bluuebunny/crossref_metadata_2025_split huggingface dataset:
Circumcision
Authors: SCHOEN EDGAR J. 
Published: December 2021

In Reply.—
Dr Wiswell essentially agrees with the content and documentation of the report of the Task Force on Circumcision. However, he believes that the benefits of newborn circumcision outweigh the risks, whereas our report simply pointed out the advantages and disadvantages of circumcision without taking a position for or against the procedure.
The points in Wiswell's letter are well taken. His work on the increased risks of urinary tract infections (UTIs) in uncircumcised male infants had an important role in the decision of the American Academy of Pediatrics to convene our Task Force and review its position on new-born circumcision.
Adoption of Hepatitis B Virus-Infected Foreign-Born Children
Authors: HOSTETTER MARGARET K. , JOHNSON DANA 
Published: December 2021

In Reply.—
We thank Dr Sokol for his detailed comments on hepatitis B virus (HBV) infection in internationally adopted children. Several issues which he has raised deserve special attention.
1. Previous reports of HBV infection in internationally adopted children had detected a substantially lower preyalence of this disease than did our study.1-5 Indeed, two studies in Korean infants3,5 place the prevalence of HBV infection at 2.8% to 4.3%, a figure which is approximately one third of that reported for Asian countries as a whole in surveillance studies conducted by the World Health Organization.6
Abdominal Trauma - Child Abuse
Authors: DWORKIND MARCIA , MCGOWAN GEORGE , HYAMS JEFFREY 
Published: December 2021

To the Editor.—
The development of severe abdominal pain and vomiting in an infant is frequently an ominous event with a large differential diagnosis including midgut volvulus, intussusception, and incarcerated hernia. Recently we cared for an infant who developed an acute abdomen as a result of child abuse which was not appreciated until after laparotomy.
A 3-month-old girl was transferred to our hospital with a history of an acute onset of vomiting, diarrhea, fever, and lethargy.
Inadequate Breast Feeding and Jaundice
Authors: NEWMAN JACK 
Published: December 2021

To the Editor.—
It is not surprising that Kemper et al1 found that mothers of jaundiced babies were more likely to wean their infants before le month of age than those mothers whose infants were not jaundiced. However, one aspect of this problem was not discussed in their article. Is it not possible that not only might mothers stop breast-feeding earlier because of the jaundice, but also that the jaundice itself might be a symptom of inadequate feeding and therefore result in earlier termination of breast-feeding?
Routine Cholesterol Screening in Childhood
Authors: ROBERTSON L. D. 
Published: December 2021

To the Editor.—
I am alarmed by the article by Garcia and Moodie1 on "Routine Cholesterol Surveillance in Childhood" that appeared in the November 1989 issue of Pediatrics—alarmed not because they found about 20% of their study had hypercholesterolemia and not because almost half of these children would not have been detected if only children from families with known risk factors had been screened. What is alarming is that people with knowledge of only one part of a complex picture can publish in a respected national pediatric journal sweeping recommendations such as "...all children should have a random, nonfasting cholesterol test performed"; and, after a lipid profile is done in those who are positive on the initial screening, "...the large group of children with hypercholesterolemia identified should be part of a well designed study to evaluate the efficacy of drug therapy..."
Routine Cholesterol Screening in Childhood
Authors: GARCIA RICHARD E. 
Published: December 2021

In Reply.—
Dr Robertson is concerned about cholesterol screening in childhood as it relates to changing the diet of American children and subjecting a large number of children to pharmacotherapy for hypercholesterolemia. He raises several questions regarding the cost of a cholesterol screening program and whether or not there is evidence that dietary therapy (or drug therapy) will really make a difference as far as future coronary artery disease is concerned.
The purpose of the cholesterol screening program was to identify children with hypercholesterolemia and to discuss with their families the various coronary risk factors which are recognized as important for future coronary artery disease.
Earlier Rather Than Later
Authors: MCANARNEY ELIZABETH R. 
Published: December 2021

Clinicians caring for pregnant adolescents recognize their patients' risk for having behavioral problems.1 Not all pregnant adolescents, however, experience such problems. In their article in this issue, Elster and colleagues2 reports that young urban mothers who engaged in three or more problem behaviors were more likely than were urban women who reported no problem behaviors to have had a child before they were 19 years of age.
The interrelationship of adolescent problem behaviors was originally described approximately 20 years ago by Jessor et al.3,4 High-risk behaviors did cluster and young persons involved in one problem behavior were likely to engage in others (sexual intercourse, marijuana use, and problem drinking).4
Solar Pool Blankets: Another Water Hazard
Authors: SULKES STEPHEN B. , VAN DER JAGT ELISE W. 
Published: December 2021

Despite prevention efforts, pool immersion accidents continue to occur all too frequently. In this article we describe a new danger associated with an advance in swimming pool technology, the "solar pool blanket."
CASE REPORTS
Patient 1
A 30-month-old boy with infantile autism was noted to be missing by his parents, who, after an initial look at their above-ground pool, found him submerged under the intact pool blanket, pulseless and breathless 5 minutes later. Cardiopulmonary resuscitation was performed, and he was transported to a local hospital, where he arrived comatose with decerebrate posturing. His rectal temperature was 33.7°C and his arterial pH was 7.0. Diazepam, phenobarbital, and mannitol were administered and he was intubated and hyperventilated.
Adult Respiratory Distress Syndrome in Full-Term Newborns
Authors: FAIX ROGER G. , DIPIETRO MICHAEL A. 
Published: December 2021

In Reply.—
We appreciate the interest and continuing contributions of Drs Pfenninger and Tschaeppeler. We agree with their assessment that the difference in mortality rates is probably attributable to selection differences. All five of their infants would have been excluded from our series, since proven sepsis and documented persistent pulmonary hypertension were both among the criteria for exclusion. As we noted in our article, the low mortality in our series was not surprising because of such exclusions.
Persistent Bacteremia
Authors: PATRICK CHRISTIAN C. , KAPLAN SHELDON L. , BAKER CAROL J. , MASON EDWARD O. 
Published: December 2021

In Reply.—
The first issue raised by Drs Noel and Edelson is that of the reported in vitro heteroresistance of coagulase-negative staphylococci.1 They suggest that this phenomenon could have been expressed by some of the isolates infecting our patients and explain the persistent bacteremia. Although such speculation should be investigated, there are no published studies proving or refuting its validity. Heteroresistance among strains of Staphylococcus aureus has been analyzed with respect to clinical outcome, and no persistent infections were observed.2
Why Use Indomethacin?
Authors: ROSENFELD CHARLES R. 
Published: December 2021

To the Editor.—
The recent article by Van Bel et al1 on the effects of indomethacin on cerebral blood flow velocity was extremely interesting, especially the suggestion that there may have been substantial cardiovascular effects of this cyclooxygenase inhibitor that were independent of its effects on prostaglandin synthesis. Furthermore, their hypothesis that the reduction in heart rate also provided indirect evidence for a systemic effect, ie, an increase in peripheral vascular resistance and a decrease in cardiac output, should be of interest to all neonatalogists using this drug, especially in sick or compromised neonates.
Denver Developmental Test Problems
Authors: HERSHER LEONARD 
Published: December 2021

To the Editor.—
Although 80% of pediatricians feel that their training in assessing a child's development was inadequate,1 it is estimated that between 20 million to 30 million children have been screened worldwide with the Denver Developmental Screening Test.2
With ith so many children tested by so many inadequately trained physicians or their assistants, it is virtually unavoidable that the test sometimes will be used incorrectly. One effect of improper testing may be the not inconsiderable raising of anxiety among parents who are told that their children are developmentally delayed when in fact they are entirely normal.
Routine Cholesterol Surveillance in Childhood
Authors: GARCIA RICHARD E. 
Published: December 2021

In Reply.—
Dr Feldman objects to the recommendation that all children have a cholesterol screening test, citing issues of parental anxiety, cost, and the absence of controlled clinical trials to prove the efficacy of reducing cholesterol levels in reducing all-cause mortality.
The authors feel that informing parents that it is unhealthy for children to consume an excess of cholesterol and saturated fat is at least as appropriate as informing them that smoking, physical inactivity, and obesity are unhealthy.
Tin-protoporphyrin in the Management of Children With Crigler-Najjar Disease
Authors: MCDONAGH ANTONY F. 
Published: December 2021

To the Editor.—
Rubaltelli et al1 recently described the use of tin-protoporphyrin (SnPp) to block bilirubin formation in a child with the potentially fatal Crigler-Najjar Type II disease, a genetic disorder characterized by an inability to conjugate and excrete bilirubin in the normal way. Although repeated administration of SnPp failed to suppress the plasma bilirubin concentration significantly in their patient, perhaps because of the buffering effect of a relatively large extravascular pool of bilirubin, it did appear to diminish the need for phototherapy, suggesting that SnPp might be a useful adjuvant to phototherapy in the treatment of Crigler-Najjar disease.
The Total Costs of Ultrasonography Summary
Authors: BAILLE MICHAEL D. 
Published: December 2021

To the Editor.—
In a recent article, Sheih et al.1 suggest that renal ultrasonography may provide a simple and cost-effective tool for screening large populations for renal abnormalities. However, two additional cost factors need to be taken into consideration. First, there is the cost of the further evaluation of the 595 patients (of 635) who did not need surgery. At a minimum they had another ultrasonographic examination. Second, the authors imply that the 50 patients who underwent surgery were saved from the cost of treatment of renal failure.
The Total Costs of Ultrasonography Summary
Authors: SHEIH CHUNG-PIN , LIN CHING-YUANG 
Published: December 2021

In Reply.—
In our article, we reported on 645 renal abnormalities found in 132 686 school children screened through the use of renal ultrasonography. Of those with renal abnormalities, 50 patients had surgically correctable lesions. The other 595 cases have been examined fully to establish the correct diagnosis and the prevalence of renal abnormalities in school children. However, in this study, the cost to benefit ratio was determined by total expense to number of surgically treatable diseases.
Is It a New Syndrome or Due to Overstimulation in the ICU?
Authors: PERLMAN JEFFREY , VOLPE JOSEPH J. 
Published: December 2021

In Reply.—
We appreciate the interest in our recent article that identified a previously unrecognized movement disorder in infants with bronchopulmonary dysplasia. We suspect from Dr Cole's comments that she can confirm some of our observations. However, her use of imprecise language makes it difficult to draw such a conclusion decisively. We refer to language such as "frantic movement," "disorganization in the motor system," "attempt to re-organize," "attempt to defend themselves from a stressful environment," "overtaxed autonomic system," "behavioral disorganization," "tongue thrusting... a learned behavioral response to stress," and "autonomic disorganization."
Antacid Poisoning
Authors: DEB SIDDHARTHA 
Published: December 2021

To the Editor.—
Dr J. Brand and Dr F. Greer's discussion of a case of hypermagnesemia and intestinal perforation following antacid administration in a premature infant1 can be misleading to physicians who may need to use antacids for treating their patients. The patient in consideration was receiving 18 mL/kg/d of antacids. This is equivalent to more than a liter of antacids per day for an average adult weighing 60 kg.
The management of bleeding of the upper gastrointestinal tract would include the use of H2 receptor blocking agents and usually 2 to 4 mL of antacids or more per kg per day to keep the gastric pH value above 5. Hence, the complications in the baby discussed are secondary to massive overdosage and toxicity of the antacids and to not following routine antacid administration.
Familial Liability to Intrauterine Vascular Impairments
Authors: HENNEKAM RAOUL C. M. , HOFSTEE NIEK 
Published: December 2021

To the Editor.—
In 1987 in Pediatrics, Stevenson and co-workers discussed the hypothesis that neural tube defects may be produced by inadequate nutrient supply to the rapidly growing neural folds due to primary vascular abnormalities.1 Recently, we found another family which may support this hypothesis (Figure).
The proposita (Figure, III, 2) was a 5-month-old second-born child of healthy nonconsanguineous parents. The pregnancy and delivery were uneventful. Birth weight was 3630 g (75th percentile), length was 50 cm (50th percentile), and skull circumference 36 cm (75 percentile).
Familial Liability to Intrauterine Vascular Impairments
Authors: STEVENSON ROGER E. 
Published: December 2021

In Reply.—
Families such as the one reported by Hennekam and Hofstee provide the initial evidence that congenital anomalies produced through vascular pathogenesis may have a heritable basis. This evidence conflicts with the prevailing view that vascular pathogenesis implies environmental causation and, hence, a negligible recurrence risk.
Exclusive claim to any pathogenetic mechanism producing human anomalies must not be assigned to any etiology, heritable or environmental, at this point in our understanding of human development.
Letter to the Editor
Authors: Higgins Sarah S. , Hardy Christian E. , Higashino Stanley M. 
Published: December 2021

The points outlined by Rosenberg and Kisson in their Letter-to-the-Editor regarding our CPR study are interesting comments that reflect personal views and biases associated with their experience with this problem.
Their first point mentions that our survival data following CPR attempts exceeds that which is in the literature. We acknowledged that in our literature review. However, our study demonstrated a 46% reported survival statistic.
The second point regarding the potential for parents to initiate CPR erroneously was not indicated as an issue by any of the respondents in our study.
A Pediatrician's Personal Reflections on Varicella
Authors: Gospe Sidney M. 
Published: December 2021

Primary varicella infection in adults is uncommon, and the severity of this typically childhood illness can be significant. The use of varicella-zoster immune globulin (VZIG) to modify infection in either susceptible adults or compromised hosts who have been exposed to varicella is recommended.1
It is estimated that approximately 4% of the urban adult population is susceptible to varicella infection2; however some hospital worker screening studies have indicated slightly higher rates.3,4 This figure would suggest that of the approximately 1650 individuals embarking on a career in pediatrics each year,5 66 of them would be at risk for contracting chickenpox either during their residency or early in their years of practice.
Practical Significance of Lactose Intolerance in Children: Supplement
Authors:   Committee on Nutrition
Published: December 2021

Since the Committee on Nutrition issued its first statement on "The Practical Significance of Lactose Intolerance in Children" in 1978,1 there have been a few interesting clinical advances in our knowledge of the digestion of lactose. We suggest that the original statement be reviewed to provide a framework for the information presented here.
Lactose is a disaccharide that is present in almost all mammalian milks. It is digested in the small bowel by the lactase located on the brush border of the enterocyte. On digestion, lactose is broken down into two components, glucose and galactose. If lactose is not digested or is digested minimally, the intact sugar moves into the large bowel where it is fermented by enteric bacteria. This fermentation produces acids, carbon dioxide, methane, and hydrogen, and usually results in borborygmi and abdominal discomfort. Lack of digestion of lactose results in an increased number of solute particles in the large bowel with a concomitant increase in osmotic pressure. It has been suggested that the diarrhea associated with lactose intolerance occurs when the capacity of the bacteria to metabolize carbohydrate in the colon has been exceeded.2 Consequently, there is a flow of fluid into the lumen of the bowel with a resultant watery, fermentative diarrhea. These clinical signs and symptoms represent lactose intolerance, a condition that results from malabsorption and lack of digestion of lactose.
There are two useful clinical tests for lactose malabsorption. One test measures the increase in the concentration of glucose in blood following administration of a load of lactose (1 g/kg up to 50 g/kg, equivalent to a liter of milk).
Bacterial Flora of "Normal" Sinuses
Authors: Brook Itzhak 
Published: December 2021

To the Editor.—
I read with interest the study by Arruda et al1 concerning the recovery of organisms from maxillary sinuses. The authors were able to isolate bacteria from 6 (29%) of the 21 patients with normal maxillary sinus radiographs. These findings support our earlier observation in which we recovered aerobic and anaerobic bacteria in uninfected maxillary sinuses.2 The colonization of the sinus cavity with oral flora may explain the chain of events that lead to infection.
Bacterial Flora of "Normal" Sinuses
Authors: Arruda L. Karla , Solé Dirceu , Weckx L. M. , Naspitz Charles K. , Mimica Igor M. 
Published: December 2021

In Reply.—
In our opinion, the nonsterility of the normal maxillary sinuses has not been resolved completely, in part because of the obvious difficulties in performing maxillary sinus punctures in healthy individuals. We have recovered high titers of bacteria in sinus aspirates of 28.6% of our patients with normal maxillary sinus x-rays. However, all the children in our study had chronic tonsillitis and/or adenoids enlargement, and therefore our results only apply to children with those underlying conditions.
Injuries in Day Care
Authors: RIVARA FREDERICK P. , DIGUISEPPI CAROLYN 
Published: December 2021

In Reply.—
We appreciate the comments of Gielen et al on our study examining the risk of injuries to children in day care compared with the risks of injuries to children at home. Injury control, a problem ignored for far to long, is finally beginning to attract a sizeable number of investigators and practitioners. Nevertheless, resources are still extremely scarce, and we encourage others involved in this area to use criteria similar to those used at the Harborview Injury Prevention and Research Center in choosing a topic for intervention: the injuries must be frequent, they must be severe, and an effective intervention should exist.
The NICHD Phototherapy Study
Authors: PERLMAN MAX 
Published: December 2021

To the Editor.—
After following-up at 6 years of age the subjects enrolled in the National Institute of Child Health and Human Development Randomized, Controlled Trial of Phototherapy for Neonatal Hyperbilirubinemia, Scheidt et al concluded that this treatment "effectively controlled neonatal hyperbilirubinemia without evidence of adverse outcome at 6 years of age and was at least as effective as management with exchange transfusion alone."1 According to the objective of the study stated in the Abstract and the introduction, the latter "effective" refers to "preventing brain injury."
Report of the Subcommittee on Assessment and Methodologic Issues in the Management of Pain in Childhood Cancer
Authors: McGrath P. J. , Beyer J. , Cleeland C. , Eland J. , McGrath P. A. , Portenoy R. 
Published: December 2021

Pain is a complex, multidimensional experience that has at least two major components. The first, nociception, is a sensory component directly related to activity in neural pathways responsive to tissue damage. The second is the complex psychologic, physiologic, emotional, and behavioral response to the nociception. This response is determined by many intrinsic and extrinsic factors. In general, children will have less pain when the exacerbating factors, which are outlined in Table 1, are minimized.
Because pain is experienced individually and subjectively, assessment of pain in each individual is essential. Assumptions regarding an individual's pain should not and cannot be inferred from the amount of tissue damage he or she has experienced. Therefore, regarding assessment of pain in children with cancer, the following principles were agreed upon.
1. Systematic assessment of pain should be considered idered a necessary part of the management of cancer. Most children with cancer will be at risk for significant pain at some time during the course of their illness. Such pain can be caused by the disease itself, by invasive diagnostic and monitoring procedures, and by treatment. Therefore, adequate care must include a plan for comprehensive assessment ent and management of all forms of pain in addition to the disease-management protocol.
2. Assessment of pain must be ongoing throughout the course of the illness. Sources of nociception and modifying factors will change through time and must be evaluated continuously.
MEASUREMENT OF PAIN
Although comprehensive assessment of pain must include more than measurement of intensity or severity, this aspect of pain is important and has been studied the most widely.