bluuebunny/crossref_metadata_2025_split huggingface dataset:
Maternal Phenylketonuria
Authors:   Committee on Genetics
Published: December 2021

Prior to newborn screening and the availability of dietary treatment for phenylketonuria, most patients with classic phenylketonuria developed profound mental retardation and rarely reproduced.1,2 Newborn screening for phenylketonuria has been routinely available throughout the United States for approximately 25 years. Many infants who were identified as having elevated blood phenylalanine concentrations received dietary treatment. In most cases they have attained normal intelligence. A significant number of women who are no longer being treated have entered or are approaching their reproductive years. When diet is discontinued, elevated blood phenylalanine concentrations and other biochemical changes of classic phenylketonuria again become evident.
Children born to mothers whose blood phenylalanine concentrations exceed 0.6 mM (10 mg/dL) have an extremely high incidence of microcephaly and mental subnormality due to the teratogenic effects of phenylalanine and its metabolites.1-8 The incidence of other congenital anomalies, such as congenital heart defects, is also increased. When blood phenylalanine concentrations are less than 0.6 mM(10 mg/dL), the effect on offspring appears to be less severe and less constant. The outcome of such pregnancies is being investigated in a collaborative study sponsored by the National Institutes of Health.1,7 Additional data will become available soon.
All women with persistent phenylalanine elevations should be counseled prior to pregnancy about the possible adverse effect of their condition on their offspring. These women should also be counseled about the risk that their child might have phenylketonuria (approximately 1/120). Reproductive options should be discussed.
Women who decide to proceed with pregnancy should be advised that dietary treatment may improve the outcome for their child.2-4,7-9
Midazolam-Fentanyl Sedation
Authors: YASTER MYRON , NICHOLS DAVID G. , DESHPANDE JAYANT K. , WETZEL RANDALL C. 
Published: December 2021

In Reply.—
We can not disagree more with Dr Traynor. Multiple studies have repeatedly demonstrated that children are rarely treated for pain or for painful procedures even when their discomfort and anguish is obvious.1,2 Providing analgesia, amnesia, and sedation should be priorities of medical and surgical care and are hardly of "dubious" benefit. Indeed, the callousness and disregard displayed by many physicians to their patient's pain is shocking. Indeed, it is not at all surprising that patients with cancer, as an example, describe the horrors of their treatment as much worse than the disease itself.
Sucrose as an Analgesic for Newborns
Authors: SCHOEN EDGAR J. 
Published: December 2021

To the Editor.—
Blass and Hoffmeyer1 are to be congratulated for documenting the simple noninvasive use of a sucrose-flavored pacifier to relieve pain in newborns. In well-controlled studies they showed that not only did this benign therapy decrease distress during blood collection for routine newborn screening, but it also reduced crying more than 50% during circumcision. Earlier work by Blass and others indicated that a pacifying stimulus as well as oral sucrose relieves pain2-4 and that this analgesic effect is mediated through opiate pathways.5-7
Corporal Punishment
Authors: NERSESIAN WILLIAM 
Published: December 2021

To the Editor.—
The article "Hypovolemic Shock in a Child as a Consequence of Corporal Punishment"1 prompted me to reflect on several points. In their discussion and summarizing sentence, it is clear that the authors oppose any form of corporal punishment. I am concerned that this conclusion is based solely on the perceived risks (adverse effects, as evidenced in this anecdotal report) of physical punishment with no attempt to examine or study any potential benefits of physical punishment.
Corporal Punishment
Authors: FLETCHER JAMES L. 
Published: December 2021

To the Editor.—
Expecting the worst, I read with interest the article, "Hypovolemic Shock in a Child as a Consequence of Corporal Punishment," in the April issue of Pediatrics.1 My concern was not disappointed. I rejoiced, of course, that the little girl in the case report recovered from the effects of her severe paddling (ie, beating). The article raises in a biased fashion very troublesome issues, however.
Hardly anyone in organized or academic medicine speaks of public morality anymore.
Corporal Punishment
Authors: MAY RONALD B. , BEAL DOUGLAS W. 
Published: December 2021

In Reply.—
Dr Nersesian quite correctly points out that there are no controlled long-term studies to determine the beneficial effects of physical punishment. He also sets down a list of criteria to be met prior to the use of physical punishment. These criteria are well thought out and an excellent guide to a parent who feels that physical punishment is necessary. He is also correct in his assumption that the authors are generally opposed to corporeal punishment; however, our position is not based on this one case alone.
Methsuximide-Induced Movement Disorder
Authors: DOOLEY JOSEPH , CAMFIELD PETER , BUCKLEY DAVID , GORDON KEVIN , WIRRELL ELAINE , CAMFIELD CAROL 
Published: December 2021

To the Editor.—
A recent article in Pediatrics reported that methsuximide improved seizure control, without serious adverse effects, in 15 of 25 children with intractable epilepsy.1 We subsequently added methsuximide to the treatment regimen of a 17-year-old boy who was already taking valproate, clobazam, and intermittent lorazepam and paraldehyde for uncontrolled seizures. His seizures remained uncontrolled, but 24 days after the initiation of methsuximide he developed orofacial dyskinesia and akathesia, while receiving 450 mg per day (11.3 mg/kg/d).
Methsuximide-Induced Movement Disorder
Authors: TENNISON MICHAEL , GREENWOOD ROBERT , MILES MICHAEL 
Published: December 2021

In Reply.—
We appreciate comments of Dooley et al and hope that our paper will stimulate further interest in this often overlooked drug. That methsuximide could induce a movement disorder is not totally unexpected. Other antiepileptic drugs occasionally have been associated with dyskinetic movements. All treatments have a risk-to-benefit ratio and may be inappropriate for a given patient in a given circumstance; this does not diminish the value of the drug for other patients.
We do not feel that it has been proved clearly that the movements are due to methsuximide.
Burning of a Neonate due to a Pulse Oximeter: Arterial Saturation Monitoring
Authors: SOBEL DANIEL B. 
Published: December 2021

Monitoring of arterial hemoglobin saturations by pulse oximetry has become a fixture in neonatal and pediatric intensive care units, operating rooms, and in other hospital settings. Use with extremely premature neonates is especially beneficial because of their immature skin development and vulnerability to topical damage—whether due to chemicals, tape, or temperature.1,2 This report documents a case of a burn due to a presumed shorting of a pulse oximeter probe cable in an extremely premature neonate.
CASE REPORT
The patient was a 690-g Hispanic female neonate born prematurely at approximately 25 weeks' gestation with respiratory distress syndrome requiring mechanical ventilation and supplemental oxygen.
Chemotherapy for Tuberculosis in Infants and Children
Authors:   Committee on Infectious Diseases
Published: December 2021

Active tuberculosis is diagnosed in more than 1100 children annually in the United States. The therapy for patients with tuberculosis has undergone major changes during the past decade, including demonstration of the efficacy of multidrug, short-course chemotherapy for pulmonary tuberculosis in adults.1 At least nine studies of 6-month antituberculosis chemotherapy have demonstrated comparable results in children.2-10 The purpose of this statement is to give revised recommendations for treatment of tuberculosis in infants and children. These recommendations have been formulated in collaboration with the Division of Tuberculosis Elimination of the Centers for Disease Control and the American Thoracic Society.
MICROBIOLOGIC RATIONALE FOR TREATMENT
Laboratory observations of Mycobacterium tuberculosis and clinical therapy trials have led to a hypothesis concerning the populations of tubercle bacilli and the actions of various antimycobacterial drugs and drug combinations.11,12 Mycobacteria replicate slowly, can remain dormant for prolonged periods, and can be killed by drugs only during replication. In the host, bacilli live in several sites: open cavities, closed caseous lesions, and within macrophages. Each site contains bacilli with a different population size, metabolic activity, and rate of replication. Open cavities, which are rare in infants and children, have the largest number of mycobacteria. Naturally occurring drug-resistant mutants of M tuberculosis occur within large bacterial populations even before chemotherapy is started. The number of drug-resistant mutants is proportional to the size of the mycobacterial population; thus, they are common in open cavities, but less common in caseous lesions and within macrophages. Mutants naturally resistant to two drugs are virtually nonexistent.
Ibuprofin Safety
Authors: LORIN MARTIN I. 
Published: December 2021

In Reply.—
Dr Rosefsky contends that ibuprofen has a relatively good safety record, both in children as well as in adults. However, because for most children it is questionable whether or not fever needs to be treated at all, I contend that the change to a newer, more expensive, and more toxic drug is not justifiable. This is not to say that ibuprofen is not an acceptable or useful drug, but only that it should not be used for simple or routine antipyresis while a safer agent is available.
Location of Port-Wine Stains and Likelihood of Complications
Authors: TAN OON TIAN , MORELLI JOSEPH , STAFFORD TIMOTHY J. 
Published: December 2021

In Reply.—
We were interested to read Dr Lueder's comments regarding the incidence of glaucoma in patients with PWS in the trigeminal distribution. While we agree that the incidence of 7% in our study appears to be low, we also feel that the incidence of 24% he mentions in his letter may be rather high. It is our impression that the incidence of glaucoma is somewhere in between. One reason for the low incidence being reported in our study is the fact that only those who had already had the diagnosis made of glaucoma were included in our study.
Home Visitation Investment
Authors: OLDS DAVID L. , KITZMAN HARRIET 
Published: December 2021

In Reply.—
We agree with Dr Sissman that greater attention needs to be paid to the costs and financial returns that society can expect from an investment in home visitation. Our group is working on an empirical report that addresses this topic. Unfortunately, there is virtually no published evidence on the cost-savings that might be produced by an investment in home visitation per se, although there are several reports on the cost effectiveness and cost benefits of home visitation when it is combined with other services.1-3
The Anser System
Authors: GLASCOE FRANCES PAGE 
Published: December 2021

In Reply.—
How likely is it that users of the Anser System will spend what is a considerable amount of time collecting information from teachers, parents, and children, but stop short at drawing any conclusions from the findings? It is the central and everyday task of physicians to marshall data and then form judgments about the nature of the problem and interventions. The Anser System may help Pediatricians gather descriptions about children. But, it leaves the inescapable process of determining just what their difficulties are entirely to chance, whim, or idiosyncrasy.
Perineal Confusion
Authors: EMANS S. JEAN 
Published: December 2021

To the Editor.—
The recent study by Drs Kellogg and Parra1 is clearly important in documenting the prevalence of the "linea vestibularis" in the normal neonate. However, this structure is not previously "undescribed," John McCann and colleagues2 described an "avascular midline area" in the posterior fourchette in 25.6% of prepubertal girls selected for nonabuse. In this study, the possibility that some of these lines were caused by labial adhesions was not reported separately. In a study not published at the time of your article, Berenson and colleagues3 found a midline avascular area in 4% of a younger group of girls.
Questions on ECMO Study
Authors: SCANLON JOHN W. 
Published: December 2021

To the Editor.—
The remarkable study by O'Rourke et al1 about extracorporeal membrane oxygenation (ECMO) for persistent pulmonary hypertension undoubtedly will generate considerable discussion about the investigators' creative and novel approach both to the ethics of informed consent and to the methods of research design.
I have one simple question. If their entry selection criteria produced an 85% likelihood of dying, why did only 40% of conventionally treated controls die? Superficially it would seem either that their criteria were inaccurate or that care substantially improved after 1983.
A Different View of Surfactant Development
Authors: KATTWINKEL JOHN 
Published: December 2021

To the Editor.—
Dr Lucey has praised the neonatology profession for finally "getting it right" in its recent development of surfactant therapy for neonatal respiratory distress syndrome.1 Although, in some respects, I agree that we have done it better than in the past, I believe there needs to be an opposing view presented to his uniformly rosy assessment.
Yes, we do have a "therapy which we know works and is safe," and which was an international joint product of research groups, industry, and the Food and Drug Administration.
Intraventricular Hemorrhage in the Full-Term Neonate Associated With Abdominal Compression
Authors: WEHBERG KURT , VINCENT MARTIN , GARRISON BOBBY , DILUSTRO JOSEPH F. , FRANK L. MATTHEW 
Published: December 2021

Intraventricular hemorrhage (IVH) in the full-term neonate usually is associated with birth trauma and/or perinatal asphyxia. A cause can be found in approximately 75% of cases; however, the remainder have no identifiable risk factors.1 This report describes a 13-day-old full-term neonate who sustained an IVH following moderate abdominal trauma.
CASE REPORT
History
A full-term male newborn was delivered via an uncomplicated spontaneous vaginal delivery to a 35-year-old biparous mother with third trimester diet-controlled gestational diabetes mellitus. Apgar scores were 8 at 1 minute and 9 at 5 minutes. Birth weight was 3660 g, and the results of the neurologic examination were normal with a fronto-occipital head circumference of 35.0 cm.
Publish or Perish
Authors: SAHLER OLLE JANE Z. 
Published: December 2021

To the Editor.—
In a recent issue of Pediatrics,1 the editors of several pediatric journals express disgruntlement with the practices of submitting articles reporting the same data to more than one journal, or "self-plagiarism," and of dividing studies into numerous short reports or "least publishable units." To combat these practices, they infarmally" inform one another about suspected duplication.
All well and good, I suppose, and occasionally authors probably have had their hands slapped. But, the crux of the matter, really, is contained in paragraph 1, sentence 5: "We suspect that these practices are based on the desire to expand one's list of publications so as to enhance one's reputation and the chances of achieving promotion and academic tenure."
More on Dog-Bite Injuries
Authors: AVNER JEFFREY R. , BAKER M. DOUGLAS 
Published: December 2021

In Reply.—
The experience of Lackmann and Tollner confirms many of our clinical findings concerning dog-bite-related injuries in children; namely, young children are more likely to be bitten at home by a familiar dog. Although they report a lower incidence of provoked attacks than we found, it is unclear how they defined "provoked." We defined provoked as any child-initiated interaction with the dog, including playing with the dog. Clearly, these data support the recommendation that families with young children should be the target of pet safety education.
The Child as a Witness
Authors:   Committee on Psychosocial Aspects of Child and Family Health
Published: December 2021

In the last two decades, there has been a dramatic increase in the recognition and reporting of child physical and sexual abuse. This, coupled with the current 50% divorce rate and the fact that many of these separations involve child custody decisions, has led to an increasing need for children to appear in court.
Custody decisions usually involve family or civil courts; however, allegations involving sexual abuse may require a child to appear as a witness in criminal court. Although the procedures and potential consequences of these legal processes are quite distinct, all situations in which children offer testimony can be quite stressful and merit the awareness and support of pediatricians.
Pediatricians can become involved with children who are to be witnesses at several levels, including: 1) supporting patients in the pediatric office; 2) participating in legal proceedings; and 3) advocating for legal reform.
SUPPORT IN THE PEDIATRIC OFFICE
The pediatrician is an important source of support for the child who is to be a witness, from the initial contact through preparation for court appearance, and after the court proceedings. A pediatrician should attempt to keep the legal process in the child's best interest and should help the child maintain a healthy adaptation to a stressful experience. The pediatrician should also address the psychological impact of the event responsible for the child's court appearance.
When parents plan to separate, pediatricians may help the family by discussing living arrangements and visitation during an office visit. If custody is disputed, which is the case in 10% of divorces, and a child is asked to appear in family court, the pediatrician can provide counseling to help prepare the child for the court appearance.
Role of the Pediatrician in the Multidisciplinary Team
Authors: BRONFIN DANIEL R. , GELLIS SYDNEY S. 
Published: December 2021

To the Editor.—
We would like to commend Dr Lowe and the remainder of the Task Force on the recent Report on the Future Role of the Pediatrician in the Delivery of Health Care.1 The distinction between "primary care" and "level of care" is of major importance. It is correctly stated that "the essential nature of primary care services includes first contact, continuity, comprehensiveness, and coordination of needed services"; however, "level of care describes intensity of treatment, the need for technologic support, and specially trained support personnel."
Gay Teens and Suicide
Authors: FIKAR CHARLES R. 
Published: December 2021

To the Editor.—
I would like to comment upon the excellent article concerning adolescent suicide attempters by Drs Swedo et al.1 The authors correctly state that suicide is the third leading cause of death among American youth. Obviously, health care providers have an imperative obligation to become involved in the early recognition of suicidal risk factors in adolescents.
Dr Swedo's report cites many of the risk factors associated with adolescent suicide attempts, including poor self-image, depressed mood, feelings of hopelessness, and social stress.
Weight and Menstrual Function in Patients with Eating Disorders and Cystic Fibrosis
Authors: JAFFE ARTHUR C. 
Published: December 2021

In Reply.—
We appreciate Dr Hergenroeder's thoughtful comments, and have no major disagreements with any of them. His point about the difficulty of estimating ideal body weight from the height tables of Hamill et al is well taken. Our study was meant to be only a limited, "first pass" effort to evaluate the nutritional contributions to menstrual abnormalities in eating disorders, and we felt a rough approximation of ideal weight was acceptable.
We agree entirely that assessment of body composition to elucidate a possible relationship between percentage of body fat and normal menstruation would have been helpful.
Disposable Diapers vs the Environment
Authors: SUTTON MARIANNE B. 
Published: December 2021

In Reply.—
We appreciate the August 1991 Consumer Reports price figures on diapers that Dr Seitz provides. She correctly points out that the prices quoted in our article are from a 1987 Consumer Reports article. When our manuscript was accepted for publication (December 6, 1990), the more recent figures had not yet been published.
We did not intend to "nonchalantly discard the demonstrated benefit of disposable diapers in preventing diaper rash." We did provide the reader with ten references documenting this benefit.
Definition of Bronchopulmonary Dysplasia
Authors: KAPLAN MICHAEL 
Published: December 2021

To the Editor.—
Once again, a study of bronchopulmonary dysplasia (BPD), this time assessing the effect of antenatal steroid therapy, has timed the criteria for diagnosis (oxygen requirement and radiographic changes) at 28 postnatal days.1 Unfortunately, oxygen requirement, with or without radiographic changes, at this age, is being accepted widely as the clinical definition of this condition (alternatively termed chronic lung disease).2,3 Frequently, clinical studies relate minimally, if at all, to the later outcome of infants with BPD.
Definition of Bronchopulmonary Dysplasia
Authors: VAN MARTER LINDA J. , LEVITON ALAN , ALLRED ELIZABETH N. , PAGANO MARCELLO , KUBAN KARL C. K. 
Published: December 2021

In Reply.—
Dr Kaplan raises an interesting and intriguing point. He proposes that the diagnosis of BPD be reserved for infants who are oxygen-dependent with radiographic changes characteristic of the condition at 40 weeks postconceptional age. This approach, advocated by Sinkin et al1 and Merritt et al,2 has intuitive appeal to individuals interested in gestational variation in pulmonary development as well as the pathophysiology and short-term outcome of BPD. A potential problem with the new standard proposed by Dr Kaplan is that gestational age is often uncertain and is not readily established by pediatric examination in very low birth weight infants.
Do Pediatricians Like Childish Ads?
Authors: FISCHER HOWARD 
Published: December 2021

To the Editor.—
I have long thought that much of the advertising in pediatric journals is "childish": It uses cartoon-type drawings or comic strip characters. To evaluate this impression I counted the number of illustrated advertisements in one year's issues of three pediatric and two internal medicine journals and determined the proportion of "childish" advertisements found. Illustrated advertisements were those which contained any form of image (photograph, drawing, graph); "childish" advertising is defined above. Results may be seen in the Table.
Crystalluria Following Cephalexin Overdose
Authors: CLARK RICHARD F. 
Published: December 2021

Crystalline forms of certain drugs can appear in the urine, especially when the specimen is concentrated. Most often they are of little clinical significance,1 but the unexpected finding of crystals of an unknown etiology can be disconcerting. This is a case of a child with hematuria and crystalluria following a cephalexin overdose.
CASE REPORT
A 3-year-old boy weighing 24 kg was brought to the emergency department by his mother; the chief complaint was hematuria. His mother stated that the child had been asymptomatic and his urine had been normal prior to the day of presentation. Five hours earlier, she had
Use of Acyclovir in the Treatment of Chickenpox
Authors: LASSITER HERBERT A. 
Published: December 2021

To the Editor.—
In a recently reported well-designed study, oral acyclovir significantly reduced the severity and duration of symptoms of chickenpox in otherwise healthy children.1 The study was randomized, double-blind, and placebo-controlled. Of the 724 children who were enrolled and evaluated, 367 received acyclovir and 357 received placebo. Clearly, the severity of itching and the duration of vesicles and fever were diminished in the acyclovir recipients. The incidence of important complications did not differ significantly