bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fever Therapy Failure
Authors: SWEET LAWRENCE 
Published: December 2021

To the Editor.—
Drug efficacy depends, in part, upon adequate dosage. It has been recognized in our outpatient pediatric clinic that parents have sometimes unwittingly given to their febrile child amounts of liquid acetaminophen inadequate for fever control.
Based on available clinical and pharmacokinetic data, oral acetaminophen should be administered in single doses in the range of 10 to 15 mg/kg at four-hour intervals.1 To achieve this dosage range in infants, only small volumes of concentrated acetaminophen "drops" (80 mg/0.8 mL) are necessary.
Marijuana in Urine
Authors: SCHWARTZ RICHARD H. 
Published: December 2021

Silber underscores the importance of urine toxicology for detection of recent cannabinoid use by adolescent patients.
Because Δ9-THC, the major psychoactive component of cannabis, is lipophilic, it is stored in adipose tissue and released slowly and unevenly back into the bloodstream during the 21 days or more after use. 9-Carboxy-tetrahydrocannabinol (THC), a stable nonpsychoactive metabolite of cannabis, is excreted in relatively large amounts in feces (70%) and urine (30%) and can be detected by urine toxicology for several days after last use of marijuana or hashish.
Clinical Estimation of Liver Size in Newborn Infants
Authors: ASHKENAZI SHAI , MIMOUNI FRANCIS , MERLOB PAUL , REISNER SALOMON H. 
Published: December 2021

In Reply.—
Brion and Avni have compared the clinical estimation of liver size by the liver span and the size of its edge below the right costal margin.
Some of their results are in accordance with ours, such as the lack of differences between the measurements immediately after birth and a few days later, and the reduced size of liver edge found in our preliminary measurements in infants who were small for gestational age (Table).
It seems to us that the practical approach to the clinical estimation of liver size in the newborn should include routine measurement of liver edge in every healthy newborn infant.
Zinc Deficiency: Cause of Hypoproteinemia or Its Result?
Authors: KUMAR SAVITRI P. , ANDAY ENDLA K. 
Published: December 2021

In Reply.—
We agree with Weizman that quantification of enteric protein loss is best carried out by the use of51 Cr-albumin. Although this test has been used in adults and older children, there is no published study on the use of this method in neonates or low-birth-weight infants. The use of radioactive isotopes and the necessity of obtaining fecal samples without urinary contamination makes this an undesirable test in infants. Although the fecal clearance of α1-antitrypsin overcomes all the drawbacks of the 51Cr-albumin method, there are again no studies to date, on its use in neonates.
Levothyroxine Poisoning
Authors: WHITE J. DOUGLAS , LITOVITZ TOBY L. 
Published: December 2021

To the Editor.—
We read the recent report by Lehrner and Weir1 of acute levothyroxine ingestions with concern. Advocacy of an aggressive approach disregards their own cases as well as the medical literature,2-5 Which contains at least seven cases of acute excessive ingestion of levothyroxine (five of which were overlooked by the authors). These reports repeatedly emphasize "a striking discrepancy between the high concentrations of active hormones and the minor clinical symptoms"4 and "the benign course after massive ingestion of levothyroxine."5
Provision of Related Services for Children with Chronic Disabilities
Authors:   Committee on Children with Disabilities
Published: December 2021

The term "related services" is defined in Public Law 94-142, the Education for All Handicapped Children Act of 1975, as follows:
. . . related services means transportation, and such developmental, corrective and other supportive services (including speech pathology and audiology, psychological services, physical and occupational therapy, recreation, and medical and counseling services, except that such medical services shall be for diagnostic and evaluation purposes only) as may be required to assist a handicapped child to benefit from special education, and includes the early identification and assessment of handicapping conditions in children.
Under PL 94-142, all handicapped children are to have available to them "a free, appropriate, public education which includes special education and related services to meet their unique needs." Such services are to be provided at no cost to the child or family in conformity with an Individual Education Plan.
PROBLEMS
In the implementation of PL 94-142, the physician's role in providing related services has been narrowly defined as meaning:
. . . services provided by a licensed physician to determine a child's medically related handicapping condition which results in the child's needs for special education and related services.
This definition fails to recognize the physician's potential role in the supervision, program planning, medical management, and monitoring process.
According to the definition, the physician's role in the delivery of related services has become limited to diagnosis. Little physician input is sought on treatment-related issues. As a result, the delivery and coordination of related services have posed a serious problem.1,2
Cost of Varicella Epidemic
Authors: MILLER PATTI J. , LANDRY SANDRA , SEARCY MARY ANN , HUNT ELLA , WENZEL RICHARD P. 
Published: December 2021

To the Editor.—
Nosocomial airborne transmission of varicella has been documented.1,2 The disease is characterized by an incubation period of ten to 21 days with infectivity beginning at approximately one day before the onset of rash.3 On June 27, 1984, a pediatric resident at the University of Virginia Medical Center who was known to be susceptible to chickenpox examined an 18-month-old black male infant with papular, vesicular lesions on his face, upper extremities, back, and groin.
PARENTS' RIGHT TO DECIDE
Authors: Student  
Published: December 2021

Dave and Debbie Bailey, a couple in Orange, Calif., were given 45 minutes to decide the fate of the 20-ounce infant that had just been born to them 16 weeks prematurely. Knowing that most such infants die eventually, and that half of the survivors suffer some handicap, they tearfully resolved to let nature take its course. But their doctor obtained a court order to continue treatment to keep the infant alive at any cost. As Andrew Malcolm of The Times reported, the hospital's ethics committee backed the doctor in every respect except allowing the parents to believe their choice would be decisive. . . .
No baboon heart could have been implanted in Baby Fae if her parents had denied consent. Why should not the Baileys have had the same veto over the rescue of their child? . . . Like Procrustes, who stretched or cut his guests to fit a single-size bed, public policy seems to accord all infants an absolute right to life, not just by divine will but by all conceivable medical heroics. Parents can be given too much choice, but none at all seems too little.
"Inactive" Ingredients in Pharmaceutical Products
Authors:   Committee on Drugs
Published: December 2021

Pharmaceuticals often contain agents that have a variety of purposes including improvement of the appearance, bioavailability, stability, and palatability of the product. Excipients frequently make up the majority of the mass or volume of oral and parenteral drug products. These pharmaceutical adjuvants are usually considered to be inert and do not add to or affect the intended action of the therapeutically active ingredient.
Some 773 chemical agents have been approved by the Food and Drug Administration for use as inactive ingredients in drug products.1 Inasmuch as these compounds are classified as "inactive," manufacturers are not presently required to list them on the product label. These ingredients are used for a variety of different purposes (Table 1). Because of the large number of these agents and their frequency of use, practicing physicians have recently become concerned about their possible physiologic effects. The increasing number of reports of adverse effects associated with pharmaceutical excipients2 has led to professional and consumer organizations formally requesting the FDA (Food and Drug Administration) to require complete disclosure on the product label of all substances contained in pharmaceuticals. Problems encountered with "inactive" ingredients, include the following.
ADVERSE EFFECTS OF PHARMACEUTICAL EXCIPIENTS
Benzyl Alcohol
This antimicrobial agent is commonly used as a preservative in many injectable drugs and solutions. A number of neonatal deaths and severe respiratory and metabolic complications in infants have been associated with use of this agent.3-5 In a controlled study, intraventricular hemorrhage, metabolic acidosis, and increased mortality were positively correlated with substantial benzoic acid and benzyl alcohol levels in neonates.6
School-Aged Children With Motor Disabilities
Authors:   Committee on Children With Disabilities
Published: December 2021

Pediatricians are commonly asked to evaluate school-aged children with motor deficits and to participate in the writing of a prescription for physical and/or occupational therapy that is deemed necessary to remediate and/or treat the disability. In the majority of states, physical therapy services are available only through a physician's prescription. Occupational therapy services, on the other hand, are generally available in nonhospital settings (such as in schools) without physician-written prescriptive orders. The problem is as follows: Many of the therapeutic programs developed for the motor-impaired child have not been subjected to careful, scientific evaluations; therefore, it is necessary for the pediatrician to be aware of those therapeutic modalities that have and have not received scientific scrutiny and, also, be cognizant of those that are generally regarded as helpful.1 Furthermore, the physician should be able to help the parents and educators understand what can and cannot be accomplished by a therapy program. 2,3
The first responsibility of the physician is to provide an accurate diagnosis, if possible, and to ensure that the child does not have a progressive disability. The spectrum of static disorders ranges from dyspraxia (clumsiness) to cerebral palsy.4 In addition to the primary neuromotor disorder, all potential associated problems such as learning disabilities, emotional difficulties, and epilepsy must be identified and treatment programs recommended. If the parents, educator, and physician agree that the child's motor difficulties are interfering with his or her educational program, then by law (Public Law 94-142)5 a physical and/or occupational therapy program might be considered to provide assistance in the student's educational endeavors.
Smoking and Asthma
Authors: PEDREIRA FRANK 
Published: December 2021

In Reply.—
We thank Dr Berkowitz for his thoughtful response to our paper in the March 1985 issue of Pediatrics. Our study was not designed to address the problem of smoking effect on asthma.
However, a number of investigations have shown that atopic individuals may develop wheezing after exposure to tobacco smoke.1-4 Moreover, several studies have demonstrated that cigarette smoke can cause bronchoconstriction and associated decrease in lung function.5-7 These studies support the clinical impression of Dr Berkowitz that children with asthma will "have less problems if their parents stop or decrease their amount of cigarette smoking."
TV and Adolescents
Authors: STRASBURGER VICTOR C. 
Published: December 2021

To the Editor.—
We applaud the publication of the Zuckerman and Zuckerman1 article on television and children. It is a subject that has received sparse attention in the pediatric literature. We would like to comment briefly on two important omissions.
1. Adolescents are not specifically mentioned. Although the Zuckermans do mention concerns about violence, stereotyping, decreased school performance, and poor health attitudes, additional areas of concern are the effect of television on adolescents' world-view, their use of alcohol, and their sexual activities.
The Business of Missing Children
Authors: BERGMAN ABRAHAM B. 
Published: December 2021

No pediatric issue has so captured the attention of the American public during the past year as that of missing children. It is impossible to escape the haunting faces who peer out at us from television screens, milk cartons, breakfast cereal boxes, grocery sacks, bus posters, and business envelopes. Corporations vie with each other over sponsorship of public service campaigns to "publicize the plight of missing children," while television stations compete with a whole variety of specials.
Naturally, whenever emotional concerns of such magnitude are raised, politicians are sure to become involved with stern demands for "immediate action." In May 1985, no less than three separate congressional committees held hearings on missing children all in the same week.
Acute Medical Care of Severe Head Injury Is Not Enough
Authors: FREEMAN JOHN M. 
Published: December 2021

As indicated by Jacobson et al in this issue (Pediatrics 1986;77:236) significant head trauma is a major and frequent occurrence in adolescents and in younger children as well. The major advances in emergency medical services—helicopter transport, trauma centers, and management of increased pressure—has had dramatic effects on the survival rate and, probably, on the quality of survival of children with closed head injury. However, discharge from the hospital of a child who is able to walk, although often considered the end point by the surgical team, is clearly not sufficient for the parent and child.
As Jacobson and his colleagues indicate, discharge is not the end but the start of many problems.
Predicting Outcome in Low Birth Weight Infants
Authors: FISCHER ALLEN F. , FRANKEL LORRY R. , STEVENSON DAVID K. 
Published: December 2021

To the Editor.—
We read with interest the paper by Gaylord et al,1 in which a statistical method was developed for predicting mortality in low birth weight infants. Using a multivariate linear discriminant analysis to determine the variables most predictive of death, they were able to predict mortality in infants of less than 1,500 g birth weight who developed pulmonary interstitial emphysema using only birth weight and the highest peak expiratory pressure on day 1 of life.
On Partial Splenectomy in Gaucher's Disease
Authors: STELLIN G. P. , LILLY J. R. , GITHENS J. H. 
Published: December 2021

To the Editor.—
In a recent issue of Pediatrics (1985;76:398-401), Bar-Maor and Govrin-Yehudain describe three children with Gaucher's disease who had a partial splenectomy for hypersplenism and mechanical problems. Neither hypersplenism nor massive splenomegaly recurred in clinical follow-up that was 4, 3, and ½ years, respectively. We warn that partial splenectomy in patients with Gaucher's disease may not always be so long-lasting. Hypersplenism and splenomegaly recurred in our patient within 9 months.
Our patient was a 4-year-old girl with the diagnosis of type III Gaucher's disease which was made at 2 years of age.
Involuntary Smoking—A Hazard to Children
Authors:   Committee on Environmental Hazards
Published: December 2021

Children who live in households with smokers are involuntarily exposed to sidestream and secondhand cigarette smoke. The health hazards that result from passive smoking will be reviewed. This statement updates a 1982 American Academy of Pediatrics statement on the environmental consequences of tobacco smoking.1
COMPOSITION OF SIDESTREAM AND SECONDHAND SMOKE
Sidestream smoke arises from the burning end of a cigarette.2,3 Secondhand or exhaled mainstream smoke is drawn into the respiratory tract of the smoker and then is exhaled. Both sidestream and secondhand smoke contain measurable quantities of such toxins as carbon monoxide (CO), ammonia, nicotine, and hydrogen cyanide. They also contain carcinogens, including benzo[a] pyrene, dimethylnitrosamine, tar, formaldehyde, and β-naphthylamine.2 Concentrations of most of these materials are higher in sidestream than in mainstream smoke.2 Air-sampling surveys have documented the involuntary exposure of nonsmokers to the products of cigarette combustion.2,3 These studies have shown that smoking in enclosed rooms can produce CO levels greater than the national ambient air quality standard of 9 ppm.4 Similarly, elevated concentrations of airborne nicotine, benzo[a] pyrene, and suspended particulates have been documented.4
Biologic evaluations of nonsmokers involuntarily exposed to cigarette smoke have demonstrated elevations of 1% to 3% in carboxyhemoglobin concentration.5 Biologic evaluations of involuntary smokers have also found increased levels of nicotine and of cotinine,6,7 the major metabolite of nicotine, in the urine and saliva. In addition, studies have demonstrated increased activity of enzymes that metabolize benzo[a]pyrene in the placentas of women who smoke8 and, possibly, in the placentas of women involuntarily exposed to cigarette smoke.9
Measles Elimination
Authors: LEVY DAVID 
Published: December 2021

To the Editor.—
The Public Health Service deserves enormous credit for its campaign to eliminate measles in the United States. The recent review1 attests to this fact. I must, however, disagree with the conclusion of the article. The glaring omission is that measles is again on the increase. After a record low of 1,436 cases reported in 1983, 1984 saw an increase of about 69.3% to 2,534 cases, and 1985 will probably see more cases than 1984.2 The statement in the conclusion, "Although 2% to 10% of vaccinated persons will remain susceptible, there is no reason to believe that such individuals can lead to sustained transmission of measles in the United States," is totally unfounded and deters the pediatrician from the future challenges of measles.
Aversive Taste Treatment of Finger and Thumb Sucking
Authors: FRIMAN PATRICK C. , BARONE VINCENT J. , CHRISTOPHERSEN EDWARD R. 
Published: December 2021

Thumb sucking is common and adaptive in infancy and early childhood. But when sucking occurs beyond 4 years of age, a common result can be an anterior, open bite that requires expensive orthodontic correction.1 Prolonged sucking may also be a factor in class II malocclusion, narrowing of the dental arches, mucosal trauma, and digital malformation.1-4 In addition to the physical sequelae of sucking, the habit, because it is not socially approved, can generate persistent negative feedback which can adversely affect a child's self-esteem.5
Thumb sucking is a frequently reported child behavior problem that, in some children, can be associated with broader behavior disorders that require treatment.
Currency, Competency, and Credibility: New Directions for Pediatric Continuing Education
Authors: SMITH MARTIN H. 
Published: December 2021

One of the historic cornerstones of the American Academy of Pediatrics has been the development of educational programs designed to assure the highest quality of pediatric care. Although our commitment to this goal remains unwavering, changes in the manner in which pediatric care is—and will be—rendered demand that we constantly look for new and better ways to satisfy the educational needs of the membership.
Toward that end, the Academy recently has embarked on a nationwide search for a director of the Department of Education at the Academy's Elk Grove Village, IL, headquarters. A search committee comprised of Blair E. Batson, MD, Floyd W. Denny, Jr, MD, and Doris A. Howell, MD, has been appointed to pursue this effort.
Questioning Role of Hypochloremia in Bronchopulmonary Dysplasia
Authors: GOODMAN GARY , PERKIN RONALD M. 
Published: December 2021

To the Editor.—
In response to the article "Is Chloride Depletion an Important Contributing Cause of Death in Infants With Bronchopulmonary Dysplasia?" (Pediatrics l986;77:212-216), we are compelled to point out that furosemide (Lasix) therapy may well be directly responsible for the metabolic alterations observed. Hazinski (J Pediatr l985;l06:8l-85) beautifully demonstrated in rabbits that chronic furosemiode administration not only caused metabolic alkalosis (pH 7.46) associated with hypochloremia (Cl 84 mEq/L) but also resulted in compensatory alveolar hypoventilation and secondary respiratory acidosis (Paco2 55 mmHg).
Who Says There Is a Handgun Epidemic?
Authors: CHRISTOFFEL KATHERINE K. , CHRISTOFFEL TOM 
Published: December 2021

In Reply.—
Dr Schrein raises two objections to our commentary on handguns: he (1) challenges the validity of our use of the term "epidemic" and (2) doubts whether the risk posed by handguns is greater than that of other consumer products, such as cars, BMX bikes, skateboards, and curling irons.
An epidemic is an "occurrence in a community or region of ...health related events clearly in excess of normal expectancy."1 The handgun death toll in this country meets this definition beyond any doubt.
Questions About Early Enteral Feeding Study
Authors: EDWARDS KAREN S. , JOHNSON ROBERT WOOD 
Published: December 2021

To the Editor.—
Osterag et al (Pediatrics 1986;77:275-280) report that early feeding of sick very low birth weight infants does not increase the incidence of necrotizing enterocolitis. However, the authors failed to address the high likelihood of a false-negative result due to the small sample sizes.
With only 17 neonates in each group, the power of the study to detect an increase in the incidence of necrotizing enterocolitis from .35 to .55 is only 33%. In other words, there is a 67% chance that an increase of this size was missed.
Transcutaneous Oxygen Monitors Are Reliable Indicators of Arterial Oxygen Tension (If Used Correctly)
Authors: ROOTH G. , HUCH A. , HUCH R. 
Published: December 2021

The following recommendations should always be kept in mind:
1. Each new transcutaneous equipment, or modification of equipment, must be adequately tested in vivo as well as in vitro.
2. The users must have basic understanding of the principles and the major requirements for applying the tcPo2 technique.
3. Calibration procedures must be carefully adhered to according to the manufacturer's instruction.
4. The temperature of the electrode must be kept at 44°C for premature infants and at 44° or 45°C for term infants if the clinical aim is to estimate arterial Po2 levels. Resetting of the electrode must then be done every two hours. For sick infants, this may be needed more frequently.
5. Whenever there is cause to compare tcPo2 values with arterial ones, the latter must be obtained from an appropriate vessel. Great care must be taken when drawing and analyzing blood for Po2. The infant should not be crying.
6. Significantly lower transcutaneous Po2 values than arterial Po2 values are due to either one or several of the errors indicated above or to an insufficient circulation under the electrode. In recent years, technical or clinical errors seem to have become more and more common. Thereby the technique has unjustly fallen into disrepute.
7. Insufficient circulation under the electrode rarely occurs in the newborn infant and then only in those who are in overt shock.