bluuebunny/crossref_metadata_2025_split huggingface dataset:
Letters to the Editor
Authors: Stare Fredrick J. 
Published: December 2021

There is nothing in our paper referred to by Dr Campbell that indicates or implies that it is "the final word on the ineffectiveness of the Feingold diet." All we wrote was that "The reality is that we still have a great deal to learn about this condition (hyperkinesis) ... it appears now that diet plays at most, a very minor role." That doesn't sound to me like "the final word"!
Neither Harvard's Department of Nutrition nor the American Council on Science and Health is my institution, though I am active in both.
Letters to the Editor
Authors: Baron Michael A. , Fink Howard D. 
Published: December 2021

We agree completely with Dr Mangravite'ss comments and have been advising parents as he suggests.
Implicit in Mangravite's remarks is the observation that a single test is no more reliable for diagnosis than is any single historical datum or physical sign. The constant exercise of clinical judgment and careful follow-up of patients is therefore essential and can prevent excessive reliance on "blood tests." It should be kept in mind that young infants are at especially high risk for bacteremia; that this risk varies directly with temperature and inversely with age: and that one or many of the risk factors for bacteremia may be absent in culture-proven bacteremia.
Prader-Willi Syndrome
Authors: Barol Daniel H. 
Published: December 2021

It was my impression that Crnic et al (Pediatrics 66: 787, 1980) posited a causal relationship between uncontrolled obesity and the severity of mental deficit in Prader-Willi syndrome.
Possibly I overlooked either a key proof or a quiet disclaimer, but it seems equally possible, from my reading of their intriguing report, that the observed correlation is altogether noncausal, ie, that greater controllability of weight and higher IQ may simply be twin attributes of "mild" disease, or conversely that lower IQ and lower amenability to weight control may be co-features of more severe disease.
Value of Child Maltreatment Tests
Authors: PASCOE JOHN M. 
Published: December 2021

To the Editor.—
Rosenberg et al1 have made a commendable attempt to define early markers of maltreated children. Their effort demonstrates how difficult it is to develop an instrument to identify families with complicated, low-prevalence psychosocial disease. The sensitivity and positive predictive value of such assessment tools are usually very low. This example is no exception. The sensitivity of a test is defined as the "test positivies" in patients with the disease (eg, abused children in the sample who are unkempt and abnormally parented in the emergency room) divided by all the patients with the disease (all abused children in the sample).2
Parental Information and Circumcision: Another Look
Authors: LAND JACK A. , POLICASTRO ANTHONY M. 
Published: December 2021

To the Editor.—
We found "The Role of Parental Information in the Incidence of Circumcision" (Pediatrics 1982;70:597-598) to be most interesting. At Malcolm Grow USAF Medical Center, Andrews Air Force Base, Maryland, we performed a similar study. Pregnant women, followed by the obstetrical service, were given appointments to attend, with their husbands, a four-hour general counseling session during their eighth month of pregnancy. During the session, circumcision was discussed in such depth that it constituted informed consent. Women who did not attend the session received no structured informed consent.
Febrile Children
Authors: MCCARTHY PAUL L. , CICCHETTI DOMENIC V. 
Published: December 2021

In Reply.—
A high percentage (87%) of the 55 ill-appearing (scale score &gt;10) febrile children in our study1 had at least one laboratory test performed; a lesser percentage (45%) of the 110 well-appearing (scale score ≤10) febrile children had at least one laboratory study performed. Nearly half (47%) of the total laboratory studies performed, however, were performed on well-appearing febrile children.
Despite a nearly equal number of total laboratory studies in well- and in ill-appearing febrile children, only three of 23 abnormal test results (p 805, table 2) occurred in well appearing children.
Eikosiphobia
Authors: COHEN MARK L. 
Published: December 2021

To the Editor.—
Watchko and Oski1 deserve commendation for dramatizing the bilirubin dilemma with reason and style. Their alert anonymous resident no doubt has read Lucey's startling commentary2 which calls into serious question our understanding of this problem.
This scene has value that goes well beyond the newborn's jaundiced eye. Countless variations can be imagined: phenobarbital for seizures, antihistamines for stuffy ears, CBCs and chest films for surgery. As residents, we were aware of the well-known "Rule of 3, 7, 10, or 14" which states that: "The length of treatment for any positive culture is directly proportional to who's on service this month."
The Silent Patent Ductus Arteriosus
Authors: ELLISON R. CURTIS , PECKHAM GEORGE J. , LANG PETER , TALNER NORMAN S. , LERER TRUDY S. , LIN LILLIAN , DOOLEY KENNETH J. , NADAS ALEXANDER S. 
Published: December 2021

In Reply.—
We appreciate the comments of Kashani, Swensson and Merritt. We are cognizant of the pioneering work done through the years at the University of California at San Diego in relation to the management of respiratory distress syndrome (RDS).
The multicenter trial1 established diagnostic criteria for patent ductus arteriosus (PDA) in 1978. In view of the unknown toxicity of indomethacin at that time, high specificity rather than maximum sensitivity was of prime concern. We wanted to enroll in our trial only those infants in whom the degree of ductal shunting was leading to sufficient cardiopulmonary compromise to cause a threat to the infant and to warrant the use of a potentially toxic drug or surgery.
Efficacy of Penicillin Prophylaxis
Authors: KAPLAN EDWARD L. 
Published: December 2021

To the Editor.—
I read with interest the article by Hess and colleagues.1 The objectives of that study, to determine the incidence of postextraction bacteremia and to evaluate the efficacy of antibiotic prophylaxis, are worthy although not novel.
The authors point out, in assessing the "efficacy of penicillin prophylaxis as recommended by the American Heart Association to prevent the onset of bacterial endocarditis," that "the results of our study indicate that transient postextraction bacteremia can occur in patients receiving parenteral penicillin prophylaxis recommended by the American Heart Association."
Protest Views of Singer
Authors: BONGIOVANNI ALFRED M. 
Published: December 2021

To the Editor.—
The commentary by Singer1 must not go unchallenged. This member of the American Academy of Pediatrics takes exception to this statement, and he in no way espouses "religious mumbo-jumbo" which Singer applies to his possible opponents. Nor does this writer espouse the application of heroic measures to the preservation of human life under all circumstances. There is such latitude in Singer's discussion that "quality of life" can mean almost anything.
I will not belabor the many aspects of Singer's rhetoric but must make two points.
Pharyngeal Gonorrhea
Authors: RIS HANIA W. 
Published: December 2021

To the Editor.—
The article, "Screening for Pharyngeal Gonorrhea in the Urban Teenager,"1 calls attention to the pharynx as an important site of infection and recommends routine culture of the pharynx in this population group.
Among 80 adolescents with gonorrhea, 15 (19%) had pharyngeal infection. Twelve patients had a positive culture from the pharynx alone and three patients had positive cultures from both pharynx and cervix.
It should be kept in mind that a single cervical culture is not infallible and even under optimal conditions in a research laboratory does not diagnose all infected females; 10% to 30% of infected patients will be missed.2
Pharyngeal Gonorrhea
Authors: CHACKO MIRIAM R. 
Published: December 2021

In Reply.—
We agree with Ris' comments on the dependability of a single cervical culture for gonorrhea, and therefore it is possible that some of the 12 patients with pharyngeal gonorrhea alone had cervical infection as well. An alternative to taking a second cervical culture prior to treatment would be to take a cervical culture following treatment to ensure cure.
Regarding the prevalance of rectal gonorrhea in this study population,1 20% of the patients with gonorrhea had rectal gonorrhea and 19% had pharyngeal gonorrhea (our figure 1).
Histoplasmosis: A Reinterpretation
Authors: WEINBERG GEOFFREY A. , KLEIMAN MARTIN B. 
Published: December 2021

In Reply.—
Prominent features of the serum sickness-like hypersensitivity reaction associated with cefaclor always include rashes, usually erythema multiforme, and occasionally arthritis.1 Joint involvement is usually symmetrical, often affecting fingers, ankles, and knees (K. Israel, MD, Lilly Research Laboratories, Indianapolis, personal communication). In a report of eight children receiving cefaclor for "persistent" otitis media, six had prior contact with the drug.1 Symptoms developed five to 19 days after beginning cefaclor therapy. Our patient had not previously received cefaclor.
Introduction to Recombinant DNA
Authors: Cederbaum Stephen D. 
Published: December 2021

Seldom has a scientific or biomedical break-through evoked the awe, controversy, or sheer incredulity that has accompanied the developments in the field of recombinant DNA technology or more popularly, gene cloning and genetic engineering. Now little more than one generation after Avery, et al1 demonstrated that genes were encoded in DNA and Watson and Crick2 interpreted the structure of these molecules, genes are being cut, manipulated, and recombined to produce unprecedented new insights into genetics and molecular biology and the prospect of gene therapy. These developments have not occurred without anxiety to both scientists and laymen. At the moment, neither the most apocalyptic fears nor the most optimistic dreams appear to be imminent, although I believe that the dreams are closer to fulfillment than the fears.
Recombinant DNA technology is already having great impact in hematology, oncology, endocrinology, immunology, and infectious disease and will soon play an important role in other medical subspecialities as well. In none, however, will it have quite the same impact as in genetics because DNA is the material that genetics "is all about." The cloning and study of phenylalanine hydroxylase is one of the first instances in which this technology has important implications in the diseases traditionally classified as inborn errors of metabolism.
In order to understand and appreciate the presentation by Woo on phenylalanine hydroxylase as well as the many future papers that will play so vital a role in all of our professional lives, it is necessary to acquire the basic vocabulary of the field.
Parental Consent for Immunization
Authors: HALAC ELIAS , MEISLIN AARON G. 
Published: December 2021

To the Editor.—
The New York Pediatric Society, a 50-year-old professional organization of practicing and academic physicians dedicated to the study and welfare of children, is submitting this letter, previously sent to the Academy offices, in the interest of stimulating further discussion of the question of parental consent for routine immunizations. We have reviewed the March 1983 report on DTP (diphtheria, pertussis, tetanus), DT, and TD immunizations provided by the American Academy of Pediatrics, and wish to register our strong objection to the formal request/consent forms favored, or at least publicized by the Academy.
Use of Denver Developmental Screening Test
Authors: VANDERVOORT ROBERT L. , LEE EVON BATEY 
Published: December 2021

To the Editor.—
Allan et al1 presented the developmental outcome of children with periventricular and intraventricular hemorrhage. They defined developmental delay as a "delay of 6 months or greater" as noted on the Denver Developmental Screening Test (DDST). The DDST is a screening test, not a diagnostic instrument, and as such, it is capable of determining children who are at increased risk of developmental delay. It does not indicate that a child is functioning at a particular age level.
Necrotizing Enterocolitis and Neuraminidase-Producing Bacteria: A Challenge for Future Investigations
Authors: DUC G. 
Published: December 2021

To the Editor.—
The importance of intestinal bacteria as primary causal agents or as secondary invaders in necrotizing enterocolitis has been debated widely.1 Epidemic outbreaks of necrotizing enterocolitis have been found to be associated with the presence of Pseudomonas, Salmonella, Klebsiella, Escherichia coli, Coxsackie 2, and clostridia in the stools of affected babies. However, these same organisms are commonly found in nonaffected infants in neonatal intensive care. Thus, the causal relationship remains doubtful. Simultaneous detection of bacteria (such as Clostridium difficile) and toxin in babies with necrotizing enterocolitis,2 suggests that under some conditions, commensals may become pathogenic and play a primary role in the outbreak of epidemics.
Meat Tenderizer and Bee Stings
Authors: CARDONI ALEX A. , ROSENBERG PHILIP , AGOSTINUCCI WILLIAM 
Published: December 2021

To the Editor.—
We recently came across Lanier's letter, "Meat Tenderizer and Stings,"1 and we were interested in his comments about potential lack of efficacy of meat tenderizer products to treat Hymenoptera stings. Each year the Connecticut Poison Center receives approximately 300 calls related to insect stings and bites, and we have been aware of the many first-aid measures recommended to treat reactions secondary to these stings. Ice, baking soda paste, topical corticosteroids, topical antihistamines, and meat tenderizer pastes have all been recommended.
Pediatricians, Antibiotics, and Office Practice
Authors: DISNEY FRANK A. 
Published: December 2021

To the Editor.—
I recently participated in a telephone conference call sponsored by an unidentified drug house on the subject of detailmen as seen by the private pediatric practitioner. There were seven of us (plus a nonphysician discussion leader); we were all from different states throughout the country and all of us were practicing pediatricians, except for one neonatologist. All were Board certified and all had been in private practice for a period of 10 to 25 years.
Self-Induced Urinary Tract Infection in Boys
Authors: LABBÉ JEAN 
Published: December 2021

To the Editor.—
It is well recognized that urinary tract infection (UTI) is relatively uncommon in boys after the first months of life. Most authors also agree that, especially in children less than 10 years of age, boys with UTI are more likely than girls to have a urinary tract malformation and a secondary renal damage.1-5 Therefore, radiologic investigation is recommended at a first UTI in boys.6 On the other hand, ureteral instrumentation (like catheterization) can cause UTI in a normal urinary tract.
Use of Noninvasive Tests to Predict Significant Jaundice in Full-Term Infants: Preliminary Studies
Authors: SMITH DAVID W. , INGUILLO DOROTHY , MARTIN DARREL , VREMAN HENDRIK J. , COHEN RONALD S. , STEVENSON DAVID K. 
Published: December 2021

Hyperbilirubinemia continues to be a common problem of the neonate. A major factor contributing to the occurrence of significant neonatal jaundice is increased bilirubin production, and in hemolytic diseases the production may exceed the normal neonatal mean by up to tenfold.1-3 However, impaired elimination of bilirubin from the body, eg, decreased conjugation or increased intestinal reabsorption, is also an important contributing factor.4
In full-term infants, the concentration of bilirubin in serum is greatest at approximately 72 hours of age,4 and significant hyperbilirubinemia occurs in approximately 5% of these neonates.5 Motivated by hospital costs and by parental requests, many pediatricians are discharging infants from the hospital before 48 hours of age.
Use of Oral Fluid Therapy and Posttreatment Feeding Following Enteritis in Children in a Developed Country
Authors:   Committee on Nutrition
Published: December 2021

The 1982-1983 report by the United Nations Children's Fund (UNICEF) on the State of the World's Children recommended widespread implementation of oral rehydration as one of the four strategies projected to save the lives of 20,000 children each day.1 In the developing countries, oral rehydration has been shown to be an effective, simple, and inexpensive therapy for dehydration caused by severe enteritis in infants.2-8 The modern concepts of oral fluid therapy for diarrheal diseases evolved in part from the clinical observation that orally administered glucose-electrolyte solutions can replace diarrheal fluid losses in cholera. Previous laboratory investigation had demonstrated the presence of a cotransport system of sodium with glucose or other actively transported small organic molecules in the small intestine in animals and in man. Clinical studies suggest that this sodium-glucose cotransport system remains intact not only when the pathophysiologic agent is an enterotoxin, such as that elaborated by Vibrio cholerae or enterotoxigenic strains of Escherichia coli, but also with inflammatioion such as that associated with rotavirus, Campylobacter jejuni, E coli, and Yersinia enterocolitica.4-8 These observations have provided a physiologic rationale for an appropriately efficient ratio of sodium to glucose in formulating solutions to be used in the developing countries for oral therapy in the treatment of infants with life-threatening diarrheal dehydration.
The question we address in this commentary is that of the appropriate implementation of oral hydration therapy in a developed country. Pediatricians and others concerned with the health of children in this country are not usually confronted with the problem of obtaining uncontaminated water nor with the management of large numbers of severely malnourished young infants with multiple health problems.
Prevention of Hepatitis B Virus Infections
Authors:   Committee on Infectious Diseases
Published: December 2021

Infants born to mothers who are hepatitis B surface antigen (HBsAg) positive are frequently infected with hepatitis B virus (HBV). Many of these newborns will become chronic carriers of HBV and will subsequently develop chronic liver disease. Recent studies have demonstrated that perinatal transmission can be prevented by immunization of the newborn. Recommendations for the management of infants at risk are presented.
PERINATAL TRANSMISSION OF HBV INFECTIONS
Perinatal infection of infants by mothers who are HBsAg positive is most likely to occur if mothers are also hepatitis Be antigen positive. About 90% of infants whose mothers are positive for both markers will become infected and most will become permanent carriers.1 Infants whose mothers are HBeAg negative or who have antibody to HBeAg are at lesser risk, but can still be infected.2
Infected infants usually will not become HBsAg positive until several weeks after birth. Although clinical jaundice or acute hepatitis are rare in infected infants, elevations in transaminase levels are frequent.3 It is estimated that about one in four infants who become chronic carriers following perinatal infection will develop cirrhosis or hepatocellular carcinoma later in life. As they are persistent carriers, later in life they may transmit infection to other family members, to sexual contacts, or to others by transfusions or inoculation of their blood. Infection of female infants may eventually result in transmission of HBV to their own infants. Indeed, transmission from mother to infant is a major method of perpetuation of this virus in hyperendemic areas, eg, the Far East.
Relationship Between Hospital-Based and Private Practice Physicians
Authors:   Committee on Hospital Care
Published: December 2021

For a number of reasons, hospitals appoint full-time and part-time physicians to practice medicine within the hospital or its outlying divisions. Such physicians provide a wide variety of primary, specialty, and subspecialty services. Among other advantages for hospitals are a potentially tighter reinon quality control and an increased bed occupancy and revenue at a time when financial issues have become increasingly important.
Physicians engaged solely in administration or research rarely pose a problem in the relationship between the hospital and private practice physicians. However, it is more likely that friction (which might adversely affect patient care) may occur when there is overlapping of services provided by the private practice physicains and the hospital-based physicians, whether they are salaried by the hospital or on a fee-for-service basis. Therefore, the Committee on Hospital Care of the American Academy of Pediatrics offers the following guidelines concerning this interface.
ROLE OF HOSPITAL-BASED PHYSICIANS
The Committee on Hospital care believes that many appropriate roles exist for hospital-based physicians. Certain specialties may advantageously be hospital based, or regional hospital units are involved. Such specialists might include (among others) those involved in burn care, spinal cord injuries, dialysis, cardiac surgery, emergency medicine, pediatric and neonatal intensive care, medical education, radiology, pathology, and anesthesiology. Certain hospital units benefit from continual organization and supervision which may best be provided by hospital-based physicians.
The Committee believes that research and teaching (including primary care teaching) must be maintained in certain hospitals. Commonly, these programs are centered around hospital-based physicians, although private practice physicians have participated productively in most programs.
Vitamin K Deficiency
Authors: ABALLI ARTURO J. 
Published: December 2021

To the Editor.—
The article by Payne and Hasegawa1 on vitamin K deficiency of the newborn correctly stresses the existence of differences between vitamin K deficiency and Coumadin effect. This has been somewhat forgotten in important studies on the mode of action of prothrombin.2-4 Modern techniques as the Echis time5 and certain sophisticated electrophoretic6 methods confirm the suspected differences between these two disorders. However, many years ago it was shown7-9 that microgram doses of any vitamin K rapidly corrected the coagulation defect in deficiency.