bluuebunny/crossref_metadata_2025_split huggingface dataset:
Temperature Measurement—Gold Standard
Authors: WEISSE MARTIN E. 
Published: December 2021

To the Editor.—
I would like to comment on the article by Freed and Fraley in the March 1992 issue of Pediatrics.1 I have no argument with their study design and in fact applaud them for using Altman and Bland's method of analysis. Their conclusions, as written, are correct, that the tympanic thermometer "is unreliable compared with conventional methods of temperature determination." The three issues that I would like to raise are: (1) the relative accuracy of rectal and tympanic temperatures in predicting core temperature, (2) rectal temperature as the "gold standard," and (3) axillary thermometry as an acceptable conventional method of clinical temperature.
The Use of Sodium Bicarbonate in Neonatal Resuscitation: Help or Harm?
Authors: HEIN HERMAN A. 
Published: December 2021

Those who cannot remember the past are condemned to repeat it.
George Santayana
The Life of Reason
Sodium bicarbonate has long been used in neonatal resuscitation, and recommendations for its use are currently included in guidelines issued as a part of a national program to improve neonatal resuscitation.1 Given our relatively long experience using sodium bicarbonate in neonatal resuscitation, one might assume that the early experimental data on which usage was predicated were extensive and compelling and that modern data continue to support its use.
Sodium bicarbonate was first commercially produced in the late 1950s, and soon thereafter, its use in premature neonates became commonplace, not for treating neonatal asphyxia per se, but rather as a therapy designed to prevent azotemia, hypoglycemia, and elevations in serum potassium levels as well as for correcting metabolic acidosis (the socalled Usher regimen).2
Compartment Syndrome Following Intraosseous Infusion
Authors: VIDAL R. , KISSOON N. , GAYLE M. 
Published: December 2021

Cannulation of an intraosseous (IO) site allows rapid access to the vascular space under emergency conditions. With increasing acceptance of this technique, some of its complications are now being fully appreciated. We present a case of a child who developed compartment syndrome and had a lower extremity amputation after infusion of fluids through an IO needle inserted in the proximal tibia. This case is presented to highlight the precautions that may prevent compartment syndrome. Additional emphasis is placed on early recognition and aggressive treatment of compartment syndrome to preserve function in the affected limb.
CASE REPORT
A 1-month-old infant with fever and irritability was treated at a community hospital.
Prenatal Marijuana Exposure and Neonatal Outcomes in Jamaica: An Ethnographic Study
Authors: Dreher Melanie C. , Nugent Kevin , Hudgins Rebekah 
Published: December 2021

Objective. To identify neurobehavioral effects of prenatal marijuana exposure on neonates in rural Jamaica.
Design. Ethnographic field studies and standardized neurobehavior assessments during the neonatal period.
Setting. Rural Jamaica in heavy-marijuana-using population.
Participants. Twenty-four Jamaican neonates exposed to marijuana prenatally and 20 nonexposed neonates.
Measurements and main results. Exposed and nonexposed neonates were compared at 3 days and 1 month old, using the Brazelton Neonatal Assessment Scale, including supplementary items to capture possible subtle effects. There were no significant differences between exposed and nonexposed neonates on day 3. At 1 month, the exposed neonates showed better physiological stability and required less examiner facilitation to reach organized states. The neonates of heavy-marijuana-using mothers had better scores on autonomic stability, quality of alertness, irritability, and self-regulation and were judged to be more rewarding for caregivers.
Conclusions. The absence of any differences between the exposed on nonexposed groups in the early neonatal period suggest that the better scores of exposed neonates at 1 month are traceable to the cultural positioning and social and economic characteristics of mothers using marijuana that select for the use of marijuana but also promote neonatal development.
Zidovudine and Didanosine Combination Therapy in Children With Human Immunodeficiency Virus Infection
Authors: Husson Robert N. , Mueller Brigitta U. , Farley Maureen , Lewis Linda L. , Balis Frank M. , Brouwers Pim , Butler Karina M. , Jarosinski Paul , Pizzo Philip A. , Woods Lin , Goldsmith Jonathan C. , Avramis Vassilios I. , Church Joseph A. , Kovacs Andrea , Ono Janice , Rasheed Suraiya , Venzon David 
Published: December 2021

Objective. Zidovudine and didanosine are both beneficial for the treatment of human immunodeficiency virus (HIV) infection in children. Because disease progression and toxicity often limit their long-term use as single agents, new approaches to using nucleoside analogues are necessary to improve current antiretroviral therapy.
Design. We conducted a phase I-II study to evaluate the tolerance, pharmacokinetics, and antiviral activity of the combination of zidovudine and didanosine in children with HIV infection. Sixty-eight children who were either previously untreated or who had manifested hematologic toxicity on full-dose zidovudine were enrolled. Eight dose combinations were studied in the previously untreated children, with doses of zidovudine ranging from 90 to 180 mg/m2 every 6 hours and doses of didanosine ranging from 90 to 180 mg/m2 every 12 hours.
Results. Fifty-four previously untreated HIV-infected children were enrolled in this part of the study, of whom 49 remained in the study for a minimum of 24 weeks. For children with previous zidovudine-related hematologic toxicity, three dose levels with zidovudine at 60 mg/m2 every 6 hours orally and didanosine ranging from 90 to 180 mg/m2 every 12 hours orally were used. A total of 14 children were enrolled in this part of the study, and 12 remained on therapy for at least 24 weeks. No evidence of new or enhanced toxicity was observed in either group. After 24 weeks, the median CD4 cell count for all patients increased from 331 to 556 cells/mm3 (P = .01). For the previously untreated group, the median increase in CD4 counts was from 386 to 726 cells/mm3 (P = .003). The median p24 antigen concentration (in those with a detectable level at baseline) decreased from 95 to &lt;31 pg/mL (P &lt; .001). The geometric mean titer of HIV in plasma decreased from 83.1 to 2.7 tissue culture infectious doses/mL (P = .001).
Conclusions. The combination of zidovudine and didanosine was well-tolerated at doses as high as those used in single agent therapy. Potent in vivo antiviral activity was observed. Combination therapy with nucleoside analogues may be an important approach to optimizing the use of these agents in the treatment of HIV infection.
THIS FEDERAL HEALTH PLAN WORKED TOO WELL
Authors: L. J. F. 
Published: December 2021

Before okaying any plan that attempts to increase access to health care while harnessing costs, congress ought to re-examine the government-funded End-State Renal Disease program. It shows that per-treatment costs can be controlled by setting limits on what providers are paid, but controlling the volume is vastly more complex...
A program that initially served 11,000 people today serves 165,000 and is expected to soon have 300 000 beneficiaries...
First year costs were $229 million and reached $1 billion by 1977. In 1991, the program cost $6.6 billion.
Even so, efforts by Medicare, which administers the program, to control perpatient costs have been a great success. Administrators capped the reimbursement rate early and steadfastly refused to raise it—not even to compensate for inflation. Twice the rate was lowered. Thus, the cost in constant dollars of a dialysis treatment has fallen 61%—$54 from $138...
Today dialysis patients are older and sicker, and people over age 65 form the fastest growing group of new users. Among the aged beneficiaries are people in a persistent vegetative state and nursing-home residents who go to dialysis centers on stretchers...
In Britian it is rare for anyone over age 55 to go on dialysis, largely because the British health-care system contains an implicit bias against providing dialysis for any kidney patient with multiple serious disorders, which elderly patients almost always have. As a result, for every million people in Britain, 154 are on dialysis; in the U.S., 539 people out of every million are on dialysis.
Summary of Major Changes in the 1994 Red Book: Report of the Committee on Infectious Diseases
Authors: Peter Georges 
Published: December 2021

The 1994 edition of the Red Book was recently published by the American Academy of Pediatrics (AAP), providing the most recent recommendations and guidelines for prevention, control, and treatment of infectious diseases in infants and children.1 These recommendations and guidelines are based on information available through 1993 and replace those given in the 1991 Red Book. To aid physicians and other health care professionals in assimilating new recommendations and information into their practices, a summary of major changes is given in the Red Book. This summary, with minor changes, is reprinted here. Subsequent recommendations of the AAP are published as Committee statements in AAP News and Pediatrics. In keeping with the current 3-year intervals between editions of the Red Book, the next edition is anticipated no later than 1997.
Major changes in recommendations and related information in the 1994 Red Book are summarized as follows:
1. Immunization recommendations. The schedules for routine immunization, including changes in recommendations for Haemophilus influenzae type b, hepatitis B, measles, and oral polio vaccines have been revised. In view of the increasing complexity of the immunization recommendations for infants and children, particular attention should be given to the comments and footnotes in these schedules. In addition, because licensure of new vaccines and revised recommendations after publication of the Red Book will result in continuing changes, the Committee anticipates the publication of an updated immunization schedule each year in the interval before the next edition of the Red Book is published.
2. Guidelines on active immunization.
In Reply: Scalding Water Temperatures
Authors: GREENSHER JOSEPH 
Published: December 2021

The observations by Lukefahr and Ezekiel regarding scald burns and the potentially harmful recommendations by some manufacturers of automatic dishwasher detergent brands are well taken.
The American Academy of Pediatrics has supported changes in building codes to stipulate that water heaters be set at safe temperature levels (125 to 130°F) when installed and model state legislation was drafted requiring all water heaters leased or sold to be preset at 120°F. Manufacturers' acceptance and adherence is anticipated.
Occupational Health and Safety Issues for Child-Care Providers
Authors: Calder Judith 
Published: December 2021

This paper reviews the occupational health and safety issues for child-care providers. Specifically, it answers the following questions: Who are the care givers? What are their risks of occupational illness and injury? What are the risks to children from care givers? Who pays to reduce the risk? What future research is needed to identify potential risks to and strategies for this work force and their clients?
WHO ARE THE CARE GIVERS?
Out-of-home child care is provided in two ways: in child-care centers (larger facilities designed especially for the care of children) and in family day-care homes. Persons who obtain day care know the care givers personally. They are the people who make it possible for parents to be dependable, productive, and worry-free employees or students. More importantly, they are the ones entrusted to care for children for as much as 50 hours a week. Parents expect their children to be safe, treated with respect, and nurtured in ways that are specific, familiar, and compatible with the family's child-rearing beliefs. Parents also expect care givers to be adroit in addressing their concerns as well as their children's. Despite all of this personal interaction, few parents are aware of the characteristics of the child-care work force, the conditions under which they work, and their impact on quality child-care services.
The Child-Care Employee Project (CCEP), a national non-profit resource organization devoted to addressing adult needs associated with child care, developed a profile of child-care workers by compiling and examining data on center-based child care as part of the National Child-care Staffing Study (NCCSS).1
Gastrointestinal Maturation and Motility Patterns as Indicators for Feeding the Premature Infant
Authors: Lebenthal Emanuel 
Published: December 2021

The Koenig et al study1 showed different effects of two-thirds concentration feeding compared with one-third concentration in relation to shorter mean time of onset and longer duration of fed response. The different motility response can be related to availability of regulatory mechanisms. Similar studies of individual food component,26 eg, glucose, triglyceride, and casein hydrolysate, disrupted fasting activity but had differing effects on the duration of fed activity and the increase of contractile activity. Glucose followed by peptides then lipids caused the greatest increase in contraction and duration of fed activity.26 It is assumed that each group of nutrients induces the secretion of different peptide hormones that may be responsible for the fed pattern of motility. It is suggested that the feeding releases gastrin and cholecystokinin27 that in return change the pattern of motility activity to the fed pattern. When a protein feeding was given intraduodenally both cholecystokinin and pancreatic polypeptide were released in large quantities and the intestinal motility changed to fed pattern.27 Peptide YY is also released in large quantities after both a large protein and fatty meal.28 The main question that the Koenig et al study1 raises is how the concentration, volume, and presence of the feed in the stomach or duodenum affect the release of regulatory gut peptides and gastrointestinal hormones. In addition it is important to know how the ontogeny of gut hormones and regulatory peptide can be manipulated by changing the mode, content, concentration, and volume of feeding.
Available fat, carbohydrate, and protein in the premature diet might be important in modifying the developmental pattern of intestinal and pancreatic enzymes as well as affecting gastric emptying.
THE VALUE OF BED REST DURING PREGNANCY QUESTIONED
Authors: L. J. F. 
Published: December 2021

Physicians recommend bed rest for one of every five pregnant women for at least 1 week and occasionally for 2 months or more. Yet, the high costs and unproven effectiveness of bed rest for preventing or treating pregnancy complications argue against its widespread use, according to the Low Birthweight Patient Outcomes Research Team (PORT)...
The medical literature does not offer enough evidence to recommend bed rest at home or in the hospital to prevent first-trimester spontaneous abortion...
TIPP—The First Ten Years
Authors: Bass Joel L. 
Published: December 2021

The following is an addendum to the Commentary entitled "TIPP—The First 10 Years," written by Joel L. Bass that appeared in the February 1995 issue of Pediatrics on page 274:
In addition to sponsoring the 1988 revision of TIPP, Sandoz Pharmaceuticals Corporation also provided an educational grant for the 1994 TIPP revision.
The Effect of Bronchopulmonary Dysplasia on Growth at School Age
Authors: Vrlenich Laura A. , Bozynski Mary E. A. , Shyr Yu , Schork M. Anthony , Roloff Dietrich W. , McCormick Marie C. 
Published: December 2021

Objective. To determine the effect of bronchopulmonary dysplasia (BPD) on growth at school age.
Design. A prospective cohort study.
Methods. The sample included 406 children selected from a reconstructed cohort of infants of very low birth weight previously enrolled in a multisite, randomized, controlled clinical trial. The children were contacted at 8 to 10 years of age. Height, weight, and head circumference (HC) were measured. Possible confounders including sociodemographic data, and neonatal factors were also recorded.
Results. The children in the BPD group were significantly smaller in weight (z score, -0.50 ± 1.19 SD vs -0.06 ± 1.30 SD) and HC (z score, -1.41 ± 1.32 SD vs -0.63 ± 1.62 SD) than those without BPD. However, after controlling for cofounders (using analysis of covariance), no significant differences were demonstrated between the two groups. Power analyses showed that a difference of at least 0.43 z score units could have been detected. The previously documented associations between BPD and suspected confounders were reconfirmed.
Conclusions. Significant differences were noted between children with and without BPD for weight and HC but not height. When possible confounders were taken into account, the differences were no longer appreciated. Thus, the previously reported poor growth in children with BPD may have been related to other factors and not necessarily to BPD.
Steroids and Asthma
Authors: Shapiro Gail G. 
Published: December 2021

It is impossible to read about asthma in the 1990s without being informed that it is an inflammatory disease and that all but the mildest cases require anti-inflammatory therapy for optimal management.1 Bronchoalveolar lavage studies document the influx of inflammatory cells and the upregulation of inflammatory cytokines in bronchial washings of patients with chronic asthma.2 Biopsy specimens confirm an inflammatory cell accumulation and the destructive change to the epithelium that one would expect from this insult.3
The pathophysiology of asthma would seem to justify the use of corticosteroids for its management. A single dose of prednisone can be shown to decrease inflammatory leukotrienes while there is a concomitant increase in forced expiratory volume in 1 second.4
Response to Dr Smith
Authors: Eaton Antoinette Parisi 
Published: December 2021

I am pleased to have the opportunity to comment on Dr Smith's article. He has shared with us collaborative approaches to the organization and delivery of health care that have been used in the Dallas inner city to break down structural and cultural barriers to health care at the community level. In the June 1994 issue of Pediatrics, Albert Scheiner points out that "Ninety-five percent of pediatric health care is provided in the community .... All community practice settings are home ground for the family and the child and provide opportunities for a continuity of care experience that is family-centered and that includes such concepts as child advocacy, disease prevention, and health promotion."1
Dr Smith aptly points out that rapidly evolving changes in the health care system and health care financing can provide an opportunity to accomplish many of the positive changes for children that pediatricians long have sought. I would like to share some thoughts about how we create the health care, education, and research components of the new community pediatrics. New kinds of collaboration will be critical to developing these components, and such collaboration will challenge all of us to partner with institutions and individuals with whom in the past we may have been unfamiliar or even uncomfortable.
Because it is always good to define our terms, let us take as a starting point Haggerty's definition of community pediatrics,2 which captures the essence of the Dallas program. Says Haggerty:
Community pediatrics seeks to provide a far more realistic and complete clinical picture by taking responsibility for all children in a community, providing preventive and curative services, and understanding the determinants and consequences of child health and illness, as well as the effectiveness of services provided.
PEOPLE WANT MORE INFORMATION FOR HEALTH CHOICES, SURVEY FINDS
Authors: L. J. F. 
Published: December 2021

Most people would like to have more information to help them choose hospitals, doctors, and health care plans, a new survey by Louis Harris and Associates has found.
Many large employers already receive reports from health maintenance organizations and other health plans on how satisfied their members are. Many employers and health plans also collect appraisals of doctors and hospitals by patients. But such reports are not often shown to the consumers themselves, company benefits executives say.
In the Harris survey, which was commissioned by Towers Perrin, a benefits consulting firm, 66% said they would like to see report cards for hospitals, 58% said they would like to see consumer ratings of physicians, and 52% wanted ratings for health plans.
The telephone survey of 1081 people was weighted to reflect all United States heads of households or spouses age 21 or older. The margin of error was plus or minus 3 percentage points. Most were employees of large companies, which other surveys have shown are most likely to offer choices of health plans.
Blood Pressure Ranges in Premature Infants: II. The First Week of Life
Authors: Hegyi Thomas , Anwar Mujahid , Carbone Mary Terese , Ostfeld Barbara , Hiatt Mark , Koons Anne , Pinto-Martin Jennifer , Paneth Nigel 
Published: December 2021

Objective. To examine the arterial blood pressure in the first week of life in a healthy premature population.
Design. Population-based cohort study.
Setting. Three intensive care nurseries in central New Jersey.
Patients. Premature infants with birth weights less than 2000 g.
Main Outcome Measures. We documented daily maximum and minimum systolic and maximum and minimum diastolic blood pressures during the first 7 days of life. To examine the effects on these ranges of blood pressure of specific risk factors likely to affect blood pressure, we identified four groups of infants: (1) healthy infants without any of the major risk factors (n = 193); (2) infants who were mechanically ventilated but free of any of the other conditions (n = 225); (3) infants with histories of maternal hypertension or preeclampsia (n = 38); and (4) infants with low Apgar scores (less than 3 at 1 minute and less than 6 at 5 minutes) regardless of the presence of other conditions (n = 86).
Results. Blood pressure increased steadily in the first week of life in all four groups. There was no relationship between any of the four blood pressure variables, or trends in blood pressure over time, with birth weight, gender, or race. Regression equations (based on all infants with available data) for blood pressure ranges by day of life revealed that the maximum systolic blood pressure increased by 2.6 mm Hg/d, the minimum systolic blood pressure increased by 1.8 mm Hg/d, the maximum diastolic blood pressure increased by 2.0 mm Hg/d, and the minimum diastolic blood pressure increased by 1.3 mm Hg/d.
Conclusions. Infants with birth asphyxia and ventilated infants had significantly lower systolic and diastolic blood pressures than healthy infants.