bluuebunny/crossref_metadata_2025_split huggingface dataset:
Recurrent Abscess Formation Following DTP Immunizations: Association with Hypersensitivity to Tetanus Toxoid
Authors: CHURCH JOSEPH A. , RICHARDS WARREN 
Published: December 2021

Adverse local reactions to vaccines containing diphtheria and tetanus toxoids and pertussis antigen (DTP) are common, but generally benign. Most often, these reactions are manifested by erythema, induration, and tenderness occurring at the injection site 12 to 24 hours following immunization.1-3 Less frequently, abscess formation may complicate intramuscular injections and these may be staphylococcal, clostridial, or sterile in etiology.4
Tetanus toxoid has been associated with a reaction incidence of 3% to 13%,5,6 and adverse reactions appear to be related to the number of prior immunizations and the height of preexisting antibody responses.3,6 However, recurrent abscess formation associated with hypersensitivity to one or more of the components of the DTP vaccine has not been reported previously.
Polaroid Confirmation of the `Difficult-to-Demonstrate' Inguinal Hernia
Authors: KRASNA IRWIN H. 
Published: December 2021

Pediatric surgeons are often confronted with a child referred for an inguinal hernia, in which the hernia cannot be elicited or demonstrated at physical examination. The mother usually gives an excellent history, but in spite of pushing and prodding of the baby, and making the baby cry, the hernia does not appear. This report will demonstrate how a clever mother confirmed the presence of a bulge in spite of the surgeon's inability to demonstrate it on three visits.
CASE REPORT
A 15-month-old male infant was seen because the mother had noticed a left inguinal bulge. On physical examination, in spite of every maneuver attempted, no bulge was demonstrated.
Misleading Editorial
Authors: LILDHOLDT TORBEN 
Published: December 2021

To the Editor.—
The commentary, "The Attack on the Tympanic Membrane,"1 "calls for some comments as the author referred to a preliminary report of my study.2
Stickler1 suggests that we "demand prospective studies of untested surgical procedures before our patients are subjected to them," and nobody can disagree with that. However, the aim of such investigations is to arrive at a scientific analysis that is based on a weighing of the pros and cons. This process is going on concerning the use of ventilation tubes in secretory otitis media and, if a status has to be made, both types of information should be evaluated.
Ipecac Use in the Home
Authors: RUMACK BARRY H. 
Published: December 2021

The two articles concerning syrup of ipecac in the home (appearing in this issue of Pediatrics) raise and partially answer some questions of importance to pediatricians and poison centers. As is constant in the medical literature, additional questions are raised which provide grist for other studies. It seems unlikely that we will ever run out of questions and completely "solve" the quandries of pediatrics or poisoning.
Both studies rely on the telephone management and follow-up of patients. This admittedly results in secondhand data and can never be as good as that which an individual researcher observes. It is, however, "real" in that poison centers and pediatricians operate in this way much of the time.
Preventing Sexual Abuse of Children in Day Care: Whose Problem Is It Anyway?
Authors: KRUGMAN RICHARD D. 
Published: December 2021

In his 1977 C. Anderson Aldrich Award address, Henry Kempe highlighted child sexual abuse as "another hidden problem." It is no longer hidden. Public and professional awareness of the issue is rapidly increasing (reported cases have increased more than 600% in the last 7 years). The disclosure of multiple child victims in day care centers in California, Nevada, New York, and elsewhere has led to demands that "something be done."
Legislators have responded by passing packages of laws that increase penalties for perpetrators, mandate long sentences for repeat offenders, and/ or require fingerprinting and FBI (Federal Bureau of Investigation) background checks on day care center employees.
Questions on the Vitamin E Study
Authors: SPEER MICHAEL E. , RUDOLPH ARNOLD J. , HITTNER HELEN M. 
Published: December 2021

In Reply.—
Regarding the efficacy of a few early intramuscular injections of vitamin E to decrease the incidence and severity of intraventricular hemorrhage reported by Speer et al,1 Jansen adds his concerns to those already expressed in the commentary by Phelps.2
The intraventricular hemorrhage data were a retrospective study, the inborn and outborn infants were not randomly separated into control and treatment groups, and the small numbers resulted in some nonsignificant differences between control infants and treated infants.
Subdural Hemorrhage in Utero
Authors: GUNN TANIA R. , MOK PUI M. , BECROFT DAVID M. O. 
Published: December 2021

Acute subdural hemorrhage following the trauma of a difficult birth is a recognized cause of an increase in head circumference and anemia soon after birth.1 Although major subdural hemorrhages occurring in the fetus before the onset of labor are relatively rare, in most reported cases these also have been traumatic, the result of motor vehicle accidents or assaults.2-7 With few exceptions, there have been associated uteroplacental or other fetal injuries.
In 1977, MacDonald et al8 believed they were making the first case report of an infant born with hydrocephalus and anemia due to bilateral subdural hematomas in which there was no history of maternal trauma.
Behavioral and Cognitive Effects of Anticonvulsant Therapy
Authors:   Committee on Drugs
Published: December 2021

Behavioral disturbances associated with the use of anticonvulsant therapy may be readily apparent and easily diagnosed. They are most commonly reported with the use of barbiturates and usually include hyperactivity, disturbed sleep, irritability, and emotional lability. But, subtle behavioral disturbances may also adversely affect performance and learning. Behavioral changes resulting from therapy with barbiturates and benzodiazepines tend to be idiosyncratic as opposed to the dose-related affects seen with phenytoin and valproate therapy. Carbamazepine and valproate can affect mood and behavior negatively, but, generally, this occurs less frequently than when several other anticonvulsants are used; this is especially true in patients without CNS damage.
The suspicion that there may be a causal relationship between anticonvulsant therapy and impairment of cognitive skills in nonintoxicated patients is gaining increasing support. Neuropsychologic studies in acutely exposed normal volunteers, studies in epileptic patients receiving monotherapy, and crossover studies between drugs have incriminated barbiturates and hydantoin drugs. Memory/cognitive dysfunction, although affected to a greater extent with higher drug dosages, has been reported with levels within the therapeutic range. Thus, serum drug levels cannot be considered good predictors of which patients will have subtle side effects. Carbamazepine and valproate seem to be relatively free of many adverse neuropsychologic effects, although additional studies need to be performed.
The complete separation of seizure effects from drug effects remains on ongoing goal. Similarly, in comparative studies to date, the issues of whether the differences between the drugs are due to negative effects of one or positive psychotropic effects of the other, or both, are not adequately addressed. In addition, because current physician office procedures do not detect subtle mental impairments, more sensitive techniques are needed to assess potential cognitive and behavioral side effects of medications.
Postpartum (Neonatal) Sibling Visitation
Authors:   Committee on Fetus and Newborn
Published: December 2021

A fundamental goal of maternal newborn care is to foster parent-newborn-family relationships; therefore, the concept of family-centered care should be integrated into every aspect of perinatal services.1
Sibling visitation is consistent with the concept of family-centered perinatal care. Parents respond very favorably to the opportunity for sibling visits.2 Children who visit their mothers after the birth of a sibling have been reported to be more responsive to their mothers and siblings than nonvisiting children.3 In two studies of sibling visits to neonatal intensive care units, there were no adverse effects noted.4,5
Umphenour6 and Wranesh7 have both demonstrated no effect of bacterial colonization of neonates with the institution of sibling visitation to normal neonates. In a controlled study of sibling visitation to a neonatal intensive care unit, Maloney and associates4 demonstrated no increase in infectious disease rates in those infants who were visited.
Due to differences in hospital facilities and personnel, it is essential that each hospital develop its own set policies for sibling visitation. Guidelines should be developed with input from nursing, pediatric, obstetric, and infectious disease personnel.
The following guidelines can be used for institution of antipartum visitation by children:
1. Siblings should not have been exposed to known communicable diseases (eg, chickenpox).
2. Siblings should not have fever or symptoms of acute illness such as upper respiratory tract infection or gastroenteritis.
3. Children should be prepared in advance for their visit.
4. Children should be supervised by parents or a responsible adult during the entire hospital visit.
Because limited data are available, there is a need for continued evaluation and reporting of the risks and benefits of sibling visitation.
Pancuronium Risks
Authors: KILCHEVSKY EITAN S. , WUNG JEN T. 
Published: December 2021

To the Editor.—
We would like to congratulate Cabal et al1 on their article and their suggestion that the benefits of pancuronium in ventilated neonates might be outweighed by its possible risks.
We have been bothered by the many reports in the literature that recommend such use of pancuronium. The finding of Cabal et al that pancuronium did not increase the TcPo2 is in contrast to prior reports2 and should be emphasized, because the improvement in Po2 is cited as the criteria for the success of the drug.3
Are Granulocyte Transfusions of Value in Septic Neonates Without Neutrophil Storage Pool Depletion?
Authors: NEWMAN RICHARD S. , OCARIZ JOSE A. 
Published: December 2021

To the Editor.—
A recent report by Cairo et al1 suggests the possible value of granulocyte transfusions in septic neonates who do not have bone marrow neutrophil pool (NSP) depletion. In this study, three of seven neonates who had documented sepsis and who did not receive granulocyte transfusions did not survive, and only one of seven of these neonates had neutrophil storage pool depletion at the time of entry into the study. Because approximately one half of the neonates who had documented sepsis and did not receive granulocyte transfusions survived, one must conclude that a significant number of neonates in the study of Cairo et al probably received granulocyte transfusions unnecessarily.
Dynamics of Nasopharyngeal Colonization With Haemophilus influenzae b During Antibiotic Therapy
Authors: GILSDORF JANET R. 
Published: December 2021

Haemophilus influenzae type b, a major cause of serious infections in infants and young children, may colonize the nasopharynges of healthy, asymptomatic carriers as well as patients with invasive H influenzae type b disease. Person to person spread of this organism is suspected to be by infected respiratory tract secretions. Recently, clusters of epidemiologically related cases have been recognized among young household and day-care contacts of children with H influenzae type b disease,1 demonstrating the contagious potential of H influenzae type b infections.
Serious nosocomial infections with H influenzae type b have been described in pediatric patients in acute and chronic care hospitals.2-4
Chest Pain
Authors: ROGERS WILLIAM B. 
Published: December 2021

To the Editor.—
I was interested in the article by Dr Selbst on chest pain (Pediatrics 1985;75:1068-1070). I was interested not only because of the numerous cases of chest pain I have seen in 40 years, but also because I, as an adolescent, experienced recurrent episodes of severe thoracic pain too.
Unlike Dr Selbst, who reported the most common etiologies were idiopathic or muscular skeletal, I have found the majority to be a distinct clinical entity called "benign pleuralgia," or "catch in the chest."
Intramuscular Penicillin
Authors: WEIR MICHAEL. R. 
Published: December 2021

To the Editor.—
Stollers and Losey's report of vascular damage with intramuscular benzathine penicillin argues that the delivery system obscures the safeguard against intravascular injection,1 an argument made previously but less colorfully.2 The millions of doses used worldwide attest to the efficacy of persistent low penicillin blood levels in therapy and prophylaxis. The occasional reports of vascular complications including avascular necrosis of the gluteal region, the perineum, and the ipsilateral or contralateral foot, sciatic nerve palsy, and transverse myelopathy raise questions about safety as well as mechanisms of injury.
Vitamin E: What Should We Do?
Authors: POLAND RONALD L. 
Published: December 2021

In Reply.—
Dr Newport's questions present us with an excellent opportunity to clarify our statement on the use of vitamin E for the prevention of retinopathy of prematurity. The Committee reviewed all of the available information and concluded that protocols for the use of vitamin E as a prophylaxis against retinopathy of prematurity had not been evaluated in a large enough population to give us a valid estimate of the risks v the benefits. Our statement was published about the time that Johnson and her associates1 reported significant risks associated with the administration of vitamin E to increase the serum concentration well above the 1- to 2-mg/dL that has been generally accepted as normal.
Light and Transcutaneous Po2 Device = Problem?
Authors: HERMANSEN MARCUS C. , MOONEY LAURA , HINES CASEY 
Published: December 2021

To the Editor.—
We would like to call attention to a recently recognized and potentially dangerous interaction of a skin surface Po2/Pco2 monitor with a phototherapy device.
A five-day-old, 1,200-g infant was receiving mechanical ventilation for the treatment of respiratory failure and phototherapy for the treatment of hyperbilirubinemia. An observation was made that within a few seconds of removal of the phototherapy unit from the bedside the skin surface Pco2 would increase dramatically. If the phototherapy was then reintroduced, the Pco2 would decrease as dramatically.
Auditory Testing and Bilirubin
Authors: SHAPIRO STEVEN M. , HECOX KURT B. 
Published: December 2021

To the Editor.—
Nakamura et al (Pediatrics 1985;75:703-708) provide a useful correlation of the auditory brainstem response (ABR) with unbound bilirubin levels. However, their findings of normal I-V interwave intervals despite increased wave I latencies are surprising in light of other reports of increased interwave intervals in neonates with hyperbilirubinemia. Their suggestion that with bilirubin toxicity alone "brainstem function probably is not involved" contradicts other studies of hyperbilirubinemic neonates that have found central (brainstem), in addition to peripheral, auditory brainstem response abnormalities.
Aplastic Anemia Following Chloramphenicol Therapy Still Happens!
Authors: LEPOW MARTHA L. 
Published: December 2021

To the Editor.—
Chloramphenicol is still the drug of choice for treatment of ampicillin-resistant Haemophilus influenzae b meningitis, brain abscess,1 Rocky Mountain spotted fever in severely ill patients and young children, and typhoid fever. Intravenous oral and intraocular routes of administration have been widely used.
Smith and Webber2 have recently reviewed the pharmacology of chloramphenicol. Reversible erythroid suppression is dose related and more common in children. Genetic predisposition of the stem cell to inhibition of nucleic acid synthesis is thought to be the explanation for the "idiosyncratic" chloramphenicol-induced bone marrow aplasia, although Daum et al3 reported a probable dose-related case.
Pathogenesis of Biliary Atresia
Authors: MOORE THOMAS C. 
Published: December 2021

In Reply.—
The letter of Esterly is an important one with some significant observations regarding a potential acquired inflammatory and viral etiology of biliary atresia. A marked and progressive inflammatory component of biliary atresia with extensive early round cell infiltration and progressive fibrosis was reported by one of the authors in 1953.1 This observation led to strong recommendations for early operation in biliary atresia.2,3
It has been suggested that biliary atresia, neonatal spontaneous perforation of the extrahepatic bile ducts, and choledochal cysts may be variants of an acquired infalmmatory process, possibly viral, such as cytomegalovirus, and possibly oncogenic.4
The American Occupational Therapy Association, lnc, Viewpoint
Authors: BING ROBERT K. 
Published: December 2021

To the Editor.—
The American Occupational Therapy Association would like to provide the profession's perspective to your recently published statement entitled "School-Aged Children With Motor Disabilities" which appeared in Pediatrics (1985;76:648-649). We commend the Committee on Children With Disabilities on their efforts to establish guidelines regarding the treatment of children with dyspraxia and other motor disabilities, and we strongly encourage pediatricians to become knowledgeable of education-related services available to these children. However, it is important that their statement reflect current practice and research relevant to the services discussed.
Home Phototherapy Recommendations Questioned
Authors: GRABERT BRIAN E. 
Published: December 2021

To the Editor.—
The report and recommendations for home phototherapy, as reported by the Committee on the Fetus and Newborn (Pediatrics 1985;76:136-137), was well intentioned but in my opinion hastily conceived and fell far short of expectations. Just when the pediatric community was convinced that the bilirubin/kernicterus issue was "a real mess,"1 this committee seemingly attempts to provide order where chaos has reigned.
I am concerned about the lack of referencing of available data2,3 on home phototherapy, albeit limited, in the committee's report.
Life Insurance for Disabled Children
Authors: VINCE DENNIS J. 
Published: December 2021

To the Editor.—
Most parents consider the achievement of financial and psychologic independence as a desirable goal for their children. In our increasingly complex society, these goals are becoming difficult to achieve. To finance self-employment opportunities or to purchase a home, disabled adults usually require life insurance. Because of this, many parents of disabled children apply for life insurance for their child so that these options will be available to them as adults. The life insurance company usually will then request that the child's physician comment on the medical condition and prognosis.
Prudent Life-style for Children: Dietary Fat and Cholesterol
Authors:   Committee on Nutrition
Published: December 2021

In the 1983 AAP Committee on Nutrition statement, "Toward a Prudent Diet for Children," the evidence linking dietary factors with the risk of atherosclerosis was reviewed.1 Based on the analysis of the available information, the Committee made seven recommendations concerning steps to be taken during childhood that would reduce the risk of atherosclerotic cardiovascular disease in adults. With respect to childhood eating habits, it was noted that, after 1 year of age, a varied diet that includes items from each of the major food groups is the best assurance of nutritional adequacy. The dietary trends in the United States during the last few decades, with emphasis on decreased consumption of saturated fats, cholesterol, and salt and increased intake of polyunsaturated fats, were recommended as sensible when followed with moderation.1
OTHER FINDINGS
Since publication of that Committee statement, recommendations for alteration of childhood diets have also been made by the American Heart Association, 2 by the American Health Foundation, 3 and by a Consensus Development panel sponsored by the National Institutes of Health (NIH).4 All three of these groups have recommended more restrictive childhood diets than had been recommended by the Committee on Nutrition.
The American Heart Association2 recommends a total fat intake that would be approximately 30% of total calories; this 30% would include 10% or less from saturated fat, 10% from monounsaturated fat, and less than 10% from polyunsaturated fat. The recommendation for daily cholesterol intake was 100 mg/1,000 calories and not to exceed 300 mg/d, total.
Similar recommendations have been made by the American Health Foundation3 to achieve a target goal of serum total cholesterol values averaging 140 mg/dL for children and young adults.
Sexuality, Contraception, and the Media
Authors:   Committee on Adolescence
Published: December 2021

Approximately half of all American adolescents have experienced coitus by 17 years of age.1 The majority say their first experience was not anticipated. More than 85% have first coitus before seeking professional advice about prevention of pregnancy or infection. The earlier the first coitus, the longer the interval until such advice is sought. The consequences of unprotected coitus include pregnancy, often unwanted, and exposure to sexually transmitted infections, which increase the risk of adverse pregnancy outcome, as well as damage to the reproductive system, which could result in sterility.2 Female adolescents who have sexual intercourse, are sexually promiscuous, and have repeated genital infections have an increased risk for cervical cancer.3 Teenagers are most likely to risk these consequences of sexual intercourse when they lack knowledge about methods of preventing pregnancy and infection, have received limited encouragement for responsible sexual behavior, and/or hold Unwarranted fears about the risks of specific contraceptive methods.4
THE MEDIA AND SEXUAL LEARNING
The average American family watches six to seven hours of television and 70 to 90 commercials daily.5 Teenagers average 24 hours of television viewing and 21 hours of radio listening a week.5 Annually, American youths spend more time watching television than they spend in school. Although the specific impact of television on psychosexual development and sexual behavior has not been documented, there is strong evidence that television influences attitudes, values, behaviors, and socialization.6
The American television audience is exposed to more than 9,000 sexual references, innuendoes, and behaviors each year.5 In many households, access to cable television and home videos has increased the exposure to more explicit sexual messages.
Leukemia and Hemophilia
Authors: OZSOYLU SINASI 
Published: December 2021

To the Editor.—
I enjoyed reading the paper by Aronis et al,1 and would like to bring to your attention that we have also recently observed leukemia in two patients with hemophilia A and B, 10 and 1½ years of age, respectively.2 Because commercial factor VIII and IX were not used and only blood, fresh frozen plasma, and plasma were given on a few occasions, it was less likely that AIDS-like immune changes were responsible for the leukemia in our patients.
Leukemia and Hemophilia
Authors: ARONIS-BOURNAS S. 
Published: December 2021

In Reply.—
As far as we know, previous data on the incidence of malignancies in hemophiliacs are lacking; nevertheless, we quite agree with the iemark of Altay et al1 that malignancies in hemophiliacs should be reported for future evaluation of their frequency.
Regarding our patient,2 we believe that his lymphoma occurred in the setting of AIDS. This is supported by our retrospective finding of his being seropositive for HTLV-III antibodies, by Western blot technique, on several occasions since 1982.