bluuebunny/crossref_metadata_2025_split huggingface dataset:
What Is the Best Test for Iron Deficiency?
Authors: DINE MARK S. 
Published: December 2021

To the Editor.—
We are indebted to Oski et al1 and to the 38 children who received injections of iron dextran for demonstrating the importance of determining not only which children had iron deficiency anemia but also those with iron deficiency without anemia. However, the primary physician needs a screening test that is efficient and not costly. Unfortunately, the history and physical examination are not effective screens for the identification of children at risk—with the exception of those children drinking in excess of one quart of milk a day.2
Outcome of Complicated Pregnancies of Less Than 27 Weeks of Gestation
Authors: KILBRIDE HOWARD W. , ELLIOT JOHN P. 
Published: December 2021

To the Editor.—
The article by Bennett et al1 is one of several recent reports2,3 presenting outcome data on very low-birth-weight infants. These reports address the question: what is the lowest birth weight that justifies resuscitation and intensive care? Perinatal and obstetrical management decisions relating to the outcome of infants weighing less than 800 g are so numerous that the relevant question should be: at what gestational age will the perinatal team provide intensive management of the maternal-fetal unit?
Subgaleal Hemorrhage
Authors: BEAUCHAMP CHARLES J. , METCALF MARY BETH 
Published: December 2021

To the Editor.—
Falvo et al1 reported two cases of subgaleal hematoma resulting from tight braids or ponytails, and they described their surgical management. We wish to report a similar case and suggest alternative management.
A 4-year-old girl was brought to the emergency room after her mother noted she had "lumps" on her head. Except for a mild cough of recent onset, she was in good health. Physical examination revealed a soft, nonpitting, and impressively fluctuant swelling underlying the entire scalp.
`The Kid' Has a Name
Authors: RAWLINGS JAMES S. 
Published: December 2021

To the Editor.—
As defined in The American Heritage Dictionary of the English Language (Boston, Houghton Mifflin Co, 1979): Kid (kid) n. 1. A young goat. 2. Leather made from the skin of a young goat. 3. Slang. a. A child. b. A young person. -adj. 1. Made of kid. 2. Informal. Younger: My kid brother. -tr. Informal. 1. To mock playfully; to tease. 2. To deceive in fun; to fool. English kide, kyde from Old Norse kidh, young goat.
A Reexamination of the Role of Oxygen in Retrolental Fibroplasia
Authors: Lucey Jerold F. , Dangman Barbara 
Published: December 2021

A critical review of the liteature of retrolental fibroplasia indicates that the cause of this disease is not yet known.
Oxygen is certainly a critical factor but it is still not possible to make precise recommendations as to the amount or the duration of therapy that is safe. We have overemphasized the role of oxygen in the past, and as a result of this the false impression has been created that RLF is a disease that can be prevented. This gross oversimplification of a complex disease with multiple causes has resulted in many unjustified malpractice claims.
A study of the present epidemic indicates that excessive oxygen administration probably plays a minor role, in contrast to the first epidemic in which prolonged oxygen administration was clearly a major factor.
A reasonable working hypothesis is that the developing retina is highly sensitive to any disturbance in its oxygen supply, either hyperoxemic or hypoxemic. The retinal circulation is subject to the same wide fluctuations as the cerebral circulation in newborn infants.134 The very low-birth-weight, sick premature infant suffers from a number of conditions, many of which can seriously disturb the retinal circulation, resulting in hypoperfusion and ischemia. These factors (immaturity, hyperoxia, hypoxia, blood transfusions, intraventricular hemorrhage, apnea, infection, hypercarbia, hypocarbia, patent ductus arteriosus, prostaglandin synthetase inhibitors, vitamin E deficiency, lactic acidosis, prenatal complications, genetic factors) may all be present in an infant. They may interact to produce various degrees of retinal damage. Nearly all of these factors cannot be prevented or controlled by our present methods of care.
Unfortunately, this means that RLF is an extremely difficult disease to prevent, treat, or investigate. A disease of this complexity with multiple causes will require very large numbers of infants in any controlled study of a therapy. Retrolental fibroplasia should not be considered an avoidable iatrogenic disease in very low-birth-weight infants. Its cause in these infants is not known.
Zinc in Formulas
Authors: HAMBIDGE K. MICHAEL 
Published: December 2021

To the Editor.—
Bhatia and Fomon1 have demonstrated that the quantities of calcium and phosphorus delivered to formula-fed infants may bear little relationship to the label claims. They also warned that, although their report was restricted to these two nutrients, other formula components may also be involved in discrepancies between what is present in the bottle and what is delivered to the infant. Confirmation of this prediction is provided by recent éxperience with measurements of zinc concentrations in Similac Special Care (Ross Laboratories, Columbus, OH) during the course of zinc balance studies on very low-birth-weight premature infants in our neonatal Clinical Research Center.
Breast-Feeding and Illness
Authors: HOLMES GRACE E. , HASSANEIN KHATAB M. , MILLER HERBERT C. 
Published: December 2021

In Reply.—
We elected not to quantify the severity of the infections among the 251 infants in our study, because we did not personally see all the infants at the time of their infections, and because only five of the 251 were hospitalized. Cunningham selected infants with four types of infection which he labeled as "more serious illnesses" and "significant illness" from our list which contained more than a dozen different types of infection. He based his conclusions on these four types or groups of infection.
He has calculated rates of illness per 100 infants. However, in calculating rates, the numerator must have all events that are being measured and each event must be in the denominator.
Newborn Screening
Authors: LEVY HAREY L. , MITCHELL MARVIN L. , RIDLEY STEPHEN E. 
Published: December 2021

To the Editor.—
With publication of recommendations on newborn screening by the Committee on Genetics of the American Academy of Pediatrics1 and now similar recommendations by McCabe et al,2 a consensus on realistic procedures for newborn screening is developing. These procedures have been successfully followed for almost a decade by a number of state laboratories and include: (1) obtaining a blood specimen from all newborn infants prior to hospital discharge regardless of how early in life this occurs as phenylketonuria (PKU) and congenital hypothyroidism can be identified in most infants even during first hours of life;
How Dangerous Are Blood Transfusions in `Premies'?
Authors: WEINBLATT MARK E. 
Published: December 2021

To the Editor.—
Piccoli et al1 reported an uncommon, but highly interesting report of transfusion-acquired malaria in a neonatal intensive care unit. In addition to alerting pediatricians about this rarely suspected malady in newborns, the report also serves to publicize a more common problem frequently overlooked in neonatal centers.
Because premature neonates require only small volumes of blood transfusions at any given time, it is in the best interests of optimal utilization of a limited resource, human blood, to divide a single unit of donor blood into several small aliquots for multiple transfusions.
Suctioning and Cerebral Blood Flow
Authors: VOLPE JOSEPH J. , PERLMAN JEFFREY M. 
Published: December 2021

In Reply.—
We regret not knowing the results of our study, designed to define the systemic and cerebral hemodynamic effects of suctioning in the preterm infant, before we did the study. Thereby, we could have answered Trevathan's questions, and as he suggests, avoided the need for prospective study of the relationship of these hemodynamic effects to the subsequent occurrence of intraventricular hemorrhage (IVH). The design of such a study will be particularly complex and certainly will require very much more than performing ultrasound scans before onset of suctioning.
Frostbite
Authors: ROWLINGSON JOHN C. , CARRON HAROLD 
Published: December 2021

To the Editor.—
Upon reading the article by Brown et al,1 concerning frostbite in children resulting in digital deformity, we were struck by the subsequent changes shown in the radiographs which were similar to those associated with chronic reflex sympathetic dystrophy (RSD). In both syndromes there is an induced vascular insufficiency which apparently disrupts the normal mineralization process in bone. This results in spotty osteoporosis at first and, later, a picture of diffuse bony atrophy in RSD.2 These same changes are part of the radiographic picture described in the two cases of frostbite.1
Asbestosis and Old Incubators
Authors: FUENFER MICHAEL M. 
Published: December 2021

To the Editor.—
The Armstrong X-4 model 500 baby incubator (Fig 1) has been a fixture in newborn nurseries in North America since its introduction in 1948. A survey of hospitals in northern Connecticut revealed that 12 of 17 nurseries are currently using the original X-4 incubator or its more recent version, the X-P, model 22 baby incubator, still in production (Ohio Medical Products). Incubators manufactured up to and including 1974, contained an asbestos gasket around the outer rim of the incubator top upon which the lid of the warmer closes.
Cerebral Infarction Related to Neck Position
Authors: ZIMMERMAN ANDREW W. 
Published: December 2021

To the Editor.—
Hope et al1 are correct in pointing out that a congenital vascular abnormality in the vertebrobasilar system, when compromised by head position or neck manipulation, can contribute to ischemic lesions. The patient they described is similar in some ways to a previously reported patient2 whose ischemic lesion followed chiropractic manipulation of the neck. A striking similarity was a family history that was positive for migraine. Individuals who inherit a migraine diathesis may be susceptible to ischemic injury when the neck is rotated and hyperextended, particularly in the presence of a congenital hypoplastic vertebral artery.
Birth Weight and α-Fetoprotein in the Newborn
Authors: MIZEJEWSKI GERALD J. , BELLISARIO RONALD , CARTER THOMAS P. 
Published: December 2021

To the Editor.—
While assessing the potential use of α-fetoprotein (AFP) as a diagnostic aid to newborn screening, we developed a method of reliably and reproducibly measuring AFP concentrations in minute samples of dried blood.1 To determine AFP normal ranges for healthy neonates during the first postnatal week, a radioimmunoassay commercial kit was adapted to measure AFP in 1.6-mm disks (0.75 µL of blood) punched from dried blood spots. In further studies2 we observed that an entirely new perspective emerges when birth weight is taken into account.
Role of Zinc in Testicular Function of Chronic Renal Failure
Authors: NISHI YOSHIKAZU , HATANO SHUICHI , AIHARA KATSUAKI , USUI TOMOFUSA 
Published: December 2021

To the Editor.—
We read with great interest the paper of Marder et al1 on hypergonadotropism in peripubertal boys with chronic renal failure. However, their discussion does not mention the role of zinc in testicular function.
Zinc deficiency not only reduces zinc levels in the reproductive tissues but also impairs the responsiveness of the Leydig cells to gonadotropins, and thus may cause primary hypogonadism in humans as well as in experimental animals.2-4 Moreover, testicular hypofunction, elevated serum gonadotropin levels, and subnormal plasma zinc levels have been reported in renal failure.5,6
Role of Zinc in Testicular Function of Chronic Renal Failure
Authors: MARDER HAROLD K. , SRIVASTAVA LAXMI S. , BURSTEIN STEPHEN 
Published: December 2021

In Reply.—
We thank Nishi et al for outlining the role that has been suggested for zinc in normal testicular function and the speculation that zinc deficiency might contribute to the hypergonadotropic hypogonadism found in males with chronic renal failure. We have no data concerning zinc levels in our patients, and so we felt we could offer no further insight into the possibility that zinc deficiency might play a role in the etiology of the hypergonadotropism we described.
The Society for Behavioral Pediatrics: A New Portal in a Rapidly Moving Boundary
Authors: Cohen Michael I. 
Published: December 2021

In January 1976, at the first meeting of the members of the Task Force on Pediatric Education, its chairman, Henry Kempe, made the following statement: All who care about children must care deeply about the education of those who provide their health services. To paraphrase a basic tenet of the report of the Task Force: pediatric education must be based on what is best for infants, children, and adolescents. It cannot be based on what is best for doctors, faculty, departments, and hospitals.1
The underlying hypothesis was that health needs must form the basis for pediatric education.2 Any rationale for change should therefore be predicted on unmet health needs. To again quote Kempe from his 1978 presidential address to the American Pediatric Society3 on the same topic: "the concept that educational activities in our departments should relate to the health needs of children was not as universally accepted as you might think. A few feel to this day that it should be the other way around—that the needs of their departments should be addressed by a ready supply of sick and funded children, each in their appropriate subspecialty."
If indeed we care about children and their health needs and truly wish to realign clinical programs, educational policies, and research strategies along a track that will meet these needs and thus improve the health status of America's children, the first objective must be a reasoned assessment of the unmet health needs of our young. This same rationale holds true in the area of developmental and behavioral pediatrics.
Welcome to the Faculty or the Franchise?
Authors: McDonald J. M. 
Published: December 2021

Well, Dr Smith, we're delighted that you could come back to join us. Your chairman and future colleagues have given you their highest recommendation, and the department seems very eager to have you.
Let's see here. You're 32, Harvard undergrad, biochemistry major. That thesis on the micromolecular rearrangements leading to carcinogenesis at the P 189 locus was pretty hot stuff—comes from getting started early with a first-rate team. Top 10% of the class. House staff at Hopkins—one of our great institutions—tough training. Three years in Dr Winstead's lab at NIH.
Imitation and Substitute Milks
Authors:   Committee on Nutrition
Published: December 2021

Since the publication of a statement on filled and imitation milks by this Committee in 1972,1 there have been both a proliferation of fabricated products that simulate milk and changes in regulations concerning them. Currently,"substitute" milk is defined by the Food and Drug Administration as nutritionally equivalent to whole or skim milk based upon its content of only 14 on 15 nutrients, omitting many nutrients that are recommended as necessary components of infant formula.2 There is no current requirement that these products undergo testing to evaluate their biologic activity or the bioavailability of these components. Fabricated products that simulate milk but do not meet the standard of identity for substitute milk proposed in 19783 must be labeled as "imitation" milk.
Neither substitute nor imitation milks meet the nutritional requirements for infant formula as proposed by this committee and incorporated into the Infant Formula Act of 1980. They should not be used as a major source of nutrition for infants. Popularity, extravagant claims, and special marketing practices cannot make white liquids nutritionally equivalent to infant formula.
Bleeding in Cystic Fibrosis?
Authors: LANE PETER A. , HATHAWAY W. E. 
Published: December 2021

In Reply.—
We agree with Rosenstein that the possibility of fat malabsorption should be considered in any infant with vitamin K deficiency. In addition to cystic fibrosis, biliary atresia,1 α-1-antitrypsin deficiency,2 and abetalipoproteinemia3 have all been seen in infancy with vitamin K deficient hemorrhage. Certainly, a sweat chloride test, fractionated bilirubin determination, and review of the peripheral blood smear for acanthocytes would be important in the evaluation of such patients. Our patient had no acanthocytes, a normal α-1-antitrypsin level, and no evidence of biliary atresia or cystic fibrosis at autopsy.
Whole Cow's Milk, Age, and Gastrointestinal Bleeding
Authors: WILSON JOHN F. 
Published: December 2021

To the Editor.—
The recent statement by the American Academy of Pediatrics' Committee on Nutrition1 raises "unanswered" questions. There may be an answer to question 3: "Can the change to cow's milk when the unfant is 6 months old produce anemia from occult blood loss when the milk is fed in excessive amounts and there is no iron supplementation?"
[See table in the PDF file]
The answer is to be found in a review of the research records of the 34 subjects in a 1974 report2; the records contain detailed dietary histories recorded by me.
New Sign of Middle Ear Disease?
Authors: PASCOE JOHN M. 
Published: December 2021

To the Editor.—
For years I have observed children pulling on their ears "in sickness and in health." Now, my 11-month-old daughter has introduced me to a new symptom of middle ear disease that was not described during my medical school or residency training. In addition, I have never observed it in my patients.
She developed a right purulent otitis media and was treated with antibiotics. Following ten days of antibiotic therapy, she developed a persistent middle ear effusion for about 2 months.
New International Classification of Retinopathy of Prematurity
Authors: PATZ ARNALL 
Published: December 2021

The new international classification of the acute retinopathy of prematurity appearing in this issue1 is a timely and important contribution to the ocular examination and management of the retinopathy in these premature infants.
During the epidemic period of the retinopathy of prematurity, generally designated then as retrolental fibroplasia, the survival rate of very small premature infants with birth weight less than 1,000 g was less than 10%. By the 1980s, due to improved neonatal care, that survival rate has increased by fourfold or greater. These low-birth-weight infants, who are at the highest risk of developing the retinopathy of prematurity, are surviving today, but in the early 1950s they would not have lived long enough to develop the disease.
Neonatal Mortality Statistics
Authors: SEPKOWITZ SAMUEL 
Published: December 2021

To the Editor.—
Shapiro et al1 are properly cautious in attributing any decline in neonatal mortality to the use of neonatal intensive care. There was no decrease in mortality in 1976, the first year of their area-wide program, when compared with the 1974 to 1975 base line.2 Furthermore, the 17.9% decline in neonatal mortality between 1976 and 1978 to 1979 appears to be due to factors other than neonatal intensive care when weight-specific declines are considered.
Among the larger babies, birth weight greater than 2,500 g, there was a 24.8% reduction in weight-specific neonatal mortality.
Cystic Fibrosis Study Questioned
Authors: WAGENER JEFFREY S. , TAUSSIG LYNN M. , CORRIGAN JAMES J. 
Published: December 2021

To the Editor.—
Ater and associates1 reported that patients with cystic fibrosis (CF) increase their hemoglobin values while receiving oral iron therapy, and they suggested that this indicates a relative iron deficiency which helps to explain why hypoxic patients with CF do not develop polycythemia. Similar data have been reported by Nickerson and colleagues.2 However, neither study related hematologic response to degree of hypoxia and both studies failed to recognize that polycythemia is not a necessary response to chronic hypoxia.
Equation Error
Authors: MITSUOKA J. CHRIS , FLECK RICHARD J. 
Published: December 2021

In Reply.—
We thank McCormick for pointing out the error in equation 1. The correct term should be: Cpo e-Ke(t + t'). The term (t) should be considered to be the elapsed time from the beginning of the maintenance infusion.
The assumptions in the program are based upon theoretically ideal circumstances, that is, the loading dose is delivered precisely over 30 minutes beginning immediately after the initial serum level is drawn. The instant the loading dose is delivered, the maintenance infusion is initiated.
Autologous Blood Transfusion in Pediatrics
Authors: DEPALMA LOUIS , LUBAN NAOMI L. C. 
Published: December 2021

Public concern about the risk of transfusion-transmitted disease, especially acquired immunodeficiency syndrome, has resulted in unprecedented growth in autologous blood donation programs.1 In addition to eliminating transfusion-transmitted viral diseases, the use of autologous blood transfusion avoids the risk of sensitization to red blood cell antigens and subsequent antibody formation. Although there are many published studies that illustrate both the effectiveness and safety of such programs,2-4 there are comparatively few that specifically address the pediatric patient.
Autologous transfusion is defined as the collection and reinfusion of a patient's own blood. This may be accomplished by one of three modalities: (1) preoperative blood donation with subsequent blood bank storage and reinfusion during or following surgery; (2) acute normovolemic hemodilution, whereby blood is collected immediately preceding or following anesthetic induction and reinfused at the end of the surgical procedure; and (3) intraoperative and postoperative blood salvage, whereby blood shed into the operative field or enclosed space is collected, washed, and reinfused during or after surgery.
Neonatal Bacteremia and Circumcision
Authors: BRAUN DAVID 
Published: December 2021

To the Editor.—
Wiswell and Geschke recently reported a decreased incidence of neonatal bacteremia among circumcised babies.1 Surprisingly, the neonatal bacteremia rate in the whole population was 40 per 136 086 (0.029%). In other studies, the rate of bacteremia has been substantially higher (0.1% to 1.0%2). If these other estimates apply, a large majority of the babies in question were missed in the analysis. The authors suggest that some portion of the patients were admitted to other hospitals and thus could have been missed.
More on Risks of Circumcision
Authors: WISWELL THOMAS E. 
Published: December 2021

In Reply.—
Dr Williams asks, does this settle the debate regarding the "cause and effect" relationship of the intact prepuce and urinary tract infections?1,2 Perhaps not in and of itself; however, three other investigators3-5 recently confirmed our previous observations regarding this association. The risk for urinary tract infection during infancy appears to be at least 10- to 39-fold higher among uncircumcised boys.
What are the reasons boys are not circumcised? I do not have a proportional breakdown, but the two broad categories are (1) parental choice for their healthy child following informed consent counseling and (2) one of several presupposed "medical" contraindications, including prematurity, neonatal illness (pneumonia, persistent pulmonary hypertension, etc), known family history of "bleeding disorders," and recognized genitourinary malformations (most commonly hypospadias).