bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pulse Oximetry in Very Low Birth Weight Infants With Acute and Chronic Lung Disease
Authors: Ramanathan Rangasamy , Durand Manuel , Larrazabal Carlos 
Published: December 2021

With improved survival of very low birth weight infants, the incidence of bronchopulmonary dysplasia has significantly increased. Pulse oximetry appears to be an adequate alternative to transcutaneous Po2, for continuous arterial oxygen saturation (Sao2) monitoring in neonates; however, its usefulness has not been very well documented in very low birth weight infants. We studied 68 patients with birth weight &lt; 1,250 g; 44 neonates had respiratory distress syndrome and 24 had bronchopulmonary dysplasia. Using a Nellcor N-100 pulse oximeter, we compared transcutaneous oxygen saturation with simultaneous arterial samples analyzed for Sao2 (range 78% to 100%) using an IL 282 co-oximeter. Fetal hemoglobin was measured in 66 patients. We also evaluated the accuracy of transcutaneous Po2 in reflecting arterial Po2 in patients with bronchopulmonary dysplasia. Over a wide range of Po2, Pco2, pH, heart rate, BP, hematocrit, and fetal hemoglobin, linear regression analysis revealed a close correlation between pulse oximeter values and co-oximeter measured Sao2 in patients with acute (r = .88, Y = 19.41 + 0.79X) and chronic (r = .90, Y = 9.72 + 0.92X) disease. Regression analysis of transcutaneous v arterial Po2 in infants with bronchopulmonary dysplasia showed an r value of .78. In addition, in these patients with chronic disease, the mean difference between pulse oximeter Sao2 and co-oximeter measured Sao2 was 2.7 ± 1.9% (SD); whereas the mean difference between transcutaneous and arterial Po2 was -14 ± 10.7 mm Hg.
Our findings indicate that pulse oximetry can be used reliably in very low birth weight infants with acute and chronic lung disease, for Sao2 values greater than 78%. This technique is more advantageous than transcutaneous Po2 in infants with bronchopulmonary dysplasia. Additional studies are needed to evaluate the performance of the pulse oximeter in tiny infants with Sao2 values &lt; 78%.
Percutaneous Central Venous Silastic Catheters in Newborn Infants
Authors: CARRERA GIUSEPPE , COCCIA CARLO , COPPALINI BERNARDO , LIBERATORE ALDO , MINOLI IOLANDA 
Published: December 2021

To the Editor.—
We were interested to read the paper by Durand et al,1 and wish to point out that the same technique has been
[See table in the PDF file]
used in the Department of Perinatal Pathology of the Provincial Maternity Hospital of Milan, Italy, since January 1981 by means of the Vygon catheter (internal diameter 0.3 mm, external diameter 0.6 mm). Our preliminary results have been published.2
From Jan 1, 1981, to Dec 31, 1985, we placed 555 catheters in 438 newborns (241 boys, 197 girls) with a mean birth weight of 1,845 g (range 600 to 4,000 g) and a mean gestational age of 32 weeks (range 24 to 42 weeks).
Baby Walkers
Authors: PIDCOCK FRANK S. 
Published: December 2021

To the Editor.—
The list of reasons for discouraging the use of walkers in infancy is growing. The recent article by Rieder et al1 rightfully indicts infant walkers as a significant cause of accidental trauma in the "preambulatory" age group.
The use of walkers has been shown to have adverse developmental implications for both normal and abnormally developing children. A study by Kauffman and Ridenour2 demonstrated an abnormal electromyographically documented walking pattern in one randomly selected twin from each of six twin pairs who received a gait-training program consisting of two hours per day in a walker.
Cytomegalovirus and the Brain
Authors: ADES A. , PECKHAM C. S. , PREECE P. M. 
Published: December 2021

To the Editor.—
Conboy et al1 report a study on the intellectual development of 6- to 12-year-old children with congenital cytomegalovirus infection. We are in complete agreement with the authors' emphasis on looking for impairment in asymptomatic children with cytomegalovirus, who make up about 90% of all children with congenital cytomegalovirus. However, we believe that their study is less than definitive in ruling out the possibility that congenital cytomegalovirus infection, even when asymptomatic, can lead to intellectual impairment:
Size of Study.
Benzyl Alcohol in Neuromuscular Blocking Agents
Authors: JORDAN GLENN D. , THEMELIS NICHOLAS J. , MESSERLY SUSAN O. , JARRETT ROBERT V. , GARCIA JOSE , FRANK C. GILBERT 
Published: December 2021

In Reply.—
The comments of van der Hal et al serve to further underscore our concerns regarding the uncritical appropriation for use in neonates of pharmacologic agents belonging to the "adult" formulary. The issue is pervasive—the overwhelming preponderance of drugs used in neonatal intensive care settings are the adopted progeny of research into adult pathophysiology.
Following our initial identification of the risk of benzyl alcohol toxicity associated with continuous infusions of doxapram (Pediatrics 1986;78:540-541), we subjected to close scrutiny the formulation of all agents administered iv in our nursery.
Junctional Epidermolysis Bullosa of the Larynx
Authors: GONZALEZ ANA , SCHACHNER LAWRENCE , MILLER MADELINE 
Published: December 2021

To the Editor.—
The article by Kenna et al (Pediatrics 1986;78:172-174) points out the complication of respiratory compromise secondary to laryngeal involvement in junctional epidermolysis bullosa. Junctional epidermolysis bullosa, a mechanobullous disorder with autosomal recessive inheritance, has been associated with not only skin lesions but gastrointestinal, respiratory tract, and genitourinary tract abnormalities as well.1 The figure that was presented in the article incorrectly showed a split in the upper layers of the epidermis inconsistent with junctional epidermolysis bullosa.
Light, Sleep, and Development
Authors: SHELDON STEPHEN H. , BELL ERIC 
Published: December 2021

To the Editor.—
The commentary by Avery and Glass1 on light and retinopathy of prematurity was read with great interest. It points out a significant area of human development of which little is known.
Intensive care nurseries and advances in the care of the neonate and critically ill child have given life to those who would have not survived immaturity and illness a mere 25 years ago. Major efforts have focused on pulmonary, cardiovascular, and CNS support; the treatment of infections; and the physiologic maintenance of other vital functions.
Bed-Wetting Therapy
Authors: LENOIR G. , BARTHELEMY J. , JUIF-BIELSKY M. C. 
Published: December 2021

To the Editor.—
We read the recent article1 concerning childhood enuresis and offer the following comments from our group regarding this common pediatric problem.
An obvious mistake was made in table 4: the distress associated with this condition occurred "a great deal" in 31 of 140 children, ie, 22% (and not 32% as reported), thus inverting the boys to girls ratio; indeed, we know that girls are much more distressed than boys in this situation.
Bed-Wetting Therapy
Authors: VALDEZ R. BURCIAGA 
Published: December 2021

In Reply.—
We thank Drs Lenoir, Barthelemy, and Juif-Bielsky for pointing out the error in table 4, 22% of boys were rated as experiencing "a great deal" of distress about their bed wetting and 27% of girls are so distressed. Thus, parents are more likely to worry about their daughters (21% v 14%) and the girls are also more likely to be reported as distressed.
Recently, we became aware of numerous groups in the United States that have been successful in treating children with reinforcement approaches.
Super Diapers and Premature Infants
Authors: HERMANSEN MARCUS C. , BUCHES MARY 
Published: December 2021

To the Editor.—
Lavin (Pediatrics 1986;78:1173-1174) recently reported that superabsorbent Pampers brand diapers felt dry, even after urination. This could lead to the false impression of inadequate urine output in newborn infants. We have observed the opposite phenomena with the use of superabsorbent diapers—evidence of urine production in the presence of no urine output.
Four superabsorbent Pampers were weighed and then placed in an incubator (model C-86, Air Shields, Hatboro, PA) set for maximum heat and humidity outputs.
PULMONARY HYALINE MEMBRANES IN NEWBORN INFANTS
Authors: BLYSTAD WILHELM , LANDING BENJAMIN H. , SMITH CLEMENT A. 
Published: December 2021

The results of statistical, morphologic and experimental studies on the nature, occurrence and significance of hyaline (asphyxial) membranes seen in the lungs of infants who die in the neonatal period are presented. Analysis of material from 509 consecutive autopsies on newborn infants, together with analysis of the infants' histories, shows that these membranes occur most commonly in premature infants and in more mature infants with a history of a complication of pregnancy, labor or delivery capable of causing fetal anoxia. These hyaline membranes are not seen in stillborn infants nor in infants living less than one hour. They appear to cause atelectasis, by blocking the mouth of alveoli, and to be a major cause of death in the neonatal period.
Studies on vernix, meconium and amniotic fluid indicate that these hyaline membranes are not formed of vernix or meconium, but of the concentrated protein of aspirated amniotic fluid. A rise in the squamous cell content of amniotic fluid during the third trimester of pregnancy is demonstrated; this may explain the difference in microscopic appearance between hyaline membranes formed of amniotic fluid which is aspirated before this rise in squamous cells takes place and those containing squamous cells which are seen if the fluid is aspirated after this increase occurs. The membranes are demonstrated to be independent of pulmonary hemorrhage, edema or inflammation and not to be formed of degenerated airway epithelium.
Similar membranes were produced experimentally by repeated intratracheal injection of small amounts of amniotic fluid into the excised respiratory tracts of animals while the lungs were alternately expanded and contracted for one hour. The time and volume factors necessary for successful experimental production of these membranes are discussed.
The significance of pulmonary hyaline membranes in the production of neonatal atelectasis is indicated. No instances of "congenital alveolar dysplasia" were found in the 509 cases reviewed, and evidence that it may not be a valid clinical and pathologic entity is presented.
Perinatal Statistics
Authors: SOFATZIS JOHN , IOAKIMIDOU VASSO 
Published: December 2021

To the Editor.—
Evaluation of the effect of good medical care of pregnant women and newborn infants and/or the impact of birth weight distribution on crude perinatal mortality rates is based upon the use of birth weight-specific mortality rates and standardized perinatal mortality rates.1-4 We agree with the suggestion made by Hermansen and Hasan5 that all future reports on perinatal statistics should comply with the recommendations made by WHO. Moreover, meaningful comparisons of standardized perinatal mortality rates over time and place require the use of a standard birth weight distribution.
Psychosocial Screening
Authors: BOROWITZ KATHLEEN , GLASCOE FRANCES P. 
Published: December 2021

In Reply.—
Dr Frankenburg has raised a number of interesting points. Initially, he addresses concern about the use of "questionable" scores for individual sectors of the Denver Developmental Screening Test (DDST). Although we understand that the DDST should not be scored by individual sectors, to obtain a total test result each sector must be scored. On page 26 in the DDST manual/workbook currently distributed, a questionable score results with the following circumstances: "1 or more sectors with 1 delay and in that same sector no passes intersect the age line" (underline appears in manual).1
Breast-Feeding and Jaundice
Authors: FLEISS PAUL M. , JELLIFFE DERRICK B. 
Published: December 2021

To the Editor.—
Recently Maisels and Gifford1 stated that 123 mothers who breast-fed their infants on demand while in the hospital with encouragement from nursing staff nursed on the average only six to eight times in 24 hours. Experience with unmedicated mothers at home revealed that newly born infants will breast-feed on demand ten to 12 times per day. These babies were not jaundiced. Similarly, in an earlier study in 1982, De Carvalho et al2 found significantly lower bilirubin levels in infants nursed more than eight times in 24 hours.
Drug Errors
Authors: BULLABOY CHARLES A. 
Published: December 2021

To the Editor.—
Excellent recommendations to avoid error in drug dosage and administration were made by Koren et al1 and in the "Letters to the Editor" correspondence between him and Dr Lamont.2 However, I believe two statements require further clarification.
Dr Lamont's PEDICard gives an energy dose of 1 to 3 joules/kg for cardioversion. Cardioversion is the timed depolarization of myocardial cells used to restore a stable rhythm and must be synchronized with the QRS complex(es).
Has Routine Screening of Infants for Anemia Become Obsolete in the United States?
Authors: DALLMAN PETER R. 
Published: December 2021

Iron deficiency anemia was common and often severe as recently as 15 years ago in the United States.1 During that period, it had become a well-established routine to evaluate all term infants for anemia at about 1 year of age2; screening at the preschool checkup and in adolescence also became widespread.
Declining Prevalence of Iron Deficiency Anemia
During the past decade, iron deficiency anemia has become less and less common.1,3 The first strong evidence of a relatively low nationwide prevalence of anemia was provided by the second National Health and Nutrition Examination Survey (NHANES II) conducted between 1976 and 1980.4 In that large, representative sampling of the US population, only about 6% of adolescent girls between 15 and 17 years of age were anemic.4
Treatment of Swallowing Syncope
Authors: KENIGSBERG KENNETH 
Published: December 2021

To the Editor.—
Woody and Kiel reported a child in whom syncopal episodes occurred while swallowing.1 They treated the child by implanting a permanent pacemaker. In the article, they referred to other possible treatments such as the use of atropine to block the, presumably, vagal reflux. Unfortunately, there was no mention made of a test of this hypothesis.
We reported a similar case in 19722 and were able to document blocking of the reflux with atropine.
Blood Pressure
Authors: HORAN MICHAEL J. 
Published: December 2021

In Reply.—
Dr Park's first question centers around why data from the earlier NIH report were excluded from the current report. As indicated in the new report, because of the absence of prospective cohort data that can clearly link level of BP to cardiovascular risk, the Task Force did the next best thing which was to gather together the most comprehensive and reliable normative BP data to establish normal BP curves for children by age.
Meconium Suctioning
Authors: EISNER PERRY 
Published: December 2021

In Reply.—
The technique that I described is briefly as follows. The finger device is removed from a standard suction catheter and attached to a 3.0- or 3.5-mm endotracheal tube after removing the endotracheal tube's adaptor. The infant is intubated with this endotracheal tube and the wall suction tubing is attached with low wall suction applied. The technique has two advantages over Dr Beck's procedure. Although they both are effective means of removing meconium without risk to the resuscitator, the delivery room must first be stocked with a 10-F semistiff suction catheter with a side suction control valve.
Cow's Milk Protein Intolerance
Authors: GILBERTSON NICOLA J. , BENTLEY DONALD 
Published: December 2021

To the Editor.—
With regard to the diagnosis of cow's milk protein intolerance, we were interested by the findings of Kahn et al (Pediatrics 1985;76:880-884) and Dr Lecks' subsequent comments (Pediatrics 1986;78:378). A hitherto undescribed clinical feature that may contribute to the establishment of this diagnosis is the presence of hyperemia of the rectal mucosa in affected infants. Proctoscopy may readily be performed using a lubricated pediatric otoscope. The procedure is well tolerated, inexpensive, and takes only a few seconds.
Phototherapy and Patent Ductus Arteriosus
Authors: SCHEIDT PETER C. , BRYLA DOLORES A. , HOFFMAN HOWARD J. 
Published: December 2021

To the Editor.—
Rosenfeld et al1 recently reported a positive relationship between phototherapy exposure and patent ductus arteriosus in small premature infants. In this study, 74 infants with birth weights less than 1,500 g with respiratory distress syndrome and prophylactic phototherapy for neonatal jaundice were randomly assigned to either receive chest shielding or full exposure to light. The two groups, which were otherwise similar with regard to size, gestational age, severity of respiratory distress syndrome, fluid intake, and duration of phototherapy, significantly differed with regard to the incidence of patent ductus arteriosus (shield group 11/36 v no shield group 23/38, P = .009).
Elevated α-Fetoprotein in a Neonate With a Benign Hemangioendothelioma of the Liver
Authors: URBACH ANDREW H. , ZITELLI BASIL J. , BLATT JULIE , GARTNER J. CARLTON , MALATACK J. JEFFREY 
Published: December 2021

To the Editor.—
We recently had the opportunity to care for a neonate with a large intrahepatic mass who was also noted to have an elevated serum α-fetoprotein of 13,800 ng/mL (13,800 µg/L). The elevation of this protein prompted us to consider hepatoblastoma as a likely diagnosis. Although radiologic studies suggested a hemangioma, a biopsy was performed to rule out malignancy, and a benign hemangioendothelioma was found. The lesion spontaneously regressed and the serum α-fetoprotein decreased to 308 ng/mL (308 µg/L) at 2 months of age and to 20 ng/mL (20 µg/L) at 6 months of age.
Message From a Multihandicapped Child
Authors: PROUD VIRGINIA K. 
Published: December 2021

To the Editor.—
This is a message, a plea, a cry from 6-month-old Elizabeth at her death. Elizabeth had Goldenhaar syndrome. Her condition was particularly severe.
Will we ever have the wisdom to truly look at, listen to, and experience the lives of the handicapped children committed to our care? Will we ever be able to follow the ethical guidelines or to listen to the moral cues we receive from these children?
My Life
Stop
Think
Cerebral Edema and Galactosemia
Authors: WELCH R. J. , MILLIGAN D. W. A. 
Published: December 2021

To the Editor.—
We noted with interest the report from Belman et al1 describing the radiologic detection of cerebral edema in a child with galactosemia. We would like to provide further evidence of cerebral edema in this condition using ultrasonography.
Our patient was the first child of a single mother, born after an uneventful pregnancy. Labor started spontaneously, but the baby was born by forceps delivery after a delay in the second stage which lasted one hour 20 minutes.
Day Care for Sick Children
Authors: WEINBERG NEAL R. 
Published: December 2021

To the Editor.—
Dr Sterne's commentary (Pediatrics 1987;79:445-446) on day care for sick children presented a succinct summary of the dilemmas faced by working parents and the current options available to them when their children are ill. I am in full agreement that ideally there should be liberalized parental leave policies as well as improved understanding and acceptance of certain minor illnesses by existing day-care centers. However, because of the cost, it is doubtful that corporations can or will pay for home care services, which are twice as costly as an infirmary model, or will they be willing to grant additional paid days off to parents.
Inborn Errors of Metabolism
Authors: WISWELL THOMAS E. , WEISSE MARTIN E. 
Published: December 2021

To the Editor.—
We read with great interest the review by Dr Burton on inborn errors of metabolism.1 These myriad disorders frequently present with clinical manifestations that are associated with a variety of more common neonatal diseases. Dr Burton is to be commended for presenting a lucid, rational approach for the diagnosis of these oft-confusing afflictions.
However, there is another manifestation of these disorders, not previously recognized in the pediatric literature, that we wish to address.
Preparing Residents for the Doctor Denver
Authors: GARGAS DONALD C. 
Published: December 2021

At 10 weeks she could grasp a rattle, at 6 months she imitated speech sounds, and at 2 years she pedaled her first tricycle. She had aced the Denver Developmental Screening Test.
Now, at age 30 years, she is about to face yet another growth and development hurdle: The Doctor Denver. Will she ace it again? Or could there be a "delay"?
She is verbal, assertive, confident, current, and highly skilled. The newly trained, board-eligible physician represents high-tech, state-of-the-art medicine. But how well prepared, as a person, is the young physician to make the critical transition from university medicine to community practice?
Pediatrics and Poverty
Authors: GRAHAM GEORGE G. 
Published: December 2021

To the Editor.—
In his commentary on "Pediatrics and Poverty" (Pediatrics 1987;79:567-569), Dr Oberg expresses alarm about the increase in the percentage of children defined as living in poverty, being "malnourished," being homeless, and lacking health insurance. He quotes assertions about "an increasing incidence of low birth weight and preterm infants, failure to thrive, and an increase in infant mortality." This "grim situation" is attributed to "the severe recession of the early 1980s," to "recent budgetary reductions which we have witnessed during the last 4 to 5 years," and to the "reduction since 1981" in "low-income benefit programs."
Larger Numbers Needed
Authors: ALTSCHUL MARTIN S. 
Published: December 2021

To the Editor.—
In a letter to Pediatrics Cunningham1 suggested that there might be methodologic problems with the study of urinary tract infection and circumcision by Wiswell et al.2 Wiswell responded with further retrospective data.3,4 In an effort to shed more light on this subject, I have collected data on all cases of infants younger than 1 year of age with urinary tract infection admitted to Northwest Region Kaiser Foundation Hospitals from 1979 through 1985.
Transcutaneous Arterial Oxygen Tension and Retrolental Fibroplasia
Authors: WILLARD D. , MESSER J. 
Published: December 2021

To the Editor.—
According to Rooth et al1 transcutaneous monitoring of the newborn gives a reliable indication of arterial oxygen tension, if correctly used. We have evidence2 confirming such a point of view, often considered as controversial in the United States. Since 1980, we have used this system of monitoring, without any additional blood control, on every oxygen-dependent newborn treated in our neonatal care unit with few exceptions.
From January 1980 to July 1986, 1,672 premature infants (approximately one third of whom weighed less than 1,500 g) were assessed by means of indirect ophthalmoscopy to rule out classical forms of retinopathy.
Ascendency of the Black Bottle (Activated Charcoal)
Authors: GREENSHER JOSEPH , MOFENSON HOWARD C. , CARACCIO THOMAS R. 
Published: December 2021

Previous well-established guidelines for the management of poisonous ingestions in children are undergoing significant change. The time-honored practice of syrup of ipecac-induced vomiting as the primary means of gastrointestinal decontamination now frequently yields to the administration of activated charcoal. Practitioners and emergency room physicians who are increasingly relying on advice from and participation in treatment by regional poison control centers need to understand the rationale behind what many consider contradictions to accepted teaching.
A case in point was a recent letter to the American Academy of Pediatrics from a pediatrician questioning the treatment of an ingestion of poison in a toddler.