bluuebunny/crossref_metadata_2025 huggingface dataset:
Accidental Carbon Monoxide Poisoning
Authors: Gozal David , Ziser Avishai , Shupak Avi , Melamed Yehuda
Published: November 2007

Six cases of accidental carbon monoxide poisoning in children are presented. The importance of hyperbaric oxygen therapy as the cornerstone of treatment in the prevention of either acute or delayed complications is discussed.
Cerebrocostomandibular Syndrome
Authors: Smith Kim G. , Sekar K.C.
Published: November 2007

Cerebrocostomandibular syndrome (CCM) is characterized by micrognathia, cleft palate, rib defects, and frequently, mental deficiency. Death from respiratory complications occurs in 40 percent of cases before they reach 1 year of age. We describe a case of CCM with the previously unreported findings of large for gestational age at birth, radiologic evidence of bilaterally displaced radial heads, and development of brachycephaly.
Significance of Placental Findings in Early-Onset Group B Streptococcal Neonatal Sepsis
Authors: Novak Robert W. , Platt Marvin S.
Published: November 2007

Assessment of placental pathology and its relationship to historical data, initial laboratory parameters, and outcome was undertaken in 22 cases of early-onset group B streptococcal sepsis of the neonate. Fourteen (64%) of the placentas demonstrated chorioamnionitis, six (27%) funisitis, and in nine (41%) gram stain demonstrated organisms within the membranes. Focal villous edema was observed in five (23%) cases and diffuse villous edema in four (18%). No placenta demonstrated chorangiosis. Placental inflammation was significantly (p < 0.05) associated with prematurity, prolonged rupture of membranes, and onset of symptoms at less than 3 hours of age. No placental change was significantly associated with outcome or with neutropenia, which was the only parameter assessed that appeared to have prognostic value.
Hypernatremic Dehydration in Children with Severe Psychomotor Retardation
Authors: Listernick Robert , Sidransky Ellen
Published: November 2007

Three cases of hypernatremic dehydration in children with severe psychomotor retardation are described. All the children were receiving processed foods that contained extremely high amounts of sodium and were unintentionally deprived of free water. Salt and water intake must be monitored closely in children who can neither communicate thirst nor regulate their diet.
Neurofibromatosis and Malignancy
Authors: Warrier R.P. , Kini K.R. , Raju U. , Shumacher B. , Wu K.
Published: November 2007

Neural crest and nonneural crest tumors occur frequently in neurofibromatosis (NF). We report one case of NF and recurrent malignant fibrous histiocytoma, a tumor that is uncommon in childhood, and another case of the concomitant occurrence of NF, hemophilia B, and a paratesticular rhabdcrrnytrsarcoma.
Leg-length Inequality in Hemophilia
Authors: Heim Michael , Horoszowski Henri , Martinowitz Uri
Published: November 2007

A hemophiliac child with flexion contracture of the knee and symptoms of leg length difference was treated with a shoe lift on the affected side, which failed to aid the problem. Further investigation revealed that the affected limb was actually longer than the contralateral side. The chronic synovitis of the knee that had resulted in the contracture also caused supplementary bone growth around the distal femoral epiphysis, resulting in the lengthening of that leg.
Pertussis Complicated by the Syndrome of Inappropriate Antidiuretic Hormone Secretion
Authors: Matherne Paul , Matson James , Marks Melvin I.
Published: November 2007

Two cases of pertussis complicated by the syndrome of inappropriate antidiuretic hormone secretion (SIADH) are reported. Both patients experienced seizures associated with hyponatremia. Patients with severe pertussis are at risk for SIADH and should be monitored closely for its development.
Ophthalmoplegic Migraine in Infancy
Authors: Woody Robert C. , Blaw Michael E.
Published: November 2007

Ophthalmoplegic migraine, headache associated with oculomotor nerve dysfunction, may present early in the pediatric age group. Two cases of ophthalmoplegic migraine in infants 5 and 7-months-old are presented and their clinical management discussed.
Cerebral lnfarction in Hemophilus Influenzae Type B Meningitis
Authors: Taft Thomas A. , Chusid Michael J. , Sty John R.
Published: November 2007

Over a 5-year period, 8 (4.7%) of the 170 children diagnosed at Milwaukee Children's Hospital as having Hemophilus influenzae type b (HITB) meningitis developed cerebral infarction. Compared with children who did not develop infarcts or with children who developed other neurologic complications, such as subdural effusion, empyema, or meningoencephalitis, these children had significantly higher cerebrospinal fluid (CSF) leukocyte counts on initial lumbar puncture and had a greater likelihood of seizure activity. In seven of eight patients with cerebral infarction, a focal or generalized seizure heralded neurologic findings associated with abnormal radiographic studies. Two of the eight patients died, and two were permanently severely damaged. In the other four patients, there was eventual recovery from gross neurologic deficits. The mortality in patients with HITB meningitis complicated by cerebral infarction (25%) was significantly greater than that in other patients with HITB meningitis (0.6%). The pathophysiology of infarction in patients with bacterial meningitis is uncertain but may in part relate to arteriospasm. Cerebral infarction is a serious, and in the present experience, not uncommon complication of H. influenzae meningitis.
Normative Data of Hemoglobin Concentration and Free Erythrocyte Protoporphyrin in a Private Pediatric Practice
Authors: Benjamin John T. , Dickens Michael D. , Ford Raymond F. , Gleason Charles H. , Perriello Vito A. , Wood James B.
Published: November 2007

Free erythrocyte protoporphyrin (FEP) and hemoglobin concentrations in 788 children were investigated during routine check-ups in a private pediatric practice. FEPs > 3.0 ZPP/gm hemoglobin were found in 29.8 percent of 9-month-olds and in 9.6 percent of the total group tested. Correlations between FEP levels and hemoglobin concentrations are presented.
Salmonella enteritidis
Authors: Ross Steven A. , Townes Philip L. , Hopkins Timothy B.
Published: November 2007

A previously healthy 2.5-year-old boy developed symptoms of acute pyelonephritis following an acute gastroenteritis. The patient received parenteral ampicillin and gentamicin for 72 hours and then ampicillin for an additional 11 days when the original urine and stool cultures grew Salmonella enteritidis, sensitive to ampicillin. The patient responded very well to treatment, but B-mode renal ultrasonogram revealed a left hydronephrosis and megaureter suggestive of longstanding obstruction of the ureterovesicular junction, later confirmed by other diagnostic studies and by surgical exploration and repair. Salmonella infection has been rarely documented to cause pyelonephritis in children. Obstructive uropathy appears to be a predisposing factor for this unusual complication of Salmonella enteritis.
Differential Leukocyte Count in Infants of Diabetic Mothers
Authors: Mimouni Francis , Porat Shimon , Merlob Paul , Zaizov Rina , Reisner Salomon H.
Published: November 2007

The differential leukocyte count was studied within the first 24 hours of life in 115 infants of diabetic mothers (IDMs) appropriate for gestational age (AGA), 16 IDMs large for gestational age (LGA), 104 infants of non-diabetic mothers (INM's) AGA, and 22 INMs-LGA. A significant "shift to the left" was found in IDM's-LGA only. The usual causes of "shift to the left" such as maternal hypertension or fever, respiratory distress syndrome, meconium aspiration, neonatal asphyxia, sepsis, convulsions, or hypoglycemia could not explain this finding. It is hypothesized that increased glucocorticoid secretion may possibly play a role.
Pycnodysostosis with Visceral Manifestation and Rickets
Authors: Santhanakrishnan B.R. , Panneerselvam S. , Ramesh S. , Panchatcharam M.
Published: November 2007

Pycnodysostosis is a rare bone disease. Visceral manifestations associated with anemia and/or rickets have been reported in pycnodysostosis. Five children with typical findings of pycnodysostosis with hepatosplenomegaly, anemia with rickets, one with visceromegaly and anemia, and another with rickets alone are reported here. These findings strongly suggest that extramedullary erythropoiesis does occur in pycnodysostosis.
Isolation of Neisseria gonorrhea from the Urethra of Asymptomatic Adolescent Males
Authors: Smith Jerry A. , Linder Charles W. , Jay M. Susan , DuRant Robert H.
Published: November 2007

Symptomatic infection with Neisseria gonorrhea (NG) has become a major health problem in the adolescent population. While sexually active adults, who carry Neisseria gonorrhea may serve as a reservoir of infection even when asymptomatic, there are few data documenting the frequency of the asymptomatic carrier state in adolescent males. The purpose of this study was to determine the frequency of NG isolates in a sample of asymptomatic adolescent males (ages 13-18 years). Urethral cultures and gram stains were performed on 249 males (95% black) from a lower socio-economic background presenting to an adolescent clinic for routine health care. Of the 249 males cultured, 177 were without symptoms or signs of urethritis. NG were isolated from four (2.26%) patients (Z = 2.03, p ≤ 0.043). They were also isolated from 65 (90.3%) of the remaining 72 who had either symptoms or signs of urethritis. Although 26% of the patients had documented gonococcal disease, only 8% offered a genitourinary complaint at the time of initial evaluation. Our data indicate a low but statistically significant incidence of NG colonization comparable to that found in adult males in this population of asymptomatic adolescent males.
The Children's Depression Rating Scale for Normal and Depressed Outpatients
Authors: Shanahan Karen M. , Zolkowski-Wynne Joanna , Coury Daniel L. , Collins Edward W. , O'Shea John S.
Published: November 2007

The Children's Depression Rating Scale (CDRS) was devised by Poznanski, Cook, and Carroll in 1979, to diagnose depression in 6- to 12-year-olds. The authors state a score of 30 indicates significant depression, with scores in the 20 to 30 range indicating borderline depression. Normative outpatient data for the CDRS have not, however, been established. In this study, 25 apparently well-adjusted children from a pediatric primary care unit were evaluated by the CDRS. Their scores (ranging from 16 to 18) differed significantly from the normal values noted by the founders of the scale, based on the study of inpatients. On the other hand, a study of six of our clinically depressed children indicated scores of 22 to 49. With this definition of the normal score the outpatient child who scores greater than 20 is classified as in need of close follow up to determine if he is depressed.
Urolithiasis and Enteric Hyperoxaluria in a Child With Steatorrhea
Authors: Jones Deborah P. , Stapleton F. Bruder , Whitington Gene , Noe H. Norman
Published: November 2007

Malabsorptive states are frequently associated with increased urinary oxalate excretion. The authors describe a 10-year-old girl with steatorrhea, hyperoxaluria, and a renal calculus in a single functioning kidney. Successful management of steatorrhea corrected both the chronic diarrhea and hyperoxaluria. Enteric hyperoxaluria is a well-known etiology of calcium oxalate urolithiasis in adults. Pediatricians caring for children with malabsorptive conditions should be aware of the risk of urinary calculus formation as a result of increased dietary oxalate absorption.
Paroxysmal Nocturnal Hemoglobinuria Presenting As Recurrent Hemolytic Uremic Syndrome
Authors: Kletzel Morris , Arnold Watson C. , Berry Daisilee H.
Published: November 2007

Paroxysmal nocturnal hemoglobinuria (PNH) may present with acute anemia, thrombocytopenia and, if hemoglobin nephropathy or dehydration is present, azotemia. Thus PNH may be confused with the hemolytic uremic syndrome (HUS). Recurrent episodes, though common in PNH, are unusual in HUS. A positive acid hemolysis test can be used to differentiate between the two diseases.
Early Pulmonary Interstitial Emphysema in the Newborn: A Grave Prognostic Sign
Authors: Heneghan Margery A. , Sosulski Richard , Alarcon Margarita B.
Published: November 2007

Chest radiographs and clinical records of 58 newborns with pulmonary interstitial emphysema (PIE) were reviewed to determine the diagnostic and prognostic significance of this finding in the first 24 hours of life. Thirty-nine infants developed PIE before 1 day of age (early PIE). In the absence of infection, early PIE was associated with younger gestational age, lower birth weight, lower 1 and 5 minute Apgar scores, and higher mortality, as compared with patients in whom air leak occurred later. Survival in infants with PIE seemed to be influenced mainly by coexisting risk factors such as extreme prematurity, birth asphyxia, and perinatal infection. Most cases of early PIE in newborns less than 30 weeks gestational age occurred at peak ventilation pressures < 25 cm H 2O, and probably reflect increased sensitivity of the underdeveloped lung to barotrauma. In infants older than 30 weeks gestational age, early PIE was strongly associated with bacterial sepsis. These data indicate that the occurrence of PIE in the first 24 hours of life is a particularly ominous sign, and is frequently associated with clinical conditions which carry a poor prognosis.
infant Home Apnea Monitoring
Authors: Rowland Thomas W. , Donnelly Joseph H. , Landis John N. , Lemoine Marie E. , Sigelman David R. , Tanella Cari J.
Published: November 2007

Home apnea/bradycardia monitoring is commonly utilized in the management of infants who have had apnea episodes. Little is established, however, regarding appropriate decision-making guidelines and efficacy. The 5-year experience of the Western Massachusetts Apnea Evaluation Program was reviewed to examine patient outcome and to identify prognostic clinical features. Significant recurrent sleep apnea occurred in 7 of 110 infants in the combined awake and asleep group, and in 2 of 45 siblings of babies dying of SIDS. Unclear histories, normal laboratory tests, and uncertain diagnoses made it impossible to identify features that would indicate infants at risk for recurrence of apnea. Our data indicate that home apnea monitoring lacks specificity but is probably effective in reducing morbidity and mortality. It currently appears to be the most optimal means of managing infantile apnea.
Chest Pain, Dyspnea on Exertion, and Exercise Induced Asthma in Children and Adolescents
Authors: Nudel Dov B. , Diamant Shmuel , Brady Timothy , Jarenwattananon Marisa , Buckley Barbara J. , Gootman Norman
Published: November 2007

The contribution of maximal exercise tests to the evaluation of 180 patients with chest pain associated with exercise (n = 147) or dyspnea on exertion (DOE, n = 33) was examined. The ages ranged from 5 to 22 (mean 13.2) years, and 68 patients were females. All patients had a normal cardiovascular examination, electrocardiogram, chest x-ray, and 2D-echocardiogram. Maximal exercise tests were performed on a treadmill or bicycle ergometer, and flow volume loops were performed before and after exercise (n = 65). Exercise tests did not reveal any cardiovascular abnormalities, but 14 patients with chest pain (9.5%) and seven patients with DOE (21.2%) developed exercise-induced asthma. Postexercise decrease in peak expiratory flow rate was 26.2 ± 3.7 percent in patients with chest pain and 39.4 ± 8.9 percent in those with DOE. Only five patients had a personal history and four others had a family history of asthma. Seven patients had a personal or family history of allergies. Implications: 1) exercise-induced asthma should be considered in pediatric patients with symptoms of chest pain or dyspnea on exertion; 2) when exercise tests are performed, flow volume loops should be included before and after exercise; 3) maximal exercise tests are unlikely to unmask any cardiovascular abnormalities in such patients.
Childhood Dermatomyositis
Authors: Miller Laurie C. , Michael Alfred F. , Kim Youngki
Published: November 2007

The presentation, clinical course, and long-term follow-up (3-22 years) of 39 children with dermatomyositis followed from 1962-1982 is presented. The medical course of these patients was complicated by respiratory diseases (20%), gastrointestinal diseases (24%), and calcinosis (30%). Patients presenting prior to 1972 received a wide variety of treatments. Since 1972, treatment has consisted of long-term prednisone, supplemented in some patients with azathioprine. Ten patients died (eight of whom were first seen before 1972) of complications after intestinal perforation (5) or aspiration pneumonia (5). Of 29 survivors, three have persistent calcinosis and/or contractures. Improved outcome since 1972 probably relates to better clinical assessment, management of complications, and regulation of drug therapy.
Stress Management Techniques in Childhood and Adolescence
Authors: Smith Mark Scott , Womack William M.
Published: November 2007

Many childhood and adolescent stress-related symptoms have a psychophysiological component that involves muscular tension and/or autonomic nervous system dysfunction. Examples of this include recurrent headache, chest pain, abdominal pain, syncope, and dizziness. After a careful medical and psychosocial evaluation, the clinician may identify many patients who are appropriate for the application of stress reduction techniques such as progressive muscular relaxation, meditation, biofeedback, and relaxation/mental imagery (self-hypnosis). This review describes these techniques and their application with selected children and adolescents.
Transient Neutropenia of Childhood
Authors: Valiaveedan Rose , Rao Sreedhar , Miller Scott , Brown Audrey
Published: November 2007

Patient characteristics and clinical course are described in 21 children with newly discovered neutropenia (absolute neutrophil count <1500/μl). Only children over age 3 months are included ; 19 of 21 were less than age 2 years. The majority had respiratory tract infections and 11 had been on various medications at the time neutropenia was discovered. Bacteria were isolated from the blood of three patients ( S. pneumoniae in two, H. influenzae in one) and from urine in one (E. coli). Respiratory syncytial virus was cultured from the nasopharynx of two patients. Opportunistic, gram-negative and staphyloccal infections did not occur. Neutrophil counts in all but one child returned to normal within 6 weeks of onset; half recovered within 7 days. Bone marrow examination was performed in 13 patients: maturation arrest at various stages in the myeloid series was noted in six, and seven had normal myeloid maturation. Bone marrow findings did not correlate with degree or duration of neutropenia. These observations indicate that previously well infants with isolated neutropenia generally have a benign clinical course, although three patients were ultimately proven to have significant chronic illness. Recommendations are made as to management.
Neurologic Aspects of Bronchopulmonary Dysplasia
Authors: Campbell L. Rebecca , McAtister W. , Volpe Joseph J.
Published: November 2007

Thirty seven infants were identified with bronchopulmonary dysplasia (BPD). Their hospital records were examined and survivors evaluated to determine the neurologic aspects of BPD. Five infants exhibited progressive neurologic disease; nine infants, nonprogressive neurologic disease; and 19, normal neurologic outcome. In four, neurologic outcome was indeterminate because of early death. Thus, evaluation of this population of infants with BPD has established two syndromes of neurologic disease—progressive and nonprogressive. The patients with nonprogressive neurologic disease exhibited static neurologic deficits identical to those described in earlier reports of outcome in infants with BPD. The infants with apparently progressive neurologic disease had clinical courses comparable to the fatal pattern of cerebral deterioration previously described. The syndromes appear to be distinct in etiology and clinical presentation. Intraventricular hemorrhage complicated by hemorrhagic intracerebral involvement appears the factor most clearly associated with nonprogressive neurologic disease. The etiology of the striking progressive neurologic syndrome could not be so clearly established but appears to be related to the course and treatment of BPD.
Intracranial Hemorrhage in Term or Near-term Newborns With Persistent Pulmonary Hypertension
Authors: Oelberg David G. , Temple David M. , Haskins K. Stephen , Bigelow Robert H. , Adcock Eugene W.
Published: November 2007

To substantiate the clinical impression of an increased incidence of intracranial hemorrhage (ICH) in term and near-term infants with persistent pulmonary hypertension (PPH), a retrospective chart review of 35 affected patients was performed. ICH was diagnosed in 40 percent of the patients. Multiple regions of the brain were affected; in many patients, at more than one location. In addition, 43 percent of ICH victims had hemorrhages of the type associated with periventricular bleeding in preterm newborns. Of multiple obstetric and neonatal factors analyzed, many of which are identified risk factors for periventricular hemorrhage, only thrombocytopenia (p = 0.02) was significantly associated with ICH. We conclude that the risk of ICH in newborns with PPH is significant and warrants consideration by clinicians caring for this population. Risk factors (except thrombocytopenia) previously implicated in other types of neonatal ICH, particularly periventricular hemorrhage, do not significantly correlate with ICH in infants with PPH.
A Protocol of Plain Radiographs, Hip Ultrasound, and Triple Phase Bone Scans in the Evaluation of the Painful Pediatric Hip
Authors: Alexander J.E. , Seibert J.J. , Aronson J. , Williamson S.L. , Glasier C.M. , Rodgers A.B. , Corbitt S.L.
Published: November 2007

A useful protocol for the evaluation of hip pain in the pediatric patient, using a combination of plain radiographs, hip ultrasound (US), and triple phase radionuclide bone scans is presented. Patients with hip pain were initially evaluated by plain radiographs of the pelvis and hips. If no diagnosis was reached, the hips were studied for effusions by real-time hip ultrasonography. If an effusion was present, the joint was aspirated for diagnosis. If no effusion was present by US or if no diagnosis was reached by aspiration, triple phase radionuclide bone scans were performed.

Fifty patients were evaluated by this prospective protocol, and the diagnosis was reached in 48 of the 50 cases (10 by plain radiographs, 16 by US, and aspiration of the joint, and 22 by triple phase bone scans). Hip effusions were found in 20 patients by US, with no false positives or false negatives.

Previous studies for detecting effusions by US have emphasized absolute measurements of the capsular width, but we report a typical appearance of the hip capsule when fluid is present (a bulging convex capsule). When no effusion is present, the capsule is concave and parallels the long axis of the femoral neck.
High Levels of Lactate, Pyruvate, and Alanine in Anemic Children
Authors: Ceyhan Mehmet , Özalp Imran , Altay Çigdem
Published: November 2007

Lactate, pyruvate, and alanine levels were investigated in patients with iron deficiency anemia and other types of anemia. The study was carried out on 36 children between 2 and 16 years of age. The study group was divided into three groups, each comprised of 12 children. It was shown that the anemic children have lower PO2, higher PCO2 and higher levels of lactate, pyruvate, and alanine than the control group (p < 0.05). There was a negative linear correlation between lactate levels and hemoglobin values (r = -0.6213; p < 0.05), but no correlation between hemoglobin and the alanine and pyruvate levels. Levels of lactate, pyruvate and alanine were similar in the iron deficiency and the other anemia groups.

In conclusion, iron has no direct effect on the levels of lactate, pyruvate, and alanine, but the hypoxemia caused by anemia could be responsible for the higher levels of the lactate, pyruvate, and alanine. In cases with high levels of lactate, pyruvate, and alanine, anemia has to be considered in the differential diagnosis of hyperlactatemia.
Neonatal Gastric Volvulus Secondary to Rectal Atresia
Authors: Mizrahi Solly , Vinograd Itzhak , Schiller Medad
Published: November 2007

The "upside-down stomach" is a rare form of organo-axial neonatal volvulus, which occurs because of absent or attenuated anatomical anchors and abnormal motility of the stomach. It is considered a surgical emergency that requires immediate correction.

We report a previously undescribed etiology of gastric neonatal volvulus caused by an extremely distended transverse colon, secondary to rectal atresia. The etiologic and diagnostic considerations are discussed. Gastropexy in the form of gastrostomy proved to be an effective treatment.
Acute Gastroenteritis: Clinical Features According to Etiologic Agents
Authors: Khuffash Faisal A. , Sethi Sarvan K. , Shaltout Azza A.
Published: November 2007

The clinical manifestations in 595 children hospitalized with gastroenteritis during a 15-month time frame were studied. They were divided into eight groups according to etiologic agent: rotavirus (203 patients); Salmonellae (98); Escherichia coli (55); Campylobacter (36); Shigella (22); combined rotavirus and salmonellae (44); combined rotavirus and other bacteria (26); and no pathogen (111). The mean duration of diarrhea was shortest in the rotavirus and "no pathogen" groups (4.8 and 5.6 days, respectively) and longest with pure and mixed salmonella infections (12.3 and 12.9 days, respectively).

Associated manifestations were most frequent with salmonellae and least frequent with rotavirus and E. coli infections. Malnutrition also was most common with salmonellae and lowest with rotavirus and E. coli. There were no differences in the frequency of hypernatremia. Hyponatremia was most frequently encountered with salmonella (25% compared to 9% in the rest of the patients). Evidence of septicemia was found in 22 patients, 21 of whom were in the salmonella groups. The four deaths in this series (0.7%) also were in the salmonellae groups. The clinical severity of salmonella infection in developing countries, particularly in young and malnourished children, warrants attention to more intensive management. The selective use of antibiotics may help reduce the mortality and morbidity of gastroenteritis.
Twelve-hour Spontaneous Nocturnal Growth Hormone Secretion in Growth Retarded Patients
Authors: Spadoni G.L. , Cianfarani S. , Bernardini S. , Vaccaro F. , Galasso C. , Manca Bitti M.L. , Costa F. , Boscherini B.
Published: November 2007

Twelve-hour nocturnal GH secretion was studied in 30 children with familial short stature (FSS), constitutional growth delay (CGD), total growth hormone deficiency (TGHD), partial growth hormone deficiency (PGHD), or idiopathic short stature (ISS). No difference was observed between subjects with FSS and children wtih CGD. The mean 12-hour serum GH concentration was significantly lower in patients with TGHD (p < 0.001), children with PGHD (p < 0.01), and subjects with ISS (p < 0.01) than in subjects with FSS and CGD. No overlap was observed between the range of mean concentration values of children with TGHD and that of subjects with FSS.

A significant correlation was found between growth velocity expressed as SD from the mean for bone age and GH concentration (p < 0.001). All patients with a growth velocity <3rd percentile for bone age showed a mean nocturnal concentration <4 ng/ml.

These data suggest that evaluation of 12-hour spontaneous nocturnal GH secretion with GH sampling every 30 minutes can be usefully employed in the diagnosis of GH deficiency.
Transient Blindness Following Mild Head Trauma
Authors: Yamamoto Loren G. , Bart Robert D.
Published: November 2007

A series of seven children in Hawaii experienced transient cortical blindness following mild head trauma. All children, ages 3 through 8, recovered fully. The most prominent clinical feature was initial restlessness and agitation following relatively mild head trauma without significant loss of consciousness (LOC). One child may have experienced this several times.

The clinical features associated with a benign outcome in this syndrome include: pediatric age group, mild head trauma, brief or no LOC, onset of blindness occurring within hours of the head injury, absent optokinetic nystagmus, duration of blindness less than 24 hours, agitation and restlessness, absence of skull fracture or visible cerebral injury on CT scan, absence of other neurological deficits, and EEG findings that initially show posterior slowing with subsequent normalization. Transiently fixed and dilated pupils have been described in these patients but should be viewed cautiously by clinicians in making this diagnosis, since cortical blindness is defined by sparing of the pupils.

This syndrome may be underdiagnosed, since it may not be obvious that the child is blind unless the diagnosis is considered.
Clinical Aspects of Mental Retardation
Authors: Montgomery Thomas R.
Published: November 2007

The charts of 101 mentally retarded children were studied to determine how their retardation first came to the attention of their pediatrician. It was found that Speech Delay, Developmental Delay, and School Failure were the three most common parental concerns. Speech Delay accounted for over 50 percent of all referrals of children age 2 to 6 years. A first step to improve accurate evaluation and treatment of mental retardation is to recognize how children ultimately diagnosed as retarded are initially brought to the attention of the pediatrician.
Dermoids of the Posterior Fossa
Authors: Starinsky R. , Wald U. , Michowitz S.D. , Lahat E. , Schiffer J.
Published: November 2007

Three children are presented with dermoid cysts of the posterior fossa, one of the most common locations of dermoid. They were initially diagnosed as having abscesses. Clinical presentations included hydrocephalus and recurrent meningitis. A helpful clue for identification is a bony defect of the skull on plain film or on a bone-window at Computed Tomography (CT).
Carving a Niche: The General Academic Pediatrician as Consultant
Authors: Listernick Robert , Tanz Robert R. , Davis A Todd
Published: November 2007

The General Academic Pediatrician (GAP) may act as a consultant to both primary care pediatricians and tertiary care subspecialists. The authors surveyed a consultation service staffed by three GAP's in a tertiary care children's hospital. The service was financially successful and generated new sources of referrals for its parent institution. The increasing complexity of the role of a GAP within a department of pediatrics in regards to clinical, teaching, and research activities is explored.
In an Infant with Previously Undiagnosed Hemophilia A
Authors: Faillace Walter J. , Warrier Indira , Canady Alexa I.
Published: November 2007

We report a 3-month-old infant who became paraplegic from an epidural hematoma caused by a diagnostic lumbar puncture for work-up of sepsis. The differential diagnosis of the cause of paraplegia was epidural hematoma formation versus spinal abscess. Hemophilia A was diagnosed when coagulation studies were discovered to be abnormal, and non-contrast CT scan revealed an epidural mass with spinal cord displacement. The coagulopathy was rapidly corrected preoperatively with an infusion of cryoprecipitate. A medially limited bilateral T8-L4 laminectomy allowed complete evacuation of the hematoma with maximum preservation of normal bone tissue, but no clinical improvement resulted.

Coagulopathy should be highly suspect in an infant who becomes paraplegic after lumbar puncture. The coagulopathy may be rapidly corrected with deficient factor replacement, allowing major spinal surgery to be performed safely.
Giftedness
Authors: Shapiro Bruce K. , Palmer Frederick B. , Antell Sue E. , Bilker Stacey , Ross Alan , Capute Arnold J.
Published: November 2007

A cohort of 200 children, who were followed from birth and periodically evaluated as part of a longitudinal study of child development, was used to determine the ability of the Bayley Scales of Infant Development (BSID) to predict children who would be considered intellectually gifted at 7.5 years. The cohort was predominantly white (91%), upper middle class (70% in Hollingshead class 1 or 2), and had preschool educational experiences (94% ).

At outcome, 36 children had WISC-R verbal, performance, or full scale IQs greater than 135 and were called gifted. On average, gifted children walked 0.7 months earlier and spoke two-word sentences 2.2 months earlier than the non-gifted group. As a group, gifted children showed statistically significant, but clinically small, advantages for age of walking, age of speaking two-word sentences, BSID, and Stanford Binet IQ.

Of the 36 children who later proved to be gifted, only two had BSID IQs > 134. Of the four children who had BSID IQs > 134, two maintained their superior function but 2 did not. A discriminant function analysis was used to predict giftedness for individual children based on BSID performance. The resulting classification achieved sensitivity = 0.69 and specificity = 0.39.

Although groups of infants who will be gifted have higher BSID scores, the BSID cannot be endorsed as a method of identifying individual infants who will later demonstrate superior cognitive function.
Measures of Attention Deficit
Authors: Blondis Thomas A. , Accardo Pasquale J. , Snow Jeffrey H.
Published: November 2007

Despite much progress in the diagnosis and management of children with attentional problems, hyperactivity, and learning difficulties, current diagnostic techniques remain inadequate to readily distinguish a primary attentional disorder from a more complex secondary problem. Developmental and behavioral questionnaires to supplement office evaluation of hyperactivity, neuromaturation, and selected cognitive processes continue to be improved. These measures suffer from different biases, focus on different childhood characteristics and associated problems, and approach childhood interaction with the environment differently. Several are psychometrically more sound, and several provide the physician with developmental and social information that may help improve the habilitative prescription.

The general pediatrician can use these questionnaires to complement his or her evaluation and follow-up of children who present with learning and behavioral problems. Prior to choosing an instrument, the clinician should review the advantages of each and choose the one most suited to his or her practice.
Left Pleural Effusion
Authors: Schwartz I. David , Olson Lloyd C.
Published: November 2007

The authors describe a young girl presenting with fever and respiratory distress and a chest x-ray showing a left lower lobe infiltrate and an effusion. She also had splenomegaly. Salmonella enteritidis serotype Heidelberg was isolated by thoracentesis. Further evaluation disclosed an occult but large left subphrenic abscess, explaining the misleading presentation and radiograph. A review of salmonella infections associated with subphrenic abscess is discussed.
Very-low-birth-weight, Preterm Infants With or Without Intracranial Hemorrhage
Authors: Ford Lisa M. , Kim Han B. , Steichen Jean , Babcock Diane , Fogelson Harold
Published: November 2007

Fourteen very-low-birth-weight (VLBW) preterm infants with and without intracranial hemorrhage (ICH) were prospectively followed from birth to 4 to 8 years for the purpose of determining neurologic and cognitive sequelae associated with ICH severity and to correlate outcomes with brain morphology as determined by Magnetic Resonance Imaging (MRI).

Intracranial hemorrhage was documented by cranial ultrasonography performed in early life. Follow-up assessments included neurologic and psychometric examinations and cranial MRI scans. Of six children with no ICH, five had normal results on all three follow-up measures. Three children with Grade I-II ICH had mild to moderate neurologic and cognitive sequelae with focal white matter MRI abnormalities. Five children with Grade III-IV ICH had severe neurologic, cognitive, and MRI deficits, including MRI regional and diffuse white matter abnormalities and/or cortical atrophy. Focal and diffuse neurologic deficits correlated with the extent of MRI morphologic abnormalities.

Results of this study indicate that ICH severity correlated with outcomes in children at follow-up ; the more severe the ICH, the more adverse the neurologic, cognitive, and MRI results. MRI white matter abnormalities were present in all children with any degree ICH, while ventriculomegaly was seen only in severe ICH (Grade III-IV ICH). Neurologic deficits correlated with MRI structural abnormalities.
Down Syndrome
Authors: Caputo Anthony R. , Wagner Rudolph S. , Reynolds David R. , Guo Suqin , Goel Ameet K.
Published: November 2007

A total of 187 medical records of Down syndrome individuals over a 10-year period were reviewed retrospectively for strabismus, myopia, hyperopia, astigmatism, nystagmus, cataract, glaucoma, and other significant eye findings. This study showed that a higher proportion of these individuals than reported in previous studies had strabismus (57%). Refractive errors of myopia (22.5%), hyperopia (20.9%) and astigmatism (22%) were common. The primary care physician needs to be aware of the specific eye problems of Down syndrome individuals so that he or she may initiate or refer the patient for appropriate ophthalmologic care, because most of the eye findings in Down syndrome are treatable. Significant visual loss, a usually avoidable event in Down syndrome, should occur rarely.
Effects of Hospitalization Derived from a Family Diary
Authors: Schum Timothy R.
Published: November 2007

Management of psychosocial issues associated with hospitalization are essential to the practice of pediatrics. The personal experience of our son's prolonged hospitalization due to osteomyelitis (23 days) was detailed by an ongoing diary. The impact of this hospitalization on our family is presented, including: 1) normal but bothersome behavioral changes in the patient and his sibling; 2) the effects of excessive parental stress; 3) the development of parental coping strategies ; and 4) stresses and coping strategies specific to a physician-father. Specific recommendations are presented to assist health professionals in addressing psychosocial issues.
Sonographic Observations in a Patient with Typhlitis
Authors: Merine Dimitri , Nussbaum Anna R. , Fishman Elliot K. , Sanders Roger C.
Published: November 2007

The sonographic findings in a patient with typhlitis are presented. Sonography showed a solid mass with a "target" sign in the right lower quadrant, continuous with the ascending colon. In addition to suggesting the diagnosis, sonography was helpful in the follow-up examination of the patient because it was able to assess the gradual decrease in the thickness of the bowel wall and ultimate resolution of the inflammatory process.
Auditory Dysfunction
Authors: Oberklaid Frank , Harris Claire , Keir Eddie
Published: November 2007

One hundred thirty-three children with school problems referred to a hospital-based multidisciplinary clinic were screened audiologically to determine the frequency of auditory problems, and to determine whether one could predict auditory problems from clinical data. Ninety-three (69.9%) failed one or more parts of the screening procedure. Twenty-two children (7.9% of the total group) had abnormal hearing acuity, 33 (30.6%) abnormal speech discrimination in noise, and 73 (62.4%) abnormal short term auditory memory. These figures are significantly higher than those found in a representative sample of school children.

Not one of 16 items from parent and teacher questionnaires and neurodevelopmental findings predicted auditory acuity or speech in noise problems; there were correlations between short term auditory memory items and parental and teacher rating of a language problem, teacher rating of reading and sequencing problem, and neurodevelopmental finding of auditory sequencing problem. In view of this inability to clinically predict auditory processing deficits, the authors suggest that a full audiological assessment, including short term memory and speech in noise testing, is warranted as part of the evaluation of children with learning difficulties.
Capillary Blood Glucose Monitor
Authors: Presti Blair , Kircher Tobias , Reed Chuck
Published: November 2007

The performance of a rapid capillary blood glucose monitor, the Glucoscan 2000, was evaluated in a neonatal patient population by comparison with a reference method on 283 paired patient samples. The median glucose was 56 mg/dL (3.1 mmol/L). The slope of the regression line was .93 with a correlation coefficient r of .82. The average error in Glucoscan values at low, intermediate and high glucose ranges was 43%, 20% and 12% respectively. Precision analysis by replicate determinations also showed an increased coefficient of variation, 7.4%, at low glucose values.

The Glucoscan 2000 lacks sufficient accuracy and precision at low glucose values to serve as the exclusive analytic test for the diagnosis of neonatal hypoglycemia.
The Child as Proband
Authors: Gidding Samuel S. , Whiteside Penelope , Weaver Stephanie , Bookstein Lisa , Rosenbaum Diane , Christoffel Katherine
Published: November 2007

The authors evaluated the lipids of parents of hypercholesterolemic children to assess the prevalence of unrecognized and/or untreated hyperlipidemia. Biologic parents of 34 children had measurements of total cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides (n = 47) or total cholesterol only (n = 14). Lipid abnormalities were defined according to guidelines established by the National Cholesterol Education Program. Abnormal values were defined as total cholesterol greater than 240 mg/dl, low-density lipoprotein (LDL) cholesterol greater than 160 mg/dl, HDL cholesterol less than 35 mg/dl, and triglycerides greater than 250 mg/dl. Borderline values were defined as total cholesterol between 200 and 240 mg/dl and LDL cholesterol between 130 and 160 mg/dl. Abnormal values were found in 32/61 (52%) and borderline values were found in 12/61 (20%) parents. Of the abnormal parents, 13/32 (41%) had unrecognized or known but untreated hyperlipidemia, and 9/12 (75%) of the borderline parents had unrecognized abnormalities. In all families where both parents were tested, at least 1 had a lipid abnormality. The authors conclude that when children with hypercholesterolemia are identified, parents should also have lipids assessed. Treatment programs for children should also be directed at the parents.
Thyroid Storm
Authors: Aiello Domenic P. , DuPlessis Adre J. , Pattishall Evan G. , Kulin Howard E.
Published: November 2007

Thyroid storm is a rare occurrence in the adult population and is even more unusual in children. The current report is of a 3.5-year-old girl who had thyroid storm with unique neurologic manifestations, namely seizure and coma. Acute medical management with propylthiouracil, saturated solution of potassium iodide, hydrocortisone, and propranolol brought about complete resolution of symptoms.
Relapsing Post-hepatitis Aplastic Anemia
Authors: Shannon Kevin , Koehne William , Heyman Melvin B. , Koerper Marion A.
Published: November 2007

A 20-month-old Hispanic male developed severe aplastic anemia after an episode of non-A, non-B hepatitis. Prompt and complete recovery of all hematopoietic cell lines occurred after treatment with antithymocyte globulin (ATG) and high-dose corticosteroids. Severe aplasia recurred two months later coincident with a mild upper respiratory infection. A second course of immunosuppressive therapy was followed by complete, sustained improvement. The authors' experience provides clinical evidence indicating that immunologic mechanisms are important in the treatment of severe post-hepatitis aplastic anemia. Children in whom aplastic anemia recurs after immunosuppressive treatment may respond to a second course of therapy.
Potential Substance Abuse
Authors: Schwartz Richard H. , Wirtz Philip W.
Published: November 2007

The authors administered an abbreviated revision of a previously field-tested, self-administered, brief screening test (the 30-item Drug and Alcohol Problem Quick Screen) to 355 consecutive middle-class adolescent patients seen at a five-pediatrician group practice setting. Ninety-six percent (341) of the subjects completed the 30-item screening questionnaire. Eighty-nine percent of the 341 responders wrote in their names in the space provided for that purpose. Fifty-two patients (approximately 15%) of the 341 responded "yes" to six or more items in the current study. Based on a previous study comparing scores from 200 adolescents from the same pediatric practice with answers from 100 identified adolescent drug abusers at a drug abuse treatment facility, those patients with a score of 6 or more were considered high risk for "red flag" behaviors, particularly drug or alcohol abuse. Forty (77%) of those patients who scored six or greater identified themselves by name.

Four key items on the questionnaire accounted for 70 percent of the variation between those at high and those at low risk for drug or alcohol abuse. These four most important items encompassed 1) use of tobacco products; 2) accusation by others of having a drinking or drug problem; 3) school suspension; and 4) riding in a motor vehicle with a driver who drank too much. The DAP Quick Screen appears to be practical as a screening tool in physician's offices for detection of serious problems during adolescence.
Munchausen Syndrome by Proxy and Apnea (MBPA)
Authors: Light Michael J. , Sheridan Mary S.
Published: November 2007

The authors sent questionnaires to 127 apnea monitoring programs asking whether they had treated patients whose apnea appeared to have been induced by a parent (Munchausen syndrome by proxy-apnea, or MBPA). Fifty-one programs (40%) reported 54 cases of this kind from among their 20,090 monitored patients (0.27%). The authors obtained further information on 32 of these patients, 83% of whom presented with infantile apnea before the third month of life.

Although medical problems were documented, including apnea, the clinical condition of these infants was inconsistent with the multiple life-threatening episodes typically reported by parents. Twenty-one of the infants reportedly received cardiopulmonary resuscitation at home, 15 had ambulance calls to the home, and 24 were rehospitalized. Child Protective Service agencies were consulted for 12 patients, 5 of whom were placed in foster homes. Three index infants and five siblings are known to be dead, and one additional infant is severely brain damaged from abuse.

The typical presentation of MBPA is multiple, reported, serious episodes of apnea occurring in the presence of only one person. When neither episodes nor cause can be documented satisfactorily, the diagnosis of MBPA should be considered and steps taken to confirm or refute it.
Thrombocytopenia Absent Radius Syndrome Associated with Renal Insufficiency
Authors: Fivush Barbara , McGrath Sharon , Zinkham William
Published: November 2007

Thrombocytopenia absent radius (TAR) syndrome, associated with small, echogenic kidneys and subsequent end-stage renal disease, was seen in a full-term newborn. In this infant, renal insufficiency may have increased the known risk of bleeding that is associated with TAR syndrome. Renal abnormalities and dysfunction are unusual in TAR syndrome. When they are present, however, treatment with frequent transfusions and early dialysis may be necessary to prevent serious and life-threatening hemorrhagic episodes.