bluuebunny/crossref_metadata_2025 huggingface dataset:
Health Education and Schools
Authors:   Committee on School Health
Published: December 2021

Health education is a key element in comprehensive health care. The primary purpose of health education is to establish patterns of living that will discourage disease and enhance well-being. Beginning in early childhood and throughout life we make decisions that affect our health. For the most part, these decisions are made without much contact with a health care system; yet, their cumulative impact has a greater effect on the length and quality of life than the effect of all of our medical care combined. Many of our nation's major health problems are caused by or are exacerbated by personal practices (life-styles) detrimental to health. Modification of these practices might improve health more than any spectacular biomedical breakthrough.

The Committee on School Health believes that community health education programs are a viable method of changing poor health practices; therefore, the Committee makes the following recommendations:

1. Health education is a subject that should be taught as part of basic education. Health education deserves the same priority in the curriculum as the traditional subjects that are taught in school.

2. Planned integrated programs of comprehensive health education should be a requirement for students from kindergarten through grade 12. Instruction should be given by teachers specifically qualified and, if possible, certified to teach health education. The health curriculum should be appropriate for the children's age and maturity at each grade level. A comprehensive health education program should include in integrated fashion the following subjects: physiology, genetics, accident prevention, venereal disease, alcoholism, mental health, parenting, sex education, medication and drug use and abuse, environmental and consumer health, nutrition, exercise, preventive medicine, anatomy, and bacteriology. The comprehensive approach to health education is more successful in developing positive health habits than approaching health education by isolated health subjects, such as "Drug Abuse Control" or "Venereal Disease Control."
Heparinization of Alimentation Solutions
Authors: POLAND RONALD L. , BEDARD MARY P.
Published: December 2021

We read with interest the article by Alpan and associates (Pediatrics 1984;74:375-378) concerning heparinization of alimentation solutions administered through peripheral veins. The authors conclude that heparinization of these solutions should be considered because they observed a significant reduction in the incidence of phlebitis and a prolongation of the mean period of catheter patency. The data presented in their table 2, however, reveals (through calculation) that the 13 infants in the heparinized group received peripheral vein alimentation for a mean duration of 20 days whereas those in the nonheparinized group received it for only ten days.
In Reply: Relative Risk
Authors: BOYCE W. THOMAS
Published: December 2021

Sheps' point is appropriate and well-taken. Because of its greater familiarity to most readers, the term "relative risk" was used to refer to the comparative probability of various injury causes within sex and age categories of injured children. It would perhaps have been more accurate to describe this probability ratio as a "relative likelihood."
Extracorporeal Circulation in Neonatal Respiratory Failure: A Prospective Randomized Study
Authors: Bartlett Robert H. , Roloff Dietrich W. , Cornell Richard G. , Andrews Alice French , Dillon Peter W. , Zwischenberger Joseph B.
Published: December 2021

A prospective controlled randomized study of the use of extracorporeal membrane oxygenation to treat newborns with respiratory failure was carried out using the "randomized play-the-winner" statistical method. In this method the chance of randomly assigning an infant to one treatment or the other is influenced by the outcome of treatment of each patient in the study. If one treatment is more successful, more patients are randomly assigned to that treatment. A group of 12 infants with birth weight greater than 2 kg met objective criteria for high mortality risk. One patient was randomly assigned to conventional treatment (that patient died); 11 patients were randomly chosen for extracorporeal membrane oxygenation (all survived). Intracerebral hemorrhage occurred in one of 11 surviving children. Extracorporeal membrane oxygenation allows lung rest and improves survival compared to conventional ventilator therapy in newborn infants with severe respiratory failure.
Medical Care Use and Expenditure Among Children and Youth in the United States: Analysis of a National Probability Sample
Authors: Butler John A. , Winter William D. , Singer Judith D. , Wenger Martha
Published: December 2021

Good access to health care for all US children and youth remains an important social policy goal. Recent patterns of access as reflected in the presence of regular care sources, health care use, health insurance coverage, and expenditures for medical care are described and analyzed using the subsample of all children 0 to 18 years of age from the 1980 National Medical Care Utilization and Expenditure Survey. Data from the survey indicate that in 1980, 92% of US children and youth had a regular care source and the same percentage were covered for the full year or part of the year by some form of public or private health insurance. However, use rates and patterns of expenditure continued to differ dramatically according to family background factors, particularly race, ethnicity, poverty status, and location of residence. These differences are analyzed and comparative data are presented for groups of children from various sociodemographic groups. Minority-group and near-poor children were found to be at highest risk for limited utilization of services and inadequate insurance coverage.
Risk Factors for Measles Vaccine Failure Among Immunized Students
Authors: Hull Harry F. , Montes Jean M. , Hays Patricia C. , Lucero Robert L.
Published: December 2021

An outbreak of measles occurred in a municipal school system which had reported 98% of students immunized against measles. A case-control study was conducted to determine reasons for vaccine failure Vaccine failure was associated with immunizations that could not be documented in the provider's records. Among children with provider-documented immunization, vaccine failure was associated with vaccination at 12 to 14 months of age with an odds ratio of 4.73. Among children vaccinated at 15 months or older, vaccine failure was not associated with time elapsed since vaccination. Studies should be conducted to determine whether unreliable immunization records are a more widespread problem. Further consideration should be given to routine revaccination of children previously vaccinated at 12 to 14 months of age.
Effect of Hypocalcemia on Cardiac Function in Very-Low-Birth-Weight Preterm Neonates: Studies of Blood Ionized Calcium, Echocardiography, and Cardiac Effect of Intravenous Calcium Therapy
Authors: Venkataraman Pankaja S. , Wilson Don A. , Sheldon Roger E. , Rao Radhakrishna , Parker Michael K.
Published: December 2021

Traditionally, in infants, a serum calcium value less than 7.0 mg/dL is considered to impair cardiac function. In very-low-birth-weight infants, we studied the hypotheses that decline in serum calcium to 6.0 mg/dL (1) would not impair cardiac function and (2) ionized calcium would remain greater than 3.0 mg/dL. We also evaluated the effect of calcium infusion on cardiac function. We studied 15 normokalemic and normonatremic infants whose birth weights were 822 to 1,450 g and were less than 32 weeks' gestation. When serum calcium declined to less than 6.0 mg/dL, 18 mg/kg of calcium as 5% calcium gluconate was infused for 10 minutes. Serum total calcium concentration, blood ionized calcium concentration, ECG, and M-mode echocardiogram were obtained on entry into the study, when the infants were hypocalcemic, immediately after treatment with calcium, and eight hours after treatment. Ionized calcium values were calculated based on serum total calcium and serum protein, and corrected calcium values were calculated based on serum total calcium, serum albumin, and blood pH. In all infants, serum calcium value declined to less than 7.0 and in eight infants to less than 6.0 mg/dL. Assessment of heart rate, systolic blood pressure, ejection fraction, left ventricular systolic time interval, right ventricular systolic time interval, fiber shortening index, and left ventricular mean velocity of circumferential fiber shortening showed no significant alteration from baseline during hypocalcemia or in association with intravenous slow bolus infusion of 18 mg/kg of calcium. In association with a decline in serum total calcium to as low as 6.0 mg/dL, whole blood ionized calcium was maintained at more than 3.0 mg/dL. Serum total calcium and calculated ionized calcium values correlated significantly with measured blood ionized calcium concentrations; however, these measures were not reliable predictors of blood ionized calcium. We speculate that the hypoproteinemia and hypoalbuminemia noted in these infants may result in relative protection of the blood ionized calcium in these infants. We suggest that in neonates with wide ranges in gestation, serum protein, and blood pH levels, total serum calcium and calculated ionized calcium values may be poor measures of derangement of calcium metabolism. Decline in total serum calcium concentration to 6.0 mg/dL was not associated with impaired cardiac function, and slow bolus calcium infusion in these hypocalcemic very-low-birth-weight infants neither improved nor impaired cardiac function.
Clinical Predictors of Acute Bacterial Diarrhea in Young Children
Authors: DeWitt Thomas G. , Humphrey Kim F. , McCarthy Paul
Published: December 2021

This prospective study assessed the value of presenting history, physical examination, and screening laboratory tests in predicting whether diarrhea in a young child is associated with a stool culture positive for a bacterial pathogen. Acutely ill children less than 4 years old were studied in a hospital outpatient setting. Two hundred patients were seen in a 9½-month period, which encompassed the seasons of summer, fall, and winter. One hundred ninety-five patients had cultures completed and twenty-nine (15%) had a bacterial pathogen isolated. The best predictive variable for a stool culture positive for a bacterial pathogen was the presence of polymorphonuclear cells in the stool, with a sensitivity of 85%, a specificity of 88%, and positive and negative predictive values of 59% and 97%, respectively. A cluster of three historical variables—abrupt onset of diarrhea, greater than four stools per day, and no vomiting before the onset of diarrhea—was identified that delineated a subpopulation of patients with an increased probability of having a stool culture positive for a bacterial pathogen (27% v 4% if any of the three variables was absent). It is suggested that these findings can be combined in a stepwise manner using the historical cluster as an initial screening, followed by examination for stool polymorphonuclear cells in the high probability subgroup, to identify those patients with a very high probability of having a bacterial pathogen isolated in their stool.
Extrahepatic Biliary Atresia in One Human Leukocyte Antigen Identical Twin
Authors: MOORE THOMAS C. , HYMAN PAUL E.
Published: December 2021

Extrahepatic biliary atresia is a neonatal disorder of unknown etiology that occurs approximately once in every 10,000 births. The absence of biliary atresia in stillborn infants suggests an acquired cause for this malformation. The nature of its occurrence in twins clearly would be helpful in gaining a better insight into the pathogenesis of biliary atresia.

Only three reports of biliary atresia in twins have appeared in the literature. In two reports, biliary atresia occurred in only one of nonidentical twins.1,2 In one report, in the Russian literature, biliary atresia occurred in both twins of unknown zygosity.3 We now report the occurrence of operatively established extrahepatic biliary atresia in only one HLA identical twin.
Extracorporeal Membrane Oxygenation and the Play the Winner Rule
Authors: PANETH NIGEL , WALLENSTEIN SYLVAN
Published: December 2021

The therapeutic trial comparing extracorporeal membrane oxygenation with conventional treatment in neonatal respiratory failure reported by Bartlett et al (Pediatrics 1985;76:479-487) uses a method of comparing treatments unlikely to be familiar to most pediatricians. Known as the "randomized play the winner" method, it has thus far been little used in clinical research. Most clinical investigators consider the conventional randomized clinical trial to be the last word in treatment comparisons.

But randomized clinical trials are costly, cumbersome, and to some observers less than ideal ethically. The ethical problem arises from the fact that during a "successful" randomized clinical trial (ie, one that demonstrates a significant advantage to one treatment) about half of the trial subjects will receive a treatment which, at the end of the trial, will be known to be inferior.
Attention Deficit Disorder
Authors: SHAYWITZ SALLY E. , SHAYWITZ BENNETT A.
Published: December 2021

In the article by Eichlseder (Pediatrics 1985;76:176-184), a practicing pediatrician in West Germany, reviews 1,000 cases of attention deficit disorder seen in his office practice during a 10-year period. Such a report is intriguing, not only because of the author's sincerity and diligence in caring for this population, but also because his involvement may serve as a potential model for the kind of clinical studies that practicing pediatricians elsewhere might be encouraged to undertake. However, if other practicing pediatricians are to emulate Eichlseder, they need to pay careful attention to methodologic details if their observations are to be meaningful. The following comments we hope will serve as a gentle reminder of some of the pitfalls in clinical research in attention deficit disorder.
Prevention of Pertussis—Are We Failing?
Authors: BRUNELL PHILIP A.
Published: December 2021

Through the years, a system has evolved to assure that children are protected against pertussis and other infectious diseases. Its success is attested to by the dramatic decline in diseases caused by the organisms these vaccines are designed to prevent. The infrastructure upon which this system is dependent has been invisible. Components become apparent only as we become concerned about its viability. It is useful to identify each of these and attempt to assess how it is performing in order to identify specific problems.

Pertussis vaccine is one of the oldest vaccines in continuous use. It is an experiential preparation. Its use is based on the observation that a given number of injections of vaccine, which has been standardized by the vaccine's ability to protect mice against intracerebral challenge with virulent pertussis organisms, reduces the risk and severity of pertussis in those who are exposed.
Propylene Glycol Plasma Level
Authors: GLASGOW ALLEN M. , BOECKX ROGER L. , MILLER MARILEA K. , MACDONALD MHAIRI G. , AUGUST GILBERT P. , GOODMAN STEPHEN I.
Published: December 2021

In Reply.—

We thank Dr Hall and his associates for pointing out the typographical error in our formula for estimating propylene glycol concentration from osmolal gap.1 The correct formula is, as presumed by Hall et al, propylene glycol (mg/dL) = 47.5 + (osmolal gap x 9.2).

It is important to remember that both our formula and that developed by Fligner et al2 are determined from linear regression analysis of experimentally derived data and are not theoretical calculations based on chemical properties of propylene glycol.
Tough Love: Help for Parents with Troubled Teenagers—Reorganizing the Hierarchy in Disorganized Families
Authors: Newton Barbara
Published: December 2021

There has been confusion among professionals and the public about the purpose and appropriateness of the "tough love" approach to parenting troubled teenagers. This article addresses some of the questions and tries to clarify misconceptions about the tough love approach. A description of a model "Tough Love" training/support group and results of parent feedback surveys are included to provide a clearer picture of the goals and effectiveness of tough love.
Divorce and the American Teenager
Authors: Lebowitz Marcia Lipman
Published: December 2021

Divorce is woven into the fabric of today's American society, and parents and professionals alike are concerned about the effects of divorce on children of all ages. Research in this area is in its infancy, particularly research about how divorce effects teenagers, but research thus far has helped us to appreciate that divorce is difficult for children of all ages. This paper considers the effects of divorce on teenagers by drawing from existing research and clinical experiences with teenagers. The focus of this presentation is how teenagers feel when parents divorce and how they behave in response to divorce. The purpose of this focus is to provide those who interact with teenagers a greater understanding of how teenagers react to divorce.
Prevention of Perinatal Acquisition of Hepatitis B Virus Carriage Using Vaccine: Preliminary Report of a Randomized, Double-Blind Placebo-Controlled and Comparative Trial
Authors: Xu Zhi-Yi , Liu Chung-Bo , Francis Donald P. , Purcell Robert H. , Gun Zhi-Li , Duan Shu-Cheng , Chen Ru-Jun , Margolis Harold S. , Huang Chen-Hsiang , Maynard James E. ,   the United States-China Cooperative Study Group on Hepatitis B
Published: December 2021

Hepatitis B is a serious disease of global significance. In developing countries, hepatitis B virus (HBV) infection and its sequelae rank among the public health problems of highest priority. Infants born to mothers who are chronic carriers of HBV are at particularly high risk of acquiring infection and becoming chronic HBV carriers. The efficacy of hepatitis B vaccine alone in preventing the transmission of HBV to infants born to HBV carrier mothers was determined in a double-blind placebo-controlled trial. Infants received plasma-derived vaccine at birth, 1 month, and 6 months of age. Of 180 infants born to hepatitis B surface antigen (HBs Ag)-positive mothers, equal numbers received National Institute of Allergy and Infectious Disease (NIAID) vaccine, Beijing Institute of Vaccine and Serum (BIVS) vaccine, and placebo. The cumulative seroconversion to the vaccines at 1 year of age was 95% and 75%, respectively. Vaccine efficacy as measured by the prevention of HBs Ag-positive events was 88% for the NIAID vaccine and 51% for the BIVS vaccine. Vaccine efficacy was similar among infants born to hepatitis Be antigen-positive mothers. Because of the low efficacy of the BIVS vaccine, an additional group of 28 infants was given vaccine and hepatitis B immune globulin at birth. The resulting efficacy was 83%. The results of this trial indicate that hepatitis B vaccine alone can substantially reduce perinatally acquired HBV infection and the resulting chronic carrier state.
Oral Trimethoprim/Sulfamethoxazole for Prevention of Bacterial Infection During the Induction Phase of Cancer Chemotherapy in Children
Authors: Kovatch Anthony L. , Wald Ellen R. , Albo Vincent C. , Prin William , Orlando Salvatore J. , Wollman Michael R. , Phebus Carol K. , Shapiro Eugene D.
Published: December 2021

We conducted a randomized, double-blind, placebo-controlled study to evaluate the efficacy of oral trimethoprim/sulfamethoxazole (TMP/SMX) in the prevention of bacterial infections in children with cancer. Sixty-three patients with acute leukemia were studied during the induction phase of chemotherapy; 28 patients with solid tumors who were starting intensive chemotherapy were also enrolled and treated for 2 months. There was no significant difference in the frequency of febrile episodes between the 43 children receiving trimethoprim/sulfamethoxazole and the 48 receiving placebo. However, when the group of 74 children who experienced granulocytopenia (absolute granulocyte count < 500/µL) was analyzed separately, significant reductions in the frequencies of confirmed bacteremia (2.6% v 20.0%, P = .02) and febrile episodes (35.9% v 65.7%, P = .01) were observed in the trimethoprim/sulfamethoxazole group. Furthermore, life table analysis showed that children with leukemia receiving trimethoprim/sulfamethoxazole had significantly more days without fever and without bacteremia. No benefits from prophylaxis were recognized in the subgroup with solid tumors. Although the frequency of oral thrush was greater (P = .02) in the trimethoprim/sulfamethoxazole group (25.6%) than in the placebo group (6.3%), invasive fungal infection did not occur. Although the mean duration of granulocytopenia was greater among those receiving trimethoprim/sulfamethoxazole (13.7 v 9.0 days, P = .05), this did not appear to increase the overall risk for bacterial infection. These data suggest that trimethoprim/sulfamethoxazole reduces the frequency of bacteremia and febrile episodes in granulocytopenic children undergoing induction chemotherapy for acute leukemia.
Anticipatory Guidance: A Modest Intervention in the Nursery
Authors: Adam Henry M. , Stern Elizabeth K. , Stein Ruth E. K. , Donovan Patricia , Kopet Jacquelyn , Lovejoy Doris , Jones-Parker Mimi
Published: December 2021

Although the importance of anticipatory guidance in the care of children is well recognized, pediatricians devote only about 10% of the average well child visit to parent education. The reluctance to engage more extensively in preventive interventions may relate to the paucity of evidence that such efforts are effective. This study was designed to test whether a modest anticipatory intervention, easily adaptable to other settings, could favorably influence maternal behavior. Mothers of newborn infants in a municipal hospital were assigned in alternate 2-week periods to an intervention program (n = 49) or a control group (n = 54). The intervention in the nursery consisted of a short group meeting, reinforced by a handout, advocating delayed introduction of solid foods and juices, and the use only of safe pacifiers. The mothers were interviewed at all visits to the general pediatric clinic using a standard format questionnaire. The two groups of mothers were demographically comparable but differed significantly in both the foods they introduced and the pacifiers they used for their babies. As an unexpected benefit, intervention mothers tended to view their babies as healthier than did control mothers. The implications of these findings are discussed.
Fiftieth Anniversaries Are Special
Authors: HAGGERTY ROBERT J.
Published: December 2021

Golden anniversaries are very special. The 50th anniversary of Title V of the Social Security Act of 1935 has extra significance for the American Academy of Pediatrics. The Academy owes its existence in large part to the events leading up to the Act and the current implementation of the Act has been greatly influenced by the Academy. The story deserves telling again.1,2

Maternal and Child Health (MCH) received national visibility with the first White House conference in 1909, which led to the formation of the Children's Bureau in 1912. The first studies done by this organization highlighted the high rate of infant mortality and severe handicaps among children.
Worldwide Control of Hepatitis B Virus: An Approaching Reality?
Authors: FRANCIS DONALD P.
Published: December 2021

Hepatitis B virus (HBV)-related diseases, which include acute hepatitis, chronic hepatitis and cirrhosis, and primary liver cancer, are major problems throughout much of the world. During the past several years, safe and effective HBV vaccines have been produced that have opened the way for the eventual control of these diseases.

Although of use throughout the world, the greatest need for HBV vaccine is in east Asia and subsaharan Africa where the vast majority of the population is infected with this virus by early adulthood.1 Early in HBV vaccine history, the late Dr Maupas and his colleagues2 showed that the control of HBV infection in the developing world was possible.
Black Patients—White Doctors
Authors: KAMINER RUTH KAHAN
Published: December 2021

To the Editor.—

Dr Levy's article, "White Doctors and Black Patients: Influence of Race on the Doctor-Patient Relationship" (Pediatrics 1985;75:639-643), addresses an important topic but concludes by giving contradictory advice. The underlying issue is one of cross-cultural communication between doctors and patients who belong to different subcultures in the same society. The physician needs to know and respect the usual pattern of beliefs and behaviors in the patient's subculture in order to know which premises are shared with him or her, to recognize deviation, and to communicate effectively.
Black Patients—White Doctors
Authors: LEVY DAVID R.
Published: December 2021

In Reply.—

My article on white doctors and black patients represent a modest attempt to address a complex and neglected issue in pediatric practice. I certainly do not regard myself as an expert and some might go further and say it is presumptious for a white, middle class male to write about black, indigent females. Thus, Dr Kaminer's comments and approaches are much appreciated and assuredly enhance the relationship between doctors and patients. I believe I can justify my contention that the advice I gave was not contradictory, but rather than highlight our minor differences, I would much rather welcome and endorse Dr Kaminer's valuable contribution based on her extensive and varied experiences in treating a truly multiethnic community in the Bronx.
Epidemiology of Neonatal Hyperbilirubinemia
Authors: LAU S. P. , FUNG K. P. , FOK T. F.
Published: December 2021

To the Editor.—

The reported positive associations between certain factors (use of contraceptive at the time of conception, premature rupture of membrane, and bleeding in the first trimester) and neonatal hyperbilirubinemia are puzzling and difficult to explain by present date knowledge of the relevant pathophysiology (Pediatrics 1985;76:770-774). The authors offer no explanation for their findings. The pertinent question is whether the statistical associations between one or more variables and neonatal jaundice occur simply by chance. It must be appreciated that the likelihood of statistical type I error can be considerable in this type of exercise when a multitude of 19 variables is analyzed simultaneously.1,2
Bifid Uvula
Authors: SHPRINTZEN ROBERT J.
Published: December 2021

In Reply.—

I would like to acknowledge in a very positive way Dr Eavey's letter. I will represent my own opinions as well as those of my co-authors with whom I have consulted. He has made several very good points. We regret that he believes we have been a bit too overstated in our approach to the potential problems presented by bifid uvula. Toward this end, his comments regarding the removal of adenoids to relieve obstructive sleep apnea (OSA) are well taken.
Hospital Influences on Early Infant-Feeding Practices
Authors: Reiff Michael I. , Essock-Vitale Susan M.
Published: December 2021

Newborn nursery nursing staff members were surveyed to determine their attitudes and teaching practices regarding breast- and bottle-feeding. Concurrently, mothers using this nursery responded to a structured interview concerning their infant-feeding practices at 14 to 21 days postpartum and possible hospital influences on these practices. The nursing staff strongly advocated breast-feeding and did not favor specific bottle-feeding practices or products. Nursing staff counseling was generally interpreted by mothers as supporting breast-feeding, but this did not deter a large proportion of mothers who stated an initial preference for breast-feeding from introducing formula as a supplementary or exclusive form of infant feeding during the short study period. Almost all mothers doing any amount of bottle-feeding at the time of their interview were using the same formula brand and a ready-to-feed preparation used during their hospital stay. Other influences on mother's infant-feeding patterns are discussed. It is concluded that the hospital staff and routines exerted a stronger influence on mothers's infant-feeding practices by nonverbal teaching (the hospital "modeling" of infant formula products) than by verbal teaching (counseling supporting breast-feeding). Future studies might explore new ways of supporting mothers who desire to breast-feed by designing innovative hospital routines to model breast-feeding rather than feeding by infant formula.
Cardiovascular Collapse in Infants: Association With Paroxysmal Atrial Tachycardia
Authors: Gikonyo Betty Muthoni , Dunnigan Ann , Benson D. Woodrow
Published: December 2021

Four infants, aged 16 to 28 days (mean 23 days), were seen in the emergency room with acute cardiovascular collapse and with normal heart rate and rhythm. During evaluation for cardiovascular collapse, no infant had sepsis; cardiac assessment revealed normal intracardiac anatomy but global cardiac chamber enlargement and poor left ventricular systolic function, which resolved with supportive treatment. However, three of the four infants demonstrated ventricular preexcitation on their surface electrocardiogram and, subsequently, two infants had transient episodes of tachycardia. During a transesophageal pacing study to evaluate inducibility and electrophysiologic characteristics of tachycardia, sustained tachycardia was initiated in all four infants. Reentrant tachycardia used an accessory atrioventricular connection as evidenced by (1) the presence of preexcitation during sinus rhythm (three infants), (2) the ability to initiate and terminate tachycardia by programmed electrical stimulation (four infants), (3) minimum ventriculoatrial interval recorded in the esophagus (V-Aeso) exceeded 70 ms (four infants), (4) transient bundle branch block during tachycardia prolonged the cycle length and the V-Aaso by 30 to 50 ms (three infants). Findings in these infants suggested prior episodes of prolonged tachycardia as the probable etiology of the cardiovascular collapse.
Elevation in Systemic Blood Pressure in the Neonate During Abdominal Examination
Authors: SINKIN ROBERT A. , PHILLIPS BARRY L. , ADELMAN RAYMOND D.
Published: December 2021

Systemic BP is a function of circulating blood volume, cardiac output, and total peripheral vascular resistance. Important variables affecting an infant's BP include sodium and water balance, cardiac function, especially myocardial contractility, and neurohumoral factors.1

External devices that increase intraabdominal pressure such as abdominal binders,2 pneumatic trousers3,4 and manual abdominal compression5,6 also increase systemic BP, presumably by increasing venous return and intrathoracic pressure. Their benefit in improving cardiac output has been demonstrated during cardiopulmonary resuscitation.7,8

Because of these studies and the casual observation of an increase in BP in a newborn infant following abdominal palpation, we evaluated the effect of routine abdominal examination such as palpation of the liver, kidney, and bladder on systemic BP in the neonate.
Intrauterine Growth Retardation: Adaptation or Pathology?
Authors: WARSHAW JOSEPH B.
Published: December 2021

Intrauterine growth retardation can result from a variety of environmental or genetic influences on fetal growth.1 The sequelae of intrauterine growth retardation resulting from impairment of nutrient flow from mother to fetus are well known and include low birth weight with sparing of brain growth, polycythemia, and hypoglycemia resulting from decreased storage fuels and defective gluconeogenesis. Despite the generally held assumption that nutritionally related intrauterine growth retardation (either maternal malnutrition or impaired uteroplacental blood flow) represents a serious pathologic insult to the fetus, the available data suggest that the vast majority of infants with intrauterine growth retardation have normal development without significant differences in IQ or neurologic scores from normal infants.2
Decreasing Trends in Reye Syndrome and Aspirin Use in Michigan, 1979 to 1984
Authors: Remington Patrick L. , Rowley Diane , McGee Harry , Hall William N. , Monto Arnold S.
Published: December 2021

The incidence of Reye syndrome has been decreasing in Michigan, perhaps as a result of decreased aspirin use among children. To evaluate possible changes in the frequency of aspirin use, 199 families in Tecumseh, MI, with children younger than 18 years of age were interviewed by telephone in February 1981 and again in February 1983. Based on the reported use of medications for colds or influenza between 1981 and 1983, fewer parents gave aspirin (56% v 25%), but acetaminophen use did not change (59% v 55%). Younger parents and parents who had heard of the association between aspirin and Reye syndrome were more likely to stop giving aspirin. More parents chose to use either no medication or medications containing neither aspirin nor acetaminophen (6% v 32%) for the treatment of colds or influenza. Approximately 90% of parents who chose not to give aspirin for fever also gave medications for colds or influenza that did not contain aspirin. These results suggest that fewer children are receiving aspirin during illnesses that may precede Reye syndrome. The associated decrease in the incidence of Reye syndrome tends to support the hypothesis that the use of aspirin increases the risk for the development of Reye syndrome.
Is Chloride Depletion an Important Contributing Cause of Death in Infants With Bronchopulmonary Dysplasia?
Authors: Perlman Jeffrey M. , Moore Valerie , Siegel Marilyn J. , Dawson Jeffrey
Published: December 2021

A retrospective analysis of infants with bronchopulmonary dysplasia requiring prolonged hospitalization (>100 days) was carried out to determine those factors associated with fatal outcome. Twenty-three infants made up the study population. Eleven infants died and 12 survived (survivors). No differences were noted between the groups regarding ventilator requirement, radiographic changes, and medication use (digoxin, aldactazide), except for furosemide which was used twice as frequently in the group of infants who died v the group of infants who survived (P < .001). Differences noted between the groups included moderate hypochloremia (chloride < 80 mEq/L) in all 11 infants who died v six of 12 survivors, severe hypochloremia (chloride < 70 mEq/L) in the nine of 11 infants who died v two of 12 survivors, metabolic alkalosis (pH > 7.45) in nine of 11 infants who died v three of 12 survivors, hypertension (systolic BP > 113 mm Hg) in eight of 11 infants who died v one of 12 survivors, decrease in head growth in ten of the 11 infants who died v one of the 12 survivors; these differences were all significant (P < .001). The metabolic alkalosis and head growth changes appear to be related to the hypochloremia. The data suggest that chloride deficiency may be an important contributing factor in the genesis of poor outcome in infants with bronchopulmonary dysplasia and that close attention to chloride supplementation might influence outcome.
Long-Term Outcome of Group B Streptococcal Meningitis
Authors: Wald Ellen R. , Bergman Ira , Taylor H. Gerry , Chiponis Darleen , Porter Carol , Kubek Kimberly
Published: December 2021

Group B Streptococcus is a common cause of neonatal sepsis and meningitis. The purpose of this study was to evaluate the neurologic, psychologic, and academic status of children who had group B streptococcal meningitis and to compare these children with their siblings. Seventy-four children who acquired group B streptococcal meningitis between one day and 6 months of life formed the study population. Survivors were 3 to 18 years. old at the time of their follow-up evaluations. Twenty children (27%) died, two were institutionalized, one severely affected child died at age 2 years, 15 were assessed by phone interview, and two were lost to follow-up. Thirty-four children and 21 siblings were comprehensively evaluated with physical and neurologic examinations, hearing tests, and tests of intellectual, perceptual-motor, and behavioral-adaptive functions. Of the total population, nine children (12%) had major neurologic sequelae (spastic quadraplegia, profound mental retardation, hemiparesis, deafness, or blindness). Six children had acute hydrocephalus; two were doing well after shunt placement. In general, those children surviving group B streptococcal meningitis without major sequelae appeared to be functioning normally or comparably to their sibling in intellectual, social, and academic matters.
Haemophilus influenzae Vaccine
Authors: MOXON E. RICHARD
Published: December 2021

The primary advice from both the Committee on Infectious Diseases of the American Academy of Pediatrics1 and the Immunization Practices Advisory Committee2 is to recommend that a newly licensed vaccine against Haemophilus influenzae type b should be given to all children at 24 months of age. It is a bold step, a milestone in pediatrics which is emotionally appealing but controversial. The inclusion of a vaccine of such limited efficacy as a routine immunization is unprecedented and the cost of the vaccine will strain the financial resources of some state health departments. Thus, although this initiative will be welcomed by many, there is much upon which to reflect.
Woodticks
Authors: COCHRAN WILLIAM D.
Published: December 2021

To the Editor.—

I was half charmed and half appalled to read the article about how to get rid of woodticks in Pediatrics (1985; 75:997-1002). Charmed because I could understand it all, appalled that it received such status. In the days of yore on Cape Cod when mostly the dogs, but occasionally us, got woodticks, we would pull them out vigorously (sometimes 50 at a setting), skin and all coming if they were firmly enough attached.
Impact of Maternal Work Outside the Home During Pregnancy on Neonatal Outcome
Authors: Zuckerman Barry S. , Frank Deborah A. , Hingson Ralph , Morelock Suzette , Kayne Herbert L.
Published: December 2021

The impact of mothers' work during pregnancy upon neonatal outcome has not been fully elucidated. A study of maternal health habits and neonatal outcome conducted from 1977 to 1979 at Boston City Hospital assessed the effects of paid work outside the home during pregnancy, particularly third trimester work in a standing position, upon duration of gestation and intrauterine growth, while controlling for potentially confounding variables. Postpartum, 1,690 low-income women were interviewed to provide detailed information on their sociodemographic and health characteristics. Of the 1,507 women whose work status during pregnancy could be classified, 55% did not perform paid work outside the home or attend school, 7% worked into the third trimester in a standing position, and 38% had other work histories or attended school. Infants were examined according to a standard protocol by pediatricians blind to mothers' work history. There was no significant relationship between the mothers' work history during pregnancy and the infants' length of gestation, weight, or head circumference at birth, when confounding variables were controlled statistically by multiple regression analyses. However, women who worked in a standing position into the third trimester delivered infants who were longer than infants born either to mothers with other work histories or to mothers who did not work or attend school. Healthy women with uncomplicated low-risk pregnancies who feel well enough to attend school or work during pregnancy, even in a job requiring some standing, may do so without fear that their infant will suffer shortened gestation or impaired intrauterine growth.
Use of Oral Gentamicin, Metronidazole, and Cholestyramine in the Treatment of Severe Persistent Diarrhea in Infants
Authors: Hill Ivor D. , Mann Michael D. , Househam Keith C. , Bowie Malcolm D.
Published: December 2021

Oral gentamicin, metronidazole, and cholestyramine were given either as single agents or in various combinations to infants who still required treatment after seven days in the hospital for persistent diarrhea. The effect of these drugs and the interactions between them were assessed by comparing daily stool output during treatment with that in the pretreatment period. The effect of the drugs on apparent nitrogen and fat absorption was also studied. On the first day of treatment the presence of cholestyramine was associated with a significantly greater decrease in stool output. This effect appeared to be largely due to an interaction with gentamicin. Thereafter, only gentamicin produced a significantly greater decrease in stool weight. At no stage was metronidazole of benefit. Gentamicin and cholestyramine also indirectly improved apparent nitrogen and fat absorption by reducing stool output. The combination of oral gentamicin and cholestyramine is recommended as a safe and effective way of treating infants with severe persistent diarrhea following acute gastroenteritis.
An Impossible Assignment for the Pediatrician
Authors: CHARLES SEYMOUR , SHELNESS ANNEMARIE
Published: December 2021

The review of the epidemiologic and clinical pattern of adolescent morbidity and mortality from the "highway epidemic," which appears in this issue of Pediatrics (1986;77:603-607), will be educational for those pediatricians who underestimate the awesome toll of this major pediatric health threat. The multifactorial causes of adolescent disruptive behavior the authors describe, however, will come as no surprise to pediatricians practicing adolescent medicine. Those of us who treat adolescents are accustomed to the instability of the exchange between the adolescent's immaturity and his or her environment which is capable of producing unpredictable crises.
Polysorbate 80 and E-Ferol Toxicity
Authors: Alade Solomon L. , Brown R. E. , Paquet Andrew
Published: December 2021

The relatively recent introduction and use of an intravenous form of a vitamin E preparation (E-Ferol) has been associated with the development of an unusual syndrome and fatalities among low birth weight (<1,500 g), premature infants in neonatal intensive care units. We have observed an inhibitory effect by this vitamin E preparation on the in vitro response of human lymphocytes to phytohemagglutinin (PHA). E-Ferol suppressed the expected response to low doses of PHA. However, this suppression was not due to the α-tocopherol acetate (vitamin E) component, because α-tocopherol acetate by itself was not inhibitory; in fact, it often enhanced the PHA response. Because a mixture of polysorbate 80 and polysorbate 20 is used as a carrier in E-Ferol, these components were also tested and were found to be responsible for the suppression, especially the polysorbate 80. Concurrent with this suppression of PHA-induced mitogenesis was a decrease in the percentage of T11 lymphocytes.
Changing Epidemiology of Reye Syndrome in the United States
Authors: Barrett Michael J. , Hurwitz Eugene S. , Schonberger Lawrence B. , Rogers Martha F.
Published: December 2021

The average annual incidence of Reye syndrome reported through national surveillance was lower during 1981 to 1984 than during the previous five surveillance years. This is accounted for by a decrease in cases among children younger than 10 years of age; the number of cases in 10- to 19-year-old persons remained relatively stable during this period. The overall decline in incidence and the differing age-specific incidence trends are apparent for both varicella-associated cases and for nonvaricella-associated cases. During 1985, the incidence has been much lower than during any previous year since surveillance was initiated; this most recent decrease includes children 10 to 19 years of age. Independently conducted surveys suggest that the prevalence of salicylate use for viral illnesses has decreased among children in recent years, particularly among children younger than 10 years of age. The changing epidemiology of Reye syndrome may reflect, in part, the declining use of salicylates among children and teenagers in the United States.
Forgotten Full-Term Infant Mortality Rate
Authors: DUJARDIN B. , VANDENBUSSCHE P. , BUEKENS P. , BECKERS R. , VERLINDEN M. , WOLLAST E.
Published: December 2021

To the Editor.—

In a recent article,1 Bloom discussed the problem of future reductions in infant mortality. He has proposed three ways of meeting this problem: by determining the efficacy, effectiveness, and cost of each intervention in medical care, by substituting less expensive interventions in place of more expensive care, and by separating social solutions from medical solutions for illness.

We appreciate his proposals, but we find that such an approach rules out the following two steps: (1) It is necessary to have a better understanding of the current changing trends in neonatal and postneonatal mortality.
Life Insurance for Children With Cardiovascular Disease
Authors: Truesdell Susie C. , Skorton David J. , Lauer Ronald M.
Published: December 2021

To determine the life insurability of young people with cardiovascular disease, we sent questionnaires to 99 life insurance companies concerning 18 congenital defects, rheumatic heart disease, and four dysrhythmias. We received 50 responses (50%) from companies whose sales make up 41% of the life insurance market. The concensus of insurability for the defects listed was: standard rates—mild pulmonic stenosis, rheumatic fever without carditis, mitral valve prolapse without regugitation, and the following postoperative lesions: patent ductus arteriosus, atrial septal defect, pulmonic stenosis, ventricular septal defect; uninsurable—most unoperated lesions, postoperative lesions with complex dysrrhythmias, severe aortic insufficiency, idiopathic hypertrophic subaortic stenosis, Ebstein's anomaly, truncus arteriosus, tricuspid atresia; insurable at increased rates—most other defects, including dextrotransposition of the great vessels, postoperative aortic stenosis, mild aortic insufficiency, postoperative coarctation of aorta, postoperative tetralogy of Fallot, and small ventricular septal defect. We conclude that life insurance is available to many children with cardiovascular disease, including most postoperative patients. Whether the increased rates requested for some defects are prohibitive is a matter to be decided by each family.
Childhood Homicide in Erie County, New York
Authors: Abel Ernest L.
Published: December 2021

Childhood homicide during 1972 to 1984 constituted 7.6% of the total homicides in Erie County, NY, a relatively higher percentage than that for the United States as a whole. The age-specific rate for black children less than four years of age was 17.9 per 100,000, a rate higher than that for Northern Ireland. Areas in which childhood homicide occurred most frequently were characterized by poverty and unemployment. The most common cause of death was a blunt trauma. Most homicides occurred on a Saturday and during spring and fall. In most cases, the offender was the child's mother. Most homicides occurred in the bedroom.
Partial Seizures in Children
Authors: Holmes Gregory L.
Published: December 2021

Although partial seizures occur frequently in childhood, the clinical and EEG manifestations have not been well described. Clinical and EEG features of 198 partial seizures in 56 children with seizures recorded during videotape monitoring with simultaneous telemetered EEG recordings were analyzed. Simple partial seizures were short in duration and consisted primarily of motor symptoms and were not associated with postictal impairment. Complex partial seizures were longer and could be categorized into four subgroups based on the initial clinical manifestations: staring, automatisms, motor phenomena, and drop attacks. All complex partial seizures were associated with changes in facial expressions, and in 87% of the patients automatic behaviors occurred either initially or at some point during the seizures. Unlike simple partial seizures, complex partial seizures were often associated with postictal symptoms. Although complex partial seizures were variable in manifestations from patient to patient, in children with more than one seizure recorded clinical events were usually stereotyped.