bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improved Perinatal Knowledge and Care in the Community Hospital Through a Program of Self-Instruction
Authors: Kattwinkel John , Cook Lynn J. , Nowacek George A. , Ivey Hallam H. , Short Jerry G. 
Published: December 2021

Evaluation of the perinatal in-patient services of nine rural community hospitals (CH) revealed that equipment and cognitive knowledge were inadequate for the complexity of patients cared for. These deficiencies were present despite prior exposure to traditional continuing education programs.
In response to these findings, a six-month perinatal educational program was developed. The program is unique in that it is: (1) initiated by a hospital self-inventory through which patient care goals and the corresponding equipment, services and personnel needs are identified; (2) entirely CH based except for a workshop held at the regional center for two CH staff nurses who subsequently coordinate the program in their hospital; (3) self-paced and self-instructional (five books covering 19 subjects and 20 skills); and (4) completed by nurses, physicians, and support personnel thus facilitating uniform patient care and nurse-physician communications.
The program was delivered to 362 CH nurses, physicians, and support personnel, representing 77% of total available perinatal health care professionals from the nine CH. Test scores improved by 24 percentage points with perinatal professionals approaching or exceeding criterion level following the program. A review of 1,404 CH charts showed that 12/28 patient care practices improved significantly. Spontaneous performance of eight pretransport stabilizing activities improved from 44% to 86%.
It is concluded that a self-study, community-based program of this type can markedly improve both the knowledge of CH perinatal professionals and the CH care for transported and locally-managed babies.
Potential Effect of Demographic and Other Variables in Studies Comparing Morbidity of Breast-Fed and Bottle-Fed Infants
Authors: Sauls Henry S. 
Published: December 2021

Comparing the morbidity of breast-fed and bottle-fed infants is confounded by inherent differences in breast-feeding and bottle-feeding mothers and their infants. Self-selection introduces complex variables encompassing much more than milk source used for infant feeding. Reasons for selecting breast or bottle feeding relate to demographic, socioeconomic, educational, ethnic, cultural, and psychological factors, as well as maternal and infant physical and emotional health. Many of the differences in the maternal populations may affect infant care practices, access to medical care, and infant health status.
Studies published to date have not quantified these confounding effects and other potential biases in comparing morbidity of breast- and bottle-fed infants and the relationship between milk source and incidence of infantile disease remains in question. There is need for more cautious use of the available data and investigators must seek ways to design future studies to take into account the differences between breast-feeding and bottle-feeding mothers that affect both reported and actual infant morbidity.
The Association of Kernicterus with Bacterial Infection in the Newborn
Authors: Pearlman Mark A. , Gartner Lawrence M. , Lee Kwang-Sun , Eidelman Arthur I. , Morecki Rachel , Horoupian Dirkan S. 
Published: December 2021

A total population of 29,395 neonates cared for in the six-year period from 1971 to 1976 was reviewed for evidence of autopsy-proven kernicterus. A total of 327 neonates died and 232 were autopsied. The only cases of kernicterus occurred in four near-term infants with antemortem proven sepsis. All four of these infants weighed more than 2,200 gm and were delivered after gestations of either 36 or 37 weeks.
These cases of kernicterus occurred during a period when more aggressive management of hyperbilirubinemia in low-birth-weight infants had apparently eliminated immaturity as a predisposing factor in the development of kernicterus, uncovering bacterial infection as the major remaining etiologic co-factor.
Naloxone Use in Newborns
Authors: Segal Sydney , Anyan Walter R. , Hill Reba M. , Kauffman Ralph E. , Mofenson Howard , Pruitt Albert W. , Shinefield Henry R. , Singer Harvey S. , Weinberger Miles M. 
Published: December 2021

Naloxone hydrochloride (Narcan) is a pure narcotic antagonist that is the drug of choice in the treatment of central nervous system and cardiores-piratory depression due to narcotic agonist drugs. It has virtually no agonist activity and therefore produces no narcotic effect even when administered in greater than recommended doses, in contrast to nalorphine hydrochloride and levallorphan tartrate, which have mixed agonist-antagonist activity.
In 1975 the FDA approved a dosage form of naloxone in a concentration of 0.02 mg/ml that was specifically designed for use in newborns whose mothers receive narcotic analgesics during labor and who are born with narcotic-induced respiratory depression; this drug was marketed for general prescription use. Three years after its introduction, the role of naloxone in the management of the depressed newborn merits clarification. In addition, recent information regarding opiate receptors and endogenous opioids raises questions concerning the long-term safety of naloxone in neonates. A review of available published and unpublished data pertaning to naloxone use in the newborn infant by the Committee on Drugs forms the basis for the following commentary and recommendations.
EFFICACY
The potent narcotic antagonist activity of naloxone is well documented in infants and children as well as in adults. Naloxone has been effectively used postoperatively to reverse respiratory depression in infants and children who received narcotics for analgesia.1,2 Additional cases have been reported in which naloxone was successfully and safely used to treat children who were poisoned with narcotic agonists such as diphenoxylate hydrochloride (Lomotil),3,4 methadone hydrochloride, 57 and propoxyphene hydrochloride (Darvon).8
Most of the controlled clinical trials to study the safety and efficacy of naloxone in treating respiratory depression in the narcotic-exposed newborn have been carried out on full-term, healthy infants whose mothers received morphine or meperidine hydrochloride during labor, but who showed no overt clinical evidence of respiratory or CNS depression at birth.
Presidential Address: The Ambulatory Pediatric Association, May 1, 1979
Authors: Comerci George D. 
Published: December 2021

I consider myself especially privileged to have served as your president for the past year and now to have the honor of addressing the membership at this our 19th annual meeting of the Ambulatory Pediatric Association. I feel especially privileged because this association has expressed its confidence in a clinician-teacher with rather meager academic credentials, as might be judged by the memberships of other academic societies.
I consider my fellowship in ambulatory pediatrics to have been my four years of private general pediatric practice. Following my "fellowship," Dr Arthur McElfresh, then Professor and Chairman of Pediatrics at St Louis University, accepted me into his Department as an Assistant Professor and Director of Ambulatory Pediatric and Emergency Services. I never expressed my gratitude to him prior to his untimely death in 1977, first, for accepting me into academic pediatrics from private practice, and second, for the guidance and counseling that he provided me.
There are issues and concerns that touch each of us involved in academic general pediatrics. In this presentation I will address those that I consider relevant to our membership, indeed, some that I believe critical to the survival of the academic generalist. The question of why there must be generalists on medical school faculties should be addressed. Must all faculty do research, and is it possible to be a good teacher without being involved in original research? Must all inquiry and scholarly contributions be based on reproducible data and numbers, and must one do research in order to qualify as a scholar?
New Developments in Hyperphenylalaninemia
Authors: O'Brien Donough , Berlow Stanley , Donnell George , Justice Parvin , Kaufman Seymour , Levy Harvey L. , McCabe Edward R. B. , Snyderman Selma 
Published: December 2021

In recent years it has become apparent that hyperphenylalaninemia in newborn infants may be caused by a variety of defects in the enzyme phenylalanine hydroxylase or by an abnormality in either the enzyme dihydropteridine reductase (DHPR) or the synthesis of dihydrobiopterin (BH2) (Figure). Despite the rarity of the latter conditions1 there are important implications for management in making this diagnosis. It has been suggested that all new cases of hyperphenylalaninemia now be screened for these variants.2 The purpose of the Task Force was to define the feasibility of this course at the present time.
BACKGROUND
The hepatic system for conversion of phenylalanine to tyrosine is complex and consists of at least two essential enzymes, phenylalanine hydroxylase (catalyzing reaction 1) and dihydropteridine reductase (catalyzing reaction 2), and an essential, nonprotein cofactor, tetrahydrobiopterin3: (1) Phenylalanine + O2 + tetrahydrobiopterin → tyrosine + H2O + quinonoid dihydrobiopterin; (2) nicotinamide adenine dinucleotide (reduced form) + H+ + quinonoid dihydrobiopterin → nicotinamide adenine dinucleotide (oxidized form) + tetrahydrobiopterin.
Most cases of hyperphenylalaninemia detected by newborn infant screening programs are caused by deficiencies of phenylalanine hydroxylase ranging from the severe "classic phenylketonuria (PKU)" to the more benign "hyperphenylalaninemic variant." The patients with classic PKU usually respond to a diet low in phenylalanine. However, of the estimated 400 cases of classic PKU detected annually in the United States, up to 3% may show progressive neurologic deterioration despite adequate dietary treatment. The elevated phenylalanine in these infants may be caused by either DHPR deficiency or a deficient synthesis of BH2 or to other still unidentified causes.
Estimates of Need and Recommendations for Personnel in Neonatal Pediatrics
Authors: Brann Alfred W. , Cassady George 
Published: December 2021

The American Academy of Pediatrics Committee on the Fetus and Newborn, as a technical advisory committee, and the Section on Perinatal Pediatrics, representing pediatricians with a special interest in neonatology, have examined current practice and manpower needs in neonatal pediatrics. This effort has been undertaken to provide current objective information and to make recommendations regarding personnel numbers and distribution.
Advances in perinatal knowledge have resulted in major technological achievements and improved care of pathophysiologic states as well as enhanced understanding of emotional aspects of the human birthing experience. General acceptance of perinatal regionalization and formal recognition of perinatology as a subspecialty, including sub-boards of Neonatal-Perinatal Medicine of the American Board of Pediatrics and Maternal-Fetal Medicine of the American Board of Obstetrics and Gynecology, have occurred in this decade. In March 1977, an ad hoc group of neonatologists, with representation from obstetrics, nursing, government, and voluntary organizations, met to quantify US neonatal manpower needs. Progress was made in conceptualizing aspects of the problem, but a consensus regarding validity of conclusions was not reached and a formal report not written. The concerns leading to and from that conference, plus later communications to the Section and Committee, emphasized an acute need for additional effort. It is not the purpose of this statement to directly address the issue of structure, content, and quality of training programs in Neonatal-Perinatal Medicine; this is a consideration of the sub-board.
NEED FOR SUBSPECIALIST
NEONATOLOGISTS
Manpower needs to care for sick infants can be estimated from different data such as total number of births; estimates of infants requiring special care, especially the low-birth-weight or prematurity rate; perinatal mortality rates; and aspects of provider services, including number of beds available for neonatal care and length of stay.
Renal Stones and Intravenous Fielding
Authors: Pascual Jose F. 
Published: December 2021

Adelman et al1 report nephrolithiasis as another complication that may be seen associated with total parenteral nutrition (TPN). The authors implicate parenteral calcium infusion as the cause of calcium phosphate calculi in their patient.
Another possible etiologic factor in renal stone formation is that of hypophosphatemia. Urinary excretion of pyrophosphate, a potent inhibitor of calcium crystal formation, is decreased in the presence of hypophosphatemia, thus favoring calculi formation. It has also been shown that a decrease in cellular phosphate in the renal cortex2 may stimulate increased formation of 1,25(OH)2D3, which in turn will cause an increase in urinary calcium excretion.3
Experimental Power: The Other Side of the Coin
Authors: Berwick Donald M. 
Published: December 2021

The article by Mitchell et al,1 in this issue of Pediatrics is laudable in many respects, including the rigor of its methodology. In a paragraph on page 974, the reader will find one particularly valuable nugget. There the authors write, "...clinically important differences... were unlikely to have been missed. Specifically, for GCI (general cognitive index) a difference of 15 points would have been found 91% of the time, and a difference of 20 points 99% of the time, while a difference of 10 points would be found 64% of the time."
That is pure gold. Not only do the authors tell us that their study failed to find a certain effect (a difference in GCI between cases and comparisands), but they then tell us how likely it was, given the size and design of their study, that they missed an effect which we might care about.
Letters to the Editor
Authors: Goldman Steven L. , Brady June P. , Dumpit Fe M. 
Published: December 2021

We appreciate Dr Kattwinkel's concerns and we would like to clarify several of his comments:
1. Comparison of work of breathing—Dr Kattwinkel correctly points out that, by adding the PE 20 sampling catheter, we have increased the resistance of the nasal prongs over their resistance when used clinically. In fact, the catheter does increase the measured resistance of the nasal prongs by about 36%. We must concur that work of breathing measured with the nasal prongs would have been less if the sampling catheter was not present.
Infantile Water Intoxication at Home
Authors: Schulman Joseph 
Published: December 2021

Water intoxication in infants living at home has been considered an unusual entity.1-4 This paper describes two infants who were seen because of seizures. It appears that the metabolic derangements were a consequence of parental error. In view of the similarity between these and previously reported cases,1-4 including the context of parental poverty, the problem and population at risk may be more common than previously recognized.
CASE REPORTS
Case 1
T.W. is a 5-month-old boy with no previously known health problems. After being irritable for most of the afternoon, he developed generalized seizures in the evening. His temperature was 97 F rectally, blood pressure 70 mm Hg by palpation, pulse rate was 132 beats per minute, and respirations 20/min.
A Comparison of Three Antibiotic Regimens for Eradication of Haemophilus influenzae Type b from the Pharynx of Infants and Children
Authors: Horner Douglas B. , McCracken George H. , Ginsburg Charles M. , Zweighaft Teresa C. 
Published: December 2021

The communicability of Haemophilus influenzae type b has recently been shown to be comparable to that of Neisseria meningitidis.1,2 The secondary attack rate of H influenzae type b disease is approximately 2% in young contacts of an index case, an observation that has stimulated investigators to attempt to identify effective chemoprophylactic regimens. Elsewhere in this issue are two studies reporting successful use of rifampin in eradicating H influenzae type b from the pharynx of infants and children who were exposed to patients with the disease.3,4 Other regimens have not been effective.5,6
The purpose of this brief communication is to report our results with three antimicrobial agents that were given in an attempt to eliminate pharyngeal carriage of H influenzae type b in infants and children.
DR MORRILL WYMAN'S TREATMENT OF THE OLDEST SON OF PRESIDENT ELIOT OF HARVARD ABOUT 1870
Authors: C. T. E. 
Published: December 2021

President Charles William Eliot (1834-1926), one of Harvard's greatest presidents, must have been so impressed with the treatment of his oldest son by Dr Morrill Wyman (1812-1903) that he could vividly describe it in an address almost a half a century later. Dr Wyman who received his MD from the Harvard Medical School in 1837 was a greatly loved and admired physician during the more than 60 years he practiced in Cambridge, Massachusetts.
In addressing the Cambridge Historical Society in 1917, Eliot described the visit to Dr Wyman's office as follows:
I remember taking to him one day my oldest boy, Charles, then perhaps ten or twelve years old, on whose neck I had noticed a small protuberance. Dr. Wyman looked at it, felt of it, and said—he was a man of quick observation and quick speech—"That is a wen. You had better have it right out." He said that to the boy, and immediately produced a lancet. In half a minute the little growth was out; and the doctor applied a simple dressing. Then he remarked to Charles, "There, that will cost you two dollars, because you have come to my office, but if you had gone in to get that done by a surgeon in Boston he would have charged you twenty-five dollars"; which I have no doubt was an underestimate of the probable Boston charge.1
Tuberculosis Control
Authors: Farer Laurence S. 
Published: December 2021

Two actions of the Public Health Service have been cited by Dr Kendig1 as serving "to minimize the seriousness" of the tuberculosis problem in American children. These are the discouragement of routine tuberculin testing in this country and the change in counting tuberculosis cases which was instituted in 1975.
In correspondence which I have had with Dr Kendig, we have agreed on our mutual commitment to eradication of tuberculosis in children. I do not think he intended to suggest that the Public Health Service is not concerned about tuberculosis in children.
Some Children Have Occasional Obstacles to Learning (SCHOOL)
Authors: Ushkow Martin 
Published: December 2021

Parcel et al in their article "A Comparison of Absentee Rates of Elementary Schoolchildren with Asthma and Nonasthmatic Schoolmates" (Pediatrics 64:878, 1979) report that schoolchildren with chronic disease will be absent more than their healthy peers.
School districts provide homebound instruction for students who because of permanent severe defects are unable to attend school and others who are temporarily incapacitated. Since the cost is borne by the district, a waiting period is required to control the number of students receiving homebound instruction.
Letters to the Editor
Authors: Kendig Edwin L 
Published: December 2021

I have read Dr Lindenbaum's letter in regard to the article and commentary on tuberculin testing (Kraut JR, Christoffel KK, Berkelhamer JE, et al: Assessment of tuberculin screening in an urban practice. Pediatrics 64:856, 1979; Kendig EL Jr: Tuberculin testing in the pediatric office and clinic. Pediatrics 64:965, 1979).
At a recent press conference, the Center for Disease Control reported that, with the exception of pneumonia, more deaths in the United States result from tuberculosis than any other reportable disease.
Child Abuse Presenting as Chylothorax
Authors: Green Hubert Gordon 
Published: December 2021

Child abuse may be seen with a broad array of signs and symptoms.1,2 Some cases are easily recognized, with one or more of the now classic historical and physical features of this condition. Others come to attention only after more subtle findings lead to consideration of the diagnosis. Some cases, unfortunately, escape recognition and are not identified as instances of child abuse, leading to incomplete diagnosis and possibly inappropriate treatment and follow-up.
Our purpose in reporting this case is to alert health professionals to an unusual manifestation of child abuse.
CASE REPORT
The patient, A.R., was an 8-month old girl who had, according to her parents, manifested symptoms of an upper respiratory infection for a week prior to her admission to hospital.
Increased Intracranial Pressure Following Treatment of Cystic Fibrosis
Authors: Roach Ewell Steve , Sinal Sara Hendricks 
Published: December 2021

Elevated intracranial pressure in children with cystic fibrosis has been previously attributed to vitamin A deficiency,1,2 which is a well recognized cause of increased intracranial pressure.3 Although there are several reports of suture diastasis after improvement of poor nutritional status,4-6 only one similar patient with a bulging fontanel following treatment of cystic fibrosis could be found in the literature.7
We have recently encountered two patients who developed bulging anterior fontanels soon after beginning treatment for cystic fibrosis. Both patients remained asymptomatic. A lumbar puncture demonstrated elevated intracranial pressure in one patient.
CASE REPORTS
Case 1
A 4½-month-old white male infant was admitted for evaluation of poor weight gain, vomiting, and intermittent diarrhea.
Faith, Doubt, and Statistics
Authors: Day Richard L. 
Published: December 2021

Dr Grover Powers's reputation as a clinician, teacher, and sympathetic doctor is worldwide. I do not need to waste words in telling you how appreciative I am of the honor of being invited to stand here.
A more accurate title for this talk might have been simply "Statistics," but that would have led members of any potential audience to find more urgent duties elsewhere, especially those who, like me, know that I am not a statistician. I do, however, respect both faith and doubt, the latter sometimes being elevated to hypothesis, and concerning which we can gather evidence and which our statistician friends can quantify, if we abide by certain ground rules in the accumulation of information. Uncertainty can be quantified but never eliminated. It can be given a comforting value, such as P &lt; .01. My talk is intended to show how necessary it is for us to give the statistician data of high quality, and why we often fail to do so.
The ancient method of making progress has been by observing events and comparing the results with previous experience–in medicine, with "my clinical experience." In Latin, the technique is described by the phrase "post hoc, ergo propter hoc." In the stone age, it led to the pressure flaking of razor-sharp knives from flint and obsidian. Later, our ancestors discovered agriculture, cheese-making, brewing, and the fermenting of grapes; the smelting of tin, copper, bronze, and iron; carbon steel; the recognition of all poisonous plants and animals; and tea, coffee, tobacco, hashish, opium, cocaine, quinine, oil of wintergreen, digitalis, mercury, cascara, curare, castor oil, and the Model T Ford.
Retrolental Fibroplasia: A Modern Parable by William A. Silverman
Authors: L. J. F. 
Published: December 2021

This 585-gm book had a gestational period of 30 years. It has been worth the wait. It is a remarkable book. It's clearly written, exciting, informative, and fascinating. It's also provocative and scary.
Retrolental fibroplasia has been the subject of hundreds of scientific articles over the past 35 years, but the full story of that awful iatrogenic epidemic has never been told. This is it. Silverman is a master storyteller. He was a researcher and practitioner in the midst of the epidemic and involved in the events and decisions.