bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ribavirin Therapy of Respiratory Syncytial Virus
Authors:   Committee on Infectious Diseases
Published: December 2021

Ribavirin is an antiviral drug that has recently been approved by the FDA in an aerosolized form for the therapy of respiratory syncytial virus infections in hospitalized children who do not require assisted ventilation. Ribavirin is different from other antiviral drugs both in its spectrum of activity and in its mode of administration.1,2 The following statement is presented to identify which children should be considered for ribavirin therapy. Questions also have arisen as to the benefits afforded by treatment in comparison to the potential unknown toxicity of the drug and as to whether ribavirin should be administered to infants who require assisted ventilation; the package insert has warned against using the drug in such patients. Whether pregnant women or personnel who care for infants being treated with ribavirin are at risk from exposure to the drug is also of concern. Finally, physicians must be aware that the cost of ribavirin needed for three days of therapy is almost $700.
BACKGROUND
Respiratory Syncytial Virus Disease
Respiratory syncytial virus is the most important cause of lower respiratory tract disease in infants and young children. It usually appears in yearly winter to spring outbreaks and infects essentially all children during their first 3 years of life. The number of infected infants who require hospitalization has been estimated to range in different locations from one in 50 to one in 1,000. Currently, the mortality in hospitalized infants who were previously normal is low, less than 1%.3 In infants with underlying diseases, however, the mortality may be strikingly higher.3-5
Statistics and Sudden Infant Death Syndrome
Authors: OREN JOSEPH , KELLY DOROTHY H. , SHANNON DANIEL C. 
Published: December 2021

In Reply.—
Dr Cummins' letter raises two questions regarding the statistical analysis in our report and we forward the following explanations.
First, we agree that the Fisher exact test is superior to the χ2 statistic in analyzing associations between small subgroups. However, as we have already shown, in response to Dr Leblanc's letter (Pediatrics 1986;78:957), the results of the Fisher exact test are in good agreement with the published values using χ2 analysis.
Second, in Figs 1 and 2 the ordinate depicts the 95% confidence interval of the relative risk and not the relative risk per se.
Why I Have Difficulty Being Enthusiastic About Recommending That Children Wear Helmets on Bicycles
Authors: WEISS BARRY D. 
Published: December 2021

In Reply.—
Dr Ciastko raises an important point. Serious head injury is not limited to victims of bicycle mishaps. Pedestnians, motor vehicle occupants, playground users, and others are all at risk for serious head injury. Physicians and others involved in preventive health cane certainly should direct their efforts at preventing these other causes of childhood mortality and death.
Nonetheless, the importance of bicycle-related head trauma should not be underestimated. Despite Dr. Ciastko's findings, the literature suggests that bicycle mishaps are an important cause of serious head injuries.
Qualifications and Utilization of Nursing Personnel Delivering Health Services in Schools
Authors:   COMMITTEE on SCHOOL HEALTH
Published: December 2021

The demands of school nursing services have grown rapidly in recent years. Nursing personnel who work on a day-to-day basis with schoolchildren should have the expertise required to meet these ever-increasing demands.
Today's school nurse should be equipped to assess health problems related to infectious diseases such as immunodeficiency and herpes, pregnancy, drug and alcohol abuse, child abuse (including sexual abuse), chronically disorganized families, mental illness/depression and suicide, eating disorders, physical and learning disabilities, athletic injuries, poor nutrition, and chronic disease. It is important that the school nurse be able to recognize and manage minor illness, offer skilled health counseling and guidance, detect potential health problems, make appropriate medical referrals, and act as the personal physician's extension into the school setting to meet the health needs of the child patient during the school day.
SCHOOLCHILDREN WITH DISABILITIES
The mandates of Public Law 94-142 create an additional need for professional nursing services in schools. Children with varying degrees of disabilities are now in the regular school setting. Many of these students require specialized caretaking procedures such as tracheostomy suctioning, catheterization, ostomy care, nasogastric tube feeding, or maintenance of orthopedic devices. Some children require administration of medications with varying side effects, in varying amounts, and at varying times during the school day. It is often important that a professional school nurse assess the problem, consult with the child's physician or school medical consultant, and administer the physician-prescribed services.
In preschool programs and classrooms for the severely disabled, the professional school nurse working with the child's regular physician, the school medical consultant, or a local health officer should provide in-service instruction regarding prevention of the spread of infectious disease and provide supervision of handwashing, diapering, custodial concerns, and methods of food handling.
Phototherapy Effect on the Incidence of Patent Ductus Arteriosus
Authors: WARD KENT E. 
Published: December 2021

I just finished reading the article by Rosenfeld et al (Pediatrics 1986;78:10-14). The abstract was quite intriguing and compelled me to read the entire paper. Unfortunately, I found two major flaws in the materials and methods sections that I believe cast serious doubt on the validity of the study.
First, although the findings on physical examination can be helpful in determining the hemodynamic significance of a medium-or large-sized patent ductus, I do not believe the presence or absence of a ductus can be reliably determined in very small premature infants solely on the basis of a physical examination.
In Reply: Phototherapy Effect on the Incidence of Patent Ductus Arteriosus
Authors: ROSENFELD WARREN 
Published: December 2021

Dr Ward points to two major problems that we discussed in our paper. At the time this study was begun in our neonatal intensive care unit, only M-mode echocardiography was available. We agree our methods were relatively gross estimations of ductal patency, and we are presently studying the effect of phototherapy using two-dimensional and Doppler echocardiography.
The second flaw of nonblinding was an extremely difficult one to solve in our unit. Those physicians involved in the study spent considerable time in the unit and, even if shields were removed during the scheduled daily examination, it would be difficult to truly blind observers because shields would have been replaced.
Evaluation of Interpersonal Skills and Ethics After Pediatric Training
Authors: MONTGOMERY WILLIAM C. 
Published: December 2021

In this issue of Pediatrics (pp 829-833) there is a statement by the Medical Ethics Subcommittee of the American Board of Pediatrics entitled "Teaching and Evaluation of Interpersonal Skills and Ethical Decision Making in Pediatrics." The American Academy of Pediatrics agrees with and supports the thoughts and plans expressed in this statement and agrees that candidates should be examined on these issues as part of the Board's certifying process.
In 1978, the Academy published a report entitled The Future of Pediatric Education, the authorship of which was a joint effort of representatives from ten medical organizations concerned with educating pediatricians. That report clearly stated the need for formal education in medical ethics and interpersonal skills in the pediatric residency curricula in order that the biosocial needs of infants, children, and adolescents be satisfactorily addressed.
Generic Prescribing, Generic Substitution, and Therapeutic Substitution
Authors:   Committee on Drugs
Published: December 2021

This Clinical Report was reaffirmed May 2005, October 2008, October 2012, and September 2019.
Pressures generated by a constellation of professional consumer, legislative, and health care provider vider groups in this era of increasing health care costs have led to enactment of generic substitution laws in 50 states. The general acceptance of this concept, despite conflicting evidence that it has reduced the cost of prescription items to the consumer, has led to the concept of therapeutic substitution. Considerable confusion exists among health care professionals regarding the precise meaning of these concepts.
Generic prescribing is the prescribing of a drug by a physician using the generic name. This leaves the choice of brand to the dispensing pharmacist. Generic substitution is a pharmacist-initiated act by which a different brand or an unbranded drug product is dispensed instead of a drug brand that was prescribed by the physician. This means substituting the same chemical entity in the same dosage form for one marketed by a different company. Therapeutic substitution is a pharmacist-initiated act by which a pharmaceutical or therapeutic alternate for the physician-prescribed drug is dispensed without consulting the physician. This denotes replacement of the prescribed drug with a chemically different drug within the same therapeutic category, eg, hydrochlorothiazide for furosemide; ranitidine for cimetidine; chloramphenicol for erythromycin.
In 1976, the AAP Committee on Drugs published a commentary in Pediatrics (1976;57:275-277) on generic prescribing and concluded that "the lack of data on bioavailability and bioequivalence in children precludes blanket support of generic prescribing for infants and children." The Committee recently reviewed this issue and concluded that the situation has changed little during the past decade.
Neonatal Personpower
Authors:   For the AAP Committee on Fetus and Newborn, MERENSTEIN GERALD B. 
Published: December 2021

In Reply.—
We appreciate Dr Katzman's interest in this complex issue. His position is similar to that previously suggested by Auld1 and would certainly suggest an increased need for more neonatologists.
The current number of neonatologists has already had a significant impact on regionalization and upon the practicing pediatrician.2 Katzman suggests that neonatal-perinatal medical care skills include resuscitation of as-phyxiated newborns, identification and treatment of high-risk newborns, management of respiratory failure, and evacuation of pneumothorax.
Smokeless Tobacco and Hypertension in an Adolescent
Authors: ADELMAN RAYMOND D. 
Published: December 2021

To the Editor.—
Concern has been expressed recently about the health hazards of the widespread use of smokeless tobacco by
[See figure in the PDF file]
children. Some surveys have reported regular use by as many as 12% to 33% of male high school students.1,2 Complications of smokeless tobacco include oral cancer, periodontal disease, and dependence. Hypertension may also occur due to the sodium and nicotine content of smokeless tobacco1 and glycyrrhizinic acid. This extract of Glycyrrhiza glabra root, present in many chewing tobaccos and natural licorice, has potent mineralocorticoid activity and may produce hypertension and, in some patients, hypokalemia, alkalosis, sodium and water retention, and suppressed plasma renin activity.3-5
Benzyl Alcohol in Neuromuscular Blocking Agents
Authors: VAN DER HAL ANDRE L. , MACDONALD HUGH M. , SHAW LAURENCE , SREEPATHI SUKSHMA , BEASLEY SCOTT A. 
Published: December 2021

To the Editor.—
Recent letters to the Editors1,2 suggested discontinuation of clinical trials with doxapram for apnea of prematurity, because the preparation contains the preservative benzyl alcohol, implicated as the cause for the gasping syndrome at doses of 94 to 245 mg/kg/d.3 After we reexamined our standard arsenal of drugs used in the neonatal intensive care unit, we found an additional class of drugs containing benzyl alcohol: neuromuscular blocking agents. Pancuronium bromide (Pavulon, [Organon]) is prepared in 1-mg/mL vials containing 1% (10 mg/mL) benzyl alcohol.
Pimozide Treatment of Tic and Tourette Disorders
Authors: Shapiro Arthur K. , Shapiro Elaine , Fulop George 
Published: December 2021

Tourette disorder is a chronic multiple tic condition that begins in childhood and may require lifelong treatment. Neuroleptics are the most effective and frequently used drugs for the treatment of both Tourette and tic disorders. Haloperidol was the first neuroleptic drug approved by the Food and Drug Administration (FDA) for the treatment of adult patients with Tourette disorder in 1969 and for children in 1978. Its effectiveness in the treatment of tics is well documented.1,2 However, adverse effects limit its usefulness and new drugs that have fewer adverse effects and greater efficacy are needed.2-5
The need for new medications is critical because of the epidemic increase in the number of patients with the diagnosis. We now know that Tourette disorder was underdiagnosed because of the erroneous belief that the etiology was psychologic and that the diagnosis required the presence of coprolalia, echolalia, and intellectual and psychologic deterioration. Following the development of accurate diagnostic criteria, early detection and diagnosis was facilitated. This in turn led to a dramatic increase in the number of physicians diagnosing and treating tic disorders and the establishment of Tourette disorder clinics throughout the country. The lifetime prevalence in the United States is now estimated as 0.5% for Tourette disorder and 1.6% for both Tourette and chronic motor tic disorders.6,7
However, a new neuroleptic drug, pimozide, was recently approved by the FDA for use in patients with Tourette disorder in 1984. Our studies on the effectiveness of pimozide, begun in 1977, were largely responsible for appoval of pimozide.
Brain Death?
Authors: MORRAY JEFFREY P. , KRANE ELLIOT J. , LYNN ANNE M. , TYLER DONALD C. 
Published: December 2021

To the Editor.—
Because we are now able to provide long-term cardio-pulmonary support, the determination of cerebral death in children is a critical issue, both to provide an unambiguous diagnosis of death and, when appropriate, to allow recovery of organs for transplantation. Perhaps this latter issue provided the impetus for Drake et al1 to evaluate their recent experience at Loma Linda and to present a protocol for the determination of brain death in children.
JUVENILE PERNICIOUS ANEMIA
Authors: REISNER EDWARD H. , WOLFF JAMES A. , MCKAY R. JAMES , DOYLE EUGENIA F. 
Published: December 2021

Histories have been presented of two pairs of sibling children with recurrent macrocytic anemia with megaloblastic bone marrow responding specifically to liver extract and vitamin B12.
The clinical features and laboratory findings were similar to those of adult pernicious anemia in every respect except for the inconstant presence of histamine refractory achlorhydria. All the patients responded to vitamin B12 given parenterally, but in three to whom it was given by mouth no response was obtained. Two of these subsequently responded to oral B12 when it was accompanied by normal gastric juice. The other two developed histamine refractory achlorhydria while in hematologic remission. This is interpreted as proof that the anemia was due to deficient intrinsic factor in the gastric juice.
Three patients showed evidence of disease of the spinal cord, in two of whom the symptoms were severe. These symptoms were compatible with a diagnosis of dorsolateral sclerosis, and improved with antipernicious anemia therapy. In one of these patients, treated with folic acid, the neurologic lesions were aggravated severely.
Pernicious anemia due to the absence of gastric juice intrinsic factor occurs in children. The presence of free hydrochloric acid in the gastric contents does not preclude the possibility of the disease.
Bronchopulmonary Dysplasia and Care Techniques
Authors: PHILIP ALISTAIR G. S. , KESSLER DALE L. 
Published: December 2021

To the Editor.—
Although the paper by Avery et al1 is both interesting and provocative, readers should be cautioned about the inherent limitations of data generated by a retrospective, multicentered study design.
First, the definition of chronic lung disease leaves much to be desired. The diagnosis was "arbitrarily defined" as an oxygen requirement greater than room air at 28 days of age. Evaluation of the need for oxygen at 3 months is a much more clinically relevant end point, but the numbers in this category were too small to evaluate adequately.
Brain Death Determination in the Newborn
Authors: VOLPE JOSEPH J. 
Published: December 2021

This commentary is addressed to the determination of brain death in the newborn and young infant and in particular is meant to elaborate the rationale for two aspects of the guidelines established by the Task Force on Brain Death in Children.1 The two aspects are (1) the application of the guidelines to term infants seven days of age or older and (2) the recommendation of an observation period of at least 48 hours in infants between seven days and 2 months of age.
The two essential requirements for the diagnosis of brain death are, first, the establishment of cessation of all brain functions, ie, cerebral and brainstem functions, and second, the demonstration that cessation of these functions is irreversible.
Psychosocial Screening
Authors: FRANKENBURG WILLIAM K. 
Published: December 2021

To the Editor.—
The study by Borowitz and Glascoe (Pediatrics 1986;78:1075-1078) reported on the sensitivity of the Denver Developmental Screening Test (DDST). Although more studies validating psychosocial screening tests are needed to determine the efficacy of such tests, the study by Borowitz and Glascoe was misleading for two major reasons.
First, the authors did not interpret the DDST in the prescribed manner. They stated, "Standard administration and scoring of the DDST were used, resulting in a pass, fail, or questionable score for each of the four sectors of the test.
Circumcision
Authors: WISWELL THOMAS E. 
Published: December 2021

In Reply.—
Thompson and Thompson conjecture that our previous findings of an increased risk for urinary tract infections may be explained by incomplete and/or biased end point determination over time.1,2 We disagree with their speculations.
First, the Thompsons refer to the apparent decline in the percentage of "hospitalized urinary tract infections" in circumcised boys (from 0.16% to 0.07%) as an indication of incomplete or differential end point determination over time. They are incorrect in this assumption.
Genetics in Pediatrics
Authors: HECHT FREDERICK 
Published: December 2021

To the Editor.—
In the past I have been critical of the dearth of genetic communications in pediatric journals such as Pediatrics. The genetic articles, instead, have been published largely in genetic specialty journals to which most pediatricians do not subscribe.
When the late Stanley Wright was alive (he was a pediatrician and pioneering medical geneticist at UCLA), he urged me and other fledgling pediatric geneticists to report our results and their meaning in the pediatric journals.
Drug Errors
Authors: KOREN GIDEON 
Published: December 2021

In Reply.—
In Canada, pediatric Lanoxin is available, as stated in our article, in a concentration of 0.05 mg/mL (Compendium of Pharmaceuticals and Specialties, ed 21. Ottawa, Canadian Pharmaceutical Association, 1986). This is another source of errors; physicians today moving from country to country should always check the stock solutions of drugs available and not assume that they are the same as at home.
Hymens in Newborn Female Infants
Authors: JENNY CAROLE , KUHNS MARY L. D. , ARAKAWA FUKIKO 
Published: December 2021

Few physicians are comfortable testifying in courts of law. Fewer still are comfortable when the subject at hand involves sexual abuse and when there is often a paucity of physical or laboratory findings. Yet, with increasing public awareness, the number of cases of child sexual abuse involving the criminal justice system is dramatically increasing, with a concomitant need for expert witness testimony.
When sexual abuse is alledged, a physician may be asked to assess a child's genitalia and anus for signs of past sexual activity. In girls, this entails looking for changes in the hymen, such as tears or scarring, estimating the diameter of the introitus, and looking for dilation of the hymenal ring.1
Preventive Pediatrics: The Promise and the Peril
Authors: Eisenberg Leon 
Published: December 2021

I was deeply honored to have been invited by the Canadian Paediatric Society to serve as its 18th Queen Elizabeth II Lecturer. Even as I relished the honor, I found it daunting, given the distinction of my predecessors. Having considered at length how best to respond, I chose to address prevention, a field with which pediatrics has been concerned since its inception as a specialty. Although the commitment of pediatrics to disease prevention has been unswerving, the diseases that have been the target of its efforts have necessarily changed as the distribution of disease in the population has changed and as scientific advances have created new opportunities for intervention.
What pediatricians were once almost alone among medical specialists in emphasizing has now become the target of government policy in Canada,1 the United States,2 and the United Kingdom.3 This, however, is not quite the triumph it may seem. Physicians who advocate prevention do so in the hope of avoiding unnecessary suffering and premature death for their patients. Politicians who do so may not be unmindful of these goals, but their primary motivation is controlling the costs of medical care. The US Forward Plan for Health2 was unabashed about it: "the primary focus of our program is a major attack on cost escalation." The differences in motivation between physicians and politicians have important consequences for health policy, consequences that imperil the promise of prevention.
Let me, then, begin with a few words of history, move on to the promise of preventive pediatrics in the years to come, and conclude by discussing the hazards associated with the use of prevention as a political rather than a medical slogan.