bluuebunny/crossref_metadata_2025_split huggingface dataset:
Should Chloral Hydrate Be Banned?
Authors: Steinberg Alfred D. 
Published: December 2021

Objective. Current federal regulations of potentially carcinogenic environmental chemicals are based on the assumption that risks for humans can be extrapolated from the effects of chronic high-dose exposure of rodents. It is assumed that all chemicals induce cancer by a genotoxic mechanism (direct interaction with DNA) and that humans metabolize chemicals by the same pathways as the test rodents. Trichloroethylene, a former medicine, is now regulated because of rodent studies. Its major metabolite, chloral hydrate, widely used as a sedative in both adults and children, is in danger of being banned by comparable studies. This paper assesses the safety of chloral hydrate.
Design. Analysis of the literature regarding the metabolic, toxicologic, and epidemiologic data on trichloroethylene and chloral hydrate.
Results. The dose-response relationship for carcinogenesis of chioral hydrate and other chemicals in its metabolic breakdown pathway is nonlinear in rodents: very high doses given chronically, sufficient to cause cellular necrosis, are necessary for induction of malignancies. In addition, epidemiologic data on people exposed to substantial amounts of trichloroethylene (which is metabolized to chloral hydrate) show no increase in mortality or cancers.
Conclusions. The assumptions underlying current regulatory practices for environmental chemicals are not applicable to the medicinal use of chloral hydrate. Instead, a threshold model is appropriate. The data do not suggest the need to ban chloral hydrate as a medicine; however, possible modifications in its use are suggested.
How Aggressive Should Delivery Room Cardiopulmonary Resuscitation Be for Extremely Low Birth Weight Neonates?
Authors: DAVIS DEBORAH J. 
Published: December 2021

The neonatology staff attending high-risk deliveries are often faced with difficult ethical decisions. One of these is whether or not to perform cardiopulmonary resuscitation on extremely low birth weight neonates in the delivery room. Unfortunately, there is a paucity of information in the medical literature addressing this dilemma. To determine whether guidelines for resuscitation of the extremely low birth weight neonate could be set, I undertook a chart review of all neonates born with a birth weight of 1000 g or less in our institution.
METHODS
All babies born at the Ottawa General Hospital who weighed 1000 g or less at birth were identified through the neonatal intensive care unit logbook, which records all births at which a neonatal physician is in attendance.
Linea Vestibularis: Follow-up of a Normal Genital Structure
Authors: KELLOGG NANCY D. , PARRA JUAN M. 
Published: December 2021

Keen observation and precise documentation have become increasingly important in the physical evaluation of a child who may have been sexually abused. The task of proper interpretation of these
[See table in the PDF file]
physical findings depends on the recognition of normal anatomy.
Much work has been done to differentiate normal anatomic variants from physical changes resulting from injury.1-7 In a recent study, healthy female newborns were examined to establish the presence of a white midline streak in the posterior vestibule.8 In the initial phase of this study, 123 newborns were examined. A white linear structure in the mid-posterior vestibule, termed linea vestibularis (LV), was found in 10% (n = 13) of the group and a white spot in the mid-posterior vestibule, termed partial linea vestibularis (PLV), was found in 14% (n = 17) of the group.
Use of Ribavirin in the Treatment of Respiratory Syncytial Virus Infection
Authors:   Committee on Infectious Diseases
Published: December 2021

Ribavirin is an antiviral drug that was approved by the Food and Drug Administration in 1986 for aerosol treatment of serious respiratory syncytial virus (RSV) infections in hospitalized children. Ribavirin has a broad spectrum of antiviral activity in vitro, where it inhibits replication of RSV, influenza, parainfluenza, adenovirus, measles, Lassa fever, and Hantaan viruses. Proof of efficacy for human infection has been obtained in double-blind placebo-controlled studies of RSV,1,2 Lassa fever, and Korean hemorrhagic fever. Presently, only anecdotal reports support the efficacy of this drug for treatment of measles or parainfluenza. Ribavirin treatment for RSV infections has been controversial because of the aerosol route of administration, concern for potential toxicity for exposed persons, cost, and the unpredictable and highly variable course of illness in the absence of specific therapy. These issues necessitate ongoing review of ribavirin therapy and the following updated recommendations by the American Academy of Pediatrics.
BACKGROUND
RSV Disease
Respiratory syncytial virus is the most important cause of lower respiratory tract disease in infants and young children. Disease usually appears in yearly outbreaks in the winter or spring, and essentially all children become infected during their first 3 years of life. The number of infected infants who require hospitalization has been estimated to range from 1 to 50 per 1000 in different locations. Currently, the mortality rate in hospitalized infants who previously were healthy is low (less than 1%). In infants with underlying diseases, however, the mortality can be much higher. Conditions that increase the risk of severe or fatal RSV infection are cyanotic or complicated congenital heart disease (including pulmonary hypertension); underlying pulmonary disease, especially bronchopulmonary dysplasia; prematurity; and immunodeficiency disease or therapy causing immunosuppression at any age.
Lead Poisoning: Twenty Years After
Authors: SACHS HENRIETTA , MOEL DONALD I. 
Published: December 2021

To the Editor.—
In October 1991, the Centers for Disease Control decreased the blood lead level PbB) from 25 to 10 µg/dL and designated it as abnormal because of "overwhelming and compelling scientific evidence"1 that 10 µg/dL is associated with adverse neurobehavioral development. We have evidence to the contrary, obtained in a long-term follow-up of severely lead-poisoned children whom we treated before 1972 for PbBs between 80 and 470 µg/dL (mean, 150.3 ± 77.1 µg/dL); their mean age was 28 months.
Homosexuality and Adolescence
Authors:   COMMITTEE ON ADOLESCENCE
Published: December 2021

Pediatricians should be aware that some of the youths in their care may be homosexual or have concerns about sexual orientation. Caregivers should provide factual, current, nonjudgmental information in a confidential manner. These youths may present to physicians seeking information about homosexuality, STDs, substance abuse, or various psychosocial difficulties. The pediatrician should ensure that each youth receives a thorough medical history and physical examination (including appropriate laboratory tests), as well as STD (including HIV) counseling and, if necessary, appropriate treatment. The health care professional should also be attentive to various potential psychosocial difficulties and offer counseling or refer for counseling when necessary.
The American Academy of Pediatrics reaffirms the physician's responsibility to provide comprehensive health care and guidance for all adolescents, including gay and lesbian adolescents and those young people struggling with issues of sexual orientation. The deadly consequences of AIDS and adolescent suicide underscore the critical need to address and seek to prevent the major physical and mental health problems that confront gay and lesbian youths in their transition to a healthy adulthood.
In Reply: Different Views on Adolescent Abortion
Authors: FLEMING GRETCHEN V. , O'CONNOR KAREN 
Published: December 2021

This is in reply to several letters that have been received by Pediatrics commenting on our article published in Pediatrics in March 1993, entitled "Adolescent Abortion: Views of the Membership of the American Academy of Pediatrics" (91:561-565).
The letter from Patricia Lee June, MD, makes several points that merit further discussion. First, she defends the safety of childbirth to adolescents, based on maternal mortality statistics. This is certainly justified, but, as we pointed out in the paper, the risks of adolescent pregnancy are seen more clearly instead in problems of social functioning.
COURTS LET UTILIZATION REVIEW FIRMS OFF THE HOOK—AND LEAVE DOCTORS ON
Authors: L. J. F. 
Published: December 2021

One of the most striking—and disturbing—changes under way in medicine is the rapid erosion of the physician's authority for managing the patient. More and more allied health professionals and organizations such as HMOs and PPOs clamor for the right to direct patient care.
Yet when it comes to assuming some of the risk for malpractice suits, these groups want the burden to remain entirely on the doctor.
Another claimant to knowing better than doctors what patients need: the utilization review firm. UR companies have made doctors' lives miserable by denying hospitalization, demanding earlier discharge, and generally questioning every aspect of patient management.
When a malpractice suit arises, though, the UR firms all too often deny any responsibility. How? They say they're just interpreting the benefits a plan offers. This and other forms of legal hairsplitting leave the doctor holding the malpractice bag.
Effect of Ambient Temperature on Capillary Refill in Healthy Children
Authors: Gorelick Marc H. , Shaw Kathy N. , Baker M. Douglas 
Published: December 2021

Objectives. To assess the effect of moderately decreased ambient temperature on capillary refill (CR) time in healthy children, and to measure the reliability of CR measurements between observers.
Design. Prospective interventional study with crossover design.
Setting. Urban pediatric emergency department.
Participants. 32 well-hydrated children aged 1 month to 12 years brought to the emergency department for care of minor illness or injury.
Interventions. Participants were assigned in random order to a 15-minute waiting period in each of two rooms, with and without air-conditioning (cool and warm rooms, respectively). At the end of each waiting period, fingertip CR was measured with a stopwatch, three times by each of one or more three trained observers.
Results. Mean CR time was 0.85 ± 0.45 seconds in the warm room (mean ambient temperature 25.7°C) vs 2.39 ± 0.76 seconds in the cool room (mean temperature 19.4°C). The mean overall difference in CR time between the two environments was 1.53 seconds (95% confidence interval [CI]: 1.31, 1.75; P &lt; .001); the difference was significant regardless of age or sequence of exposure. 100% of patients were considered to have normal CR (less than 2 seconds) in the warm room, whereas only 31% were considered normal in the cool room. In the 16 patients with CR measured by three observers, interobserver reliability was fair, with an intraclass correlation coefficient of 0.70 (95% CI: 0.56, 0.85), and κ of 0.54 (95% CI: 0.33, 0.73).
Conclusions. Decreases in ambient temperature within a range found in typical office/emergency department settings may cause significant prolongation of CR time in children with normal circulatory status. There is marked interobserver variability in the measurement of CR even when performed by experienced observers. These findings suggest limitations to the use of CR in the assessment of ill or injured children.
Shunts in Patients With Respiratory Distress Syndrome
Authors: SKINNER JONATHAN R. , HEY EDMUND N. 
Published: December 2021

To the Editor.—
We enjoyed this recent paper from Walther et al1 assessing pressure gradient across the arterial duct in neonates with respiratory distress syndrome. However, the initial statement that there have been no previous studies relating severity of respiratory distress syndrome to pulmonary artery pressure is incorrect. The conclusions of this study need to be related to the three earlier studies of Halliday et al,2 Evans and Archer,3 and Skinner et al,4 all of which studied the relationship of pulmonary artery pressure to disease severity.
Annual Summary of Vital Statistics—1992
Authors: Wegman Myron E. 
Published: December 2021

A new low in the infant mortality rate was reached in 1992, at 848.7 deaths per 100 000 live births, a decline of 5% from 894.4 in 1991. Birth, death, and marriage rates were also lower, but the divorce rate inched up to 4.8 per 1000 population, the same level as in 1988. The age-adjusted death rate was 504.9 per 100 000 population, the lowest in US history. Natural increase in the population, excess of births over deaths, decreased from 1 941 389 to 1 907 000, from 7.7 to 7.5 per 1000 population. Births outside hospital were fewer, both in numbers and in proportion to all births. Birth rates increased at both ends of the age range but declined in the principal childbearing years. Births to unmarried mothers increased again, comprising more than one fifth of white births and two thirds of black births. A higher proportion of newborns weighed less than 2500 g than in 1989.
Life expectancy at birth increased again, to 75.7 years overall, paralleled in both sexes and white and black races. The age-adjusted death rate for cardiovascular diseases declined, but malignancies of the respiratory system increased again, to almost six times what it was in 1940. Chronic obstructive pulmonary diseases, despite slight improvement since 1991, caused death more than eight times as often as in 1940.
Black and white infant mortality rates both showed a decline, greater in the white neonatal component; the black/white discrepancy widened slightly. Infant mortality in those of Hispanic origin was slightly higher than non-Hispanic whites, but the National Center for Health Statistics warns that Hispanic rates may be understated. There was little change in causes of infant mortality, or in black to white ratios for the several causes.
On the world scene, most industrialized countries showed declines in infant mortality matching the US. In 1991, 21 countries, 15 in Europe, 3 in Asia, 2 in Oceania, and 1 in North America, had infant mortality rates less than the US. The decline in most other countries has been more rapid than in the US.
Randomized Trial of Silver Nitrate, Erythromycin, and No Eye Prophylaxis for the Prevention of Conjunctivitis Among Newborns Not at Risk for Gonococcal Ophthalmitis
Authors: Bell Thomas A. , Grayston J. Thomas , Krohn Marijane A. , Kronmal Richard A. ,   The Eye Prophylaxis Study Group
Published: December 2021

Objective. To compare the efficacy of commonly used forms of eye prophylaxis for newborns with no prophylaxis in the prevention of nongonococcal conjunctivitis.
Design. Randomized doubly masked clinical trial.
Setting. University of Washington Hospital and affiliated clinics, Seattle, between 1985 and 1990.
Subjects. The medical records of 8499 women were evaluated for possible participation; 2577 were eligible. Of the 758 enrolled, the infants of 630 were evaluable.
Intervention. Comparison of silver nitrate, erythromycin, and no eye prophylaxis given at birth for the prevention of conjunctivitis.
Main outcome measures. Conjunctivitis during the first 60 days of life and nasolacrimal duct patency in the first 2 days of life.
Results. The frequency of impatent tear ducts at the 30- to 48-hour examination did not differ significantly by prophylaxis group. Among the 630 infants randomized and observed, 109 (17%) developed mild conjunctivitis. Sixty-nine (63%) of the cases appeared during the first 2 weeks of life. After 2 months of observation, infants allocated to silver nitrate eye prophylaxis at birth had a 39% lower rate of conjunctivitis (hazard ratio = 0.61, 95% confidence interval = 0.39 to 0.97), and those allocated to erythromycin had a 31% lower rate of conjunctivitis (hazaid ratio = 0.69, 95% confidence interval = 0.44 to 1.07), than did those allocated to no prophylaxis.
Conclusion. Silver nitrate eye prophylaxis caused no sustained deleterious effects and even provided some benefit to infants born to women without Neisseria gonorrhoeae. However, the effect was modest and against microorganisms of low virulence. The results suggest that parental choice of a prophylaxis agent including no prophylaxis is reasonable for women receiving prenatal care and who are screened for sexually transmitted diseases during pregnancy.
Surfactant Therapy and Intracranial Hemorrhage: Review of the Literature and Results of New Analyses
Authors: Gunkel J. Harry , Banks Phillip L.C. 
Published: December 2021

Background and objective. Surfactant replacement is a powerful therapy for newborns with respiratory distress syndrome, but limited observations suggest that alterations of cerebral blood flow can accompany the use of several available surfactants. An early European multicenter controlled study with beractant demonstrated an increased rate of intracranial hemorrhage in treated patients. Nine additional controlled studies were subsequently performed and included follow-up evaluations through 2 years adjusted age. This clinical experience provided a database of approximately 1700 infants to examine retrospectively for any relationship between surfactant therapy and intracranial hemorrhage.
Methods. Cumulative incidence rates, hazard ratios, and 95% confidence intervals for intracranial hemorrhage were computed for each study and for appropriately pooled studies of similar design. Where an association between surfactant and the risk of intracranial hemorrhage was found, additional analyses were performed to attempt to identify intermediate physiologic events that might link administration of surfactant to the occurrence of intracranial hemorrhage. These analyses were guided by literature reports of hemodynamic changes observed in association with surfactant therapy.
Results. During the controlled studies with beractant, treated newborns of 600 to 750 g birth weight were at higher risk for grades I and II intracranial hemorrhage than control newborns. There was no increased risk for grades III and IV hemorrhage among these newborns, nor was there increased risk of hemorrhage among any other patient groups. This finding did not result in increased morbidity for the affected patients; at 2 years adjusted age, they were not different from the control infants of 600 to 750 g birth weight. Retrospective examination of the database could not pinpoint the mechanism behind the finding, but it might have been related to changes in cerebral blood flow after surfactant uncompensated by ventilator management of oxygenation and ventilation.
Conclusion. Surfactant therapy may set in motion hemodynamic changes that could predispose to intracranial hemorrhage in certain circumstances, but this can probably be compensated by careful management of oxygenation and ventilation. A relationship between surfactant therapy and intracranial hemorrhage is probably not isolated to any particular surfactant preparation or method of delivery; studies comparing surfactants have shown no differences in rates of intracranial hemorrhage.
Neurodevelopmental Testing of Children Born to Human Immunodeficiency Virus Type 1 Seropositive and Seronegative Mothers: A Prospective Cohort Study in Kigali, Rwanda
Authors: Msellati Philippe , Lepage Philippe , Hitimana Deo-Gratias , Van Goethem Christiaan , Van de Perre Philippe , Dabis François 
Published: December 2021

Objective. The results of developmental testing of 218 children born to human immunodeficiency virus (HIV)-seropositive mothers and infected or uninfected themselves were compared with those of 218 children born to HIV-seronegative mothers in an ongoing cohort study in Kigali, Rwanda.
Methods. When the children were 6, 12, 18, and 24 months of age, a specific neurodevelopmental examination was performed blindly by study physicians assessing gross motor development, fine motor development, language acquisition, and social contacts.
Results. Only one acute severe HIV-related encephalopathy was identified among the 50 infected children. The proportion of abnormal neurologic examinations in HIV-infected children varied from 15% to 40% according to age and was always higher than in HIV-uninfected children born to HIV-seropositive and seronegative mothers (≤5% or less of abnormal examinations at each time period). fter excluding those children with clinical ac-quired immunodeficiency syndrome (AIDS) from the analysis, the proportion of abnormal examinations in infected children was 12.5% at 6 months, 16% at 12 months, 20% at 18 months, and 9% at 24 months of age and was still more frequent than in HIV-uninfected children. The developmental delay was principally due to significantly lower gross motor scores.
Conclusions. HIV-1-infected children are more frequently developmentally delayed than uninfected children during the first 2 years of life in this African population. This developmental delay is related to the AIDS stage of pediatric HIV infection.
Psychosocial Risks of Chronic Health Conditions in Childhood and Adolescence
Authors:   Committee on Children With Disabilities and Committee on Psychosocial Aspects of Child and Family Health
Published: December 2021

Chronic health conditions affect many children and adolescents. These conditions are illnesses or impairments that are expected to last for an extended period of time and require medical attention and care that is above and beyond what would normally be expected for a child or adolescent of the same age, extensive hospitalization, or in-home health services.1 These conditions include, among others, juvenile rheumatoid arthritis, asthma, cystic fibrosis, diabetes, spina bifida, hemophilia, seizure disorders, neuromuscular disease, acquired immunodeficiency syndrome, and congenital heart diseases. Although each specific condition may be relatively or extremely rare, when they are considered together, many children and adolescents are affected.
Health conditions may be characterized by their duration and their severity. Although these terms are often linked, they refer to different aspects of a health condition. A chronic condition is generally one that has lasted or is expected to last more than a defined period of time, usually 3 months or longer. Conditions vary widely in their onset, course, and duration.2 Severity refers to the impact a condition has on a child's physical, intellectual, psychological, or social functioning.3 This impact may occur as a result of persistent symptoms, required treatments, limitations of activity or mobility, or interference with school, recreation, work, and family activities.
Current estimates are that between 10 and 20 million American children and adolescents have some type of chronic health condition or impairment. Most of these conditions are relatively mild and interfere little with the children's ability to participate in usual childhood activities.4 However.
Statistics and Swedish `Sambos'
Authors: ALLEN STEVEN R. 
Published: December 2021

To the Editor.—
I read with interest Myron E. Wegman's comments about infant mortality in Sweden in "Annual Summary of Vital Statistics—1991" (Pediatrics. 1992;90:835-845). It is necessary to understand a major difference between Sweden and the United States that renders Swedish statistics on out-of-wedlock birth irrelevant to the US statistics. The vast majority of children born out-of-wedlock in Sweden are nevertheless born into a stable two-parent family; many Sweden simply choose to live together without being married.
What Sunscreen Should I Use for My 3-Month-Old Baby?
Authors: MORELLI JOSEPH G. , WESTON WILLIAM L. 
Published: December 2021

To the Editor.—
With the commercial availability of sunscreens for children, we are frequently asked by parents and by our colleagues in Pediatrics, "What sunscreen should be used on babies under 6 months?" Our answer is simple. "None." Although there is no evidence to suggest that sunscreens are harmful to infants, there is no compelling reason for infants less than 6 months to have sun exposure prolonged enough to require sunscreens. Babies younger than 6 months are not mobile and will not be exposed to the sun unless placed there.