bluuebunny/crossref_metadata_2025 huggingface dataset:
Kilnefelter Syndrome and Its Variants: An Update and Review for the Primary Pediatrician
Authors: Visootsak Jeannie , Aylstock Melissa , Graham John M.
Published: June 2007

Klinefelter syndrome is the most common chromosomal abnormality in humans. Recent prospective, unbiased studies have clarified many of the previous misconceptions associated with Klinefelter syndrome, thereby improving our recognition and management of this condition for affected individuals. The primary-care physician has an important role in caring for these individuals and their families by providing anticipatory guidance regarding issues relating to endocrinology, behavior, development, and preventive medical care. Furthermore, the primarycare giver can serve as a valuable source of support and advocacy for the family of a boy with Klinefelter syndrome. We review the current state of knowledge regarding Klinefelter syndrome and its variants, with an emphasis on medical and early developmental interventions.
Irritable Bowel Syndrome and Nonspecific Diarrhea in Infancy and Childhood Relationship with Juice Carbohydrate Malabsorption
Authors: Moukarzel Adib A. , Lesicka Hanna , Ament Marvin E.
Published: June 2007

Lactose intolerance and malabsorbed carbohydrate present in some fruitjuice may trigger symptoms commonly seen in irritable bowel syndrome. In a two-site study, 28 subjects 9 months to 18 years old (mean 6.9 ±5.9 years) with significant intake of apple juice or pear nectar (> 6 oz a day) with the diagnoses of irritable bowel syndrome, functional abdominal pain, or chronic nonspecific diarrhea were recruited. Breath hydrogen tolerance tests utilizing lactose, sucrose, and apple juice in the amount they typically consumed were positive in 32%, 0%, and 50%, respectively. Subjects were asked to refrain from the ingestion ofjuice for 1 month: 13 of the 28 (46%) subjects improved while 15 (54%) showed no change in their symptoms. In fact, none consuming 6 to 12 oz of apple or pear juice daily improved, 27% of those consuming 12 to 16 oz improved, and 91% of those consuming > 16 oz improved (P< 0.02). Subjects were then given comparable amounts of white grape juice for 1 year. The initial symptoms did not recur in any of the subjects who initially responded to the juice-free diet. Of the 15 subjects who did not respond to the juice-free diet, seven became asymptomatic. Overall, 20 subjects (71%) were asymptomatic, and eight (29%) had no change in their symptoms. Some individuals with irritable bowel syndrome have their symptoms based on their malabsorption of carbohydrates present in apple juice and pear nectar and may improve with adequate choices of fruit juice such as changing to white grape juice.
Clinical Findings and Resource Use of Infants and Toddlers Dependent on Oxygen and Ventilators
Authors: O'Brien Jane E. , Dumas Helene M. , Haley Stephen M. , O'Neil Margaret E. , Renn Margaret , Bartolacci Teresa E. , Kharasch Virginia
Published: June 2007

Medical records were reviewed to describe characteristics, report clinical and resource measures, and determine if differences exist between the diagnostic groups of prematurity and multiple congenital anomalies/neurologic conditions for initial admissions of 37 infants and toddlers to an inpatient pulmonary rehabilitation program. More than 75% of the children had a tracheostomy at admission and discharge. Forty-six percent of the sample was admitted requiring only oxygen, whereas 51% were discharged requiring only oxygen and not mechanical ventilation. Thirty percent of the children weaned to a less invasive mode of ventilation while just under half of the children were discharged home. Between-group comparisons indicated statistically significant differences for nutritional support at discharge (p < = 0.05) and discharge disposition (P = 0.04). Complete weaning of oxygen or ventilator support during an initial inpatient pulmonary rehabilitation admission occurred less frequently than weaning to a less invasive mode of ventilation. This is an important consideration for referring children to rehabilitation programs, for clinical program improvement activities, and for setting realistic expectations for referral sources, patients and families, clinical staff, and payers. Further study is recommended using clinical data in program planning, in program improvements, and for setting outcome expectations for infants and toddlers dependent on pulmonary technology.
Delay in Diagnosis of Williams Syndrome
Authors: Huang Lennox , Sadler Laurie , O'Riordan Mary Ann , Robin Nathaniel H.
Published: June 2007

Williams syndrome (WS) is a well-known genetic disorder with a variable phenotype. In many cases, physical manifestations are subtle and may not be apparent at an early age, making diagnosis difficult in infants and young children who lack classic manifestations such as supravalvular aortic stenosis and hypercalcemia. Clinical suspicion is essential because the diagnostic genetic finding is not detectable on routine chromosomal analysis. Furthermore, early diagnosis allows for earlier detection and treatment of developmental, behavioral, and medical problems. In an effort to understand how and why individuals with WS are diagnosed, we conducted a survey-based study of parents of WS children. Packets containing a cover letter, consent form, parental survey and preaddressed stamped envelope were distributed to parents of children with WS. The survey included questions concerning initial diagnosis, WS findings present, medical specialists involved, and tests performed. Forty-six completed surveys were returned for analysis. The mean age at diagnosis was 3.66 years (SD 4.13). The mean age at which there were initial concerns was 0.98 year (SD 1.24) resulting in a mean delay in diagnosis of 2.77 years (SD 4.10). In addition, the involvement of a geneticists correlated with earlier diagnosis (2.26 years vs. 5.09 years without geneticist involvement, p = 0.03) and fewer tests ordered (5.2 vs. 8.2 in the nongeneticist group, p=0.0006). We observed a significant delay in the diagnosis of WS. Of note, the involvement of a geneticist was associated with earlier diagnosis and reduced number of tests.
Stage I Vitamin D-Deficiency Rickets Mimicking Pseudohypoparathyroidism Type II
Authors: Srivastava Tarak , Alon Uri S.
Published: June 2007

The clinical presentation and biochemical features of stage I vitamin D-deficiency rickets (VDR) and pseudohypoparathyroidism (PHP) type II are quite similar. These 2 entities have therefore often been mistaken for one another. We report our experience with 2 cases of stage I VDR that were originally diagnosed as PHP type II. The report provides an insight into the pathophysiology of VDR and PHP and thus allows for better differentiation between the 2 disease entities. It has become essential for pediatricians to recognize VDR owing to its resurgence in developed countries.
Patient, Physician, and Nurse Satisfaction with Antibiotics
Authors: Steele Russell W. , Blumer Jeffrey L. , Kalish Geoffrey H.
Published: June 2007

To prospectively evaluate patient (parent), physician, and nurse satisfaction with antibiotics, 12,102 children in 661 pediatric study centers throughout the United States with infections to be treated on an outpatient basis were followed with questionnaires completed by parents and with interviews of patients and their parents. Comprehensive surveys were also completed by participating pediatricians and their nursing staffs of which 11,913 (98.4%) contained adequate information for inclusion in an analysis. Data were combined and analyzed using standard statistical methods. Loracarbef was perceived as being superior to other antibiotics based on cost, palatability, and dosing intervals. Few differences were seen among most antibiotics based on treatment outcome or adverse events. All antibiotics studied offered acceptable efficacy and were well tolerated as judged by physicians, nurses, parents, and children. Slight differences might result in increased compliance for some patients.
Obstructive Uropathy: An Important Cause of Chronic Renal Failure in Children
Authors: Roth Karl S. , Koo Harry P. , Spottswood Stephanie E. , Chan James Cm
Published: June 2007

Care of individuals with renal failure continues to impose a tremendous burden on our national health care budget. Chronic renal failure is the final common denominator of a multiplicity of pathologic processes, some of which progress silently over years. Of these, obstructive uropathy is a prominent cause of kidney failure, accounting for 16.5% of all pediatric renal transplants in 1997. The pathophysiology of obstructive uropathy is reviewed as the basis for a differential diagnosis. In view of the significant role played by obstructive uropathy in the development of renal failure, early and definitive treatment of this clinical entity is imperative.
Randomized Trial of Alcohol Versus Triple Dye for Umbilical Cord Care
Authors: Golombek Sergio G. , Brill Patricia E. , Salice Anne L.
Published: June 2007

Over a 4-month period, all infants admitted to the well-baby nursery were enrolled in a prospective study designed to compare cord separation times between infants treated with triple dye once, followed by daily alcohol application, to infants treated with daily alcohol application alone. Follow-up phone calls were done 7 days after discharge, with weekly calls until cord separation occurred. The objective was to determine whether the umbilical cord care regimen of triple dye followed by alcohol has an advantage over the alternative regimen of alcohol alone, with regard to cord separation, parenting, or healthcare caretaker preferences. In total, 634 infants were enrolled, with 599 infants (94%) completing the study. Infants in the alcohol alone group had a shorter cord separation time by 3 days (10 versus 13 days) (p < 0.0001). There was no reported increase in infection, and monetary savings were noted. We conclude that alcohol applied once a day appears to be a safe and effective means of promoting cord detachment.
Attention Deficit Hyperactivity Disorder: Comorbidity and Medication Use
Authors: Kube David A. , Petersen Mario C. , Palmer Frederick B.
Published: June 2007

Children evaluated for attention deficit hyperactivity disorder (ADHD) may have other disorders resembling ADHD leading to inappropriate stimulant medication use. This study was completed to identify relationships between referral complaints of ADHD, behavior problems or learning problems and age, gender, final diagnosis, and medication use. One hundred eighty-nine children ages 2 to 15 years referred for evaluation of ADHD, behavior or learning problems were evaluated by an interdisciplinary team. Diagnoses of ADHD, specific learning disability (SLD), mental retardation (MR), developmental language disorders (LANG), and other behavior disorders (DIS) were established. Medication use pre-and post-evaluation was reviewed. Forty-three percent of all subjects had a final diagnosis of ADHD. Forty percent referred specifically for presumed ADHD did not have it. More children older than 5 years were diagnosed as having ADHD than those 5 years old or younger (p<0.0001). More subjects 5 years old or younger were diagnosed as having LANG than those older than 5 years (p<0.0001). Fewer subjects with a chief complaint of ADHD were diagnosed with MR than those with behavior or learning problems (p=0.001). In subjects 5 years old or younger, 35% were diagnosed with MR and 49% with other DIS. In children older than 5 years, 41% were diagnosed with SLD. Ten percent of subjects without ADHD were using stimulants. Only 48% of subjects with confirmed ADHD took stimulants. Children presenting with behavior problems or those 5 years old or younger are at higher risk for MR, LANG, and DIS and less likely to have ADHD. Children presenting with learning problems or those older than 5 years are more likely to have SLD or ADHD. Multiple diagnoses were common for all ages and presentations. Ten percent of children without confirmed ADHD used stimulants before evaluation.
Recurrent Hemolytic Uremic Syndrome
Authors: Siegler Richard L. , Pavia Andrew T. , Sherbotie Joseph R.
Published: June 2007

Hemolytic uremic syndrome (HUS) in children follows a diarrheal prodrome (D+) approximately 90% of the time, and recurrence due to enteric reinfection with Shiga toxin producing E. coli (e.g., 0157:H7) can occur but is rare. It is not well recognized that nondiarrheal (D-) recurrences can also follow an episode of D+ HUS; we report 2 unrelated females who experienced multiple D-episodes following an initial episode of D+ HUS. We also present an HUS classification system that includes recurrence risk. It illustrates that recurrence is seen most frequently with familial HUS but can also occur in cases that are secondary to drugs, cancer, and pregnancy.
Role of Imaging in the Diagnosis of Acute Appendicitis in Children
Authors: Even-Bendahan G. , Lazar I. , Erez I. , Guttermacher M. , Verner M. , Konen O. , Rathaus V. , Freud E.
Published: June 2007

The aim of the study was to investigate the place of imaging in the diagnosis and treatment of acute appendicitis. The files of 2,427 children with suspected acute appendicitis were reviewed for clinical management and operative findings. The sample was divided into 3 groups at time of admission: (1) before diagnostic imaging was available in our department (1991-1994); (2) after the introduction of imaging studies on a random basis in equivocal cases (1995-1998); and (3) after a policy was formulated for ultrasound use in all equivocal cases followed by computed tomography if necessary (1999-2000). Results showed that the rate of misdiagnosis decreased from 13.2% in group 1 to 6.5% in group 2 and 6.1% in group 3. False-positive findings (normal appendix with positive scan) were noted in 16.7% of group 2 and 25% of group 3; false-negative findings (appendicitis at surgery with negative scan) in 23.8% and 9.5%, respectively. Computed tomography was performed in 8 children and prevented unnecessary surgery in 4 of them. We conclude that in equivocal cases of acute appendicitis, imaging studies performed by skilled operators can improve the accuracy of diagnosis, saving patients unnecessary surgery, and identifying other conditions that mimic appendicitis.
Human Growth Hormone and Gonadotropin Releasing Hormone Analog Combination Therapy Increases Predicted Height in Short Normal Girls
Authors: Maniati-Christidi M. , Livadas S. , Voutetakis A. , Tolis G. , Dacou-Voutetakis C.
Published: June 2007

The “short normal” child constitutes a real challenge for the pediatric endocrinologist. In a subgroup of short normal children, puberty starts at a normal age but with low height, and hence, the final height is expected to be quite compromised. Efforts to improve the outcome in this group have been made in the past with equivocal results. We present the growth data of 8 short girls with normal growth hormone values on provocative testing and low height at puberty initiation. At intervention the height and the stage of puberty were 129.3 ± 5 cm and II to III, respectively, and the predicted height was 148.8 ± 2.6 cm. Gonadotropin releasing hormone analog, triptorelin (3.6 ± 0.5 pg/kg/day) and growth hormone (0.5 IU/kg/week) were used in different sequential order and simultaneously in each child. The mean total treatment period was 47.6 ± 11.2 months. The mean predicted and the mean final height in the total group were 148.8 ± 2.6 and 154.5 + 3.6 cm, respectively (p:0.028). The final height did not differ from the target height (154.8 ± 8 cm versus 154.5 + 3.6 cm), while in 4 children, the final height was greater than the target height. The height gain (Δ Final height Predicted height) was 5.7 ± 1.3 cm. If we analyze separately the girls in whom growth hormone was started first and gonadotropin releasing hormone analog followed versus those who started the analog first, the Δ Final height Predicted height was 8 ± 3 cm in the former and 4.8 ± 3.1 cm in the latter (p:0.03). It seemed that the difference was accounted for by duration of growth hormone therapy (51.3 ± 10.6 months versus 28.6 ± 10.6 months) (p:0.026), rather than by other factors. In conclusion, under the conditions of the present study, the combination of puberty arrest and growth hormone therapy significantly improved predicted height. The most significant determinant of the height gain was the duration of growth hormone therapy.
Measures of Cardiac Repolarization and Body Position in Infants
Authors: Baker Sherri S. , Talner Norman S. , Milazzo Angelo S. , Sanders Stephen P. , Valente Anne Marie , Kanter Ronald J. , Paul Ian M. , Li Jennifer S.
Published: June 2007

Sudden Infant Death Syndrome (SIDS) is the most common cause of death in children between 1 and 6 months of age. Recent data suggest that a prolonged QTc interval on the 12-lead electrocardiogram (ECG) is associated with SIDS. Prone body position during sleep is also known to be a risk factor for SIDS; this has prompted the American Academy of Pediatrics to promote the “Back to Sleep” campaign. We postulated that the QTc interval in infants might change as a function of body position, linking the observations relating body position and QTc interval to SIDS. We recorded ECGs in a group of infants in both the supine and prone position to determine if the QTc interval and QT dispersion differ between the 2 positions. Forty-seven standard 12-lead ECGs and high-amplitude, rapid-sweep 12-lead ECGs were performed on 45 healthy infants (mean age 26 + 40 days) in both the supine and prone positions. The infants were asleep in a quiet, restful state. The ECGs were reviewed by 2 investigators blinded to the position of the infants during recording. Measurements included the average QTc interval (using Bazett's correction) and QT dispersion (the difference between the longest and the shortest QT intervals on a standard 12-lead EKG). The study was designed to detect a 3% difference in QTc interval with 80% power and c=-0.05. All subjects had telephone or clinical follow-up at 1 year. The average QTc interval was 403 ± 20 milliseconds (msec) in the supine position and 405 ± 27 msec in the prone position (p=NS). The QT dispersion was 20 ± 12 msec in the supine position and 22 ± 13 msec in the prone position (p=NS). One infant in the study group died of SIDS at the age of 3 months. The ECG of this patient revealed a QTc interval of 382 msec in the supine position and 407 msec in the prone position; the QT dispersion was 34 msec in the supine position and 34 msec in the prone position. We found no difference in QTc interval or QT dispersion as a function of body position in healthy infants resting quietly. Prolongation of the QTc interval is unlikely to explain the increased risk for SIDS associated with prone body position in the general population of healthy infants, unless patients with long QT syndrome are somehow more influenced by body position than normal patients are
Pediatric Pain Measurement Using a Visual Analogue Scale: A Comparison of Two Teaching Methods
Authors: Shields Brenda J. , Cohen Daniel M. , Harbeck-Weber Cynthia , Powers Jean D. , Smith Gary A.
Published: June 2007

The goals of this study were to evaluate the validity of the visual analogue scale (VAS) for young children and to compare a newly developed method of teaching children to use a VAS with one used in our previous studies. It was hypothesized that the new method would increase the number of children who understand the VAS and correctly mark their responses on the VAS line. The association between child's age and ability to understand the VAS was also evaluated. One hundred-six children with a laceration requiring sutures and receiving a lidocaine injection for local anesthesia participated in the study. They ranged in age from 5 to 14 years. Two outcome measures were used to assess the baseline and lidocaine injection pain: a 5-point Likert scale and a VAS. A calibration study was used to determine whether the subjects were able to use the VAS to make proportional judgments about their perceptions. Teaching method had no effect on the number of subjects who could correctly mark their responses on the VAS line, nor did it significantly increase the number of subjects who could understand the concept of the VAS. Subjects who were able to understand the VAS were significantly older (mean = 9.8 years, SD = 2.8) than those who did not (mean = 8.2 years, SD = 2.5). Overall, only about one third of the subjects were able to correctly mark the VAS and understand the concept of the VAS. Other measures of pain that are better understood by young children may be more valid indicators of pain than the VAS.
Adverse Drug Reactions in Breastfed Infants: Less Than Imagined
Authors: Anderson Philip O. , Pochop Stacey L. , Manoguerra Anthony S.
Published: June 2007

Medication use during breastfeeding shortens the duration of breastfeeding often because of overly cautious information given by healthcare providers. No comprehensive review of the literature on infant adverse reactions from drugs in breastmilk has been published. All published studies and case reports on adverse events in infants caused by medications (excluding drugs of abuse) in breastmilk were identified and analyzed. Of 100 case reports evaluated, none were considered to be "definite" using a standard ranking scale; 47% were "probable" and 53% were "possible." Drugs with central nervous system activity accounted for half of all reports. All 3 reported fatalities involved central nervous system depressants, but each had extenuating circumstances. At least 63% of reported cases were in neonates and 78% were in infants 2 months or younger; only 4% of adverse reactions occurred in infants older than 6 months of age. Published studies expand on and generally reinforce the analysis of case reports. By taking a few simple precautions in drug selection and considering the infant's age, breastfeeding rarely needs to be discouraged or discontinued when a mother needs drug therapy.
Abdominal Pain Associated with Lactose Ingestion in Children with Lactose Intolerance
Authors: Gremse David A. , Greer A. Scott , Vacik Jonathan , Dipalma Jack A.
Published: June 2007

The causal relationship between lactose ingestion and gastrointestinal symptoms is questionable. The aim of this study was to assess symptoms associated with milk ingestion in children with lactose maldigestion. Thirty children (11 males) age 3 to 17 years with lactose maldigestion were studied. In a double-blind, crossover design, subjects ingested 240 m L daily of either lactose-hydrolyzed or lactose-containing milk for 14 days. Diaries were kept daily that recorded diet, medication use, and symptoms. There was a significant increase in abdominal pain experienced by study participants during the lactose ingestion period when compared to the lactose-free period. We conclude that ingestion of 12 g of lactose daily is associated with increased abdominal pain in susceptible children with lactose maldigestion. A trial of dietary lactose restriction may be beneficial in reducing abdominal pain in children with lactose maldigestion.
Vertebral Fractures in Boys with Duchenne Muscular Dystrophy
Authors: Bothwell J. E. , Gordon K. E. , Dooley J. M. , Mac Sween J. , Cummings E. A. , Salisbury S.
Published: June 2007

Osteoporosis causes significant morbidity for boys with Duchenne muscular dystrophy. Corticosteroid therapy given to prolong mobility may increase the rate of osteoporosis and risk of fracture. This study of 33 boys with Duchenne muscular dystrophy determined retrospectively the incidence of vertebral fractures particularly after initiation of corticosteroids. A latency period of 40 months after commencement of steroids occurred before the first vertebral fracture appeared. However, by 100 months of treatment approximately 75% had sustained a vertebral fracture.
Academic Outcomes in Children with Congenital Heart Disease
Authors: Griffin Karla J. , Elkin T. David , Smith Clinton J.
Published: June 2007

Congenital heart disease (CHD) is often associated with intellectual, developmental, and academic late effects related to the diagnosis itself and treatment. This literature review examines what is currently understood about these intellectual and academic deficits. It appears that children with CHD, and particularly those with cyanotic CHD, are at risk for significant impairments in visual spatial skills, visual motor skills, and overall processing speed. Early neurocognitive interventions, especially with younger children, may prove beneficial for remediating some of these deficits.
Lack of Association of Race/Ethnicity and Otitis Media in tie First 2 Years of Life
Authors: Woods Charles R.
Published: June 2007

Race has been identified as a risk factor for otitis media (OM) in several studies. To further explore this, a database of visits with age at visit < 24 months was constructed from data captured electronically at a public health clinic in North Carolina between July 1994 and December 1996. Among 3,108 children with at least 1 visit, 45% were African-American, 26% were Latino, and 29% were White. There were no differences among the groups in episodes of OM per child or ratio of OM episodes to total visits per child. A cohort of 166 children with follow-up throughout their first 2 years of life was identified. In this group, being uninsured or having exposure to out-of-home child care was associated with an increased risk of OM. Race/ethnicity had no association with frequency of OM as measured by episodes per child, proportion with > 1 episode, or proportion with? 3 episodes.
A Comparison of Time to Positive Culture and Time to Clinical Identification of Serious Bacterial Infection in Infants
Authors: Brown Julie C. , Del Beccaro Mark A. , Clausen Carla R.
Published: June 2007

To compare the time to positive culture with the time to clinical detection of serious bacterial infection (SBI) in young infants, a retrospective case series of 949 infants age 0-60 days, who had a body fluid cultured in the emergency department or within 24 hours of admission was analyzed. Times to first report of positive culture and first clinical diagnosis of SBI were compared. Of 44 infants with positive cultures, 48% were clinically diagnosed with SBI at first evaluation. Of 21 infants with cultures reported positive after 24 hours, 14 were already diagnosed with SBI. Infections that altered therapy were identified after 24 and 36 hours in 4 infants and 1 infant, respectively. In infants with SBIs, the time to positive culture is longer than the time to identification of infection.
Mucosal Eosinophilia and Response to H1/H2 Antagonist and Cromolyn Therapy in Pediatric Dyspepsia
Authors: Friesen Craig A. , Sandridge Linda , Andre Linda , Roberts Charles C. , Abdel-Rahman Susan M.
Published: June 2007

Both eosinophils and mast cells have been implicated in the generation of abdominal pain. The purposes of this retrospective study were to determine the prevalence of duodenal eosinophilia in pediatric dyspepsia and to determine the clinical response rate of these patients to combined H1 and H2 receptor antagonist and mast cell stabilizer therapy. Fifty-nine patients (ages 3.5–17.7 years) with dyspepsia undergoing endoscopy were evaluated. All patients had a minimum of 2 forceps biopsies obtained from each of the esophagus, antrum, and duodenal bulb. Routine histologic evaluation was performed and duodenal biopsies were additionally evaluated to determine eosinophil counts. Patients with > 10 eosinophils/hpf were treated with ranitidine and hydroxyzine (H1/H2). Nonresponders were then treated with oral cromolyn. Patients were followed up and response recorded in an abdominal pain database and/or medical chart, which were reviewed for this study. Forty-two patients (71%) had duodenal eosinophilia. Twenty-one (50%) of these were responders to H1/H2. The response rate did not differ between patients with and without noneosinophilic esophagitis, gastritis, or duodenitis, respectively. Two patients were lost to follow-up and considered nonresponders. Seventeen of the remaining 19 (89%) were responders to cromolyn. Overall, the response rate to this treatment pathway was 90%. Duodenal eosinophilia is common in pediatric patients with dyspepsia. These patients appear to be clinically amenable to combination H1/H2 therapy and/or oral cromolyn.
Lessons Learned from Pediatric Residents on a Community Pediatrics Rotation
Authors: Takagishi Jennifer , Christner Jennifer , McCoy Rosha , Dabrow Sharon
Published: June 2007

Pediatric residents on block community rotations completed journals and exit interviews regarding their perceptions of the rotation. Three common themes present in residents’ responses were identified via qualitative analysis: enlightenment and attitude change, impact of direct participation, and rotation challenges. Advantages and disadvantages to block rotations in community pediatrics, and their relationship to learning child advocacy skills, are discussed. Finally, the use of journals as a tool to document systems-based practice competency is explored.
Evaluation of Prolonged aPTT Values in the Pediatric Population
Authors: Shah Mona D. , O’Riordan Mary Ann , Alexander Sarah W.
Published: June 2007

To assess the likelihood of significant bleeding disorders in children with prolonged activated partial thromboplastin times (aPTTs), a retrospective chart review was performed. Data analyses determined that in the absence of symptoms and a negative family history, the diagnosis of a bleeding disorder was unlikely in an individual with a prolonged aPTT (negative predictive value = 80%). Conversely, a prolonged aPTT was predictive (positive predictive value = 62%) in the presence of both clinical symptoms and a documented family history. The scope of laboratory investigation in any child with a prolonged aPTT should be tempered by the clinical presentation and the associated personal and family histories.
Vitamin D Deficiency in a Healthy Group of Mothers and Newborn Infants
Authors: Lee Joyce M. , Smith Jessica R. , Philipp Barbara L. , Chen Tai C. , Mathieu Jeffrey , Holick Michael F.
Published: June 2007

Plasma 25-hydroxyvitamin D was measured in 40 healthy, mostly Black, mother-infant pairs. Although a majority of mothers received a daily prenatal multivitamin, vitamin D deficiency (<30 nmol/L), was found in 50% of mothers and 65% of their newborn infants, with a positive correlation between maternal and infant plasma 25-hydroxyvitamin D concentrations. Maternal vitamin D deficiency may represent an important risk factor for the development of rickets in children.
Digital Rectal Examination and the Primary Care Physicians: A Lost Art?
Authors: Safder Shaista , Rewalt Mary , Elitsur Yoram
Published: June 2007

Digital rectal examination (DRE) in children is crucial to differentiate between simple (habitual) and complicated constipation. Previous experience suggests that primary care physicians (PCPs) avoid DRE in children with constipation before referral. We evaluated the rate of DRE performance by West Virginian PCPs in patients referred to our gastroenterology clinic. Data were collected from the physicians’ referral letters and parental reports. We found that the vast majority (85%) of WV-PCPs do not perform DRE before referring their patients, resulting in missed diagnoses and treatment. We concluded that the lack of DRE in children with constipation may result in unnecessary referral to the specialist. To improve standard of care for children with constipation, an educational campaign for PCPs is clearly warranted.
Caustic Gastroesophageal Lesions in Childhood: An Analysis of 473 Cases
Authors: Doğan Yaşar , Erkan Tülay , Çokuğraş Fügen Çullu , Kutlu Tufan
Published: June 2007

Ingested corrosive agents produce oropharyngeal and gastroesophageal injuries ranging from minor burns to severe necrosis, depending on the agent amount, concentration, and duration of exposure. The aim of this study was to present our patients with corrosive ingestion retrospectively. Four hundred seventy-three children younger than 16 years of age (mean age, 3.7±0.1 years) who were admitted to our hospital for suspected corrosive ingestion between the years 1995 and 2003 were studied. Two hundred eighty-six (60.5%) of 473 patients were males. Household bleaches (36.6%) and oven cleaners (23%) were the most frequently encountered corrosive agents. During endoscopy, lesions in the esophagus were recorded in 379 children. Eighty-one of the cases had gastric lesions. During the follow-up, esophageal stricture, esophageal perforation, and gastric outlet obstruction (GOO) developed in 11 cases, 1 case, and 2 cases, respectively. Caustic ingestion of alkali substances such as oven cleaner seem to cause more severe injuries. Early admission to the hospital with clinical and endoscopic evaluation and early surgery when required may reduce morbidity and mortality.
Insulin Therapy in Pediatric Patients with Type I Diabetes: Continuous Subcutaneous Insulin Infusion versus Multiple Daily Injections
Authors: Nahata Leena
Published: June 2007

The goal of this article was to review studies comparing continuous subcutaneous insulin infusion (CSII) to multiple daily insulin injections (MDIs) in children and adolescents with type I diabetes on five parameters: glycemic control, adverse events, required insulin dosage, weight gain, and psychosocial implications. Two of the five studies (sample sizes 19-75 patients) showed that insulin pumps provided better glycemic control, fewer adverse events, and better psychosocial implications than MDIs. Three of the five showed a lower required insulin dosage in CSII and one of the five showed less weight gain with CSII. Studies 4 and 5, both done in preschoolers, showed no significant difference on any of the five parameters. The majority of the patients and families chose to continue with CSII after the completion of the studies, even in studies where insulin pumps showed no objective benefit. Insulin pumps appear to offer potential benefit over MDIs, but the efficacy, safety, and cost effectiveness of CSII versus MDIs as first-line therapy for type I diabetes in this population has not yet been clearly established. Until more data are available from large, randomized, controlled studies, MDIs may be used as first-line therapy and CSII should be considered in patients who have poor glycemic control or who are not compliant with multiple injections.
Creatinine for Evaluation of Glomerular Filtration Rate in Children
Authors: Hellerstein Stanley , Berenbom Max , Erwin Pat , Wilson Nancy , DiMaggio Sylvia
Published: June 2007

This report is to provide primary care physicians with a convenient method for identifying children with impaired kidney function. This is important because of the prevalence of chronic kidney disease in adults and because intervention may delay disease progression. The glomerular filtration rate (GFR) measured using cimetidine clearance and calculated using height and serum creatinine concentration were compared during 222 clearance studies in 32 pediatric patients over 8 years. A child 1 year or older with a calculated GFR < 60 mL/min/1.73 m2 has a significantly reduced GFR and should be referred to a pediatric nephrologist for further evaluation.
A Youth Development Program: Lasting Impact
Authors: Meltzer Iris J. , Fitzgibbon James J. , Leahy Peter J. , Petsko Kathleen E.
Published: June 2007

The purpose of the study was to examine whether participation in a youth development program positively impacted participants' adult outcomes. Length of time adolescents spent in a comprehensive youth development program was correlated to their adult outcomes and functioning was assessed. All 141 adult past participants of a youth development program were identified. A survey was administered to 97% of the past participants located. School completion, higher education, alcohol and drug use, pregnancy and childbearing, employment, and involvement with the juvenile and adult justice systems were assessed. Degree of involvement in the program (low, medium, and high) was calculated and correlated with outcomes. Of the six areas surveyed, statistically significant findings (p<0.05) were obtained in three: education, employment, and criminal justice. Nonsignificant, but positive, trends were observed in the areas of pregnancy/parenthood and illicit drug use. Best outcomes were achieved with those who participated for at least 201 days.
Prenatal Office Practices Regarding Infant Feeding Choices
Authors: Dusdieker Lois B. , Dungy Claibourne I. , Losch Mary E.
Published: June 2007

The objective of this study was to determine the obstetric care providers’ roles in breast-feeding promotion during prenatal care. A questionnaire addressing breast-feeding issues was sent to family practitioners (FP), obstetric-gynecologists (OB/GYN), and nurse midwives (NM) in Iowa, USA. All NM, 97% of FP, and 85% of OB/GYN reported asking infant feeding preference—usually only at the first prenatal visit. NM (73%) were most likely to provide extensive breast-feeding counseling. OB/GYN (68%) and FP physicians (90%) reported doing their own breast-feeding counseling. Breast examinations targeting future breast-feeding problems were done in 82% to 84% of patients. NM practices shared more information supportive of breast-feeding. Nearly all providers offered prenatal classes, but only 41% of FP offered breast-feeding classes. Free formula samples were available in 73% of FP, 54% of OB/GYN, and 36% NM offices. Pamphlets on formula feeding and also breast-feeding were readily available. Overall NM (64%) reported being strong breast-feeding advocates compared to only 13% of FP and 7% of OB/GYN. In conclusion, little promotion of breast-feeding occurs in most prenatal practice settings.
Diagnosis and Management of Childhood Bipolar Disorder in the Primary Care Setting
Authors: Faust Douglas S. , Walker Douglas , Sands Mark
Published: June 2007

Early-onset bipolar disorder (BD) is often misdiagnosed and inadequately treated because of the varying constellation of symptoms that occur across different developmental stages, the variety of disorders with similar presentation, and the frequent comorbidities. The etiology of BD is complex, but research confirms the major role that genetics and environment play in its development. The pediatrician initially identifies most cases, with subsequent referral to mental health providers. A complex case involving a child initially diagnosed with attention deficit hyperactivity disorder (ADHD) and later found to have comorbid childhood BD is considered, illustrating diagnostic considerations and appropriate behavioral and psychopharmacological intervention.
Factors Associated With Specific Language Impairment and Later Language Development During Early Life: A Literature Review
Authors: Prathanee Benjamas , Thinkhamrop Bandit , Dechongkit Sumalee
Published: June 2007

It has been reported that 50% of children with specific language impairment (SLI) have persistent SLI, which has been associated with various risk factors. To date, however, there has not been a comprehensive review of studies into different risk factors that could be used by clinicians to facilitate parental counseling and individual case-management. Several studies about the factors associated with SLI were reviewed based on study design. This article presents a review of factors associated with later language development and SLI, and reviews the risk for children who have SLI during early life. The summary provides data including specific biologic and environmental factors that are significantly associated with SLI, to ensure early intervention for children with SLI in the presence of identified risk factors.
The Internet and the Pediatrician: Should There Be a Connection?
Authors: Fikar Charles R
Published: June 2007

The Internet, an extensive network of interlinked computers storing immense quantities of information, is growing exponentially. The author was interested in discovering what sources of information exist on this network that might be of importance to the pediatric health care provider. To accomplish this aim, a literature review was undertaken, relevant articles were studied, and the Internet and its own resources were used to seek out information that might be helpful to pediatric practitioners. Many interesting resources of potential importance to the pediatric health care provider were found and are described in this paper. Besides being an important storehouse of documents, images, and factual information, the Internet has, in addition, communication facilities, such as e-mail and Listserv, that make it a particularly useful resource. It seems prudent that all pediatric practitioners should have some form of access to the Internet.
Amphotercin B Lipid Complex Treatment of a Leukemic Child wlth Disseminated Fusarrium solani Infection
Authors: Patterson Thomas S. , Barton Leslie L. , Shehab Ziad M. , Hutter John J.
Published: June 2007

We report a case of Fusarium solani infection in a 2'2-year-old girl with acute lymphoblastic leukemia and severe neutropenia. The infection, initially limited to her sinuses, became disseminated, as evidenced by the development of a characteristic cutaneous lesion on her left leg after a cumulative dose of amphotericin B of 18.3 mg/kg. Amphotericin B lipid complex (ABLC), 5 mg/kg/day, in conjunction with repeated surgical debridement of the sinuses and correction of neutropenia with granulocyte colony stimulating factor (GCSF), led to clinical and mycologic cure.
Significance of Pleural Fluid Cholesterol and Beta-2 Microglobulin Levels for the Differentiation of Pleural Effusions in Childhood
Authors: Kalayci Ayhan Gazi , Gurses Nuran , Adam Bahattin , Albayrak Davut
Published: June 2007

We studied 60 children, ages 3-15 years, with pleural effusions to determine the usefulness of different criteria for the separation of transudates from exudates. Twenty of these effusions were classified as transudates and 40 as exudates. Pleural cholesterol (P chol), pleural/serum cholesterol ratio (P/S chol), and pleural/serum 12 microglobulin (P/S 12 m) were determined to characterize pleural effusions and were compared with Light's criteria (pleural/serum protein ratio, pleural LDH, pleural/serum LDH ratio). With a threshold of 0.3, the sensitivity and specificity of P/S chol for diagnosis of exudates were 95 and 90%, respectively. With a threshold of 1.3, the sensitivity of P/S 12 m was 77.5%, and its specificity was 95%. Our findings indicate that determination of P chol and P/S chol, as well as Light's criteria, is of value for characterizing pleural effusions in childhood, but the measurement of P/S 12 m is less sensitive in distinguishing transudates from exidates and it should not be used routinely.
Slipping Rib Syndrome as a Cause of Chest Pain in Children
Authors: Taubman Bruce , Vetter Victoria L.
Published: June 2007

Four patients with the slipping rib syndrome presenting as chest pain are described, and the appropriate literature is reviewed. In two of the patients the physicians caring for the children were initially concerned that a cardiac condition was the cause of the chest pain, and a cardiac evaluation was done. In one patient an emotional cause for the pain was first considered and then a cardiac cause was pursued. In the last patient esophagitis was thought to be the cause and the child was referred to a gastroenterologist. It is suggested that slipping rib syndrome should be considered by physicians when evaluating children with a complaint of chest pain. The condition can be easily diagnosed on physical examination and therefore may save some patients from an unnecessary cardiac or gastroentestinal evaluation.
Treatment of Acute Gastroenteritis: Too Much and Too Little Care
Authors: Merrick Nancy , Davidson Bruce , Fox Steven
Published: June 2007

This paper reviews the health services literature regarding care for gastroenteritis in children. United States health care utilization, use of oral rehydration therapy (ORT), and quality of care considerations are described. The literature suggests that some US children may receive too much care while others may not be getting enough and that physician practices continue to differ from expert recommendations.
Continuity of Care Between Obstetrical and Pediatric Preventive Care: Indicators of Nonattendance at the First Well-Child Appointment
Authors: Grossman Lindsey K. , Humbert Aloysius J. , Powell Michelle
Published: June 2007

This study evaluates appointment behavior for first well-child visits for first-born children and identifies factors that target infants at increased likelihood for missing their first pediatric appointment. Timely appointments were not scheduled for 10.3% of newborns; 20.1% of those scheduling did not keep the first appointment. Younger, less educated mothers who did not remember when they had learned about well-baby care, and mothers of infants in the newborn intensive care unit were unlikely to schedule the appointment; young mothers learning about well care from friends or relatives and who chose a pediatrician without a previous prenatal visit were more likely to miss the child's first appointment. Prenatal pediatric visits as well as prenatal classes and written materials may improve compliance with the first well-child appointment.
Toward a Pathophysiology of Attention-Deficit/Hyperactivint Disorder
Authors: Castellanos F. Xavier
Published: June 2007

Converging insights into attention-deficit/hyperactivity disorder (ADHD) support the notion that ADHD is best characterized behaviorally as a disorder of self-regulation or executive functioning. Anatomic neuroimaging studies suggest that the relevant regulatory circuits include the prefrontal cortex and the basal ganglia, which are modulated by dopaminergic innervation from the midbrain and by stimulant medications. The emerging model proposed in this review encompasses a developmental perspective into this common condition.
A Review of the Newer Antiepileptic Drugs and the Ketogenic Diet
Authors: Barron Todd F. , Hunt Sarah L.
Published: June 2007

Since 1994, three new antiepileptic drugs, felbamate, lamotrigene, and gabapentin, have been released for the treatment of epilepsy. The present paper provides an overview of these three drugs and reviews their potential uses in pediatric epilepsy even though felbamate is the only one with an approved use in children. Topiramate and vigabatrin, which are under investigation, are briefly reviewed. In addition, a discussion of the ketogenic diet is included because of its recent publicity. Patient examples included provide clinical illustrations for the reader.
Management of Asymptomatic Term Neonates Whose Mothers Received Intrapartum Antibiotics Part–1: Rationale for ltrapartum Antibiotic Therapy
Authors: Allen Steven R.
Published: June 2007

The evaluation of the potentially septic newborn is often a source of frustration for practitioners. In the past, it has often been standard practice to evaluate and treat empirically all neonates whose mothers received antibiotics during labor, regardless of whether the infant had any signs or symptoms suggestive of infection. With the advent of recommendations for intrapartum antibiotic therapy to prevent early-onset neonatal group B streptococcal infections, this strategy is no longer practicable because too many infants would thus be evaluated and treated needlessly. This two-part review addresses the issues involved in managing asyrnptomatic newborns whose mothers received intrapartum antibiotics. This first part reviews the rationale behind strategies for preventing intrapartum transmission of bacterial infection. The administration of intravenous antibiotics to laboring mothers appears to reduce the incidence of group B streptococcal infections in neonates. Additionally, intrapartum antibiotic therapy for maternal chorioamnionitis may inhibit transmission of infection to the infant. Part 2–to be published separately–will address the evaluation and management of the newborn.