bluuebunny/crossref_metadata_2025_split huggingface dataset:
Periventricular Leukomalacia (PVL) and Myelination
Authors: VAN DE BOR MARGOT 
Published: December 2021

In Reply.—
The hypothesis of our study was that periventricular-intraventricular hemorrhage may damage the glia precursors in the subependymal germinal layer, the site of origin of the hemorrhage. Our results showed that glia precursors in the subependymal germinal layer are not so severely damaged that the subsequent production of myelin by oligodendroglia is impaired.1 Our prime goal was not to study the local effects of a `parenchymal extension' of the hemorrhage. Volpe2 suggests that parenchymal extension of an intraventricular hemorrhage as described by Papile et al3 is not merely an extension of the hemorrhage but a hemorrhagic infarction secondary to obstruction of venous flow by a large quantity of intraventricular blood.
Are We Becoming a Two-Class Society Based on Neonatal Circumcision?
Authors: NEIBERGER RICHARD E. 
Published: December 2021

To the Editor.—
In 1975, an Ad Hoc Task Force on Circumcision of the American Academy of Pediatrics reported that "there is no absolute medical indication for routine circumcision of the newborn."1 In 1983, both the American Academy of Pediatrics and the American College of Obstetrics and Gynecology jointly published Guidelines to Perinatal Care in which routine neonatal circumcision was discouraged.2
Since 1983, many public tax-supported hospitals simply stopped performing neonatal circumcision. Circumcision is no longer an option at many major public hospitals.
More on Meconium Aspiration
Authors: KARLOWICZ M. GARY 
Published: December 2021

To the Editor.—
The report by Wiswell et al in the May 1990 issue of Pediatrics1 provides valuable insight into meconium aspiration syndrome. However, I am concerned that there is a possible cause of meconium aspiration syndrome in the vigorous neonate which has not received enough emphasis, either in this or other reports. Namely, vigorours babies who develop meconium aspiration syndrome may be insidiously aspirating regurgitated meconium in the first few hours after leaving the delivery room.
Perpetual Poverty: Child Health and the Underclass
Authors: Kliegman Robert M. 
Published: December 2021

Poverty is a predominant social precursor to poor health.1-9 The disadvantaged health status among the poor is associated with reduced life expectancy and a high risk of death from preventable illnesses.2,10-12 Child health is affected particularly, as exemplified by excessive rates of low birth weight, prematurity, and neonatal, infant, and postneonatal mortalities. Specifically postneonatal deaths among poor children are often due to preventable or treatable illnesses such as diarrhea, pneumonia, influenza, and accidents. (New York Times. July 17, 1990: A10; New York Times. August 6, 1990:A1).2,3,11,16-18 In addition rates of teenage pregnancy, drug dependence, and death due to intentional and unintentional injuries are excessively high among poor, urban adolescents (New York Times. July 17, 1990:A10; New York Times. August 6, 1990:A1).7,17-18
UNDERCLASS STATUS AS A RISK FACTOR
Related risk factors that adversely affect pregnancy or neonatal outcome include, single parent status, adolescent age, minority status, limited education, unemployment, and alcohol and illicit drug use. However, between 80% to 90% of poor women with these factors have healthy infants. It has become apparent that all poor women are not equally at risk or even equally financially disadvantaged despite having in common the traditional poverty-associated risk factors (Newsweek. May 28, 1990:78).7,15,19 The subpopulation of poor people which has the highest risk for infant mortality and other health complications, includes the most disadvantaged people, known collectively as the underclass. Although use of this term has been considered controversial and may have negative implications, the idea that there is a group of the most disadvantaged citizens has been accepted for some time (Newsweek.
Chronic Fatigue Immune Dysfunction Syndrome: An Epidemic?
Authors: KMINEK MUDR ALEŠ , SIMUNEK MUDR IVO 
Published: December 2021

To the Editor.—
We read with great interest the article "Chronic Fatigue in Adolescents" by Smith et al in the August 1991 issue.1 We appreciate the statement by the authors that "the CDC-recommended criteria for case definition of the chronic fatigue syndrome (CFS) were developed mainly from adult populations and may not be appropriate for children and adolescents."
We have studied children suffering from unexplained fatigue, mild fever, nonexudative pharyngitis, lymphadenopathia, etc, since 1987, ie, prior to publication of CDC-recommended criteria of CFS.2
Lessons from an Adolescent with Pectus Excavatum
Authors: ASNES RUSSELL S. 
Published: December 2021

To the Editor.—
Of the many factors which contribute to the challenge, excitement, and satisfaction derived from pediatric practice, the continuing education we receive from our patients is among the most significant. I would like to share a recent poignant "lesson" provided by Adam, a 17-year-old. Adam sent me the following copy of his response to a college application question: "What condition have you been forced to deal with mentally, physically, and emotionally, and how has it had an impact on your life?" "I was born with a hole in my chest.
Design of ICUs
Authors: WHITE ROBERT , WHITMAN THOMAS 
Published: December 2021

To the Editor.—
Most newborn intensive care units (NICUs) today stand as monuments to the technology and efficiency that dramatically improved survival of premature newborns during the last two decades. Beginning as small "premie nurseries" which held five or six newborns per room, NICUs evolved in the late 70s and the early 80s into large, bright, noisy, high-tech wards housing 30, 40, or even 60 newborns. State building codes and recommendations for NICU design were formulated during this era which emphasized cleanliness and efficiency, but largely neglected the impact of the NICU environment on the premature newborns themselves.
Round Table Discussion
Authors: CLIFFORD STEWART H. , SNELLING CHARLES ERNEST , LATHROP A. S. , BOULWARE JAMES R. 
Published: December 2021

I. Responsibilities of the Hospital
Chairman Clifford: The swing from the home to the hospital as the scene of childbirth is almost complete. In 1948 85% of all births in the United States took place in hospitals. In 13 states 98% of births were in hospitals. This rapid shift created a major problem for our hospitals as they were caught with an increased patient load without a commensurate increase in physical plant and personnel and without time to develop adequate technics of management. The trend toward a shortened period of hospitalization helped in permitting the institutions to care for a greater number of patients. The Standards and Recommendations for the Hospital Care of Full-term and Premature Infants of the American Academy of Pediatrics were of undoubted help to the hospitals in safeguarding the newborn.
A. Medical Service Responsibilities
I feel very strongly that for a Newborn Service to function so as to best protect the interests and welfare of its patients, it should be made the direct responsibility of a qualified pediatrician. Further, this individual must be so trusted by the trustees and the obstetric, nursing and administrative departments that he be given adequate authority to do the job. Practically every man attending this Round Table has signified that he works in or is in charge of a newborn nursery in his home area. In your hospitals is there a problem of trying to educate the hospital administration and medical administration as to the wisdom of appointing a pediatrician interested in the newborn infants to the job of being responsible for the service? Are you satisfied that in your various hospitals this problem is well taken care of?
ADRENOCORTICOTROPIC HORMONE IN THE THERAPY OF RETROLENTAL FIBROPLASIA
Authors: LANMAN JONATHAN T. , GUY LOREN P. , DANCIS JOSEPH 
Published: December 2021

Five premature infants thought to be developing retrolental fibroplasia were treated early, vigorously and persistently with ACTH from a single Armour lot. Activity of the ACTH employed was evidenced in each case by physiologic changes in the recipient.
One of the five treated patients died during therapy. The mode of death and possible relationship to ACTH administration are discussed.
Retrolental fibroplasia progressed in the four remaining treated cases to cicatrix formation behind the lens.
ACTH as employed in this study was an ineffective therapeutic agent in retrolental fibroplasia.
CORRESPONDENCE
Authors: VEEDER BORDEN S. 
Published: December 2021

As examiner in pediatrics for the National Board of Medical Examiners, I would like to bring to the attention of the pediatricians an important change in Part III of the examination, as it involves pediatrics. This is the oral examination given at the end of a year's internship by "subsidiary boards" in 29 medical centers throughout the country. The clinical nature of the examination provides an opportunity to determine the candidate's ability to apply the knowledge which he has previously demonstrated in the written examination of Parts I and II.
For many years the examination has included medicine, surgery, and obstetrics as major subjects, while pediatrics has been included in a group of specialties as being of minor importance.
SALMONELLA BREDENEY MENINGITIS
Authors: KANTOR HOWARD L. 
Published: December 2021

A case of Salmonella bredeney meningitis with recovery in a 19 day old infant is reported. This is the youngest patient with Salmonella meningitis known to have recovered. This is the second known case of Salmonella meningitis with recovery in a patient less than one month of age. Treatment with multiple antibiotics and chemotherapy both parenterally and intrathecally produced rapid improvement. An equally effective supportive blood transfusion may have aided this recovery. The use of chloromycetin after discontinuance of all other antibiotics was effective in producing a clinical recovery without relapse. No sequelae were noted at the end of a three month observation period.
Attempts at discovering the carrier state of the infesting organism by careful examination of the family revealed no source of infection.
MAXIMUM BREATHING CAPACITY AND VITAL CAPACITY OF MALE CHILDREN AND ADOLESCENTS
Authors: FERRIS B. G. , WHITTENBERGER J. L. , GALLAGHER J. R. 
Published: December 2021

Expected mean values and a range of normal values (plus or minus two standard deviations) are presented for the vital capacity and the maximum breathing capacity of male children and adolescents.
It is recommended that calculations of the above values be based upon four attributes (age, height, weight, and body surface area) rather than upon a prediction deriving from a single attribute (especially in the individual who does not have a standard height and weight for his age).
Sudden Infant Death Syndrome and Sleeping Position
Authors: HUNT CARL E. , SHANNON DANIEL C. 
Published: December 2021

Do something, anything! is a universal cry at the onset of the pain and suffering of illness; healers have responded with imagination and boundless enthusiasm.
—Lewis Thomas (NY Rev Books. September 24, 1987)
We have learned, to our sorrow, that strong emotional interest in the force of speedy medical action when there is substantial uncertainty has led to recurring iatrogenic disasters.
—William Silverman1
The American Academy of Pediatrics Task Force on Infant Positioning and SIDS recently has reviewed the existing epidemiological data and concluded that (1) the weight of evidence implicates the prone position as a significant risk factor for sudden infant death syndrome (SIDS), and (2) for healthy and full-term infants, prone sleeping should be abandoned in favor of the supine or lateral position.2
The Issues
Authors: JONES JAMES FLY 
Published: December 2021

The recent FDA label warnings of severe varicella infection following corticosteroid therapy and therapeutic recommendations are provocative.1 On the one hand, the warnings appropriately raise the level of concern regarding the seriousness of varicella infection in healthy and immunosuppressed children. On the other hand, the blanket inclusion of corticosteroids of all administration modes without reference to dosage, proof of immunosuppression, and subsequent increased risk, is of concern.
A review of the literature regarding steroids and varicella supports high oral doses (≥1.0 mg/kg of prednisone) as being associated with rare fatalities.2
Cerebral Infarction Complicating Hemorrhagic Shock and Encephalopathy Syndrome
Authors: BRATTON SUSAN L. , JARDINE DAVID S. 
Published: December 2021

Hemorrhagic shock and encephalopathy syndrome (HSES) is a severe, life-threatening illness affecting infants and young children. Patients stricken with this illness suffer high rates of neurological injury and mortality. We describe a child with HSES whose course was complicated by global cerebral infarction. This injury, although extensive and severe, was not appreciated during the initial examination of the child. Cerebral infarction during HSES may not be detected reliably unless imaging studies of the central nervous system are preformed after cerebral edema has resolved.
CASE REPORT
The patient was a 7-week-old girl born to a healthy 20-year-old woman. The infant had been healthy until 1 week prior to admission when she developed an upper respiratory tract infection.
Temperature Measurement
Authors: FREED GARY L. , FRALEY J. KENNARD 
Published: December 2021

In Reply.—
We thank Alexander and Terndrup for their comments on our paper and appreciate the opportunity to respond to them.
Those performing FIRST temp measurements for our study were instructed to use both the appropriate mode and "offsets" for comparison. Although we did not independently verify the "offset" for each temperature determination, we have no reason to suspect it was not performed appropriately.
However, it is the misinterpretation by Alexander and Terndrup of the meaning of "mean differences" in Table 2 that is of greater concern.
Ethical Decisions in Neonatal Intensive Care Units: The Dutch Experience
Authors: Sauer Pieter J. J. 
Published: December 2021

Modern technology makes it possible to keep more sick, extremely small, and vulnerable neonates alive. Many neonatologists in the Netherlands believe they should be concerned not only about the rate of survival of their patients, but also about the way the graduates of their care do, in fact, survive beyond the neonatal period. In most cases, we use all available methods to keep newborns alive. However, in some instances there is great concern about the quality of life, if the newborn should survive; here questions do arise about continuing or withholding treatment. In this commentary, I present my impression of the opinions held by a majority of practicing neonatologists in the Netherlands, as well as some personal thoughts and ideas.
Recently, a committee convened by the Ministers of Justice and Health in the Netherlands issued an official report regarding the practice of euthanasia and the rules of medical practice when treatment is withheld.1 In this report of more than 250 pages, only 2 pages focus on the newborn. The following conclusions were made in this small section of the report. In almost one half of the instances of a fatal outcome in a neonatal intensive care unit in the Netherlands, discussions about sustaining or withholding treatment did take place at some stage of the hospital stay. A consideration of the future quality of life was always included in the discussion. The committee agreed with doctors interviewed for the report that there are circumstances in which continuation of intensive care treatment is not necessarily in the best interest of a neonate.
Looking at the Child Care Landscape
Authors: Lombardi Joan 
Published: December 2021

This introductory paper has a threefold purpose: (1) to provide an overview of the various types of child care, any or all of which may be found in an individual American community; (2) to present some terminology that may be used repeatedly in the papers of this supplement; and (3) to begin to discuss the role of the medical community in child care.
OVERVIEW OF CHILD CARE
This topic may best be explored by discussing the process new parents go through to select child care and by describing some of the obstacles they may face. For those readers who are from the child care community, and therefore familiar with this information, these are problems that can be shared with the medical community in your area.
Expectant parents may not begin to think about care until after their baby is born. It is often hard to anticipate the issues related to balancing work and family life until you are actually in the situation. Child care may not be included as a topic in childbirth classes, even though that is probably the first place that the options should be discussed.
Once the child is born, a decision may have to be made within the first few weeks after birth, because parental leave is, unfortunately, not guaranteed in the United States. Parents may turn to the pediatrician for advice, but most often they talk with neighbors and friends about child care options. A growing number of parents are beginning to use local Child Care Resource and Referral organizations, which provide consumer education and referral to parents, as well as support and resources to child care providers, policy makers, and the private sector.
Quality of Child Care as an Aspect of Family and Child Care Policy in the United States
Authors: Scarr Sandra , Phillips Deborah , McCartney Kathleen , Abbott-Shim Martha 
Published: December 2021

The quality of child care services in the United States should be understood within a context of child care policy at the federal and state levels. Similarly, child care policy needs to be examined within the larger context of family-support policies that do or do not include parental leaves to care for infants (and other dependent family members) and family allowances that spread the financial burdens of parenthood.
Maynard and McGinnis1 presented a comprehensive look at the current and predictable policies that, at federal and state levels, affect working families and their children. They note the many problems in our "patchwork" system of child care—problems of insufficient attention to quality and insufficient supply for low-income families. Recent legislation is a step toward improving the ability of low-income families to pay for child care (by subsidizing that part of the cost of such care which exceeds 15% rather than 20% of the family income) and some steps toward training caregivers and improving regulations. They note the seeming political impasse over parental leaves, even unpaid leaves, and the impact of this lack of policy on the unmet need for early infant care.
We should step back from the current morass of family and child care policies in the United States and look at what other nations have done and continue to do for their working families. By comparison with other industrialized countries in the world, the United States neglects essential provisions that make it possible for parents in other countries to afford to rear children and to find and afford quality child care for their children.
Principles of Child Health Care Financing
Authors:   Committee on Child Health Financing
Published: December 2021

Inequitable financing mechanisms contribute to the current level of preventable mortality and morbidity today among American infants, children, and adolescents. Current financing systems must be improved to maximize access to and ensure the quality of comprehensive pediatric care.
The American Academy of Pediatrics (AAP) advocates universal and insured financial access to quality health care for all pregnant women and infants, children, and adolescents through age 21 years, here-inafter referred to as pregnant women and children. Such insurance should be a comprehensive benefit package which contains preventive care, including immunizations, and acute and chronic care services.
As the public and private sectors and the AAP continue to explore the structure of health care financing, the following principles will be used to evaluate proposed changes.
1. Children's Right to Access to the Health Care System.
• All pregnant women and children have a right to comprehensive health care.
• Financial barriers should not prevent pregnant women and children from receiving comprehensive health care.
• When families are not covered by insurance provided by an employer, purchase of a private plan, or personal means, pregnant women and children should be insured by public funding.
• Health care financing mechanisms should permit the patient and his/her family to choose a health care professional who provides quality pediatric care, particularly pediatricians whose offices will serve as the medical home and from which referrals would be made only as appropriate.
• Managed care plans should not restrict access to qualified pediatric primary care or appropriate referral to pediatric subspecialty and inpatient care.
Saddened Not Amused
Authors: HAMMER SANDRA JO 
Published: December 2021

To the Editor.—
I am writing to express my outrage at your publication of the paper by D.S. Nelson (Pediatrics 1992;89:1089-1090) which I read with interest as the title was intriguing.
Although humor and good stress reducing mechanisms are vitally important to the healthy maintenance and well-being of staff in emergency departments, this paper described what is in effect a derision of patients and parents, first by the emergency department staff and then by the author's bold affectation of this as research and a "fertile source of medical humor."
Pelvic Examination—An Essential Skill
Authors: STAFFORD ELIZABETH M. 
Published: December 2021

To the Editor.—
In "Technical Skills Required in General Pediatrics" the authors suggest that a basic list of 24 skills considered to be necessary by 95% of pediatricians surveyed serve as a guide for skills training in pediatric residency.1 As an educator in the field of adolescent medicine, I was alarmed to find that the pelvic examination was omitted. It was one of 72 skills to be ranked by general pediatric practitioners.
I suspect that an element of sampling bias effected the omission of the pelvic examination as nonessential.