bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acute Hyponatremia and Seizures in an Infant After a Swimming Lesson
Authors: BENNETT HOWARD J. , WAGNER TEEKIE , FIELDS ALAN 
Published: December 2021

There have been a number of recent reports describing water intoxication in infants.1-4 In each case, hyponatremia followed an excessive intake of free water, either as the result of feeding mismanagement1-3 or vigorous hydration with water during a febrile illness.4 This report describes an infant who developed hyponatremia and seizures after swallowing an unknown volume of water during a swimming lesson. We will discuss the case and comment on present recommendations for preschool swimming instruction.
CASE REPORT
An 11-month-old girl was in excellent health until the day of admission. During a 60-minute swimming lesson, she was noted to swallow more water than usual, but exhibited no unusual symptomatology while in the pool.
More on Newborn Screening for Phenylketonuria: Recommendations of the Committee on Genetics
Authors: SCRIVER CHARLES R. 
Published: December 2021

In Reply.—
In the 12 months subsequent to publication of the statement by the Committee on Genetics,1 there has been no adverse correspondence with the Journal or the Academy on the issues raised in the statement. Nonetheless, Schoen now raises a question of potentially broad relevance; it concerns the recommendation about repeat testing for hyperphenylalaninemia in the newborn discharged from the nursery before the third day of life. Schoen is critical of the data that the Committee used to reach its conclusions.
Infant Drownings in Toilets!?
Authors: NEHAMEN DENNIS A. 
Published: December 2021

To the Editor.—
Because of a growing recognition of fatalities or near-fatalities resulting from infants drowning in toilets, I am conducting a broad research survey. I am seeking brief capsule reports of noted incidents and would like to add that in the event the research is ultimately published, honorariums will be paid to contributors.
Some Pediatricians Uninformed
Authors: WEISS JEFFREY C. , DE JONG ALLAN R. , CALLAHAN CLARA 
Published: December 2021

To the Editor.—
Policy statements and articles that appear in Pediatrics, Pediatrics in Review, and News and Comment of the American Academy of Pediatrics attempt to disseminate information about various legal and social issues that are important to pediatricians. Because we were interested to learn whether or not our house officers were knowledgeable in these areas, we administered a quiz to the 22 residents and to the 15 full-time faculty members in our department. The physicians could respond by marking "true," "false," or "don't know."
Growth Failure and Inflammatory Bowel Disease: Approach to Treatment of a Complicated Adolescent Problem
Authors: Rosenthal Susan R. , Snyder John D. , Hendricks Kristy M. , Walker W. Allan 
Published: December 2021

Severe retardation of linear growth occurs in a minority of children with Crohn's disease. It appears to be associated with increased disease activity and decreased caloric intake. Why some children are affected and others are not is unknown, but some degree of growth retardation is probably more prevalent than is generally appreciated. The use of somatomedin-C levels may be of some future value in predicting which children will be affected. Growth failure is often difficult to treat and requires vigorous medical and nutritional support. No current treatment is without attendant problems. Proper and frequent assessment of growth and development will help ensure intervention while growth potential still exists in these children.
Large cooperative studies are needed to compare the effects of various treatment plans on the growth velocity and ultimate stature of children with Crohn's disease-related growth retardation.
Optimism and Myths
Authors: GEME JOSEPH W.ST. 
Published: December 2021

In Reply.—
Klein expresses his point of view with clarity and intensity. That is important. I am optimistic about pediatrics and its future. That is important to me. I also believe that the optimism is reasonable. There is an increasing sense of competition between pediatrics and family medicine. The same seems to be true for internal medicine and family medicine. The competition in the spheres of educational program and clinical performance is healthy. We will continue to learn from each other and the roles of the pediatrician, internist, and family physician will evolve as a function of our knowledge, our clinical competence, the desires of our patients, and, perhaps, our enthusiasm about what we do.
Aeromonas hydrophila: A Treatable Cause of Diarrhea
Authors: KIPPERMAN HARRY , EPHROS MOSHE , LAMBDIN MORRIS , WHITE-ROGERS KAREN 
Published: December 2021

Aeromonads are bacteria, found in water and soil, which cause a wide spectrum of human infections in normal and compromised hosts.1 Although primarily gastrointestinal pathogens, aeromonads also cause trauma-related infections of skin, soft tissue, muscle and bone, as well as non-trauma-related infections, including endocarditis.1-4 Gastrointestinal infections due to Aeromonas sp are frequently identified in Southeast Asia, India, and Australia3,5-7 but rarely in the United States.2,8 This report describes a case of profuse watery diarrhea due to Aeromonas hydrophila in a child from Maine.
CASE REPORT
A 5-month-old female infant with Down's syndrome and Hirschsprung's disease developed diarrhea and vomiting.
Protest Views of Singer
Authors: BONGIOVANNI ALFRED M. 
Published: December 2021

Editor's Note:
A Commentary represents an individual's opinion. Commentaries are often controversial. They are not AAP policy statements. No matter how often this is pointed out some individuals persist in condemning or threatening the Editor and the AAP when we publish commentaries that are contrary to their views. Some individuals seem to believe that the journal should not print views that differ from their own. The AAP's official position on life-sustaining treatment for seriously ill newborns was stated in the October 1983 issue of Pediatrics.
Biostatistics Articles Needed
Authors: JACOBS STEPHEN E. 
Published: December 2021

To the Editor.—
I read with great interest Hayden's article, "Biostatistical Trends in Pediatrics: Implications for the Future" (Pediatrics 1983;72:84-87). While emphasizing the importance of the care with which journal editors review the statistical analyses employed in the articles published, the author does not dwell on the readers' low level of knowledge.
The editorial by Feinstein, "Prophylactic and Remedial Therapy for the Intellectual Ailments of `Biostatistics,' " in the same issue (Pediatrics 1983;72:131-133) reiterates the points made in the article.
Biostatistics Articles Needed
Authors: HAYDEN GREGORY F. 
Published: December 2021

In Reply.—
As Jacobs suggests, his experience is far from unique. Many physicians have had little or no training in biostatistics and research design and, therefore, feel ill-prepared to understand the methods of published studies. Responding to this need, several medical schools have recently developed new courses in clinical epidemiology and biostatistics. This trend, if it continues and spreads, should help to relieve the problem in the years ahead.
For a more immediate solution, I applaud Jacobs' enthusiasm for a series of biostatistical tutorials, and note that three prominent journals have already published, or announced their intentions to publish, such articles.1-3
An Outbreak of Clostridium difficile Necrotizing Enterocolitis
Authors: MATHEW OOMMEN P. , BHATIA JATINDER S. , RICHARDSON C. JOAN 
Published: December 2021

To the Editor.—
Han et al1 present some interesting epidemiologic observations on an outbreak of necrotizing enterocolitis (NEC). These investigators conclude that Clostridium difficile may be implicated as an etiologic factor in the reported outbreak of NEC "based on the remarkably strong association of the toxin and/or organism in 12/13 cases of NEC; and the absence of organism and very limited presence of toxin in the unaffected controls (2/17)." One wonders about the causal relationship between C difficile and NEC when this conclusion is viewed in the context of high colonization rate2,3 in babies in intensive care and the lack of association2,4 between C difficile and NEC reported by others.
Guidelines for Home Care of Infants, Children, and Adolescents with Chronic Disease
Authors:   Ad Hoc Task Forces on Home Care of Chronically III Infants and Children
Published: December 2021

Many infants, children, and adolescents with long-term, serious health problems are confined to hospitals for prolonged treatment during recovery, and such patients are rehospitalized frequently. Hospitalized patients usually lack the normal, interpersonal family relationships that are important to growth and development. Combining the benefits of home care with optimal medical treatment and support is a challenge requiring development of innovative programs between hospitals, physicians, parents, and communities.
Although home care programs for patients with chronic diseases have been implemented, objective data about the efficiency, risks, benefits, and cost of these programs are limited. Careful planning and coordination of family, hospital, and community resources are essential for home care programs, and initial guidelines for program development and assessment are needed.
The goal of a home care program for infants, children, or adolescents with chronic conditions is the provision of comprehensive, cost-effective health care within a nurturing home environment that maximizes the capabilities of the individual and minimizes the effects of the disabilities.
PROGRAM DEVELOPMENT
Comprehensive planning for all aspects of home health care is essential to minimize physical and emotional risk to the patient, adverse effects on the family members, or unforseen financial burdens. Because of the many factors to be considered, a multidisciplinary team interested in implementation of home health care should be organized. The team should include a pediatrician and may include other physicians (eg, generalists, community physicians, neonatologists, intensivists); nurses; occupational, physical, and speech therapists; developmentalists; child life workers; nutritionists; social workers; teachers; home care providers (eg, nursing providers outside the hospital and equipment providers); parents; and insurers.
Fetal Research
Authors:   Committee on Research
Published: December 2021

In the past several decades, we have witnessed astounding improvements in the health of infants and children as a result of successes in translating knowledge derived from laboratory and clinical research into effective therapies for the fetus and newborn. Improvements in survival and reduction in newborn suffering would not have been possible without direct evaluation of the safety and efficacy of these therapies in the pregnant woman and fetus. For example, work done with pregnant women and their fetuses has led directly to the current Rh screening programs and the use of Rhogam, and has resulted in a marked decrease in pregnancy wastage and newborn morbidity due to erythroblastosis.
The outcome of thousands of pregnancies has been improved as a result of the evaluation of fetal lung maturity by lecithin-sphingomyelin ratio (L/S ratio) and the administration of glucocorticosteroids to enhance lung maturity in infants at risk for hyaline membrane disease. Again, in these studies validation of normal developmental profiles and evaluation of safety and efficacy were required.
Our current success in monitoring pregnancy outcome is based on the safe evaluation of normal growth and our ability to detect adverse genetic and environmental influences in the developing fetus. We now can recognize fetal hypoxia during pregnancy and at delivery by knowledge of fetal heart rate profiles obtained by fetal research. Even the effects of noninvasive measures such as maternal bed rest and improved nutrition on fetal outcome in the pregnancy complicated by maternal hypertension must be assessed by continued fetal research.
Use of Tricyclic Medications in Children
Authors: WOODY ROBERT C. , LIVINGSTON RICHARD , WEINBERG WARREN A. 
Published: December 2021

To the Editor.—
The recent report by Rauber and Maroncelli summarizing the results of a mail survey of pediatricians and family practitioners regarding their knowledge and usage of tricyclic medications1 demonstrates two points: (1) the pediatricians surveyed rarely (0.9%) used tricyclic medications for psychopharmacologic purposes in their practices, and (2) their knowledge of the toxic side effects (defined by Rauber and Maroncelli as tachycardia and seizures) is limited (67%). The authors state that the standard use of tricyclic medications, such as imipramine for enuresis, represents "the use of a dangerous drug for the treatment of a nonlethal disease."
Peripheral Lesions of the Retina in the Premature Newborn
Authors: WILLARD D. , MESSER J. , GERHARD J. P. , TEMPE D. 
Published: December 2021

To the Editor.—
Lucey and Dangman1 showed why a multifactorial explanation of the retinopathy of prematurity seems likely. However, data on the actual role of oxygen, in carefully matched groups, are still lacking. Our survey may contribute to this investigation.
The results of a biomicroscopic investigation of the retina were assessed in two groups of prematurely born children who weighed less than 1,500 g at birth. A Goldman's contact glass made it possible to observe the especially at risk peripheral retina.
Phenobarbital Side Effects: Hyperactivity with Speech Delay
Authors: LEVENSTEIN DAVID , GUTGESELL MARGARET E. , PERCY PHYLLIS 
Published: December 2021

To the Editor.—
Hyperactivity is a reported side effect of phenobarbital usage,1 but we are unaware of any reports of language delay accompanying the hyperactivity. We are writing to draw your attention to an interesting series of cases.
D.R. had been receiving therapeutic levels of phenobarbital for more than 2 years, because he had had two seizures before 1 year of age (the first with fever). Developmental testing after 1 year of age revealed mild mental retardation and delays in all areas.
Written Explanation of Temperament Scores
Authors: LITTLE DAVID L. 
Published: December 2021

Most parents find it worthy of their time to complete the Carey and McDevitt Infant Temperament Questionnaire1 and review the results with the pediatrician.2 This subjective approval is encouraging but the question arises, "Does it improve parenting?" Prior to measuring parenting changes, a standard method of presenting temperament data to parents had to be developed. A brief, inexpensive instrument was needed but none was found.
A written explanation form was developed (Table 1). The definitions were derived from various sources,3,4 including the Carey and McDevitt Questionnaire. The parents' ratings of this form are presented and discussed. The form should be useful for clinicians using temperament measurements in their practices.
Overpsychologized
Authors: GERSH MARVIN J. 
Published: December 2021

To the Editor.—
Cohen's article on the Society for Behavioral Pediatrics1 affords me a long-awaited opportunity to offer some personal comments on behavioral pediatrics. I am in the twilight of a pediatric career (these comments could hasten the night) and my long association with and the mutual respect I share with Cohen and the others involved, allows me to express another point of view without being labeled "hostile." The editor may find my remarks tangential to Cohen's article, but nevertheless, I believe they are relevant to the future of behavioral science in pediatrics.
Does Statistical Significance Equal Real Significance
Authors: HERSHER LEONARD 
Published: December 2021

To the Editor.—
In what is probably the best-controlled study ever published on the controversial question of the effect of stressful life events in a family on childhood illness, Beautrais et al1 have demonstrated unequivocally that those events correlate positively with childhood morbidity.
The authors, however, grossly overinterpret the clinical importance of the results of their study. They state, for example, that "...the net effect of life events on child health was large ..." and that "... children from families experiencing 12 or more life events had ...six times the risk of hospital admission compared with children from families with three or fewer life events."
Early Termination of Breast-Feeding: Identifying Those at Risk
Authors: Loughlin Howard H. , Clapp-Channing Nancy E. , Gehlbach Stephen H. , Pollard John C. , McCutchen Thomas M. 
Published: December 2021

In a private pediatric practice, 94 infants who were breast-feeding were followed for the first 2 months of life in order to define the frequency of cessation of breast-feeding and to identify factors that would predict mothers and infants at risk for early cessation.
At 8 weeks, 30% of the mothers had stopped nursing. Factors associated with cessation were: maternal lack of confidence in breast-feeding (P &lt; .001); anticipated duration of nursing less than 6 months (P = .002); ratings by the nursery staff of infant's excessive crying (P = .007), infant's demanding personality (P = .007), trouble with féeding (P = .001), and future trouble with feeding (P = .004). Together, these factors predicted 77% of the mothers who terminated breast-feeding. Supplementing with formula before the 2-week office visit also led to termination of breast-feeding by 8 weeks (P = .006). This decision was frequently made without medical advice. Nearly 64% (14/22) of the mothers who added formula within the first 2 weeks did so without contacting the pediatric practice.
Bronchiolitis and Recurrent Wheezing
Authors: WELLIVER ROBERT 
Published: December 2021

To the Editor.—
I read with interest the article by McConnochie and Roghmann on bronchiolitis and wheezing.1 I especially applaud the effort that extends epidemiologic studies of possible long-term effects of bronchiolitis to patients whose original illness was mild enough to permit outpatient management. The authors found a portion of recurrent wheezing following bronchiolitis that could not be explained by personal or family history of atopic illness, passive smoking, or any factor other than bronchiolitis itself.
Breaker's Back
Authors: BITHONEY WILLIAM G. 
Published: December 2021

To the Editor.—
I wish to bring to the attention of Pediatrics readers a cause of back trauma among urban adolescents. In the Comprehensive Child Health Program, we recently saw a male adolescent who complained of lumbar back pain, relieved by rest and aggravated by bending over and by vigorous physical activity. He had also noted a mass about the size of an orange in the center of his back; he denied any history of trauma to the area.
Jean Seam Coccygodynia
Authors: STOSHAK MARCIE L. , MORTIMER EDWARD A. 
Published: December 2021

To the Editor.—
We believe we have identified a new syndrome that may be of practical interest to those who care for adolescents. We present two case reports.
Case 1. This 14-year-old female student complained of low back pain and tenderness, which she had experienced for 2 months, since her return to school in September. On examination, there were no findings but the location of the pain was determined to be the coccyx. On questioning, she acknowledged wearing tight blue jeans with heavy reinforced seams to school.
Roentgenology and Malabsorption Syndromes
Authors: SMITH DAVID S. 
Published: December 2021

To the Editor.—
The paper by Weizman et al1 in which radiologic manifestations observed in association with intestinal malabsorption syndromes are reevaluated is reminiscent of a similar concern in our department, some 40 years ago, that culminated in the paper, "The Roentgenologic Pattern of the Small Intestine in Infants and Children" by Henry Zwerling and Waldo E. Nelson.2 Naturally, I was not aware of their study until my association with Dr Nelson a few years later.
The stimulus for each of these studies was similar, viz, roentgenlogic demonstration of intestinal patterns that had been attributed to intestinal malabsorption (see references in each article) in children who had no clinical evidence of this disorder.
E-Ferol
Authors: PHELPS DALE L. 
Published: December 2021

In Reply.—
Bowen and Johnson raise two issues regarding my commentary on E-Ferol. One is a technical misunderstanding, which I clarify below. The other issue, was my choice of title and its implications. My commentary was titled "E-Ferol: What Happened and What Now?" It is puzzling how this title could be misconstrued as intending "to comment on what went wrong to cause E-Ferol to be marketed for as long as it was." Bowen and Johnson further extrapolate from this to an incorrect and unsupported inference: "The implication of Phelps is that the Food and Drug Administration was unaware of this product when the contrary is true...." Neither the title nor the content of the commentary was meant to imply this.
Guidelines for the Elective Use of Conscious Sedation, Deep Sedation, and General Anesthesia in Pediatric Patients
Authors:   Committee on Drugs,   Section on Anesthesiology
Published: December 2021

The goals of sedation and general anesthesia in the ambulatory patient are: (1) patient welfare; (2) control of patient behavior; (3) production of positive psychological response to treatment; and (4) return to pretreatment level of consciousness by time of discharge.
DEFINITION OF TERMS
Terms used in this document are defined as follows:
Pediatric patients: Includes all patients who are infants, children, and adolescents less than age of majority.
Must or shall: Indicates an imperative need and/or duty; as essential or indispensable; mandatory.
Should: Indicates the recommended manner of obtaining the standard; highly desirable.
May or could: Indicates freedom or liberty to follow a suggested or reasonable alternative.
Conscious sedation: Conscious sedation is a minimally depressed level of consciousness that retains the patient's ability to maintain a patent airway independently and continuously, and respond appropriately to physical stimulation and/or verbal command, eg, "Open your eyes." For the very young or handicapped individual, incapable of the usually expected verbal responses, a minimally depressed level of consciousness for that individual should be maintained. The caveat that loss of consciousness should be unlikely is a particularly important part of the definition of conscious sedation, and the drugs and techniques used should carry a margin of safety wide enough to render unintended loss of consciousness unlikely.
Deep sedation: Deep sedation is a controlled state of depressed consciousness or unconsciousness from which the patient is not easily aroused, which may be accompanied by a partial or complete loss of protective reflexes, including the ability to maintain a patent airway independently and respond purposefully to physical stimulation or verbal command.
To Tube or Not to Tube: That Continues to Be the Question
Authors: TEELE DAVID W. , ROSNER BERNARD , KLEIN JEROME O. 
Published: December 2021

In Reply.—
We appreciate Chamberlin's thoughtful comments about the associations between otitis media with effusion and development of speech and language and his concern about results that are statistically significant but may not be "clinically significant." We share his view that measurements of the sequelae of disease should include those that are meaningful to the child.
We reported results of tests of speech and language that indicated that children who had spent many days with middle ear effusion during the first years of life scored significantly lower than did children who had not spent such time.