bluuebunny/crossref_metadata_2025 huggingface dataset:
Why Adolescent Medicine?
Authors: Strasburger Victor C.
Published: November 2007

Teenagers can be challenging patients. Physicians trained in a variety of specialties may vary greatly in their interest in adolescent health problems and their experience in dealing with them. Four cases are discussed in which important aspects of adolescent growth and development were overlooked and resulted in diagnostic errors. Physicians in all disciplines who deal with teenage patients need to familiarize themselves with the basic physiology and psychology of puberty and the common disease processes seen during adolescence.
Skinfold Measurements in Children
Authors: Jung Eduard , Kaufman Jean J. Mason , Narins Dorice C. , Kaufman Gary E.
Published: November 2007

Two types of calipers to measure skinfolds have been compared in adults, but the same type of comparison has not been done in a pediatric population who generally would have smaller skinfolds. Biceps and triceps skinfold measurements were made in 240 pediatric patients ranging in age from 2 weeks to 18 years. Skinfold measurements obtained with a McGaw caliper were on the average 12.6 percent lower than those obtained with a Lange caliper on the same patient. Differences between measurements by two investigators using the same caliper on the same patient averaged 20.4 percent for the Lange caliper and 17.6 percent for the McGaw caliper (root mean square differences). We conclude that McGaw and Ross plastic calipers would be an adequate substitute where cost prohibits the use of Lange calipers.
Intussusception Associated with Necrotizing Enterocolitis
Authors: Smith Vernon S. , Giacoia George P.
Published: November 2007

Two premature infants whose clinical picture initially was that of necrotizing enterocolitis eventually developed intussusception. The symptomatology of these two conditions is similar, and when they coexist, recognition of a complicating intussusception is difficult. The pathogenic relationship between necrotizing en terocolitis and intussusception remains obscure. The possibility that necrotizing enterocolitis can be a leading point in the development of intussusception is dis cussed.
Ectopic Gastric Duplication Cyst in an Infant
Authors: Curran John P. , Behbahani Morteza , Kim Byung-Hoon , Parlamis Nicholas
Published: November 2007

A case of an ectopic gastric duplication cyst that appeared to arise from the pancreas in a 10-week-old infant with a superficial mass in the left upper quadrant is reported. Preoperative ultrasound showed a cystic lesion with an inner echogenic layer (mucosa) and an outer anechoic rim (muscle). Technetium scan demonstrated that there was a gastric-type mucosa in the cyst. It is suggested that the ultrasound findings are specific for a gastric duplication cyst and that ultrasound and technetium scan alone will adequately characterize these lesions preoperatively.
Grocery Store Baking Soda
Authors: Booth Beverley E. , Gates Jay , Morris R. Curtis
Published: November 2007

Oral sodium bicarbonate is used to treat metabolic acidosis in patients with renal tubular acidosis. Since infants and young children are unable to swallow tablets, those affected must ingest sodium bicarbonate in a powder or liquid form. Pharmacy-weighed sodium bicarbonate is expensive and inconvenient to obtain; some pharmacists are reluctant to provide it. We determined that the sodium bicarbonate contained in 8-oz boxes of Arm and Hammer Baking Soda® was sufficiently constant in weight that, dissolved in water to a given volume, it yielded a quantitatively acceptable therapeutic solution of sodium bicarbonate at a cost of approximately 3 percent of that of pharmacy- weighed sodium bicarbonate. Grocery store baking soda can be a safe, economical, and convenient source of sodium bicarbonate for the treatment of chronic metabolic acidosis in infants and young children.
Baby Powder Use in Infant Skin Care
Authors: Hayden Gregory F. , Sproul George T.
Published: November 2007

One hundred parents of infants aged 2 weeks to 6 months were surveyed at the time of routine well-child visits to assess parental knowledge about baby powder and to determine whether hospital policy of providing a free powder sample to newly delivered mothers was unwittingly promoting powder usage. Most parents (69%) reported regular baby powder use as part of routine infant skin care. Powder-users were significantly more likely than nonusers to attribute to baby powder the ability to kill bacteria and yeast and to prevent diaper rash (p < 0.01). Even among nonusers, fewer than half were aware that aspiration/ingestion of baby powder was a potential health hazard.

Almost all parents reported receiving a free sample of baby powder while in the hospital as part of a complimentary gift pack provided by the manufacturers. Most powder-users were currently using a brand they had received as a sample, and eight parents cited the receipt of a sample as the major determinant for selecting a particular brand of powder. The short- and long-term effects of distributing sample packs to newly delivered parents deserve further study.
Congenital Hyperextension of the Knees in Twins
Authors: Dungy Claiboume I. , Leupp Monte
Published: November 2007

Bilateral congenital hyperextension of the knees occurring in dizygotic twins is reported. Twin A had the mild form of the disease, genu recurvatum, while twin B had a more severe form of the disease, congenital subluxation. Hyperextension of the knee may occur as a sporadic abnormality, in conjunction with multiple dislocations or as a feature of a syndrome. Early detection and diagnosis are im portant, especially in the more severe forms of the condition, subluxation and dislocation, which require aggressive immediate intervention to prevent long-term sequelae. Conservative treatment consisting of manipulation and immobilization usually will correct the mild forms of the condition if instituted soon after birth. Prognosis is less favorable with delayed treatment, in the presence of other congenital anomalies, and with genetic syndromes.
Developmentally Disabled Infants Can Be Hard to Trace
Authors: McLaughlin John F. , Gustafson Cheryl B. , Sutton Mary , Stone E. Franklin , Davis Nora E. A.
Published: November 2007

The purpose of this study was to determine how well the existing medical care system in a large geographic region communicates about and keeps track of the developmental problems of infants receiving tertiary inpatient care. Two hundred thirty-seven infants hospitalized in the first months of life were tracked, using a postal questionnaire at a mean age of 20 months. A discharge summary was present in 98 percent of charts, and a follow-up physician was identified in 95%. Questionnaires were returned by 116 physicians about 182 infants (77%). Seventy-one physicians had received a discharge summary. Current developmental information was obtained for 111 infants: 44 normal, 52 with known disabilities, and 15 with developmental delays. One hundred twenty-six infants could not be located at the time of the study. We conclude that many infants likely to have major disabilities are hard to track using simple retrospective techniques.
Evaluation of Cefotaxime in Bacterial Infections
Authors: Varghese Matthew , Khan Abdul J. , Kumar Kusum , Schaeffer Henry A. , Pierro Michael , Evans Hugh E.
Published: November 2007

Cefotaxime, a third generation cephalosporin antibiotic, was evaluated in 26 infants and children for the treatment of documented or suspected bacterial infections, including pneumonia (10 cases), soft tissue skin infection (13 cases), and urinary tract infection (3 cases). An average daily dose of 60 mg/kg in 3 to 4 divided doses was administered parenterally for an average of 7 days. In 14 of the cases, primary pathogens, including Haemophilus influenzae b (resistant to ampicillin), Staphylococcus aureus, Staphylococcus pyogenes, Streptococcus pneumoniae and Escherichia coli, were eradicated. Clinical recovery occurred in each case. Blood levels at different time intervals and biological half-life were similar to those reported for adults. Mild and transient side effects observed were elevation of SGOT in two cases, alkaline phosphatase in one, and eosinophilia in one case.
Generalized Convulsions as the Presenting Sign of Amoxapine Intoxication
Authors: Rogol Alan D. , Schoumacher Robert , Spyker Daniel A.
Published: November 2007

Two infants presented for medical evaluation with sudden onset of seizures or coma, without obvious cause. Suspicious circumstances led to toxicological screening analysis. Amoxapine, a recently released antidepressant, was found in the gastric contents of both children an undetermined time after the putative ingestion, but elevated serum concentrations were noted only in one. The pharmacokinetics are described.

There were no obvious cardiotoxic or anticholinergic effects in these infants. Thus, they, like older children and adults, manifest mainly central nervous system toxicity rather than the cardiotoxicity and anticholinergic effects of overdose seen with tricyclic antidepressants.
Rubelia Myocarditis in a 9-year-old Patient
Authors: Kriseman Tony
Published: November 2007

A 9-year-old male with myocarditis is described. A greater than four-fold rise in titers against rubella with a subsequent fall supports the conclusion that his myocarditis was associated with rubella infection. Other than neonates, rubella myocarditis has been reported previously in only six patients, one of whom was a child.
Benign Paroxysmal Torticollis in Infancy
Authors: Hanukoglu A. , Somekh E. , Fried D.
Published: November 2007

We present four children with benign paroxymsal torticollis (BPT) and a review of the literature. BPT appears to be a self-limited disorder that occurs predominantly in females. The attacks of head tilting usually start in infancy, may recur at varying intervals until the age of 1 to 5 years, and may be confused with other seizures. Other symptoms, such as ataxia and vomiting, may be associated with the attacks of torticollis. Less frequently, infantile migraine also may be associated.
Systemic Haemophilus influenzae Infection in Finland
Authors: Peltola Heikki , Virtanen Marita
Published: November 2007

A total of 813 patients from the years 1976 to 1980 who had a bacteremic Haemophilus influenzae infection were analyzed. Special attention was paid to disease entities (16.5% of the total) other than meningitis (60.5%) or epiglottitis (23.0%). Ninety-six cases in the nonmeningitis, nonepiglottitis (NMNE) group showed the following distribution: 25 patients with septicemia without specific focus, 21 arthritis, 19 cellulitis, 17 pneumonia, six otitis, four local abscess, two laryngotracheo bronchitis, and two with an eye infection. Eighty-eight percent of the cases were children who were less than 5 years old; in the septicemia and pneumonia groups, however, 33 percent were 15 years of age and older, and 10 percent were over 60 years of age.

All diseases in the NMNE group were acute; 51 percent of the patients sought medical advice within two days. C-reactive protein (CRP) was elevated constantly at presentation, erythrocyte sedimentation rate (ESR) was increased (>20 mm/hr) in 87 percent, high fever greater than 38.5°C (101.3°F) was measured in 85 percent, and leukocytosis (>15 × 109/1) was present in 71 percent. Various antimicrobial agents were given for an average of 17 days. The mean period of hospi talization was 13 days. Case fatality rate was 4 percent; all deaths occurred among patients with an underlying disease. No permanent damage was observed.
Mild Splenic Sequestration Crises in Sickle-Hemoglobin C Disease
Authors: Andrews Joann , Buchanan George R.
Published: November 2007

Acute splenic sequestration crisis (ASSC), a common complication in homozygous sickle cell anemia, has been described infrequently in sickle-hemoglobin C (SC) disease in the absence of high altitude exposure. In this report, we describe three children with hemoglobin SC disease who developed episodes of ASSC that were milder than those generally described in sickle cell anemia. In one patient, an antecedent triggering event was not recognized. The other two children may have had a predisposing cause for massive intrasplenic sickling in that one had an associated mononucleosis syndrome and the other an episode of hypovolemic shock following severe epistaxis. ASSC may occur in patients with SC disease and does not necessarily require a hypoxic trigger associated with high altitudes.
Management of Infants with Apnea and Potential Apnea
Authors: Lewak Norman , Zebal Bradley H. , Friedman Stanford B.
Published: November 2007

Conflicting opinions and inadequate data have led to confusion regarding the relationship of sudden infant death syndrome (SIDS) and infantile apnea. Consensus regarding appropriate eval uation and management strategies for infants presumed at risk has not been reached. This study surveyed pediatric opinion regarding these issues. Questionnaires were mailed to 1000 randomly selected members of the American Academy of Pediatrics, and to faculty at all approved U.S. pediatric residency programs. Results indicated that respondents as a group were uncertain about the relationship between SIDS and apnea. Most respondents would (1) initially evaluate infants presenting with apnea at either a hospital or an apnea evaluation center, (2) refer subsequent siblings of SIDS infants to an apnea center, and (3) recommend no intervention, but provide reassurance, to anxious parents requesting a "test for SIDS" for a normal newborn. Respondents' comments showed diverse opinions regarding appropriate evaluation and management strategies for these three types of infants, and reflected concern regarding dilemmas posed to clinicians responsible for their care. Further research and continuing medical education efforts are needed to reduce current confusion.
Cardiopulmonary Responses of Asthmatic Children to Strenuous Exercise
Authors: Chryssanthopoulos C. , Maksud M.G. , Gallen W.G. , Hause L.L.
Published: November 2007

The purposes of the study were to investigate the cardiopulmonary adaptations of asthmatic children to physical exercise and to evaluate the effects of theophylline. Two groups of children were evaluated.

Eight asthmatic children participated in two exercise sessions. Half of the patients received theophylline in predetermined doses during the first session and half prior to the second session. Seventeen normal children matched for age, height, and weight served as controls. Various car diorespiratory parameters were measured every 2 minutes during exercise and prior to termination of maximal physical effort.

The results indicate that children with chronic asthma reach the range of predicted maximal aerobic capacity for their age. Theophylline increases the endurance of asthmatic children to maximal physical efforts without improving the cardiorespiratory parameters that were measured. The use of theophylline in therapeutic doses appears safe under conditions of vigorous exercise.
Swyer-James Syndrome—Unilateral Hyperlucent Lung Syndrome
Authors: Daniel Terri L. , Woodring John H. , Mac Vandiviere H. , Wilson H. David
Published: November 2007

Swyer-James syndrome is a pulmonary condition acquired following bronchiolitis obliterans early in life. Clinically characterized by repeated bouts of pulmonary infections, Swyer-James syndrome is characterized radiographically by a unilateral small, hyperlucent lung that demonstrates diminished arterial supply to the involved lung, air-trapping, and bronchiectasis. Radioimaging procedures may reveal otherwise unsuspected bilateral involvement. A 14-year-old Caucasian female with classic findings of Swyer-James syndrome is presented. The differential diagnosis of conditions that may present with a unilateral hyperlucent lung is discussed. Therapy is aimed primarily at control of the intercurrent episodes of bacterial pneumonia.
Multiple Pulmonary Complications in a Patient with Stevens-Johnson Syndrome
Authors: Virant Frank S. , Redding Gregory J. , Novack Alvin H.
Published: November 2007

Since first described in 1922, Stevens-Johnson syndrome has been associated frequently with pneumonia of many etiologies. This "mucosal respiratory syn drome," first reported by Stanyon and Warner in 1945, is associated with "early" pneumonia which resolves 2 to 3 weeks after onset of the rash. In our patient, pneumonia began 10 days after rash onset and was nearly resolved by day 20. The unique feature of this case was the onset of late pulmonary complications 25 days after the appearance of the exanthem, manifesting as acute noninfectious interstitial disease with superimposed airway obstruction.
Warning Labels
Authors: Benson Blaine E. , Klein-Schwartz Wendy , Oderda Gary M. , Lucy Jaquelyn S.
Published: November 2007

The Hazardous Substances Act specifies that warning labels for household products contain specific signal words. This study was designed to determine whether this warning label format provides enough information for parents to accurately assess product toxicity. One hundred forty- two parents from two different sites (community health clinic, private pediatrician's office) were asked to rate the toxicity of four common household products (Crystal Drano, Lysol Basin/Tub and Tile Cleaner, Clorox Bleach, Tempera Poster Paint) and four imaginary products based on the warning labels found on them. Parents had a fairly accurate perception of the toxicity of products and the toxicity to be anticipated based on the warning label. There was considerable variability in response for products which were less toxic or nontoxic. Confusion was noted regarding the meaning of the term nontoxic.
Experience with Home Oxygen in the Management of Infants with Bronchopulmonary Dysplasia
Authors: Abman Steven H. , Accurso Frank J. , Koops Beverly L.
Published: November 2007

We followed the clinical course of 23 infants with bronchopulmonary dysplasia (BPD) on home oxygen therapy during the first year of life in order to monitor patterns of growth, need for hospital readmission, and improvement in oxygenation. Oxygenation was assessed by serial, resting, awake, and room air transcutaneous PO2 (tcPO2) measurements at clinic visits. Weight gain was poor, with boys growing below the fifth percentile and girls growing at the tenth percentile. Ten of the 23 infants (43%) required rehospitalizations. There were no deaths. Fourteen of the 23 infants (61%) were taken off supplemental oxygen by 12 months corrected age, at a mean age of 7.9 months. Mean rate of improvement in tcPO2 was 3 torr/month, but wide individual variation was found. Infants off of oxygen treatment at 12 months corrected age grew at a significantly greater rate than those still requiring oxygen supplementation (p < 0.02). Infants with right ventricular hypertrophy (RVH) by electrocardiogram tended to resolve their RVH while on home oxygen therapy. We conclude that infants with BPD on home oxygen therapy generally show steady improvement in oxygenation, but grow poorly and require frequent hospitalizations.
Infant Oxygen Administration by Modified Nasal Cannula
Authors: Kloor T.H. , Carbajal Donna
Published: November 2007

In both pediatric and neonatal intensive care settings, and occasionally at home, there exists the need to deliver chronic low dose oxygen therapy to small, uncooperative patients. To be effective, a method of oxygen delivery must be both reliable and comfortable, and, at the same time, inexpensive and safe. We believe that this may be achieved by a simple modification of existing pediatric nasal cannulae.
The Role of Bilirubin Production in Breast-fed Infants with Elevated Serum Bilirubin Concentrations at 2 Weeks of Life
Authors: Meyers Cynthia H. , Kwong Linda K. , Vreman Hendrik J. , Stevenson David K.
Published: November 2007

The carboxyhemoglobin level (COHb), an accepted qualitative index of bilirubin production, was measured in normal, full-term, breast-fed (n = 9) or formula-fed (n = 11) infants at 2 days and 2 weeks of life. The mean COHb did not differ significantly at 2 days and 2 weeks in either of the groups, nor did the mean COHb differ between the groups at 2 weeks. The mean serum bilirubin concentration was lower in the formula-fed infants compared to the breast-fed infants at 2 weeks (p < 0.05). The mean serum bilirubin concentration decreased by only 14 percent among the breast-fed infants, and actually increased in three infants by 2 weeks. In comparison, the mean serum bilirubin concentration of the formula-fed infants decreased by 61 percent (p < 0.05), with the serum bilirubin concentration decreasing in each infant by 2 weeks. These findings are consistent with the generally held belief that bilirubin production is not the primary etiology of elevated serum bilirubin concentrations associated with breast-feeding in the second week of life. However, continued high bilirubin production at 2 weeks may contribute to the potential for significant jaundice in some infants with impaired hepatic function or increased enterohepatic circulation of bilirubin.
Giant Hemangioma in the Newborn and Infant
Authors: Stringel Gustavo , Mercer Stanley
Published: November 2007

Most hemangiomas do not cause major problems but they may be functionally or emotionally unacceptable. In uncomplicated cases spontaneous involution is frequent and treatment consists of expectant care. We report three newborn babies and two infants with giant hemangiomas in whom acute life-threatening complications required immediate treatment. Complications included cardiac failure, hemorrhage, platelet trapping, and disseminated intravascular coagulation (DIC). Modes of therapy employed were surgical excision, steroids, embolization, radiotherapy, intermittent pneumatic compression (Jobst), and continuous compression treatment (Jobst). Our five cases show that several modalities of treatment may be necessary to control the life-threatening complications of giant hemangiomas.
Difficulties in the Neonatal Diagnosis of Menkes' Kinky Hair Syndrome—Trichopoliodystrophy
Authors: Gunn Tania R. , Macfarlane Scott , Phillips L.I.
Published: November 2007

The recognition of Menkes' kinky hair syndrome, trichopoliodystrophy, may present problems in the early neonatal period. The serum copper, and ceruloplasmin levels are within the range of normal infants in the first week of life; they are higher than normal in the cord blood of affected infants and fall gradually. Pili torti may only develop later, as the primary fetal hair is normal. The baby may appear bald, or both normal and abnormal hair may be found in different areas of the skull. The roentgenographic signs of wormian bones in the skull, metaphyseal spurring of the long bones, and diverticuli of the bladder develop progressively and may not be seen until after 6 weeks of age. However, diagnosis is possible in the neonatal period, if male infants with unexplained hypothermia, hypotonia, septicemia, or seizures are investigated by serum copper and ceruloplasmin levels after 1 month of age.
Haemophilus influenzae Infections
Authors: Marks Melvin I.
Published: November 2007

The clinical manifestations of Haemophilus influenzae infections and the growing problem of ampicillin-resistant strains are reviewed. Despite the fact that approximately 25 percent of H. influenzae are resistant to penicillin and ampicillin, oral aminopenicillins (ampicillin, amoxicillin, bacampicillin, and cyclacillin) are commonly used for the outpatient management of these infections. The characteristics of these drugs and the rationale for their use are discussed and compared with alternative approaches to therapy. This subject requires periodic review in consideration of the increasing prevalence of ampicillin and multiple antibiotic resistance among H. influenzae isolates.
Coagulase-negative Staphylococcal Bacteremia in Newborns
Authors: Calnen Gerald , Campognone Paul , Peter Georges
Published: November 2007

Coagulase-negative staphylococci (C-NS) recently have been identified as common causes of septicemia in high-risk newborns. In this review of the incidence and clinical significance of C- NS blood culture isolates from infants with suspected septicemia in a newborn intensive care unit (NICU), 2.2 percent of blood cultures in an 18-month period yielded C-NS. Based on the criterion of growth in multiple blood cultures as evidence of bacteremia, six of 30 infants (20%) were bacteremic, 17 (57%) represented probable contaminants (on the basis of growth in only one of two paired blood cultures with CN-S), and seven cases (23%) were indeterminant (only one culture was obtained). In those infants considered bacteremic, onset occurred between 12 and 51 days of age. In those with probable contaminants, all but three occurred in the first week of life. All infants had manifestations of suspected sepsis and survived the clinical episode. These findings indicate that C-NS growth can be due to nosocomial bacteremia but frequently represents blood culture contamination, especially in infants in the first week of life. At least two paired peripheral blood cultures should be obtained in infants with suspected septicemia to differentiate bacteremia from contamination.
An Attempt to Influence Health Care Visits of Frequent Hospital Emergency Facility Users
Authors: O'Shea John S. , Collins Edward W. , Pezzullo John C.
Published: November 2007

In this study, 445 patients under 19 years of age who visited an urban hospital emergency facility for acute illnesses four or more times over 2 years were randomly divided into two groups. The parents of 230 of the patients received three letters that stressed the value of continuous pediatric care and the lack of continuity available in emergency facilities. The letters indicated a willingness to offer advice as to how they could obtain continuing care. The remaining 215 patients served as controls. During the following year, the patients whose parents received the letters and the controls were compared in their visits to the hospital's emergency facility, primary care unit, and subspecialty clinics. Very few differences were noted between the two groups.
Growth and Tolerance Studies of a New Infant Formula
Authors: Sickles V.S. , Tuley R.J. , Bader P. , Carnaggio V.A. , Exon W.J. , Hargett I.R. , Keathley S.E. , Wolf R. , Cordano A.
Published: November 2007

A new routine infant formula has been developed and clinically tested. The clinical study reported here involved 337 normal newborns cared for by six private pediatric group practices. Infants were examined regularly by the investigators until six months of age. Serum biochemistries, hematology, and growth and tolerance variables were compared to infants fed control formulas and to reported values for breast-fed infants. This new formulation compared favorably, in all areas studied here, to controls and previously reported values.
The Present Day Epidemiology of Severe Protein-Energy Malnutrition in Nigeria
Authors: Oyedeji Gabriel Ademola
Published: November 2007

Eighty-eight patients with severe protein-energy malnutrition (PEM) admitted into the Wesley Guild Hospital, Ilesa, Nigeria over a 9-month period were studied to define the patterns and factors encountered currently in PEM. Severe PEM now occurs predominantly in the 6- to 18- month age group, which is earlier than was reported previously. The majority of the parents were Yoruba Christians and were low-income workers or unemployed. Poverty was a factor in 54.5 percent. Most of the parents were literate. About half of the families were polygamous. The prevalence of social problems was high, with 72.7 percent of the parents living apart. Attacks of measles and recurrent or prolonged gastroenteritis were preceding precipitating factors in 30.7 percent and 33 percent of the patients, respectively. Failure or cessation of breast-feeding or bottle-feeding with cow's milk from the first month of life preceeded the development of PEM in a large percentage of patients. The implications of these findings are discussed.
Fatal Fulminant Hepatitis with Hemolysis in Wilson's Disease
Authors: Kraut Jerome R. , Yogev Ram
Published: November 2007

We report a child with the presentation of Wilson's disease as acute fulminant hepatic failure and severe hemolysis. Our review of the literature suggests the following criteria for considering this diagnosis in the child with acute liver failure: discordance between mildly elevated serum transaminases and extremely elevated bilirubin levels; anemia associated with hemolysis (increased reticulocytes in the absence of bleeding); elevated hepatic copper; and other copper metabolic abnormalities (elevated serum copper, excessive 24-hour urine copper excretion, and reduced serum ceruloplasmin). Establishing the correct diagnosis enhances the possibility of detecting asymptomatic siblings or other family members in whom early inauguration preventative therapy should be successful.
Alimentary Absorption of Gentamicin in Preterm Infants
Authors: Bhat Abdul M. , Meny Robert G.
Published: November 2007

Fifty-two preterm neonates receiving oral gentamicin from birth, as prophylaxis against necrotizing enterocolitis (NEC), had serum gentamicin levels measured on the second day of life (52 infants) and on the seventh to tenth days (43 infants). The serum gentamicin concentrations on the second day were 0.5 μg/ml or less in 21 percent, 0.6 to 1.0 μg/ml in 15 percent, 1.1 to 2 μg/ml in 34 percent, 2.1 to 5 μg/ml in 25 percent, and 5 to 7.1 μg/ml in 4 percent of the infants. Paired serum gentamicin levels were significantly lower (p < 0.001) on the seventh to tenth day as compared to the second day. We conclude that preterm infants in the first few days of life absorb orally administered gentamicin. Concomitant use of systemic gentamicin under such circumstances may potentially lead to toxic serum gentamicin concentration.
Exclusion of III Children from Day-care Centers
Authors: Shapiro Eugene D.
Published: November 2007

Despite evidence that children who attend group day-care centers have an increased frequency of infectious illnesses, appropriate criteria for exclusion of ill children from day-care centers have not been defined. Of the 89 licensed day-care centers in the New Haven area, 53 (60%) returned an anonymous questionnaire about their practices in managing ill children. Most of the centers (median size—38) included only children aged 3 to 5 years. The percentage of centers that excluded children with specific signs or symptoms varied from 100% for fever to 30% for either cough or runny nose. Although all of the day-care centers excluded children with fever, the minimum temperature defined as fever varied substantially (median—99.1°F). Most centers (62%) relied on the parents' discretion for allowing an ill child to return to the center.
Accidental Carbon Monoxide Poisoning
Authors: Zeller W. Patrick , Miele Angelo , Suarez Carlos , Hannigan Jerome , Hurley R. Morrison
Published: November 2007

In this case report of an accidental automobile carbon monoxide poisoning, we identify the following risk factors: freezing temperature, young passenger age, location in the rear of the auto, smaller patient mass, and auto disrepair. The pathogenesis of carbon monoxide poisoning is reviewed. Emergency treatment and suggested criteria for hyperbaric oxygen use in pediatric patients are discussed.
Mothers of Abused Children
Authors: Oates R.K. , Forrest D. , Peacock A.
Published: November 2007

A group of 36 mothers whose children had suffered from child abuse at an average of 5½ years previously was compared with a group of mothers of similar social class where there had been no reported instances of abuse of their children. There was no significant difference between the two groups with regard to marital, housing, or financial problems or in physical health. Statistically significant differences were found between the abuse and comparison group mothers in the following areas: the abuse group mothers (1) were less likely to have been brought up by their own parents; (2) had more negative feelings towards their fathers; (3) were more likely to have received help for an emotional disorder; (4) had higher expectations for their children; (5) perceived a greater number of personality problems in their children; and (6) were more likely to have assertive, demanding, and suspicious personality traits. It is possible that these maternal factors will influence the emotional development of their children.
Moxibustion
Authors: Reinhart Michael A. , Ruhs Herbert
Published: November 2007

An approach emphasizing an understanding of differing patient and family models of illness and the implementation of culturally appropriate health care is described. The physician who observes a practice such as moxibustion should attempt to gain an understanding of the parents' "model" of illness, develop and maintain rapport with the family, and attempt to develop a culturally appropriate treatment plan which minimizes the injurious practice. Counselors of the same ethnic group who are more acculturated to our society may be very helpful.
Family-focused Services for Children with Rare Disorders, Exemplified by Bladder Exstrophy
Authors: Vandvik Inger Helene , Storhaug Kari
Published: November 2007

Families of children with rare disorders have many experiences in common, as well as special problems related to the specific disorder. This paper presents Frambu Health Centre and the family-focused services offered to patients with bladder exstrophy during the first information and treatment course arranged for this group at the Centre. Main areas of concern as reported by the families are presented.
Inappropriate Uses of Stimulant Medications
Authors: Volkmar Fred R. , Hoder E. Lawrence , Cohen Donald J.
Published: November 2007

The utility of stimulant medications in the treatment of attention deficit disorder (ADD) has been demonstrated repeatedly. Over 500,000 children receive these medications in the United States each year. The drugs, however, may be used inappropriately in cases where a presumptive diagnosis of "hyperactivity" is mistakenly made on the basis of nonspecific increases in activity levels or when an initial sedative response is taken as diagnostic confirmation of ADD. In this series of six cases, stimulant medications had been used inappropriately to manage a range of developmental problems. The importance of a careful diagnostic evaluation before instituting stimulants, careful monitoring, and a consideration of their risks are emphasized.
Scorpion Sting in Children
Authors: Amitai Yona , Mines Yoram , Aker Memet , Goitein Kalman
Published: November 2007

Scorpion sting in children is a hazardous and potentially lethal condition. Fifty-one infants and children were admitted to the Pediatric Departments at the Hadassah-Hebrew University Hospitals in Jerusalem, during a 5-year period, following scorpion sting. Fifteen (29.4%) had severe systemic signs of envenomation and two (3.9%) died. Analysis of our data showed that patients with severe toxicity were brought to the hospital after a significantly longer time lapse than were the patients with mild-to-moderate symptoms. The current management of children with scorpion envenomation consists of administration of specific antivenom and close surveillance in an intensive care unit, where vital signs and continuous cardiac monitoring enable early initiation of therapy for life-threatening complications, such as cardiac and respiratory failure, convulsions, or hypertension.
Neonatal Theophylline Neurotoxicity
Authors: Clancy Robert R. , Kaplan Karen M. , Baumgart Stephen , Rosenberry Kathleen R.
Published: November 2007

Despite the frequency with which theophylline is administered to premature infants, there are few reported cases of neurotoxicity. We describe a theophylline- treated premature infant with chronic bronchopulmonary dysplasia and hepatitis who displayed a focal seizure and irritability followed by other systemic signs of theophylline intoxication, at a postnatal age of 5 months. An unrecognized accidental drug overdose combined with a prolonged elimination half-life were responsible for clinical intoxication. The potential mechanisms of theophylline's neurotoxicity are discussed briefly.
Tentative Evidence of Y-linked Statural Gene(s)
Authors: Smith David W. , Marokus Roy , Graham John M.
Published: November 2007

The linear growth data of 48 XY individuals, presumed to be androgen-insensitive as a consequence of the testicular feminization syndrome, were found to be similar to normal male standards and tall for normal female standards. These data are interpreted as evidence for one or more Y-linked gene function(s) which augment stature independently of testosterone effects.
Evaluating Drug Effectiveness in an Office Setting for Children with Attention Deficit Disorders
Authors: Ottinger Donald R. , Halpin Bruce , Miller Michael , Demian Lisa , Hannemann Robert
Published: November 2007

Stimulant medications have been demonstrated to be useful in treating groups of children with attention deficit disorders, but placebo effects and situaticanal differences in behavior in individual cases need to be followed and assessed. A simple procedure for systematically assessing these factors in the individual child in the ofhce setting is described and illustrated. The procedure provides an objective means of determining the drug and placebo effects on the reported problem behavior and the differences between parent and teacher perceptions of the behavior.
Clostridium difficile Isolation in Leukemic Children on Maintenance Cancer Chemotherapy
Authors: Chiesa Claudio , Gianfrilli Paola , Occhionero Mirella , Luzzi Ida , Multari Giuseppe , Werner Beate , Pacifico Lucia , Midulla Mario
Published: November 2007

Between December 1982 and November 1983, stool specimens from 15 children with acute lymphoblastic leukemia, who were on maintenance cancer chemotherapy, were examined weekly for the presence of Clostridium difficile and its toxin. Four out of 15 patients were positive for C. difficile: three patients had stool specimens that did not contain toxin, but cultures yielded growth of toxigenic C. difficile on only one occasion. The fourth patient, who had a recent history of hospitalization, particularly aggressive cancer chemotherapy, neutropenia, and antibiotic therapy, excreted both C. difficile and its toxin for at least 1 month. All children were asymptomatic at the time of positive cultures. This preliminary study reveals a low rate of C. difficile colonization in leukemic children on maintenance cancer chemotherapy.
Factors Affecting Visitation of Sick Newborns
Authors: Giacoia George P. , Rutledge Darnelle , West Kerstin
Published: November 2007

A study of visiting patterns to an intensive care nursery over a 6-month period was undertaken. Data on visits were obtained from 167 admissions, 99 of which were from infants transferred from other towns. In addition, the parents were interviewed to determine factors precluding visiting. Inborn (Group A) and out-of-town (Group B) data were analyzed. For Group A, the mean number of weekly visits was 6.59 (range, 1.7-16.5) and the total cost of visiting during hospitalization was $135.00 (range, 5.76-649.36); for Group B, the figures were 3.6 (range, 0.1- 12.4) and $328.00 (range, 12.96-1523.36), respectively.

Parents in Group B visited less often, made fewer telephone inquiries, and earned a lower salary than parents in Group A. Frequency of visits was correlated to social class. The most commonly identified factors limiting visiting were care of siblings, demands of work, cost of the trip, and distance.
Metoclopramide as a Lactogogue
Authors: Gupta Abha P. , Gupta Pradeep K.
Published: November 2007

Thirty-two mothers with no or inadequate breast milk were treated with metoclopramide. Improved lactation occurred in 66.67 percent of mothers with no breast milk and 100 percent of those with inadequate milk output. Improvement persisted after discontinuing the treatment. No untoward effects were noticed in any of the mothers or their infants.
Echocardiographic Evaluation of Infective Endocarditis in Children
Authors: Bricker J. Timothy , Latson Larry A. , Huhta James C. , Gutgesell Howard P.
Published: November 2007

To determine the incidence and prognostic importance of the echocardiographic abnormalities associated with infective endocarditis, we reviewed these findings in 45 episodes occurring in 41 children and young adults. Thirty-three patients had congenital cardiac abnormalities, and eight patients had no previously known heart disease. Echocardiographic abnormalities were detected in 16 of the 45 episodes of endocarditis (36%). M-mode echocardiography revealed abnormalities in seven of the 35 episodes (20%) in which it was performed, and two-dimensional echocardiog raphy revealed abnormalities in 16 of the 28 episodes (59%) in which it was used. The presence of echocardiographic abnormalities was unrelated to the causative organism and to the need for early operation.
Association of Arterial Hypertension with Poor Outcome in Children with Acute Brain Injury
Authors: Kanter Robert K. , Carroll James B. , Post Ernest M.
Published: November 2007

We studied intensive care unit (ICU) records of 42 comatose children with acute brain injuries to define the relationship between high arterial blood pressure and poor neurologic recovery. Diagnoses included head trauma, anoxia, Reye's syndrome, and central nervous system infection. The highest systolic blood pressure in all 42 patients exceeded the 95th percentile. In those whose highest systolic pressure exceeded 95th percentile by more than 20 torr, severe neurologic deficit or death occurred in 19 of 34 (56%), while in those with milder hypertension, poor outcome occurred in only one of eight (13%, p = 0.0316). Of those with high blood pressure persisting until ICU discharge, 14 of 19 (74%) had poor outcome, while those with blood pressure normalizing prior to ICU discharge had poor outcome in only six of 23 (26%, p = 0.0026). High blood pressure was not usually a reflex effect of elevated intracranial pressure. This finding suggests that measures to control high blood pressure are indicated in the management of the acutely brain-damaged child.
Treatment of Patients with a History of Recurrent Tonsillitis Due to Group A Beta-hemolytic Streptococci
Authors: Brook Itzhak , Hirokawa Ronald
Published: November 2007

Forty-five patients with a history of recurrent tonsillitis associated with Group A beta- hemolytic streptococcal (GABHS) infection participated in a prospective, randomized study comparing penicillin, erythromycin, or clindamycin therapy. Surface tonsillar cultures were obtained before therapy, 10 days after termination of therapy, and once a month for a period of 12 to 18 months. The specimens were processed for aerobic and anaerobic bacteria. Beta lactamase-producing aerobic and anaerobic bacteria were present in 43 of the 45 (96%) tonsillar cultures. GABHS colonization was eradicated in two of 15 patients treated with penicillin, in six of 15 treated with erythromycin, and in 14 of the 15 treated with clindamycin. In long-term follow-up, 12 of 14 patients treated with penicillin, eight of 14 treated with erythromycin, and one of 15 treated with clindamycin (p < 0.0001 when compared to penicillin and p = 0.002 when compared to erythromycin) continued to suffer from recurrent tonsillitis.
Intestinal Flora in the Second Week of Life in Hospitalized Preterm Infants Fed Stored Frozen Breast Milk or a Proprietary Formula
Authors: Stevenson David K. , Yang Christine , Kerner John A. , Yeager Anne S.
Published: November 2007

Twenty infants fed stored frozen breast milk or a proprietary formula only had both aerobic and anaerobic cultures performed at a chronologic age of 8 to 14 days. Nine out of 10 stools from the infants fed stored frozen breast milk contained Enterobacteriacae and one stool was sterile. One contained a Pseudomonas species; one contained anaerobic gram-positive rods; one contained anaerobic gram-negative rods; and four contained anaerobic gram-positive cocci. No anaerobes were found in six stools. Six stools had aerobic gram-positive cocci, none of which was hemolytic. Nine out of 10 stools from infants fed a proprietary formula had Enterobacteriaceae. Six stools had anaerobic gram-positive rods, three had anaerobic gram-negative rods, and four had gram-positive cocci. Four stools had no anaerobic bacteria. All 10 stools had nonhemolytic aerobic gram-positive cocci. Enterobacteriaceae were predominant in the stools of the infants fed either stored frozen breast milk or a proprietary formula, and the colony counts of aerobic bacteria were similar in both groups. This pattern of intestinal flora in hospitalized preterm infants in the second week of life is very different from that of normal term infants and may contribute to their increased incidence of systemic and localized infections. The use of stored frozen breast milk for the purpose of suppressing coliform and other potentially pathogenic organisms may not be effective in hospitalized preterm infants who have been treated previously with broad-spectrum, parenteral antibiotics.
Strangulated Congenital Diaphragmatic Hernia in Infants
Authors: Zamir Oded , Goldberg Meir , Lernau Omri Z. , Mogle Paul , Nissan Shemuel
Published: November 2007

Two previously healthy children, 7 and 12 months old, respectively, presented with respiratory distress and severe sepsis. Chest x-rays were suggestive of inflammatory disease of the left lung. At operation, necrotic bowel was found to be herniated through a left congenital posterolateral diaphragmatic hernia. These patients illustrate the difficulty in establishing the diagnosis of strangulated congenital diaphragmatic hernia and the grave consequences when operation is delayed.
Adolescent Homosexuality
Authors: Remafedi Gary J.
Published: November 2007

Homosexuality is among the most complex and controversial issues of adolescent health care. Although homosexual activity is common during adolescence, the prevalence and origins of homosexuality per se are poorly understood. Homosexual identity formation is a potentially tumultous process that begins in childhood and extends through adulthood. The adolescent's experiences may ultimately contribute to a variety of physical and mental health problems. The sociological, psychological, and medical issues are considered, and guidelines for the care of homosexual youths are proposed.
Persistent Hypertransaminasemia as the Presenting Finding of Childhood Muscle Disease
Authors: Rutledge Joe , Andersen John , Fink Chester W. , Cook Jay , Strickland Alan
Published: November 2007

Four children with isolated, persistent elevations of serum transaminases were investigated for hepatic disease and followed for 4 to 24 months before serum creatine kinase determinations were obtained and found to be markedly elevated. Evidence of muscle disease was obtained by close questioning, retrospectively, and mild abnormalities were found on physical examination. Review of laboratory tests in our center for 6 months revealed 30 additional cases of anicteric hypertransaminasemia (20% of those with elevated enzymes), only two of which were unexplained by the admitting diagnosis.

Serum transaminase values are elevated in a variety of diseases of different organ systems. Creatine kinase determinations may provide the clue to the diagnosis of occult muscle disease in some children with unexplained anicteric hypertransaminasemia.
Oculoglandular Syndrome Caused by Francisella tularensis
Authors: Halperin Scott A. , Gast Thomas , Ferrieri Patricia
Published: November 2007

Oculoglandular syndrome developed in a 9-year-old boy with a recent history of tick bites and minor eye trauma. Francisella tularensis was isolated on chemically supplemented chocolate agar from a swab of a conjunctival ulcer and an aspirate of a preauricular lymph node, confirming the diagnosis of tularemia. In addition, a rise in agglutination titer to the pathogen was detected in paired sera. The differential diagnosis of oculoglandular syndrome is discussed, with emphasis on the clinical characteristics which led to the diagnosis of tularemia.