bluuebunny/crossref_metadata_2025_split huggingface dataset:
More to Be Learned From Crigler-Najjar Patients
Authors: GALBRAITH RICHARD A. , DRUMMOND GEORGE S. , KAPPAS ATTALLAH 
Published: December 2021

In Reply.—
We thank Dr Hansen for his comments on our study in Crigler-Najjar patients published recently in Pediatrics. A collaborative study of this rare genetic disease does seem in order as Dr Hansen indicates; to the extent that such a study might involve an examination of the efficacy of the heme oxygenase inhibitor tin-mesaporphyrin for ameliorating (with other therapeutic modalities) hyperbilirubinemia in this syndrome, we would be happy to collaborate with other investigators and to provide some resources for the study as required.
Hypoxaemia in infants with bronchopulmonary dysplasia
Authors: SINGER LYNN T. 
Published: December 2021

In Reply.—
We appreciate the comments of Poets et al that weaning infants with BPD from supplemental O2 should proceed with caution, because episodes of desaturation may have numerous detrimental consequences. The main challenge appears to be to a specific O2 saturation which avoids these problems as well as the need for unnecessary O2 administration. For this reason we were reluctant to make a specific recommendation in our article.1 Although we cannot disagree with maintenance of a baseline O2 saturation of 93% to 94%, an additional recommendation may need to be made for periods of oral feeding when ventilation is further compromised in infants with BPD.
Parents Often Urge Overtreatment
Authors: PHOON COLIN K. 
Published: December 2021

To the Editor.—
Having recently worked in a neonatal intensive care unit at a tertiary care facility, I read Dr Silverman's essay1 with great interest. His perception that many "seriously compromised" neonates are overtreated is justified. However, he emphasized the role of the medical profession In overtreatment, while he sided with parents who have been angry with and resentful of their child's outcome. Although the medical establishment can rightly be blamed for overtreatment in many instances, my experience with who exactly is overtreating is somewhat different.
Prevalence and Natural History of Cryptorchidism
Authors: Berkowitz Gertrud S. , Lapinski Robert H. , Gazella Jacqueline G. , Dolgin Stephen E. , Bodian Carol A. , Holzman Ian R. 
Published: December 2021

Objective. A prospective hospital-based cohort study was conducted to determine the prevalence rates of cryptorchidism at birth, 3 months, and 1 year of age.
Design. A total of 6935 consecutive male neonates delivered at Mount Sinai Hospital in New York City between October 1987 and October 1990 were examined at birth for cryptorchidism. Standardized examination and classification criteria were used. Infants classified as cryptorchid at birth were reexamined at 3 months and 1 year after the expected date of delivery.
Results. Of 6935 neonates assessed at birth, 255(3.7%) were found to be cryptorchid at birth. The rates were significantly elevated for low birth weight, preterm, small-for-gestational age, and twin neonates. The overall rate had declined to 1.0% by the 3-month assessment and 1.1% at the 1-year assessment. Although the rates at the 1-year assessment tended to be higher for low birth weight and preterm infants, no significant group differences were observed.
Conclusions. Since the prevalence rates in this study are similar to those reported several decades ago, these data provide no evidence that the rate of cryptorchidism has increased either at birth or by 1 year of age. Furthermore, most testes that descend spontaneously do so within the first 3 months after the expected date of delivery.
Patient Satisfaction and Side Effects With Levonorgestrel Implant (Norplant) Use in Adolescents 18 Years of Age or Younger
Authors: Berenson Abbey B. , Wiemann Constance M. 
Published: December 2021

Objectives. Levonorgestrel implants (Norplant) have recently been approved for use in the United States. Adolescents may be especially suited for this method of contraception because of its long duration of action and lack of dependence on patient compliance for efficacy. To date, however, its use in young patients has not been investigated. This study was undertaken to compare side effects and satisfaction with this new method during the first 6 months of use among adolescents and adults.
Methods. Twenty-one adolescents 18 years of age or younger and 30 adults 19 years or older participated in this study. Information on side effects and satisfaction was obtained from clinic records and a structured interview conducted 6 months after insertion.
Results. The most frequent reason adolescents gave for selecting Norplant was convenience. None of the adolescents were upset by the insertion process or by its appearance in the arm, although 10 (48%) reported that it was visible. The most frequent side effect reported by both adolescents (71%) and adults (53%) was abnormal menstrual bleeding. Weight gain was reported by 8 adolescents (38%), 3 of whom attributed it to an increase in their appetite. Other side effects commonly reported by adolescents included emotional disturbances (33%) and headaches (38%), whereas adults reported acne (27%) and mastalgia (37%). Only 1 adolescent (5%) and 1 adult (3%) reported experiencing no side effects. A similar percentage of adolescents (8%) compared with adults (6%) requested removal of the implant because of side effects during the 6-month period. Overall satisfaction was expressed by 86% (18/21) of adolescents, all of whom stated that they preferred Norplant to their previous contraceptive method.
Conclusions. This investigation demonstrates that levonorgestrel implants are well tolerated by most young patients. Clinicians involved in the care of adolescents should consider Norplant as an appropriate option of birth control for this population.
Heart Murmurs. If You Allow for Mistakes Costs Are Even Higher!
Authors: TOEWS WARREN H. 
Published: December 2021

To the Editor.—
I read with the recent article by Danford et al regarding "cost assessment of heart murmur evaluation." I agree completely with the authors that echocardiographic evaluation of heart murmurs is more costly than referral to a pediatric cardiologist.
In this study, the authors utilized echocardiograms ordered at their own institution, presumably performed by technicians trained and experienced in the evaluation of children for congenital heart disease, and interpreted by pediatric cardiologists trained and experienced in interpretation of pediatric echocardiograms.
Are Parents' Self-reported Total Cholesterol Levels Useful in Identifying Children With Hyperlipidemia? An Examination of Current Guidelines
Authors: Resnicow Ken , Cross Donna 
Published: December 2021

Objective. Recently, the American Academy of Pediatrics (AAP) Committee on Nutrition adopted the recommendation of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents (NCEP) that children and adolescents with a family history of premature cardiovascular disease or parental hypercholesterolemia (≥240 mg/dL) be screened for hyperlipidemia. The rationale for using parental hypercholesterolemia as a screening trigger is based on sensitivity estimates using parents' actual lipid values. However, in clinical practice pediatricians may often have to rely on parents' self-reported cholesterol levels to determine a child's family risk history. This study examines the feasibility and utility of parental self-reported cholesterol levels as a means of identifying children with elevated total cholesterol levels.
Methods. As part of a school-based risk factor screening program that included total cholesterol measurement, conducted in nine elementary schools between 1989 and 1991, parents of participating children were asked if they had their cholesterol tested in the past year and if they had, to provide their total cholesterol values.
Results. If only the children who had one parent with a self-reported total cholesterol value ≥240 mg/dL would have been screened, between 90% and 93% of children with elevated total cholesterol values, either ≥170 mg/dL or ≥200 mg/dL, would have been missed.
Conclusions. These data suggest that parents' self-reported cholesterol values are an ineffective means of identifying children with elevated total cholesterol and modification of the current AAP and NCEP guidelines for selective cholesterol screening in children may be warranted.
Changes in Cerebral Hemodynamics and Oxygenation in the First 24 Hours After Birth Asphyxia
Authors: van Bel Frank , Dorrepaal Caroline A. , Benders Manon J.N.L. , Zeeuwe Petra E.M. , van de Bor Margot , Bergen Howard M. 
Published: December 2021

Objective. To investigate whether or not postasphyctic cerebral hypoperfusion and decreased cerebral metabolism occur in the perinatally asphyxiated neonate, as has been reported in adults and newborn animals.
Methods. Using near-infrared spectroscopy, we monitored changes in oxyhemoglobin (HbO2), deoxyhemoglobin (HbR), total hemoglobin (HbO2 + HbR, which represents changes in cerebral blood volume [CBV]), and cytochrome oxidase (Cytaa3, which indicates changes in oxidation level of this intracerebral mitochondrial enzyme). Thirty-one neonates (gestational age &gt;34 weeks), divided into three groups, were monitored between 2 and 12 hours or between 12 and 24 hours of life. Group I consisted of healthy newborns: N = 8 (2 to 12 hours) and N = 5 (12 to 24 hours). Patients in group II were moderately asphyxiated newborns but neurologically normal in the first 24 hours of life: N = 6 (2 to 12 hours) and N = 3 (12 to 24 hours). Group III consisted of severely asphyxiated newborns with an abnormal neurologic behavior within 24 hours after birth: N = 5 (2 to 12 hours) and N = 4 (12 to 24 hours).
Results. From 2 to 12 h, CBV levels in groups I and II were stable. In group III CBV decreased in all infants. This decrease in CBV was associated with a drop in both HbO2 and HbR. Cytaa3 was stable in groups I and II, but showed a marked decrease in two of the five infants of group III. There was a positive relationship between CBV and mean arterial blood pressure in groups II and III. Between 12 and 24 hours, all groups showed stable CBV and Cytaa3 patterns. A positive relation existed now between transcutaneous Pco2 and CBV in groups II and III.
Conclusions. CBV, HbO2 HbR, and Cytaa3 decreased in the first 12 hours of life in severely asphyxiated neonates who subsequently developed neurologic abnormalities. We therefore suggest that posthypoxic-ischemic reperfusion injury of the brain during early neonatal life occurs in neonates with severe birth asphyxia.
Effects of Repeated Application of Emollient Cream to Premature Neonates' Skin
Authors: Lane Alfred T. , Drost Sharon S. 
Published: December 2021

Objective. Emollient cream moisturizers are often used on premature newborns in neonatal intensive care units without accurate knowledge of the risks or benefits to the neonate.
Design. We prospectively compared premature neonates treated with a water-in-oil emollient cream for up to 16 days to untreated premature neonates.
Setting. The study was completed in a neonatal intensive care unit on neonates admitted for respiratory distress and/or possible sepsis.
Patients. Thirty-four neonates, between 29 and 36 weeks estimated gestational age, entered the study.
Interventions. One-half of the neonates were treated twice a day with an water-in-oil emollient cream, and the other half served as controls.
Outcome Measures. The skin condition of the neonates' hands, feet, and abdomen was evaluated on entering the study and twice a week. Fungal cultures and quantitative bacterial cultures were obtained from the axilla and abdomen on entering the study and twice a week.
Results. The mean gestational age of the treated neonates was 32.3 weeks, whereas the mean gestational age of the control neonates was 32.5 weeks. The neonates treated with emollient cream demonstrated statistically less dermatitis of their hands (day 2 through day 11), their feet (day 2 through day 16), and their abdomen (day 7 through day 11). Fungal cultures and quantitative bacterial cultures of the abdomen and axilla were equivalent in both groups.
Conclusions. These studies document that emollient cream moisturizer therapy of premature neonates decreases dermatitis without changing the microbiological flora.
Turner Syndrome With Unusual Conotruncal Defect
Authors: ROSTI LUCA , FESTA PIERLUIGI , FRIGIOLA ALESSANDRO , ROSTI DARIO 
Published: December 2021

The Turner syndrome is a frequently occurring chromosomal syndrome. It is characterized by X monosomy, mosaicism 45X/46XX, partial deletion of X chromosome, and various rearrangements of X chromosome, leading to several clinical features and congenital anomalies: short stature, webbing of the neck (pterygium colli), nuchal cystic hygroma, hypogonadism, with absent ovarian tissue, and renal anomalies.1 Congenital heart defects occur often in the Turner syndrome1,2; there is a high prevalence of coarctation of the aorta3-5 and bicuspid aortic valve6; ventricular septal defects, atrial septal defects, and hypoplastic left heart syndrome are less frequent.7,8
Conotruncal defects have never been reported, to our knowledge, in patients with the Turner syndrome.
The Pediatrician's Role in Promoting the Health of Patients in Early Childhood Education and/or Child Care Programs
Authors:   Committee on Early Childhood, Adoption, and Dependent Care
Published: December 2021

American families are changing; more parents are working, and most young children are being cared for in some form of child care.1 To promote optimal child health and development, pediatricians should work not only with parents, but also with other caregivers, agencies, and organizations that are part of the child's and family's support system. This statement discusses the roles pediatricians should play in the care of infants and young children enrolled in early childhood education and child care settings.
ADVISING FAMILIES
Beginning at the prenatal visit and at each subsequent visit, the pediatrician should review the plans and arrangements that parents may have made for alternative care of their children. The child's adaptation to these arrangements should be reviewed.2 The pediatrician should discuss with parents how they are balancing their work and family life. As a trusted family advisor, the pediatrician can help parents identify, evaluate, and choose among their child care options.
Adjusting Work and Schedules and Getting Help From Employers
When both parents work, they can sometimes coordinate their work hours to share the child's care or make arrangements with their employers to provide some child care at the work site. One or both parents might be able to arrange for part-time work while the children are very young. Some parents may want to share care with another family by staggering work and child care hours. Some families have relatives who are able and willing to provide good-quality, low-cost child care. One or both parents may be eligible for financial help from their employers for child care in community facilities.
Residency Training and Continuing Medical Education in School Health
Authors:   Section on School Health
Published: December 2021

Children between the ages of 5 and 18 spend a significant amount of their time in school. School health is a vital part of pediatric practice and an important concern for pediatric graduate medical education. There are few substantiated data, however, to suggest that residents entering pediatric practice or academic medicine are exposed to school health in a significant way. Many pediatricians, upon entering practice, find that they are consulted by school systems and parents whose children have problems related to school. Pediatricians find themselves unprepared for this new role and express the need for postgraduate education in school health.1-4
The American Academy of Pediatrics Task Force on Pediatric Education5 and the most recent report from the Pediatric Residency Review Committee have both underscored the appropriateness and importance of education in school health as an important part of the residency curriculum.6 The American Academy of Pediatrics believes that education in school health should be an important part of graduate medical education for pediatric residents and of continuing medical education for practicing pediatricians.
Many advances in pediatrics that affect the well-being of the child relate directly to the school setting. Increased attention to federal legislation (Section 504 of PL 93-112, the Rehabilitation Act of 1973; parts B and H of PL 102-119, the Individuals with Disabilities Education Act), health education including education about the prevention of drug and alcohol abuse and acquired immunodeficiency syndrome, new approaches to screening and health services in the schools, immunization requirements, physical fitness, and knowledge about the school environment—all are important aspects of school health and areas in which many residents and/or pediatricians have had little or no training or experience.
The Lead Controversy
Authors: ASCHNER MICHAEL 
Published: December 2021

To the Editor.—
Dr Herbert Needleman's frightful description of his investigative ordeal, unnecessary as it may have been, will hopefully serve as an eye opener to the scientific community. It reemphasizes that where there is money at stake there is advocacy language on both sides. Anyone can seriously attack any statistical risk assessment on the premise that if a compound has no effect on a given measurement, about 1 of 20 studies to report such an association would be on the basis of change.
Is Neonatal Medicine in the United States Out of Step?
Authors: SILVERMAN WILLIAM A. 
Published: December 2021

Here are the results of an informal survey which suggest that the number of neonatologists is disproportionately high in the United States: the ratio of neonatologists to liveborn infants may be two to six times higher than in six other countries examined (Table). The rough estimates raise some disturbing questions that can only be answered by formal surveys in each country which include the annual cost of neonatal intensive care (as percent of gross domestic product) and the compensation of neonatologists.
In recent years, most of the discussion about the limits of neonatal intensive care has been focused on ethical issues. As costs of medical care have soared throughout the world, questions are now raised about the economic limits of this activity. For example, compared with the United States, has the rest of the world set more realistic financial limits on neonatal intensive care by controlling the number of neonatologists and their compensation? Is the relative surfeit of neonatologists explained by a disproportionate number of high-risk neonates in the United States, or is the number of practitioners market-driven in our laissez-faire medical system? These and other unsettling questions may be ignored, but they will not go away.
Different Views on Adolescent Abortion
Authors: THORREZ DAVID C. , BOYER DEBRA L. , HARRISON MARK 
Published: December 2021

In their survey of American Academy of Pediatrics on adolescent abortion published in March 1993, Fleming and O'Connor state that 48.8% supported parental notification, 43.3% did not favor access to abortion for all of the reasons identified in the questionnaire, and 35.4% believed abortion should clearly be restricted in some circumstances.
They concluded that these numbers provide a "mandate" for the Academy to support legislation encouraging adolescent abortion. Rather, it seems clear to us that these numbers indicate that it is inappropriate for the Academy to take sides on a political issue over which its membership is so obviously divided. There is no consensus, and no "mandate."
`GENE THERAPY' FOR GAUCHER'S DISEASE SHOWS PROMISING RESULTS IN TEST ON MICE
Authors: L. J. F. 
Published: December 2021

University of Pittsburgh researchers reported promising results in mice with a potential "gene therapy" for Gaucher's disease that eventually may replace Ceredase, a Genzyme Corp. drug whose high cost has sparked controversy.
The study indicated it would be possible to transfer a gene into certain cells of people with the disease that would permanently correct a genetic defect underlying their disorder. The potential treatment, however, is at least several years away from widespread use in patients, and its development may face economic stumbling blocks.
SMOKING ISSUE IS HEATING UP CUSTODY SUITS
Authors: H. B. 
Published: December 2021

Parental concern about secondhand smoke is adding a new wrinkle to some custody and divorce battles.
Estranged spouses are taking an increasingly aggressive court stance when a child is exposed to cigarette smoke of one parent. Secondhand smoke has become a point of contention in custody cases in more than a dozen states, almost all involving children with respiratory ailments such as asthma and allergies.
And smoking may become an issue in many more custody cases, according to some lawyers. Recent medical reports have cited the heightened likelihood of respiratory disease and middle-ear infection even in healthy children exposed to secondhand smoke. In at least one case a judge has been asked to rule that exposing a child with medical problems to cigarette smoke constitutes child abuse.
Utility of Routine Laboratory Testing for Detecting Intra-abdominal Injury in the Pediatric Trauma Patient
Authors: Isaacman Daniel J. , Scarfone Richard J. , Kost Susanne I. , Gochman Robert F. , Davis Holly W. , Bernardo Lisa M. , Nakayama Don K. 
Published: December 2021

Objective. To assess the prevalence of laboratory abnormalities (complete blood cell count, electrolytes, blood urea nitrogen, creatinine, glucose, aspartate aminotransferase, alanine aminotransferase, amylase, lipase, urinalysis [U/A]) and the sensitivity and specificity of the physical examination (PE) and screening laboratory tests for identifying intra-abdominal injury (IAI) in moderately injured pediatric patients.
Design, participants, and setting. Phase I: Retrospective review of 285 consecutive level II (moderately injured) trauma patients seen at a children's hospital emergency department/pediatric trauma center. All patients were received directly from the scene and had the following data recorded: mechanism of injury, Glasgow coma score, trauma score, pediatric trauma score, systematically recorded PE findings, laboratory results, and injuries detected during hospitalization. Phase II: To confirm the sensitivity of the PE and U/A found in phase I, the model was applied to 91 additional trauma patients identified by International Classification of Diseases, 9th revision (ICD-9) codes as having IAI.
Intervention. None.
Results. Phase I: A total of 3939 tests were ordered for the 285 patients entered in phase I. Aspartate aminotransferase and alanine aminotransferase values were obtained in 59% of patients; glucose level was obtained in 78% of patients; complete blood cell count, U/A, and levels of electrolytes, blood urea nitrogen, creatinine, amylase, and lipase were obtained in more than 85% of patients. The overall prevalence of laboratory abnormalities was 5.7%. Fourteen patients (4.8%) were identified who had a total of 23 significant IAIs (9 pancreatic, 6 splenic, 5 renal, 3 hepatic). The PE combined with U/A showing more than five red blood cells per high-power field had a sensitivity of 100%, specificity of 64%, positive predictive value of 13%, and negative predictive value of 100% for the detection of IAI. The presence of laboratory abnormalities suggesting injury did not increase the sensitivity of the model and significantly decreased both specificity and positive predictive value. Phase II: The PE combined with U/A identified an abnormality in 89 (97.8%) of 91 cases (95% confidence interval = 94.8% to 100%).
Conclusions. In the moderately injured pediatric trauma patient, (1) there is a low prevalence of laboratory abnormalities; (2) the PE combined with U/A is a highly sensitive screen for IAI; and (3) in patients with a normal PE of the abdomen and a normal U/A, laboratory testing seldom identifies unsuspected IAI.