bluuebunny/crossref_metadata_2025_split huggingface dataset:
Accumulating Evidence: Using Meta-Analysis to Carry Out Research Reviews in Pediatrics
Authors: LIGHT RICHARD J. 
Published: December 2021

In pediatric research, as in most fields, new findings generate the most excitement. Summarizing old ones has traditionally been a task assigned to research assistants. But as research results accumulate, should we make stronger efforts to see what a body of research, taken overall, tells us? And would systematic methods to do this improve on the ad hoc or idiosyncratic efforts of the past?
In this spirit, several books and articles have recently appeared describing procedures called meta-analysis.1-9 They urge both researchers and policymakers to improve the quality of research reviews by making them more systematic, and they outline simple but concrete techniques for doing this.
Necrotizing Tracheobronchitis
Authors: KIRPALANI H. , PERLMAN M. , FRIEDBERG J. , CUTZ E. 
Published: December 2021

To the Editor.—
We read with interest the report by Mimouni et al1 of a case of necrotizing tracheobronchitis. We agree that survival is possible for patients with necrotizing tracheobronchitis. We recently reported eight cases of necrotizing tracheobronchitis diagnosed prospectively (between January 1983 and September 1984) and 12 cases identified retrospectively.2 From these cases, we identified characteristic clinical findings. These findings, which follow, should alert clinicians early enough to institute therapy for necrotizing tracheobronchitis.
Necrotizing tracheobronchitis supervenes on a previously stable course in an infant requiring mechanical ventilation.
All-Terrain Vehicles—Who Says Four-Wheelers Are Safer?
Authors: SNEED R. C. 
Published: December 2021

To the Editor.—
After a paucity of information on all-terrain vehicles (ATV's) in the medical literature, several reports have appeared recently raising concerns about injuries associated with these vehicles.1-7
Since our own report, the Spain Rehabilitation Center has been involved with four additional all-terrain vehicle accidents resulting in serious, permanent injury.5 A 6-year-old girl sustained on a three-wheel all-terrain vehicle a depressed skull fracture and penetrating brain injury resulting in quadriparesis, coma, transient aphasia, and after 12 months, persistent cognitive deficits.
Questioning Role of Hypochloremia in Bronchopulmonary Dysplasia
Authors: BRINSON ALAN 
Published: December 2021

To the Editor.—
The title of the recent report by Perlman et al asks an important question for those of us who frequently treat infants who have bronchopulmonary dysplasia ("Is Chloride Depletion an Important Contributing Cause of Death in Infants With Bronchopulmonary Dysplasia?" Pediatrics l986;77:2l2-2l6). They suggest that chloride deficiency may be an important factor in the poor outcome of patients with bronchopulmonary dysplasia. While I am sure no one will seriously suggest that severe hypochloremia will not have a deleterious effect on an already seriously ill infant, I do have questions regarding how they arrived at their conclusion.
Super Effective Diaper Can Cause Confusion
Authors: LAVIN ARTHUR 
Published: December 2021

To the Editor.—
In the first 24 hours after birth, 93% of all newborns urinate, and by the end of the first 48 hours, 99% of all newborns have urinated.1,2 For the next 6 months the infant will urinate, on the average, 20 times a day,3,4 requiring four to eight diaper changes a day. Frequency of diaper changing is often used as a guide to newborn hydration status. Here I report the discovery of a new confounding variable that may mislead pediatricians who use frequency of diaper changing as a measure of urine output.
Sudden Infant Death Syndrome
Authors: STIVRINS PATRICIA 
Published: December 2021

To the Editor.—
I believe that the article by Davidson Ward (Pediatrics 1986;77:451-455) may adversely influence the use of home cardiorespiratory monitoring in the United States. There are several serious problems with this paper.
1. The authors admit that they only had responses from 35% of the apnea programs and 40% of the vendors in their state. This may have very seriously distorted their findings.
2. Death should not be the lone evaluation mode for benefit for home monitoring.
Who Says There Is a Handgun Epidemic?
Authors: SCHREIN DANIEL D. 
Published: December 2021

To the Editor.—
I noted with interest the commentary on handguns in the May 1986 issue of Pediatrics (1986;77:781-782). The word "epidemic" caught my eye and I would like to know how significant the epidemic is to our children. Is it any where near the epidemic proportions of auto accidents, BMX bike injuries, skateboard injuries, or pornography? With the estimate of 40 to 50 million handguns in the United States it should not be difficult to figure the ratio of injuries or deaths in children per hand gun available.
Questions About Early Enteral Feeding Study
Authors: GRYLACK LAWRENCE 
Published: December 2021

To the Editor.—
I would like to comment on the article by Ostertag et al, "Early Enteral Feeding Does Not Affect the Incidence of Necrotizing Enterocolitis" (Pediatrics 1986;77:275-280). Support for the concept of early gastrointestinal nutrition in the high-risk newborn comes from animal studies that showed that dogs with bowel ischemia that were given intraluminal substrate (10% glucose) had higher levels of adenosine triphosphate in mucosal cells and less morphologic damage than animals without that infusion.1
Questions About Early Enteral Feeding Study
Authors: RADECKI LEONARD , KHAWAM JEAN R. , BEAUMONT ED , SHAW THOMAS , JONES ALAN , FERDIG JUDY 
Published: December 2021

To the Editor.—
We were amazed at the report on the incidence of necrotizing enterocolitis and feeding practice (Pediatrics 1986;77:275-280). The rate of necrotizing enterocolitis in both groups of patients is astronomical and yet acceptable to the authors.
During a 2-year period in our neonatal intensive care unit, the incidence of necrotizing enterocolitis was 9/1,114 admissions (0.08%). The incidence in infants with birth weights less than 1,500 g was 8/159 (3.08%); for infants with birth weights less than 1,000 g it was 3/101 (2.9%).
Aspiration of Makeshift Pacifier
Authors: JOHNSON GUY H. 
Published: December 2021

To the Editor.—
The recent paper by Millunchick and McArtor (Pediatrics 1986;77:369-370) succinctly describes the danger of aspiration associated with the use of a makeshift pacifier and suggests that intensive care and normal nurseries purchase one-piece commercial pacifiers. Although the recommendation to avoid the use of contrived pacifiers is certainly well founded, the limitation to one-piece pacifiers seems overly restrictive.
Multipiece pacifiers are just as safe as the one-piece varieties. Strict federal safety standards (16CFR Part 1511) apply to all pacifiers.
Can We Rediscover the Bedside?
Authors: GEME JOSEPH W. ST 
Published: December 2021

Osler1 beckoned us to the bedside to learn clinical medicine. He knew that fundamental human biology could be found there too.2
We know now that the clinic will become the ultimate bedside for the care of children. The clinic will also become the essential site for the teaching of the art and science of this care. The education of family physicians and internists and the care of adults is moving swiftly in the same direction.3 The control of prematurity, trauma, and poverty will erase the existing remnants of pediatric inpatient care and bedside teaching.
During the lingering years of hospital pediatrics, perhaps no more than the end of this century, let us encourage the full use of the traditional bedside for our educational programs.
Asbestos Exposure in Schools
Authors:   Committee on Environmental Hazards
Published: December 2021

Asbestos-induced cancer and asbestosis are diseases that are almost never seen in children. Practicing pediatricians should not expect to see any asbestos-related disease in their patients. There is a mounting concern, however, that exposure to asbestos in childhood, particularly in school settings, can put children at increased risk later in life for diseases caused by asbestos. Pediatricians are frequently asked to advise school authorities and parents on the dangers posed by asbestos. In this statement, current information on asbestos exposure in schools is reviewed and basic remedial approaches to prevent significant exposure to children are described.
BACKGROUND
Asbestos was used as a spray-on material in the construction of school ceilings, primarily during the 1950s through early 1970s, because of its acoustical, fire-proofing, and decorative qualities. Such dried materials can, over time, become friable; this process is dramatically speeded up by any external factors that disrupt the structural integrity of the ceiling material. Friable asbestos often flakes off as a fine dust that settles on surfaces but is readily resuspended in classroom air.
Asbestos was also used in insulating materials for pipes, boilers, and structural beams in schools. Less commonly, this use of asbestos may be a problem for children when deteriorating conditions lead to disruption and spread of asbestos fibers. In 1973, the US Environmental Protection Agency (EPA) banned most uses of spray-on asbestos materials. Concern for potential long-term effects in children surfaced dramatically in 1976 when flaking of asbestos ceiling materials was noted in six schools in one state. The initial public health strategy, which continues unchanged, was that (1) medical screening and follow-up of children so exposed should not be recommended because of the transient and uncertain degree of exposure, the probable rarity of significant asbestos-related disease, and the extremely long latent periods (probably 30 or more years) for any effects that might occur, and (2) public health efforts should focus on the prevention of exposure to assure that any long-term risks are minimized or completely removed.
Health Supervision Visits: Should the Immunization Schedule Drive the System?
Authors: HAGGERTY ROBERT J. 
Published: December 2021

The Centers for Disease Control (CDC) recently recommended that the vaccines usually given at the 15- and 18-month visits could be given simultaneously at 15 months, thereby omitting the 18-month well-child visit.
There is little doubt that measles-mumps-rubella (MMR) immunization, now recommended by the American Academy of Pediatrics to be given at 15 months of age, and the diphtheria-tetanus-pertussis (DTP) and oral polio booster immunizations, now recommended to be given at 18 months of age, could be given together with no problem at 15 months. But this is not a good enough reason to abandon the 18-month well-child visit. Although I will not argue that we have solid evidence for the effectiveness of any well-child procedures other than immunizations, I believe that the 18-month visit is one of the more important ones and should not be discontinued for all children.
FEROCIOUS FERRETS
Authors: Marcuse Edgar K. 
Published: December 2021

Some 33 infants and young children have been reported in California as having been attacked by pet European ferrets (descendants of the European polecat, Mustela putorius, not to be confused with the endangered black-footed ferret, Mustela nigripes, of the Great Plains). The animals seem attracted to babies, perhaps due to odors resembling those of suckling rabbits. Typically, attacks are made when parents are absent or asleep; the ferret escapes its cage and jumps into the baby's crib. One infant died; others nearly bled to death. One lost her nose, another half of both ears. Up to hundreds of bites were rapidly inflicted on all parts of the face, the result resembling ground beef according to some observers, although all exposed parts of the body are attacked as well. Older children and adults were bitten on the face and extremities, the animal often holding on tenaciously until killed or pried loose.
Bites may be unreported to avoid loss of illegal ferrets. Sometimes ferrets are confused with weasels due to inability to differentiate them. Ferrets are more massive. Weasels and European ferrets differ in length (inches from nose tip to tail tip), weight and color as follows: Weasels—7½ to 22 in, 1½ to 11 oz, brown above, white or yellow below. May turn white in winter. End of tail black throughout year. Ferret—17½ to 22 in, 1 to 6 lb, yellow-buff undercoat overlaid with blackish guard hairs. Blackish mask, limbs and tail (entire length). May be albino.
PIETAS AND THE ALIMENTA ITALIAE
Authors: McNamara John J. 
Published: December 2021

Pietas is the Roman virtue which describes the concern and respect of the father for his children, or the state for its citizens. The Roman state was informed by religious values and traditional virtues. The Alimenta Italiae is the first known nutrition program for children initiated by the emperor Nerva (96-98 A.D.) and expanded by the emperor Trajan (98-117 A.D.). The scheme worked in this fashion: The state, in order to support agriculture made available to farmers low interest loans, however, the interest on the loans was repaid directly to municipalities which were obliged to use the money to provide food and necessities for poor children. The scheme ultimately came to cover thousands of children in Italy and was widely acclaimed. "Alim. Italiae" appears frequently on the coins of Trajan proclaiming the program to the known world.
Despite much blather about traditional virtues, there is no positive family policy in this country. However, we do have a new agricultural policy which is to liquidate dairy herds lest the land be flowing with milk if not honey. Here, in one of the wealthier provinces failure to thrive is endemic. At the Brockton Hospital it is rare that a child is not hospitalized with the diagnosis of nonorganic failure to thrive.
"Quo usque tandem abutere patientia nostra?"; loosely translated with apologies "Gimme a break."
THE PRESIDENT'S PAGE
Authors: BEAVEN PAUL W. 
Published: December 2021

I AM sure that the greater part of our membership is not aware of the immense amount of productive work accomplished by our scientific committees.
Unfortunately I cannot comment on all of them because there is not space. I shall outline the composition and objectives of three of these committees which shall serve as examples. I was going to include the Committee on Education, but I will refer to that committee in a later letter.
The Committee on Immunization and Therapeutic Procedures has as its chairman John Miller of San Francisco. This committee is composed of nine pediatricians whose chief interest lies in the field of immunology. There are those interested in bacterial, viral, rickettsial, and other childhood diseases for which active or passive immunization has significance. Others are specialists in immune sera, vaccines, or other antigens, and still others in the public health aspect of contagious diseases. Together they have just finished the revision of the Red Book. It will soon be in your hands and you will realize when you see it the labor expended. It is not intended to be a text book but a concise and contemporaneous reference on what the committee regards as good standard practice.
Peter Danis of St. Louis is the chairman of the Committee on Hospitals and Dispensaries. This committee is also composed of nine child specialists, and each was chosen because he or she was particularly qualified to contribute a special knowledge in the differing areas of the care of the child in the hospital.
INHIBITION OF GROWTH AND OTHER EFFECTS OF ACTH IN PREMATURE INFANTS
Authors: SILVERMAN WILLIAM A. , DAY RICHARD L. , BLODI FREDERICK C. 
Published: December 2021

Premature infants who received more than ACTH 5 mg./kg./day became hyperirritable and ravenous. Many became pallid immediately after injection of the hormone. During the course of treatment infections which appeared could be controlled with antibacterial therapy.
Untreated premature infants excreted increasing amounts of chemically assayed urinary "corticosteroids" with increased body weight. Under the influence of doses of ACTH in excess of 5 mg./kg./day the urinary excretion of "corticosteroids" increased significantly.
Retardation of growth occurred during the administration of more than 5 mg. ACTH/ kg./day. "Rebound" increase in growth took place upon cessation of hormonal administration.
THE PRESIDENT'S PAGE
Authors: BEAVEN PAUL W. 
Published: December 2021

I AM SURE that the majority of our members are not aware of the influence of the Academy in public health and child welfare. For this reason I will recount some of the incidents that have occurred in the past few months which illustrate this.
In May, Dr. Edward Davens, representing our Committee on School Health, went to a meeting in Washington arranged by the National Educational Association to examine the real meaning of citizenship in our country. Excerpts from his report will be published in the News Letter.
Last January, Dr. Reginald Higgons attended a conference on school health in Cleveland, which he reported in full to the Executive Board and which will appear in the agenda of committees published in Pediatrics. I would commend this to anyone interested in school health work.
In April, Dr. Stewart Clifford used the report of this same School Health Committee, of which Dr. Thomas Shaffer is Chairman, to modify the school health laws in Massachusetts to conform to its recommendations. If members in states are attempting to introduce modern practices in school health, they are referred to the central office. Dr. Christopherson will be glad to send them a copy of Dr. Shaffer's report.
In February, Dr. Danis' Committee on Hospitals and Dispensaries sent representatives to a meeting in New York, called to discuss the care of contagious diseases in a general hospital. This group represented many organizations, including the American Public Health Association, the American Medical Association, the American Hospital Association, the American Nursing Association, and others. It was financed by the National Foundation for Infantile Paralysis.
ELECTROCARDIOGRAPHIC PATTERNS OF NORMAL CHILDREN FROM BIRTH TO FIVE YEARS OF AGE
Authors: GROS GERARD , GORDON ARMOND , MILLER ROBERT 
Published: December 2021

The ECGs of 104 normal children from a few hours old to 5 years of age were studied. These ECGs consisted of the standard limb leads, the aV limb leads and six precordial leads: V4R, V1, V2, V4, V5 and V6.
While the number of cases in each group are small, the following conclusions are suggested by this study:
1. ECGs of the newborn infant present important variations from those seen in later life. This is especially true during the first week of life. Thereafter the contour evolves [SEE FIG. 2 IN SOURCE PDF] in a definite manner until the adult-like pattern is reached.
2. The vertical and semivertical "electric" positions were the most frequently encountered in this age group.
3. P-waves present a rather permanent pattern in this age range:
a. is usually upright in lead 1 and 2, aVF, V4, V5 and V6.
b. is usually inverted in lead 2 and aVR.
c. is either upright, inverted or diphasic in lead 3, aVL, V4R, V1 and V2.
4. The P-R interval varies from 0.10 sec. minimum to 0.16 sec. maximum with the average being 0.12 sec. in this age range. It tends to become greater in the older age groups.
5. QRS duration is shorter in the younger age groups and increases slowly with age.
6. Polyphasic, M-shaped or slurred QRS complexes are not uncommon in the ECGs of normal children in this age range.
7. A Q wave is frequently absent in lead 1 and in all chest leads during the first week of life. Thereafter up to 5 years of age the pattern of the Q wave is as follows:
a. Q is generally absent in lead 1, V4R, V1, V2 and V4.
b. Q is generally present in lead 3, V4R, aVF, V5 and V6.
8. There is a distinct pattern of right ventricular dominance in leads from the sternum and to its right at birth. This pattern gradually undergoes involution, probably related to normal physiologic development, until the left ventricle becomes dominant. Thus the evolution of the S-wave parallels a gradual involution of the R-wave in right precordial leads and probably also in aVR. This dominance of the left ventricle over the entire precordium is usual by about 3 years, but may be delayed normally until 5 years of age.
9. The T-wave is upright or diphasic in V4R, V1, and V2 and inverted in V5 and V6 for the first 24 hours of life; it gradually alters so that by the fourth day it is inverted in V4R, V1 and V2 and upright in V5 and V6 and thereafter.
10. The transition zone of QRS varies from one age group to another and tends in some ages to be broad. In some instances no real transition zone can be determined.
Round Table Discussion
Authors: DIETRICH HARRY F. , WHEATLEY GEORGE M. , BROOKS GLIDDEN L. , KOTTE ROBERT H. , WYVELL DOROTHY 
Published: December 2021

Chairman Dietrich: We wish to direct attention to the much neglected problem of accidents in children. It is a unique one. The ultimate solution rests on child-parent relationship, and we as pediatricians are responsible for guiding that relationship. So far, the medical profession's attack on the problem has been piecemeal, perfunctory and without potency. For this round table discussion, our plan is as follows: Dr. George Wheatley of the Metropolitan Life Insurance Company will present the size and shape of the accident problem, Dr. Glidden Brooks will indicate the hospital's role in the problem of accidents and outline the research needs in this field, I will briefly outline what I think is a practical theory of accident prevention, and Dr. Wheatley will sketch some areas of thought on community organization for accident prevention.
Dr. Wheatley: Pediatricians are well aware of the child accident problem. But they are apt to look at it almost exclusively from the point of view of the day-to-day treatment of pediatric emergencies. Unquestionably proper management of accidents is important but it overlooks the basic approach in solving the problem. This major concern with accident-treatment contrasts with the modern pediatrician's orientation toward disease prevention.
What are the facts? The highest accident fatality rate is found in the preschool age group from 1 to 4 years, the period during which most of the children spend more of their time in the home environment under closer supervision than any other period in their lives. The remarkable conquest of the common childhood diseases has sharpened our focus on the child accident picture.
MIDDLEBROOK-DUBOS HEMAGGLUTINATION REACTION
Authors: ANDERSON H. W. , PLATOU R. V. 
Published: December 2021

The Middlebrook-Dubos hemagglutination test, measuring a humoral antibody against a polysaccharide fraction of the tubercle bacillus, has been studied in 343 sera from 287 infants and children. The test appears to be practical and may be useful as an index to activity of tuberculous disease.
A transient rise in level of antibodies was observed in some sera after either negative or positive skin tests with old tuberculin; this occasional provocative effect is largely dissipated within a month or two. Little or no antibody may be demonstrated in most sera from patients with either far advanced or healing tuberculosis. An age factor makes "unexpectedly" negative serologic results in most infants and younger children apparently quite meaningless.