bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy of Phototherapy in Prevention and Management of Neonatal Hyperbilirubinemia
Authors: Brown Audrey K. , Kim Mae Hee , Wu Paul Y. K. , Bryla Dolores A. 
Published: December 2021

This report concerns the efficacy of phototherapy in preventing hyperbilirubinemia in infants with birth weight less than 2,000 g and in controlling already established hyperbilirubinemia in infants weighing more than 2,000 g in the National Institute of Child Health and Human Development (NICHHD, also called NICHD) phototherapy study initiated in 1974.
The details of the protocol have been reported by Bryla.18
STUDY POPULATION
The study included 1,339 infants from the six participating institutions: 672 were randomly assigned to the phototherapy group and 667 to the control group. As described previously, these infants were studied according to specific protocols in three birth weight groups.18
In infants weighing less than 2,000 g at birth (group A), the efficacy of phototherapy begun at 24 ± 12 hours of age in preventing hyperbilirubinemia was examined. In the other two birth weight groups infants with birth weight 2,000 to 2,499 g [group B] and infants with birth weight 2,500 g or more [group C], the effect of phototherapy on already-established hyperbilirubinemia was examined.
MODE OF USE OF PHOTOTHERAPY
Phototherapy using Westinghouse daylight fluorescent bulbs in an Air Shields unit was administered continuously. Duration of phototherapy was 96 hours for all treated infants.
In each study group, an attempt was made to apply phototherapy in a manner that mimicked common usage, except that control subjects were used. Further, because no infant was to be exposed to bilirubin levels considered "unsafe," maximum bilirubin levels were established for each weight group and exchange transfusions were performed in both phototherapy-treated and control infants when these levels were reached.
Phototherapy for Hyperbilirubinemia of Hemolytic Disease of the Newborn
Authors: Maurer Harold M. , Kirkpatrick Barry V. , McWilliams Nancy B. , Draper David A. , Bryla Dolores A. 
Published: December 2021

Although phototherapy has proven effective in lowering the serum bilirubin concentration of fullterm and premature infants with physiologic or idiopathic hyperbilirubinemia, its effect on serum bilirubin concentration in hemolytic disease due to ABO blood group incompatibility remains uncertain. Sisson and associates91 have reported a marked effect of phototherapy on serum bilirubin levels and exchange transfusion rates in premature and full-term infants with ABO incompatibility. Others have reported similar findings, but studies were retrospective49 or uncontrolled.80 On the other hand, Patel and associates79 found no significant clinical response to phototherapy in five infants (four with birth weight &gt;2,500 g) with ABO and one infant (birth weight 2,660 g) with Rh incompatibility.
A total of 1,339 infants were randomly selected for study between May 1974 and June 1976. Of the 1,339 infants, 79.4% weighed less than 2,500 g and 276 (20.6%) were 2,500 g or more at birth. Of the 1,063 infants who weighed less than 2,500 g, 17 had positive findings on Coombs tests, 14 due to ABO incompatibility and three due to Rh incompatibility. As phototherapy was administered early and prophylactically in infants weighing less than 2,000 g and late and therapeutically in infants weighing between 2,000 and 2,499 g, a combined analysis of the infants weighing less than 2,500 g and who had positive results on Coombs test was not possible.
Of the 276 infants whose birth weight was 2,500 g or more, 64 (23.1%) had positive findings on Coombs tests, 58 due to ABO incompatibility and six to Rh incompatibility.
Comparison of Phototherapy Results in Small-for-Gestational-Age and Appropriate-for-Gestational-Age Infants Weighing Less Than 2,000 Grams
Authors: Hodgman Joan E. , Wu Paul Y. K. , White Nathaniel B. , Bryla Dolores A. 
Published: December 2021

The infant who is small for gestational age (SGA) is more mature at birth than similar weight infants who are appropriate for gestational age (AGA). Whether the SGA infant behaves as does the larger gestationally equivalent infant, or whether there are specific changes related to intrauterine growth retardation is a matter of some interest in the understanding of the special needs of these infants. The National Institute of Child Health and Human Development (NICHD) phototherapy study provided a large newborn population for whom birth weight, gestational age at birth, and, thereby, intrauterine growth were carefully assessed. Infants who weighed 2,000 g or more at birth were included in the study only when they became jaundiced, whereas infants who weighed less than 2,000 g at birth were routinely entered into the study. Consequently, this report will be limited to the lowbirth-weight population selected by birth weight. Too few SGA babies were present in the groups with greater birth weight to allow meaningful comparisons.
PATIENT SELECTIQN
All infants whose birth weight was less than 2,000 g were entered into the study at 24 ± 12 hours. Those excluded from the study were: (1) infants who died before 24 hours, (2) infants with serious congenital defects, and (3) infants whose mothers refused consent for study. The study population consisted of 922 infants surviving at 24 hours. Gestational age was calculated from the first day of the last menstrual period obtained from maternal history and also by the evaluation techniques of Dubowitz.25 Intrauterine growth was determined by plotting birth weight and gestational age on the Denver Intrauterine Growth Curves8; infants below the 10th percentile were considered SGA.
Balloons as a Cause of Suffocation
Authors: BROOK ITZHAK 
Published: December 2021

To the Editor.—
Accidents are the major cause of mortality in young children.1 I would like to highlight the danger of aspiration of a foreign body and suffocation that can occur in infants and toddlers following rupture of a balloon.
It was recently necessary to resuscitate a 2-year-old infant who suffocated after he had aspirated the distal portion of a balloon (Figure). The child bit the balloon and the force of the rupture blew the distal part of the balloon into the rear of his mouth.
Pertussis Vaccine and Neurologic Disease
Authors: KUMAR MARY L. , MORTIMER EDWARD A. 
Published: December 2021

To the Editor.—
The revised recommendations of the Committee on Infectious Diseases concerning the use of pertussis vaccine in infants with proven or suspected neurologic disease1 warrant comment. Such modified recommendations are needed because of confusion about the causation of coincident or preexisting neurologic disease that appears or is first recognized in temporal association with the administration of diphtheria, tetanus, pertussis, (DTP), which confusion has resulted in extensive litigation over alleged personal injury. Although most authorities believe that pertussis vaccine does on rare occasions produce permanent neurologic damage, it is clear that the vast majority of these alleged injuries are of other etiology.
Breast-Feeding and Hyperbilirubinemia in Full-Term Newborn Infants
Authors: CORCHIA CARLO , RUIU MARIA , ORZALESI MARCELLO 
Published: December 2021

To the Editor.—
Osborn et al1 have reported a positive association between breast-feeding and neonatal hyperbilirubinemia in full-term infants. To give further support to the findings of Osborn et al, we wish to report the results of two similar studies that have been completed in two different hospitals.
The first study was carried out in the nursery of the Second School of Medicine of Naples.2 Rooming-in was practiced from 9 am to 12 pm, and during the day, breastfed babies were only offered a supplement of 5% dextrose in water when appropriate.
Home Phototherapy
Authors:   Committee on Fetus and Newborn
Published: December 2021

Equipment designed for delivering phototherapy in the home has become available in several parts of the United States in the past few years. Home phototherapy for neonatal hyperbilirubinemia has been suggested as an alternative means of providing care for selected infants while saving much of the cost of continued or added hospitalization. Not enough information is available presently, however, on the safety or efficacy of home phototherapy as compared with alternatives to warrant an endorsement of this form of therapy.
This statement provides preliminary guidelines for physicians who might choose home phototherapy for their patients. No attempt is made here to address the pros and cons of phototherapy per se or to define types of equipment.
A physician who considers the use of home phototherapy should limit its use to infants with the following characteristics: (1) term infants, older than 48 hours, otherwise healthy; (2) serum bilirubin concentration greater than 14 mg/dL but less than 18 mg/dL; (3) no elevation in direct-reacting bilirubin concentration; and (4) diagnostic evaluation (described below) negative.
Prior to therapy, a diagnostic evaluation should include: (1) history and physical examination; (2) hemoglobin concentration or hematocrit; (3) WBC count and differential count; (4) blood smear for red cell morphology platelets; (5) reticulocyte count; (6) total and direct-reacting bilirubin concentration; (7) maternal and infant blood typing and Coombs test; and (8) urinalysis including a test for reducing substances.
The physician should estimate the rate of rise of the serum bilirubin concentration with laboratory determinations at least four hours apart before home phototherapy is initiated.
An AAP-Women Gap
Authors: SILVERMAN WILLIAM A. 
Published: December 2021

To the Editor.—
Appellate Judge Bork recently1 pointed out that a fundamental requirement of the law in this country is one of democratic legitimacy. The disturbing lack of that characteristic in the recently passed "Baby Doe Amendment" is evident in the results of a survey2 conducted by Wellesley College Center for Research on Women. Sixty-four percent of nearly 120,000 women opposed laws that would require treatment of severely defective infants.
Why did the American Academy of Pediatrics distance itself so from the wishes of the majority of women by supporting passage of a measure that mandates actions that would be considered cruel and inhumane by many.
Epilepsy and Swimming
Authors: GREENSHER JOSEPH 
Published: December 2021

In Reply.—
If all swimming were limited to pools that were always supervised by a lifeguard or competent adult, we would not have approximately 1,500 children drowning each year.
The risk of drowning or near-drowning for a child with epilepsy is four times that of other children. The risks to children who have been seizure-free for 1 year are only minimally greater than for the general population if they have stable therapeutic anticonvulsant levels, are mentally normal, and are well supervised in the water.1
E-Ferol
Authors: BOWEN FRANK W. , JOHNSON LOIS 
Published: December 2021

To the Editor.—
Phelps' commentary, "E-Ferol: What Happened and What Now?"1 is an important reminder of the danger of using untested drugs. We feel, however, some points of clarification are needed.
First, Phelps cited Myers et al2 as using 1.1 mg/kg/d of E-acetate IV and raising serum E levels to 6 mg/dL in preterm infants. This is misquoted. Myers et al used 10 mg/kg of vitamin E over one hour (dl-α-tocopherol [Hoffman LaRoche] not E-acetate) and achieved levels of 0.6 mg/dL not 6 mg/dL at the end of the infusion.
Developmental Pediatrics: Not Just the Care of Children with Developmental Disabilities
Authors: PARMELEE ARTHUR H. 
Published: December 2021

To the Editor.—
I am concerned about the article by Bennett et al,1 on a training program in developmental pediatrics. Although I am in agreement with all of the contents of the training program, I am concerned about the narrow definition of developmental pediatrics as only the identification and care of children with developmental disabilities. They state that a major goal was ". . . to differentiate developmental and behavioral pediatrics despite their obvious overlaps and shared expertise" and that the primary focus of behavioral pediatrics is on the behavioral or psycho-social aspects of pediatric practice.
Effectiveness of Moped Legislation
Authors: WESTMAN JUDITH A. 
Published: December 2021

To the Editor.—
In a previous report studying moped-related injuries in children,1 we urged pediatricians to support and promote legislation encouraging the legal, safe use of mopeds. Since the time of the initial study, the state of Ohio passed legislation requiring that moped drivers be aged 14 years or older, wear an approved safety helmet, carry no passengers, ride within 3 ft (0.9 m) of the right side of the road when possible, have a rearview mirror, and have turning signals on the moped.
Child Life Programs for Hospitalized Children
Authors:   Committee on Hospital Care
Published: December 2021

There is increasing emphasis on the finances involved in the care of children in hospitals. In times of financial difficulty, biosocial programs may be curtailed. One of the most progressive, useful, and humane programs to be initiated in recent years is the child life concept. These programs are essential to quality care, and the Committee on Hospital Care (COHC) of the American Academy of Pediatrics (AAP) is concerned that existing child life programs may be endangered and plans for new programs abandoned, because of fiscal restraints. The purpose of this statement is to describe the concept of child life, its nature, function, and inherent worth. Information is provided for physicians, hospital administrators, government officials, and others who make decisions affecting the sponsorship of child life programs in children's hospital units.
CHILD LIFE PROGRAMS
A unique activity in pediatric departments is the child life program. Originally developed in children's hospitals and in hospitals affiliated with medical schools, child life programs now are found in other children's units. The COHC believes that such programs are an essential component of quality care for hospitalized children.
Child life specialists meet developmental, emotional, recreational, and educational needs of hospitalized children and their families. They use play and other forms of communication to help children cope with health care experiences more positively. The child who uses a place devoted to play in the hospital commonly changes his perception of himself and his abilities. Hence, playrooms must be large enough to accommodate wheelchairs, traction beds, stretchers, and accompanying apparatus—such as that used for suction and intravenous administrations—so that most patients can come and enjoy activities in these rooms.
Pesticide Residues in Food
Authors: JACKSON RICHARD J. , GOLDMAN LYNN 
Published: December 2021

To the Editor.—
The Environmental Health Committee of the Northern California Chapter of the American Academy of Pediatrics is concerned about the finding of pesticide residues in food, particularly the fumigant ethylene dibromide (EDB), which is a known carcinogen in animals and a mutagen in many testing systems, including mammals.1,2 Recently, Gerber Products published a statement, "Ethylene Dibromide Background Information," in their widely disseminated journal Pediatric Basics.3
Gerber rightly states that analytical testing ability has improved during the past 30 years.
Divergent Paths for Children and the Elderly
Authors: PRESTON SAMUEL H. 
Published: December 2021

In the past two decades we have witnessed a sharp reversal of fortunes for the two large groups of age-related dependents in the United States. Conditions among the elderly have improved markedly, whereas those among children have deteriorated. These changes reflect alterations in family structures, in public policy, and in the size of the two dependent groups.
One of the most straightforward ways to compare children with the elderly is to measure the fraction of the two groups that live in poverty. Because children generally do not have independent incomes, one cannot directly compare personal income. One can, however, measure the incomes of the families in which the children live and compare the incomes to a minimum standard of need.
Nutrition Study Design Questioned
Authors: JANAS LYNN MARIE , PICCIANO MARY FRANCES , HATCH TERRY F. 
Published: December 2021

In Reply.—
We welcome the interest in our study1 and are pleased to have the opportunity to respond to Dr Wilson's letter. At the initiation of our study, there were two equivocal reports on indices of protein metabolism in full-term infants fed human milk, whey-predominant formula, or cow's milk formula.2-4 Therefore, our objective was to assess whether specific parameters of protein metabolism responded quantitatively to dietary intakes of protein, nitrogen, and amino acids. Our results did confirm that plasma aminograms are elevated with feeding either a whey-predominant or a cow's milk formula3; however, we are the first to report that total protein (total nitrogen) intake is as important as protein quality in determining plasma amino acid response in infants.
Controversies in Screening for Middle Ear Disease and Hearing Loss in Children
Authors: Bluestone Charles D. , Fria Thomas J. , Arjona Sandra K. , Casselbrant Margaretha L. , Schwartz Daniel M. , Ruben Robert J. , Gates George A. , Downs Marion P. , Northern Jerry L , Jerger James F. , Paradise Jack L. , Bess Fred H. , Kenworthy O. T. , Rogers Kenneth D. 
Published: December 2021

GOALS
—Charles D. Bluestone, MD, and Thomas J. Fria, PhD
The goal of this Workshop was to assemble experts in pediatrics, infectious disease, otolaryngology, epidemiology, audiology, and biostatistics to assess the current status of screening for otitis media in infants and children. The need for such a Workshop has become increasingly apparent with the advent of the widespread use of tympanometry as a case-finding method and the controversies that have surrounded these proliferating screening programs. Specifically, the objectives of the Workshop were to (1) review the state of our knowledge of middle ear disease in children in terms of its epidemiology, diagnosis, management, complications, and sequelae, all of which pertain to the justification for screening; (2) review the epidemiologic basis of screening and relate these to otitis media; (3) review current viewpoints on screening for middle ear disease from professionals in the field; (4) review the current status of screening programs in the United States; (5) attempt to reach concensus as to the target population to be identified by screening and the most appropriate and reasonable method for screening and referral; and, (6) make recommendations as to the best manner in which to resolve the remaining controversial issues. In addition to the above named specialists, representatives from federal funding agencies and from screening instrument companies were present in an ex officio capacity. A summary of the discussions is presented here.
INCIDENCE, PREVALENCE, AND NATURAL HISTORY OF OTITIS MEDIA
—Margaretha L. Casselbrant, MD
Otitis media is one of the most common diseases of childhood and, thus, has important economic and health care implications in society.
School Attendance of Children and Adolescents With Human T Lymphotropic Virus Ill/Lymphadenopathy-Associated Virus Infection
Authors:   COMMITTEE ON SCHOOL HEALTH,   COMMITTEE ON INFECTIOUS DISEASES
Published: December 2021

As of October 15, 1985, there have been 204 cases of acquired immunodeficiency syndrome (AIDS) (or 1% of the total number of cases) reported in American children. Serologic testing has detected additional high-risk children (eg, hemophiliacs) who are human T lymphotropic virus type Ill/ lymphadenopathy-associated virus (HTLV-III/ LAV) antibody positive and are apparently well. Some of these children are of school age; thus, a policy on school attendance of children with HTLV-III infection is required.
The present AAP recommendations are based on (1) a review of available data related to potential transmission of HTLV-III by school-aged children and (2) the Centers for Disease Control (CDC) statement of August 30, 1985.
BACKGROUND
These recommendations apply to all children known to be infected with HTLV-III/LAV including (1) children with AIDS as defined for reporting purposes (see Table); (2) children determined to have an illness due to infection with HTLV-III/ LAV but who do not meet the case definition, which has been called AIDS-related complex (ARC; symptoms may include chronic lymphadenopathy, weight loss, fever, chronic diarrhea, anemia, thrombocytopenia, and mild signs of opportunistic infections); (3) children who are asymptomatic but have virologic or serologic evidence of HTLV-III/LAV infection.
It is important that the serologic screening test for HTLV-III be confirmed by specific tests to eliminate false-positive results. True seropositive individuals have a high probability of being infected with HTLV-III and, therefore, are potentially Capable of transmitting the virus to others.
The adult and adolescent cases, which constitute about 99% of all cases, are transmitted primarily through sexual contact (homosexual and heterosexual) and by intravenous injection of infected blood or blood products.
GUILTY! DON'T WORRY
Authors: Girone Joseph A. C. 
Published: December 2021

It's amazing. The lawyers make the malpractice laws, witch hunt until a case is found, and then take a large portion of any award given. They are not satisfied with that. Robert V. Wills, JD, writing in Surgical Rounds gives we physicians three maxims on how to react when slapped with a malpractice suit.
The lawyers don't want the physicians to get upset or overreact when accused of negligence, carelessness, or reckless behavior. Wills reminds us there is better than a 50/50 chance of resolution of the claim in the doctor's favor. These cases should be treated as an economic nuisance and you may not be the primary defendant. He further suggests physicians regard a malpractice claim as a "cost of doing business."
Are we going to accept this advice so kindly offered by the legal councilors? After all, they don't give free advice often. The medical profession is special in many ways. Therefore, any allegation of wrongdoing or mistreatment of a patient must be addressed by that profession the best way available. The medical profession should never approach the malpractice crisis in this country with an attitude of "economic nuisance" or percent chances of resolution in the doctor's favor.
The physician's attitude and feelings toward a malpractice action are more accurately described by a fellow physician, Dave Ellison, MD, in the piece "Not Guilty." These cases are a direct attack on the competence and integrity of the victim—physician. Let's take the advice of Dr. Ellison and show our colleagues who are sued, respect, compassion, and concern. Unknowingly, he put in prospective the lawyer's maxims when he wrote "[it's] no more useful than advising a depressed patient to "cheer up!" We need not look outside of our profession to advise us on our behavior in this difficult situation.
Varicella Vaccine: A Point of Decision
Authors: Plotkin Stanley A. 
Published: December 2021

The governmental authorities on biologics soon will be asked to decide on the licensure of a live varicella vaccine. Pediatricians may then have to decide whether and how to use it. This commentary summarizes the data and provides a viewpoint in favor of licensure and use in normal children and adults. Additional articles are published in the accompanying supplement to this issue of Pediatrics.
The goals of a varicella vaccine are three: (1) to protect normal children against the complications of varicella, (2) to protect normal adults against the complications of varicella, and (3) to protect immunosuppressed children (particularly those with leukemia) against disseminated varicella.