bluuebunny/crossref_metadata_2025_split huggingface dataset:
HIV and Day Care
Authors: MORROW ARDYTHE L. , PICKERING LARRY K. 
Published: December 2021

In Reply.—
We appreciate Dr Fenster's letter, especially since it underscores issues raised by the possibility of having human immunodeficiency virus(HIV)-infected children in day care centers. There are three issues raised by the letter: (1) the question of parent rights; (2) the role of physicians and public health institutions to assess health risks posed by individuals for the population as a whole; and (3) the content of the educational message that should be provided
Telephone Triage by Primary Care Physicians
Authors: Yanovski Susan Zelitch , Brown Richard L. , Balaban Donald J. , Yanovski Jack A. , Malley James D. 
Published: December 2021

To determine if experienced primary care physicians are more likely to reach correct decisions on the telephone than their less experienced colleagues, we asked 31 first-year and 29 third-year residents, 21 faculty, and 36 private practitioners in pediatrics and family practice to evaluate three pediatric patients via a telephone interview with a simulated mother and to decide whether each patient needed to be seen that evening.
Compared with first-year residents, the third-year residents, faculty and private practitioners decided less frequently to see children who were not severely ill (P &lt; .05) or injured (P &lt; .01); however, less than half obtained histories considered adequate to rule out potential serious illnesses. Faculty did better than either residents or private practitioners in managing a severely dehydrated child; 100% of the faculty, but less than 60% of the residents or private practitioners, chose to see the patient promptly (P &lt; .001). More than one third of all residents and private practitioners reached inappropriate management decisions despite obtaining information that should have altered their decisions.
In these simulations, experience in private practice was not associated with improved telephone management of very sick children. Faculty physicians appeared to be better able to identify severely ill children without inappropriately evaluating those who were less ill. In all three simulations, attainment of the correct decision appeared to be determined not by the number or type of questions asked, but rather by the physician's interpretation of the information collected.
Hypercholesterolemia Screening Questioned
Authors: SHEPS SAM 
Published: December 2021

To the Editor.—
The allure of screening has reached epic proportions in a medical world that apparently has difficulty finding enough to keep itself intellectually and gainfully occupied. A case in point, is the recent article by Steiner et al,1 entitled "Hypercholesterolemia in Adolescence: Effectiveness of Screening Strategies based on Risk Factors." Despite the fact that the authors clearly demonstrate that high-risk status as defined by either the 1985 or 1989 American Academy of Pediatrics (AAP) criteria (or both) is not predictive of high cholesterol levels in adolescents (Table 3 notes positive predictive values ranging from .09 to .11), the authors conclude with the startling statement that "Until all the related controversies surrounding cholesterol testing are more clearly understood, all adolescents must be screened to adequately identify those with hypercholesterolemia."
The Overdiagnosis of Erythema Multiforme
Authors: WESTON JANET A. , WESTON WILLIAM L. 
Published: December 2021

To the Editor.—
Erythema multiforme (EM) is an acute, self-limited mucocutaneous eruption characterized by the abrupt onset of symmetrical, fixed, red papules, some of which evolve into target lesions, the hallmark of EM.1 Since the original description by Ferdinand von Hebra in 1860, there has been confusion regarding the diagnosis.2 From children referred for a National Institutes of Health-sponsored research study of EM, we noted that a large majority of the children did not meet the criteria for EM.1
Chronic Fatigue Immune Dysfunction Syndrome: An Epidemic?
Authors: SMITH MARK SCOTT 
Published: December 2021

In Reply.—
The chronic fatigue syndrome (CFS) remains an enigma. A recent Australian study estimated the point prevalence at 37.1/100 000 (5.5 of age 0 to 9 years; 47.9 for 10 to 19 years).1 Since the diagnostic criteria of the study were less stringent than those proposed by Centers for Disease Control (CDC),2 this is probably an overestimate. All the 15 adolescents in our report had profound chronic fatigue, multiple somatic complaints, and marked functional disability, but only six met CDC CFS criteria.
Bilirubin Recommendations Present Problems: New Guidelines Simplistic and Untested
Authors: WENNBERG RICHARD P. 
Published: December 2021

Newman and Maisels1 raise strong arguments to change our approach to neonatal jaundice in the wellbaby nursery. The plea for a more gentle approach to the jaundiced newborn is long overdue, but what do we then do? Newman and Maisels not only identify the problem, but they offer a detailed solution which would significantly alter standards of practice for neonates.
While one might bicker about their selection of evaluation tests to be conducted in the nursery, the proposed guidelines present two more fundamental problems: (1) the recommendation for intervention (total bilirubin concentration 25 to 29 mg/dL) sustains the myth that the total unconjugated bilirubin is the best clinical predictor of kernicterus and ignores known and proposed pathochemical processes involved in bilirubin encephalopathy, and (2) no mechanism is proposed to evaluate the safety and efficacy of their proposal.
Yet Another Expert Opinion on Bilirubin Toxicity!
Authors: JOHNSON LOIS 
Published: December 2021

Drs Newman and Maisels1 have provided valuable new guidelines for management of jaundice in the term newborn which take into account age at discharge from the hospital and some of the factors altering the general risk of bilirubin toxicity. They note that much of the information needed to identify the individual at risk is still unavailable and remind their readers that their "recommendations should be reevaluated periodically as new data become available."
I have serious concerns, however, with the second half of their paper which almost completely downplays the toxic potential of bilirubin, its often erratic expression, and its ability to cause a spectrum of damage ranging from frank kernicterus to insults that are so minor as to be compensated for completely over time.2-4
Response to Commentaries Re: Evaluation and Treatment of Jaundice in the Term Newborn: A Kinder, Gentler Approach
Authors: NEWMAN THOMAS B. , MAISELS M. JEFFREY 
Published: December 2021

We thank Dr Lucey for soliciting expert commentaries on our manuscript and for providing us the opportunity to respond to them. Although we do not have space to respond to each of the commentaries in depth, we will address the major points brought up by more than one author and selected points from the individual commentaries.
Drs Poland and Wennberg emphasize that neurotoxicity due to bilirubin is a complicated process, with many determinants besides the serum bilirubin level; Dr Cashore's four example cases illustrate this point. We agree. A bilirubin level that may be toxic in one infant may not be hazardous in another.
Facing Tragic Decisions with Parents in NICU: Clinical Perspectives
Authors: NARKEWICZ RICHARD M. 
Published: December 2021

To the Editor.—
As a primary care physician I read with great interest the article by Dr Jellinek et at1 about the tragic decisions in neonatal intensive care units. Their perspective seems to be very worthwhile and helpful both to physicians, parents, and patients.
I was disappointed, however, that the family's primary care pediatrician was relegated to the next to the last paragraph, almost an afterthought. Family pediatricians have a great perspective on the interaction between families and their children.
Zinc Deficiency in a Full-Term Breast-Fed Infant: Unusual Presentation
Authors: KHOSHOO VIKRAM , KJARSGAARD JOHN , KRAFCHICK BERNICE , ZLOTKIN STANLEY H. 
Published: December 2021

Zinc is an essential trace mineral for all mammals. The activities of many enzymes, including those needed for protein synthesis, are zinc dependent. It is therefore not surprising that zinc deficiency is cinically expressed in rapidly growing tissues. Zinc deficiency commonly presents with specific skin lesions, diarrhea, growth failure, alopecia, irritability, and anorexia.
Acquired zinc deficiency is an uncommon entity. It has most often been described in patients receiving total parenteral nutrition with inadequate or no zinc in the nutrient mixture.1,2 It has also been described in breast-fed premature babies3,4 in whom symptoms become apparent by 4 to 5 months of age.
Eosinophilic Pustular Folliculitis
Authors: DARMSTADT GARY L. , TUNNESSEN WALTER W. , SWEREN RONALD J. 
Published: December 2021

Eosinophilic pustular folliculitis is a cutaneous disorder that consists of recurrent crops of pruritic, sterile, papulopustules in a follicular distribution. In pediatric patients, EPF presents primarily in the scalp and is confused with several other more common dermatoses in children. The diagnosis of EPF rests on its inclusion in the differential diagnosis of papulo-pustular disorders, the recognition of the clinical presentation, and the presence of an eosinophilic infiltrate on biopsy. Treatment with midpotency topical coticosteroids has thus far met with modest success.
This is the first report on EPF in the pediatric literature. As pediatricians become more aware of EPF as a distinct clinical entity and as our clinical experience and insight into the pathogenesis of EPF grows, perhaps more effective treatment modalities will be devised.
The Use of Whole Cow's Milk in Infancy
Authors:   Committee on Nutrition
Published: December 2021

The pediatrician is faced with a difficult challenge in providing recommendations for optimal nutrition in older infants. Because the milk (or formula) portion of the diet represents 35% to 100% of total daily calories and because WCM and breast milk or infant formula differ markedly in composition, the selection of a milk or formula has a great impact on nutrient intake.
Infants fed WCM have low intakes of iron, linoleic acid, and vitamin E, and excessive intakes of sodium, potassium, and protein, illustrating the poor nutritional compatibility of solid foods and WCM. These nutrient intakes are not optimal and may result in altered nutritional status, with the most dramatic effect on iron status. Infants fed iron-fortified formula or breast milk for the first 12 months of life generally maintain normal iron status. No studies have concluded that the introduction of WCM into the diet at 6 months of age produces adequate iron status in later infancy; however, recent studies have demonstrated that iron status is significantly impaired when WCM is introduced into the diet of 6-month-old infants. Data from studies abroad of highly iron-deficient infant populations suggest that infants fed partially modified milk formulas with supplemental iron in a highly bioavailable form (ferrous sulfate) may maintain adequate iron status. However, these studies do not address the overall nutritional adequacy of the infant's diet. Such formulas have not been studied in the United States.
Optimal nutrition of the infant involves selecting the appropriate milk source and eventually introducing infant solid foods. To achieve this goal, the American Academy of Pediatrics recommends that infants be fed breast milk for the first 6 to 12 months. The only acceptable alternative to breast milk is iron-fortified infant formula. Appropriate solid foods should be added between the ages of 4 and 6 months. Consumption of breast milk or iron-fortified formula, along with age-appropriate solid foods and juices, during the first 12 months of life allows for more balanced nutrition. The American Academy of Pediatrics recommends that whole cow's milk and low-iron formulas not be used during the first year of life.
Guidelines for Monitoring and Management of Pediatric Patients During and After Sedation For Diagnostic and Therapeutic Procedures
Authors:   Committee on Drugs
Published: December 2021

In the last 5 years there has been an increase in invasive diagnostic, radiologic, and minor surgical procedures on pediatric patients outside the traditional operating room setting. As a consequence, there has been a marked increase in the use of sedatives and general anesthetic agents in physician offices, dental offices, subspecialty procedure suites, imaging facilities, emergency departments, and ambulatory surgery centers.1-17 In recognition of the expanding need for both the elective and emergency use of these agents in nontraditional settings, the American Academy of Pediatrics guidelines for the use of depressant agents in children, first presented in 1985 under the title "Guidelines for the Elective Use of Conscious Sedation, Deep Sedation, and General Anesthesia in Pediatric Patients,"18 have been revised.
This revised statement reflects our current understanding of appropriate monitoring needs, both during and after a procedure, for children receiving sedatives and general anesthetic agents.19-29 The monitoring and care outlined in these guidelines may be exceeded at any time, based on the judgment of the responsible physician. Although they are intended to encourage high-quality patient care, observing these guidelines cannot guarantee a specific patient outcome. They are subject to revision from time to time, as warranted by the evolution of technology and practice.
These guidelines are proffered with the awareness that regardless of the intended level of sedation or route of administration, the sedation of a patient represents a continuum, and may result in the loss of the patient's protective reflexes;30 a patient may move easily from a light level of sedation to obtundation.1-6,8,12,14,15,26,29
Positioning and SIDS
Authors:   AAP Task Force on Infant Positioning and SIDS
Published: December 2021

SUMMARY STATEMENT
Based on careful evaluation of existing data indicating an association between Sudden Infant Death Syndrome (SIDS) and prone sleeping position for infants, the Academy recommends that healthy infants, when being put down for sleep, be positioned on their side or back. The most common position currently used in the United States is prone.
This recommendation is made with the full recognition that the existing studies have methodologic limitations and were conducted in countries with infant care practices and other SIDS risk factors that differ from those in the United States (eg, maternal smoking, types of bedding, central heating, etc). However, taken as a group the studies are convincing. No reports show an advantage to the prone position with regard to SIDS incidence and there are no data proving, or even strongly suggesting, that sleeping in the lateral or supine position is harmful to healthy infants. Thus, assessment of the risk/benefit balance for prone vs nonprone positioning for such infants favors the latter. It should be stressed that, the actual risk of SIDS for an infant placed prone is still extremely low.
There are still good reasons for placing certain infants prone. For premature infants with respiratory distress, for infants with symptoms of gastroesophageal reflux or with certain upper airway anomalies, and perhaps for some others, prone may well be the position of choice. A nonprone sleeping position is recommended for healthy infants only.
REPORT
Health care professionals frequently are asked how it is best to place an infant down for sleep, prone or supine.
Questions Collaborative Dexamethasone Trial
Authors: JONES ROSAMOND , GRANT ADRIAN ,   Collaborative Dexamethasone Trial Group
Published: December 2021

In Reply.—
We are glad to respond to Dr MacMahon's letter about the generalizability of the results of our trial. Basing trial entry on `clinical uncertainty' is actually one of the strengths of this trial.1
No trial can ever include a random sample of all human beings who meet the eligibility criteria; there is always selection of subjects (whatever the entry criteria). Inevitably, therefore, at some point there has to be a leap of faith from the evidence to clinical practice.2
Pediatricians in Court
Authors: BENJAMIN JOHN T. 
Published: December 2021

To the Editor.—
I have been a practicing pediatrician for 18 years. There have been many changes in our specialty during that time. Some of the changes have been good and others more troublesome. Good changes have included greater recognition of the importance of our specialty; higher pay scale for residents, and, for that matter, practitioners; our greater ability to diagnose and treat patients: computed tomography, magnetic resonance imaging, and marvelous laboratory tests not even imagined 20 years ago; increased numbers and complexities of medications and methods of monitoring those medications—all of these changes have contributed to improved medical care for children.
More to be Learned from Crigler-Najjar Patients
Authors: HANSEN THOR WILLY RUUD 
Published: December 2021

To the Editor.—
In a recent study by Galbraith et al,1the use of tin-mesopor-phyrin in two patients with the Crigler-Najjar type I syndrome is described. The feasibility of this kind of treatment is documented, and their comments on the size of the total-body bilirubin pool as well as their calculations on bilirubin production and clearance in these patients are very interesting and illuminating.
However, I am personally as much intrigued by aspects of the case reports, about which the authors do not comment, probably because it is outside the focus of their paper.
THE PEDIATRICIAN AND THE PUBLIC
Authors: BAUER LOUIS H. 
Published: December 2021

The American Medical Association was organized in 1847. Its original aim was the improvement of medical education in the United States. This still remains one of its important activities but the Association has expanded tremendously since its formation.
It now consists of 2,011 component county and district societies and 53 constituent associations in the States, Territories and Possessions. County and district societies elect delegates to the state associations and the whole membership of these county societies takes part in their election. These delegates form a State House of Delegates which in turn elects delegates to the American Medical Association.
The A.M.A. House of Delegates is the legislative body of the Association and is responsible for all official policies. All reports, resolutions and recommendations are referred by the House to several Reference Committees who hear testimony on both sides of every question and then render reports to the House. Here all reports are debated again and brought to a vote. Any member of the Association, whether or not a member of the House, can appear before a Reference Committee and state his opinions and recommendations on the matter under discussion.
Between sessions of the House of Delegates, the Board of Trustees is the governing body.
HYPOTONIC CEREBRAL PALSY IN MENTAL DEFECTIVES
Authors: YANNET HERMAN , HORTON FRANK 
Published: December 2021

The relative importance of the hypotonic type of cerebral palsy among the mentally defective is stressed. This type of cerebral palsy manifests itself in either of three clinical pictures with some overlapping, namely, atonic, ataxic and athetoid. The etiology is variable in each of these groups and may be effective in either the prenatal, paranatal or postnatal periods.
The severity of the mental defect, the high incidence of convulsive disorders, and the tendency toward microcephaly point towards the widespread nature of the pathologic process regardless of etiology.
The syndrome of atonic diplegia, as herein described, is probably invariably associated with the more severe degrees of mental deficiency.
EXOGENOUS HEMOCHROMATOSIS IN MEDITERRANEAN ANEMIA
Authors: FRUMIN ABRAHAM M. , WALDMAN SYDNEY , MORRIS PAUL 
Published: December 2021

A patient with Mediterranean anemia who received many blood transfusions over a period of years is presented.
The pigment deposition in Mediterranean anemia, originally thought due to an inherited defect, is attributed to multiple blood transfusions.
It is maintained that this abnormal pigment deposition represents another instance of exogenous hemochromatosis.
GASTROINTESTINAL ALLERGY IN INFANCY
Authors: ROSENBLUM ARTHUR H. , ROSENBLUM PHILIP 
Published: December 2021

The syndrome of gastrointestinal allergy as observed in 60 infants is a clinical entity characterized by diarrhea, colic or vomiting, alone or in varying combinations. Diarrhea is almost twice as common as colic or vomiting.
The syndrome may be suspected upon the demonstration of clumps of eosinophiles, or large numbers of scattered eosinophiles in the stools. The stools are generally high in mucus content, and the eosinophiles are most numerous in the mucus. A rapid, easy method for demonstrating eosinophiles in the stool mucus is described.
The allergic nature of the signs and symptoms is further suggested by:
a. The positive family background of allergy.
b. The development of other major allergic manifestations in the subsequent course of these patients.
c. The striking frequency with which symptoms disappear after the removal of the offending food from the diet. This may be anything in the diet, but is generally cow's milk. Results may not be apparent until a week has elapsed after specific food elimination.
d. Recurrence of symptoms may be demonstrated upon readministration of the offending substance.
The ultimate fate of these babies with regard to the development of later allergic disturbances will have to await long range follow-up studies. It is hoped that the control of these early allergic manifestations may minimize later allergic symptomatology.
Evidence is presented that the first allergic disturbances may occur in the newborn period.