bluuebunny/crossref_metadata_2025 huggingface dataset:
Utility of Rheumatoid Factor in the Diagnosis of Juvenile Rheumatoid Arthritis
Authors: Eichenfield Andrew H. , Athreya Balu H. , Doughty Robert A. , Cebul Randall D.
Published: December 2021

Rheumatoid factor is commonly used by clinicians to assess children with possible juvenile rheumatoid arthritis. To assess its usefulness, we reviewed the case histories of patients in whom latex agglutinating rheumatoid factor was determined during 1981 to 1982 at our institution. A total of 437 charts were available for review. There were 11 patients with positive tests for rheumatoid factor, of whom five had juvenile rheumatoid arthritis, all polyarticular. A total of 426 children had negative results, of whom 100 had juvenile rheumatoid arthritis. This yields a sensitivity of 4.8% and a specificity of 98%. We then estimated the prevalence of juvenile rheumatoid arthritis in three clinical settings: a primary practitioner's office, a tertiary children's hospital walk-in clinic, and a pediatric rheumatology center. The predictive values and marginal benefits for rheumatoid factor were then calculated in those settings using Bayes' theorem. In the two general outpatient settings, the primary practitioner's office and tertiary walk-in clinic, the positive predictive values were 0.7% and 0.5%, respectively; marginal benefits were 0.4% and 0.3%, respectively. Rheumatoid factor testing appeared to be of some benefit in the pediatric rheumatology center with a positive predictive value of 72.5% and marginal benefit of 22.5%. In no case was rheumatoid factor testing helpful in establishing a diagnosis of juvenile rheumatoid arthritis or in ruling it out. Testing for rheumatoid factor is a poor screening procedure for juvenile rheumatoid arthritis in the general situations in which it is more likely to be requested and of supportive diagnostic value only in the highly restricted population of older children with polyarticular arthritis.
Transition of Severely Disabled Children From Hospital or Chronic Care Facilities to the Community
Authors:   Committee on Children With Disabilities
Published: December 2021

There has been an increase in the number of children with significant chronic illness requiring long-term care, as well as those with significant limitations of activities.1-4 This increase is, in large part, the result of improvements in medical care and technologic advances. Among the groups of children with chronic conditions requiring long-term care are children with developmental disabilities and major congenital defects; survivors of major trauma with residual severe neurologic, neuromuscular, or orthopedic abnormalities; and children with low incidence and extremely costly chronic disorders ranging from those who are dependent on ventilators or have renal failure to children who may be hospitalized less frequently, such as those with cystic fibrosis or hemophilia. These conditions tend to be costly not only in economic terms but also in psychologic respects.5-8

TRANSITIONAL CARE

Many children with sever disabilities or long-term illness require special services to support home rather than institutional care. Transitional care may be defined as those services that support the move of the child from an institution to home and community. At times, special transitional care units provide such services, although, more typically, transitional care services refer to activities that directly strengthen the capacity of the family and community to care for the child at home. Transition to the community requires (1) careful planning and discharge efforts, (2) determination of special home equipment and service needs, (3) educational activities for family and community providers, and (4) development of an explicit plan to provide nursing care and other support services as needed.
Doxapram and Potential Benzyl Alcohol Toxicity: A Moratorium on Clinical Investigation?
Authors: JORDAN GLENN D. , THEMELIS NICHOLAS J. , MESSERLY SUSAN O. , JARRETF ROBERT V. , GARCIA JOSE , FRANK C. GILBERT
Published: December 2021

To the Editor.—

Barrington et al1 recently undertook an investigation designed to elucidate the mechanism of action and clinical effects of doxapram in neonates. There is currently considerable interest in the use of this agent as a therapeutic adjunct in cases of refractory apnea,2-4 and the study by Barrington et al offers important additional insights into the pharmacophysiology of this agent. However, as we reviewed the literature in preparation for using this agent at our institution, an alarming potential complication of doxapram usage emerged.
Doxapram and Potential Benzyl Alcohol Toxicity: A Moratorium on Clinical Investigation?
Authors: JACKSON DAVID
Published: December 2021

In Reply.—

We read with interest and due concern the letter of Dr Jordan et al about the potential risk of benzyl alcohol toxicity in premature newborns who received infusions of Dopram Injectable (containing benzyl alcohol 0.9% as a preservative) for treatment of apnea.

In May 1982, the Food and Drug Administration issued a "Dear Doctor" letter and, in August 1982, published an article in the FDA Drug Bulletin raising concerns about the use of solutions containing benzyl alcohol or other prcservatives in treating newborns.
Ionized Calcium, Cardiac Function, and Electrocardiogram in Preterm Neonates
Authors: VENKATARAMAN PANKAJA S. , SHELDON ROGER E.
Published: December 2021

In Reply.—

We thank Drs Möller and Tegtmeyer for sharing their experiences with us. We concur with the view that measurement of blood of serum ionized calcium concentration is important in understanding the derangements of serum calcium homeostasis in neonates. Preterm infants, especially those whose postnatal course is complicated by asphyxia, lung disease, disturbances of fluid and electrolyte balances, and patent ductus arteriosus1 may be at risk for associated cardiac dysfunction, and measurement of blood or serum ionized calcium in these situations may be helpful.
Comprehensive Asthma Care Reduces Hospitalization
Authors: PLAUT THOMAS F.
Published: December 2021

To the Editor.—

Rubin et al1 devised a computer game to convey asthma information to children 7 to 12 years of age. They did not include parents in the learning process. They express surprise that the children's increased knowledge did not lead to a decrease in hospital days due to asthma. We are not surprised.

In 1984, our patients with asthma were hospitalized at 31% of the national rate. We admitted at a rate of 1.3/1,000 and had an average length of stay of 2.5 days.
Varicella: Complications and Costs
Authors: Preblud Stephen R.
Published: December 2021

Vanicella (chickenpox) has long been considered a benign, inevitable disease of childhood. Complications are generally mild and rarely severe, and virtually every individual is infected by adulthood. Infection is associated, however, with a high risk of serious complications in certain high-risk groups, such as leukemic children. Concerns about the severity of varicella in this population have led to the development and testing of a live, attenuated vaccine. Because of the favorable results thus far available, the vaccine may soon be licensed for use in high-risk individuals. The fact that a vaccine may soon be available has led to an increased interest in the potential benefits of a childhood varicella vaccine program. The costs associated with varicella infection in normal persons without a varicella vaccination program have been estimated to be approximately $400 million, 95% of which is the cost of caring for a child at home. Vaccination of normal 15-month-old children with a safe and effective vaccine with long-lasting immunity could reduce the cost by 66% and result in a savings of $7 for every dollar spent on the vaccination program. This assumes that vaccine would be administered only once with measles, mumps, and rubella vaccine, that there would be no increase in the number of varicella cases in older persons who are at increased risk for complications, and that there would be no deleterious effect on the occurrence and severity of herpes zoster. If the assumptions cited above hold true, then it would appear that normal children would benefit from prevention of varicella by vaccination, not by virtue of the severity of the disease but rather because of the inevitability of the disease and its associated expense.
Clinical Overview of Varicella Vaccine: Development and Early Studies
Authors: Takahashi Michiaki
Published: December 2021

A live varicella vaccine was developed in 1973 and has been used effectively and safely in normal as well as high-risk children. Some precautions are necessary for use in the high-risk children.
Emotional and Health Impact of Home Monitoring on Mothers: A Controlled Prospective Study
Authors: McElroy Evelyn , Steinschneider Alfred , Weinstein Steven
Published: December 2021

The psychologic and health effects of home monitoring were evaluated in mothers, whose infants (epidemiologically not at high risk for sudden infant death syndrome) were placed on electronic surveillance because of results obtained from a laboratory sleep study conducted at 4 weeks of age. Mothers of these infants were studied prospectively at several periods following the infants' births: 6 weeks, 12 weeks, and 1 year. The initial sample consisted of 56 mothers. Evaluation procedures included the Neonatal Perception Inventories, Anxiety Inventory (State and Trait), Depression Inventory, Brief Symptom Inventory, and a Recent Life Changes Questionnaire. The results obtained from these women were compared with those of women who had delivered at about the same time but whose infants were not placed on a home monitoring program. A total of 57 women started in the control group. Very few statistically significant group differences were observed between the two subject groups: 2 weeks after initiating the home monitoring program, monitor mothers (when compared to nonmonitor mothers) perceived their infant's behavior differently (although not more bothersome) and had an increased degree of situational anxiety (although not to an abnormal degree). There were no statistically significant differences between the two groups 12 weeks or 1 year after giving birth. These results suggest that a home monitoring program, which includes an aggressive and readily available support system, does not impose a marked health hazard to mothers.
Serum, Retinal, Choroidal Vitreal Vitamin E Concentrations in Human Infants
Authors: Bhat Rama
Published: December 2021

Vitamin E is being used as an antioxidant in preterm neonates in an attempt to decrease the severity of retinopathy of prematurity. However, its efficacy may depend on many factors, a major one being its concentration in the retina. There is very little information available on the α-tocopherol levels in the human eye tissue. The present study was carried out to determine the total α-tocopherol levels in the retina, choroid, and vitreous and to compare the retinal levels with the serum levels obtained at the time of death. Thirteen whole eye donations were available during the past 22 months for the study. The data from this small number of cases showed that (1) retinal levels of α-tocopherol were higher than choroidal and vitreal levels; (2) higher serum levels were associated with higher retinal levels; and (3) both serum and retinal α-tocopherol levels were lower in the unsupplemented (group A) infants. Further studies on pharmacokinetics of vitamin E in human newborns and its distribution are needed.
Management of Contacts of Children in Day Care With Invasive Haemophilus influenzae Type b Disease
Authors: DASHEFSKY BARRY , WALD ELLEN , LI KARL
Published: December 2021

Haemophilus influenzae type b (HIB) is the most common cause of serious bacterial disease in children in the United States with 20,000 cases occurring annually. In 1979, it was convincingly reported that this pathogen could spread in households, resuiting in a significantly increased risk of subsequent disease in household contacts.1 Confusion resulting from changing recommendations of the Committee on Infectious Diseases of the American Academy of Pediatrics regarding rifampin prophylaxis for HIB disease2,3 and the recent advent of the HIB vaccine4 prompt this commentary on the management of contacts of children with invasive HIB disease with special emphasis on the day-care setting.
Cranial Bruising and Intraventricular Hemorrhage
Authors: KUBAN KARL C. K. , BROWN ELIZABETH , LEVITON ALAN , KRISHNAMOORTHY KALPATHY
Published: December 2021

In Reply.—

The letter of Acs and Kilchevsky gives us an opportunity to reemphasize that our study was designed to evaluate the efficacy of phenobarital as prophylaxis for intracranial hemorrhage of the premature newborn. To this end, we defined possible confounders as those variables associated with both hemorrhage and phenobarbital administration. The observation of Acs and Kilchevsky that cranial bruising occurred more often in the phenobarbital-treated group and in the babies with intracranial hemorrhage is indeed important.
Statistics and Sudden Infant Death Syndrome
Authors: LEBLANC MICHAEL H.
Published: December 2021

To the Editor.—

Drs Oren, Kelly, and Shannon1 used an uncorrected χ2 test to analyze their data. All of the probability tables would have expected values of less than 5.2 Thus, either a Yates correction should be used or the Fisher exact test2 should be used. (To avoid numerical overflow on small computers taking the logarithm of the Fisher equation prior to computation and the antilog of the calculated probability after calculation is helpful.) With more appropriate statistics (1) the comparison of infants requiring subsequent resuscitation by mouth-to-mouth or vigorous stimulation v those not requiring such subsequent resuscitation would have P < .02 instead of < .007;
Pittsburgh Insulin-Dependent Diabetes Mellitus Morbidity and Mortality Study: Physical Activity and Diabetic Complications
Authors: LaPorte R. E. , Dorman J. S. , Tajima N. , Cruickshanks K. J. , Orchard T. J. , Cavender D. E. , Becker D. J. , Drash A. L.
Published: December 2021

The long-term health consequences of chronic physical activity for patients with type I diabetes are unknown. In the current study, the association of physical activity to diabetic complications was assessed in 696 type I diabetic individuals diagnosed between 1950 and 1964. Participation in team sports in high school or college was not associated with a decreased prevalence of severe retinopathy or blindness later in life. There was, however, a suggestion of a negative association between physical activity and both cardiovascular disease and overall mortality, ie, individuals who participated in team sports were somewhat less likely to report macrovascular disease at follow-up or to have died than nonparticipants. The relationship between physical activity and diabetic complications only appeared in male subjects. The results suggest that activity early in life by patients with type I diabetes does not appear to be associated with an adverse health effect and may, in fact, be beneficial.
Microcephaly and Congenital Cytomegalovirus Infection: A Combined Prospective and Retrospective Study of a Swedish Infant Population
Authors: Ahlfors Karin , Ivarsson Sten-Anders , Bjerre Ingrid
Published: December 2021

Microcephaly and its etiology were studied in an unselected Swedish urban infant population. Virtually, all live-born infants (14,724) born between October 1977 and December 1983 in the city of Malmö, Sweden, were included in the study. Special attention was given to the role of congenital infections, particularly to cytomegalovirus infection. The infant population was studied from two points of view. One part of the study was prospective and based on regular cytomegalovirus isolation in urine within the first week of life. About 80% of the newborns were adequately studied by this test. None of 56 infants shown to be cytomegalovirus excreters (congenitally infected) and followed up were born with or developed microcephaly (head circumference smaller than 3 SD below the mean for age and sex) during the first 1 to 7 years of life. However, two of the 56 infants had a head circumference of –2 SD. In the beginning of 1985, an inventory was made of the presence of symptomatic microcephaly in the abovementioned population still living in the city or deceased there. Of about 10,000 such children, 12 were found to have symptomatic microcephaly. By studies of personal, clinical, and laboratory data and by retrospective serologic studies of frozen pre- and postconceptional maternal sera, a possible explanation or a recognized syndrome was obtained in ten of the 12 cases. In one of them, the mother had a primary cytomegalovirus infection, possibly in early pregnancy. Although the infant had symptoms compatible with a congenital infection, no laboratory evidence of transmitted infection was found. In no case were congenital rubella virus or Toxoplasma gondii infections suspected.
Expired Ipecac Syrup Efficacy
Authors: Grbcich Patricia A. , Lacouture Peter G. , Kresel James J. , Russell Margaret T. , Lovejoy Frederick H.
Published: December 2021

A controlled prospective study to evaluate the efficacy of expired ipecac syrup was conducted at two regional poison control centers in New England. During a 6-month period, 200 study patients treated with expired ipecac syrup and 200 control patients treated with unexpired ipecac syrup were evaluated. There were no statistical differences between the control and study groups in patient characteristics (age and sex) and product characteristics (general class, emetic potential, pretreatment, previously opened bottles, and manufacturer). In both control and study groups, emesis occurred in 100% of cases with 90% of patients vomiting with the first dose. The mean time to emesis was 24.7 minutes and 24.8 minutes in the study and control groups, respectively. Expired preparations ranged from 1 month to greater than 4 years postexpiration, with the duration of expiration not altering the mean time to emesis. Mean time to emesis between the two groups was also not affected by manufacturer, pretreatment with milk, or whether the ipecac syrup bottle was previously opened. We conclude that expired ipecac syrup (up to 4 years postexpiration date) is an effective emetic.
Necrotizing Tracheobronchitis
Authors: MIMOUNI F. , BALLARD E. T. , COTTON R. T. , BALLARD J. L.
Published: December 2021

In Reply.—

We thank Kirpalani et al for their interest in our article1 and their comments. We also read with interest their report,2 which was published while our article was in press, and which confirms that survival is possible after necrotizing tracheobronchitis. Furthermore, we speculate that many "mild" cases of necrotizing tracheobronchitis may have not been recognized in the past, when obstruction was relieved solely by suctioning, and the "mucous plug" was not examined histologically.

Treatment of necrotizing tracheobronchitis will probably be the source of controversy in future years.
Alcohol, Drugs, and Head Injury
Authors: SCHWARTZ RICHARD H.
Published: December 2021

To the Editor.—

Jacobson and colleagues (Pediatrics 1986;77:236-24l) present a convincing case for comprehensive reassessment of adolescents with serious closed head injuries. However, they make no mention of evaluating such patients for drug or alcohol abuse. Such abuse/dependency can contribute significantly to the etiology of traumatic injuries.

We interviewed 202 middle-class adolescents in treatment for drug/alcohol abuse/dependency: 86 (43%) had been involved in at least one motor vehicle accident while intoxicated by drugs, alcohol, or both; 50% had been involved in more than one such incident.
Neuroblastoma in Duchenne Muscular Dystrophy
Authors: JOHNSTON KATHREEN M. , ZOGER SEYMOUR , GOLABI MAHIN , MULVIHILL JOHN J.
Published: December 2021

To the Editor.—

In reporting two patients with neuroblastoma and cystic fibrosis, Moss et al1 noted that "reports of cystic fibrosis and other genetic abnormalities in individual patients are usually regarded as chance associations."

We encountered an analogous situation in caring for a boy in whom stage III neuroblastoma developed at 9 months of age; he responded to surgery and chemotherapy and subsequently was found to have classical Duchenne muscular dystrophy at 3½ years of age.
Urine Specific Gravity As an Indicator of Neonatal Necrotizing Enterocolitis
Authors: STINE MARY JO , HARRIS HOWARD
Published: December 2021

To the Editor.—

We have noted a large increase in urine specific gravity at the onset of necrotizing enterocolitis in many of our premature newborns. A statistical review of 27 cases of necrotizing enterocolitis at our institution has confirmed a significant increase (P < .0001) in urine specific gravity associated with this disease. The difference persisted despite correction for glucosuria. The increase in urine specific gravity is probably secondary to third-space fluid losses in the gastrointestinal tract.1

Urine specific gravity is a routine test in most neonatal intensive care units.
Experience With Heart Transplantation in Children
Authors: Fricker F. Jay , Griffith Bartley P. , Hardesty Robert L. , Trento Alfredo , Gold Larry M. , Schmeltz Kathy , Beerman Lee B. , Fischer Donald R. , Mathews Robert A. , Neches William H. , Park Sang C. , Zuberbuhler J. R. , Lenox C. C. , Bahnson Henry T.
Published: December 2021

Between March 1981 and March 1986, 200 orthotopic heart transplantations were performed at the University of Pittsburgh. Fourteen of those procedures were carried out in children 2 to 16 years of age. Two children received combined liver and heart transplants; one because of familial hypercholesterolemia with associated ischemic heart disease, and the other because of dilated cardiomyopathy associated with intrahepatic biliary atresia. Eight patients had dilated cardiomyopathy, and two had myocarditis. Two had heart transplantations for congenital heart disease: one had multiple muscular ventricular septal defects repaired in infancy and had an associated cardiomyopathy, and the other developed a cardiomyopathic ventricle from a congenital right coronary artery to right atrial fistula. Chronic immune suppression consisted 0.2 to 0.5 mg/kg/d of prednisone and 5 to 50 mg/kg/d cyclosporine, with the addition of antithymocyte globulin for unresolved moderate or severe acute rejection. There were three early postoperative deaths: one from intracranial bleeding, one from Pseudomonas mediastinitis, and one from ischemic injury to transplanted organs. Early postoperative complications included reversible renal failure, hypertension, and seizures. Late problems were related to allograft rejection and side effects of cyclosporine and corticosteroids. Significant rejection episodes occurred in all patients surviving longer than 2 weeks, with seven requiring antithymocyte globulin. Two patients died 8 months following transplantation of severe acute and chronic rejection; another patient required retransplantation for ischemic cardiomyopathy resulting from chronic rejection but subsequently died of recurring rejection 3 months after the second transplantation. Eight surviving patients 4 months to 4 years after heart transplantation had returned to age-appropriate activities. These early results have encouraged the authors to continue to use heart transplantation as a viable alternative in children with terminal heart disease.
Sudden Infant Death Syndrome
Authors: KEENS THOMAS G. , WARD SALLY L. DAVIDSON
Published: December 2021

In Reply.—

Dr Stivrins' letter allows us to clarify some important points made by our paper entitled, "Sudden Infant Death Syndrome in Infants Evaluated by Apnea Programs in California" (Pediatrics 1986;77:451-455).

The purpose of the study was to investigate the characteristics of infants who died after evaluation by an apnea program for apneic episodes or for statistical increased risk for SIDS. Although this does not represent a complete sampling of the apnea programs in California, it presents data on more than 3,000 infants who were evaluated.
Tactile/Kinesthetic Stimulation Effects on Preterm Neonates
Authors: SAIGAL SAROJ , WHYTE ROBIN
Published: December 2021

To the Editor.—

The provocative study by Field et al (Pediatrics 1986;77:654-658) attributes a 47% increase in rate of weight gain to tactile/kinesthetic stimulation of preterm infants, but the reader is presented with a number of perplexing problems in interpretation. We are unable to understand the randomization process, which was achieved after a stratification exercise designed to divide patients into eight poststratification groups. If these were equal in size, then each group must have contained five patients, an odd number.
Errors in Drug Administration
Authors: KOREN GIDEON
Published: December 2021

In Reply.—

Although the ban of decimal points may resolve some confusion, it probably would not prevent mathematical incompetence of medical personnel which is a common and serious problem. The statement that tenfold errors in drug doses do not occur when the decimal point is banned has to be proven. Before I started studying the tenfold errors problem, I did not imagine how common and multifactorial it is. I believe that, if Dr Bury continuously and closely studies the problem in his hospital, he is likely to identify it.
Pulmonary Vascular Lipid Deposition After Administration of Intravenous Fat to Infants
Authors: Shulman Robert J. , Langston Claire , Schanler Richard J.
Published: December 2021

The incidence of pulmonary vascular lipid deposits in infants who did or did not receive intravenous lipid emulsion was determined through a review of the pulmonary histopathology and clinical course of 39 neonates who died during a two-year period. The relationship between pulmonary vascular lipid deposits and the duration and amount of administered intravenous fat emulsion was assessed. In addition, the effect of monitored serum triglyceride levels on the development of pulmonary vascular lipid deposits was evaluated. The incidence of pulmonary vascular lipid deposits was greater in the group that received intravenous fat emulsion (P < .02). Both the amount (grams per kilogram per day) and duration (days) of intravenous fat emulsion infusion were correlated positively with severity (P < .05) in infants who had pulmonary vascular lipid deposits. No relationship was seen between peak serum triglyceride levels, the frequency of elevated triglycerides, and pulmonary vascular lipid deposits. Although administered fat emulsion was a risk factor for the development of pulmonary vascular deposits, two of 13 infants who had not received intravenous fat emulsion had such deposits.
Familial Bathing Patterns: Implications for Cases of Alleged Molestation and for Pediatric Practice
Authors: Rosenfeld Alvin A , Siegel Bryna , Bailey Robert
Published: December 2021

In a cross-sectional study of how 576, upper-middle class children were socialized around bathing behaviors, families were found to be variable in their handling of bathing practices. But as a group, children were found to bathe alone more frequently as they grew older, and parents were found to bathe less frequently with the child of the opposite sex, particularly as children grew older. It was uncommon for mothers to bathe or shower with sons older than 8 years of age or for fathers to bathe or shower with daughters older than 9 years of age, although most had stopped before that age. This cross-sex aversion may be a reflection of the incest taboo. Several suggestions are made about the development-related changes in bathing practices identified in the study.
Serious Head Injuries From Lawn Darts
Authors: Tay Jean S. , Garland Jeffery S.
Published: December 2021

Serious injuries secondary to lawn darts have not been reported. In this article two cases of penetrating skull injuries are reported. One patient developed a polymicrobial brain abscess necessitating surgical drainage and a prolonged hospitalization. Psychologic function was diminished at discharge. The second child required surgical repair of a depressed skull fracture. Thirteen lawn dart head injuries have been reported to the Consumer Product Safety Commission between 1983 and 1985. These injuries are summarized along with the reported cases to point out the seriousness (neurologic impairment in 5/10 head injuries) of such injuries and warn parents and physicians of the potential dangers of this game.
Animal Models for Evaluation of Drugs for Use in the Mature and Immature Newborn
Authors: deLemos Robert A. , Kuehl Thomas J.
Published: December 2021

The need for a better defined and controlled approach to new therapies for possible neonatal application appears clear in light of present practice and recent history. At this conference several animal models were discussed that could be used for pharmacokinetic and pharmacodynamic studies and for evaluation of efficacy and safety prior to human newborn testing. This, coupled with a requirement for comprehensive human data collection following preliminary approval of new drugs, would, we believe, significantly improve present practice. It will, however, require pressure from the medical community and patient advocates to encourage change in current government regulations and industry policies.
Absent Hypoxic and Hypercapnic Arousal Responses in Children With Myelomeningocele and Apnea
Authors: JAMES HECTOR E.
Published: December 2021

To the Editor.—

The findings by the authors of a recent report about abnormalities in hypoxic and hypercapnic arousal responses in children with myelomeningocele and Arnold-Chiari malformation, who were symptomatic with apnea and/or hyperventilation, are interesting indeed, and the abnormalities have been reported well.1

In the discussion, the authors failed to tell the readers about the known anatomical substrate for such abnormalities. The anatomical substrate is a malformation of brainstem nuclei and consequently brainstem connections of the cranial nerve nuclei and reticular formation.
Lack of Statistical Power
Authors: DONOWITZ LEIGH G.
Published: December 2021

In Reply.—

Dr Pascoe's statistical analysis of the small numbers of nosocomial infections is one with which I agree. It is for precisely his reasons that intravascular catheter tip colonization was studied using this as another marker of nosocomial infection. This additional information provided another support for the argument that overgown use did not affect the incidence of device-related colonization or infection.
Too Many Warnings on Missing Children
Authors: GREEN GORDON
Published: December 2021

To the Editor.—

The statement on missing children by the Committee on Early Childhood, Adoption, and Dependent Care (Pediatrics 1986;78:370-372) is helpful in defining the role of the pediatrician in dealing with this tragic situation. It did not, however, address a secondary problem that is now being seen.

One result of the extensive media attention and public awareness of the problem of missing children is a heightened level of anxiety in the kids themselves. Some children are fearful to go outdoors, even in their own familiar neighborhoods.
Pediatric Brain Injuries: The Nature, Clinical Course, and Early Outcomes in a Defined United States' Population
Authors: Kraus Jess F. , Fife Daniel , Conroy Carol
Published: December 2021

Acute brain injury is the cause of approximately 100,000 pediatric hospital admissions per year in the United States. This report examines the nature of the brain injury, clinical diagnosis, hospital course, and discharge outcome of all pediatric cases in the population of San Diego County, California, for 1981 (N = 709). Brain-injured children were identified from hospital records, death certificates, and coroners' records. Severity of injury was determined using the Abbreviated Injury Scale and the Glasgow Coma Scale. Three percent of brain-injured children died at the accident site; an additional 3% died in the hospital. All in-hospital deaths occurred among the 5% of children with Glascow Coma Scale scores of 8 or less, and in this group the case fatality rate was 59%. Fractures of the skull, present in 23% of cases, seemed to be associated with excess mortality even after type of lesion was considered. Type of lesion, but not presence or absence of a skull fracture, had some predictive power for disability among survivors. Concussion was the most frequent diagnosis. Mildly brain-injured children accounted for 93% of all cases and about 90% of all hospital days.
Atherosclerosis
Authors: MAUER ALVIN M.
Published: December 2021

In his commentary, Kwiterovich has done science a disservice. In his opening section, he acknowledges that more information is needed to establish the factors involved in the development of atherosclerosis. He then poses the question, "What are the available data, and, given the current state of the evidence, are physicians and scientists able to make a reasonable and sound recommendation?" Indeed, in the minds of some the available evidence is sufficient at this time to make dietary recommendations designed to reduce the risk of the consequences of atherosclerosis.
Boys on Girls' Teams
Authors: FAIGEL HARRIS C.
Published: December 2021

The letter by Dr Goldenring regarding girls on boys' teams (Pediatrics 1986;78:718) and the reply by Dr Dyment fail to address a singular and insidious problem of even greater dimensions, that of boys on girls' teams.

Dr Goldenring is not wrong about the issue of injury to girls physically when they play against boys. There are increasing reports of such injuries. Dr Dyment is not wrong in his belief that the girls should have access if they can play well enough to make the team.
RESULT-ORIENTED CENSORSHIP IN MEDICAL JOURNALS
Authors: Student
Published: December 2021

The experience described in medical journals tends to constitute, in the aggregate, a biased base for learning about any given issue. The reason why any generalization, however restricted, from published studies tends to be invalid is that the studies are not published simply on the basis of how informative they are about the object of study; an added, major consideration is the result itself. Scientific manuscripts are subjected not only to review of merit but to result-oriented censorship as well. For the journals to be a forum for unbiased evidence, that is, a basis for valid inference, the sole criterion for the decision to publish would have to be, apart from the topic itself, the informativeness of the study. To this end, the editors would have to take the decision about publication on the basis of a manuscript from which the author has blanked out all the actual results, indicating only the terms in which the results would be presented.
IDIOPATHIC APLASTIC ANEMIA IN CHILDREN
Authors: STURGEON PHILLIP
Published: December 2021

With the use of the concentration and volumetric bone marrow aspiration technics in the differential diagnosis of idiopathic acquired aplastic anemia from aleukemic lymphatic leukemia in children, it is possible to establish an early reliable diagnosis. In this clinic specific therapy with the indicated agents has not had to await an indefinite period of observation pending the development of unmistakable clinical and peripheral blood signs nor the more difficult procedure of surgical biopsy.

Bone marrow aspirations performed in four cases of aplastic anemia and studied by these technics have shown normal or increased ease and rate of aspiration, normal or increased fat, and absent myeloid-erythroid layer.

Five cases of aleukemic leukemia presented as typical of numerous others studied revealed marked difficulty in the aspirations, absent fat and a variable myeloid-erythroid layer.

Study of histologic material obtained with the use of the preceding technics revealed the marrow from all cases of aplastic anemia to be fatty and hypoplastic in contrast to the marrow from a case of aleukemic leukemia, which was hyperplastic and without fat tissue. These later observations correlate well with the observed differences in volumetric data.
Round Table Discussion
Authors: SANFORD HEYWORTH N. , ROOT J. HAROLD , GRAHAM R. H.
Published: December 2021

Chairman Sanford: Dr. Herman N. Bundesen, Commissioner of Health of Chicago, organized 12 years ago the "Chicago Premature Plan." This consists in registering all premature infants with the City Health Department within a few hours after birth. The premature infant who is born at home, or in a hospital that does not have adequate premature care, is transported in an oxygenated incubator ambulance to a hospital which specializes in such care.

From 1936 to 1947 premature infant deaths in Chicago have been lowered 6½%. The full term infant death rate during the same period has been lowered about 3%. Inasmuch as the premature death rate has been lowered about double that of the full term infant rate, we believe this procedure has been the cause of reduction. In 1936 there were 47,000 live births in Chicago. In 1947 there were 82,000, or an increase of 80%. In this number the full term infants increased from 45% to 60%, whereas the premature infants increased from 2000 to over 5000, or about 140% increase of premature infants born in Chicago during the last 10 years.

This adds a considerable increase to the number of infants for our available premature infants beds. Where formerly we planned 5 premature births to each 100 full term births, we now find that prematures have increased to 8 per 100 full term infants.

Causes of prematurity are multiple births, toxemia, heart disease, syphilis, tuberculosis, infections, accidents, premature separation of the placenta and abnormalities of the reproduction tract. It is generally understood that there is a tendency for more premature births among the Negro race than the white race.
EFFECT OF THE CAROTID-JUGULAR-ANASTOMOSIS OPERATION UPON INTELLIGENCE
Authors: KESSLER JANE W.
Published: December 2021

The psychologic findings on 33 children following the c-j-a operation have been reported. The results show that almost all the patients improved in mental age but only at the same rate, in comparison with the chronologic age, which was evident prior to the operation. There was one instance of significantly increased rate with an I.Q. improvement of 18 points, and one instance of significantly decreased rate with an I.Q. loss of 20 points. The average difference in I.Q. following surgery was slight and in a minus direction.

Certain sources of confusion in evaluating intellectual changes have been discussed. A change in I.Q. within 10 points sometimes occurs with repeated tests for no specific reason beyond the measuring error inherent in the intelligence test. The mere fact of improved functioning in a child means little as far as evaluating surgical intervention is concerned, since most children are still in the process of growth, although it may be slow. Moreover, individual I.Q.'s obtained before the chronologic age of 3 years should be interpreted with discretion; this is particularly true in the case of spastic children who, in standard tests, are unfairly handicapped on a purely physical basis.

On the basis of the data reported in this study, the previous claim that "this procedure represents the first successful attempt at correction of mental retardation on an organic basis" is not fulfilled. Although in previous reports by Beck, McKhann and Belnap, the concept of the I.Q. is used freely in general statements, no statistical facts have been provided. The improvement in two cases presented in the first published report by these authors has not been sustained by later study. The statement that children with I.Q.'s between 40 and 60 show the greatest improvement is contradicted by the present author's findings. There is virtually no evidence in this study (significant improvement in one case out of 33) for crediting the c-j-a surgical procedure with improvement of the intellect. The majority of the cases herein reported were tested several months after surgery so that whatever improvement was going to occur should have been manifest, according to the statement of McKhann, Belnap and Beck that "improvement usually begins to appear in the retarded children within the first two postoperative months."
STUDIES ON PREMATURITY
Authors: STEINER MORRIS , POMERANCE WILLIAM
Published: December 2021

The weight lag periods of 623 premature infants with birth weights ranging between 1000 and 2250 gm. were studied. It was found that the time required for a premature infant to regain its birth weight and continue to gain (weight lag period) was inversely related to the length of its gestation period.

The importance of considering gestation period (degree of maturity) in studies of premature infants is emphasized.
PSEUDOCYST OF THE PANCREAS IN CHILDHOOD
Authors: MITHOEFER JAMES
Published: December 2021

The literature pertaining to pseudocyst of the pancreas is reviewed briefly. The third authenticated case of pseudocyst of the pancreas in childhood is reported.
SPLANCHNICECTOMY FOR PANCREATIC FIBROSIS
Authors: AYERS W. B. , STOWENS DANIEL , OCHSNER ALTON , PLATOU R. V.
Published: December 2021

Based on the rationale that splanchnicectomy might interrupt a viscero-visceral autonomic reflex are responsible for bronchospasm and bronchorrhea, this operation has been performed on 24 infants and children with mucoviscidosis, most of whom were poor operative risks. Three of them died at or soon after operation, and six others have died at intervals of from 2 to 12 months postoperatively. Of the remaining 15, manifestations are essentially unchanged in five, and equivocally ameliorated in six. No information could be secured concerning the late effects in one child (Patient 17, K. W.). Three patients may have been materially benefited by the procedure.
PAROXYSMAL HYPERTENSION SIMULATING PHEOCHROMOCYTOMA
Authors: ARONSON NATALIE , STERN GERTRUDE S. , COHLAN SIDNEY Q.
Published: December 2021

An eight year old child with intermittent attacks of hypertension and vomiting has been described, The blood pressure fell dramatically in response to Benzodioxane®, suggesting the presence of a pheochromocytoma, but this tumor was not found after an extensive exploratory laparotomy. The episodes of hypertension and vomiting together with the associated findings in this child of crying without tears, frequent blotching of the skin and excessive sweating and salivating are considered to be indications of an unusually labile autonomic nervous system. These latter characteristics were present in a younger sibling who also had an extremely labile blood pressure but who did not exhibit periodic attacks of hypertension and vomiting.

A variety of agents were studied for their effects on the patient's signs and symptoms but none of these were demonstrated to have any therapeutic value.
FACTORS AFFECTING PROGNOSIS OF TUBERCULOUS MENINGITIS TREATED WITH STREPTOMYCIN
Authors: FINBERG LAURENCE
Published: December 2021

A series of 35 consecutive unselected cases of tuberculous meningitis treated with streptomycin is presented briefly. The over-all survival rate with a minimum observation period of six months is 37.2%. The longest observation on a survivor is 49 months.

It is shown that for this group of cases of tuberculous meningitis that the coexistence of roentgenographic evidence of miliary lesions in the lungs changed the prognosis for survival from 55% to 13%. It is also noted that applying this factor to the published data from other clinics seems to resolve in part some apparent discrepancies in results.
CONGENITAL LOBAR EMPHYSEMA
Authors: ROBERTSON ROSS , JAMES E. STEWART
Published: December 2021

Congenital lobar emphysema is a surgical emergency of infancy. It may be diagnosed without much difficulty and treated by lobectomy with gratifying success.

The exact nature of the congenital defect in the bronchus should be revealed by a more thorough study of similar cases.

If the condition is not suspected, it might readily be missed at routine autopsy, and consequently may occur more frequently than realized.
SERUM COMPLEMENT IN ACUTE GLOMERULONEPHRITIS AND THE NEPHROTIC SYNDROME
Authors: LANGE KURT , SLOBODY LAWRENCE , GRAIG FRANK , OGUR GLORIA , OBERMAN JACOB , LOCASTO FRED
Published: December 2021

The literature on glomerulonephritis as an antigen-antibody reaction has been briefly reviewed. This reaction is complement-binding. A method to determine complement titres has been described and a unit of complement defined. The value for complement in 52 control children ranged between 0.84 and 3.0 units with an average of 1.68 units; only one child showed a value below 1.0 units.

The complement titre in five cases of acute glomerulonephritis in children ranged between 0.08 and 1.0 units with an average of 0.43 units. Similar values were found in eight adult cases.

The complement titre in nine cases of nephrosis in children ranged between 0.09 and 1.0 unit with an average of 0.57 units. No immunologic differences were observed between the nephrotic syndrome in glomerulonephritis and so-called pure nephrosis as far as complement was concerned.

Complement levels return to normal approximately one week after the subsidence of clinical and laboratory signs of activity of glomerulonephritis.

Diuresis, whether spontaneous or induced by ACTH therapy, is accompanied by a return of complement to normal values in spite of persistence of the same degree of proteinuria, hypoproteinemia and hypercholesterolemia.
Fetal Minoxidil Exposure
Authors: ROSA FRANZ W. , IDANPAAN-HEIKKILA JUHANA , ASANTI RITA
Published: December 2021

To the Editor.—

Kaler et al (Pediatrics 1987;79:434-436) provided a case report of hypertrichosis and multiple congenital anomalies with maternal minoxidil use. Reports such as this contribute to alerting national drug safety offices of possible teratologic questions. Maternal drug exposure data, since 1979 when minoxidil was marketed, is available to the Food and Drug Administration (FDA) from 73,000 pregnancies (15,600 birth defects, 4,400 spontaneous abortions, and 53,000 normal outcomes). This yields, in addition to the report by Kaler et al, only two other births with maternal minoxidil exposures:
Blood Transfusion Effect on the Respiratory Pattern of Preterm Infants
Authors: Joshi Ashok , Gerhardt Tilo , Shandloff Patty , Bancalari Eduardo
Published: December 2021

Anemia may increase the risk of tissue hypoxia in preterm infants. This could lead to respiratory center depression and an increased risk for apnea. Heart rate and breathing pattern were recorded in 30 preterm infants (gestational age 30.0 ± 2.3 weeks, postnatal age 46.6 ± 20.8 days, and weight 1,438 ± 266 g) before and after a transfusion of 10 mL/kg of packed RBCs. All infants were stable clinically, breathing room air, and free of prolonged apneic episodes. After transfusion, hematocrit levels increased from 27.0% ± 2.5% to 35.8% ± 4.7%. Heart rate decreased from 157.2 ± 13.6 beats per minute to 148.4 ± 13.9 beats per minute. There was no change in respiratory rate or BP. The duration of periodic breathing decreased significantly, as did the duration of the longest periodic breathing episode (P < .01). The number of respiratory pauses lasting 5 to 10 seconds and the number of pauses lasting 11 to 20 seconds also decreased significantly (P < .05). The total duration of respiratory pauses, excluding pauses during periodic breathing, were significantly lower after transfusion (P < .05), as was the number of episodes of bradycardia. These results indicate that preterm infants have a more irregular breathing pattern while anemic than after correction of the anemia. The irregular breathing pattern is probably caused by mild hypoxic respiratory center depression.