bluuebunny/crossref_metadata_2025_split huggingface dataset:
Molybdenum Cofactor Deficiency: Another Inborn Error of Metabolism With Neonatal Onset
Authors: BURTON BARBARA K. 
Published: December 2021

In Reply.—
Matsuo and co-workers correctly point out that molybdenum cofactor deficiency may present in the neonatal period and, therefore, add yet another disorder to the list of inborn errors of metabolism affecting the neonate. Hypouricemia may be a clue, as noted, and ectopia lentis, as seen in isolated sulfite oxidase deficiency, is an additional important finding. The importance of a careful eye examination in infants suspected of having an inborn error of metabolism is again emphasized.
Ascendancy of the `Black Bottle'
Authors: GREENSHER JOSEPH , MOFENSON HOWARD C. , CARACCIO THOMAS R. 
Published: December 2021

In Reply.—
It was not our intent to undermine confidence in syrup of ipecac as a useful and effective means of inducing emesis when indicated, particularly as a home first aid measure. However, it must be recognized that activated charcoal has definite advantages in inactivating larger quantities of ingested substances particularly in circumstances in which the use of syrup of ipecac would no longer be of great benefit. We pointed out that resistance to acceptance of activated charcoal by children limits present use predominantly to emergency departments where compliance can be assured.
Plasma Atrial Natriuretic Peptide in Patients With Congenital Heart Diseases
Authors: Matsuoka Suguru , Kurahashi Yoshihide , Miki Yohko , Miyao Masuhide , Yamazaki Yasuhiro , Nishiuchi Takeshi , Saito Shiro 
Published: December 2021

The plasma level of human α-atrial natriuretic peptide was measured in healthy children and patients, 1 month to 15 years of age, with congenital heart diseases. Significant increases were found in patients with a ventricular septal defect, tricuspid valve atresia, patent ductus arteriosus, and atrial septal defect but not in those with pulmonary valve stenosis or tetralogy of Fallot.
The levels were significantly higher in children with ventricular septal defects (221 ± 123 pg/mL) or patent ductus arteriosus (124 ± 38 pg/mL) than in those with atrial septal defects (65 ± 42 pg/mL) (P &lt; .01). The increased levels appeared to be correlated with enlargement of the left atrium (r = .85, P &lt; .01) but not with the right atrial size or the mean right atrial pressure. They were higher in younger than in older healthy infants, but this age difference did not affect the results. These findings indicate that human α-atrial natriuretic peptide is released into the circulation in response to chronic atrial expansion in patients with congenital heart disease and may have an important role in volume homeostasis.
Amino Acids in Premature Infants
Authors: RÄIHÄ NIELS C. R. 
Published: December 2021

To the Editor.—
In a recent paper in Pediatrics, Heird et al1 reported their evaluation of the use of a new amino acid mixture for parenteral nutrition in low birth weight infants. On the basis of their results the authors made the following statement: "These observations refute the concept that the metabolic capacity of LBW infants for amino acids is limited in comparison to that of term infants, older infants, and chi1dren."1(p49) Such a conclusion is not justified on the basis of the presented data.
Amino Acids in Premature Infants
Authors: HEIRD WILLIAM C. 
Published: December 2021

In Reply.—
Dr Raiha is correct. Our data1 do not necessarily "refute" the concept of the LBW infant's metabolic immaturity. However, they raise the issue of the clinical significance of the well-documented developmental delays in hepatic activities of several enzymes involved in metabolism of amino acids. Specifically, these data suggest that enzymatic immaturities are of limited clinical significance with respect to the LBW infant's tolerance of parenterally administered amino acids. No differences in plasma amino acid pattern were observed between LBW infants weighing less than 1,250 g at birth and those weighing more than 1,250 g, between the LBW infant population1 and the population of term infants and older children studied earlier,2 or between LBW infants who received a typical peripheral vein regimen and those who received a typical central vein regimen.
Snowmobile Statement
Authors:   Committee on Accident and Poison Prevention
Published: December 2021

Small, speedy, lightweight snowmobiles are popular and readily available to children and adolescents in the snowbelt states. There are no uniform requirements for either vehicle registration or driver licensure. Therefore, the number and condition of snowmobiles, and the extent of their use, are unknown. Nevertheless, in 1985 the Consumer Product Safety Commission recorded 62 deaths directly attributable to snowmobiles. In addition, the National Electronic Injury Surveillance System reported that 12,687 snowmobile injuries were treated in emergency rooms in 1985, and another 11,829 injuries were treated in 1986. Of these, 18% occurred in children younger than 14 years of age and 48% occurred in adolescents and young adults between the ages of 15 and 24 years. Three quarters of the accident victims were boys. Alcohol use was frequently mentioned as a contributing factor.
Head injuries are the leading cause of death; drowning is a close second. The risk of drowning is highest in early winter before lakes are firmly frozen and again during the spring thaw.1 Fractures of the lower extremity, frequently severe, are the most common nonfatal injury.2 Injury can also result from frostbite and hypothermia. Hearing loss can result from prolonged exposure to excessive engine noise.3
RECOMMENDATIONS
Snowmobiles are inappropriate for use by children and young adolescents and should not be used by children younger than 16 years of age. For these children, we recommend more developmentally appropriate winter recreational activities. Consistent with this recommendation, we believe that advertisements should not be directed at the young adolescent, nor should advertisements depict adolescents driving snowmobiles.
Fluctuations in Arterial Blood Pressure in Premature Infants
Authors: ETCHES PHILIP C. , FINER NEIL N. 
Published: December 2021

To the Editor.—
Perlman and Thach1 presented interesting data from premature infants with respiratory distress syndrome associating fluctuations in esophageal pressure with fluctuations in arterial blood pressure. We would like to ask two questions. First, in the section reporting data analysis, it was stated that, to avoid bias in the selection process of epochs for measurement, corresponding respiratory pressure changes were ignored, but it is not stated how this was done. We agree that it would be essential to ignore the esophageal pressure tracing when selecting these epochs, but to do this the esophageal tracing should be completely obscured, and we would like to be reassured that this was, in fact, done.
Lyme Disease: Acute Focal Meningoencephalitis in a Child
Authors: FEDER HENRY M. , ZALNERAITIS EDWIN L. , REIK LOUIS 
Published: December 2021

Nervous system involvement in Lyme disease was originally described as meningitis, cranial neuritis, and radiculoneuritis,1-3 but Lyme disease can also involve the brain parenchyma. We describe a child whose first manifestation of Lyme disease was an acute, focal meningoencephalitis with signs and symptoms such as fever, headache, slurred speech, hemiparesis, seizure, and CSF pleocytosis.
CASE REPORT
A 7-year-old boy was hospitalized Aug 27, 1985, because of hemiparesis. Six weeks prior to admission he had vacationed at Old Lyme, CT. There was no history of rash or tick bite. He had been well until eight hours prior to admission when fever and headache developed.
Health Needs of Homeless Children
Authors:   Committee on Community Health Services
Published: December 2021

Families with children represent more than one third of the homeless population nationally and more than 50% of the homeless population in many cities. Lack of a permanent dwelling deprives children of the most basic necessities for proper growth and development. Homeless children have unique risks that compromise their health status. Pediatricians are encouraged to be aware of this growing population of children and include them in their service and advocacy efforts.
BACKGROUND
A homeless person is defined by the National Governors Association as "an undomiciled person who is unable to secure permanent and stable housing without special assistance." The US General Accounting Office defines homeless individuals as those persons who lack resources and community ties necessary to provide for their own adequate shelter.
Estimates of the number of people who lacked access to conventional dwelling or residence in 1987 range from 350,000 to more than 3 million.1 Although there is disagreement concerning the exact number of homeless persons, there is consensus that the numbers are large and continuing to increase.2 The average increase from 1986 to 1987 in the number of people needing shelter was 20%, and one quarter of this need could not be met with existing emergency shelters. (US Conference of Mayors, unpublished data, December 1987).
Several societal problems contribute to the increasing rate of homelessness among American families, including lack of affordable housing; decrease in availability of rent subsidies; unemployment, especially among those who have held only marginal jobs; personal crises such as divorce and domestic violence; cutbacks in public welfare programs; substance abuse; and deinstitutionalization of the mentally ill.
Perinatal Human Immunodeficiency Virus Infection
Authors:   Task Force on Pediatric AIDS
Published: December 2021

Infection with human immunodeficiency virus (HIV), the causative agent of acquired immunodeficiency syndrome (AIDS) has become a significant medical problem during the 1980s. Hundreds of infants and thousands of women have been reported to have AIDS. In addition, there are thousands more women infected with HIV, at risk for AIDS, and capable of transmitting HIV to their fetuses/infants if they become pregnant.
DEFINITIONS
Perinatal, the time period including pregnancy through 28 postnatal days; congenital (intrauterine) infection, infection acquired transplacentally; intrapartum infection, infection acquired during the time of delivery; postnatal infection, infection acquired after pregnancy and delivery; HIV infection, asymptomatic or symptomatic infection with HIV; AIDS, meeting the Centers for Disease Control definition for AIDS.
EPIDEMIOLOGIC FEATURES OF AIDS AND HIV
The primary risk factor for AIDS in infants is congenital (and possibly intrapartum) exposure to a mother infected with HIV. Other risks have included transfusion of blood or clotting factor concentrates. However, since the institution of routine testing of blood donors, these risks have become extremely small. Because the majority of women with AIDS (78%) are of childbearing age, it is important that the physician inquire about risk factors in women of childbearing age to provide optimal care and prevention of HIV transmission. The primary risk factors for AIDS in the reported cases in women are IV drug abuse (49%), hetero-sexual transmission from a person known to be at risk of HIV infection (28%), and transfusion or clotting factor therapy before blood was screened in middle 1985 (11%).1,2 Although the sex distribution of pediatric AIDS cases is relatively even (54% boys, 46% girls), the racial distribution of pediatric AIDS is uneven: blacks 54%, Hispanics 24%, whites 21%, and others 1%.3
Caution on Statistics
Authors: MALLOY MICHAEL H. , REED GEORGE F. 
Published: December 2021

To the Editor.—
We read with some concern the article by Maisels and Gifford.1 Although we agree with the results as they are calculated, we would like to express our concern about the logistic modeling used in the analysis. Most important, we would like to caution prospective users of logistic regression of the hazards of using the stepwise procedure. Although, the stepwise procedure will win you variables that demonstrate significant associations, it may exclude variables that are more important biologically to modeling the risk factors for the disease being studied.2
Caution on Statistics
Authors: MAISELS M. JEFFREY , ANTLE CHARLES 
Published: December 2021

In Reply.—
We appreciate the comments of Drs Malloy and Reed, and we agree (with some embarrassment) that our use of the term "risk-ratio" is inappropriate; we should have used "odds" and this term should be substituted for risk ratio throughout the paper.1
We also agree that one should be cautious in the interpretation of observational data subjected to multivariate logistic analysis. We were certainly aware of the variables considered biologically important in the modeling of risk factors for neonatal jaundice.
SI Units
Authors:   COMMITTEE ON DRUGS
Published: December 2021

Le Systeme International d'Unites or SI units is a system of measure that is an outgrowth of the metric system, widely used in countries other than the United States. This system comprises seven base units from which all other measurements are made (Table).
The aim of SI units is to (1) provide a coherent system of measure, (2) ensure that quantities and units are uniform in concept and style, and (3) minimize the number of multiples and submultiples in common use. A more complete review of metrification and SI units has been published in this journal.
The conversion to SI units was mandated in December 1984 by the American Medical Association House of Delegates to "provide physicians and other scientists in the United States with an improved common language for fluent scientific communication between nations as well as between sciences."
In several published articles there have been suggestions that the United States should, during the next year, begin uniformly reporting laboratory test data in SI units, including drug concentrations in molar units. Although drugs would continue to be prescribed in mass units, the desirability of prescribing and dispensing drugs in molar units has been suggested.
The focus of this commentary is to summarize the problems and inconsistencies of expressing drug concentrations in molar units, assuming that prescribing and dispensing would continue in mass units.
PHARMACOKINETIC CALCULATIONS
In a recent study tenfold dosing errors were demonstrated, resulting from mathematical miscalculations while using traditional units. The introduction of additional calculations for conversion to SI units, and the fact that SI units involve decimal places with several significant figures, will likely magnify this type of error.
Indications for Cholesterol Testing in Children
Authors:   COMMITTEE ON NUTRITION
Published: December 2021

The American Academy of Pediatrics' Committee on Nutrition believes that a child with a family history of either early coronary heart disease or hyperlipidemia should have a complete evaluation, including serum or plasma measurement of cholesterol, other lipids, and lipoproteins. On the other hand, the Committee on Nutrition does not favor universal testing of blood cholesterol levels of children either in the hospital or in the office of the private physician. At this time, the value of routine testing appears outweighed by the disadvantages; office testing has additional limitations.
We believe that universal cholesterol testing should not be part of continuing well-child care for the following reasons.
1. The standardization of equipment and the measurement of cholesterol are fraught with difficulties. Precision and accuracy are essential cornponents of any laboratory measurement. Survey data show that replicate measurements of a sample containing 240 mg/dL of cholesterol resulted in values ranging from 192 to 288 mg/dL. Because a low-fat diet could only be expected to decrease the cholesterol level 10% to 15% (204 to 216 mg/dL), an improvement could thus be obscured by the error of the measurement.
2. Many of the instruments suggested for the measurement of cholesterol in the office have not been adequately standardized for field conditions. Cholesterol measurements obtained from an assortment of instruments available commercially ranged from 187 to 379 mg/dL (the reference standard was 262 mg/dL). Hospital laboratories are often precise but not always accurate; office determinations frequently lack both precision and accuracy. Moreover, proper performance of this laboratory procedure requires technical skill not always available in the office.
FREQUENCY OF RICKETS IN INFANCY IN BOSTON IN 1898
Authors: C. T. E. 
Published: December 2021

Classic cases of rickets are now rarely seen in the pediatric practice of Boston physicians. But 90 years ago, 8 out of 10 infants under 2 years of age, seen at the Boston Infants' Hospital, were found to have had rickets, as noted below.
Four hundred consecutive infants under two years of age, medical out-patients at the Infants' Hospital, were examined for evidences of rickets. Eighty percent showed more or less marked signs. A rosary was present in every case. Only those enlargements were considered as a rosary which could be felt both parallel and vertical to the long axis of the rib. It was the only symptom in 40 percent. It was accompanied by but one other symptom in 20 percent. The single associated symptom was most often delayed dentition, next, enlargement of the cranial eminences. Delayed dentition occurred in more than 50 percent. Large fontanelle, large eminences, retraction at the diaphragm, and the enlargement of the epiphyses of the extremities were each present in about 15 per cent but were symptoms of later development. Marked rhachitic deformities were rare. About 40 percent of the cases were Russian and Polish Jews. Only 12 per cent came from the southern races. Breast milk was a part of the diet in 43 per cent and formed the whole in 18 per cent. The only influence acting on all alike was improper hygienic surroundings. These therefore must be considered as the most potent cause of rickets in Boston and vicinity.
BARZUN ON TESTING STUDENTS
Authors: Student  
Published: December 2021

Multiple-choice questions test nothing but passive-recognition knowledge, not active usable knowledge.
Knowing something means the power to summon up facts and their significance in the right relations. Mechanical testing does not foster this power. It is one thing to pick out Valley Forge, not Dobbs Ferry or Little Rock, as the place where George Washington made his winter quarters; it is another, first, to think of Valley Forge and then to say why he chose it rather than Philadelphia, where it was warmer.
In subjects that require something other than information—the development of skill, as in reading, writing and mathematics—straining toward a plausible choice is not instructional. Nobody ever learned to write better by filling in blanks with proffered verbs and adjectives. To write is to fill a totally blank sheet with words of your own.
Instead of forcing—and coaching—young minds in form-filling exercises, telling them "choose and take a chance," schools would be well advised to return to Ralph Waldo Emerson's "Tell us what you know."
SOME OF THE CHARGES IN THE E-FEROL INDICTMENT: COUNTS XX THROUGH XXV
Authors: Student  
Published: December 2021

The Grand Jury further charges:
2A. Under Title 21, United States Code, Sections 352 (a) and 321 (n) in that the labeling for said drug [E-Ferol] was false and misleading in that said drug was recommended and suggested as appropriate for intravenous use in premature infants, when defendants knew of, and failed to reveal in the labeling, the following material facts:
(1) The drug had been reported to defendants to be associated with serious, life threatening injuries to premature infants, even when E-Ferol was used under the conditions of use prescribed, recommended, and suggested in the labeling of the drug product;
(2) No adequate investigation was conducted by the defendants to determine the validity of the associations of E-Ferol to said injuries that had been reported to them;
(3) No scientifically adequate or well controlled studies existed that established that E-Ferol could be safely and effectively used under the conditions of use prescribed, recommended, and suggested in the labeling of the drug product; and
(4) The safety and effectiveness of E-Ferol had not been established for use in premature infants.
PRICE OF TWO WHALES
Authors: Student  
Published: December 2021

Two million dollars for two whales. I couldn't help thinking about how much I could do with one-tenth of that. I could fully immunize 30,000 kids and treat 10,000 major diseases with $200,000.
I suppose one's priorities depend on one's perspective, and if you don't have children dying in front of you and don't know that they are dying like flies, then the fate of two poor little whales brought into your sitting room from a remote cold coast with all the drama and immediacy of television suddenly has enormous importance.
Summary of Annual Meeting of the Section on Pediatric Urology
Authors: PARROTT THOMAS S. 
Published: December 2021

The Section on Urology of the American Academy of Pediatrics met for two and a half days in conjunction with the 57th Annual Meeting of the Academy in San Francisco, Oct 15 to 17, 1988. Papers presented at this meeting thought to be of interest to the practicing pediatrician are summarized here according to topic.
HYDRONEPHROSIS: CLINICAL ASPECTS
Urinary obstructive lesions are increasingly being diagnosed prenatally. Prior to the routine use of prenatal ultrasonography, these conditions would not have been diagnosed, because often no abdominal mass is palpable in the newborn infant and urinary tract infection has not intervened. The current management of these infants has become a source of major controversy, because it is becoming increasingly obvious that not all dilated urinary systems are obstructive and some neonatal dilations improve spontaneously.
Chronic Idiopathic Intestinal Pseudoobstruction: A Commonly Misdiagnosed Disease in Infants and Children
Authors: GLASSMAN MARK , SPIVAK WILLIAM , MININBERG DAVID , MADARA JAMES 
Published: December 2021

Intestinal pseudoobstruction is characterized by signs and symptoms of recurrent intestinal obstruction in the absence of an identifiable mechanical lesion. Underlying illnesses that have been associated with intestinal pseudoobstruction include scleroderma, amyloidosis, various endocrinopathies (eg, hypothyroidism), narcotic or laxative abuse, and electrolyte disturbances (eg, hypokalemia). Although the underlying cause of idiopathic intestinal pseudoobstruction is unknown, the primary pathophysiologic dysfunction in patients with idiopathic pseudoobstruction is a disorganization or lack of smooth muscle contractility that results in disordered peristalsis or aperistalsis involving bowel and/or urinary bladder.
The clinical manifestations of the motility disorder associated with chronic idiopathic intestinal pseudoobstruction include periodic vomiting, abdominal distension, constipation, urinary retention, and weight loss.