bluuebunny/crossref_metadata_2025 huggingface dataset:
Neonatal Hyperviscosity Association With Lower Achievement and IQ Scores at School Age
Authors: Delaney-Black Virginia , Camp Bonnie W. , Lubchenco Lula O. , Swanson Carol , Roberts Loretta , Gaherty Patricia , Swanson Barbara
Published: December 2021

A longitudinal study was conducted to determine whether the early neurologic and motor impairment observed in children with neonatal polycythemia and hyperviscosity persisted into school age. Forty-nine children who had neonatal polycythemia and hyperviscosity were evaluated at a mean age of 7 years. Of these, 21 (group 1) received a partial plasma exchange transfusion, whereas 28 (group 2) received symptomatic care. Forty control children (group 3) with a normal neonatal hematocrit were also evaluated. Testing consisted of a battery of measures to evaluate IQ, achievement, neuromotor function, and gross and fine motor skills. Maternal education and IQ were also assessed to avoid potential confounding by differences in the home environment. The neonatal course of the children with polycythemia and hyperviscosity was characterized by an increased number of problems, including hypoglycemia and cyanosis. At 7 years of age, the 49 children who had hyperviscosity (groups 1 and 2) had significantly lower "spelling" and arithmetic achievement test results and gross motor skill scores. Scores for reading, visual motor integration, and neurologic signs did not differ significantly from group 3. Maternal IQ scores were similar for both groups. Left-hand preference was seen in 14% of group 1 and 2 children and 7% of group 3 children (not significant). The scores for IQ, achievement, neuromotor function, and visual motor integration were compared for the hyperviscosity group (groups 1 and 2) and the control group (group 3) by multivariate analysis of variance with sex and hyperviscous group as independent variables and maternal education and maternal IQ as covariates (P = .040). Univariate F tests were significant for IQ (P = .002), arithmetic achievement (P = .026), and reading achievement (P = .034). Two of group 1, and 5 of 28 group 2 children were left-handed (not significant). Better left-hand skills were shown in the fine motor scores for group 1, however (P < .02). Additionally, although both groups were examined at a comparable age, the school grade achieved by group 1 was significantly higher (P < .005). These results suggest that the sequelae associated with neonatal polycythemia and hyperviscosity, although subtle, persist into school age. The etiology of these abnormalities is not clear. The small differences previously observed between the group that received an exchange transfusion and the group that did not persisted.
Daily Single-Dose and Daily Reduced-Dose Prednisone Therapy for Children With the Nephrotic Syndrome
Authors: Warshaw Barry L. , Hymes Leonard C.
Published: December 2021

Most current reference sources recommend that initial therapy for minimal lesion nephrotic syndrome consist of prednisone, 60 mg/m2 per 24 hours or 2 mg/kg per 24 hours, given in divided doses, and that this regimen be repeated for each relapse. The need for divided-dose daily-administered prednisone is predicated on anecdotal observations that single-dose daily administration is not effective. Because single-dose daily-administered and reduced-dose daily-administered prednisone has been used to treat this condition for several years, experience with these regimens in nephrotic children was analyzed. Forty-one patients were studied, including 22 treated from the onset of their disease. Of these 22, 17 (77%) responded to single-dose daily-administered prednisone (2 mg/kg); after subsequent biospy, each of the nonresponders proved to have lesions other than minimal change disease. The mean response time with single-dose daily-administered prednisone (9.6 days for treatment of the initial onset of nephrotic syndrome and 11.1 days for treatment of relapses) was comparable to that previously reported with divided-dose regimens. In 14 patients with frequent relapses, a single reduced-dose daily-administered dose of prednisone (0.2 to 1.5 mg/kg/d) successfully induced remissions in 55 of 63 relapse episodes. It is concluded that a single morning dose of prednisone effectively induces remission in children with minimal lesion nephrotic syndrome. Among selected patients with frequent relapses, additional steroid sparing may be achieved by the use of this regimen with reduced doses during treatment of relapses.
Perioperative Factors Affecting the Outcome Following Repair of Biliary Atresia
Authors: Lally Kevin P. , Kanegaye John , Matsumura Mitsuyoshi , Rosenthal Philip , Sinatra Frank , Atkinson James B.
Published: December 2021

The records of all patients with biliary atresia seen at the Childrens Hospital of Los Angeles during a 14-year period were reviewed. Of the 41 patients who could be evaluated, 32 were treated with trimethoprim and sulfamethoxazole prophylaxis, five were given other agents, and four received no prophylaxis after surgery. At least one episode of cholangitis occurred in nine patients. With one exception, all patients destined to have cholangitis did so within 9 months of surgery. Of the nine patients, five were receiving prophylaxis at the time the disease developed, but two were no longer receiving any prophylaxis. The other two patients in whom cholangitis developed never received antibiotic prophylaxis. In the 24 patients who had a Kasai type of portoenterostomy, cholangitis developed in three of the five (60%) with a Roux-en-Y limb length < 40 cm and in two of the 19 (10.5%) with limb lengths > 40 cm (P < .02). When performed earlier than 61 days after birth, surgery resulted in adequate bile flow in 64.7% (11/17) of patients who could be evaluated as compared with 31.8% (7/22) for surgery at 61 days or later (P < .05). Of the patients with adequate biliary drainage 11 had no apparent liver disease, but only two of the patients with poor drainage were free of clinical liver disease. The conclusion from this series is that a combination of timely surgery, intestinal conduit at least 40 cm in length, and subsequent long-term antibiotic prophylaxis favors the best bile flow and reduces the occurrence of cholangitis, resulting in the best outcome.
Lavage Treatment of Distal Intestinal Obstruction Syndrome in Children With Cystic Fibrosis
Authors: Koletzko Sibylle , Stringer David A. , Cleghorn Geoffrey J. , Durie Peter R.
Published: December 2021

The efficacy, adverse reactions, and long-term effects of intestinal lavage treatment with a balanced electrolyte solution (Golytely) was evaluated in patients with cystic fibrosis and distal intestinal obstruction syndrome. Twenty-two patients with cystic fibrosis (mean age 21.8 years, range 14 to 34 years, 15 boys or men) who sought medical attention because of abdominal pain and a mass in the right iliac fossa received Golytely, 5.6 ± 1.9 L (mean ± 1 SD), either orally (n = 14) or via nasogastric tube (n = 8) during 5.6 ± 2.4 hours. No serious side effects occurred. Serum electrolyte values remained within normal limits. Body weight did not change significantly. Minor adverse reactions included bloating (n = 12), nausea (n = 8), vomiting (n = 1), and chills (n = 3). All but one patient reported impressive relief of symptoms and remained pain free for an average of 3 months (range 1 to 19 months). Symptoms of abdominal pain and radiologic signs of fecal impaction assessed before and after lavage both decreased significantly (P < .0001). During follow-up (mean 15.2 months, range 4 to 26 months), 11 patients required a total of 38 (range one to nine) additional doses of Golytely. Seven patients drank the solution at home (21 treatments); only two patients chose a nasogastric tube. In ten patients with symptoms of recurrent distal intestinal obstruction syndrome prior to institution of therapy, duration of hospitalization was significantly reduced by this treatment (5.1 ± 7.6 v 2.3 ± 6.3 hospital days per annum, P < .02). It is concluded that intestinal lavage is a well-accepted, safe, and effective therapy for distal intestinal obstruction syndrome in patients with cystic fibrosis.
Liquid-Crystal Thermometer Use in Pediatric Office Counseling About Tap Water Burn Prevention
Authors: Katcher Murray L. , Landry Gregory L. , Shapiro Mary Melvin
Published: December 2021

Tap water scald burns are an important topic of injury prevention in pediatricians' offices. Consecutive pediatric clinic clients, randomized to two groups, received an informational pamphlet, a one-minute discussion about tap water safety, and a baseline questionnaire. The first group also received a liquid-crystal thermometer for testing maximum hot tap water temperature. One month later in a follow-up telephone interview (n = 503), the impact of the added thermometer on knowledge regarding scalding, temperature testing, and thermostat lowering was assessed. Approximately 80% of each group read the pamphlet. Reading the pamphlet was associated with greater temperature testing in the thermometer (T) group but not in the pamphlet only (P) group. Temperatures were checked by 46.4% of the T group but by only 23.0% of the P group (P < .001). In the households in which the reported water temperature exceeded 54.4°C (130°F) and the water heater was accessible, 77.3% reported lowering the setting, independent of receiving the thermometer. The reliability of selfreported water temperature was assessed after 1 year by home visits. The use of relevant facilitating devices, such as a liquid-crystal thermometer, in-office anticipatory guidance efforts may increase behavioral compliance.
High Incidence of Upper Gastrointestinal Tract Involvement in Children With Crohn Disease
Authors: Lenaerts C. , Roy C. C. , Vaillancourt M. , Weber A. M. , Morin C. L. , Seidman E.
Published: December 2021

This retrospective study of Crohn disease in 230 children and adolescents with a mean age of 12.5 years at the time of diagnosis and an average follow-up of 6.6 years showed that 30% had lesions of the esophagus, stomach, and duodenum. Three patients had Crohn disease isolated to the upper gastrointestinal tract. The 169 patients with both small and large bowel disease were at greater risk (33%, P < .05) of having upper gastrointestinal lesions than the 37 with isolated small bowel disease and the 21 with disease limited to the colon and/ or rectum. An aggregate of symptoms and signs more likely present in those with upper gastrointestinal involvement included: dysphagia, pain when eating, nausea and/or vomiting, and aphthous lesions of the mouth. Furthermore, weight loss was more severe and hypoalbuminemia more frequent. Because upper gastrointestinal series x-ray studies failed to detect upper gastrointestinal lesions in 13 patients of 69 of those with upper gastrointestinal disease, endoscopy should be considered in all children and adolescents in whom a diagnosis of Crohn disease is entertained. Endoscopy and biopsy of the upper gastrointestinal tract should be done in any patient with symptoms suggestive of proximal involvement. Finally, in view of the fact that endoscopy established the diagnosis of Crohn disease in five patients previously thought to have chronic ulcerative colitis, the procedure should routinely be performed in all patients with chronic ulcerative colitis or indeterminate colitis before surgery is performed.
sANOTHER FIRST PLACE
Authors: Student
Published: December 2021

American teen-agers have the highest rate of abortion in the developed world, double that of teen-agers in most European counties . . . 4.4 percent of women aged 15-19 had abortions every year.
Occult Core Hyperthermia Complicating Cardiogenic Shock
Authors: BUCK SCOTT H. , ZARITSKY ARNO L.
Published: December 2021

Cardiogenic shock severely limits tissue perfusion. Conventional therapy of cardiogenic shock is directed at increasing cardiac output; however, decreasing oxygen demand by recognition and control of core (central thoracic) hyperthermia is also helpful. Core hyperthermia complicating cardiogenic shock has been reported in adults but not in children. In the last year, we treated three children with cardiogenic shock in whom core temperature was much higher than rectal temperature. Without central temperature measurement, this occult core hyperthermia would not have been recognized or treated. Treatment of core hyperthermia combined with standard therapy (mechanical ventilation, inotropes, and vasodilators) resulted in long-term survival of all patients.
Streptococcal Pharyngitis Study
Authors: READ JENNIFER S. , BEEKMAN ROBERT H.
Published: December 2021

Redd and co-workers found the sensitivity of their rapid diagnostic test for group A streptococcal pharyngitis to be 62.8% and its specificity to be 96.9%. Furthermore, the positive predictive value of the test was determined to be 91.5%, sufficiently high to significantly influence the care provided to their patients.

We strongly disagree with the authors' conclusion that their findings can be extrapolated to the general pediatric setting. Bayes theorem clearly relates a test's positive predictive value to its sensitivity as well as to the prevalence of true disease in the population.
Newborn Screening for Sickle Cell Disease: Effect on Mortality
Authors: Vichinsky Elliott , Hurst Deborah , Earles Ann , Kleman Klara , Lubin Bertram
Published: December 2021

Newborn screening for sickle cell disease has been recommended as a method of decreasing patient mortality. However, its effectiveness in accomplishing this has not been reliably measured. To help determine the effectiveness, 10 years of experience in newborn screening have been summarized. The effects of early patient enrollment in a comprehensive treatment program on long-term morbidity and mortality are reported. From 1975 to 1985, 84,663 newborns were screened regardless of race or ethnic background. Hb Bait's was present in 5%, hemoglobin AS in 2.6%, and hemoglobin AC in 0.75%. Excluding Bart's, approximately 3.6% of all newborns were carriers for hemoglobinopathy. Sickle cell disease occurred in 1:951 births (58 Hb 55, 25 Hb FSC, three Hb S-β+-thalassemia, and three Hb S-β°-thalassemia). In addition, one in every 4,233 newborns had a clinically significant thalassemia syndrome (eight Hb FE, ten Hb F only, two Hb H). Compared with other newborn screening programs in California (congenital hypothyroidism, 1:3,849; phenylketonuria, 1:22,474; galactosemia, 1:74,103), hemoglobinopathies are the most prevalent congenital disease. Eighty-one newborns with sickle cell disease were followed up for 7.2 years. Patients experienced 513 hospitalizations, including 13 episodes of sepsis with or without meningitis and ten acute sequestration crises. The overall mortality rate for patients with sickle cell anemia diagnosed in the newborn period was 1.8%. In comparison, the clinical course of 64 patients with sickle cell anemia diagnosed after 3 months of age and followed up for an average of 9.4 years was analyzed. Five of these patients died. In two of these, sickle cell anemia was diagnosed at the time of the death. Overall mortality rate in this group was 8%. In summary, the data indicate that newborn screening, when coupled with extensive follow-up and education, will significantly decrease patient mortality.
Experience With Newborn Screening Using Isoelectric Focusing
Authors: Kleman Klara M. , Vichinsky Elliott , Lubin Bertram H.
Published: December 2021

Electrophoretic techniques are used for hemoglobinopathy diagnosis. Confirmation of the hemoglobin variants is necessary. Currently, citrate agar electrophoresis is the most available, but high performance liquid chromatography is highly recommended in a reference laboratory.

Thin layer isoelectric focusing is an excellent technique that can be easily adapted for large-scale newborn hemoglobinopathy screening. Although the initial instrument cost can be about twice as much as the cost for standard electrophoretic equipment, cost-effectiveness for newborn screening is considerable because repeat analysis for uninterpretable results is not necessary. Resolution of hemoglobins is much better with thin layer isoelectric focusing than for any of the other electrophoretic methods currently available, and thin layer isoelectric focusing is the best method to use to establish a definitive diagnosis using newborn blood samples. Cord blood samples may be contaminated with maternal blood, and evaluation of Hb A2 levels in such samples can serve as the method to detect contamination. Follow-up testing is required regardless of the method of blood collection.
Alternative Methods for Screening
Authors: Garrick Michael D.
Published: December 2021

Alternative methods (Fig 1) are already available for screening newborns for hemoglobinopathies. When choosing among the methods, one should remember three aims: (1) to identify Hb S; (2) to detect when Hb A is absent, suggestive of an S/S homozygote or a double heterozygote for S/β°-thalassemia or for S/C or S/another β-globin variant; and (3) to screen for other potentially pathologic states. (Double heterozygosity for S/β+-thalassemia is also important to detect, for example.) Detection of β-thalassemia major by newborn screening would be useful but is not yet reliable.

SPECIMENS

Blood

Both liquid (anticoagulated) blood and dried blood spots have been used. Liquid blood is easier to hemolyze, but dried blood spots are much easier to mail and store. Dried blood spots are already used in most states to screen for other disorders.

Age

In most states, a newborn capillary blood sample is obtained by heel puncture before the baby leaves the hospital to screen for phenylketonuria (and often for other disorders such as hypothyroidism). Cord blood, however, can be obtained in larger volume and is less likely to be contaminated by transfusion but more likely to be contaminated by maternal blood. I prefer the newborn specimen because of the advantages of coordinating screening programs both for thorough population coverage and for economic savings at several levels. In a coordinated screening program for multiple disorders, hemoglobinopathy screening may help in recognizing specimens from infants in whom a transfusion has taken place but the time the specimen was taken for screening has not been noted.
Selected Testing of Newborns for Sickle Cell Disease
Authors: Ohene-Frempong Kwaku
Published: December 2021

There are two main reasons for sickle cell testing: the early detection of those with sickle cell disease and the detection of the carrier state, sickle cell trait. The mortality of the severe forms of sickle cell disease is particularly high during the first 5 years of life. Recent data have shown that early detection of sickle cell disease and institution of expert medical care and follow-up may reduce early mortality and morbidity. The ability to detect most forms of sickle cell disease in the newborn period has made the goal of preventive care theoretically possible.

The purpose of the detection of the carrier state, sickle cell trait, is less clear. Sickle cell trait has almost no clinical importance to the individual. Although a few case reports have suggested that sickle cell trait may not be a benign condition, most experts agree that sickle cell trait does not significantly alter health or disease. The main purpose of carrier testing is for genetic counseling. Mass screening of African Americans for sickle cell trait was advocated in the 1960s. However, no data have shown that results of such screening have had any impact on reproductive planning.

Ideally, sickle cell testing should provide the following results. All newborns with various forms of sickle cell disease should be diagnosed by 3 months of age, before the onset of clinical problems. All heterozygotes for the βs-globin gene, or the genes for other hemoglobinopathies that may combine with βs gene to produce clinically significant forms of sickle cell disease, should be aware of the relevant genetic information at childbearing age.
Parental Receptivity to Neonatal Sickle Trait Identification
Authors: Rowley Peter T.
Published: December 2021

The demonstration that penicillin prophylaxis and early entry into programs of comprehensive care can reduce morbidity and mortality from infection has precipitated widespread discussion of the desirability of neonatal screening for sickle hemoglobin. However, the blood test that detects sickle cell disease also detects carriers of sickle cell disease and other abnormal hemoglobins. Is informing parents that their newborn has sickle trait beneficial?

The possible benefits of sickle trait identification at birth are twofold. The first is the education of the child of the significance of sickle trait when older. However, the time lapse makes its realization uncertain. The second is the identification of reproducing couples at risk for having a child with sickle cell disease. We have attempted to evaluate this second possible benefit. Its realization requires determining which newborns (about one in 12) have both parents as hemoglobinopathy carriers.

METHODS

In Rochester, NY, we are conducting a hemoglobin screening program to study the benefits and burdens of carrier identification. Although our primary focus has been detection during pregnancy, we have collected some data concerning the consequences of newborn detection. My office is specifically charged by the New York State Health Department to notify parents of newborns with sickle trait in the nine-county area surrounding Rochester. The mothers of newborns with sickle trait were seen for this reason between August 1983 and February 1987. The demographic data were collected from the whole group. The knowledge data (Table) were collected from an unselected subset of 30 of these mothers.
CARE OF INFANTS WITH DISEASE: THE ULTIMATE OBJECTIVE OF NEWBORN SCREENING
Authors: Brown Audrey K. , Miller Scott T. , Agatisa Patricia
Published: December 2021

We conclude that newborn screening with a comprehensive follow-up program, emphasizing parental education and the use of penicillin prophylaxis, is effective in reducing morbidity and mortality from pneumococcal infections in infants with sickle cell disease. One of the 159 infants followed-up during 1981 to 1986 died as a result of overwhelming sepsis. This compares with an anticipated mortality rate at that time of 10%.

Penicillin prophylaxis should be started at 3 months of age in infants with Hb SS and should also be given to infants with hemoglobin SC and S- β-thalassemia. The duration for which prophylaxis must be given is not known, but it should be continued at least through the age of 5 years. Monthly injections of benzathine penicillin is an inadequate regimen; we recommend that, if penicillin is to be administered by the intramuscular route, it should be given every 3 weeks and supplemented in the last week with oral penicillin. However, we now emphasize that the daily oral administration of penicillin is the preferred method of administration for prophylaxis.

Pneumococcal vaccine continues to be given at 2 years of age, with a booster dose recommended at 4 to 5 years of age. H influenzae vaccine conjugates are immunogenic when given at 18 months, and newer vaccines may soon be available that can be given much earlier.

Finally, and most important, the program must be structured in such a way as to thoroughly involve the parents in assuming responsibility for their child's continued health and well being.
Social Work Perspective
Authors: Hernandez Sandra
Published: December 2021

The ultimate objective of newborn screening for sickle cell disease should be twofold. The first essential step is the identification of the infants at risk. This has been effectively done in New York state as of 1975 through the New York State Newborn Screening Program. However, identifying these children is not enough. Second is the much more complicated task of providing comprehensive follow-up care for families whose children are affected by the disease, including the much needed psychosocial services. This area continues to be sorely neglected.

The increased risk of death due to overwhelming infection in the first 3 years of life for children with sickle cell disease has been noted in the literature. When there is no specialized care, 15% to 20% do not survive. Therefore, it is essential for knowledgeable staff to make contact and begin to develop a trusting relationship as soon as possible with parents of infants born with sickle cell disease. Prophylactic penicillin and pneumococcal vaccination can reduce mortality during the early years. Family involvement with a consistent, available team of health care providers is pivotal in understanding this chronic illness and coping effectively with this extraordinary stress. Our staff is available by telephone for consultations with patients or other medical staff during clinic and emergency room visits and hospitalizations.

One element that is clear in our experience at the St Luke's-Roosevelt Hospital Sickle Cell Center in New York City is that adjustment to this chronic illness is a lifelong process. One or two counseling sessions at the time of diagnosis are not sufficient to enable families to fully understand the information given or to realize the impact of having a child with a chronic illness.
Survey of Comprehensive Centers for Sickle Cell Disease
Authors: Scott Roland B.
Published: December 2021

The ten National Institutes of Health-supported centers are currently involved in screening newborn infants for sickle cell disease. Early detection or sickle cell disease, institution of penicillin prophylaxis to start no later than 3 months of age, and follow-up in a comprehensive health program are essential for significant reduction in morbidity and mortality that is due mainly to intercurrent potentially lethal infections such as pneumonia, sepsis, and meningitis. Tracking patients and at-risk individuals for follow-up management and counseling have been identified as problems. Certain socioeconomic and environmental factors impact upon the solution to these problems. Finally, additional research will be required to determine how long penicillin prophylaxis should be continued to provide adequate control of potentially serious and lethal infections. A special study to address this need is being inaugurated by the National Institutes of Health.
HOW TO PROLONG LACTATION IN MOTHERS OF VLBW INFANTS
Authors: Student
Published: December 2021

We have carried out a randomised trial [of skin to skin contact with their mothers] among babies of less than 1500 gm . . . Mothers using skin to skin contact lactated for four weeks longer on average than the control group . . . [This maneuver] can enjoyably be offered to very low birthweight infants especially in developing countries where mother's lactation is vital.
AS DEVELOPMENT SLOWS, CHILDREN DIE
Authors: Student
Published: December 2021

Half a million children died last year because families in the developing world are sliding back into severe poverty after 40 years of progress.

According to the Unicef report, more than 14 million children under 5 years old died in 1987. The estimate that at least half a million of those deaths could be attributed to "the slowing down of the development process in the 1980's" was based on trends in 16 third-world countries where there has been "a definite slowing down" in the 1980's in the rate of decline in child mortality.
NOT-SO DISPOSABLE DIAPERS
Authors: Student
Published: December 2021

For more than a decade, the disposable diaper has been a symbol of contemporary child care. Today it is emerging as a symbol of the nation's garbage crisis.

More than 16 billion diapers, containing an estimated 2.8 million tons of excrement and urine, are dumped each year into a dwindling number of landfills around the nation. Like almost everything else in landfills, the diapers' impact on public health and the environment is unknown.

It's a perfect case where we're using a disposable product that costs more than a re-usable product, is more environmentally dangerous and uses up nonrenewable resources.
DON'T BOTHER ME WITH THE FACTS..
Authors: Student
Published: December 2021

I know that most men, including those at ease with problems of the greatest complexity, can seldom accept even the simplest and most obvious truth if it be such as would oblige them to admit the falsity of conclusions which they have delighted in explaining to colleagues, which they have proudly taught to others, and which they have woven, thread by thread, into the fabric of their lives.
Human Herpesvirus-6 Infection (Exanthem Subitum) Without Rash
Authors: Suga Sadao , Yoshikawa Tetsushi , Asano Yoshizo , Yazaki Takehiko , Hirata Shoji
Published: December 2021

Two patients with a three-day febrile episode in whom exanthem subitum was expected showed no appearance of skin eruption after subsidence of the fever. Virus was isolated from peripheral blood mononuclear cells in the acute stage, which was identified by the cytopathic effects of infected cells and the specific immunofluorescent staining of the cells with convalescent sera from exanthem subitum, but the virus could not be isolated from those in the convalescent stage. The morphology of the virus was similar to herpes group virus. There were seroconversions against representative strain of the causative agent of exanthem subitum in the two patients. The results indicated the presence of atypical clinical course of exanthem subitum.
Severe Acute Asthma in a Pediatric Intensive Care Unit: Six Years' Experience
Authors: Stein Renato , Canny Gerard J. , Bohn Desmond J. , Reisman Joseph J. , Levison Henry
Published: December 2021

The management of children with severe acute asthma who required admission to the intensive care (ICU) of this hospital during 1982 to 1988 was reviewed retrospectively. A total of 89 children were admitted to the ICU on 125 occasions. During the study period, 24% of the patients were admitted to the ICU on more than one occasion. Prior to admission to this hospital, patients had been symptomatic for a mean of 48 hours. Although all patients had received bronchodilators before admission to hospital, only 23% of patients had received oral corticosteroids. According to initial arterial blood gas values determined in the ICU, 77% of the patients had hypercapnia (PaCO2 >45 mm Hg). The pharmacologic agents used in the ICU included nebulized β2agonists (100% of admissions), theophylline (99%), steroids (94%), nebulized ipratropium bromide (10%), IV albuterol (38%), and IV isoproterenol (10%). Mechanical ventilation was necessary in 33% of admissions; the mean duration of ventilation was 32 hours. Ten patients had pneumothorax; in six cases, these were related to mechanical ventilation. Three of the patients who received mechanical ventilation died, representing a mortality of 7.5%. In each of these patients, sudden, severe asthma episodes had developed at home, resulting in respiratory arrest. They had evidence of hypoxic encephalopathy at the time of admission to the ICU and eventually were declared brain dead. It was concluded that delay in seeking medical care and underuse of oral corticosteroids at home may have contributed to the need for ICU admission. The mortality and morbidity for children with severe asthma who require ICU admissions are small, provided that bronchodilators and IV steroids are used optimally and that patients who require mechanical ventilation are carefully selected.
Bilirubin and Brain Damage: What Do We Do Now?
Authors: NEWMAN THOMAS B. , MAISELS M. JEFFREY
Published: December 2021

In many ways, the study reported by van de Bor and her colleagues has a message akin to the classic telegram: "Bad news. Start worrying. Details to follow." Perhaps we should start worrying about low levels of bilirubin in very low birth weight infants, but it is premature to do anything else, other than wait for the critical details that might dictate a change in current practice.

Compared with similar previous investigations, this study has several strengths. First, the sample of 831 surviving infants includes many more very low birth weight infants than previous studies. Second, follow-up evaluations were performed on 100% of the surviving children—a truly remarkable achievement.
Hypoallergenic Infant Formulas
Authors:   COMMITTEE ON NUTRITION
Published: December 2021

Antigenic constituents of human milk or of alternative feedings for infants may be responsible for adverse reactions in a subset of infants with milk protein intolerance. These reactions include those commonly associated with atopy, such as angioedema, urticaria, wheezing, vomiting, and eczema. Pulmonary hemosiderosis, malabsorption with villous atrophy, and eosinophilic enterocolitis, perhaps mediated by immune complexes or T cells, have also been associated with the ingestion of cow's milk proteins and/or soy proteins in infant feedings. Colic, sleeplessness, and irritability are symptoms seen in almost all infants at some time during infancy, including those few infants with immune-mediated reactions to dietary antigens.

Determining that adverse reactions are, in fact, immune mediated is often difficult and is accomplished by an in vivo challenge with the potential offending antigen, together with in vitro confirmation of immunoreactivity to the challenge antigen. Double-blind challenge with purified dietary antigens is useful in relating symptoms to a specific antigen, but the results may be difficult to interpret if the appearance of symptoms is delayed beyond several hours in a young infant. In vitro testing is compromised by the presence of some form of immunoreactivity, such as hemagglutinating antibodies, to dietary antigens in a large percentage of infants without symptoms and by lack of standardization of clinical tests for cell-mediated reactions to dietary antigens.

Much effort also has been devoted to predicting in which infants immune-mediated reactions to dietary proteins will develop in advance of their introduction into the diet. Increased cord blood IgE concentrations and parental history of atopy place an infant at highest risk for atopic disease during infancy and early childhood.
In Reply: Sample Sexual Assault Data Sheet
Authors: SCHONBERG S. KENNETH
Published: December 2021

The Committee appreciates the comments of Drs Emans and Paradise. Their suggestions for altering the "Sample Sexual Assault Data Sheet" are both thoughtful and appropriate. That data sheet was, as stated, meant to be a sample to be adjusted to local circumstances, improvements in therapy, and the experience and reason of other health professionals. The inclusion within the data sheet of places for documenting repetitive and chronic sexual abuse, notation of transfer of evidence to the police, and the method used to detect Chlamydia would seem worthwhile improvements.
Hyperbilirubinemia in Preterm Infants and Neurodevelopmental Outcome at 2 Years of Age: Results of a National Collaborative Survey
Authors: van de Bor Margot , van Zeben-van der Aa Thea M. , Verloove-Vanhorick S. Pauline , Brand Ronald , Ruys Jan H.
Published: December 2021

As part of a prospective national survey of preterm and small for gestational age infants in the Netherlands, the relationship between maximal serum total bilirubin concentration in the neonatal period and neurodevelopmental outcome at the corrected age of 2 years was studied. Initially, 1,338 infants with a gestational age of less than 32 completed weeks and/or a birth weight of less than 1,500 g were enrolled in the study; 146 were subsequently excluded because of congenital malformations and 361 died during the study period. At the corrected age of 2 years, 831 children were available for follow-up. Children with minor and major handicaps had significantly greater maximal serum total bilirubin concentrations than children with a normal neurodevelopmental outcome (P = .02). A consistent increase in prevalence of handicaps was found for each 50-µmol/L (2.9 mg/dL) increase of maximal serum total bilirubin concentration. The handicaps consisted mainly of cerebral palsy. Logistic regression analysis involving seven suspected confounding factors (gestational age, birth weight, seizures, intracranial hemorrhage, respiratory distress syndrome, ventriculomegaly, and bronchopulmonary dysplasia) revealed that the odds ratio was 1.3. This indicates that, on a multiplicative scale, the risk of a handicap increased by 30% for each 50-µmol/L (2.9 mg/dL) increase of maximal serum total bilirubin concentration (P = .02). Further analysis treated bilirubin as a categorized exposure. A striking systematic increase was found, suggesting a causal relationship between maximal serum total bilirubin concentration and neurodevelopmental outcome.
Semipermeable Polyurethane Membrane as an Artificial Skin for the Premature Neonate
Authors: Knauth Alison , Gordin Margaret , McNelis Wendy , Baumgart Stephen
Published: December 2021

A thin and semipermeable polyurethane membrane adherently applied to premature neonates as an artificial skin was investigated as an atraumatic surface barrier sufficient to reduce transepidermal water loss without inhibiting natural infant skin development during the first few days of life. A sample group of 18 neonates (birth weight [mean ± SEMI] 1.39 ± 0.12 kg, gestation [mean ± SEMI] 31 ± 1 weeks) received two 3 x 3-cm polyurethane patches adherent over the chest and abdomen. Transepidermal water loss was measured before and after application and after membrane removal. During longitudinal study, seven infants were treated day 1 through day 4 of life and were evaluated for skin integrity 24 hours after patch removal on day 5. Polyurethane membranes produced an acute and significant reduction in transepidermal water loss for the 18 subjects: 21.1 ± 2.0 g/m2/h before application v 10.5 ± 1.4 g/m2/h with membranes in place (P < .001). Immediately after patch removal, transepidermal loss returned to 22.8 ± 3.0 g/m2/h. Throughout the first four days of life, daily measurements of water loss were significantly less: 53% to as much as 72% reduction from polyurethane-covered sites when compared with adjacent naked skin. After polyurethane membrane removal, skin development of transepidermal barrier function was comparable over both sites. Dressings did not lose adhesive or plastic properties during an extended time in either radiant warmer or incubator environments, electronic monitoring through membranes was not impeded, and adhesive injuries were not observed. An adherent, semipermeable polyurethane membrane may be effective as an atraumatic artificial barrier to prevent large transepidermal water loss and protect the skin of the premature neonate.
POLAR BEAR'S SECRET
Authors: L. J. F.
Published: December 2021

Polar bears can remain active throughout the year in air temperatures that range from +25°C to -50°C. Eskimos have long known that polar bear fur is both warm and hard-wearing, but exactly how it is so effective has recently been the subject of fierce debate. The outer hairs are straight and tough: over most of the body, they stand erect like a brush over the dense, woolly underfur. Snow does not melt on the outer hairs although the skin feels warm to the touch—cold hands soon warm up if you bury them in the bear's fur. The long, straight outer hairs of polar bear pelt are hollow—as are those of deer—and their white colour arises from light scattering within the hair shaft, not from the presence of a pigment. Much of the visible and infrared light from the Sun is transmitted through the fur and is absorbed by the skin, which is black. All black bodies radiate heat when warm, and polar bear skin is no exception, but the heat does not escape because the white hairs reabsorb it. This recycled warmth heats up the thick layer of air trapped around the wooly underfur, which insulates the body from cooling by conduction and convection of heat to the cold wind around it. Thus on sunny days, the long outer hair enable bears to use solar radiation as well as body heat for warming their underfur. The mechanism is so effective that sometimes the skin is warmer than the middle of the body, even when the air temperature is well below zero. Resting or slowly moving bears lose so little heat across their surface that they are difficult to locate using infrared thermal imaging apparatus. Indeed, from a distance, the only detectable heat is a little patch in front of the nose—the bear's expired breath.
AIDS and Doctors
Authors: M. R. J.
Published: December 2021

Santa Monica, CA—. . .While there isn't a single documented case of a patient catching acquired immune deficiency syndrome from a doctor or other healthcare worker, medical caregivers with AIDS—and those who have tested positive for the AIDS virus but don't have the disease—raise difficult and sensitive questions for the medical community. The central question: whether these people should continue to treat and maintain contact with patients. "What you have are fundamental ethical issues of fairness, justice and moral responsibility," says Ronald Bayer, a Columbia University bioethics professor. . .

As of last September 3, 182 health-care workers were known to have AIDS, including 356 physicians, according to the US Centers for Disease Control. . . most hospitals that have discovered an attending physician or health-care worker with AIDS do try to re-assign the individuals to other duties, especially if they are involved in performing invasive procedures. But. the courts have consistently held that AIDS is a physical handicap protected under state and federal anti-discrimination laws. . . .

Procedures used to handle the question of what to do about doctors with AIDS will only work if these doctors identify themselves. But a handful of infected physicians have learned the hard way what happens when word of their condition leaks out. . .

(After a newspaper report revealed that a Dallas-area pediatrician had AIDS last year) local medical authorities assured parents that the doctor wasn't a threat to their children. But the assurances did no good, and his practice collapsed. "Any risk is too great when you're dealing with my children," (said the parent of a patient.). . .(The pediatrician's) advice to other doctors with AIDS: "Don't tell anyone."
Survival of Infants With Persistent Pulmonary Hypertension Without Extracorporeal Membrane Oxygenation
Authors: Dworetz April R. , Moya Fernando R. , Sabo Barbara , Gladstone Igor , Gross Ian
Published: December 2021

A retrospective evaluation was performed of the survival after conservative therapy of infants with persistent pulmonary hypertension who met the published criteria of Bartlett et al (Pediatrics. 1985;76:479-487) or Short et al (Clinics in Perinatology. 1987;14:737-748) for extracorporeal membrane oxygenation (ECMO) therapy. An 80% to 90% mortality rate can be predicted with these criteria, which are based on historical data, if ECMO is not used. The records of infants with the diagnosis of persistent pulmonary hypertension, weighing > 2 kg at birth and who were treated during two time periods, January 1980 to December 1981 [23 patients] and January 1986 to December 1988 [17 patients], were reviewed. During the earlier period, hyperventilation was the mainstay of our therapy, whereas during the later period, a more conservative approach (avoidance of hyperventilation) was adopted. In 1980 to 1981, 1 of the 6 patients (17%) who were eligible for ECMO by criteria of Bartlett et al survived, which is consistent with the published data. However, in 1986 to 1988, 9 of 10 ECMO-eligible patients (90%) survived (P < .02). The corresponding survival figures using the alveolar-arterial oxygen difference criteria of Short et al were 0 of 5 survivors (0%) in 1980 to 1981 and 8 of 9 (89%) in 1986 to 1988 (P < .006). These data indicate that approximately 90% of patients who are candidates for ECMO now survive in our institution without the use of that therapy. Because this was a retrospective analysis, it is not known whether the improved survival is related primarily to the change in ventilator therapy. Because the prognosis of persistent pulmonary hypertension is changing with time, indications for alternative modes of therapy, such as ECMO, and assessment of the effectiveness of such therapy should not be based on historical data. A randomized clinical trial in which conservative ventilation is compared to hyperventilation and to ECMO in the management of persistent pulmonary hypertension should be undertaken before further expenditures on ECMO centers are made. The focus of such a study should be on morbidity as well as mortality.
DISMAL STATE OF SCIENTIFIC LITERACY
Authors: L. J. F.
Published: December 2021

"Well under half of the American public and only one-third of the British know that the earth revolves around the sun once a year," Oxford University professor John Durant reported at the AAAS annual meeting in San Francisco. "Even fewer in Britain have much knowledge of medicine. Most of the people surveyed think that antibiotics kill viruses," he added.

There is more. Jon D. Miller of Northern Illinois University reported that 12% of Americans, asked a survey question about scientific process, correctly recognized that astrology is "not at all scientific."A rapid arithmetical calculation shows that a whopping 88% got it wrong.

About 35% of both Americans and British think that radioactive milk can be made safe by boiling. (It cannot.) But a reassuring 97% of people in both countries know that hot air rises.
Slow-Release Terbutaline and Theophylline for the Long-Term Therapy of Children With Asthma: A Latin Square and Factorial Study of Drug Effects and Interactions
Authors: Chow Olivia Kit Wun , Fung Kam Pui
Published: December 2021

To evaluate the long-term effects of slow-release formulations of theophylline and terbutaline on pulmonary function, clinical symptoms, and side effects, 24 children with stable and moderately severe perennial asthma participated in a prospective double-blind crossover study. The patients and the treatments were randomized according to the Latin square design to eliminate all possible period/climate biases throughout the protracted study period. The treatments consisted of terbutaline, 5 mg, theophylline, 200 mg, the combination, and placebo, given twice daily orally and crossing over every 28 days. The two drugs, administered alone or in combination, improved lung function and symptoms when compared with placebo. The interaction of theophylline and terbutaline was quantitatively shown by 2 x 2 factorial statistical design to be essentially additive rather than synergistic in the control of asthma. No increase in side effects was noted when the combined therapy was used. These findings suggest therapeutic advantages to combining submaximal oral doses of sustained-release theophylline and terbutaline for the long-term treatment of children with asthma.
Near Fatal Aspiration of a Candy Pacifier
Authors: RAMSEY KEITH P. , GOLDBACH ROBERT H. , STEPHENSON STEPHEN R.
Published: December 2021

In several articles the dangers of aspiration of makeshift pacifiers and pacifier and nipple parts have been cited. Ten deaths of aspiration of baby bottle nipples have been reported to the Consumer Product Safety Commission as of 1983. We have been warned of the danger of these real and makeshift nipples and pacifiers, but no mention has been made of the candy pacifiers that are sold in many convenience and grocery stores.
Cefuroxime Treatment Failure and Haemophilus influenzae Meningitis: Case Report and Review of Literature
Authors: ARDITI MOSHE , HEROLD BETSY C. , YOGEV RAM
Published: December 2021

Bacterial meningitis continues to be a major cause of morbidity and mortality in children despite effective antimicrobial therapy. Ampicillin and chloramphenicol have been the treatments of choice for bacterial meningitis in children older than 3 months of age, but recommendations also include cefuroxime and third-generation cephalosporins as possible single-drug alternatives. Although cefuroxime has been reported to be as effective as conventional therapy and some have recommended it for treatment of bacterial meningitis in children, there have been recent concerns about its efficacy.

The purpose of this report is to describe an infant who had a relapse of Haemophilus influenzae meningitis 1 day after completing 30 days of therapy with iv cefuroxime for H influenzae meningitis complicated by sterile subdural effusion and possible osteomyelitis.