bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fever Revisited
Authors: Kluger Matthew J. 
Published: December 2021

It has been 12 years since I last wrote a Commentary on fever for Pediatrics.29 As I pointed out in that review, fever, which occurs in response to infection or trauma, should be differentiated from "hyperthermia." During fever, the host behaves as if the temperature around which it is regulating (its thermoregulatory "set-point") were elevated. As such, during the rising phase of fever, the infected person will often shiver (increases heat production), will be peripherally vasoconstricted (a response that reduces heat loss), and will crawl under the covers or wear heavier clothing (behavioral responses that decrease heat loss). During hyperthermia, the core body temperature is above the thermoregulatory set-point, and the individual uses both physiological and behavioral means to lower body temperature. This is what happens as a result of exercising, particularly in a warm environment, or as a result of sitting in a sauna. When a fever "breaks" it is thought that the thermoregulatory set-point has returned toward normal, and it is at this time that the individual is hyperthermic. This is why the person will feel warm and will sweat during defervescence.
Since 1974 it has been known that fever has had a long phylogenetic history.63 Fevers occur not only in infected birds and mammals, but also in infected reptiles, amphibians, fishes, and even insects (Table 1). The thermoregulatory set-point has risen in the infected "cold-blooded" organisms; and as a result, they behaviorally seek a warmer microclimate. Individuals who have tropical fish may have noticed that when their fish are sick, they tend to congregate near the light (or heat source). I suspect this is an attempt to get their body temperatures up to their raised thermoregulatory set-point.
WHAT CAUSES THE RISE IN THERMOREGULATORY SET-POINT?
Most evidence indicates that some stimulus (eg, bacterial endotoxin or viruses) causes the release of an endogenous pyrogen (EP), a small molecular weight protein, from macrophages. EP travels through the circulation to the brain, where in the anterior hypothalamus it causes a rise in set-point, presumably by causing an increase in prostaglandin E2. Shortly after the first cytokines were identified, most investigators working in the area of temperature regulation and fever concluded that the cytokine, interleukin-1 (IL-1), was the circulating EP. IL-1, of which there are two forms: α and β, are thought to be responsible for numerous immune and nonimmune host-defense responses.
Tocopherol Levels in Infants ≤1000 Grams Receiving MVI Pediatric
Authors: AMORDE-SPALDING KAREN , D'HARLINGUE ARTHUR E. , PHILLIPS BARRY L. , BYRNE WILLIAM J. , CHENG K. STEVE , COOK NANCY E. , IRIAS JULIAN J. 
Published: December 2021

Achieving vitamin E sufficiency in the premature infant during parenteral nutrition requires early intravenous vitamin E supplementation. The optimal dose of intravenously administered vitamin E has not been determined. The antioxidant properties of vitamin E have led to its prophylactic use in the prevention of retinopathy of prematurity and intraventricular hemorrhage in premature infants, with variable results.1-4 Risks associated with pharmacologic doses of vitamin E include necrotizing enterocolitis and sepsis, and such adverse effects may be related to high plasma vitamin E levels.3
A plasma vitamin E level of 0.5 mg/dL is considered sufficient in premature infants.5 Johnson recomended that vitamin E levels in premature infants be maintained in a range of 1.0 to 3.0 mg/dL.
Even Advantaged Children Show Cognitive Deficits From Low-Level Lead Toxicity
Authors: CUMMINS SUSAN K. , GOLDMAN LYNN R. 
Published: December 2021

Over the past fifteen years, knowledge of the spectrum of lead neurotoxicity has increased dramatically. Since 1979, when Needleman and colleagues1 showed that deciduous tooth lead levels were inversely related to intellectual performance and behavior in school-age children, many well-designed epidemiological studies have confirmed that low-level, subclinical lead exposure in early life is associated with decrements in childhood cognitive performance.2 These human findings cohere with substantial primate evidence, which consistently demonstrates measurable and long-lasting neurodevelopmental deficits from exposure to low levels of lead.3
In response to compelling evidence of neurotoxicity from low-level lead exposure, the United States Centers for Disease Control (CDC) issued a revised lead statement—Preventing Lead Poisoning in Young Children—in October 1991.4
Could the Childhood Vaccine Act Be Bad?
Authors: HALL CAROLINE BREESE 
Published: December 2021

In Reply.—
The immediate problem of cost is certainly a barrier to the acceptability of the hepatitis B universal infant and adolescent immunization program. Whereas I agree that the mechanism of sole purchase may result in the detrimental and devastating effects you suggest, is it not possible to suggest that various groups of physicians or clinics combine to seek bulk purchase rates from all manufacturers? Could we encourage the various manufacturers to offer lowered bulk purchase rates, concurrently encouraging and sustaining commercial competitiveness? My assumption would be that the lowered bulk purchase price would not be detrimental to the manufacturer and their needed resources for production and research, as costs could be saved in distribution, sales, and greater use of the vaccines.
Mythology of Lead Poisoning
Authors: NEEDLEMAN HERBERT L. 
Published: December 2021

In Reply.—
I thank Dr Lakatos for his generous comments. His finding that DPA reduces bilirubin levels in neonates is intriguing; whether this is related to neonatal lead levels is unknown. Considerable work needs to be done before chelation can be considered as a therapy for newborn lead burdens.
Banner et al are concerned about the "mythology surrounding the issue of lead poisoning and its treatment," but they manage to propagate a few new myths of their own.
Questions about Bilirubin
Authors: SALERNO MARK , ZACKIN MICHAEL , CHARNEY EVAN 
Published: December 2021

To the Editor.—
We are responding to the recent article entitled "Hyperbilirubinemia in Low Birth Weight Infants and Outcome at 5 Years of Age"1 as well as its predecessor "Hyperbilirubinemia in Preterm Infants and Neurodevelopmental Outcome at 2 Years of Age."2
Both articles are equally impressive for the quality of follow-up and the careful analysis of the data. However, there are several questions that merit clarification:
1. Three hundred sixty-one children from the original cohort died within the first 2 years of life, or 27% of the original cohort.
The Pediatrician's Role in Helping Parents With Out-of-Home Child Care
Authors: Donahoe Eileen Chamberlain , Donahoe John Joseph 
Published: December 2021

The purpose of this paper is to identify a variety of parental concerns about child care and to suggest ways in which pediatricians and child care specialists could help ensure that children receive the best care possible.
Most parents are well aware that the decisions they make about their child's care are central to the child's well-being. Children in full-time care spend a significant portion of their day in the child care setting. Just as a good home is important to children's development, the quality of the child's day care will impact his or her physical health, mental development, and emotional security.
Generally, parents choose a child care arrangement with the hope and belief that the care will be beneficial. Despite good intentions and much expended energy, the care of the child does not always turn out to be optimal. There are often competing concerns about cost and quality, and gaps between what is sought and what is available. Furthermore, many parents experience a high degree of stress about their child care. Some of the stress stems from the complicated logistics associated with getting their child to and from child care. Much of it, however, is caused by the underlying worry that the care may turn out to be detrimental to the child.
Pediatricians and child care specialists could be of great help to parents, both in teaching them how to make better choices about child care and in alleviating much of the stress they feel about it. As a group, pediatricians are unique in that they have both wide access to parents and a high degree of credibility in terms of matters related to the welfare of children.
International Perspectives on Child Care Policies and Programs
Authors: Kamerman Sheila B. 
Published: December 2021

Child development research is more extensive and more sophisticated in the United States than in any other country in the world. US policy makers have access to more and better information about the factors known to enhance or impede good child development than those in almost any other country. Nonetheless, the United States lags far behind almost all the major advanced industrialized countries with regard to supply, quality, and affordability of out-of-home child care services for children under the age at which compulsory school begins (5, 6, or 7 years).
This paper provides a brief overview of child care internationally, primarily in northern and western Europe, the leaders in this field. The objective is to document the availability and quality of child care services and related policies in these countries. The paper begins by defining the terms that will be used in discussing child care internationally. The major focus is on identifying and describing the policy choices that the advanced, industrialized, western countries have made regarding child care for young children of different ages (preschoolers and infants).
DEFINING THE TERMS
The child care programs I will describe include preschools (kindergartens, prekindergartens, compensatory early-education programs, nursery schools); day-care centers (nurseries, creches); and family-day-care-homes (both regulated and unregulated). Relative care, occasional baby-sitting, and care provided within a child's own home are not included in this discussion, nor are programs for children with special needs (handicapped children). Nor, because of space limitations, are before- and after-school programs covered.
The major cross-national differences have to do with the financing of services and the extent of the role of the public sector; the predominance of the education, health, or social welfare system in delivering the services; the proportion of children of different ages served by these programs; whether services are limited to the children of working mothers; and the quality of the care provided.
Putting a Child in Day Care: Issues for Working Parents
Authors: Brazelton T. Berry 
Published: December 2021

In 1981, more than half the mothers in the United States were employed outside the home. By 1990, it was predicted that 70% of children would have two working parents. The number has been increasing each year since World War II, and 10 times as many mothers of small children work now as did in 1945. Now it is more culturally acceptable than even before for mothers to have jobs.
Even so, there is still a strong bias against mothers leaving their babies in substitute care unless it is absolutely necessary. Society does not yet whole-heartedly support working mothers and their choices about substitute care.
We do not have enough studies yet to know about the issues for the infant. The studies we do have are likely to be biased or based on experiences in special, often privileged populations. We need to know when it is safest for the child's future development to have to relate to two or three caregivers; what will be the effects of a group care situation on a baby's development; when babies are best able to find what they need from caregivers other than their parents; when parents are best able to separate from their babies without feeling too grieved at the loss. In a word, we need information on which to base general guidelines for parents. For it could be that the most subtle, hard-to-deal-with pressure on young adults comes indirectly from society's ambivalent and discordant attitudes, which create a void of values in which the building and nurturing of a family becomes very difficult.
Listening to Parents
Authors: O'CONNELL DENIS F. X. 
Published: December 2021

To the Editor.—
I found the article by Wood et al1 to be very interesting. The quality of health care for both the poor and nonpoor is an important issue. Under "Discussion," five potential explanations are given, and later in the article it is mentioned that adequate comprehension and retention of information are additional crucial elements to the physician-family partnership. I feel that the latter is a primary explanation and should be listed with the other potential explanations.
The Changing Role and Responsibilities of a Chairman—Letters
Authors: BRENT ROBERT L. 
Published: December 2021

In Reply.—
I would like to thank the scores of readers who wrote and called to tell me how much they enjoyed and appreciated the article dealing with the role of academic clinical chairmen.1
Dr Strasburger emphasizes one of the points addressed in my article. As stated, this article "is directed toward deans and search committees, because they frequently have criteria for selecting chairmen that do not include the personal qualities discussed in this manuscript." If any changes are to be instituted in the charge to search committees they would have to be determined by the dean and faculty.
Pectus Excavatum
Authors: LILLY JOHN R. , BAILEY WM. CARL 
Published: December 2021

To the Editor.—
Dr Asnes' Letter to the Editor (Pediatrics 1992;89:979) which recounts the painful story of a 17-year-old college applicant with pectus excavatum and his difficult passage through childhood and adolescence evokes sympathy and sadness. The patient's struggle with taunts, ridicule, and humiliation and his final accommodation to the physical and psychological impact of his deformity command our respect and admiration. The poignant lesson Dr Asnes draws is that the pediatrician not only has an obligation to attend the physical growth of his patient, but also to "observe, monitor, and nurture" emotional growth.
Evaluation of Febrile Infant
Authors: LIEU TRACY , BASKIN MARC , FLEISHER GARY 
Published: December 2021

In Reply.—
We appreciate Dr Levin's contribution to our analysis for febrile infants and agree that including the imperfect sensitivity of the CSF cell count in identifying meningitis improves the model's completeness. However, taken in perspective, the addition does not substantially alter our findings. In the original analysis, All Sepsis Tests + IV Antibiotics prevented 78% of sequelae, and All Sepsis Tests + IM Ceftriaxone prevented 76% of sequelae.1 Rodewald's study2 reported that a CSF cell count ≥6 had a sensitivity of 98.4% in identifying bacterial meningitis.
Amused Not Saddened
Authors: NELSON DOUGLAS S. 
Published: December 2021

In Reply.—
Ms Hammer's letter contains many important points with which I agree. Significant barriers to medical care exist for a large percentage of our population, and visits to an emergency department (ED) should be used as an opportunity to educate our patients. I believe that recognition of humor does not preclude delivery of appropriate (and even superior) health care. It is neither elitist nor callous to chuckle (usually along with the patient's parents) when something humorous occurs.
Sale of Individual Cigarettes: A New Development
Authors: ARCHBALD CHERYL 
Published: December 2021

To the Editor.—
Each year, more people die as a result of cigarette smoking than from acquired immunodeficiency syndrome or crack/cocaine. As such, use and abuse of tobacco remains a serious health concern in our society. The fact that a recent study concluded that young children were as adept at recognizing Old Joe, the cartoon camel that promotes Camel cigarettes, as they were at identifying Mickey Mouse, vividly demonstrates the influence of one tobacco company on our children.
Developmental Issues in Foster Care for Children
Authors:   Committee on Early Childhood, Adoption, and Dependent Care
Published: December 2021

Pediatricians who provide care for children in foster care have a unique opportunity and a special responsibility to assess the totality of the child's experience and to be a sympathetic and objective advocate for the child.1 Many children in foster care have suffered repeated abuse and prolonged neglect and often have a myriad of unmet medical and mental health needs.2 However, paramount in the lives of these children is their need for continuity and a sense of permanence. Legal responsibility for establishing where these children will live and which adults will have custody of them rests jointly with the child welfare system and the judiciary. Pediatricians and other professionals with expertise in child development should participate actively as advisors to social workers and judges about the child's needs and best interests, especially in the context of placement and permanency planning.
Maintaining the integrity of distressed families by providing adequate support services is generally in the best interest of the child. Keeping families together, however, may not be best for all children. Alternatives based upon an assessment of the developmental needs of the children and the capabilities of the family to meet those needs must be given consideration. As a society we value the rights of the birth family, sometimes hold them to be inviolable, and presume that families are competent. This belief and a lack of resources for assessment, planning, and services have resulted in inaccurate assessment of the child's relationships with his/her family by social service agencies and courts.
Vitamin A Treatment of Measles
Authors:   Committee on Infectious Diseases
Published: December 2021

In spite of the availability of effective vaccines, measles continues to be a public health problem throughout the world. In 1990, the Centers for Disease Control received more than 27 672 reports of measles in the United States. Complications were reported in one third of infected children younger than 5 years of age.1 Of the 89 measles-related deaths in 1990, 55% occurred in children younger than 5 years old.
Several recent investigations have indicated that vitamin A treatment of children with measles in developing countries has been associated with reductions in morbidity and mortality. The World Health Organization (WHO) and the United Nations International Children's Emergency Fund (UNICEF) issued a joint statement recommending that vitamin A be administered to all children diagnosed with measles in communities where vitamin A deficiency (serum vitamin A &lt;10 µg/dL) is a recognized problem and where mortality related to measles is ≥1%. The recommended regimen is 100 000 IU by mouth at the time of diagnosis for infants younger than 12 months of age, and 200 000 IU for older children. In the presence of ophthalmologic signs of vitamin A deficiency, such as night blindness, Bitot's spots (grayish white deposits on the bulbar conjunctiva adjacent to the cornea) or xerophthalmia, the WHO recommends the dose be repeated in 24 hours and again 4 weeks later.2 Vitamin A is available in low-cost liquid formulations and is supplemented in infant formulas (2000 µ/L).
RATIONALE FOR VITAMIN A
Vitamin A is a necessary substrate for preserving epithelial cell integrity and in addition plays a role in immune modulation.1-3
Sepsis and Jaundice
Authors: JOHNSON ANDREW MYRON 
Published: December 2021

To the Editor.—
Maisels and Kring1 have suggested that indirect hyperbilirubinemia as the only manifestation of bacteremia or sepsis in the newborn period is a rare event. Indeed, a previous study by Benaron and Bowen2 has shown that neonatal sepsis is associated with decreased maximal indirect bilirubin levels in newborns. The authors of that study suggested that bilirubin is consumed as an antioxidant in response to the release of oxidants by phagocytic cells. However, our own data suggest that the decrease may be at least in part due to more rapid maturation of the hepatic conjugating and excretory mechanisms for bilirubin secondary to the acute phase response (or "stress").3
Twins and HIV
Authors: GLOMB WM BRENDLE , WARD SALLY L. DAVIDSON , LEE STEVE S. , DURFEE MICHAEL J. 
Published: December 2021

To the Editor.—
We recently read the report of Thomas et al1 which suggested an association between twin gestation and human immunodeficiency virus (HIV) positivity in the offspring via vertical transmission. Dr Thomas speculated that there might be "an association between [maternal] drug use and twinning." She mentions that "the results of an analysis of 1988 birth certificates in progress at the New York City Department of Health suggests a higher incidence of twinning among women who mentioned narcotics use on the birth certificates."
Acetaminophen Hepatotoxicity After a Prolonged Ingestion
Authors: WALSON PHILIP D. , GROTH JOHN F. 
Published: December 2021

To the Editor.—
The Rumack-Matthew nomogram has been useful in predicting hepatotoxicity following single, acute acetaminophen ingestions.1 We report a case of acetaminophen hepatotoxicity to emphasize the lack of predictive value of the nomogram if the ingestion occurs during a prolonged period.
A 16-year-old girl reportedly ingested between 7.5 and 10 g of acetaminophen during a 4-hour period (7:00 to 11:00 am). She vomited twice spontaneously between 11:00 am and 3:30 pm A serum acetaminophen concentration drawn at 3:15 pm was 114 mg/L.
Acetaminophen Hepatotoxicity After a Prolonged Ingestion
Authors: DART RICHARD C. , RUMACK BARRY H. 
Published: December 2021

In Reply.—
Drs Walson and Groth are correct; the nomogram was designed to deal only with a single-point ingestion following a time interval sufficient to permit peak absorption.
It is critical to point out that current knowledge indicates continued dosing of N-acetylcysteine (NAC) (Mucomyst) very likely would have benefitted this patient. The reasons for this follow.
1. Smilkstein et al1 have reported previously that administration of NAC up to 24 hours after ingestion may have some, albeit reduced, benefits.
Health Insurance Differentials Among Minority Children With Chronic Conditions and the Role of Federal Agencies and Private Foundations in Improving Financial Access
Authors: McManus Margaret A. , Newacheck Paul 
Published: December 2021

Minorities experience a disproportionate share of the financial barriers resulting from higher rates of uninsuredness and a greater reliance on Medicaid vs private insurance. As a result, health services use and patterns of expenditures vary markedly by race and ethnicity.1,2
National survey data reveal a rapid increase in the number of uninsured black and Hispanic persons between 1977 and 1987.3 The major factors contributing to this increase are (1) overall growth in the size of the minority population, especially Hispanics; (2) reductions in private insurance coverage; and (3) the lack of significant expansions in public programs, largely Medicaid (note: several Medicaid eligibility expansions affecting poor children occurred during and after 1987).
In 1987, 14% of white children younger than age 18 were uninsured compared to 22% of black children and 33% of Hispanic children (Cornelius LJ. Unpublished data). Black and Hispanic persons were more likely to rely on Medicaid as their primary financing source than were white persons.3 In 1987, 8% of white children were covered by Medicaid vs 38% of black and 28% of Hispanic children (Cornelius LJ. Unpublished data from the Agency for Health Care Policy and Research, 1992.). Despite Medicaid's importance as a financing source, low reimbursement rates have resulted in inadequate provider participation and corresponding access barriers.4,5
In comparison with white persons, minorities have less access to employer-based insurance benefits. Part of the reason lies in the types of jobs that are disproportionately held by minorities. Personal service and agricultural employers typically do not offer health insurance to their employees.