bluuebunny/crossref_metadata_2025_split huggingface dataset:
Infant Feeding and Infectious Disease
Authors: MULFORD CHRIS 
Published: December 2021

To the Editor.—
I read with interest the article "Relationship Between Infant Feeding and Infectious Illness: A Prospective Study of Infants During the First Year of Life" by Rubin et al in the April issue.1 Two things puzzle me. The first is that, despite the authors' stated goal of paying close attention to methodology, their definition of breast-feeding fails to meet the standards set forth by most experts on lactation. The second is that, given their substantial investment of time and money in obtaining detailed data on 500 babies for a full year, the authors chose to ask their particular research question.
Childhood Injuries: Where We Are
Authors: Rosenberg Mark L. , Rodriguez Juan G. , Chorba Terence L. 
Published: December 2021

INJURY RESPONSIBLE FOR EXCESS CHILD MORTALITY IN THE UNITED STATES
Child mortality rates are higher in the United States than in most European industrialized countries. This excess in mortality is not due to a difference in death rates from all natural causes; rather, all the excess mortality among US children can be attributed to injury (Fig 1). These differences are particularly notable for children 15 to 19 years of age. Suicide rates among 15- to 19-year-olds are higher in the United States than in most other industrialized countries (Fig 2). Excess homicide mortality among 15- to 19-year-olds is particularly striking (Fig 3). In 1985, 1579 homicides occurred among males and females aged 15 to 19 years in the United States. In the same year, only 150 homicides occurred among 15- to 19-year-old males and females in the Federal Republic of Germany, France, England and Wales, Sweden, Canada, and Japan, despite the fact that the combined population of these countries is 1.4 times the populations of the United States.
Our successes in infectious disease control dramatize our failures to control injuries effectively and increase the relative importance of injury. Injury is now the leading cause of childhood mortality and disability and a leading cause of childhood morbidity. In the last 60 years, death rates due to infectious diseases declined 90%, but death rates due to injuries declined only 40%. Since 1968 rates of injury deaths among children declined 25%, but death rates for diseases declined 56% (Fig 4). Deaths from diseases have decreased in the United States, but deaths from injuries have not decreased as much.
A Varicella-Induced Pupil Abnormality
Authors: CAPUTO ANTHONY R. , MICKEY KEVIN J. , GUO SUQUIN 
Published: December 2021

To the Editor.—
The varicella virus is a well known cause of ophthalmologic complications in its classic recurrent form of herpes zoster ophthalmicus. Ocular complications may also accompany the primary infection, however, and have been well documented. These conditions include vesicular lid lesions with corresponding irritation, phlyctenular keratoconjunctivitis, superficial punctate keratitis, uveitis, optic neuritis, and external ophthalmoplegia from encephalitic cranial nerve palsies.1,2 Internal ophthalmoplegia, a rare complication affecting pupillary constriction and accommodation, has also been
Hypercholesterolemia Screening Questioned
Authors: HARVEY BIRT 
Published: December 2021

In Reply.—
r. Sheps is concerned that policy may develop based on the results and interpretation of the study by Steiner and her colleagues. Another unmentioned concern might be that physicians will unhesitatingly follow the recommendation of these authors that all adolescents be screened.
This recommendation for screening is accompanied by a caveat: "Until all of the related controversies surrounding cholesterol testing are more clearly understood ...," and both the authors and Dr Sheps share concern about one of those controversies, the safety and efficacy of intervention for hypercholesterolemia.
The Diaper Controversy
Authors: NEWMAN ELIZABETH 
Published: December 2021

To the Editor.—
An article encouraging pediatricians to advocate cloth diapers was published recently in Pediatrics.1 Embarrassing, but true ... we, too, used to look down upon those who used disposable diapers, along with Cadillac owners, cigar smokers, and lepers. Six months ago little Rebecca came into our lives and we have learned alot from her. It's not the stuff they teach in medical school or prenatal classes. We'd like to share some observations with you. We still don't drive a Cadillac or smoke cigars, but we think that Pampers are simply amazing! We were going to be the best parents and also politically correct: breast-feeding and cloth diapers (there was no doubt about it).
CONGENITAL DISLOCATION OF THE HIP
Authors: PRAY L. G. 
Published: December 2021

Limited hip abduction, when present, is a valuable early sign of congenital hip dysplasia. Other signs and symptoms should be looked for.
Confirmation by roentgenographic studies should be sought in all patients. Roentgen changes may be equivocal or lacking during the first three months of life in patients with hip dysplasia.
The Frejka pillow splint is a convenient and effective means of treating hip dysplasia or subluxation in early infancy. It is as effective as a cast during this period, and is cleaner and more comfortable.
It would seem that a high percentage of cases of congenital hip dysplasia recover spontaneously. However, in view of the seriousness of hip dislocation and the value of early treatment of hip dysplasia, it seems best to treat all infants with clinical signs of this disease.
EFFECTS OF PENICILLIN AND BROAD-SPECTRUM ANTIBIOTICS ON THE EMERGENCE OF A GRAM-NEGATIVE BACILLARY FLORA IN THE UPPER RESPIRATORY TRACT OF INFANTS
Authors: MCCURDY ROBERT S. , NETER ERWIN 
Published: December 2021

A study was undertaken on 107 infants to determine the effect of penicillin and broad-spectrum antibiotics (aureomycin, chloromycetin and terramycin), alone and in combination, on the emergence of a predominant gram-negative, bacillary flora of the upper respiratory tract. The following data were obtained:
1. Such a change of the flora took place in 4 out of 12 patients treated with penicillin, 15 out of 22 treated with penicillin and a broad-spectrum antibiotic, and in only 4 out of 21 infants who received a broad-spectrum antibiotic exclusively.
2. Of the 32 cases whose flora had thus changed, members of the E. coli-A. aerogenes group were found in 30 instances, members of the genus Proteus in 3; Ps. aeruginosa in 2; Paracolobactrum in 1; and combinations thereof in four cases.
3. This change of the flora took place in 18 out of 71 infants suffering from respiratory infection and in 14 out of 36 children suffering from other diseases.
4. Reappearance of clinical manifestations was observed in 6 out of 19 patients whose respiratory tract flora changed following the use of penicillin and in none of the four individuals who were treated with a broad-spectrum antibiotic alone. In view of the small number of cases this observation requires confirmation.
5. It is concluded that in infants the use of penicillin used in conjunction with a broad-spectrum antibiotic is followed rather frequently by the emergence in the upper respiratory tract of a predominant gram-negative, bacillary, aerobic flora; such a change occurs less frequently after the use of a broad-spectrum antibiotic alone. The clinical significance of these data is discussed.
ECMO and Sepsis. If Differences Could Be Due to Chance Alone, Are Trends Worth Discussing?
Authors: HOCKER JAMES R. , SIMPSON PIPPA M. , RABALAIS GERARD P. , STEWART DAN L. , COOK LARRY N. 
Published: December 2021

In Reply.—
We agree with Dr Weiss that from a purely statistical standpoint, our retrospective data do not offer proof that ECMO is superior to conventional medical therapy in improving the survival of neonates with overwhelming group B streptococcal sepsis. If this study had more power (ie, more patients), a statistically significant difference may have been noted. Of course, with this particular study design, we had no control over sample size. It is up to the reader to decide if there is a clinically significant difference between the two therapeutic strategies.
Authors' Correction
Authors: IRIGOYEN MATILDE , DAVIDSON LESLIE 
Published: December 2021

To the Editor.—
In the article, "Randomized, Placebo-Controlled Trial of Iron Supplementation in Infants with Low Hemoglobin Levels Fed Iron-Fortified Formula" by Irigoyen et al (Pediatrics 1991;88:320-326), an error was made on Table 1 (p323) regarding the proportion of children fed milk-based and soy-based formulas. The corrected data follow:
[See table in the PDF file]
Although this error only relates to the dietary background informarion and does not affect the trial or its results, we would appreciate going on record as having the data corrected.
Meconium Aspiration Syndrome (MAS)
Authors: WISWELL THOMAS E. 
Published: December 2021

In Reply.—
I am confused by Dr Waage's letter. What does he mean by "the literature supports that the majority of meconium-stained neonates fall into such a category?" Does he mean it is substantiated that the majority of these neonates do not require intubation? Yes, 95% of such neonates will not develop MAS, but how does one identify those at risk who "require" intubation. Clearly, depressed neonates born through thick meconium are at the highest risk for MAS, but MAS will occur in apparently vigorous newborns or those born through thin-consistency fluid.1,2
Mythology of Lead Poisoning
Authors: LAKATOS LAJOS 
Published: December 2021

To the Editor.—
I read with interest the recent paper by Drs Glotzer and Bauchner and enjoyed reading the excellent commentary by Drs Needleman and Jackson.1,2 It is stated correctly that "the overall consensus is that elevated lead burdens in childhood . . . can result in adverse neurodevelopmental outcomes." Of even more concern is the detrimental effect of lead on developing and growing nervous systems: behavioral and learning disorders have been attributed to lead exposure in utero and in early infancy.
The Changing Role and Responsibilities of a Chairman—Letters
Authors: ROSENQUIST GLENN C. 
Published: December 2021

To the Editor.—
I enjoyed the article by Robert L. Brent in Pediatrics (1992;90:50-57) on the changing role and responsibilities of chairmen. The article is a "must read" for anyone contemplating the job—and for anyone who used to have the job (like me).
As usual Dr Brent has shown the insight we have all admired for years. Keep up the good work.
The Changing Role and Responsibilities of a Chairman—Letters
Authors: ROIZEN MICHAEL F. 
Published: December 2021

To the Editor.—
I have read the excellent article by Robert L. Brent with interest and admiration. I'd like to add two additional characteristics that I believe are important for a department chairman. (1) The ability of the chairman to seek and accept advice. None of us know all of the answers, many others have faced similar problems, and advice can easily be sought from ex-chairmen, chairmen, or individuals in other business fields who have had experience with similar problems.
Exercise and Breast-Feeding: A Different Experience
Authors: DEWEY KATHRYN G. , LOVELADY CHERYL 
Published: December 2021

To the Editor.—
Although we find the study of Wallace et al1 interesting, we are concerned that their finding of decreased infant acceptance of postexercise breast milk due to increased lactic acid concentration will be misinterpreted to mean that there are disadvantages to exercising during lactation. It is important to emphasize that the subjects in their study underwent a maximum exercise test before collection of breast milk samples. Lactic acid levels in milk are likely to be much higher following maximum exercise than they would be after the more moderate levels of exercise needed to maintain fitness and enhance weight loss.
Saddened Not Amused
Authors: ASNES RUSSELL S. , GORDON SUSAN G. 
Published: December 2021

To the Editor.—
The writers of this letter are two physicians who collectively have spent many years in the delivery of medical services to children and the teaching of medical students and pediatric house officers. Both of us were quite distressed on reading the article by D.S. Nelson (Pediatrics. 1992;89:1089-1090) about documenting humor in the pediatric emergency department.
We consider ourselves as having good senses of humor. We enjoy a good joke and a humorous story.
Amused Not Saddened
Authors: CHASTAIN DAVID O. 
Published: December 2021

To the Editor.—
The article by Nelson concerning humor in the pediatric emergency department brings to mind several humorous situations in adolescent medicine.1
In adolescents the shift from concrete to abstract (or "formal") thought begins at about 12 years of age and usually is completed by 15 years of age.2 This delay in cognitive maturation is demonstrated by the adolescent who responds to the question, "Are you sexually active?" by pausing, looking puzzled, then responding, "I guess so... I used to just lay there, but now I move around more."
Intraoperative Anaphylaxis to Latex
Authors: PASQUARIELLO CAROLINE A. , LOWE DAVID A. , SCHWARTZ ROY E. 
Published: December 2021

Since systemic reactions to latex were first described 5 years ago, an increasing number of these type I (IgE-mediated) allergic reactions have been reported in patients with long-term exposure to latex.1-6 The allergic manifestations range from localized erythema, urticaria, and pruritus of the exposed area to life-threatening angioedema and anaphylaxis. The reported cases of anaphylaxis have almost exclusively occurred intraoperatively. The children at greatest risk are those with myelomeningocele or congenital urologic abnormalities.7,8 These children have undergone multiple surgical procedures and/or repeated bladder catheterizations and radiologic procedures in which rubber catheters are used.
We describe two patients who experienced intraoperative anaphylaxis to latex.
Congenital Microgastria and Limb Reduction Defects
Authors: CUNNIFF CHRISTOPHER , WILLIAMSON-KRUSE LORI , OLNEY ANN HASKINS 
Published: December 2021

In 1842 Robert1 reported the case of a girl with microgastria; hypoplastic left forearm, hand, and wrist; and asplenia. Since that time, six additional patients with a similar pattern of malformation have been described.2-7 The purposes of this report are to describe three additional cases of the microgastria-limb reduction complex which illustrate the clinical variability of this condition, to discuss overlap of this disorder with other malformation syndromes and associations, and to present evidence that suggests that the microgastria-limb reduction complex represents a developmental field defect.
CLINICAL REPORTS
Patient 1
Patient 1 was evaluated at age 1 month for bilateral absent thumbs.
Bilirubin and Brain Toxicity in Neonates: Dead but Won't Lie Down?
Authors: HANSEN THOR WILLY RUUD 
Published: December 2021

To the Editor.—
During a meeting a few years ago, while discussing the issue of bilirubin and neurotoxicity, Dr Timos Valaes, a notable expert in the bilirubin field, suggested to me that "we may be flogging a dead horse." A couple of provocative articles recently published in Pediatrics seem to argue along the same lines.1,2 However, commentaries on those same articles, as well as the continued scientific interest in bilirubin neurotoxicity, suggest that the "animal" may still be standing.
Bilirubin and Brain Toxicity in Neonates: Dead but Won't Lie Down?
Authors: NEWMAN THOMAS B. , MAISELS M. JEFFREY 
Published: December 2021

In Reply.—
We agree with Dr Hansen that much current management of hyperbilirubinemia is based on assumptions in need of scientific validation. This explains the considerable practice variation in different institutions that he described.
We disagree, however, that changing guidelines for management of hyperbilirubinemia is ethically unacceptable. An ethical obligation to treat jaundiced babies in any particular fashion must be based not on tradition, but on data that babies treated in that fashion do better than other babies.
Niacin Treatment of Hypercholesterolemia in Children
Authors: Colletti Richard B. , Roff Nancy K. , Neufeld Ellis J. , Baker Annette L. , Newburger Jane W. , McAuliffe Timothy L. 
Published: December 2021

Objective. To determine the efficacy and adverse effects of niacin treatment of hypercholesterolemia in children.
Design. Retrospective review.
Setting. Two university hospital referral clinics.
Patients. All children who received single-drug niacin treatment for severe hypercholesterolemia between 1980 and 1991.
Results. Twenty-one children, aged 4 to 14 years, were treated with niacin, 500 to 2250 mg daily. Pretreatment total serum cholesterol value (mean ± SD) was 7.84 ± 1.14 mmol/L (303 ± 44 mg/dL), and low-density lipoprotein cholesterol value was 6.28 ± 1.16 mmol/L (243 ± 45 mg/dL). Niacin treatment in daily doses &gt;1000 mg reduced total cholesterol by 23% and low-density lipoprotein cholesterol by 30% (P &lt; .001) but had no effect on highdensity lipoprotein cholesterol and triglycerides. As in adults, reversible adverse effects were common, occurring in 16 (76%) of the 21 children. Six children (29%) had reversible dose-related elevations of serum aminotransferase levels. Niacin therapy was discontinued in 8 children (38%) because of flushing, abdominal pain, vomiting, headache, or elevated serum aminotransferase levels. Conclusions. This study suggests that although niacin treatment in children is efficacious, adverse effects are common. Until further study demonstrates long-term safety, niacin treatment should be reserved for the closely-supervised treatment of severe hypercholesterolemia by a lipid specialist.
Early Treatment of Premature Infants With Recombinant Human Erythropoietin
Authors: Messer Jean , Haddad Joseph , Donato Lionel , Astruc Dominique , Matis Jacqueline 
Published: December 2021

Objectives. The specific objectives of this study were (1) to assess the safety and efficacy of recombinant human erythropoietin (rhEPO) in reducing postnatal hemoglobin decline in premature infants of less than 33 weeks' gestation, and thus reducing the need for transfusion; and (2) to determine the optimal dosage of rhEPO.
Materials and methods. Three groups of premature infants of less than 33 weeks' gestation were treated with rhEPO: group 1 (n = 10) received 300 U/kg per week; group 2 (n = 11), 600 U/kg per week; and group 3 (n = 10), 900 U/kg per week. These three groups were compared to a reference group of 20 infants of the same gestational age and birth weight. Treatment started on the 10th day of life and lasted 6 weeks. All infants were given oral iron and vitamin E supplements.
Results. Treated infants had significantly higher reticulocyte counts, and the effect was dose dependent (P = .009). Postnatal decline of hemoglobin and hematocrit was lessened in the treated groups; the percent of decrease of hemoglobin and hematocrit was significantly reduced in the treated infants at 35 days of age (P = .0025 and P = .0036, respectively). The need for blood transfusion was also reduced in the rhEPO-treated groups: 19% of treated vs 45% of reference infants received transfusions, and the treated infants received less blood. Serum iron and transferrin saturation percentage dropped significantly during the study and a dose-dependent relationship in treated infants was displayed, suggesting high iron consumption (P = .0008 and P = .006, respectively). No dose effect on hemoglobin level and the need for blood transfusion was found, possibly because of the higher degree of illness severity and iron consumption in groups 2 and 3. No side effects related to rhEPO therapy were observed.
Conclusions. It is concluded that rhEPO therapy is safe in premature babies when given in the three dosages used in this study; in addition, it enhances erythropoiesis and reduces the need for blood transfusions. rhEPO therapy seems more efficient when given in higher dosages; however, illness severity and iron consumption represent major limiting factors. Controlled, randomized studies are warranted to confirm these data and to determine precise modalities and indications of rhEPO therapy in premature infants.
CHINA: SEX IN THE OPEN
Authors: H. B. 
Published: December 2021

The results of two nationwide surveys on "sex civilisation" conducted in 1989-90 in 15 large cities are to be published before the end of the year. The publication, On the Sex of the Chinese People, marks a turning point in Chinese attitudes to the discussion of sex. Until the 1980s, any discussion of the subject (except the minimum necessary for official family planning policy) was regarded as hooliganism or a sign of mental disturbance. The first course of public lectures on sex was held in Shanghai in 1985. Shanghai-based Prof Liu Dalin, author of the report, told the news agency Xinhua, "The age of being mysterious and innocent about sex has passed."
China has almost 1000 researchers working in areas such as sex medicine, sex psychology, sociology, and sexually transmitted diseases. Sex-education classes are held in more than a quarter of the higher education colleges, and over 87% of students have enrolled or would like to enrol. Sex education in middle schools, introduced as an experiment in 1988 in 7000 schools, is shortly to be extended to all schools.
In Reply: International Statistics—Incomparable
Authors: HOWELL EMBRY M. , VERT PAUL 
Published: December 2021

Dr Sepkowitz makes several correct points about the French vital registration system that leads to incomparability with Michigan vital statistics.
• Definitions of fetal deaths are dissimilar. The French registration system ignores fetal deaths at less than 28 weeks gestation.
• In France, it is the responsibility of parents to register births.
• France has had a unique category of "deaths before registration."
However, he is incorrect in suggesting that these differences affected the results reported in our article. It is precisely for these reasons that we did not use data from the French vital registration system. Instead we used data that were carefully collected during a 1-year period in Lorraine's hospitals under the direction of the French Health Ministry that directly controls French hospitals.
HOSPITAL EXECUTIVES' PAY ROSE SHARPLY IN A DECADE
Authors: L. J. F. 
Published: December 2021

WASHINGTON, Sept. 29—The rise in nonprofit hospital executives' compensation in the 1980's was one of the fastest-growing components of the overall rise in medical costs, with the earnings of a few executives at the most prestigious institutions approaching or exceeding $1 million.
Although executive pay represents a small fraction of total revenues in any hospital, it is a matter of particular interest to Internal Revenue Service auditors. Special audits of about 20 hospitals nationwide are under way, examining if these educational and charitable institutions, in their zeal to compete in the high-stakes health-care field, are straying from the ground rules governing tax-exempt status.
Among other things, these rules prohibit nonprofit organizations from providing "excessive" benefits to private individuals, a definition open to a range of interpretations. IRS officials said that executive salaries are one of the issues under scrutiny in their audits...
While salaries for top hospital executives around the nation tend to run in the $200,000 range, with compensation routinely $100,00 to $200,000 higher for doctors serving as chief executive officers, a few hospitals pay at double or triple the base rates...
[The] president and chief executive officer of New York City's Memorial Sloan-Kettering Cancer Center made more than $1 million in total compensation in both 1990 and 1991 . A 1988 "signing bonus," . . . brought his total compensation for that year to $2.2 million. The center employs 5,600 and has a $700 million budget for 1992.
[The] head of Brigham and Women's Hospital in Boston made $872,628 in total compensation in 1991 . The teaching hospital, affiliated with Harvard Medical School, employs about 8,000 people.