bluuebunny/crossref_metadata_2025_split huggingface dataset:
Letter to the Editor
Authors: Silverman William A. 
Published: December 2021

I am delighted to see that my comments have provoked at least three of your readers. But I was hoping that those who were skeptical about the rough estimates I obtained would support my plea for reliable numbers based on formal surveys in each of the seven countries.
If I understand your correspondents correctly ("... we are right on target"), they seem to know the answers to all the questions I raised. But I can't agree that an international comparison is irrelevant.
Nitric Oxide and Bleeding Time
Authors: Gaston Benjamin , Keith Julian F. 
Published: December 2021

Abman, Kinsella, and co-workers caution against the widespread use of nitric oxide (NO) gas in the neonatal intensive care unit.1,2 However, like other leading advocates of NO therapy, they limit their remarks concerning toxicology to a discussion of the risks of acute lung injury and methemoglobinemia. It must be remembered that NO may have other important side effects as well.
In particular, NO inhalation in concentrations of 30 ppm prolongs bleeding time in rabbits and humans,3 making it a uniquely dangerous agent for use in preterm infants at risk for intraventricular hemorrhage.
A 20-Year Population-Based Study of Postdiarrheal Hemolytic Uremic Syndrome in Utah
Authors: Siegler Richard L. , Christofferson Ryan D. , Milligan Mark K. , Pavia Andrew T. 
Published: December 2021

Objective. To determine epidemiologic features, trends in frequency, and predictors of clinical outcome of postdiarrheal hemolytic uremic syndrome (HUS) in Utah.
Design. A 20-year population-based study of HUS with a review of the HUS registry, hospital records, transplant registry, and a survey of pediatricians and pediatric nephrologists to ensure completeness of ascertainment.
Population. All Utah residents under 18 years of age with HUS occurring after a diarrheal prodrome between 1971 and 1990.
Outcome measures. Incidence of HUS, severity, complications, and long-term sequelae.
Results. There were 157 cases during 20 years; 140 (89%) occurred after a diarrheal prodrome. The mean annual incidence was 1.42/100 000 children (range 0.2 to 3.4/100 000 children/year). Periods of high incidence occurred; however, there was no overall sustained increase in incidence. Escherichia coli O157:H7 was isolated from the stool of 62% of children who had specimens submitted. There were no differences between the first and second decade in the proportion with diarrheal prodrome, bloody diarrhea, most abnormal laboratory values, hospital course, or outcome. However, admission laboratory abnormalities were more severe during the first decade suggesting a delay in diagnosis. Age &lt;2 years, anuria before admission, and higher white blood cell counts on admission predicted severe disease. Bad outcome (death, end-stage renal disease, or stroke) occurred in 11%; 5% died. Chronic renal sequelae, usually mild, were found on follow-up (median 6.5 years) in 51% of survivors.
Conclusions. HUS has been an important clinical and public health problem in Utah for 20 years. The consistency of the clinical and epidemiologic features over 2 decades suggests that a common etiologic agent has accounted for most cases of HUS in this region since 1971.
Effect of Immediate Resuscitation on Children With Submersion Injury
Authors: Kyriacou Demetrios N. , Arcinue Edgardo L. , Peek Corinne , Kraus Jess F. 
Published: December 2021

Study objective. To determine the effect of immediate resuscitative efforts on the neurological outcome of children with submersion injury.
Design. A case-control study was designed to determine if immediate resuscitation by rescuers or bystanders reduces the frequency of severe neurological damage or death in children with a documented submersion event. Logistic regression was used calculate an adjusted odds ratio.
Participants. The study group consisted of 166 children, aged zero to 14 years, having a submersion event during May 1984 through August 1992, and admitted through various emergency departments to Huntington Memorial Hospital in Pasadena, California.
Measurements and main results. All study subjects had an observed and documented episode of apnea at the time of submersion. Outcomes were evaluated on the basis of neurological impairment or death. Exposure was verified from historical accounts of postsubmersion events provided by family, friends, and/or paramedical personnel. The study factors included age and gender, duration of submersion, hypothermia, presence of apnea, resuscitative efforts, and clinical outcome. Children with a good outcome were 4.75 (adjusted odds ratio (OR)) times more likely to have a history of immediate resuscitation than children with poor outcome (95% confidence interval: 3.44 &lt; OR &lt; 6.06, P = .0001). Various types of resuscitative efforts and potential confounding factors were also evaluated. CPR and mouth-to-mouth resuscitation were the most effective types for the prevention of death or severe anoxic encephalopathy.
Conclusion. Immediate resuscitation before the arrival of paramedical personnel is associated with a significantly better neurological outcome in children with submersion injury.
Epileptic Seizure-Induced Hypoxemia in Infants with Apparent Life-Threatening Events
Authors: Hewertson John , Samuels Martin P. , Southall David P. , Poets Christian F. , Boyd Stewart G. , Neville Brian G. R. 
Published: December 2021

Objective. To describe the physiologic changes that occur during epileptic seizure (ES)-induced apparent life-threatening events (ALTE) and to provide an explanation for the mechanism whereby the hypoxemia characterizing these events occurred.
Patients and design. Six infants were retrospectively selected from a group of 17 because they had ALTE documented on physiologic recordings where the first change in signals was in the electroencephalogram (EEG). The 17 infants had clinical features suggestive of partial seizures (but normal standard EEGs) and were from a sample of 172 infants with recurrent ALTE. All 17 infants underwent continuous recordings of breathing, electrocardiogram (ECG), oxygenation, and EEG, but only in 6 was an ES-induced ALTE recorded and the physiologic changes described.
Results. Twenty-three ALTE were documented in six infants. Events commenced with an abnormality in the EEG, followed by a decrease in SaO2 after a median interval of 27 seconds (range 2 to 147). Despite resuscitation, the median duration of severe hypoxemia (SaO2 ≤60%) was 40 seconds (range 8 to 74). In 18 events (five infants) there was a median of four apneic pauses (range 1 to 9) preceding the decrease in SaO2 by a median duration of 24 seconds (range 3 to 48). The longest apneic pause per event lasted a median of 19 seconds (range 8 to 47). Breathing movements continued in five events (four infants), and expiratory airflow in one. Sinus tachycardia was found in 19 of the 23 events (six infants), but there were no cardiac arrhythmias.
Conclusions. ES in infants can manifest as ALTE and be accompanied by potentially life-threatening episodes of severe hypoxemia and apnea, despite a normal EEG between events.
Enteroviral Meningitis in Infancy: Potential Role for Polymerase Chain Reaction in Patient Management
Authors: Schlesinger Yechiel , Sawyer Mark H. , Storch Gregory A. 
Published: December 2021

Study objective. To evaluate the performance characteristics and potential clinical utility of a polymerase chain reaction (PCR) assay for enteroviral RNA in comparison to viral culture in infants under 3 months of age with meningitis.
Specimens and testing. Specimens were obtained from a collection of cerebrospinal fluid specimens from infants under 3 months of age (excluding those in the neonatal intensive care unit) undergoing lumbar puncture at St. Louis Children's Hospital during a 12-month period. Those tested by PCR included all 27 with pleocytosis, 8 others from infants without pleocytosis but from whom an enterovirus was cultured, and 10 from infants who did not have pleocytosis and had a negative viral culture of cerebrospinal fluid. Viral cultures were performed at the discretion of physicians caring for individual patients.
Results. PCR was positive for enteroviral RNA on cerebrospinal fluid (CSF) specimens from 11 of 12 patients with definite or probable enteroviral meningitis, as well as on 6 of 13 with possible enteroviral meningitis, and was negative on all 10 with absence of pleocytosis and negative enteroviral cultures. CSF viral cultures were negative in 6 of the patients in whom PCR was positive. Viral cultures had minimal impact on patient management. In contrast, under study assumptions, PCR could have saved an average of 1.2 days of hospitalization per patient in the 27 patients with CSF pleocytosis.
Conclusions. Enterovirus PCR performed on CSF is a sensitive and specific method for the diagnosis of enteroviral meningitis. This method has the potential for improving the accuracy of diagnosis in young infants and for saving costs by allowing earlier diagnosis and discharge from the hospital when clinically appropriate.
Colonic Transit and Anorectal Manometry in Children With Severe Brain Damage
Authors: Staiano Annamaria , Del Giudice Ennio 
Published: December 2021

Objective. This study was conceived to determine the physiologic abnormalities in distal gastrointestinal motility that are responsible for constipation in brain-damaged children.
Design. Colonic transit and anorectal manometry were evaluated in 16 children with severe brain damage and constipation (mean age ± SD; 5.1 ± 3.5 years) and the results were compared with findings in 15 age- and sex-atched children with functional fecal retention and normal mental development. Anorectal motility findings also were compared with those from 11 asymptomatic children. The progress of radiopaque markers, as determined by sequential plain abdominal radiographs, was used to evaluate segmental colonic transit times.
Results. In children with brain damage, colonic transit was prolonged at the level of left colon in 18.8% of the patients, at both left colon and rectum in 56.2%, and at rectum only in 25% These findings differed (P &lt; .05) from those in children with functional fecal retention wherein transit was prolonged in the left colon and rectum in 20% of the patients and the rectum only in 80%. By anorectal manometry, no significant intergroup differences were detected in anal pressures and in the anorectal motor responses to rectal distention. The rectal compliance in children with severe brain damage was similar to the asymptomatic controls, whereas children with functional fecal retention had increased rectal compliance.
Conclusions. This study shows that colonic transit abnormalities in both the left colon and rectum may be responsible for constipation in children with severe brain damage.
Limitation of Private Attending Pediatricians' Neonatal Intensive Care Privileges in Level III Institutions Throughout the United States
Authors: Harper Rita G. , Sia Concepcion G. , Spinazzola Regina , Wapnir Raul A. , Orner Shahnaz , Harper Robin 
Published: December 2021

Objective. To determine the privileges of Private Attending Pediatricians (PAP) in caring for newborns requiring intensive (ITC), intermediate (IMC), or continuing (CC) care in Level III neonatal intensive care units (NICUs) throughout the United States.
Design. A two-page mail questionnaire was sent to 429 Level III NICUs to obtain the statement best describing the PAPs' privileges, the number of PAP, and some of the PAPs' functions. Level III NICUs were classified by geographic region as Eastern, Central, or Western United States.
Results. Responses were received from 301 NICUs (70%) representing 48 states, the District of Columbia, and &gt;9000 PAP. Twenty-two institutions had no PAP. In the remaining 279 institutions, 96% (267/279) had restricted the PAPs' privileges partially or completely. In 32% (88/279), the PAP were not allowed to render any type of NICU care. In 18% (51/279) of the institutions, the PAP were allowed to render CC only. In 27% (76/279) of the institutions, the PAP were allowed to render IMC and CC only. Limitation of PAPs' privileges were reported in all geographic areas in the U.S., were more pronounced in the Eastern than the Central or Western sections of the country, and were noted in institutions with small (≤10) as well as large (≥60) numbers of PAP. Limitation of PAPs' privileges was determined by the PAP him/herself in many institutions. Proficiency in resuscitation was considered to be a needed skill. Communication with parents of an infant under the care of a neonatologist was encouraged.
Conclusions. The PAPs' privileges were limited partially or completely in most Level III NICUs. Knowledge of this restricted role impacts significantly on curriculum design for pediatric house officers, number and type of health care providers required for Level III NICUs and future house officer's career choices.
Changing Attitudes and Practices Regarding Local Analgesia for Newborn Circumcision
Authors: Ryan C. Anthony , Finer Neil N. 
Published: December 2021

Study objective. To change physician attitudes and practices regarding the routine use of local and regional anesthesia for newborn circumcision.
Design. Interventional study, followed by an audit of physician practice over a 1-month period, 1 year following interventions.
Setting. The newborn nurseries of the Womens' Pavilion, Royal Alexandra Hospital, Edmonton.
Interventions. A broad range of awareness and educational programs were directed at physicians who perform newborn circumcisions, including posters, newsletters, presentations at grand rounds, video recordings, and practical "hands-on" demonstration of the techniques of local anesthesia to the prepuce and dorsal penile nerve block.
Results. Only one physician was using local analgesia for newborn circumcision prior to the introduction of the educational program. The audit, performed 12 months later, documented 46 circumcisions performed by 22 physicians, each performing between 1 and 6 circumcisions (median = 1). Sixteen of the 22 physicians (73%) used either local anesthesia to the prepuce (19 cases) or dorsal penile nerve block (13 cases) during circumcisions. Thus, local analgesia was used in 66% (32/48) of all circumcisions. Six physicians, performing 16 circumcisions, did not use any form of analgesia.
Conclusions. This simple educational program has been associated with a remarkable change in attitudes and practice regarding local analgesia for neonatal circumcision. Our ideal objective, which we hope to achieve through repeated education and practical demonstrations of the techniques to interested physicians, is that all newborn circumcisions are performed under local or regional anesthesia in our institution.
Letter to the Editor
Authors: Lederman Sally Ann 
Published: December 2021

I am writing regarding some problems I noted in the article "Adolescent Gestational Weight Gain and Birth Weight" (Stevens-Simon et al, Pediatrics 1993;92:805-809). Several of the procedures used in the reported study are either inadequately described or improperly done. Some of these may affect the major points of the article.
One concern is the description of the study as opposed to the report of the findings. The data collection section describes a variety of "psychosocial data" including a measure of "stress" (Newton's scale) and of "environmental stressors" (also citing Newton et al), both measured twice during pregnancy.
THE EFFECT OF VACUUM CLEANERS ON THE CONCENTRATION AND PARTICLE SIZE DISTRIBUTION OF AIRBORNE CAT ALLERGEN
Authors: Graft David F. 
Published: December 2021

Purpose of the Study. To define the types and models of vacuum cleaners releasing the least amount of cat allergen.
Methods. Nine vacuum cleaner models were loaded with dust containing 50 mg of Fel d I (the major cat allergen) and run for 15 minutes in a laboratory room (volume = 18 m2). The airborne concentration of Fel d I was measured.
Results. Vacuum cleaners using a double-thickness dust bag had much less leakage than those with a single-thickness bag. Two water-filter vacuum cleaners emitted high concentrations of Fel d I; furthermore, 90% of the allergen was in particles of less than 2.5 µm. Taping electrostatic filter paper over the air outlets controlled this.
Reviewer's Comments. It is obviously important that individuals who have cat allergy and have cats in the home use a vacuum cleaner that reduces cat allergen exposure rather than increase it. This study demonstrates that certain types of vacuum cleaners may actually increase airborne cat allergen and furthermore, that certain refinements may improve their function.
ACROLEIN INCREASES AIRWAY SENSITIVITY TO SUBSTANCE P AND DECREASES NEP ACTIVITY IN GUINEA PIGS
Authors: Kinberg Kirk , Kobayashi Roger H. 
Published: December 2021

Purpose of the Study. Airway hyper-responsiveness is a consistent observation seen in asthmatic patients. In asthma, inflammatory cellular influx and mediator release results in epithelial damage, vascular leak, and alterations in mucus production and secretion. Studies suggest that C-fibers which innervate airway epithelium may be more densely packed with substance P in asthmatic patients than in normal subjects. Damage to the epithelium may increase stimulation of the C-fibers and subsequent tachykinin release including substance P. Tachykinins are metabolized by neutral endopeptidase (NEP) which are found in airway epithelium and smooth muscle. Airway damage may cause enhanced tachykinin-induced effect. The purpose of this study was to investigate the inter-relationship between tachykinins and reduced NEP on the effects of pulmonary functions as well as bronchoalveolar lavage findings.
Methods. Guinea pigs were given an aerosolized solution of acrolein, a component of cigarette smoke and smog, which is known to cause epithelial cytotoxicity and increased sensitivity to acetylcholine. Pulmonary functions were measured via body box. Dose response curves were calculated from subject guinea pigs given the acrolein as well as the control group following substance P administration. Subsequently, subject as well as control guinea pigs were exposed to thiorphan to inhibit NEP. They were then given subsequent challenges of either IV or aerosolized substance P and pulmonary testing as well as bronchoalveolar lavage was performed. NEP activity was measured at 1, 7, and 28 days after exposure.
Results. Pulmonary intonation and epithelial damage were prominent on the day after acrolein exposure showing influx of monocytes, neutrophils, and epithelial damage.
THERAPEUTICAL DOSES OF SALBUTAMOL INHIBIT THE SOMATOTROPIC RESPONSIVENESS TO GROWTH HORMONE-RELEASING HORMONE IN ASTHMATIC CHILDREN
Authors: Mehta Hemalini , Lemanske Robert F. 
Published: December 2021

Purpose of the Study. To determine the effects of therapeutic β2 agonists (specifically salbutamol) on growth hormone (GH) response to growth hormone releasing hormone (GHRH) in children with asthma.
Study Population. Fifteen prepubertal children with asthma, ages 6-11 (average age of 9) with normal or normal short stature were studied. Those with an endocrine abnormality, nutritional deficiency, psychological deprivation, or other systemic disease were excluded. Only those children with known bronchial asthma, who showed a 15% decrease of the 1-second forced expiratory volume (FEV1) with methacholine challenge were included. All patients were asymptomatic, and had not experienced an asthma exacerbation, respiratory infection or allergen exposure in the month preceding the study. No child was on medications.
Methods. Subjects were divided into two groups. Both groups had baseline GH response to GHRH determined. After an overnight fast, GH levels were obtained the following morning at -60, 0, and then every 15 minutes until 120 minutes after GHRH administration. Two days following this, Group A received salbutamol (0.125 mg/kg) orally at -60 minutes and GH response to GHRH was remeasured. Group B received aerosolized salbutamol (2 mg over 15 minutes) (details of administration were not specified by the authors). All serum GH levels were measured in duplicate by immunoradiometric assay (sensitivity of 0.1 µg/L).
Findings. Basal GH levels were similar in both groups. Orally administered salbutamol (Group A) markedly inhibited GH response to GHRH (peak of 3.7 ± 0.6 vs. 18.6 ± 4.7 g/L). Inhaled salbutamol (Group B), although blunting the GHRH-induced GH response, did so to a lesser extent (peak of 20.0 ± 7.5 vs. 35.8 ± 9.4 g/L, P &lt; .02).
BECLOMETHASONE GIVEN AFTER THE EARLY ASTHMATIC RESPONSE INHIBITS THE LATE RESPONSE AND THE INCREASED METHACHOLINE RESPONSIVENESS AND CROMOLYN DOES NOT
Authors: Graft David F. 
Published: December 2021

Purpose of the Study. To investigate whether beclomethasone or cromolyn provides any protection from the late asthmatic response if given after the allergen exposure.
Methods. Ten patients with mild, stable, atopic asthma with late asthmatic responses entered a double blind, double dummy trial comparing a single dose of inhaled beclomethasone (500 µg), cromolyn (20 mg), and placebo administered 2 hours after allergen challenge on the severity of the late asthmatic response and the change in the log of PC20 methacholine.
Findings. The late asthmatic response after beclomethasone of 7.3% ± 6.1% decrease in FEV1 was significantly less than that experienced after cromolyn (20.4% ± 15.2%) or placebo (26.4% ± 8.2%); cromolyn was not different than placebo. There was a trend for the change in log PC20 methacholine to be less following beclomethasone administration than that seen with placebo or cromolyn.
Reviewer's Comments. It is well known that a single dose of cromolyn given before allergen exposure inhibits both the early and late phase response, whereas beclomethasone given prior to exposure will only prevent the late phase response. However, many individuals don't plan ahead well enough and need to know what medication should be taken if they have forgotten to take any pretreatment. This study indicates that, if bedomethasone, albeit in a dose equal to 12 puffs of the U.S. concentration, is taken even as late as 2 hours after the exposure, it can significantly inhibit the development of the late phase response. Cromolyn given at that time provides only minimal benefit.
HERPES SIMPLEX VIRUS-2 (HSV-2) TYPE-SPECIFIC ANTIBODY CORRELATES OF PROTECTION IN INFANTS EXPOSED TO HSV-2 AT BIRTH
Authors: Nimmagadda Sai , Spahn Joseph 
Published: December 2021

Purpose of the Study. Accurate identification of infants at risk for developing HSV-2 after exposure remains difficult. Acquired maternal HSV-2 antibody may play an important role in protection of the neonate soon after birth. To identify potential HSV-2-specific antibodies that confer protection, the authors examined HSV-2 antibody profiles of 40 infants and mothers infected with genital HSV-2 at the time of delivery.
Methods. Screening viral cultures of cervical and vulvar specimens were obtained over a 7-year period. All infants exposed to HSV-2 infection had sera and viral cultures obtained. Maternal serum was also drawn at delivery and 6 weeks after delivery. Western blot analysis was utilized to detect HSV-2-specific antibody from all exposed infants. Serum from all infants were coded so that the bands were scored in a blinded manner.
Findings. Of more than 15 000 mothers who had cultures performed, 51 had HSV-2 diagnosed from genital tract cultures; 40 had serum available for testing. Of these 40 mothers, 13 were classified with a first episode of infection, while the other 27 were classified as having recurrent episodes of infection. Of the 13 women who had seroconverted, four had "primary infection" and nine had "non-primary first episode of HSV-2 infection (ie, HSV-1-positive, new onset of HSV-2 infection). Four infants developed neonatal herpes, one of the four was born to a mother with primary HSV-2, and the other three were born to mothers with "non-primary first episode of HSV-2." When the prevalence values of the four infected and 36 uninfected infants were compared, the most dramatic difference was seen in the prevalence of antibody to gG-2, an HSV-2 glycoprotein.