bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gas Formation in the Pleural Space of a Child with an Anaerobic Streptococcal Pneumonia and Empyema
Authors: Fischer Philip R. , Stanberry Lawrence R. , Glasgow Lowell A. 
Published: December 2021

Anaerobic pleuropulmonary infections are common in adults1 but are unusual in children.2 Since the advent of antimicrobial chemotherapy, intrathoracic gas formation associated with these infections in children has not, to our knowledge, been reported.3 The purpose of this report is to describe a severe anaerobic streptococcal pneumonia and empyema with gas formation in a 9-year-old child and to review the diagnostic considerations stimulated by the presence of intrathoracic air-fluid levels.
CASE REPORT
A 9-year old white girl was transferred to the Primary Children's Medical Center, University of Utah for treatment of an apparent lung abscess. Thirteen days prior to transfer this previously healthy girl had been admitted to another hospital with a one-day history of lower midabdominal pain.
Carbamazepine-Isoniazid Interaction
Authors: Block Stanley Hoyt 
Published: December 2021

Carbamazepine (Tegretol) is a frequently prescribed anticonvulsant that is particularly effective against complex partial and generalized tonic-clonic seizures.1 Manifestations of carbamazepine toxicity include aplastic anemia, rashes, stomatitis, dizziness, diplopia, confusion, headache, anorexia, and nausea.2
Carbamazepine has been noted to have a variety of interactions with other medications. The use of carbamazepine in combination with oral anticoagulants, contraceptives, or doxycycline, decreased the effectiveness of these medications by the probable induction of microsomal enzymes by carbamazepine. When taken with propoxyphene or troleandomycin, an increased carbamazepine effect has been noted, probably due to inhibition of microsomal enzymes by those drugs.3
The following case report describes the interaction of carbamazepine with isoniazid.
Salt and Caffeine Intake in a 19-Month-Old Child
Authors: Rider Paul S. 
Published: December 2021

I recently saw at his regular checkup a 19-month-old male child with a history of marked polydipsia and polyuria. The mother stated that for the past month she had been using at least 20 diapers a day and he was awakening 15 to 20 times a night for a drink. The mother said she had begun keeping a pitcher of water at her bedside to meet the child's needs.
The child's growth and development were normal.
Oral Aqueous Suspension of Indomethacin Should Be Abandoned
Authors: Scanlon John W. 
Published: December 2021

Despite considerable clinical and experimental data that indomethacin can close the patent ductus arteriousus (PDA) in human newborns, reports of therapeutic failures have been published. Brash et al1 note pharmacokinetic vagaries after intravenous administration and these relate to clinical response, but most previous reports discuss orally administered indomethacin. There may be a simple pharmacologic explanation for some therapeutic failures after oral indomethacin in the newborn.
In published papers, and in many nurseries, indomethacin is usually prepared by dissolving the contents of one 25-mg capsule in 10 ml of distilled water.
X-Linked Mental Retardation and Fragile-X or Marker-X Syndrome
Authors: Rhoads Frances A. 
Published: December 2021

Gerald's commentary1 on this subject is timely. We have been investigating this disorder, and I offer a few additional comments that are based on our own observations and on those of others working in the field and which may be helpful for pediatricians:
1. The term nonspecific sex-linked mental retardation covers a heterogeneous group of disorders with individuals with the fragile site or marker, now designated fra(X)(q28), estimated to account for one third to one half of all cases.
Letters to the Editor
Authors: Gerald Park S. 
Published: December 2021

Rhoads provides some interesting facts. It is my opinion that insufficient information is available to conclude that males hemizygous for the fragile-X cytogenetic defect are infertile. Indeed, some evidence to the contrary may be available (for example, Rhoads' reference 6).
The mutation frequency for the fragile-X has yet to be determined and is vital for informed genetic counseling. The conclusion that one third of fragile-X males will be new mutations is derived from Haldane's well-known analysis.
Treatment of Fragile-X
Authors: Harpey Jean-Paul 
Published: December 2021

In their commentary, "Fragile Sites on Chromosomes," (Pediatrics 69:121, 1982) Hecht, Glover, and Kaiser-Hecht stress the possibility of therapy in cases of fragile-X linked mental retardation. I have had the opportunity to treat three members of a family with the fragile-X chromosome.
A 21-year-old man with mental retardation and psychotic symptoms, had macroorchidism and fragile-X site in 13% of his cells in 199 medium. A first therapeutic trial with folic acid, 10 mg, orally, per day and vitamin B12, 1 mg, orally, per day resulted in a great improvement of his comportment without change in the percentage of the fragile-X site.
Aspirin and Reye Syndrome
Authors:   Committee on Infectious Diseases, Fulginiti Vincent A. , Brunell Philip A. , Cherry James D. , Ector Walton L. , Gershon Anne A. , Gotoff Samuel P. , Hughes Walter T. , Mortimer Edward A. , Peter Georges 
Published: December 2021

Because of the unique nature and importance of this report, the Committee urges that members read it in its entirety, and examine the report of the Reye Syndrome Working Group convened by the Centers for Disease Control (National surveillance of Reye syndrome 1981: Update, Reye syndrome and salicylate usage. Morbidity Mortality Weekly Rep 31:53-56, 61-63, 1982).
For some years there has been a suspicion that Reye syndrome is due, at least in part, to one or more drugs administered during an antecedent viral illness, usually influenza or chickenpox. Suspected drugs have included antiemetic and antipyretic preparations. More recently, concern has centered on salicylates.
In November 1980, summaries of epidemiologic studies of Reye syndrome performed for two consecutive years in Ohio and in Michigan were reported (Morbidity Mortality Weekly Rep 29:532, 1980). These studies demonstrated an association of Reye syndrome with the administration of aspirin during the antecedent illness. In December 1980, a full report of a small study of Reye syndrome in Arizona by Starko and colleagues (Pediatrics 66:859, 1980) produced similar results. The membership was made aware of these studies by the Committee on Infectious Diseases and the Committee on Drugs via News & Comment in March 1981.
More recently the Committee has had an opportunity to review full reports of the Ohio and Michigan studies, not yet published. The Committee believes that the results of this review should be brought to the attention of the membership.
Each of these studies, including that from Arizona, was performed using the case-control method.
STATISTICAL PYROTECHNICS
Authors:   Student
Published: December 2021

The term medical research dignifies a heterogeneous group of activities. These range from well-designed studies intended to test clearly articulated hypotheses to anecdotal accounts of arbitrarily selected cases. The former speak eloquently for themselves, and of the latter the least said the better. Somewhere between lies a category of studies known disparagingly as "fishing expeditions." These arise when investigators have no clear idea of what is being sought but collect data in the hope of finding some hitherto unsuspected associations between measurable variables . . . the cynic may perhaps be forgiven for objecting that fishing expeditions often beg far more questions than may feasibly be answered . . . .
Data generated by fishing expeditions do not have any logical structure imposed upon them by prior hypotheses and therefore they tend to be numerous, messy, and difficult to interpret. Generally help is sought from statistics, in the form of significance tests which are performed on all conceivable associations in the data. Associations found to be statistically significant at, say, the 5% level are reported and all too often these are widely and uncritically accepted as genuine. Regrettably, the dangers of data-dredging by significance tests are insufficiently recognised.
ISAAC WATTS ON OBEDIENCE TO PARENTS, AS VIEWED IN THE EIGHTEENTH CENTURY
Authors: C. T. E. 
Published: December 2021

Isaac Watts (1674-1748), a non-conformist English preacher, was famous in his own time for his textbooks on Logick and on the Principles of Geography and Astronomy. Today he is best remembered for his hymns and certain moralistic verses for children. A favorite verse known to many past generations of British and American children is the following1:
Obedience to Parents
Let children that would fear the Lord,
Hear what their teachers say;
With reverence meet their parent's word,
And with delight obey.
Have you not heard what dreadful plagues
Are threatened by the Lord,
To him that breaks his father's law,
Or mocks his mother's word?
What heavy guilt upon him lies!
How cursed is his name!
The ravens shall pick out his eyes,
And eagles eat the same.
But those who worship God, and give
Their parents honor due,
Here on this earth they long shall live,
And live, hereafter too
Newborn Screening for Phenylketonuria
Authors: Berry Helen K. , Porter Leonard J. 
Published: December 2021

The Committee on Genetics of the American Academy of Pediatrics recently reviewed problems of screening for phenylketonuria (PKU).1 They recognized that some affected infants will be missed by screening and made recommendations on the structure of screening programs and timing of collection of blood samples. We have also examined some of the issues regarding the reliability of screening for PKU at a given age.
Several factors affect the reliability: the rate of rise in level of phenylalanine in an affected infant after birth, the effect of protein intake on the rate of rise of phenylalanine, and the sensitivity of the procedure for measuring phenylalanine.
Another View of Carbon Dioxide and Retrolental Fibroplasia
Authors: GOLE G. A. , GANNON B. J. 
Published: December 2021

To the Editor.—
Wolbarsht et al1 advanced several hypotheses in their letter regarding the role of CO2 in retrolental fibroplasia. We take issue with their letter on the following grounds: 1. No evidence is presented that levels of retinal Pco2 rise during O2 induced retinal vasoconstriction. CO2 has a high diffusion coefficient, 20 times that of oxygen2 and we suggest that such CO2 produced in the retina would rapidly diffuse the short distance to the high-flow choroidal circulation. 2.
Likelihood Ratio, Skull Roentgenograms, and Clinical Decision-Making
Authors: LEONIDAS JOHN C. , BINKIEWICZ ANNA , SCOTT R. MICHAEL , PAUKER STEPHEN G. 
Published: December 2021

In Reply.—
We appreciate the thoughtful comments of Leventhal and Lembo and concur with their conclusion that the clinician needs to know "the probability of skull fracture in a patient with head trauma." Unfortunately, their proposed "clinical likelihood ratio" (CR) will not further that end because it compares the predictive value (or, more precisely, the posterior probability) of a skull fracture after a positive clinical finding to the posterior probability after a negative finding. After the patient has been examined, the patient does not have both findings; thus, the CR cannot apply to the individual patient.
Intoxication from Accidental Marijuana Ingestion
Authors: WEINBERG DIANA , LANDE ARTHUR , HILTON NANCY , KERNS DAVID L. 
Published: December 2021

The increasing availability and use of marijuana in children, adolescents, and adults have been well documented in recent years. Adverse reactions have been described in adults who absorb the drug via inhalation or by oral and intravenous routes.1-5 To our knowledge, no cases of oral intoxication in very young children have been reported in the pediatric literature. We describe the adverse effects experienced by three children after an accidental oral ingestion of marijuana.
CASE REPORTS
Case 1
J.H., a 3-year-old previously healthy, white girl, was noted by her baby-sitter to be behaving abnormally a short time after lunch. Approximately two hours later, her mother observed the child to have an ataxic gait and a voracious appetite.
Donors for Liver Transplantation
Authors: STARZL THOMAS E. , HAKALA THOMAS R. , ROSENTHAL J. THOMAS , DENNY DON 
Published: December 2021

There is good evidence that the decade of the 1980s will witness an expansion of efforts to transplant extrarenal organs. This will have a profound effect in pediatrics, and particularly in the field of hepatology. The number of infants born with biliary atresia is not known with certainty, but it is likely that there are approximately 500 new cases each year in the United States. The number of lethal hepatic based inborn errors of metabolism that can be effectively treated with liver replacement has steadily grown. Other acquired hepatic disorders are not uncommon in infancy and childhood.
If transplantation of the liver (or of the kidney, heart, intestine, pancreas, and possibly other organs) is to reach its full potential, pediatricians will have to be more acutely aware of the need for organs, and will need to collaborate actively in the procurement process.
Differing Opinions on the Emergency Treatment of Choking
Authors: DAY RICHARD L. 
Published: December 2021

In this issue, Montgomery1 criticizes Heimlich's article2 published last year and goes on to cast doubt on the Heimlich maneuver and Heimlich's fear of back blow. Valid research on choking is difficult, and impossible to conduct in children because it would be unethical. Experimental and anecdotal data concerning adults, although scarce, do exist. The reader is referred to Gordon et al,3 Ruben and MacNaughton,4 Redding,5 and Day et al.6
The last of these four studies introduces measurement of the ballistic forces on the neck in response to the momentary straightening of the spine induced by a back blow. A supraglottic foreign body would be expected to be forced downward with more than three times the pull og gravity.
Sudden Infant Death Syndrome and Phenothiazines
Authors: KAHN A. , BLUM D. 
Published: December 2021

In Reply.—
Stanton reminds us of the hypothesis that overheating could be a major factor in some unexpected infant deaths.1 Phenothiazine, by impairing normal temperature regulation, could induce overheating and hence the sudden death of the baby.
We presently have no data to appreciate the proposed mechanism. In our hospital, among 98 victims of SIDS, the skin temperature was reported to the abnormally hot in seven (7.1%), normal in 43 (43.9%), and abnormally cold in 48 (49%) when discovered.
Multiple Anaerobic Pulmonary Abscesses
Authors: STERN ROBERT C. , BERKOWITZ ROBERT J. 
Published: December 2021

In Reply.—
Behrents and colleagues reemphasize some of the points we made in our article, and so it is difficult for us to find much fault with their ideas. We feel that we presented a strong case for a cause-effect relationship between the beginning of orthodontic treatment and the development of multiple localized pulmonary abscesses whose etiologic agent was an organism found in oral secretions. Behrents and colleagues are not convinced. We stand by our conclusions and invite the readers of Pediatrics to reread our article and decide for themselves.
Benzyl Alcohol: Toxic Agent in Neonatal Units
Authors:   Committee on Fetus and Newborn,   Committee on Drugs
Published: December 2021

As advances have been made in the care of very low-birth-weight infants, some techniques or practices have caused unexpected complications. One such practice is umbilical vessel catheterization to monitor an infant's arterial blood pressure, infuse fluids and medications, and obtain blood specimens for laboratory examinations. The catheters frequently are flushed with sterile isotonic saline or a 5% solution of dextrose in water, with the flush solution frequently being obtained from a multiple-dose vial. The United States Pharmacopeia requires all medications or solutions marketed in a multiple-dose vial to contain an antimicrobial preservative. Benzyl alcohol, an aromatic alcohol, is used for this purpose in a wide variety of medications and fluids for parenteral therapy, usually in a concentration of 0.9%.
Two groups of investigators, Gershanik et al1 (New Orleans) and Brown et al2 (Portland), independently concluded that an intravascular infusion of flush solutions containing 0.9% benzyl alcohol caused severe metabolic acidosis, encephalopathy, respiratory depression with gasping, and perhaps other abnormalities leading to the death of a total of 16 infants. Blood and urine from several affected infants had high levels of both benzoic and hippuric acids, known metabolites of benzyl alcohol. Both groups stated that no additional cases occurred after solutions with benzyl alcohol preservative were banned in their nurseries.
Subsequently, in May 1982, the Food and Drug Administration3 with the concurrence of the American Academy of Pediatrics and the Centers for Disease Control,4 urged pediatricians and other personnel in hospitals not to use fluids preserved with benzyl alcohol (or other antimicrobial agents) as intravascular flush solutions for newborn infants and not to use diluents with this preservative to reconstitute or dilute medications for infants.
Neonatal Screening for Cystic Fibrosis: Position Paper
Authors:   Ad HOC COMMITTEE TASK FORCE ON NEONATAL SCREENING, CYSTIC FIBROSIS FOUNDATION, Taussig Lynn M. , Boat Thomas F. , Dayton Delbert , Fost Norman , Hammond Keith , Holtzman Neil , Johnson Wendy , Kaback Michael M. , Kennel John , Rosenstein Beryl J. , Stolz Walter S. , Trause Mary Ann ,   Cystic Fibrosis Foundation Medical Staff, Beall Robert J. , Keramidas Sherry L. 
Published: December 2021

Neonatal screening represents the search for a disorder in a general newborn population. The purpose of screening may be to improve the health of the affected infant, to provide counseling, or for research. Screening tests have been widely accepted for conditions such as phenylketonuria, hypothyroidism, and other metabolic conditions. Cystic fibrosis (CF) is the most common lethal genetic disorder among the white population (with a lower incidence among blacks), and thus there has been interest in screening newborns for CF1 However, proposals emanating from this interest have remained controversial.2-4 The recent development of a relatively simple test—the dried blood immuno-reactive trypsinogen (IRT) assay—has increased this interest.5-12
Besides considering technical reliability and validity of newborn screening methods, it is crucial that all other aspects of screening (including medical, ethical, psychosocial, and economic aspects) be rigorously examined before implementing mass screening.13-15 To address these issues the Cystic Fibrosis Foundation convened a Task Force on Neonatal Screening. Although the Task Force considered the current status of the IRT test, it focused on the generally accepted criteria for newborn screening, summarized in the Table,14 and the relationship of these criteria to the present state of knowledge related to CF. The issues identified by the Task Force, are summarized in this paper, and recommendations are presented at the conclusion.
EFFECTIVENESS OF PRESYMPTOMATIC TREATMENT
Evidence suggesting that the initiation of treatment before clinical manifestations of CF first appear improves prognosis has been controversial. Whereas some studies have yielded supportive data,16 others have not.4 There are no generally accepted treatment protocols for use in symptomatic or asymptomatic patients.
Circumcision
Authors: MAISELS M. JEFFREY 
Published: December 2021

In Reply.—
Contrary to Wallerstein's opinion, the fact that we admitted to certain limitations in our study design does not "invalidate the study." Whether or not the mothers received additional information from other sources, pro or con, is irrelevant because the process of randomization makes it highly likely that similar information was received by both groups. Our written material expressed, quite clearly, the opinion of the American Academy of Pediatrics—that circumcision is not a medically justified procedure.
Car Seat Burns
Authors: CARTER BOYD A. 
Published: December 2021

To the Editor.—
In our office we have recently seen two children with burns obtained while being placed in a car seat. The first child was a 2-year-old toddler with a mild first degree burn to the right thigh area requiring minimal further care. However, the second child was a 15-month-old infant who was seen in our office with a second degree burn requiring debridement as well as local antibiotic care. The burn healed well, but these occurrences suggest the possibility of severe burns.
Short Children and Growth Hormone
Authors: COPELAND KENNETH C. 
Published: December 2021

To the Editor.—
The article by Bright et al1 was a provocative description of two subjects with short stature, normal growth hormone (GH) responses to provocative testing, and low somatomedin-C (SM-C) concentrations, which increased after administration of GH. The authors conclude that the short stature in these individuals may be due to a biologically inactive GH molecule or to decreased dose responsiveness to GH of SM-producing cells. Their data also seem compatible with a third possibility: normal short children respond to GH administration with increases in SM-C plasma concentrations and growth rates.
Malpractice Issues
Authors: HECHT FREDERICK 
Published: December 2021

To the Editor.—
With interest I read the correspondence between Turetsky and Carstensen (readers) and Brent (author) on "The Irresponsible Expert Witness," (Pediatrics 1983;71:990-991). I agree with their concerns and wish to add several observations and recommendations based upon service as an expert witness in malpractice and toxic tort cases:
1. Certain physicians and scientists appear recurrently as expert witnesses.
2. The fees for expert witnesses, as Brent notes, are soaring. Today an active expert witness can make a living from this pursuit or supplement his income handsomely.
The Prenatal Visit
Authors:   Committee on Psychosocial Aspects of Child and Family Health
Published: December 2021

A visit to the pediatrician's office by the expectant couple makes good sense; yet, it appears to be the exception rather than the rule. In a recent survey, 73% of 118 practicing pediatricians reported that they conduct prenatal visits, but only 22% of their expectant couples had actually been seen before their infant's birth. This percentage is even lower in other settings.
On their first contact with the pediatrician, expectant parents should be encouraged to make an appointment for an office visit. This visit, which usually takes place during the eighth or ninth month of pregnancy, represents an opportunity for the pediatrician to gather data, give information, initiate a continuing relationship, and enhance the parents' competency in decision making. The session helps the parents select a pediatrician with whom they are comfortable and enables them to feel that they are meeting their responsibility to provide skilled care for their infant.
In the beginning of the prenatal visit, the pediatrician should convey a personal interest in the prospective parents by asking questions that provide an opportunity for him or her to become acquainted with the parents and their expectations: "How long have you lived in the community?" "What kind of work do you do?" "What are your interests and hobbies?" "How have you been feeling?" "How do you expect to deliver?" How do you plan to feed your baby?" "Have you obtained an infant car seat to take the baby home in?" "Is it a boy or girl?" Prenatal discussions with the pediatrician may augment the expectant couple's confidence in their feelings about breast-feeding, circumcision, and rooming-in.