bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changing Spectrum of Serious Child Abuse
Authors: BERGMAN ABRAHAM B. 
Published: December 2021

In Reply.—
Dr Hanson seems to be so upset with our article that she appears not to have read it. I thought we packed our paper with disclaimers of our imperfect data system and our fallibility in identifying perpetrators. In epidem research on clinical problems, one must play with the cards that are dealt.
The diagnosis of physical abuse is a medical one and was made by the pediatrician attached to the child abuse teams or by the King County medical examiner.
Cranial Bruising and Intraventricular Hemorrhage
Authors: ACS HEDDA , KILCHEVSKY EITAN 
Published: December 2021

To the Editor.—
We read with interest the article by Kuban et al1 that concluded that phenobarbital might be associated with an increased risk of subependymal-intraventricular-in-traparenchymal hemorrhage in premature infants. The authors compared the incidence of cranial bruising and found it to be 17.2% in the phenobarbital-treated group and 9.6% in the placebo-treated group. Szymonowitz et al2 found that, of all the obstetric data obtained from premature infants in whom intracranial hemorrhage developed, birth trauma, as evidenced by severe bruising, was the only significant factor.
Dyslipoproteinemia and Migraine
Authors: LEVITON ALAN 
Published: December 2021

To the Editor.—
Glueck and Bates1 describe a greater than expected incidence of dyslipoproteinemias in boys who were brought to the Children's Hospital of Cincinnati for evaluation of disabling migraine. They will have made an important contribution if their findings are replicated, and treatment of the lipid disorders in these children and their families does indeed reduce their risk of cardiovascular disorders.
Two implications of their work were not considered in the article. First, who should be screened for dysilipoproteinemias?
Sudden Death Associated With Biotinidase Deficiency
Authors: BURTON BARBARA K. , ROACH E. STEVE , WOLF BARRY , WEISSBECKER KAREN A. 
Published: December 2021

To the Editor.—
We report a case of sudden death in a patient with presumed biotinidase deficiency and emphasize the importance of suspecting this diagnosis in patients who present with compatible clinical findings.
A nonconsanguineous couple was seen for genetic counseling following the death of their first child, a boy, at 23 months of age. A review of the history revealed that the child was normal until 5½ months of age when seizures developed which were eventually controlled with carbamazepine.
Emergency Care of the Child
Authors: BUSHORE MARTHA 
Published: December 2021

Optimal emergency care of the child requires a well-developed EMS-C system. The components are easy to identify. We need macroregions with institutions acknowledging their institutional capabilities for pediatric emergency care and supporting field triage and transfer agreements. We need highly educated and skilled prehospital care providers, from emergency medical technicians in the field to air and ground transport services with specialized pediatric transport teams. In addition to having an appropriate hospital emergency department attending physician staff, hospitals must develop networks of cooperation between emergency departments appropriate for pediatrics and childern's emergency care centers.
These centers strive for quality care through systematic record keeping, chart reviews, and audits identifying care deficiencies and appropriate remedies. Subsequent reviews document improved care. There are meetings of prehospital and hospital-based providers to discuss the management of challenging cases. Comprehensive pediatric emergency care involves integration of emergency stabilization patient care with community and hospital social services, patient education programs (such as Child Life), and comprehensive rehabilitation programs, as well as community accident prevention and basic life support programs.
As we strive to develop optimal emergency medical services for our country to best serve our people, comprehensive emergency care of children must have separate consideration from comprehensive emergency care of adults. If we are to assure optimal outcome for the life-threatened child, we need to continuously assess regional needs and capabilities and encourage optimal involvement of health care providers and institutions.
Neonatal Personpower
Authors: KATZMAN GERALD 
Published: December 2021

To the Editor.—
There have been several attempts to define the person-power needs for neonatologists in the United States.1-3 The reports by Merenstein et al2 and the AAP Committee on Fetus and Newborn1 maintain that there is presently an adequate number of neonatologists, whereas in a 1981 editorial, Robertson3 predicted increasing shortages of neonatologists. Why the difference between the conclusions? My answer to this question is that the reports by Merenstein et al and the AAP used calculated ratios of neonatologists to live births or lengths of stay, whereas the Robertson editorial expressed concern about the critical care needs of the physiologically unstable neonate.
Cerebrospinal Fluid Endorphins and the Infant Apnea Syndrome
Authors: SOUTHALL DAVID P. 
Published: December 2021

To the Editor.—
In his interesting paper (Pediatrics 1986;78:233-237), Orlowski states that one explanation for elevated levels of endorphins might be that they increase in response to the stress of a prolonged apneic episode. He rightly points out that elevated endorphin levels alone do not demonstrate a causal relationship to prolonged "abnormal" apnea. Unfortunately, he subsequently implied that, because the number of short, normally occurring, apneic pauses of 4 to 10 seconds in the group with high endorphin levels appear to be reduced in frequency by naloxone, this finding supports a primary role for endorphins in the genesis of abnormal apnea.
Cytomegalovirus and the Brain
Authors: CONBOY THOMAS J. , PASS ROBERT F. , BOLL THOMAS J. 
Published: December 2021

In Reply.—
We agree with Ades et al that our study1 was not definitive in ruling out the possibility of intellectual impairment in children born with asymptomatic cytomegalovirus and said as much in our discussion, mentioning the relatively small sample size as one of several caveats. It is important to note that our study included only asymptomatic children with normal hearing in order not to confound the effects of hearing loss on intellectual performance with possible effects of the virus.
Steroid Effects on the Course of Abdominal Pain in Children With Henoch-Schonlein Purpura
Authors: ROSENBLUM NORMAN D. , WINTER HARLAND S. 
Published: December 2021

Henoch-Schonlein purpura is a systemic vasculitis of unknown cause that is characterized primarily by abdominal pain, arthritis, and purpuric skin lesions. Abdominal pain is the most common gastrointestinal symptom, but intestinal bleeding and intussusception may occur. Previous studies have supported the use of steroids in managing the abdominal pain of Henoch-Schonlein purpura.1,2 Because there are no controlled trials using steroids in this disease, their value in affecting the intestinal lesions of Henoch-Schonlein purpura remains unknown. The purpose of this retrospective study was to assess the effect of corticosteroids on the outcome of abdominal pain in children with Henoch-Schonlein purpura.
PATIENTS AND METHODS
Congenital Pilar and Smooth Muscle Nevus
Authors: GVOZDEN ANDRE B. , BARNETT NANCY K. , SCHRON DEBORAH S. 
Published: December 2021

Dermatologists and pediatricians are often consulted by parents and other health professionals about the prognosis, management, and aesthetic effect of congenital nevi. In this paper we review the literature and report two new cases of a recently described and possibly underdiagnosed form of congenital lesion, the pilar and smooth muscle nevus.
CASE REPORTS
Case 1
A 6-month-old girl was evaluated for a skin lesion present since birth on her left flank. At the time of examination, it consisted of a well-defined brownish blue, lightly pigmented, barely visible macule with coarse blond hair, 6 x 7 cm (Fig 1). Upon stroking, slight, transient erection of the hair was appreciated.
ORAL HEALTH IN PEDIATRICS
Authors: BIGLER JOHN A. 
Published: December 2021

Symposia on oral health in children have been all too few on pediatric programs. Although there have been numerous articles in the dental and public health journals, comparatively few have appeared in pediatric and other medical literature. When one considers that children are particularly vulnerable to dental caries and it is estimated that 92% of the population have some dental problems, the importance of this subject becomes evident.
There are not enough dentists in this country to take care of the problems. For this reason, prevention and control of dental caries becomes the responsibility of the physician as well as the dentist. It becomes even more an obligation than a responsibility because we as pediatricians assume care that makes for total child health.
With this in mind the pediatrician must keep abreast of the theories of dental caries initiation, its control and prevention. He should also recognize when children are getting proper dental care.
EFFECTS OF ACTH AND CORTISONE ON LEUKEMIA IN CHILDHOOD
Authors: SCHULMAN IRVING , LANMAN JONATHAN T. , LAXDAL OLIVER E. , HOLT L. EMMETT 
Published: December 2021

The results of treatment of 14 children with leukemia with ACTH and cortisone have been presented. Complete laboratory and clinical remissions lasting 1 to 33 weeks were induced in six patients; incomplete remissions were induced in two others.
No favorable responses were encountered in terminal states, monocytoid leukemia, and granulocytic leukemia differentiated beyond the blast stage. No relationship could be demonstrated between refractoriness to the hormones and to antifolic acid therapy; patients completely refractory to one agent have shown complete response to the other.
Although repeated remissions may be induced by hormone therapy, increasing resistance to the drugs tends to develop. While permanent benefit has not been obtained, ACTH and cortisone constitute valuable additions to the therapy of leukemia.
Circumcision
Authors: THOMPSON ROBERT S. , THOMPSON DIANE C. 
Published: December 2021

To the Editor.—
Wiswell et al,1 in 1985, and Wiswell and Roscelli,2 in 1986, report three retrospective cohort studies (Tripler, Brooke, and all Army hospitals) in which the association of circumcision status (circumcised v noncircumcised) and subsequent hospitalizations for urinary tract infection in the first year of life is evaluated. Cases appear to have been determined from examination of available hospital discharge data and the diagnosis confirmed by suprapubic bladder tap or catheterization. The authors report a ten- to 20-fold increase in hospitalized urinary tract infections among noncircumcised boys in the first year of life.
Lawn Darts Peril Underlined
Authors: AMOURY RAYMOND A. 
Published: December 2021

To the Editor.—
Drs Tay and Garland stated in their abstract (Pediatrics 1987;79:261-263), "Serious head injuries secondary to lawn darts have not been reported." In 1984, we reported a similar injury due to a lawn dart in the Annals of Emergency Medicine (1984;13:484-486). I concur with the authors that lawn darts are potentially dangerous.
When the cause of a head injury has been identified as a lawn dart, it is most important to proceed with a CT scan, as the authors indicated.
α-Fetoprotein Screening
Authors:   Committee on Genetics
Published: December 2021

The Committee on Genetics of the American Academy of Pediatrics endorses the following guidelines for maternal α-fetoprotein screening, developed by the American Society of Human Genetics.1
Before maternal serum α-fetoprotein (MSAFP) screening is started, the following minimal criteria should be met.
1. Adequate physician/health professional education: The objective of this education is to assure that physicians and other health care professionals understand the nature and range of severity of each of the detectable conditions and anomalies, the objectives of screening and testing, the importance of timing and reporting the low predictive value of test results, and the follow-up procedures and counseling.
2. Access to a qualified MSAFP and amniotic fluid α-fetoprotein laboratory: Criteria for quality control in these laboratories are detailed in the full statement.
3. Adequate facilities and personnel for follow-up of abnormally high or low MSAFP values: Counseling, level I and level II sonography, amniocentesis, and qualitative amniotic fluid acetylcholin-esterase assay should be available.
4. Adequate patient education: Information should be provided on the nature of the defects detectable by MSAFP screening, on confirmatory procedures, and on the options available should an abnormal result be confirmed.
The optimal time for MSAFP screening is between 16 and 18 weeks of gestation.
The common MSAFP screening protocol would include: first serum specimen evaluation, second serum specimen evaluation (if indicated), counseling, ultrasonography, amniocentesis, amniotic fluid α-fetoprotein testing (acetylcholinesterase and fetal blood evaluation), karotyping.
Once the program is underway, physician's offices, laboratories, and referral centers should have staff available who can answer questions concerning procedures related to MSAFP screening.
Physical Fitness and the Schools
Authors:   Committee on Sports Medicine,   Committee on School Health
Published: December 2021

During the last decade our concept of what "physical fitness" means has undergone a major change. Traditionally the "physically fit" child was one who had obvious motor (or athletic) abilities, ordinarily defined by such parameters as muscle strength, agility, speed, and power. But the high levels of power, speed, and agility necessary for success in most competitive sports have little or no relevance in the daily lives of most adults. Today, the words "physical fitness" imply optimal functioning of all physiologic systems of the body, particularly the cardiovascular, pulmonary, and musculoskeletal systems.1
DEFINING PHYSICAL FITNESS
Physical fitness is now considered to include five components: muscle strength and endurance, flexibility, body composition (ie, degree of fatness), and cardiorespiratory endurance. Good cardiorespiratory endurance may be associated with a lessened chance of disability or death due to cardiovascular disease. Schools in the United States have traditionally emphasized sports such as football and baseball, both of which require agility and skill but are not particularly fitness enhancing. Aerobic activities (eg, activities requiring maintenance of 75% of maximal heart rate for 20 to 25 minutes), if performed at least three times a week, can lead to enhanced cardiorespiratory endurance. This improvement in fitness can be achieved by swimming, running, bicycling, field hockey, aerobic dancing, fast walking, etc.
SCHOOL PROGRAMS
Unfortunately, just as the understanding of the importance of health-related physical fitness has become widespread, our ability to direct youth activities toward fitness is being countered by several new pressures: (1) Financial strains may lead public school systems to reduce physical education budgets.
Sexual Behavior in the Home
Authors: ROSENFELD ALVIN 
Published: December 2021

In Reply.—
Dr Smith states that "if the estimates of incest are accurate, then some of the 576 families in the sample would be expected to think and behave incestuously." If Sigmund Freud was correct, thinking incestuously, at least unconsciously, is normal, perhaps even a sign of healthy emotional development; behaving incestuously is psychopathologic and illegal.
How frequent is actual incest between parents and/or stepparents and their children? Finkelhor1 used a broad definition of "victimization" and surveyed 530 women and 266 men attending colleges and universities.
Familial Hiatal Hernia
Authors: LEUNG ALEXANDER K. C. 
Published: December 2021

To the Editor.—
Hubert and Toyama1 reported a 2-month-old infant and his mother with hiatal hernia at the age of 2 months and suggested that the condition is transmitted by an autosomal dominant gene.
Unlike congenital diaphragmatic hernia, most reviews fail to mention the familial occurrence of gastroesophageal reflux or hiatal hernia. Crabb et al2 described a family in which eight members in three generations had gastroesophageal reflux. In 1984, I reported a 13-month-old girl with gross gastroesophageal reflux.3
Pediatrician's Role in Development and Implementation of an Individual Education Plan
Authors:   Committee on Children With Disabilities
Published: December 2021

According to the US Department of Education, 4.36 million children in the United States (more than 11% of children 3 to 21 years of age) received some special education services during the 1984/1985 school year.1 Therefore, it is likely that a sizeable percentage of children seen in a pediatric practice for initial evaluation and follow-up care will have a developmental disability that requires an individual education plan. Pediatricians must understand the importance of such a plan and be aware of their role in its development, implementation, and interpretation.
BACKGROUND
Public Law 94-142, the Education for All Handicapped Children Act of 1975, was intended as an educational bill of rights for handicapped children, guaranteeing them a free and appropriate education. The law required identification, diagnosis, education, and related services for children 5 to 18 years of age. In 1977, the age range was extended to include children between 3 and 21 years, with services for children between the ages of 3 and 5 years remaining optional. Not only were these services to be provided, but states were encouraged to seek out handicapped children who had not been previously served. Public Law 99-457, the Education of the Handicapped Act Amendments of 1986, further extends the range of the law by mandating services for children 3 to 5 years of age. This new law also provides funding for states to voluntarily develop programs that serve infants and toddlers (birth to 3 years of age) who are at risk for or are suspected of having handicapping conditions.
Pediatrics and Poverty
Authors: OBERG CHARLES N. 
Published: December 2021

In Reply.—
In response to Dr Graham's concerns about the recently published commentary,1 I concur that the increase in poverty among our children is not attributable to a single administration. Indeed, the escalation commenced in the middle 1970s and has continued to the present time. However, the recent and significant budgetary reductions observed in the early 1980s appear to have reduced essential social support services at a time when such assistance was most in need.
Blood Pressure Measurement
Authors: LONDE SOL 
Published: December 2021

To the Editor.—
The report of the Second Task Force on Blood Pressure Control in Children1 recommends the use of K4 in preadolescent children because the authors say that K5 readings are frequently difficult to obtain in that age group, and K5 is easier to record in adolescents. We have used K5 in our studies because we are more certain of it. We have challenged the use of K4 because its recognition depends on subjective judgment of a qualitative change in the character of the sounds.2
Adolescent Varicocele
Authors: OKSTEIN CHARLES J. 
Published: December 2021

To the Editor.—
The recent article on testicular histology in the adolescent with a varicocele (Pediatrics 1987;79:996-998) pointed out the potential histologic testicular damage that can occur in the presence of this condition. The authors stated that, in some cases of unilateral varicocele, histologic abnormalities were found in the contralateral testis. They further commented that early ligation of varicoceles would seem reasonable if it could be shown that progressive histologic damage could be arrested by the procedure.
Hypoxemia and Retinopathy of Prematurity
Authors: KATZMAN GERALD , SATISH MALINI , KRISHNAN VENKATESAN 
Published: December 2021

To the Editor.—
We read with interest the article by Bancalari et al1 regarding the incidence of retinopathy of prematurity in neonates managed with and without transcutaneous Po2 monitoring. It occurred to us that Bancalari et al may be in a position to use their data to test an association that we observed in Toledo.
In our work, Pao2 was analyzed by assuming linear trending between individual Pao2 values determined from blood samples taken from umbilical artery catheters.
Vitamin Dosages for Premature Infants
Authors: WALSH WILLIAM F. 
Published: December 2021

To the Editor.—
I was confused by the article about multiple vitamin preparation for total parenteral nutrition by Moore et al (Pediatrics 1986;77:530-538). The study of vitamin levels is crucial to making recommendations, but why would the authors choose to give all premature infants 65% of the recommended dose for infants and children, when the package insert clearly states, "Infants less than 1 kg: the daily dose should not exceed 30% of the contents. Do not exceed this daily dose."?
Blood Pressure Cuff Confusion
Authors: LOGGIE JENNIFER 
Published: December 2021

To the Editor.—
Since the report of the Second Task Force on Blood Pressure Control in Children (Pediatrics 1987;79:1-25) was published, several individuals have asked me (1) why we changed the recommendation for cuff size from one that covers two thirds to one that covers three quarters of the upper arm and (2) what data formed the basis for this change in recommendations?
When I reread the published report to verify cuff size recommendations, it appeared to me that somewhere along the line a transcription error had taken place.
Vitamin E and Retinopathy of Prematurity
Authors: JOHNSON LOIS , ABBASI SORAYA , QUINN GRAHAM E. , OTIS CHARI , BOWEN FRANK W. 
Published: December 2021

To the Editor.—
In the 1987 April issue of Pediatrics1 Dr Phelps and colleagues reported the results of their study of prophylactic vitamin E and retinopathy of prematurity and related them to those of other trials. They concluded that the evidence for efficacy of tocopherol in decreasing "severe" retinopathy of prematurity is not convincing and that its use in infants weighing ≤1,000 g at birth may be contraindicated and even produce death.
With regard to toxicity, the reader needs to be reminded that the fatalities referred to followed administration of high doses of a preparation of IV tocopherol acetate (E-Ferol) which was not subjected to field testing and was not used in any of the clinical trials.
AIDS, Children, and Breast-Feeding
Authors: CANTANI ARNALDO 
Published: December 2021

To the Editor.—
The article by Rogers et al1 concerning AIDS in children draws attention to important epidemiologic and prognostic issues. As of Aug 1, 1987, the number of affected children reached 720—558 from the United States and 58 from Europe. However, the studies on vertically infected infants reviewed by me2-6 indicate that the incubation period of AIDS in such infants varies between 22 and 12 months.5 Rogers et al state that the incubation is 1 to 86 months.
Urine Latex Particle Agglutination
Authors: FRIEDMAN ALLAN D. 
Published: December 2021

To the Editor.—
Ramsey et al1 recently reported their experience with two immunochemical methods for the detection of the capsular antigens of Haemophilus influenzae and Streptococcus pneumoniae in the urine and serum of patients with lower respiratory tract infection. S pneumoniae was detected in 26 urine specimens by bacterial coagglutination (Phadebact). H influenzae was detected by latex agglutination in nine patients.
From September 1986 to March 1987, we studied 26 patients with radiographically documented pneumonia.