bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Irresponsible Expert Witness
Authors: TURETSKY ROCHELLE A. 
Published: December 2021

To the Editor.—
Congratulations are in order to Robert L. Brent for calling attention to the ethical and scientific problems of the expert witness (Brent RL: The irresponsible expert witness: A failure of biomedical graduate education and professional accountability. Pediatrics 1982;70:754-762). That the recent American Academy of PEdiatrics meetings in New York devoted a Round Table session to this issue, points up the concern with which health care professionals view the interface of law and medicine.
Two points alluded to by Brent deserve to be clearly restated.
BCG Vaccine and Isoniazid Prophylaxis
Authors: BRUNELL PHILIP A. 
Published: December 2021

In Reply.—
The Committee on Infectious Diseases, after carefully considering the advice of its consultants and reviewing the available data, recommends that isoniazid (INH) should not be used concurrently with bacillus Calmette-Guerin (BCG). As indicated in the most recent report of the Committee,1 there is concern about the protection conferred by BCG,2,3 even when it is given without INH. To administer a drug that inhibits the replication of BCG, therefore, appears to be imprudent.
That INH inhiits the replication of BCG is generally acknowledged.
Erythema Multiforme: Confusion with Child Battering Syndrome
Authors: ADLER ROBERT , KANE-NUSSEN BRYNA 
Published: December 2021

A diagnosis of battered child syndrome has important psychological and social ramifications beyond the medical realm and should not be taken lightly. In fact, most states require the physician to report suspected cases of child abuse. This has led to increased awareness of the condition but also to occasional overdiagnosis. Reports in the literature have identified some of the diseases that mimic the battered child syndrome1,2 This report describes another such condition that can be so classified: erythema multiforme (EM) lesions which progress to ecchymotic lesions, a common disease with an unusual presentation.
CASE REPORTS
Case 1
A 22-month-old male infant was seen in the emergency room (ER) with bruises on the abdomen.
Cutaneous Amebiasis
Authors: BROOK ITZHAK 
Published: December 2021

To the Editor.—
Rimsza and Berg1 described a child with amebic liver abscess and vulvar skin lesion which they attributed to ameba. Although there is no doubt the child had amebic liver abscess, it is not certain that the vulvar lesion was due to this microorganism. It is not clear whether proper anaerobic cultures were done to isolate these pathogens from the skin lesion—and the statement that no pathogens were recovered is insufficient. Indeed when proper anaerobic cultures are done, anaerobic organisms are frequently isolated from vulvovaginal lesions in children.2
Shouldn't We Seek To Know More About Slower Growth?
Authors: WALKER ALEXANDER R. P. , STEIN HARRY 
Published: December 2021

To the Editor.—
Currently, much is heard of retarded, normal, attainable, and maximal growth, although the clinical significance of such during youth, and the possible ramifications in adulthood, have been insufficiently studied.
Slower growth is characteristic of the huge bulk of the world's population, and is likely to remain so. In the not-so-distant future, because of population increase it will be imperative to make more economical use of land. Therefore, there will have to be far greater reliance on plant food, which, when consumption is large, is associated with slower growth.
Sleep and Nasal Obstruction
Authors: SHAW EDWARD B. 
Published: December 2021

To the Editor.—
Many of the numerous theories that have recently been advanced to account for respiratory failure in infancy have failed to establish a single persuasive cause for this disaster and have ignored some of the early and perhaps significant proposals to account for sudden infant death syndrome (SIDS). The recent article by van Someren and Stothers1 at least refers to one possible etiology that I have always believed.
During the early months of life, most infants breathe via the nasal passage.
Special Susceptibility of Children to Radiation Effects
Authors:   Committee on Genetics and Environmental Hazards
Published: December 2021

In a nuclear war, children who survive the acute effects of radiation—the blast and intense heat—may also have to survive the loss or disability of parents who provide food, shelter, and love, so necessary for physical and emotional development. The likelihood of provision of even limited medical services following a nuclear blast is virtually nil. Finally, persons exposed to radiation as children have a substantially greater susceptibility to delayed effects than do those persons exposed as adults.
1. The peak frequency for leukemia is higher and occurs earlier among those less than 15 years of age exposed to radiation than among those who are older.
2. Breast cancer occurs excessively when females who were exposed to radiation during childhood reach the usual age for developing this malignancy. The rates for breast cancer for those who were 10 to 19 years of age at the time of the bomb are greater than those for females who were older at that time. Unexpectedly, an excessive occurrence of breast cancer has been observed among females who were 9 years old or younger at the time of the bomb, an age range when they would have had very little breast tissue. If cases continue to occur at the same rate as these women grow older, the excessive occurrence of breast cancer will be greater than among all other age groups.
3. Persons less than 30 years old at the time of the bomb are apparently more susceptible than older persons to radiogenic thyroid cancer. Benign thyroid tumors have occurred among nearly all children exposed to radioiodine-containing fallout from a nuclear weapons test on the Marshall Islands in 1954.
Subgaleal Hemorrhage
Authors: FALVO CATHEY E. , FILIPPO J. ANTHONY SAN 
Published: December 2021

In Reply.—
We are pleased to see Beauchamp and Metcalf's case report and discussion of the management of subgaleal hematoma. Inasmuch as subgaleal hematoma not accompanying other trauma is rare, the best method of treatment is not well delineated. We had had experience with two patients with subgaleal hematoma from other causes. One patient developed infection and died; the other patient developed calcification.
Clearly, a compilation of national experience with subgaleal hematoma in different age groups and of differing etiologies is needed if we are not to be excessively or insufficiently aggressive in our treatment of these patients.
Adolescent Chest Pain
Authors: BROWN ROBERT T. 
Published: December 2021

To the Editor.—
The study by Pantell and Goodman1 on adolescent chest pain was most interesting and informative. I have a question, however, about their statement that their criteria for diagnosis of costochondritis were more restrictive than were mine in my previous study. 2 On the contrary, our criteria for the diagnosis of costochondritis were exactly the same: pain that is reproducible by palpating the affected rib cartilage when no other signs or symptoms are present. There are other reasons possible for the discrepancy between the prevalence of costochondritis in our two reports.
Neonatal Circumcision
Authors: ICHTER JOSEPH T. 
Published: December 2021

To the Editor.—
In the June 1983 issue of News and Comments, the following letter to the editor was published.
Strong stand against routine circumcision
It is my impression that most physicians, and pediatricians in particular, are of the belief that routine neonatal circumcision in the male infant is not a medically necessary procedure. It is my understanding that the AAP Committee on Fetus and Newborn has made statements about the issue.
There are several reasons that are promulgated to justify the performance of the procedure.
Neonatal Circumcision
Authors: LITTLE GEORGE A. 
Published: December 2021

In Reply.—
Don't circumcise neonates. That message has been stated in various fashion in communications of the American Academy of Pediatrics for at least 13 years. For example:
There are no valid medical indications for circumcision in the neonatal period.1
There is no absolute medical indication for routine circumcision of the newborn.2
There are no medical indications for routine circumcision, and the procedure cannot be considered an essential component of health care.3
Furthermore, the AAP through its postgraduate effort, Pediatrics in Review, has this year included a module that makes a strong attempt to meet the need for education in counseling parents of the uncircumcised infant.
Postmortem Protocol
Authors: NEIDENGARD LEE , LONG KATHY , TEDONE LOUIS , EKEGREN JAMES K. , PETERSON RICHARD 
Published: December 2021

To the Editor.—
We were interested in the article by Kronick and colleagues on a penimortem protocol for suspected genetic disease.1 They have emphasized the collection of specific body fluids and tissue samples. In 1981, Opitz2 outlined methods for study of a dysmorphic stillborn infant that would be appropriate for a teaching hospital. In San Luis Obispo County, we have several community hospitals that provide care for virtually all newborn infants, and we have recently adopted a protocol for the local evaluation of infants and stillborns with genetic-dysmorphic concerns.
Hemorrhagic Periventricular Leukomalacia and Spastic Diplegia
Authors: KUBAN KARL C. , GILLES FLOYD H. 
Published: December 2021

To the Editor.—
Levene et al1 recently described their experience with a new application for real-time ultrasonography. They reported that hemorrhagic periventricular leukomalacia (PVL) could be diagnosed by ultrasound in 7.5% of their series of 120 infants of birth weight less than 1,501 g. The report of Levene et al is important in that it expands the clinical utility of this relatively new technology. However, comments about the issue of pathologic verification are warranted.
The authors report that autopsy was performed in two of the nine cases with ultrasound-documented hemorrhagic PVL.
DPT in the Finger
Authors: GEDISSMAN A. 
Published: December 2021

To the Editor.—
I would like to share with my colleagues an incident that occurred recently in my office.
One of the nurses working in my office reported to me that her right index finger started to hurt suddenly a few hours into the working day and because of the swelling she was unable to move it. The finger was very edematous but not erythematous, and it was very tender to touch in an area that appeared to have a very small puncture wound.
Prognosis for Black Infants with Leukemia
Authors: SEELER RUTH ANDREA 
Published: December 2021

To the Editor.—
In a recent paper, Sadowitz and Oski1 demonstrated that black infants both healthy and ill (with bacterial meningitis) had significantly lower absolute granulocyte counts than white infants. They pointed out that granulocyte counts may not be as valuable in arriving at the diagnosis of infection in black infants as in white infants. However, I would like to raise another implication for serious consideration, namely, the poorer prognosis of black children with acute lymphocytic leukemia.
Frostbite
Authors: BROWN FORST E. 
Published: December 2021

In Reply.—
Rowlingson and Carron suggest consideration of transcutaneous electrical nerve stimulation (TENS) in the management of frostbite. As they mentioned, sympathetic blocks have been effective in the management of early frostbite; blood flow increase has resulted in the salvage of damaged digits. Interarterial reserpine and prostacycline also have been shown to overcome digital vasoconstriction.
In the two patients we described, persistent vasoconstriction as seen in reflex sympathetic dystrophy (RSD) was not the problem. Moreover, the changes seen in the radiographs were not comparable to those seen in RSD.
Everybody Needs Reeducation
Authors: DE CARVALHO MANOEL 
Published: December 2021

In Reply.—
The table presented by Michael is similar to one published by Holt in 1899.1 Although up to ten feedings were recommended during the first month of life, a predetermined schedule was considered important because "the baby should be taught to be regular in its habits."
Until the 19th century, feeding schedules were rarely mentioned in English-language guidebooks for parents. The industrial revolution and the significant changes in the sociologic, economic, and cultural conditions of women may all have contributed to changing the recommendations on feeding schedules.
Suctioning and Cerebral Blood Flow
Authors: MARSHALL TERRY A. 
Published: December 2021

To the Editor.—
The article by Perlman and Volpe1 provides interesting information on physiologic changes associated with suctioning in the preterm infant. My observations during laryngoscopy and endotracheal intubation in preterm infants have also revealed a significant increase in arterial blood pressure which occurred before the onset of hypoxemia. It is possible that mechanical stimulation of the laryngopharyngeal and tracheobronchial regions as described in cats2 may arouse reflexes that increase sympathetic efferent activity, thereby contributing to the increase in blood pressure.
Soy Formula
Authors: MOFENSON HOWARD C. 
Published: December 2021

To the Editor.—
The excellent commentary by the Committee on Nutrition of the American Academy of Pediatrics on soy-protein formulas1 needs an addition to the instances when soy-protein should not be used. Soy-protein may be harmful in cystic fibrosis of the pancreas as the protein is contaminated with trypsin inhibitors which can aggravate the pancreatic insufficiency and interfere with absorption of protein resulting in hypoalbuminemia and its manifestations.2-4
I think this addition will remind pediatricians that soy-based formulas are not recommended for patients with cystic fibrosis.
Free Amino Acids in Citrullus vulgaris (Watermelon)
Authors: TEDESCO T. A. , BENFORD S. A. , FOSTER R. C. , BARNESS L. A. 
Published: December 2021

To the Editor.—
Currently accepted dietary management of citrullinemia and other urea cycle disorders includes protein restriction, sodium benzoate, and dietary supplements of keto acids or essential amino acids with postblock intermediates such as arginine in citrullinemia and arginino-succinic aciduria. When a child survives the neonatal period on such a regimen and solid foods are introduced into the diet, there is at least one fruit that should be avoided, Citrullus Vulgaris, commonly known as watermelon.
Quantitation of free amino acids extracted from 1 g wet weight of watermelon fruit yielded the following (in mmoles per gram wet weight): Phenylalanine, 1.25; histidine, 0.24; tryptophan, 0.35; lysine, 0.82; ornithine, 0.32; arginine, 11.36; aspartic acid, 0.97; threonine, 0.74; serine, 1.05; glutamine, 3.86; glutamic acid, 1.38; citrulline, 23.68; alanine, 1.15; valine, 0.17; isoleucine, 1.24; leucine, 0.24.
Usefulness of Screening for Hypertension
Authors: FIXLER DAVID E. 
Published: December 2021

In Reply.—
Grossman has expressed the opinion that among the criteria for any screening procedure is that the disease being screened for is either prevalent or has severe health consequences. Although these are notable criteria, they in no means represent indications for initiating mass screening programs. Justification for a screening program is based on its having a high yield, that is, that early detection in a significant number of patients will lead to appropriate treatment and a significant decrease in morbidity and mortality.
Learning Disabilities, Dyslexia, and Vision
Authors:   Committee on Children with Disabilities of the AAP, and Ad Hoc Working Group of the American Association for Pediatric Ophthalmology and Strabismus and American Academy of Ophthalmology
Published: December 2021

POLICY
The American Academy of Pediatrics, the American Academy of Ophthalmology, and the American Association for Pediatric Ophthalmology and Strabismus upport the position that a child or adult with dyslexia or a related learning disability should receive: (1) early medical, educational, and/or psychological evaluation and diagnosis; and (2) remediation with educational procedures of proven value, demonstrated by valid research.
BACKGROUND
Dyslexia and related learning diabilities have become matters of increasing public attention. A child's or adult's inability to read with understanding is a major obstacle to school learning and may have far-reaching social and economic implications. The normal and appropriate concern of parents for the welfare of their children and of society for its disadvantaged children and young adults has fostered a proliferation of purportedly diagnostic and remedial procedures, many of which are controversial. Research has shown that deficient visual perception of letters or words accounts for inability to read in only a small minority of children; the majority suffer from a variety of linguisting defects.1,2 Therefore, the diagnosis and treatment of dyslexia and associated learning disabilities have recently been reviewed with the following conclusions endorsed by the three societies named above.
EVALUATION AND CONCLUSIONS
1. Learning disabilities, including the dyslexias, as well as other forms of learning underachievement, often may require a multidisciplinary approach from medicine, education, and psychology in evaluation, diagnosis, and treatment. Certain problems may be detected during early childhood through the use of screening techniques by educational specialists. Children with potential problems include those with language defects, emotional problems, or a family history of learning disability.
The Pediatrician's Role in Promoting the Health of a Patient in Day Care
Authors:   Committee on Early Childhood, Adoption, and Dependent Care
Published: December 2021

American families have changed. More mothers are working, and more young children are being cared for outside the home. The stresses inherent in this sociologic change are great.
Pediatric practice has also changed. Increasingly, pediatricians are involved not only in the medical care of the child, but in the ecologic system in which the child exists. The pediatrician has traditionally worked with parents and children to promote healthy functioning, which encompasses the physical, emotional, cognitive, and social health of the growing and developing child. Now, the pediatrician must expand this role to include working with significant other adults who interact closely with the child who spends much of the day away from home. In this way, the pediatrician will contribute to the promotion of the child's general wellbeing, and some maladaptive behaviors will be prevented.
Parents and adults whom parents delegate to provide child care on a regular basis have the greatest responsibility for children. With increasing numbers of single-parent families and families in which both parents work, there is a greater use of the variety of alternative care-giving arrangements involving adults who are neither parents nor relatives of the child. Effective communication among the child's pediatrician and regular care givers is more difficult to achieve than in the past when parents provided most of the child's care. When developmental irregularities or a chronic illness are a concern, it is particularly important for pediatricians to communicate to the person(s) providing child care the unique features of the child and family. Thus the care giver will be better able to prepare an individualized program that enhances the child's development, increases self-esteem, and supports the parents' child-caring capacity.
Biliary Atresia and Liver Transplantation: The National Institutes of Health Point of View
Authors: LILLY JOHN R. 
Published: December 2021

In August 1983, a bulletin, Liver Transplantation,1 printed and distributed under the aegis of the National Institutes of Health (NIH), was mailed to physicians throughout the United States. The bulletin was the product of a concensus panel convened to consider offered evidence (expert presentation of the available data) about liver transplantation. The panel was composed of a singular assortment of individuals including physicians in private practice, medical and pediatric department chairmen, a dean, a hospital director, and a person with a PhD in mathematics and statistics.
Whatever the validity of their transplantation conclusions, the panel's recommendations about extrahepatic biliary atresia appear arbitrary and suspect, if not downright erroneous.
Care of Infants with Myelomeningocele
Authors: VENES JOAN L. 
Published: December 2021

To the Editor.—
In the era of "Baby Doe," Gross et al (Pediatrics 1983;72:450-458) are to be commended for their forthright presentation of the Oklahoma Children's Memorial Hospital Center policy concerning those children born with meningomyelocele.
I would agree with their premise that immediate operation is not indicated but would not agree that prolonged delay is without hazard for increased rates of infection. Nevertheless, certainly time is available for reasoned and considered discussion with at least one, and preferably both parents, prior to the initiation of therapy.
Care of Infants with Myelomeningocele
Authors: MCLONE DAVID G. 
Published: December 2021

To the Editor.—
I read with disbelief the article by Gross et al,1 concering the treatment of children with a myelomeningocele. They stated "...it is prima fascie irresponsible to obtain knowledge about the results of surgery on high risk infants and then not to use the negative results..." I would argue that it is equally and probably more irresponsible not to use the positive results. The authors believe not only in selecting death—"if one is persuaded that death is preferable to life under certain circumstances" but also in the selective use of the literature.
Neonatal Mortality Statistics
Authors: SHAPIRO SAM , MCCORMICK MARIE C. , STARFIELD BARBARA 
Published: December 2021

In Reply.—
Sepkowitz uses data in our paper to question the influence of neonatal intensive care units (NICUs) during the 1970s in reducing neonatal mortality. Part of the argument is based on the calculation that about 43% of the total reduction in such deaths between 1976 and 1978 to 1979 occurred among infants weighing more than 2,500 g at birth, a group for which "neonatal intensive care ... would seldom be necessary ..."
Certainly there are many factors—social, environmental, and medical, including improved care in the antenatal and intrapartum periods—that have affected the reduction in neonatal mortality.
Neonatal Bacteremia and Circumcision
Authors: WISWELL THOMAS E. 
Published: December 2021

In Reply.—
Dr Braun's conjecture regarding our study's conclusions is incorrect. He has misinterpreted the methods and results presented in our recent report.1 We stated that we were interested in bacteremia that related to the uncircumcised state or to the circumcision procedure itself. We did not include cases of neonatal bacteremia that could not be attributed to either condition. Of 108 boys with urinary tract infections, 37 (34.3%) had concomitant bacteremia (virtually all were due to Escherichia coli).