bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Maternal-Fetal Platelet Incompatibility on Fetal Development
Authors: PALCHAK ANDREW E. , ASTER RICHARD H. , GOTTSCHALL JEROME , OPITZ JOHN M. 
Published: December 2021

To the Editor.—
The effects on the fetus of maternal-fetal incompatibility involving RBC antigens are well known. Similar effects involving platelet antigens are less well known. We should like to call attention to the dramatic and potentially lethal results of such incompatibility which currently, unless suspected, often is undiagnosed.
Recently, we studied a young married woman who has been pregnant four times. At 19 years of age, she had a first trimester therapeutic abortion. At 22 years of age, she aborted spontaneously a set of twins at 13 weeks; these twins were not studied and the pathogenesis of their demise is unknown.
Mortality and Infectious Disease Associated with Infant-Feeding Practices in Developing Countries
Authors: Jason Janine M. , Nieburg Phillip , Marks James S. 
Published: December 2021

This review examines the available studies bearing on the relation between infant-feeding mode and infectious illness in the populations of less-developed countries.
A companion critical review of studies of the relationship of infant-feeding methods and infection in industrialized countries has concluded that, although laboratory studies provide biologic plausibility for a lower infection rate in breast-fed infants, an effect, if present, is apparently modest.39 The strongest evidence for a protective effect of breast-feeding in industrialized countries is for gastrointestinal (diarrheal) illness. In this review of studies among populations in developing countries we found the evidence for an important protective effect of breast-feeding against infectious illness to be much stronger. This conclusion was reached despite serious problems in the design of many of the studies reviewed.
One characteristic that distinguishes populations in less-developed countries from those of industrialized ones is the infant mortality. Even today, infant mortality for much of the world is up to ten times higher than infant mortality in the United States and Northern Europe.46 This undoubtedly reflects differences in sanitation, nutrition, housing, and other indicators of socioeconomic status. Much of the difference in rates of infant and child mortality and morbidity is attributable to high rates of infectious illness, especially gastrointestinal disease. Thus, in these populations, the positive effects of breast-feeding are of greater potential importance for the health of the infant population and should be easier to detect in clinical and epidemiologic studies.
In this review we will address the following key questions: (1) whether the method of infant feeding (breast v other) is associated with differences in rates of mortality, both overall and infectious, and in rates of infectious morbidity in less-developed countries;
The `Dynamic Transcutaneous Po2 Histogram' or How to Deal with Immense Quantities of Monitoring Data
Authors: FALLENSTEIN F. , BUCHER H. U. , HUCH R. , HUCH A. 
Published: December 2021

Monitoring of transcutaneous oxygen pressure (Po2) is a routine procedure in the management of sick newborn infants. The clinician frequently requires information on trends in transcutaneous Po2 and variability in relation to clinical procedures. However, long-term measurement of transcutaneous Po2 presents problems with documentation and analysis of the data (Fig 1).1-9
PRINCIPLE OF TRANSCUTANEOUS Po2 HISTOGRAM
To analyze transcutaneous Po2 information in a simple and efficient way, one can observe the frequency distribution of measured transcutaneous Po2 values within a desired time interval, instead of examining a long paper chart from a trend recorder. This method is shown in Fig 2.
Recommendations for Using Pneumococcal Vaccine in Children
Authors:   Committee on Infectious Diseases
Published: December 2021

A 23-valent pneumococcal polysaccharide vaccine licensed in the United States in 1983 replaces the 14-valent polysaccharide vaccine licensed in 1977. This statement contains new data about pneumococcal vaccine and its effectiveness that have become available since 1977 and new recommendations regarding its use in children.
PNEUMOCOCCAL DISEASE
Streptococcus pneumoniae (pneumococcus) is the most common cause of acute otitis media, and it is a frequent cause of bacterial pneumonia, bacterial meningitis, and sinusitis in children. Pneumococcus is the most common cause of bacteremia in infants and children aged 1 to 24 months; some of these children with fever and bacteremia have no evidence of a primary focus of infection.
Mortality from pneumococcal disease is highest in patients who have bacteremia or meningitis and in patients with certain underlying medical conditions. Patients at increased risk of developing severe pneumococcal disease, because of impaired immunologic response to pneumococcus, are those with sickle cell anemia, Hodgkin disease, congenital or acquired immunodeficiency, nephrotic syndrome, and splenic dysfunction, and those who have had splenectomy or organ transplantation. Certain other patients also may be at greater risk of suffering severe pneumococcal infections, such as some patients with diabetes mellitus, congestive heart failure, chronic pulmonary disease, and renal failure. Patients with CSF leakage complicating skull fracture or neurosurgical procedure may have recurrent pneumococcal meningitis.
To date, 83 pneumococcal types have been identified by the serologic properties of their capsular polysaccharides. Certain of these polysaccharides share physicochemical and antigenic properties. Ten serotypes account for the majority of pneumococcal infections in children and adults.
Neonatologist Versus General Pediatrician
Authors: BERGESON PAUL S. 
Published: December 2021

In Reply.—
Dr. Scanlon's remarks are timely and appropriate. There are no easy answers to the dilemmas Dr Scanlon raises. Indeed, neonatologists commonly are available on an around-the-clock basis in the neonatal intensive care unit (NICU). This availability may well be one significant factor responsible for the decrease in neonatal mortality rates seen in recent years.
The Committee on Hospital Care (COHC) of the American Academy of Pediatrics has observed in its statement that "the neonatologist is much more available to the newborn than is the private pediatrician."
Health Hazards of Cow's Milk
Authors:   Swiss Pediatric Association,   Committee on Nutrition, TÖNZ O. 
Published: December 2021

To the Editor.—
In a recent Pediatrics' supplement, Oski1 reviewed potential hazards of bovine milk-feeding and came to the conclusion that:
Whole bovine milk should not be fed to infants during the first year of life because of its association with occult gastrointestinal bleeding, iron deficiency anemia, and cow's milk allergy. The consumption of whole milk after the first year of life should be discouraged because of its potential role in a variety of disorders including atherosclerosis, recurrent abdominal pain of childhood, cataracts, milk-borne infections, and juvenile delinquency.
Lessons From the E-Ferol Tragedy
Authors: Balistreri William F. , Farrell Michael K. , Bove Kevin E. 
Published: December 2021

"Those who cannot remember the past are condemned to repeat it."—G. Sabtatana
Several factors combined to suggest that supplemental vitamin E should be administered to low birth weight infants. The persistent concern and controversy, the latter confounded by a paucity of data, have been discussed in recent editorials.1,2 At birh, tissue stores of the naturally occurring lipidsoluble antioxidant vitamin E (α-tocopherol) are low. The amount of total tocopherol in the tissue of premature infants is approximately one half that of full-term infants. 3 Maternal vitamin E supplementation seems to have minimal effect on serum vitamin E levels in the newborn because there is poor placental transfer; maternal blood levels are higher than cord levels.1-3
Cultural "latrogenic" Cleft Palate
Authors: BARAKAT AMIN Y. , ITANI USAMA , ZAYTOUN GEORGE M. 
Published: December 2021

Pediatricians are familiar with congenital cleft palates and those occurring as a part of a multisystem abnormality. We have encountered a child with a cultural "iatrogenic" cleft palate.
The patient is a 5-year-old girl who appeared normal until 4 months of age, at which time she became febrile and had difficulty breathing as a result of an upper respiratory tract infection. She was not attended to by a physician, but a uvulectomy, supposedly to prevent respiratory distress, was performed by a laywoman considered by the villagers to be a "specialist" in the procedure.
Following the uvulectomy, the infant experienced feeding difficulty, choking on solid and liquid foods.
Screening for Developmental Disabilities
Authors:   Committee on Children With Disabilities
Published: December 2021

Early identification and treatment of developmental disabilities that cause school-related problems is of considerable importance to practicing pediatricians. The motivation for early identification programs is: (1) to identify the barriers to children's participation in the educational process, (2) to assist these children and their families in finding medical, educational, or other appropriate services, and (3) to overcome or mitigate the adverse effects of the disability.
The need for visual and auditory examinations to identify deficits in these areas is readily accepted. Use of these examinations is standard practice. However, use of preschool examinations for developmental problems, potential learning disabilities, and mental retardation needs to be encouraged. These disorders, which may be less obvious, may have a major impact on the physical and mental health of children and their families.
Screening identifies most children who have or who are at risk of having developmental disabilities. Pediatricians have the opportunity to incorporate screening examinations in the context of well-child care and to refer their patients for confirmatory testing by an appropriate consultant, if indicated.
The conduct of a scheduled health evaluation, as described in Academy guidelines,1 includes a systematic evaluation of development at all ages, commencing in the perinatal period. Simple instruments that identify developmental problems are readily available.2-4 These tests assure early identification of a range of developmental disabilities.
Specific safeguards, including carefully developed guidelines and procedures, should accompany the application of such screening tests when practiced as part of a large community-based program, as well as in the pediatrician's office. Participation by pediatricians in the development and implementation of these screening procedures will assure that such efforts are comprehensive and effective.
Questioning Role of Hypochloremia in Bronchopulmonary Dysplasia
Authors: PERLMAN JEFFREY M. , DAWSON JEFF 
Published: December 2021

In Reply.—
We appreciate the interest in our report published in Pediatrics (1986;77:212-216). The three letters raise similar questions, and in response we would like to make three points.
First, including the two infants in the control group who died with the infants in the study group still resulted in significant differences between the two groups regarding duration of furosemide (Lasix) therapy, hypochloremia, or metabolic alkalosis (P &gt; .001). Second (as noted in our discussion), bronchopulmonary dysplasia is a complex disease process.
Transdermal Patch Poisoning
Authors: HAMBLIN JOAN E. , MARTIN CHARLES A. 
Published: December 2021

To the Editor.—
We wish to report a case of an accidental ingestion of clonidine from a transdermal patch by a 9-month-old baby. A.M., a 9-month-old boy, was seen in a local emergency room six hours after he had accidentally mouthed a transdermal clonidine patch. A.M.'s father had applied a 2.5-mg transdermal clonidine patch to his left wrist under his watch ten to 12 days earlier for BP control. The night before the incident, the father had removed his watch.
Pain—A Subject Ignored
Authors: RANA SOHAIL R. 
Published: December 2021

To the Editor.—
The majority of hospitalized children with severe pain do not receive optimal analgesia for its relief. Our opinion is based upon personal experience, communication with colleagues, and published surveys.1,2 Misuse of analgesics includes subtherapeutic doses, "prn" orders, inappropriately long intervals between doses, and use of placebos to prove that pain is not organic. This maltreatment reaches cruel proportions in infants and neonates when surgical procedures are sometimes performed without anesthesia and postoperative analgesia.
Health Care of Foster Children
Authors:   COMMITTEE on EARLY CHILDHOOD, ADOPTION, and DEPENDENT CARE
Published: December 2021

Children entering foster care generally have a higher than average number of health problems, and the care they receive is usually insufficient to meet their needs. These circumstances arise from the preplacement history of these children and from within the dual systems of foster care and publicly funded health care to which responsibility for their well-being is assigned.
BACKGROUND
Children enter foster care because their parents are unwilling or unable to provide for their physical and emotional needs. Most often, these children come from single-parent households where poverty, lack of formal education, and absence of social support contribute to inadequate and inappropriate child care. More than 80% of the children have experienced physical or sexual abuse and/or neglect. Their previous health care is likely to have been fragmented. As a consequence, foster children are likely to have unrecognized or untreated chronic disorders, a high rate of emotional and developmental problems, and impaired school performance.
Placement of children into foster care is ordinarily a court-ordered process used when the application of resources by social service agencies fail to, or appear unlikely to, improve a home situation deemed detrimental to the children's well-being. Foster care is intended to be a planned temporary service designed to strengthen families and to enhance the quality of life for children. The imposed separation of children from parents is a decision intended to be based on the best interests of the children. It is to be an opportunity for families to receive the social support and counsel they require to be reconstituted.
ABSORPTION OF α-TOCOPHEROL AND TOCOPHERYL ESTERS BY PREMATURE AND FULL TERM INFANTS AND CHILDREN IN HEALTH AND DISEASE
Authors: FILER LLOYD J. , WRIGHT STANLEY W. , MANNING MARY PARKE , MASON KARL E. 
Published: December 2021

The ability of premature and full term infants in health and disease to absorb vitamin E (tocopherol) was determined using the technic of multiple withdrawals of small samples of capillary blood at three hour intervals following an oral dose of α-tocopherol or α-tocopheryl esters.
Premature infants were found to absorb vitamin E as well as full term infants, when compared on the basis of the area under the curve for a 12 hour period following an oral dose of tocopherols at 20 mg./kg. body weight. This is in marked contrast to the diminished ability of the premature infant to utilize vitamin A and fats.
In a series of 29 infants, those disease states diagnosed as fibrocystic disease of the pancreas, diarrhea and cirrhosis were characterized by a poor response to the test, i.e., the tolerance curve was low. Others, infants with a variety of disorders not associated with fat or fat-soluble vitamin intolerance, had characteristic absorption curves with a maximum nine hours after receiving oral tocopherol.
In a series of 14 children and 1 adult, patients with sprue, celiac syndrome and lupus erythematosis were noted to absorb tocopherols poorly. Metabolic disorders with associated hypercholesterolemia were observed to give abnormally high values for the area under the curve.
A comparison of vitamin A absorption with vitamin E or tocopherol absorption in a series of 10 observations indicated that patients responding poorly to one test did poorly in both.
No difference in response was noted when various esterified forms of tocopherol were administered in place of α-tocopherol. This is contrary to the reported increase in biologic potency (rat assay) of the esterified forms of tocopherol.
An index calculated from the fasting and nine hour levels of serum tocopherol which corrected for the tocopherol equivalents supplied by the ester forms compared favorably with the area measurements and failed to demonstrate any difference in absorption of the free versus ester tocopherol.
HEAT PROSTRATION IN FIBROCYSTIC DISEASE OF THE PANCREAS AND OTHER CONDITIONS
Authors: KESSLER WALTER R. , ANDERSEN DOROTHY H. 
Published: December 2021

Twelve cases of heat prostration in infants and children are reported. Ten of these occurred during the New York City heat wave of August 1948.
Seven of these patients had cystic fibrosis of the pancreas. These patients differed from those with heat prostration but without fibrocystic disease in the following ways: They were considered to be doing well prior to the acute onset; the onset was later in the course of the heat wave than was the case in the nonfibrocystic patients; onset was with vomiting; the clinical response to therapy was prompt while the return of plasma chlorides to normal was more gradual.
Patients with fibrocystic disease of the pancreas are especially susceptible to heat prostration during prolonged periods of high atmospheric temperature. This fact has a practical application in prophylaxis for known cases of this disease, and in arousing a suspicion of the disease in infants and children with heat prostraton who have previously been considered healthy.
MYOSITIS OSSIFICANS PROGRESSIVA
Authors: RILEY HARRIS D. , CHRISTIE AMOS 
Published: December 2021

Four new cases of myositis ossificans progressiva have been presented and the literature on the subject has been reviewed.
At the onset typical cases will usually develop palpable masses over the fascial planes of the head and neck. Biopsy of these lesions suggests tumor tissue but this subsequently goes on to calcification and ossification.
This point illustrates that the disease title—myositis ossificans—is really a misnomer since there is no calcification of muscles themselves but rather a calcification of the connective tissue between the muscles.
When the disease progresses as illustrated by the cases reported, they frequently present themselves with gait or posture disturbance or with other orthopedic complaints. Microdactylism and hallux valgus deformity of the great toe are two of the outstanding findings.
The cases reported illustrate the various stages of the disease under discussion. From inflammation, swelling, induration of the muscles and connective tissues to tumefaction, the disease finally progresses to calcification in from 2 to 8 months. Finally, the calcification progresses to ossification and severe crippling. Serial illustrations and roentgenograms on several of these cases illustrate these progressive changes.
All biochemical determinations have been normal but marked subjective improvement following cortisone therapy in one early case suggests the possible relationship of this disease process to disturbed steroid metabolism.
Clinical Guidelines for the Pediatrician
Authors: Stickler Gunnar B. 
Published: December 2021

Much of clinical medicine is still based on empiricism, particularly the approach to diagnosis. One aspect of diagnosis that is talked about is the intuition of the experienced clinician. Most physicians working in a referral center have developed certain guidelines for themselves and have adopted suggestions from their teachers and colleagues. Some of these rules are recorded in books and essays, and others are passed by word of mouth from one generation of physicians to the next. It should not be necessary to emphasize that these are rules and not laws. Indeed, exceptions occur, and if there are not too many, they tend to prove the validity of a rule.
I want to suggest some of the rules I have found useful. It is impossible to state who was the author of them, even if I might claim that most of them are my own. I hope they generate responses and discussion, which perhaps will lead to deletions, additions, and refinements.
1. Determine the true "chief complaint" and do not accept previous diagnoses as the chief complaint. For example, if a patient presents because of urinary frequency and painful urination, he or she is not complaining of a "urinary tract infection." The chief complaint should be listed in simple English as what the patient or parent states as the reason for consulting the physician and not as a previous diagnosis.
2. Listen to the mother or the primary caretaker; these persons are the best observers and describe the situation well.
Guidelines for Expert Witness Testimony
Authors:   COMMITTEE ON MEDICAL LIABILITY
Published: December 2021

The American Academy of Pediatrics joins with other specialty organizations in emphasizing the obligation of objectivity when its members respond to requests to serve as expert witnesses in the judicial system. Regardless of the source of the request, such testimony ought to embody the relevant facts and the expert's knowledge, experience, and best judgment regarding the case. At the same time, the AAP reiterates that it cannot condone participation of its members in legal actions in which their testimony will impugn some performances that clearly fall within the accepted standards of practice or, conversely, will endorse some obviously deficient practices. Because experts are relied upon to help courts and juries understand the "standards of practice" as applicable to a given case, care must be exercised that such "expert testimony" does not narrowly reflect the experts' views about applicable standards to the exclusion of other acceptable choices. The Academy considers it unethical for any expert to provide testimony that does not adhere scrupulously to the goal of objectivity.
The AAP also recognizes its responsibility and that of its Fellows for continued efforts to improve health care for children. However, the Academy believes that many claims of medical malpractice represent the response of a litigation-oriented society to a technologically advanced form of health care that has, unfortunately, fostered some unrealistic expectations and often unexpectedly high risks. As technology continues to become more complex, risks as well as benefits continue and sometimes increase, making a complication-free practice of medicine less and less probable.
Potential Hazard of Hypoalbuminemia in Newborn Babies After Exchange Transfusions With ADSOL Red Blood Cell Concentrates
Authors: TUCHSCHMID P. , MIETH D. , BURGER R. , DuC G. 
Published: December 2021

To the Editor.—
During the preparation of packed red blood cells for blood transfusions, plasma is partially removed. The recent introduction of ADSOL as additive allows the removal of more than 80% of the plasma. The use of plasma-poor packed red blood cells in exchange transfusions for neonatal hyperbilirubinemia represents a potential hazard, as the excess of bilirubin is not optimally removed and the patient's plasma is depleted from albumin (Arch Dis Child. 1988;63:104). The effect of exchange transfusions using ADSOL-packed red blood cells on plasma proteins was studied in nine newborn babies (gestational age 31 to 40 weeks; birth weight 1735 to 3750 g) who needed exchange transfusions because of hyperbilirubinemia (total bilirubin exceeding 250 to 350 µmol/L) at the age of 0 to 3 days.