bluuebunny/crossref_metadata_2025_split huggingface dataset:
Round Table Discussion
Authors: GRULEE CLIFFORD G. , ELAM JAMES O. 
Published: December 2021

1. The following equipment was described:
A. A tracheotomy inhalator for administering humidified oxygen, with optional use of positive pressure.
B. Modifications in the respirator collar and headpiece to accommodate the tracheotomy patient.
2. A scheme of treatment which distinguishes between ventilatory deficiency and alveolar deficiency in poliomyelitis was mentioned.
3. The oximeter is useful in determining the indications for oxygen therapy, and artificial respiration and, in some instances, tracheotomy.
4. The bulbar patient with excessive mucus accumulation in the tracheobronchial tree may require frequent bronchoscopic aspiration. Removal of mucus by suction catheter should be limited to brief intervals.
5. The administration of oxygen to the respirator patient before and during the time the respirator ports are open for 5 minute intervals prevents hypoxic insults.
6. Patients may be liberated from the respirator as rapidly as is physiologically expedient on the basis of oximetry.
7. The respirator tends to produce hyperventilation when the arbitrary pressures are used. This may be prevented by adjusting the pressure on the basis of measured respiratory minute volume.
8. Following excessive ventilation in the respirator the patient becomes uncomfortable by sudden reduction in the respirator pressure apparently because his respiratory center has become adjusted to a low arterial CO2 tension. Hence the patient's comfort is not a satisfactory index of normal ventilation in the respirator.
CONGENITAL CORONARY ARTERIOVENOUS FISTULA
Authors: Gasul Benjamin M. , Arcilla Rene A. , Fell Egbert H. , Lynfield Joshua , Bicoff J. Pedro , Luan Lawrence L. 
Published: December 2021

Five patients with congenital coronary arteriovenous fistula communicating with the right ventricle are presented. Case 5, a 3-week-old infant, represents the youngest patient to be diagnosed and studied, in the literature. The clinical features, hemodynamics and angiocardiographic findings are analyzed.
Two major types of fistula affecting the coronary arterial system are recognized. In coronary arteriovenous fistula the functional disturbance consists of a left-to-right shunt, and a diastolic overloading of the left heart chambers and of the right heart chambers into which the fistula opens. In coronary arterio-systemic fistula the altered hemodynamics are essentially those of an internal fistula confined to the systemic circulation. A postulate regarding the nature of the blood flow through the various types of fistulae is given, and this is correlated with the phonocardiographic and hemodynamic findings.
The diagnosis should be strongly suspected on the basis of a loud, superficial and continuous cardiac murmur localized in an area atypical for a patent ductus arteriosus. If the continuous murmur is maximal at the pulmonary area, it is extremely difficult to differentiate this anomaly from a patent ductus arteriosus and/or aortic-pulmonary septal defect. Phonocardiographic demonstration of a louder diastolic than systolic component is very suggestive of a coronary arteriovenous fistula communicating with the right ventricle.
The roentgenologic and electrocardiographic findings are not specific. Cardiac catheterization is not diagnostic, although when correlated with the clinical picture it may strongly suggest the diagnosis.
Angiocardiography, particularly retrograde aortography, is diagnostic. The information obtained from the various methods used is discussed. Dilatation of the ascending aorta demonstrated by angiocardiography was a constant finding in our series. Its pathogenesis is discussed, and its importance as a differential sign in the angiocardiogram against the diagnosis of ventricular septal defect is stressed. The differential diagnosis by retrograde aortography between coronary arteriovenous fistula into the right ventricle and ruptured aortic sinus of Valsalva into the same chamber is discussed and illustrated.
While this anomaly is compatible with longevity, the potential complications to which the patient with it may be subjected and the relative innocuousness of corrective surgery without the need for hypothermia or cardiopulmonary bypass, demonstrated in previous reports and in our series, make us believe that surgery should be considered in practically all cases of fistula of the coronary arterial system.
ENVIRONMENTAL FACTORS AFFECTING HUMAN DEVELOPMENT, BEFORE AND AFTER BIRTH
Authors: Knobloch Hilda , Pasamanick Benjamin 
Published: December 2021

The relationship of socioeconomic factors to pregnancy experience and later neuropsychiatric functioning was investigated by a series of retrospective and anterospective epidemiologic studies.
The studies demonstrated an increased amount of brain damage in the lower socioeconomic strata, where a higher incidence of complications of pregnancy and a greater number of babies with low birth weights are found.
In 992 infants examined at 40 weeks of age, pregnancy experience, birth weight and later physical status were the only major factors which could explain group differences in developmental quotients.
The studies further indicated that the relatively small amount of variability found in infancy could be explained largely by the presence of damage to the central nervous system, and supported the view that at this period of life social factors affect the psychologic level of integration primarily through biologic mechanisms. Later, during the preschool period, the direct influence of the sociocultural forces on the psychologic performance becomes manifest.
IMMUNOHEMATOLOGIC OBSERVATIONS ON ERYTHROBLASTOTIC INFANTS. I. DIAGNOSIS AND PROGNOSIS
Authors: STURGEON PHILLIP 
Published: December 2021

With the use of the described developing test and other technics in immunohematologic observations on red blood cells and sera from untreated neonatal infants suspected of having erythroblastosis, it has been possible to make a specific diagnosis and to obtain data which will contribute to a more accurate prognosis than has been possible heretofore.
The AB serum, saline, and blocking tests as described lack the specificity and sensitivity of the direct developing tests for diagnosis; but when used alone, if the results are positive, they are of some value in the estimation of prognosis.
RUMINATION AND GROWTH FAILURE IN MALE FRATERNAL TWIN
Authors: Hollowell Joseph G. , Gardner Lytt l. 
Published: December 2021

Observations on a male infant with the rumination syndrome and growth failure are presented. The infant's twin sister did not exhibit rumination. The rumination and growth failure in the male twin began concurrently with intense marital conflict and anxiety in the family environment. Hospitalization of the male and mothering by the nursing staff strikingly reversed his growth failure. With aid from multiple sources a more suitable family environment was established, the father returned to the home, and psychiatric assistance was provided. Special attention was given to the male twin during and after the hospitalization. During this time the female twin's linear growth and weight increments began to decelerate, so that by age 2 3/12 years both twins were of comparable size. At age 3 4/12 years both were slightly above the 3rd percentile for linear growth.
Possible explanations for the findings are presented and the subject of rumination in infants is reviewed. These cases offer further evidence that growth failure associated with certain types of disordered family environments may be psychosomatic in origin.
Effects of Vitamin C on Osteogenesis Imperfecta
Authors: Kurz Diann , Eyring Edward J. 
Published: December 2021

Biochemical and clinical effects of vitamin C on children with osteogenesis imperfecta have been documented. There is a significant drop in serum zinc correlated with ascorbate ingestion (25 to 50 mg/kg/day). This tendency contrasts to the trend in normal controls which is upward. Family members behave either like the affected child or normally whereas control families show only the expected increases.
Incidence of fracturing drops with chronic vitamin C ingestion. While encouraging this observation is not well controlled. Larger groups of patients must be observed before arriving at firm conclusions.
Report of the Ad Hoc Task Force on Circumcision
Authors: Thompson Hugh C. , King Lowell R. , Knox Eric , Korones Sheldon B. 
Published: December 2021

There is no absolute medical indication for routine circumcision of the newborn. The physician should provide parents with information pertaining to the long-term medical effects of circumcision and noncircumcision, so that they make a thoughtful decision. It is recommended that this discussion take place before the birth of the infant, so the parental consent to the surgical procedure, if given, will be truly informed.
A program of education leading to continuing good personal hygiene would offer all the advantages of routine circumcision without the attendant surgical risk. Therefore, circumcision of the male neonate cannot be considered an essential component of adequate total health care.
Erythromycin's Effect on Theophylline Blood Level
Authors: Cummins Leo H. , Kozak Peter P. , Gillman Sherwin A. 
Published: December 2021

Recently we have been performing serum theophylline determinations in our office, using a Waters high-pressure liquid chromatography unit and a simplified micromethod.1
Theophylline determinations done on patients who were receiving bronchodilators orally around the clock and who had problems with vomiting resulted in a surprising association of high theophylline levels in some patients receiving erythromycin. Several of these patients had serum theophylline determinations prior to starting erythromycin. The serum theophylline determination was repeated because of vomiting and the theophylline levels were significantly elevated (Table I).
Neonatal Anesthesia
Authors:   Committee on Fetus and Newborn,   Committee on Drugs,   Section on Anesthesiology,   Section on Surgery
Published: December 2021

In the past, some practicing physicians have advocated withholding anesthetic or analgesic agents from neonates undergoing surgical procedures. The rationale expressed for such practice is that some neonates undergoing surgery are often so unstable that the risk of an anesthetic agent is too great to justify the possible benefit of pain relief. An analogy may be drawn to the adult patient with major trauma who must undergo life-saving surgery in whom anesthesia is reduced or withheld because of the fear of worsening an already compromised physiologic homeostasis.1 Also cited in support of this practice is the impression that nerve pathways are not sufficiently myelinated to transmit painful stimuli or that neonates do not have sufficiently integrated cortical function to recall painful experiences.
There is an increasing body of evidence that neonates, including those born preterm, demonstrate physiologic responses to surgical procedures that are similar to those demonstrated by adults and that these responses can be lessened with anesthetic agents.2-6 Other studies have suggested that stability of variables such as blood pressure, heart rate, and oxygenation is important in reducing complications such as intraventricular hemorrhage or pulmonary hypertension.7,8 There is also increasing evidence that neonatal cortical function is far greater than previously thought9,10 and some suggestion that short-term behavior may be affected by prior painful stimuli.11,12
The Committee on Fetus and Newborn, The Committee on Drugs, the Section on Anesthesiology, and the Section on Surgery believe that local or systemic pharmacologic agents now available permit relatively safe administration of anesthesia or analgesia to neonates undergoing surgical procedures and that such administration is indicated according to the usual guidelines for the administration of anesthesia to high-risk, potentially unstable patients.
Benign Epilepsy of Childhood and Gowers's Statements
Authors: FREEMAN JOHN M. 
Published: December 2021

In Reply.—
Mea Culpa! One should always go back to the original citation as indicated by Drs Bouma and Peters. Fortunately, Gower's statement would have supported both our thesis and my favorite dictum "All that's new is rarely true, and all that's true is rarely new." The authors' speculation about treating for a short period of time (3 to 6 months) is equally as valid as ours not to treat. What is needed are studies and a rethinking of the prevalent concept that all epilepsy should be treated for 2-4 years or more.
Report of the Task Force on Pertussis and Pertussis Immunization—1988
Authors: Cherry James D. , Brunell Philip A. , Golden Gerald S. , Karzon David T. 
Published: December 2021

Pertussis (whooping cough) is an endemic and epidemic disease due to Bordetella pertussis. The disease has been and still is a major cause of morbidity and mortality in young children throughout the world. The World Health Organization estimates that 600,000 deaths due to pertussis occur yearly; virtually all of these deaths occurred in unimmunized infants.1 In the United States, pertussis has been successfully controlled by the routine mass immunization of infants and children. In the prevaccine era, there were 115,000 to 270,000 cases of pertussis and 5,000 to 10,000 deaths due to the disease each year.2 During the last 10 years, there have been 1,200 to 4,000 cases and five to ten deaths per year.3-6
Unfortunately, the control of pertussis by immunization has not enjoyed sustained international success because of controversy relating to vaccine reactions and effectiveness. Since 1982 this controversy has been a problem in the United States. Most pediatricians as well as a large number of parents are aware of the present pertussis vaccine controversy; however, few understand the facts. This controversy involving the media, political and legal sectors, and the scientific community is a major threat to our present immunization program and the future control of pertussis in the United States7-11 ("20/20," ABC News, Feb 5, 1985; "DPT: Vaccine Roulette," National Broadcasting Co, Date, 1982; Democrat and Chronicle, Rochester, NY, March 8-12, 1987, p 1; The Fresno Bee, Dec 2-3, 1984, p 1; Dec 5, 1987, p B14). Because of this, a task force on pertussis and pertussis vaccine was created by the Executive Board of the American Academy of Pediatrics to review the problem.
d-Penicillamine and Retinopathy of Prematurity
Authors: LAKATOS LAJOS 
Published: December 2021

To the Editor.—
The letter to the editor by Johnson et al1 and studies by others regarding vitamin E prophylaxis for retinopathy of prematurity suggest that further research into the prevention of retinopathy of prematurity should not be limited to vitamin E.
On the basis of clinical observations we reported that d-penicillamine treatment in the neonatal period was associated with a marked decrease in the incidence of severe retrolental fibroplasia among the very low birth weight infants.2
Changing Profile of Congenital Heart Disease
Authors: BENSON D. WOODROW , Moller James , Fyler Donald C. , Fixler David E. 
Published: December 2021

In the past 20 years, considerable change has occurred in the profile of congenital heart disease regarding both diagnosis and treatment. The profile has changed from older to younger patients; the essence of this change has been from pediatric to infant to neonatal cardiology. There has been a shift from palliative to more definitive surgical procedures and a change from invasive (cardiac catheterization) to noninvasive (echocardiography) diagnostic methods. The profile has changed from definitive surgical treatment limited to simple lesions to surgical treatment of the most complex lesions.
There has been steady improvement in the recognition of cases of congenital heart disease. Of all children admitted to hospitals for treatment of congenital heart disease, the portion less than three days of age has increased from 24% in 1969 to 1972 to 33% in 1982 to 1986.
Intentional Banding
Authors: JOHNSON CHARLES F. 
Published: December 2021

Banton et al have called attention to banding of children's appendages in their description of six new cases. By emphasizing recognition and treatment of this unusual malady, they inadvertently diminished the importance of considering a nonaccidental cause, in certain instances.
The possibility of intentional injury was not suggest in cases 5 and 6, which involved banding in infants by fabric filaments from a known object—mittens. In case 2, the source of the fiber was said to be "apparently from an item of clothing." In cases 1, 3, and 4, the constrictions were caused by hairs.
Children, Adolescents, and Television
Authors:   Committee on Communications
Published: December 2021

In 1984 the American Academy of Pediatrics Task Force on Children and Television issued a statement1 that cautioned pediatricians and parents about the potential for television to promote violent and/or aggressive behavior and obesity. The influence of television on early sexual activity, drug and alcohol use and abuse, school performance, and perpetuation of ethnic stereotypes was also stressed. Advances in our understanding of the effects of television on children have prompted this update of the Academy's policy.
In 1989 the average child in the United States still spent more time watching television than performing any other activity except sleeping. According to recent Nielsen data,2 children aged 2 to 5 years view approximately 25 hours of television per week, children aged 6 to 11 years watch more than 22 hours per week, and adolescents 12 to 17 years watch 23 hours of television per week. Although the amount of commercial television viewed by children has declined since 1980, the most recent estimates of television viewing do not include the use of video cassette recorders. Therefore, the amount of time that children in our country spend in front of the television set has probably not decreased significantly in the past 8 years.
Television's influence on children is a function of the length of time they spend watching and the cumulative effect of what they see. By the time today's child reaches age 70, he or she will have spent approximately 7 years watching television.3 Therefore, television may displace more active experience of the world.
Dexamethasone Therapy for Bacterial Meningitis in Infants and Children
Authors:   Committee on Infectious Diseases
Published: December 2021

BACKGROUND
Bacterial meningitis affects an estimated 15 000 infants and children in the United States each year. The case-fatality rates for these patients are from 5% to 10%; as many as 20% to 30% of survivors have long-term sequelae, the most common of which is hearing impairment.1 The reported incidence of hearing loss after meningitis has ranged from 5% to 20% of patients, depending on the selection of patients, techniques used to assess hearing, and etiology.2-5 In 1972 to 1977, Dodge and co-workers2 documented hearing loss in 31% of patients with Streptococcus pneumoniae meningitis, 10% with Neisseria meningitidis meningitis, and 6% with Haemophilus influenzae meningitis. Bilateral sensorineural hearing impairment occurred in 14%, 10%, and 3%, respectively. Newer antimicrobial agents with superior bactericidal activity in cerebrospinal fluid have not reduced morbidity and case-fatality rates compared with conventional therapy.
The pathophysiologic events believed to contribute to adverse outcome from bacterial meningitis include alteration of cerebral capillary endothelial cells that comprise the blood-brain barrier, cytotoxic and vasogenic cerebral edema, and increased intracranial pressure.6 These events can lead to decreased cerebral perfusion pressure with a resultant diminution in cerebral blood flow causing regional hypoxia and focal ischemia of brain tissue.
Because of its anti-inflammatory effects, corticosteroid therapy has been evaluated in experimental meningitis and in infants and children with meningitis. Dexamethasone produced significant reductions in intracranial pressure, brain edema, and lactate concentrations in cerebrospinal fluid in experimental H influenzae and S pneumoniae meningitis.7,8 In addition, the administration of dexamethasone was associated with decreased concentrations of prostaglandin E2 in cerebrospinal fluid and lowered mortality and clinically evident neurologic sequelae in rabbits with experimental pneumococcal meningitis.9
Primary Care: The Future for Pediatric Education
Authors: Alpert Joel J. 
Published: December 2021

There is a continuing crisis in primary care, characterized by inadequate numbers of appropriately trained primary care physicians and the failure to mount an effective and consistent graduate educational program for primary care. This paper reviews the history of the primary care crisis; revisits the definition of primary care; and, through identification of critical issues, presents a primary care educational agenda for the 1990s. Pediatrics is at a crossroads regarding primary care, as powerful social and economic forces are impacting on today's major pediatric care problems.
Before the second World War there were more than 300 primary care physicians available for each 100 000 of our population. Today the ratio is 75 for 100 000. This is despite the fact that a shortage of 50 000 physicians 10 years ago no longer exists. The majority view is that a physician surplus of 70 000 will be present by the early 1990s.1 Whether there is a surplus is subject to interpretation and the surplus may end up as nonexistent. Moreover, the availability of primary care physicians varies with geographic location, and even a single figure for this nation provides a distorted picture. The shortage is especially serious in inner cities and in many rural areas. In addition, the use of overall numbers assumes that all primary care physicians are appropriately trained in the general disciplines.
For the past century, physicians have cared for patients usually as family physicians. Today, however, the generalist has been replaced by the specialist. Is this a function of financial rewards and society's needs and values or the educational experience?
Race, Culture, and Ethnicity
Authors: PACHTER LEE M. 
Published: December 2021

To the Editor.—
In a recent article published in Pediatrics regarding cosleeping in a community sample of 2- to 3-year-old children,1 Madansky and Edelbrock reported that cosleeping was more common among nonwhite families and that this might reflect a "subcultural practice." Putting aside for the moment the question of what is meant by "subculture," I feel that the use of "white" and "nonwhite" or "black" as cultural categories requires some discussion.
There is a distinction that has to be made between the concepts of "race" and "culture."