bluuebunny/crossref_metadata_2025_split huggingface dataset:
Guidelines for Pediatric Cardiology Diagnostic and Treatment Centers
Authors:   Section on Cardiology
Published: December 2021

This document describes the clinical and physical environment in which the pediatric patient with heart disease can undergo accurate and safe diagnostic and therapeutic procedures. Effective utilization of facilities, development of new technologies, and deployment of personnel capable of providing care for the fetus, infant, child, and young adult with heart disease are outlined. Guidelines in this statement update a previous document published in 19781; these current guidelines are in concert with those developed by the Joint Commission on Accreditation of Health Care Organizations2 and are intended for use by health planning agencies and health service organizations to evaluate existing pediatric cardiac centers and to establish the need for new centers.2-5
Young patients with heart disease have unique medical problems that can be met best by a team with training and expertise in the management of such pediatric patients. The primary purpose of this document is to recommend guidelines by which evaluation and treatment can be accomplished safely and effectively and to offer mechanisms to assist in assuring excellence in the quality of pediatric cardiology care.
GENERAL BACKGROUND
Pediatric cardiology patients require continuity and expertise in patient care. A pediatric cardiologist, along with the patient's primary physician, should provide a continuing care program. In some centers, pediatric cardiologists who have expertise in the management of patients with congenital heart disease may provide new or continuing care for adults with congenital heart defects; in others, an orderly transfer of medical management between pediatric and adult cardiologists will provide the best care for older patients.
On Making a Difference
Authors: Green Morris 
Published: December 2021

A question being much discussed today, here and elsewhere, is how to be helpful to all children and their families, especially those who are highly vulnerable and at special risk. It is a question that also intrigued Abraham Jacobi, a vigorous advocate for children and a vocal opponent of practices and conditions he viewed as inimical to their best interests.
Now, as in Jacobi's day, the privileged status that society confers on the professions carries implicitly, and increasingly explicitly, the charge that they remain responsive to the needs of the times. In the case of pediatricians, there is the expectation that we will do whatever is in our individual or collective power to help children and their families master the rapid changes and risks that confront them today. Pediatricians are being challenged increasingly to become involved in social as well as biomedical issues and to promote healthy adaptation as well as growth and development.
PEDIATRICS AND ADAPTATION
These remarks on the potential role of pediatricians in promoting adaptation to developmental, social, educational, and psychosocial issues call for an extension of their traditional role in helping children and parents cope with biomedical problems.1,2 As exemplified in Table 1, such adaptation may be biomedical or psychosocial and prospective, concurrent, or rehabilitative. For successful adaptation to occur, the child or adolescent must advance from the "Risk" box in Figure 1 to the one labeled "Mastery." Those who end in the box labeled "Maladaptation" are life's losers, penalized by symptoms, poor functioning, and unhappy families.
Cardiac Tumors and the Nevoid Basal Cell Carcinoma Syndrome
Authors: COTTON JOHN L. , KAVEY RAE-ELLEN W. , PALMIER CATHERINE E. , TUNNESSEN WALTER W. 
Published: December 2021

Nevoid basal cell carcinoma syndrome is a multisystem disease with a wide range of initial symptoms that can be seen at any age. The most characteristic features are vertebral or rib anomalies, intracranial falx calcification, multiple basal cell carcinomas, odontogenic keratocysts of the jaw, and palmar and/or plantar pits. Pediatricians need to be aware that if any one of these major anomalies is seen, this diagnosis should be considered.
There now appears to be an established association between cardiac tumors and nevoid basal cell carcinoma syndrome. Primary cardiac tumors have been associated with cerebral tuberous sclerosis and neurofibromatosis,20,21 and evaluation of cardiac status is recommended when these genetically determined syndromes are diagnosed. This communication should serve to alert pediatricians to the need for complete cardiac evaluation and genetic counseling when a diagnosis of nevoid basal cell carcinoma is made.
Pollakiuria, Extraordinary Daytime Urinary Frequency: Experience in a Pediatric Practice
Authors: BASS LEE W. 
Published: December 2021

Pollakiuria1,2 (pollakis: Greek, meaning often), or increased daytime frequency of urination, has been reported recently.3-5 This article documents pollakiuria with a prospective 1-year study in a general pediatric practice; compares its incidence with that of lower urinary tract infections in the same practice; describes a method of determining etiology; notes anxiety-producing situations, such as fear of death, as possible precipitating factors; and discusses an approach to therapy. The desirability and practicality of avoiding invasive and/or expensive procedures is emphasized.
Pollakiuria, with urination as often as every 5 to 10 minutes, occurs during the waking hours only, and most commonly in children of preschool or kindergarten age.
Management Strategies for Perinatal Hypoxic-Ischemic Encephalopathy
Authors: MOODLEY MANIKUM , ADHIKARI MIRIAM 
Published: December 2021

To the Editor.—
The paper by Dr Vanucci1 (Pediatrics. June 1990) addresses an important issue in neonatal medicine
[See table in the PDF file]
namely the management of hypoxic-ischemic encephalopathy (HIE). The review is comprehensive and lucid, and the section on "new management strategies" comes at a time when considerable interest has been directed toward this form of therapy. HIE remains a major problem in developing countries where the incidence may be as high as 4% to 6% compared with about 0.2% to 0.9% in the developed world.1-3
Water Temperature and Drowning
Authors: NICHTER MARK A , EVERETT PERRY B. , SALTIEL ALBERT 
Published: December 2021

To the Editor.—
We read with interest the report by Quan et al.1 The authors described normal or near-normal neurologic outcomes after cardiopulmonary arrest in 8 of 38 victims. We are encouraged by these results and agree that early, effective cardiopulmonary resuscitation is the most effective treatment for pediatric submersion victims. Several additional factors, however, must be considered when interpreting the results of this study.
Quan et al describe the King County, Washington climate as "temperate" and note that "submersion victims in this region did not receive the potentially beneficial rapid cooling that icy waters may provide."
Water Temperature and Drowning
Authors: QUAN LINDA , WENTZ KIM R. 
Published: December 2021

In Reply.—
Dr Nichter et al propose that the normal or mildly impaired survival of five asystolic children in our series was due to the rapid induction of hypothermia by the cold waters of the Puget Sound area. However, we reported that hypothermia (rectal temperature &lt;34°C) was not associated with increased survival. In addition, the data in the Table show that none of these five children experienced cold-water submersions.
The ambient temperatures and thus possibly swimming pool temperatures in this temperate area's summers are certainly less warm than Florida's.
Etiology of Autism: Genetic Influences
Authors: Folstein Susan E. , Piven Joseph 
Published: December 2021

Infantile autism was first described by Kanner in 1943.1 Based on the observation that symptoms often began shortly after birth and always by two or three years of age, Kanner believed that autism was caused by an unknown, inborn defect. Because this syndrome was so severe and peculiar, it seemed unlikely to be an understandable outcome of a child's life experiences. In the years since Kanner first described this disorder, research findings have supported his initial interpretations. It is now generally accepted that autism has a biologic cause, and considerable research has been carried out with the aim of uncovering its nature. Both hereditary factors and the prenatal and perinatal environment have been considered. This paper will review the role of genetic factors in the cause of autism; the role of the prenatal and perinatal environment is considered in the paper by Nelson.51
Three types of genetic associations have been described: (1) the familial aggregation of autism, per se—autism is more common in the sibs of affected children; (2) the familial aggregation of other disorders in the family members of autistic children—a variety of disorders that are mild, but probably conceptually related, have recently been described in relatives; and (3) autism appears in association with a few particular disorders of known genetic etiology.
FAMILIAL AGGREGATION OF AUTISM
Population and Family Studies
In most case series and a few population-based studies, the prevalence of autism in the siblings of autistic children has been estimated to be about 2% to 3%.2,3 While this number is small, it is 50 to 100 times greater than the expected rate of autism of 4 to 5 per 10 000 in the population.4,5
Systemic and Other System Disorders
Authors: OSTROM NANCY K. 
Published: December 2021

Pathophysiology
TOXIC SHOCK SYNDROME ASSOCIATED WITH STAPHYLOCOCCUS AUREUS SINUSITIS
Ferguson MA, Todd JK. J Infect Dis. 1990;161:953-955.
Purpose of the Study
This study was performed to highlight, through case reviews, the potential for toxic shock syndrome to occur in pediatric patients as a result of Staphylococcus aureus sinusitis.
Study Population
The case studies involved 3 patients between 8 and 14 years of age.
Methods
The study was carried out by case review of medical records.
Findings
Three cases of toxic shock syndrome with sinusitis as their sole focal site of infection were reviewed. Two of the cases had culture documentation of S aureus with a positive nasal culture and good response to antistaphylococcal therapy. Blood and other cultures were negative. All three cases manifested fever, rash, desquamation, and hypotention or orthostatic dizziness, as well as three or more minor criteria demonstrating involvement of other organ systems. The third case, without sinus culture, represented recurrent sinusitis associated with recurrent toxic shock syndrome. All three cases responded to usual therapy for toxic shock syndrome including fluid volume, support, and antistaphylococcal antibiotics.
Conclusions
The authors concluded that sinusitis can be a nonmenstrual site of S aureus infection underlying toxic shock syndrome in pediatric patients. They noted other similar situations such as nasal surgery or nasal packing which had been associated with toxic shock syndrome perhaps due to similar focal growth conditions promoting optimal toxin production. The authors recommended aspiration of sinuses in such cases, not only for diagnosis but as an important therapeutic procedure.
Butterfly-Shaped Mark
Authors: METZKER ARYEH , SHAMIR RAANAN 
Published: December 2021

In Reply.—
We were delighted to encounter interest in our "Butterfly-Shaped Mark" (BSM), and read Dr Oakes' remarks with interest. Alas, his critical attitude derives mainly from confusion of terminology. A call for an accepted agreement on common terminology is long due.1 When using the term nevus flammeus (a port wine stain), we clearly differentiate it from capillary hemangioma (strawberry hemangioma). We are quite aware of, and quoted accordingly, the occurrence of several capillary hemangiomas with spinal lesions.2
A Matter of Terminology
Authors: RAMOS DE ALMEIDA J. M. 
Published: December 2021

To the Editor.—
O2 "saturation" of hemoglobin has been used as a noninvasive, continuous measurement, adjunct to Pao2 and Paco2 invasive measurements, in mechanical ventilation of the newborn. It reflects the relationship between oxyhemoglobin and total hemoglobin and is expressed in percent.1 O2 saturation measurement is safe and useful if kept below 90%, the point where the dissociation curve starts its horizontal alignment.
In medical literature authors invariably use the expression "O2 saturation." This expression is inaccurate.
Questioning Asthma Treatment Study
Authors: MCJUNKIN JAMES E. , STALLO PAMELA S. 
Published: December 2021

To the Editor.—
The article "Methylprednisolone Therapy for Acute Asthma in Infants and Toddlers: A Controlled Clinical Trial" by Tal et al1 is interesting, but it does have some weak areas which perhaps the authors can address. First of all, the outcome which seems to be most emphasized in the study, ie, percent admitted, is a fairly weak outcome measure when compared with other more objective measures such as changes in pulmonary function. Note that the decision to discharge was made by the senior resident in charge of the emergency department.
The Future of Primary Care
Authors: MOSCOLA RITAMARIE 
Published: December 2021

To the Editor.—
In the article "Primary Care: The Future of Pediatric Education"1 Dr Alpert addresses many issues facing pediatrics. I agree with his list of problems. However, I doubt that the social, economic, and cultural changes he describes will ever occur.
My informal survey of pediatricians in practice is a song of frustration and boredom. The ringing telephone provides the rhythm. How does a patient-physician relationship develop in an environment of missed appointments, 3 AM emergency department visits, and managed care? Many families change physicians whenever employers change health benefits packages.
Infirmary-Style Sick-Child Day Care: Do We Need More Information?
Authors: Furman Lydia 
Published: December 2021

At least 8.2 million children younger than the age of 4 years have working mothers.1 More than half of these infants and children receive out-of-home care: approximately 23% attend day-care centers, 37% are in "family day care," 8% are cared for by the mother herself at work, and the remainder are cared for at home by a relative or sitter.1 Illness is a significant and frequent problem for children of parents working out of the home. We know that respiratory illnesses are the most common acute illness among children in the United States,2 and a recent study found that for children younger than the age of 3, the prevalence of medicated respiratory tract infections is lowest in children cared for in their own homes, higher in those receiving "family day care," and highest in those attending child-care centers.3 Children in day-care centers are additionally at greater risk of several other infectious diseases.4-6 The Bureau of National Affairs concluded that on any given day more than 359 000 children younger than the age of 14 with both parents working are too ill to attend school or day care.7 Who is caring for these sick children? Several recent reviews have examined this question in detail.8,9
A variety of patterns of care for sick children of parents working outside the home have evolved. These can be grouped by type of provider and by location of care. Possible care givers include (1) a parent, (2) a familiar care giver who is not the parent, or (3) a trained but unfamiliar health worker.
The Relationship Between Pertussis Vaccine and Brain Damage: Reassessment
Authors:   Committee on Infectious Diseases
Published: December 2021

Administration of pertussis vaccine has been associated temporally with local and systemic reactions, including febrile convulsions. Based on the National Childhood Encephalopathy Study (NCES), a large case-controlled, epidemiologic study in Great Britain, permanent neurological disability (brain damage) has not been considered a common sequela of rare, severe, adverse neurological events temporally related to pertussis immunization. Recently, however, reassessment of this conclusion has been prompted by the following events: a review of the NCES by a workshop convened to make recommendations for a possible future United States study of the association of pertussis vaccination and serious neurological illness,1 a legal decision in Great Britain questioning the findings of NCES;2 further investigations of the role of pertussis vaccine in causation of acute and chronic neurologic illness;3-6 and continuing reassessment of recommendations for pertussis vaccination by national committees in Canada,7 Great Britain,8 and the United States. Recent reviews and editorials also have addressed this and related questions concerning adverse events attributed to pertussis vaccine.9-12
The Committee herein reports its reassessment of the role of pertussis vaccine as a cause of chronic neurological disability. In this review, the term "encephalopathy" is avoided deliberately. Definition of this term is difficult, and its use can be misleading. For example, the NCES study population was children with acute, serious neurological illness, the majority of whom had convulsions lasting 30 minutes or more.13 Thus, in assessing the nature of the relationship between pertussis immunization and neurological events, the term "acute, serious neurological illness" is considered more appropriate than "encephalopathy."
The Status of Acellular Pertussis Vaccines: Current Perspective
Authors:   Committee on Infectious Diseases
Published: December 2021

Clinical studies of component ("acellular") pertussis vaccines have been undertaken in recent years, and several acellular vaccines have been used in Japan for 10 years. The Committee has reviewed these trials and related data and herein provides its assessment regarding the current status of the acellular vaccines and their possible use in the United States.
The pertussis vaccines in current use in the United States are prepared from whole cells of a strain of Bordetella pertussis that is grown in broth medium, harvested by centrifugation, and killed or partially detoxified by heat or by the addition of a chemical agent, such as thimerosal, or by a combination of these methods. In contrast, the acellular vaccines developed in Japan and used in that country since 1981 contain one or more antigens derived from biologically active components of the B pertussis organism.1 An inactivated form of lymphocytosis promoting factor (LPF), also known as pertussis toxin and a variety of other synonyms, is a frequent component of acellular pertussis vaccines, as are filamentous hemagglutinins (FHA). Other constituents included in acellular vaccines are agglutinogens, a term denoting a variety of protein antigens on the surface of the B pertussis organism. Of the agglutinogens, a 69-kd outer membrane protein, when injected into neonatal mice, protects against B pertussis challenge.2 Acellular vaccines also have recently been derived from mutant pertussis toxin molecules prepared with recombinant DNA technology.3
The acellular vaccines produced in Japan have been classified into two types: B type, which contains LPF and FHA in roughly equal amounts; and T type, which contains mostly FHA but some LPF and agglutinogens.1,4
The Use of Dexamethasone in Premature Infants at Risk for Bronchopulmonary Dysplasia or Who Already Have Developed Chronic Lung Disease: A Cautionary Note
Authors: HARKAVY KENNETH L. 
Published: December 2021

In Reply.—
The letter-to-the-editor from Dr Frank is a cautionary note about the risks of glucocorticoid therapy for chronic lung disease in infants. These concerns are real and have been enumerated in most papers on the subject. Only one study to date has suggested a long-term benefit (decreased mortality); yet consistently respiratory therapy support is decreased by steroid use. I have performed a limited meta-analysis because all studies have had similar enrollment criteria and treatment regimens. Two lengths of treatment have been compared and the combined data compared with the controls (Table 1).
[See table in the PDF file]
This analysis suggests that there is no major difference in outcome by length of treatment, although short treatment was associated with less hyperglycemia and longer duration of intubation. Comparison of all steroid-treated patients with placebo-treated babies showed treated infants had more hyperglycemia (P &lt; .01 χ2) but an average of 11 fewer days of mechanical ventilation (intermittent mandatory ventilation, ImV). (t test was not done due to lack of raw data; however, difference was significant in each subgroup.)
Strength Training, Weight & Power Lifting, and Body Building by Children and Adolescents
Authors: SHEPHERD ROBERT 
Published: December 2021

To the Editor.—
The conclusions1 of the Committee on Sports Medicine concerning this topic are conservative and laudable. However, the definitions of the major lifts described in the article are unclear and possibly misleading.
In the section "Definitions" are mentioned "major lifts,' and `the power clean and the incline and overhead presses.' The article then states, "These lifts involve the use of free weights lifted through the extremes of joint motion in a ballistic rather than a controlled fashion.
AN ENGLISH EXPERT'S VIEW OF AMERICAN "INFORMED CONSENT"
Authors: L. J. F. 
Published: December 2021

Scientists also feel that overzealous ethical review boards and, in particular, informed consent rules have driven science away.
In the mid-80's, Dr. Richard Peto, a well-known epidemiologist at Oxford University, approached American cardiologists to enlist patients for a study of the drug streptokinase as a treatment for heart attacks. Although the Americans were enthusiastic, in the time that British doctors referred 6,000 patients, only 400 entered from the other side of the Atlantic. He holds consent procedures largely to blame.
"The American documents were three pages of legalistic junk," Dr. Peto said, who had written a single page consent form for British use. "That's not the sort of thing you want to push under someone's nose as he's having a heart attack, terrified, with chest pain, on morphine. You want to tell him about the trial, but you want to be humane."
Although countries in Europe require that researchers discuss a study with potential subjects, the requirement is far less formalized.
PEDIATRICS VANS: HOUSE CALLS FOR THE HOMELESS
Authors: L. J. F. 
Published: December 2021

The Children's Health Project, with two mobile medical vans, was created three and a half years ago by the singer and songwriter Paul Simon to give free health care to homeless children in New York City. The vans, which have everything one would find in a regular pediatrician's office, make daily visits to family shelters, shelters for children without families and welfare hotels.
Most patients have common ailments: ear infections, bad colds. Children needing special care are transferred to hospitals.
The project, run by the Children's Health Fund at 919 Third Avenue, near 56th Street, is the largest of its kind in the country. It fills such a gap for the city's roughly 11,000 homeless children that a third van is being added in July. Twenty other cities, including Newark, want to use the project as a model for their own programs.
COMPETITORS' DRUGS BATTLE SEPTIC SHOCK
Authors: L. J. F. 
Published: December 2021

Two competitors, Centocor Inc. and Xoma Corp., are seeking clearance from the Food and Drug Administration for an entirely new sort of anti-infection drug...
The new drugs, unlike antibiotics that act upon the bacteria, latch on to toxins made by the bacteria, thus blocking the next biochemical step in the disease process. Both drugs are monoclonal antibodies, proteins that zero in on selected targets in the body. Centoxin is derived from human spleen cells; Xoma's drug, called Xomen E-5, from mouse spleen cells.
... Some estimates... put the combined U.S. and European sales for both drugs at $750 million by the mid-1990s.
One reason for the jumbo market projections is sky-high prices for drugs produced by biotechnology. Centoxin and Xomen-E5 both are expected to cost between $1,500 and $2,500 for a single course of treatment, given by injection.