bluuebunny/crossref_metadata_2025_split huggingface dataset:
Neonatal Screening for Phenylketonuria
Authors: KOCH RICHARD , TWELMEYER DEBRA 
Published: December 2021

To the Editor.—
The article by McCabe et al1 reported the findings from a large survey consisting of data gathered from completed questionnaires obtained from 26 countries. The data involved an analysis of serial blood phenyalanine concentrations obtained from newborns during the first 2 weeks of life, who were siblings of known patients with classic phenylketonuria (PKU). The authors should be applauded on their efforts, which represent a significant compilation of data on the important issue of newborn screening.
Neonatal Screening for Phenylketonuria
Authors: MCCABE EDWARD R. B. , MCCABE LINDA 
Published: December 2021

In Reply.—
The comments of Koch and Twelmeyer and of Berlow are appreciated as they allow us to reemphasize points made in our recent article1 on newborn screening for phenylketonuria (PKU) and permit us to address additional relevant issues. Koch and Twelmeyer have stated that "only two of the 26 countries reported false-negative results involving the Guthrie test" and therefore these false-negative results "could be treated as outliers" affecting "the conclusion reached as a result of this survey."
Theophylline Poisoning
Authors: WEINBERGER MILES 
Published: December 2021

To the Editor.—
The conclusions in the recent letter by Kossoy et al1 and the reply by Sahney2 regarding the original report3 suggesting conservative treatment of high theophylline levels until neurologic signs are present do not adequately consider the high frequency of mortality and serious neurologic sequelae once theophylline-induced seizures occur.4,5 Unfortunately, the chemical success of charcoal hemoperfusion after the onset of seizures has not been matched by the desired clinical results.6 Although the risks of vigorous intervention in a patient not yet having serious symptoms must be considered, the small number of cases reported without serious consequences should not provide great reassurance given the potentially serious outcome, ie, death or brain damage, that commonly follows onset of the seizures even in the presence of subsequent dialysis and otherwise optimal intensive care.
The American Privilege To Disagree
Authors: SILVERMAN WILLIAM A. 
Published: December 2021

To the Editor.—
Your correspondent from the US Office of Special Education and Rehabilitative Service1 has implied that the Declaration of Independence is the source of inspiration for the present government's new policy of social control when a severely malformed infant is born. The unprecedented intrusion of government into the privacy of the family circle is a gross shift toward totalitarianism—I am amazed that we are asked to believe the oppressive policy is as American as apple pie.
Echocardiographic Study of Premature Infants
Authors: JOHNSON GREGORY L. , Chandler Albert B. 
Published: December 2021

In Reply.—
Levine has correctly pointed out an important potential source of error in performing echocardiographic measurements in small infants. Measurements of aortic root dimension in the multicenter study we reported were, indeed, performed utilizing the outer-to-inner (ie, leading edge) method as recommended by the American Society of Echocardiography and noted in the methods portion of our manuscript. Due to the reduction in figure size associated with publication, our figure 1 (Pediatrics 1984;72:865) appears, at first glance, to demonstrate inner-to-inner measurement as Levine points out.
Automatic Passenger Protection Systems
Authors:   Committee on Accident and Poison Prevention
Published: December 2021

THE ISSUES
Despite safety improvements to the motor vehicle and roadway and despite educational and legislative measures to promote safe driving, crash injuries remain the leading cause of death and serious injury for children, adolescents, and young adults. Annually, nonpedestrian motor vehicle mishaps claim more than 18,000 lives of Americans less than 25 years of age.1 The vast majority die as occupants of passenger cans. Teenage boys and young male adults are at greatest risk with annual death rates exceeding 100/100,000 population for licensed drivers aged less than 25 years. One out of every one hundred 15-year-old boys will die in a motor vehicle crash before reaching age 25 years.2
To deal with the silent "highway epidemic," the American Academy of Pediatrics launched the "First Ride—Safe Ride" program in 1980. Increasing the use of car seats by newborns was an appropriate Academy project goal as pediatricians can be particularly effective in counseling new parents. The "Every Ride—Safe Ride" program will expand this effort to deal with the more difficult task of reducing occupant injuries to older children and adolescents. This program will promote safe and responsible driving behavior and encourage the use of car seats and automobile seat belts (active restraints).
Seat belts, when used, can reduce the likelihood of a crash fatality by about 50%. Car seats can be even more effective, and there is some evidence that, when properly used, they can reduce the likelihood of death by 90% and serious injury by 70%. However, despite past educational efforts, seat belt use rates are in the 10% to 15% range and even with car seat use laws enacted in most states, actual use rates in excess of 30% to 40% have not been demonstrated.
Guidelines for Urgent Care in School
Authors:   Committee on School Health
Published: December 2021

Minor injuries and illnesses can occur in children during the course of the school day. They are usually well handled by the nurse in consultation with the school medical advisor; true medical emergencies are quite rare. Many school systems, however, have part-time school medical advisors and nurses who cover more than one school building and may not be readily available. Therefore, the burden of emergency recognition and management may fall on teachers, principals, or other personnel in the local school. Inappropriate and delayed care may result in increased morbidity or possible death. Finally, consideration must be given to the question of malpractice or assault charges being filed by the families of inappropriately treated children.
In order to solve this problem, it is important for school administrators in consultation with the school medical advisor and nursing service to formulate a guide for emergency care. The Committee on School Health of the American Academy of Pediatrics suggests the following:
1. Every school district should have an identified, qualified administrator with decision-making status.
2. An emergency care manual and standing orders for first aid should be written and made available to nurses, athletic staff, and faculty volunteers. A sample manual1 is available from the Connecticut State Department of Health (540 Nortontown Rd, Guilford, CT 06437 [$ 8.50]).
3. The school nurse in each building should be the key person to carry out the program as she or he is most familiar with the student's health problems. All nurses should be trained in a program of emergency care developed by physicians, emergency medical technicians, and/or other nurses with special training in emergency care.
Care of Infants with Myelomeningocele
Authors: ROBINOW MEINHARD , PINA GLORIA , TURK MARGARET A. 
Published: December 2021

To the Editor.—
The article on myelomeningocele by Gross et al1 seems to us a step backward. The authors claim to have followed the selection criteria of Shurtleff et al2 and "to a lesser extent those considered significant by Lorber.3 It should be noted that Shurtleff et al considered only 11.3% (36/319) unsuitable for active treatment, whereas Gross et al recommend nonintervention for nearly half (48%) of their infants.
The criteria of Lorber were based on treatment and rehabilitation facilities available at that time in Britain. Those were the days of less effective shunt procedures, the time before computed tomographic (CT) scans, ultrasonography and shuntograms, before intermittent catheterization and artificial sphincters, to name only a few of the advances of the past decade.
Cystic Fibrosis Study Questioned
Authors: ATER JOANN 
Published: December 2021

In Reply.—
Wagener and colleagues make a valid point that increase in plasma volume can be an appropriate response to hypoxia, without the development of polycythemia. This probably is a factor contributing to the inappropriately low hemoglobin values we found in our patients with cystic fibrosis. However, as in anything in medicine, there is rarely a single reason for any clinical observation. Our finding that some of our patients with low iron stores, as reflected by low serum ferritin values, had a significant increase in hemoglobin values with oral iron therapy, provides good evidence that iron deficiency may be one factor limiting the development of polycythemia in these patients.
Equation Error
Authors: MCCORMICK KENNETH 
Published: December 2021

To the Editor.—
I believe there is an error in the article entitled "A System for Individualized Dosing of Intravenous Aminophylline Using a Programmable Calculator" by J. Chris Mitsuoka and Richard J. Fleck (Pediatrics 1984;73:64-67). In the first equation, the first term Cpo e-Ke(t-t') should be Cpo e-Ke(t + t') if t represents the time elapsed after the infusion has commenced.
The paper is confusing as to exactly what t represents; the authors state "duration of therapy" but does therapy begin with the loading dose or with the infusion.
Morbidity Is Decreased by Neonatal Intensive Care
Authors: ETCHES PHILIP C. , ROBERTSON CHARLENE M. T. 
Published: December 2021

To the Editor.—
A recent annotation by "Student" (Pediatrics 1989;83:180) is a quote from a letter from Johnson and MacFarlane in The Lancet of July 16, 1988, stating that, in geographically defined populations, a reduction in the level of morbidity among low birth weight survivors has not yet been demonstrated. We believe that there are, however, some encouraging signs.
There is a report from the Federal Republic of Germany1 describing a reduction in the frequency of neurologic sequelae in a very low birth weight population, born between 1977 and 1983, from a neonatal intensive care unit.
More on Risks of Circumcision
Authors: WILLIAMS H. STEPHEN 
Published: December 2021

To the Editor.—
The diligent and thoughtful efforts of Wiswell and his collaborators in pursuing the original observation of Ginsburg and McCracken,1 that urinary tract infections in male infants occurred more frequently among those who were uncircumcised, have led to some rethinking of previous recommendations regarding routine circumcision. In the most recent report, Wiswell and Geschke2 neatly summarize the minimal risk of properly performed circumcisions and provide important new information regarding the serious threat to health and life itself that urinary tract infections pose to afflicted uncircumcised male neonates.
Rearing Children in Hospital Facilities ("Boarder Babies")
Authors: FOMUFOD ANTOINE K. , STREET ANNE A. 
Published: December 2021

To the Editor.—
It is a tragic realism that many hospitals in major cities in this country are having to care for newborn babies and infants abandoned by their biologic parents and immediate relatives. The problem of child abandonment is not an entirely new one for hospitals; it is the explosive increase in the frequency of occurrence and the escalating numbers of these infants in recent times that make it an issue that urgently needs to be addressed.
Cough as a Risk Factor for Neonatal Intraventricular Hemorrhage
Authors: PERLMAN JEFFREY 
Published: December 2021

In Reply.—
The purpose of the study cited by Dr Argent et al was to elucidate potential mechanisms for the fluctuations in arterial blood pressure observed previously. We agree with the authors that the cough-like Valsalva maneuvers contribute significantly to the circulatory variablility. The data also indicate the close temporal relationship between apneic pauses and stable blood pressure. We support the statement of the authors that ventilator support should be optimized before paralysis. Moreover, other "less noxious" interventions, such as sedation, might have similar beneficial effects regarding stabilization of blood pressure.
Long-Term Trends in Blood Lead Levels Among Children in Chicago: Relationship to Air Lead Levels
Authors: Hayes Edward B. , Orbach Hyman G. , Fernandez Alina M. , Lyne Sheila , Matte Thomas D. , McElvaine Michael D. 
Published: December 2021

Objectives. To evaluate trends in blood lead levels among children in Chicago from 1968 through 1988, and to determine the impact of the changes in the Centers for Disease Control and Prevention (CDC) blood lead level of concern.
Methods. We reviewed a systematic sample of blood lead screening records of the Chicago Department of Health Laboratory for high-risk children aged 6 months to 5 years. Median blood lead levels for each quarter of the years 1974 through 1988 were determined and regressed against mean air lead levels recorded at air-monitoring stations in Chicago during the same period.
Results. Median blood lead levels declined from 30 µg/dL in 1968 to 12 µg/dL in 1988, and were strongly associated with declining average air lead levels (r = .8, P &lt; .001) from 1974 through 1988. A regression model using log-transformed data predicted a decline of 0.56 µg/dL in the median blood lead level with each 0.1 µg/m3 decline in the mean air lead level when the air lead level was near 1.0 µg/m3; the predicted slope was steeper at lower air lead levels. Despite the nearly 20-fold reduction in air lead levels, the median blood lead level of 12 µg/dL in 1988 indicates substantial continuing lead exposure. The CDC blood lead level of concern was lowered twice from 1968 to 1988, but due to the decline in blood lead levels, fewer than 30% of the children were above the level of concern throughout most of the study.
Conclusion. Although substantial lead exposure persists in Chicago, reductions in airborne lead emissions seem to have contributed to a long-term decline in the median blood lead level of high-risk Chicago children.
Epidural Analgesia in the Management of Severe Vaso-Occlusive Sickle Cell Crisis
Authors: Yaster Myron , Tobin Joseph R. , Billett Carol , Casella James F. , Dover George 
Published: December 2021

Objectives. To determine whether continuous epidural analgesia could effectively decrease pain and thereby improve the management of severe vaso-occlusive crisis in children with sickle cell disease who were unresponsive to conventional analgesic therapy.
Design. Retrospective observational study.
Setting. A tertiary care hospital with a large pediatric sickle cell patient referral population.
Patients. The study describes nine children in 11 painful vaso-occlusive crises, unresponsive to high-dose systemic opioids, nonsteroidal anti-inflammatory drugs, and adjunctive measures, who underwent continuous epidural analgesia to control pain.
Outcome Measures. Subjective pain scores, arterial oxygen saturation monitoring, and plasma lidocaine levels.
Methods. Placement of an epidural catheter for the administration of a continuous infusion of local anesthetic, alone, or in combination with fentanyl, in the management of vaso-occlusive crisis.
Results. At initiation of epidural analgesic therapy, 8 of 9 patients reported severe pain (8 to 10 on a scale of 0 to 10, 0 = no pain, 10 = the worst pain they ever experienced). Analgesia was immediate (pain score 0 to 2) in 8 of 9 patients, and continuously effective in 9 of 11 crises. Five patients required either the addition of fentanyl or changing the local anesthetic from lidocaine to bupivacaine to maintain analgesia for 2 to 5 days. In 7 of 9 patients, oxygen saturation dramatically increased from 87 to 95% to 99 to 100% after epidural analgesia was initiated. In all patients, plasma lidocaine levels ranged from 1.1 to 4.6 mg/L and dose-related toxicity did not occur. One patient developed hypotension secondary to high sympathetic blockade (T-4), one had an inadvertent dural puncture during insertion of the catheter, one had the epidural catheter removed for fever, and one achieved analgesia only transiently. There were no other complications, and epidural analgesia was not associated with sedation, respiratory depression, or limitation of movement. All epidural catheters were cultured on removal, and colonization did not occur.
Conclusions. Epidural analgesia with local anesthetics administered alone or in combination with fentanyl effectively and safely treats the pain of sickle cell vaso-occlusive crisis unresponsive to conventional pain management and does so without causing sedation, respiratory depression, or significant limitation on ambulation. Furthermore, early treatment of painful crisis with this technique may improve oxygenation, a critical factor in the evolution of further sickling.
Issues of Confidentiality in Adoption: The Role of the Pediatrician
Authors:   Committee on Early Childhood, Adoption, and Dependent Care
Published: December 2021

Adoption practices in the United States have been designed to protect each member of the adoption triad. Traditionally they preserve the anonymity and privacy of the birth parents. These practices have supported the concept that adoptive parents need to establish a relationship with their new child without concern of unwanted interference by members of the child's birth family. In addition, they emphasize protecting adopted children from potentially disturbing facts about their birth families and/or psychological confusion that might arise from any continued relationship with their birth families.
To protect confidentiality in adoption, all records of the adoption proceedings are sealed. The child's original birth certificate is sealed, and a new one is issued that typically contains only the child's adoptive name and substitutes the names of the adoptive parents for the birth parents. The original birth certificate and adoption records can be opened only by a court order and only for "just cause." Recently, however, three states have developed open adoption records, and more than 30 other states have developed mutual consent registries.1 The exact statutes regarding mutual consent registries vary from state to state, but the basic concept allows adult adoptees and birth parents to register their desire to meet each other. If a mutual consent is achieved, identifying information can be released and a meeting may be facilitated. Some states require both parties to register independently. Other states allow a state agency to locate the birth parent(s) to determine whether consent will be granted to release information to the adult adoptee.1
Comparing Bayesian Posterior Passing with Meta-analysis
Authors: Pritsker Joshua 
Published: December 2021

Brand, von der Post, Ounsley, and Morgan (2019) introduced Bayesian posterior passing as an alternative to traditional meta-analyses. In this commentary I relate their procedure to traditional meta-analysis, showing that posterior passing is equivalent to fixed effects meta-analysis. To overcome the limitations of simple posterior passing, I introduce improved posterior passing methods to account for heterogeneity and publication bias. Additionally, practical limitations of posterior passing and the role that it can play in future research are discussed.
Анализ потенциальной продуктивности травянистой растительности овражно-балочных комплексов Белгородской области
Authors: Чернявских В.И. , Думачева Е.В. , Дегтярь О.В. , Дегтярь А.В. , Бородаева Ж.А. 
Published: December 2021

Биологическая продуктивность экосистем – важнейший результирующий показатель характеризующий скорость формирования биомассы, в основе которого лежит эффективность использования энергии Солнца в процессе фотосинтеза. В Ботаническом саду НИУ «БелГУ» начиная с 2003 года ведется активная работа по изучению продуктивности степного биома в целом и отдельных его составляющих. Наиболее интенсивно ведётся исследование продуктивности естественных фитоценозов овражно-балочных комплексов, имеющих широкое распространение в регионе. На фоне изменяющейся антропогенной нагрузки и климатических изменений большое значение приобретает мониторинг продуктивности растительных сообществ, особенно в условиях неустойчивого состояния территорий со сложным рельефом. Проведенное изучение состояния растительности и накопления надземной фитомассы различными травянистыми сообществами балок и овражно-балочных комплексов позволяет использовать эти данные для мониторинга первичной биологической продукции и воспроизводства биомассы сообществами, как важнейшей составляющей энергетического баланса экосистем. Общее количество надземной фитомассы, накапливаемое за вегетационный период различными сообществами овражно-балочных комплекс в различных экотопах, колеблется от 109.0 до 1127.0 г/м2 – минимально на склонах южной экспозиции и максимально велико на днищах балок в местах, ранее используемых под возделывание интенсивных кормовых многолетних культур (пырейно-люцерно-разнотравное и люцерно-мятликово-шалфейное сообщества).
PREJUÍZOS DO DIAGNÓSTICO TARDIO EM HANSENÍASE: UMA REVISÃO INTEGRATIVA
Authors: Silva Ferreira Izabelle , Zanon Lopes Ribeiro Andréia 
Published: December 2021

Introdução: A hanseníase é uma doença crônica infectocontagiosa com período de incubação prolongado. Pode se apresentar com alterações cutâneas, neurológicas e até levar a incapacidades e deformidades. Apresenta caráter hiperendêmico no Tocantins. Objetivo: Fazer uma revisão da literatura em periódicos nacionais a respeito dos prejuízos de um diagnóstico tardio em Hanseníase. Metodologia: Trata-se de uma revisão integrativa com a pesquisa dos artigos obtidos através de bases de dados da Biblioteca Virtual em Saúde (BVS). Foram selecionados trabalhos de 2015 a 2019 e 27 publicações foram incluídas no estudo. Resultados e Discussão: A demora do reconhecimento da doença aumenta as chances de incapacidades. Ainda é uma patologia estigmatizante, na qual os seus portadores sofrem preconceitos, podendo levar a sintomas depressivos. Considerações Finais: As incapacidades e as deformidades geradas se associam a demora do seu reconhecimento, além do potencial para prejuízos biopsicossociais que diminuem a qualidade de vida da população afetada.
Palavras-Chave: Hanseníase; Diagnóstico; Pessoas com Deficiência.
EPIDEMIOLOGIA DO COVID-19: UMA ANÁLISE DAS REGIÕES DE SAÚDE DO ESTADO DO TOCANTINS
Authors: BEZERRA SIRTOLI DANIELA 
Published: December 2021

A COVID-19, doença causada pelo novo coronavírus (SARS-CoV-2), possui um quadro clínico que pode variar de infecções assintomáticas a quadros respiratórios graves. O objetivo do presente estudo foi realizar uma análise descritiva sobre a distribuição da infecção pelo Covid-19 nas diversas regiões de saúde do Tocantins. Realizou-se um estudo de caráter exploratório e descritivo com ênfase no número de casos confirmados do Covid-19 no Tocantins e sua distribuição nas regiões de saúde. Com base nos dados publicados diariamente pelo Centro de Informações Estratégicas de Vigilância em Saúde / SES-TO. No dia 18/08/2020, o Tocantins contabilizou 38.845 casos confirmados da doença, destes, 23.555 pacientes foram recuperados e 14.759 estão ativos ainda em isolamento domiciliar ou hospitalar, além de 531 óbitos. A região Médio Norte Araguaia foi a que teve o maior número de casos registrados. Dessa maneira é importante avaliar, em cada situação epidemiológica de cada município para que seja feito o planejamento e combate a pandemia.