bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of CF Summer Camp
Authors: Kaplan Ted A. , McKey Robert M. , Toraya Norma , Moccia Gina
Published: November 2007

In two consecutive years, patients with cystic fibrosis were studied at the beginning and end of a nine-day summer camp program to assess the program's effects on weight gain and pulmonary function. The camp experience includes daily exercise and a high-protein and high-fat diet. There were a total of 58 children between 6 and 12 years of age (42 different patients) and 10 adult counselors from 19 to 30 years of age (eight different patients). On the first and eighth days patients were weighed, sputum cultures were collected, and spirometry was performed. In year 2, peak expiratory flow rate was monitored daily. Also in year 2, campers and counselors with CF were prescreened by sputum culture and excluded from camp if they had Pseudomonas cepacia in their sputum. Only one candidate screened was positive before camp. In year 1, no significant group changes in pulmonary function were identified. In year 2, significant increases on post-camp testing were found for FEF 25%-75% and PEF. Mean body weight for all patients increased significantly, by 0.4 kg in year 1 and 0.9 kg in year 2 (p <. 05) . In year 1, a total of nine patients acquired a new organism in their follow-up sputum culture, including five who acquired a new Pseudomonas species. There was no intra-cabin pattern of spread. Four patients were positive for P. cepacia on day 1 culture. No new subjects acquired this organism on follow-up examination. In year 2, only one subject had P. cepacia on the first camp collection; he alone was positive on day 9. Physiological effects on body weight and pulmonary function varied on an individual basis, revealing significant group benefits in body weight and, in year 2, a reduction of pulmonary obstruction. P. cepacia was not transmitted in this setting, with or without prescreening.
Obstetric and Perinatal Events
Authors: Casey Rosemary , Rieckhoff Monica , Beebe Susan A. , Pinto-Martin Jennifer
Published: November 2007

Physicians commonly rely on maternal recall of events during pregnancy, delivery, and the perinatal period. Investigators who are doing research in the reproductive and perinatal areas also rely on maternal recall. However, there is little information regarding its accuracy. This study evaluates the accuracy of maternal knowledge of events during pregnancy, delivery, and the perinatal period by comparing maternal report with information recorded on the medical records of the mother-infant pair. Results are presented as sensitivity, specificity, and chance-corrected agreement. Mothers demonstrated poor knowledge of pregnancy and delivery-room events. Agreement between maternal reports and hospital records was excellent for infant birth weight and type of delivery, and good for infant jaundice. However, other important areas of the infant's history, such as an evaluation for sepsis, were poorly recalled. The implications of these results are both medical- and research-specific. Physicians must be aware of possible inaccuracies in the mother's history and make every attempt to obtain the nursery discharge summary. In addition, researchers must verify the results of their data when relying on maternal recall, with the exception of infant birth weight and method of delivery.
Report of a Case of Phenobarbital-Induced Dystonia
Authors: Lacayo Alvaro , Mitra Nirmala
Published: November 2007

We report a case of acute dystonia in a child hours after an initial oral loading dose ofphenobarbital was given.
Temporary Blindness Due to Sodium Nitroprusside Overdosage in a Postoperative Patient: an Unusual Adverse Effect
Authors: Olgunturk F. Rana , Yener Ali , Tunaoglu F. Sedef , Gokgoz Levent , Aslamaci Sait
Published: November 2007

Sodium nitroprusside dihydrate (SNP) is a powerful and easily managed vasodilator which is administered by intravenous infusion following appropriate dilution. Although it was first used in 1951 for treating hypertensive crises in adults, its use in children for this indication was first reported in 1969.1 Since this report, it has been widely used in various cardiovascular and other disorders amenable to hypotensive therapy. The drug must be used carefully because it has some undesirable effects like fatigue, syncope, and shock due to rapid fall in blood pressure. Also, if the drug is administered in high dosage, symptoms of cyanide (CN) poisoning may appear.2 Symptoms and signs of nitroprusside toxicity in children have been underemphasized in the medical literature. In this article, a child is presented who had temporary blindness due to SNP intoxication in the postoperative period after correction of coarctation of the aorta.
Predicting Length of Hospitalization of Sick Neonates from Their Initial Status
Authors: Pearlman Stephen A. , Stachecki Sharon , Aussprung H. Leon , Raval Nikhil
Published: November 2007

It has been suggested that the estimated date of confinement (EDC) may be used to predict the length of hospital stay for sick newborns. We have found this method unreliable and designed the following study to develop a mathematical model to predict length of stay (LOS). We reviewed the records of 393 neonates. Statistical analysis was performed using multiple linear regression. The factors that reached statistical significance were birth weight (BW), gestational age (GA), and a combined respiratory score (RES). The RES was developed to quantify the degree of initial respiratory illness. Through this model we developed the following formula: loge (LOS) = 4.395 - 0.023 (GA) - 0.00054 (BW) + 0.0274 (RES). The R value is 0.78. The model predicts an LOS ±10 days in 73% of cases. Overall, this model yields a 29% improvement in predictability of LOS compared with a model which used EDC only. This formula may provide useful information for parents and caregivers of hospitalized neonates.
Effect of Dietary Aspartame on Plasma Concentrations of Phenylalanine and Tyrosine in Normal and Homozygous Phenylketonuric Patients
Authors: Mackey Stephanie A. , Berlin Cheston M.
Published: November 2007

Six normal subjects each ingested a single 12 - oz can of a diet cola (Diet Coke) providing 184 mg aspartame (APM), of which 104 mg is phenylalanine (Phe), and, on another occasion, a single 12 - oz can of regular cola (Coke Classic). Neither cola significantly affected plasma concentrations of Phe or tyrosine over the three-hour postingestion study period. Each of five homozygous phenylketonuric (PKU) subjects (ages 11, 16, 17, 21, and 23 years) ingested a single 12 - oz can of the same diet cola. In these five subjects (three with classic PKU and two with hyperphenylalinemia), the increase in plasma Phe concentrations varied from 0.26 mg/dL to 1.77 mg/dL two or three hours after ingestion (baseline levels, 5.04 to 17.2 mg/dL) . Tyrosine concentrations did not differ significantly from baseline levels. The data indicate that ingestion of dietary Phe, as supplied in a single can of diet cola, is readily handled in both normal and PKU subjects. The small increases in plasma Phe concentrations in the homozygous PKU patients are not considered clinically significant.
Interobserver Variability in Assessing Pediatric Postextubation Stridor
Authors: Kemper Kathi J. , Benson Michael S. , Bishop Michael J.
Published: November 2007

The reliability of parameters used to assess pediatric postextubation upper respiratory distress is unknown. We prospectively studied the interobserver reliability of six parameters commonly used to assess respiratory distress in children. Eligible patients were <15 years old and hospitalized for traumatic injuries at Harborview Medical Center between March and September 1989. At extubation, patients were examined independently by a physician, a nurse, and a respiratory therapist, each of whom evaluated respiratory rate (RR), stridor, air movement, flaring/retractions (F/R) , level of consciousness (LOC), and oxygen saturation (02 sat). Reliability was measured by percentage agreement and weighted kappa (Kw). The 25 children (27 extubations) had a median age of 7 years, and eight of the 27 required treatment for upper airway obstruction. Percentage agreement ranged from 82% (for air movement) to 96% (for 02 sat). Weighted kappas were excellent for RR and F/R (Kw >.6); moderate for LOC, stridor, and 02 sat (0.4 <Kw <.06); and poor for air movement (Kw <.4). Further improvements in interobserver agreement are required to provide more consistent upper airway management in critically ill children.
Regional Anesthesia in the Preterm Neonate
Authors: Tobias Joseph D. , Flannagan John
Published: November 2007

The physiologic immaturity of respiratory musculature and central respiratory control centers leads to an increased risk of apnea and respiratory complications following general anesthesia in the neonate. Regional anesthetic techniques, such as spinal and caudal epidural anesthesia, may obviate the need for general anesthesia and lessen the risks of perioperative morbidity. Although these techniques have been previously described in infants, most reports focus on regional anesthesia in the former preterm infant outside the actual neonatal period. There is relatively little or no information concerning regional anesthesia in neonates during the first week of life. We present four neonates (weight, 1.07 to 2.8 kg; gestational age, 27 to 35 weeks) who required anesthetic care during the first week of life for various surgical procedures, including vesicostomy placement, gastroschisis closure, and debridement of a lower-extremity wound. Either caudal epidural or spinal anesthesia was successfully used in the four neonates. Regional anesthesia was used as the sole technique without supplementation with intravenous or inhalational agents in three of the four neonates. The advantages, risks, and applications of regional anesthesia in the neonate are discussed.
Urinary Tract Infections and the Uncircumcised State: An Update
Authors: Wiswell Thomas E. , Hachey Wayne E.
Published: November 2007

In a two-part study of the circumcision status of boys with urinary tract infections (UTIs), we reviewed the occurrence of UTIs in 209,399 infants born in US Army hospitals worldwide from 1985 to 1990. During the first year of life, 1,046 (0.5%: 550 girls and 496 boys) were hospitalized for UTIs. Noncircumcised male infants had a 10-fold greater incidence of infection than did circumcised male infants. The frequency rate of circumcision rose significantly, from 70.3% to 80.2%, during the study period. Among uncircumcised boys younger than 3 months with UTIs, 23% had concomitant bacteremia involving the same organism. The second part of the study consisted of a meta-analysis of all nine previous reports on the circumcision status of boys with UTIs. These studies revealed a fivefold to 89-fold increased risk of infection in uncircumcised boys; the combined data yielded a 12-fold increase in UTIs in this population. Parents should be told of the lower risk of UTIs for circumcised boys during informed-consent counseling.
A Technique for Placement of a Totally Implantable Central Venous Port
Authors: Gilchrist Brian F. , Novak Zina
Published: November 2007

The use of totally implantable central venous catheters with reservoirs has grown steadily over the past few years. These systems mitigate many of the inherent problems associated with catheter systems that protrude from the skin. Totally implantable systems are easily cared for and permit activities such as swimming. These features have led many surgeons and patients to favor their use. However, some surgeons have resisted their use because of the added technical difficulty in placing the reservoir. The technical problem in seating a subcutaneous reservoir can be solved by utilizing the technique described below. It is especially useful in the pediatric patient, where the operative field is confined.
Urine Collection From Disposable Diapers in Premature Infants: Biochemical Analysis
Authors: Muratore Christopher , Dhanireddy Ramasubbareddy
Published: November 2007

Urine collection for analysis is commonly done in premature infants in sterile adhesive bags. Leakage due to poor adherence of the bag and irritation of the skin are frequent drawbacks with this technique. Urine retrieved from the fiber padding of disposable diapers has been shown to be reliable for biochemical analysis.1-3 However, the previous studies were done under laboratory conditions and the volume of urine used was much larger than a premature infant may void at one time. The purpose of this study was to determine the reliability of urine collected from disposable diapers for biochemical analysis in premature infants in the intensive care nursery.
Pediatric Liver Transplantation
Authors: Kocoshis Samuel A. , Tzakis Andreas , Todo Satoru , Reyes Jorge , Nour Bakr
Published: November 2007

Pediatric liver transplantation has advanced remarkably over the past three decades. One-year survival has progressively increased to nearly 90% in patients transplanted for most forms of liver disease. Parallel advances in organ procurement, operative technique, immunosuppression, and infection control are responsible for improved patient survival. Among the most important advances are use of the University of Wisconsin (UW) organ preservation solution, the employment ofvenovenous bypass and/or "piggyback" operative technique, the development of cyclosporine A (CyA) and FK506, and the emergence of acyclovir, ganciclovir, foscarnet, and alpha interferon to combat life-threatening viral infections. The current organ shortage is being addressed by "cutdown" liver transplantation, "split liver" transplantation, and living-related donations. The next decade is likely to see advances in multivisceral transplantation, induction of chimerism by simultaneous bone marrow-solid organ transplantation, and performance of cross-species xenografting.
Financial and Emotional Cost Of Bronchopulmonary Dysplasia
Authors: McAleese Kelly A. , Knapp Marcia A. , Rhodes Torunn T.
Published: November 2007

Bronchopulmonary dysplasia (BPD) in infants with neonatal respiratory disease significantly increases the duration of hospitalization and cost of medical care. Early discharge on home oxygen therapy results in cost savings for third-party payers and the hospital, but adds financial and emotional burdens for the family. The median cost of initial hospitalization for 59 infants was $173,160 each. The median duration of home oxygen therapy was 92 days; the median cost was $5,195, compared with a projected cost of $46,920 for hospitalization for the same period. Two thirds of the 59 families experienced increased financial stress associated with marital status, reduced income, type of health insurance, and/or lack of respite or nursing help. Emotional stress was assessed in 26 (44%) of the families; one half coped well. Parents' perception of adequate insurance and stable income was significantly associated with positive coping. Providing home care for an infant with BPD on oxygen therapy is rewarding in many respects, but success requires appreciating its financial and emotional impact on families and providing them with social and financial support.
Catch-U Head Growth and Motor Performance in Very-Low-Birthweight Infants
Authors: Simon Neal P. , Brady Nancy R. , Stafford Richard L.
Published: November 2007

The relationship between catch-up head growth and motor performance was examined in 48 very-low-birthweight (< 1,500 g) infants. All infants were nonasphyxiated, normocephalic, and appropriately grown for gestational age at birth. Serial cranial ultrasonography during the first month of life revealed no intracranial pathology. The age of catch-up head growth, defined as the corrected age when the head circumference recovered to the 5th percentile, was determined for each infant. At 12 months corrected age, the infants were evaluated and grouped according to normal (n = 37) or abnormal (n = 11) motor assessments. The abnormal group achieved catch-up head growth by 7.7 ± 2.1 months vs 3.7 ± 3.1 months for the normal group (P< .05). Only 27% of the motor-delayed infants achieved catch-up head growth by 6 months corrected age, as compared with 89% of the normal infants (P< .05). Premature infants who have achieved catch-up head growth by 6 months corrected age, corresponding to the period of maximal postnatal brain growth, have fewer motor abnormalities than infants who attain catch-up head growth later. There is a significant relationship between head circumference at 6 months corrected age and motor development in very-low-birthweight infants.
Clinical Profile of Pediatric Patients Hospitalized With Respiratory Syncytial Virus Infection
Authors: La Via William V. , Grant Steven W. , Stutman Harris R. , Marks Melvin I.
Published: November 2007

To update the clinical profile of pediatric patients hospitalized with RSV infection, we retrospectively reviewed the records of 246 children (male:female ratio 1.44:1) admitted during one season to a tertiary-care hospital. The most common admitting diagnoses were bronchiolitis (37.4%), pneumonia (32.5%), and possible septicemia (13%). Median age was 3 months; median length of stay, three days. Twice as many minorities were admitted with RSV infection as all other admissions during the same year. Family history of asthma, while common (35%), did not affect length of stay or complications. Of the 38 (15%) patients requiring intensive care, 29 (76%) underwent ventilation. Patients with underlying cardiopulmonary disease had more complications, were more likely to require intensive care (about 50%), and had significantly longer hospital stays than others. All three patients (1.2%) who died had congenital heart disease. Common risk factors included young age, chronic cardiopulmonary disease, male sex, and possibly family history of asthma. Although the most typical clinical diagnoses remain bronchiolitis and pneumonia, a systemic illness resembling the sepsis syndrome has emerged at our institution as a significant clinical presentation.
Predictors of Mortality, Morbidity, and Disability in a Cohort of Infants ≤ 28 Weeks' Gestation
Authors: Msall Michael E. , Buck Germaine M. , Rogers Brian T. , Duffy Linda C. , Mallen Sharon R. , Catanzaro Nancy L.
Published: November 2007

This study attempted to identify predictors for mortality, morbidity, disability, and educational handicap at age 4 years in a cohort of 194 infants born at 23 to 28 weeks' gestation at one regionalized tertiary center from 1983 to 1986. Forty-one infants died (21%); standardized neurodevelopmental and functional assessments were conducted on 149 of 153 (97%) survivors at a mean age of 52 months. Five significant predictors of death were identified with logistic regression analysis: gestational age 23 to 26 weeks, intraventricular hemorrhage grades 3 or 4, male gender, five-minute Apgar ≤3, and absence of prophylactic calf lung surfactant extract. Significant predictors of neurodevelopmental morbidity included sepsis, male gender, and nonwhite race. Significant predictors of disability at age four included neurodevelopmental impairment and severe retinopathy of prematurity. Low socioeconomic status, nonwhite race and male gender were predictive of educational handicap. These findings suggest that outcomes may have distinct pathophysiologies. The role of biomedical events appears strongest for death.
Attitudes of Asthmatic and Nonasthmatic Adolescents Toward Cigarettes and Smoking
Authors: Brook U. , Shiloh S.
Published: November 2007

A comparison study was made between attitudes of asthmatic and nonasthmatic adolescents toward cigarettes and smoking. Subjects were 67 asthmatic 9th- to 12th-grade students, of whom 38 (57%) had active asthma with recurrent cough and/or dyspneic attacks and 29 (43%) had reactive airway disease and/or the least severe form of asthma expressed by recurrent cough. The control group included 62 nonasthmatic students from the same high school. All subjects completed a questionnaire to determine attitudes, beliefs, and intentions regarding smoking. Their responses suggested that the group at highest risk of becoming smokers were those who had previously had asthma. The same adolescents had a more positive attitude toward cigarettes and smoking, a stronger intention to become smokers, and a self-image more closely linked with their perceptions of smokers. Thus, these adolescents may represent a high-risk group for becoming smokers in the future.
Miller Fisher Syndrome, a Brainstem Encephalitis, Mimics Brain Death
Authors: Ragosta Kevin
Published: November 2007

Miller Fisher syndrome is a rare focal encephalitis of the brainstem characterized by cranial nerve palsy, ataxia, and areflexia.1,2 While this condition usually is mild and self-limiting, as this case documents, findings may fulfill many of the criteria in the clinical examination for brain death. Unlike brain death, however, it is not associated with irreparable structural damage of the brain or, as is mandatory, does it fulfill a very important prerequisite of brain death, the exclusion of potentially reversible causes of coma. 3 Treatment of Miller Fisher syndrome is supportive. 4
Cocaine Poisoning: An Easily Missed Diagnosis in an Infant
Authors: Edell Dean S.
Published: November 2007

We describe an infant with a positive urine drug screen for cocaine. Given the fact that he was bottle fed and 9 months of age, we presume that this drug was intentionally administered to the patient.
Yield of Reticulocyte Counts and Blood Smears in Term Infants
Authors: Newman Thomas B. , Easterling M. Janet
Published: November 2007

Reticulocyte counts and blood smears are commonly recommended to evaluate jaundice in newborns. To investigate the results and diagnostic yield of these tests, we reviewed a computerized database and medical records of term newborns who had reticulocyte counts (n = 799) or blood smears (n = 781) within the first week after birth at two hospitals. Nearly a threefold difference was noted in reticulocyte counts between the two hospitals (median 8.0% vs 2.8%; P < .0001), apparently due to differences in laboratory methods. Among the patients with "abnormal" reticulocyte counts or blood smears (n = 192), isoimmunization was diagnosed in 54, presumed hemolysis of unknown etiology in two, G6PD deficiency in one, and pyropoikilocytosis in one. We conclude that better standardization of reticulocyte counts is needed. When ordered as screening tests for hemolysis in jaundiced infants, reticulocyte counts and blood smears seldom lead to diagnoses of hemolysis other than isoimmunization.
Chronic Pancreatitis in Late Childhood and Adolescence
Authors: Mathew Prasad , Wyllie Robert , Caulfield Maureen , Steffen Rita , Kay Marsha
Published: November 2007

Acute pancreatitis is unusual in pediatric patients, and chronic pancreatitis is even less common. Between 1983 and 1988, we diagnosed 24 patients in late childhood and adolescence with chronic pancreatitis. Our review revealed that chronic pancreatitis presents as recurrent abdominal pain in late childhood and adolescence. Individual laboratory and radiological investigations may be normal during acute exacerbations of pain, but the determination of serum amylase and lipase concentrations — combined with ultrasonography — will accurately identify most patients. We found that endoscopic retrograde cholangiopancreatography is a valuable tool in the diagnosis of structural abnormalities. Surgical intervention may reduce symptoms in patients with structural abnormalities. There is a tendency toward decreased frequency and severity of pain as the patients increase in age.
The Practitioner's Role
Authors: Braverman Paula K. , Strasburger Victor C.
Published: November 2007

Practitioners who provide care for adolescents have a unique opportunity to address issues of adolescent sexuality. This article discusses shortcomings in residency training and possible solutions. The role of the practitioner in the office setting, issues of confidentiality and consent, and school-based sexuality education are reviewed.
Prevalence of Lymphopenia in Children with AIDS
Authors: Suarez Angeli D. , Rao Sreedhar P. , Miller Scott T.
Published: November 2007

Hematologic abnormalities, such as anemia, neutropenia, lymphopenia, and thrombocytopenia, are frequently observed in patients with acquired immunodeficiency syndrome (AIDS). While lymphopenia has been noted in up to 80% of adults, only 50% of children with AIDS are reported to be lymphopenic. We reviewed the blood counts of hospitalized children with AIDS to determine the frequency of lymphopenia and other hematologic abnormalities. Seventy-four children with AIDS (ages 4 months to 9.5 years) were admitted to Kings County Hospital Center (Brooklyn, New York) from January 1990 to March 1991; data consisted of 709 CBCs (range one to 39, median 11) from 176 admissions (range one to 15). In some patients admitted during the study period, charts from previous admissions were reviewed. Anemia (Hb less than than third percentile for age) was noted in 68 of 74 (92%) patients. Leukopenia (WBC less than 4000/mm 3) was noted in 32 of 74 (43%) patients. Lymphopenia (lymphocyte counts below normal for age) was seen in 59 of 74 (78%) patients; of these, more than half (31 of 59) had persistently low absolute lymphocyte counts. Thrombocytopenia (platelet count less than 150,000/mm3) was seen in 20 of 74 (27%) and was found in four of eight patients who expired. Pancytopenia was seen in nine of 74 (12%) patients. Progression of hematologic abnormalities with anemia followed by lymphopenia, thrombocytopenia, and finally leukopenia was demonstrated in 22 patients. This review shows a prevalence of hematologic abnormalities that is similar to those of previous reports in children except for a considerably higher prevalence of lymphopenia. As expected, lymphopenia was a marker for disease progression.
External Hydrocephalus in a Set of Triplets
Authors: Camerota Anthony J. , Rash F.C.
Published: November 2007

External hydrocephalus appears to be a benign form of infantile macrocephaly which typically resolves in the second year of life. Macrocephaly may persist into adulthood and is closely associated with benign familial macrocephaly. 1 The CT findings include a prominent and widened interhemispheric fissure, enlargement of the subarachnoid space over the frontal convexities, and prominent basal cisternae.2 Although obstruction of the arachnoid villae has been proposed, the etiology of the accumulation of this extra-axial fluid is unknown.3 The following case study of dizygotic triplets with idiopathic external hydrocephalus highlights the hereditary basis of the condition.
Prevalence of Lead Poisoning in an Urban Cohort of Infants With High Socioeconomic Status
Authors: Casey Rosemary , Wiley Catherine , Rutstein Richard , Pinto-Martin Jennifer
Published: November 2007

The purpose of this study was to assess the prevalence of lead poisoning in an urban cohort of infants with high socioeconomic status and to determine the usefulness of the Centers for Disease Control (CDC) questionnaire in predicting lead poisoning. The CDC questionnaire was administered to consecutive parents of infants, beginning with their 6-month well-child visit. All infants had a venous lead level by 12 months of age. The 165 infants were between 5.9 and 12 months (X = 9.4 months). The majority (67%) lived in a major city, had parents who were college graduates (67%), and had private medical insurance (85%). The overall prevalence of lead poisoning (Pb ≥10μg/dL [0.483 μmol/L]) was 29%. The relative risk of lead poisoning, given exposure as defined by the CDC instrument, was 0.99 (95% CI = .81 to 1.21). The sensitivity and specificity of the questionnaire were 40% and 60%, respectively. We conclude that the prevalence of lead toxicity and the poor sensitivity of the CDC questionnaire in this cohort of urban infants with high socioeconomic status support the 1991 CDC recommendation for universal lead screening in this region.
Reasons for Condom Utilization Among High-Risk Adolescent Girls
Authors: Rosenthal Susan L. , Biro Frank M. , Succop Paul A. , Baker Janet G. , Stanberry Lawrence R.
Published: November 2007

Two hundred forty-eight adolescent girls responded to a list of 30 statements describing reasons for using and not using condoms. For 24 of the statements, most adolescents (>70%) gave the same response regarding why they did or did not use condoms. Therefore, only the six remaining statements were used in further analyses. The relationship between the six statements and psychosexual history, condom use, and sexually transmitted disease (STD) history was examined. Those adolescent girls who had been sexually active longer were more likely to report lack of enjoyment as a reason that they did not use condoms ( P<.03), and those adolescents who had been sexually active less time were more likely to report personal (P < .005) and partner (P <.0006) enjoyment of sex with condoms as a reason for using condoms. Longer relationships before intercourse were associated with having condoms available ( P<.01) and partner insistence on their use (P<.02). Partner insistence on condom use was related to fewer episodes of sexually transmitted diseases (P = .03). These findings indicate the importance of relationship and partner variables in adolescent girls' perceptions of condom use.
Lung Abscess in Infants and Children
Authors: Emanuel Benjamin , Shulman Stanford T.
Published: November 2007

We retrospectively reviewed 18 cases of primary lung abscess and 10 cases of secondary lung abscess in infants and children during a 6-year period. Among 18 patients with primary abscesses, nine were boys and nine girls, from 9 months to 20 years old, but only two of 18 were less than 5 years old. Each had a solitary abscess. Location of abscesses included the right lower lobe (8), the right upper lobe (3), the left upper lobe (1), and the left lower lobe (6). One patient had Streptococcus pneumoniae bacteremia. Other bacterial isolates were from the upper respiratory tract and of uncertain significance. All patients recovered, although lobectomy was considered necessary in five patients because of failure to respond to intravenous antibiotic therapy. Secondary lung abscesses occurred in six boys and four girls who were from 2½ months to 13 years old. All 10 had solitary, right-sided lesions, seven in the right lower lobe and three in the right upper lobe. Bacteria of unclear significance were recovered from three of 10 patients, while two had documented gram-negative bacteremia. Three secondary abscess patients underwent lobectomy because of perceived inadequate response to medical therapy, including intravenous antibiotics. Based upon the literature and our experience, therapy for pulmonary abscess should include a parenteral antibiotic with gram-positive activity against both penicillinase-producing Staphylococcus aureus and anaerobes for a minimum of 3 weels. Lobectomy should be reserved for those patients with very severe abscesses and those who fail to manifest clinical and radiologic evidence of improvement after at least 3 weeks of appropriate intravenous antibiotic therapy.
Spinal Cord Injury in Youth
Authors: Apple David F. , Anson Carol A. , Hunter John D. , Bell R. Bryan
Published: November 2007

To identify special characteristics of the pediatric spinal cord-injured (SCI) population, we analyzed a database of 1,770 traumatic SCI patients; 88 (5%) fell into the two pediatric subgroups: 0-12 years (n = 26) and 13-15 years (n = 62) at time of injury. Differences between age groups were identified with regard to demographics, neurologic characteristics, associated injuries and complications, and management. Mode level of bony injury was C2 in preteens, C4 in teens, and C4-C5 in adults. Scoliosis developed far more frequently in children, particularly preteens (23%), than in adults (5%). Violent etiologies, predominantly gunshots, accounted for a disproportionate share of injuries to preteens (19%) and African-Americans (28%), as compared with adults (12%) and Caucasians (7%). This last finding underscores the urgent need to mount a response to the nationwide proliferation of gunshot-related SCI in children and minorities.
Risk of Lead Poisoning in Abused and Neglected Children
Authors: Flaherty Emalee Gottbrath
Published: November 2007

This study examined the prevalence of lead poisoning in 746 abused and neglected children taken into protective custody by Cook County, Illinois, Child Protective Services, Department of Children and Family Services (DCFS). Most of these children had a history of neglect (62%) or dependency (23%); they were predominantly African-American (88%). Venous blood lead concentrations (PbB) were obtained on 589 children, ages 6 months to 6 years, between January 1, 1992, and December 31, 1992. Three hundred eighty-one (64.7%) children tested had a PbB ≥ 10 μg/dL (0.48 μmol/L); the mean PbB was 12.23 μg/dL (0.587 μmol/L). These data support a recommendation for lead screening in any child with a history of abuse or neglect if environmental risk factors cannot be assessed.
Concepts of Illness Causality in a Pediatric Sample
Authors: Kury Susannah P. , Rodrigue James R.
Published: November 2007

In this study, we evaluated whether previous medical experience is associated with more sophisticated conceptions of illness causality among 64 children ages 4 to 16 years old. Although age and prorated IQ were found to be strongly related to children's illness causality concepts, duration of medical condition, total hospitalization days, and higher life-threat medical conditions were not associated with more sophisticated illness concepts in this pediatric sample. Using multiple regression analysis, age and IQ accounted for 59% of the variance in illness causality scores; contrary to expectations, medical experience variables (i.e., diagnosis, illness duration, hospitalizations) were not significant predictors of children's illness concepts. These findings highlight the need for pediatricians to guard against overestimating the illness concepts of children with prior medical experience.
Kawasaki Syndrome Masquerading as Bacterial Lymphadenitis
Authors: Waggoner-Fountain Linda A. , Hayden Gregory F. , Hendley J. Owen
Published: November 2007

We present two case reports of older children who initially presented with cervical lymphadenitis and who were eventually diagnosed and treated for Kawasaki syndrome (KS). Both children presented with unilateral cervical lymphadenopathy and fever and later developed additional clinical features of KS, including cardiac aneurysms in one of the patients. Of the five KS clinical criteria which accompany fever for 5 days, cervical lymphadenopathy of ≥1.5 cm is the least commonly found. Both patients were treated as having bacterial adenitis prior to the diagnosis of KS. We hope to illustrate that in the case of atypical cervical lymphadenitis, KS should be carefully considered in the differential diagnosis.
Evaluation of Vision Screening Practices of Illinois Pediatricians
Authors: Marcinak John F. , Werntz Yount Sharon C.
Published: November 2007

A survey of vision screening practices of American Academy of Pediatrics physicians in Illinois is described. The response rate was 42%. Sixty percent of physicians tested visual acuity of children 5 years and older, and half of this group tested children 2 to 4 years old. The most common reasons for not testing visual acuity were inadequate time (42%), children too young (18%), or screening done at school (18%). The majority (88%) refer to an ophthalmologist after a single vision screening failure, while about half perform the cover-uncover test on infants and children. The results suggest many Illinois pediatricians do not perform vision screening of preschool children, though screening does occur at other sites.
Congenital Diaphragmatic Hernia
Authors: Rais-Bahrami Khodayar , Robbins Sandra T. , Reed Vera L. , Powell David M. , Short Billie L.
Published: November 2007

In recent years, increasing numbers of patients with congenital diaphragmatic hernia (CDH) have been offered extracorporeal membrane oxygenation (ECMO) preoperatively if they can not physiologically tolerate early surgical repair. These infants are sicker and more unstable than those repaired pre-ECMO and, in most cases, have not had a "honeymoon" period (i.e., PaO2 >100 mm Hg at some point). ECMO before surgical repair was offered to 27 CDH patients in our institution; of the 16 (59%) survivors, 11 are now 2 years of age or older. To determine the outcome risk for this critical population, we compared 11 infants placed on ECMO pre-CDH repair (Group A) with our previous series of 22 survivors who had their surgery prior to ECMO (Group B). Both groups were similar in birth weight, gestational age, and Apgar scores. In Group A, a greater number were females (73% vs 23%), had right-sided hernia (64% vs 23%), and required patch repairs (82% vs 23%). The mean time on ECMO, time to extubation, and mean length of hospitalization were longer in group A. In both groups combined, the frequency of reherniation was higher in the patch-repair infants compared with those with a primary closure. Incidence of reflux was high in both groups, with increasing frequency of Nissen fundoplication in Group A patients (45% vs 6%). Both groups demonstrated similar delayed growth at 1 year of age. Although infants placed on ECMO presurgery are sicker, with more post-ECMO morbidity, their growth failure is similar to the less sick infants repaired pre-ECMO. Therefore, we recommend close followup of all CDH infants treated with ECMO in multidisciplinary follow-up clinics.
Social Factors Associated with Behavioral Problems in Children with Asthma
Authors: Butz Arlene M. , Malveaux Floyd J. , Eggleston Peyton , Thompson Lera , Huss Karen , Kolodner Ken , Rand Cynthia S.
Published: November 2007

The objective of this study was to describe the proportion of children with a behavior problem and examine which independent variables are associated with the presence of a behavior problem in a group of 392 inner-city children with asthma. Data on child asthma symptoms, medication use, health-care utilization, and school absences were obtained from the parent during a structured telephone interview. Included in the interview was a measure of behavior problems and social support questions. Children classified with a high level of asthma symptoms were more than twice as likely to experience a behavior problem than children classified with a low level of asthma symptoms ( P = 0.002). Use of theophylline medication was not correlated with behavior problems ( P = 0.45). Significant variables were low level of social support and high or moderate level of asthma symptoms. We have identified a group of children at risk for behavior problems, specifically in families that lack adequate social and financial resources.
Longitudinal Assessment for Lead Poisoning
Authors: Casey Rosemary , Wiley Catherine , Rutstein Richard , Pinto-Martin Jennifer
Published: November 2007

In a previous study, we showed that in our region the prevalence of lead poisoning (Pb ≥ 10 μg/dL [0.483 μmol/L]) was high (29%) among urban infants. The objectives of this study were to assess the prevalence of lead poisoning over time in this cohort to determine the best screening strategy. Eighty nine percent (115/129) of infants who were initially screened for lead poisoning between 6 and 12 months of age had a repeat venous lead level by age 3 years (χ=19.8 months). The majority (70%) lived in a major city and had private medical insurance (80%). The initial and repeat mean venous lead levels were similar for the overall population (lead1 = 8.7 μg/dL ± 6.2 [0.420 ± 0.299 μmol/L] and lead2 = 7.7 μg/dL ± 6.8 [0.371 ± 0.328 μmol/L]). However, the percentage of lead-poisoned (Pb ≥ 10 μg/dL or 0.483 μmol/L) children whose levels were ≥15 μg/dL (0.724 μmol/L) increased from 28% to 48% on repeat. The utility of the initial screen in predicting a second elevated lead level ≥20 μg/dL (0.966 μmol/L) was as follows: sensitivity = 33%, specificity = 97%, positive predictive value = 40%, negative predictive value = 96%. We conclude that in this population, a single screen at 18-24 months of age would reduce the need for multiple venipunctures and would detect those children in need of an intervention.
Percutaneous Endoscopic Gastrostomy Without an Antireflux Procedure in Neurologically Disabled Children
Authors: Borowitz Stephen M. , Sutphen James L. , Hutcheson Rachel L.
Published: November 2007

In children with major neurologic impairment, gastrostomies are often used to alleviate malnutrition and feeding difficulties. There has been a trend toward performing "protective" antireflux surgery in these children. Nineteen children with major neurologic impairment and feeding failure were prospectively evaluated and followed up after placement of a percutaneous endoscopic gastrostomy (PEG) without any antireflux procedure. Mean age at PEG placement was 34 months with mean follow-up of 20.7 months. All parents would recommend PEG to families with disabled children, and if given the chance, 95% would elect PEG again for their child. No child developed choking, gagging, or retching postoperatively. At the time of follow-up, postoperative gastroesophageal reflux did not appear to be a major clinical problem.
So, You Want to go to Medical School?
Authors: Strasburger Victor C.
Published: November 2007

Editor's Note: Spinal Column is a commentary about controversial topics in pediatrics. Readers are encouraged to submit Letters to the Editor or columns of their own for possible publication.
Behavioural language teaching: using the natural language environment
Authors: Colmar Susan , Wheldall Kevin
Published: November 2007

This paper argues for a new behavioural model of language facilitation. Current behavioural language programmes are critically analysed in terms of their poor generalizability to the natural language environment. More cognitively oriented developmental language research is cited as providing a relevant data base upon which to build behavioural language facilitation procedures. Such methods, which exploit the natural language environ ment and which emphasize child-initiated conversations, are more likely to facilitate appropriate language use which, in turn, is more likely to generalize. Practical examples of such methods are described. Finally, tentative implications of this for a behavioural theory of language teaching are proposed for consideration.
Setting up an infant language unit: a pilot study
Authors: Stringer Helen B.
Published: November 2007

An Infant Language Unit was set up in a well established special school for a seven-month pilot period. All aspects of the Unit organization were evaluated. The basis of speech therapy provision in the Infant Department was examined in order to provide the most effective treatment for the children in the broad areas of phonology, syntax and comprehension. The progress of twelve children aged 5 to 7 years was measured, and the relevance of the assessments discussed. The results of the pilot study led to the long-term continuation of the Language Unit. Points for further discussion arising from the pilot study are set out.
The 'point' of language intervention lessons
Authors: Bobkoff Karyn , Panagos John M.
Published: November 2007

There has been a small accumulation of studies of clinician-child discourse. Early work has demonstrated the value of careful description of real lessons as they are carried out by clinicians working with speech and language-disordered children. In this descriptive report the role of non verbal communication is emphasized, particularly with reference to pointing as a clinical teaching device. Transcriptions of three clinician-led lessons were analysed. The results verified the systematic nature of pointing as an augmentation to remedial control. The need for full descriptions of nonverbal communication as it facilitates lesson applications is discussed.
Children as authors and actors: literacy development through 'basic activities'
Authors: Harris-Schmidt Gail , McNamee Gillian Dowley
Published: November 2007

Storytelling and dramatization activities are described for language- learning-disabled children which highly motivate them to write, listen to, and dramatize stories. The work of the Soviet psychologist L. S. Vygotsky, and other recent research in mediated learning, demonstrates that when children participate in such activities that challenge them, they gradually become aware of the skills necessary to carry out the tasks, and internalize the means for doing so based on the help they are receiving from teachers and peers. Thus children become literate by mastering skills in the context of an activity that has a purpose which makes sense to them.
Developing form awareness and appreciation in children's writing
Authors: Woods Gerard M.
Published: November 2007

Young children consider only the meaning of their messages. Awareness of the form of their messages is a later and less organized development. This paper looks at the vocabulary of reading resources and the classroom presentation of words in relation to this development, and suggests a procedure for stimulating form awareness in children's writing.
From January to January: teaching the spelling of initial consonant clusters to a boy with a phonological disability
Authors: Grauberg Eva
Published: November 2007

The study gives a description of one year's teaching of a single aspect of spelling to an 11-year-old boy with a phonological handicap and a weakness in recognizing and remembering visual patterns. The aspect of spelling taught is initial consonant clusters. Changes of approach over the year are explained, teaching procedures are described, and details are given of the pupil's performance at different stages of the instruction process. Some theoretical and practical questions raised by the study are discussed.
A use of LARSP in secondary units for hearing-impaired pupils
Authors: Williams Edward
Published: November 2007

This article shows how LARSP—the Language Assessment, Remediation and Screening Procedure of Crystal, Fletcher and Garman, 1976—is used to evaluate the written language of severely deaf pupils in secondary hearing-impaired units. Samples of the pupils' free writing are obtained in the course of their everyday schoolwork and made available to the peripatetic teacher. They are then transcribed, analysed grammatically, and profiled on the LARSP chart. Using the completed LARSP profile it is possible to write a brief assessment report on the language used in the original sample. This article consists mainly of examples of these reports. It is intended to demonstrate how useful the LARSP analysis has been in facilitating discussion of deaf pupils' linguistic development.
The Moor House School remedial programme: an evaluation
Authors: Ripley Kate
Published: November 2007

Moor House School is a school for children of average nonverbal ability who have specific speech and language disorders. The educational careers of 120 children who left the school during the period 1979-1985 were investigated. The subjects were divided into four groups: Receptive Dysphasic (N = 12), Expressive Dysphasic (N = 21), Language Delay (N = 57), and Deviant Articulation (N = 30). Verbal ability at the time of entry to the school was compared with verbal ability when the remedial programme ended. The Receptive Dysphasic, Expressive Dysphasic, and Language Delay groups showed significant gains in verbal ability. The language development of the Deviant Articulation group was within normal limits at the time of entry and showed no significant gain. 35.8% of the children were able to return to mainstream education before reaching the statutory school-leaving age.