bluuebunny/crossref_metadata_2025_split huggingface dataset:
Medical Necessity for the Hospitalization of the Abused and Neglected Child
Authors:   Committee on Hospital Care
Published: December 2021

Denial of payment for services rendered to some children hospitalized with the diagnosis of child abuse or neglect has been called to the attention of the Committee on Hospital Care (COHC) of the American Academy of Pediatrics. Specifically, peer review organizations have denied that such admissions are medically required, regarding child abuse as a social rather than a medical problem. Refusals are particularly common if the final diagnosis does not identify a fracture or other physical problem.
The COHC believes that, in most areas of the country and for most children, the hospital remains the proper place for initial diagnosis and treatment of suspected child abuse and neglect. It is often the only facility available. Often, the diagnosis of the extent of injury is unclear and diagnostic tests that cannot be performed immediately on an outpatient basis are indicated. Monitoring of parent-child interactions by nursing, social service, and other staff cannot be accomplished in an outpatient setting. Attending physicians, who often may be unacquainted with the parents, will acquire information most rapidly and efficiently by working in conjunction with the hospital team. Accurate diagnosis and disposition are facilitated speedily. Refusal of payment could seriously interfere with the prompt and adequate investigation of suspected child abuse cases.
In addition, the hospital provides a haven during the diagnostic workup in which to ensure the patient's safety. Physicians may admit a child not only for medical evaluation but also to ensure that the all-important social evaluation takes place. Because abusive parents may not comply with the need to keep scheduled appointments, hospitalization is usually the only way to complete an assessment.
All-Terrain Vehicles: Two-, Three-, and Four-Wheeled Unlicensed Motorized Vehicles
Authors:   Committee on Accident and Poison Prevention
Published: December 2021

This Policy Statement was revised. See https://doi.org/10.1542/peds.2022-059279.
TWO-WHEELED VEHICLES
Miniature motorcycles intended for off-road use by children and adolescents have enjoyed wide popularity since the 1960s.1 Manufacture of these small two-wheeled motor vehicles is not regulated by any federal motor vehicle safety standards. Neither the rider nor the vehicle are required to be licensed. Some of these vehicles are small enough for a 4-year-old child and many are intended for use by school-aged children.2
Minibikes, weighing less than 45 kg (100 lb), are the smallest and most primitive of these vehicles. The more sophisticated minicycles are constructed to resemble miniature motorcycles. Trailcycles are larger than minicycles and have power and design characteristics that make them suitable for rough terrain. All of these vehicles have a short wheelbase and a low profile; thus, they are relatively unstable and poorly visible.3
Injuries
In 1978, there were approximately 19,000 motorbike-related injuries treated in emergency rooms. Nearly half of these injuries were attributed to accidents involving the minibike (US Consumer Product Safety Commission, news release, Aug 27, 1979). In 1982, there were an estimated 12,000 children 14 years of age and younger who suffered minibike- and trailbike-related injuries (National Electronic Injury Surveillance data, National Information Clearing House, US Consumer Product Safety Commission, 1985). Since 1980, the Consumer Product Safety Commission has collected at least 24 death certificates that implicate minibikes and trailcycles. Half of those who died were children 14 years of age or younger. Children often use these vehicles illegally on roadways. Injury typically results from falls or collisions with fixed objects or other motor vehicles.
STUDIES ON THE PREVENTION OF MUMPS
Authors: HENLE GERTRUDE , HENLE WERNER 
Published: December 2021

THE development of satisfactory procedures for the propagation of mumps virus in the chick embryo has brought within reach the possibility of immunization against the disease. Before discussing the various approaches to prevention of mumps, it is well to define clearly the need for such vaccines and who should be vaccinated.
Mumps on the whole is a childhood disease and usually mild when restricted to the salivary glands. In the adult the disease may be more severe, particularly on account of socalled complications such as the involvement of the reproductive glands in the male. In view of this experience vaccination of children should be attempted only if (a) a prolonged immunity can be attained or (b) if certain other clinical conditions in the child render an attack of mumps undesirable at a particular time. In the latter case as well as in adults vaccination may he considered of value even if only a short term immunity can be induced. Vaccines appear desirable for susceptible parents, for instance, who have been exposed by their children, for hospital staffs in contact with mumps patients, and for college students or military personnel, where outbreaks of the disease may interrupt the normal course of training.
A second point to be considered concerns the question of susceptibility. It has been well established, particularly since the advent of specific immunologic procedures, that mumps virus causes overt disease in about two thirds of human beings; in the other third the infection remains inapparent but nevertheless induces permanent immunity.
RETROPERITONEAL TERATOMAS IN INFANCY AND CHILDHOOD
Authors: ARNHEIM ERNEST E. 
Published: December 2021

The histogenesis, pathologic and clinical features, diagnosis and treatment of retroperitoneal teratomas in infancy and childhood, based upon a study of 44 cases, are reviewed. Two cases of benign retroperitoneal teratomas with recovery, and one case of malignant retroperitoneal teratoma with subsequent death are presented.
Retroperitoneal teratomas were usually noted in female infants under the age of 1 year as large, left-sided, abdominal tumors extending into the lumbar region, rarely causing symptoms, and revealing areas of ossification on roentgen examination.
In this series 6.8% of the teratomas had undergone malignant changes, and 29.5% of the tumors were not operated upon and were described at autopsy.
Successful treatment of retroperitoneal teratomas was dependent upon early operation, careful operative technic through a liberal transperitoneal incision, and adequate preoperative and postoperative management. The operative mortality was 29%.
The histologic features constituted an important factor in prognosis: 10 cases of benign retroperitoneal teratoma in infancy and childhood were well for periods of over one year after operation, and no cure of malignant retroperitoneal teratoma has been reported in this age group.
INTRACRANIAL COMPLICATIONS OF CONGENITAL DERMAL SINUSES
Authors: MATSON DONALD D. , INGRAHAM FRANC D. 
Published: December 2021

Ten patients are presented in whom intracranial extension of a congenital dermal sinus was disclosed by operation. The complications of this lesion include infection in the form of meningitis, abscess formation and osteomyelitis as well as hydrocephalus due to obstruction of the spinal fluid pathways.
In unexplained meningitis, the entire midline area of skin over the neural axis should be examined carefully for evidence of a dermal sinus opening. Whenever a dimple or subcutaneous mass is found in the midline of the scalp, RGs should be examined carefully for an underlying skull defect. When such a defect exists, intracranial exploration is indicated.
Surgical treatment previous to development of intracranial infection is relatively simple and should be rewarded by complete cure. Excision after infection has occurred is difficult and the results in this group have been poor.
PSEUDOMONAS AERUGINOSA INFECTION AS A COMPLICATION OF THERAPY IN PANCREATIC FIBROSIS (MUCOVISCIDOSIS)
Authors: GARRARD STERLING D. , RICHMOND JULIUS B. , HIRSCH MARVIN M. 
Published: December 2021

Four cases of proved pancreatic fibrosis in which Ps. aeruginosa was the organism associated with the terminal, bronchopulmonary manifestations have been presented. These children had received prolonged antibacterial therapy varying from one to five years.
Ps. aeruginosa, or similarly resistant organisms, which ordinarily have a low pathogenicity, may become predominant and invasive as a result of prolonged antibacterial therapy. The opportunity for the emergence of resistant strains would seem to be enhanced by recent recommendations advocating continuous antibacterial therapy with a single compound. Intermittent therapy, alternating the various antibacterial agents and correlating their use with careful bacteriologic studies of the nasopharyngeal and tracheobronchial flora, would seem to be the logical approach to treatment in the light of present knowledge of the development of bacterial resistance. Mixtures of two antibiotics having a different mechanism of action may be more desirable than the use of a single agent.
CONGENITAL MEGACOLON (HIRSCHSPRUNG'S DISEASE)
Authors: SWENSON ORVAR 
Published: December 2021

A NEW concept of the pathology and surgical treatment of congenital megacolon has been published. The pathology was described as absence of ganglion cells in Auerbach's plexus in the rectosigmoid and rectum. This segmental congenital defect in the myenteric plexus was postulated to account for the absence of peristalsis in the distal colon. Surgical resection of the functionally defective bowel relieved these patients. The following clinical experiences and experiments sustain this concept.
Colostomy above the rectosigmoid in four patients with congenital megacolon relieved abdominal distention and colonic stasis. Six months after colostomy closure, these four patients, in whom rectosigmoid resection was not performed, suffered a complete recurrence of the disease. Reopening the colostomy in these patients again relieved all their symptoms with return of the colon to approximately normal size. The dilatation and hypertrophy of the colon seem to have been secondary to a functional obstruction in the rectum and rectosigmoid.
Tracings of large bowel peristalsis were made to determine the nature of the rectosigmoid dysfunction. Three small rubber tubes with balloons attached were inserted through a transverse colostomy and positioned so that one balloon was at the splenic flexure, one in the descending colon, and one in the rectosigmoid. The balloons were inflated with 10 cc. of air and attached to recording manometers. Normal recordings were secured from two patients who had transverse colostomy as a result of right colectomy for gangrenous intussusception. The kymograph tracings showed a progression of the peristaltic waves from the transverse colon to the anus.
Round Table Discussion
Authors: MCGUINNESS AIMS C. , JODAR E. O. , MILLER JOHN FLEEK 
Published: December 2021

I shall talk first about diphtheria, tetanus and whooping cough, and the use of single and then multiple antigens. Following this we will have a short period for discussion.
Diphtheria: Up to World War II it was generally assumed that most of the adult population of the United States was immune to diphtheria. Many studies since 1941 have shown this is no longer the case. Depending upon locality 25 to 50% of our adult population now is susceptible. Infants of susceptible mothers likewise are not immune, and there has been an increasing amount of diphtheria in infants under 6 months of age. This phenomenon, of course, is due to the steadily decreasing carrier rates. Immunity to diphtheria depends upon constant restimulation which now, in general, must be provided artificially. Immunity following active immunization cannot be counted on lasting more than 3 to 4 years.
Reactions to diphtheria toxoid have been one of the chief problems in diphtheria immunization, especially in older children and adults. Methods of purification developed by Pillemer and others in recent years have made available vastly superior toxoids which also contain considerably less alum than the pre-War products. One must remember, however, that some individuals are sensitive to toxoid itself, and such persons will react adversely to the material regardless of its freedom from impurities. Most infants and young children are not sensitive to diphtheria toxoid. Older children and adults should receive a Schick test and Schick test control prior to immunization in order to rule out those who definitely are sensitive to the material.
EFFECT OF ADRENOCORTICOTROPHIC HORMONE ON RHEUMATIC FEVER
Authors: DORFMAN ALBERT , SMULL KATHERINE , BERGENSTAL DELBERT M. , HOWARD ROBERT , MULLER RICHARD , OLESON DUNLAP , SENZ EDWARD 
Published: December 2021

ACTH therapy represses the manifestations of active rheumatic fever including those of carditis. There is as yet no conclusive evidence as to whether ACTH therapy affects the natural course of rheumatic fever. A relatively large percentage of patients in this study showed evidence of reactivation of disease on withdrawal of drug.
As used in these studies ACTH therapy did not uniformly prevent death due to acute rheumatic pancarditis. There is no evidence to indicate whether treatment of active rheumatic fever with ACTH changes the incidence of late valvular deformities.
Wrong Dose Warning
Authors: FIKAR CHARLES R. 
Published: December 2021

To the Editor.—
I wish to bring to attention a potentially serious error appearing in Dr Hoekelman's recently published textbook.1 The concentration recommended for intracardiac epinephrine is 1:1,000, but the usually recommended concentration is 1:10,000.2 Diluting the 1:1,000 epinephrine may avoid complicating ventricular arrhythmias.
School Performance and Theophylline
Authors: SCHRIVER ROBERT C. 
Published: December 2021

To the Editor.—
My interest in the article by Rachelefsky et al (Pediatrics 1986;78:1133-1138) stems in part from the heightened media coverage it received. I must admit as a professional biostatistician that I have some difficulties with regard to its conclusions.
The authors report a P value equal to .004 for the intergroup comparison of change scores for the teacher's behavioral assessment. However, the statistically significant change (P = .04), a reduction for placebo and an increase for theophylline, in the posttreatment score when compared to the pretreatment score is completely ignored.
Relaxation and Examination for Sexual Abuse
Authors: HANSEN KAREN KIRHOFER , PALMER WILLIAM M. 
Published: December 2021

To the Editor.—
We were pleased with the article by Herman-Giddens and Frothingham concerning physical findings in sexually abused girls (Pediatrics 1987;80:203-208). Their experiences were similar to ours after evaluation of more than 2,263 cases of alleged sexual abuse since 1980. No mention was made, however, of the effect of the degree of a patient's relaxation during the examination on the appearance of the vaginal opening. We have seen numerous children in whom the truly enlarged size of an apparently small vaginal opening became obvious when the patient relaxed.
Human Immunodeficiency Virus Infection in Childhood, Adolescence, and Pregnancy: A Status Report and National Research Agenda
Authors: Nicholas Stephen W. , Sondheimer Diane L. , Willoughby Anne D. , Yaffe Sumner J. , Katz Samuel L. 
Published: December 2021

During the first half of this decade, much new information about the acquired immunodeficiency syndrome (AIDS) became available, including landmark reports of the syndrome in children from Oleske et al, Rubinstein et al, and Scott et al; descriptions of AIDS in pregnancy by Wetli et al, Rawlinson et al, and Minkoff et al; and discovery of the agent that causes AIDS, the human immunodeficiency virus (HIV, formerly called HTLV-III/LAV).
The first sets of health guidelines pertaining to HIV-infected children and adolescents in school, day-care and foster care settings were published by the American Academy of Pediatrics' Committee on Infectious Diseases in March 1986 and 1987. In 1987, the Surgeon General's Workshop on Children With HIV Infection and Their Families provided the first comprehensive set of recommendations relevant to the provision of pediatric and obstetrical care to infected mothers, infants, children, and adolescents. Most recently, during February 1988, the Secretary of Health and Human Services formed the Secretary's Work Group on Pediatric HIV Infection and Disease that consisted of members from each of the health and human services agencies, including the Social Security Administration and the Health Care Financing Administration. The broad mandate of this group was to make recommendations to facilitate the removal of barriers to care, treatment, and financial burdens of children and adolescents with HIV infection and their families.
In contrast, HIV infection has not received sufficiently widespread attention from the obstetric, pediatric, or adolescent research communities. The uneven geographic distribution of the disease; its associated social, legal, and ethical complexities; and the lack of sufficient research monies all have contributed to this problem.
Impact of Rock Lyrics and Music Videos on Children and Youth
Authors:   COMMITTEE ON COMMUNICATIONS
Published: December 2021

Rock music has undergone dramatic changes since its introduction 30 years ago and is an issue of vital interest and concern for parents and pediatricians.
Rock music lyrics have become increasingly explicit during the last two decades—particularly with reference to sex and drugs. Some lyrics communicate potentially harmful health messages. These lyrics are of special concern in today's environment, which poses unprecedented threats to the health and well-being of adolescents, including pregnancy, drug use, acquired immunodeficiency syndrome (and other sexually transmitted diseases), accidents, and suicide.
The American Academy of Pediatrics (AAP) strongly opposes censorship. According to the Federal Communications Commission, the public owns the airways, which are leased back to radio and television stations that are obligated to produce programming in the public's best interest. Good taste and self-regulation by consumers, media, and the music industry would be appropriate and effective solutions.
The AAP, therefore, recommends that:
1. The public, and parents in particular, be made aware of sexually explicit, drug-oriented, or violent lyrics on records and tapes.
2. Broadcasters and the music industry be encouraged to demonstrate good taste and self-restraint in decisions regarding what is produced and allowed to be broadcast.
3. Rock performers be reminded that they can serve as positive role models for children and teenagers.
4. The AAP and other concerned organizations encourage parents to take a more active role in monitoring music to which their children are exposed.
5. Local coalitions of pediatricians, educators, and parents discuss the effects of the media on children and teenagers.
6. Research concerning the impact rock music has on the behavior of adolescents and preadolescents be developed and supported.
Sickle Cell Trait and Competitive Athletics: Is There a Risk?
Authors: Pearson Howard A. 
Published: December 2021

The gene for sickle hemoglobin has a nearly global distribution, occurring with great frequency in Africa (and from there to the Western Hemisphere), southern Europe, the Mideast, and parts of the Indian subcontinent. In the homozygous state, homozygosity for sickle cell genes (sickle cell anemia) produces great concentrations of sickle hemoglobin [HbS] within the RBCs, usually &gt;90%. Such large concentrations of HbS are associated with spontaneous sickling under physiologic conditions in vivo that result in severe hemolytic anemia and vasooclusive complications that compromise and threaten health, and even survival.
In contrast, the heterozygous state, designated sickle cell trait, is associated with only 30% to 40% HbS in the RBCs, most of the remainder being normal adult hemoglobin (HbA). These relatively small concentrations of HbS are not associated with in vivo sickling.
IN YOUR NEIGHBORHOOD: A MODERN CHILD CARE CENTER
Authors: Esbenshade John F. 
Published: December 2021

The "Little Ponies" day care center, located at Clos de Cheval d'Argent 1, has 60 beds for children, 30 in the infant section and 30 in the "large" section. It is open from Monday through Friday from 7:30 am to 6:30 pm and is closed on legal holidays.
Charges are fixed by the French Community Council. They are determined by parental income and range from 50 to 400 F ($1.25 to $8) per day.
The center is directed by a nurse and our little ones are taken care of and directed by early childhood specialists. Further, several times each week a medical consultation for the kids is provided by a pediatrician attached to each day care center.
Maintenance staff assures perfect upkeep of the buildings and material.
Meals are prepeared at the center by a cook: light breakfast at 9:00, lunch at 11:00, snack at 3:00. As for the menus, they are made up by the nurse-director and the pediatrician in collaboration. Special diets are prepared as needed and scrupulously followed according to the request of the parents or the family doctor. Formula is also prepared at the center, except if it is a special one.
When welcoming parents and child in the morning, the nurse or child care worker in charge asks parents for useful information about the baby: has he slept well . . . when did he eat. . . ? Note is made of everything unusual that might be mentioned, and of any special treatments or diets that might need to be followed.
During the day, numerous stimulating activities are organized: games on the floor on foam pads, cushions to climb over, drawing, crafts. . . . Games, of course, are adapted to the age of the little ones and take place in well-separated areas in the sections for infants and toddlers.
In the evening, when the parents come to pick up their children, they are informed about any useful information about the behavior of their baby during the day.
Annual Summary of Vital Statistics—1988
Authors: Wegman Myron E. 
Published: December 2021

Data for this article, as in previous reports, are drawn principally from Monthly Vital Statistics Report, published by the National Center for Health Statistics (NCHS). US data for 1988 come from the NCHS annual summary and are estimates by place of occurrence, based upon a count of all certificates received in state offices between two dates, 1 month apart, regardless of when the event occurred. Mortality data by cause and age, however, come from the Current Mortality Sample, a systematic 10% sample of those certificates. For the United States as a whole, the estimates, with few exceptions, have proved to be close to the subsequent final figures. There are considerable variations in some states, however, because provisional figures are by place of occurrence.
Advance final reports for births, deaths (including infant deaths), marriages, and divorces provide more detail on items like age, sex, race, education, and certain indices of health care. These reports are by place of residence for births and deaths but marriages and divorces are by place of occurrence.
Careful attention should be paid to differing denominators in text and tables. For overall rates, like the birth rate or death rate, the standard denominator is 1000 total population. In instances in which more refined analysis is possible, other denominators are used, such as 100 000 for cause of death data. The particular denominator is indicated in each table.
The international data come from the annual Demographic Yearbook and the quarterly Population and Vital Statistics Report, both published by the Statistical Office of the United Nations, which has also been kind enough to provide directly more recent data reported by various countries.