bluuebunny/crossref_metadata_2025_split huggingface dataset:
Neonatal and Infant Mortality in Relation to Phototherapy
Authors: Lipsitz Philip J. , Gartner Lawrence M. , Bryla Dolores A. 
Published: December 2021

Of all the parameters for assessing the effectiveness and safety of phototherapy in the management of neonatal hyperbilirubinemia, none is as unambiguous as death. Although death rates are definitive, any relationship to the treatment modality or lack thereof may be confounded by other events. No prior data suggest the possibility of either enhanced or reduced mortality in infants treated with phototherapy.34,50
The groups were allocated randomly and the care given the two groups was the same, with the exception that one group received phototherapy. It was stipulated that research protocol requirements were at no time to take precedence over the medical care needs of the infant.
RESULTS
Seventy-two (10.7%) of the 672 newborns entered into the phototherapy group and 62 (9.3%) of the 667 newborns in the control group died during the first year of life. During the period prior to discharge from the nurseries, there were 68 (10.1%) deaths in the phototherapy group and 51 (7.6%) in the control group. All of the deaths except one in each group were in newborns who weighed less than 2,000 g at birth. These differences, as well as deaths in the first seven or 28 days of life, were not significantly different (X2 with Yates correction) when P &lt; .05 was taken to be the upper level of significance (Table 1).
DEATHS BY BIRTH WEIGHT SUBGROUPS
The number of newborns entered into each study group and the deaths prior to discharge from the hospital for the birth weight groups 1,000 g or less and 1,001 to 1,999 g are indicated in Table 2.
Incarcerated Youths: Urgent Needs
Authors: OWENS JAMES W. M. 
Published: December 2021

Each year in the United States, approximately 1 million children are incarcerated. Fewer than half are held in juvenile facilities; the remainder are kept in adult jails. The conditions under which many of the children are confined and the results of their incarceration are often damaging to the child and to society.1,2
The American Academy of Pediatrics has had a long-standing concern with the special needs of youths incarcerated in detection and long-term residential facilities. The numbers of these children and the emotional, social, health, legal, and other problems that they and their families face are impressive.
In 1973, the Academy published its first statement on health standards for juvenile court residential facilities.3
Bronchiolitis and Recurrent Wheezing
Authors: MCCONNOCHIE KENNETH M. , ROGHMANN KLAUS J. 
Published: December 2021

In Reply.—
We appreciate the comments of Welliver regarding our recent article. His primary concerns relate to the issue of causality, particularly the methodology of establishing a causal relationship.
These concerns are addressed in our article (Pediatrics 1984;74:1-10) as follows:
Although a historical cohort study cannot, by its nature, prove causality, this study's findings are consistent with the hypothesis that bronchiolitis is a causal factor in wheezing. One may speculate that there is a latent factor accounting for the observed bronchiolitis-wheezing association (possibly a genetic factor common both to children who develop bronchiolitis and to children who wheeze during middle childhood years) that is measured by none of the methods employed in this study.
Rock in the Nose
Authors: FISCHER HOWARD 
Published: December 2021

To the Editor.—
I would like to share with my colleagues a method of removing nasal foreign bodies which I recently had occasion to use. My 4-year-old daughter came into the house and announced that she had a "rock" in her nose. Inspection revealed a pebble lodged out of finger reach in the right nasal cavity. Keeping her upright, I occluded the nonobstructed side with finger pressure and blew into her mouth, after making a tight seal, much in the manner of mouth-to-mouth resuscitation.
Self-Examination by Adolescents
Authors: GOLDBLOOM RICHARD B. 
Published: December 2021

Adolesence is a period of intense self-examination. More hours are spent contemplating the mirror during the teen years than at any other time of life. Physical change occurs so rapidly that teenagers may see someone different each time they consider their reflected images—the obverse of the Dorian Gray dilemma. This phenomenon has both pleasing and unsettling effects. The pleasures of growth and maturation are comingled with self-doubts and anxieties. The latter include worries about health and fears of illness—despite the fact that illness during adolescence is rarer than at any other period in the life-span.
In Western society, people are understandably preoccupied with preventing cancer and reducing cancer mortality, and early detection is considered an important key to this accomplishment.
Prolonged Infantile Apnea: 1985
Authors:   Task Force on Prolonged Infantile Apnea
Published: December 2021

Knowledge regarding the etiology and optimal management of prolonged infantile apnea and its relationship to sudden infant death syndrome (SIDS) is tentative. Consequently, infantile apnea is a controversial subject; professional discussion and media attention are often emotional and even erroneous.
Prolonged apnea is defined as cessation of breathing for at least 20 seconds or as a briefer episode of apnea associated with bradycardia, cyanosis, or pallor. Brief episodes of apnea are a normal occurrence in infants, but prolonged apneic episodes may lead to morbidity and rarely mortality. The vast majority of infants with prolonged apnea are not victims of SIDS; most SIDS victims were never observed to have had prolonged apnea prior to the terminal event. The risk of death from SIDS is somewhat greater in the group of infants with prolonged apnea than in the general population. Infants with sleep apnea who have required active intervention, such as positive pressure "resuscitation," may be at significant risk.
Apnea of undetermined etiology that occurs in the premature infant between the actual date of birth and the original due date is apparently not predictive of SIDS. There is, however, indication that preterm infants as a group and perhaps siblings of infants who were victims of SIDS are at somewhat increased risk.
Infants who have had an episode of prolonged apnea are perceived by parents and physicians as having experienced a life-threatening event and being at risk for another. Prolonged apnea can be a symptom of many disorders including infection, seizures, airway abnormalities, hypoglycemia or other metabolic problems, anemia (in preterm infants), gastroesophageal reflux, impaired regulation of breathing during sleeping and feeding, and abuse.
Manpower Needs in Neonatal Pediatrics
Authors:   Committee on Fetus and Newborn
Published: December 2021

In 1980, the American Academy of Pediatrics' Committee on the Fetus and Newborn and the Section on Perinatal Pediatrics estimated the need for neonatologists.1 That statement suggested that needs might be satisfied by 1983 and recommended reassessment in the early 1980s. The present report is a reevaluation of those needs and comments concerning the present and future manpower status of neonatal pediatrics.
The previous statement encouraged the participation of pediatricians in all levels of infant care. The Committee reaffirms this participation, especially in Level II care.2 Pediatricians directing Level II neonatal services should have 6 months of training in neonatal special care. Level III services should be directed by Sub-Board certified neonatologists.
Every subspecialty faces the difficult problem of defining its own manpower needs. Neonatal pediatrics is no exception; it is difficult to ascertain whether the present number of neonatologists is needed to provide optimum care or whether some current care practices are actually created because of the increasing number of neonatologists.3 Defining the manpower needs in neonatology requires answers to some important questions: (1) What is the current numerical, functional, and geographic status of the subspecialty? (2) How many pediatricians (non-Sub-Board eligible, Sub-Board eligible, and Sub-Board certified) are practicing exclusively in the area of newborn care? (3) How much actual involvement does the Board-certified pediatrician have in providing Level II newborn care? This statement attempts to address these questions.
As of April 1, 1984, there were 1,346 Sub-Board-certified neonatologists (unpublished data, American Board of Pediatrics). There are approximately 125 fellows graduating from neonatal training programs each year.4
Pediatricians, Antibiotics, and Office Practice
Authors: CROOK WILLIAM G. 
Published: December 2021

To the Editor.—
In his letter, "Pediatricians, Antibiotics, and Office Practice," Disney discussed a telephone conference dealing with the choice and use of antibiotics.1 Seven pediatricians participated. Disney, past president of the American Board of Pediatrics was "astonished" and "alarmed" at the methods that certified pediatricians in practice were using to select antibiotics. He was especially concerned that laboratory studies were little used and that "They (the pediatricians) mostly stated that either the drug was picked at random or was selected by the doctor's preference for one drug or another chosen on the basis of available samples or side effects...."
Roentgenology and Malabsorption Syndromes
Authors: WEIZMAN ZVI , STRINGER DAVID A. , DURIE PETER R. 
Published: December 2021

In Reply.—
We thank Smith for providing an interesting and important historical perspective regarding the radiologic manifestations attributed to intestinal malabsorption in childhood. The remarkable similarity in findings between our recent report and the earlier studies some 40 years ago, serves to emphasize the need for considerable caution in interpreting the significance of the so-called radiologic malabsorption pattern on small bowel follow-through examination. In addition, it should be emphasized that all subjects included in our report were evaluated with the use of nonflocculating contrast media, providing support for Smith's observation that these newer materials have failed to completely negate the problem of demonstrating radiologic manifestations of malabsorption in a normal child.
Vitamin E and the Prevention of Retinopathy of Prematurity
Authors:   Committee on Fetus and Newborn
Published: December 2021

In spite of numerous human and animal studies, the etiology of retinopathy of prematurity (previously called retrolental fibroplasia) remains obscure. Prevention attempts with judicious use and careful monitoring of supplemental oxygen, while decreasing the incidence, have not eradicated this complication of prematurity. Currently, retinopathy of prematurity is a condition that cannot be prevented in certain infants, especially those of very low birth weight.
One controlled trial suggested that the prophylactic oral administration of 100 mg/kg/d of free vitamin E to babies at highest risk, while not decreasing the incidence of retinopathy of prematurity, decreases the severity in affected infants.1 Three other controlled trials showed a lower incidence of severe retinopathy of prematurity in treated groups (25 mg/kg intramuscular or 25 mg/d oral, or variable intravenous doses), but none of these differences were statistically significant.2-4 These observations have led some authors to suggest that vitamin E be routinely administered to all infants weighing less than 1,500 g at birth.5,6
It must be noted that any effective prophylaxis with vitamin E in the United States would require that 22,000 surviving infants of birth weight less than 1,500 g be treated annually to prevent approximately 2,000 infants from developing the cicatricial sequelae of retinopathy of prematurity.7 The treatment of 20,000 infants who would not develop retinopathy of prematurity would be acceptable if it were certain that the administration of vitamin E was completely safe or, at least, that the benefits of its use outweighed the risks by a substantial margin. Preliminary reports, however, suggest the possibility of complications associated with the administration of pharmacologic doses of vitamin E.8,9
To Tube or Not to Tube: That Continues to Be the Question
Authors: CHAMBERLIN ROBERT W. 
Published: December 2021

To the Editor.—
I wish to congratulate Drs. Teele, Klein, and Rosner on their study of otitis media with effusion (Pediatrics 1984;74:282-287). However, in their interpretation of the results, I think they are confusing statistical significance with clinical significance. They report a small, but statistically significant difference in scores on several speech and language tests for their sample as a whole (N = 200) for different time periods of effusions. They do not report how many of the children in each group were delayed enough to require speech therapy (clinical significance).
Health Care and the Corridor Poor
Authors: OBERG CHARLES N. 
Published: December 2021

There is no denying that health care costs have increased at an alarming rate, partially fueled by the increased demand created by programs such as Medicaid. In 1983, the total Federal and state outlays for Medicaid were $35.6 billion.13 As the 1980s progress, we will see a variety of cost-containment strategies. These will include Medicaid prepaid capitation projects, the initiation of copayments and deductibles, and further tightening of eligibility criteria. However, in our zeal to contain costs, let us not lose sight of or exacerbate the plight of the corridor poor.
There are alternatives that will allow us to incorporate the disenfranchised and uninsured during the coming decade. These initiatives may include the following.
Hunger Debate
Authors: MEYERS ALAN , SPIVAK HOWARD 
Published: December 2021

To the Editor.—
Graham's1 recent commentary on malnutrition and infant mortality in the United States is dangerously misleading. The inaccuracy of some of his statements raise serious questions regarding his self-portrayal as an objective and unbiased commentator.
Graham criticizes the Massachusetts Nutrition Survey, a study that is as yet unpublished in the medical literature and, therefore, is inaccessible to most readers. He decries the use of the terms "stunting" and "wasting"; yet these terms, coined by Waterlow2,3 to describe the anthropometric presentation of (respectively) chronically and acutely undernourished children, have been widely used and internationally accepted.4
Retinopathy of Prematurity, Intraventricular Hemorrhage, and Oxidative Damage
Authors: CROWE JOHN , REA PHILLIP A. , ROLFE PETER 
Published: December 2021

To the Editor.—
Hittner et al1 and Speer et al2 have recently reported that supplementation of vitamin E in premature infants reduces the incidence of retinopathy of prematurity and intraventricular hemorrhage, respectively. Ensuing correspondence3,4 has been primarily concerned with the potentially toxic effects of vitamin E. (It should be noted that, in contrast, Phelps5 found no evidence that the use of vitamin E reduced the incidence of intraventricular hemorrhage.)
However, we believe that the most significant aspect of these papers1,2 is their support of the hypothesis that both retinopathy of prematurity and intraventricular hemorrhage are manifestations of oxidative damage caused by oxygen-derived free radicals.
Zinc Deficiency and Edema
Authors: KUMAR SAVITRI P. , ANDAY ENDLA K. 
Published: December 2021

In Reply.—
We thank Drs Golden and Golden for their comments, but we would like to point out several differences between the two patient groups which may explain the dissimilarity in response to zinc. Our patients were appropriately grown, very premature infants receiving adequate protein and caloric intake who were noted to be edematous and hypoproteinemic at less than 40 weeks' postconceptional age. As they were part of a vitamin E and retinopathy of prematurity study being conducted at that time, their serum levels were closely monitored to maintain vitamin E sufficiency.
New Abuse of Ipecac
Authors: ENTE GERALD , PENZER PAUL H. 
Published: December 2021

To the Editor.—
There are three articles in the June issue of Pediatrics1-3 about ipecac without any mention of the new abuse of the drug. We think it is worthwhile to share with pediatricians the information that syrup of ipecac has become the latest addition to the drug abuse list.
More than 35,000 Americans, who have anorexia nervosa—bulimia syndromes are abusing syrup of ipecac repeatedly to induce vomiting after eating and bingeing. Ipecac is a cardiotoxic drug, and chronic repeated use can lead to permanent cardiac damage.
New Abuse of Ipecac
Authors: RUMACK BARRY H. 
Published: December 2021

In Reply.—
The comments by Drs Ente and Penzer are very important. Although some individuals have abused syrup of ipecac and toxicity has been temporarily related to its use, there is no evidence to support the statement that 35,000 Americans are abusing the drug. The only cardiotoxicity ever reported with syrup of ipecac has been in the abuse state, and this has never been associated with emergency induction of emesis in recommended dosages. Unfortunately, a number of physicians have written to the Food and Drug Administration proposing a listing of syrup of ipecac as a prescription agent.
Colchicine Therapy in Sarcoid Arthropathy
Authors: RUBINSTEIN ISRAEL , BAUM GERALD L. 
Published: December 2021

To the Editor.—
We read with great interest the article by Lindsley and Godfrey1 but wish to disagree with one of their conclusions. They suggested that oral corticosteroid therapy is the treatment of choice in sarcoid arthropathy because salicylate and other nonsteroidal anti-inflammatory drugs have only limited success in such cases. We believe, however, that this is not the case, because low-dosage colchicine therapy has provided good results in the agement of both the acute and chronic forms of sarcoid arthropathy when there was no adequate response to nonsteroidal anti-inflammatory agents and bed rest. Colchicine was first used in the treatment of sarcoid arthropathy by Kaplan,2,3 who reported a dramatic improvement, usually within a few days, with the use of 0.5 mg of oral colchicine daily. Subsequently, maintenance oral therapy with colchicine, 1 to 2 mg/d, was introduced to treat the chronic form of the disease, with similar beneficial results.3-7
Steroid Therapy as Treatment for Idiopathic Fibrosis of the Retroperitoneum and Mediastinum
Authors: FEILD CHARLES , ARNOLD WATSON , GLOSTER ELIZABETH S. , SHARP GREG , REDMAN JOHN 
Published: December 2021

Multifocal idiopathic fibrosis of both mediastinum and retroperitoneum is rare in childhood.1,2 We describe a patient who presented with biopsyproven mediastinal and retroperitoneal fibrosis associated with progressive pulmonary fibrosis, cardiomyopathy, and bilateral ureteropyelocaliectasis; the patient responded to intravenous pulse and oral steroid therapy with relief of his uretenal obstruction and an improvement in pulmonary and cardiac function. Although surgical ureterolysis is generally the management of choice for ureteral obstruction caused by retroperitioneal fibrosis,3,4 steroid pulse therapy and a regimen of oral prednisone may provide an alternative modality of themapy.5-7
CASE REPORT
This 12-year-old black boy was seen in the emergency room with a chief complaint of shortness of breath.
Hypertrichosis and Congenital Anomalies Associated With Maternal Use of Minoxidil
Authors: KALER STEPHEN G. , PATRINOS MARY ELAINE , LAMBERT GEORGE H. , MYERS THOMAS F. , KARLMAN ROBERTA , ANDERSON CRAIG L. 
Published: December 2021

Minoxidil is a potent peripheral vasodilating agent used in the treatment of severe hypertension refractory to more conventional therapy. Its use in pregnant women and its effect on pregnancy outcome have not previously received attention in the medical literature.
Hypertrichosis is a well-known side effect of minoxidil.1 It occurs in nearly all patients treated for longer than 4 weeks and is reversible after discontinuation of the drug.2
We recently observed hypertrichosis and multiple congenital anomalies in an infant whose mother was on a regimen of minoxidil, as well as captopril and propranolol, continuously throughout pregnancy As the importance of case reporting in instances of possible teratogenicity has recently been underscored,3 we wish to describe our findings and to encourage additional reports of pregnancy outcome after maternal use of minoxidil.
Alcohol Use and Abuse: A Pediatric Concern
Authors:   Committee on Adolescence
Published: December 2021

Since the beginning of recorded history, humans have consumed alcoholic beverages for purposes of religious ceremony, celebration, medicinal therapy, and recreation. Unfortunately, problem drinking also has been recognized and reported for thousands of years.1 There is continuing debate as to whether alcohol is a beverage or a drug and whether its use is always hazardous or is, at times, beneficial to physical and/or psychologic health. There is even greater debate as to whether youth should be restricted from all use of alcohol or encouraged to develop safe and responsible drinking patterns through progressive controlled exposure.
ALCOHOL USE AMONG YOUTH
Alcohol is the drug most often abused by the largest number of children and adolescents. More than 90% have tried alcohol at least once before graduation from high school. In 1984, two thirds of senior high school students admitted to using alcohol at least once a month. Nearly 50% of male high school seniors and 30% of female seniors reported drinking excessively at least once every 2 weeks. One in 20 high school seniors reported drinking daily. Despite efforts to address this problem, there has been no significant change in these statistics for the past decade according to several national surveys. 2,3 Alcohol use by school drop-outs has not been recorded but is suspected to be even greater.
Exposure to alcohol frequently occurs before or during early adolescence. Of high school students who have used alcohol, 10% had their first drink by grade 6, 30% by grade 8, and 55% by grade 9 according to one national survey.3
Impedance Bridge (Tympanometer) As a Screening Device in Schools
Authors:   Committee on School Health
Published: December 2021

STATEMENT OF PROBLEM
There is confusion in schools about the proper use of the impedance bridge. Some groups recommend its use as a substitute for audiometry and suggest physician referral on the basis of an abnormal tympanogram. In our opinion this is inappropriate.
BACKGROUND
The impedance bridge primarily detects asymptomatic middle ear effusion. This effusion may cause a conductive hearing loss (rarely greater than 20 to 30 dB). There is no consensus as to the advisability of treating this effusion, because it usually remits spontaneously within 2 to 3 months.
RECOMMENDATIONS
The Committee on School Health recommends that (1) the impedance bridge should not be used in mass screening programs for the detection of hearing loss or middle ear effusion; (2) the impedance bridge may be used in the school setting only as an aid in the diagnosis of individual children who are at high risk for, or who are suspected of having, otitis media with effusion; (3) hearing screening by pure-tone audiometry be used as the primary method of detection of hearing loss in school children; (4) the impedance bridge not be used as a replacement for audiometric screening, because it will not detect sensory neural hearing loss and may lead to overreferral of children with asymptomatic middle ear effusion; (5) any persistent abnormality detected by either the impedance bridge or pure-tone audiometry should result in a prompt referral to the child's pediatrician.