bluuebunny/crossref_metadata_2025_split huggingface dataset:
INTRODUCTION
Authors: SCHECHTER NEIL L. , ALTMAN ARNOLD J. , WEISMAN STEVEN J. 
Published: December 2021

Inadequate management of pain is a significant problem in all aspects of pediatric care. In every clinical situation which has been studied, children's pain receives far less attention than that of adults.1 Nowhere is this situation more unfortunate, however, er, than in the management of pain associated with childhood cancer. Poorly controlled cancer pain validates the worst fears of parents and children that cancer is accompanied by inevitable and excruciating pain. Inadequate control of the pain associated with diagnostic procedures creates an anticipatory dread in the child of the next procedure and colors his or her attitudes toward the hospital and the staff providing care.
This unfortunate situation has arisen partly because physicians dealing with these most devastatating of childhood diseases have not had easy access to information on the control of this most feared symptom. The complexities associated with research in childhood pain (in general, difficulties of assessment and ethical constraints) have been compounded by the relative rarity of childhood cancer and have resulted in limited research activity or interest in the management of cancer pain in children. The available research is often published in journals not generally read by those who care for children with cancer. Major pediatric texts contain virtually no information on the management of the pain associated with childhood cancer.2 The limitations of the available literature have allowed the development of few guidelines within institutions and virtually none across institutions (Hickman et al. 1988. Unpublished manuscript). As a result, the relative importance of adequate management of pain as well as specific treatment regimens are left to the discretion of the individual pediatric providers, most of whom have minimal training in this area.
Report of the Subcommittee on the Management of Pain Associated With Procedures in Children with Cancer
Authors: Zeltzer L. K. , Altman A. , Cohen D. , LeBaron S. , Munuksela E. L. , Schechter N. L. 
Published: December 2021

The ideal goal of pain management for pediatric procedures is to make the procedure comfortable for the child and his or her parents. Success will be manifested by the child who is not afraid of subsequent procedures and not merely by a child who can be held still for procedures. This goal is often difficult to achieve entirely, but at least an attempt to achieve it should be considered as evidence for an adequate standard of care. The orientation of this section will be a developmental one, with specific recommendations for five age categories: 0 to 6 months of age, 6 months to 2 years of age, 2 to 5 years of age, 5 to 12 years of age, ≥12 years of age. Initially, we discuss general principles of pain management (Table 5). The painful procedures include bone marrow aspiration and biopsy (Table 6); lumbar puncture (Table 7); and needle sticks including intravenous and intramuscular injection, phlebotomy, finger sticks, heel lances, and suturing (Table 8). Nonpainful radiographic diagnostic and therapeutic procedures that require patient cooperation in remaining still (eg, computed tomographic scan, magnetic resonance imaging, radiation therapy) are also discussed (Table 9).
GENERAL PRINCIPLES OF MANAGEMENT
There are several principles of management that are applicable for all age groups and procedures. These points need to be highlighted because pediatric procedures currently are not being managed in an organized fashion at many hospitals and oncology units. In a survey of the major pediatric oncology centers, more than 75% of the centers had no defined protocol for procedures of pain management (Hickman et al. 1988.
Blood Pressure and Intraventricular Hemorrhage in Premature Infants
Authors: PERRY EDWARD H. , BADA HENRIETTA S. , DAY JOHN D. , KORONES SHELDON B. , ARHEART KRISTOPHER L. , MAGILL HUBERT L. 
Published: December 2021

In Reply.—
We appreciate the interest and comments of Drs Puccio and Soliani regarding our article "Blood Pressure Increase, Birth Weight Dependent Stability Boundary and Intraventricular Hemorrhage."1 In response, we address the following points:
1. Although mean blood pressure (BP) values greater than 100 mm Hg were observed in some of our patients, these were quite rare. The mean BP was found to be less than 60 mm Hg 99% of the time. Thus, unless one is recording BPs through long periods and sampling quite often, the brief spikes likely would not be observed.
Little Help from Article on Anaboiic Steroids
Authors: LEVINE RICK 
Published: December 2021

To the Editor.—
As a high school teacher I have been looking for guidance on preventing the abuse of anabolic steroids by our students. The article "Anabolic Steroid Use by Male Adolescents" by Johnson et al1 not only failed to provide this guidance, but the results failed to support the authors' conclusions.
The study shows that, of the teenage users of steroids surveyed, 38% correctly identified liver disease, 35% cancer of the liver, and 30% stunted growth as side effects of steroid use.
Little Help from Article on Anaboiic Steroids
Authors: JOHNSON MIMI D. 
Published: December 2021

In Reply.—
Thank you for your letter regarding the article, "Anabolic Steroid Use by Male Adolescents," published in the June 1989 issue Pediatrics. I will attempt to address each of your concerns. The intent of the article was: (1) to inform health care providers about the prevalence of use of anabolic steroids in a population of 11th grade male students, (2) to increase provider awareness of the knowledge and some of the beliefs held by steroid users, and (3) to encourage providers to become knowledgeable about these drugs, so that they might be able to offer more appropriate guidance to the teenager in the clinical setting.
Ibuprofen for Fever
Authors: LORIN MARTIN I. 
Published: December 2021

To the Editor.—
I am writing to voice concern about the use of ibuprofen for simple antipyresis in infants and young children. Although there have been enough data about the new liquid preparation to convince the Federal Drug Administration to release it, it must be recognized that the total number of infants and young children reported who have received this drug is far from massive. Recognition of aseptic meningitis as a complication of ibuprofen therapy1,2 and reports of metabolic acidosis as a complication of overdosage3 are both relatively recent events.
More on Sports Deficit Disorder
Authors: STIRLING JOHN 
Published: December 2021

To the Editor.—
It was most enlightening to read the article on "Sports Deficit Disorder" in the June issue of Pediatrics.1 Drs Burke and McGee deserve credit for their pioneering work in describing this tragic and all-too-common condition. As it happens, we in the Northwest independently have recognized the need for such a diagnosis and for appropriate therapy. We must, however, take issue with several of the recommendations made in Burke and McGee's article.
First, the sobriquet "Sports Deficit Disorder," while sounding properly medical (vague, yet alliterative), is perhaps too vague, and it offers no suggestion as to therapy.
Public Disclosure of Private Information About Victims of Abuse
Authors:   Committee on Child Abuse and Neglect
Published: December 2021

This Policy Statement was retired May 2005.
Media publication of information about child abuse victims and their families may be detrimental to the victims. This is particularly true in cases of sexual abuse, but it may be just as serious in some cases of physical abuse or neglect. Many states lack laws that restrict publicity concerning the identity of child abuse victims and their families. As a result, serious harm to children can occur, not only at the time of the trial or hearing, but when subsequent stories appear years later.
The American Academy of Pediatrics recommends that all states adopt laws to prevent public disclosure of information that identifies victims of child abuse. The laws should grant courts the discretion to take one or more of the following measures during hearings of alleged civil or criminal child abuse/neglect: (1) exclude the public and media from a proceeding during the testimony of the child victim; (2) exclude the public (but not the media) from an entire proceeding; and (3) use pseudonyms in court records for the child victim and his or her family members.
Criteria by which the need for such protective measures should be judged include (1) the likelihood of identification of the child victim to the public if the protective measure is not taken; (2) the nature of the conduct that is the basis for the proceeding; (3) the child victim's age and level of maturity; (4) the desires of the child victim; and (5) in cases in which a family member is the defendant, the need to protect the family from publicity to encourage the resolution of family problems.
Diagnostic Imaging of Child Abuse
Authors:   Section on Radiology
Published: December 2021

The concept of child abuse as a medical entity has its origins in the radiologic studies of the pediatric radiologist Dr John Caffey, as well as many other specialists in the field of diagnostic imaging. When all cases of child abuse and neglect are studied, the incidence of physical alterations documentable by diagnostic imaging is relatively small. However, imaging studies are often critical in the infant and young child with evidence of physical injury, and they also may be the first indication of abuse in a child who is seen initially with an apparent natural illness. As most conventional imaging studies performed in this setting are noninvasive and entail minimal radiation risks, recommendations regarding imaging should focus on examinations, which provide the highest diagnostic yield at acceptable costs.
SKELETAL IMAGING
Although skeletal injuries rarely pose a threat to the life of the abused child, they are the strongest radiologic indicators of abuse. In fact, in the young infant, certain radiologic abnormalities are sufficiently characteristic to allow a firm diagnosis of inflicted injury in the absence of clinical information. This fact mandates that imaging surveys performed to identify skeletal injury be carried out with the same level of technical excellence utilized in examinations routinely performed to evaluate accidental injuries. The "body gram" or abbreviated skeletal surveys have no place in the imaging of these subtle, but highly specific bony abnormalities.
In general, the radiographic skeletal survey is the method of choice for skeletal imaging in cases of suspected abuse. Modern pediatric imaging systems commonly use special film, cassettes, and intensifying screens to minimize exposure.
Statement on Pediatric Fellowship Training
Authors:   Federation of Pediatric Organizations
Published: December 2021

The following statement was adopted by the Federation of Pediatric Organizations in February, 1990. The Federation consists of the following pediatric organizations: Ambulatory Pediatric Association, American Academy of Pediatrics, American Board of Pediatrics, American Pediatric Society, Association of Medical School Pediatric Department Chairmen, Association of Pediatric Program Directors, Society for Pediatric Research.
The Federation supports the concept that "the principal goal of fellowship training should be the development of future academic pediatricians." Graduates of pediatric fellowship programs usually work in academic centers with significant time set aside for research. Some fellowship-trained pediatricians, particularly neonatologists, allergists, and neurologists, may not work in hospitals or ambulatory settings that are associated closely with academic programs. Fellowship-trained pediatricians in all settings should be encouraged to continue their interest in research to add to the body of pediatric knowledge. To achieve the goal of training pediatric scientists, the following guidelines for fellowship education are recommended:
1. Upon completion of a pediatric fellowship, the trainee should be proficient in clinical care, teaching, and research. Fellowship training should prepare a pediatrician to care for children with complex illnesses within his/her area of special expertise and to serve as a consultant for the general pediatrician. In addition, the fellowship-trained pediatrician should be responsible for the education of pediatric residents and the continuing education of practicing pediatricians. For this reason, fellowship training should include interpersonal skills and pedagogical techniques.
2. Research training should begin as soon as possible; premedical students, medical students, and pediatric residents should be encouraged strongly to participate in meaningful research, and research activities should be carried out throughout fellowship training.
Phenytoin (Dilantin) Prescribing Practices Among Long Island, NY Pediatricians
Authors: MCABEE GARY , ATLURU VIJAYA , CARACCIO THOMAS , MOFENSON HOWARD 
Published: December 2021

To the Editor.—
A recent increase in phenytoin (PHT) toxicity in children prompted us to investigate prescribing practices of pediatricians in Long Island, NY. Questionnaires, consisting of 18 questions regarding the use, kinetics, and side effects of PHT, were sent to 603 pediatricians. There were 97 respondents (16%). Of the respondents, 29% originally prescribed PHT themselves (n = 76 = number who responded to question). The mean number of children treated per month was 2.3 (range 1 to 12).
Early Intubation and MAS
Authors: TRAVERSE LIONEL D. 
Published: December 2021

To the Editor.—
I was particularly interested by the article by Wiswell et al, entitled "Meconium Aspiration Syndrome: Have We Made a Difference?"1 because it is one of the few articles that has addressed issues of direct interest for the "trenches paediatrician." I would like to propose the following comments to the authors.
Intubation of a newborn, by an experienced and trained person, is a benign gesture. Except for the occasional vagal stimulation and very transient bradycardia associated, and the potential trauma to cords (which in good hands is probably easy to avoid), I am not aware of any medium- or long-term sequelae of intubating an infant once or twice.
Encopresis Caused by Mother's Stoma
Authors: DE VOS ILSE , MESSER ANTHONY P. , WOLTERS WILLEM H. G. 
Published: December 2021

To the Editor.—
We read the very interesting case report in Pediatrics1 about the boy who became extremely anxious and refused to go to the toilet after he saw a horrifying television commercial about a toilet. This led to constipation. We have an experience that corroborates this observation and smartly exposes the underlying mechanism.
A 5-year-old girl who had a severe defecation problem for 2 years was brought to our hospital. She persistently refused to go to the toilet or to use a potty.
Selenium in Pediatric Nutrition
Authors: Litov Richard E. , Combs Gerald F. 
Published: December 2021

Se is an essential nutrient that provides antioxidant protection in concert with vitamin E. Several selenoproteins have been identified, but only one, SeGSHpx, has a known function, that of neutralizing toxic hydroperoxides. Plasma Se concentration, being responsive to changes in Se intake, is the most practical and widely used measure of nutritional Se status. The plasma Se concentrations of the majority of healthy infants and children fall within the range of 50 to 150 µg/L. Although SeGSHpx activity measures the metabolically functional form of Se, the lack of a standardized analytical method has limited its usefulness as an index of nutritional Se status. Se deficiency was first observed in animals, but it is now recognized to occur in humans. Two human diseases associated with severe nutritional Se deficiency have been reported from China: a juvenile cardiomyopathy named Keshan disease and a chondrodystrophy named Kaschin-Beck disease. Long-term TPN, which provides negligible amounts of intrinsic Se, has been demonstrated in some cases to result in biochemical and clinical impairment. Although there are no consistent signs and symptoms characteristic of TPN-associated Se deficiency, in addition to the low blood selenium levels, some patients will experience leg muscle pain and altered serum transaminase and creatine kinase activities. These manifestations of Se deficiency usually take years to develop.
Recent information about the amount of dietary Se needed to maximize plasma SeGSHpx activity in adult men has allowed for better estimates of the Se requirement for humans. Recommended daily dietary allowances published recently by the National Academy of Sciences have been revised for infants and children in this paper by making appropriate adjustments for the protein requirements of these age-groups. These recommended intakes for Se can generally be met by consuming adequate amounts of cereals, meat, eggs, dairy products, human milk, and infant formula, which are good sources of highly available Se and are of low risk of providing excess amounts of Se. Suboptimal Se intakes by pregnant women may predispose their infants to low Se status at birth, which in turn may affect the infants' ability to maintain adequate Se status during the first few months of life. In those situations where protein intake is restricted, such as in phenylketonuria and maple syrup urine disease, Se-supplemented formulas should be used. The most critical situation for Se supplementation is in pediatric patients receiving long-term TPN therapy. When supplementing with Se, consideration must be given to the amount and form of Se to be used; with long-term TPN therapy, plasma Se levels should be monitored.
VACTERL Association With High Prenatal Lead Exposure: Similarities to Animal Models of Lead Teratogenicity
Authors: LEVINE FRED , MUENKE MAXIMILIAN 
Published: December 2021

The VACTERL association is one of the more common patterns of multiple malformations in children, with an incidence of approximately 1.6 cases per 10 000 live births.1 The pattern of defects consists of vertebral anomalies (found in 70% of patients), anal atresia with or without fistula (80%), cardiac defect (50%) with ventricular septal defect being most common, tracheoesophageal fistula (70%), renal anomalies (53%), and limb anomalies (65% with radial anomalies and 23% with lower extremity defects).2
The definition of the VACTERL association as a distinct entity is based on the finding that its constituent anomalies are associated in a nonrandom manner.1,3,4
Serious Error
Authors: JAIN LUCKY , VIDYASAGAR DHARMAPURI , RAJU TONSE N. K. 
Published: December 2021

To the Editor.—
The paper by Ware et al concerning the follow-up of survivors from a surfactant trial1 contains a serious error in Table 5 regarding the source of surfactants in our studies.2 As clearly stated in our abstract, we used Surfactant TA (Tokio Akita Inc, Tokyo, Japan) in the initial trial,3 and a surfactant material, now named Survanta (Abbott Laboratories, North Chicago, IL), in the later multicenter trial.4 These surfactant materials were derived from bovine lung and not from therapeutic abortions, as stated in Table 5 of report by Ware et al.
Judging the Validity of Developmental Screening Tests
Authors: CUNNINGHAM ROBERT DANA 
Published: December 2021

To the Editor.—
In judging the validity of developmental screening tests, there is frequent difficulty in obtaining the ideal "gold standard" by which to judge the screening instrument. For example, while it is useful to know how the Denver Developmental Screening Test compares with the Stanford-Binet when attempting to identify children with mental retardation at 3 years of age, perhaps it is even more useful to know how the screening test compares with the Stanford-Binet in predicting which 3 year olds will go on to become labeled as mentally retarded at 6 years of age, a time when IQ scores are more stable and school systems are more likely to make special services available.
The Social Filter Effect of Informed Consent in Clinical Research
Authors: THONG Y. H. , HARTH S. C. 
Published: December 2021

Few would disagree with the moral principle of respect for individual autonomy in the conduct of clinical research.1-3 After all, self-determination and informed choice are the cultural norms of free societies. Rather, it is the legal and regulatory provisions of the informed consent doctrine that have caused the most difficulties. Some 25 years after the promulgation of this doctrine,4,5 many problems remain with its practical implementation.
The doctrine of informed consent has four essential components. 6-8First, there must be full disclosure of risks and benefits and the therapeutic alternatives. Second, the information must be provided in writing in an easily comprehensible form, but given the intermix of medical terminology and legal jargon, this is easier said than done.9
Managing Hemangiomas
Authors: HURVITZ CAROLE , ALKALAY ARIE 
Published: December 2021

To the Editor.—
We read with interest the article, "Management of Alarming Hemangiomas in Infancy: A Review of 25 Cases" by Enjolras et al, in the April, 1990 issue of Pediatrics. We note that all three patients with liver hemangiomas died. We would like to draw your attention to two articles that we have published with regard to treatment of life-threatening hemangiomas with cyclophosphamide.1,2
In our series of four patients, the very large intrahepatic tumor resistant to prednisone in one infant who also had congestive heart failure completely resolved with two courses of cyclophosphamide.
Pierre Robin Sequence Management
Authors: GIVAN DEBORAH C. , BULL MARILYN J. , SADOVE A. MICHAEL , BIXLER DAVID , HEARN DIANE 
Published: December 2021

In Reply.—
We thank Dr Brooks for emphasizing our central point that oximetry alone is inadequate for evaluating these children. The data we used for analysis of these patients and for assessing the nature of their apnea were data collected from tracings taken during sleep time to minimize the artifact that Dr Brooks points out. To improve the accuracy of our interpretation, pulse data from the oximeter and heart rate from the cardiotachometer are compared constantly.
Turner Syndrome and Partial Anomalous Pulmonary Venous Drainage
Authors: NOONAN JACQUELINE A. 
Published: December 2021

To the Editor.—
In a recent report, Moore et al1 reported that 3 of 12 patients with karyotype XO had partial anomalous pulmonary venous return with an intact atrial septum. In 1984, I presented a poster at the Southern Genetics Meeting which reported three patients with Turner syndrome who had partial anomalous pulmonary venous return demonstrated by cardiac catheterization. An additional infant with aortic atresia was noted at postmortem to have premature closure of the foramen ovale and partial anomalous pulmonary venous return.
Turner Syndrome and Partial Anomalous Pulmonary Venous Drainage
Authors: KIRBY WILLIAM C. 
Published: December 2021

In Reply.—
We certainly agree with Dr Noonan's comments regarding the association of partial anomalous venous drainage (PAPVD) and Turner's syndrome. We also have anecdotal information about several additional patients with Turner syndrome and PAPVD. Knowledge of such patients does not define further the overall incidence of these venous anomalies in the population of patients with 45,XO karyotype.
Our study demonstrates that patients with only a single anomalous pulmonary vein may have quite subtle clinical findings.
Testing for Maternal Drug Abuse: How Much Is Enough?
Authors: MAYNARD EDWARD C. 
Published: December 2021

To the Editor.—
In their recent statement on drug-exposed infants,1 the Committee on Substance Abuse discourages universal screening for perinatal drug abuse, citing concern that "the harm vs the benefits of "labeling" the infant and/or the mother are not known." Just how widely we should be testing for perinatal drug abuse remains unclear, however; recent data from our institution suggest that even with broad screening criteria we are missing most cases of perinatal drug abuse.