bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reimbursement for Medical Foods for Inborn Errors of Metabolism
Authors:   Committee on Nutrition
Published: December 2021

Inborn errors of amino acid metabolism such as phenylketonuria, maternal phenylketonuria, maple syrup urine disease, homocystinuria, methylmalonic acidemia, propionic acidemia, isovaleric acidemia and other disorders of leucine metabolism, glutaric acidemia type I and tyrosinemia types I and II, and urea cycle disorders are rare diseases that are treatable by diet. Treatment might include the restriction of one or more amino acids, the restriction of total nitrogen, or the supplementation of specific substances. Untreated, these diseases culminate in severe mental retardation or death.
Once diagnosis is confirmed, treatment of amino acid and urea cycle disorders must be carefully monitored by a physician with expertise in metabolic diseases. Special medical foods, commercially available, are indispensable for the active, ongoing treatment of diagnosed amino acid and urea cycle disorders. Special medical foods would, if used as the sole dietary source, represent a hazard to affected and healthy children. US Public Law (Publ L) 100-290 defines the term medical food as ". . . a food which is formulated to be consumed or administered enterally under the supervision of a physician and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements, based on recognized scientific principles, are established by medical evaluation."1
After passage of Publ L 100-290, many states provided funding for these products through Medicaid, and most states offered assistance through Crippled Children's and Women, Infant, and Children's programs. Some states now have laws mandating private insurance coverage for special medical foods.
It is the position of the American Academy of Pediatrics that special medical foods that are used in the treatment of amino acid and urea cycle disorders are medical expenses that should be reimbursed.
Tobacco-Free Environment: An Imperative for the Health of Children and Adolescents
Authors:   Committee on Substance Abuse
Published: December 2021

1. Tobacco is a major health hazard to children and adolescents.
2. Maternal use of tobacco has significant adverse effects on pregnancy and fetal outcome.
3. Exposure to ETS has major effects on the health and psychosocial well-being of children.
4. Tobacco use by children is associated with chronic and recurrent medical problems as well as with increased risk for significant morbidity and mortality. Furthermore, tobacco use may be a marker for youth at risk for other behavioral problems.
5. Nicotine is an addicting substance and may serve as a gateway drug for the subsequent use of illicit substances.
6. Tobacco advertising is appealing to young people and may have a powerful effect in influencing them to begin tobacco experimentation.
7. A tobacco-free environment is an imperative for the health of children and adolescents.
Letter to the Editor
Authors: Theroux Mary C. , West David 
Published: December 2021

We thank Drs Lopez and Urbansky for their comments. Their observation that the placebo group may have sufficiently biased the combined placebo/control group to account for the significant findings noted is reasonable, despite no significant differences being found between the placebo group and the control group.
Analysis of variance among the three groups was carried out for the objective outcome variables. Differences in mean heart rate changes and maximum heart rate changes remained significant, and differences between study versus control groups and study versus placebo groups were both found to be significant, accounting for multiple comparisons.
Letter to the Editor
Authors: Harrison Helen 
Published: December 2021

Dr Katcher brings up some important issues related to family diversity that were very much on the minds of the parents who drafted "The Principles for Family-Centered Neonatal Care.1 Rather than isolate these issues into separate principles, however, we chose to incorporate them throughout the document.
To address misunderstandings that arise from differences in the backgrounds of parents and staff, we have made a number of proposals including: active encouragement for families to discuss their views with caregivers, full parental access to relevant information, courses in communication for perinatal and neonatal prpfessionals, peer support in the neonatal intensive care unit, and systematic investigation into the issue of how parents with differing needs can best be served by various formats of information.
Parental Monitoring and Peer Influences on Adolescent Substance Use
Authors: Steinberg Laurence , Fletcher Anne , Darling Nancy 
Published: December 2021

Objective. To examine the joint influences of parental monitoring and peer influence on adolescent substance use over time.
Subjects. 6500 adolescents attending six high schools in Wisconsin and northern California.
Design. Longitudinal study.
Results. Parental monitoring was negatively associated with substance use, whereas the more involved an adolescent's peers were in substance use, the more likely he or she also was to use drugs and alcohol. Effects of monitoring and peer coercion were strongest for boys and girls at the transition into substance use, rather than at the transition from experimentation to regular use. The effect of parental monitoring on changes in adolescent substance use is mediated not so much by the nature of the adolescent's peer associates, but by its direct effect on the adolescent. Specifically, poorly monitored adolescents are more likely to use drugs, and drug-using adolescents seek out like-minded friends. Once an adolescent associates with drug-using peers, his or her own substance use approaches their level.
Conclusions. Intervention efforts should include both parents and community-level efforts. Parental monitoring is an effective tool both in the prevention of drug use and in the amelioration of drug use.
Estimating Neonatal Mortality Risk: An Analysis of Clinicians' Judgments
Authors: Stevens Sonya M. , Gray James E. , Richardson Douglas K. , McCormick Marie C. , Goldmann Donald A. 
Published: December 2021

Background. Clinicians' estimates of mortality risk in the neonatal intensive care unit (NICU) have implications for patient triage, transfer, initiation and termination of life support, and allocation of medical resources. The accuracy of these judgments has not been studied, nor the differences between nurses and attending physicians.
Objectives. 1) evaluate the accuracy of subjective judgments of NICU unit mortality risk, 2) identify the key components of clinician judgments, 3) compare accuracy between attending physicians and nurses, and 4) examine the utility of combining an objectively computed risk and clinician judgments to improve predictions.
Methods. We obtained estimates of mortality risk on 544 admissions to two NICUs on the day of admission from the attending physician and primary nurse. These were compared with an objective computed mortality risk based on birth weight and the Score for Neonatal Acute Physiology (SNAP) using a linear judgment analysis model, as well as with actual outcomes.
Results. Physicians and nurses had good discriminating power with actual mortality rates ranging from 0% among low risk patients to 67% among those with the highest mortality estimates. Physicians had a tendency to overestimate mortality risk. Clinicians base their estimates on the same factors and similar judgment weights as the empiric mortality risk model (22% birth weight, 62% illness severity (SNAP), 13% low Apgar, and 3% for intrauterine growth restriction). Clinicians place additional emphasis on therapeutic as well as physiologic factors. When the computed risk and physician judgment were combined, both made significant contributions in a logistic mortality risk model.
Conclusions. Clinician judgments of mortality risk are fairly accurate and similar to an objective illness severity index. This simple method provides insight into clinical decision making and has important applications in improving direct patient care, appropriate allocation of medical resources, and medical training.
Children in Car Crashes: Analysis of Data for Injury and Use of Restraints
Authors: Johnston Carden , Rivara Frederick P. , Soderberg Robert 
Published: December 2021

Objective. To determine the effect of car restraints on motor vehicle injury rates for children aged 0 to 14 years.
Methods. A probability sample of all police-reported car crashes in the United States in 1990 and 1991 was analyzed for injury rates of passengers aged less than 15 years in relation to restraint usage, age, and seating position.
Results. Optimal restraint usage (defined as car seats for children 0 to 4 years old and lap shoulder belts for children 5 to 14 years old) was 40%. The use of the car seat was 76% for infants (0 to 12 months old) and 41% for toddlers (1 to 4 year olds). The non use of a restraint was highest for 10 to 14 year olds (43%).
The rate of involvement in car crashes for all children was 21.4 (per 1000/yr). The highest rate was the 14 year olds with 29.6 followed by 2 year olds with 26.5.
Injury rates were 4.76 (per 1000/yr) for all children. The lowest rate was 2.91 for infants but increased to 4.78 for 3 year olds. The single strongest risk factor for injury was the non use of a restraint. (Adjusted odds ratio 2.7; 95% CI 2.4 to 3.0.) The risk factor for injury for the front seat was 1.5 (95% CI 1.4 to 1.7).
Use of the car seat reduced injuries by 60% for 0 to 4 year olds, whereas the lap shoulder harness was only 38% effective for 5 to 14 year olds (P ≤ .001) Injury rates of unrestrained 0 to 4 and 5 to 14 year olds were similar.
Conclusions. Greater involvement in car crashes and less use of car restraints explains the 64% higher rate of injury for 3 year olds than for infants. It is time to target the toddlers.
Restraints designed for adults are not as effective for the school age child as car seats are for the preschool child. A better restraint for the school age child should be designed and evaluated. Meanwhile, increased usage of current restraints must be encouraged, as they substantially reduce injuries.
Intellectual Impairment in Children of Women Who Smoke Cigarettes During Pregnancy
Authors: Olds David L. , Henderson Charles R. , Tatelbaum Robert 
Published: December 2021

The acknowledgement section of the following two articles should have included the statement listed below:
Intellectual Impairment in Children of Women Who Smoke Cigarettes During Pregnancy. Pediatrics. 1994;93:221-227.
We thank Robert Chamberlin for serving as co-investigator on the original trial; John Shannon for his administrative support of the work; and Elizabeth Chilson, Diane Farr, Georgianna McGrady, Jacqueline Roberts, and Lyn Scazafabo for their work with the families enrolled in the program.
Rate of Weight Gain of Inpatients with Anorexia Nervosa Under Two Behavioral Contracts
Authors: Solanto Mary V. , Hertz Stanley , Jacobson Marc S. , Golden Neville H. , Heller Lenore 
Published: December 2021

Objective. To ascertain the rate of weight gain of inpatients with anorexia nervosa under two behavioral contracts, differing in criterion weight gain required to earn increasing privileges.
Design. Follow-up comparison of cohorts receiving different interventions.
Setting. Eating disorders service, operating on a general adolescent medicine unit.
Patients. Patients admitted consecutively who met the following criteria: (1) weight at least 15% less than that expected for age, sex, and height; (2) female gender; (3) absence of chronic medical illness; (4) hospital stay of at least 28 days. Twenty-two patients meeting these criteria were treated between July 1987 and October 1988, when contract 1 was in effect. This cohort of patients was compared with a group of 31 patients, also meeting the these criteria, who were treated between November 1988 and December 1991, when contract 2 was in effect.
Interventions. The behavioral contract, signed by the patient on admission, specifies the minimum 4-day weight gain necessary to earn increasing ward privileges, such as use of phone, frequency of visits, etc. Contracts 1 and 2 differed only in the 4-day weight gain criterion: 0.8 lb (0.36 kg) and 1.2 lb (0.55 kg), respectively.
Results. The results of analysis of covariance, with admission weight as the covariate, revealed a significant interaction between contract and day, such that patients receiving contract 2 gained weight more rapidly (0.36 lb/d) than those receiving contract 1 (0.20 lb/d). There was no confounding difference between groups in the use of psychotropic medication, and no complications of refeeding in either group.
Conclusion. Increasing the 4-day criterion weight gain from 0.8 to 12 lb in a behavioral contracting intervention was associated with a significant increase in the rate of weight gain, without an accompanying increase in complications of refeeding. This result simultaneously: (a) provides support for the efficacy of behavioral contracting and (b) reveals malleability in the rate of gain based on the targeted gain specified in the contract.
Unexpected Death Due to Acute Airway Obstruction in Daycare Centers
Authors: Byard Roger W. 
Published: December 2021

Sudden collapse due to acute upper aerodigestive tract obstruction in infants and young children is most often caused by ingested food or toy parts.1,2 Although attention has been previously drawn to the different pattern of food asphyxiation in children compared with adults,2 the following two cases taken from the autopsy files of the Adelaide Children's Hospital over a 20-year period demonstrate particular risk factors associated with young children eating in daycare centers.
CASE REPORTS
Case 1
A 19-month-old healthy boy was eating a sausage happily in a daycare center when last observed by a caretaker who was then absent for several minutes.
The Pediatrician's Role in Helping Children and Families Deal With Separation and Divorce
Authors:   Committee on Psychosocial Aspects of Child and Family Health
Published: December 2021

Each year over 1 million children experience divorce, but many pediatricians may only learn of this agonizing crisis from their patient's behavioral reaction or if the family, as a consequence of the divorce, moves to a different community. Since the average length of marriages that end in divorce is just under 7 years, many of the children affected are young. The combination of out-of-wedlock births and divorce will result in 61% of all children living with a single parent.1,2
Divorce may be a solution to a discordant marriage and any decrease in intrafamilial hostility may be constructive; however, for many children, the tensions continue and the entire divorce process is a long, searing experience. Divorce is the termination of the family unit, and, like termination of any important relationship, it is often characterized by painful losses.3 Approximately half of all children do not see their father after divorce and few have spent a night at their father's home in the past month.4
The divorce itself is usually only the first of a series of major changes in the lives of affected children. Their sense of loss is ongoing and may re-emerge especially on holidays, birthdays, special school events, and when attempting to integrate multiple new family relationships.
The custodial parent may have to start work or work longer hours, the family may have to move to a new community, and there may be secondary losses of relatives, local friends, and a familiar school. The family home may have to be sold.
Letter to the Editor
Authors: Helbock Harold J. 
Published: December 2021

I acknowledge the reports referenced by Drs Reynolds and Hanna.1,2 These presentations indeed raised the issue of adrenal insufficiency in ill premature infants. Given the limits of space I deleted reference to the Portland Group's abstract when I added their full publication.3 For the same reason, other references were included only as required by the text. I regret and apologize for any inadvertent discourtesy resulting from my choice of references.
We agree that it is important to recognize adrenal abnormalities in the small premature infant.
PREVENTION OF NEURAL TUBE DEFECTS
Authors: L. J. F. 
Published: December 2021

On the basis of increasing evidence, including the preliminary report of Czeizel and Dudas' Hungarian study,1 the U.S. Public Health Service released an advisory on September 11 stating,
In order to reduce the frequency of NTDs [neural-tube defects] and their resulting disability, the United States Public Health Service recommends that: All women of childbearing age in the United States who are capable of becoming pregnant should consume 0.4 mg of folic acid per day for the purpose of reducing their risk of having a pregnancy affected with spina bifida or other NTDs. Because the effects of higher intakes are not well known but include complicating the diagnosis of vitamin B12 deficiency, care should be taken to keep total folate consumption at &lt;1 mg per day, except under the supervision of a physician.2
Pediatric Resident Attitudes About Technologic Support of Vegetative Patients and the Effects of Parental Input—A Longitudinal Study
Authors: Rubenstein Jeffrey S. , Unti Sharon M. , Winter Robert J. 
Published: December 2021

Objective. To evaluate the change over time of attitudes about withdrawal of care from hopelessly ill children among a cohort of pediatric residents.
Design. Prospective data collection via surveys.
Setting. A pediatric residency program in a children's hospital.
Subjects. Pediatric residents beginning training in 1987 and 1988; 29 residents completed the study.
Interventions. Study participants completed a structured case-oriented questionnaire yearly from June 1988 through the completion of their residency training. The withholding of vasoactive agents or cardiopulmonary resuscitation, and the withdrawal of intravenous fluids, nutrition, or mechanical ventilation were the specific therapeutic options presented for a patient in a persistent vegetative state. The effects of time (further training) and parental wishes on resident decisions were assessed.
Measurements and main results. No resident wanted to provide intensive care to a child in a persistent vegetative state who was in respiratory failure; all residents would withhold vasoactive agents and CPR from such a child. At the conclusion of training, most (97%) would withdraw mechanical ventilation. A minority would withdraw intravenous (IV) fluids (41%) or nutrition (35%). Residents became more willing to withdraw IV fluids from these patients (0/16 vs 6/16; P = .03) and to withhold or withdraw therapies in general (P = .03) over the course of their training. All of this change occurred over the first year of training. Parental wishes altered treatment plans for these patients significantly, both when parents desired additional treatment (P &lt; .0001), and when parents wanted treatment stopped (P = .04). The residents' level of training had no effect on responses to parents' therapeutic requests.
Conclusion. Although exposure to level of care issues occurs throughout pediatric residency training, almost all changes in trainees' attitudes occur during the first year. Efforts to promote effective learning and coping should be concentrated in this period.
Intensive Care Treatment Decisions: The Roots of Our Confusion
Authors: Clark Frank I. 
Published: December 2021

Background. Decisions to withdraw or withhold treatment from infants and children are continuing concerns. Physicians voice confusion over perceived legal requirements. This confusion may lead to overtreatment of patients. Recent evidence suggests legal concerns still shape physician treatment decisions.
Objective. This study was undertaken to determine if the legal standard governing these medical decisions was clearly stated.
Design. Conventional legal research was performed. Because the 1984 Federal Child Abuse Amendments require these issues to be resolved by state laws, statutes of the 50 states and the District of Columbia were reviewed to ascertain if they would support a charge of child abuse for the inappropriate withdrawal of life-support from a child. An electronic legal database was queried for all cases involving withdrawal of life-support in children since 1984; the cases were analyzed to determine if judges were applying the federal legal standard.
Results. Current child abuse reporting laws would support the federal standard in all 50 states and the District of Columbia. Six reported withdrawal cases were identified; none applied the federal standard. There is an emerging state legal standard that is flexible and subjective and allows a quality of life analysis because it is based on parental authority. This standard conflicts with the federal standard.
Conclusions. The current law is unclear because two competing legal standards coexist; physicians cannot simultaneously meet both standards. Choosing to apply the state legal standard in clinical medical practice should support families in times of stress and relieve physicians of the burden of considering who is potentially overtreated.
Screening for Lead Poisoning in an Urban Pediatric Clinic Using Samples Obtained by Fingerstick
Authors: Schonfeld David J. , Cullen Mark R. , Rainey Petrie M. , Berg Anne T. , Brown David R. , Hogan James C. , Turk David S. , Rude Catherine S. , Cicchetti Domenic V. 
Published: December 2021

Objective. To assess the false positive rate of blood (BPb) determinations on sample obtained by fingerstick from children screened in an urban clinic.
Method. From a single fingerstick (N = 1573), blood was collected in a capillary tube for determining lead concentration (CPb) by graphite furnace and an additional sample was absorbed onto a filter paper for determining lead concentration (FPb) by atomic absorption spectrophotometry with Delves cup. Zinc protoporphyrin (ZPP) was measured immediately and a confirmatory venous lead (VPb) specimen was obtained at the same visit if the ZPP was ≥35 µg/dL (0.6 µmol/L); children with either a CPb or FPb ≥15 µg/dL (0.7 µmol/L) were later recalled for determining VPb.
Results. For the 172 children who had a VPb on the same day as the screening tests, the false positive rates (95% confidence intervals) at a lead threshold of 15 µg/dL (0.7 µmol/L) were: CPb, 13.5% (6.7-20.3); FPb, 19.1% (11.8-26.4). Analyses using all 679 screens with a paired venous specimen (mean delay between screen and venous testing = 30 days) yielded much higher false positive rates (CPb, 31.3%; FPb, 46.0%).
Conclusions. Screening for lead poisoning is feasible within an urban pediatric clinic by direct measurement of lead concentration in blood samples obtained by fingerstick. The false positive rate that can be obtained is acceptable given the precision of measuring BPb concentration. Practitioners using a staged screening protocol may incorrectly attribute a higher false positive rate to the screening tests, when much of the error may be due to the temporal variability of BPb resulting from both biologic variability in BPb concentration and intermittent exposures.