bluuebunny/crossref_metadata_2025_split huggingface dataset:
Care Practices and Bronchopulmonary Dysplasia Debate
Authors: KELLER JACOB , AVERY MARY ELLEN 
Published: December 2021

In Reply.—
We appreciate the opportunity to clarify the issues raised by Barry et al. We tested the significance of the differences among centers in the incidence of chronic lung disease, adjusted for sex, race, and birth weight, by computing two multiple logistic regression models. The first model included only sex, race, and birth weight as independent variables. The second model additionally included seven dummy variables representing the eight centers. Twice the difference in the log likelihoods in the two models has a χ2 distribution with 7 df under the null hypothesis of no center differences.
Adolescent Varicocele
Authors: KASS EVAN J. 
Published: December 2021

In Reply.—
Until objective guidelines are established, I would be opposed to a more aggressive approach to the adolescent varicocele because not all of these children are at risk for future problems. At the present time, we are primarily concerned about individuals with a large varicocele, particularly when there is volume loss of the testis ipsilateral to the varicocele.
Surgical ligation of a large varicocele is routinely performed as a brief outpatient procedure with the aid of optical magnification to facilitate ligation of the multiple venous collaterals so often found in individuals with a large vanicocele.
Call It Asthma
Authors: PLAUT THOMAS F. , JONES EMLEN H. , MARSH DAVID R. , GOTTSEGEN DAVID N. 
Published: December 2021

To the Editor.—
The childhood wheezing season is here again. With it comes advice from many quarters for pediatricians to eradicate the symptoms with inhaled adrenergic drugs or theophylline, but "don't call it asthma." Call it a wheezing-associated respiratory illness,1 a wheezing problem, or bronchitis to avoid upsetting parents with the word "asthma."
We diagnose wheezing as asthma in almost every child older than 1 year of age in whom bronchodilators cause an abatement of symptoms or a 20% increase in the peak expiratory flow rate.
Behavioral Pediatrics: A Time for Research
Authors: Haggerty Robert J. 
Published: December 2021

There are many children with problem behaviors who are not being helped, in large measure because we do not know enough about the causes of their problems or the effectiveness of therapy for them. The study of office visits by Starfield et al1 demonstrated that at least 15% of children have psychosomatic problems and another 5% to 10% social and behavioral problems (Table 1). The cause and impact of these problems are like the interrelated layers of an onion, with biologic and social environmental forces interacting to ultimately affect the functioning of the child. These are not new problems. Although the term "the new morbidity" has been applied to many of them, most are not "new." In colonial times in America, one third of the women were pregnant at the time of their marriage. Premarital conception was an issue then as it is now. It is only the solution or consequences that are different today. The great frequency of these problems yesterday and today, the serious impact that they have, and the failure to treat or prevent most of these problems suggest that a major effort should be placed on research.
Advocating research does not mean that we should scrap current service programs as advocated by some2 or isolate the research worker from the stress and difficulty of coping with clinical problems and real people. Romano3 said, "clinical medicine is not a spectator sport," and I would add that clinical research in behavioral pediatrics cannot be a spectator sport but is best done by those who are actively caring for children with problem behaviors.
Plastic Handguns That Resemble Toy Guns: New Technology Creates a Uniquely Hazardous Product
Authors: WINTEMUTE GAREN J. , TERET STEPHEN P. , KRAUS JESS F. 
Published: December 2021

Pediatricians are well aware that handguns are a hazard for children.1-3 This hazard exists, in part, because children cannot reliably differentiate between realistic toy guns and real guns.2-5 Moreover, children holding toy guns have on occasion appeared to highly trained adults to be truly armed, often with tragic results2 (Time Magazine, April 20, 1987, p 33; Sacramento Bee, July 31, 1987, p 1).
It is less well known that real handguns made almost entirely of plastic may soon enter the marketplace, making the differentiation of real guns from toy guns immensely more difficult. The physical characteristics of these guns, and the likelihood of their promotion as a new means of personal and household defense, will almost certainly result in increased shootings of children (and of others by children).
Nerds Cereal and Red Stools
Authors: GUTGESELL MARGARET E. , DOUGHERTY JANET 
Published: December 2021

To the Editor.—
Bright red stools are an alarming sign at any age. In a previously well child, such stool can produce marked anxiety in both patient and parent. We are writing to report a case of such stools following the ingestion of the cereal "Nerds."
A 5-year-old boy was brought to the pediatric night clinic at the Children's Medical Center of the University of Virginia, with the chief complaint of blood in stool. About one hour prior to arrival in the clinic, he passed a bright red-orange stool.
Bacteremia: Occult or Nonoccult?
Authors: RUBIN LORRY G. 
Published: December 2021

In Reply.—
In our study we sought to evaluate the efficacy of bacterial antigen detection in highly febrile young children with occult or "unsuspected" bacteremia, ie, patients whose presentations did not necessarily mandate IV antibiotic therapy, but in whom parenteral a antibiotic therapy would be indicated if bacteremia could be reliably diagnosed at the initial ambulatory visit. The patients referred to by Dr Mauro, those with no focus of infection, constitute a small proportion of occult bacteremic patients (although a group at relatively high risk for bacteremia).
Health Assessment and Screening During Adolescence
Authors: RUBIN STEVEN E. 
Published: December 2021

To the Editor.—
In the recommendations for health screening for Adolescence (Pediatrics 1987;88:146), vision testing is appropriately recommended. However, it is suggested by the authors that these patients be referred to optometrists or ophthalmologists if abnormalities are detected. As you know, optometrists are not physicians and hence do not receive the same degree of intensive training received by ophthalmologists and pediatric ophthalmologists, and they are not licensed to practice medicine or surgery. In my opinion, the level of care delivered by such a nonphysician does not approach that which can be delivered by physician specialists and subspecialists.
Annual Meeting of the Section on Pediatric Urology
Authors: GLASSBERG KENNETH I. 
Published: December 2021

The Section on Urology of the American Academy of Pediatrics met for three days in conjunction with the 55th Annual Meeting of the Academy n Washington, DC. Papers of interest to the pediatrician are summarized herein according to topic. The number of basic research papers is continuing to increase, and this in no small part is due to the encouraging influence of the recipient of this year's Pediatric Urology Medal, F. Douglas Stephens.
FETAL OBSTRUCTIVE UROPATHY
The majority of cases of hydronephrosis diagnosed in the newborn are first detected prenatally by in utero ultrasound. It is important to realize that not all cases of renal pelvic distension represent obstruction. Of 100 cases of abnormal antenatal renal ultrasound, Ahmed and LeQuesare found that surgery was necessary in 48 infants. The remainder either had normal kidneys on imaging studies after birth or the dilation was insignificant or decreased with time. The most common abnormality seen was ureteropelvic junction obstruction. Schwarz and coauthors evaluated the efficacy of antenatal ultrasound in diagnosing hydronephrosis at various times during gestation and found a low sensitivity before 20 weeks and a high sensitivity between 35 and 40 weeks. They found that the fetal hydronephrotic kidney did well in utero, leading them to believe that most cases of hydronephrosis should not be tampered with but instead should be dealt with postnatally.
Elder and coauthors reviewed the literature to determine whether in utero treatment of fetal obstructive uropathy has been effective. They found numerous instances of misdiagnosis and complications that included inadequate shunt drainage or migration (20%), onset of premature labor within 48 hours (10%), chorioamnionitis (6%), and urinary ascites (6%).
Palpable Lymph Nodes
Authors: BAMJI MAHRUKH , STONE RICHARD K. , KAUL ADITYA , USMANI GHAZALA , SCHACHTER FRANCES FUCHS , WASSERMAN EDWARD 
Published: December 2021

In Reply.—
The observations of Dr Embree et al are indeed iteresting. The fact that axillary lymph nodes were palpable in 27.7% of infants in their survey is noteworthy. In our study, axillary nodes were found in 1% of neonates 0 to 72 hours of age. The discrepancy may be due to differences in environmental or genetic factors of the two groups (different ethnic groups examined). Infants with positive serologic tests for syphilis were excluded from our study population.
Head Circumference Data
Authors: ROCHE ALEX F. , GUO SHUMEI , MUKHERJEE DEBABRATA , MOORE WILLIAM M. 
Published: December 2021

In Reply.—
The comments made by Drs Wember and Manz are of interest and help us to clarify some points made in our paper that may have been obscure. The percentiles in figs 1 and 2 were calculated from the raw data and not from the means and standard deviations on the assumption of normality of the distributions. The data in table 1 for the means suggest that a slow increase in head circumference may be occurring in boys near the age of 18 years.
Clinical Spectrum of Mucolipidosis Type IV
Authors: WEITZ RAPHAEL , KOHN GERTRUDE 
Published: December 2021

To the Editor.—
We read with interest the presentation by Amir et al1 concerning the clinical spectrum and natural history of mucolipidosis type IV. Based on their experience with 20 patients, they try to provide guidelines for the clinical diagnosis of this lysosomal storage disease. It appears that severe visual impairment (due mainly to corneal opacities, myopia, and retinal degeneration) and psychomotor retardation are the cardinal features of this entity.
However, corneal clouding and mild motor delay in their early stages may frequently be missed by even experienced pediatricians and we recently examined a 15-month-old boy who was referred to us for evaluation of a possible congenital myopathy.
Elemental Mercury Exposure
Authors: SWINEHART LOY T. 
Published: December 2021

To the Editor.—
In the article by Hudson et al1 concerning mercury exposure of children of thermometor plant workers, they stated that "this is the first report demonstrating mercury exposure in children of mercury workers." On Sept 28, 1954, a case report of primary mercury poisoning in an infant was presented at a meeting of the North Pacific Pediatric Society, Victoria, British Columbia, Canada. Unfortunately, the case was never submitted for publication.
The patient, a 20-month-old male infant, was referred because of fever, irritability, tremor, and refusal to walk.
Salary or Fee-for-Service
Authors: FERRY JOHN J. , REDLENER IRWIN E. 
Published: December 2021

To the Editor.—
That physicians in training were motivated by the method of reimbursement to influence the use of out-patient services by their patients is a noteworthy, albeit not startling, finding (Pediatrics 1987;80:344-350). Our department has struggled with whether to attempt such an experiment to answer the authors' and other questions in recent years. We have not done so because of the strongly held opinions of some faculty members that to use financial incentives during the period of training is inappropriate.
Continuous Auscultation of Heart and Bilateral Breath Sounds
Authors: SCHWARTZ NATHAN , EISENKRAFT JAMES B. 
Published: December 2021

To the Editor.—
The frequent determination of vital signs, such as heart rate and bilateral breath sounds, is a mainstay in the care of critically ill infants. Unfortunately, the routine determination of such vital signs involves the manipulation and disturbance of the infant, unnecessary risk of exposure to cold, increased risk of apnea, and infection.1,2 In addition, the frequent disruption of the infant's sleep pattern may take an unaccountable physiologic and psychologic toll. To deal with this common and challenging problem we have devised a simple and inexpensive monitoring device, using readily available supplies, which facilitates the continuous or intermittent evaluation of heart rate and bilateral breath sounds.
What Is `Significant' and DTP Reactions
Authors: HOFFMAN HOWARD J. , HUNGER JEHU C. , HASSELMEYER EILEEN G. , DAMUS KARLA , PAKTER JEAN , PETERSON DONALD R. , VAN BELLE GERALD 
Published: December 2021

In Reply.—
The two letters received in response to our article1 express a diversity of opinion regarding the inferences to be drawn from the findings regarding SIDS and DTP reported from the NICHD SIDS Cooperative Epidemiological Study. In the first instance, Dr Eden suggests that we were too cautious in our concluding statement that: "DTP immunization does not appear to be a significant factor in the occurrence of SIDS." The critical point to be made is that in any study, regardless of the number of subjects included and the care taken in study design and implementation, the most that can be claimed is a statistical result that admits a small probability of exception.
Repeat Throat Cultures?
Authors: WALD ELLEN R. 
Published: December 2021

In Reply.—
If patients treated for pharyngitis are symptomatic (with sore throat) at the end of treatment, repeat throat cultures are appropriate. However, if the patient is asymptomatic, routine reculturing is not recommended. The rationale for not performing cultures routinely is that a positive culture from an asymptomatic individual usually identifies a "carrier." Carriers are not thought to be at risk for rheumatic fever, nor are they a source for transmission of the streptococci to their close contacts.
Indian Health Service
Authors: PORVAZNIK JOHN 
Published: December 2021

To the Editor.—
In response to the article by Honigfeld and Kaplan (Pediatrics 1987;80:575-578), I would like to make several comments. The Indian Health Service is pleased to see a steady reduction in infant mortality in the general American Indian and Alaskan Native population to a level that is equal to or slightly less (10.2 deaths per 1,000 live births in 1983) than US rates. This progress is largely due to the work of committed professionals who often work under less than optimal circumstances in isolated areas.
Aspirin and Reye Syndrome
Authors: ORLOWSKI JAMES P. 
Published: December 2021

In Reply.—
It is a pleasure to hear from one of the coauthors of the original article describing Reye syndrome.1 I have to admit to being unaware of the letter to the editor which Dr Baral wrote because its title concealed any relationship to Reye syndrome or aspirin.2 I was also unaware that the tables which did not accompany the original article in the Lancet were still available 25 years later.
I am, however, concerned and confused about some apparent contradictions.
Cocaine Abusers as Mothers
Authors: CHASNOFF IRA J. 
Published: December 2021

In Reply.—
I would like to thank Dr Cersonsky for his comments regarding our article (Pediatrics 1987;80:836-838). I certainly agree that the social aspects of a case regarding maternal substance abuse in pregnancy are important in the ultimate prognosis for the exposed child. In our experience with addicted pregnant women, our major work has been pointed toward the importance of early intervention in pregnancy. Unfortunately, the woman reported in this article was not referred to our program, and her physicians never obtained any type of substance abuse history during the pregnancy.
Resident Stress
Authors: Bergman Abraham B. 
Published: December 2021

In the absence of confirmatory evidence, one can only sense that the lives of residents have become increasingly stressful since the late 1950s. Certainly residency stress is receiving more attention in the medical literature.1-4 An excellent conference on stress in pediatric housestaff training sponsored by the Study Group on Pediatric Education and Ross Laboratories was held in 1985.5 Whatever took place in the past, present-day residents carry heavy burdens that materially affect their current performance and future lives. Some of these burdens could and should be lightened. The first step is for medical educators to acknowledge that they exist.
It is neither possible nor advisable to eliminate all stress in residency training; after all, young physicians are being prepared for a taxing marathon race. Attempts should be made, however, to differentiate between useful stress and needless annoyances. Working long hours, behaving effectively in emergencies, dealing with death and dying, managing difficult patients, and coping with the uncertainties of diagnosis and treatment are examples of the first category. For high achievers used to getting As in school, accepting a less than perfect diagnosis, a disease without a treatment, or a mistake that kills is frustrating but must be endured. The annoyances will be discussed later.
GLOBAL CAUSES
Faculty probably can have only limited impact on some of the more global causes of resident stress. It is important, however, that they be recognized and, even more important that residents know that they are recognized. First, there are the normal issues of adult development common to young persons striving to put their personal and professional lives in order.6
National Childhood Vaccine Injury Compensation Act
Authors: SMITH MARTIN H. 
Published: December 2021

The past four decades have been years of phenomenal progress in all of medicine, yet in terms of numbers of lives saved or in years of productive lives spared, nothing has equaled the record of preventative pediatrics, specifically, our national immunization program. In the past several years, however, this immunization program has almost fallen into shambles. The sources of this reversal would have been from vaccine liability leading to exorbitant costs or loss of supply of vaccines. In the 1970s and 1980s, a series of crises that were only narrowly averted threatened interruption of the national immunization program.
It is now worthwhile to trace the events of the past several years so that we can review the continuity of the course of events through those years to understand the necessity for the specific resolution of these problems in the form of the National Childhood Vaccine Injury Compensation Act. The American Academy of Pediatrics played a leading and pivotal role in the long struggle to enact this legislation. It is expected that the act should be the means of avoiding any future threats to our national immunization program through loss of supply. Furthermore, and of equal importance, after time for stabilization and experience with its administration, the act should reduce the cost of vaccines. The courts have dealt with the matter of vaccine injury in an irregular and sometimes unpredictable manner. This legislation should provide a more predictable and just outcome for those few who suffer vaccine injuries. Because this is the first major legislation the Academy has undertaken, the membership should be informed of the time involved in promoting passage of this legislation: the costs in hours by the members, officers, and staff, as well as the monetary costs to the Academy.
Twenty-Fifth Anniversary of the National Sudden Infant Death Syndrome Foundation
Authors: BERGMAN ABRAHAM B. 
Published: December 2021

When 6-month-old Mark Addison Roe of Greenwich, CT, died suddenly and unexpectedly in October 1958, his parents were told that the cause was "acute bronchial pneumonia." In those days, "it" was called by many names, such as suffocation, overlaying, aspiration, or various forms of pneumonia. The common thread was that all of the terms connoted that parents were either directly, or indirectly, by virtue of failing to secure medical care, responsible for the infant's death.
Mark's death might have been the end of it were it not for the existence of a life insurance policy that his grandparents had bought at the time of his birth.
Acquired Immunodeficiency Syndrome Education in Schools
Authors:   Committee on School Health
Published: December 2021

Aids Education
The AIDS epidemic has been with us for the past 6 years. As of October, 1987, 42,000 total cases of AIDS in persons of all ages have been reported, and the number is predicted to increase to 250,000 cases by 1991. Because no vaccine or cure is available, education offers a reasonable approach to prevention. The American Academy of Pediatrics believes that the nation's schools should immediately initiate AIDS education programs as part of a comprehensive health education plan.
ORGANIZATION OF THE PROGRAM
School Health Advisory Committee
AIDS education programs in the schools should be advocated for and supervised by a school health advisory committee or similar school-related organization in each community.1 The committee for each school or district should consist of the school medical advisor, a community pediatrician and/or public health physician, a school nurse, a health educator, a mental health professional, a school administrator, and a faculty member, a parent, and appropriate community representatives. In smaller school systems, a single school health advisory committee should suffice. These programs should be coordinated by the school medical advisor, school administrators, and school nursing supervisor.
Physician and Nurse Training
Physicians, especially pediatricians and family physicians, and school nurses should receive training about AIDS by participating in educational programs sponsored by regional medical centers, state medical societies, state nursing organizations, public health departments, or organizations such as the state chapters of the American Academy of Pediatrics. Those trained would then: (1) conduct education programs for teachers, school administrators, parent groups, community groups, psychologists and other mental health personnel, and students; (2) assist schools and organizations in the development of educational programs for special groups; (3) review, adapt, and develop educational materials; (4) participate in public panel discussions, including radio and television programs; (5) take part in open discussions between school administrators and staff or between administrators and parents; and (6) facilitate networking among parents, educators, and AIDS support groups.
Physician Reimbursement
Authors: HICKSON GERALD B. 
Published: December 2021

In Reply.—
In our study1 in which practice characteristics of residents in a continuity clinic randomized to fee-for-service v salary reimbursement groups were compared, we found that patients enrolled to fee-for-service physicians experienced more well-child care and fewer emergency room visits per patient. However, these observations do not necessarily represent a cause and effect but, rather, may have occurred because fee-for-service reimbursement impacts both outcomes independently. The data also suggested that the higher rate of well-child visits in the fee-for-service group was due to both fewer missed indicated well-child visits and more visits completed in excess of American Academy of Pediatrics' guidelines.2