bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sleep, Feeding, and Opinions
Authors: WALKER MARSHA 
Published: December 2021

To the Editor.—
I wish to express some concerns about the article by Pinilla and Birch which detailed how to teach young infants to sleep through the night.1As the authors stated in their introduction, making infants sleep through the night at an early age has become one of the major goals of parenting in the US. Parents are told that this is necessary so they can return to work and experience minimal disruption in their real lives.
Sleep, Feeding, and Opinions
Authors: PINILLA THERESA , BIRCH LEANN L. 
Published: December 2021

In Reply.—
In our recent paper, we reported the results of a study using behavioral procedures that were successful in helping breast-fed infants to sleep through the night by 8 weeks postpartum.1 The caretaking techniques taught to parents included giving a feeding between 10 pm and midnight, and first using caretaking procedures other than feeding to sooth the distressed infant who awakened between midnight and 5 am In the newborn, feeding and sleeping patterns are tightly linked, and breast-fed newborns must wake and feed frequently in order for successful lactation to be established.
Think Globally; Act Locally
Authors: FISCHER PHILIP R. 
Published: December 2021

To the Editor.—
Environmentalists use bumper stickers and other means to urge us to "think globally; act locally." The American Academy of Pediatrics could well make the same recommendations to authors who contribute to its publications. From one geographic location, we should not allow our writing to imply an ignorance of or disregard for the situations in which other child health care providers live.
Whether reporting and discussing research findings or proposing practice guidelines, we should be careful to clearly define the relevant populations.
Oral Immunoglobulins for Treatment of Acute Rotaviral Gastroenteritis
Authors: Guarino Alfredo , Canani Roberto Berni , Russo Stefania , Albano Fabio , Rubino Armido , Canani Mario Berni , Ruggeri Franco Maria , Donelli Gianfranco 
Published: December 2021

Objective. Preliminary evidence has been reported on the antirotavirus effect of human serum immunoglobulin administered orally. The aim was to see whether such treatment might be effective in rotavirus acute gastroenteritis.
Methods. A prospective, double-blind, placebo-controlled study was performed. Ninety-eight children admitted with acute gastroenteritis were enrolled and randomly assigned to groups A (treated) and B (control). Children in group A received a single oral dose of 300 mg/kg body weight of human serum immunoglobulin. Parameters of efficacy were clinical condition, frequency and consistency of stools, duration of diarrhea, duration of viral excretion, and length of hospital stay. Antirotaviral activity was determined in the immunoglobulin preparation by a specific neutralization assay.
Results. Seventy-one of the 98 children enrolled had rotaviral gastroenteritis; 36 belonged to group A. Children who received immunoglobulin had significantly faster clinical improvement of clinical condition and stool pattern than control children. Mean total duration of rotaviral diarrhea was 76 hours in group A and 131 in group B (P &lt; .01). Viral excretion lasted 114 and 180 hours, respectively (P &lt; .01). Hospital stay was significantly reduced in children in group A. Neutralizing antibodies against rotavirus were detected in the immunoglobulin preparation.
Conclusion. Oral administration of immunoglobulin is associated with a faster recovery from acute gastroenteritis and should be given to children hospitalized with this illness.
The Transfer of Drugs and Other Chemicals Into Human Milk
Authors:   Committee on Drugs
Published: December 2021

This statement was first published in 1983,1 with a revision published in 1989.2 Information about the transfer of drugs and chemicals into human milk continues to become available. This current statement is intended to revise the lists of agents transferred into human milk and describe their possible effects on the infant or on lactation, if known (Tables I through 7). The fact that a pharmacologic or chemical agent does not appear on the lists is not meant to imply that it is not transferred into human milk or that it does not have an effect on the infant; it only indicates that there were no reports found in the literature. These tables should assist the physician in counseling a nursing mother regarding breast-feeding when the mother has a condition for which a drug is medically indicated.
The following question and options should be considered when prescribing drug therapy to lactating women. (1) Is the drug therapy really necessary? Consultation between the pediatrician and the mother's physician can be most useful. (2) Use the safest drug, for example, acetaminophen rather than aspirin for analgesia. (3) If there is a possibility that a drug may present a risk to the infant, consideration should be given to measurement of blood concentrations in the nursing infant. (4) Drug exposure to the nursing infant may be minimized by having the mother take the medication just after she has breast-fed the infant and/or just before the infant is due to have a lengthy sleep period.
Data have been obtained from a search of the medical literature.
Secretory Anti-Giardia lamblia Antibodies in Human Milk: Protective Effect Against Diarrhea
Authors: Walterspiel Juan N. , Morrow Ardythe L. , Pickering Larry K. , Ruiz-Palacios Guillermo M. , Guerrero M. Lourdes 
Published: December 2021

Objective. To determine whether anti-Giardia lamblia secretory IgA (sIgA) antibodies in human milk protect infants from acquisition of or symptoms associated with Giardia infection.
Methods. One hundred ninety-seven Mexican mother/infant pairs were followed weekly from birth for diarrheal disease and feeding status. Infant stool specimens were collected weekly and were cultured for bacterial pathogens and tested for Giardia and rotavirus by enzyme-linked immunosorbent assay. Maternal milk samples were collected weekly for 1 month postpartum and monthly thereafter. To determine the protective effect of anti-Giardia sIgA in milk against infection and against diarrhea due to Giardia, milk samples from mothers of infected infants and appropriately matched controls were assayed for anti-Giardia sIgA by enzyme-linked immunosorbent assay.
Results. Asymptomatic, infected infants ingested significantly (P = .046) higher amounts of milk anti-Giardia sIgA compared with symptomatic, infected infants. However, milk anti-Giardia sIgA concentrations did not differ between Giardia-infected and noninfected infants.
Conclusion. The amount of anti-Giardia sIgA in human milk was associated with prevention of symptoms of diarrhea due to Giardia, but not with acquisition of the organism.
A Nationwide Study of the Risk of Injury Associated With Day Care Center Attendance
Authors: Briss Peter A. , Sacks Jeffrey J. , Kresnow Marcie-jo , O'Neil Joann , Addiss David G. 
Published: December 2021

Objective. Because an increasing proportion of US children spends time in day care center environments, a national estimate of injury risks in day care centers is needed.
Methods. We interviewed directors of 1797 day care centers from every state and the District of Columbia from October to December 1990 and analyzed medically attended injuries and center characteristics reported by the directors.
Results. The centers were attended by 138 404 children. In the 2 months before the center directors were interviewed, 556 children sustained injuries requiring medical attention while attending the centers. The injury rate was 1.5 injuries per 100 000 child hours in day care. The most common injuries were cuts or lacerations (31%), bumps or bruises (15%), fractures (10%), and dental injuries (8%). Most injuries (51%) occurred on the play-ground. Many injuries (18%), and more than half of fractures and concussions (53%) were due to falls from climbing equipment.
Conclusions. Day care center injury rates estimated by this study were relatively low. Many injuries that occur in this setting are probably minor. However, lowering the height of playground equipment and providing more resilient playground surfaces could further reduce injury risks in day care centers.
Prevalence and Health Impact of Developmental Disabilities in US Children
Authors: Boyle Coleen A. , Decouflé P. , Yeargin-Allsopp M. 
Published: December 2021

Objective. Data from the 1988 National Health Interview Survey—Child Health Supplement were used to examine the prevalence of selected developmental disabilities and their impact among children ages 0 through 17 years.
Design. The following conditions, identified through a structured in-person interview with a parent or other adult household member, were examined: deafness or trouble hearing, blindness, epilepsy or seizures, stammering and stuttering, other speech defects, cerebral palsy, delay in growth or development, learning disabilities, and emotional or behavioral problems. The impact was defined by measures of perceived health status, school performance and attendance, and health care utilization.
Results. Seventeen percent of children in the United States were reported to have ever had a developmental disability. The prevalence of the individual disabilities ranged from 0.2% for cerebral palsy to 6.5% for learning disabilities. These conditions taken together had a substantial impact on the health and educational functioning of affected children: 1.5 times more doctor visits, 3.5 times more hospital-days, twice the number of school-days lost, and a 2.5-fold increase in the likelihood of repeating a grade in school compared with children without these conditions. The extent of this impact was much greater among children with multiple disabilities or with either cerebral palsy, epilepsy or seizures, delays in growth and development, or emotional or behavioral problems. The impact on school performance was most pronounced for children reported to have learning disabilities.
Conclusions. Future research efforts should be focused on ways to reduce the impact of these developmental disabilities on quality of life.
Cortical Hyperostosis: A Complication of Prolonged Prostaglandin Infusion in Infants Awaiting Cardiac Transplantation
Authors: Woo Karen , Emery Janet , Peabody Joyce 
Published: December 2021

Background. Infants awaiting heart transplantation for congenital heart disease frequently require prostaglandin E1 (PGE1) infusion for prolonged periods. As a result, complications of prolonged PGE1 infusion, such as cortical hyperostosis, are being encountered more commonly.
Objective. To determine the incidence and severity of cortical hyperostosis in newborns requiring prolonged PGE1 infusion.
Methods. Chest radiographs of 86 infants receiving PGE1 infusion awaiting heart transplantation were reviewed. The chest radiographs were graded for the severity of cortical hyperostosis (no bony changes, minimal hyperostosis, or severe hyperostosis). Duration of PGE1 infusion, total PGE1 dose, and highest alkaline phosphatase were recorded for each patient. Infants were arbitrarily divided into three groups according to the duration of PGE1 infusion (&lt;30 days, 30 to 60 days, &gt;60 days).
Results. Fifty-three of the 86 infants (62%) had radiologic evidence of cortical hyperostosis. Forty-two of 80 infants (53%) had elevated alkaline phosphatase. The percentage of infants with hyperostosis increased with increasing duration of PGE1 infusion (42% at &lt;30 days; 87% at 30 to 60 days; 100% at &gt;60 days). The incidence and severity of cortical hyperostosis were related (by Kruskal-Wallis) to the duration of PGE1 infusion (P &lt; .0001) and the total dose of PGE1 received (P &lt; .0001). The highest alkaline phosphatase levels were observed in infants with the most severe grades of hyperostosis (P &lt; .0001). The percentage of infants with elevated alkaline phosphatase increased with greater severity of hyperostosis (26% of infants with no bony changes, 59% with minimal changes, and 85% with severe changes). Two infants had symptomatic bone tenderness or swelling mimicking osteomyelitis.
Conclusion. It is concluded that cortical hyperostosis is a frequent, often asymptomatic, side effect of prolonged PGE1 infusion that should be evaluated in any infant on long-term PGE1 therapy. When symptoms occur in infants awaiting transplantation, osteomyelitis must be excluded rapidly to avoid an unnecessary delay in transplantation.
Monitoring for Anthracycline Cardiotoxicity
Authors: Lipshultz Steven E. , Sanders Stephen P. , Colan Steven D. , Goorin Allen M. , Sallan Stephen E. , Krischer Jeffrey P. 
Published: December 2021

Objective. To review the basis for recommendations of the Cardiology Committee of the Children's Cancer Study Group, published in Pediatrics, for serial cardiac monitoring of cancer patients during anthracycline therapy and reduction of therapy should cardiac studies show abnormalities.
Design. Because the effects of overall morbidity and mortality should be considered when a recommendation is made to withhold potentially lifesaving chemotherapy based on abnormal cardiac findings of patients without clinical evidence of cardiac dysfunction, supporting studies referenced in the published recommendations were reviewed. Specifically, studies were evaluated to determine whether a reduction in anthracycline dose, as a result of abnormal cardiac findings by monitoring, reduced cardiac morbidity and related mortality compared with a prospectively followed control population without dose modification. In addition, the effects of cardiac monitoring and subsequent anthracycline dose modification on oncologic morbidity and mortality were reviewed in these studies. Finally, the contributions of the cardiac and oncologic effects of dose modification were examined to determine the effect of this change in therapy on overall morbidity and mortality.
Results. None of the studies cited in developing these recommendations prospectively determined, with controls, the effects of cardiac monitoring and anthracycline dose modification on cardiac, oncologic, or overall morbidity and mortality. Therefore, none of the studies cited in support of cardiac monitoring and subsequent dose reduction demonstrated the efficacy of such an approach. In the absence of such data, concerns are raised as to whether such a monitoring program with subsequent dose modification might do more harm than good. In addition, none of the methods of screening for anthracycline cardiotoxicity has been shown to be adequately predictive of early or late cardiac outcomes. Finally, adoption of these recommendations would inhibit the investigation of the efficacy of the proposed plan.
Conclusion. Given the absence of supportive data and the potential to do harm, no recommendation for dose modification based on abnormal cardiac findings in patients without clinical evidence of cardiotoxicity can be endorsed, including those of the Cardiology Committee of the Children's Cancer Study Group. When clinical evidence of cardiotoxicity is present, anthracycline dose modification is recommended. A prospective controlled study to determine the effects of dose modification based on cardiac test results is indicated.
Reading Ability of Parents Compared With Reading Level of Pediatric Patient Education Materials
Authors: Davis Terry C. , Mayeaux E. J. , Fredrickson Doren , Bocchini Joseph A. , Jackson Robert H. , Murphy Peggy W. 
Published: December 2021

Objectives. To test the reading ability of parents of pediatric outpatients and to compare their reading ability with the ability necessary to read commonly used educational materials; to compare individual reading grade levels with the levels of the last grade completed in school; and to further validate a new literacy screening test designed specifically for medical settings.
Design. Prospective survey.
Setting. Pediatrics outpatient clinic in a large, public university, teaching hospital.
Participants. Three hundred ninety-six parents or other caretakers accompanying pediatric outpatients.
Measurements. Demographics and educational status were assessed using a structured interview. Reading ability was tested using the Rapid Estimate of Adult Literacy in Medicine (REALM) and the Wide Range Achievement Test-Revised2. Written educational materials were assessed for readability levels with a computer program (Grammatik IV).
Results. The mean score on the REALM for all parents placed them in the seventh to eighth grade reading range, despite the mean self-reported last grade completed in school being 11th grade 5th month. Wide Range Achievement Test-Revised2 scores correlated well with REALM scores (0.82). Eighty percent of 129 written materials from the American Academy of Pediatrics, the Centers for Disease Control, the March of Dimes, pharmaceutical companies, and commercially available baby books required at least a 10th grade reading level. Only 25% of 60 American Academy of Pediatrics items and 19% of all materials tested were written at less than a ninth grade level, and only 2% of all materials were written at less than a seventh grade level.
Conclusion. This study demonstrates that parents' self-reported education level will not accurately indicate their reading ability. Testing is needed to screen at-risk parents for low reading levels. In a public health setting, a significant amount of available parent education materials and instructions require a higher reading level than most parents have achieved. In such settings, all materials probably should be written at less than a high school level if most parents are to be expected to read them. The REALM can easily be used in busy public health clinics to screen parents for reading ability.
Life-Threatening Reaction to Trimethoprim/Sulfamethoxazole in Pediatric Human Immunodeficiency Virus Infection
Authors: Chanock Stephen J. , Luginbuhl Lynn M. , McIntosh Kenneth , Lipshultz Steven E. 
Published: December 2021

Trimethoprim/sulfamethoxazole (TMP/SMX) is frequently administered to children with human immunodeficiency virus (HIV) infection for treatment or prevention of bacterial and opportunistic infections.1 The incidence of adverse reactions to this drug combination in HIV-infected individuals seems to be higher than in those without HIV infection.2-6 Severe life-threatening reactions to TMP/SMX are rare and have been reported in adult patients with and without HIV infection.
Two HIV-infected children with life-threatening reactions after rechallenge with TMP/SMX are described. In each case, the patient survived, but only after intensive care management. With the expected increase in the number of HIV-infected children and the need to administer prophylaxis against Pneumocystis carinii pneumonia, pediatric care providers should be aware of this dangerous, adverse reaction to TMP/ SMX.
Precocious Puberty in Girls With Myelodysplasia
Authors: Elias Ellen Roy , Sadeghi-Nejad Ab 
Published: December 2021

Myelodysplasia is a relatively common anomaly occurring in 1 to 5 per thousand live births. It is seen more frequently in girls. The severity of developmental defect and the resultant neurological impairment is variable; however, hydrocephalus is a common finding.1 True precocious puberty, premature activation of the hypothalamic-pituitary-gonadal axis, also occurs more frequently in girls.2,3 It has been our clinical impression that sexual precocity is more common in girls with myelodysplasia than in otherwise healthy children. To assess the degree and nature of this association, if any, we retrospectively studied 62 girls with myelodysplasia.
MATERIALS AND METHODS
All female patients with myelomeningocele attending our multidisciplinary myelodysplasia clinic at the New England Medical Center (Floating Hospital for Children) between September 1989 and May 1991 were studied.
Neurologic Manifestations of Cocaine Exposure in Childhood
Authors: Mott Stephen H. , Packer Roger J. , Soldin Steven J. 
Published: December 2021

Objective. To describe the neurologic manifestations of cocaine exposure in children and adolescents as the neurologic effects of cocaine have been described in adults and neonates.
Methods. During 1-year period, 41 children between the ages of 2 months and 18 years who had been exposed to cocaine, were examined in the emergency department at the Children's National Medical Center. Cocaine exposure was documented on urine samples; all were confirmed by urine gas chromatographic/mass spectrometric analysis.
Results. Nineteen (46%) of 41 had neurologic abnormalities, including seizures (7), obtundation (6), delirium (4), dizziness (1), drooling (1), and ataxia (1). In 14 others, the neurologic effects of cocaine were difficult to determine because of other concomitant medical conditions, including head injuries and severe abdominal or chest trauma. Two major age-related patterns were seen: (a) in each child &lt;5 years of age, seizures and obtundation; and (b) in 11 older children, delirium (3), dizziness (1), drooling (2), and lethargy (4). Seizures, occurring at ages 12 months to 8 years, were focal with secondary generalization in three and generalized in four. They were associated with fever in two children. Six children had no further seizures, and one developed a mixed-seizure disorder. Passive intoxication while being in a room in which "crack" was smoked was the most likely cause of exposure for young victims. Multiple drug abuse was not documented in any child with neurologic impairment.
Conclusions. 1) Cocaine exposure is common in children in our urban setting; 2) neurologic manifestations frequently occur; 3) in children 8 years of age or younger, "passive" ingestion/inhalation is associated with focal and generalized seizures without evidence of structural brain injury; 4) cocaine may lower seizure threshold in children predisposed to seizures; 5) in children &gt;8 years of age, manifestations are similar to those in adults; 6) trauma and motor vehicle accidents were seen in the adolescent age group exposed to cocaine; and 7) urine toxicological study in cocaine exposure is recommended in all first-time seizures as well as first-time febrile seizures.
CANADA'S FAILURE
Authors: L. J. F. 
Published: December 2021

The direct costs of Canada's national health insurance are not as troublesome as the distortive effect they have on health care delivery. Health care facilities have been forced to cut back severely on their capital expenditures, thus depleting the availability of advanced medical equipment. As a result, many patients must seek advanced treatment elsewhere. According to a recent study reported in the New England Journal of Medicine, nearly one-third of Canada's doctors have sent patients outside the country for treatment during the past five years. About 10% of all British Columbia residents requiring cancer therapy have been sent to the U.S. In Toronto, because the government doesn't provide enough money for personnel, 3,000 beds have been removed from service, while thousands of patients are on waiting lists for admission.
Even where advanced equipment is available, bureaucratic absurdities prevent proper use. According to the April issue of "Fraser Forum," dogs at York Central Hospital in metropolitan Toronto were able to get CAT scans immediately while humans were put on a waiting list. The reason? Canadian patients are not allowed to pay for CAT scans, and the procedure costs too much to operate more than a few hours a day for nonpaying customers. Dog owners, on the other hand, were permitted to pay to use it. The user fees paid by the dog owners allowed the machine to operate longer, thus more human patients could be scanned. When this information was released, instead of considering user fees for humans, the Canadian government banned the tests for dogs!