bluuebunny/crossref_metadata_2025_split huggingface dataset:
Report of the Task Force on Diagnosis and Management of Meningitis
Authors: Klein Jerome O. , Feigin Ralph D. , McCracken George H. 
Published: December 2021

Children still die or suffer permanent neurologic sequelae as a result of bacterial meningitis. Prompt diagnosis and aggressive management are the goals, but early signs of meningitis are often subtle and nonspecific and, therefore, may be recognized only in retrospect. The physician must identify among the many febrile children seen every day in office practice—most of whom have spontaneously resolving illnesses usually caused by viruses—the few children who have serious bacterial infection requiring early intervention. No single test or battery of tests replaces the clinical acumen of the physician in identifying the child with early signs of bacterial meningitis. Because of controversies about diagnosis and treatment of meningitis voiced in various forums, including the courtroom, the Task Force on Diagnosis and Management of Meningitis has been asked by the Executive Board of the American Academy of Pediatrics to prepare a report on the causes, diagnosis, management, and outcome of meningitis in infants and children.
This task force selected for discussion issues of current relevance and controversy in the diagnosis and treatment of bacterial and nonbacterial meningitis. Many other aspects of meningitis are discussed elsewhere. Commentaries on the prevention of disease by chemoprophylaxis (antimicrobial agents) or immunoprophylaxis (vaccines) have been prepared by the Committee on Infectious Diseases of the American Academy of Pediatrics. In addition the Morbidity and Mortality Weekly Report (Centers for Disease Control, Atlanta) publishes recommendations on vaccine usage and chemoprophylaxis formulated by the Advisory Committee on Immunization Practices. These resources are of value to the practitioner who cares for children and needs information on optimal measures for the treatment and prevention of meningitis.
Diphtheria, Pertussis, and Tetanus (DTP) Immunization Local Reactions Do Not Predict Central Nervous System Reactions
Authors: BLATTNER RUSSELL J. , FEIGIN RALPH D. 
Published: December 2021

To the Editor.—
Our purpose in writing this letter is to comment on the controversy that currently surrounds DTP immunization and the recent marked increase in the cost of this vaccine that apparently reflects the cost of pending litigation.
In 1967, Russell J. Blattner, MD, was Chairman of the Department of Pediatrics at the Baylor College of Medicine. At that time, he performed a small clinical study to compare the rates of minor or local reactions secondary to administration of whole-cell DTP vaccine with the rates of similar reactions to fractionated or split-cell DTP vaccine.
Intravascular Injection of Long-Acting Penicillin
Authors: WALSON PHILIP D. , GALLETTA GARY 
Published: December 2021

To the Editor.—
Recent discussions in Pediatrics (1985;75:785-786 and 1986;77:783-784) have pointed out the problems associated with intravascular injection of long-acting penicillins. There is an obvious need for continued education of health care providers concerning the physical properties of these agents and their delivery systems.
Wyeth, the manufacturer of the Tubex cartridge system, has recently redesigned their product so that the flow of any aspirated blood is directed to one side of the glass barrel, immediately past the hub, where it can be more easily seen.
Errors in Drug Administration
Authors: BURY GRAHAM 
Published: December 2021

To the Editor.—
Koren et al (Pediatrics 1986;77:848-849) report recommendations to avoid administration of incorrect drug doses. I must confess surprise, in view of the fact that tenfold errors seem to be the most common ones made, to find no recommendation to ban the decimal point. This is common practice in the hospital in which I work. If any decimal point has to be used, then that particular drug dose is written in long hand, eg, one point five mgs.
Errors in Drug Administration
Authors: LAMONT JEFFREY H. 
Published: December 2021

To the Editor.—
I read with interest the article by Koren et al, "Tenfold Errors in Administration of Drug Doses: A Neglected Iatrogenic Disease in Pediatrics" (Pediatrics 1986;77:848-849). Errors such as those described by the author are perhaps most likely to occur during an emergency resuscitation situation. Several factors contribute to this increased likelihood. (1) emotional stress of the situation, (2) the urgency of need for the medications, leading to excessive haste in their preparation for administration and at the same time a decrease in the likelihood that the dose will be double checked before administration, and (3) the relative lack of familiarity of the members of the resuscitating team with the medications being used.
Liver Injury After Oral and Rectal Administration of N-Acetylcysteine for Meconium Ileus Equivalent in a Patient With Cystic Fibrosis
Authors: BAILEY DAVID J. , ANDRES JOEL M. 
Published: December 2021

N-acetylcysteine (NAC) is a mucolytic agent (Mucomyst, Mead-Johnson) that is often used for the treatment of meconium ileus equivalent, a complication of cystic fibrosis.1-3 No serious adverse reactions to nonparenterally administered NAC have been observed, and there have been no reports of significant hepatotoxicity. We describe a patient in whom severe hepatic dysfunction occurred on two occasions after the administration of NAC for the treatment of meconium ileus equivalent.
CASE REPORT
A 3-year-old, 12.5-kg, white boy with cystic fibrosis was admitted for treatment of a fractured left femur. His medications included theophylline, metaproterenol, cefaclor, nebulized isoethanine, and pancreatic enzyme replacement with meals.
Residents on the Phone
Authors: WOOD PAMELA RUNGE 
Published: December 2021

In Reply.—
I appreciate the remarks of Drs Fosarelli and Katz. Their study seems to confirm the results of my own work. As they point out, the clinical experience of a pediatric resident answering calls from patients with whom he is not familiar may not be far removed from the experience of a practitioner in a busy HMO setting. I await with interest publication of the full study.
Intensive Care Unit Resources and Costs
Authors: BUSHORE MARTHA 
Published: December 2021

In Reply.—
The discussion by Dr Pollack et al about objective analysis of ICU resources is useful to all pediatricians. Objective analysis may be especially helpful in individual case discussions when a physician's fears about one or more patients seem to be excessive and result in inappropriate utilization of high-cost care. Former stressful experiences of the physician or of the patient and family with the specific medical disorder, within a health care institution, or with one another may result in a disproportionate anxiety and sense of threat not easily soothed by simple reassurance.
Computerized Ventilation
Authors: ANBAR RAN D. 
Published: December 2021

To the Editor.—
Carlo et al1 report an "expert system" based on an algorithm for mechanical ventilation of infants with respiratory distress syndrome which would have corrected arterial blood gas derangements in 89% of 106 clinical trials. This algorithm was applied to additional trials using an independently designed computer-generated ventilation simulation program (VSP).
Written in BASIC, VSP expects its user to manage a randomly "created" infant with respiratory distress syndrome by monitoring arterial blood gas values, physical examination findings, and chest x-ray film findings.2
Presidential Address
Authors: SMITH MARTIN H. 
Published: December 2021

The time has come for me to give my final report of my year as president of the American Academy of Pediatrics. It has been an interesting year, a busy year, and I hope a year that has had some accomplishments. Last October at our business meeting, I discussed with you some problems that could be anticipated at the beginning of the year. During the year, there have been other problems that have arisen of equal importance that could not have been anticipated. I wish that I could tell you that all of our problems have been confronted and have been solved. It is not possible to wrap them all up according to our schedule.
Last October, I commented to you that the Academy now functions with the Executive Committee acting more as a team that hopefully carries the gains from one year to the next without interruption while the office of president changes each year.
COARCTATION OF THE AORTA AS A CAUSE OF DEATH IN EARLY INFANCY
Authors: BAHN ROBERT C. , EDWARDS JESSE E. , DUSHANE JAMES W. 
Published: December 2021

This is a report of three cases in each of which an infant exhibited coarctation of the aorta at the level of a closed or closing ductus arteriosus. In all cases the collateral channels were poorly developed. It appears from the available evidence that death resulted from left ventricular congestive failure secondary to an obstructive hypertension.
The development of collaterals to by-pass a coarctation of the aorta seems to depend upon the relation of the aortic coarctation to the aortic mouth of the ductus arteriosus. When the coarctation lies distal to the ductus, collaterals develop. When the coarctation lies proximal to the ductus, adequate collaterals do not develop before birth. When the coarctation lies opposite the aortic mouth of the ductus arteriosus, the development of collaterals during fetal life seems to depend upon the direction that the blood flowing in the ductus arteriosus takes. When the flow is into the aorta proximal to the coarctation, collaterals would be expected to develop; while when the ductal flow is into the descending aorta, adequate collaterals would not be expected to develop in the fetus. The three cases reported fall into the latter category.
MUMPS MENINGOENCEPHALITIS
Authors: KRAVIS LILLIAN P. , SIGEL M. MICHAEL , HENLE GERTRUDE 
Published: December 2021

An analysis has been presented of the results obtained in complement fixation tests employing both the soluble, or S, and virus, or V, antigens in 85 cases of mumps meningoencephalitis. Thirty-eight of 71 cases for which clinical data were complete had failed to reveal preceding, concurrent or subsequent involvement of the salivary glands. Only 25 (35%) had such involvement prior to onset of meningitis.
In 62 of the patients, definite serologic evidence of infection with mumps virus was obtained in one of two ways: (1) The presumptive test was positive in 43 cases, i.e., the first serum showed a high antibody level against the S antigen and distinctly lower titers against V. (2) In 19, a positive diagnosis was based on the demonstration of a rise in both antibodies. The remaining 23 patients gave evidence suggestive of mumps infection by virtue of high antibody levels in the first available serum.
The anti-S &gt; anti-V pattern occurs most frequently when the meningoencephalitis is not preceded by salivary gland involvement and when the serum is obtained before the end of the first week of illness. Delay in withdrawing the blood and occurrence of overt or possibly inapparent glandular involvement prior to the meningitis is associated with the presence of antibodies in relatively high titer to both the S and V antigens. Such results can only be regarded as suggestive of recent infection.
Even when serum from patients with no salivary gland involvement is obtained in the first week of illness, about one third will not show the anti-S &gt; anti-V pattern. At present, under proper conditions, the early serologic diagnosis appears possible in about two thirds of cases of mumps meningoencephalitis without preceding or concurrent salivary gland involvement.
The clinical findings and routine laboratory data on spinal fluids and blood are presented; these findings and data are in accord with those previously reported by others.
CORRESPONDENCE
Authors: BAUER EDWARD L. 
Published: December 2021

The furor created by the reports of paralysis occurring in extremities injected with antigens in patients developing poliomyelitis within one month after the injection has assumed the proportions of hysteria.
Anderson and Skaar (Pediatrics 7:741, 1951) clearly acquit "injections" given prior to one month before the onset of poliomyelitis of any recognizable part therein and certainly play no part in the etiology of poliomyelitis itself.
The public and many public health authorities however are reacting to the serious detriment of the overall disease prevention picture.
HYPERVITAMINOSIS A
Authors: ARENA JAY M. , SARAZEN PAUL , BAYLIN GEORGE J. 
Published: December 2021

An unusual case of hypervitaminosis A with severe craniotabes in a 6½ month old infant is presented. This is the youngest infant reported with this condition and the first to present craniotabes.
Symptoms of hypervitaminosis A are compared with those of hypervitaminosis D and with those of infantile cortical hyperostosis. In the case presented prompt and complete disappearance of craniotabes and other symptoms followed withdrawal of administration of vitamin A.
Additional Publication Information
Authors: JOHNSON CANDICE , DEBAZ BAZ P. , SHURIN PAUL A. 
Published: December 2021

To the Editor.—
We regret that in our paper "Renal Ultrasound Evaluation of Urinary Tract Infections in Children" (Pediatrics 1986;78:871-878) we neglected to mention that cinical data on the 64 children in our "first series" had been previously published in Pediatric Infectious Disease (1985;4:656-662). Readers interested in further epidemiologic data on these children should consult the earlier study.
School Performance and Theophylline
Authors: RACHELEFSKY GARY S. , WO JULIE , ADELSON JUDITH , MICKEY M. RAY , SPECTOR SHELDON L. , KATZ ROGER M. , SIEGEL SHELDON C. , ROHR ALBERT S. 
Published: December 2021

In Reply.—
Mr Schriver's first concern is the appropriate interpretation of results from placebo-controlled, double-blind clinical trials. Our understanding is that the function of the placebo-treated group is to provide a control against which to judge the effect of the treatment. It is not particularly unusual to observe an "effect" in the placebo "arm" of such a controlled study, and we would consider it inappropriate to emphasize the effect in either arm considered by itself other than in reference to the planning and interpretation of such trials.
Defecation Dynamics
Authors: LOENING-BAUCKE VERA 
Published: December 2021

In Reply.—
We do not agree that testing of rectal sensation and the ability to defecate rectal water-filled balloons is diagnostic overkill" in children with chronic constipation and encopresis. Schmitt1 pointed out that he individualizes the treatment regimen and provides careful followup. Balloon defecation and sensibility testing helps in individualizing the treatment regimen, in counseling of patients and parents, and in the educating about the problem prior to embarking on months to years of laxative treatment, dietary manipulation, toilet sittings, record keeping of bowel movements and soiling episodes, etc.
FOALS ARE GETTING HELP
Authors: L. J. F. 
Published: December 2021

KENNETT SQUARE, Pa.—Nearly as rare as the colt that grows up to be a racing champion is the birth of twin foals. Yet a tiny and brave filly and her weaker twin brother grow stronger every day here in an intensive care unit for newborn horses.
Established in 1983 and directed . . . by Dr. Wendy E. Vaala, a . . . veterinarian, the University of Pennsylvania's intensive care unit for foals was built. . . . It is one of only seven such units in the country, and they have led to the development of a new specialty in veterinary medicine—equine neonatology.
Recipes for formula fed to foals were borrowed from those used at the University of Pennsylvania Hospital in Philadelphia. The intensive care unit uses ultrasound equipment, heart monitors and other devices commonly used in human neonatal medicine. Treatments for infections, poisoning, ulcers, birth defects, even difficult births were adopted from human medicine. . . . But there are no incubators. . . .The foals are too active.
Pediatric Procedures: Do Parents Want to Watch?
Authors: BAUCHNER HOWARD , VINCI ROBERT , WARING CHRISTINE 
Published: December 2021

Invasive medical procedures, such as venipuncture or obtaining intravenous access, may be frightening and painful experiences for children and their parents. It is our experience that many pediatricians request that parents not be present during these procedures. A review of the medical literature revealed no information about parental preference with regards to these procedures. The purpose of this study was to determine whether parents prefer to be present when their children undergo venipuncture or intravenous placement.
METHODS AND RESULTS
The study was conducted during a 2-month period in the pediatric emergency department at Boston City Hospital. All parents, except those with a critically ill child who required immediate medical attention, were eligible for the study.
Bicycle Helmets
Authors:   Committee on Accident and Poison Prevention
Published: December 2021

Bicycling has become extremely popular in the last 5 years. There were an estimated 88 million cyclists in the United States in 1988.1 In addition to providing efficient transportation, bicycling can afford an enjoyable form of aerobic exercise. It is not without hazards, however. In 1985, there were more than 500 000 emergency room visits and 1300 deaths attributable to bicycles.2 Many of those injured on killed were children and adolescents. The most common cause of death (70% to 80% of cases) and the leading cause of disability from bicycling is head injury.3,4 One third of injured bicyclists treated in emergency room have head injuries, as do two thirds of those admitted to the hospital.5-7 The majority of bicycle crashes involving children do not involve cars. Most children are injured falling from their bicycles on colliding with fixed objects.
The manufacture of relatively low-cost, light-weight bicycle helmets capable of protecting against much of this head injury has been accomplished because of recent technological advances. Voluntary impact standards have been developed by the Snell Memorial Foundation and the American National Standards Institute (ANSI), and helmets meeting these standards have a label (Snell or ANSI) affixed to the helmet. Studies in Australia8 and England9 have clearly demonstrated the efficacy of helmet use, and a recent study in Seattle showed that helmets reduced the risk of head injury by 85% and of brain injury by 88%.3 Despite this, helmets are used by less than 5% of child bicyclists. Reasons for nonuse have varied, but generally are thought to be due to a lack of awareness of the problem, peer pressure, and a lack of availability of helmets at many retail outlets where bicycles are purchased.
Child Abuse
Authors: DE JONG ALLAN R. , ROSE MIMI 
Published: December 2021

In Reply.—
We thank Dr Smith for his interesting perspective regarding screening for child abuse. We had hoped our article would help physicians focus on the verbal evidence of abuse and show how insensitive the physical evidence is in predicting which child had been abused sexually. To apply the principles of sensitivity and specificity to the assessment of child abuse or sexual abuse, we must have a gold standard which characterizes these problems. Neither a child protective services decision nor a legal determination of "no proven abuse" can be used as a gold standard, unless we can accept a "gold standard" made of iron pyrite.
Reviews of Lay Literature in Child-Care: What Parents Are Reading
Authors: GLASCOE FRANCES PAGE , MOORE WILLIAM O. , BAUMGAERTEL ANNA 
Published: December 2021

L. Canter, L. Hausner. Homework without Tears. New York: Harper & Row Publishers, 1987; list price $7.95 (No. 30 on the 1990 bestseller list of books on child care from Ingram Book Co., distributor of trade books).
This text offers parents some solid advice about children and homework, including: establishing an appropriate study area, working with teachers, time management, task analysis, test preparation and independent completion of work. The authors wander onto shaky ground when they suggest that parents should not help children learn concepts and when they fail to mention that a child's need for assistance with homework may be indicative of significant trouble with school work and learning problems. Accordingly, parents are not directed toward psychoeducational evaluations, tutors or other resources. Further, they are not helped to acquire insight into their child's feelings about school, developmental readiness for various academic activities, self-concept, peer pressure, or the impact of different kinds of educational experiences (e.g., self-versus teacher-directed activities, private versus public schools, large versus small classes, etc.). Despite these weaknesses, the book contains many helpful suggestions and fills a void in the offerings on child-care by focusing specifically on homework issues.
Household Magnetic Fields and Childhood Leukemia: A Critical Analysis
Authors: Michaelson Sol M. 
Published: December 2021

For the past two decades, considerable interest and concern have been expressed, particularly in the lay media, over the hazards of exposure to the electric and magnetic fields from high-voltage transmission lines, electric appliances in the home, and video display terminals. Laboratory research and observations on human populations indicate that electric fields from these sources do not constitute a health hazard to humans or animals. There are reports, however, of an apparent association between magnetic fields and cancer or leukemia in selected populations. The quality of these reports and the validity of the conclusions, however, are questionable.
Nevertheless, these studies have generated considerable public anxiety. This is exemplified by an article published in the New Yorker magazine (July 1990). The author relates in graphic detail accounts of a suspected cancer cluster on a single street in a community in Connecticut. Resources for this investigative report were largely second-hand accounts from newspapers and personal interviews with small nuclei of residents that suggested a relationship with exposure to electric and magnetic fields from a nearby electric substation. This article fanned the fires of public concern about electric and magnetic field-induced health dangers despite the fact that state and local health officials emphasized there was no evidence to confirm a connection. Almost weekly discussions in newspapers and magazines and on television, as well as the publicity given to a forthcoming Environmental Protection Agency report, have exacerbated the concern.
ENVIRONMENTAL FACTORS
Humans are exposed to a wide variety of natural and artificial electromagnetic fields. The predominant natural magnetic field is the earth's static magnetic field, which has a strength of about 0.5 G. Electric power is transmitted as direct current and/or as alternating current (AC) at 50 or 60 Hz.
The Diaper Controversy
Authors: SUTTON MARIANNE B. 
Published: December 2021

In Reply.—
We would like to thank Dr Newman for her personal and amusing comments about parenting and diapers. We agree that parents should decide which type of diapers suit their family's needs. We nevertheless feel that pediatricians should be prepared to discuss diapering options with parents and help them to make educated personal choices in much the same way a pediatrician would give advise on child rearing.