bluuebunny/crossref_metadata_2025_split huggingface dataset:
Extraordinary Urinary Frequency
Authors: BLOOM DAVID A. , SEDMAN AILEEN , ZOUBEK JERI 
Published: December 2021

In Reply.—
Thank you for your letter and the comment on our paper. Dr Colodny raises some important points.
Our main point is that children with isolated extraordinary daytime frequency do not need extensive hematologic, radiologic, urodynamic, and psychiatric studies nor do they need routinely vigorous pharmacologic treatment. Even oxybutynin chloride is not innocuous. In addition to heat intolerance, facial flushing, and dry mouth, we have seen it cause attention deficits at school, hair loss, irritability, constipation, diarrhea, and dental problems, so we are reluctant to use this as liberally as we would a placebo.
Pierre Robin Sequence Management
Authors: BROOKS LEE J. 
Published: December 2021

To the Editor.—
The recent report by Bull et al, "Improved Outcome in Pierre Robin Sequence: Effect of Multidisciplinary Evaluation and Management" (Pediatrics. 1990;86:294-301), emphasized the importance of multidisciplinary approach, including a sleep center evaluation for patients with complex craniofacial disorders. The authors' point that oximetry alone is inadequate should be emphasized, their data demonstrates the difficulty in interpreting polysomnographic data in children, especially during active times such as feeding.
In Figure 2, the signal from the thoracic and abdominal strain gauges are of low amplitude and irregular, with no obvious relationship to airflow.
Career Satisfaction in Pediatrics
Authors: STRAIN JAMES E. 
Published: December 2021

In Reply.—
Dr Bosley cites the article by Schunk and Osterud on "Duration of Pediatric and Internal Medicine Practice in Oregon" (Pediatrics. 1989;83:28-432). A survey of Oregon pediatricians and internists older than 60 years of age showed close agreement between the two groups in their satisfaction with their career choices. Internists averaged 8.2 on a linear scale (with 0 representing low satisfaction and 10 representing high satisfaction), and pediatricians averaged 8.0.
Despite similar responses to career satisfaction, 76% of the internists indicated they would select internal medicine if they had it to do over again, but only 44% of the pediatricians said they would select the same specialty.
Diabetes Mellitus Associated With Cystic Fibrosis: Applying American Diabetes Association Standards
Authors: SHEEHAN JOHN P. , ULCHAKER MARGARET M. 
Published: December 2021

To the Editor.—
The article of Reisman et al1 in the September 1990 issue of Pediatrics suggests that a diagnosis of diabetes mellitus does not impact survival negatively, in contradiction to an earlier study.2 It is therefore pertinent to look at the diagnostic and treatment criteria for Reisman et al's patients. First, the nondiabetic patients were not proven to be so based on glucose tolerance test. A recent study highlighted the fact that the glucose tolerance test may be required to diagnose accurately more than 60% of patients.3
Diabetes Mellitus Associated With Cystic Fibrosis: Applying American Diabetes Association Standards
Authors: REISMAN JOE 
Published: December 2021

In Reply.—
John Sheehan and Margaret Ulchaker make several interesting points in their letter. They were critical of the fact that nondiabetic patients were not proven to be so by glucose tolerance testing. To test more than 530 patients regularly with such testing is not felt to be indicated or practical in our clinic. Although such testing may identify individuals with abnormal glucose metabolism, this manuscript was concerned with survival of insulin-dependent diabetics.1 Such patients when untreated will spill sugar in their urine, and/or exhibit other clinical symptoms, and thus be identified at their regular clinic visits.
Neuroanatomic Imaging in Autism
Authors: Courchesne Eric 
Published: December 2021

In the last decade, neuroimaging research has established that neuroanatomical abnormalities often occur in autistic individuals, but no single type of reported abnormality is ubiquitous in autism. Abnormalities in cerebral cortex, thalamus, basal ganglia, and brainstem have been inconsistently found or infrequently reported, but definitive studies remain to be done. Enlargement of cerebrospinal fluid spaces is present in some autistic people.1-10 One of the most frequently found abnormalities in autism with and without mental retardation is a reduction of cerebellar tissue.1,2,4,5,11-22 The reduction in cerebellar tissue appears to be greatest in neocerebellar regions within the vermis and hemispheres.4,11,12,15,16,18-22 The reduction appears to be the result of developmental hypoplasia rather than damage following full development, and so it may serve as a temporal marker to identify the events that damage the developing brain in autism, including other neural structures that may be concomitantly damaged.11
CEREBRAL HEMISPHERES, THALMUS, BASAL GANGLIA, AND LATERAL AND THIRD VENTRICLES
Quantitative Imaging Studies
Early quantitative computed tomography (CT) studies reported unusual parietooccipital and frontal asymmetries in autistic patients.23 Fourteen recent CT and magnetic resonance (MR) studies involving 283 autistic subjects have quantitated the size, volume, night-left asymmetry, and radio density on signal intensity of either the cerebral hemispheres, thalamus, basal ganglia, limbic structures, lateral ventricles, or third ventricle (Tables 1 and 2). In addition, these structures have been microscopically examined at autopsy in several cases of autism (Table 1).
As seen in Tables 1 and 2, in quantitative neuroimaging studies there is no substantial evidence of abnormality in the cerebral hemispheres, corpus callosum, thalamus, basal ganglia, brain volume, lateral ventricles, and third ventricles.
Microscopic Neuroanatomic Abnormalities in Autism
Authors: Bauman Margaret L. 
Published: December 2021

Since its initial description in 1943,1 autism has been primarily conceptualized as a behavioral disorder, and for many years it was believed to be the result of parental and environmental influences. With heightened clinical interest in the disorder, coincident with advances in medical technology, however, evidence for an underlying neurologic basis for autism has become increasingly apparent.
HISTORICAL NEUROPATHOLOGIC PERSPECTIVE
Based largely on the constellation of symptoms that characterize the disorder, various anatomical sites within the brain have been suggested as a possible primary source of pathology in autism. Suspected regions have included the medial temporal lobe,2-5 the thalamic nuclei,6 the basal ganglia,7 and the vestibular system.8 Computed tomographic imaging studies have shown inconsistent findings.9-14 More recently, however, magnetic resonance imaging studies have described abnormalities in portions of the cerebellum and posterior fossa.15-17
Direct microscopic examination of the autistic brain has, until recently, yielded little information. Aarkrog18 reported "slight thickening of the arterioles, slight connective tissue increase in the leptomeninges, and some cell increase" in a frontal lobe biopsy performed on an autistic patient. Later, in 1976, 33 cases of childhood psychosis were reviewed by Darby.19 Although he suggested a possible correlation between limbic system lesions and the affective symptomatology of autism, no consistent neuropathologic findings were found. In 1980, Williams et al20 studied sections of brain from four patients with autistic-like behavior; looking primarily for cell loss and gliosis, they failed to find any consistent abnormalities.
MICROSCOPIC NEUROANATOMIC OBSERVATIONS
In 1984, anatomic abnormalities were reported in the brain of a 29-year-old man with well-documented autism; the technique of whole brain serial section was used, and the patient was studied in comparison with an identically processed age- and sex-matched control subject.21,22
Summary of Major Changes in the 1991 Red Book
Authors:   Committee on Infectious Diseases
Published: December 2021

In 1991, the new edition of the Report on the Committee on Infectious Diseases (the Red Book) has been published by the American Academy of Pediatrics (AAP), providing the most recent recommendations and guidelines for control and management of infectious diseases in infants and children.1 These recommendations and guidelines are based on information available through October, 1990 and replace those given in the 1988 Red Book. To aid physicians and other health care professionals in assimulating new recommendations and information into their practices, a summary of major changes is given in the Red Book. This summary is reprinted here (with minor changes). Subsequent recommendations of the American Academy of Pediatrics are published as committee statements in AAP News and Pediatrics. In keeping with the 2-to 3-year intervals between the editions of the Red Book, the next edition is anticipated in late 1993 or 1994.
Major changes in recommendations and related information in the 1991 Red Book are summarized as follows:
1. Immunization Recommendations. The schedules for routine immunization incorporate the changes in recommendations for Haemophilus b, as of October, 1990 (See "Note.") and measles vaccines. In view of the increased complexity of immunization schedules, particular attention should be given to the footnotes in the immunization schedules. The schedule recommended by the World Health Organization Expanded Programme on Immunization (EPI) is also included.
2. Reporting of Adverse Events. The new procedure for reporting adverse events following administration of vaccines (VAERS) is described.
3. Contraindications to Vaccines. The recommendation concerning a minor illness as a possible contraindication to diphtheria-tetanus-pertussis (DTP) immunization has been modified.
Evaluation of Heart Murmurs
Authors: SMYTHE JOHN F. , TEIXEIRA OTTO H. P. , VLAD PETER , DEMERS PIERRE PAUL , FELDMAN WILLIAM 
Published: December 2021

In Reply.—
We find that when the patient has not been diagnosed as having organic heart disease, the authority of the cardiologist is challenged rarely, because most people accept the concept that those who dedicate full time to a specific activity (the cardiologist) have a higher level of confidence than those who do not (family physician). Obviously, the problem is more complicated when there is need to delabel a child previously diagnosed incorrectly. We find then that laboratory studies are helpful to alleviate unnecessary but persistent parental concerns.
Newborn Screening for Cystic Fibrosis
Authors: LYON IAN C. T. , WEBSTER DIANNE R. 
Published: December 2021

To the Editor.—
The report on newborn screening for cystic fibrosis1 illustrates the need for continued evaluation of such programs. The authors state that the identification of cases of cystic fibrosis (CF) by an elevated level of immunoreactive trypsinogen (IRT) in second (follow-up) samples from infants with positive initial screening tests could result in false negatives in 27% of cases of cystic fibrosis without meconium ileus (MI).
We have screened 401 122 infants using the method originally reported.2
Foreign Body Pulmonary Granulomas in an Abuser of Nasally Inhaled Drugs
Authors: JOHNSON DANIEL COREY , PETRU ANN , AZIMI PARVIN H. 
Published: December 2021

Development of pulmonary granulomas from injected foreign substances is a known complication of intravenous drug abuse.1 We observed the development of foreign body granulomas in the lungs of a patient who abused methamphetamines solely by nasal inhalation.
CASE REPORT
J.R. was a 15-year-old white boy who presented with a 1-month history of intermittent fever, night sweats, pleuritic chest pain on inspiration, and cough. He specifically denied anorexia, weight loss, intravenous drug abuse, homosexuality, known exposure to asbestos or silicone, or contact with birds or hay. He admitted to a severalmonth history of snorting "crank," a powdered form of methamphetamines. He had smoked one pack of cigarettes per day for the previous year.
Treatment of Lyme Borreliosis
Authors:   Committee on Infectious Diseases
Published: December 2021

The increasing number of cases of Lyme disease has resulted in frequent questions about the prevention, diagnosis, and treatment of this disease. The following information and guidelines may be helpful.
EPIDEMIOLOGIC CONSIDERATIONS
Lyme disease is caused by infection with the spirochete Borrelia burgdorferi. The organism is carried by a small tick, usually nymphal Ixodes dammini on the East Coast and Ixodes pacificus in the West. The disease is clustered in specific areas, with most cases reported in the Northeast, Wisconsin, Minnesota, and California. For patients who do not live in or have not traveled in those areas, the chances of acquiring Lyme disease are very small. However, at least some endemic cases have been reported from 46 states and Canada. Dogs can be infected with this spirochete and can develop symptoms of arthritis.
PREVENTION
Tick bites can be decreased by wearing clothing with long sleeves and long pants. Permethrin sprayed on clothing is effective in decreasing tick attachment. Tick repellents such as DEET are effective, but they require repeated application every 1 to 2 hours,1 and they have some negative side effects. For example, seizures have been reported coincidently with the application of DEET.2 If used, DEET should be applied sparingly only to exposed skin and should not be used on children's faces or hands. It should not be applied to irritated or abraded skin and should be washed off after coming indoors.
Daily inspection and prompt removal of ticks should help prevent infection because prolonged attachment appears to be required for an infected tick to transmit spirochetes.
Questioning Asthma Treatment Study
Authors: TAL ASHER , LEVY NISSIM , Bearman Jacob E. 
Published: December 2021

In Reply.—
We thank Drs McJunkin and Stallo for their interest in our paper. Their suggestion of using objective lung function measurements in young children and infants with acute asthma in the emergency department is impractical. The pulmonary index score we used includes at least one important lung function measure, namely, respiratory rate; this score also has been shown to be very reliable in children.1 Although we routinely use the peak expiratory flow rate in children in the emergency department, most of our patients were younger than 3 years of age and could not cooperate with this objective measurement.
The Future of Primary Care
Authors: LOBECK CHARLES C. 
Published: December 2021

To the Editor.—
As a pediatrician who has been a medical school administrator for almost 17 years, I am troubled by the lack of pediatric leadership in the primary care movement. Joel Alpert1 calls attention to the failure of the discipline to respond within itself to the need for change in pediatric education. I am concerned about a larger issue.
At the time of the Millis Commission report in 1966, pediatrics was the only clinical discipline active in primary care.
Teen Suicide
Authors: SAHLER OLLE JANE Z. 
Published: December 2021

To the Editor.—
Congratulations to Drs Adler and Jellinek for their special article "After Teen Suicide: Issues for Pediatricians Who Are Asked to Consult to Schools."1 As someone who does such consultations, I appreciate their suggestions and have sent copies of the article to the superintendent of my school district for his use and distribution; I urge others to do the same for their districts.
There are three points I would like to discuss. The first is that a suicide is often a district-wide event.
The BPD Problem
Authors: SINKIN ROBERT A. , COX CHRISTOPHER , PHELPS DALE L. 
Published: December 2021

In Reply.—
The above letter by Merritt et al gives us the opportunity to emphasize the goals of our report. Our model was not meant to be applied to individual neonates for prognostic reasons but only to select the most appropriate neonates for enrollment in clinical trials testing therapy for the prevention or treatment of "BPD." In this way, neonates with a low risk for BPD would be ineligible, enriching the frequency of BPD in the study population.
The Weismann-Netter Syndrome: A Cause of Bowed Legs in Childhood
Authors: FRANCIS GARY L. , JELINEK JAMES J. , MCHALE KATHLEEN , ADAMSON MEGAN , LEVIN SONDRA W. 
Published: December 2021

The Weismann-Netter syndrome is a rare, heritable skeletal dysplasia which often presents as asymptomatic bowing of the lower legs or short stature.1 Although more than 40 cases have been described, there is mention of only 8 cases in patients who were younger than 16 years of age.1-9 In retrospect, most of the affected adults reported symptoms during childhood. We recently had the opportunity to evaluate a 4-year-old boy, whom we believe to have the Weismann-Netter syndrome. This case served to heighten our awareness of this condition, which should be recognizable in the pediatric age range.
CASE REPORT
The proband (Fig 1), a four-year-old Arabic boy, was the product of a full-term, uncomplicated pregnancy.
Remembering As We Look Ahead: The Three E's and Firearm Injuries
Authors: WIDOME MARK D. 
Published: December 2021

There was a little man, and he had a little gun,
And his bullets were made of lead, lead, lead;
He went to the brook, and he saw a little duck,
And he shot it through the head, head, head.
—Mother Goose
Four decades ago, Harry Dietrich,1 a member of the American Academy of Pediatrics' newly established Accident Prevention Committee, described a developmentally based approach to the prevention of childhood injury. Dietrich stressed the great need for protection ("passive immunization") for the young child and for safety education ("active immunization") as the child matures. It was also in the early 1950s that George Wheatley, the first chairman of the Accident Prevention Committee, popularized the "three E's"2—education, enforcement, and engineering—as a framework for developing and categorizing strategies to prevent injuries.
Asthma and Food Sensitivity
Authors: CROOK WILLIAM G. 
Published: December 2021

To the Editor.—
In their article in the January issue of Pediatrics, Hughes et al1 stated, "Asthma is the most common chronic medical condition affecting children .. Treatment of the asthmatic child is often crisis oriented, possibly at the expense of ongoing care and preventive measures."
Although these investigators stated that study subjects had significantly less school absenteeism than control subjects and spent fewer days in hospitals, I could find no mention of the role of food sensitivities in asthma in children.
Asthma and Food Sensitivity
Authors: HUGHES DANIEL M. , GOLDBLOOM RICHARD B. 
Published: December 2021

In Reply.—
Dr Crook inquires about the role that food sensitivities might play in our study subjects with asthma. During the initial assessment visit, we reviewed the triggers of asthma, including allergens, in all subjects. Where specific foods were identified by the parent as triggering asthma symptoms—and this was a rare occurrence—the child was encouraged to continue to avoid the particular food. Recognizing the limitations of skin testing for foods, we did not undertake to carry out this procedure.
Starvation Ketosis After Rehydration With Diet Soda
Authors: LEWIS PAUL 
Published: December 2021

Pediatricians often tell parents to give their children clear liquids for hydration during acute gastroenteritis. Since the release of aspartame (Nutrasweet) in 1981, the composition of some clear liquids for hydration of children has changed. Although 12 ounces of sucrose-sweetened carbonated beverage contains about 100 calories, the same volume of aspartame-sweetened beverage contains about one calorie. Therefore, using aspartame-sweetened beverage to support hydration in children with diarrhea theoretically increases the potential for a starvation state to develop. A case of oral rehydration associated with starvation ketosis is described.
CASE HISTORY
In the 3 weeks preceding admission, a 5-year-old boy had been treated with oral cephalexin (Keflex) for a knee infection (septic arthritis vs cellulitis).
Gastroesophageal Reflux, as Measured By 24-Hour pH Monitoring, in 509 Healthy Infants Screened for Risk of Sudden Infant Death Syndrome
Authors: Vandenplas Yvan , Goyvaerts Harry , Helven Rudy , Sacre Liliane 
Published: December 2021

Continuous long-term esophageal pH monitoring has become the preferred test to quantify acid gastroesophageal reflux. Because reflux to a limited extent is physiologic, the determination of optimal thresholds to separate normal from abnormal reflux is mandatory. Esophageal pH was measured during 24 hours in 509 healthy thriving infants, aged 3 days to 1 year, using a glass microelectrode with an external reference electrode connected to a portable recorder.
Percentiles of the four parameters studied (reflux index or percent of the investigation time with a pH &lt;4, number of episodes with a pH &lt;4 during 24 hours, number of episodes lasting &gt;5 minutes, the duration of the longest episode (in minutes)) are presented. A percentile curve of the reflux index regarding the age distribution shows that the normal range for the reflux index during the first 12 months of life is about 10% (95 percentile), decreasing from 13% at birth to 8% at 12 months. Application of an age-related percentile curve offers a close-to-reality possibility of data interpretation and illustrates that there is inevitably an overlap of data between normal and abnormal populations, because reflux is a phenomenon occurring to some extent in every human being.
Frogger
Authors: WIDOME MARK D. 
Published: December 2021

"I see nobody on the road," said Alice.
"I only wish I had such eyes," the King remarked in a fretful tone. "To be able to see Nobody! And at that distance too!"
—Through the Looking-Glass
"Frogger," the video game, is now a classic. The game is played from the frog's point of view. Video frogs must cross the road, negotiating lanes of increasingly hostile traffic. Many frogs get squished. When you run out of frogs, you push the reset button and play again.
Rivara,1 in this issue of Pediatrics, reports on an ambitious effort to educate early elementary schoolage children on the rudiments of traffic safety.
Decline in Breast-Feeding?
Authors: TOGNETTI JANET , HIRSCHMAN JAY D. , MCLAUGHLIN JOAN E. 
Published: December 2021

To the Editor.—
The study "Recent Declines in Breast-Feeding in the United States, 1984-1989" by Ryan et al1 recently was brought to our attention because it reports a negative statistical association between participation in the United States Department of Agriculture's Special Supplemental Food Program for Women, Infants and Children (WIC) and the initiation and duration of breast-feeding.
WIC staff at all levels have been working actively to promote breast-feeding in the Program2-4 for many years, and they certainly would be concerned about a negative impact of the Program on breast-feeding.
Pedia-What!
Authors: FISCHER HOWARD 
Published: December 2021

To the Editor.—
Several pharmaceuticals manufactured for children have the prefix "pedia-" in their names. These include Pedicare (a line of cold and allergy preparations, McNeil), Pedialyte (oral electrolyte maintenance solution, Ross), Pediacof (a codeine-containing cough preparation, Winthrop Pharmaceuticals), PediaSure (liquid nutrition for children, Ross), Pediaflor (fluoride drops, Ross), Pediapred (prednisolone sodium phosphate, Fisons), and PediaProfen (Ibuprofen, McNeil).
The first two on this list are sold without prescription. Although they are very different in appearance and therapeutic aim, I have seen some confusion among parents about these two preparations.