bluuebunny/crossref_metadata_2025_split huggingface dataset:
Russell-Silver Syndrome and XXY Karyotype
Authors: BIANCHI ELENA , ARICO' MAURIZIO , SEVERI FRANCESCA , PASQUALI FRANCESCO 
Published: December 2021

To the Editor.—
In 1974, we reported1 a 3-year 7-month-old boy with Russell-Silver syndrome and a 47,XXY karyotype. We considered it very likely that the XXY condition was a coincidence. Recently, we have observed a second patient with Russell-Silver syndrome and a 47,XXY karyotype. The patient's age is 1 year 10 months. The diagnosis was based on the infant's small size at birth (birth weight 1,750 g) despite being born at term, triangular shape of the face, downslanting oral corners, increased curve of the fifth fingers, asymmetry of the legs and feet and marked retarded skeletal age.
Pharyngeal Gonorrhea
Authors: SILBER TOMAS 
Published: December 2021

To the Editor.—
Chacko et al1 advocate screening for pharyngeal gonorrhea, in adolescents who undergo genital cultures for gonorrhea. They base their recommendation on an incidence of 2.7% positive results. Their finding is almost identical with a prospective study we did in 1975,2 and with the high frequency of pharyngeal gonorrhea discovered in a prenatal clinic urban population.3 In addition, several years later we did a retrospective review of all our patients with pharyngeal gonorrhea and found the situation to be the same if not worse.4
Probable Graft-Versus-Graft Reaction
Authors: GITHENS JOHN H. , HAYWARD ANTHONY R. , LAUER BRIAN A. 
Published: December 2021

In Reply.—
Buckner points out the difficulty in distinguishing a generalized viral infection from a graft-versus-host reaction (GVHR) on a clinical basis in the immunologically deficient infant. This was the initial differential diagnosis raised in our recent case report1 of an infant believed to have GVHR following an exchange transfusion. Although the presence of donor lymphocytes could not be documented in the blood by HLA typing in our case, we believe the evidence strongly favors the diagnosis of a GVHR rather than a generalized viral infection.
Speculation on Carbon Dioxide and Retrolental Fibroplasia
Authors: WOLBARSHT M. L. , GEORGE GREGORY S. , KYLSTRA JAN , LANDERS M. B. , SHEARIN W. ARTHUR 
Published: December 2021

To the Editor.—
Gole and Gannon1 have apparently misconstrued our letter.2 It was not our intention that the proposed model for the development of retinopathy of prematurity (ROP) be accepted as a basis for clinical treatment. Instead, this model was propounded in hopes of stimulating further research into the possible role of CO2 in the pathogenesis of ROP. Therefore, we must respond to their charges of "speculation" by stating that this letter was obviously speculative in nature; however, all the assumptions made can be defended.
Alternative to Diminishing Rural Pediatric Health Services
Authors: APPEL TED C. 
Published: December 2021

To the Editor.—
I read with great interest the recent article by Budetti et al1 concerning trends in distribution of child health providers. Clearly it appears that, overall, there are fewer pediatricians practicing in rural areas and that a large share of health services to rural children are currently delivered by family and general practitioners. The authors suggest that this trend implies that rural access to pediatricians will continue to be limited and that efforts of the pediatric community should be directed toward training family practitioners to fill more of this role.
Acute Versus Chronic Salicylate Poisoning
Authors: FINK CHESTER W. 
Published: December 2021

To the Editor.—
The paper by Gaudreault et al1 comparing acute versus chronic salicylate poisoning is misleading in that the two groups are in many ways dissimilar and therefore really cannot be compared. The acute group was comprised of healthy children whereas the chronic group was comprised of ill children who probably had one or more of the signs and symptoms upon which severity was based (nausea, vomiting, dehydration, etc) prior to ingesting salicylate. This may have played a part in their disease in spite of the comments to the contrary.1
Illegal Number Crunching
Authors: GROOTHUIS JESSIE R. 
Published: December 2021

In Reply.—
The authors would like to thank Student for bringing to our attention the point that utilizing mean and standard deviation to analyze Apgar scores is not appropriate. We further feel that this information would be of benefit to other investigators, as a great deal of analysis is done on such nonarithmetic operations as clinical scoring systems and staging of malignancies (as two examples). This point may therefore be as enlightening to other investigators as it was to us.
Aminophylline Confusion
Authors: PATANO THOMAS 
Published: December 2021

To the Editor.—
In reading the statement of the Section on Allergy and Immunology of the American Academy of Pediatrics,1 I have come across an item that I believe needs clarification. On page 876, the fourth paragraph refers to the fact that for each milligram per kilogram (of lean body weight) of aminophylline, one can expect to see an average of a 2 µg/mL increase in the serum theophylline concentration.
Unfortunately, this statement doesn't reflect any footnotes or reference numbers.
Naldecon Claims Disputed
Authors: LUCIANO WALLY , WADE PHILLIP H. , O'BRIEN DOUG 
Published: December 2021

To the Editor.—
In the October 1982 issue of Pediatrics is an advertisement by Bristol Laboratories concerning the use of Naldecon to improve the therapeutic outcome of otitis media with effusion. The advertisement states: "Naldecon improves therapeutic outcome in otitis media. A landmark study found that adjunctive administration of one antihistamine/decongestant liquid did more than relieve nasal symptoms. Naldecon actually improved the therapeutic outcome!"
This statement appears to be in direct conflict with the study cited in the advertisement.1
Mothers Are Always the Problem—or Are They? Old Wine in New Bottles
Authors: CHESS STELLA 
Published: December 2021

Pediatricians know that it is desirable for an infant to have a healthy start in life. But they also know that the young child who suffers inadequate nutrition, a severe infection, or physical trauma, is not thereby doomed, except in extreme cases, to a life of physical inadequacy. The human organism is resilient and in most instances capable of recouping the damage caused by malnutrition, infection, or trauma.
The issue is the same for psychological development. It is desirable for the mother and the father to have immediate and active contact with their newborn baby. But absence of such contact does not prevent parent bonding to the infant nor does it doom the infant to less than optimal development. A relaxed and emotionally positive attachment between the 1-year-old infant and the mother is indeed valuable. But the mother does not need extraordinary capacities for this to occur. And if, for some reason, either the mother's bonding to the infant or the infant's attachment to the mother is impaired, this does not foretell failure in later emotional relationships. The establishment of reasonable feeding and sleep routines and ease in toilet training are assets for healthy development. But difficulties with these or other socialization landmarks do not necessarily predict psychological outcomes.
As I have stated previously,19 "The emotionally traumatized child is not doomed, the parents' early mistakes are not irrevocable, and our preventive and therapeutic intervention can make a difference at all age-periods."
Environment, Genes, and Alcohol
Authors: GOLDEN NANCY L. 
Published: December 2021

In Reply.—
Casey's point is well taken. An association between socioeconomic status and infant outcome has been documented. Our study and control groups were not matched on that factor, but on age, race, and gestational age at birth. A retrospective analysis of the socioeconomic status of study and control mothers indicates that they are all of low socioeconomic status (Hollingshead groups 4 and 5) and that there is no significant difference between the study and control groups.
Guidelines for Pediatric Intensive Care Units
Authors:   Committee on Hospital Care and Pediatric Section of the Society of Critical Care Medice
Published: December 2021

The second half of the 20th century has produced an explosion of knowledge applied to the critically ill. The pathophysiology of life-threatening processes such as shock, respiratory failure, and increased intracranial pressure has been explored extensively. Advances in electronic patient monitoring, pharmacology, and improvement in transport systems are but a few of the factors that have drastically changed the nature of critical care.
Simultaneous with the scientific and technical advances has been the evolution of the pediatric intensive care unit (PICU). Children have special medical needs, and it is appropriate, therefore, to provide their critical care in units of excellence dedicated exclusively to children, where care is provided by pediatric specialists. There is also increasing recognition of the degree of sophistication implicit in the term "intensive care," which has culminated in the acceptance by the American Board of Medical Specialists of the joint application by the American Boards of Anesthesiology, Internal Medicine, Pediatrics, and Surgery for a Certificate of Special Competency in Critical Care Medicine. Thus, a new subspecialty has been born which reflects the developments in this field.
The purpose of this paper is to provide guidelines for pediatric intensive care units which will serve as a reference for those wishing to develop new units or to modify existing ones. The contributors to this set of guidelines have included pediatricians, anesthesiologists, intensivists, emergentologists, surgeons, engineers, nurses, and child life specialists who focus on the care of children in hospitals.
The following should be interpreted as guidelines only. Because of continuing ongoing developments in this field, periodic revisions of these guidelines will be necessary.
Aluminum Toxicity
Authors: SHERRARD DONALD J. 
Published: December 2021

To the Editor.—
The article by Griswold et al1 is useful in demonstrating again the toxicity of aluminum. Several points in the case report, however, demonstrate that a fair amount of information accumulated in adult nephrology may be unknown to pediatricians.
First, hypercalcemia is common with this form of osteomalacia.2-5 Second, the mild parathyroid hormone elevations in this patient were almost certainly due to retention of inactive parathyroid hormone metabolites as a result of renal insufficiency.6 The combination of hypercalcemia and minimal parathyroid hormone elevation led to an inappropriate, indeed hazardous parathyroidectomy.
Prediction of Child Abuse—Does It Work?
Authors: BALABAN DONALD J. , GOLDFARB NEIL I. 
Published: December 2021

To the Editor.—
Rosenberg et al1 report on a prospective, "random" study of 476 patients up to 2 years of age seen in an emergency room. The paper is concerned with a problem of importance to health care providers and of great interest to parents and society. The paper reports statistically significant differences in rates of observed or reported child abuse between children grouped according to the presence of certain abnormal features. Our concern is that the reported results may be easily misinterpreted and, therefore, may be misleading.
Bonding, Humanism, and Science
Authors: EMDE ROBERT N. , OSOFSKY HOWARD J. 
Published: December 2021

To the Editor.—
We are concerned about possible misinterpretations arising from the review of parental bonding studies.1. Our concern is of two sorts: (1) that we not lose ground concerning improved options for families now available in hospitals partly because of the trail-breaking work of Klaus and Kennell, and (2) that we maintain some historical perspective about the research enterprise in general and research related to social policy in particular.
Few would fail to give major credit to Klaus and Kennell and the Cleveland pediatric group for their reports concerning the beneficial effects of allowing parents to be with their infants in the postpartum period.
Handicapped Infants
Authors: SCHULMAN STANFORD T. 
Published: December 2021

To the Editor.—
The following statement has been approved by the majority of faculty members of the Department of Pediatrics of Northwestern University Medical School and The Children's Memorial Hospital.
"Recently issued federal regulations called for posting of signs and provision of `hot lines' to report cases where treatment is withheld from handicapped infants. Such regulations implied that a widespread campaign exists whereby hospitals and physicians secretly decide who should survive. In fact, no such sinister campaign exists.
Sleep and Nasal Obstruction
Authors: VAN SOMEREN V. , STOTHERS J. K. 
Published: December 2021

In Reply.—
While we agree with Shaw that nasal obstruction is one possible cause of sudden infant death syndrome (SIDS), the purpose of our article was to highlight the pitfalls in diagnosing obstructive apnea.
Implicit in his letter is a criticism of the direction of SIDS research over the past few years: countless hours of "respiratory" monitoring of questionable physiologic quality and analysis of dubious meaning, usually followed by complex statistical comparisons of little clinical import. We share this view and hope that research along such lines will cease shortly to make demands on already strained financial resources.
Impact of Litigation on Immunization of Children
Authors: BRUNELL PHILIP A. 
Published: December 2021

There have been an increasing number of lawsuits claiming compensation for injuries related to vaccines. Increased litigation can be expected to result in reluctance on the part of some practitioners to use certain vaccines, consideration in changes in recommendations for immunization, and increased cost of vaccines.
The costs of oral polio vaccine (OPV) and diphtheria-tetanus-pertussis (DTP) vaccine have been increased markedly presumably because of litigation. It is estimated that the nearly tenfold increase in DTP vaccine charged by one manufacturer could add approximately $50 million per year to the cost of protecting children against these diseases. Manufacturers have been leaving the vaccine business and now only a few remain.
Study on Cystic Fibrosis Criticized
Authors: NEWMAN THOMAS B. 
Published: December 2021

To the Editor.—
The study design and data of Ater et al1 do not justify the authors' conclusion that iron deficiency contributes to relative anemia in patients wih cystic fibrosis. The statistically significant (but meager) increase in hemoglobin concentration in their study came only after vitamin E was added to the regimen of oral iron. They apparently assume that since an increase in hemoglobin could not be correlated with an initially low serum tocopherol level, the vitamin E supplementation had no effect.
Outcome of Complicated Pregnancies of Less Than 27 Weeks of Gestation
Authors: BENNETT FORREST C. 
Published: December 2021

In Reply.—
I would certainly agree with Kilbridge and Elliot that obtaining outcome information from perinatal teams utilizing specified management approaches is the optimum. Attitudes of obstetricians and pediatricians about extremely low-birth-weight infants can influence both mortality and morbidity. Thus, the necessity for consistent cooperation and communication in the care of the extremely premature maternal-fetal unit is increasingly important both clinically and medicolegally. The surprisingly good early outcome of many extremely low-birth-weight survivors, as reported by us and others, mandates such an approach.
Adolescent Chest Pain
Authors: SMITH MARK SCOTT 
Published: December 2021

To the Editor.—
I read with extreme interest the article on adolescent chest pain by Pantell and Goodman.1 This was an excellent clinical study and I agreed entirely with their findings. I am curious why they registered surprise at the finding that the majority of adolescents with chest pain felt this indicated "heart" problems since this is a common concern and previously reported.2
Of additional interest is a report of 100 children and adolescents who were evaluated in a pediatric cardiology department.
Adolescent Chest Pain
Authors: GOODMAN BENJAMIN W. , PANTELL ROBERT H. 
Published: December 2021

In Reply.—
Brown has focused on both diagnostic and selection criteria in order to explain the discrepancy between the prevalence of costochondritis in our two studies.1,2 Our techniques for palpation did differ and may in part have accounted for a difference. We believe the most appropriate comparison group for our population is Brown's patients with chest pain; however, inasmuch as 80% of his patients with chest pain and 77.5% of his patients with abdominal pain had costochondritis the discrepancy with our rate (16%) is not attributable to selection criterion.
Adolescent Chest Pain
Authors: LANTNER INGRID L. 
Published: December 2021

To the Editor.—
I have some questions about Pantell and Goodman's article on adolescent chest pain.
Was there any urine testing for cannabinoids? Were there inquiries regarding the use of marijuana? It's not unusual for teenagers to smoke this drug exclusively. In my pediatric practice, I have seen several adolescents with left-sided or substernal pain, in some instances not accompanied with chronic cough. The roentgenograms of the chest, EGG, tuberculosis tests, and other routine laboratory tests were negative, including some skin tests for respiratory allergies in a few.
Congenital Leukemia: Two Transient Regressions Without Treatment in One Patient
Authors: CHU JEN-YIH , O'CONNOR DENNIS M. , GALE GORDON B. , SILBERSTEIN MICHAEL J. 
Published: December 2021

In Reply.—
The cases of congenital leukemia described by Warner et al further illustrate the interesting but poorly understood features of congenital leukemia. In the last 20 years in our hospital, there have been five cases of congenital leukemia, all diagnosed between 1975 and 1979.1 These five infants developed leukemia between ages 1 day and 8 weeks. As we pointed out in our paper, there is some difficulty in classifying the cell type of some newborns with congenital leukemia.2
Postmortem Protocol
Authors: KRONICK JONATHAN B. , SCRIVER CHARLES R. , GOODYER PAUL R. , KAPLAN PAIGE B. 
Published: December 2021

In Reply.—
We agree that a total body radiograph would be a useful addition to the protocol in some cases. Collection of a CSF sample would also be useful in other situations. Our protocol is neither exclusive nor inclusive for all situations. Our primary goals are to improve diagnosis, increase awareness that mutation is an important cause of death in infancy and childhood, and deal as best we can with the possibility of recurrence. In this regard we are pleased that Whelan and Neidengard et al and others hold similar views.
Early Diagnosis of Cystic Fibrosis: To Screen or Not To Screen—An Important Question
Authors: FARRELL PHILIP M. 
Published: December 2021

To the Editor.—
Cystic fibrosis (CF) is one of the most complex disorders faced by pediatricians and continues to be not only a challenge but an enigma for both physicians and researchers. Although there is no cure for the pulmonary disease associated with CF, a variety of clinical observations1-3 strongly suggest that early recognition and aggressive treatment can have a beneficial effect on the course of the disease. Thus, there has been considerable interest in the possibility of routine neonatal diagnosis by screening.
Uses Higher Level
Authors: COCHRAN WILLIAM D. 
Published: December 2021

To the Editor.—
Watchko and Oski's one act play about yellow fever among pediatricians was deeply appreciated (Bilirubin 20 mg/dL = vigintiphobia Pediatrics 1983;71:660-663). I note they cite several of the Acta Paediatrica Scandinavica articles for their references but fail to cite my favorite by Bengtsson and Verneholt (Acta Paediatr Scand 1974;63:70-80). In this article 108 Coombs negative term infants were reported and followed from ages 6 to 13 years, all of these infants had a peak bilirubin &gt; 20 mg/dL.
Who Has Bugs?
Authors: KULBERG ALAN , GOLDFRANK LEWIS 
Published: December 2021

To the Editor.—
Recently, a 26-month-old female child was brought into our emergency service by her mother who claimed that the child had "bugs." An extensive search for head lice, scabies, or any other evidence of infestation revealed nothing.
When the mother was questioned again about where the bugs were, she pointed to the child's skin and tried to demonstrate that she too had them, by vigorously "rubbing" them out of her palms and forearms, again to no avail. It was then noticed that the mother was slightly tremulous and diaphoretic while obviously intensely concerned about the "bugs."
Prevention of Perinatal Transmission of Chronic Hepatitis B Surface Antigen (HBsAg) Carrier State
Authors: SINATRA FRANK R. , TONG MYRON J. 
Published: December 2021

In Reply.—
In response to the letter by Salvioli and co-workers, although we would agree that the incidence of perinatal transmission of hepatitis B from HBeAg-negative mothers is low, the consequences may be severe. One of the three infants in our study was born to a HBeAg-negative and anti-HBe-positive American mother of European ancestry.1 Following publication of our original report, we cared for an infant who developed fulminant icteric hepatitis 8 weeks after being born to a HBeAg-negative and anti-HBe-positive mother.
Food and Drug Administration Warning on Dead Space in Tracheal Tubes
Authors: HAFFNER MARLENE E. 
Published: December 2021

To the Editor.—
A health hazard concerning device incompatibilities has recently come to the attention of the Food and Drug Administration (FDA)/National Center for Devices and Radiological Health (NCDRH). This hazard, which affects newborns and small infants almost exclusively, can occur when certain breathing system connectors and adapters intended to reduce dead space are used together. The connectors and adapters are made by many different companies. The FDA/NCDRH recently sent a letter to all US hospitals advising them of the problem.
Intestinal Flora Rediscovered
Authors: BARNESS LEWIS A. 
Published: December 2021

To the Editor.—
The article by Yoshioka et al on intestinal flora in neonates1 is important not only for the information it contains, but also for the admonishment that man is mortal and fame is fleeting.
Paul Gyorgy and co-workers,2-4 beginning in 1953 and continuing for the next 23 years, wrote not only of the importance of lactobacillus bifidus in the stool flora of human infants, but also characterized some of the factors that were responsible for this flora.
Floor Furnace Burns
Authors: GROSSMAN ELMER R. 
Published: December 2021

To the Editor.—
Bergen and Kalishman1 concluded their article, "Floor Furnace Burns to Children," with suggestions for prevention. As our pediatric practice is in an area with old homes that have these hazardous furnaces, we have for many years recommended a simply made wooden grid which fits over the furnace outlet. An adult or older child can step over it as it is only about eight inches high. If made according to the instruction sheet (Figure), it will withstand prolonged use without danger of charring or burning, replacing the danger of burned extremities with the annoyance of stubbed toes.
Echocardiographic Study of Premature Infants
Authors: LEVINE O. ROBERT 
Published: December 2021

To the Editor.—
In the multicenter echocardiographic study of premature infants reported by Johnson et al,1 the measurement of aortic root dimension is shown in their figure 1 as inner-to-inner echoes. The recommendation of the American Society of Echocardiography, as reported by Sahn et al2 is for an outer-to-inner (ie, leading edge) measurement. In small premature infants with aortic root dimension of approximately 6 mm, such a measurement difference may amount to 1 to 2 mm, and will lower the normal left atrial to aortic root ratio (LA:Ao) to less than unity as compared with the value of 1.1 or higher reported by Johnson et al.