bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rehydration
Authors: SANTOSHAM MATHURAM , SACK R. BRADLEY 
Published: December 2021

In Reply.—
We do not believe that our recent study was mistitled. The difference between patients who have 5% or more weight loss compared with those who have less than 5% weight loss (minimal dehydration) as a result of diarrhea is that the former patients have clinically visible signs of dehydration and require a larger volume of fluids to replace their deficit. Patients with minimal dehydration have no clinical signs of dehydration and require a smaller volume of replacement fluids.
On Partial Splenectomy in Gaucher's Disease
Authors: BAR-MAOR J. A. , GOVRIN-YEHUDAIN J. 
Published: December 2021

In Reply.—
We appreciate the thoughtful comments of Stellin et al about the possibility of recurrent hypersplenism after partial splenectomy in Gaucher's disease. Fortunately, it did not happen (yet?) in our patients, although in one of them the remaining spleen enlarged considerably. (Our paper was sent for publication in July 1984, and since then there was a significant growth of the remaining spleen.) We even raised the question whether this growth is actually not a sign of regeneration of the spleen induced by partial splenectomy.
Medicaid Policy Statement
Authors:   Committee on Child Health Financing
Published: December 2021

The American Academy of Pediatrics recognizes the achievements of the Medicaid program in reducing financial barriers to health care for poor children; however, the legislative intent of the program has yet to be fully achieved.
An administrative structure focused on ensuring access to acute care and long-term care has allowed vital preventive care for children to languish while program expenditures have soared.
Confusing eligibility requirements have eliminated many of the neediest children from program participation.
State discretion in covered services has resulted in major disparities among geographical areas, leaving many eligible children with inadequate care.
The American Academy of Pediatrics in its desire to uphold the quality of children's care and in accordance with its standards seeks to remedy this situation. The following specific proposals are the minimum provisions that the Medicaid program should include for its child beneficiaries.
I. Eligibility
A. The sole determinant of program eligibility for children should be financial need. Categorical requirements, eg, only children from single-parent families, should be eliminated from eligibility criteria.
B. The means test for children should include limits on readily disposable assets and an income standard at least equal to the federal poverty line.
1. The income standard could be adjusted to reflect geographical differences and should be recalculated annually to reflect changes in the federal poverty income standard.
2. "Spend-down" provisions for children in families whose income before medical expenses exceed the eligibility limit should be continued.
C. Automatic eligibility of unborn and newborn children should be included as long as the child's family meets the means test requirements.
Vision Screening and Eye Examination in Children
Authors:   Committee on Practice and Ambulatory Medicine
Published: December 2021

Vision screening and eye examination are important for the detection of conditions that distort or suppress the normal visual image and, ultimately, may lead to blindness in children. Examination of the eyes can and should be performed at any age, beginning in the newborn period. Vision screening should be performed at as early an age as is practicable. Conditions that interfere with vision are of grave import because visual stimuli are critical to the development of normal vision. Decreased visual acuity often contributes to inadequate school performance. In addition, retinal abnormalities, cataract, glaucoma, retinoblastoma, eye muscle imbalance, and systemic disease with ocular manifestations may all be identified by careful examination.
Vision screening should be carried out as part of a regular plan of continuing care, beginning in the preschool years. Screening examinations may be effectively performed by paramedical personnel under appropriate medical supervision. As with other specialty areas, it is important for the pediatrician to establish contact with an area ophthalmologist in the same geographical area who is familiar with children's eye problems. A close working relationship with such a specialist will clarify questions about procedures for eye screening as well as indications for referral.
TIMING OF EXAMINATION AND SCREENING
Children should have age-appropriate assessment for eye problems in the newborn period and at subsequent health supervision visits. Vision screening can begin as early as 3 years of age. Infants at risk for eye problems, such as retrolental fibroplasia, or those with a family history of congenital cataracts, retinoblastoma, and metabolic and genetic diseases should have an ophthalmologic examination in the nursery.
Pseudomonas aeruginosa Otitis Externa in an Infant Associated With a Contaminated Infant Bath Sponge
Authors: SHETH KUMUDCHANDRA J. , MILLER ROBERT J. , SHETH NEELA K. , REMENUIK EUDOKIA , MASSANARI R. MICHAEL 
Published: December 2021

Pseudomonas is a Gram-negative bacterium frequently recovered from environmental sources, particularly an aquatic environment. Epidemics of skin rash,1 otitis externa,2 isolated cases of urinary tract infections,3 and pneumonia4 have been associated with whirlpools contaminated by Pseudomonas aeruginosa. This report describes P aeruginosa otitis externa in an infant associated with a contaminated infant bath sponge.
CASE REPORT
K.E., a 3-month-old, first born, healthy girl was seen for drainage from the left ear. She was listless and febrile and had a moderate amount of whitish drainage from the left ear canal. There was no discharge from the right ear canal, but on examination there was right otitis media.
Phototherapy for Neonatal Hyperbilirubinemia
Authors: POLAND RONALD L. 
Published: December 2021

To the Editor.—
I read with fascination the reports of the 1974-1976 National Institute of Child Health and Human Development Randomized, Controlled Trial of Phototherapy for Neonatal Hyperbilirubinemia.1 The results of this well-designed cooperative study are extremely important for the care of newborn infants. Focusing on the smallest infants reported, we find that the use of prophylactic phototherapy was associated with a significant reduction in the need for exchange transfusion.2 The study group, however, used a liberal set of criteria for exchange transfusion compared to others published recently.3-5
The American Occupational Therapy Association, lnc, Viewpoint
Authors: COHEN HERBERT J. 
Published: December 2021

In Reply.—
We welcome the letter from Dr Berg of the American Occupational Therapy Association and agree with many of his comments. Our Committee believes that the treatment of children with disabilities in schools should be a team effort involving educators, therapists, physicians, and professionals from other disciplines. We clearly recognize a significant role for occupational therapists in this regard as specified in PL 94-142, The Education for All Handicapped Children Act.
We believe that many children with mild degrees of motor dysfunction show some improvement with maturation.
Insomnia and Cow's Milk Allergy in Infants
Authors: LECKS HAROLD I. 
Published: December 2021

To the Editor.—
From a pragmatic view, after perusal of the paper by Kahn et al (Pediatrics 1985;76:880-884), I was most impressed that the authors were making much ado about the commonly encountered clinical entity usually called "infantile colic." This syndrome has been attributed to many causative factors, among which is cow's milk hypersensitivity. Often, the pediatrician or practitioner will eliminate this food and use a soy replacement, particularly if there is a genetic background of atopy in the family and other clinical manifestations of allergy.
Transition of Severely Disabled Children From Hospital or Chronic Care Facilities to the Community
Authors:   Committee on Children With Disabilities
Published: December 2021

There has been an increase in the number of children with significant chronic illness requiring long-term care, as well as those with significant limitations of activities.1-4 This increase is, in large part, the result of improvements in medical care and technologic advances. Among the groups of children with chronic conditions requiring long-term care are children with developmental disabilities and major congenital defects; survivors of major trauma with residual severe neurologic, neuromuscular, or orthopedic abnormalities; and children with low incidence and extremely costly chronic disorders ranging from those who are dependent on ventilators or have renal failure to children who may be hospitalized less frequently, such as those with cystic fibrosis or hemophilia. These conditions tend to be costly not only in economic terms but also in psychologic respects.5-8
TRANSITIONAL CARE
Many children with sever disabilities or long-term illness require special services to support home rather than institutional care. Transitional care may be defined as those services that support the move of the child from an institution to home and community. At times, special transitional care units provide such services, although, more typically, transitional care services refer to activities that directly strengthen the capacity of the family and community to care for the child at home. Transition to the community requires (1) careful planning and discharge efforts, (2) determination of special home equipment and service needs, (3) educational activities for family and community providers, and (4) development of an explicit plan to provide nursing care and other support services as needed.
Doxapram and Potential Benzyl Alcohol Toxicity: A Moratorium on Clinical Investigation?
Authors: JORDAN GLENN D. , THEMELIS NICHOLAS J. , MESSERLY SUSAN O. , JARRETF ROBERT V. , GARCIA JOSE , FRANK C. GILBERT 
Published: December 2021

To the Editor.—
Barrington et al1 recently undertook an investigation designed to elucidate the mechanism of action and clinical effects of doxapram in neonates. There is currently considerable interest in the use of this agent as a therapeutic adjunct in cases of refractory apnea,2-4 and the study by Barrington et al offers important additional insights into the pharmacophysiology of this agent. However, as we reviewed the literature in preparation for using this agent at our institution, an alarming potential complication of doxapram usage emerged.
Doxapram and Potential Benzyl Alcohol Toxicity: A Moratorium on Clinical Investigation?
Authors: JACKSON DAVID 
Published: December 2021

In Reply.—
We read with interest and due concern the letter of Dr Jordan et al about the potential risk of benzyl alcohol toxicity in premature newborns who received infusions of Dopram Injectable (containing benzyl alcohol 0.9% as a preservative) for treatment of apnea.
In May 1982, the Food and Drug Administration issued a "Dear Doctor" letter and, in August 1982, published an article in the FDA Drug Bulletin raising concerns about the use of solutions containing benzyl alcohol or other prcservatives in treating newborns.
Ionized Calcium, Cardiac Function, and Electrocardiogram in Preterm Neonates
Authors: VENKATARAMAN PANKAJA S. , SHELDON ROGER E. 
Published: December 2021

In Reply.—
We thank Drs Möller and Tegtmeyer for sharing their experiences with us. We concur with the view that measurement of blood of serum ionized calcium concentration is important in understanding the derangements of serum calcium homeostasis in neonates. Preterm infants, especially those whose postnatal course is complicated by asphyxia, lung disease, disturbances of fluid and electrolyte balances, and patent ductus arteriosus1 may be at risk for associated cardiac dysfunction, and measurement of blood or serum ionized calcium in these situations may be helpful.
Comprehensive Asthma Care Reduces Hospitalization
Authors: PLAUT THOMAS F. 
Published: December 2021

To the Editor.—
Rubin et al1 devised a computer game to convey asthma information to children 7 to 12 years of age. They did not include parents in the learning process. They express surprise that the children's increased knowledge did not lead to a decrease in hospital days due to asthma. We are not surprised.
In 1984, our patients with asthma were hospitalized at 31% of the national rate. We admitted at a rate of 1.3/1,000 and had an average length of stay of 2.5 days.
Cranial Bruising and Intraventricular Hemorrhage
Authors: KUBAN KARL C. K. , BROWN ELIZABETH , LEVITON ALAN , KRISHNAMOORTHY KALPATHY 
Published: December 2021

In Reply.—
The letter of Acs and Kilchevsky gives us an opportunity to reemphasize that our study was designed to evaluate the efficacy of phenobarital as prophylaxis for intracranial hemorrhage of the premature newborn. To this end, we defined possible confounders as those variables associated with both hemorrhage and phenobarbital administration. The observation of Acs and Kilchevsky that cranial bruising occurred more often in the phenobarbital-treated group and in the babies with intracranial hemorrhage is indeed important.
Statistics and Sudden Infant Death Syndrome
Authors: LEBLANC MICHAEL H. 
Published: December 2021

To the Editor.—
Drs Oren, Kelly, and Shannon1 used an uncorrected χ2 test to analyze their data. All of the probability tables would have expected values of less than 5.2 Thus, either a Yates correction should be used or the Fisher exact test2 should be used. (To avoid numerical overflow on small computers taking the logarithm of the Fisher equation prior to computation and the antilog of the calculated probability after calculation is helpful.) With more appropriate statistics (1) the comparison of infants requiring subsequent resuscitation by mouth-to-mouth or vigorous stimulation v those not requiring such subsequent resuscitation would have P &lt; .02 instead of &lt; .007;
Necrotizing Tracheobronchitis
Authors: MIMOUNI F. , BALLARD E. T. , COTTON R. T. , BALLARD J. L. 
Published: December 2021

In Reply.—
We thank Kirpalani et al for their interest in our article1 and their comments. We also read with interest their report,2 which was published while our article was in press, and which confirms that survival is possible after necrotizing tracheobronchitis. Furthermore, we speculate that many "mild" cases of necrotizing tracheobronchitis may have not been recognized in the past, when obstruction was relieved solely by suctioning, and the "mucous plug" was not examined histologically.
Treatment of necrotizing tracheobronchitis will probably be the source of controversy in future years.
Alcohol, Drugs, and Head Injury
Authors: SCHWARTZ RICHARD H. 
Published: December 2021

To the Editor.—
Jacobson and colleagues (Pediatrics 1986;77:236-24l) present a convincing case for comprehensive reassessment of adolescents with serious closed head injuries. However, they make no mention of evaluating such patients for drug or alcohol abuse. Such abuse/dependency can contribute significantly to the etiology of traumatic injuries.
We interviewed 202 middle-class adolescents in treatment for drug/alcohol abuse/dependency: 86 (43%) had been involved in at least one motor vehicle accident while intoxicated by drugs, alcohol, or both; 50% had been involved in more than one such incident.
Neuroblastoma in Duchenne Muscular Dystrophy
Authors: JOHNSTON KATHREEN M. , ZOGER SEYMOUR , GOLABI MAHIN , MULVIHILL JOHN J. 
Published: December 2021

To the Editor.—
In reporting two patients with neuroblastoma and cystic fibrosis, Moss et al1 noted that "reports of cystic fibrosis and other genetic abnormalities in individual patients are usually regarded as chance associations."
We encountered an analogous situation in caring for a boy in whom stage III neuroblastoma developed at 9 months of age; he responded to surgery and chemotherapy and subsequently was found to have classical Duchenne muscular dystrophy at 3½ years of age.
Urine Specific Gravity As an Indicator of Neonatal Necrotizing Enterocolitis
Authors: STINE MARY JO , HARRIS HOWARD 
Published: December 2021

To the Editor.—
We have noted a large increase in urine specific gravity at the onset of necrotizing enterocolitis in many of our premature newborns. A statistical review of 27 cases of necrotizing enterocolitis at our institution has confirmed a significant increase (P &lt; .0001) in urine specific gravity associated with this disease. The difference persisted despite correction for glucosuria. The increase in urine specific gravity is probably secondary to third-space fluid losses in the gastrointestinal tract.1
Urine specific gravity is a routine test in most neonatal intensive care units.
Sudden Infant Death Syndrome
Authors: KEENS THOMAS G. , WARD SALLY L. DAVIDSON 
Published: December 2021

In Reply.—
Dr Stivrins' letter allows us to clarify some important points made by our paper entitled, "Sudden Infant Death Syndrome in Infants Evaluated by Apnea Programs in California" (Pediatrics 1986;77:451-455).
The purpose of the study was to investigate the characteristics of infants who died after evaluation by an apnea program for apneic episodes or for statistical increased risk for SIDS. Although this does not represent a complete sampling of the apnea programs in California, it presents data on more than 3,000 infants who were evaluated.
Tactile/Kinesthetic Stimulation Effects on Preterm Neonates
Authors: SAIGAL SAROJ , WHYTE ROBIN 
Published: December 2021

To the Editor.—
The provocative study by Field et al (Pediatrics 1986;77:654-658) attributes a 47% increase in rate of weight gain to tactile/kinesthetic stimulation of preterm infants, but the reader is presented with a number of perplexing problems in interpretation. We are unable to understand the randomization process, which was achieved after a stratification exercise designed to divide patients into eight poststratification groups. If these were equal in size, then each group must have contained five patients, an odd number.
Errors in Drug Administration
Authors: KOREN GIDEON 
Published: December 2021

In Reply.—
Although the ban of decimal points may resolve some confusion, it probably would not prevent mathematical incompetence of medical personnel which is a common and serious problem. The statement that tenfold errors in drug doses do not occur when the decimal point is banned has to be proven. Before I started studying the tenfold errors problem, I did not imagine how common and multifactorial it is. I believe that, if Dr Bury continuously and closely studies the problem in his hospital, he is likely to identify it.
Absent Hypoxic and Hypercapnic Arousal Responses in Children With Myelomeningocele and Apnea
Authors: JAMES HECTOR E. 
Published: December 2021

To the Editor.—
The findings by the authors of a recent report about abnormalities in hypoxic and hypercapnic arousal responses in children with myelomeningocele and Arnold-Chiari malformation, who were symptomatic with apnea and/or hyperventilation, are interesting indeed, and the abnormalities have been reported well.1
In the discussion, the authors failed to tell the readers about the known anatomical substrate for such abnormalities. The anatomical substrate is a malformation of brainstem nuclei and consequently brainstem connections of the cranial nerve nuclei and reticular formation.
Lack of Statistical Power
Authors: DONOWITZ LEIGH G. 
Published: December 2021

In Reply.—
Dr Pascoe's statistical analysis of the small numbers of nosocomial infections is one with which I agree. It is for precisely his reasons that intravascular catheter tip colonization was studied using this as another marker of nosocomial infection. This additional information provided another support for the argument that overgown use did not affect the incidence of device-related colonization or infection.
Too Many Warnings on Missing Children
Authors: GREEN GORDON 
Published: December 2021

To the Editor.—
The statement on missing children by the Committee on Early Childhood, Adoption, and Dependent Care (Pediatrics 1986;78:370-372) is helpful in defining the role of the pediatrician in dealing with this tragic situation. It did not, however, address a secondary problem that is now being seen.
One result of the extensive media attention and public awareness of the problem of missing children is a heightened level of anxiety in the kids themselves. Some children are fearful to go outdoors, even in their own familiar neighborhoods.
Boys on Girls' Teams
Authors: FAIGEL HARRIS C. 
Published: December 2021

The letter by Dr Goldenring regarding girls on boys' teams (Pediatrics 1986;78:718) and the reply by Dr Dyment fail to address a singular and insidious problem of even greater dimensions, that of boys on girls' teams.
Dr Goldenring is not wrong about the issue of injury to girls physically when they play against boys. There are increasing reports of such injuries. Dr Dyment is not wrong in his belief that the girls should have access if they can play well enough to make the team.
IDIOPATHIC APLASTIC ANEMIA IN CHILDREN
Authors: STURGEON PHILLIP 
Published: December 2021

With the use of the concentration and volumetric bone marrow aspiration technics in the differential diagnosis of idiopathic acquired aplastic anemia from aleukemic lymphatic leukemia in children, it is possible to establish an early reliable diagnosis. In this clinic specific therapy with the indicated agents has not had to await an indefinite period of observation pending the development of unmistakable clinical and peripheral blood signs nor the more difficult procedure of surgical biopsy.
Bone marrow aspirations performed in four cases of aplastic anemia and studied by these technics have shown normal or increased ease and rate of aspiration, normal or increased fat, and absent myeloid-erythroid layer.
Five cases of aleukemic leukemia presented as typical of numerous others studied revealed marked difficulty in the aspirations, absent fat and a variable myeloid-erythroid layer.
Study of histologic material obtained with the use of the preceding technics revealed the marrow from all cases of aplastic anemia to be fatty and hypoplastic in contrast to the marrow from a case of aleukemic leukemia, which was hyperplastic and without fat tissue. These later observations correlate well with the observed differences in volumetric data.