cells was evaluated in 33 babies who received granulocyte transfusion because of neonatal sepsis. Nine age-matched babies were examined as control. A first group of 19 infants was examined only once between 6 and 23 months of age. Alloantibodies were searched by the following serologic methods: standard techniques for red cell antibodies; lymphocytotoxicity test; agglutination and immunofluorescence tests on granulocytes and platelets. No antibodies were demonstrated. The immunologic profile was investigated by determining the Ig levels, the percentage of E rosetteforming cells, and the lymphocyte blastic response to phytohemagglutinin and concanavalin A. Granulocyte function was studied by phagocytosis and killing of Candida. No significant differences were observed between treated and control babies. In a second group of 14 infants the occurrence of early immunization within 3 to 9 weeks after the last transfusion was investigated. No evidence of early immunization was found. The present data suggest that following neonatal granulocyte transfusion the risk of adverse immune reactions should be low.
Fatal and Nonfatal Farm Injuries to Children and Adolescents in the United States
Authors: Rivara Frederick P.
Published: December 2021

Agriculture is the second most dangerous occupation in the United States, and unlike other occupations, children make up a significant portion of the work force. This study presents national data on the morbidity and mortality due to farm injuries to children and adolescents ≤19 years of age. Data sources used were 1979 to 1981 mortality statistics from the National Center for Health Statistics, farm injuries treated in emergency rooms as reported to National Electronic Injury Surveillance System (1979 to 1983), farm deaths investigated by the Consumer Product Safety Commission, and the 1980 census. Nearly 300 children and adolescents die each year from farm injuries, and 23,500 suffer nonfatal trauma. The fatality rate increases with age of the child; the rate for 15- to 19-year-old boys is double that of young children and 26-fold higher than for girls. More than half (52.5%) die without ever reaching a physician; an additional 19.1% die in transit to a hospital, and only 7.4% live long enough to receive inpatient care. The most common cause of fatal and nonfatal injury is farm machinery. Tractors accounted for one half of these machinery-related deaths, followed by farm wagons, combines, and forklifts. Overall, 10% of children with nonfatal injuries require hospitalization, and one in 30 children younger than age of 5 years with a farm injury is hospitalized or dies. The magnitude of the problem requires the evaluation of a number of preventive strategies including legislation and improvement of emergency care in rural areas.
Double-Blind, Randomized Trial of a Calf Lung Surfactant Extract Administered at Birth to Very Premature Infants for Prevention of Respiratory Distress Syndrome
Authors: Shapiro Donald L. , Notter Robert H. , Morin Frederick C. , Deluga Karl S. , Golub Leonard M. , Sinkin Robert A. , Weiss Kerry I. , Cox Christopher
Published: December 2021

Organic solvent extraction of surfactant obtained by lavage of calf lungs yields a highly surfaceactive material. A double blind, randomized clinical trial to determine the effect of this material on respiratory distress syndrome in premature infants was initiated in the Neonatal Intensive Care Unit at the University of Rochester in December 1983. Infants 25 to 29 weeks gestational age were eligible for entry into the trial. At the time of this interim analysis 32 patients had been randomly selected and entered into the trial, 16 surfactant-treated patients and 16 in a control group who received only saline. At birth, intrapulmonary instillation of the calf lung surfactant extract dispersed in saline or saline alone occurred in the delivery room immediately after intubation and prior to ventilation; infants were then ventilated and treated as usual. At 6, 12, 24, 48, and 72 hours after birth, the severity of respiratory distress was categorized as either minimal, intermediate, or severe based on oxygen and mean airway pressure requirements. Differences observed at six hours after birth were of marginal significance, but at 12 and 24 hours the surfactant-treated group had significantly (P < .01) less severe respiratory distress compared with the control group. Differences between treated and control infants were not statistically significant at 48 and 72 hours after birth. In four surfactant-treated infants the severity of respiratory distress worsened between 24 and 48 hours after birth, suggesting that one dose of surfactant at birth may not be sufficient for some infants.
Transient Thrombocytopenia in Systemic Onset Juvenile Rheumatoid Arthritis
Authors: SHERRY DAVID D. , KREDICH DEBORAH W.
Published: December 2021

Three children have been presented who have had long-standing, typical systemic juvenile rheumatoid arthritis. They also had a transient illness with thrombocytopenia, antiplatelet antibodies, and the simultaneous appearance of anti-DNA antibodies and hypocomplementemia. Other single abnormalities included the development of a positive ANA, Coombs, and lupus bands test. All responded to high-dose steroid therapy. Their similar clinical and serologic findings are noteworthy and represent one of the numerous complications seen in patients with systemic juvenile rheumatoid arthritis.
Percutaneous Nephrostolithotomy: An Alternative Approach to the Management of Pediatric Calculus Disease
Authors: HULBERT JOHN C. , REDDY PRATAP K. , GONZALEZ RICARDO , YOUNG ANTHONY D. , CARDELLA JOHN , AMPLATZ KURT , LANGE PAUL H. , CASTANEDA-ZUNIGA WILFREDO
Published: December 2021

Urinary calculi in children are rare in industrialized countries; less than 1% of the urinary calculi in the United States occur in the pediatric age group.1-3 Those stones that occur tend to be the result of metabolic disorders such as hyperparathyroidism, renal tubular acidosis, hyperoxaluria, myeloproliferative disorders, or other diseases that result in hyperuricemia. Children subject to recurrent urinary tract infections are also at risk, this being particularly important in those patients with neurovesical dysfunction due to conditions such as myelomeningocele or sacral agenesis. Herein are presented six cases of young patients aged 16 years and younger who were treated for symptomatic calculus disease by percutaneous nephrostolithotomy.
Pediatricians and Lactation Management
Authors: COREIL JEANNINE
Published: December 2021

To the Editor.—

The important contribution of pediatricians in the promotion of breast-feeding has been noted.1-4 In these discussions, the pediatrician's instrumental activities have been described primarily in terms of influence on the choice of feeding method, intervention in hospital postpartum routine, communication of support for the lactating mother, and provision of advice regarding the introduction of other infant foods. Little attention has been given to the role of pediatricians in the practical and maternal aspects of lactation management.
Bulimia in Adolescents: A Review
Authors: Lustick Michael J.
Published: December 2021

This report reviews the occurrence of bulimia in female adolescents, a relatively common disorder. Features contributing to its occurrence in adolescents and treatment modalities are highlighted. A high degree of suspicion is needed to make the diagnosis and further work is required to clarify the unique aspects of this disorder in adolescents.
Fanconi Anemia: Prenatal Diagnosis in 30 Fetuses at Risk
Authors: Auerbach Arleen D. , Sagi Michal , Adler Barbara
Published: December 2021

We report our experience, since 1978, with prenatal diagnosis in fetuses at risk for Fanconi anemia. Amniotic fluid cells from 30 fetuses from 24 families were monitored for baseline and diepoxybutane-induced chromosomal breakage. Seven of the fetuses at risk were diagnosed as affected; baseline and diepoxybutane-induced breakage ranged from 0.18 to 0.45 and 0.69 to 0.96 breaks per cell, respectively. The range of baseline and diepoxybutane-induced chromosomal breakage in amniocytes from the 23 pregnancies at risk that were diagnosed prenatally as unaffected ranged from 0 to 0.08 and 0 to 0.13 breaks per cell, respectively. Four of these cases were also diagnosed as normal on the basis of chromosomal breakage studies in cells obtained by chorionic villus sampling. The range of baseline and diepoxybutane-induced breakage in cells from five control fetuses was 0 to 0.05 and 0 to 0.10 breaks per cell, respectively. Of the pregnancies diagnosed as affected, two were carried to term, whereas five were terminated. One newborn and two abortuses had congenital malformations including abnormalities of the thumb and radius. The other affected live-born infant, now 5½ years old, has severe growth retardation and pancytopenia. No Fanconi anemia-associated malformations were found in any of the other fetuses or newborns studied. In all cases in which tissue was available for study, diagnoses were confirmed by chromosome breakage studies. This method thus permits reliable detection of Fanconi anemia.
Tularemia in Adults and Children: A Changing Presentation
Authors: Jacobs Richard F. , Condrey Yoland M. , Yamauchi Terry
Published: December 2021

Tularemia, a febrile zoonosis with six clinical types, recently has been shown to occur at an increased incidence in children compared with previous reports. Ulceroglandular and glandular tularemia are still the most common types, but pneumonic tularemia has increased in incidence. However, with these changes, an overall decline in mortality has been observed. Children exhibit fever, pharyngitis, hepatosplenomegaly, and constitutional symptoms more often than affected adults. The complication of late lymph node suppuration is found in half of the tularemia patients with lymphadenopathy. A high index of clinical suspicion and a good medical history and physical examination confirmed by specific serologic studies are the critical factors in the successful diagnosis of tularemia in children.
Pediatrics and the Malpractice Crisis
Authors: CURTIS PAUL
Published: December 2021

To the Editor.—

Pediatricians, like all physicians, are increasingly becoming targets of malpractice suits. Pediatricians, however, are likely to find themselves at special risk. In most states, the statute of limitations allows 2 years for discovery procedures. An infant plaintiff has an added allowance simply because of youth. In effect, a case may be allowed to brew for 21 years before the attorney considers it ripe.

Deferring a medicolegal attack is good strategy. Medical standards and procedures change.
Vitamin E and Complement
Authors: RUDENSKY BERNARD , ISACSOHN MEYER , EIDELMAN ARTHUR I.
Published: December 2021

To the Editor.—

The pros and cons of vitamin E therapy for premature infants have been quite extensively written about during the past year, especially in Pediatrics.1-4 We were interested in the report of Johnson et al,5 showing increased incidence of sepsis and necrotizing enterocolitis in neonates with elevated serum vitamin E levels. Major et a16 reported that vitamin A inhibited complement-induced hemolysis of sensitized erythrocytes, at concentrations similar to those for vitamin E, implicated by Johnson et al as resulting in increased sepsis rates.
Are Granulocyte Transfusions of Value in Septic Neonates Without Neutrophil Storage Pool Depletion?
Authors: CAIRO MITCHELL S.
Published: December 2021

In Reply.—

We have reviewed the records of our patients who died in the nontreated granulocyte septic newborn group and have not found an increased I/T ratio, suggesting that these patients went on to NSP depletion prior to their deaths. Although we did not do repeat bone marrow evaluations on the four patients who died, judging from their peripheral complete blood cell counts and I/T ratios, we find no suggestion that they went on to NSP depletion.
Vietnamese Are Not Genetically Short
Authors: STICKLER GUNNAR B.
Published: December 2021

In Reply.—

Dr Deinard's opinion about the growth pattern of children from Southeast Asia is of interest and hopefully will hold up. Just looking around the Rochester soccer fields, this is doubtful. His opinion is in contrast to that repeatedly misquoted information about the Japanese who migrated to California. It is true that earlier studies showed better growth in California in comparison to those Japanese born in Japan, but this did not prove to be true with remeasurements in 1971.
Insomnia and Cow's Milk Allergy in Infants
Authors: Kahn A. , Mozin M. J. , Casimir G. , Montauk L. , Blum D.
Published: December 2021

A group of eight infants (six boys and two girls, 7 to 46 weeks of age) is reported, in whom a causal relationship between cow's milk allergy and chronic sleeplessness was suspected. They were referred because of waking and crying episodes that had occurred since the early days of life during sleep hours. During an average night, they slept about 4.5 hours and woke their parents about five times. They cried a lot during the day and were described as fussy. Two infants had been treated with phenothiazine without improvement. No cause for chronic insomnia was found during a standard medical and psychologic workup. An all-night polygraphic recording confirmed the disrupted sleep pattern of these infants, as compared with that of normal infants, and excluded further causes of arousals. Due to a clinical suspicion of atopy, the infants were further subjected to a series of allergy tests. IgE levels were shown to be elevated in each child, and radioallergosorbent tests were positive for cow's milk protein. The infants were than fed exclusively with a hydrolyzed milk protein mixture for 4 weeks. Sleep normalized within 2 weeks in every infant: night sleep increased to a median of 10 hours, and the awakenings only occurred occasionally. In four infants less than 6 months of age, cow's milk was reintroduced in the diet, and within 1 week all four became severely sleepless. Cow's milk was again excluded from the diet and the babies' sleep behaviors were again normalized. It is concluded that, when no evident cause for sleeplessness can be found in an infant, the possibility of milk allergy should be given serious consideration.
The Anus in the Newborn
Authors: Haddad M. El , Corkery J. J.
Published: December 2021

The size of the anus is defined in newborns of varying weights. A plea is made for proper examination of the anus at birth.
Bromate Poisoning From Hair Permanent Preparations
Authors: WARSHAW BARRY L. , CARTER MELODY C. , HYMES LEONARD C. , BRUNER BARBARA S. , RAUBER ALBERT P.
Published: December 2021

Potassium bromate is a tasteless, odorless, and colorless chemical found in the neutralizing solution of cold wave home hair permanents and profesional solutions. Toxic ingestions of this substance were initially reported during the 1940s and 1950s and are characterized primarily by gastrointestinal symptoms, hearing impairment, and acute renal failure.1 Although many manufacturers have now substituted less toxic substances as neutralizers, use of potassium bromate in some hair permanent solutions continues, and poisonings from this substance still occur.2-4

Because renal failure from potassium bromate intoxication may be severe, dialysis may be necessary for replacement of renal function. Moreover, a major toxicology reference presently suggests that "if readily available, the prompt use of hemodialysis or peritoneal lavage may serve to remove absorbed but unreacted bromate in significant amounts."1
Capitation Reimbursement for Pediatric Primary Care
Authors: Gordon Toby , DeAngelis Catherine , Peterson Ronald
Published: December 2021

A feasibility analysis of capitation reimbursement for a primarily Medicaid population in The Johns Hopkins Pediatric Primary Care Clinic was conducted. The utilization of all inpatient and outpatient care of 2,261 patients was monitored for a 6-month period. As a result, per capita rates based on charges were determined for each group of patients according to type of insurance. Blue Cross and private insurance patients had capitation rates three times that of the Medicaid patients and over ten times that of the self-pay patients. This variation in utilization was attributed to the selection of enrollees, the morbidity of the population, and the varying services covered by payor group. Administrative issues regarding establishing a pediatric health maintenance organization are also discussed. Close supervision of house staff in treating patients, including admissions, length of stay, and specialty referral is of utmost importance in containing costs in this clinic setting.
Acute Poisoning in a Children's Hospital: A 2-Year Experience
Authors: Fazen Louis E. , Lovejoy Frederick H. , Crone Robert K.
Published: December 2021

In a 2-year retrospective review, 90 patients were treated in a children's hospital for acute overdoses. In 90%, the history was the most important indicator of poisoning. On physical examination, 64% of patients were found to have altered sensorium, and 69% of cases were confirmed with a routine qualitative toxicology screening test. Accidental overdoses were most frequently due to ingestion of petroleum distillates, digoxin, carbamazepine, and theophylline. Suicidal patients ingested alcohol, barbiturates, tricyclic antidepressants, benzodiazepines, and aspirin. The majority of children with accidental overdoses received medical attention within 2 hours, but suicidal patients presented significantly later. Appropriate treatment with gastric lavage or emesis was used for 85% of patients on an emergency basis prior to admission. The inpatient therapy is based on continued gastrointestinal decontamination, basic organ system support, and monitoring for toxic effects and complications of therapy. Specific antidotes were available for only 10% of patients. In this study, 50% of patients were able to be discharged to their homes after one day of hospitalization. Pediatric patients treated in the intensive care unit incur less morbidity than adults in a similar setting. Adolescents who attempt suicide and are treated in the intensive care unit are likely to take prescription drugs in a similar manner as their adult counterparts.