bluuebunny/crossref_metadata_2025_split huggingface dataset:
Meningomyelocele and Hirschprung Disease: Theoretical and Clinical Significance
Authors: MERKLER RICHARD G. , SOLISH SHARYN B. , SCHERZER ALFRED L. 
Published: December 2021

Evidence to support a unifying theory to explain the embryogenesis of numerous midline anomalies, including neural tube defects, has been widely sought.1,2 The impetus for this search has been the finding of certain combinations of these anomalies at incidence rates higher than those predictable by chance,1,2 such as the occurrence of oral clefts with neural tube defects,1 or Hirschprung disease with neuroblastoma.2
To further document the possible midline developmental relationship, we present the first reported case of Hirschprung disease occurring in a patient with meningomyelocele and hydrocephalus.
CASE REPORT
Care, Costs, and Health: Reactions to and Reinterpretation of the Rand Findings
Authors: Starfield Barbara , Dutton Diana 
Published: December 2021

The reports of Valdez et al1 and Leibowitz et al2 mark the culmination of a landmark effort. Initiated over a decade ago, the Rand Health Insurance Experiment—the most ambitious and expensive randomized controlled trial ever conducted in health services research—was designed to produce estimates of the costs of various forms of national health insurance. Projected estimates of the costs of Medicaid and Medicare had been far too low and health policy experts hoped to obtain information that would prove closer to the mark in the (then) seemingly likely passage of some form of national health insurance.
Although national health insurance has not materialized, the impact of medical care costs on utilization of services and health status is still of great interest. The amount of "cost-sharing" (medical costs paid by patients) has increased dramatically in public insurance programs, and many health policymakers favor increases in private insurance programs. The central question now, however, is how much of the cost burden can be borne by patients without inducing reductions in utilization that are harmful to health.
The two papers1,2 in the May issue of Pediatrics reported on the impact of cost-sharing on children's utilization and health. The basic findings were similar to those for adults. In general, the higher the costs paid by families, the fewer the children receiving medical care and the fewer the services per user. The only exception was hospitalization of children aged 5 to 13, which was largely unaffected by cost-sharing; higher costs did appear to reduce hospitalization of younger children, as well as ambulatory care for children of all ages.
Infant Rash Caused by Paracetamol in Breast Milk?
Authors: MATHESON I. , LUNDE P. K.M. , NOTARIANNI L. 
Published: December 2021

To the Editor.—
According to Wilson et at,1 adverse drug reactions in breast-fed infants associated with maternal drug intake are rarely reported. We report such a reaction after paracetamol ingestion by the mother.
The patient was a 2-month-old, healthy, and fully breast-fed girl. Her 34-year-old mother had rheumatoid arthritis and also developed a postpartum borderline psychosis, which was first treated with 2 mg of flupentixol and 100 mg of nortriptyline daily. Later nortriptyline was replaced by 100 mg of desipramine.
Munchausen Syndrome by Proxy
Authors: GUANDOLO VINCENT L. 
Published: December 2021

In Reply.—
There was an older sibling of the patient reported in "Munchausen Syndrome by Proxy: An Outpatient Challenge." This child's past medical history as disclosed by the mother included numerous allergies, a tonsillectomy/adenoidectomy at an early age, recurrent urinary tract infections during infancy, and chronic bouts of bronchitis and croup. These conditions predated the family's transfer to our office for pediatric care. There were infrequent office visits for minor medical problems in this child during the time that the mother concentrated on the patient described in our report.
Flying, Peanuts, and Crying Babies
Authors: STAFFORD ELISABETH M. 
Published: December 2021

To the Editor.—
Guidelines from the American Academy of Pediatrics for injury prevention state that "physicians caring for children should counsel parents in age-appropriate, season-appropriate, locality-appropriate strategies which reduce common serious injuries".1 In keeping with this philosophy, many pediatricians educate parents about foods that may be unsafe for their child at a given age. Yet, there seems to be a substantial number of caretakers whom we obviously have not reached, judging by my observations of travelers feeding peanuts to toddlers on airplanes.
Infantile Myofibromatosis
Authors: WISWELL THOMAS E. , SAKAS E. LAWRENCE , STEPHENSON STEPHEN R. , LESICA JOHN J. , REDDOCH SHIRLEY R. 
Published: December 2021

We recently cared for an infant with infantile myofibromatosis, a rare condition involving the dermal, visceral, musculoskeletal, and subcutaneous tissues. Most reports of this disorder have appeared in the pathology, cancer, and radiology literature.1-7 We report this case and review this condition in order to familiarize pediatricians with the clinical manifestations, histopathologic features, and prognosis of affected infants.
CASE REPORT
A 2,970-g female infant was born at term to a gravida 2, para 1 woman following an uncomplicated pregnancy. The family history was unremarkable. The infant's initial physical examination revealed a raised, hard, violaceous mass on the left side of the face, measuring 4 x 5 cm and extending from the upper lip to the lower eyelid and involving the nose (Fig 1).
Diffuse Retinopathy Following Measles, Mumps, and Rubella Vaccination
Authors: MARSHALL GARY S. , WRIGHT PETER F. , FENICHEL GERALD M. , KARZON DAVID T. 
Published: December 2021

Blindness due to optic neuritis or panretinopathy has been reported as an acute complication of natural measles infection.5 Recently, loss of visual acuity following measles, mumps, and rubella (MMR) vaccination with the fundoscopic changes of optic neuritis has been described.6 We have observed a child with blindness due to diffuse neuroretinitis temporally associated with measles, mumps, and rubella vaccination and the development of a postvaccination measles syndrome.
CASE REPORT
A 16-month-old baby girl presented with acute loss of vision 16 days after routine measles, mumps, and rubella vaccination.
The infant had been previously healthy and developmentally normal. She had received three previous oral polio and diphtheria, tetanus, and pertussis vaccinations without adverse reactions.
Metolazone and Furosemide Therapy for Edema
Authors: ARNOLD WATSON C. 
Published: December 2021

In Reply.—
Drs Garin and Richard have presented data that confirm our finding that a combination of furosemide and metolazone is efficacious in inducing a diuresis and natriuresis in children with edema resistant to furosemide alone. They echo valid concerns regarding the safety of combination diuretic therapy.
The increased incidence of complications noted in their experience may have been due to their higher doses of furosemide (5 mg/kg/d). We limited furosemide to 2 to 4 mg/kg/d.
Phenothiazine-Induced Sleep Apneas and the Opioid System
Authors: KAHN ANDRÉ 
Published: December 2021

In Reply.—
Dr Sandyk suggests that the increased number of apneas seen in sleeping infants after the administration of phenothiazine could be related to an increase in endogenous opioids. If validated, this suggestion could be of interest for the understanding of the mechanisms inducing central and obstructive sleep apneas. As suggested naloxone could be tried in case of phenothiazine-induced apneas, but it seems advisable to systematically avoid the administration of phenothiazine-containing drugs to children younger than 2 years of age.
Circumcision and Urinary Tract Infections
Authors: WISWELL THOMAS E. 
Published: December 2021

In Reply.—
Dr Cunningham apparently believes that there is no plausible physiologic explanation for the association between a decreased incidence of urinary tract infections and circumcisions as we recently described,1 and that we should seek alternative explanations for our findings. However, we disagree with most of the alternative suggestions and the comments that he has made.
We recently completed a second study evaluating the occurrence of urinary tract infections during the first year of life in more than 400,000 infants.
Salicylate Toxicity Rediscovered
Authors: PEARLMAN LYON N. 
Published: December 2021

To the Editor.—
Howrie, Moriarty, and Breit are to be commended for again bringing to the attention of your readers, the fact that oil of wintergreen is a highly toxic susbtance.1 However, I would gently chide them on their statement that its use as a flavoring agent for homemade candy was "a previously unappreciated source" of poisoning. As long ago as 1940, the late W. T. Shirreff and myself2 pointed out that methyl salicylate was frequently used as a liniment and not uncommonly as a flavoring medium in foods.
Don't Do It in Front of the Kids
Authors: ROSENBERG MORTON B. , AHLGREN LAURIE S. , HARRIS BURTON H. 
Published: December 2021

To the Editor.—
Our new day-surgery facility includes an architectural plan that allows the parents of patients to remain with their children. Satisfied with the design, we were surprised to discover that frequently when we went to talk to parents after an operation, they were nowhere to be found. An undercover investigation by the hospital security force revealed that the missing parents were almost always in the cafeteria. This was so different from the expected perioperative family hovering that it defied explanation.
Kawasaki Syndrome, Reye Syndrome, and Aspirin
Authors: BUSHORE MARTHA 
Published: December 2021

In Reply.—
Because the incidence of each of these serious pediatric diseases is low, but the need for prompt recognition and skillful management is essential to optimal outcome, Drs Takahashi and Mason's excellent review and knowledgeable guidance are invaluable to the practicing pediatrician who rarely manages either of these disorders. Our concern that aspirin may interfere with platelet adhesion (when not therapeutically desirable), may increase airway resistance, and may be associated with Reye syndrome should not lead us to discontinue recommending appropriate use of this excellent drug when therapeutic benefit outweighs risk.
School Buses and Seat Belts
Authors: AHRONHEIM GERALD A. 
Published: December 2021

To the Editor.—
The epidemic of motor vehicle injuries and fatalities may be no less amenable to control than, say, infectious diseases such as pertussis or measles. As two papers in September's issue of Pediatrics suggest, the task is not necessarily a technical one, such as vaccine development, but a behavioral one analogous to the introduction of effective hygienic practices. In recent decades the majority of North American parents seem to have come to accept clean food and water, as well as childhood immunizations, as normal parts of life.
Farm Accidents
Authors: COGBILL THOMAS H. , BUSCH HENRY M. , STIERS GARY R. 
Published: December 2021

In Reply.—
We appreciate the interest and comments by Dr Paulson relative to our paper (Pediatrics 1985;76:562-566). In our series of 105 children injured in farm accidents, we reported one mortality (1%) and one child (1%) with major long-term disability. Follow-up ranged from 2 to 80 months based upon review of complete outpatient records in this stable rural population. Serious neurologic and physiologic sequelae were accurately recorded.
We agree with Dr Paulson that a retrospective chart review will underestimate the number of minor disabilities including subtle neurologic, orthopedic, and pulmonary sequelae.
College Measles
Authors: WHITE FORREST P. 
Published: December 2021

To the Editor.—
The increase in measles cases on college campuses during the past year brings into question our national policy about measles immunization. Is it correct and comprehensive? Or has our success in eliminating smallpox led us down the garden path of dangerous assumptions?
Conventional wisdom holds that we can eliminate measles just as we did smallpox. Does anybody really think we can reach every village in every remote region of the world to identify every case of measles? Smallpox is a devastating, readily identifiable disease, and vaccination against it leaves a distinctive mark.
Relationship Between Bilirubin and Hearing Loss
Authors: GALLAHER KEITH J. , MAISELS M. JEFFREY 
Published: December 2021

To the Editor.—
De Vries et al1 describe an interesting association between serum bilirubin levels &gt; 14 mg/dL and sensorineural deafness in low birth weight infants. A similar association (in infants who were exposed to lower serum bilirubin levels) was reported by Bergman et al.2 These results are important because of their potential influence on how we treat these infants, yet they raise certain questions.
The authors classified infants as "high risk" or "low risk" based on the presence of certain "adverse factors," but they do not tell us about the distribution of these factors in the study patients.
Relationship Between Bilirubin and Hearing Loss
Authors: DE VRIES LINDA S. 
Published: December 2021

In Reply.—
We were most interested in Gallaher and Maisels' comments on our paper. Although they mention that sensorineural deafness is an unusual event in their experience, they do not provide us with an incidence and also do not mention their method for testing hearing.
Most of our infants, were classified as high risk because they required ventilation for hyaline membrane disease. The ten deaf infants who were high risk and their ten matched controls were all ventilated.
Pathogenesis of Biliary Atresia
Authors: ESTERLY JOHN R. 
Published: December 2021

To the Editor.—
The report of biliary atresia in one identical twin is of interest. As the authors' state, the observation suggests that the malformation may be acquired rather than of genetic origin. Many pediatric pathologists consider biliary atresia an acquired defect in a large, but unknown, proportion of affected patients. The evidence to support the hypothesis is circumstantial. Stages of a presumed continuum from mild periportal inflammation and neonatal hepatitis to obstructive atresia have been found at autopsy in patients with the congenital rubella syndrome.2
Henoch-Schönlein Purpura and Human Parvovirus Infection
Authors: LEFRÈRE J. J. , COUROUCÉ A. M. , SOULIER J. P. , CORDIER M. P. , GIRAULT M. C. GUESNE , POLONOCSKI C. , BENSMAN A. 
Published: December 2021

To the Editor.—
Human parvovirus is already known to be responsible for aplastic crisis in chronic hemolytic anemia,1 for erythema infectiosum or fifth disease,2 and for arthropathies,3,4 and it has recently been isolated from the serum of patients with vascular purpura.5 We report the case of Henoch-Schonlein purpura associated with human parvovirus infection.
H. T., a 6-year-old girl, without any significant past history, was admitted on March 8, 1985, for joint pain and swelling (wrists, knees, ankles) associated with intense abdominal pain.
Steroid Abuse by Adolescents
Authors: DYMENT PAUL G. 
Published: December 2021

In Reply.—
Dr Kwasman has raised an important point, that androgen misuse by athletes is widespread, and this problem should be addressed by pediatricians in their offices when caring for such youth.1 As sports in which muscle strength or size is important are the most likely to be the ones for which the drugs are taken (weight lifting, throwing events in track, football, and muscle building), the physician should discuss this subject with every athlete seen participating in these events.
The Child Is Father of the Man
Authors: GLUECK CHARLES J. 
Published: December 2021

Wordsworth was both metaphorically and literally1 accurate in concluding that ". . .the child is father of the man."2 The anatomic,3-5 biochemical, epidemiologic, nutritional, genetic, and clinical genesis of atherosclerosis is in childhood.1,6-13 There is also compelling evidence that relates antemortem coronary heart disease risk factors to the development of early atherosclerotic lesions,5 evidence that should stimulate pediatric primary prevention of atherosclerosis.
By virtue of extensive studies of schoolchildren,11,14-18 and of national population groups (Second National Health and Nutrition Examination Survey),19 excellent age-, sex-, and race-specific distributional data are available for major coronary heart disease risk factors including total, high-, and low-density lipoprotein cholesterol (HDL-C, LDL-C), height, weight, Quetelet index, skinfolds, BP, nutrient intake, and cigarette smoking.
Megavitamins and Hyperactivity
Authors: RIMLAND BERNARD 
Published: December 2021

To the Editor.—
The report by Haslam et al,1 purporting to have demonstrated megavitamin therapy to be of no value in treating hyperactivity, and even to have produced mild adverse side effects, received wide media coverage. This is regrettable, because Haslam et al used a very incomplete version of megavitamin therapy.
Haslam et al claimed to have followed the regimen of Cott2 but failed, without mentioning the omission, to use the 25 mg/d of the B complex and 200 mg/d of magnesium that Cott advocates.
Prospective Diagnosis of Pseudohypoaldosteronism
Authors: SCHINDLER ALAN M. , BERGMAN GARRETT E. 
Published: December 2021

Pseudohypoaldosteronism is characterized by salt wasting in spite of elevated plasma renin activity and serum aldosterone concentration. If the salt wasting is severe, pseudohypoaldosteronism may present as early as the first or second week of life. We were able to demonstrate pseudohypoaldosteronism on the second day of life in an asymptomatic newborn baby whose father and 1-year-old sister were known to have pseudohypoaldosteronism.
CASE REPORTS
Case 1
The patient was a 6-week-old white girl, who was born at term. Her mother was 24 years old, primigravida, and had an uncomplicated pregnancy. The baby was admitted to the hospital for evaluation of lethargy, poor feeding, vomiting, and failure to thrive when fed breast milk and, later, a proprietary formula.
Light and Retinopathy of Prematurity: What Is Prudent for 1986?
Authors: AVERY GORDON B. , GLASS PENNY 
Published: December 2021

What's the Problem?
The survival in substantial numbers of extrauterine fetuses, barely entering their last trimester at birth, has caused these babies to complete their retinal vascularization in the unnatural environment of the modern intensive care nursery. The result is a second epidemic of retinopathy of prematurity, the greatest risk factor for which is clearly survival after extremely immature birth. A flurry of investigations has addressed factors that might contribute to this problem, and at least a dozen are supported by some epidemiologic associations.1-3 Oxygen is on this list but by no means in the preeminent way of the past.
Virilizing Adrenocortical Tumors in Childhood
Authors: HONOUR J. W. , PRICE D. A. , GRANT D. B. 
Published: December 2021

To the Editor.—
It was of considerable interest to read about the experience of virilizing adrenal tumors at the Childrens Memorial Hospital, Chicago,1 and the literature review is of particular value. In 1984, we published results from our study during 12 years of 12 infants with virilizing adrenal tumors without cortisol excess. We were able to define very precisely the secretory products of the tumors by using capillary column gas chromatography with mass spectrometry to separate and identify steroids in urine, and the data were rationalized in the context of routine endocrine tests.
Persistent Colonization During Therapy for MHaemophilus influenzae Type b Disease
Authors: GILSDORF JANET R. 
Published: December 2021

In Reply.—
I agree with Dr Barton's warning to avoid "complacency regarding the lack of communicability of H influenzae type b in acute care settings" and to continue to be alert to the remote possibility that intrahospital transmission of H influenzae type b disease may occur. However, in the meantime, policy decisions on the duration of isolation precautions for patients with H influenzae type b infections need to be made. Based on my data1 and on the fact that only one possible case of nosocomial transmission has been reported in an acute care hospital, 2 I think the current recommendation of the American Academy of Pediatrics remains appropriate.
Girls on Boys' Teams
Authors: DYMENT PAUL G. 
Published: December 2021

In Reply.—
Dr Goldenring expresses a viewpoint probably widely shared by pediatricians, and the last statement on this subject by the American Academy of Pediatrics (Pediatrics 1975;55:563) advises against girls competing against boys in "heavy collision sports." However, I personally believe that in schools in which separate teams for a particular sport for boys and girls do not exist, girls should have the opportunity to compete for a position on the "boys" team, regardless of whether or not it is a collision sport.
Failure of Trimethoprim/Sulfamethoxazole As Prophylactic Therapy of Gram-Negative Sepsis in Pediatric Patients With Cancer
Authors: ESQUEMBRE C. , FERRIS J. , VERDEGUER A. , CASTEL V. 
Published: December 2021

To the Editor.—
We read with interest the article "Oral Trimethoprim/Sulfamethoxazole for Prevention of Bacterial Infection During the Induction Phase of Cancer Chemotherapy in Children (Pediatrics 1985;76:754-760). The authors report that there are no reports of fatal septicemia due to resistant enterobacteriaceaes in children under infectious chemoprophylaxis with this drug.
From 1980 to 1984 42 episodes of bacterial sepsis have been demonstrated in 38 of our cancer patients. Organisms isolated were Escherichia coli (13 cases), Streptococcus (12 cases), Staphylococcus (11 cases), Pseudomonas aeruginosa (three cases), Klebsiella pneumoniae (two cases), Haemophilus (two cases), Serratia marcescens (one case), Salmonella (one case), and Enterobacter (one case).
Guidelines for Air and Ground Transportation of Pediatric Patients
Authors:   Committee on Hospital Care
Published: December 2021

A pediatric transport system should be capable of rapidly delivering advanced pediatric skilled critical care to the patient's bedside at the referring hospital and of maintaining that level of care during transport to the receiving hospital. Physicians and others with special expertise in pediatric transport have developed specific recommendations for pediatric transport systems.1-9 The Committee on Hospital Care of the American Academy of pediatrics, in collaboration with expert consultants, offers the following guidelines for pediatric transport. These recommendations require periodic review as new equipment, techniques, and data evolve in this rapidly progressing field. Some of these recommendations may need modification to fit local circumstances. This statement modifies and enlarges upon a previously published chapter in the AAP manual, Hospital Care of Children and Youth.10 Neonatal transport systems have many of the same characteristics.
OPTIMAL COMPONENTS OF A PEDIATRIC AIR-GROUND SYSTEM
The most important components of a pediatric transport system are medical control by a qualified pediatric specialist and a medical transport team composed of individuals qualified to care for critically ill children in a transport setting. Although a pediatric transport system may share components with an adult transport system (eg, dispatch, vehicles, emergency medical technicians), it should have its own medical director, its own protocol, a transport team specifically trained in pediatric critical care, and equipment and supplies appropriate for the care of pediatric patients.
An optimal pediatric transport system has available to it both air and ground ambulances combined into a flexible, coordinated system.