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Program Goals: Facing the COVID-19 pandemic and the need for social distancing, our residency programremoved residents from certain clinical settings including the resident continuity clinic This created aneducational gap in resident training and dramatically affected the way we deliver healthcare to our patients To facilitate medical care in the safest way possible, our clinic implemented virtual visits via phone and videobeginning in mid-March Whenever appropriate, sick and well care visits were completed via virtualencounters preceded by nurse-only visits for vaccines when indicated Initially attendings performed thesevisits to develop virtual skills, build provider condence, and ensure that proper infrastructure was in place Recognizing that telemedicine represented an important educational opportunity for residents, we laterincorporated residents into clinic Residents were rst asked to observe a virtual encounter performed by anattending, and then they were observed conducting a virtual encounter Residents then conducted encountersindependently, precepting with attendings via videoconference (including the family) or by putting the family on hold Evaluation: 15 residents participated in telemedicine clinics within the rst 3 weeks of initiating thisprogram 11 respondents from all years of training provided feedback Residents reported completing 2-5telemedicine visits per half-day session When asked about the educational value of a telemedicine clinicsession, 82% of residents reported this was similar or more educational as compared to a usual continuityclinic session Educational benets included the opportunity to improve phone triage skills and increaseexperience with a technology that residents expect to use in the future Educational challenges includedfeeling “rushed trying to navigate the technology' and discomfort with an unfamiliar process for precepting All participants reported increased level of comfort with providing care via telemedicine after these sessions,and 91% of residents agreed or strongly agreed with the statement “I feel comfortable with providing care viatelemedicine now ” Although residents felt challenged by the inefficiency of reading screening tools aloud, bydelays due to connectivity problems, and by limited physical exam capabilities, they noted many strengthsincluding improved visit attendance rates and convenience for patients Discussion: Innovative care deliverymodels are necessary to protect the community and the healthcare workforce while also providing neededmedical care and educational opportunities for our residents As we move forward, we will continue to solicitfeedback to effectively meet new and evolving educational needs We anticipate a role for virtual visits wellbeyond the COVID-19 pandemic As such, we will continue to train our residents through virtual visits and willsoon be engaging medical students in telemedicine electives We will continue to identify innovative ways toengage learners in telemedicine and streamline processes for determining which visits are appropriate for avirtual visit

Pediatric human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) surveillance should expand to include perinatal HIV exposure and HIV infection as well as AIDS to delineate completely the extent and impact of HIV infection on children and families, accurately assess the resources necessary to provide services to this population, evaluate the efficacy of public health recommendations, and determine any potential long-term consequences of interventions to prevent perinatal transmission to children ultimately determined to be uninfected as well as for those who become infected. Ensuring the confidentiality of information collected in the process of surveillance is critical. In addition, expansion of surveillance must not compromise the established, ongoing surveillance system for pediatric AIDS. An expanded pediatric HIV surveillance program provides an important counterpart to existing American Academy of Pediatrics and American College of Obstetricians and Gynecologists recommendations for HIV counseling and testing in the prenatal setting.

As a result of the expanding human immunodeficiency virus (HIV) infection epidemic and recently published recommendations for routine HIV testing with consent for all pregnant women in the United States, pediatricians are becoming increasingly involved in providing care to infants born to HIV-infected women. This article provides guidelines about counseling the parent or care giver of the infant, use of antiretroviral therapy to reduce the risk of infection in the infant, medical treatment of the HIV-exposed infant, laboratory testing to determine the infection status of the infant, laboratory monitoring of hematologic and immunologic parameters, prophylaxis for Pneumocystis carinii pneumonia, and recommendations for immunizations and tuberculosis screening.

A prospective study was conducted in the Bronx, New York, of 70 infants of human immunodeficiency virus (HIV)-infected (n = 33) and uninfected (n = 37) mothers who had a history of intravenous drug use or of intravenous drug-using sex partners. Infants were observed from birth to a median age of 23 months (range 3 to 54 months). HIV infection was confirmed in seven infants (21%) of seropositive mothers; six developed HIV disease, with symptoms observed in the first year. Of these, three died (3, 9, and 36 months) of HIV-related causes; 3 of 4 survivors were >25 months of age. HIV symptoms preceded or were concurrent with abnormalities in T-lymphocyte subsets; postneonatal polymerase chain reaction confirmed HIV infection in five infants with symptoms and one without symptoms. Among infants of seropositive mothers, seven without laboratory evidence of HIV (including polymerase chain reaction) had findings suggestive of HIV infection, including persistent generalized lymphadenopathy, hepatosplenomegaly, oral candidiasis, parotitis, and inverted T-lymphocyte ratios. These findings were not observed in infants of seronegative mothers. Although the presence of HIV proviral sequences was associated with HIV disease, the observation of indeterminate symptoms in at-risk infants indicates the importance of long-term clinical follow-up to exclude HIV infection. Disease manifestations in comparable infants of seronegative mothers are important for assessment of the impact of maternal drug use, development of specific clinical criteria for early diagnosis of HIV and eligibility for antiretroviral therapy.

The human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) epidemic has grown during the past 15 years. Education remains a critical component of our efforts to prevent HIV infection/AIDS in school children and young adults. To accomplish this goal, school personnel should receive updated information about HIV infection/AIDS so that accurate teaching on this topic can be included in the K–12 health education curriculum. Informed pediatricians and nurses can serve as important resources for school health services and administration to provide current information for the curriculum. Each community should have a school health advisory committee that enlists community support and provides input to health education programs in schools.

Chairman Zuelzer: Anemia happens to be one of the manifestations of erythroblastosis, but we intend to keep the purely hematologic aspects to a minimum and shall consider the disease as a whole, paying particular attention to its clinical features. The Rh factor which appears in the title of this discussion is likewise only of incidental interest to us. In recent years we have heard too much about Rh and too little about the clinical entity erythroblastosis fetalis which is our topic for today. We have agreed for our purpose to define erythroblastosis as a disorder of fetal and neonatal life resulting from maternal sensitization against antigens of the Rh group present in the fetal cells. We exclude deliberately the still controversial cases of so-called erythroblastosis due to incompatibility in the O-A-B system of blood groups and will touch on this problem only in so far as it has a bearing on diagnosis. Only a few words are needed in regard to the Rh antigens. The emphasis on the subtypes of Rh which are of interest mainly to the geneticist and immunologist have made the subject unpalatable to the clinician and the unnecessarily complex nomenclature has further beclouded a basically simple issue. For the clinician the original Rh antigen with a distribution of 85% in the white population is still by far the most important. In the simple language of the Fisher-Race theory we are chiefly concerned with the genes D and d, familiar to some of you as Rho and rh. The genetic background of maternal isoimmunization can be summarized by the simple statement that sensitization is possible only when a homozypous mother carries a heterozygous fetus. An heterozybous mother (Dd) cannot be sensitied since both antigens are present in her own cells. The homozygous fetus (DD or dd) cannot sensitize its mother because by definition it receives the same type of gene from both parents and must therefore be compatible with the mother. In the usual situation of erythroblastosis the mother is Rh negative (dd), i.e. homozygous, the Rh positive fetus is ipso facto heterozygous (Dd). Rarely a homozygous Rh positive mother may become sensitized to the c-d-e genes of a heterozygous fetus. While the basic relationship of erythroblastosis fetalis to antigenic differences between mother and fetus is well established it seems only fair to say that we know as yet very little about the reasons why certain women become sensitized and others not.

Since infantile autism is a puzzling and challenging condition, or group of conditions, with causes uncertain or complex and treatment often unsatisfactory, one approaches a new book on the subject with eagerness and a hope of finding some new answers or clarification. Infantile Autism is a compilation of invited papers and discussions by 26 English and American workers in the field of autism, who participated in a colloquium at Indiana University in 1968. The colloquium focussed on some central questions: Is infantile autism a clinical entity?

The complexity of the interaction of genetic and environmental factors on human behavior is both a fascination and a frustration. It is fascinating to try to assess the relative contribution of each factor to the development and personality of individual patients. It is frustrating to try to separate genetic and environmental influences, which begin to interact even before birth. Any investigator who reports behavioral characteristics of patients with a genetic abnormality has the important responsibility to document the genetic diagnosis and to include data about psychosocial factors, so that the reader may make a critical appraisal of his conclusions with regard to multiple interacting influences on development.

Dr. Hook's comments about our study are received with appreciation. Children with abnormalities of the sex chromosomes are so rare that it is difficult for any one center to see enough of them to make valid conclusions about differences in their development. However, it is possible that pooling of data from several centers will show significant trends. In fact, in June 1974, investigators from a number of centers where prospective studies of such children are being conducted met to share their data and consider a plan for some ongoing collaboration.

In the recent article by our townsman, Dr. Hans H. Neumann, "Pica–Symptom or Vestigial Instinct?" (Pediatrics, 46:441) the concept of vestigial instinct is used as part of the basis for discounting emotional deprivation as one of the most significant factors leading to pica in this country. Dr. Neumann's otherwise fascinating report does not define adequately what he means by instinct, nor does he use the word pica in its usual sense. He admirably describes how a mother in West Africa introduces her infant to a piece of wood for chewing.