bluuebunny/crossref_metadata_2025_split huggingface dataset:
Statement on Infant Mortality
Authors:   Task Force on Infant Mortality
Published: December 2021

Why Is Infant Mortality Important?
Rates of infant mortality are sensitive indicators of a broad range of factors affecting children's health. As such, infant mortality is the "tip of the iceberg" of child health problems, and changes in infant mortality are a signal of factors affecting child health more broadly. In addition to its role as a general gauge of child health, infant mortality itself represents an important health problem. It is well to remember that infant death rates are the highest of any age group less than 65 years.
The message conveyed by infant mortality rates if better understood in terms of the causes of mortality at different times during the first year of life.
Neonatal Mortality
Neonatal mortality rate is defined as the number of infants dying between 0 and 27 days of life per 1,000 live births. These deaths in the first month of life reflect primarily factors associated with health of the mother before and during pregnancy and the special problems of the newborn. Deaths in this age range result chiefly from inadequate intruterine growth (prematurity, intrauterine growth retardation) and congenital anomalies. As a result, neonatal mortality rates provide an indicator of the factors affecting pregnancy, delivery, and the neonate and the adequacy of services in the prenatal, intrapartum, and neonatal periods.
Postneonatal Mortality
Postneonatal mortality rate is defined as the number of infants dying between 28 days and 11 months of life per 1,000 live births, ie, deaths occurring during the remainder of the first year of life.
Questioning Role of Hypochloremia in Bronchopulmonary Dysplasia
Authors: HARRIS HOWARD , STINE MARY JO 
Published: December 2021

To the Editor.—
The recent report by Perlman et al1 suggesting that chloride deficiency may be a significant contributing factor in the poor outcome of infants with bronchopulmonary dysplasia seems invalid because of the composition of the study and control groups. Although they found no difference between the two groups relative to the requirements for oxygen and mechanical ventilation, it would seem plausible that the study group, who all died in the neonatal intensive care unit, had more severe bronchopulmonary dysplasia than the control group, who were all able to be discharged home.
Silver-Russell Syndrome With Unusual Findings
Authors: HANSEN KAREN KIRHOFER , LATSON LARRY A. , BUEHLER BRUCE A. , LATSON LARRY A. 
Published: December 2021

In 1953, Silver et al1 described a syndrome of short stature and low birth weight with hemihypertrophy and abnormal sexual development. Independently, in 1954, Russell2 described a condition with similar findings, but his description emphasized disproportionately short arms, maternal difficulty during pregnancy, and craniofacial dysostosis. These two descriptions are now accepted as a continuum of the same entity, termed the Silver-Russell syndrome. A hallmark of the syndrome is its extreme clinical diversity. The findings most commonly seen in children with Silver-Russell syndrome are summarized in the Table.3
Recently, we encountered multiple cafe-au-lait spots, primary hypoparathyroidism, congenital glaucoma, congenital heart disease, and glucose-6-phosphate dehydrogenase deficiency in a newborn black girl with severe intrauterine growth retardation.
Smoke and Ear Effusions
Authors: ETZEL RUTH A. 
Published: December 2021

To the Editor.—
The Committee on Environmental Hazards of the American Academy of Pediatrics has reviewed the acute and long-term health effects of involuntary smoking and offered recommendations to reduce the exposure of children to tobacco smoke.1
Chronic middle ear effusions requiring tympanostomy tube placement occur more often in the children of parents who smoke than in the children of parents who do not smoke.2,3 Although not mentioned in the Committee's statement, this is another important adverse health effect associated with involuntary smoking about which both parents and pediatricians should be informed.
Intensive Care Unit Resources and Costs
Authors: POLLACK MURRAY M. , GETSON PAMELA R. , RUTTIMANN URS E. 
Published: December 2021

To the Editor.—
Dr Bushore's perceptive and progressive commentary on the need to reduce health care expenditures while assuring appropriate care for appropriate patients should be applauded.1 Too little emphasis on this important, national issue has been given in the pediatric literature. Dr Bushore's commentary referred to only one paper, our recent analysis of inappropriate intensive care unit (ICU) admissions2 and emphasized the importance of an objective method for evaluations of potential resource reduction. The use of objective methods for these evaluations should be expanded upon.
Neonatal Intracranial Hemorrhage and Phenobarbital
Authors: BATTISTI O. G. , BERTRAND J. M. , LANGHENDRIES J. P. 
Published: December 2021

To the Editor.—
We appreciate the recent study by Kuban et al1 about neonatal intracranial hemorrhage and phenobarbital use, but we would like to mention several points.
The number of neonates not having been enrolled represents a high proportion of the eligible population (263/554 or 47.5%) from which 48 (8.7%) had hemorrhage before enrollment, suggesting that the inclusion criteria were not sufficient according to the pathophysiology of cerebral blood flow variability in the neonates. In fact, the authors were missing 48/140 (34.3%) of infants with any hemorrhage (the number of infants with any hemorrhage they studied was 92).
Too Many Warnings on Missing Children
Authors: STERNE GEORGE G. 
Published: December 2021

In Reply.—
Dr Green's point is well taken. The Committee's statement on missing children began by noting that concerns about missing children are a serious source of parental anxiety. Although we were also aware of anecdotal data concerning fears in children, we did not know of any available data documenting or quantifying this.
The Committee's intent was to provide pediatricians with information so that they could counsel the parents of their patients. By giving relative risk estimates, we hope to relieve parental, and indirectly children's, anxiety.
PITUITARY ADRENOCORTICOTROPIC HORMONE (ACTH) AND 11-DEHYDRO-17 HYDROXY CORTICOSTERONE (CORTISONE) THERAPY IN THE LEUKEMIAS AND LYMPHOMAS OF CHILDREN
Authors: SNELLING C. E. , DONOHUE W. L. , LASKI BERNARD , JACKSON S. H. 
Published: December 2021

The data concerning 16 cases of leukemia and one case of lymphosarcoma in children treated with pituitary adrenocorticotropic hormone (ACTH) and 11-dehydro-17-hydroxy corticosterone (cortisone) are presented.
Treatment of this group of diseases in children with these hormones resulted in complete but temporary remissions in a large proportion of the cases. Most patients in which remissions were produced were almost completely refractory to retreatment with the hormones. Chemical studies indicated that in those patients in which a remission was produced, coincident with the remission there was a mass destruction of leukemic tissue.
Great variations were noted from patient to patient and also in the same patient in regard to the cytologic, physiologic and biochemical effects of the hormones.
Although ACTH and cortisone are unsatisfactory for permanent treatment of the leukemias and lymphomas, they offer invaluable tools for the investigator in the study of these diseases.
INCONCLUSIONS OF STUDIES, MOSTLY OF PREMATURE INFANTS
Authors: GORDON HARRY H. 
Published: December 2021

We do not know whether or how the rate of oxygen consumption by the cells of premature infants differs from that of full term infants. We do not know the clinical significance of subnormal body temperatures in premature infants. We do not know how much immature renal function and how much handicaps in intracellular defenses contribute to [See CHART 4, CHART 5 in Source PDF] the tendency of premature infants to develop disorders of water and acid-base balance. We do not know the nature of the deviation in ability of premature infants to absorb fat. We do not know how ascorbic acid and other dietary factors promote breaking open of the phenol ring of tyrosine or phenylalanine. We do not know what constitutes "immunity" to malaria.
This is a doleful summary; it is a consolation to note the epigram of Rabbi Tarfon, written almost 1,900 years ago: "It is not for thee to complete the work, but neither art thou free to desist from it."
COR PULMONALE IN INFANCY AND EARLY CHILDHOOD
Authors: ROYCE STEPHEN W. 
Published: December 2021

A higher incidence of cor pulmonale exists in the pediatric age group, especially among infants, than was previously suspected. The majority of cases come from the patients whose lung disease is associated with fibrocystic disease of the pancreas; and because these children now tend to live longer, with improved antibiotic therapy, the chances of seeing this complication are increased. A large proportion (over 70% in this series) of infants and children with this type of lung disease show cor pulmonale at autopsy. This means, statistically speaking, that fibrocystic disease has a high rank among the precursors of pulmonary heart disease in the general population. Other severe lung diseases of childhood, tuberculosis and bronchiectasis, for example, rarely produce cor pulmonale, and the asthmatic patients usually escape entirely.
Approximately half the patients with cor pulmonale have terminal decompensation and die in severe right-sided cardiac failure. This may occur suddenly, only a few days after the first signs of chest disease, or may come on gradually after many years. The duration of disease bears an inverse ratio to the severity of the initial insult. Massive overloading of the pulmonary circulation by blood-borne foreign bodies may cause immediate death, and fibrocystic lung disease may produce such abrupt pulmonary hypertension that the patient survives only a few days. But most infants and children are able to compensate after the initial strain and show a gradual progression to the decompensated state over a period of years.
The diagnosis of cor pulmonale assumes greatest interest at the infant level. It is now clear that otherwise mysterious episodes of infant cardiac failure have been on the basis of pulmonary disease. In an older child with extensive pulmonary disease and clinical evidence of a failing heart, the presence of proved fibrocystic disease makes cor pulmonale a likely postmortem finding. An infant with the same combination of signs presents a more difficult problem in differential diagnosis since his critical condition often makes direct analysis of pancreatic enzymes hazardous, and stool analysis for trypsin activity may be unreliable under these circumstances. Once the diagnosis is established, however, all effort should be directed toward clearing the chest of infection, since therapy of the secondary cardiac involvement is generally unsuccessful.
SPECIAL REVIEWS
Authors: CROCKER ALLEN C. 
Published: December 2021

It is suggested that the term "xanthoma" be limited to lesions containing a high percentage of lipid as cholesterol and, since these are small yellow tumors, this seems appropriate.
The patient with these lesions deserves careful clinical study, and an estimation of serum lipids. If possible, total serum lipid determination with partition is desirable, especially in the obscure cases. At least an accurate estimation of serum cholesterol is needed before a logical prognosis and course of treatment can be provided. The Schoen-heimer-Sperry cholesterol method has the widest acceptance.
Patients with xanthomas can be divided into those with normal serum lipids and those with elevated lipids.
A. Xanthoma disseminatum lesions are the most frequent and the most benign, and are associated with normal serum cholesterol values.
B. Xanthomas without elevation of serum lipids are also found in patients with the "eosinophilic granuloma syndromes," and occasionally with other chronic diseases.
C. In xanthoma tuberosum the serum cholesterol is markedly elevated, and the frequent cardiac involvement gives the full-blown patient a poor prognosis.
D. Secondary or eruptive xanthomas can accompany most of the conditions with chronic hyperlipemia irrespective of the cause, but they are most common in diabetes mellitus and idiopathic familial hyperlipemia.
Another case of idiopathic familial hyperlipemia in an infant is reported, with a total serum lipid level of 6.2%, as well as two cases of the nephrotic syndrome in childhood with secondary xanthomas, a case of xanthomas complicating chronic obstructive liver disease, an example of eruptive xanthomata in von Gierke's disease, and a description of a diabetic girl with a serum total lipid level of 19.4%.
The basic cause for the accumulation of cholesterol in any of these conditions is unknown. Surgical removal of the lesions is rarely advisable, and dietary treatment is indicated only in certain of the hypercholesterolemic syndromes.
CRYSTALLINE VITAMIN B12 AND SODIUM FOLVATE IN PREMATURITY
Authors: MITCHELL TOM , ETTELDORF JAMES N. , TUTTLE A. H. , CLAYTON GEORGE W. 
Published: December 2021

The effects of vitamin B12, a combination of vitamin B12 and sodium folvate, and sodium folvate alone, on the weight, length, hemoglobin, hematocrit, etrythrocyte count, reticulocyte count, M.C.H., M.C.V. and M.C.H.C. has been studied in 52 premature infants. Twenty-four premature infants receiving neither sodium folvate nor vitamin B12 served as controls.
We were unable to demonstrate any influence of these vitamins singly or in combination during the first 50 days of life.
THE PEDIATRICIAN AND THE PUBLIC
Authors: GORDON HARRY H. 
Published: December 2021

IT IS my purpose this morning to describe some facets of the program at the University of Colorado School of Medicine, the development of which has been conditioned by the needs of our community, i.e., of Denver and of Colorado.
A word is in order about some of the local stimuli to these developments. First, Dean Ward Darley and President Robert L. Stearns point out that as a state-supported institution we bear a special obligation to meet the varying needs of both rural and urban Colorado. Second, members of the faculty have participated actively in the reorganization of the Department of Health and Hospitals of Denver since 1947. Third, under the guidance of Dr. Alfred H. Washburn, the Child Research Council of Denver has for the past 20 years been making a multidisciplined study of the factors influencing human growth and adaptation. Fourth, from the Department of Philosophy on the Boulder campus comes Professor David Hawkins to tell us that the Hippocratic vision of medicine is of a "science extending far beyond the boundaries of the organism and including the investigation of whatever touches upon human health and welfare." Finally because our practice at the medical school is at present limited to the medically indigent, we have daily examples of our need to concern ourselves with social factors.
Intestinal Myiasis Caused by Parasarcophaga crassipalpis (Diptera: Sarcophagidae)
Authors: SHIOTA TSUNEZO , YOSHIDA YUKIO , HIRAI SACHIYO , TORII SHOZO 
Published: December 2021

Intestinal myiasis occurs when fly eggs or larvae that were previously deposited in food are ingested and survive in the gastrointestinal tract. Some infested patients are asymptomatic; others have abdominal pain, vomiting, and diarrhea. Although babies and small children seem more susceptible to intestinal myiasis than adults, probably the age distribution can be explained by childhood activity, fearlessness of wormlike creatures, and experimentation.1,2 The signs and symptoms of intestinal myiasis can easily be confused with other intestinal disturbances. In this article, we describe the clinical course of intestinal myiasis in a 4-year-old boy with severe abdominal pain.
CASE REPORT
The patient was a 4-year-old previously healthy boy residing in Osaka City, Japan.
Recommendations for Developmental Monitoring: The Role of Surveillance
Authors: DWORKIN PAUL H. 
Published: December 2021

In Reply.—
Dr Cunningham raises several important issues regarding developmental surveillance in general and, more specifically, the early identification of children with mild mental retardation. Dr Cunningham equates surveillance with "eyeball" estimates of development. Although I agree (and acknowledge in my review) that subjective impressions of children's developmental status are often inaccurate, the process of developmental surveillance is actually far more sophisticated. It includes eliciting and attending to parental concerns, making accurate and informative longitudinal observations of children, and obtaining a relevant development history.
Economy, Convenience, and Safety: Can We Have It All?
Authors: WIDOME MARK D. 
Published: December 2021

In this issue of Pediatrics, we learn about the dangers of travel in the cargo beds of pick-up trucks,1 a problem that is both old and new. Although we may have only recently given this hazard the attention it deserves, the issues surrounding safe travel in pick-up trucks are common to most other injury control problems. This is but the latest example of the challenge encountered when safety measures appear to threaten individual freedom, personal convenience, or economic "reality."
In the South, the Southwest, and much of rural America, the pick-up truck is, for many families, the only practical vehicle for both work and family transportation.
The Doughnut Sign
Authors: BLUM ALEXANDER 
Published: December 2021

To the Editor.—
Determining whether breast tissue is present in an obese child can be difficult. We have found in obese children without breast development a palpable depression ion beneath the nipple in the center of the areola when they are examined in the supine position. It feels like a doughnut; a depression surrounded by firm tissue. It is possible that the depression represents the area of future ductal development. We have no biopsy material to confirm this hypothesis.
Perinatal Human Immunodeficiency Virus (HIV) Testing
Authors:   Task Force on Pediatric AIDS
Published: December 2021

PERINATAL INFECTIONS
The primary route of human immunodeficiency virus (HIV) infection in infants is vertical transmission from HIV-infected mothers. This is of particular concern as the number of infected women and the number of children infected by perinatal transmission continue to increase rapidly. The number of perinatally acquired acquired immunodeficiency syndrome (AIDS) cases increased 17% in 1989 and 21% in 1990. Similarly, the number of heterosexually acquired AIDS cases increased 27% in 1989 and 40% in 1990. There is evidence that vertical transmission of HIV can occur in utero (congenital/transplacental, similar to rubella),1,2 in the postpartum period (breast-feeding), and perhaps in the intrapartum period (similar to hepatitis B).3 The relative frequency and efficiency of transmission during each of these periods remains uncertain. The best estimates of vertical transmission from an HIV-seropositive mother to the fetus range from 12.9% to 39%4-6 Although the risk of transmission appears to be increased in women who are symptomatic, this point is still unclear.5 Preliminary information suggests that the presence of high levels of high-affinity/avidity antibodies to specific epitopes of the gp 120 of HIV may be protective and may decrease or prevent vertical transmission,7-10 although others have not been able to confirm this finding.11 More detailed information on perinatal HIV infection,12 and infection control13 in pediatric HIV infection is available in previously published statements from the AAP Task Force on Pediatric AIDS.
SEROPREVALENCE
Anonymous seroprevalence data from newborn specimens are being collected in 44 states, Puerto Rico, and the District of Columbia. In some states, seroprevalence data are available by metropolitan area and/or by hospital of birth.
Talented Students
Authors: MILLS CAROL J. 
Published: December 2021

In Reply.—
It is with pleasure that I respond to the thoughtful remarks of Kim and Kwasman. Their concerns are well-founded and remarkably in accord with the philosophy and practice followed by the Center for Talented Youth (CTY) at Johns Hopkins University.
Kim and Kwasman observed that frustration and disillusionment with school are not restricted to gifted children. As they point out, "all students whose needs are not met adequately at an early age become frustrated and disillusioned with school."
TETANY AND PARATHYROID HYPERPLASIA IN THE NEWBORN INFANT: INFLUENCE OF DIETARY PHOSPHATE LOAD
Authors: GARDNER LYTT I. 
Published: December 2021

Three cases of newborn tetany are described, pointing out the relationship between dietary phosphate load and the manifestations of this disease.
An additional three newborn infants are described who showed other symptomatology than tetany in association with dietary phosphate load.
[See Table 1 in Source Pdf].
Data concerning diet, cause of death and degree of parathyroid hyperplasia are tabulated in eight newborns who were found to have parathyroid hyperplasia at autopsy. Similar data are tabulated on eight newborns and five older children who were found to have normal parathyroid glands at autopsy.
Several other factors possibly involved in newborn tetany and newborn parathyroid hyperplasia are discussed. The importance of measuring serum inorganic P in the differential diagnosis of neonatal distress is pointed out.
Neonatal Screening for Dependents of Active-Duty Military Personnel
Authors: PETTETT GARY 
Published: December 2021

To the Editor.—
In the February issue of Pediatrics the Committee on Genetics issued their most recent statement and recommendations on newborn screening for metabolic/inherited disorders.1 Within the text of this statement there is incorrect information concerning newborn screening for dependents of active-duty military personnel. In the commentary on universal screening (Goal 21p346) the Committee reports: The absence of a standardized neonatal screening policy or program for dependents of the United States Uniformed Services also placed them at increased risk for failure to be screened, particularly those born outside the US.
Bronchopulmonary Dysplasia Criteria: A Mathematical Impossibility
Authors: NORTHWAY WILLIAM H. 
Published: December 2021

In Reply.—
Drs Schwartz, Stayer, and Pasquariello1 correctly noted the typographical error in the diagnostic criteria for bronchopulmonary dysplasia in "Bronchopulmonary Dysplasia: Twenty-five Years Later"2 They are also correct that a Pao2 above 500 mm Hg is not achievable at sea level in 21% oxygen. More importantly, a Pao2 above 500 mm Hg is achievable and is not a mathematical impossibility with supplemental oxygen at sea level but is clearly not part of the diagnostic criteria cited.