bluuebunny/crossref_metadata_2025 huggingface dataset:
Odontoid Fracture in a Child Occupying a Child Restraint Seat
Authors: DIEKEMA DOUGLAS S. , ALLEN DAVID B.
Published: December 2021

General agreement exists regarding the importance of using infant and toddler car seats. However, current guidelines regarding the proper time to change the direction of a convertible safety seat are still debated. We report a case in which an unusual, but preventable, injury was sustained by a child occupying a "properly" installed child restraint device. The rarity and potential seriousness of this injury illustrates the safety advantage of using rearward facing infant car seats as long as possible during infancy.

CASE REPORT

A 10-month-old girl weighing 8.04 kg (17 lb 14 oz) occupied a properly installed forward facing convertible safety seat located in the rear seat of an automobile involved in an accident.
Intravenous γ-Globulin Use in Children With Kawasaki Disease
Authors:   Committee on Infectious Diseases
Published: December 2021

A recent controlled American trial1 of treatment for Kawasaki disease compared the use of acetylsalicylic acid (aspirin) alone v aspirin at the same dose plus a single preparation of IV γ-globulin, which is not currently licensed in the United States. The dosage of IV γ-globulin was 400 mg/kg/d for four days, and the dosage of aspirin was 80 to 100 mg/kg/d for as many as 8 weeks. The results indicated that, if administered within ten days of onset of fever, the combined treatment significantly lowered the prevalence of coronary artery dilation and aneurysms detected at 2 and 7 weeks postenrollment. The IV γ-globulin-treated group showed significant and rapid reduction in fever, WBC count, and generalized inflammatory signs. Prior studies in Japan also showed benefit from IV γ-globulin.2

Because the etiology of Kawasaki disease is not known and the active component of the immune globulin has not been identified, it is not known whether all IV γ-globulin preparations currently licensed in the United States will be effective. Further studies are underway to compare different IV γ-globulin preparations and to determine the optimal dose and schedule of administration.

Pediatricians should consider using IV γ-globulin and aspirin for the treatment of patients who meet the strict criteria for this syndrome.3 If IV γ-globulin is to be used, therapy should be initiated with any one of the products licensed in the United States and administered within ten days of the onset of illness at the dosage schedule described above. The efficacy of such therapy if initiated more than ten days after onset of illness or after aneurysms have been found has not yet been demonstrated.
Cocaine Abusers as Mothers
Authors: CERSONSKY JEFF
Published: December 2021

To the Editor.—

I have two points to raise concerning the article by Chasnoff et al (Pediatrics 1987;80:836-838). First, the history of alcohol intake given was consistent with dependency. As an addictionologist working with teenage alcoholics and addicts, I can give you a pretty good assurrance that the alcohol intake related by this mother was a gross underestimation. The physical features of this child lead one to believe that the child did suffer from prenatal maternal abuse and should have been further discussed.
Carbohydrate Malabsorption Following Fruit Juice Ingestion in Young Children
Authors: Hyams Jeffrey S. , Etienne Nancy L. , Leichtner Alan M. , Theuer Richard C.
Published: December 2021

We performed breath hydrogen analyses in 13 healthy children (9 to 36 months of age) and seven children (14 to 27 months of age) with chronic nonspecific diarrhea after they had ingested pear, grape, and apple juices and a 2% sorbitol solution. Excess breath H2 excretion was found in virtually all study subjects following the ingestion of either pear juice (with approximately 2% sorbitol content) or the 2% sorbitol solution, in approximately 50% of those ingesting apple juice (0.5% sorbitol), and in 25% of those ingesting grape juice (no sorbitol) (P < .001, analysis of variance). No differences were noted between the healthy children and those with chronic nonspecific diarrhea. Forty percent of all study subjects in whom excess breath hydrogen excretion occurred also had diarrhea and abdominal cramping. Carbohydrate malabsorption appears to be frequent following the ingestion of common fruit juices and in some children may be associated with nonspecific gastrointestinal symptoms.
Congenital Malformations and Intrauterine Growth Retardation: A Population Study
Authors: Khoury Muin J. , Erickson J. David , Cordero José F. , McCarthy Brian J.
Published: December 2021

The relationship between congenital malformations and intrauterine growth retardation was investigated using data from the population-based Metropolitan Atlanta Congenital Defects Program. Between 1970 and 1984, the system ascertained 13,074 infants with major structural malformations diagnosed in the first year of life and born to metropolitan Atlanta residents. These infants were classified as having intrautenine growth retardation if their birth weight was below the race-, sex-, and gestational age-specific tenth percentile limits for all Atlanta births. Overall, the frequency of intrauterine growth retardation among malformed infants was 22.3% (relative risk 2.6). Of 48 defect categories evaluated, 46 were associated with excess intrauterine growth retardation, most notably chromosomal anomalies (eg, 83.7% for infants with trisomy 18, relative risk 46) and anencephaly (73.3%, relative risk 25). Only a few isolated defects (such as isolated polydactyly, pylonic stenosis, and congenital hip dislocation) were not associated with excess intrauterine growth retardation. Among infants with multiple malformations, the frequency of intrauterine growth retardation increased markedly with increasing number of defects—from 20% for infants with two defects to 60% for infants with nine or more defects. The relationship between malformations and intrauterine growth retardation can be explained by one or more of three mechanisms: (1) intrauterine growth retardation can be a secondary disturbance to the presence of malformations; (2) intrauterine growth retardation can predispose the fetus to malformations; and (3) intrauterine growth retardation can coexist with malformations because of common etiologic factors. Because the risk of a major defect diagnosed in the first year increases from 3.3% for infants without intrauterine growth retardation to 8.0% for infants with intrauterine growth retardation, the presence of intrauterine growth retardation may help in the prenatal and neonatal detection of congenital malformations.
Vesicoureteral Reflux in the Primate. Iv. Infection as Cause of Prolonged High-Grade Reflux
Authors: Roberts James A. , Kaack M. Bernice , Morvant Anne B.
Published: December 2021

High-grade reflux commonly lasts longer than moderate reflux, which disappears with maturtion of the ureterovesical junction. It is known that ureteral function is affected by urinary tract infection from studies in experimental animals, as well as through clinica1 findings in patients with upper tract infection. Whether infection might affect the ability of the ureter to prolong high-grade reflux was questioned. This observation might explain why high-grade reflux does not disappear as rapidly as moderate reflux in children with recurrent urinary tract infections. Vesicoureteral reflux was produced surgically in combination with bladder neck obstruction using infant monkeys. The reflux thus produced was high grade with ureteral dilation and caliectasis. In the group of animals in which the bladder neck obstruction was relieved surgically, the reflux rapidly disappeared. In the other group, a bladder infection was produced with Escherichia coli at the time of release of the bladder neck obstruction. The reflux lasted significantly longer, an average of 18 months. Therefore, it appears that treatment of urinary tract infection rather than vesicoureteral reflux is the most important therapy.
Hearing Disorders in Children With Fetal Alcohol Syndrome: Findings From Case Reports
Authors: Church M. W. , Gerkin K. P.
Published: December 2021

Fourteen children with the fetal alcohol syndrome were evaluated by standard audiologic procedures. Thirteen of the 14 children had childhood histories of hearing disorders. All 13 of these children (93%) had clinically significant histories of bilateral recurrent serous otitis media (ie, they were otitis prone), and at least four children (29%) had bilateral sensorineural hearing losses in addition to being otitis prone. Many of the children with recurrent serous otitis media required repeated myringotomies with placement of ventilation tubes, and those with sensorineural hearing losses required sound amplification during childhood. Recurrent respiratory infections (secondary to immune deficiencies) and eustachian tube dysfunction (secondary to embryonic malformations of the first and second branchial arches) are discussed as possible etiologic factors in the presence of the recurrent serous otitis media. An alcohol-induced neuroectoderm syndrome and alcohol ototoxicity are discussed as possible etiologic factors in the occurrence of sensorineural hearing loss. The findings suggest that hearing disorders are a heretofore unrecognized characteristic of the fetal alcohol syndrome. Such hearing disorders may contribute to the speech and language and learning difficulties seen in children with fetal alcohol syndrome. The present study also provided confirmatory evidence of visual, health, and speech and language disorders in children with this syndrome.
Right-Sided Brain Lesions in Infants Following Extracorporeal Membrane Oxygenation
Authors: Schumacher R. E. , Barks J. D.E. , Johnston M. V. , Donn S. M. , Scher M. S. , Roloff D. W. , Bartlett R. H.
Published: December 2021

In retrospective review of survivors of neonatal extracorporeal membrane oxygenation, eight patients with varying degrees of right hemispheric brain injury were identified. The extent of preextracorporeal membrane oxygenation hypoxia and ischemia was documented: five of eight patients had arterial Po2 values of <40 mm Hg, seven of eight required dopamine for blood pressure support, and five of eight required cardiopulmonary resuscitation. Two patients had proven neurologic abnormalities before extracorporeal membrane oxygenation. Postextracorporeal membrane oxygenation CT brain scans showed right hemispheric focal abnormalities in three patients. Seven infants had neuromotor abnormalities which were laterlizing in nature; all were left sided, suggesting right-sided brain injury. EEGs showed an increased incidence of slowing and attenuation over the right hemisphere. These findings indicate that right-sided brain abnormalities exist after extracorporeal membrane oxygenation and that carotid artery ligation for extracorporeal membrane oxygenation is not without risk.
Extracorporeal Membrane Oxygenation Selection Criteria: Partial Pressure of Arterial Oxygen Versus Alveolar-Arterial Oxygen Gradient
Authors: Marsh T. David , Wilkerson Shirley A. , Cook Larry N.
Published: December 2021

Extracorporeal membrane oxygenation (ECMO) has dramatically increased the survival rate of hypoxemic neonates who are unresponsive to maximum conventional medical therapy. Because ECMO involves multiple risks, including ligation of the right common carotid artery and right internal jugular vein, ECMO candidates should be neurologically intact neonates with a high probability of death despite maximum conventional ventilatory support. Currently, criteria based on the calculated alveolar-arterial oxygen gradient (A-aDo2) have replaced the neonatal pulmonary insufficiency index for predicting mortality and, thus, ECMO eligibility. A retrospective review of death prediction for the 26 months prior to the initiation of an ECMO program revealed a sensitivity of 67% and a specificity of 96% using the criterion of a Pao2 of less than 50 mm Hg for four hours. An equivalent A-aDo2 criterion of greater than or equal to 630 for four hours produced a sensitivity of 61% and a specificity of 96%. Prediction of mortality in neonates with sepsis was poor regardless of the criteria used. Excluding the deaths due to sepsis increased the sensitivity to 86% and 79% using criteria based on Pao2 and A-aDo2, respectively. It is concluded that the use of criteria based on Pao2 is equivalent to criteria based on A-aDo2 for predicting mortality. Criteria based on Pao2 may, however, decrease both the false-negative rate (patients with an elevated Pco2) and the false-positive rate (patients with intentionally induced hypocarbia secondary to hyperventilation alkalosis).
Reading Disability With Motor Problems May Be an Inherited Subtype
Authors: Regehr Sonya M. , Kaplan Bonnie J.
Published: December 2021

There is evidence from a number of studies that various forms of reading disability are inherited. The familial patterns of one specific type of reading disability that occurs together with impaired coordination and balance were evaluated. Ten reading-disabled children with these motor problems, ten children with only reading problems, and ten control children without reading disabilities were examined along with their siblings and parents. The control children were matched to the reading-disabled children for age, sex, and family socioeconomic status. A high prevalence of reading and motor problems was found in the relatives of the children with reading disability and motor problems, whereas a high prevalence of only reading problems was found in the relatives of the children with only reading disability. There were no differences among the three groups of children or their siblings on number of pregnancy and birth complications or prevalence of attention deficit disorder. It was concluded that reading disability with motor problems may be an inherited type of reading disability, distinct from reading disability without motor problems, which is also inherited.
Hematuria and Clinical Findings as Indications for Intravenous Pyelography in Pediatric Blunt Renal Trauma
Authors: Lieu Tracy A. , Fleisher Gary R. , Mahboubi Soroosh , Schwartz J. Sanford
Published: December 2021

The essential aids in the evaluation of suspected blunt urinary tract injury are urinalysis and IVP. In 78 consecutive children who had IVPs because of trauma from January 1982 to March 1986, the following were evaluated (1) the yield of IVP; (2) the correlations between IVP and hematuria, mechanism of injury, and associated clinical findings; and (3) the effect of IVP on patient management. Of the 26 children (33%) with abnormal IVP findings, 13 had congenital urinary tract anomalies only and 13 had urinary tract injuries (eight renal contusions, four renal lacerations with extravasation, and one bladder rupture). The number of RBCs per high-power field correlated with IVP evidence of injury (P < .05). If only those patients with ≥20 RBCs per high-power field had received IVPs, 42% of IVPs would have been avoided and no injuries or surgically correctable anomalies would have been overlooked. Urinary tract injury occurred significantly more often in patients with extremity fractures (P < .05) and pelvic fractures (P < .05). Mechanism of injury, admission to the hospital, and flank tenderness or hematoma were not associated with IVP evidence of trauma (P > .05), however. In four patients with trauma, results of IVP led to lengthened hospitalization or further diagnostic studies but did not result in surgery. Two patients in whom ureteropelvic junction obstruction was discovered incidentally had delayed corrective surgery. It is concluded that (1) IVP has a substantially higher yield among children with ≥20 RBCs per high-power field; (2) for those with <20 RBCs per high-power field, IVP still may be required based on clinical findings; and (3) abnormal IVP findings influence the management of children with trauma in a minority of cases.
Anencephalic Infants as Organ Donors
Authors: Botkin Jeffrey R.
Published: December 2021

Transplantation technology has been refined in recent years and now offers hope to pediatric patients with a variety of end stage disease processes. The lack of available donors for the smallest potential organ recipients has led to the suggestion that anencephalic infants be used as organ donors. This suggested policy is contrary to current law and raises fundamental ethical issues relating to the definition of death and the treatment of the dying. The technical issues in the potential organ supply from this source are described and the opposing ethical positions developing in this debate are discussed.
Barbiturate Anticonvulsants as a Cause of Severe Depression
Authors: BARABAS GABOR , MATTHEWS WENDY S.
Published: December 2021

To the Editor.—

In a recent issue, Brent et al1 compared patients treated with phenobarbital with those treated with carbamazepine for seizure disorders. They noted that there was a much higher prevalence of major depressive disorder and suicidal ideation among those taking phenobarbital. They emphasized that the incidence of psychiatric disturbances is higher among epileptic children as compared with controls and that on occasion this may be due to iatrogenic effects of anticonvulsants and not only to factors intrinsic to epilepsy or secondary emotional factors.
Barbiturate Anticonvulsants as a Cause of Severe Depression
Authors: BRENT DAVID A.
Published: December 2021

In Reply.—

I appreciate the comments of Drs Barabas and Matthews. It is nice to receive additional clinical validation for our observations of an association between phenobarbital treatment and affective symptomatology in epileptic patients. A recently published study of adult epileptic patients has also found an association between phenobarbital treatment and depressive symptomatology.1

It is of interest to learn that other barbiturate anticonvulsants as well may be associated with depression. Drs Barabas and Matthews emphasize three points that we touched on, too—the importance of a high index of suspicion for depression in patients treated with phenobarbital, the possibility that such symptoms may occur at nontoxic doses, and the findings of depression in young children such as lability, irritability, and agitation that may be termed "hyperactivity."
Pink Rings Lymphocyte: A New Cytologic Abnormality Characteristic of Mucopolysaccharidosis Type II (Hunter Disease)
Authors: MAIER-REDELSPERGER MICHELINE , STERN MARC-HENRI , MAROTEAUX PIERRE
Published: December 2021

To the Editor.—

Mucopolysaccharidoses are a group of rare hereditary storage disorders characterized by various lysosomal hydrolase deficiencies. Clinical condition, radiologic and ophthalmologic examinations, urinary mucopolysaccharides dosage, and leukocyte morphology are generally sufficient for diagnosis.1 However, a more precise classification may be difficult. We herein describe a new lymphocyte abnormality observed in 9/9 cases of type II (Hunter disease) in only 3/19 cases of other types of mucopolysaccharidoses.

Capillary blood was collected from 28 children with mucopolysaccharidosis referred to the pediatric department.
Renal Calcification
Authors: WELCH THOMAS R. , DE ROVETTO CONSUELO RESTREPO , HUG GEORGE
Published: December 2021

To the Editor.—

Jacinto et al1 presented data concerning a group of 20 very low birth weight infants with renal calcification, most of whom had hypercalciuria. For 13 of these infants, furosemide administration was presumed to be the major factor contributing to the renal abnormality. For the remaining seven, there was no apparent basis for the increased calcium excretion and nephrocalcinosis. Although these children may have a heterogenous group of disorders, we suggest a specific diagnosis that may have been present in one or more of them.
Primary Immunization of Infants With an Acellular Pertussis Vaccine in a Double-Blind Randomized Clinical Trial
Authors: Blennow Margareta , Granström Marta , Jäätmaa Eva , Olin Patrick
Published: December 2021

The rate of adverse reactions and the immunogenicity of a two-component acellular pertussis vaccine as compared with a plain whole-cell vaccine and a placebo were evaluated for primary immunization in 319 6-month-old infants in a double-blind randomized clinical trial. The acellular vaccine produced few and mild systemic and local reactions. Fever (≥38°C) occurred in 6% to 8% of acellular vaccinees as opposed to 25% to 37% of whole-cell vaccinees. Redness (≥1 cm) appeared in 2% to 13% of the acellular vaccine and 24% to 32% of the whole-cell vaccine recipients. Antibody response to pertussis toxin measured in a neutralization test was obtained in 97% to 100% of the infants receiving either two or three doses of the acellular vaccine as compared to 59% after three doses of whole-cell vaccine.
Pediatric Chest Pain: A Prospective Study
Authors: Selbst Steven M. , Ruddy Richard M. , Clark B. J. , Henretig Frederick M. , Santulli Thomas
Published: December 2021

Previous studies of childhood chest pain have been retrospective or considered only limited age groups or referred patients. In this study, all children who were admitted to the emergency department with chest pain were evaluated prospectively. Patients with ill-defined chest pain had ECGs and echocardiograms performed. A total of 407 children were evaluated. The most common causes of the pain were idiopathic (21%) and musculoskeletal (15%). Cardiac problems were found in 4%. Chest pain was acute (of <48 hours' duration) in 43% and chronic (of >6 months' duration) in 7%. Pain caused 30% of children to stay out of school and 31% to awaken from sleep. Chest wall tenderness was the most common abnormality. ECGs were obtained in 47%; results of 31/191 were abnormal but only 4/191 ECG abnormalities were related to the diagnosis. Echocardiograms were obtained in 34%; results of 17/139 were abnormal (12/139 showed mitral valve prolapse). Young children are more likely to have cardiorespiratory problems; children older than 12 years of age are more likely to have psychogenic pain. The description and location of the pain and the patient's sex are not related to the diagnosis. Nonorganic disease is related to a family history of heart disease or chest pain or having chronic pain. Organic disease is related to pain of acute onset, abnormal physical examination results, pain that awakens the child from sleep, and the presence of fever. Laboratory tests are rarely helpful in evaluating children with chest pain. Chest pain in children is usually benign. Psychogenic pain and idiopathic pain are less common than previously believed.
In Vivo 31P Nuclear Magnetic Resonance Measurement of Chronic Changes in Cerebral Metabolites Following Neonatal Intraventricular Hemorrhage
Authors: Younkin Donald , Medoff-Cooper Barbara , Guillet Ronnie , Sinwell Teresa , Chance Britton , Delivoria-Papadopoulos Maria
Published: December 2021

The purpose of this study was to determine whether cerebral metabolic changes occur after intraventricular hemorrhage in the newborn. Five babies with bilateral grade 3 to 4 intraventricular hemorrhage were compared with 15 preterm infants without intraventricular hemorrhage. Cerebral high-energy phosphorus metabolites and intracellular pH were measured with in vivo 31P nuclear magnetic resonance spectroscopy. Spectra were collected initially within the first 2 weeks of life, and then every other week until discharged from the hospital. The phosphocreatine to inorganic phosphate ratio and the phosphocreatine to adenosine triphosphate ratio were significantly lower in the group with intraventricular hemorrhage, but differences in intracellular pH were not significant. Differences between babies with and without intraventricular hemorrhage varied with postconceptional age: in those with intraventricular hemorrhage, the phosphocreatine to adenosine triphosphate ratio was decreased at all postconceptional ages, and the phosphocreatine to inorganic phosphate ratio was lower in babies with intraventricular hemorrhage and younger than 30 weeks. Results of this study confirm the presence of chronic metabolic changes following intraventricular hemorrhage which may exacerbate neurologic damage after intraventricular hemorrhage in the newborn.
Gynecomastia as a Presenting Sign of Fibrolamellar Carcinoma of the Liver
Authors: MCCLOSKEY JOHN J. , GERMAIN-LEE EMILY L. , PERMAN JAY A. , PLOTNICK LESLIE P. , JANOSKI ALFONSO H.
Published: December 2021

Gynecomastia is generally a benign occurrence in 39% to 67% of the normal adolescent male population.1,2 Although the etiology of the breast development is not entirely clear, it may be due to a transient increase in serum estradiol leading to an increase in the estradiol to testosterone ratio. Gynecomastia in adolescent boys may also be associated with a variety of pathologic conditions in which there is an elevation in the estradiol to testosterone ratio. Examples of these conditions include Klinefelter syndrome, congenital anorchia, androgen resistance, orchitis, trauma, congenital adrenal hyperplasia, thyrotoxicosis, starvation, cirrhosis, testicular tumors, adrenal tumors, and primary liver carcinoma.3
Palatal Burn Due to Bottle Warming in a Microwave Oven
Authors: HIBBARD ROBERTA A. , BLEVINS RONALD
Published: December 2021

Infections, tumors, nutshells, and foreign bodies may all be seen clinically as unusual lesions of the palate in children.1,2 We describe the case of an infant girl who had a palatal lesion, eventually determined to be secondary to a scald burn. We emphasize this case because the eventual diagnosis was not considered until almost 2 months after the patient was first seen, at which time additional history was elicited.

CASE REPORT

C.P. was a 4-month-old girl referred to our hospital for evaluation and treatment of poor weight gain with a palatal lesion. She was delivered by cesarean section for cephalopelvic disproportion after an uncomplicated fullterm pregnancy; her birth weight was 3,820 g (90th percentile).
Chronic Ipecac Poisoning in Infancy: A Case Report
Authors: BERKNER PAUL , KASTNER TED , SKOLNICK LAWRENCE
Published: December 2021

Syrup of ipecac is an important component in the treatment of acute toxic ingestion. The American Academy of Pediatrics1 recommends that syrup of ipecac be kept in the household to be used for the conscious patient in the treatment of toxic ingestion when advised by a physician. Syrup of ipecac is not without toxicity, however, and this increased availability opens the door to poisoning by ipecac itself.

Toxicity has been observed in adults ranging from direct noxious effects on the gastrointestinal system2-4 to cardiomyopathy,2,5 generalized myopathy,6,7 and fatalities secondary to dehydration or electrolytic distubrances.8 Little is known about the signs and symptoms of ipecac toxicity in infants and children.
TrophAmine
Authors: ZLOTKIN STANLEY H.
Published: December 2021

To the Editor.—

Heird et al1 recently described the use of a new parenteral amino acid mixture for low birth weight infants which included a peptide of tyrosine (N-acetyl-l-tyrosine). They concluded that infants tolerated the new mixture well and stated that it was "more efficacious with respect to nitrogen retention and weight gain than other available mixtures." It is my contention that their results do not substantiate their claims.

First, the efficiency of nitrogen retention with TrophAmine (70% retention) is not superior to older amino acid solutions.
A Catch in the Reye
Authors: ORLOWSKI JAMES P.
Published: December 2021

In Reply.—

McGee and Sienko suggest that Reye syndrome may be a different disease in infants and young children than in older children and adolescents. This is an intriguing concept and is based partly on their observation that our patients1 were noticeably younger than the ones reported in the other four studies they reference. It is important to notice, however, that the age ranges in three of those four studies were purposely distorted and skewed to older children.
Reye Study Criticized
Authors: HALL SUSAN M.
Published: December 2021

To the Editor.—

Orlowski et al1 conclude from their finding that only one of their 20 patients with Reye syndrome had taken aspirin and that the "purported association" between aspirin and Reye syndrome is "coincidental." This conclusion is based on a series of observations that do not stand up to critical analysis.

First, Reye syndrome is the same disease in Australia as it is in the United States. The authors correctly emphasize the similarities between their Australian series of patients with Reye syndrome and those reported to the British surveillance scheme.2
Another Solution for the Foreign Body in the Nose Problem
Authors: HENDRICK JIM G.
Published: December 2021

To the Editor.—

Years ago, pediatrician Harvey Garrison, Jr, told me how to construct the "perfect" instrument for nasal foreign body removal—simple, available, and inexpensive. Open a paper clip and bend about 3 mm of the tip of either end about 45° by clamping the tip between the handle end of bandage scissors (Figure). By sliding the bent tip of this "medical instrument" over the foreign body and then drawing it outward, I have quickly and safely removed objects from the nose during the past 40 years of my pediatric practice.
Prospective Pricing Model for Neonatologists and Obstetricians in Tertiary Care Centers
Authors: Resnick Michael B. , Ariet Mario , Carter Randolph L. , Bucciarelli Richard L. , Furlough Robert R. , Evans Janet H. , McCloud Allen J. , Cruz Amelia C. , Curran John S. , Ausbon William W.
Published: December 2021

According to the new federal diagnosis-related group (DRG) system, hospitals are reimbursed fixed sums based on discharge diagnoses, rather than variable sums that depend on specific goods and services consumed and number of days hospitalized. The government is now exploring DRGs as a potential mechanism for reimbursing physicians. In Florida, two DRG-type reimbursement systems were developed for neonatal and obstetrical hospitalizations in tertiary care settings, as departures from the federal DRG system. Called neonatal care groups (NCGs) and obstetrical care groups (OBCGs), both classification systems predicted hospital charges in these settings more accurately than did federal DRGs. The feasibility of a prospective pricing system for neonatologists and obstetricians based on NCGs and OBCGs was investigated. The data showed that neonatologists' charges had a high correlation with hospital charges (r = .90) and that increasing levels of intensity of care as defined by the NCGs were reflected by consistent increases in reimbursement to neonatologists. If the NCG system were to be applied, neonatologists would receive compensation equivalent to that which they currently earn according to the fee-for-service system. In contrast, obstetricians' charges bore almost no relationship to hospital charges. However, modest differences in obstetrician's charges did emerge as a reflection of number of complications, which are incorporated into the OBCG categories; this suggests that a reimbursement system based on hospital OBCG categories might be applied to obstetricians.
Once-Daily Administration of Ceftriaxone for the Treatment of Selected Serious Bacterial Infections in Children
Authors: Frenkel Lawrence D. ,   The Multicenter Ceftriaxone Pediatric Study Group
Published: December 2021

Ceftriaxone treatment (50 to 80 mg/kg once daily) was given to 201 children between 1 month and 18 years of age. There were 201 serious bacterial infections, including epiglottitis, pneumonia, cellulitis, osteomyelitis, septic arthritis, pyelonephritis, sepsis, and meningitis. The common pathogens responsible for pediatric infections isolated from these patients included Haemophilus influenzae, Staphylococcus aureus, Streptococcus pyogenes, Streptococcus pneumoniae, and Escherichia coli. The overall clinic cure rate was 94%. Ten patients were clinically improved but not cured. There were two clinical failures. Bacteriologic failure occurred in six patients. The overall bacteriologic cure rate was 97%. Twenty patients (10%) experienced adverse effects; none required discontinuation of therapy. The efficacy, safety, spectrum, and convenience of ceftriaxone monotherapy make this antimicrobial agent a candidate for the treatment of choice of selected serious pediatric infections.
Infant-Feeding Practices Among Middle-Class Anglos and Hispanics
Authors: Wright Anne L. , Holberg Catharine , Taussig Lynn M. ,   The Group Health Medical Associates Pediatricians
Published: December 2021

Feeding practices have been analyzed prospectively in a sample of 1,112 healthy infants selected from families using an HMO. Data were collected at well-child visits during the first year of life regarding breast-feeding, formula feeding, and use of solid foods and cow's milk. Seventy percent of all infants were breast-fed, with the mean duration of breast-feeding being almost 7 months. Factors positively associated with breast-feeding included education and marriage, whereas maternal employment outside the home and ethnicity (being Hispanic rather than Anglo-American) were related to bottle feeding. Solid foods were introduced earlier by Hispanics and, also, among less well educated and single women; maternal employment was unrelated to the introduction of solid foods. Multiple regression analysis indicated different patterns for the two ethnic groups: education and employment were related to almost all feeding practices for Anglo-Americans, whereas education and employment predicted few feeding practices for the Hispanics. These findings suggest that the effects of ethnicity are independent of those of education.
AIDS and Suctioning Newborn Infants
Authors: KEMPEN PAUL M.
Published: December 2021

To the Editor.—

The current recommended therapy for patients with meconium aspiration consists of extensive suctioning of the oropharynx and nasopharynx after delivery of the head, with subsequent endotracheal intubation and deep suction with the endotracheal tube as the suction catheter. The upper airway is commonly cleared with a bulb syringe and/or a Delee suction device. With both the Delee and the currently recommended endotracheal suction methods, the physician's mouth is the source of negative pressure.
Ascendancy of the `Black Bottle'
Authors: MACGREGOR DONALD F.
Published: December 2021

To the Editor.—

Greensher et al1 commented on the increasing advice given to emergency room and primary care physicians regarding the use of activated charcoal instead of syrup of ipecac as first-line therapy for ingested toxins. This may be the direction that hospital facilities should be taking but, hopefully, will not undermine the confidence that many practitioners and the public have in syrup of ipecac. Many developing countries take their lead from North America and there are still areas on this continent where immediate emergency room access is impossible.
Human Immunodeficiency Virus Infection in Hemophilic Children
Authors: Jason Janine M. , Stehr-Green Jeanette , Holman Robert C. , Evatt Bruce L. ,   The Hemophilia-AIDS Collaborative Study Group
Published: December 2021

The following groups were compared: (1) children <18 years old who have hemophilia-associated acquired immunodeficiency syndrome (AIDS) with other children with AIDS and with adults who have hemophilia-associated AIDS and (2) asymptomatic HIV-infected hemophilic children with asymptomatic HIV-infected hemophilic adults. Children with hemophilia-associated AIDS were older than other children with AIDS (medians 13 and 1 years, respectively) and less frequently had lymphocytic interstitial pneumonitis (5% v 48%) but had similar incidences of Pneumocystis carinii pneumonia (51% v 53%) and similar case to fatality ratios (59% v 61%). Children with hemophilia-associated AIDS had P carinii pneumonia significantly less often than did adults with hemophilia-associated AIDS, but both had similar case to fatality ratios (adults 72% with P carinii pneumonia, 68% dead). Significantly more hemophilic children than adults with AIDS were nonwhite (30% v 14%) and resided in the tristate area of New York/New Jersey/Pennsylvania (43% v 25%). The immune effects of human immunodeficiency virus (HIV) to date on asymptomatic pediatric and adult hemophiliacs are similar but may be more severe in adults. It is concluded that, although some of the clinical manifestations of AIDS (eg, lymphocytic interstitial pneumonitis) occurring or not occurring in older children infected through blood factor products differ from those of other children with AIDS, disease outcome to date is equally poor. The reasons for the differences between hemophilic children and hemophilic adults with and without AIDS warrant further investigation.
Haemophilus influenzae Type b Immunization of Children With Sickle Cell Diseases
Authors: Frank Arthur L. , Labotka Richard J. , Rao Sudha , Frisone Lisa R. , McVerry Patrick H. , Samuelson Joel S. , Maurer Helen , Yogev Ram
Published: December 2021

Haemophilus influenzae type B vaccine is recommended for children 1.5 to 6 years of age with sickle cell anemia, but the adequacy of their response is unknown. A total of 69 children with sickle cell syndromes, 1.5 to 5.6 years of age, were immunized with two vaccines alternately, single blind PRP vaccine was given to 36 children and a diphtheria toxoid conjugated vaccine, PRP-D, was given to 36. Coded pre- and postvaccine sera were tested by radioimmunoassay for anti-PRP antibody. The groups did not differ in age distribution or type of sickle hemoglobinopathy. Preexisting antibody levels were low in both vaccine groups; 65% were <0.15 µg/mL. The vaccines were safe but associated with frequent minor reactions. PRP-D gave higher geometric mean titers and mean fold titer increase than PRP in all children (15.58 µg/mL [234-fold] v 2.63 µg/mL [29-fold]) and in the subgroups 1.5 to 2.5 years of age or with pretiter values <0.15 µg/mL. Titers for 64% of children receiving PRP and 94% receiving PRP-D were ≥1.0 µg/mL. Thus, both vaccines were useful in this population, but PRP-D was more immunogenic. Duration of antibody levels postvaccination, booster responses, and PRP-D immunogenicity in younger children with sickle cell syndromes all require further study.
Rapid Group A Streptococcal Antigen Detection Kit: Effect on Antimicrobial Therapy for Acute Pharyngitis
Authors: Redd Stephen C. , Facklam Richard R. , Collin Sheila , Cohen Mitchell L. ,   The Medical Staff of the Indian Health Service Hospital, Tuba City, Arizona
Published: December 2021

Newly introduced rapid diagnostic tests for group A streptococcal pharyngitis should facilitate appropriate antimicrobial use in patients with group A streptococcal pharyngitis. Because of high rates of acute pharyngitis in Tuba City, AZ, at the Navajo Indian reservation, the use of a rapid diagnostic test was prospectively evaluated. The sensitivity and specificity of the test was measured and changes in physician prescribing patterns attributable to use of the test were correlated. Of 320 patients with pharyngitis enrolled during the present 3-week study, 86 met the study's definition of a patient with streptococcal pharyngitis and 163 met the study's definition of a patient with nonstreptococcal pharyngitis. The rapid test was 62.8% sensitive and 96.9% specific in identifying patients from whom group A streptococci were isolated. Although treatment of patient with streptococcal pharyngitis at the time of the first visit increased from 36.5% in a retrospective sample to 72.5% during the study, treatment of patients in whom cultures were negative remained the same. Further analyses showed that physicians tended to treat patients with signs characteristic of streptococcal pharyngitis and, as the study prograssed, to rely less on negative rapid test results as a reason to withhold antimicrobial agents. It was concluded that rapid tests with good specificity but limited sensitivity may improve treatment of patients with streptococcal pharyngitis by allowing earlier specific therapy. A more sensitive test with a higher negative predictive value would be necessary to prevent treatment of persons with nonstreptococcal pharyngitis.
High Prevalence of Genital Tract Papillomavirus Infection in Female Adolescents
Authors: Martinez Jaime , Smith Raymona , Farmer Mychelle , Resau James , Alger Lindsay , Daniel Richard , Gupta Jean , Shah Keerti , Naghashfar Zohreh
Published: December 2021

To investigate clinical condyloma, abnormal cervical cytologic findings, and evidence of human papillomavirus infections, 89 adolescent girls were examined. Cellular DNAs extracted from exfoliated cervical cells were examined for human papillomavirus genomic sequences by Southern transfer hybridization using 32P-labeled human papillomavirus DNA probes. Human papillomavirus sequences were detected in 12 (13%) young women, abnormal cytologic specimens in 21 (24%), and vulvar condylomas in 12 (13%). The human papillomavirus types identified included HPV-6/11 (four instances), which is known to be associated with benign lesions, and HPV-16, -18, and -31 (eight instances) which are considered to have oncogenic potential. Two young women were infected with both HPV-16 and -31. Human papillomavirus sequences were found in 48% of the young women with abnormal cytologic findings and in 3% of patients with normal cytologic findings (P < .0001). Condylomatous changes in the cervical smear were associated with the presence of HPV-6/11 and mild dysplasia with the presence of HPV-16, -18, and -31. The presence of vulvar condylomas correlated with condylomatous changes in the cervical smear and with the recovery of HPV-6/11 from the cervical epithelium. The results indicate that the prevalence of human papillomavirus infections in this population is high and that a majority of the infections are with viruses associated with lower genital tract malignancies.
Preschool Behavior Problems and Subsequent Risk of Injury
Authors: Davidson L. L. , Hughes S. J. , O'Connor P. A.
Published: December 2021

The hospital records of 951 children from a previously established birth cohort for which behavioral and extensive background information was available were checked for 3 years following the fifth birthday of the youngest child. The aim was to determine whether children with certain specific behavior disorders had a higher rate of injury than those without. Although the predicted relationships between overactive behavior, decreased concentration, and injury rate were not found, the hypothesis of an increased risk of injury for boys and for children with discipline problems was confirmed. Also, the association between male sex and injury remained after controlling for the behavior variables related to injury. In general, some support was found for the suggestion of increased risk of injury among children who have specific behavior problems, although, contrary to widespread belief, this relationship accounts for only a small percentage of the injuries found in the cohort. Moreover, the relationship is modified by maternal characteristics and by the sex of the child. Unexpectedly, encopresis and marked fears were found to be risk factors for injury, although these effects were relatively small.
Laser Therapy for Selected Cutaneous Vascular Lesions in the Pediatric Population: A Review
Authors: Tan Oon Tian , Gilchrest Barbara A.
Published: December 2021

Three cutaneous vascular lesions of childhood (the spider angioma [nevus araneus], the strawberry hemangioma, and the port wine stain] are reviewed, with particular emphasis on the present and future role of laser therapy in their management.
Prediction of Abnormal Pulmonary Follow-up in Premature Infants
Authors: BANCALARI EDUARDO
Published: December 2021

The article by Shennan and collaborators1 raises some interesting questions concerning the diagnosis of chronic lung disease and the predictability of respiratory outcome in early infancy. The first question addressed by the authors relates to the definition of bronchopulmonary dysplasia. This term was introduced by Northway et al2 in 1967 to describe a group of infants in whom severe chronic lung changes developed after prolonged mechanical ventilation and oxygen therapy. Most of these were infants with birth weights greater than 1000 g in whom chronic respiratory failure developed and whose chest radiographs appeared abnormal. In recent years, there has been an increase in the survival rate of infants with birth weights less than 1000 g, which has resulted in an increase in the population at risk for the development of chronic lung disease.
Mortality Rates and Health Progress
Authors: WEGMAN MYRON E.
Published: December 2021

Mortality rates, when properly interpreted, can be of much use in allowing us to follow the progress of a community's health status. Pediatricians have tended to look mainly at infant mortality, traditionally a sensitive general indicator, but similar data for other children are also of value. In this issue of Pediatrics, Hoekelman and Pless1 reviewed National Center for Health Statistics data regarding the trend, since 1900, of US mortality at the several ages of childhood, analyzing the factors that appear to have had most influence and seeking lessons for future action. Wisely, before making any interpretations, they examined carefully whether statistical factors such as completeness of reporting or changes in classification procedures might have interfered seriously with any of their conclusions and justifiably believed none did.
Religion and Child Abuse
Authors: FOST NORMAN C.
Published: December 2021

In Reply.—

I agree with all of Dr. Fletcher's cautions about the hazards of state intrusion, especially when treatment is of uncertain benefit. It is not accidental that the statement cites only "easy" cases: it is precisely the clear cases that are outrageous and which require state protection.

His concern that "an arrogant physician" may dangerously impose uncertain treatment is the reason we have legal procedures for resolving such disputes. By reporting cases of medical neglect, the physician acknowledges that he or she should not be imposing judgment on parents of children but that a process should be initiated that allows representation of the interested parties, consideration of the relevant facts, and adjudication by a dispassionate, disinterested person.
A Catch in `a Catch in the Reye'
Authors: REMINGTON PATRICK L. , SULLIVAN KEVIN , MARKS JAMES S.
Published: December 2021

To the Editor.—

The "Catch in the Reye"1 is not in the data but rather in the authors' interpretation. They incorrectly surmise that finding that only one in 20 patients with Reye syndrome had taken aspirin makes it unlikely that aspirin is a risk factor for Reye syndrome. This conclusion ignores the relationship between the prevalence of a risk factor (such as aspirin), the relative risk (RR), and the population attributable risk (PAR). In a population in which aspirin use is uncommon, such as Australia, only a small proportion of all patients with Reye syndrome will have a history of aspirin use.
AIDS-Associated Lymphoma of the Brain in a Child
Authors: MURPHY SHARON B.
Published: December 2021

Invited Comment.—

The HIV-infected infant with a primary lymphoma of the brain reported by Professor Cocchi and colleagues from Italy adds another case to the series of pediatric AIDS-associated brain lymphomas already reported by others.1-3 The true frequency of these opportunistic cancers is unknown, but, surely, we are just beginning to see the tip of the iceberg. Neurologic deterioration is common in pediatric AIDS,2 and, unless cases suspicious for brain lymphoma are aggressively investigated by neuroradiologic examinations and brain biopsy, they are unlikely to be diagnosed antemortem.