bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment Variables and Intellectual Outcome in Children With Classic Phenylketonuria
Authors: Legido Agustin , Tonyes Linda , Carter Donald , Schoemaker Ann , Di George Angelo , Grover Warren D.
Published: November 2007

Records of 46 patients with classic phenylketonuria (PKU) were used to determine treatment variables associated with intellectual outcome. Patients comprised three groups: phenylalanine-restricted diet started 1) after 3 months and loss of diet control at a mean age of 7 years, 2) before age 3 months and loss of diet control at a mean age of 5 years, and 3) before age 3 months and through a mean age of 11 years. All underwent IQ testing during the diet; groups 1 and 2 were retested at a mean of six years off the diet. On the diet, groups 2 and 3 had higher IQs than group 1; group 3 IQ was also higher than IQ off diet in groups 1 and 2. After discontinuing the diet, group 2 IQs decreased significantly. Predictors of IQ in group 1 were age at loss of diet control and percentage of phenylalanine concentrations >15 mg/dL; in group 2, mean phenylalanine concentrations and age at loss of diet control. Predictors of changes in group 1 IQs were global degree of dietary control and percentage of phenylalanine concentrations >15 mg/dL; in group 2, phenylalanine concentrations of <3 mg/dL and age at start of diet. Group 1 patients with phenylalanine concentrations <3 mg/dL or >15 mg/dL achieved no IQ gain by continuing the diet after age 7 years. Thus, intellectual prognosis is best for PKU patients who start a phenylalanine-restricted diet early and continue through age 12 years.
A Comparative Evaluation of Whey Hydrolysate and Whey-Predominant Formulas
Authors: Hauser Bruno , Keymolen Kathelijn , Blecker Uwe , Suys Bert , Bougatef Adel , Loeb Helmuth , Vandenplas Yvan
Published: November 2007

Whey hydrolysate formulas are a recent and important innovation in infant feeding. This study compared clinical tolerance and acceptability of a whey hydrolysate formula (WH) with those of a whey-predominant formula (WF) in 45 infants. Four infants (16%) who refused to drink WH formula were eliminated from the study. Mean volume intake was significantly lower for WH (120 mL/kg/day) than for WF (147 mL/kg/day; P <.001). Consequently, mean caloric intake was also significantly different: 80 kcal/kg/day (WF) vs 97 kcal/kg/day (WF; P <.001). Nevertheless, weight gain from birth to 13 weeks of age was nearly identical in both groups (171% for WH vs 178% for WF). No significant differences were noted in duration of feeding, number of pauses during feeding, number of stools per day, or number of regurgitations per day. The lower rate of caloric intake and the dropout rate of 16% for WH raise questions about the use of WH formula in normal infants, as has become the case in some Western European regions.
False-Negative Urine Latex Particle Agglutination Testing in Neonates With Group B Streptococcal Bacteremia
Authors: Becker Jeffrey A. , Ascher David P. , Mendiola Joe , Yoder Brad , Weisse Martin , Waecker Norman , Heroman William M. , Davis Charles , Fajardo J.E. , Fischer Gerald W.
Published: November 2007

Although blood cultures remain the most specific indicator of Group B streptococcus (GBS) sepsis, a potentially life-threatening infection in neonates, test results may not be available for 24 to 48 hours. Detection of GBS antigen in the urine by latex particle agglutination (LPA) may speed diagnosis. This study analyzed the sensitivity of the GBS urine LPA assay under clinical conditions. The urine of neonates with early-onset GBS bacteremia was analyzed for GBS antigen over a three-year period at six military medical centers. Overall, 53.5% (38/71) of infants with positive blood cultures had a positive urine LPA test. Only one medical center routinely followed manufacturer's recommendations to concentrate urine specimens before testing. These data suggest that the sensitivity for the urine LPA assay, when performed on unconcentrated urine, is lower than previously reported. Clinicians should insist that the laboratory maximize sensitivity by concentrating urine prior to GBS LPA testing.
Early Transfer to a Rehabilitation Hospital For Infants With Chronic Bronchopulmonary Dysplasia
Authors: Bachrach Steven J. , Pidcock Frank S. , Branca Paul A. , Gilbert Patricia L. , Schneider Adele , Walko Lisa , McHugh Barbara
Published: November 2007

Shortly after being weaned off the respirator, 43 infants with severe chronic bronchopulmonary dysplasia (BPD) were transferred from an intensive-care nursery at a teaching hospital to an affiliated children's rehabilitation hospital in a program that included special staff instruction. Morbidity, measured by rate of transfer back to the acute-care hospital, was lower than in a comparison group of 15 infants treated for severe BPD during the previous two years. Average length of stay was significantly shortened and an average of $60,000 per patient was saved. Using a rehabilitation hospital as a step-down unit shifts the emphasis from acute needs to chronic and developmental needs and from intensive monitoring and nursing care to care given at home by parents with nursing assistance.
Early Detection and Treatment of Sexually Transmitted Disease in Pregnant Adolescents of Low Socioeconomic Status
Authors: Matson Steven C. , Pomeranz Albert J. , Kamps Kathleen A.
Published: November 2007

This study evaluated the prevalence of sexually transmitted disease (STD) in adolescents presenting to a primary pediatric care clinic (PPCC) for the diagnosis of pregnancy and our ability to eradicate identified infections. We followed 168 pregnant adolescents of low socioeconomic status from their original pregnancy diagnosis until their first prenatal clinic visit. We collected screening cervical cultures for Neisseria gonorrhoeae and Chlamydia trachomatis by completing a pelvic examination on 91 patients at our PPCC. At the PPCC visit, 29% were positive for gonorrhea, chlamydia, or both. Screening tests for these infections were collected on all patients at the initial prenatal clinic visit. The risk for presenting to the prenatal clinic with a STD was significantly greater in patients not screened and treated for STD at the PPCC. Average delay from diagnosis to first prenatal clinic visit was 35.7 days. Thus, in this adolescent population, primary care providers are missing an important therapeutic opportunity by failing to identify and treat STD at initial diagnosis of pregnancy.
Transient Subcapsular Cataract Formation in a Child With Diabetes
Authors: Phillip Moshe , Ludwick David J. , Armour Karen M. , Preslan Mark W.
Published: November 2007

Transient cataracts in patients with insulin-dependent diabetes mellitus (IDDM) are rare and have been reported only in association with severe ketoacidosis or hyperosmolarity. 1-3 We present an adolescent with transient bilateral posterior subcapsular cataracts, which developed after the recent onset of IDDM without ketoacidosis or severe hyperosmolarity.
Contraception
Authors: Braverman Paula K. , Strasburger Victor C.
Published: November 2007

The United States has the highest rate of teen pregnancy in the Western world. Although abstinence may be the ideal solution for the prevention of this problem, one half of adolescents in the United States are sexually active. This article reviews the epidemiology of contraception among adolescents, barriers to effective use of contraception, and ways to improve efficacy. Major methods of contraception, including oral contraceptive pills, Norplant, Depo-Provera, condoms, spermicide, sponge, intrauterine device (IUD), diaphragm, and rhythm/periodic abstinence, are discussed along with method-specific issues related to adolescents.
Clostridium Septicum Sepsis and Meningitis as a Complication of the Hemolytic-Uremic Syndrome
Authors: Broughton Robert A. , Lee Eun Y.
Published: November 2007

Hemolytic-uremic syndrome (HUS) is recognized by the triad of acute microangiopathic hemolytic anemia, thrombocytopenia, and oliguric renal failure. The condition is usually preceded by gastroenteritis associated with bloody diarrhea. Escherichia coli 0157:H7, an enterohemorrhagic verotoxin producing E. coli, is now recognized as the most common pathogen associated with hemorrhagic colitis and HUS in North America.1

Since its description, a variety of gastrointestinal and neurologic complications of HUS have been noted. An association between HUS and meningitis due to Hemophilus influenzae 2 and Streptococcus pneumoniae3 has been previously reported. In addition, the first reported case of Clostridium septicum sepsis and cerebritis complicating gastrointestinal involvement in HUS was reported in 1988.4

We report the second confirmed case of fatal C. septicum sepsis and meningitis as a complication of HUS, suggesting that this entity may be more common than previously recognized. We review the epidemiology and clinical manifestations of C. septicum infections and speculate on the pathogenesis of the colitis and invasive C. septicum infection in our patient.
Effect of Position and Support on Oral-Motor Skills of a Child with Bronchopulmonary Dysplasia
Authors: Kerwin MaryLouise E. , Osborne Mary , Eicher Peggy S.
Published: November 2007

The effects of position (upright vs reclining) and support (held vs chair) on the development and maintenance of feeding behavior were examined in a child with bronchopulmonary dysplasia and gastroesophageal reflux. A reclining position initially facilitated acceptance and swallowing with relatively rapid generalization to an upright position. Oral-motor skills did not differ across levels of support. Practice of emerging motor skills preceded increases in vomiting, as well as episodes of respiratory distress. This study illustrates a methodology that can be employed to elucidate complex interrelationships among oral-motor skills, gross motor skills and functioning, and symptoms of gastroesophageal reflux.
Sexually Transmitted Diseases
Authors: Braverman Paula K. , Strasburger Victor C.
Published: November 2007

Adolescents have the highest rate of sexually transmitted disease (STD) of any sexually active age group. This article reviews the biological, psychological, and social factors that place adolescents at increased risk for STDs. The major STDs are reviewed, including epidemiology, clinical presentation, methods of diagnosis, and treatment modalities. In addition, major sequelae of STDs — including pelvic inflammatory disease, perihepatitis, Reiter's syndrome, and disseminated gonorrhea infection — are discussed.
Psychological Aspects of Parenting Critically Ill Neonates
Authors: McGettigan Marie C. , Greenspan Jay S. , Antunes Michael J. , Greenspan David I. , Rubenstein S. David
Published: November 2007

This study was designed to objectively examine depression and distress levels in parents of ill versus parents of healthy neonates by utilizing two well-validated questionnaires, the Beck Depression Inventory (BDI) and Kellner Symptom Questionnaire (KSQ). In addition, morbidity of infants was assessed by the Minde-Whitelaw Neonatal Morbidity Scale, and parents completed a socioeconomic questionnaire. Analysis of mean BDI and KSQ scores revealed significant differences between parents of ill neonates and parents of healthy neonates in BDI, total KSQ scores, KSQ anxiety, and depression scale scores. Within these groups, respondents whose scores fell into moderate to severe ranges of distress on either questionnaire were referred for counseling. The BDI and KSQ, can be tools for better understanding about distress levels in parents of ill and healthy neonates.
Selection of Patients for Management of Attention Deficit Hyperactivity Disorder in a Private Practice Setting
Authors: Waldrop Ron D.
Published: November 2007

Attention deficit hyperactivity disorder (ADHD) is a syndrome characterized by age-inappropriate levels of motor activity, impulsivity, and inattention. A system of triage was developed to select an ADHD patient population which was manageable in a private practice setting. Seventy-four subjects with symptoms suggestive of ADHD were evaluated and diagnosed with ADHD and followed for 2 years. All subjects included in the study were shown a teaching videotape, received a full physical examination, and were counseled for approximately 1 hour. The diagnosis of ADHD was made based on the presence of eight of 14 criteria described in DSM-III, elevated Connors Rating Scale (CRS) scores, physical examination, observation, and historical information. A treatment plan involving behavioral therapy and medication was implemented with frequent follow-up. Ninety-six percent of the patients showed improvement in behavior (parental report and decreased CRS scores) and/or grades (one letter grade in two classes for 12 weeks). Fifteen percent of the treated subjects were suspected of having coexistent disorders and 4% did not respond to treatment. By implementing a simple triage system and protocol for diagnosis, treatment, and follow-up, a manageable patient population with ADHD and similar disorders was selected and successfully treated in a private practice setting.
Physician Beliefs, Attitudes, and Approaches Toward Lyme Disease in an Endemic Area
Authors: Eppes Stephen C. , Klein Joel D. , Caputo Gregory M. , Rose Carlos D.
Published: November 2007

To assess the beliefs and practice habits regarding Lyme disease among practitioners, questionnaires were sent to physicians in a seven-county Lyme-endemic region. One hundred twenty-four evaluable responses were returned from 53 family physicians, 39 pediatricians, 27 internists, and five subspecialists who diagnosed three to four cases of Lyme disease per year, on average. The majority presented with erythema migrans (EM) or other early symptoms, although arthritis was the presenting sign in 16%. The enzyme-linked immunosorbent assay (ELISA) was the most frequently ordered diagnostic test, but 45% of respondents did not specify which test when ordering Lyme serology. The majority would use amoxicillin or doxycycline to treat EM in children or adults, respectively. Nearly all would use ceftriaxone for meningitis, and half would use it to treat Lyme arthritis or Bell's palsy. Physicians differed markedly in the duration of therapy they would prescribe. Eighty-three percent would treat a patient for possible Lyme disease with antibiotics (many intravenously), even in the absence of EM or positive serology. Thirty-five percent of practitioners prescribed antibiotics for deer-tick bites. Our survey documents significant variation in approaches to Lyme disease among primary-care physicians and suggests the need for well-designed clinical trials, continuing basic research, and physician education.
Problems With Serum IgM as a Screening Test for Congenital Infection
Authors: Mahon Barbara E. , Yamada Eileen Gayle , Newman Thomas B.
Published: November 2007

The purpose of this study was to determine the usefulness of the total serum IgM level as a screening test for congenital infection in asymptomatic or mildly symptomatic infants. A retrospective medical record review was performed on 168 infants in whom the serum IgM was measured as a screen for congenital infection. The indications for testing, the yield of testing, and the adequacy of follow-up of abnormal values were examined. Only one infant was diagnosed with a congenital infection which was not specifically suspected prior to screening; this was a case of congenital cytomegalovirus (CMV). Inappropriate screening was frequently performed in infants in whom indications for specific evaluation were present. Appropriate follow-up testing was performed in only 30% (seven of 23) of the infants with elevated serum IgM who received their pediatric care at our institution. Because of the low yield (<1%) and lack of follow-up shown in this study, as well as poor sensitivity, serum IgM was not a useful screening test for congenital infection in our institution.
Cardiac Function in Malnourished Children
Authors: Phornphatkul Chalie , Pongprot Yupada , Suskind Robert , George Varghese , Fuchs George
Published: November 2007

The cardiovascular status of severely malnourished children was characterized before, during, and after nutritional rehabilitation. In most children with third-degree malnutrition, cardiac mass was decreased on admission to the hospital and recovered subsequent to nutritional therapy. All children had echocardiographic and Doppler measurements indicative of impaired ventricular function which significantly improved during the course of hospitalization, as evidenced in part by the change in fractional shortening (P= 0.015), mean velocity of circumferential fiber shortening (P= 0.038), and systolic time interval (P = 0.030). We conclude that children with primary third-degree malnutrition not only have cardiac muscle wasting, but also have inherent ventricular dysfunction as the result of severe malnutrition that responds to nutritional therapy. Particular care with fluid administration is imperative in the first week of therapy, when heart function is the most compromised.
Parental Recall After a Visit to the Emergency Department
Authors: Grover Geeta , Berkowitz Carol D. , Lewis Roger J.
Published: November 2007

Using exit interviews, we determined parental recall of their child's diagnosis, treatment, and follow-up instructions after a visit to the emergency department (ED). Over 2 weeks, 159 parents were interviewed. Exclusion criteria were: parental language other than Spanish or English, admission, trauma, child abuse, or a primary psychiatric diagnosis. Neither language nor parental satisfaction with communication (reported in 93%) was associated with ability to state the diagnosis correctly ( P = NS). Seventy-five percent (88 of 117) of parents of children given a single diagnosis stated it correctly; 55% (23 of 42) of parents of children given multiple diagnoses were able to correctly state them all ( P = 0.013). If a single medication was prescribed, 30% (20 of 67) of parents knew its name, while only 13% (four of 31) knew all names of multiple medications (P= 0.070). Of those parents given a single medication, 51% (34 of 67) knew how to administer it, while only 10% (three of 31) knew how to administer multiple medications ( P <0.001). Similarly, 58% (46 of 79) of parents given a single appointment knew the date and place of their child's follow-up, while only 16% (three of 19) given multiple appointments knew all dates and locations ( P = 0.001). These data suggest that despite high parental satisfaction with communication, many parents cannot fully recall their child's diagnosis, treatment, and follow-up — especially when multiple diagnoses, medications, or appointments are given.
Compulsive Water Drinking in Infants and Young Children
Authors: Horev Zeev , Cohen Avner H.
Published: November 2007

The management and follow-up of five patients with asymptomatic compulsive water drinking is described. Three out of the five patients were female and two were male. The age range was 6 to 20 months. All the patients presented with polyuria or polydipsia and urine osmolalities of 39 to 112 mOsm/L. The daily fluid intake ranged from 3.5 to 5 L, and the urine output was 11 to 14 mL/kg/hr. Significant improvement was noticed after a gradual weaning process. As fluid intake returned to normal, urine osmolalities reached values between 210 and 500 mOsm/L after 4 weeks, and between 630 and 800 mOsm/L after 8 weeks. No relapse was noted during the 6- to 24-month follow-up period. Pediatricians should be aware of this potentially dangerous — yet not uncommon — habit.
Primidone or Phenobarbital Use Complicating Disruptive Behavior Disorders
Authors: Sylvester Carrie E. , Marchlewski Anthony , Manaligod James M.
Published: November 2007

We describe an adolescent from a chaotic environment in whom behavioral side effects of primidone may have contributed to his maximum-security incarceration.
It's Not What It Seems
Authors: Glascoe Frances Page
Published: November 2007

Parents of children with significant behavioral or emotional problems have tended to be concerned about their behavior or emotional well-being, whereas parents of children with speech-language impairments were more concerned about speech-language development. The present study was designed to assess whether a parallel relationship between type of parental concern and type of developmental problem continues when children have global delays. Subjects were 95 parents and their children from birth to 6 years of age who attended day-care centers. Parents' concerns were categorized into developmental domains. Children were given a criterion battery of intelligence and adaptive behavior tests. Global delay was identified in 18 children (19%). Concerns about global development were raised by only 5% of all parents. Concerns about speech-language and/or behavior were sensitive in detecting global deficits (83%), while the absence of such concerns had modest specificity in detecting normal development (47%). Parents' concerns continue to be useful in prescreening and can identify patients in need of further screening. However, pediatricians should anticipate that parents of children with global delays may raise concerns, not about global development, but rather about behavior/emotional status and/or speech-language skills. The best response to such concerns is to administer screening measures which assess multiple developmental domains.
Pulse Oximetry at Moderate Altitude
Authors: Beebe Susan A. , Heery Lee B. , Magarian Salem , Culberson Julie
Published: November 2007

Pulse oximetry is commonly used in both outpatient and inpatient settings to assess children with respiratory illness. This study was designed to obtain reference values for oxygen saturations in young children living at moderate altitude and to assess the impact of upper respiratory infection (URI) on oxygen saturation. We hypothesized that oxygen saturations of sick children at the University of Utah, Salt Lake City (1,500 meters above sea level), would be lower than oxygen saturations of those who were well. Eighty well children and 74 children with URI and nasal congestion were recruited from the University of Utah Pediatric Clinic. Subjects were 2 to 23 months of age. Oxygen saturations were recorded at 1-minute intervals for 5 minutes, and an average value was then calculated for each child. Mean oxygen saturation for well children (range 96% to 100%, mean 98.9%) corresponded to reported values at sea level. Oxygen saturations of children with URI were significantly lower (mean 97.5%, P<.001). Although the difference between well and sick children was statistically significant, given the small difference, URI cannot be considered the cause of clinically significant oxygen desaturation in previously healthy children at moderate altitude.
Nasogastric or Gastrostomy Feedings in Children with Neurologic Disabilities
Authors: Naureckas Sara M. , Kaufer Christoffel Katherine
Published: November 2007

Although pediatricians are increasingly aware of the problem of undernutrition in children with neurologic disabilities, many of these children remain poorly nourished despite prolonged attempts at oral feedings. We studied the effects of tube feeding on such children, using either nasogastric (NG) or gastrostomy (GT) feedings. Twenty-six patients (16 male, mean age at first visit 40.7 months) were followed while receiving tube feedings for a mean of 23 months. Thirteen children in the NG group were tube fed by nasogastric tube. The GT group consisted of two groups of children: 10 who began with nasogastric feedings and then changed to gastrostomy because of intolerance or need for reflux surgery, and three who were always tube fed via gastrostomy. Mean percent ideal body weight for height age (%IBWH) for the whole group improved from 73.2% to 94.2 % (P <.0001), for the NG group from 72.1 % to 89.3% (P<.002), and for the GT group from 74.2% to 98.8% (P<.0001). One patient died of unrelated severe upper airway obstruction. No patients reported hospitalization due to tube-feeding complications. Seventeen of the parents perceived that their child's mood was improved and that they spent less time in child care after NG or GT feedings were begun. We conclude that (1) both nasogastric and gastrostomy feedings safely improved nutrition in these children and (2) this objective improvement was often accompanied by subjective improvement. We suggest aggressive use of tube feedings in selected patients.
Primitive Reflexes
Authors: Blasco Peter A.
Published: November 2007

In evaluating the infant for significant motor impairment, a framework to organize and analyze data is presented. Five general areas of information are essential: (1) motor milestone attainment, (2) the classic neurological examination, (3) primitive reflex and postural reaction patterns, (4) progressive vs static nature of the dysfunction, and (5) associated evidence for neurological dysfunction and/or structural nervous system damage. A sixth criterion, age of onset, is relevant - but controversial - to making the specific diagnosis of cerebral palsy. The treatment of and prognosis for children with cerebral palsy have been linked to the historical and examination features outlined, particularly primitive reflexes. For the practicing pediatrician, understanding the fundamentals of the primitive reflex/postural reaction transition and achieving clinical facility with the elicitation of these signs represent skills that are readily acquired, easy to incorporate in routine clinical practice, and diagnostically useful.
The CAT/CLAMS Assessment for Early Intervention Services
Authors: Rossman Maura J. , Hyman Susan L. , Rorabaugh Mary L. , Berlin Linda E. , Allen Marilee C. , Modlin John F.
Published: November 2007

The Clinical Adaptive Test/Clinical Linguistic and Auditory Milestone Scale (CAT/CLAMS) is a relatively new test of language, problem-solving abilities, and visual-motor skills for children ages 0 to 36 months of age. This instrument was compared to the Bayley Mental Developmental Index (MDI), the generally accepted standard of infant developmental tests. This study evaluates 328 normal children tested in infancy and then at 18 and 30 months of age. Specificity was excellent (95% to 100%) at both 18- and 30-month levels when compared to the Bayley MDI. Sensitivity, however, was 21 % at the 18-month level and 67% at the 30-month level. Predictive validity (.65) and within-test validity (.69) are good. The CAT/CLAMS compares favorably with the Bayley MDI assessment of children between 18 and 30 months of age and can be used for clinical assessment of toddlers referred for development assessment prior to admission to early intervention programs.
Changing Pattern of Glomerular Disease at Beijing Children's Hospital
Authors: Zhang Yuwen , Shen Ying , Feld Leonard G. , Bruder Stapleton F.
Published: November 2007

Current clinical experience with glomerular disease at a pediatric referral center in Beijing, China, was reviewed. In 1992, renal disorders accounted for 505 of a total 6,885 (7.3%) pediatric medical discharges. Acute glomerulonephritis accounted for 30% of renal diagnoses, while nephrotic syndrome accounted for 28% and Henoch-Schönlein purpura nephritis accounted for 16% of renal disease. Mortality in children with renal disease was 0.4% (two of 505). All children with acute glomerulonephritis recovered or improved at last follow-up, regardless of the relationship to a streptococcal infection. In children with uncomplicated nephrotic syndrome, 91 % had a complete or partial response to corticosteroids. Nephritis developed in 81 of 278 patients with Henoch-Schönlein purpura (29%). Since 1956, a dramatic decrease in the diagnosis of acute glomerulonephritis has occurred at this pediatric hospital. Nephrotic syndrome, in contrast, has increased from 45.3 cases per year in the 1956-to-1965 decade to 146 cases annually in the period from 1986 to 1992. Similarly, Henoch-Schönlein purpura has increased from 45.3 cases annually in the 1956-to-1965 period to 238 cases per year in the past 6 years. The incidence of nephritis in patients with Henoch-Schönlein purpura has remained constant at 29% in the past 36 years. These data should be helpful for individuals and institutions who are planning educational or clinical collaborations with pediatric nephrologists in China.
Growth Patterns of Hyperlipidemic Children Enrolled in a Preventive Cardiovascular Health Clinic
Authors: Cetta Frank , Driscoll David J. , Lucas Alexander R. , Urevig Robin L. , Huse Diane M. , Eckert Susan K. , Weidman William H.
Published: November 2007

The objective of this study was to assess growth patterns of hyperlipidemic children enrolled in a preventive cardiovascular health clinic. A retrospective chart review of hyperlipidemic children enrolled in the Mayo Clinic Cardiovascular Health Clinic for the Young was performed. All participants were counseled to eat an American Heart Association Step-One Diet and exercise regularly. Weight and height were measured every 3 months. Growth was assessed using attained heights and weights and body-mass index Z scores compared to standard distributions for North American children. Sixty-three patients (33 males and 30 females) were enrolled in the study. Mean age at clinic entrance was 7.8 ± 3.5 years (range: 2 to 16 years). We conclude that participation in a preventive health clinic is generally safe for hyperlipidemic children. However, medical management of hyperlipidemic children must include meticulous surveillance to detect the infrequent occurrence of excessive weight loss or weight stabilization resulting from inappropriate response to dietary counseling.
Progression of Tympanometry and Acoustic Reflectometry
Authors: Babonis Tom , Weir Michael R. , Kelly Patrick C. , Krober Marvin S.
Published: November 2007

The presence of middle ear effusion (MEE) following acute otitis media (AOM) has been assessed by impedance tympanometry and acoustic reflectometry but has not been assessed serially from the time of presentation for AOM in the same group of patients. This descriptive study examined serial measurements by tympanometry and reflectometry in children with clinical AOM at the time of diagnosis, 3 to 5 days later, and at final follow-up 12 to 15 days after diagnosis. The study entry criteria were conservative in order to represent obvious cases of AOM and included 90 patients representing 107 ears. The objective was to describe the evolution of instrumental findings and to attempt to identify unique patient subpopulations with differing prognoses. We found that combined use of initial tympanometry and reflectometry, while yielding intriguing results, does not allow for identification of subpopulations with good or poor progression for MEE clearance at 2-week follow-up. It is our conclusion that initial tympanometry and reflectometry add to the cost of AOM diagnosis without clear benefit for the individual patient.
Permanently Damaged: Long-Term Follow-Up of Shaken Babies
Authors: Fischer Howard , Allasio David
Published: November 2007

Shaken baby syndrome (SBS) is a term denoting a particularly harmful form of child abuse. By definition, 1 these infants have intracranial and retinal hemorrhages in the absence of signs of head trauma or skull fracture. Most SBS victims appear to have significant neurologic damage at the time of diagnosis.2,3 The medical literature, however, does not describe these children as they grow older. A 1986 article4 called for follow-up studies on these children, but a computerized literature search turned up only one paper on long-term follow-up in SBS. Sinal and Ball5 described cranial computerized tomog-raphic (CT) and clinical follow-up in 24 brain-injured children, 17 of whom had SBS. They followed the 15 surviving shaken infants for about 4 years: seven had severe handicaps, and only one was normal.
Sinusitis in Status Asthmaticus
Authors: Fuller Catherine G. , Schoettler Joyce J. , Gilsanz Vicente , Nelson Marvin D. , Church Joseph A. , Richards Warren
Published: November 2007

The relationship between sinusitis and status asthmaticus (SA) remains obscure. The purposes of this study were to determine the prevalence of abnormal sinus radiographs (SXRs) and investigate possible risk factors among unselected children admitted with SA. Eighty-eight patients over 2 years of age (range 2 to 16 years) consecutively admitted with SA were studied. The principal investigator, blinded to SXR findings, interviewed and examined the patients with respect to 10 physical parameters and 14 historical parameters. Two staff radiologists, blinded to the clinical findings, interpreted the SXRs. Relationship of historical and physical findings with positive SXRs was determined by statistical analysis. Twenty-seven percent of patients were found to have abnormal SXRs, manifesting two thirds or greater opacification of the sinuses. The mean age, sex, and race of patients with abnormal SXRs was not significantly different from those with normal films. A history of two or more admissions per year for SA, and, in children under 5 years of age, a history of chronic otitis media, and the physical finding of otitis media were significantly more frequent among patients with abnormal SXRs. Although not found to be statistically significant, a history of sinusitis and cough occurred more frequently in association with abnormal SXRs.
Readability of Pediatric Patient Education Materials
Authors: Klingbeil Carol , Speece Mark W. , Schubiner Howard
Published: November 2007

Written patient education materials are an important part of ambulatory pediatric practices. We evaluated the readability of 33 representative pediatric education materials using three common formulas: Fog, Fry, and SMOG. The majority of pamphlets had readabilities of grade nine or above. The need to use multiple readability formulas was also demonstrated. Although the three readability formulas were highly correlated, they were significantly different from each other when using a repeated measures analysis of variance (ANOVA) design. In almost half, the readability estimates differed by at least two grade levels. In addition, a large intrapamphlet variability for some pamphlets suggests a need to focus more attention on the readability of multiple sections within a pamphlet, not only on the overall or average readability. We conclude that the readability levels of patient education materials continue to be too high.
Impact on Empiric Treatment of Group A Streptococcal Pharyngitis Using an Optical Immunoassay
Authors: Harris Richard , Paine Donald , Wittler Robert , Bruhn Frederic
Published: November 2007

The potential impact of using a rapid diagnostic test (Strep A OIA) on detection and treatment of group A β-hemolytic streptococcal (GABHS) pharyngitis in a large-volume pediatric and adolescent clinic was examined. Of 519 swabs processed for both culture and the OIA test, 114 were culture-positive for GABHS compared with 133 positive by the OIA test, for an agreement of 94%. OIA test sensitivity compared with culture was 96%, and specificity was 94%. Forty-seven percent of all study patients were empirically placed on antibiotics. In-clinic OIA testing could have reduced inappropriate therapy and been a cost-effective alternative to culture.
Moraxella (Branhamella) Catarrhalis Bacteremia in Children
Authors: Meyer Gretchen A. , Shope Timothy R. , Waecker Norman J. , Lanningham Frederick H.
Published: November 2007

We report two cases of Moraxella catarrhalis (M. catarrhalis ) bacteremia in apparently healthy children. One patient had bilateral otitis media and the other had pharyngitis and sinusitis; both patients had uncomplicated clinical courses. A literature review revealed 22 reported cases of M. catarrhalis bacteremia in children, 14 (63%) of which occurred in patients who had no identified underlying condition. Eight (36%) cases were seen in children who were immunocompromised. Nine (40%) patients presented with either purpura, petechia, or a maculopapular rash. M. catarrhalis is well known as a respiratory pathogen, but it has not been recognized as a common cause of unsuspected bacteremia in children.
Neonatal-Onset Chronic Intestinal Pseudo-Obstruction Syndrome
Authors: Huang Yhu-Chering , Lee Hung-Chang , Huang Fu-Yuan , Kao Hsin-An , Yeh Ming-Lung , Chang Pei-Yeh , Sheu Jiin-Cherng , Shih Sing-Lin , Chen Be-Fung
Published: November 2007

Between January 1985 and January 1990, six cases of neonatal-onset chronic intestinal pseudo-obstruction syndrome (CIPS) were identified. Failure to gain weight in six cases, abdominal distention in five, and vomiting in five were the most common presenting symptoms. The contrast studies of the gastrointestinal tract demonstrated delayed transit time in 6/6, jejunal or ileal dilatation in 1/6, megaduodenum in 1/6, dilatation of the colon with barium retention in 4/6, and microcolon in 1/6. Urinary tract involvement was noted in three patients. Laparotomy, performed in three patients, revealed no mechanical obstruction. Except for hypoganglionosis in Patient 4, no recognizable neuropathy or myopathy was noted histopathologically. Four patients expired within 2 months after discharge. We conclude that CIPS with neonatal onset should be suspected when infants have urinary retention and abdominal distention or constipation beginning at birth or soon after. The prognosis of CIPS presenting in the newborn period appears worse than that presenting in childhood or adulthood.
Assessin Children's Development Using Parents' Reports
Authors: Ireton Harold , Glascoe Frances P.
Published: November 2007

The Child Development Inventory (CDI), completed by parents at home, assesses the development of social, self-help, motor, language, letter and number skills, and presence of symptoms and behavior problems of children between the ages of 15 months and 5 years. The results provide the pediatrician with a profile of the child's development, problems, and strengths, and are an aid to comprehensive assessment. CDI norms and validity were determined for a community sample of 568 children. The CDI developmental scales correlate closely with age (r= 0.84). CDI results identified all the normative group children who were enrolled in early childhood/special education (N = 26) and correlated with academic achievement for children in kindergarten (N = 132). CDI scales correlated with reading achievement in kindergarten as follows: general development 0.69, letters 0.56, language comprehension 0.42, expressive language 0.36, and self-help 0.35. Thus, the CDI provides a useful measure of children's development and, because of its reliance on parental reports, offers an effective approach to developmental assessment in the busy pediatric practice.
The Ohio Bicycle Injury Study
Authors: Ashbaugh Stephanie J. , Macknin Michael L. , VanderBrug Medendorp Sharon
Published: November 2007

To understand bicycle injuries and determine how to prevent them, we designed prospectively a descriptive study of bicycle-crash-related admissions in July 1993 to 10 major Ohio hospitals that admit child trauma patients. All patients studied were under the age of 16. In the 52 cases (38 male, 73%), impact with another vehicle accounted for 23 (44%) crashes. Of these crashes, only three (13%) were caused by definite motor vehicle operator error, and all 20 (87%) of the remaining motor vehicle-bicycle collisions were caused by bicyclist error, including 10 (43%) caused by bicyclists failing to yield properly at an intersection. Head injuries were the primary cause of morbidity in 29 (56%) cases. No child was wearing a bicycle helmet at the time of the crash. Efforts to reduce childhood morbidity from bicycle-related crashes should focus on helmet education and safe riding skills.
Results of a Pediatric Sedation Program on Head MRI Scan Success Rates and Procedure Duration Times
Authors: Hollman Gregory A. , Elderbrook Marcia K. , VanDenLangenberg Beth
Published: November 2007

The purpose of this study was to determine if a pediatric sedation program improved head magnetic resonance imaging (MRI) scan success rates and procedure duration times compared with the year preceding the program. Sedation was successful in 189 (85.1%) of 222 children before the program compared with 211 (98.1%) of 215 children during the program (P <0.001). Mean procedure duration times for head MRI scans with and without contrast were shorter in the program compared with before the program (58.7 ± 1.4 min versus 71.8 ± 3.0 min, P <0.001, and 46.7 ± 1.2 min versus 58.5 ± 1.9 minutes, P<0.001, respectively). No major complications occurred during the 15-month period in the sedation program. We conclude that sedation for pediatric MRI, managed by an organized pediatric sedation program, is highly successful, efficient, and safe.
Diagnosing Gaucher Disease
Authors: Sidransky Ellen , Tayebi Nahid , Ginns Edward I.
Published: November 2007

The diagnosis of Gaucher disease, the inherited deficiency of glucocerebrosidase and the most common inherited disorder of Ashkenazi Jews, can often be missed by clinicians. Medical records from patients with Gaucher disease were reviewed, revealing a wide range of initial misdiagnoses and the frequent use of unnecessary invasive diagnostic procedures. The diagnosis of Gaucher disease is readily established by enzymatic or DNA analyses in conjuction with a thorough history and physical examination. Consequently, greater awareness of the symptoms encountered in these patients could alleviate unnecessary anxiety, testing, and confusion. A definitive diagnosis of Gaucher disease has important implications for genetic counseling and treatment.
Infant Sleep Position and the Sudden Infant Death Syndrome
Authors: Carolan Patrick L. , Moore James R. , Luxenberg Michael G.
Published: November 2007

A questionnaire survey was conducted to assess the impact of the April 1992 American Academy of Pediatrics Task Force Statement, "Infant Positioning and SIDS," on the routine advice provided by pediatricians in Minnesota to families with newborn infants regarding sleep practices, including sleep position. There was a trend toward more discussion between all pediatric practice groups and families regarding infant sleep practices following the AAP Sleep Position Statement (P<0.001-0.003). Prone sleep recommendations ranged from 9.2% for newborn infants to 21.4% for infants 6 months of age. Recommendations for the supine or lateral sleep positions predominated at all infant ages. Pediatricians in private practice were more likely to identify the AAP Statement as establishing a medicolegal standard (P<0.05). We conclude that the 1992 AAP Statement has had a significant impact on the routine advice provided to families regarding infant sleep practices, including infant sleep position.
Gonococcal and Chlamydial Genitourinary Infections in Symptomatic and Asymptomatic Adolescent Women
Authors: Biro Frank M. , Rosenthal Susan L. , Kiniyalocts Melissa
Published: November 2007

To determine the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae endocervical infections in a group of adolescent women, gynecologic histories and evaluations were done on symptomatic and asymptomatic adolescent women presenting for pelvic examinations in an urban, hospital-based, adolescent clinic. C. trachomatis and N. gonorrhoeae cultures and three nonculture diagnostic tests for chlamydia (two ELISA assays and one DNA-probe) were performed on each patient. Patients were 12 to 21 years of age (mean 17.0); 53% were African-American, and 47% were Caucasian. Two hundred twenty-eight women were asymptomatic and 249 women had symptoms. There were 64 cases of chlamydia and 19 cases of gonorrhea; an additional 11 patients had both chlamydia and gonorrhea. Approximately one third of patients with chlamydia, gonorrhea, or both had asymptomatic disease, an important reservoir of infection.
Time of Onset of Necrotizing Enterocolitis in Newborn Infants with Known Prenatal Cocaine Exposure
Authors: Lopez Susanna L. , Taeusch H. William , Findlay Richard D. , Walther Frans J.
Published: November 2007

Cocaine exposure can lead to diminished gut-blood supply and thereby contribute to the pathogenesis of necrotizing enterocolitis (NEC). Investigating the hypothesis that NEC occurs at a younger age in cocaine-exposed infants, we reviewed 1,284 neonatal intensive care admissions. Infants with NEC were divided into cocaine-exposed and cocaine-nonexposed groups, each subdivided into two birth-weight groups, using 1,500 g as the cutoff weight. Time of onset of NEC for each infant was determined and survival curves for the cocaine-exposed and nonexposed groups were calculated using their birth-weight subdivision. Hazard function curves were done. Neonatal risk factors in both groups were compared. Twelve percent (28/231) of cocaine-exposed infants developed NEC stage II or III versus 3% (34/1053) in the nonexposed group ( P<0.05). Eight percent of cocaine-exposed and 2% of nonexposed survivors had NEC by day 7 versus 20% and 5% by day 28 after birth (P<0.05). Infants >1,500 g were at risk for NEC until day 8 only, whereas infants ≤1,500 g had both an early and continuing risk for NEC with a biphasic pattern of onset. The accentuated peak in early-onset NEC may be attributed to antenatal cocaine exposure, while late-onset NEC in the ≤1,500 g group probably relates to a variety of pathogenetic factors.
Treatment of Obstructive Sleep Apnea in Pediatric Patients
Authors: Rains Jeanetta C.
Published: November 2007

This study evaluated the efficacy of behavioral techniques (i.e., parent training, modeling, and desensitization) to facilitate use of nasal continuous positive airway pressure (CPAP) in four children with obstructive sleep apnea (OSA) secondary to anatomic disorder of the upper airway. All patients tolerated CPAP with training: Polysomnographic data revealed improvement in sleep architecture, apnea, and oxygenation, and patients were discharged on CPAP units. All patients continued to use CPAP throughout the 3-month follow-up period and none required additional treatment for OSA. Three of four patients continued to use CPAP at the 9-month follow-up visit. Treatment resulted in improvements in alertness, attention/concentration, and behavior/temperament. Children generally have been considered poor candidates for nasal CPAP, and historically they have been offered instead more invasive procedures. This study suggests that CPAP is a viable treatment for such children when paired with behavioral interventions that facilitate its use.
High-Risk Children Referred to an Early-Intervention Developmental Program
Authors: Britain Lee Ann , Holmes Grace E. , Hassanein Ruth S.
Published: November 2007

Early-intervention programs for infants with developmental disabilities or with high-risk factors for such problems were first established in the United States more than 20 years ago. The benefits of such programs are generally recognized. This study describes the presenting problems of 698 children referred to an early-intervention program over a 15-year period (1975-1989). Medical condition groups rather than specific diagnoses are considered. The developmental progress of 464 children who attended the program for at least 6 months was determined by comparing their admission and discharge developmental quotients (DQ). Admission trends over time are noted and the value of intervention programs for young children with disabilities is discussed.