bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nipple Confusion
Authors: WALKER MARSHA 
Published: December 2021

To the Editor.—
I wish to comment on the article "Single Daily Bottle Use in the Early Weeks Postpartum and Breast-Feeding Outcomes."1 Several of the conclusions of this article contradict what I see in clinical practice as a lactation specialist. The selection and definition of the sample groups puzzle me. Specifically, there is no totally breast-fed group. This is a design flaw that many breast-feeding research studies exhibit. An infant being fed up to two bottles a week and infants fed by bottle in the hospital are not totally breast-fed and have experienced the use of an artificial nipple.
Nipple Confusion
Authors: NEWMAN JACK 
Published: December 2021

To the Editor.—
Cronenwett et al1 have jumped to a completely unwarranted conclusion from the data they present in their article on bottle use, that "no support was found for the nipple confusion hypotheses" Rather, there is no support to make such a statement. There seems to be confusion in the minds of the authors by what is meant by "nipple confusion" or "nipple preference."
In the first place, those of us who handle breast-feeding problems on a daily basis would not argue that the occasional bottle, introduced once breast-feeding was well underway and both mother and baby were doing well, would cause serious problems in most instances.
Nipple Confusion
Authors: AUERBACH KATHLEEN G. 
Published: December 2021

To the Editor.—
The results of Cronenwett et al1 are interesting for the answers they provide and the questions they generate.
Most striking in their discussion is the authors' dismissal of "nipple confusion" in light of the timing of their investigations into the effect of regular bottle-feedings for breast-feeding infants. I have observed that infants who are exposed to rubber nipples before they have learned how to effectively suckle the human breast2 seem to try to use the breast as if it were a rubber nipple.
Nipple Confusion
Authors: CRONENWETT LINDA 
Published: December 2021

In Reply.—
The issue that seemed to cause the most concern stemmed from our comment about not finding support for the nipple confusion hypothesis. Certainly, there was no intent on our part to deny that some infants have difficulty with the latching on and sucking patterns necessary for breast-feeding. In our study, our point was merely that the vast majority of participants had babies who alternated between bottle and breast early in the postpartum period and subsequently for prolonged breast-feeding periods.
Are the King County SIDS Data Generalizable?
Authors: BROOKS JOHN G. 
Published: December 2021

To the Editor.—
I wish to applaud Dr Haas and his colleagues for taking advantage of the probably unique, well-validated, longitudinal sudden infant death syndrome (SIDS) database in King County, WA, to try to clarify the interpretation and implications of the multiple reports of consistent associations between certain clinical and demographic characteristics and the occurrence of SIDS.1 I am concerned, however, that most of the differences which they report in prevalence of specific risk factors in each of their three subgroups of SIDS cases ("classic SIDS," "probable SIDS," "ossible SIDS"), result from the specific criteria which they used to define the three groups.
Heart Murmurs. If You Allow for Mistakes Costs Are Even Higher!
Authors: DANFORD DAVID A. , NASIR ARWA , GUMBINER CARL 
Published: December 2021

In Reply.—
Dr Toews' thoughtful letter highlights an important assumption which we made in our analysis of costs of specific strategies in the evaluation of heart murmurs in children. The presumption is made that echocardiography is performed in a diagnostically definitive fashion so that diagnostic inaccuracies are not encountered in the echocardiography-first strategy. We agree that this presupposes the availability of echocardiographic equipment appropriate for use in infants and children, technical support staff with adequate training and ongoing experience, and experienced pediatric echocardiographers to interpret the images.
Passive Tobacco Exposure and Sudden Infant Death Syndrome
Authors: LEE PETER N. 
Published: December 2021

To the Editor.—
Drs Schoendorf and Kiely1 report increased risk of SIDS, both in mothers smoking during and after pregnancy ("combined exposure") and in mothers smoking only afterward ("passive exposure"). Most previous studies2-18 that reported that maternal smoking is associated with SIDS considered only smoking during pregnancy, but some2,4,11,15 considered smoking after pregnancy. However, I am unaware of any previous study which attempted separation of smoking during and after pregnancy. Although such an attempt is commendable, certain problems with the analysis and data of Drs Schoendorf and Kiely merit comment.
Attitudes and Practices Regarding Analgesia for Newborn Circumcision
Authors: Wellington Nancy , Rieder Michael J. 
Published: December 2021

Study objective. To determine attitudes regarding routine use of analgesia for newborn circumcision among primary care physicians in southwestern Ontario.
Design. Questionnaire survey conducted among all family physicians and pediatricians belonging to the London Academy of Medicine. The majority of pediatric primary care in this region is provided by family physicians.
Setting. Metropolitan center in Southwestern Ontario.
Respondents. A questionnaire was mailed to 279 physicians; 171 (61%) responded.
Results. Seventy-four (43%) respondents performed circumcisions. Among physicians performing circumcisions, a minority (17; 24%) used any form of analgesia. The most commonly used analgesic (14; 20%) was oral ethanol. Only 3 (4%) physicians used dorsal penile nerve block. The most common reasons listed for not employing analgesia were lack of familiarity with analgesia use among neonates (56%), lack of familiarity with the technique of dorsal penile block (50%), and concern over adverse effects of analgesic drugs (49%) and regional analgesia (44%). Only a small minority of physicians (7; 12%) responded that they believe that neonates do not feel pain, and 20 (35%) believe that neonates do not remember pain.
Conclusions. Despite evidence that neonates perceive pain and that there is a physiologic stress response to circumcision which can be reduced if analgesia is employed, the vast majority of physicians performing newborn circumcisions either do not employ analgesics or employ analgesics of questionable efficacy. Lack of familiarity with the use of analgesics among neonates and with dorsal penile block in particular are the most common reasons cited for lack of analgesic use. Educational efforts and research into less invasive techniques of analgesia for newborn circumcision are urgently required.
Association of the Common Cold in the First Trimester of Pregnancy With Birth Defects
Authors: Zhang Jun , Cai Wen-wei 
Published: December 2021

Objective. To examine the association between the common cold with or without fever in the first 3 months of pregnancy and birth defects in offspring.
Design. A case-control study.
Setting. Data are from the Shanghai Birth Defects Monitoring Program, conducted in 29 hospitals in Shanghai, China from October 1, 1986 to September 30, 1987.
Subjects. A total of 986 birth defects cases, 990 frequency-matched live birth controls, and 159 stillbirth controls.
Results. Modestly elevated risk of birth defects was identified among women who reported having a cold with or without fever in the first trimester of pregnancy. Notably increased relative risks were observed for anencephalus (odds ratio [OR] = 3.9, 95% confidence interval [CI] = 2.0 to 7.7), spina bifida (OR = 4.1, 95% CI = 1.7 to 9.7), hydrocephalus (OR = 2.3, 95 % CI = 1.1 to 5.1), cleft lip (OR = 2.2, 95 % CI = 1.4 to 3.4), and undescended testicle (OR = 1.8, 95 % CI = 1.0 to 3.0). Our study further found that the overall relative risks were consistent by using two different control groups, suggesting that this association was unlikely to be due to recall or report bias.
Conclusion. Common cold in the first trimester of pregnancy may be associated with an increased risk of birth defects in offspring. However, these findings should be interpreted cautiously.
Is There a Relationship Between Dietary Fat and Stature or Growth in Children Three to Five Years of Age?
Authors: Shea Steven , Basch Charles E. , Stein Aryeh D. , Contento Isobel R. , Irigoyen Matilde , Zybert Patricia 
Published: December 2021

Study objective. To determine whether a moderately reduced fat diet affects the stature or growth of healthy preschool children.
Design. Cohort study with mean of 25 months of follow-up.
Setting. Primary care pediatrics practice at a large urban medical center.
Subjects. A predominately Hispanic group of 215 children aged 3 to 4 years at baseline.
Measurements and main results. The children's diet was assessed using four 24-hour recalls and three Willett semiquantitative food-frequency questionnaires administered to the children's mothers over a 1-year baseline period. Stature was defined in terms of height, weight, and body mass index at baseline. Growth was defined in terms of change during follow-up in height, weight, and body mass index. Total fat provided a mean of 27.1% of caloric intake in the lowest quintile of intake compared with 38.4% in the highest quintile. There were no differences in stature or growth across quintiles of children defined by consumption of total fat, saturated fat, or cholesterol. These findings were consistent across the two methods of diet assessment. Children who consumed a smaller percentage of total calories from fat consumed significantly less total calories, saturated fat, cholesterol, calcium, and phosphorus, as well as more carbohydrates, iron, thiamine, niacin, vitamin A, and vitamin C.
Conclusions. These data support the safety of a moderately reduced fat diet in healthy preschool children. Maintenance of calcium and phosphorus intake should be part of any program of dietary fat reduction. Substitution of low-fat milk for whole milk, rather than elimination of whole milk, is one such strategy.
EFFECTS OF EARLY INTENSIVE SPORTS TRAINING
Authors: L. J. F. 
Published: December 2021

It has been suggested that the intensive training of athletes from a young age could be bad for the developing body—a good reason not to screen for potential champions too young. However, that idea has been firmly repudiated by one of the biggest studies of young athletes ever carried out. In the study, known as the Training of Young Athletes (TOYA), a sample of 453 British children aged between 8 and 12, both athletes and non-athletes, were followed for five years to measure the effects of sport on the developing body.
. . ."There is no evidence that athletic activity affects physical development," says Nicola Muffulli, an orthopaedic surgeon who ran and analysed the F1 million programme, funded by the Sports Council. "This contradicts some predictions from the US," he adds. American scientists had quoted studies of forced exercise by laboratory animals to suggest that children could be injured more easily. "But the outcome of our study clearly means that elite sports participation does not mean you run a higher risk of being injured," says Muffulli.
Missed Immunization Opportunities
Authors: DERAUF DAVID D. , DERAUF D. CHRISTIAN 
Published: December 2021

We read with great interest the recent studies in Pediatrics on missed opportunities for childhood immunization. Given the current national debate on ways to control health care costs and the recent proposals for federal procurement of all vaccine supplies, it is encouraging and illuminating to know that significant increases in immunization rates might be achieved without tremendous additional expense.
One of the major limitations of these studies, clearly acknowledged by the authors of the first but not the second study, was the inability to assess the role of immunization record availability in missed opportunities. Our experience leads us to agree that lack of immunization records contribute to missed opportunities for immunization far more often than the 2% of visits suggested by the first study.
Parent Dissatisfaction With Neonatal Intensive Care Unit Care and Suggestions for Improvements
Authors: LUCEY JEROLD F. 
Published: December 2021

The article, "The Principles for Family-Centered Neonatal Care," in this issue is unique. I believe it is the first article we've published that is authored by a group of parents.
This special group of parents whose infants were cared for in intensive care nurseries was selected because of their previous attempts in the lay literature to communicate with the medical establishment through newspapers, association newsletters, books, or television interviews. They are unhappy with the present situation, and they want to see change.
Ross Laboratories sponsored a 2-day meeting of some of these parents with a small group of neonatologists. pediatricians, social workers, and intensive care nursery nurses.
Arterial Catheters and Retinopathy of Prematurity Risk: Need for a Multicenter Controlled Trial
Authors: RAPISARDI GHERARDO , DONZELLI GIAN PAOLO , FROSINI RICCARDO , CAMPA LUCIANA 
Published: December 2021

To the Editor.—
During the period from January 1, 1987, to December 31, 1992, a total of 891 infants were admitted to the neonatal intensive care unit (NICU), A. Meyer Children's Hospital, Department of Pediatrics, University of Florence, Italy. Of these infants, 406 had a gestational age ≤33 weeks, and 273 were very low birth weight (≤1500 g, VLBW). Of them 779 (87.4%) survived. All the survivors were examined regularly by two experienced ophthalmologists, starting from the third or fourth postnatal week and then repeatedly at least every 2 weeks until retinal vascularization was completed.
Penicillin-Resistant Systemic Pneumococcal Infections in Children: A Retrospective Case-Control Study
Authors: Tan Tina Q. , Mason Edward O. , Kaplan Sheldon L. 
Published: December 2021

Objective. To determine whether there are any risk factors that differentiate children with systemic infections due to Streptococcus pneumoniae relatively or fully resistant (minimum inhibitory concentration &gt;0.1 µg/mL) to penicillin from those children with infections due to S pneumoniae susceptible to penicillin.
Design. Retrospective case-control study.
Setting. A large children's hospital.
Participants. Forty-three children with systemic penicillin-resistant S pneumoniae infections identified at Texas Children's Hospital over the 51-month period from January 1989 through March 1993. Each case had one or two controls matched only for age and date of S. pneumoniae infection. Sixty-six controls were selected from a group of 341 children with susceptible isolates.
Outcome measures. Variables compared included gender, race, diagnosis, underlying conditions, past hospitalization, geographic area of residence, antibiotic use in past month, amoxicillin-clavulanic acid use in past month, and outcome.
Results. Thirty-seven patients (86%) had relatively resistant isolates (minimum inhibitory concentration range 0.125 to 1.0 µg/mL) and six patients (15%) had fully resistant isolates (minimum inhibitory concentration range 2.0 to 8.0 µg/mL). Thirty-three percent of the cases vs 36% of the controls had underlying conditions. Seventy-one percent of the cases vs 39% of the controls had received antibiotics in the previous month. Compared with their matched controls, the patients with penicillin-resistant systemic pneumococcal infections were more likely (P = .02) to have received a course of antibiotics within the month prior to their infection.
Conclusion. The only identified associated risk factor in children who developed a systemic penicillin-resistant pneumococcal infection appears to have been the use of antibiotics within the month prior to their infection.
The Inconspicuous Penis
Authors: Bergeson Paul S. , Hopkin Robert J. , Bailey Robert B. , MCGill Leigh C. , Piatt Janice P. 
Published: December 2021

Objective. To describe the etiology and management of the group of abnormalities referred to as the inconspicuous penis.
Design. Analysis of 19 cases seen over a period of 2 years by chart review.
Setting. Children's hospital in a major metropolitan area.
Patients. Nineteen boys referred to two pediatric urologists over a period of 2 years with penises that appeared abnormally small, but on palpation and measurement, were found to have a normal shaft with a normal stretched length. Diagnoses included were buried penis, webbed penis, and trapped penis. Patients ages ranged from 1 week to 13 years.
Findings. There were eight patients (42%) with trapped penis, and all were complications of circumcision (age 1 week to 7 months). Of nine (47%) patients with buried penis, two had been circumcised prior to diagnosis. One (5%) patient had webbed penis and one (5%) had combined buried and webbed penis.
Intervention. Six trapped penises were surgically repaired, and two resolved spontaneously. Five patients with buried penis had surgical repair, and two are being followed up for probable repair at age 9 to 12 months. Two were not repaired because of medical conditions or parental concerns. The webbed penis was surgically repaired as was the combined buried and webbed penis. The repairs were all successful and had no complications.
Conclusions. Inconspicuous penis encompasses a group of conditions in which the penis appears small but the shaft can be normal or abnormal in size. Circumcision is contraindicated in these patients until they have been evaluated by a urologist. Further study is needed to determine the natural history of these disorders and to better define which patients will benefit from surgical intervention and at what age.
Clinical Features and Epidemiology of Invasive Kingella kingae Infections in Southern Israel
Authors: Yagupsky Pablo , Dagan Ron , Howard Charles B. , Einhorn Menachem , Kassis Imad , Simu Alexander 
Published: December 2021

Objective. To characterize the clinical spectrum and epidemiology of invasive Kingella kingae infections in children living in southern Israel.
Design. Five-year observational, descriptive study.
Population. Children in whom K. kingae was isolated from blood or other normally sterile body fluid.
Results. Twenty-five patients with invasive K. kingae infection (13 male and 12 female) were identified. Twenty-four of these children were younger than 2 years. The annual incidence was 14.3, 27.4, and 31.9 cases per 100 000 children ≤4 years, ≤24 months, and ≤12 months, respectively. Seventeen (68%) of 25 patients sought treatment between July and December. Concomitant upper respiratory tract infection or stomatitis was observed in 14 (56%) of the patients, suggesting a respiratory or buccal source for the infection. Four children were bacteremic: 2 of them suffered from a lower respiratory tract infection, and the remaining 2 had bacteremia with no evident focal infection. Twenty-one children had skeletal infections and none of them was bacteremic; 16 had septic arthritis, 3 had osteomyelitis, 1 had both osteomyelitis and septic arthritis of the adjacent joint, and 1 had dactylitis of the hand. Involvement of the ankle was unusually frequent among children with septic arthritis, whereas the calcaneus was involved in 3 of the 4 children with osteomyelitis. Antibiotic treatment resulted in full recovery in all cases, and only 2 patients with septic arthritis required surgical drainage.
Conclusion. Kingella kingae is a much more common cause of invasive infection in young children than has been previously recognized. The disease has a clear seasonal pattern, usually affects the skeletal system, frequently involves unusual bones and joints, and follows a benign course.
Childhood-Onset Systemic Lupus Erythematosus: Antiphospholipid Antibodies in 37 Patients and Their First-Degree Relatives
Authors: Molta Charles , Meyer Olivier , Dosquet Christine , de Oca Marcela Montes , Babron Marie-Claude , Danon Françoise , Kaplan Cécile , Clémenceau Sylvie , Castellano Françoise , Levy Micheline 
Published: December 2021

Objective. Antiphospholipid antibodies (aPL) are noted with increased frequency in patients with systemic lupus erythematosus (SLE). The main manifestations found to be associated with aPL are arterial and venous thrombotic events, thrombocytopenia, and recurrent pregnancy loss This study is an attempt to define the incidence of aPL in patients with childhood-onset SLE and in their relatives and to correlate their presence with clinical manifestations, and especially, to evaluate the risk of thrombosis in aPL-positive subjects.
Methodology. We studied 37 unrelated patients and 107 of their first-degree relatives. VDRL, IgG and IgM anticardiolipin, and IgG antiphosphatidylethanolamine antibodies were studied in all probands during periods of clinical remission and in first-degree relatives at the time of interview. Lupus anticoagulant had only been studied in probands during an SLE flare-up.
Results. Thirty-eight percent of probands and 19% of relatives were positive for at least one aPL, with little over-lap between the different aPL studied. -No aPL-negative proband developed thrombosis. Two of the aPL-positive probands had thrombotic events before testing, and a third one showed thrombosis after testing. Only two probands had high levels of IgG aCL and showed thrombosis. The occurrence of aPL positivity in relatives was not always related to its presence in probands. None of the aPL-positive relatives had hadthrombosis, but recurrent fetal loss was noted in one aPL-positive mother with SLE. Although there was a high frequency of SLE, SLE-like disease, auto-immune disorders or positive serological findings for lupus in first-degree relatives, many of these relativew did not test positive for aPL.
Conclusion. The high levels of IgG aCL may be considered a risk factor for thrombosis. Findings in relatives suggest a multifactorial origin for autoimmune disease and antibody production.
Hypervitaminosis D After Prolonged Feeding With a Premature Formula
Authors: NAKO YASUSHI , FUKUSHIMA NAOBUMI , TOMOMASA TAKESHI , NAGASHIMA KANJI , KUROUME TAKAYOSHI 
Published: December 2021

Hypervitaminosis D is one of the causes of severe hypercalcemia in children. Most cases of hypervitaminosis D during childhood are due to an excessive supplementation of vitamin D by physicians or parents.1,2
To prevent metabolic bone disease of prematurity (rickets of prematurity), formulas designed for premature infants ("premature formulas"), which contain more calcium and vitamin D than standard formulas, are given to premature infants in addition to human milk.1 In some cases, separate vitamin D products are also given to these infants, although requirements for vitamin D and calcium intake in the premature infant and the formerly premature infant have not been fully estimated.1
MOTHER GETS 6 YEARS FOR DRUGS IN BREAST MILK
Authors: L. J. F. 
Published: December 2021

CORONA, Calif., Oct. 27 (AP)—In a case that appears to broaden the prosecution of women who pass drugs to their infants through their bodies, a woman was sentenced here Monday to six years in prison because her breast milk, tainted with methamphetamine, had killed her baby daughter.
In recent years, 160 women in 24 states have been charged with delivering drugs to their babies either during pregnancy or, through the umbilical cord, immediately after childbirth. But the case here in this town 40 miles southeast of Los Angeles is apparently the first in the nation based on the passing of drugs through breast milk.