bluuebunny/crossref_metadata_2025_split huggingface dataset:
First Aid for the Choking Child
Authors:   Committee on Pediatric Emergency Medicine
Published: December 2021

There are more than 300 annual deaths of children in the United States due to choking.1 Prompt, effective first aid provided by a bystander may and often does prevent morbidity or death. Pediatricians should review the risk of choking with parents during routine health care visits and encourage families to obtain formal training from local agencies such as the American Red Cross and American Heart Association.
Toys, food, or other foreign objects find their way into youngsters' airways. Any child who has choked on a foreign body and is coughing, crying, or speaking is best left to his/her own reflexes to relieve the obstruction. If the child or infant is unable to make sounds or if complete obstruction develops, without evidence of respiratory air movement, immediate first aid is required to avoid permanent disability or death.
CURRENT TECHNIQUES
Abdominal Thrust Technique
Most experts agree that the abdominal thrust maneuver (Fig 1), as originally described by Henry Heimlich, MD, is the most effective method of relieving airway obstruction in children more than 1 year of age.2-8 This method utilizes the following concepts: (1) four fifths of normal respiration occurs using the diaphragm; (2) abdominal pressure compresses the diaphragm upward, thereby raising intrathoracic pressure; (3) rapid increase in intrathoracic pressure may expel the obstructing object; and (4) as a patient becomes hypoxic, muscle tone diminishes. Thus, repeated abdominal thrusts that may be ineffective initially become effective minutes later.
Controversy exists concerning first aid management for a choking child less than 12 months of age: abdominal thrust technique versus back-blow and chest thrust technique.
Plasma Phenylalanine and Tyrosine Responses to Different Nutritional Conditions (Fasting/Postprandial) in Patients With Phenylketonuria: Effect of Sample Timing
Authors: van Spronsen F. J. , van Rijn M. , van Dijk T. , Smit G. P.A. , Reijngoud D. J. , Berger R. , Heymans H. S.A. 
Published: December 2021

Objective. To evaluate the adequacy of dietary treatment in patients with phenylketonuria, the monitoring of plasma phenylalanine and tyrosine concentrations is of great importance. The preferable time of blood sampling in relation to the nutritional condition during the day, however, is not known. It was the aim of this study to define guidelines for the timing of blood sampling with a minimal burden for the patient.
Design. Plasma concentrations of phenylalanine and tyrosine were measured in nine patients with phenylketonuria who had no clinical evidence of tyrosine deficiency. These values were measured during the day both after a prolonged overnight fast, and before and after breakfast.
Results. Phenylalanine showed a small rise during prolonged fasting, while tyrosine decreased slightly. After an individually tailored breakfast, phenylalanine remained stable, while tyrosine showed large fluctuations.
Conclusion. It is concluded that the patient's nutritional condition (fasting/postprandial) is not important in the evaluation of the phenylalanine intake. To detect a possible tyrosine deficiency, however, a single blood sample is not sufficient and a combination of a preprandial and postprandial blood sample on the same day is advocated.
Shunts in Patients With Respiratory Distress Syndrome
Authors: WALTHER FRANS J. , LEIGHTON JOHN O. 
Published: December 2021

In Reply.—
We agree with Dr Evans that bidirectional ductal shunting is more common than net right-to-left ductal shunting in premature neonates with severe RDS and persistent pulmonary hypertension. Our conclusion that large right-to-left shunts via the ductus are common findings in these cases was not intended to exclude the presence of concomitant left-to-right shunting. In our study population the incidence of right-to-left ductal shunting at 12 and 24 hours of age was 86% and 94% in premature neonates with fatal RDS, 39% and 34% in the severe RDS group, 4% and 0% in the no/mild RDS group, and 6% and 0% in the full-term neonates without RDS.
Control of Jaundice in Preterm Newborns by an Inhibitor of Bilirubin Production: Studies With Tin-Mesoporphyrin
Authors: Valaes Timos , Petmezaki Sophia , Henschke Claudia , Drummond George S. , Kappas Attallah 
Published: December 2021

Background. Studies in vitro, in animal models, and in adult and newborn humans have demonstrated that certain tin(Sn)-porphyrins that competitively inhibit the activity of heme oxygenase, the rate-limiting enzyme in heme catabolism, reduce production of bilirubin and can thereby substantially diminish plasma levels of the bile pigment.
Objectives. To assess the effectiveness of increasing doses of the heme oxygenase inhibitor, Sn-mesoporphyrin (SnMP), in moderating the development of significant hyperbilirubinemia and thus the requirements for phototherapy in preterm newborns.
Methods. In five randomized, blinded, placebo-controlled trials, SnMP in increasing doses from 1 µmol to 6 µmol/kg body weight was administered intramuscularly in the first 24 hours of life in preterm newborns of 210 to 251 days gestational age. "Special blue" lamps (Phillips F20T12/BB) were used for phototherapy in newborns exceeding a predetermined plasma bilirubin concentration, irrespective of study group.
Results. A total of 517 newborns were randomized in the five trials carried out sequentially over a 4-year period. SnMP in a dose-related manner significantly ameliorated the course of hyperbilirubinemia in the treated newborns Of all gestational ages. With a SnMP dose of 6 µmol/kg body weight, the mean peak incremental plasma bilirubin concentration was reduced by 41% and the phototherapy requirements were decreased by 76% compared to control subjects. Erythema observed in a few SnMP-treated newborns who required phototherapy was mild, transient, and without sequelae. No other untoward effects were observed during hospitalization or at a follow-up at post-term age of 3 and 18 months.
Conclusions. SnMP, by inhibiting the production of bilirubin, substantially moderates the development of hyperbilirubinemia in preterm newborns. This compound and similarly acting enzyme inhibitors merit further clinical study as agents for controlling neonatal hyperbilirubinemia, particularly in neonatal populations for whom other treatment modalities are not available.
Letter to the Editor
Authors: Hansen Thor Willy Ruud 
Published: December 2021

Dr Aschner has some very interesting comments on the role of glial cells in bilirubin neurotoxicity. His suggestion that bilirubin researchers should focus some of their interest on this group of cells, given the increase in knowledge about their more complex role in nervous system homeostasis, is well taken. It would certainly be quite welcome if investigators with relevant research experience would include bilirubin in their future experimental designs.
It seems appropriate in this context to mention the fact that bilirubin researchers in the past have given attention to glial cells, although perhaps with a more limited scope than that suggested by Dr Aschner.
Letter to the Editor
Authors: Merenstein Gerald B. , Hathaway William E. , Miller Robert W. 
Published: December 2021

We thank Dr Israels for his thoughtful comments on the AAP Vitamin K Task Force statement. He raises two issues: the risk of cancer from currently recommended doses of intramuscular vitamin K1 and the need for the task force to reconsider the physiology of vitamin K.
The ultimate measure of carcinogenicity in the human is an excess of cancer in the human—not predictive tests in vitro or in animals, useful though they may be to raise suspicions.
Aspartame, Behavior, and Cognitive Function in Children With Attention Deficit Disorder
Authors: Shaywitz Bennett A. , Sullivan Colleen M. , Anderson George M. , Gillespie Sheila M. , Sullivan Barbara , Shaywitz Sally E. 
Published: December 2021

Objective. To determine the effects of large doses of aspartame on behavior, cognition, and monoamine metabolism in children with attention deficit disorder.
Design. A randomized, double-blind, placebo-controlled crossover study of unmedicated children meeting Diagnostic and Statistical Manual of Mental Disorders (3rd ed) criteria for attention deficit disorder.
Setting. Behavioral assessments were performed in the child's home by their parents and in the classroom by a teacher. Cognitive tests were administered and blood drawing was performed during a 2-day inpatient admission to our Children's Study Center.
Interventions. Administration of aspartame (single morning dose, 34 mg/kg) or placebo for alternate 2-week periods.
Main outcome measures. Behavioral and cognitive tests included the Matching Familiar Figures Test (MFFT), Children's Checking Task (CCT), the Airplane Test, the Wisconsin Card Sorting Test (WCST), the Subjects Treatment Emergent Symptom Scale (STESS), the Multigrade Inventory for Teachers (MIT), and the Conners Behavior Rating Scale. Blood was drawn for complete blood cell count and liver function tests, as well as amino acid, methanol, formate, serotonin, and monoamine metabolite analyses, and urine was collected for measurement of catecholamine and monoamine metabolite excretion.
Results. No clinically significant differences between aspartame and placebo were found for the STESS, MIT, or Conners ratings, or for the MFFT, CCT, WCST, or Air-plane cognition tests. Also, no differences were noted for any of the biochemical measures, except for the expected increase in plasma phenylalanine and tyrosine following aspartame.
Conclusions. The findings indicate that aspartame at greater than 10 times usual consumption has no effect on the cognitive and behavioral status of children with attention deficit disorder. In addition, aspartame does not appear to affect urinary excretion rates of monoamines and metabolites.
Coronary Risk Factors in Adolescents Related to Their Knowledge of Familial Coronary Heart Disease and Hypercholesterolemia: The Muscatine Study
Authors: Muhonen Linda E. , Nelson Richard P. , Burns Trudy L. , Lauer Ronald M. 
Published: December 2021

Objective. To determine the utility of a school-based questionnaire, to identify adolescents with adverse coronary risk factor levels.
Design. In Muscatine, IA, students (9th through 12th grade) completed a questionnaire providing medical history information about first- and second-degree relatives. Anthropometric measures were obtained and blood pressure, lipid, lipoprotein, and apolipoprotein levels were determined.
Results. A history of parental coronary heart disease (CHD) was rare and a history of parental high cholesterol frequently was unknown; however, when known, a history of high cholesterol or early (30 to 55 years of age) or later (&gt;55 years of age) CHD (myocardial infarction, coronary bypass, or death from a heart attack) in grandfathers enriched the identification of adolescents with adverse coronary risk factors. Parental history of CHD was associated with an increased risk for high body mass index and low apolipoprotein A1 levels in their children. Grandfather history of early or later CHD was associated with an increased risk for low apolipoprotein A1 and high density lipoprotein cholesterol levels and high body mass index in their grandchildren. Students with positive grandfather histories of high cholesterol had higher total cholesterol, low density lipoprotein cholesterol, apolipoprotein B, and low density lipoprotein cholesterol to high density lipoprotein cholesterol ratios. Grandmother histories, because most were negative, did not help identify adolescents in this population with adverse coronary risk factors.
Conclusions. A parental history of CHD as well as a grandfather history of high cholesterol or CHD enriches the identification of children with adverse coronary risk factor levels. The positive predictive values associated with using a school-based history obtained from adolescents, many with the aid of their parents, are small and many adolescents do not know their family history. It is essential that pediatricians inquire about parental and especially grandparental medical histories in accordance with the National Cholesterol Education Program guidelines to help identify children at highest familial risk. The importance of determining parental and grandparental histories of CHD or hypercholesterolemia should be emphasized to families who are uncertain of their histories to identify children and adolescents who require a physician's care. It is also important for pediatricians to remind their colleagues who care for patients with premature ischemic heart disease to refer their progeny for pediatric care so that their lipids and lipoproteins may be screened and counseling provided.
MODERN WITCH HUNT—CHILD ABUSE CHARGES
Authors: L. J. F. 
Published: December 2021

The 1974 act—sometimes known as the Mondale Act, after one of its sponsors—was implemented to fight a genuine problem. Up to that year, child abuse was rarely reported and frequently covered up. It was Congress's intent to rectify this deplorable situation by providing incentives for states to set up programs for child abuse research, identification, prosecution and treatment. Federal funding was made available to match state spending, and this served as an incentive for states to create such programs.
The law, however, has had results that its authors did not intend. In America today, child sex-abuse accusations are burgeoning. In many cases, it is probable that the charges are valid. But when the charges arise from vicious child custody disputes, where the vengeance element and the opportunity for exclusion of a hated spouse is operative, or in venues such as day-care centers, where the potential pedophile has little opportunity for contact with the child alone, the prevalence of child abuse is in reality quite low.
The Child Abuse Establishment
Nevertheless, the number of charges in these areas escalate. The primary reason: The Mondale Act has strengthened the "child abuse establishment"—a network of social workers, psychiatrists, psychologists and law enforcement officials—that through its very existence frequently validates an individual's charges. In other words, this establishment, unintentionally or intentionally, encourages charges of child abuse whether they are reasonable or not.
Brain Injury Caused by Intraventricular Hemorrhage: Is Indomethacin the Silver Bullet for Prevention?
Authors: Volpe Joseph J. 
Published: December 2021

After a series of promising but inconclusive reports concerning the role of neonatal administration of indomethacin in prevention of IVH (see earlier discussion), the largest and most recent study (n = 431), reported by Ment et al,4 indicates that indomethacin led to a decrease in incidence and severity of the lesion. The clinically important grade 4 IVH appeared to be nearly eliminated in the indomethacin-treated group. Thus, is it now clear that indomethacin should be administered at 6 to 12 hours of life to all very low birth weight neonates? Although such a recommendation might be appropriate, I have several concerns.
First, as discussed earlier, experimental studies and observations of human infants indicate that indomethacin is a cerebral vasoconstrictor, leads to a decrease in cerebral blood flow, blunts adaptive vasodilatory responses, and may cause decreases in cerebral oxygen delivery marked enough to impair oxygen utilization. The threat of cerebral ischemia after indomethacin seems real, but notably in the study of Ment et al4 the frequency of ultrasonographic evidence of cerebral ischemic injury was no different in the indomethacin versus the placebo-treated neonates. This reassuring finding must be tempered by the awareness that cranial ultrasonography is somewhat insensitive in the detection of periventricular ischemic injury in the premature infant.41,42
A second concern relates to factors associated with the study of Ment et al.4 As discussed earlier, the placebo-treated group had an unusual preponderance of grade 4 versus grade 3 IVH, and the relatively large proportion of neonates with onset of IVH before 6 to 11 hours of age were not included in the study. Would earlier administration of indomethacin benefit the neonates with early IVH, or would complications be more prominent?
A third concern relates to the recent study of the neonatal complications in infants exposed antenatally to indomethacin for treatment of preterm labor.43 Thus, when compared with a matched group of untreated infants, infants exposed to indomethacin before delivery exhibited a higher incidence of IVH (28% vs 9%, P = .02) and of necrotizing enterocolitis (29% vs 8%, P = .005). However, it is quite possible that the adverse effect of antenatal indomethacin on the occurrence of IVH related to the interaction of factors associated with labor and delivery (eg, increases in cerebral venous pressure) and associated with indomethacin (eg, inhibition of platelet aggregation). Such an interaction of factors would not occur with postnatal administration of indomethacin. Nevertheless, the findings of Norton et al43 are arresting in this context.
Finally, Ment et al4 are to be congratulated for a carefully designed and well-executed study. The data are very promising and indicate the importance of a multicenter study to evaluate the role of indomethacin administered at or very shortly after birth on the subsequent occurrence of IVH and periventricular hemorrhagic infarction.
Letter to the Editor
Authors: Katcher Avrum L. 
Published: December 2021

Helen Harrison and her associates are to be congratulated on the thoughtful, useful, and appropriate "Principles for Family Centered Neonatal Care," which were published in the November 1993 issue of Pediatrics. I suggest that these principles, with some slight modifications, could well apply to the care of all newborn babies and really, by extension, to all the work that pediatricians do.
Mrs. Harrison and her associates might consider two additional principles:
11. Parents and professionals must work together to overcome the barriers caused by discrepancy between parent and professional, social status, educational level, cultural, religious, or ethnic backgrounds.
Role of Panic Attacks in the Intractability of Asthma in Children
Authors: Baron Chantal , Marcotte Jacques-Édouard 
Published: December 2021

Many authors have stressed the impact of anxiety on asthma. Kinsman has demonstrated how a "panicky" life-style could interfere with asthma management and even result in an increase in use of medications.1 Similar findings were observed in children at our institution.2,3
Contrary to the concept of a "panicky" patient as used by Kinsman,1 the American Psychiatric Association defines a specific entity called panic state or panic disorder remarkable by its intensity and painfulness as well as in the intense fear of resurgence it provokes in patients.
The official criteria of panic disorder in DSM3-R4 in the adult classification are:
A) One or more panic attacks (discrete periods of intense fear or discomfort) that were unexpected, ie, did not occur immediately on exposure to a situation that almost always caused anxiety.
Are Children at Risk for Sexual Abuse by Homosexuals?
Authors: Jenny Carole , Roesler Thomas A. , Poyer Kimberly L. 
Published: December 2021

Objective. To determine if recognizably homosexual adults are frequently accused of the sexual molestation of children.
Design. Chart review of medical records of children evaluated for sexual abuse.
Setting. Child sexual abuse clinic at a regional children's hospital.
Patients. Patients were 352 children (276 girls and 76 boys) referred to a subspecialty clinic for the evaluation of suspected child sexual abuse. Mean age was 6.1 years (range, 7 months to 17 years).
Data collected. Charts were reviewed to determine the relationships of the children to the alleged offender, the sex of the offender, and whether or not the alleged offender was reported to be gay, lesbian, or bisexual.
Results. Abuse was ruled out in 35 cases. Seventy-four children were allegedly abused by other children and teenagers less than 18 years old. In 9 cases, an offender could not be identified. In the remaining 269 cases, two offenders were identified as being gay or lesbian. In 82% of cases (222/269), the alleged offender was a heterosexual partner of a close relative of the child. Using the data from our study, the 95% confidence limits, of the risk children would identify recognizably homosexual adults as the potential abuser, are from 0% to 3.1%. These limits are within current estimates of the prevalence of homosexuality in the general community.
Conclusions. The children in the group studied were unlikely to have been molested by identifiably gay or lesbian people.
Goat's Milk as a Substitute for Cow's Milk in Undernourished Children: A Randomized Double-Blind Clinical Trial
Authors: Razafindrakoto Odile , Ravelomanana Noéline , Rasolofo A. , Rakotoarimanana Roland D. , Gourgue Pierre , Coquin Pierre , Briend André , Desjeux Jehan-François 
Published: December 2021

Objective. This paper compares the effects of goat's milk and cow's milk on weight gain and fat absorption, in children with overt malnutrition.
Methods. Thirty hospitalized malnourished children aged from 1 to 5 years were included in a randomized double-blind trial. The children were fed either goat or cow's milk with a randomized will defined composition, added with vegetable oil, sugar, vitamins and minerals o achieve 1 000 kcal/liter. Children were offered 100 kcal/kg on the first day, with a regular daily increase in energy intake thereafter that reached 200 kcal/kg per day on the tenth day.
Results. Both groups of children had the same degree of malnutrition on inclusion. The mean weight-for-height Z score was -1.7 in both groups. One death with candidiasis occurred in the goat's milk group. Weight gain was similar in both groups: 8.5 g/kg/day (SE = 137) with goat's milk and 7.8 (SE = 1.9) with cow's milk. There was no significant difference in HEM intake: 157 ml/kg/day (SE = 4), vs 162 (SE = 4) for goat and cow's milk, respectively. Fat absorption coefficients on the 15th day of treatment were also similar in both groups.
Conclusion. These results suggest that goat's milk has a nutritional value similar to that of cow's milk and could be used as an alternative to cow's milk for rehabilitating undernourished children.
INFANT DEATH RATE DROPS WHILE RACE GAP WORSENS
Authors: L. J. F. 
Published: December 2021

ATLANTA—The U.S. infant mortality rate dropped to a record low, but black babies died at more than twice the rate of whites, and the gap is growing, health officials reported Thursday.
For every 1,000 births in 1990, 9.2 babies died before age 1, down from 9.8 in 1989, the Centers for Disease Control and Prevention said. It credited most of the drop to a new way of treating the underdeveloped lungs that kill thousands of premature and underweight babies.
The rate in 1990, the most recent year for which data are available, propelled the United States up two notches—to 20th place—in UNICEF's ranking of infant mortality in 23 developed countries. Japan has the world's best rate, 5 per 1,000.
Despite the new lung treatment, 38,351 babies died in 1990, down from 39,655 in 1989. The District of Columbia had by far the deadliest rate, 20.7. Vermont had the lowest rate, 5.4.
The mortality rate for black infants was 18, compared with 7.6 for whites, and the disparity is growing, the CDC said.
Low birthweight was the leading killer of black babies, while birth defects claimed more white babies.
Vt. is best
Infant mortality rates in 1990, from the Centers for Disease Control and Prevention. Numbers are per 1,000 live births:
• Connecticut, 7.9
• Maine, 6.2
• Massachusetts, 7.0
• New Hampshire, 7.1
• New York, 9.6
• Rhode Island, 8.1
• Vermont, 5.4, the nation's lowest rate
• United States, 9.2