bluuebunny/crossref_metadata_2025_split huggingface dataset:
Science and Empiricism in Pediatrics
Authors: Goldbloom Richard B. 
Published: December 2021

Whatever the duration of your experience in looking after children, it doesn't take many years before you can look back with some amusement on abandoned practices in child care. The further you retrospect, the more ludicrous some of the antique customs seem—proving the fundamental equation that comedy equals tragedy plus time.
As we read or listen to scientific presentations laden with chi-squares and P values—measures of a significance that is sometimes more mathematical than social, we might easily be seduced into believing that the age of scientific reason had arrived—that our every daily act in caring for children and their families had been tested and proven efficacious in accordance with the rigorousrules of scientific evidence.
But notwithstanding our scientific airs and graces, pediatric empiricism is still with us, in our sophisticated and prestrigious tertiary care hospitals and in daily clinical practice in this community. Let me cite a few instances to support the notion that our management of the commonest childhood illnesses is still rooted as much in empiricism as in science. Let me also suggest that those very empiricisms identify research priorities and call for a new collegiality between pediatric clinicians and researchers. Too often we pediatricians come to be labeled as either "academic" or "practicing"—an artificial distinction which excludes the combination of qualities to which most of us aspire, thus doing us all a disservice.
One of our peculiar inconsistencies is that the rigor with which we apply the rules of scientific proof is highly situational. Before we allow a new vaccine or antibiotic to be released for use among the general public, we and our governments insist on the critical review and publication of carefully controlled trials, first in laboratory animals and finally in groups of consenting humans.
Methemoglobinemia in an Infant Treated with the Folk Remedy Glycerited Asafoetida
Authors: KELLY KEVIN J. , NEU JOSEF , CAMITTA BRUCE M. , HONIG GEORGE R. 
Published: December 2021

Methemoglobinemia can be caused by inherited enzyme deficiencies or abnormal hemoglobin structure. Methemoglobinemia may also be the result of oxidative stress that overwhelms normal red cell protective mechanisms.1
We present a case of methemoglobinemia in an infant who was treated with gum asafoetida, a compound used as a folk remedy and contained in certain foods. Laboratory investigation demonstrated an oxidizing effect of asafoetida on fetal hemoglobin but not on adult hemoglobin. This chemical, which is sold over the counter in pharmacies, must be considered as being potentially life threatening if given to infants.
CASE REPORT
A previously well, 5-week-old black male infant was admitted to the hospital six hours after the onset of tachypnea, grunting, and cyanosis.
Bleeding in Cystic Fibrosis?
Authors: ROSENSTEIN BERYL J. 
Published: December 2021

To the Editor.—
I read with interest the article by Lane and colleagues1 in which they described a fatal intracranial hemorrhage in a normal infant secondary to vitamin K deficiency. In their patient, vitamin K deficiency was attributed to lack of newborn prophylaxis, with breast-feeding and antibiotic administration as possible contributing factors.
It is important to point out that a bleeding disorder can be the presenting manifestation of cystic fibrosis during the first year of life and that this possibility needs to be considered in the differential diagnosis in all infants with evidence of vitamin K deficiency.
Why Do We Keep Using Phototherapy in Healthy Newborns?
Authors: HEIN HERMAN A. 
Published: December 2021

To the Editor.—
Prevention of kernicterus is a laudable pursuit. However, unsubstantiated beliefs about neonates at risk for kernicterus may have caused numerous babies to receive needless phototherapy and/or exchange transfusions. Early studies that suggested the association of bilirubin levels greater than 20 mg/dL and kernicterus, and on which modern policy seems to be based, were heavily slanted toward babies who were preterm or had hemolytic disease or sepsis.1-3 Few, if any data attest to the risks of bilirubin levels in excess of 20 mg/dL but less than 25 mg/dL in otherwise healthy, term neonates.
Atlantoaxial Instability in Down Syndrome
Authors:   Committee on Sports Medicine
Published: December 2021

Some issues related to participation in certain sports by persons with Down syndrome require clarification.
Since 1965 there have been occasional reports about a condition described at various times as instability, subluxation, or dislocation of the articulation of the first and second cervical vertebrae (atlantoaxial joint) among persons with Down syndrome.1-15 This condition has also been found in patients with rheumatoid arthritis,16,17 abnormalities of the odontoid process of the second cervical vertebra,4,5,12,13,15 and various forms of dwarfism.18 Atlantoaxial (C-1, C-2) instability has not attracted general attention because clinical manifestations are rare and the condition is limited to a small portion of the population. The incidence of atlantoaxial instability among persons with Down syndrome has been reported by various observers to be 10% to 20%.2,9,15 When atlantoaxial instability results in subluxation or dislocation of C-1 and C-2, the spinal cord also may be injured. This is a rare but serious complication.
In March 1983, the Special Olympics, Inc, sponsors of a nationwide competitive athletic program for developmentally disabled persons, without prior announcement, mandated for participants with Down syndrome special precautions to prevent serious neurologic consequences from stress on the head and neck in sports competition.19 Although thousands of persons with Down syndrome have taken part in sports events during the 15-year history of the Special Olympics without a known occurrence of neurologic complications due to participation, the new directive requires all persons with Down syndrome who wish to participate in certain sports that might involve stress on the head and neck (gymnastics, diving, pentathlon, butterfly stroke in swimming, diving start in swimming, high jump, soccer, and warm-up exercises that place undue stress on the head and neck muscles) to have a medical examination, lateral-view roentgenograms of the upper cervical region in full flexion and extension, and certification by a physician that the examination did not reveal atlantoaxial instability or neurologic disorder.
Care of Infants with Myelomeningocele
Authors: DEKLOTZ RICHARD L. 
Published: December 2021

To the Editor.—
In the article by Gross et al1, the topic of infection was not addressed. In two of the references that they cited, there was a 60% greater incidence of meningitis or ventriculitis in the groups with delayed closure compared with the groups with immediate closure. The numbers in the Smyth et al article2 are 8/53 (15%) infected in the group with immediate closure and 11/46 (24%) in the group with delayed closure. In the Sharrard et al study3 the numbers are 5/20 (25%) infected in the group with immediate closure and 8/20 (40%) in the group with delayed closure.
Care of Infants with Myelomeningocele
Authors: FARBER JON MATTHEW 
Published: December 2021

To the Editor.—
I greatly appreciated the article by Gross et al1 describing their program's approach to the difficult medical and ethical question of dealing with infants with myelcmeningocele. There is one potentially quite disturbing point in their article, however, which I feel cannot be allowed to go unnoticed. A program that allows for the nontreatment of these children must have superb selection criteria for deciding who is treated and who is not. The authors state that there were five infants for whom they did not recommend intervention, but the parents still wished it, so treatment was given.
Coronavirus?
Authors: PAYNE CLAIRE M. , RAY C. GEORGE 
Published: December 2021

To the Editor.—
We read with great interest the paper by Rousset et al1 in which the presence of coronavirus-like particles in intestinal lesions of neonates with necrotizing enterocolitis was described. The presence of viral particles in thin-sectioned material is often difficult to demonstrate because of the striking similarity of some viral particles to normal cell organelles and structures. We agree with the authors that coronavirus-like particles may be an etiologic agent in some cases of neonatal necrotizing enterocolitis of nonbacterial origin2,3; we do not agree, however, that their published electron micrographs unequivocally demonstrate viral particles.
Photodosimeter Badge System
Authors: Scheidt Peter C. , Sternthal Phyllis M. , Anderson Robert , Studholme Robert , Bryla Dolores A. , Fetterly Karen L. 
Published: December 2021

The Committee on Phototherapy in the Newborn of the National Academy of Sciences has recommended10 development of a compact system to continuously measure radiant energy exposure of infants treated with phototherapy. A small bilirubinimpregnated photodosimeter film badge was developed by the Beckman Instrument Company for this purpose and was used during the National Institute of Child Health and Human Development (NICHD) phototherapy study. This report summarizes the results of data obtained with this measurement device and briefly describes the performance of this system.
METHODS
The film badge dosimeter system consists of a 5.2x2.6-cm plastic badge composed of an imbedded disk of bilirubin cast in a polymeric substrate and sandwiched between two layers of clear plastic. Before exposure to light, the badge exhibits a high optical density at 460 nm due to a relatively high concentration of bilirubin. The optical density of the badge at 400 to 500 nm decreases as a function of the total dose of light within the action spectrum for the photodecomposition of bilirubin to which the badge has been exposed. Initial optical density at 460 nm is measured by a densitometer designed and dedicated specifically for this purpose. After exposure, the optical density is again measured by insertion into the densitometer; the total dosage, which is the time-integrated irradiance received by the badge during the photodecomposition process, is derived from the difference in optical density between the two readings. (A description of the calibration of the badge is available on request from Biometry Branch, Epidemiology and Biometry Research Program, National Institute of Child Health and Human Development, Bethesda, Maryland.)
The National Institutes of Health Point of View
Authors: LILLY JOHN R. 
Published: December 2021

In Reply.—
Except for the unquestionably magnified personal commendation, Randolph's letter presents a reasonable analysis of the potential hazards of National Institutes of Health (NIH) consensus panels. In fact, his is the most well-balanced of more than two dozen letters and telephone calls I have received since publication of "Biliary Atresia and Liver Transplantation: The National Institutes of Health Point of View (Pediatrics 1984;74:159-160). For the most part, these communications have been from pediatric surgeons who take hot exception, not to liver transplantation per Se, but to what is perceived as a deliberate decision by their pediatric colleagues to withhold surgical treatment (other than liver transplantation) from patients with biliary atresia.
Misleading Editorial
Authors: STICKLER G. B. 
Published: December 2021

In Reply.—
Lildholdt's comments are perplexing. He is the author of an extensive prospective study of tympanotomy in 150 children with primary secretory otitis.1 He inserted a ventilation tube into one ear and left the other tympanic membrane intact. His patients were children ranging in age from 1 to 10 years with a mean age of 3.9 years. He noted suppuration in 25% of the ears with ventilation tubes in the follow-up period which averaged 3.2 years.
CHALLENGE TO A CHERISHED NOTION
Authors: Student  
Published: December 2021

What is startling about Jerome Kagan's book, The Nature of the Child, is its strong challenge to a number of beliefs about children that are so widely accepted—by parents, therapists and even some of Mr. Kagan's colleagues—that they are taken as givens. These include some treasured notions—the notions that a certain set of essential experiences in children's home life allows them to grow into healthy and happy adults, that the temperament of the infant foretells the character of the child, that the child's personality foreshadows the adult's and that the child's psychological traits are shaped by what happens between parent and child.
It is not, Mr. Kagan argues, that the parent-child bond does not matter—just that the specifics of parenting are not so crucial to the child's future as parents would like to think. While some lay readers may be taken aback by Mr. Kagan's questioning of such golden tenets of modern parenthood, many therapists no doubt will be upset by his assault on some basic premises of their calling. Foremost among these is his attack on the notion that, as he puts it, "a mother's love for her infant is necessary for the child's future mental health," or, more technically, that a bond of secure attachment to a parent during the first three years of life leaves the child less vulnerable to later psychological disorders.
Munchausen Syndrome by Proxy
Authors: SHELDON STEPHEN H. 
Published: December 2021

To the Editor.—
The article, "Munchausen Syndrome by Proxy: An Outpatient Challenge," by Vincent L. Guandolo, MD,1 was read with interest. It was a compelling description of a very worrisome problem for all professionals involved in providing for the welfare of children. Munchausen syndrome by proxy results in multiple hospitalizations and unnecessary painful, invasive, and expensive procedures. The potential consequences warrant accurate early diagnosis, management, and disposition.
Seizures secondary to Munchausen syndrome by proxy may be fictitious (the parent deliberately providing a false history) or may be an actual convulsive episode precipitated by an action of the parent (eg, anoxic seizures secondary to smothering).2 A misdiagnosis of epilepsy is common and consequences range from the persistence of fictitious symptoms into adulthood to death of the child.
Kawasaki Syndrome, Reye Syndrome, and Aspirin
Authors: TAKAHASHI MASATO , MASON WILBERT 
Published: December 2021

To the Editor.—
Aspirin is the mainstay of therapy for Kawasaki syndrome. Its early initiation and continued low-dose therapy have been effective in reducing morbidity and mortality.1 However, a dark cloud of fear has arisen for those physicians and parents involved with Kawasaki syndrome. A number of reports, including a pilot study by the Public Health Service Task Force, cite association between use of aspirin and Reye syndrome.2
Let us examine epidemiologic features of both syndromes.
Lectures on the Diseases of Children by Eli Ives, MD, of Yale and New Haven: America's First Academic Pediatrician
Authors: Pearson Howard A. 
Published: December 2021

Eli Ives of New Haven, CT and Yale University was a successful and respected practitioner, professor, and medical statesman. For nearly 40 years between 1813 and 1852, he lectured to an estimated 1,500 Yale medical students on materia medica, botany, the theory and practice of medicine, and the diseases of children. Some of those lectures, meticulously recorded in flowing penmanship by Yale medical students during this time, are preserved in the manuscript and archives section of Yale University's Sterling Library. The Ives Lectures on Diseases of Children represent the first systematic and dedicated American course of instruction in what today is known as the specialty of pediatrics.
During the 1820s, Ives' title at Yale was Professor of Materia Medica, Botany, and the Diseases of Children and so he held the earliest American academic appointment in pediatrics. There were other early 19th century academic physicians with demonstrated interest and involvement in children and their diseases.1 These pediatric pioneers included William Potts Dewees of the University of Pennsylvania and John Eberle of the Jefferson and Cincinatti Medical Colleges who authored early American pediatric textbooks. However, they did not have formal academic titles nor did they present separate substantive courses in pediatrics at their institutions.
By the latter half of the 19th century pediatrics began to attain academic recognition in the United States. Dr Abraham Jacobi of New York established a children's clinic at the New York Medical College in 1861. He held the academic title of Professor of Infantile Pathology and Therapeutics and lectured on the diseases of children.
Guidelines for the Elective Use of Conscious Sedation, Deep Sedation, and General Anesthesia in Pediatric Patients
Authors:   Committee on Drugs Section on Anesthesiology
Published: December 2021

Clarification
The AAP Committee on Drugs and Section on Anesthesiology wish to clarify those portions of the Guidelines (Pediatrics 1985;76:317-321, August) that pertain to an intravenous line.
Under some circumstances (eg, very short procedures, availability of persons skilled in establishing intravenous lines in children), it may not be necessary that an intravenous line be in place. Therefore, the Guidelines are modified as follows.
In section II, "Deep Sedation," the recommendation should read:
Patients receiving deep sedation should have an intravenous line in place or have immediately available a person skilled in establishing intravenous infusions in pediatric patients.
In section III, "General Anesthesia: Intravenous Access," the recommendation should read:
Patients receiving ambulatory general anesthesia shall have an intravenous line in place or have immediately available a person skilled in establishing intravenous infusions in pediatric patients.
Auditory Testing and Bilirubin
Authors: NAKAMURA HAJIME 
Published: December 2021

In Reply.—
We appreciate the comments of Shapiro and Hecox regarding our article. Their primary concerns relate to the methodologic and analytic aspects of our study.
1. Auditory nerve and brainstem response patterns obtained by "logon" stimulus differ significantly from those by "click" stimulus; although interpeak latencies in these two instruments generally agree, absolute latencies do not. This is caused by start time definition. The preferred "time zero" is the instant that the stimulus pulse impacts on the tympanic membrane with the instrument Teledyne TA-1000.
Second Testing for Hypothyroidism
Authors: LEVINE GILBERT D. , THERRELL BRADFORD L. 
Published: December 2021

To the Editor.—
The article by La Franchi et al (Pediatrics 1985;76:734-740) regarding newborn screening for hypothyroidism at two time periods in the Northwest Regional Screening Program (NWRSP) confirms the experiences previously reported for Texas.1,2 Since the beginning of our hypothyroid screening program in 1980, a second test at 1 to 4 weeks has been strongly recommended. Since 1983, this specimen has been required on infants screened prior to 36 hours of age or prior to 24 hours of protein intake.
Severe Reactivation of Sunburn Following Methotrexate Use
Authors: MALLORY SUSAN B. , BERRY D. H. 
Published: December 2021

Methotrexate is not an infrequently used drug in chemotherapy protocols. The following, however, is an uncommon side effect of this medication.
CASE REPORT
A 13-year-old white boy was diagnosed as having non-Hodgkin's lymphoma by lymph node biopsy 2 years prior to the onset of his dermatitis. While on a fishing trip in May 1984, a mild sunburn developed after 1½ hours in the sun. Two days later, his sunburn was barely noticeable. He underwent chemotherapy which included highdose intravenous methotrexate with leucovorin rescue, as well as intrathecal methotrexate, cytarabine, and hydrocortisone. Shortly after the injection of intravenous methotrexate, he noted tingling and burning at the sites of his resolving sunburn.
In Reply: Atherosclerosis
Authors: KWITEROVICH PETER O. 
Published: December 2021

In his letter, Dr Mauer has expressed concern that my prior commentary constituted a "disservice to science" and "closes the book" on future hypothesis testing.
My commentary was written in response to a previous commentary by Dr Mauer. I was concerned that Dr Mauer's comments, namely, "The significance of serum cholesterol levels as an independent variable could not be definitely assigned" and "there are no available data on children," were misleading. At the very least, the pediatrician deserved a detailed review of the literature and a careful exposition of the cholesterol hypothesis.
School Performance and Theophylline
Authors: RACHELEFSKY GARY S. , WO JULIE , ADELSON JUDIH , MICKEY M. RAY , SPECTOR SHELDON L. , KATZ ROGER M. , SIEGEL SHELDON C. , ROHR ALBERT S. 
Published: December 2021

In Reply.—
Drs Weinberger, Lindgren, and Joad's comments are appreciated, and they raise a number of questions about our report of the adverse effects of theophylline. We appreciate their concerns, and we hope the following satisfies them.
Because the manuscript was published in Pediatrics and reported by the staff of USA Today, we will concern ourselves with the peer-reviewed published paper.
The study was randomized and double blinded; the investigators, the children, the teachers, and the parents had no way of knowing whether the children were on theophylline or not, and there was no prior experience with theophylline titration.
Gift to a Litigious Society
Authors: SAPIRE DAVID W. , WOLF WENDY J. , CASTA ALFONSO 
Published: December 2021

To the Editor.—
The article by Dr Garson1 impacts significantly on all physicians who treat children with cardiac dysrhythmias. We recognize that Dr Garson is an authority in the diagnosis and management of cardiac rhythm disorders in children, and we agree with his view that arrhythmia therapy can be potentially hazardous. However, we do take exception to the format and presentation of the information in this article.
By using the term "medicolegal" in the title, a potential red flag is raised to attract the attention of tort lawyers who might justifiably believe they can use this information for their own purposes.
Purulent Tendon Sheath Infection
Authors: FISCHEL DAVID R. 
Published: December 2021

To the Editor.—
We recently cared for a young patient who had a rather unusual infection. Review of the standard pediatric literature and a Medline search yielded no other descriptions of this particular entity. Therefore, I am submitting a description of this child's examination and treatment in order to share this with other pediatricians who may have already encountered or who may in the future encounter a similar clinical problem.
Five days before this child's admission, the babysitter of this 12-month-old caucasian girl reported to the infant's mother that the child would not bear weight on her left foot and would not walk.
Daytime Urinary Frequency
Authors: BLOOM DAVID A. , SEDMAN AILEEN , ZOUBEK JERI 
Published: December 2021

In Reply.—
We missed the paper by Leung and Robson, and appreciate the chance to learn of it. It should be included in the definitive bibliography for extraordinary frequency. Certainly, as they say, the problem is more prevalent than recognized generally.
The enuresis and urgency would have disqualified 3 of their 10 patients from our series. The pH of 5 in half of their patients was of interest. We didn't, off hand, know the normal pH range of children in a urology clinic.