bluuebunny/crossref_metadata_2025_split huggingface dataset:
What's New in Pediatric Surgery—1989
Authors: Altman R. Peter 
Published: December 2021

The recent developments in pediatric surgical research as well as new concepts and clinical applications in the specialty are emphasized in this report. There is no attempt to make this review all inclusive. Rather, it focuses on specific areas in which new data or techniques will influence future investigations or the management of patients.
EXTRACORPOREAL MEMBRANE OXYGENATION
No area has commanded more investigational effort than extracorporeal membrane oxygenation (ECMO). By oculopneumoplethysmography Foglia et al1 assessed the effects of right internal carotid artery ligation on cerebral perfusion in lambs during ECMO. Postnormoxic lambs had good right hemispheric perfusion after right internal carotid artery ligation, and posthypoxic animals showed marked initial depression of ipsilateral hemispheric perfusion which improved progressively and was comparable to the normoxic model at 20 hours. Foglia et al postulated a loss of autoregulation and/or intracranial edema, both of which were reversible. It is known that ECMO is associated with an early increase in inflammatory mediators. Simoni et al2 documented a second peak of complement activation and prostaglandin synthesis after 72 hours of high-flow ECMO. They reported increased levels of endotoxin, free radical activity, and tumor necrosis factor, all markers of systemic sepsis. Early weaning, meticulous technique, and periodic replacement of the ECMO circuit for the extended run are emphasized. Crombleholme and co-workers3 proposed using ECMO as a bridge to transplantation with reduced-size lung grafts. They demonstrated the technical feasibility of the procedure in immature swine recipients. The graft was ventilated preferentially and accepted the entire cardiac output. Ongoing studies by Stolar and Dillon4 demonstrated a biphasic prostanoid response in newborn lambs undergoing ECMO perfusion.
Cholesterol Screening?
Authors: GARCIA RICHARD E. 
Published: December 2021

In Reply.—
Dr Dennison points out the complexity of the issue of pediatric cholesterol screening. The total cholesterol value of 200 mg/dL is the 95th percentile for children according to the lipid research clinic's population data book. The adult screening strategy was not extrapolated to the pediatric population; we simply felt that children whose total cholesterol exceeded 200 mg/dL should have a lipid profile to verify the finding and possibly to help define the lipid abnormality.
Toward a Comprehensive Emergency Medical System for Children
Authors: Haller J. Alex 
Published: December 2021

Systems management of life-threatening injuries in children and adults is now accepted as state-of-the-art by those who care for trauma victims in the United States and Canada. A few regional trauma systems for adults have had several decades of experience and have recently served as models for inclusion of pediatric trauma.1 In certain instances, notably the state of Pennsylvania, an emergency medical services (EMS) system has come into being with fully integrated adult and children's components. That the National Pediatric Trauma Registry includes more than 12 000 children is indicative of the significant problem of trauma in childhood; the Registry has provided a necessary base for statistical analysis of injury severity and long-term rehabilitation needs.2
Since 1985, several federally funded state demonstration grants for EMS for children (EMSC) have attempted to establish guidelines for patient care and to suggest methods of ongoing monitoring of the effectiveness of these systems, surveillance of quality, and review of patient outcome.
A statewide designated pediatric trauma center for Maryland located in The Johns Hopkins Children's Center has been functional for 12 years.3 Data are now available for objective evaluation of the effectiveness and impact of this regional pediatric trauma program.
The level of compliance within Maryland's regionalized pediatric trauma system from 1979 through 1986 was recently examined using hospital discharge abstract data routinely recorded for all discharges from 58 acute care hospitals in the state of Maryland.4 Compliance with regionalization was measured by examining (1) the proportion of patients with injuries of varying injury severity scores5,6 who were treated at each of three levels of care (statewide pediatric trauma center, regional trauma center, and community hospital) and (2) the proportion of in-hospital deaths occurring at each level of care.
Half-Dose Immunization for Diphtheria, Tetanus, Pertussis
Authors: ROGERS WM. B. 
Published: December 2021

To the Editor.—
I would like to praise Judy Bernbaum for the amount of work she has done on half-dose immunization for diphtheria, tetanus, pertussis as reported in Pediatrics.1 I feel, however, that the work she has begun is incomplete.
It is unfair to compare the effectiveness of diphtheria, tetanus, pertussis vaccine when given as three doses totaling 1.5 mL against three doses totaling only 0.75 mL.
I call upon Dr Bernbaum to complete her study by giving her half-dose recipients three more half-doses so that their total dosage is also 1.5 mL like the full-dose recipients.
Why Use Indomethacin?
Authors: VAN BEL FRANK , VAN DE BOR MARGOT , STIJNEN THE , BAAN JAN , RUYS JAN H. 
Published: December 2021

In Reply.—
We are very grateful for the commentary by Dr Rosenfeld on our article1 and share his concern about the possible adverse effects of indomethacin in sick and compromised preterm neonates.
We have some indication that the acute systemic effect of indomethacin (an increase in peripheral vascular resistance) also has an acute effect on ductal tissue. In most of the infants we observed, a negative diastolic flow velocity in the anterior cerebral artery existed before indomethacin treatment, suggesting a ductal steal phenomenon.
Drugs and Breast Milk
Authors: DORFMAN JOAN S. 
Published: December 2021

To the Editor.—
I have just reviewed the the article, "Transfer of Drugs and Other Chemicals Into Human Milk," from the American Academy of Pediatrics Committee on Drugs, which appeared in the November issue of Pediatrics.1
I would appreciate further information on a change that has appeared since the previous publication in the September, 1983 issue of Pediatrics.2 Naproxen has been deleted from the current table of maternal medication usually compatible with breast-feeding under the category "narcotics, nonnarcotic analgesics, anti-inflammatory agents."
Growth Hormone Deficiency in an 8-Year-Old Girl With Human Immunodeficiency Virus Infection
Authors: JOSPE NICHOLAS , POWELL KEITH R. 
Published: December 2021

Abnormalities of hypothalamic pituitary function have been reported in adult subjects with human immunodeficiency virus (HIV) infection.1-3 However, endocrine studies in children with HIV infection have failed to disclose significant hormonal abnormalities.4 Indeed, children infected with HIV who were growing poorly were found to have opportunistic infections and lower levels of T-helper cells, but normal growth hormone or insulinlike growth factor 1 concentrations.4
Herein we describe an 8-year-old girl with perinatally acquired HIV infection, growth deceleration, and isolated growth hormone deficiency.
CASE REPORT
This 8 ½-year-old female child was referred to the pediatric endocrine clinic for evaluation of growth deceleration.
Is It a New Syndrome or Due to Overstimulation in the ICU?
Authors: COLE JEAN GARDNER 
Published: December 2021

To the Editor.—
A recent article by Perlman and Volpe in Pediatrics1 described a new syndrome of movement disorder in infants with severe bronchopulmonary dysplasia. I should like to take issue with these findings and feel that what Perlman and Volpe are describing is actually infants responding behaviorally to an overstimulating environment. This "new syndrome" is, I feel, what Als calls "the consequence of a mismatch of extrauterine environment and the capacity of the central nervous system of the fetal neonate which is adapted for an intrauterine existence"2 to deal with the onslaught of stimulation which it encounters in the noisy, chaotic environment of the average Neonatal Intensive Care Unit.
The behaviors described in the article are seen routinely in preterm infants responding behaviorally to overstimulation.3 These behaviors become learned maladaptive responses to stress. They can be prevented or ameliorated by the provision of a more supportive environment, one which recognizes early signs of behavioral disorganization and responds by reducing the cause of the overstimulation, be it auditory, visual, tactile, or kinesthetic.4-6
Information on Nicotine Abuse
Authors: MOORE JOSEPH C. 
Published: December 2021

To the Editor.—
I would like to comment on some information offered in the Committee on Drugs' policy statement, "Transfer of Drugs and Other Chemicals into Human Milk", published in the November 1989 issue of Pediatrics.1 Nicotine is listed as a drug of abuse that is contraindicated during breast-feeding, in the same category as cocaine, heroin, marijuana, phencyclidine 1-(-1-phenylcyclohexyl) piperidine, and amphetamines. Three references are listed; however, none of them provide any good evidence to support a statement with such wide-ranging implications.
EDUCATION: MONEY ISN'T EVERYTHING
Authors: L. J. F. 
Published: December 2021

The education establishment and its cheerleaders would have us believe that America is not "investing enough in human capital." But while this rhetorical device has punch, it ignores the facts. Education budgets in the U.S. have never been larger, and they surpass those of virtually every other country. The problem is not in the level of investment, but in the return on that investment...
See table in the PDF file
...This is the usual result of such studies. According to Eric Hanushek of the University of Rochester, of 65 studies on the relationship of expenditures and achievement, only 20% found a positive impact, while 75% found no impact and 5% found negative impact.
Letter to the Editor
Authors: Strain James E. 
Published: December 2021

Dr Simon has captured the essence of pediatrics. The personal satisfaction that comes from the care of children and their families makes pediatrics unique among medical specialties.
Dr Simon is correct in stating that we should all be capable of promoting pediatrics as a career choice for medical students. Often the pediatric resident is in the best position to influence that choice. Students in the third year clinical clerkship consider members of the house staff as their mentors.
SAFE MOTHERHOOD
Authors: L. J. F. 
Published: December 2021

In the United States, the US Agency for International Development (USAID) has decided to fund project MotherCare, which is aimed at enhancing the services and educational programme that have a significant impact on maternal and neonatal health and nutrition. The work is being carried out by John Snow Incorporated in Washington DC and will include five projects in different countries to demonstrate the efficacy of various interventions, such as improvements in the nutrition of newborn babies, as well as the prevention and treatment of disorders known to be important to maternal and neonatal mortality and morbidity. The MotherCare project will also introduce research and training initiatives in a number of countries.
For those interested in researching a practical approach to reducing maternal mortality, the Safe Motherhood Operational Research programme is offering funding for government and non-governmental organisations in developing countries.1
Just Say No!
Authors: FREEMAN JOHN M. 
Published: December 2021

A seizure, even a febrile seizure, is terrifying to the family. Seeking reassurance that their child will not die and does not have epilepsy, parents turn to their physician. What is he or she to do?
Often the physician prescribes medication "to prevent further seizures" and then reassures the family that the child will be fine if the medicine is given daily as directed. Both the recommendation and the reassurance are wrong.
A Consensus Development Conference on Febrile Seizures held by the National Institutes of Health in 19801 concluded that they would only "consider" anticonvulsant prophylaxis when the child (1) had abnormal neurologic development, (2) had long or focal seizures, (3) had more than two seizures in 24 hours, (4) had a history of nonfebrile seizures in parent or sibling, or (5) was younger than 1 years of age.
Sex-Specific Dysanapsis and the Effect of Passive Smoking Among Asthmatics
Authors: Murray Andrew B. , Morrison Brenda J. 
Published: December 2021

In Reply.—
In view of Dr Kauffmann's suggestion, we reanalyzed our data to find whether the FEF25%-75%/FVC ratio revealed the same sex and age differences as did the FEF25%-75% percent predicted when it was used to assess the severity of asthma. The results were the same. When comparing children of nonsmoking and smoking mothers, the mean FEF25%-75%/FVC ratios were 0.81 vs 0.69 (P = .009) for boys and 0.89 vs 0.83 (P = .54) for girls.
Strength Training, Weight and Power Lifting, and Body Building by Children and Adolescents
Authors:   Committee on Sports Medicine
Published: December 2021

Some children and many adolescents use weights to increase strength or enlarge muscles. A smaller number compete in the sports of weight lifting, power lifting, and body building.
DEFINITIONS
Free weights are dumbbells and barbells that are used without the external support of a machine.
Major lifts are lifts used in the sports of weight and power lifting. Also used are the power clean and the incline and overhead presses. These lifts involve the use of free weights lifted through the extremes of joint motion in a ballistic rather than a controlled fashion. They have significant potential to cause injury.1-3 In the clean and jerk, the athlete lifts the barbell in a two-step movement from the floor to the chest and then over the head; the snatch involves the same movement of the barbell performed without interruption with a different technique. The power clean requires raising the barbell from the floor to the shoulders in a two-part maneuver. The dead lift is accomplished by raising the barbell from the floor by straightening the flexed knees. In the squat lift, the athlete holds the barbell behind the head on the shoulders, squats until the thighs are parallel with the floor, and then straightens the legs. In the bench press, the athlete lies supine on a bench, holds the barbell over the chest with the arms extended, lowers the weight to the chest, and then raises it again. The incline press is similar, except that the bench is at a 30° angle.
Injuries in Day Care
Authors: GIELEN ANDREA CARLSON , SMITH GORDON S. , CHAULK PATRICK , GUYER BERNARD 
Published: December 2021

To the Editor.—
We believe that there is insufficient evidence to state that "children are at no greater risk of injury in day care settings than in the home environment," as concluded by Rivara et al.1 Because the number of injured children was small (N = 29), it is unlikely that this study could provide accurate age-specific rates or identify rare but serious injuries. Studies of day care environments2,3 suggest that children in day care are exposed unnecessarily to many hazards that have the potential to cause serious injury (eg, unsafe playground surfaces and equipment heights).
Pediatric Emergencies
Authors: WEINBERG JOSEPH A. 
Published: December 2021

In Reply.—
Dr DiBona expresses legitimate concern regarding the different classification systems used for pediatric and neonatal units. This concern was shared by the American Medical Association Commission in its deliberations. Discussions were held with the Perinatal Section regarding changing the classification for perinatal care. The pediatric emergencies document was drafted as part of a comprehensive classification of emergency capabilities encompassing multiple disciplines. There were already precedents in trauma, spinal cord injury, burns, and general emergency medicine for level I to the highest level of care.
Are We Becoming a Two-Class Society Based on Neonatal Circumcision?
Authors: SCHOEN EDGAR J. 
Published: December 2021

In Reply.—
In 1989, a new American Academy of Pediatrics Task Force on Circumcision updated the earlier reports referred to by Dr Neiberger. The revised statement1 confirmed that there are medical advantages of newborn circumcision as well as disadvantages and affirmed that the decision to circumcise rests with the parents acting with the advice of the physician. The third-party payer should not be able to overrule this decision. Apparently, in Dr Neiberger's city, private insurers pay for newborn circumcision whereas public agencies do not.
Blood Pressure and Intraventricular Hemorrhage in Premature Infants
Authors: PUCCIO V. F. , SOLIANI M. 
Published: December 2021

To the Editor.—
We have read with great interest the recently published article by Perry et al.1
The need to define "safe" blood pressure levels in the critically ill premature infants is a central topic in the prevention of intracranial hemorrhage.
However, in Perry's paper maximum systolic blood pressure and maximum mean blood pressure values are much higher than those reported by previously published articles.2-4 High blood pressure values were reported by Lou and Friis-Hansen5 in nine newborns.
Safe Handling of Vaccines
Authors: Casto Daniel T. , Brunell Philip A. 
Published: December 2021

The development of safe and effective vaccines for the prevention of infectious diseases associated with high mortality or morbidity is among the most significant accomplishments in medicine. The ultimate goal of eradication of a disease through immunization is an elusive one, having been achieved for only one disease—smallpox. However, a significant reduction in the number of childhood cases of diphtheria, tetanus, pertussis, poliomyelitis, measles, mumps, and rubella has been realized through the use of modern immunizing agents. Recent introduction of vaccines for the prevention of invasive disease caused by Haemophilus influenzae will hopefully provide similar results in the near future.
The success of a vaccine in preventing disease is dependent on both the quality of the immunizing agent and the degree to which it is utilized. Obviously, the safest and most effective vaccine in the world will contribute nothing to the decline of a disease without clinicians' efforts to immunize at-risk individuals and without a willingness on the part of these at-risk individuals (or their parents) to receive the vaccine. This critical issue of vaccine utilization deservingly receives attention in the medical literature with some frequency.1,2 Similarly, the quality of vaccines is frequently addressed in publications concerning aspects such as reactogenicity, immunogenicity, and overall efficacy.3-6 One important factor that can influence efficacy, however, is rarely discussed—how vaccines are handled during shipment and storage.
Discussions concerning preservation of vaccine potency through proper storage and maintenance of the "cold chain" may seem more pertinent to developing countries of the world, where refrigeration is not readily available and exposure of stored product to extreme environmental conditions can be expected.7-9
Guidelines for the Evaluation of Sexual Abuse of Children
Authors:   Committee on Child Abuse and Neglect
Published: December 2021

There are few areas of pediatrics that have so rapidly expanded in clinical importance in recent years as sexual abuse of children. What Kempe referred to in 1977 as a "hidden pediatric problem"1 is certainly less hidden. Recent incidence studies, while imperfect, suggest approximately 1% of children will experience some form of sexual abuse each year.2 Children may be sexually abused either in intrafamilial or extrafamilial settings and are more frequently abused by males. Boys may be victimized nearly as often as girls. Adolescents are perpetrators in at least 20% of reported cases,2 and women may be perpetrators, especially in day-care settings.3 Pediatricians will encounter these cases in their practices and will be asked by parents and other professionals for their opinions. These guidelines are prepared for use by the primary care pediatrician. Pediatricians who "specialize" in the area of child abuse or child sexual abuse have generally developed their own protocols for their referral practices. In addition, specific American Academy of Pediatrics guidelines for the evaluation of rape of the adolescent are published and should be used for this age-group.4
Because a pediatrician has unique skills and a trusted relationship with patients and families, he or she will often be in a position to provide essential support and gain information not readily available to others involved in the investigative, evaluative, or treatment processes. By the same token, the pediatrician may feel inadequately prepared to perform a medical examination of a sexually abused child. The pediatrician should think about these issues when determining how best to utilize his or her skills while avoiding actions that may obstruct the collection of essential evidence.
Race, Culture, and Ethnicity
Authors: MADANSKY DEBORAH , EDELBROCK CRAIG 
Published: December 2021

In Reply.—
We agree with Dr Pachter's point about the distinction between race and culture and about the relative insensitivity of race as a variable where ethnicity is the relevant concern. The division of our sample into white and nonwhite categories provided only the crudest measure of ethnicity. Our findings of a difference between the two groups certainly warrants further exploration of the beliefs about cosleeping among different ethnic/cultural groups.
Outcome of ≤800-Gram Birth Weight Infants
Authors: KILBRIDE HOWARD W. , DAILY DONNA K. 
Published: December 2021

To the Editor.—
The article by Hoffman and Bennett1 suggests that there has been increased morbidity accompanying improved survival for infants ≤800 g birth weight. We reported survival and neurodevelopmental outcome for infants of this birth weight born at our institutions in 1983 to 1985 compared with an earlier 3-year period.2 Our recent survival was comparable with that of Hoffman and Bennett (40% and 46%). Using similar definitions, we found that 13% of infants &gt;1 year of age who were tested had major disabilities.
Hypovolemic Shock in a Child as a Consequence of Corporal Punishment
Authors: EICHELBERGER SCOTT P. , BEAL DOUGLAS W. , MAY RONALD B. 
Published: December 2021

Corporal punishment is an accepted form of discipline in the American home and school despite numerous publications in various fields reporting concerns.1-7 We describe a case of paddling associated with hypovolemic shock.
CASE REPORT
The patient, a 5-year-old black girl with no known underlying health problems, was seen at a local emergency department for complaints of progressive weakness. The previous day she had been paddled by her mother for disciplinary reasons. Her mother had used a wooden paddle, spanking her on the buttocks and upper thighs. Neither mother nor daughter could recall the number of blows administered. Shortly after being spanked, the child complained of generalized soreness over the area of injury.
Extraordinary Urinary Frequency
Authors: COLODNY ARNOLD H. 
Published: December 2021

To the Editor.—
I certainly enjoyed reading the article, "Extraordinary Urinary Frequency" by Drs Zoubek, Bloom, and Sedman1 from the University of Michigan, published in Pediatrics in June, 1990.
I agree with most of what their article states. However, there are a few points of disagreement I would like to call to the attention of the readers of Pediatrics.
Number one is their statement that anticholinergics are ineffective. I have found that anticholinergics frequently are effective in breaking the cycle and alleviating the symptom of extraordinary frequency.