bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vasospasm in the Neonate: Response to Tolazoline Infusion
Authors: HEATH RICHARD E. 
Published: December 2021

Vasospasm can result from either intentional manipulation of a vessel or from inadvertent contact during other procedures. The clinical problems stemming from this disorder range from transient mottling of skin color to necrosis of important body tissues. In neonates, only limited experience in treating these conditions with pharmacologic agents is reported.
Three cases of severe vasospasm and their favorable response to an infusion of tolazoline are presented.
CASE REPORTS
Case I
Infant A was born at 32 weeks of gestation and had a birth weight of 1.80 kg. Idiopathic respiratory distress syndrome developed in the infant and required intermittant mandatory ventilation with 0.6 FiO2.
Hematospermia in Adolescents and Young Adults
Authors: SILBER TOMAS J. , KASTRINAKIS MARIANA 
Published: December 2021

Blood in the ejaculate, known as hematospermia or hemospermia, was described by both Galen and Ambroise Pare.1 In the United States, it was first reported by Lydston in 1894, who attributed the condition to "unbridled license." The condition has been occasionally described and reviewed in general medical and urologic journals.1-10 Yet, to the best of our knowledge, it has not been reported in the pediatric or adolescent medical literature. Three patients presenting with hematospermia will serve as a basis for a review of this condition and current recommendations for its evaluation and treatment.
CASE REPORTS
Case 1
A 14-year-old white boy was brought to medical attention by his mother because on several occasions she noted blood stains on his pajamas.
Analgesic Premedication in the Management of Ileocolic Intussusception
Authors: TOULOUKIAN ROBERT J. , O'CONNELL JOSEPH B. , MARKOWITZ RICHARD I. , ROSENFIELD NANCY , SEASHORE JOHN H. , ABLOW RONALD C. 
Published: December 2021

Hydrostatic reduction of ileocolic intussusception by barium enema is uniformly regarded as optimal management, with surgical treatment reserved for occasions when this is not successful and for other selected circumstances.1 In an attempt to maximize the success rate of hydrostatic reduction, we examined the effect of analgesic premedication on both the outcome for the barium study and the operative findings.
MATERIALS AND METHODS
The case records and radiographs of 76 children with ileocolic intussusception treated at the Yale-New Haven Hospital between Jan 1, 1974, and Dec 31, 1984, were reviewed for patient age, sex, seasonal incidence, presenting signs and symptoms, and results of hydrostatic reduction, as well as surgical treatment with operative findings, morbidity, and mortality.
Head Start: Evolution of a Successful Comprehensive Child Development Program
Authors: KOTELCHUCK MILTON , RICHMOND JULIUS B. 
Published: December 2021

The commentary by Besharov and Hartle1 concludes that disadvantaged children deserve better than what they are getting. Indeed, it is our view—along with virtually all Americans—that all of our children deserve better. The improvement of the health, education, and welfare of all children is a never ending quest.
Perhaps the frustration with the Head Start program that permeates the Besharov and Hartle commentary is due to a fundamental misconception of the goals of the Head Start program. From its inception, Head Start has been a comprehensive child development program and not a program focused solely on long-term cognitive gains.
Role of the Pediatrician in Management of Sexually Transmitted Diseases in Children and Adolescents
Authors:   Committee on Adolescence
Published: December 2021

Approximately half of all American adolescents have experienced sexual intercourse by age 17 years.1 The second highest rate of reported gonococcal infections (1,229 cases per 100,000 persons) occurs in 15- to 19-year-old adolescents. This increased risk in the adolescent population has been associated with the greater number of young people having sexual intercourse, the infrequent use of barrier contraceptive methods, the obstacles to prompt medical care that teenagers face, with consequent delay in diagnosis and further spread of the disease, and the large number of asymptomatic carriers.2
The pediatrician has an important responsibility for providing sexuality-related care to children and adolescents.2-4
Statement on Childhood Lead Poisoning
Authors:   Committee on Environmental Hazards,   Committee on Accident and Poison Prevention
Published: December 2021

Patterns of childhood lead poisoning have changed substantially in the United States. The mean blood lead level has declined, and acute intoxication with encephalopathy has become uncommon. Nonetheless, between 1976 and 1980, 780,000 children, 1 to 6 years of age, had blood lead concentrations of 30 µg/L or above. These levels of absorption, previously thought to be safe, are now known to cause loss of neurologic and intellectual function, even in asymptomatic children. Because this loss is largely irreversible and cannot fully be restored by medical treatment, pediatricians' efforts must be directed toward prevention. Prevention is achieved by reducing children's exposure to lead and by early detection of increased absorption.
Childhood lead poisoning is now defined by the Academy as a whole blood lead concentration of 25 µg/L or more, together with an erythrocyte protoporphyrin level of 35 µg/dL or above. This definition does not require the presence of symptoms. It is identical with the new definition of the US Public Health Service. Lead poisoning in children previously was defined by a blood lead concentration of 30 µ/dL with an erythrocyte protoporphyrin level of 50 µg/dL.
To prevent lead exposure in children, the Academy urges public agencies to develop safe and effective methods for the removal and proper disposal of all lead-based paint from public and private housing. Also, the Academy urges the rapid and complete removal of all lead from gasoline.
To achieve early detection of lead poisoning, the Academy recommends that all children in the United States at risk of exposure to lead be screened for lead absorption at approximately 12 months of age by means of the erythrocyte protoporphyrin test, when that test is available. Furthermore, the Academy recommends follow-up erythrocyte protoporphyrin testing of children judged to be at high risk of lead absorption. Reporting of lead poisoning should be mandatory in all states.
Injuries Related to "Toy" Firearms
Authors:   Committee on Accident and Poison Prevention
Published: December 2021

Both projectile and nonprojectile toys, and nonpowder guns such as air guns and air rifles, are categorized as toy firearms. Although the Academy realizes that the welfare of children and adolescents would be best served by banning these instruments, we are unable to prevent their availability and use. We offer this statement in an attempt to safeguard the young user from possible injury.
Between 1980 and 1981, accidents involving projectile toys were responsible for 747 reported injunies to children younger than 15 years of age.1 Most of these injuries involved the face or eyes, 2.9% of these injuries required hospitalization, more than 400 days were lost from school and/or work, and nearly 3,000 days of activities were restricted. In addition, there have been severe or even fatal consequences following the use of substitute projectiles or live ammunition. Children have also died as a result of aspiration of projectiles.
Accidents involving air guns and air rifles are an even more frequent cause of injury to children. In 1980, approximately 23,000 injuries associated with nonpowder guns were treated in US hospital emergency rooms.2 In two thirds of the cases the victim was less than 16 years of age.
In a 1973 review of 105 air gun-related injuries to the eye, sequelae included traumatic cataract, retinal detachment, and sympathetic ophthalmitis.3 Eighteen of the injuries required enucleation of the eye. More than 70% of those injured were children 6 to 15 years of age. The continuing nature of this problem has been demonstrated by Sternberg et al4 in a 1984 review of 32 children with air gun-related eye injuries.
Foreign Body in the Hard Palate
Authors: SANDLER RICHARD H. , KUMAR ASHIR , RICHARDSON KURT A. , CONSTANT ERIKOS 
Published: December 2021

To the Editor.—
We present the case of a foreign body of the hard palate in an infant. After mucosal molding to the edges of such objects, the true nature of these foreign bodies can be obscured, often resulting in unnecessary attempted biopsy under general anesthesia.
Our patient was an 11-month-old infant with an asymptomatic white patch on the palate, noticed by the mother a few days earlier. Findings on physical examination were a comfortable-appearing infant, and an oral pharynx that appeared normal except for a white, hard, smooth, nonulcerative, well-demarkated, "punched-out" lesion of the hard palate, measuring about 1.5 cm in diameter.
Statistics and Sudden Infant Death Syndrome
Authors: CUMMINS SUSAN K. 
Published: December 2021

To the Editor.—
The recent cohort study by Oren et al1 examined risk factors for sudden infant death syndrome (SIDS) in infants with prolonged unexplained sleep apnea with color change (severe apnea of infancy). This analysis revealed three possible risk factors for SIDS death: having a subsequent monitored apnea episode needing resuscitation or vigorous stimulation, being a sibling of a SIDS victim, or developing a seizure disorder after monitoring began. Unfortunately, there are two serious problems with the authors' analysis: the misrepresentation of relative risk and the use of the χ2 statistic to test associations in small subgroups.
Tuberculosis in a Day-Care Home
Authors: NOLAN CHARLES M. , BARR HEATHER , ELARTH ANNA M. , BOASE JANICE 
Published: December 2021

It has been predicted that tuberculosis, if it occurred in child day-care centers, would spread from adults to children. This mode of spread is in contrast to that of most day-care infections which spread from child-to-child or from child-to-adult. Recognizing the theoretical risk that children might acquire tuberculosis from adult day-care workers, some states have already adopted protective regulations. The present report confirms the prediction of an adult-to-child pathway of tuberculosis transmission in a day-care setting and provides an opportunity to review the current approaches to prevention.
DESCRIPTION OF OUTBREAK
In August 1984, a 26-year-old Ethiopian man immigrated to the United States; a tuberculin test was positive (18 mm) and a chest roentgenogram showed normal findings.
Cerebrospinal Fluid Endorphins and the Infant Apnea Syndrome
Authors: ORLOWSKI JAMES P. 
Published: December 2021

In Reply.—
Dr Southall is intimately aware of the problems with the performance of polysomnograms and their interpretation in normal babies and infants with apnea syndrome.1,2 Not the least of these problems is that the polysomnograms in our infants were performed in a sleep laboratory. The artificial and foreign environment of the laboratory might well be expected to alter not only the quality of sleep but also the occurrence of apneic and respiratory pauses in the study subjects.
Baby Walkers
Authors: RESTEL MARIANNE 
Published: December 2021

To the Editor.—
Regarding the article "Patterns of Walker Use and Walker Injury" by M. J. Rieder et al (Pediatrics 1986;78:488-493), I certainly understand the motivation of Dr Rieder and co-workers leading to the study and their crusade against baby walkers (death of a 6-month-old infant involved in a walker-related accident). The article confirms previous thinking that serious accidents can occur to children in walkers.
However, in today's safety-conscious aura, I believe caretaker vigilance cannot be overemphasized.
Breast-Feeding Is Protective
Authors: CUNNINGHAM ALLAN S. 
Published: December 2021

To the Editor.—
Leventhal and colleagues1 opine that their "stratified results suggest that breast-feeding protects infants from hospitalization rather than from infections." Objective students of their data and a host of other studies would say that breast-feeding protects infants against hospitalization and infections.2-4 For example, the tenfold reduction in the risk of bacterial infections among their breast-fed infants was statistically significant (table 4), and breast-feeding was still superior in both subgroups after stratification according to the seriousness of illness (table 5).
Light, Sleep, and Development
Authors: GLASS PENNY , AVERY GORDON B. 
Published: December 2021

In Reply.—
Sheldon and Bell express concern for the effect of uncycled nursery light on sleep state and biorhythms in infants. Their concerns seem well founded. A variety of evidence suggests that the effect of light exposure in the intensive care nursery goes beyond the potential for retinal damage.
For example, we found differences in sleep state for infants exposed to bright v dim ambient nursery light.1 Bright light was associated with significantly greater amounts of active-REM sleep.
State Reporting of Births of Infants Weighing Less Than 500 Grams
Authors: RAJU T. N.K. 
Published: December 2021

To the Editor.—
The study of Wilson et al1 draws attention to an important epidemiologic issue related to an uncounted minority, extremely premature infants who weigh less than 500 g at birth. The problem of underreporting of vital events of this group has been recognized worldwide. Amazing varieties of criteria are used by various countries to determine viability and to judge the need for reporting.2 For example, note some of the interesting ones: "28 weeks of gestation" (Ireland, Czechoslovakia, France, and other European countries), "601 g birth weight," "if less than 1001 g weight, must live for 24 hours" (Poland), "a length of 30 cms" (Switzerland).
State Reporting of Births of Infants Weighing Less Than 500 Grams
Authors: WILSON ANN L. 
Published: December 2021

In Reply.—
Dr Raju's remarks highlight the humane, epidemiologic, and financial issues related to this concern and the need for all who care for families during the perinatal period to be familiar with the reporting requirements of their states. Furthermore, ways such data may be standardized across states should be considered.
Childhood Pedestrian Injuries
Authors: CHANG ALBERT , GRIFFITH JOHN G. 
Published: December 2021

To the Editor.—
We acknowledge the contribution of Rivara and Barber to the further definition of childhood pedestrian injuries (Pediatrics 1985;76:375-381). Their contribution is particularly noteworthy because pedestrian injuries are the leading cause of injury death in young school-aged children (5 to 9 years) in the United States.1
Their analysis of the socioeconomic factors associated with such injuries, however, lacks essential data to enable injury investigators to arrive at their conclusions: that the number of child pedestrian injuries are higher in children of low socioeconomic status and/or from ethnic minority families.
THERAPY OF INFECTIOUS DISEASES
Authors: NELSON WALDO E. 
Published: December 2021

A word of explanation may be in order in regard to the nature of the program arranged for this panel, since its pattern deviates somewhat from those usually arranged for clinical meetings.
In recent years the introduction of new antimicrobial agents has occurred with such rapidity that emphases have been principally upon which pathogenic organisms were susceptible to the various agents and upon the ranges of effective dosages, the routes of administration and the untoward reactions. Details of acceptable plans of usage of the various therapeutic agents are now common knowledge and are also readily available in the medical literature and in brochures published by the pharmaceutical houses. Other, and as yet unknown, antimicrobial agents will continue to appear and make it necessary for the clinician to be even more discriminating in his selection of therapy than is the case at the moment.
Perhaps of equal importance with the selection of a therapeutic agent is the decision as to whether any artificial assistance is required for the control of a particular infection. If one understood the relationship between the host and a pathogenic parasite at a given moment, he would be in an extremely favorable position to decide whether therapeutic assistance was indicated and even to decide more exactly the nature of that assistance—a clinical utopia.
This program was planned with the idea that those of us whose activities are principally clinical might gain some insight into the thinking and the accomplishments of those who are trying to find out more about the host-parasite relationship and what can be done to help the host control and conquer or live with the pathogenic invader.
THE HANDICAPPED CHILD
Authors: PERLSTEIN M. A. 
Published: December 2021

There is a great deal of correlation between the various types of clinical pictures seen in cerebral palsy and the etiologic factors. Thus there are certain noxae which have a predilection for certain portions of the brain. Anoxia tends to attack the extrapyramidal tract system, whereas hemorrhages tend to attack primarily the pyramidal tract.
Thus, one can often prognosticate on the basis of history the clinical pictures which are found. A classification of the various types of cerebral palsy can thus be based either upon an etiologic basis or upon a clinical basis. [see table 1 in source pdf]
DEVELOPMENT OF NEONATAL ELECTROLYTE HOMEOSTASIS
Authors: GRAHAM BRUCE D. , WILSON JAMES L. , TSAO MAKEPEACE U. , BAUMANN MARY L. , BROWN SHIRLEY 
Published: December 2021

A study was made of the development of chemical homeostasis in the newborn infant. In a series of 43 essentially healthy, full term, newborn infants, serial determinations during the first day of life of blood pH, plasma CO2, chloride and total base content, and serum protein were made. Comparison with similar data on premature infants and adults is presented.
Most full term infants at birth are in a state of metabolic acidosis with a lowered blood pH and plasma CO2 content, but have essentially normal plasma chlorides and total base values. The majority of these infants within a few hours have a blood pH of adult level but maintain for some time a lowered CO2 content.
INDWELLING POLYETHYLENE NASOGASTRIC TUBE FOR FEEDING PREMATURE INFANTS
Authors: ROYCE STEPHEN , TEPPER CLIFFORD , WATSON WILLIAM , DAY RICHARD 
Published: December 2021

Experiences with an indwelling polyethylene nasogastric tube in feeding 30 small premature infants for periods varying from 7 to 49 days have been described. The technic has the following advantages: 1. The interval between feedings may be shortened, if necessary, without any increase in the likelihood of esophageal irritation. 2. Feedings disturb the infant so little as to cause no fatigue. 3. Feeding can be accomplished so easily that less skill is demanded of the nurse.
Two of the 30 infants died, and each had an ulcer in the upper, anterior part of the esophagus. Similar ulcers were noted by Gruenwald and Marsh in 16⅔% of 310 autopsied infants. Two other infants developed a purulent rhinitis on the side of the tube. Each infant suffered from other, seemingly unrelated infections at the time. Thrush was never noted. Occult blood was absent in the 50 stools obtained from 18 infants, as indicated by a negative guaiac test.
Nine of the 10 infants weighing less than 1,000 gm. at birth survived, as did 15 of the 16 who weighed 1,000 to 1,499 gm.
A complete evaluation of esophageal irritation in tube as compared with gavage feeding will require a more extended study.
Results so far with the polyethylene tube lead the authors to believe it to be a better device for feeding premature infants than either the rubber gavage tube repeatedly inserted or the dropper.
Breast-Feeding and Jaundice
Authors: MAISELS M. JEFFREY 
Published: December 2021

In Reply.—
I have no doubt that Drs Fleiss and Jelliffe are correct in their assertion that certain hospital practices interfere with breast-feeding, but whether these practices contributed to our findings is difficult to determine. The vast majority of our breast-feeding mothers roomed-in with their infants (continuously if they so desired), were unmedicated, and were given both verbal and written instructions about breast-feeding techniques. No routine supplements of any kind were provided and the data on the 1,260 breast-fed infants referred to fully breast-fed, unsupplemented babies.
Cow's Milk Protein Intolerance
Authors: LECKS HAROLD I. 
Published: December 2021

In Reply.—
The literature has been replete with discussions of cow's milk protein hypersensitivity relevant to its diagnosis as well as clinical patterns of presentation since the entity was initially described by M. Rubin 40 years ago. Drs Gilbertson and Bentley now suggest a comparatively simple diagnostic procedure for detecting cow's milk protein intolerance (hypersensitivity) by merely inspecting the rectal mucosa of the infant at risk. My criticism of their observations relates initially to the specificity of rectal mucosal vascularity changes, as well as to the pragmatic aspects of this diagnostic procedure.
Diagonal Fontanel Measurements
Authors: SKOGLUND R. R. 
Published: December 2021

To the Editor.—
Duc and Largo1 assert that assessment of the size of the anterior fontanel is a part of the routine examination of the infant. The reality is that the measurement is not used routinely and indeed is rarely noted in neonatal reports or records because it has not proved to be clinically reproducible.2 This hypothesis was tested and reported using landmarks and standards described by Popich and Smith3 and Davis and Anari.4 Two physicians independently examined 50 healthy term infants with normal head circumferences by the Nellhaus graph.
Heart Transplantation
Authors: FRICKER F. JAY , GOLD LARRY M. 
Published: December 2021

In Reply.—
The authors would like to thank Mr. Lantos for his comments. The political, economic, and ethical issues raised are important ones but obviously not the focus of our paper. We will, however, provide additional information in an attempt to answer some of Mr Lantos' questions. The question about what encouraged us to start is easy to answer. An 8-year-old child languishing in our intensive care unit on IV inotropic support with no hope of survival was the first orthotopic heart transplantation performed at Children's Hospital of Pittsburgh.
Personal and Family History of Seizures and Measles Immunization
Authors:   Committee on Infectious Diseases
Published: December 2021

A recent analysis of reports of reactions following measles immunization has revealed that children who had seizures following measles vaccine were more likely to have a personal history of seizures or a history of seizures in siblings or parents than vaccinees who had nonneurologic reactions associated with immunization.1 These seizures usually are associated with fever and occur five to 11 days postimmunization when febrile reactions to live measles virus are most common; approximately 5% to 15% of vaccinees have elevated temperatures during this time. The seizures resemble typical febrile seizures which are common at this age and are rarely associated with any sequelae. In one study, the vast majority of children who had seizures following live measles vaccination had temperature elevations and about half were associated with intercurrent infections.2
The Committee strongly recommends that children who have a personal or family history of seizures should receive live measles vaccination. Seizures are unpleasant experiences but the risk of measles to unimmunized children is far more significant. Outbreaks in schools with as few as 5% of the children seronegative have been reported.3 Thus, live measles vaccine should not be denied these children.
The parents of children who have either a personal or a family history of seizures should be advised of the risk and told in advance of immunization what they should do if the child does indeed have a seizure. Because the period of risk is approximately 1 week, it is difficult to recommend an effective method of decreasing the chances of seizure occurring.