bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Changing Role and Responsibilities of a Chairman—Letters
Authors: GABBE STEVEN G. 
Published: December 2021

To the Editor.—
I recently read an excellent article in the July issue of Pediatrics (1992;90:50-57). This paper, "The Changing Role and Responsibilities of Chairmen in Clinical Academic Departments: The Transition from Autocracy," contains many important lessons and guidelines. I was interested in reference 16 in that paper, which describes a faculty development form. When I pulled the abstract in Pediatric Research, the purpose of the form was described but not the form itself. Would Dr Brent be willing to share this form with me? I believe it would be extremely helpful, particularly in guiding our junior faculty.
Endotracheal Administration of Tolazoline in Hypoxia-Induced Pulmonary Hypertension
Authors: Curtis Jerri , O'Neill J. Timothy , Pettett Gary 
Published: December 2021

Study objective. To compare the pulmonary and systemic vascular responses to intravenously (IV) and endotracheally (ET) administered tolazoline (Tz) in newborn lambs with hypoxia-induced pulmonary hypertension.
Design. Randomized, controlled study design.
Methods. Twenty lambs, 2 to 7 days of age, were anesthetized, intubated, and surgically catheterized for continuous physiologic monitoring and cardiac output meassurements using radiolabeled microspheres. After a postoperative stabilization period, the lambs were ventilated with a hypoxic gas mixture which was titrated to increase mean pulmonary artery pressure (MPAP) 30% to 50% above baseline. Each animal was randomly assigned to receive either IV-Tz (2 mg/kg), ET-Tz (4 mg/kg), or ET-saline (Sal, control group).
Results. ET-Tz significantly (P &lt; .05) reduced MPAP, PVRI (pulmonary vascular resistance index), MPAP/mean artery pressure (MAP) and PVRI/systemic vascular resistance index (SVRI), but not SVRI. IV-Tz lowered (P &lt; .05) MPAP, PVRI, and PVRI/SVRI but also produced significant reductions in MAP and SVRI while only transiently decreasing MPAP/MAP. MPAP/MAP and PVRI/SVRI ratios were consistently lower in the ET-Tz animals than either the IV-Tz or ET-Sal animals.
Conclusions. Our results suggest that ET-Tz produced a more selective pulmonary vascular response than IV-Tz and may warrant further investigation for potential clinical applications.
Ceftriaxone for Otitis Media
Authors: BRAUER HOWARD 
Published: December 2021

To the Editor.—
I am responding to the article about the use of ceftriaxone for acute otitis media published by Green and Rothrock in Pediatrics in January 1993.1
Although the results of treatment using intramuscular ceftriaxone were comparable with those using oral amoxicillin, and parent response to this was highly favorable, the use of ceftriaxone for this indication is grossly inappropriate.
In recent years, the emergence of resistant strains of microorganisms has become a very serious problem.
Controlled Trial of Oral Prednisone in the Emergency Department Treatment of Children With Acute Asthma
Authors: Scarfone Richard J. , Fuchs Susan M. , Nager Alan L. , Shane Steven A. 
Published: December 2021

Background. Recent studies have shown that the use of parenteral corticosteroids in the emergency department decreases the hospitalization rate for patients with acute asthma. We studied the efficacy of oral corticosteroids in the emergency department treatment of moderately ill children with acute asthma.
Methods. Emergency department patients aged 1 through 17 years whose chief complaint was acute asthma were assigned a pulmonary index, based on clinical evaluation. Those with a moderate exacerbation (pulmonary index = 9 through 13) received either 2 mg/kg of oral prednisone or placebo in a randomized, double-blind fashion. Patients in each group were then treated with an identical regimen of frequent aerosolized albuterol, for up to a maximum of 4 hours.
Results. Seventy-five patients were assessed. Overall, 11 (31%) of 36 in the prednisone group required hospitalization compared with 19 (49%) of 39 in the placebo group (P = .10). Among the sickest patients (initial pulmonary index &gt; 10), 7 (32%) of 22 prednisone-treated patients required hospitalization compared with 13 (72%) of 18 placebo-treated patients (P &lt; .05). Among patients who had a suboptimal response to initial β2-agonist therapy and who therefore would have been hospitalized had treatment been restricted to 2 hours, 9 (45%) of 20 in the prednisone group ultimately required hospitalization when duration of care was extended 2 additional hours compared with 15 (83%) of 18 in the placebo group (P &lt; .05). In addition, prednisone-treated patients had a significantly greater improvement in median pulmonary index (5.0 vs 3.0, P &lt; .001).
Conclusions. These data demonstrate that oral prednisone, within 4 hours of its administration, reduced the need for hospitalization among a subset of children treated in the emergency department for acute asthma.
Cardiomyopathy From Ipecac Administration in Munchausen Syndrome by Proxy
Authors: GOEBEL JENS , GREMSE DAVID A. , ARTMAN MICHAEL 
Published: December 2021

In the United States, serum of ipecac is the emetic of choice in poisoning victims if induction of vomiting is indicated. It is readily available without prescription and has been intentionally administered on a long-term basis in cases of self-abuse or abuse by caretakers. Signs and symptoms of chronic ipecac poisoning include protracted vomiting and diarrhea as well as skeletal and cardiac myopathy. We report two cases of ipecac cardiomyopathy due to Munchausen syndrome by proxy (MSBP) in children with longstanding vomiting and diarrhea.
CASE REPORTS
Case 1
At the age of 29 months, a white, previously healthy boy doveloped appendicitis and underwent appendectomy.
Trends in AIDS Epidemic
Authors: SHORR ANDREW F. 
Published: December 2021

Futterman et al provide interesting insight into the spread of the human immunodeficiency virus (HIV) among adolescents in New York City and into the impact the acquired immunodeficiency syndrome (AIDS) has had on this population. In their conclusion, however, they misrepresent the data regarding HIV and AIDS among youth. More specifically, they write, "Reported AIDS cases among adolescents increased by over 77% over the past two years. . ."
By using cumulative percent data for AIDS cases, they distort the true picture. The actual data reveal that the number of AIDS cases in this population has dropped during the past year.
The Principles for Family-Centered Neonatal Care
Authors: Harrison Helen 
Published: December 2021

As the author of The Premature Baby Book (St Martin's Press, 1983), I have received hundreds of letters and telephone calls over the past decade from parents of babies treated in neonatal intensive care units (NICUs). Many of these parents express unqualified gratitude for the skilled staff and new technologies that saved the lives of their children. Others, however, voice concern, even anguish, over the way they and their babies were treated in the NICU. These parents tell of difficulties obtaining accurate information about their babies' conditions, treatments, and prognoses; of parental exclusion from medical and ethical decision-making; of the overtreatment of marginally viable babies and the undertreatment of babies' pain; of concerns about the relentless nursery environment and the use of poorly validated therapies; of unnecessary impediments to the nursing and nurturing of babies in the NICU; and of frustration over inadequate discharge planning, follow-up, and services for NICU survivors.4-16
In 1991 I sent some letters and articles that I had received from these parents to Dr Jerold Lucey, Editor of Pediatrics. Dr Lucey immediately proposed that the two of us convene a conference in which a small group of parents and physicians could discuss the problems described by parents and explore possible solutions.
At Dr Lucey's request, I assembled a group of articulate parents who were knowledgeable about the NICU from personal experience and from their work in support organizations, disability rights groups, and hospital ethics committees. Because I wanted a group that would be sympathetic to the concerns of medical professionals, I made an effort to choose parents with a background in health care or with a spouse or close family member in the medical profession.
Effects of Biological and Social Factors on the Cognitive Development of Very Low Birth Weight Children
Authors: Weisglas-Kuperus Nynke , Baerts Wim , Smrkovsky Mila , Sauer Pieter J.J. 
Published: December 2021

Objective. To investigate the effects of biological and social factors on the cognitive development of very low birth weight children, a longitudinal follow-up study was conducted from birth to 3.6 years of age.
Methodology. The study group consisted of a cohort of 79 surviving high-risk, very low birth weight infants. Neonatal cerebral ultrasonographic findings and a neurological score were used as indicators of biological risk. A sociodemographic risk score and the Home Observation for Measurement of the Environment inventory were used as indicators of social risk. Cognitive development was assessed at ages 1 and 2 years by the Mental scale of the Bayley Scales of Infant Development and at age 3.6 years by the Kaufman Assessment Battery for Children.
Results. The mean mental index at 1 year of age was 96 (SD 19), at 2 years of age 86 (SD 26), and at 3.6 years of age for intelligence 87 (SD 13) and for achievement 86 (SD 14). In a stepwise multiple regression analysis of biological as well as social factors, the neurological score alone was the best predictor for cognitive development at 1 year of age, explaining 46% of the variance. From 2 years of age onward, the best predictors for cognitive development were the neurological score together with the home environment, explaining 46% of the variance for the Mental Developmental Index at age 2, 34% for intelligence, and 56% for achievement at age 3.6.
Conclusions. Children at high biological risk were able to catch up on their cognitive delay in a highly stimulating home environment. Children at low as well as high biological risk in a less stimulating home environment showed a decline in cognitive development. For these children, early intervention programs might be important in the prevention of cognitive disabilities.
Prevalence of Cerebral Palsy: Estimations, Calculations and Neonatal Care
Authors: Sola Augusto , Piecuch Robert E. 
Published: December 2021

Dr Bhushan et al1 published a very interesting article in the June issue of Pediatrics which should be helpful in planning for health care delivery to patients with cerebral palsy. We have performed further analysis on the estimations and calculations they reported and would like to make some comments and add some results with a somewhat different perspective.
Prevalence has been classically defined as the "percent of a population being studied that is affected with a particular disease at a given time"2 or as "the ratio between the number of people who have the disease at one point in time with the number of people at risk at that time."3
Vigintiphobia, Unbound Bilirubin, and Auditory Brainstem Responses
Authors: Funato Masahisa , Tamai Hiroshi , Shimada Seiichi , Nakamura Hajime 
Published: December 2021

Objective. The management of nonhemolytic hyperbilirubinemia in term newborns is controversial. To evaluate the usefulness of serum unbound bilirubin concentrations (UBCs) in the management of hyperbilirubinemia, we compared the concentrations with abnormal auditory brainstem responses (ABRs).
Methods. ABRs and serum UBCs in 37 hyperbilirubinemic term newborns (total bilirubin concentrations [TBCs] ≥20 mg/dL and direct bilirubin concentrations &lt;2 mg/dL) were measured before treatment with either phototherapy or exchange transfusions. Eight of these newborns had blood incompatibilities. These hyperbilirubinemic newborns were divided into three groups according to the findings of ABR: group A, normal ABR (n = 18); group B, prolonged latency of wave I only (n = 8); and group C, prolonged interpeak latency of wave I-III/I-V and/or poor amplitude (n = 11).
Results. The peak TBC was significantly different between groups A and C (22.8 ± 2.2 mg/dL and 25.4 ± 2.5 mg/dL, respectively; P &lt; .05), though there were no differences between groups A and B and between groups B and C. The peak UBCs in groups B (1.27 ± 0.7 µg/dL) and C (1.34 ± 0.37 µg/dL) were significantly higher than in group A (0.78 ± 0.26 µg/dL) (P &lt; .05 and P &lt; .01, respectively), though there was no significant difference in the peak UBC between groups B and C. Abnormal ABR findings were more clearly associated with the level of UBC at 1.0 µg/dL than that of TBC at 23 mg/dL by multiple logistic regression analysis (odds ratio 16.6, P = .0026, vs 4.2, P = .1272).
Conclusions. These results suggest that measuring UBC may help in evaluating the possible risk of bilirubin encephalopathy in full-term newborns when there is vigintiphobia (fear of 20).
Theoretical Cost Effectiveness of Management Options for Children With Persisting Middle Ear Effusions
Authors: Berman Stephen , Roark Robert , Luckey Dennis 
Published: December 2021

Objective. The purpose of this theoretical study is to assess the cost effectiveness of options involving observation, antibiotics alone, corticosteroids alone, corticosteroids plus antibiotics, and surgery to clear persisting middle ear effusions during three visits.
Methodology. In a hypothetical case the expected average per patient expenditures are calculated using the efficacy rates determined by the meta-analysis of randomized controlled clinical trials involving corticosteroids plus an antibiotic (six trials), corticosteroids alone (three trials), and antibiotic alone (four trials). In this analysis, all children whose bilateral middle ear effusions persist for 12 weeks despite medical management are referred for ventilating tubes.
Results. The most cost-effective intervention combination is corticosteroid plus an antibiotic at visit 1 (6 weeks after diagnosis of acute otitis media) followed by a second antibiotic in nonresponders at visit 2 (9 weeks after diagnosis of acute otitis media) and referral for ventilating tubes in nonresponders at visit 3 (12 weeks after diagnosis of acute otitis media). The expected average expenditures per case to clear the bilateral middle ear effusions is $600.91 based on reimbursement of private practice charges and $350.27 based on Medicaid reimbursement (all payments to providers are based on 1992 data from Colorado). The difference in the expected average total expenditures per case between this most cost-effective approach versus the use of sequential courses of antibiotics followed by surgery is $372.81 ($973.72 - $600.91) with full reimbursement of private practice charges and $202.57 ($552.84 - $350.27) with Medicaid re imbursement. In clearing the middle ear effusion, the average estimated travel expenses per case is $21.46, and lost parental wages per case are $45.12. When the expenditures associated with an additional 6-month follow-up period are included, the expected average per case expenditures is $1088.54 with reimbursement of private practice charges and $659.00 with Medicaid reimbursement. The difference in the expected average per case expenditures to clear the effusions and follow-up for 6 months between the most cost-effective approach using corticosteroids plus antibiotics at the 6- and 9-week visits followed by surgery in nonresponders at 12 weeks versus sequential courses of antibiotics is $405.30 ($1493.84 - $1088.54) with reimbursement of private practice charges and $217.32 ($876.32 - $659.00) with Medicaid reimbursement.
Recommendations. Although the analysis does not consider risks, side effects, and parental or provider preferences, the findings suggest that the implementation of cost-effective clinical guidelines can potentially reduce national expenditures for managing persistent middle ear effusions.
Pain Relief Can Reduce Hypoxemia in Distressed Neonates During Routine Treatment Procedures
Authors: Pokela Marja-Leena 
Published: December 2021

Objective. To determine whether the use of opioids could reduce the hypoxemia and hemodynamic instability associated with routine intensive care procedures in neonates with respiratory distress.
Design. Randomized and placebo-controlled study.
Methods. Physiological, plasma β-endorphin, cortisol, and glucose responses to routine treatment procedures were studied in 84 mechanically ventilated distressed neonates randomized into groups receiving 1 mg/kg meperidine or 0.9% saline 15 minutes before tracheal suction or routine nursing care.
Results. The duration of hypoxemia (transcutaneous partial pressure of 02 &lt;6.6 kPa (&lt;50 mm Hg) and/or arterial blood oxygen saturation &lt;80%) during treatment procedures was significantly longer in the saline group (mean 82 vs 36 seconds, P = .001) and distress quantified by a novel behavioral scoring method was much higher. Changes in arterial blood pressure, heart rate, or plasma β-endorphin, cortisol, and glucose concentration did not show any statistically significant differences between the groups.
Conclusion. Newborns with respiratory difficulties often suffer from hypoxemia during essential treatment procedures. The use of opioid analgesia may reduce the duration of hypoxemia and the associated distress and, therefore, may improve the long-term results of neonatal intensive care.
Prospective, Controlled Study of Developmental Outcome in Survivors of Extracorporeal Membrane Oxygenation: The First 24 Months
Authors: Wildin Susan R. , Landry Susan H. , Zwischenberger Joseph B. 
Published: December 2021

Objective. Survivors of venoarterial extracorporeal membrane oxygenation (ECMO) are considered to be at risk for developmental disabilities, but there are few controlled outcome studies. A prospective, controlled study of outcome was performed to quantify the degree and frequency of developmental disabilities in ECMO survivors compared with a matched control group.
Methods. From May 1987 through November 1990, 40 of 47 neonates treated with ECMO survived at the University of Texas Medical Branch in Galveston. Longitudinal developmental data were collected, using the Bayley Scales of Infant Development, on 22 ECMO infants and 29 healthy term control infants at 6, 12, and 24 months. Language was assessed at 24 months using the Sequenced Inventory of Communication Development. An additional 13 ECMO infants had developmental data for at least one time point.
Results. Healthy term infants performed significantly better than ECMO infants on the Bayley Scales of Infant Development at 6 and 24 months and on the Sequenced Inventory of Communication Development at 24 months. Mean scores of ECMO infants were well within the average range and 77% of the ECMO infants were developmentally normal.
Conclusions. These data suggest that early developmental morbidity in ECMO survivors is low, considering the severity of their neonatal illness.
Excess Fruit Juice Consumption as a Contributing Factor in Nonorganic Failure to Thrive
Authors: Smith Melanie M. , Lifshitz Fima 
Published: December 2021

Objective. To determine whether excessive consumption of fruit juice is a contributing factor in nonorganic failure to thrive in early childhood.
Methods. Eight patients, aged 14 to 27 months, referred for failure to thrive were evaluated by medical history, physical examination, and biochemical assessment. Growth patterns were reviewed and anthropometric measurements including skinfold thickness and midarm circumference were obtained. Diet history included 3-day food records and 24-hour diet recalls. An open-ended interview explored factors associated with fruit juice consumption. Breath hydrogen testing of fructose, sorbitol, or fruit juice was performed in three children who had a history of diarrhea or gastrointestinal complaints. Nutritional intervention focused on reducing fruit juice consumption and increasing the energy and nutrient density of the children's diets.
Results. In each case, deterioration of weight and linear growth progression coincided with excessive juice consumption. All children exhibited weights &lt;5th percentile and five also had lengths &lt;-5th percentile. Weight-for-length deficits ranged from 11% to 25%. Two patients demonstrated low arm muscle mass and five children had diminished fat stores. Organic disease was ruled out in all cases. Three children had iron deficiency. The children's diets were hypocaloric, providing 78% to 92% of recommended energy intake for age and weight. Dietary intake included considerable juice consumption (12 to 30 oz/d). Fruit juice, primarily apple juice, contributed 25% to 60% of daily energy intake. As a result, food consumption was reduced; lowering dietary protein, fat, and micronutrient intakes. Excessive juice was consumed for various reasons including children's preferences, parental health beliefs, behavioral feeding difficulties, and financial considerations. Breath hydrogen testing revealed malabsorption of fructose and/or sorbitol. After nutritional intervention, dietary intake increased to 96% to 116% of recommended intakes. Weight gain increased significantly in the first month and persisted for follow-up of 5 to 18 months.
Conclusions. These findings indicate that large intakes of fruit juices may displace more calorie- and nutrient-dense foods. Additionally, fructose and sorbitol malabsorption may occur. Excess fruit juice consumption may present a contributing factor in nonorganic failure to thrive.
THE HEALTH PLAN MISSES THE POINT
Authors: L. J. F. 
Published: December 2021

It is often difficult for laypeople to appreciate that good medicine does not reduce the percentage of people with illnesses in our population; it increases that percentage. There are proportionally more people in the United States with arteriosclerotic heart disease, diabetes, essential hypertension and other expensive chronic diseases than there are in Iraq, Nigeria or Colombia. Good medicine keeps sick people alive ...
The vast expansion of the concept of health can be demonstrated in surgery, orthopedics, mental health, gynecology—indeed, in any field of medicine. People do not have operations on their knees or elbows merely to continue to be employable, for example; most of us do not work at jobs requiring physical strength. Many such operations are performed strictly so that the patient can continue to lead a "normal" life, to be able to play golf or ski. Are these justifiable medical expenses? If one is free of pain except on the tennis court, is one "ill"? ...
We are also wrong to assume that medical technology, like CD players and personal computers, will become cheaper as the industry matures. When what is being improved is life expectancy, all the rules change; people are willing to pay substantially more money for relatively minor improvements. Medical technology will therefore continue to be expensive simply because it pays for companies to market a 5 percent improvement even though it might be 100 percent more expensive.