bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment of Disabled Infants
Authors: HEALY ALFRED 
Published: December 2021

Formal "statements of understanding" can serve several purposes. The process of writing such statements helps clarify issues and offers opportunities to resolve areas of conflict existing between the involved parties. The signing itself serves a symbolic function, announcing that previous areas of disagreement have been resolved and accord has been achieved. The statement, "Principles of Treatment of Disabled Infants," recently written and approved by nine professional associations and voluntary organizations,1 has served these varied punposes.
However, the value of such statements in accomplishing change is dependent upon the status as well as the integrity of the signatories. Fortunately, the individuals and organizations involved with this statement possess both the status to assist substantially in accomplishing its tenets, and the integrity to use this and future opportunities to influence the care and treatment of infants with disabilities.
Early Management and Decision Making for the Treatment of Myelomeningocele: A Critique
Authors: FREEMAN JOHN M. 
Published: December 2021

In a recent article, Gross et al1 have set out to do something about early decision making and the management of children with myelomeningocele. They have set out to evaluate a program that they have developed, claim is workable, and claim addresses the present ethical dilemma surrounding this issue. Have they done something worthwhile? Have they done it well?
First, let us look at what they have done. Of 68 babies with myelomeningocele, they have selected 33 babies (48%) for supportive care only. Twenty-six families accepted the team's recommendation and left their child in a special children's shelter. Of these babies, 24 died (mean 37 days). Two babies were treated later at the parents' request.
Sudden Infant Death Syndrome
Authors: SOUTHALL D. P. , ALEXANDER J. R. 
Published: December 2021

To the Editor.—
By attempting to examine the hypothesis that abnormalities in the pattern of apneic pauses in the neonatal period could predict all, or most cases of sudden infant death syndrome (SIDS), Steinschneider et al1 may have missed a valuable opportunity to determine a small proportion of cases with more definite abnormalities. Moreover, some measurements made in this study could reflect differences in variables other than apnea. For example, the measurement "A.O/D%", that is the duration of apnea/obstruction events divided by the duration of all sucking bursts x 100, is critically dependent on the duration of sucking.
Everybody Needs Reeducation
Authors: MICHAEL JOHN D. 
Published: December 2021

To the Editor.—
De Carvalho et al1 reinforce the knowledge, which was practiced at the turn of the century and recommended in pediatric textbooks until formula feeding came into common usage, that breast-feeding infants do best when fed between eight and ten times per 24 hours. They need not be required to feed that frequently but the offering should be made for those infants who are interested.
The newborn is entitled to ten nursings in twenty-four hours.
Cerebral Infarction Related to Neck Position
Authors: BODENSTEINER JOHN B. 
Published: December 2021

In Reply.—
Adventitial tears of the vertebral arteries during a breach or otherwise difficult delivery may well result in hypoplasia of the vertebral arteries as suggested by Yates.1 It is doubtful, however, that such an injury would result in the anomalous cerebral vascular supply demonstrated in our patient.2 It seems more likely that the origin of the right posterior cerebral artery from the right internal carotid may represent persistance of the fetal vascular pattern. This concept might be supported by the absence of the posterior communicating artery.
Pediatrics and the Unwanted Child in History: Foundling Homes, Disease, and the Origins of Foster Care in New York City, 1860 to 1920
Authors: English Peter C. 
Published: December 2021

In recent years, America's present means of providing for unwanted children, the foster care system, has come under severe criticism from many child-serving professional groups. The Committee on Adoption and Dependent Children of the American Academy of Pediatrics notes that children in foster care are not likely to receive routine health care, such as immunizations and screening for hypertension, dental caries, or vision or hearing problems.1 Yet these vulnerable children frequently have significant health problems, and they may require more medical attention than the average child. In Massachusetts, 33% of the children in foster care have emotional handicaps, 13% suffer from serious physical illnesses, 19% are mentally retarded, and 15% have multiple handicaps.2 Children in foster care often lack a single health provider and they have few health advocates. Despite criticism from pediatricians about the sorry state of health care provided to these children, pediatricians frequently find themselves in the uneasy position of recommending foster care placement to social service workers in intransigent cases of child abuse and neglect.
Child psychiatrists, such as Anna Freud and Albert Solnit, have joined pediatricians in criticizing foster care. They point out that a child cannot develop emotionally in a rotating system of foster homes. With each move, the foster child becomes less open, attachments less intense. As a result, children emerge from foster care with significant emotional handicaps.3
Social workers, those professionals who work most closely with unwanted children, have added to the chorus of concern over foster care. They point to the difficulty of early identification of the family in trouble and then successful intervention.
Medical Therapy for Suppurative Renal Infections
Authors: GLASER JOY H. , CASPE WILLIAM , KOENIGSBERG MORDECAI 
Published: December 2021

Focal suppurative infections of the kidney are unusual in children and their variable presentations may lead to a delay in their diagnosis. However, the ease with which noninvasive diagnostic tests, such as ultrasound and computered tomography can be performed should improve our ability to make an early diagnosis. Our two patients, one with a segmental renal infection and the other with a subcapsular abscess, were successfully treated only with antibiotics. For these patients a variety of noninvasive techniques were used to make the diagnosis and renal sonograms were helpful in monitoring the efficacy of their treatment.
CASE REPORTS
Case 1
An 8-year-old boy with no previous urologic problems was admitted to the hospital with temperature 39.7°C (104°F), pulse rate 108 beats per minute, blood pressure 110/70 mm Hg.
Usefulness of Screening for Hypertension
Authors: GROSSMAN NATHAN 
Published: December 2021

To the Editor.—
I have read with interest the article by Fixier and Laird on the value of mass blood pressure screening in children (Pediatrics 1983;72:459-463). I must strongly disagree with the conclusion reached by the authors in this study.
Among the criteria for any screening procedure is the requirement that the disease, for which the screening procedure is designed, be either prevalent enough or severe enough, or both, to justify screening for it in the first place.
The Asthmatic Child's Participation in Sports and Physical Education
Authors:   Committee on Children with Disabilities and Committee on Sports Medicine
Published: December 2021

Asthma is a chronic pulmonary disorder, frequently allergic in nature, and characterized by paroxysms of dyspnea, wheezing, tightness in the chest, and bronchospasm. Asthmatic attacks may be minor and short in duration with little discomfort, or very severe and of long duration, producing the characteristic picture of intractability. During symptomatic periods, it is usually possible to demonstrate change in certain aspects of pulmonary function, notably expiratory flow rate and forced expiratory volume. With mild symptoms or between the episodes of severe asthma, the individual may be at little or no disadvantage in most activities. Continuous exercise for five to eight minutes in cold air often causes dyspnea, wheezing, and bronchospasm (exercise-induced asthma) in an asymptomatic individual who may or may not have a history of having had asthma or hay fever. When symptoms of pulmonary distress become severe or prolonged, they may lead to interruption of the child's daily routine, including school attendance. Occasionally, such children may become home or hospital bound for periods of time.
Between the two extremes of no symptoms and severe asthma, there is a spectrum of respiratory or pulmonary disability—the nature and severity of which require that each child receive individual consideration and evaluation in the matter of his daily activity. Control of asthma in children has significantly improved during the past decade. However, asthma may contribute to inefficiency in schoolwork because of associated chronic fatigue, irritability, decreased attention span, and emotional factors.
Physical activities are useful to asthmatic children. The majority of asthmatic children can participate in physical activities at school and in sports with minimal difficulty, provided the asthma is under satisfactory control.
Parvovirus, Erythema Infectiosum, and Pregnancy
Authors:   Committee on Infectious Diseases
Published: December 2021

Recent outbreaks of erythema infectiosum (fifth disease) have caused consternation among pregnant women and their physicians, because of the risk of spontaneous abortion caused by this viral infection. This statement contains information concerning the infection and recommendations regarding control of exposure.
The agent of erythema infectiosum is a single-stranded DNA virus called parvovirus B19, which infects humans only.1,2 Parvovirus B19 is principally transmitted by respiratory secretions,3 and a primary site of replication is the red blood cell precursors found in the bone marrow.4 After an incubation period of approximately 1 week's duration, the virus produces a febrile illness accompanied by reticulocytopenia, which lasts approximately 7 days.5 The normal person recovers without evident anemia and, in some cases, within another week, a distinctive rash, consisting of a slapped cheek appearance and an erythematous, lacy rash on the trunk and extremities, will develop. Atypical maculopapular rashes also occur.6 In adult patients, particularly women, arthralgia or arthritis may develop at this stage7,8; children infrequently experience joint involvement. Asymptomatic infection without rash may occur more frequently than illness with typical rash.
Infection with parvovirus B19 can also cause aplastic crisis in patients with red blood cell abnormalities leading to shortened red blood cell halflives (such as sickle cell disease and autoimmune hemolytic anemia). The aplastic crises develop approximately 1 week after onset of the acute illness due to parvovirus B19.9 Patients with aplastic crisis appear to be contagious from the onset or before the onset of acute illness and through the subsequent week or so.
Cough as a Risk Factor for Neonatal Intraventricular Hemorrhage
Authors: ARGENT A. C. , KLEIN M. , ROTHBERG A. D. 
Published: December 2021

To the Editor.—
The recent study by Drs Perlman and Thach1 casts important light on an earlier work by Drs Perlman et al.2,3 Initially, Perlman et al2 showed that the risk of intraventricular hemorrhage in infants with the respiratory distress syndrome correlated with fluctuations in arterial blood pressure and cerebral blood flow. In their second study,3 they found the corollary: muscle paralysis eliminated the pressure and flow fluctuations and markedly reduced the risk of intraventricular hemorrhage.
Lead Poisoning Risk Determination in an Urban Population Through the Use of a Standardized Questionnaire
Authors: Schaffer Stanley J. , Szilagyi Peter G. , Weitzman Michael 
Published: December 2021

Background. The Centers for Disease Control and Prevention (CDC) has recommended using a five-item questionnaire at every regular office visit for all children 6 to 72 months of age to identify those at risk of high-dose exposure to lead.
Objective. To determine how well the questionnaire identifies children with elevated lead levels.
Research design. Comparison of results of the questionnaire, which is intended to identify children as being low-risk or high-risk for lead poisoning, with children's blood lead levels.
Setting. A pediatric continuity clinic located in a major teaching hospital in Rochester, NY.
Patients. A consecutive sample of 476 children aged 6 to 72 months without a prior history of lead poisoning who were seen in the clinic in July and August 1992, and who had not had a lead screen in the previous 6 months (for those aged &lt;36 months) or 12 months (for those aged 36 to 72 months).
Measurements and main results. Fingerstick lead samples were obtained from all children, and those ≥15 µg/dL (0.72 µmol/L) were confirmed by subsequent venous lead determinations. Twenty-eight percent had blood lead levels ≥10 µg/dL (0.48 µmol/L), 8% had levels ≥15 µg/dL (0.72 µmol/L), and 5% had lead levels ≥20 µg/dL (0.96 µmol/L). According to responses on the questionnaire, 44% were initially classified as low-risk, and 43% were high-risk. In 13% risk could not be determined because one or more items on the questionnaire had not been answered or were answered equivocally, whereas all other items were answered "No." Children for whom risk could not be determined were presumed to be at high risk and were added to that category, resulting in 56% of the study population so designated. The questionnaire was moderately effective in identifying children with elevated lead levels. Seventy percent of children having lead levels ≥10 µg/dL (0.48 µmol/L) and 82% of children having lead levels ≥15 µg/dL (0.72 ≥mol/L) had been classified as high-risk by the questionnaire. Children classified as low-risk were very unlikely to have elevated lead levels. Eighty-one percent of low-risk children had lead levels &lt;10 µg/dL, and 97% had lead levels &lt;15 µl/dL. An abbreviated questionnaire using only the first three items from the CDC questionnaire had almost identical effectiveness.
Conclusions. In this clinical setting, in which children are largely urban, poor, and have a moderate to high risk of developing elevated lead levels, the CDC risk assessment questionnaire is effective in identifying children with elevated lead burdens. However, an abbreviated version of the questionnaire may be as effective as the complete questionnaire. Additional questions should be added to the questionnaire to improve its overall sensitivity, and the questionnaire should be tested in other settings to see if it is effective with children having different environmental exposures to lead.
Do Questions About Lead Exposure Predict Elevated Lead Levels?
Authors: Tejeda David M. , Wyatt Deborah D. , Rostek Barry R. , Solomon William B. 
Published: December 2021

Objective. To assess the usefulness of the lead poisoning questionnaire developed by the Centers for Disease Control and Prevention as a screening tool for elevated lead levels.
Methods. This descriptive study used a five-question questionnaire at our hospital-based general pediatric clinic and in two local private practices. We obtained venous lead levels from 485 children aged 9 months to 6 years who were brought for health supervision visits. The questionnaire was completed by a primary caretaker of 330 patients (68%). Contingency tables were used to compare lead levels with the responses on the questionnaire.
Results. Lead levels of ≥10 µg/dL were found in 23 (7%) of 330 who completed the questionnaire. Caretakers of children with elevated lead levels were more likely to answer yes to questions about chipping paint and home remodeling than those whose children had levels &lt;10 (P = .0001). These questions had sensitivities for detecting elevated lead levels of 70% and 74% with negative predictive values of 97% and 98%, respectively. Questions about known contacts with lead poisoning and job or industrial exposure to lead each had sensitivities of &lt;10%. The Centers for Disease Control and Prevention's definition of high risk for lead poisoning (one or more positive responses) was nearly 90% sensitive for detecting elevated lead levels with a negative predictive value of 99%.
Conclusion. This risk assessment questionnaire is an effective screening method for elevated lead levels in our population. Questions about the home environment were more sensitive indicators of elevated lead levels than other standard high-risk questions.
Aminophylline Therapy Does Not Improve Outcome and Increases Adverse Effects in Children Hospitalized With Acute Asthmatic Exacerbations
Authors: Strauss Raphael E. , Wertheim David L. , Bonagura Vincent R. , Valacer David J. 
Published: December 2021

Objective. To evaluate the effects of aminophylline (Am) in children hospitalized with asthma.
Methods. Prospective, randomized, double-blind, placebo-controlled trial. Subjects were children between the ages of 5 and 18 years admitted for asthma exacerbation to either a tertiary care children's hospital or an innercity general hospital in New York. Exclusion criteria were admission to the intensive care unit, initial theophylline level &gt; 5 µg/dL, or the presence of other systemic disorders. All patients received nebulized albuterol therapy and intravenous glucocorticosteroids in standardized doses. Thirty-one patients were randomized to receive either an Am bolus followed by continuous Am infusion or placebo (P) bolus and infusion. The outcome variables were: duration of hospitalization, percent of predicted peak expiratory flow rates recorded at 12-hour intervals, number of albuterol treatments required, and adverse effects.
Results. There were no significant differences at study entry in age, sex, race, number of previous hospital admissions, prior medications used, clinical symptom scores, or initial peak flow rates for the two groups. For 26 patients who completed this study, 15 patients in the P group were hospitalized for a mean duration of 2.33 ± 1.3 days, whereas 11 patients in the Am group required 2.58 ± 1.5 days. There were no significant differences between the two groups for hospital days, peak flow rates at any time interval, or amount of albuterol therapy required (P &gt; .2). In the Am group, 6 of the 14 patients who entered the study experienced significant adverse effects consisting of nausea, emesis, headache, abdominal pain, and palpitations. Only 1 of 17 patients in the P group had an adverse effect (P &lt;. 05).
Conclusions. There is no benefit and considerable risk of adverse effects associated with the use of Am in hospitalized asthmatic children.
Toluene Embryopathy: Delineation of the Phenotype and Comparison With Fetal Alcohol Syndrome
Authors: Pearson Margaret A. , Rimsza Mary E. , Hoyme H. Eugene , Seaver Laurie H. 
Published: December 2021

Objective. To determine if maternal toluene abuse produces any structural or developmental disabilities in the developing fetus, a cohort of toluene-exposed infants was ascertained and examined.
Methodology. Eighteen infants with a history of in utero toluene exposure were examined at birth. Nine of these infants were reexamined 3 to 36 months after their initial evaluations. The clinical findings in these patients were compared with those of similarly exposed children from the literature and with patients who had the fetal alcohol syndrome.
Results. Thirty-nine percent of all toluene-exposed infants described in this and other studies were born prematurely, and 9% died during the perinatal period. Fifty-four percent were small for gestational age, and 52% exhibited continued postnatal growth deficiency. A 33% incidence of prenatal microcephaly, a 67% incidence of postnatal microcephaly, and an 80% incidence of developmental delay were observed. Eighty-three percent of the patients had craniofacial features similar to the fetal alcohol syndrome, and 89% of these children had other minor anomalies.
Conclusions. Data from the patients herein described and the available scientific literature suggest that the mechanism of alcohol craniofacial teratogenesis may be nonspecific, with a variety of teratogens, including toluene, giving rise to phenotypic facial abnormalities similar to those of the fetal alcohol syndrome. We propose a common mechanism of craniofacial teratogenesis for toluene and alcohol, namely a deficiency of craniofacial neuroepithelium and mesodermal components due to increased embryonic cell death.
Prevention of Intellectual Impairment in Children of Women Who Smoke Cigarettes During Pregnancy
Authors: Olds David L. , Henderson Charles R. , Tatelbaum Robert 
Published: December 2021

Objective. To analyze the influence of a comprehensive program of nurse home visitation on the intellectual functioning of children born to women who smoked cigarettes during pregnancy.
Design. Randomized clinical trial. Treatment 1: sensory and developmental screening at ages 1 and 2 years; treatment 2: screening plus free transportation for prenatal and well-child care; treatment 3: screening, transportation, plus prenatal home visitation; treatment 4: screening, transportation, prenatal home visitation, plus postnatal home visitation through the children's second birthdays.
Setting. Semirural community in Upstate New York.
Participants. 400 families in which the mothers registered before the 30th week of pregnancy and had no previous live births. Eighty-five percent of the mothers were either teenagers, unmarried, or poor. Analysis was limited to whites, who constituted 89% of sample.
Intervention. Nurse home visitation during pregnancy (treatments 3 and 4) or during pregnancy and the first 2 years of the child's life (treatment 4). During pregnancy, the nurses helped women improve their health-related behaviors, informal social support, and linkage with needed community services.
Main findings. Children born to women who smoked 10 or more cigarettes per day at registration during pregnancy and who were assigned to treatments 3 and 4 had IQs (averaging across the 3rd and 4th years of life) that were 4.86 (95% CI: 0.47, 9.26) points higher after adjustment for covariates than did children born to women who smoked 10+ cigarettes per day and who were assigned to treatments 1 and 2. The positive influence of the home-visiting program on reducing the harmful effect of smoking appears to be due to prenatal visitation.
Conclusion. Comprehensive prenatal home-visitation services can offset the impairment in intellectual functioning associated with substantial maternal smoking during pregnancy.