bluuebunny/crossref_metadata_2025_split huggingface dataset:
Drug-Exposed Infants
Authors:   Committee on Substance Abuse
Published: December 2021

Recent studies have documented that an increasing number of women of childbearing age are abusing licit and illicit substances. Although statistical data are insufficient, there are indications that approximately 1 in 10 infants may be exposed to illicit drugs during pregnancy. The National Institute on Drug Abuse 1988 National Household Survey1 revealed that 8.8% of women of childbearing age admitted to having used an illicit drug in the month before questioning. A recent survey of 36 private and public hospitals2 showed that approximately 11% of women delivering in these hospitals had used illegal drugs at some time during their pregnancies. A preliminary study in Pinellas County, Florida, demonstrated that cocaine and marijuana use during pregnancy were almost equally distributed across racial and socioeconomic lines.3
These incidence data parallel the increasing number of infants being admitted to special-care nurseries for complications caused by their intrauterine exposure to alcohol and other drugs. It is also important to consider that drug-exposed infants often go unrecognized and are discharged from the newborn nursery to homes where they are at increased risk for a complex of medical and social problems including abuse and neglect.
This statement addresses illicit substance use in pregnancy and its medical, social, mental health, and legal consequences for children and families. The Academy is developing a separate statement to address the issue of infants exposed to alcohol in utero.
THE PROBLEM
All illicit drugs reach the fetal circulation by crossing the placenta and can cause direct toxic effects on the fetus, as well as fetal and maternal dependency.
Clofibrate Treatment of Neonatal Jaundice
Authors: Gabilan J. C. , Benattar C. , Lindenbaum A. 
Published: December 2021

To the Editor.—
Kappas et al1 have reported the results of Sn-protoporphyrin use in the management of hyperbilirubinemia in full-term newborns with direct Coombs-positive ABO incompatibility. A commentary, "A New Era in Therapy for Hyperbilirubinemia,"2 emphasizes the great interest of this pharmacologic means of prevention of neonatal hyperbilirubinemia (inhibition of the transformation of heme into bilirubin) by the action of Sn-protoporphyrin on heme oxygenase. Anthony F. McDonagh in the Journal of Pediatrics shows that the efficiency of tin-porphyrin is limited and that phototoxic risks exist which should lead the authors to be cautious in current practice.3
Haemophilus influenzae Type b Conjugate Vaccines: Immunization of Children at 15 Months of Age
Authors:   Committee on Infectious Diseases
Published: December 2021

This statement updates previous information and recommendations regarding Haemophilus influenzae type b conjugate vaccines. The four vaccines that have received extensive clinical investigation and/or licensure by the United States Food and Drug Administration (FDA) are listed in the Table. Previously, the Committee recommended that all infants be immunized at 18 months of age with one of the two conjugate vaccines, designated PRP-D and HbOC, that were licensed at that time.1, 2 A third conjugate vaccine, designated PRP-OMP and consisting of the capsular polysaccharide of H influenzae type b complexed with outer membrane proteins of Neisseria meningitidis, was licensed by the FDA in December 1989. Currently, the FDA has approved labeling for PRP-OMP, HbOC, and PRP-D vaccines that states "Administration of Haemophilus b Conjugate Vaccine may be considered for children as young as 15 months of age when it is expected that the child will not return at 18 months for Haemophilus b immunization." After review of the data available on immunogenicity for PRP-D, HbOC, and PRP-OMP administered to children at 15 months of age, the Committee concludes that all children should be immunized at 15 months of age.
BACKGROUND
Before the introduction of immunization against H influenzae type b, it was estimated that annually approximately 16 000 cases of invasive infection occurred in the United States in children 5 years of age or younger.3 About 26.6% of cases occurred in children 18 months of age or older, and approximately an additional 9.3% occurred in children 15 to 17 months of age.
Clioquinol (lodochlorhydroxyquin, Vioform) and lodoquinol (Diiodohydroxyquin): Blindness and Neuropathy
Authors:   Committee on Drugs
Published: December 2021

This Policy Statement was retired January 2011.
Clioquinol and iodoquinol are found in topical compounds for dermatologic use. Their application in pediatrics has been for treatment of diaper dermatitis, although the current labeling for these products advises against their use in children younger than 2 years of age. The Table lists a few of the many agents currently available that contain clioquinol or iodoquinol. Some nonprescription products also contain clioquinol.
Since our 1974 commentary on the toxicity of these drugs to children,1 additional reports of toxicity following skin application have become available. Both clioquinol and iodoquinol have been known to cause serious and irreversible optic atrophy and peripheral neuropathy.2 This class of drugs was associated with several thousand cases of subacute myelo-optic neuropathy in Japan.3-5 The clinical picture was that of a subacute onset of peripheral weakness and sensory loss, spastic paraparesis, and blindness, occurring in combination in various degrees. The most common symptoms were muscular weakness of the lower extremities and dysesthesia spreading to the trunk.
A World Health Organization committee convened in 1977 to prepare a list of essential drugs and excluded clioquinol because it considered the risks of treatment greater than the potential benefit.6 Other authoritative sources of drug information state that "clioquinol has limited topical antibacterial and antifungal activity"7 and that "routine use of either compound (clioquinol or iodoquinol) is not recommended."8
A recent clinical study examined the percutaneous absorption of clioquinol.9 Five healthy male subjects received one application (5 g) of 3% clioquinol cream applied for 12 hours to a 200 cm2 area of the forearm (1.1% of body surface area).
Fever and Petechiae in Children
Authors: BAKER RAYMOND C. , SEGUIN JOHN H. , LESLIE NANCY , GILCHRIST MARY J. R. , MYERS MARTIN G. 
Published: December 2021

In Reply.—
Our recent study of children with fever and petechiae included all children admitted to the Emergency Department during the 1 year of the study. Therefore, the 7% incidence of meningococcemia is a true incidence of meningococcemia in children admitted to an emergency facility with fever and petechiae.
Although we agree that including the patients in whom an organism was not documented would have enhanced the statistical power of our results, we chose to exclude them due to the wide spectrum of illness represented in this group, both in severity of illness (ranging from viral syndrome to partially treated, presumed bacterial meningitis) and in presumed organism (viral versus bacterial).
The Work of Pediatric Residents
Authors: SCHINDLER ALAN M. 
Published: December 2021

To the Editor.—
So it took a federal grant and three PhDs to tell us1 what we all know: the pediatric resident is "the optimal hospital staff provider." Any pediatric resident would tell us that, gratis, if we could catch her between the emergency department, ward, nursery, or ambulance transport—admitting patients, discharging patients; resuscitating children, intubating children, placing chest tubes; doing ward clerk work; starting intravenous infusions, drawing blood, taking blood to the lab, getting blood from the blood bank; moving cribs and beds; obtaining cultures, making Gram stains, reading Gram stains; retrieving radiographs, reading radiographs, giving medications, changing dressings, removing sutures; changing diapers, feeding babies, loving babies; picking up trash from the floors; teaching students, organizing conferences; writing orders, writing notes, dictating charts.
The NICHD Phototherapy Study
Authors: SCHEIDT PETER C. , BRYLA DOLORES A. , NELSON KARIN B. , HIRTZ DEBORAH G. , HOFFMAN HOWARD J. 
Published: December 2021

In Reply.—
Dr Perlman expresses concern that readers of "Phototherapy for Neonatal Hyperbilirubinemia: Six-Year Follow-up of the National Institute of Child Health and Human Development Clinical Trial"1 could interpret our conclusions that phototherapy demonstrated a beneficial reduction or prevention of brain damage. We neither stated or meant to imply that phototherapy was observed to prevent brain injury. The statement in our concluding paragraph that phototherapy was "at least as effective as management with exchange transfusion" refers to "control of neonatal hyperbilirubinemia without evidence of adverse outcome" earlier in the sentence.
Periventricular Leukomalacia (PVL) and Myelination
Authors: WELCH R. J. , BYRNE PAUL 
Published: December 2021

To the Editor.—
The study of Van de Bor et al1 appears to demonstrate differences in myelination between infants with and without periventricular leukomalacia (PVL). However, we feel that it does not demonstrate, as stated, that PVL causes delayed myelination, whereas periventricular-intraventricular hemorhage (PIVH) does not. Because the study group did not contain any survivors with intraparenchymal hemorrhage, caution must be used in stating that PIVH does not influence subsequent myelination.
Myelination is a complex process which continues into adulthood.
Guidelines for Urgent Care in School
Authors:   Committee on School Health
Published: December 2021

Minor injuries and illnesses can occur in children during the course of the school day. They are usually well-handled by the school nurse in consultation with a physician who serves as the school medical advisor. True medical emergencies are rare. Many school systems have part-time school medical advisors and nurses who are responsible for more than one school building and may not be readily available. Therefore, the burden of emergency recognition and management may fall on teachers, principals, or other personnel within a school.
It is important for school administrators in consulation with the school medical advisoringand nursing service to formulate a guide for emergency care. The Committee on School Health of the American Academy of Pediatrics suggests the following:
1. Every school district should identify individuals als who are authorized and trained to make urgent medical care decisions.
2. An emergency care manual and standing orders for first aid should be written and made available to nurses, athletic staff, and faculty volunteers.1
3. Procedures should be in place to summon help in catastrophic and urgent care situations from emergency sources within the community including rescue squads and, where available, the 911 system. Transportation to a hospital or medical facility should be accessible.
4. The school nurse in each building should be the key person to carry out the program as she or he is most familiar with the students' health problems. All nurses should be trained in a program of emergency came developed by physicians, emergency medical technicians, and/or other nurses with special training in emergency care1
Tetracycline for Rocky Mountain Spotted Fever
Authors: YAGUPSKY PABLO 
Published: December 2021

To the Editor.—
In a recent editorial, Abramson and Givner addressed the problem of using tetracycline in young children for therapy of presumed Rocky Mountain spotted fever (RMSF), due to the potential risk of tooth discoloration.1 The risk appears to depend on the specific agent used (doxycycline causes less staining than do other tetracyclines, possibly because of its lower binding to calcium) and the degree of exposure to tetracycline.2 Unfortunately, current therapeutic recommendations do not provide clear guidelines on the optimal dosage required to treat RMSF.
Tetracycline for Rocky Mountain Spotted Fever
Authors: LEGGIADRO ROBERT J. 
Published: December 2021

To the Editor.—
I read with interest the editorial by Abramson and Givner on the use of tetracycline for suspected Rocky Mountain spotted fever (RMSF) in children younger than 9 years of age.1 Their discussion of the relative risks and benefits of tetracycline or chloramphenicol for RMSF and their conclusion that the contraindication of tetracycline (due to its risk of teeth-staining) in all children younger than 9 years old does not seem warranted is relevant to another tick-borne infection, tularemia.2
Tetracycline for Rocky Mountain Spotted Fever
Authors: ABRAMSON JON S. , GIVNER LAURENCE B. 
Published: December 2021

In Reply.—
Both Drs Yagupsky and Leggiadro agree with the recommendation that tetracycline would be appropriate for selected indications in children younger than 9 years of age. Dr Yagupsky raises the additional point that controlled studies to establish the length of therapy for the treatment of most rickettsial diseases, including Rocky Mountain spotted fever, are lacking. At our institution, we currently treat children with suspected or proven Rocky Mountain spotted fever until they are afebrile for 2 days or for 5 days total (whichever is longer).
Graft versus Host Disease After Blood Transfusions in a Premature Infant
Authors: FUNKHOUSER A. W. , VOGELSANG G. , ZEHNBAUER B. , TUNNESSEN W. W. , BESCHORNER W. E. , SANDERS M. , GRAEBER J. E. 
Published: December 2021

Transfusion-associated graft versus host disease (GVHD) has been reported primarily in adults with immunodeficiency secondary to malignancy and in children with severe combined immune deficiency, Wiskott-Aldrich syndrome or erythroblastosis fetalis after intrauterine transfusion and exchange transfusions.1-8 We have recently seen a premature, but otherwise apparently normal, infant in whom GVHD developed after simple blood transfusion. Engraftment of foreign lymphocytes from one donor was documented by HLA typing and recombinant DNA techniques leading to early treatment of the GVHD in this premature infant and making this case unique.
CASE REPORT
The patient was a white female, 855 g birthweight, born after 252/7 weeks' gestation to an O+, human immunodeficiency virus-negative, healthy 20-year-old woman.
Aseptic Meningitis in the Decennium of Borrelia burgdorferi Infection (Lyme Disease)
Authors: AUFRICHT CHRISTOPH , TENNER WILLI , STANEK GEROLD 
Published: December 2021

To the Editor.—
A 7-year-old boy with a 2-week history of fatigue, sore throat, and swelling of the right cheek was admitted to our hospital in May 1989. He had no history of intoxication, trauma, fever, or bite. He lived in Vienna and did not travel outside Austria.1 His mother was concerned about his irritability and emotional liability.
Physical examination revealed mild hyperemia of his pharynx and ear drums. There were enlarged cervical lymph nodes and mild nuchal rigidity.
Early Intubation and MAS
Authors: WISWELL THOMAS E. 
Published: December 2021

In Reply.—
I appreciate the comments of Dr Traverse. His opinions and practices closely reflect my own. I, too, am unaware of proven long-term sequelae which can be attributed directly to intubating meconium-stained infants once or twice.1 Additionally, I attempt to remove meconium from the upper airway in all meconium-stained infants, be they vigorous or healthy, or the meconium thick or thin. During the past 5 years, fully one third of infants with the meconium aspiration syndrome (MAS) admitted to our Neonatal Intensive Care Unit had not been intubated and had their tracheae suctioned.
Survival With Birth Weight of Less than 500 Grams
Authors: MORO GUIDO , MINOLI IOLANDA 
Published: December 2021

To the Editor.—
Advances in perinatal medicine during the recent years have resulted in reduction in mortality and a significant improvement in long-term outcome of babies with a birth weight between 700 and 1000 g. A nonaggressive attitude, however, has been recommended1-4 in babies with a birth weight less than 700 g. This may not be justified.
CASE REPORT
Valentina L. was born in the Provincial Maternity Hospital of Milan on May 7, 1988, after 27 weeks of gestation.
I Am My Keeper; I Am My Brother's Keeper
Authors: FOSARELLI PATRICIA D. 
Published: December 2021

In response to a 1987 General Assembly bill, all political jurisdictions in Maryland were required to conduct a needs assessment for school-age child care. The bill did not dictate how the assessment was to have been done; therefore, different jurisdictions solicited somewhat different information. Baltimore City, the ninth largest city in the United States (population = 790 000), selected grades in 60 and 10 randomly selected elementary and middle schools, respectively, to distribute approximately 10 000 surveys to parents for completion. The results were startling.
Overall, when parents were not at home, 4.3%, 20.4%, and 41.2% of 5- through 8-, 9- through 11-, and 12- through 14-year-olds, respectively, were in their own care, and another 25.4%, 37.2%, and 42.3% of 5- through 8-, 9- through 11-, and 12-through 14-year-olds, respectively, were home with only a sibling (age undetermined).1
"Smokeless Cigarettes" and Other Nicotine Delivery Devices
Authors:   Committee on Substance Abuse
Published: December 2021

BACKGROUND
In recent years, the Food and Drug Administration (FDA) has asserted its right to regulate a number of nicotine-containing products by recognizing them as drugs or drug delivery systems under the Food, Drug, and Cosmetic Act. These products include "Favor Smokeless Cigarettes," a nicotine vapor inhaler,1(p12) and Nicorette, a nicotine-containing chewing gum.(p13)
A leading tobacco company recently introduced a new nicotine delivery device that circumvented FDA regulation by claiming that it was a cigarette.2 By definition, a cigarette is primarily a small quantity of fine tobacco rolled in paper (usually rice paper), cylindrical in shape, for smoking.1(p10) In contrast, this nicotine delivery device had the outer paper covering of a regular cigarette, but the cylinder was a metal chamber filled with pellets of alumina mixed with nicotine extracted from tobacco, a flavoring agent, and glycerol. Tobacco was not burned. Instead, when the device was ignited, a distal charcoal tip heated the glycerol, forming an aerosol that was inhaled by the user. The mouthpiece was made, in part, of tobacco leaves, and leaf tobacco was used to insulate the metal chamber, but these were never consumed.2
This product was intended to provide the user with the sensations and enjoyment of cigarettes without burning tobacco.1(p11-12) However, it was at least as effective as conventional cigarettes at delivering carbon monoxide and nicotine,2 a substance with well-recognized pharmacologic, toxic, and addictive properties.3-5
There is a potential market for this product of more than 50 million tobacco users who are addicted to nicotine. Most of these users would like to stop smoking or have tried to stop smoking,5 and they may erroneously perceive similar devices as safe alternatives to cigarettes.
Serious Error
Authors: WARE JANICE 
Published: December 2021

In Reply.—
I write in response to your letter regarding an error in Table 5 of my recently published follow-up report of surfactant-treated infants.1 Dr Jain, Vidyasagar, and Raju are correct in noting an error in the citation for the source of their surfactant material. The correct text should have stated that their material was obtained from bovine lung preparations rather than therapeutic abortions. We thank the authors for pointing out this discrepancy.
25% "Error Rate" in Ear Temperature Sensing Device
Authors: FREED GARY L. , FRALEY J. KENNARD 
Published: December 2021

To the Editor.—
We read with interest the recent article by Kenney et al1 regarding the acceptability of the FIRST temp (Intelligent Medical Systems, Inc., Carlsbad, CA) tympanic membrane infrared temperature sensing device as a clinical tool for pediatricians.1 The authors conclude that the instrument provides body temperature measurements consistent with traditionally used methods (glass-mercury thermometer). We take exception with the analysis used to reach such a conclusion.
The authors present their data as mean differences between FIRST temp and conventional methods with 95% confidence intervals around the mean.
25% "Error Rate" in Ear Temperature Sensing Device
Authors: KENNEY RICHARD D. , FORTENBERRY JAMES D. , SURRATT S. SUZETTE , RIBBECK BETH M. 
Published: December 2021

In Reply.—
We thank Freed and Fraley for their helpful comments as based on a different manner of data presentation. We agree that reporting standard deviations would have been more informative than reporting confidence intervals (standard error of the mean). However, the following frequency table of absolute value of the differences between the two devices demonstrates that 75% of tympanic membrane thermometer readings were within 0.5°C of
[See table in the PDF file]
glass-mercury thermometer readings and more than 95% are within 1°C.
Fetal Vascular Disruption With Prenatal Exposure to Cocaine or Methamphetamine
Authors: HOYME H. EUGENE 
Published: December 2021

In Reply.—
Dr Bays has pointed out that congenital limb reduction defects associated with prenatal exposure to cocaine may be quite common. I would agree that such limb and digital disruptions are occasional accompaniments of fetal exposure to maternal cocaine abuse. However, the exact magnitude of individual fetal risk for prenatal vascular disruption associated with such exposure remains to be delineated.
One must take the percentage of cocaine-exposed children in this report as the minimal number of exposed because many of the medical records did not record prenatal drug exposure.
Procedures, Pain, and Parents
Authors: BAUCHNER HOWARD 
Published: December 2021

During the past decade certain types of pain in children have been the subject of much research and discussion. The pain associated with cancer, sickle cell disease, and the preoperative and post-operative periods have all been extensively studied and reviewed.1-4 Less information is available about acute pain inflicted in emergency rooms. Children commonly undergo procedures such as venipuncture, intravenous cannulation, lumbar puncture, and manipulation of fractures in emergency rooms without the benefit of any analgesia.
What techniques are available to reduce the pain and anxiety that children feel when they undergo procedures? Traditionally, physicians have tried to reduce pain by using pharmacological agents.