bluuebunny/crossref_metadata_2025 huggingface dataset:
THE RESEARCHER'S CHILD
Authors: Mehta Paulette
Published: December 2021

Our daughter Asha grew up among endless conversations of our research work. Her first year of life unfolded between the pages of the book we edited on Platelets, Prostaglandins and Cardiovascular Disease. Subsequently, as she grew, nighttime discussions were on platelets and prostaglandins, dinner conversations on meetings and abstracts, bedtime stories were our manuscripts, and family albums were stacked with slides relating to our research data. Vacations were squeezed in between Mommy's and Daddy's presentations at various meetings. Nevertheless, Jay and I never noticed that Asha was different from any of her school friends. Recently, however, in preparation for her seventh birthday party, I told my daughter to bring me telephone numbers of her school friends so I could call their mothers to invite them. To my surprise, Asha returned home the next day with a 12-column spread sheet. The spread sheet was neatly labeled: Invitation List for Asha Mehta's Seventh Birthday Party. Each column was neatly sublabeled: Guest Number, Name, Date of Birth, Address, Nationality, Mother's Name, Father's Name, Number of Children in Family, Telephone Number, Response of Parents, and Remarks. Each row contained complete information on each potential guest. Finally, each column was boxed off, as though ready for statistical analysis. We finally realized the impact that our lives had had on our little child.
SOMETHING FOR EVERYONE
Authors: Prettyman Penny
Published: December 2021

If you find an error, please understand it is there for a purpose. We try to publish something for everyone, and some people are always looking for something to criticize.
Vasospasm in the Neonate: Response to Tolazoline Infusion
Authors: HEATH RICHARD E.
Published: December 2021

Vasospasm can result from either intentional manipulation of a vessel or from inadvertent contact during other procedures. The clinical problems stemming from this disorder range from transient mottling of skin color to necrosis of important body tissues. In neonates, only limited experience in treating these conditions with pharmacologic agents is reported.

Three cases of severe vasospasm and their favorable response to an infusion of tolazoline are presented.

CASE REPORTS

Case I

Infant A was born at 32 weeks of gestation and had a birth weight of 1.80 kg. Idiopathic respiratory distress syndrome developed in the infant and required intermittant mandatory ventilation with 0.6 FiO2.
Lead Poisoning in a Child With a Gunshot Wound
Authors: Selbst Steven M. , Henretig Fred , Fee Maureen A. , Levy Susan E. , Kitts Albert W.
Published: December 2021

Lead poisoning has infrequently resulted from gunshot wounds with retained lead particles in adults. This has not been previously found in children. The case of an 8-year-old boy in whom lead poisoning developed soon after a gunshot wound is reported. The child had no symptoms directly related to lead poisoning, but he received chelation therapy. The case demonstrates the need to consider lead poisoning in children with retained particles following gunshot wounds.
ON KILLING THEORIES
Authors: Student
Published: December 2021

Human knowledge is a special case of animal knowledge. From amoeba to Einstein learning takes the same course: it starts from a problem caused by the clash between expectations and experience, proceeds to a solution, and then to the testing of that solution. With the emergence of science, failure need no longer be fatal: we can kill off our theories, instead `of being killed off ourselves.'
THE WEAPONRY OF BIOMEDICAL JOURNALS
Authors: Student
Published: December 2021

[Biomedical] journals, especially those with large readerships and liberal budgets, have the power not only to select competing papers for publication but also to editorialize ("hype") their content. Whether, as [has been] suggested this practice influences the opinion of the readership and creates an image of outstanding science where none in reality exists is unclear, but it certainly helps authors promote their research. If journals use speedy publication as a weapon in the competition for fashionable research, they play on the vanity of scientists and distort the system of values. Not only can they decide what type of work will receive favored treatment, but they overburden expert reviewers by demanding more rapid reviews.
THE ON-GOING TOLL OF SMOKING
Authors: Student
Published: December 2021

The proportion of pre-term births attributed to smoking ranges from 11-14 percent of all livebirths and the risk of prematurity is directly associated with smoking dose. As a result of the effects of smoking on birth weight and gestational weight, smoking increases risk of neonatal death.
Descriptive Epidemiology of Missed Cases of Phenylketonuria and Congenital Hypothyroidism
Authors: Holtzman Candy , Slazyk William E. , Cordero José F. , Hannon W. Harry
Published: December 2021

We conducted a structured telephone survey of state public health laboratory directors of neonatal screening programs to determine the extent of the problem of missed cases of phenylketonuria (PKU) and congenital hypothyroidism. A total of 76 missed cases were reported—43 PKU and 33 congenital hypothyroidism. We looked at the following characteristics of the missed cases: the stage at which the miss occurred, which included specimen collection, laboratory procedures, or follow-up; the size of the program; the type of screening program; the age of the infant at the time of screening; and any legal action that resulted from the miss. The 76 missed cases probably represent an underascertainment of the true number, yet we believe that our data provide an overview of some of the problems associated with mass neonatal screening. There was one missed case of PKU for every 70 cases detected, and one missed case of congenital hypothyroidism for every 120 cases detected; in other words, two congenital hypothyroidism cases were missed for every 1 million infants screened. Regarding the stage of screening in which the miss occurred, 14% occurred during specimen collection, 45% during the laboratory procedures stage, 16% during follow-up, 11% were the result of biologic variation, and in 14% the stage could not be identified. We conclude that neonatal screening programs have been highly successful but that there may be additional safeguards to be developed, tested, and implemented when practical.
Computed Tomographic Demonstration of Cerebral Edema in a Child With Galactosemia
Authors: Belman Anita Lesgold , Moshe Solomon L. , Zimmerman Robert D.
Published: December 2021

An eight-day-old male infant with galactosemia presented with signs of increased intracranial pressure and no evidence of intracranial infection or hemorrhage. Computed tomographic scans demonstrated the presence of diffuse cerebral edema. With treatment, the edema gradually resolved, although it persisted longer within the white matter and was associated with transient bilateral pyramidal tract signs.
Hematospermia in Adolescents and Young Adults
Authors: SILBER TOMAS J. , KASTRINAKIS MARIANA
Published: December 2021

Blood in the ejaculate, known as hematospermia or hemospermia, was described by both Galen and Ambroise Pare.1 In the United States, it was first reported by Lydston in 1894, who attributed the condition to "unbridled license." The condition has been occasionally described and reviewed in general medical and urologic journals.1-10 Yet, to the best of our knowledge, it has not been reported in the pediatric or adolescent medical literature. Three patients presenting with hematospermia will serve as a basis for a review of this condition and current recommendations for its evaluation and treatment.

CASE REPORTS

Case 1

A 14-year-old white boy was brought to medical attention by his mother because on several occasions she noted blood stains on his pajamas.
Child Abuse
Authors: HELFER RAY E.
Published: December 2021

In Reply.—

I appreciate Dr Goldson's support and his expansion of the concerns about our children in our society. I am certain that many, if not most, of the readers have similar concerns.
Anterior Fontanel: Size and Closure in Term and Preterm Infants
Authors: Duc G. , Largo R. H.
Published: December 2021

Size and closure of the anterior fontanel from birth to 24 months of age and their relationships to growth parameters, bone age, and gestational age are reported in 111 term and 128 preterm infants. Great variability of both fontanel size and age when fontanel closed was observed. There were no significant differences in size and age at closure of the anterior fontanel between term and preterm infants or between the sexes. At ages beyond term, fontanel size was negatively correlated with weight and length; however, only a few correlations reached statistical significance. No significant relationships were noted between anterior fontanel size and head circumference or bone age. Age at closure of the anterior fontanel was also not significantly related to any of the growth parameters or bone age.
b-CAPSA I Haemophilus influenzae, Type b, Capsular Polysaccharide Vaccine Safety
Authors: Black Steven B. , Shinefield Henry R. ,   The Northern California Permanente Medical Care Program Departments of Pediatrics Vaccine Study Group
Published: December 2021

The b-CAPSA I capsular polysaccharide vaccine for Haemophilus influenzae type b was given to 87,541 children 2 through 5 years of age in the Kaiser Permanente Medical Care Program, and the children were then followed using a multiple modality surveillance. Phase 1 consisted of 24-hour recall of immediate side effects which were recorded on questionnaires given to families of 13,500 children. Local side effects were found to be uncommon: 2.3% had a temperature of ≥38.3°C (≥101°F); 4.8% had local erythema, 2.9% local swelling, and 12.6% local tenderness; two children had wheezing shortly after immunization. In Phase 2, 30 days after immunization, questionnaires were mailed to parents of all 87,541 children, who were asked to respond to questions about illnesses and health care. Phase 3 consisted of active surveillance of patient health care use by physicians and nurses during the 30 days after immunization. During the 30-day reporting periods, there were 40 hospitalizations, including one for wheezing and one for febrile seizure. Of the 40 hospitalizations, only the one for wheezing was believed by the admitting physician to be probably associated with vaccine administration. Three children had seizures within 30 days of immunization. None of the seizures was believed by the reporting physician to be associated with immunization. Adverse effects of the vaccine were mild, limited to local reactions and occasional temperature elevation; bronchospasm after immunization occurred rarely.
Declining Frequency of Circumcision: Implications for Changes in the Absolute Incidence and Male to Female Sex Ratio of Urinary Tract Infections in Early Infancy
Authors: Wiswell Thomas E. , Enzenauer Robert W. , Holton Mark E. , Cornish J. Devn , Hankins Charles T.
Published: December 2021

The results of an investigation examining the circumcision frequency rate and its effect on the incidence of urinary tract infections in a large, widely dispersed population base during the 10-year period since the 1975 report of the American Academy of Pediatrics Ad Hoc Task Force on Circumcision are reported. Our study population included the 427,698 infants born in all United States Army hospitals, worldwide, from Jan 1, 1975, through Dec 31, 1984. There was an initial plateau in the circumcision frequency rate at approximately 85% during the first 4 years of the study period. In the subsequent 6 years there was a steady, significant decrease (P < .001) of 1.4% to 4.0% per year through 1984, when the circumcision frequency rate reached its nadir of 70.5%. There was a concomitant increase in the total number of urinary tract infections among male infants (P < .02) as the circumcision rate declined. This increase was due to the increase in the overall number of uncircumcised boys (who had a greater than 11-fold increased infection rate compared with circumcised boys). During the first half of the study period, there was a female predominance for urinary tract infections from birth onward. As the number of circumcised boys decreased (with a resultant increase in the total number of boys with infection), the male to female ratio of urinary tract infections during the first 3 months of life reversed, reflecting a movement toward a male predominance for infection in early infancy. This is the first, well-documented report of a decreasing rate of circumcisions performed on the American male population. We conclude that the number of urinary tract infections in male infants, as well as the male to female sex ratio, is affected by the circumcision practices of the population examined.
Inborn Errors of Metabolism: The Clinical Diagnosis in Early Infancy
Authors: Burton Barbara K.
Published: December 2021

Major advances occurring in recent years in the recognition and treatment of inborn errors of metabolism have made it more essential than ever that the physician be familiar with the clinical presentation of these disorders. Although infants with inborn errors of metabolism will continue to be best cared for in centers with expertise in the treatment of inherited metabolic disease, the initial recognition of these disorders remains the responsibility of the practicing physician. A clinical approach to the diagnosis of inborn errors of metabolism in the young infant is presented as well as suggestions for the use of readily available laboratory studies that can serve to identify these infants who will benefit from further evaluation and treatment.
Pyruvate Dehydrogenase Complex Deficiency as a Cause of Subacute Necrotizing Encephalopathy (Leigh Disease)
Authors: Kretzschmar Hans A. , DeArmond Stephen J. , Koch Thomas K. , Patel Mulchand S. , Newth Christopher J. L. , Schmidt Kathleen A. , Packman Seymour
Published: December 2021

Leigh disease is a disorder with great clinical variability and for which diverse biochemical causes have been proposed. Clarification requires rigorous correlation of biochemical abnormalities with strict morphologic diagnosis; such an unambiguous association is the subject of this report. A patient with well-documented clinical and biochemical pyruvate dehydrogenase complex deficiency is shown on postmortem examination to have the specific CNS pathology of Leigh disease. These findings, considered together with the aggregate data in the literature, suggest strongly that pyruvate dehydrogenase complex deficiency is the basic defect in a subgroup of patients with Leigh disease.
Unsuspected Non-Hodgkin’s Lymphoma of the Tonsils and Adenoids in Children
Authors: Ridgway Derry , Wolff Lawrence J. , Neerhout Robert C. , Tilford David L.
Published: December 2021

Six children with lymphoreticular malignancy arising in the pharyngeal tonsils or adenoids are presented. Early clues to the possible malignant nature of the enlargement of tonsils and adenoids in this series include: asymmetric and persistent enlargement, the absence of such manifestations of infection as fever or pain, and the association of atypical adenopathy. Lack of clinical suspicion brings with it the risk of delayed diagnosis and possible compromise of optimal therapy.
Severe Renal Osteodystrophy Without Elevated Serum Immunoreactive Parathyroid Hormone Concentrations in Hypomagnesemia Due to Renal Magnesium Wasting
Authors: Zelikovic Israel , Dabbagh Shermine , Friedman Aaron L. , Goelzer Mark L. , Chesney Russell W.
Published: December 2021

An 8½-year-old girl presented with a long history of seizures, growth retardation, muscle weakness, gait disturbance, and hearing loss. Her evaluation revealed chronic moderate renal failure (serum creatinine 2.2 mg/dL), severe hypocalcemia (5 mg/dL), hyperphosphatemia (8.1 mg/dL), hypomagnesemia (1.5 mg/dL), increased urinary magnesium excretion (2 mg/kg/d), high fractional excretion of magnesium (21.7%), hypokalemia (3.2 mEq/L), and hyperkaliuria (26 mEq/L). Low circulating immunoreactive parathyroid hormone levels for the degree of the hypocalcemia (serum N-parathyroid hormone 212 pg/mL) and severe rickets without evidence of osteitis fibrosa cystica were found. The patient probably has primary renal leak hypomagnesemia (magnesuric hypomagnesemia) which caused impaired secretion of immunoreactive parathyroid hormone leading to severe hypocalcemia and calcium deficiency rickets. Treatment with magnesium and calcium supplements, calcitriol, and aluminum hydroxide resulted in marked clinical, biochemical, and radiologic improvement. Calcium deficiency rickets due to primary or secondary renal magnesium wasting in conjunction with moderate renal failure represents a largely unrecognized metabolic bone disease.
Growth Hormone Deficiency Associated With the Ectrodactyly-Ectodermal Dysplasia-Clefting Syndrome and Isolated Absent Septum Pellucidum
Authors: Knudtzon Jørgen , Aarskog Dagfinn
Published: December 2021

Two growth hormone-deficient patients with particular developmental defects are presented. One patient had the ectrodactyly-ectodermal dysplasia-clefting syndrome with lobster-claw deformities of the hands; thin, blond, and dry hair and enamel hypoplasia; and a facial raphe on the right side of the philtrum. The other patient had isolated absence of the septum pellucidum. The facial raphe and the absent septum pellucidum are related to cleft lip and septooptic dysplasia, conditions that have been associated with growth hormone failure. The association of the ectrodactyly-ectodermal dysplasia-clefting syndrome with isolated growth hormone deficiency has not been described previously.
Chlorine Inhalation Toxicity From Vapors Generated by Swimming Pool Chlorinator Tablets
Authors: WOOD BRIAN R. , COLOMBO JOHN L. , BENSON BLAINE E.
Published: December 2021

We have presented two cases of serious respiratory injury after brief exposure to vapors from solid chlorine compounds. We could find no previous reports of such accidents and, therefore, have related these cases to alert the medical community. We would recommend that physicians caring for children include warnings about these preparations in their routine counseling of parents.
Analgesic Premedication in the Management of Ileocolic Intussusception
Authors: TOULOUKIAN ROBERT J. , O'CONNELL JOSEPH B. , MARKOWITZ RICHARD I. , ROSENFIELD NANCY , SEASHORE JOHN H. , ABLOW RONALD C.
Published: December 2021

Hydrostatic reduction of ileocolic intussusception by barium enema is uniformly regarded as optimal management, with surgical treatment reserved for occasions when this is not successful and for other selected circumstances.1 In an attempt to maximize the success rate of hydrostatic reduction, we examined the effect of analgesic premedication on both the outcome for the barium study and the operative findings.

MATERIALS AND METHODS

The case records and radiographs of 76 children with ileocolic intussusception treated at the Yale-New Haven Hospital between Jan 1, 1974, and Dec 31, 1984, were reviewed for patient age, sex, seasonal incidence, presenting signs and symptoms, and results of hydrostatic reduction, as well as surgical treatment with operative findings, morbidity, and mortality.
Head Start: Evolution of a Successful Comprehensive Child Development Program
Authors: KOTELCHUCK MILTON , RICHMOND JULIUS B.
Published: December 2021

The commentary by Besharov and Hartle1 concludes that disadvantaged children deserve better than what they are getting. Indeed, it is our view—along with virtually all Americans—that all of our children deserve better. The improvement of the health, education, and welfare of all children is a never ending quest.

Perhaps the frustration with the Head Start program that permeates the Besharov and Hartle commentary is due to a fundamental misconception of the goals of the Head Start program. From its inception, Head Start has been a comprehensive child development program and not a program focused solely on long-term cognitive gains.
Day Care for Sick Children
Authors: STERNE GEORGE G.
Published: December 2021

Children in day care, like their home-reared peers, frequently become ill. Whether they are sick more frequently than those not in day care has been a question difficult to resolve because of the problem of appropriate control studies. Many pediatricians are convinced that this is so. There are data that infections due to certain specific agents including hepatitis A, Haemophilus influenzae type B, and Giardia lamblia occur more often in day-care center attendees. Clinical entities such as diarrhea, meningitis, and otitis media have also been shown to be more common in day-care center attendees. A recent review in Pediatrics1 provides a good overview of the problem.
Cardiopulmonary Resuscitation: Standards, Guidelines, and Education
Authors: CHAMEIDES LEON
Published: December 2021

And it came to pass, after these things, that the son of the woman, the mistress of the house, fell sick; and his sickness was no sare, that there was no breath left in him ...and [Elijah] said unto her 'Give me thy son.' And he took him out of her bosom, and carried him up into the upper chamber where he adobe, and laid him upon his own bed....And he stretched himself upon the child three times, and cried unto the Lord and said: 'O Lord my God, I pray thee, let this child, s soul come back into him.'
Role of the Pediatrician in Management of Sexually Transmitted Diseases in Children and Adolescents
Authors:   Committee on Adolescence
Published: December 2021

Approximately half of all American adolescents have experienced sexual intercourse by age 17 years.1 The second highest rate of reported gonococcal infections (1,229 cases per 100,000 persons) occurs in 15- to 19-year-old adolescents. This increased risk in the adolescent population has been associated with the greater number of young people having sexual intercourse, the infrequent use of barrier contraceptive methods, the obstacles to prompt medical care that teenagers face, with consequent delay in diagnosis and further spread of the disease, and the large number of asymptomatic carriers.2

The pediatrician has an important responsibility for providing sexuality-related care to children and adolescents.2-4
Statement on Childhood Lead Poisoning
Authors:   Committee on Environmental Hazards,   Committee on Accident and Poison Prevention
Published: December 2021

Patterns of childhood lead poisoning have changed substantially in the United States. The mean blood lead level has declined, and acute intoxication with encephalopathy has become uncommon. Nonetheless, between 1976 and 1980, 780,000 children, 1 to 6 years of age, had blood lead concentrations of 30 µg/L or above. These levels of absorption, previously thought to be safe, are now known to cause loss of neurologic and intellectual function, even in asymptomatic children. Because this loss is largely irreversible and cannot fully be restored by medical treatment, pediatricians' efforts must be directed toward prevention. Prevention is achieved by reducing children's exposure to lead and by early detection of increased absorption.

Childhood lead poisoning is now defined by the Academy as a whole blood lead concentration of 25 µg/L or more, together with an erythrocyte protoporphyrin level of 35 µg/dL or above. This definition does not require the presence of symptoms. It is identical with the new definition of the US Public Health Service. Lead poisoning in children previously was defined by a blood lead concentration of 30 µ/dL with an erythrocyte protoporphyrin level of 50 µg/dL.

To prevent lead exposure in children, the Academy urges public agencies to develop safe and effective methods for the removal and proper disposal of all lead-based paint from public and private housing. Also, the Academy urges the rapid and complete removal of all lead from gasoline.

To achieve early detection of lead poisoning, the Academy recommends that all children in the United States at risk of exposure to lead be screened for lead absorption at approximately 12 months of age by means of the erythrocyte protoporphyrin test, when that test is available. Furthermore, the Academy recommends follow-up erythrocyte protoporphyrin testing of children judged to be at high risk of lead absorption. Reporting of lead poisoning should be mandatory in all states.
Injuries Related to "Toy" Firearms
Authors:   Committee on Accident and Poison Prevention
Published: December 2021

Both projectile and nonprojectile toys, and nonpowder guns such as air guns and air rifles, are categorized as toy firearms. Although the Academy realizes that the welfare of children and adolescents would be best served by banning these instruments, we are unable to prevent their availability and use. We offer this statement in an attempt to safeguard the young user from possible injury.

Between 1980 and 1981, accidents involving projectile toys were responsible for 747 reported injunies to children younger than 15 years of age.1 Most of these injuries involved the face or eyes, 2.9% of these injuries required hospitalization, more than 400 days were lost from school and/or work, and nearly 3,000 days of activities were restricted. In addition, there have been severe or even fatal consequences following the use of substitute projectiles or live ammunition. Children have also died as a result of aspiration of projectiles.

Accidents involving air guns and air rifles are an even more frequent cause of injury to children. In 1980, approximately 23,000 injuries associated with nonpowder guns were treated in US hospital emergency rooms.2 In two thirds of the cases the victim was less than 16 years of age.

In a 1973 review of 105 air gun-related injuries to the eye, sequelae included traumatic cataract, retinal detachment, and sympathetic ophthalmitis.3 Eighteen of the injuries required enucleation of the eye. More than 70% of those injured were children 6 to 15 years of age. The continuing nature of this problem has been demonstrated by Sternberg et al4 in a 1984 review of 32 children with air gun-related eye injuries.
Foreign Body in the Hard Palate
Authors: SANDLER RICHARD H. , KUMAR ASHIR , RICHARDSON KURT A. , CONSTANT ERIKOS
Published: December 2021

To the Editor.—

We present the case of a foreign body of the hard palate in an infant. After mucosal molding to the edges of such objects, the true nature of these foreign bodies can be obscured, often resulting in unnecessary attempted biopsy under general anesthesia.

Our patient was an 11-month-old infant with an asymptomatic white patch on the palate, noticed by the mother a few days earlier. Findings on physical examination were a comfortable-appearing infant, and an oral pharynx that appeared normal except for a white, hard, smooth, nonulcerative, well-demarkated, "punched-out" lesion of the hard palate, measuring about 1.5 cm in diameter.
Statistics and Sudden Infant Death Syndrome
Authors: CUMMINS SUSAN K.
Published: December 2021

To the Editor.—

The recent cohort study by Oren et al1 examined risk factors for sudden infant death syndrome (SIDS) in infants with prolonged unexplained sleep apnea with color change (severe apnea of infancy). This analysis revealed three possible risk factors for SIDS death: having a subsequent monitored apnea episode needing resuscitation or vigorous stimulation, being a sibling of a SIDS victim, or developing a seizure disorder after monitoring began. Unfortunately, there are two serious problems with the authors' analysis: the misrepresentation of relative risk and the use of the χ2 statistic to test associations in small subgroups.
Tuberculosis in a Day-Care Home
Authors: NOLAN CHARLES M. , BARR HEATHER , ELARTH ANNA M. , BOASE JANICE
Published: December 2021

It has been predicted that tuberculosis, if it occurred in child day-care centers, would spread from adults to children. This mode of spread is in contrast to that of most day-care infections which spread from child-to-child or from child-to-adult. Recognizing the theoretical risk that children might acquire tuberculosis from adult day-care workers, some states have already adopted protective regulations. The present report confirms the prediction of an adult-to-child pathway of tuberculosis transmission in a day-care setting and provides an opportunity to review the current approaches to prevention.

DESCRIPTION OF OUTBREAK

In August 1984, a 26-year-old Ethiopian man immigrated to the United States; a tuberculin test was positive (18 mm) and a chest roentgenogram showed normal findings.
Vulnerable Sibling: Hyponatremia From Caries Prevention
Authors: CALLANAN DEBORAH L. , HINER LINDA B.
Published: December 2021

Parental actions and beliefs shape every aspect of a child's health and development. Green and Solnit described a vulnerable child syndrome in which the child's development was impaired when the parents treated him or her in an inappropriate fashion because they had an unreasonable expectation that he or she would die. We recently cared for a child who suffered a life-threatening event (status epilepticus due to hyponatremia) because the parents were trying to avoid reproducing a serious, but not life-threatening, problem (nursing bottle caries) that had occurred in the older sibling. This distortion of professional advice created vulnerability to significant neurologic problems.
In Reply: Phototherapy Effect on the Incidence of Patent Ductus Arteriosus
Authors: ROJAS JORGE
Published: December 2021

I read with interest the article by Rosenfeld et al on the effect of chest shielding during phototherapy on the incidence of patent ductus arteriosus. It seems to me that an important piece of information was left out of their report that may certainly influence the interpretation of the results. The effectiveness of phototherapy is dependent on light intensity and surface area exposed. What was the effect of shielding more than 40% of the available skin surface on the effectiveness of phototherapy? What were the bilirubin levels in both groups? Was there a difference between the groups?
Influence of Transcutaneous Oxygen Monitoring on the Incidence of Retinopathy of Prematurity
Authors: Bancalari Eduardo , Flynn John , Goldberg Ronald N. , Bawol Richard , Cassady Janet , Schiffman Joyce , Feuer William , Roberts Jacqueline , Gillings Dennis , Sim Ellen
Published: December 2021

This study was performed to determine whether the use of continuous transcutaneous oxygen tension (tcPo2) monitoring could reduce the incidence of retinopathy of prematurity in preterm infants receiving oxygen therapy. A total of 296 infants with birth weights ≤1,300 g were randomly assigned to a continuous monitoring or a standard care group. Infants in the continuous monitoring group had tcPo2 monitored continuously as long as they required supplemental oxygen, and infants in the standard care group had tcPo2 monitored only during the more acute state of their illness. Management of both groups was otherwise identical. Of 148 infants in the continuous monitoring group, 101 survived; of the 148 patients in the standard care group, 113 survived. Mean birth weights and gestational ages were similar for both groups. Duration of mechanical ventilation and oxygen therapy was also similar. The overall incidence of retinopathy of prematurity was 51% in the continuous monitoring group and 59% in the standard care group. As birth weight for infants ≥1,000 g increased, a higher risk of retinopathy of prematurity developing was noted in the standard care group. Cicatricial retinopathy of prematurity developed in four infants in the continuous monitoring group and five in the standard care group. These results suggest that continuous tcPo2 monitoring may reduce the incidence of retinopathy of prematurity in infants with birth weights >1,000 g but not in the smaller infants in whom this complication occurs more frequently and is more severe.
Magnetic Resonance Evaluation of Disease of the Soft Tissues in Children
Authors: Cohen Mervyn D. , DeRosa G. Paul , Kleiman Martin , Passo Murray , Cory David A. , Smith John A. , McKinney Linda
Published: December 2021

Magnetic resonance imaging was a sensitive modality for identifying pathology in the soft tissues of 32 children, and it consistently showed more abnormality than CT. Magnetic resonance images are not histology specific, but with careful attention to the location of the abnormality, to the definition of the margins, and to the evaluation of involvement of adjacent muscle, bone, subcutaneous fat, and skin, the correct diagnosis can be strongly predicted in most cases. The ability of magnetic resonance to image in multiple planes aids in the evaluation of the extent of lesions and their relationship to adjacent structures. With magnetic resonance imaging, one can accurately predict the extent of abnormality, and there is great potential for the study of disease of soft tissues.
Hematuria and Hypercalciuria in Children With Diabetes Mellitus
Authors: Malone John I. , Lowitt Saul , Duncan John A. , Shah Shirish C.
Published: December 2021

Hematuria of unknown origin occurs in 30% of patients with diabetic nephropathy. In nondiabetic persons, hematuria may be caused by hypercalciuria with or without nephrolithiasis. Eight children with type I diabetes mellitus, hematuria, and hypercalciuria were observed in our clinic during a 1-year period. Two of these also had evidence of renal papillary necrosis. To assess the importance of hypercalciuria in the pathogenesis of hematuria in children with diabetes mellitus, we measured urinary calcium excretion in a large population of such patients. The calcium to creatinine ratio in the urine of diabetic children (0.21 ± 0.01) was greater than that of nondiabetic children (0.12 ± 0.01). A calcium to creatinine ratio of 0.28 was established as the upper limit of normal in our nondiabetic population, and 27% of the diabetic children were hypercalciuric on this basis. The diabetic children with hypercalciuria also had hyperphosphaturia and a urinary CaHPO4.2H2O molar ion product three times that found in the nondiabetic control population. These data suggest that many children with diabetes are at risk for renal damage due to hypercalciuria. Because hypercalciuria is more common in diabetic than nondiabetic children, it may play a previously unrecognized role in the renal disease associated with diabetes mellitus.
Effective Reduction of Lactose Maldigestion in Preschool Children by Direct Addition of β-Galactosidases to Milk at Mealtime
Authors: Barillas Carolina , Solomons Noel W.
Published: December 2021

We examined the efficiency of two β-galactosidase preparations—one derived from the yeast, Kluyveromyces lactis (Lactaid), the other derived from the fungus, Aspergillus oryzae (Takamine)—to assist the in vivo digestion of lactose consumed by healthy Guatemalan preschool children. Milk prehydnolyzed by in vitro incubation with enzymes was used as the standard of reference, and the degree of incomplete digestion of lactose from 240 mL of milk was determined using the hydrogen breath test. In in vivo dose-response studies, both 3,250 neutral lactose units of Lactaid and 6,635 food and chemical codex lactose units of Takamine completely eliminated excess H2 excretion in a small sample of lactose-maldigesting subjects. When evaluated in a controlled, clinical trial setting, the same dose of Lactaid added directly to the milk at consumption produced an 82% relative reduction in H2 excretion, whereas Takamine was equally as effective as the prehydrolyzed milk. Thus, intraluminal conditions and gastrointestinal transit in the preschool child support the effective assisted digestion of milk lactose in an efficient manner and with the same enzyme to milk ratios as observed previously in adults.
Acrodynia: Exposure to Mercury From Fluorescent Light Bulbs
Authors: Tunnessen Walter W. , McMahon Keven J. , Baser Michael
Published: December 2021

Medical attention was sought for a 23-month-old toddler because of anorexia, weight loss, irritability, profuse sweating, peeling and redness of his fingers and toes, and a miliarial rash. The diagnosis was mercury poisoning, and an investigation of his environment disclosed that he had been exposed to mercury from broken fluorescent light bulbs. Acrodynia resulting from fluorescent bulbs has not been previously reported.
'Athlete's Heart' in Prepubertal Children
Authors: Rowland Thomas W. , Delaney Brian C. , Siconolfi Steven F.
Published: December 2021

Bradycardia, cardiomegaly, heart murmurs, and ECG changes are typically observed in adult endurance athletes, but frequency of such changes among children involved in sports training is unclear. Pediatricians need to be aware of whether these features of the " athlete's heart" occur in their patients, because such features may mimic those of cardiac disease. Fourteen prepubertal competitive male swimmers were evaluated by physical examination, ECG and echocardiogram, and findings were compared to those of a group of active but nontrained control boys. Lower resting heart rates and echocardiographic manifestations of chronic left ventricular volume overload were observed among the swimmers. These changes were not manifest on physical examination, however, and no significant ECG alterations were identified among the athletes. These findings indicate that, although features of the athlete's heart are present in children involved in endurance training, seldom will these findings simulate heart disease or be apparent on routine clinical examination.
Detection of Congenital Cataracts and Other Ocular Media Opacities
Authors: Ruttum Mark S. , Nelson David B. , Wamser Mary Jo , Balliff Mark
Published: December 2021

Congenital cataracts and other ocular media opacities are a leading cause of preventable childhood blindness. Because of the importance of early recognition and treatment of congenital media opacities in newborn infants, we designed a study to determine the ability of relatively inexperienced examiners to detect such ocular abnormalities with either of two instruments. Eight third-year medical students examined eight children and young adults with ocular media opacities and eight age-matched normal subjects with an ophthalmoscope or a retinoscope. With respect to detection of abnormalities requiring referral to an ophthalmologist, there was an underreferral rate of 7% and overreferral rate of 5%. There was no significant difference between instruments. Based on an estimated incidence of congenital cataracts of 0.4%, the positive predictive value of this screening in the population of newborn infants is 18.7% and the negative predictive value is 99.96%. Therefore, overreferral is unavoidable in the effort to detect infants with congenital media opacities. We conclude that this examination can be easily taught and accurately performed with the readily available ophthalmoscope. The importance and technique of examining the red reflex should be stressed in the training of those caring for newborns.
Cerebrospinal Fluid Endorphins and the Infant Apnea Syndrome
Authors: ORLOWSKI JAMES P.
Published: December 2021

In Reply.—

Dr Southall is intimately aware of the problems with the performance of polysomnograms and their interpretation in normal babies and infants with apnea syndrome.1,2 Not the least of these problems is that the polysomnograms in our infants were performed in a sleep laboratory. The artificial and foreign environment of the laboratory might well be expected to alter not only the quality of sleep but also the occurrence of apneic and respiratory pauses in the study subjects.
Baby Walkers
Authors: RESTEL MARIANNE
Published: December 2021

To the Editor.—

Regarding the article "Patterns of Walker Use and Walker Injury" by M. J. Rieder et al (Pediatrics 1986;78:488-493), I certainly understand the motivation of Dr Rieder and co-workers leading to the study and their crusade against baby walkers (death of a 6-month-old infant involved in a walker-related accident). The article confirms previous thinking that serious accidents can occur to children in walkers.

However, in today's safety-conscious aura, I believe caretaker vigilance cannot be overemphasized.
Percutaneous Drainage of Splenic Abscess: Case Report and Review of Literature
Authors: RAMAKRISHNAN MANNACHANALLUR R. , SARATHY T. K. PARTHA , BALU MANI
Published: December 2021

Splenic abscess is an uncommon entity, reported in 0.14% to 0.70% of several autopsy series. Untreated, the mortality approaches 100%.1 When the diagnosis is made preopenatively and treated by antibiotics and splenectomy, there is a 17% mortality, but preoperative diagnosis was made only in 33% of the cases in one review.2 High degree of clinical awareness and aggressive diagnostic approach are essential for early diagnosis. percutaneous drainage of splenic abscess has been demonstrated to be a safe and effective method of treatment in adults in eight cases,3-5 without mortality or significant complications. We present the first pediatric age patient who was successfully treated by percutaneous drainage.
Aspirin Use and Reye Syndrome
Authors: KAUFFMAN RALPH E. , ROBERTS ROBERT J.
Published: December 2021

The search for causes of Reye syndrome has resulted in colorful, if not controversial, incrimination of numerous factors including influenza, varicella, environmental toxins, aflotoxin, inherited metabolic defects, and various medications. Attempts to associate salicylates with Reye syndrome date from the 1960s1-3; most of these reports lacked sufficient design, conduct, or controls to implicate or exclude aspirin as a risk factor. Since 1980, several epidemiologic studies4-6 renewed concern and controversy regarding the role of aspirin in Reye syndrome. As a result, a Public Health Service Task Force was formed which culminated in the Centers for Disease Control/National Academy of Sciences pilot study7 which was designed to address the problems and shortcomings identified in the previous efforts to examine the role of aspirin as a causal factor in Reye syndrome.
Breast-Feeding Is Protective
Authors: CUNNINGHAM ALLAN S.
Published: December 2021

To the Editor.—

Leventhal and colleagues1 opine that their "stratified results suggest that breast-feeding protects infants from hospitalization rather than from infections." Objective students of their data and a host of other studies would say that breast-feeding protects infants against hospitalization and infections.2-4 For example, the tenfold reduction in the risk of bacterial infections among their breast-fed infants was statistically significant (table 4), and breast-feeding was still superior in both subgroups after stratification according to the seriousness of illness (table 5).
Light, Sleep, and Development
Authors: GLASS PENNY , AVERY GORDON B.
Published: December 2021

In Reply.—

Sheldon and Bell express concern for the effect of uncycled nursery light on sleep state and biorhythms in infants. Their concerns seem well founded. A variety of evidence suggests that the effect of light exposure in the intensive care nursery goes beyond the potential for retinal damage.

For example, we found differences in sleep state for infants exposed to bright v dim ambient nursery light.1 Bright light was associated with significantly greater amounts of active-REM sleep.
State Reporting of Births of Infants Weighing Less Than 500 Grams
Authors: RAJU T. N.K.
Published: December 2021

To the Editor.—

The study of Wilson et al1 draws attention to an important epidemiologic issue related to an uncounted minority, extremely premature infants who weigh less than 500 g at birth. The problem of underreporting of vital events of this group has been recognized worldwide. Amazing varieties of criteria are used by various countries to determine viability and to judge the need for reporting.2 For example, note some of the interesting ones: "28 weeks of gestation" (Ireland, Czechoslovakia, France, and other European countries), "601 g birth weight," "if less than 1001 g weight, must live for 24 hours" (Poland), "a length of 30 cms" (Switzerland).
State Reporting of Births of Infants Weighing Less Than 500 Grams
Authors: WILSON ANN L.
Published: December 2021

In Reply.—

Dr Raju's remarks highlight the humane, epidemiologic, and financial issues related to this concern and the need for all who care for families during the perinatal period to be familiar with the reporting requirements of their states. Furthermore, ways such data may be standardized across states should be considered.
Childhood Pedestrian Injuries
Authors: CHANG ALBERT , GRIFFITH JOHN G.
Published: December 2021

To the Editor.—

We acknowledge the contribution of Rivara and Barber to the further definition of childhood pedestrian injuries (Pediatrics 1985;76:375-381). Their contribution is particularly noteworthy because pedestrian injuries are the leading cause of injury death in young school-aged children (5 to 9 years) in the United States.1

Their analysis of the socioeconomic factors associated with such injuries, however, lacks essential data to enable injury investigators to arrive at their conclusions: that the number of child pedestrian injuries are higher in children of low socioeconomic status and/or from ethnic minority families.
National Patterns of Aspirin Use and Reye Syndrome Reporting, United States, 1980 to 1985
Authors: Arrowsmith Janet B. , Kennedy Dianne L. , Kuritsky Joel N. , Faich Gerald A.
Published: December 2021

The number of cases of Reye syndrome reported annually to the Centers for Disease Control declined markedly between 1980 and 1985. In this article, we present pharmaceutical marketing research data that suggest sharp decreases in the use and purchase of children's aspirin between 1980 and 1985. These trends appear to correspond to the decrease in reporting of Reye syndrome cases. Additionally, analysis of physician mentions of aspirin and acetaminophen for treating flu and chickenpox showed statistically significant trends toward decreasing recommendations for the use of aspirin and significant trends toward increasing recommendations for use of acetaminophen. Trends in wholesale purchases of aspirin and acetaminophen by drug stores from 1979 through 1985 demonstrated a significant decline for the 81-mg children's aspirin tablet and an increase in purchases of children's acetaminophen products. Many factors may influence physician and parents' choice of analgesic/antipyretic medication, including information about Reye syndrome. Data suggest that a continuing decline in the use of aspirin for children may be accompanied by a continuing decline in the reported number of Reye syndrome cases.
Congenital Malignant Melanoma
Authors: Prose Neil S. , Laude Teresita A. , Heilman Edward R. , Coren Charles
Published: December 2021

A 6-week-old girl with congenital melanoma of the skin is reported and the literature is reviewed. We believe this to be the first case of congenital melanoma in a black infant who had no underlying giant melanocytic nevus. Because of the significant relationship between the early treatment and prognosis of malignant melanoma, we wish to alert pediatric clinicians to the existence of this rare congenital neoplasm.