bluuebunny/crossref_metadata_2025 huggingface dataset:
Survey of Pain Management Therapy Provided for Children With Sickle Cell Disease
Authors: Pegelow Charles H.
Published: November 2007

A questionnaire was sent to principal investigators of NIH-sponsored clinical research in sickle cell disease. Twenty of 21 respondents indicated they used parenteral narcotic analgesics for pain episodes sufficiently severe to warrant hospitalization. Eleven used meperidine; seven, morphine; and one each, nalbuphine, hydromorphone, and acetaminophen with codeine. They gave the agents at frequent, regular intervals or by continuous infusion. A total of 41 of more than 3,500 patients required chronic transfusion for pain control. Complications included meperidine-associated convulsions reported by nine respondents and addiction by six. This information indicates that vigorous pain-control methods are used at institutions having a special interest in providing medical care for children with sickle cell disease.
Systemic Infection Due to Group B Beta-Hemolytic Streptococcus in Children
Authors: Bonadio William A. , Jeruc William , Anderson Yvonne , Smith Douglas
Published: November 2007

We reviewed 75 outpatient cases of systemic infection due to group B beta-hemolytic streptococcus (GBS) evaluated during a 13-year period. Patient ages ranged from five days to eight months; 75% were younger than two months. Early-onset (<seven days of age) GBS disease occurred in 10% of the patients, and late-onset GBS disease in 90%. The racial distribution was 60% black, 35% white, and 5% Hispanic. Symptoms included fever, irritability, lethargy, and altered-feeding pattern which lasted less than 24 hours in 88% of patients. On presentation, 33% were afebrile (eight had GBS meningitis); 32% did not appear ill (six had GBS meningitis). Of the total, 40% had GBS meningitis, of these, a greater proportion had either early-onset GBS disease or neutropenia. Infection other than meningitis was identified in 24% of all patients: pneumonia (six cases), cellulitis/adenitis (six cases), osteomyelitis/septic arthritis (five cases), and otitis media (one case). All patients survived. Systemic GBS infection in an outpatient population can involve infants up to eight months old, is more common in blacks than in whites, can be present without fever or compromised appearance, and usually has low mortality.
Childhood Headaches
Authors: DiMario Francis J.
Published: November 2007

One hundred eight out of 256 (42%) surveys were completed by registered school nurses (SNs) working in the Connecticut public school system. Of the 108 respondents, 99% were RNs and 1% were LPNs. Each SN spent an average of 19 working days a month at school, in elementary (71 %) and/or preschool (40%) settings. Professional experience and educational backgrounds were variable. Over 40% had never received formal instruction regarding childhood headache (CH), and an additional 32% had received less than two hours. School nurses ranked CH behind minor trauma, GI upset, and URI as the fourth of the 13 most common clinical problems encountered at school. An average of 35 children with headaches were seen each month. A brief description of, and inquiry about, other systemic symptoms were nearly always made. Only 62% of the SNs usually asked a child about neurological symptoms. A child's temperature and pulse were measured routinely by 84% of SNs, whereas blood pressure and neurological assessment were obtained routinely only in approximately 12%. Treatment varied; nonetheless, 31 % routinely allowed the child to rest or sleep as part of their management plan. Analgesic was administered routinely only by 10%. Approximately one third generally discussed a disposition plan with the child's parents, whereas only 3% usually spoke with the child's physician. Although 51 % of the respondents felt they were "constrained by school policy" in their management of CH, half of these individuals (71 % of all respondents) did not want more latitude. It is concluded from this survey that despite limited formal instruction about CH, SNs dealt with CH in a reasonable manner.
Long-Term Follow-Up in Children with Steroid-Resistant Nephrotic Syndrome
Authors: Besbas Nesrin , Topaloglu Rezan , Saatci Omit , Bakkaloglu Aysin
Published: November 2007

A prospective study was performed in order to evaluate the efficacy of oral cyclophosphamide and chlorambucil in inducing a remission in children with steroid-resistant primary nephrotic syndrome (NS). Out of 215 children with steroid-resistant primary NS, 164 had been followed from one to 10 years. The children had a mean age of 8.2 years, with a range from one to 16 years. Steroid resistance was more common in children over six years of age compared with the other age groups. Hematuria was seen in 68 of the 164 children (41%); hypertension in 41 (25%); and hyperlipidemia in 112 (68%). Hypocomplementemia was noted in 24 of the 65 (37%) children in whom complement concentrations were determined. Renal biopsy was performed in 117 of the children. Pathologic changes consisted of minimal change nephrotic syndrome (MCNS) in 14 children (12%), membranoproliferative glomerulonephritis (MPGN) in 45 (38%), focal segmental glomerulosclerosis (FSGS) in 20 (25%), mesangial proliferation (MP) in 23 (20%), and membranous glomerulonephritis in six children (5%). Cyclophosphamide (2 mg/kg/day) was given to 164 patients, with complete remission and partial remission rates of 20.7% (34 of 164 children) and 24.4% (40 of 164 children), respectively. In this group, sustained remission and sustained partial remission rates were found in 20% (32 children) and 13% (21 children), respectively. Chlorambucil was given to 40 children with steroid- and cyclophosphamide-resistant nephrotic syndrome, with total remission and partial remission rates of 20% (eight children), and 12.5% (five children), respectively. These rates did not change during the follow-up. Thus, cyclophosphamide is valuable in the treatment of children with steroid-resistant NS with a variety of histologic changes.
Unilateral Bronchiolitis Obliterans: A Case Report
Authors: Dosanjh Amrita
Published: November 2007

Bronchiolitis obliterans is an infrequent form of chronic bronchiolitis. It is distinguished by pathologic findings of partially or completely obstructed bronchi and bronchioles by fibrous tissue. It can lead to unilateral hyperlucent lung syndrome (Swyer-James) and has been described in all age groups, but tends to be a disease of young adults. There is no known predilection for sex or geographic area. 1-3
Improving Resources for Foster Care
Authors: Martin Elaine D. , Altemeier William A. , Hickson Gerald B. , Davis Anita , Glascoe Frances Page
Published: November 2007

The number of foster children and their psychological and medical morbidity are growing. To gain insight into how to recruit and retain foster homes, characteristics of 64 foster families were determined by interview. Foster parents had low-to-moderate incomes, were approaching middle age, had underutilized home space, and wanted more children. Most enjoyed foster care and planned to continue. Twenty-three percent of the 64 had half of all foster children in the study in their homes at interview and had cared for seven times as many children in the past, including 66% of all the teens and 83% of all the handicapped children who had been in the 64 homes. These "high providers" functioned like group homes for mentally handicapped individuals. Adapting the group-home concept to foster homes could improve care, especially for children with special needs.
Medical and Developmental Histories Of Maltreated Children
Authors: Famularo Richard , Fenton Terence , Kinscherff Robert
Published: November 2007

This paper represents a first attempt at delineating and summarizing the issues in a child's medical and developmental history associated with the probability of suffering abuse. The sample consisted of 96 children between 5 and 10 years of age, 61 of whom had been maltreated and 35 of whom served as controls. There were 22 items about which the medical and developmental histories of the maltreated children revealed a significantly greater risk than those of the controls. A factor analysis revealed that 78% of the variance in these items can be represented by eight independent factors. None of these factors was dominant; rather, each accounted for a significant amount of the variation among the original items. The individual items tended to load on the four strongest factors in a coherent, interpretable manner: Factor 1 represented behavior problems; factor 2, neonatal issues and failure to thrive; factor 3, familial disruption, with the child suffering mental illness and/or head injury; and factor 4, a "difficult" temperament during the first year of life. We conclude there are numerous independent factors in the medical and developmental histories of maltreated children which should be considered by pediatricians involved in cases of child abuse and neglect.
Association of Reported Infant Crying and Maternal Parenting Stress
Authors: Beebe Susan A. , Casey Rosemary , Pinto-Martin Jennifer
Published: November 2007

Infant crying is a well-recognized source of parental concern and anxiety, but little is known about other possible effects of excessive crying on parents or caretakers. The objective of this descriptive study was to investigate the relationship between reported infant crying and parenting stress. Mothers, who were consecutively enrolled at the time of their infants' well-child checkups, reported the number of minutes their infant generally cried in a 24-hour day. Excessive crying was defined as more than three hours per 24-hour day. Seventy-five of 94 mothers subsequently completed the Parenting Stress Index (PSI) at their infant's 4- or 6-month checkup. Mothers who reported excessive crying were 5.7 times more likely to score high on the reinforcement subscale of the PSI. Although the direction of this association is not known, it indicates that mothers who report excessive crying are more likely than other mothers to perceive a lack of positive reinforcement from their infants.
The Psychological Functioning of Children with Hypercholesterolemia and Their Families
Authors: Rosenthal Susan L. , Knauer-Black Shari , Stahl Mary Pat , Catalanotto Thomas J. , Sprecher Dennis L.
Published: November 2007

The medical aspects of hypercholesterolemia have been studied extensively, but little research has addressed the psychological aspects of screening and treatment of the disease. This study compared the functioning of 32 children, ages 8 to 11 years, and their respective families. Eighteen children had hypercholesterolemia, and 14 had normal cholesterol levels. Responses on several psychological measures showed no differences between the two groups. Thus, hypercholesterolemia appears not to cause major psychological difficulties for children and their families. Analysis showed that those families reporting good dietary choices were more cohesive, more organized, and less conflictual than families who reported fair-to-poor dietary choices. Thus, family functioning may be related to dietary practices. These findings suggest that concern about negative psychological consequences of cholesterol screening is unfounded. Also, families for whom dietary modifications are critical may benefit from family-centered treatment as well as dietary counseling.
Use of Abdominal and Pelvic Ultrasound in The Evaluation of Chronic Abdominal Pain
Authors: Schmidt Rosemary E. , Babcock Diane S. , Farrell Michael K.
Published: November 2007

The value of sonography in assessing chronic abdominal pain (CAP) in children, the characteristics of CAP, and the local pediatrician's practice in evaluating CAP are reported. Fifty-seven patients with CAP had abdominal and/or pelvic sonography; 56 were normal. One sonogram showed an ovarian cyst on the side opposite the CAP; the cyst later resolved. Pain was usually localized in the periumbilical area (56%). Follow-up data were obtained from referring physicians and patients' medical records. No serious diagnosis related to CAP was missed. After six months, CAP had resolved in 43% of patients. Of the responding physicians, 61 % indicated they would have used more and costlier contrast studies if ultrasonography had been unavailable.
The Usefulness of the Battelle Developmental Inventory Screening Test
Authors: Glascoe Frances Page , Byrne Karen E.
Published: November 2007

Recent research supporting the effectiveness of early intervention and laws expanding services have increased the demand for accurate developmental screening tests. The Battelle Developmental Inventory Screening Test (BDIST), for children 6 months to 8 years old, has a number of desirable features, including subtests for fine and gross motor, adaptive, personal-social, receptive and expressive language, and cognitive skills; a range cutoff and age-equivalent scores; and national standardization. To assess its accuracy, the BDIST was administered to 104 children 7 to 83 months old, along with several other screening tests and a battery of criterion measures. Tied to 1.5 standard deviations below the mean, BDIST failing scores were moderately sensitive, detecting 75% of the children with developmental problems, such as mental retardation, borderline intelligence, language delays, and learning disabilities. Since 73% of the nonhandicapped children passed the BDIST, the test showed moderate specificity. Children within one month of their birthdays were likely to be over- or underreferred. Although the BDIST needs further research, it is a promising developmental screening instrument. The Receptive Language (RL) subtest, slightly more sensitive than the total BDIST but less specific, takes only a few minutes and thus is useful for prescreening in time-limited settings, such as pediatric practice.
Phallic Growth After hCG
Authors: Almaguer Manuela C. , Saenger Paul , Linder Barbara L.
Published: November 2007

Clinical and hormonal responses to a standard three-day human chorionic gonadotropin (hCG)-stimulation test (1,500 IU given intramuscularly for three days) were studied in six neonates with ambiguous genitalia. All patients were eventually determined to be 46,XY genetic males with a microphallus and various other genital abnormalities. None had an enzymatic defect in steroidogenesis or a 5α-reductase deficiency, as determined by standard adrenocorticotropic hormone (ACTH) and hCG testing. All patients demonstrated penile growth (0.25 to 0.75 cm) within five days of hCG administration, with four of six patients achieving a normal penile length (>2.0 cm) by 48 hours after the last of three daily hCG injections. Androgen responsiveness suggested by phallic growth may help support a male sex assignment in such infants.
Pediatric Miller Fisher Syndrome Requiring Intubation: A Case Report
Authors: Eggenberger E.R. , Coker S. , Menezes M.
Published: November 2007

In 1956, C. Miller Fisher described a clinical syndrome of ophthalmoplegia, ataxia, and areflexia. 1 This syndrome, which now bears his name, shares certain features with the Guillain-Barré syndrome (GBS) and generally follows a benign, restricted clinical course, especially in the pediatric population. The authors report a pediatric case of Miller Fisher syndrome (MFS) who subsequently required intubation and mechanical ventilation.
Evolution of Height and Bone Age in Primary Congenital Hypothyroidism
Authors: de Frias E. Casado , Ruibal J.L. , Reverte F. , Bueno G.
Published: November 2007

Thyroid hormones are fundamental for growth and bone maturity. Retarded physical and osseous development signals congenital hypothyroidism. This study assessed the evolution of height and bone age and final height after hormone replacement treatment in 25 patients with primary congenital hypothyroidism. Bone ages, measured periodically for 12 years after treatment began, were expressed as standard deviation scores (SDS) corresponding to chronologic age. Heights were expressed as SDS and related to standardized curves and genetic height. All patients experienced height recovery during the first year. Of 19 patients who reached their final height, 16 surpassed the expected mean for genetic height. Bone age accelerated progressively, with total recovery toward the third year, and remained accelerated, reaching +1.43 ± 1.27 in relation to chronologic age 12 years after hormone replacement began. Thus, early diagnosis and adequate treatment of congenital hypothyroidism improved growth and osseous development, although progressive acceleration of bone age may have limited final height in some children.
The Clinical Value of Screening Chest Radiography in the Neonate With Lung Disease
Authors: Spitzer Alan R. , Greer Jeanette G. , Antunes Michael , Szema Katherine F. , Gross George W.
Published: November 2007

To examine the role of routine chest radiography in the management of the critically ill neonate with pulmonary disease, 41 term and preterm infants with lung diseases were prospectively evaluated. Seventy radiographs (35%) were obtained for clinical indications and 128 (65%) for prospective screening. Studies were compared with each infant's most recent previous study, if available. Every exam was designated Level I, if the radiograph identified a new finding that required clinical intervention; Level II, if an abnormality or interval change was observed that did not require immediate intervention; or Level III, if there was no interval change since the previous radiograph. Thirty-three (47%) indication radiographs and 63 (49%) screening radiographs showed significant changes since the previous study. Twenty-four (34%) of the indication radiographs and 42 (33 % ) of the screening radiographs had Level I abnormalities (P = NS). Nine ( 13 % ) of the indication radiographs and 21 (16%) of the screening radiographs had Level II abnormalities (P= NS). Results suggest that routine screening chest radiographic studies are an important adjunct of care in critically ill newborns with respiratory disease and may identify potential problems before they are reflected in a change in clinical status.
Cardiac Tamponade in an Adolescent Female: an Unusual Manifestation of Systemic Lupus Erythematosus
Authors: Aiuto Leslie T. , Stambouly Joseph J. , Boxer Robert A.
Published: November 2007

Systemic lupus erythematosus (SLE) af fects approximately 0.6 children per 100, 000.1 The disease is extremely rare in children under 5 years of age and is diagnosed predominantly in adolescent females.2 Children tend to present with more severe multisystem involvement than adults.2,3 Pericarditis occurs in approximately 25 % of patients with SLE in all age groups. 2 Progression to tamponade is extremely uncommon in the pediatric population.2,4 In the current report, an adolescent girl is diagnosed with SLE after presenting with signs and symptoms consistent with cardiac tamponade. A review of other pediatric patients with a similar presentation is also included. 5,6
Enteral Theophylline and Necrotizing Enterocolitis in the Low-Birthweight Infant
Authors: Hufnal-Miller Carrie A. , Blackmon Lillian , Baumgart Stephen , Pereira Gilberto R.
Published: November 2007

In a two-phased retrospective study, clinical factors associated with the development of necrotizing enterocolitis (NEC) in neonates were identified. The first phase found 13 infants with NEC who had been treated more frequently with enteral theophylline (P<.025) and fed higher volumes ( >150 mL/kg/day; P<.05) than controls of comparable birthweight and postnatal age. Seven of the 13 infants with NEC, weighing < 1,250 g at birth, had previously received intravenous aminophylline and been changed to enteral theophylline within six days before the onset of NEC. Prolonged rupture of membranes was more prevalent ( P<.025) in infants with birthweight > 1,250 g who developed NEC in the first week of life. Maternal preeclampsia helped protect against the development of NEC (P <.05) . In the second study phase, 59 infants with birthweights < 1,250 g were evaluated for gastrointestinal disturbance within five days of the introduction of any enteral medication. The frequencies of NEC, NEC scare, and feeding intolerance were greater in infants treated with enteral theophylline than in those treated with all other enteral medications combined ( P<.05). This two-phased study confirms the multifactorial etiology of NEC and indicates that the administration of enteral theophylline to young infants <1,250 g may be a predisposing factor to GI disturbances and NEC. These findings warrant a further prospective investigation.
The Single-Subject Randomized Trial
Authors: Langer Jacob C. , Winthrop Andrea L. , Issenman Robert M.
Published: November 2007

The purpose of a single-subject randomized trial is to assess objectively the efficacy of a specific therapeutic intervention in an individual patient. Treatment is randomly alternated with placebo over a number of study periods. Specific outcome measures are recorded blindly and later compared via paired statistical analysis. Single-subject trials have long been successfully performed in adults, but rarely in children. We present single-subject trials of two pediatric patients done to assess the effect of cisapride on symptoms arising from gastroesophageal reflux. In the first patient, the drug affected neither vomiting nor gagging, although stool frequency increased. Since the symptoms of concern were unaffected, cisapride was discontinued. In the second patient, use of cisapride led to a significant decrease in vomiting and wheezing; the drug was therefore incorporated into the therapeutic regimen. Single-subject randomized trials are inexpensive and simple and can be used by the family physician, pediatrician, or pediatric surgeon in daily practice. They permit the rational use of effective therapy and the abandonment of ineffective measures.
Morbidity and Mortality Patterns of Ventilator-Dependent Children in a Home Care Program
Authors: Canlas-Yamsuan M. , Sanchez I. , Kesselman M. , Chernick V.
Published: November 2007

We evaluated the effectiveness of the Home Care Program of Children's Hospital of Winnipeg for ventilator-dependent children by retrospectively examining morbidity and mortality from February 1, 1979, to July 31, 1992. For the 22 study subjects, the cause of chronic respiratory failure was neurologic disorders for 14 (64%) (group A) and pulmonary disorders for eight (36%) (group B). There were no significant differences between groups A and B in the average number of hospital days, readmission rate, or length of stay per admission. Eleven patients have remained ventilator-dependent at home, four no longer require mechanical ventilation, and seven died. Factors such as diagnosis, type of family, home location, age at initiation of mechanical ventilation, and initial duration of hospital stay did not influence morbidity or mortality in either group. Within the overall mortality rate of 32% is a higher rate among patients whose disorders initially carried a poor prognosis. Ventilator-dependent children can be successfully managed at home, with few nonelective hospital readmissions, through a well-organized home care program.
Lesch-Nyhan Syndrome in Two Brothers: Why Early Diagnosis is Essential
Authors: Mangano M. , Azzia N. , Russo A. , Romeo M.A.
Published: November 2007

Lesch-Nyhan syndrome (LNS) is an X-linked recessive disorder of purine metabolism caused by the absence of hypoxanthine-guanine phosphoribosyl-transferase (HGPRT).1,2 The prevalence of LNS is estimated to be one in 10, 000 males. 3 In many cases, affected males inherit the mutant allele from asymptomatic carrier mothers. In other patients whose mothers are not carriers, the disease results from spontaneous mutations. New mutations may account for as many as one third of cases. LNS is characterized clinically by hyperuricemia, growth impairment, choreoathetosis, spasticity, mental retardation, and self-mutilation. The disease is usually diagnosed at the onset of self-mutilatory behavior. We report two brothers with LNS whose history typifies the diagnostic difficulties of this syndrome.
Tuberculosis in Adolescents
Authors: Wilcox W.D. , Laufer Susan
Published: November 2007

The resurgence of tuberculosis (TB) in the United States has placed a substantial segment of the adolescent population at high risk, particularly those adolescents residing in metropolitan areas. Physicians providing health care to adolescents must be aware of the risk factors for TB and of the epidemiology of this insidious disease. Active alliances must be established among health-care professionals in the community to ensure effective screening, diagnosis, and treatment programs.
Predictors of Nonattendance at the First Newborn Health Supervision Visit
Authors: McEvoy Specht Elizabeth , Bourguet Claire C.
Published: November 2007

Failure to attend the first newborn health supervision visit is an important problem for the Continuity Care Clinic of Children's Hospital Medical Center of Akron, Ohio. The goal of this study was to use objective data from the neonatal record to identify newborns at high risk of failure to attend. Clinical and social risk factors of the mother and newborn were abstracted from the neonatal progress notes of 319 infants. The relative risk (RR) of nonattendance was calculated for each factor, and rules for predicting failure to attend were evaluated. The best predictors were multiparous mother (RR = 2.4, P = .01), no telephone in home (RR = 2.6, P= .002), and unmarried teenage mother (RR = 5.8, P= .05). Newborns who had a medical problem and had an adult mother were more likely to attend (RR = 0.4, P = .02) . These risk factors were easily identifiable from the medical record at birth. Because interventions may be labor-intensive, it is important to target the families at the highest risk.
Neonatal Outcome in Infants With Evidence of Fetal Exposure to Opiates, Cocaine, and Cannabinoids
Authors: Nair Prasanna , Rothblum Samuel , Hebel Richard
Published: November 2007

This study evaluated the neonatal outcome of infants with evidence of fetal exposure to cocaine, opiates, and cannabinoids. Subjects were from the newborn nursery of an inner-city university teaching hospital. Meconium from 141 infants admitted to the full-term nursery was analyzed for metabolites of opiates, cocaine, and cannabinoids. The population was 72% African-American; 82% had medical assistance; history of drug use was reported in the medical records in 18%; mean maternal age was 24.2 years; mean birth weight was 3,234 ± 502 g; and neonatal abstinence syndrome was reported in 7%. Meconium analysis data showed the following: 52.5% were drug-free; cocaine was present in 31 %, opiates in 18% (cocaine and/or opiates 39%), and cannabinoids in 17%. In 38 infants in whom urine toxicology was obtained for clinical indications, meconium was more sensitive than urine in detecting drug exposure (55.3% vs 31.5%). There was no significant difference between cocaine/opiate-exposed and drug-free infants in race, socioeconomic status, maternal age, birth weight, head circumference, length, and Apgar scores. Cocaine/opiate-exposed infants had greater length of stay and increased frequency of maternal sexually transmitted diseases during pregnancy, with a trend toward a higher percent with fetal distress.
Early Diagnosis of Spinal Cord Arteriovenous Malformation in a 7-Year-Old Child
Authors: Tillotson Gwendolyn , Philipps S. Guillermo , Coker Steven , DiFazio Mark
Published: November 2007

Spinal cord arteriovenous malformations (AVMS) are relatively uncommon in the pediatric age group. 1 Early diagnosis is rarely made and the resulting complications arising from the AVM may have devastating long-lasting neurologic sequelae.2 Early diagnosis requires a high degree of clinical suspicion. We report the case of spinal cord AVM in a child who presented with two episodes of "neck stiffness" without headache in whom the prompt diagnosis and treatment prevented neurologic sequelae.
WeeFIM
Authors: Msall Michael E. , DiGaudio Kathleen , Duffy Linda C. , LaForest Suzanne , Braun Susan , Granger Carl V.
Published: November 2007

A cross-sectional community sample of 417 children, ages 6 months to 8 years without developmental delays or in developmental programs, was seen. The Functional Independence Measure for Children (WeeFIM) was used to assess independence in self-care, sphincter control, transfers, locomotion, communication, and social cognition. Mean total WeeFIM was similar for males and females. There was a significant correlation between the age of the child in months and total WeeFIM scores for children ages 2 to 5 years (n = 222, r = .80, P <.01 ) . There was a progressive increase of functional independence with increasing chronological age across all WeeFIM domains. We conclude that the WeeFIM is a useful instrument for measuring disability in children.
Home Abatement and Blood Lead Changes in Children With Class III Lead Poisoning
Authors: Swindell Sharon L. , Charney Evan , Brown Mary Jean , Delaney Joanne
Published: November 2007

We studied the effect of home abatement on blood lead (PbB) levels in children from central Massachusetts who had not undergone chelation therapy and whose homes were abated between 1987 and 1990, when stricter abatement guidelines were enacted. One hundred and thirty-two children with a mean preabatement PbB of 25.9 μg/dL (1.25 μmol/L) were studied; their mean postabatement PbB (up to 1 year later) was 21.1 μg/dL (1.02 μmol/L) ( P <.001). This reduction correlated with preabatement PbB; 32 of 33 (97%) with preabatement PbB ≥30 μg/dL (≥1.45 μmol/L) were lower postabatement, and 64 of 79 (81%) with PbB 20 to 29 μg/dL (0.97-1.40 μmol/L) were lower. However, in children with preabatement PbB <20 μg/dL (<0.97 μmol/L), only seven of 20 (35%) were lower postabatement and, in fact, there was a significant rise in PbB from 16.8 to 19.3 μg/dL (0.81 to 0.93 μmol/L) ( P= 0.05). Continued improvement in home abatement technology is needed if that strategy is to be effective in achieving the lower PbB levels now mandated in the 1991 Centers for Disease Control guidelines. Primary prevention of the initial blood lead level elevation remains the most desirable strategy.
Single-Dose Ceftriaxone Versus 10 Days of Cefaclor for Otitis Media
Authors: Chamberlain James M. , Boenning Douglas A. , Waisman Yeheskel , Ochsenschlager Daniel W. , Klein Bruce L.
Published: November 2007

We conducted a controlled clinical trial to determine the efficacy of single-dose intramuscular ceftriaxone for the treatment of acute otitis media. Fifty-four children aged 18 months to 6 years with clinical and tympanometric evidence of otitis media were randomized to receive either 50 mg/kg ceftriaxone or 10 days of oral cefaclor 40 mg/kg/day. Resolution of symptoms and clinical and tympanometric appearance of the tympanic membrane at follow-up visits were used to determine outcome. Thirty-one children received ceftriaxone and 23 received oral cefaclor. There were no treatment failures. There were no significant differences between groups in persistence of effusion or recurrence of acute otitis media. We conclude that a single intramuscular dose of ceftriaxone compares favorably with 10 days of oral cefaclor for the treatment of acute otitis media.
Pediatric Practice in a Summer Sleep-Away Camp
Authors: Trachtman Howard , Woloski-Wruble Anna C. , Kilimnick Nichele , Ausabel Jeanne F. , Klein Janis Daniels , Weissman Michelle S. , Selesny Julie , Lebowitz Yael
Published: November 2007

Clinical practice was surveyed over a 4-week period at a sleep-away camp for children ages 9 to 16 years. The facility is located in the Pocono Mountains in Pennsylvania and has an enrollment of 694 campers and 266 adult staff members. There was a total of 895 visits to the infirmary; however, 190 children were evaluated on more than one occasion. Younger children and girls were more likely to seek medical help. The most common presenting complaints involved physical injuries related to sports activities, followed by a wide range of upper respiratory difficulties, such as sore throat, conjunctivitis, and stuffed nose. Tick bites were not observed in any campers. Significant psychosocial problems were not encountered among any children. Only one child had to be sent home from camp for specific treatment; this was a 14-year-old girl who suffered a lacerated nerve of the third finger on her right hand that required surgical correction. These data indicate that, aside from an increase in minor sports-related injuries, the health problems of children in camp are not significantly different in type or severity from those they experience at home. Furthermore, children attending camp can be relied upon to accurately report their complaints and receive appropriate medical attention.
Behaviors Associated With Onset of Gastroesophageal Reflux Episodes in Infants
Authors: Feranchak Andrew P. , Orenstein Susan R. , Cohn Jeffrey F.
Published: November 2007

To identify behaviors associated with the onset of gastroesophageal reflux episodes in infants both systematically and prospectively, each of 10 patients (aged 2 to 32 weeks) was studied during 2 hours of intraluminal esophageal pH probe monitoring, using a split-screen audiovisual recording technique. Videotape analysis of eight infants who had scoreable reflux events revealed six discrete behaviors closely associated temporally ( P<.001 to <.05) with the onset of reflux events: "discomfort" (crying or frowning), "emission" (of liquid or gas, i.e., regurgitation, drooling, or burping), yawning, stridor, stretching, and mouthing. Three behaviors (hiccuping, sneezing, and thumb-sucking) were infrequent but were significantly associated with onset of reflux events in one or two patients each. A tenth behavior, coughing or gagging, was significantly associated with onset of reflux events in two patients, but not in the rest, despite relatively frequent occurrence. Exploration of temporal relations between reflux and each behavior suggested that discomfort, emission, mouthing, and cough-gag may have caused reflux episodes, and that all 10 of the behaviors may have been caused by reflux episodes. These findings and a "quiet period" immediately preceding episodes in six of the infants suggest interesting pathophysiologic mechanisms in infants which require further evaluation.
Screening for Psychosocial Dysfunction in Pediatric Inpatients
Authors: Lloyd Jack , Jellinek Michael S. , Little Michelle , Murphy J. Michael , Pagano Maria
Published: November 2007

Screening pediatric inpatients for psychosocial dysfunction offers physicians an opportunity to identify emotional and behavioral problems that might otherwise go unrecognized. In this study, the Pediatric Symptom Checklist (PSC), a brief, parent-completed questionnaire, which has been validated in a variety of outpatient settings, was used to screen 98 pediatric inpatients. Results indicated that the PSC can be easily administered in a busy inpatient setting and is well-tolerated by both house staff and patients' parents as a routine part of the admissions process. The percentage of children who screened positive with the PSC in this inpatient setting was similar to the percentages generated by using the PSC in outpatient settings. Routine use of the PSC in inpatient settings serves to heighten house staff awareness of psychosocial concerns and facilitate parent-physician discussion of pediatric mental health issues.
Perceived Anxiety of Pediatric Patients to Magnetic Resonance
Authors: Marshall Sharon P. , Smith Mark Scott , Weinberger Edward
Published: November 2007

Magnetic resonance imaging (MRI), a nonionizing radiologic technique without known adverse physical effects, is utilized frequently in children and adolescents. The MRI technique requires prolonged immobility in a narrow, confined space, and concern has been raised regarding possible patient anxiety and noncompliance. Several reports suggest that up to 10% of adults undergoing MRI may experience anxiety and/or claustrophobia. 1 However, to our knowledge, no studies of the subjective MRI experiences of children and adolescents have been published. We report here the general characteristics of 491 consecutive Pediatric patients who were evaluated with MRI at our institution, including the experience of anxiety in 85 older children and adolescents.
Marked Heterogeneity in Niemann-Pick Disease, Type C
Authors: Natowicz Marvin R. , Stoler Joan M. , Prence Elizabeth M. , Liscum Laura
Published: November 2007

Niemann-Pick disease type C (NP-C) is an autosomal recessive lysosomal lipid storage disorder of unknown etiology. Diagnosis of NP-C is based on characteristic clinical findings and reduced fibroblast esterification of LDL-derived cholesterol. We describe three patients who demonstrate the NP-C spectrum of clinical heterogeneity in age of onset, presenting signs, pattern of organ system involvement, and natural history. In addition, electron microscopic analysis of skin biopsy specimens from these patients revealed marked variability in the extent and cellular distribution of intralysosomal storage and was suggestive of the correct diagnosis in only one case. These cases demonstrate both the limitations of electron microscopy for diagnosis of NP-C and the marked clinical variability in patients with this disorder. Practical clinical guidelines for appropriate suspicion of NP-C are presented.
Unwanted Sexual Expreriences in Adolescents
Authors: Kellogg Nancy D. , Huston Rebecca L.
Published: November 2007

More than 300 patients who presented consecutively to a sexual abuse clinic, a family planning clinic, and a family practice clinic filled out an anonymous survey regarding unwanted sexual experiences. In the family planning and family practice clinics, 40% of females and 16% of males reported having at least one unwanted sexual experience prior to their 18th birthday. Although 85% had disclosed their unwanted sexual experience, time to disclosure was prolonged (mean 2.3 years, median 5 to 6 months). Fear and embarrassment were the most common reasons for delay or lack of disclosure. The most common reasons for disclosure reflected internal rather than external or environmental influences. Increased awareness of unwanted sexual experiences and patterns of disclosure may enhance detection and treatment in children and adolescents.
Morbidity and Mortality of Infants Born Before Arrival at the Hospital
Authors: Beeram Madhava , Solarin Kolawole , Young Michal , Abedin Mehnur
Published: November 2007

Recently, a number of infants have been born at home, in an ambulance, car, etc., before arrival at the District of Columbia General Hospital. Many of these infants had poor outcome. To evaluate the prevalence and outcome of these infants, we reviewed medical records of all infants born before arrival at the hospital (out-born infants) and compared them with in-hospital deliveries from July 1988 to June 1992. Data were analyzed using Fisher's Exact Test and chi-square test. There were 151 (1.8%) out-born infants and 8,169 (98.2%) in-born infants during this 4-year period. Infants in both groups were predominantly black (85%). The following were significant differences (P <0.001) between out-born and in-hospital deliveries, respectively: illicit drug exposure 35% vs 21 %; low-birth-weight (<2,500 g) infants 39% vs 16%; intensive care unit admissions 29% vs 15%; and neonatal deaths per 1,000 live births 80 vs 7. We conclude that there is a twofold increase in the morbidity (required intensive care) and an 11-fold increase in the mortality among out-born infants compared with infants delivered in-hospital. Even though out-born infants were < 2% of the total deliveries, they accounted for 17% of total neonatal mortality.
Connatal Leigh Disease
Authors: Coker Steven B. , Thomas Chinnamma
Published: November 2007

Two children are described with pathology-proven Leigh disease. Rather than the typical degenerative course with loss of acquired development, they presented with a static encephalopathy manifested by seizures from birth and failure to acquire any milestones. A similar connatal presentation has been reported in other degenerative disorders, such as Pelizaeus-Merzbacher disease. Heredodegenerative disorders should be considered when no cause is discovered for a severe, congenital, static encephalopathy.
Outcome of Lower L-Thyroxine Dose for Treatment of Congenital Hypothyroidism
Authors: Campos Susana P. , Sandberg David E. , Barrick Chris , Voorhess Mary L. , MacGillivray Margaret H.
Published: November 2007

The appropriateness of the recommended L-thyroxine dose (10-15 μg/kg/day) for the treatment of congenital hypothyroidism has been questioned because of the risk of iatrogenic hyperthyroidism. We report the outcome of 23 newborns with congenital primary hypothyroidism treated with 25 μg L-thyroxine per day (5.3-9.2 μg/kg/day) and followed for an average of 59 months. Serum thyroxine (T4) values increased (X = 11.4 ± 2.7 μg/dL) within 4 weeks posttherapy; eight infants had T4 levels ≥13 μg/dL on only half the currently recommended dose. Thyroid-stimulating hormone (TSH) values remained elevated in 18 of 21 patients for 2-21 months despite a high-normal T4. Psychometric tests were performed in 19 of the 23 patients. The mean Full Scale IQ for the congenital hypothyroid group (n = 16 ) was 101.4 ± 13.2 with comparable Verbal and Performance IQ scores. Patients with a bone age (BA) of ≤32 weeks or T4 <2 μg/dL at initial evaluation had significantly Lower Verbal IQ scores. A standardized parent-report assessment of behavioral and emotional functioning revealed subgroup scale scores that were indistinguishable from nonclinical norms. We conclude that (1) average range IQ scores and positive behavioral adaptation are observed in congenitally hypothyroid children treated with L-thyroxine doses lower than currently recommended; (2) the L-thyroxine dose should be individualized to prevent iatrogenic hyperthyroidism; (3) TSH normalization should not be a primary objective of treatment, and (4) a prospective study comparing the advantages and risks of different doses of L-thyroxine is needed.
Social Factors Associated With Behavioral Problems in Children With Asthma
Authors: Butz Arlene M. , Malveaux Floyd J. , Eggleston Peyton , Thompson Lera , Huss Karen , Kolodner Ken , Rand Cynthia S.
Published: November 2007

The objective of this study was to describe the proportion of children with a behavior problem and examine which independent variables are associated with the presence of a behavior problem in a group of 392 inner-city children with asthma. Data on child asthma symptoms, medication use, health-care utilization, and school absences were obtained from the parent during a structured telephone interview. Included in the interview was a measure of behavior problems and social support questions. Children classified with a high level of asthma symptoms were more than twice as likely to experience a behavior problem than children classified with a low level of asthma symptoms ( P= 0.002). Use of theophylline medication was not correlated with behavior problems ( P = 0.45). Significant variables were low level of social support and high or moderate level of asthma symptoms. We have identified a group of children at risk for behavior problems, specifically in families that lack adequate social and financial resources.
A Combined Cytogenetic and Molecular Approach for Diagnosing Delayed Puberty
Authors: Hon Fong Louie Mark  , Bayleran Janet K. , Seifer David B. , Meyers-Seifer Cynthia H.
Published: November 2007

A phenotypic female aged 15 4/12 years was referred because of delayed puberty and short stature. Chromosomal analysis of peripheral blood leukocytes revealed two subpopulations of cells. The modal cell line was hypodiploid with a missing X chromosome while the other cell line was diploid with one X chromosome and a G-sized chromosome that resembled a Y chromosome in morphology. Subsequent fluorescent in situ hybridization yielded results consistent with the above conventional cytogenetic studies. To provide unequivocal evidence of the Y-chromosome material, molecular analyses using the polymerase chain reaction and various primers were carried out which identified an intact short arm and centromere of the Y chromosome and structurally altered long arms. A laparoscopic bilateral gonadectomy, performed because of the risk of neoplasia, also yielded cells with both 45,X and 46,XY karyotypes. The present report thus illustrates the usefulness of a combined approach for diagnosing delayed puberty.
Expectations, Goals, and Perceived Effectiveness of Child Health Supervision: A Study of Mothers in a Pediatric Practice
Authors: Cheng Tina L. , Savageau Judith A. , DeWitt Thomas G. , Bigelow Carol , Charney Evan
Published: November 2007

The purpose of the study was to assess parent expectations and goals in child health supervision and variability by socioeconomic status (SES), family size, social support, and pediatrician. Home interviews were conducted with mothers and their pediatricians were surveyed. Two hundred mothers with at least one child age 2-3 years who see one of five pediatricians in a staff model health maintenance organization were asked to participate. Mothers' and pediatricians' goals in the following seven areas of health supervision were assessed: biomedical, development, behavior, family functioning, safety education, and interpersonal and system interaction. Mothers stated physicians were their main source of parenting information. Assurance of physical health and normal development were more important than discussion of behavioral, family, or safety issues. Mothers of low SES were more likely to feel that physical aspects of health should be the focus and were less interested in psychosocial issues. Physicians stressed interpersonal, safety, and behavioral goals more than mothers. Individual physician responses did not predict the responses of mothers in their practice. Our data suggest either that mothers do not feel that psychosocial and safety issues are the highest priorities in health supervision or that physicians are not effectively reaching mothers on these issues.
Diagnostic Criteria for Non-Insulin Dependent Diabetes in Youth (NIDDM-Y)
Authors: Dean Heather
Published: November 2007

Differentiating NIDDM-Y from IDDM in youth is a diagnostic challenge. Serum insulin levels at diagnosis may help differentiate between NIDDM-Y and IDDM if the level is elevated, but the serum insulin level is low or undetectable in 45% of patients with NIDDM-Y. Islet-specific antibodies may be present in serum at diagnosis, and ketosis or ketoacidosis may occur. For our patients, clinical features are most helpful in differentiating NIDDM-Y from IDDM and include ethnic background, age and gender at diagnosis (approximately 80% of First Nation patients from northern Manitoba are adolescent females), presence of obesity and acanthosis nigricans, lack of symptoms or weight loss, and strong family history of NIDDM. Clin Pediatr. 1998;37:67-72