bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bicycle Helmet Promotion
Authors: BROWN JEFFREY 
Published: December 2021

To the Editor.—
In two recent articles by Dr Robert Cushman and his colleagues in Ottawa,Canada,1,2 including a publication in the July 1991 issue of Pediatrics, they conclude “physicians interested in [bicycle]helmet promotion would do better to participate in the design and implementation of multidisciplinary community campaigns.”
I find this conclusion, which is identical in both articles, to be enlightening but, at the same time, disturbing. In their two articles Dr Cushman's group
Bicycle Helmet Promotion
Authors: CUSHMAN ROBERT 
Published: December 2021

In Reply.—
Dr Jeffrey Brown raises concerns about the quality of the intervention as well as the conclusion in our recent articles about bike helmet promotion.1,2
It appears that the term “cue card” gave the false impression that clinicians read the material in front of patients. Our apologies for the confusion! At the orientation sessions, in addition to the study information package, we gave participants a plasticized card so that they could review the material
Cholesterol Screening
Authors: CHRISTOFFEL KATHERINE KAUFER , GRIFFIN TIMOTHY C. , BINNS HELEN J. , STOCKMAN JAMES A. 
Published: December 2021

To the Editor.—
We are writing to correct erroneous assertions about our published article“Family History Evaluation as a Predictive Screen for Childhood Hypercholesterolemia,”1 which appeared in a recent Commentary in Pediatrics.2
1. Our study, which was conducted 4 years ago, was designed to describe the efficacy of then-prevalent cholesterol screening practices in achieving their goal: the identification of children with elevated low-density lipoprotein(LDL)-cholesterol. (Once so identified, such children generally underwent further evaluation to
T.A.C.
Authors: BONADIO WILLIAM A. , WAGNER VIRGINIA 
Published: December 2021

In Reply.—
Regrettably, there was a typographical error in our manuscript.1The actual formula used for making the adrenaline-cocaine (AC) solution involved mixing 28 g of cocaine with 120 mL of 1:1000 (not 1:100) epinephrine and adding enough normal saline to bring the total solution volume of 240 mL(not 480 mL). This formula makes the “full-strength” AC preparation, which contains a cocaine concentration of 11.8%.
With regard to the necessity of the adrenaline component,
Therapeutic Orphans
Authors: YASTER MYRON 
Published: December 2021

In Reply.—
We agree with Drs Darling and Lambert that children are “therapeutic orphans” and that precious little data exist concerning the safety and efficacy of many of the drugs used in pediatric practice. Although Drs Darling and Lambert believe that we, in “academia,” have a“responsibility” to study these drugs, they have not offered any suggestions of how to do this. These are very difficult studies to design,with soft end points, that must
Firearm Injuries Affecting the Pediatric Population
Authors:   Committee on Injury and Poison Prevention
Published: December 2021

In the United States approximately 30 000 people die from firearm injuries each year. Many more are wounded. In the mid 1980s, more than 3000 of the dead were children and adolescents aged 1 to 19 years.1 In 1989 nearly 4000 firearm deaths were among children 1 to 19 years of age, accounting for 12% of all deaths in that age group.2 All of these deaths or injuries affect other children because the victims who are killed or wounded are frequently relatives, neighbors, or friends.
Comparison data for childhood age groups demonstrate that in 1987, 203 children aged 1 to 9 years, 484 children aged 10 to 14 years, and 2705 adolescents aged 15 to 19 years died as a result of firearm injuries.1 Firearm deaths include unintentional injuries, homicides, and suicides. Among the 1- to 9-year-olds, half of the deaths were homicides and half were unintentional. Among the 10- to 14-year-olds, one third of the deaths were homicides, one third were suicides, and one third were unintentional. Among the 15- to 19-year-olds, 48% were homicides, 42% were suicides, and 8% were unintentional.1
Firearm homicides are the leading cause of death for some US subpopulations, such as urban black male adolescents and young adults.3 Table 1 indicates how firearms contributed to the deaths of children and adolescents (homicides, suicides, and all causes) in 1987. Table 2 illustrates the unusual scale of firearm violence affecting young people in the United States compared with other developed nations.4 Firearm injuries are the fourth leading cause of unintentional injury deaths to children younger than 15 years of age in the US.5
Chronic Fatigue Immune Dysfunction Syndrome: An Epidemic?
Authors: VAN AERDE J. 
Published: December 2021

To the Editor.—
Chronic Fatigue Immune Dysfunction Syndrome (CFIDS) or Myalgic Encephalomyelitis (M.E.) is a debilitating neuroimmune disorder which is taking on epidemic proportions. Some estimates indicate that 5% of the North American population might become affected this decade.
Smith et al1 confuse the symptom of "chronic fatigue" with the disease "chronic fatigue syndrome" The terminology is mixed up throughout the entire paper, but the authors clearly report on the symptom only. According to the Centers for Disease Control (CDC), the patient has to meet two major and eight minor criteria to be diagnosed with CFIDS.
Acute Diarrhea Therapy—Suboptimal?
Authors: SNYDER JOHN D. 
Published: December 2021

In Reply.—
The findings of Ms Simpson and Drs McIntyre and Ste-Marie are very interesting and raise some intriguing questions. What was the outcome of therapy in these children? Were there differences in outcome related to the therapy used? Their findings also raise the question of whether more optimal therapy would reduce admissions from their Emergency Room or return visits from children sent home. Such data would make an even stronger case for the need to improve case management practices.
Hyperbilirubinemia: Should We Adopt a New Standard of Care?
Authors: CASHORE WILLIAM J. 
Published: December 2021

The review and recommendations by Newman and Maisels1 in this issue of Pediatrics constitute a provocative critique of our current state of knowledge concerning the risks of hyperbilirubinemia in term infants and should begin a dialogue about the recommended standard of care for jaundiced newborns.
For several decades, the use of exchange transfusions to prevent kernicterus and phototherapy to prevent exchange transfusions, the puzzling emergence of low-bilirubin kernicterus, the "discovery" of breast milk jaundice, and concern over the possible contribution of bilirubin to neurologic handicap have combined to encourage preemptive intervention for moderate jaundice in asymptomatic newborns. But has this strategy of anticipatory management become hardened into an overly aggressive pattern of testing and treatment? Newman and Maisels conclude that it has.
Jaundice in Healthy, Term Neonates: Do We Need New Action Levels or New Approaches?
Authors: BROWN AUDREY K. , SEIDMAN DANIEL S. , STEVENSON DAVID K. 
Published: December 2021

All seems infected that th' infected spy,
As all looks yellow to the jaundiced eye.
—Alexander Pope
An Essay on Criticism, 1711
We take note of Alexander Pope's admonition, and we are reminded by others that, from their perspective, the evidence is unconvincing that moderate neonatal hyperbilirubinemia adversely affects the neurodevelopmental outcome of healthy, term infants. Moreover, although there is ample evidence that high levels of bilirubin may be associated with neurologic injury, a linear relationship between neonatal serum bilirubin levels and long-term neurodevelopmental impairment does not seem to exist.1 Such observations have been recognized for some time2,3 and have encouraged some of our colleagues to propose new guidelines for the treatment of jaundice in well, term infants.4,5
Radiofrequency Current for Catheter Ablation of Accessory Atrioventricular Connections in Children and Adolescents. Emphasis on the Single-Catheter Technique
Authors: Schlüter Michael , Kuck Karl-Heinz 
Published: December 2021

Catheter ablation of an accessory atrioventricular connection using 500-kHz radiofrequency current was attempted in 10 children and adolescents aged between 6 and 15 years (mean 10.5 years). Six children had the Wolff-Parkinson-White syndrome and four had tachyarrhythmias related to a retrograde-only conducting ("concealed") accessory connection. No child had associated structural heart disease. Symptoms ranged from disabling palpitations to episodes of syncope (three patients) and cardiac arrest (one patient). Ablation was attempted from the left ventricle in all children; in one child, ablation of a second, right-sided pathway was attempted via a right atrial approach. Ten of the 11 accessory connections were interrupted successfully. A single complication was encountered in a 10-year-old girl in whom the procedure had to be terminated because a thrombotic occlusion of the right internal iliac artery had evolved.
A simplification of the ablation procedure associated with reduced procedure duration and radiation exposure time was achieved in three children with th Wolff-Parkinson-White syndrome and a left free-wall accessory pathway when a single catheter placed in the left ventricle was used for pathway localization as well as ablation. It is concluded that catheter ablation using radiofrequency current is effective and safe and may supersede surgery as the curative treatment for children with serious symptoms mediated by an accessory atrioventricular connection.
Different Opinions and Thoughts on the Management of Hyperbilirubinemia
Authors: Lucey Jerold F. 
Published: December 2021

What is the standard of care for an infant with a high bilirubin level? Numerous "guidelines" based on well-intentioned opinions certainly exist, but should these really define a standard of care? I don't think so. We still don't have enough solid evidence to make rules!
After more than 40 years of research, Newman and Maisels are suggesting new guidelines for healthy fullterm infants. They have critically reviewed the evidence available and make some new recommendations. I was curious to learn the reactions of a number of "bilirubin experts" and the opinions of an American Academy of Pediatrics Task Force on the subject. I thought it might be worthwhile to have all of these published in the same issue to demonstrate the wide spectrum of opinions which exist.
Position for Lumbar Punctures
Authors: PINHEIRO JOAQUIM M.B. 
Published: December 2021

To the Editor.—
In "A Controlled Clinical Trial of Local Anesthesia for Lumbar Punctures in Newborns"1 Porter et al reported on their attempt to decrease lumbar puncture-induced physiologic instability by using lidocaine. While the cardiorespiratory measures of physiologic instability were not affected by local anesthesia, they were influenced significantly and adversely by the preparatory procedure (ie, being held flexed in the fetal position). As pointed out by the authors, the position chosen for the procedure, which included knees to chest plus flexion of head and neck has been shown to induce more adverse physiologic responses than either the sitting or the modified lateral (neck not flexed) position.2,3
Position for Lumbar Punctures
Authors: PORTER FRAN , MILLER J. PHILIP , COLE F. SESSIONS , MARSHALL RICHARD E. 
Published: December 2021

in Reply.—
Dr Pinheiro correctly points out that alternative positions for performance of lumbar punctures in newborns have been shown to result in less physiologic perturbation than the position for lumbar puncture used in our study. Although we did not select specifically to study the fully flexed lateral position, it was the most common position for lumbar punctures in our Neonatal Intensive Care Unit at the time our study was conducted.
Diarrhea Care in Private Practice
Authors: SNYDER JOHN D. 
Published: December 2021

In Reply.—
I applaud Dr Tochen, Mr Tsukamaki, and Ms Feil for developing such a thoughtful, practical and relatively inexpensive approach to acute diarrhea in their practice. We also have incorporated an educational program on the assessment and treatment of acute diarrhea as one of the core components of our well-child clinic teaching.1 The use of packets of oral rehydration salts has a number of advantages cited by Dr Tochen, Mr Tsukamaki, and Ms Feil, and packets have been used with great success in more than 100 countries.
Lomotil Overdose
Authors: AHMAD SYED RIZWANUDDIN 
Published: December 2021

To the Editor.—
I was amazed and disappointed to read the concluding paragraph of Dr Wasserman's Letter to the Editor, `Lomotil Overdose,'1 wherein he states that Lomotil (diphenoxylate/atropine) intoxications "are rarely seen" now. The 1990 Annual Report of The American Association of Poison Control Centers National Data Collection System2 lists 1654 cases of diphenoxylate-atropine poisonings which include 1004 cases (61% approximately) involving children less than 6 years old, and two deaths. Talking about loperamide Dr Wasserman asks, "Will Imodium prove to be less dangerous to infants and young children than Lomotil? So far it seems that way."
Lomotil Overdose
Authors: WASSERMAN GARY S. 
Published: December 2021

In Reply.—
I would like to thank Dr Rizwanuddin for his timely comments; actually I am in his corner in the battle against the use of antidiarrheal preparations for young infants and children. I1 did not intend to trivialize 1004 pediatric diphenoxylate-atropine cases in 1990,2 but this does not compare with the early 1970s when these intoxications were fairly frequent. My original review3 included 49 pediatric cases during a 42-month period (23 of those cases in 1973) in comparison with Dr McCarron's 8 cases in more than 12 years.4.
Infants with Anencephaly as Organ Sources: Ethical Considerations
Authors:   Committee on Bioethics
Published: December 2021

This Policy Statement was retired May 2009.
BACKGROUND
Pediatric organ transplantation offers an increasing number of seriously ill children the opportunity for a healthy life. However, there is currently a severe shortage of pediatric organs. Young children rarely die in circumstances that would make them medically acceptable sources of organs. Among the children younger than 2 years of age registered to receive transplants, an estimated 30% to 50% die before an organ becomes available.1 In April 1990, the United Network for Organ Sharing reported 320 children younger than 5 years of age waiting for kidney (99), liver (178), heart (34), or heart-lung (9) transplants. Although improved organization of the organ procurement system could partially ameliorate the problem, in all likelihood, pediatric organs will remain a scarce medical resource.2
Anencephaly is a congenital defect in which the cranium is absent and the cerebral cortex is virtually absent. However, vital organs, such as the heart and kidneys, are often normal. About 1000 to 2000 live anencephalic births occur annually in this country. Brain stem function enables many anencephalic infants to survive for hours or days and, in rare cases, for a few weeks.3
In recent years, some parents of anencephalic infants, as well as some transplant surgeons, medical ethicists, and state legislators, have proposed that these infants' organs be used for transplantation.4,5 Some parents have poignantly expressed their wish that some good might come of their loss. In their opinion, there is no compelling reason for failing to use an anencephalic infant's organs to give life and health to other children.
Strategies to Reduce Hyperkalemia-Induced Cardiac Arrhythmias in Premature Infants and Newborns
Authors: LACKMANN G. -M. , TÖLLNER U. 
Published: December 2021

With great interest we have read the paper by G.J. Kost1(Pediatrics l991;88:597-603) about critical limits, especially potassium in newborns, for emergency clinician notification at United States children's hospitals.
Stimulated by a study about life-threatening hyperkalemias in asphyxiated newborns from 1990,1 we have analyzed specifically the results of another prospective study about laboratory investigations and clinical findings in asphyxiated (N = 98) and healthy (N = 87) newborns during the first 144 hours of life in view of serum potassium levels.2
Strategies to Reduce Hyperkalemia-Induced Cardiac Arrhythmias in Premature Infants and Newborns
Authors: KOST GERALD J. 
Published: December 2021

In Reply.—
Several investigators1-7 have shown that in premature infants and newborns hyperkalemia is associated with unacceptably high morbidity and mortality due to cardiac arrhythmias. These arrhythmias can occur at potassium levels below the high critical limit for newborns (see Figure). Critical limits were obtained from two independent surveys of 55 children's hospitals.8 and 134 US medical centers.9 Mean high critical limits for newborns were 7.8 ± 0.5 mmol/L at children's hospitals8 and 7.7 ± 0.7 mmol/L at US medical centers.9
Bordetella bronchiseptica Pneumonia in a Patient with Down Syndrome: A Case Report and Review
Authors: WINTERS JEFFREY L. , O'CONNOR WILLIAM N. , BROUGHTON ROBERT A. , NOONAN JACQUELINE A. 
Published: December 2021

Bordetella bronchiseptica is primarily an animal pathogen, responsible for canine tracheobronchitis (kennel cough) and bronchopneumonia, as well as porcine atrophic rhinitis and otitis media. It readily colonizes the upper respiratory tract and oropharynx of these species.1 This organism rarely has been recognized as a human pathogen, causing mild upper respiratory tract infections in animal caretakers,1 subacute bacterial endocarditis,2 and a pertussis-like illness in children.3 Although asymptomatic nosocomial colonization of humans occurs,4 it also has been reported in immunocompromised Patients as a cause of sepsis,5 peritonitis,6 bronchitis,4,7 and pneumonia.4,8-13
To date, seven cases of human B bronchiseptica pneumonia have been reported in the literature with five of these occurring in immunocompromised patients.
Questions Collaborative Dexamethasone Trial
Authors: MACMAHON PAUL 
Published: December 2021

To the Editor.—
I read the timely article by the Collaborative Dexamethasone Trial group1 with great interest. However, I am concerned that the trial cannot possibly fulfill its stated aim of clarifying the benefits and hazards of dexamethasone treatment for neonatal chronic lung disease. The trial specifically excluded those infants in whom the administration of steroids was judged to be mandatory by the responsible clinician. No information whatsoever was given on these infants and, for all we know, dexamethasone might well have been extremely effective and perhaps lifesaving in this group.
BRAIN ABSCESS ASSOCIATED WITH CONGENITAL HEART DISEASE
Authors: GLUCK REGINA , HALL JOHN W. , STEVENSON LOUIS D. 
Published: December 2021

A review of the literature reveals 41 adequately documented cases of cerebral abscess associated with congenital heart disease. Three cases of cerebral abscess occurring in 39 autopsied cases of congenital heart disease are reported in this paper.
The clinical signs and symptoms of cerebral abscess are presented with special emphasis on the need for early surgical intervention. The occurrence of persistent headache or lethargy in a patient with congenital heart disease should be thoroughly investigated. Spinal tap, EEG and cranial air studies should be done before the diagnosis of cerebral abscess is excluded.
Several authors believe that an area of infarction in the brain precedes the development of an abscess although this process alone has not been reported in congenital heart disease. Five instances of cerebral infarction were observed in 39 autopsies on individuals with congenital heart disease.
A number of possible explanations have been offered for the development of infarction: paradoxic emboli, emboli from the lungs through the systemic arterial circulation by way of the pulmonary vein, left auricle and ventricle, emboli from the lungs through the spinal veins and finally, as a result of thrombosis of the cerebral arteries.
In addition to pulmonary and cerebral thrombosis, thrombi were found in the iliac, popliteal and renal arteries. The tendency to systemic and pulmonary thromboses in cases of congenital heart disease is best explained on the basis of decreased flow of blood due either to polycythemia or to decreased pulmonary blood flow.
Significant cerebral lesions of various kinds were found in 22 of 39 cases of congenital heart disease.
PHYSIOLOGICAL CONSIDERATION OF RESPIRATORY DISEASE
Authors: COMROE JULIUS H. 
Published: December 2021

A. Physiologic Factors Concerned in the Regulation of Respiration
Physiologists now agree that there is a medullary respiratory center which has intrinsic rhythmicity. Nevertheless this center can be influenced profoundly by many chemical and nervous factors. One of the most important of these is carbon dioxide. Under ordinary conditions the medullary center is exquisitely sensitive to changes in carbon dioxide pressure. When the respiratory center is depressed (by deep anesthesia, large doses of morphine or barbiturates, trauma, cerebral edema, increased intra-cranial pressure, severe anoxia or by high concentrations of carbon dioxide itself) it is no longer responsive to carbon dioxide though it may still permit reflex activity and continuation of respiration.
Anoxemia may also stimulate respiration; this occurs through reflexes originating in chemoreceptors of the carotid and aortic bodies. It appears certain that these chemoreceptors are functioning in the normal full-term newborn though they may not be functioning or functioning properly in prematures. When these chemoreceptors are in operation, anoxia will stimulate respiration and oxygen therapy will abolish such hyperpnea. When the chemoreceptors are not in action, one would expect no reflex effects from either oxygen or anoxia; oxygen therapy, however, might relieve cerebral ischemia and permit respiration to improve.
B. Physiologic Methods for Evaluating Respiratory and Pulmonary Function
The function of the lungs is primarily to oxygenate the venous blood and to remove excess carbon dioxide from it. To accomplish this, there must be normal respiratory volumes, normal lung volumes and aerating surface, even distribution of the inspired gas to the alveoli, unimpaired diffusion across the alveolar capillary membrane, and uniform distribution of pulmonary capillary blood flow to the functioning alveoli.
THE PEDIATRICIAN AND THE PUBLIC
Authors: ROTHMAN PHILLIP E. 
Published: December 2021

THESE are days of brilliant achievements in medical science. Research progresses with incredible rapidity. Each advance creates additional problems; former gains are often neglected. The attention of the medical profession is occupied with so many issues of immediate importance that the problems affecting the quality of medical care have been pushed aside. In an attempt to appraise the present difficulties, it is helpful to recall past experiences.
Thirty-three years after Roentgen's announcement of "a new kind of ray," Thayer issued the following warning: "It is a sad commentary on human weakness, the manner in which the discovery of a new method of investigation of great help, such as roentgenology, has led the medical public to neglect those fundamental methods of study which are far more important in themselves. . . . The information supplied by an X-ray plate is often of immense complementary value. Alone and without the information afforded by the history, the appearance of the patient and the results of physical examination, it is often of no more value than that afforded by percussion alone—indeed less. For he who percusses the chest cannot fail to observe the patient."
In a similar manner, the course of events that followed the development of electrocardiography has been described by Levine: