bluuebunny/crossref_metadata_2025_split huggingface dataset:
Future Training of Pediatricians: Summary Report of a Series of Conferences Sponsored by the American Board of Pediatrics
Authors: Cleveland William W. , Brownlee Robert C. 
Published: December 2021

Recently, the American Board of Pediatrics sponsored three conferences for consideration of specific issues relative to the training and practice of pediatricians. Two of these, to be described briefly, served as background for the third, which will be reported in detail.
The first meeting was held in San Antonio, TX, in January 1984, for the principal purpose of discussing the training and practice of subspecialists in pediatrics. The discussion was precipitated by a petition from the Sub-Board of Pediatric Hematology-Oncology to extend the period of training in hematology-oncology from 2 to 3 years. Dr David Nathan spoke on the certification of subspecialists. He questioned the concept, in general, and the specification of an exact period of time for training, in particular. He suggested that the length of training might be variable for the individual and occur at some time during the faculty appointment. Dr Charles Abildgaard presented the justification for extending training on behalf of the Sub-Board. The thrust of the argument was that the discipline has become so complex that 3 years are required to acquire clinical proficiency; the research component was also emphasized. His presentation precipitated general discussion of some questions related to practice: Should subspecialists function in community hospitals or only in academic medical centers? Should the Board certify only clinical competence or should there be certification of competence to do research? What will be the impact of the large number of graduating students and of the increasing number of women studying medicine and entering pediatrics?
At this meeting Dr Robert Brownlee proposed some changes in the pattern of certification.
Blood Pressure
Authors: PARK MYUNG K. 
Published: December 2021

To the Editor.—
Recently the National Heart, Lung, and Blood Institute Task Force on Blood Pressure Control in Children published revised normal BP standards and guidelines for children.1 I welcome this effort, as reliable normative data have been unavailable but are prerequisite for the early detection of hypertension and its proper treatment. The guidelines published by the Task Force for the detection of hypertension, the diagnostic evaluation, follow-up laboratory testing, and treatment are, in my opinion, excellent.
Meconium Suctioning
Authors: BECK ROBERT 
Published: December 2021

To the Editor.—
With reference to Dr Eisner's comment (Pediatrics 1986;78:713) that it is technically difficult to intubate a neonate's trachea with a large suction catheter, I would reply that our neonatology group has enjoyed good success in suctioning meconium from below the cords in more than 1,600 meconium deliveries during the past 2 years using wall suction and a 10-F semistiff suction catheter with a side suction control valve (Superior suction catheter, Cumberland, RI).
Tocopherol Efficacy and Retinopathy of Prematurity
Authors: PHELPS DALE L. 
Published: December 2021

In Reply.—
Drs Schick, Beck, and DeSilva raise an interesting question and one that was not examined in our study because umbilical artery catheter placement in both our centers was usually high. The actual denominators in the Schick group seem to be six incidences of retinopathy of prematurity per 24 (25%) high catheters and none per 18 low catheters for a total of 14%; whereas in our study, 31/160 infants weighing more than 1 kg had retinopathy of prematurity (19%).1
Larger Numbers Needed
Authors: WISWELL THOMAS E. 
Published: December 2021

In Reply.—
Dr Altschul presents data on urinary tract infections during infancy and reports infection rates substantially lower than those we have previously reported.1,2 He then makes several conclusions based on these differences. His data indicate that the maximum infection rates would be 0.11% among girls and 0.02% and 0.12% among circumcised and uncircumcised boys, respectively. In contrast, from a population of 422,328 infants, we found the overall incidence of symptomatic urinary tract infection during the first year of life to be 0.57% in girls, 0.11% in circumcised boys, and 1.12% in uncircumcised boys.
Care of Uncircumcised Penis
Authors: WISWELL THOMAS E. 
Published: December 2021

In Reply.—
Dr Watson addresses an important question—what is the proper method of hygiene in the noncircumcised male infant? Our position has long been that there should be no forceful retraction of the prepuce and that the external surface of the foreskin should be gently cleansed as other parts of the body are. All military health care providers we have communicated with advocate similar philosophies and have done so for many years. Thus, we do not believe that in the population we described that vigorous cleaning and prepuce manipulation were "scientific interventions" that contributed to the increased incidence of urinary tract infection in the uncircumcised boy.1,2
Acute Poststreptococcal Polymyalgia With Trismus
Authors: GREMSE DAVID A. , WALTERSPIEL JUAN N. 
Published: December 2021

Acute poststreptococcal polymyalgia is an infrequently described entity that may follow infection with group A streptococci.1 Hallmarks of this condition are diffuse pain and exquisite tenderness of skeletal muscles without concomitant arthritis or elevated plasma concentrations of muscle enzymes. We recently cared for two children in whom acute poststreptococcal polymyalgia was associated with trismus. It is important to recognize this condition and distinguish it from tetanus.
CASE REPORTS
Case 1
A 6-year-old black boy was previously healthy until five days prior to admission when fever, sore throat, back pain, and malaise developed. On the day of admission, generalized rigidity and difficulty swallowing occurred.
Keep the 18-Month Health Supervision Visit
Authors: LYBARGER CONNIE , MURPHY NANCY 
Published: December 2021

To the Editor.—
In the April 1987 issue of Pediatrics, two important editorials were published. One, by Landrigan and Graef1 was on pediatric lead poisoning. The other, by Haggerty,2 was related to retaining the 18-month health supervision visit despite a recent change in immunization policies. We wish to point out a connection between these two commentaries; the 18-month health supervision visit provides an ideal opportunity to screen children for lead toxicity and to educate parents about lead poisoning.
Blood lead levels previously thought to be safe have been found to be associated with irreversible neurologic damage.1
Vitamin Dosages for Premature Infants
Authors: GREENE HARRY L. , PHILLIPS BARRY L. 
Published: December 2021

In Reply.—
As indicated on p 533 of our article,1 the original recommendations given by the AMA Nutrition Advisory Group in 1975 indicated that, for premature infants, 10% of a vial should be given for each kilogram of body weight. By the time a pediatric formulation was manufactured according to the Nutrition Advisory Group guidelines, several investigators believed that 10% of a vial would not supply the needs of very low birth weight infants for vitamins A, D, and E. For this reason, an ad hoc committee was organized in 1983 by the FDA to make new recommendations for premature infants.
Discharging the Jaundiced Infant From the Hospital: Risky for the Infant or Physician?
Authors: WENNBERG RICHARD P. , AHLFORS CHARLES E. 
Published: December 2021

To the Editor.—
Term infants with idiopathic unconjugated hyperbilirubinemia who are otherwise well are probably at less risk for bilirubin encephalopathy than they are for having congenital hypothyroidism or galactosemia. Because approximately 10% of children have a neurologic deficit of some type, however, it is tempting to blame such deficits on newborn jaundice, particularly if the parents perceive (often in retrospect) that the attending physician was not sufficiently attentive to the problem.
Social and financial pressures have minimized the hospital stay of newborns, resulting in increased risk for undetected hyperbilirubinemia with subsequent increased risk for litigation should a jaundiced infant manifest neurologic or developmental handicaps.
Screening for Neuroblastoma
Authors: WEINBLATT MARK 
Published: December 2021

To the Editor.—
This correspondence is in regard to the recent article by Woods and Tuchman about neuroblastoma screening and the commentary by McWilliams.1,2
Woods and Tuchman make a strong case for the institution of mass screening for neuroblastoma in infants to diagnose the tumors at an earlier and more treatable stage of their disease. The feasibility of this type of screening has been successfully demonstrated for other diseases (eg, galactosemia, hypothyroidism, and phenylketonuria) with resultant decreased morbidity and mortality.
Screening for Neuroblastoma
Authors: WOODS WILLIAM G. , TUCHMAN MENDEL 
Published: December 2021

In Reply.—
Dr Weinblatt has raised several issues that were addressed in our paper1 concerning the value of screening North American infants for neuroblastoma. Dr Weinblatt is concerned that the Japanese may be diagnosing neuroblastoma in many children whose tumors would have spontaneously regressed. The prevalence of preclinically detected tumors noted by Sawada et al, one in 17,600,2 is one third to one half the rate expected in any given year,3 not sixfold as calculated by Dr Weinblatt.
Suicide and Suicide Attempts in Adolescents and Young Adults
Authors:   Committee on Adolescence
Published: December 2021

Suicide is the third leading cause of death during adolescence and the second leading cause in young adults. It is preceded in frequency only by accidental deaths and homicide. Recent statistics indicate that the number of adolescent suicides has increased dramatically in the past decade, resulting in more than 5,000 deaths annually for youths between 15 and 24 years of age. For adolescents 15 to 19 years of age, suicide rates have actually tripled in the years between 1960 to 1980.1 Among children and younger teenagers between ages 5 and 14 years, suicides increased from 205 deaths in 1983 to 232 in 1984.2 As distressing as these data are, they may represent underreporting. Furthermore, many experts believe that numerous "accidental" deaths are actually suicides.3
Suicide affects young people from all races and socioeconomic groups. For every suicide completed, between 50 and 200 are attempted. Adolescent boys succeed in killing themselves more often than girls, although adolescent girls make more nonfatal attempts. This difference appears to be related, in part, to the methods favored by each sex. Boys are more likely to complete suicide because they use more lethal methods, such as firearms or hanging. These methods leave little chance for rescue. In contrast, adolescent girls more commonly attempt suicide by ingesting pills. Recently, however, there has been a trend toward the use of more lethal methods among girls.
"Cluster suicide" has also emerged in recent years. This phenomenon refers to the occurrence of multiple suicides during a short perioed of time in the same geographic location.4
Chloride-Deficient Formulas
Authors: BARNESS LEWIS A. 
Published: December 2021

To the Editor.—
In addition to the numerous caveats described in the paper by Willoughby et al (Pediatrics 1987;79:851-857), a number of other serious criticisms should be noted. General recommendations for the use of soy bean formula frequently included the assumption that some risk factor existed in the child, limiting the use of milk-based formulas. Indeed, in the 20 infants reported by Willoughby et al, 11 are said to have had other risk factors, such as hyperbilirubinemia in six, ventricular septal defects in two, and one each with low birth weight, twinning, and Pierre-Robin anomalad.
Galactosemia—To Screen or Not to Screen?
Authors: HARRIS RUTH C. 
Published: December 2021

In Reply.—
Norway has discontinued galactosemia screening because only 1 case has been identified per 96,000 infants screened. Members of a recent workshop on galactose screening1 in the United States reported that 37 states had an average incidence of 1:62,000 or 312 cases identified per 19 million infants screened. However, there was an incidence range from 1:30,000 to 1:191,000 from state to state.
Those states using both an enzyme assay and a measure of galactose content in the blood identified more enzyme defects, and, in general, laboratories with the longest experience appeared to be better able to recognize abnormalities in the screens.
Neonatal Arytenoid Dislocation
Authors: ROBERTS DION , MCQUINN TIM , BECKERMAN ROBERT C. 
Published: December 2021

Arytenoid dislocation is a well-described injury in adults.1-6 We report here what we believe is the first neonatal case and contrast the findings and course to those previously described.
CASE REPORT
A 2,640-g girl was born at 38 weeks' gestation by spontaneous delivery after labor complicated by the passage of meconium-stained amniotic fluid. She was intubated with a 3.0-mm oral endotracheal tube without a stylet. No meconium was found below the vocal cords. Apgar scores at 1, 5, and 10 minutes were 5, 7, and 9, respectively. When the baby was admitted to the nursery, she was described as having pink color, a strong cry, no retractions, a cardiac rate of 136 beats per minute, and a respiratory rate of 48 breaths per minute.
Elemental Mercury Exposure
Authors: VOGT RICHARD L. 
Published: December 2021

In Reply.—
Dr Swinehart describes a case of mercury toxicity in a child of a furnace operator who worked in a mercury smelter. In Vermont we identified mercury exposure in workers and children as measured by urinary mercury content (Pediatrics 1987;79:935-938). We failed, however, to find clinical cases of mercurialism. As stated in our article, engineering and clothing barriers will help to protect workers and workers' children at home from mercury and other heavy metal exposure.
Relaxation and Examination for Sexual Abuse
Authors: HERMAN-GIDDENS MARCIA , FROTHINGHAM THOMAS E. 
Published: December 2021

In Reply.—
We appreciate the comments by Drs Hansen and Palmer with regard to the patient's state of relaxation during the genital examination. Although we did not use the word "relaxation" in our discussion, we thought we covered this issue by stressing the cooperation of the child, pointing out that one cannot do an adequate examination on a resisting child and that several seconds are required with a cooperative patient, after the labia are spread and being held properly, for the hymenal or vaginal tissues to optimally separate.
Sn-Protoporphyrin: A Consideration of the First Clinical Trial in Human Neonates
Authors: STEVENSON DAVID K. , VREMAN HENDRIK J. 
Published: December 2021

The history of new treatment modalities for neonates1 suggests that cautious optimism is warranted even when one considers the first successful trial of a novel and exciting strategy for the chemoprevention or treatment of neonatal hyperbilirubinemia with tin protoporphyrin (Sn-protoporphyrin). Kappas et al2 and Drummond and Kappas3 were the first to show that this synthetic protoporphyrin is effective in decreasing plasma bilirubin levels in both adult and neonatal animals and humans.
In the April issue of Pediatrics, Kappas et al,2 reported the results of administering as many as three doses (0.75 µmol/kg per dose) of Sn-protoporphyrin to human neonates with hyperbilirubinemia due to hemolytic disease caused by ABO incompatibility.
Haemophilus influenzae Type b Vaccines: Lessons From the Past
Authors: DAUM ROBERT S. , MARCUSE EDGAR K. , GIEBINK G. SCOTT , HALL CAROLINE B. , LEPOW MARTHA L. , MCCRACKEN GEORGE H. , PETER GEORGES , PHILLIPS CAROL F. , WRIGHT HARRY T. , PLOTKIN STANLEY A. 
Published: December 2021

The Committee on Infectious Diseases of the American Academy of Pediatrics attempts to provide "guidelines that complement the physician's clinical judgment and facilitate the making of well reasoned decisions. Unanswered scientific questions, the complexity of medical practice, new information, and inevitable differences of opinion between experts result in inherent limitations"1 in this process.
With regard to the first-generation Haemophilus b polysaccharide vaccines (HBPV or PRP), the Committee issued a statement on Nov 13, 1987 (PedComm: AAP Member Alert), in which its concern regarding the preliminary efficacy estimates derived from "case-control" studies performed by several investigative groups in various areas in the United States was expressed.
What Is `Significant' and DTP Reactions
Authors: EDEN ALVIN N. 
Published: December 2021

To the Editor.—
The possible association between diphtheria-tetanus-pertussis (DTP) and sudden infant death syndrome (SIDS) is of enormous concern to all of us. Therefore, I read with a great deal of interest the article by Hoffman et al (Pediatrics 1987;79:598-611). Based on the information the authors presented in their detailed report, there appears to be absolutely no relationship between a DTP shot and the subsequent occurrence of SIDS. This was good news to me until I read the last sentence in the article.
Granulocyte Transfusions
Authors: BALEY JILL E. , STORK EILEEN K. , WARKENTIN PHYLLIS I. , SHURIN SUSAN B. 
Published: December 2021

To the Editor.—
We would like to point out an inaccuracy in the commentary written by Dr Cairo1 in which he states that the three different groups in our study "should have required separate randomizations." In fact, the groups were not mixed. They were separately randomized and analyzed. Only after they were considered separately and no differences were found in outcome were the three groups combined for a total population.
Also, although the average age of presentation was older than that in the studies by either Christensen et al2 or Cairo et al,3 we only included children with over-whelming sepsis, those who were in shock and who required mechanical ventilation.
Granulocyte Transfusions
Authors: CAIRO MITCHELL S. 
Published: December 2021

In Reply.—
The comments raised by Baley et al are well taken and bring up one of the most important variables in the role of granulocyte transfusion in neonatal sepsis. Most of the studies to date have involved small numbers of patients in single institutions. This has prevented us from accumulating a large enough population of patients to adequately assess the role of either buffy coat transfusions or leukapheresed transfusions in this clinical setting.
My comments in the commentary suggested that, with only eight patients in a group of preterm infants with presumed sepsis and only five patients with presumed sepsis with birth weights greater than 1,500 g, the numbers are essentially too small to determine any statistical significance between the role of buffy coat transfusions or supportive care.
Odontoid Fracture in a Child Occupying a Child Restraint Seat
Authors: DIEKEMA DOUGLAS S. , ALLEN DAVID B. 
Published: December 2021

General agreement exists regarding the importance of using infant and toddler car seats. However, current guidelines regarding the proper time to change the direction of a convertible safety seat are still debated. We report a case in which an unusual, but preventable, injury was sustained by a child occupying a "properly" installed child restraint device. The rarity and potential seriousness of this injury illustrates the safety advantage of using rearward facing infant car seats as long as possible during infancy.
CASE REPORT
A 10-month-old girl weighing 8.04 kg (17 lb 14 oz) occupied a properly installed forward facing convertible safety seat located in the rear seat of an automobile involved in an accident.
Intravenous γ-Globulin Use in Children With Kawasaki Disease
Authors:   Committee on Infectious Diseases
Published: December 2021

A recent controlled American trial1 of treatment for Kawasaki disease compared the use of acetylsalicylic acid (aspirin) alone v aspirin at the same dose plus a single preparation of IV γ-globulin, which is not currently licensed in the United States. The dosage of IV γ-globulin was 400 mg/kg/d for four days, and the dosage of aspirin was 80 to 100 mg/kg/d for as many as 8 weeks. The results indicated that, if administered within ten days of onset of fever, the combined treatment significantly lowered the prevalence of coronary artery dilation and aneurysms detected at 2 and 7 weeks postenrollment. The IV γ-globulin-treated group showed significant and rapid reduction in fever, WBC count, and generalized inflammatory signs. Prior studies in Japan also showed benefit from IV γ-globulin.2
Because the etiology of Kawasaki disease is not known and the active component of the immune globulin has not been identified, it is not known whether all IV γ-globulin preparations currently licensed in the United States will be effective. Further studies are underway to compare different IV γ-globulin preparations and to determine the optimal dose and schedule of administration.
Pediatricians should consider using IV γ-globulin and aspirin for the treatment of patients who meet the strict criteria for this syndrome.3 If IV γ-globulin is to be used, therapy should be initiated with any one of the products licensed in the United States and administered within ten days of the onset of illness at the dosage schedule described above. The efficacy of such therapy if initiated more than ten days after onset of illness or after aneurysms have been found has not yet been demonstrated.
Cocaine Abusers as Mothers
Authors: CERSONSKY JEFF 
Published: December 2021

To the Editor.—
I have two points to raise concerning the article by Chasnoff et al (Pediatrics 1987;80:836-838). First, the history of alcohol intake given was consistent with dependency. As an addictionologist working with teenage alcoholics and addicts, I can give you a pretty good assurrance that the alcohol intake related by this mother was a gross underestimation. The physical features of this child lead one to believe that the child did suffer from prenatal maternal abuse and should have been further discussed.
Barbiturate Anticonvulsants as a Cause of Severe Depression
Authors: BARABAS GABOR , MATTHEWS WENDY S. 
Published: December 2021

To the Editor.—
In a recent issue, Brent et al1 compared patients treated with phenobarbital with those treated with carbamazepine for seizure disorders. They noted that there was a much higher prevalence of major depressive disorder and suicidal ideation among those taking phenobarbital. They emphasized that the incidence of psychiatric disturbances is higher among epileptic children as compared with controls and that on occasion this may be due to iatrogenic effects of anticonvulsants and not only to factors intrinsic to epilepsy or secondary emotional factors.
Barbiturate Anticonvulsants as a Cause of Severe Depression
Authors: BRENT DAVID A. 
Published: December 2021

In Reply.—
I appreciate the comments of Drs Barabas and Matthews. It is nice to receive additional clinical validation for our observations of an association between phenobarbital treatment and affective symptomatology in epileptic patients. A recently published study of adult epileptic patients has also found an association between phenobarbital treatment and depressive symptomatology.1
It is of interest to learn that other barbiturate anticonvulsants as well may be associated with depression. Drs Barabas and Matthews emphasize three points that we touched on, too—the importance of a high index of suspicion for depression in patients treated with phenobarbital, the possibility that such symptoms may occur at nontoxic doses, and the findings of depression in young children such as lability, irritability, and agitation that may be termed "hyperactivity."