bluuebunny/crossref_metadata_2025_split huggingface dataset:
Amiodarone in Control of Sustained Tachyarrhythmias in Children with Wolff-Parkinson-White Syndrome
Authors: SHAHAR ELI , BARZILAY ZOHAR , FRAND MIRA , FEIGL AMI 
Published: December 2021

The Wolff-Parkinson-White syndrome in children is often associated with rapid supraventricular tachyarrhythmias.1-4 Commonly, these arrhythmias are of brief duration and respond promptly to conventional medications. In some patients, however, cardiovascular compromise and even circulatory collapse may supervene due to a prolonged arrhythmia resistant to various pharmacologic agents. The wide spectrum of medications, such as digoxin, quinidine, propranolol, and verapamil, used in order to control and prevent these arrhythmias in children with Wolff-Parkinson-White syndrome indicates lack of optimal therapy.1-4 Surgical interruption of the accessory pathway has also been undertaken.5
Recent experience with amiodarone hydrochloride, a relatively new antiarrhythmic drug, has shown favorable effects in adult patients with Wolff-Parkinson-White syndrome and recurrent arrhythmias following failure of traditional medications.6-9
Azarcón and Empacho
Authors: ACKERMAN ALAN , RODMAN DOROTHY 
Published: December 2021

To the Editor.—
We were pleased to see the case report concerning azarcó-related lead poisoning from the treatment of empacho.1 Since the time Bose et al composed their paper (September 1982), several new pieces of information have become available.
1. Additional cases of azarcó poisoning have been confirmed in Michigan-four cases, Wisconsin—one case, and California—ten cases.2-4 In several of these cases, other children in the extended family have either died of seizures after receiving azarcón in Mexico—one case5 or had been chelated for lead poisoning several years previously, although no source of lead had been identified—one case.3
The Transected Urachus: An Unusual Cause of Neonatal Ascites
Authors: HEPWORTH RANDALL C. , MILSTEIN JAY M. 
Published: December 2021

Neonatal ascites may arise from a number of different causes.1,2 The purpose of this report is to describe an unusual iatrogenic cause of neonatal urinary ascites.
The patient was a 3-day-old white male infant born by precipitous vaginal delivery. His Apgar scores were 7 and 9 at one and five minutes, respectively, and birth weight was 3,147 g. Initially, the infant was noted to have hypoglycemia, which resolved with oral feeding, as well as transient tachypnea and temperature instability, which resolved spontaneously. The physical examination was otherwise normal.
On the second day of life, the patient became jaundiced and had recurrent temperature instability, hypoglycemia, and seizure activity.
Kawasaki Disease and an Unusual Primary Infection with Epstein-Barr Virus
Authors: KIKUTA HIDEAKI , MIZUNO FUMIO , OSATO TOYORO , KONNO MUTSUKO , ISHIKAWA NOBUYOSHI , NORO SHIN-ICHI , SAKURADA NORIO 
Published: December 2021

To the Editor.—
Kawasaki disease (acute febrile mucocutaneous lymph node syndrome, MCLS)1 has been increasingly encountered throughout Japan. Furthermore, this syndrome has also been identified in other countries.2 We previously suggested that this particular disease may be closely associated with an abnormal immune response to Epstein-Barr virus (EBV).3 To obtain more information, further investigations were carried out on another group of 45 Japanese patients (27 boys and 18 girls; mean age of 2.3 years) that satisfied the criteria for a definite diagnosis of MCLS.3
Survival and Morbidity of Our Smallest Babies: Is There a Limit to Neonatal Care?
Authors: COHEN RONALD S. , STEVENSON DAVID K. , ARIAGNO RONALD L. , SUNSHINE PHILIP 
Published: December 2021

To the Editor.—
We recently reported an improved outcome for infants with birth weight in the 751-to 1,000-g range; the prognosis for infants weighing 750 g or less at birth was equivocal.1 Since the publication of this report, further interesting data on the very low-birth-weight infants cared for in the Stanford University Hospital Intensive Care Unit have become available. We would like to add these data to those already published.
In the original paper,1 we reported a 28% neonatal mortality for 751-to 1,000-g birth weight infants born during 1977 to 1980.
Breast-Feeding and Illness
Authors: CUNNINGHAM ALLAN S. 
Published: December 2021

To the Editor.—
Holmes et al1 underestimated the association between breast-feeding and lowered illness rates. A separate comparison for their subgroup of more serious illnesses (lower respiratory tract infection, acute otitis media, gastroenteritis, meningitis—table 3) shows the following: For maternal education ≤11 years there were 53 such illnesses per 100 formula-fed infants (28 illnesses/53 infants) compared with 13 illnesses per 100 breast-fed infants (3/23), a fourfold excess. For maternal education ≥12 years formula-fed infants had 42 illnesses per 100 infants (raw data: 30 illnesses/71 infants) whereas the breast-fed infants had 27 illnesses per 100 infants (raw data: 28/104).
Management of Hepatic Hemangioendotheliomas of Infancy by Transarterial Embolization: A Report of Two Cases
Authors: JOHNSON D. H. , VINSON A. M. , WIRTH F. H. , PRESBERG H. J. , HARKINS G. , Nuss D. , WALBURGH C. E. , RAFF J. C. 
Published: December 2021

Hepatic hemangioendotheliomas are uncommon vascular tumors which present as abdominal masses, unexplained jaundice, bleeding disorders, or congestive heart failure.1-3 Death often results from congestive heart failure despite appropriate treatment with digoxin and diuretics.4 Verification of hepatic vascular malformations rests on selective angiography,5 hepatic scintigraphy,6 computed tomography,7 and abdominal ultrasonography.8
Successful treatment of heart failure depends on elimination of the malformation's left-to-right shunt and its adverse cardiac effects. Present theapeutic recommendations for symptomatic patients remain divided. Treatment options include surgical excision of localized lesions,9 hepatic artery ligation,10 radiation,11 and glucocorticoid therapy12,13, often combinations of these programs are used.
Principles of Treatment of Disabled Infants
Authors:   Joint Policy Statement
Published: December 2021

Discrimination of any type against any individual with a disability/disabilities, regardless of the nature or severity of the disability, is morally and legally indefensible.
Throughout their lives, all disabled individuals have the same rights as other citizens, including access to such major societal activities as health care, education, and employment.
These rights for all disabled persons must be recognized at birth.
NEED FOR INFORMATION
There is a need for professional education and dissemination of updated information which will improve decision-making about disabled individuals, especially newborns. To this end, it is imperative to educate all persons involved in the decision-making process. Parents should be given information on available resources to assist in the care of their disabled infant. Society should be informed about the value and worth of disabled persons. Professional organizations, advocacy groups, the government, and individual care givers should educate and inform the general public on the care, need, value, and worth of disabled infants.
MEDICAL CARE
When medical care is clearly beneficial, it should always be provided. When appropriate medical care is not available, arrangements should be made to transfer the infant to an appropriate medical facility. Consideration such as anticipated or actual limited potential of an individual and present or future lack of available community resources are irrelevant and must not determine the decisions concerning medical care. The individual's medical condition should be the sole focus of the decision. These are very strict standards.
It is ethically and legally justified to withhold medical or surgical procedures which are clearly futile and will only prolong the act of dying.
Floor Furnace Burns
Authors: BERGER LAWRENCE , KALISHMAN SUMMERS 
Published: December 2021

In Reply.—
We appreciate Grossman's sharing his ingenious device to prevent burns from floor furnaces. Another physician-engineer, Dr. William Green, has also created a device to prevent burns from floor furnaces (Figure).
All such constructions require a fair amount of carpentry skill, and carry with them their own hazards of falls, broken dowels, and entrapment. For these reasons, we urge parents to install gates or keep the furnace turned off when infants or toddlers are in the home.
Child Abuse: Parenteral Hydrocarbon Administration
Authors: SAULSBURY FRANK T. , CHOBANIAN MICHAEL C. , WILSON WILLIAM G. 
Published: December 2021

The recognized spectrum of child abuse and neglect has expanded enormously since the original description of the battered child syndrome by Kempe et al, in 1962.1 In addition to physical abuse, we now realize that sexual abuse and nutritional neglect, as well as emotional abuse and neglect of children are problems of considerable magnitude.
Another form of child abuse reported with increasing frequency is the intentional poisoning of children. Although this form of child abuse was mentioned by Kempe et al1 in their original report, it has only recently received more recognization and attention. Because of several unique characteristics, some authors2-4 favor considering intentional poisoning as a distinct subgroup of child abuse.
Upper Extremity Burns from Woodstoves
Authors: YANOFSKY NORMAN N. , MORAIN WILLIAM D. 
Published: December 2021

Twenty-one woodstove-related burns of the hand and forearm in preschool-aged children were reviewed concerning nature and mechanism of injury, treatment, and clinical course. Two distinct patterns of injury were seen: with infants less than 14 months of age, burns occurred almost exclusively when the child touched the stove intentionally, unable to distinguish it from another piece of furniture; in older children burns were always "accidental."
[See figure in the PDF file]
Most burns epithelialized spontaneously with surgical intervention and without functional disability. Protective devices are available and could prevent childhood burns from woodstoves.
Care of Infants with Myelomeningocele
Authors: LIPTAK GREGORY S. , MASIULIS BARBARA S. 
Published: December 2021

To the Editor.—
The article by Gross et al1 on the management of newborns with meningomyelocele is outrageously misleading. The reader unfamiliar with children who have meningomyelocele would believe, after reading this paper, that half of these children (48%) can be expected to have such a wretched existence that they should not be allowed to live. The authors imply that this 48%, who were given supportive care only, would have poor "quality of life" with "suffering," poor "intellectual prognosis," and bad "potential for human relationships."
Immunizations to the Deltoid Region
Authors: BERGESON PAUL S. 
Published: December 2021

To the Editor.—
Ipp and coworker1 should be congratulated for their brief but brilliant piece of work regarding the use of the deltoid, rather than the thigh, for diphtheria-pertussistetanus and polio immunizations in children 18 months of age and older. The observation of lesser pain and fewer severe reactions when deltoid injections compared with thigh injections are used is important. Reducing reactions to immunizations is abundantly logical as an aid to furthering the interventional immunization effort.
What Constitutes Adequate Oxygenation?
Authors: Dudell Golde , Cornish J. Devn , Bartlett Robert H. 
Published: December 2021

In an attempt to avoid the substantial risks of pulmonary injury associated with the use of high ventilator pressures and high oxygen concentrations, physicians often ask such questions as "What is the optimal Pao2?" and "What treatment should be used to achieve an optimal Pao2?" Although the intent to minimize secondary, ventilator-induced lung injury is laudable, any attempt to provide a fixed numeric response to this query is misguided not only because the oxygen requirements and clinical circumstances of our patients vary, but because the Pao2 is a particularly poor indicator of these needs.
An example is the large full-term neonate admitted to a newborn intensive care unit from the delivery room with obvious tachypnea and an arterial Po2 of 60 mm Hg in room air. Is this Pao2 acceptable? A more appropriate question may be whether the infant's "oxygenation" is adequate. But what is "oxygenation"? If by this vaguely applied term we mean the partial pressure of oxygen in the arterial blood, and if we define the acceptable limits for this parameter as being between 50 and 80 mm Hg, as is often done, then the answer must clearly be in the affirmative. If, on the other hand, we take oxygenation to mean the balance between the rate of oxygen delivery to the tissues and their rate of oxygen consumption, then we must admit that we cannot know on the basis of the information provided by the Pao2 alone.
Oxygen delivery is determined by the concentration o hemoglobin in the blood, its oxygen saturation, the rate at which this blood is circulated to the tissues (generally, the cardiac output), and the efficiency with which the oxygen is "unloaded" from hemoglobin to the tissues.
Are Pediatricians Ready for the New Guidelines on Lead Poisoning?
Authors: Bar-on Miriam E. , Boyle Russell M. 
Published: December 2021

In 1991 the Centers for Disease Control established new guidelines for the definition of and screening for lead poisoning.
Objective. To assess: (1) pediatricians' knowledge of lead poisoning including the most recent literature on the subject, and (2) their screening practices.
Design, setting, subjects. A 22-item questionnaire was developed and validated. The survey was mailed to 1183 physicians in Virginia who were self-designated as pediatricians in the state medical registry.
Results. Sixty-nine percent (391/556) of those responding practiced primary care and 27% (153/556) were subspecialists. They were evenly distributed throughout the state. Of the respondents, 62% were male, 86% were white, and 72% trained at a university program. The median year for training completion was 1978. Demographic differences were not demonstrated (χ2) between primary care pediatricians and subspecialists.
Responses demonstrated an overall deficiency in physicians' knowledge of lead poisoning with specific deficiencies in knowledge of the literature, with mean ± SD correct responses of 15.7 ± 3.4. Primary care pediatricians scored significantly better than subspecialists: 16.2 ± 3.0 vs 14.7 ± 4.1 (P &lt; .001, t-test). Twelve percent of the total group and 13.5% of primary care physicians were screening all their patients.
Conclusions. Although primary care pediatricians (self-designated) are more knowledgeable about lead poisoning than their subspecialist colleagues, there are still deficiencies, and screening practices must be modified in both groups. To successfully implement the new Centers for Disease Control and Prevention guidelines, physician education must be a priority.
Should Blood Lead Screening Recommendations Be Revised?
Authors: Harvey Birt 
Published: December 2021

In October 1991, the Centers for Disease Control and Prevention (CDC) recommended blood lead (BPb) screening for virtually all 1-year-old children and, preferably, for all 2-year-old children as well.1
In April 1993, the US Department of Health and Human Services distributed guidelines recommending that all newborns, regardless of race or ethnicity, be screened for sickle cell anemia.2
In June 1993, the National Institutes of Health issued a consensus conference recommendation that all infants be tested for hearing impairment within the first 3 months of life, preferably before newborns leave the hospital.3
In each instance, these screening recommendations were developed because a group of experts, after identifying a child health problem within its area of interest, believed that universal screening was indicated.
Autosomal Recessive Osteopetrosis: Variability of Findings at Diagnosis and During the Natural Course
Authors: Gerritsen Egbert J. A. , Vossen Jaak M. , van Loo Ingrid H. C. , Hermans Jo , Helfrich Marie H. , Griscelli Claude , Fischer Alain 
Published: December 2021

Objective. To determine the variability and the natural course of children suffering from autosomal recessive osteopetrosis to allow optimal counseling and decision making with respect to therapeutic intervention.
Design. Retrospective and longitudinal evaluation of clinical symptoms and natural course with emphasis on survival and sensoneurologic and hematologic findings.
Setting. Two large referral-based pediatric bone marrow transplantation units in Europe.
Patients. Thirty-three patients with autosomal recessive osteopetrosis admitted to units in Paris and Leiden between 1972 and 1988 were analyzed until last follow-up or the time at which bone marrow transplantation was performed. The great number of patients and unprecedented amount of data make this report one of the single largest clinical studies on autosomal recessive osteopetrosis.
Main results. Ocular involvement occurring at a median age of 2 months was the symptom at initial examination in half of the patients. A striking variability between patients was found. Retinal degeneration was present in three patients and associated generalized neurodegeneration was present in two. The probability of survival until the age of 6 years was about 30% for the group as a whole. The cumulative risk of developing visual or hematologic impairment in the first year of life was about 75% and leveled off afterward. Patients with early hematologic impairment, ie, before 3 months of age, especially when combined with early visual impairment, had a very poor prognosis regarding life expectancy.
Conclusions. Autosomal recessive osteopetrosis seems to be a variable disorder with a poor prognosis, especially in children with early visual and hematologic impairment. Allogeneic bone marrow transplantation remains the only curative approach.
The Role of Anaerobic Bacteria in Perinephric and Renal Abscesses in Children
Authors: Brook Itzhak 
Published: December 2021

Objective. To investigate the aerobic and anaerobic microbiology of renal abscesses in children.
Patients and methods. Aspirates from six children with perinephric and four with renal abscess were cultured for aerobic and anaerobic bacteria.
Results. A total of 20 organisms were recovered, 8 aerobic or facultative bacteria and 12 anaerobic bacteria. Aerobic or facultative bacteria only were recovered in one patient, anaerobic bacteria only in two, and mixed aerobic and anaerobic bacteria in seven. Anaerobic bacteria were isolated in perinephric abscesses that were associated with previous abdominal surgery and renal transplant and in renal abscesses that were related to malignancy, pyelonephritis, and orodental infection.
Conclusion. This study highlights the importance of anaerobic bacteria in perinephric and renal abscesses in children.
Pediatrician Interview Style and Mothers' Disclosure of Psychosocial Issues
Authors: Wissow Lawrence S. , Wilson Modena E.H. , Roter Debra L. 
Published: December 2021

Objective. Primary care pediatricians play an important role in the detection, diagnosis, treatment, and referral of children with mental health problems. Some parents, however, are reluctant to discuss behavioral and emotional symptoms with their child's pediatrician. Studies of patient-physician communication suggest that specific aspects of pediatrician interview style (asking questions about psychosocial issues, making supportive statements, and listening attentively) increase disclosure of sensitive information. We hypothesized that disclosures of parent and child psychosocial problems would be more likely to occur during visits when pediatricians used these techniques.
Design. Cross-sectional analysis of a systematic sample of pediatric primary care visits.
Population. Two hundred thirty-four children ages 6 months to 14 years and their mothers or female guardians attending an inner-city hospital-based pediatric primary care clinic; 52 physicians in their second or third year of pediatric residency training.
Methods. Visits audiotaped and dialogue coded using the Roter Interactional Analysis System. Independent variables included counts of pediatrician utterances in the following categories: (a) questions about psychosocial issues, (b) statements of support and reassurance, and (c) statements indicating sympathetic and attentive listening. Dependent variables were the disclosure of information about: (a) parental medical or emotional impairment, (b) family disruption, (c) use of physical punishment, and (d) aggressive or overactive child behavior.
Results. Use of psychosocially oriented interviewing techniques was associated with a greater likelihood of disclosure for all four of the topic areas studied. Odds ratios for disclosure, adjusted for parental concerns and child age, ranged from 1.09 to 1.22 depending on the interview technique and outcome involved. Positive associations were observed both for topics raised primarily in response to pediatrician questions (family and parent problems) and for topics raised primarily by mothers (behavior and punishment).
Conclusions. Three simple communication skills were associated with disclosure of specific concerns relevant to child mental health. Training pediatricians to use these skills would help to better detect and diagnose children's mental health problems.
Letter to the Editor
Authors: Isaacman Daniel J. , Rogers Kenneth D. 
Published: December 2021

The guidelines of Baraff et al1 for management of the febrile child 0 to 36 months of age have combined evidence from published studies with expert opinion to develop recommendations that seem likely to be more clinically and cost-effective than those found in standard textbooks. Unlike those in textbooks, these recommendations are clear, they describe the basis on which they were generated, and they consider cost as an important factor in decision making.
We would like to limit our comments to the guidelines suggested for the febrile infant 0 to 3 months of age, as those suggested for the febrile patient 3 to 36 months of age constitute a separate discussion.