bluuebunny/crossref_metadata_2025 huggingface dataset:
Intussusception Reduced by Barium Enema
Authors: Bonadio William A.
Published: November 2007

A retrospective study was performed of 88 consecutive cases of intussusception that occurred during a 3-year period. Forty-eight patients experienced hydrostatic reduction of intussusception with barium enema and 40 patients required surgical correction of intussusception when barium enema reduction was unsuccessful. Patients with fever or duration of symptoms greater than 24 hours, or ileo-ileocolic type of intussusception had a significantly greater rate of unsuccessful hydrostatic reduction (p < 0.001).

Of 48 cases of intussusception hydrostatically reduced by barium enema, 47 patients received repeat physical examination after reduction, 45 having normal findings. Oral feeding was tolerated in these 47 patients within 12 hours after reduction. All 41 hospitalized patients were discharged within 24 hours of reduction without developing complication; of seven non-hospitalized patients, six reported no complications during the initial 24 hour post-reduction period. The single complication that occurred was recurrence of intussusception (ileo-ileocolic type) in a patient 6 hours after initial reduction; this was the only case in which neither post-reduction physical examination nor trial of feeding had been performed.

Children with intussusception hydrostatically reduced by barium enema are at low risk for complication during the subsequent 24 hour post-reduction period. When the pre-reduction course has been relatively uncomplicated, the post-reduction physical examination does not reveal abnormalities, and the patient is able to tolerate oral feeding, close outpatient monitoring appears to be safe.
Growing Up in America: White, Male, and Medically Limited
Authors: Lee Silverman Steven
Published: November 2007

A subject that must be heavy on the mind of every pediatrician and pediatric cardiologist is "who should care for adults with congenital heart disease." Whoever takes on this challenge also must accept responsibility to work as an advocate for this population and to focus on the areas of health insurance and employment opportunity and rights. The article written by Mr. Steven L. Silverman expresses the concerns and problems regarding employment and advancement that must be faced by those whose lives are being prolonged as a result of modern medical technology.
Work-related Risk Factors for Hepatitis B Virus Infection in Personnel of a Children's Hospital
Authors: Hicks Ralph A. , Cullen John W. , Jackson Mary Anne , Burry V. Fred
Published: November 2007

Seroprevalence of hepatitis B virus markers was examined in employees participating in patient care at The Children's Mercy Hospital in Kansas City, Missouri. Of 377 workers tested in 1985-86, 36 (9.6%) were seropositive for any marker. Among 285 employees who presumably have only work-related hepatitis B exposure, 14 (4.9%) were seropositive. Age 50 years and older, black race, and education no more than 12 years were associated with seropositivity among workers with work-related exposure. Employees in the clinics, laboratories, emergency room, and operating room had an increased prevalence of hepatitis B markers compared to those in other work locations (8 vs. 2%, p < 0.05). Traditional risk factors for infection were not predictive of seropositivity. Although the risk of acquiring hepatitis B infection from employment in a children's hospital is low, this study does identify work-related risk factors. Possible reasons for this association are discussed.
Massive Levothyroxine Ingestion
Authors: Mandel Scott H. , Magnusson A. Roy , Burton Brent T. , Swanson J. Robert , LaFranchi Stephen H.
Published: November 2007

The clinical course of a 29-month-old girl who was referred for evaluation after ingesting ninety 0.2-mg tablets of levothyroxine is reported. Despite an initial thyroxine (T4) level of 282 μg/dl and a triiodothyronine (T3) level of 1,837 ng/dl at 48 hours postingestion, her symptoms were mild and included irritability, vomiting, tremor, and tachycardia. Treatment was limited to activated charcoal and propranolol. Thyroid hormone levels fell to normal by 13 days postingestion. The child's clinical course was benign.

Even after massive acute ingestions of levothyroxine, children's symptoms are usually mild and may be controlled with propranolol. This conservative approach should be considered before expensive and potentially dangerous therapies are undertaken.
A Comprehensive Approach
Authors: Taylor James A. , Grube Baiba , Heimbach David M. , Bergman Abraham B.
Published: November 2007

Toxic Epidermal Necrolysis (TEN) is a life-threatening disorder with reported mortality rates of 25-60 percent in pediatric patients. The authors report on their experience in managing six children using a standardized treatment protocol in the intensive care unit of a regional burn center. Areas of sloughed skin were covered with porcine xenograft (pig skin) until reepithelialization was complete. There was one death in the series, and one child had ophthalmologic complications. Treatment in a multidisciplinary burn center is recommended for children with TEN.
Mixed Fusobacterium and Actinomyces Pulmonary Infection
Authors: Ray Melinda S. , Feldman Sandor
Published: November 2007

This is a report of a twelve-year-old black male who presents a history of left neck pain, left shoulder pain, weight loss and minimal fever. The admission diagnosis was a malignancy, supported by radiographic findings of consolidation of left lower and left upper lobes and periosteal new bone formation along the inferior aspects of the left second, third and fourth ribs. Open biopsy of the chest wall revealed a large abscess cavity. Subsequent cultures on anaerobic blood agar plates grew Actinomyces and Fusobacterium. The patient was treated with penicillin and improved clinically. This case emphasizes the need to culture tissue specimens for a wide array of organisms, including those not commonly seen today. A high index of suspicion is required for the diagnosis of anaerobic infections. Mixed anaerobic infections, including actinomyces, although uncommon in children, should be considered in the etiology of an intrathoracic mass.
Ticarcillin/Clavulanic Acid Combination
Authors: Kristjansson Kristleifur , Cox Frederick , Taylor Luann
Published: November 2007

Eighteen patients 2 months to 11 years of age with culture proven bacterial infections were treated with parenteral ticarcillin/clavulanic acid in a noncomparative study. Seven patients had pneumonia, two had tracheobronchitis, three had soft tissue abscess, two had periorbital cellulitis, three had urinary tract infection and one had purulent bursitis. Four of the 18 were bacteremic. Organisms treated included Staphylococcus aureus (6), Pseudomonas aeruginosa (5), Haemophilus influenzae (2), Branhamella catarrhalis (2), Escherichia coli (1), Streptococcus pneumoniae (1), Klebsiella pneumoniae (1), Streptococcus pyogenes (1) and Serratia marcescens (1). Thirteen of 15 (87%) organisms tested were beta-lactamase positive.

Therapy was given intravenously in six doses per day at 310 mg/kg. Duration of treatment ranged from 5 to 28 (mean 11) days, with an average time of 4 days to clinical improvement. Seventeen patients (94%) were clinically cured. One patient with recurrent aspiration pneumonia due to mixed infection with multiple gram-negative enteric bacilli failed therapy. Adverse effects were minimal and transient. Notably, mild to moderate thrombocytosis occurred in four (22%) patients that resolved uneventfully.

We conclude that ticarcillin/clavulanic acid is safe and effective therapy for serious infections in hospitalized children.
Assessment of an Aural Infrared Sensor for Body Temperature Measurement in Children
Authors: Rhoads Frances A. , Grandner John
Published: November 2007

A newly marketed device measures body temperature using an ear probe that detects infrared radiation from the tympanic membrane. It is simple to use and gives a reading in 1-2 seconds. Its accuracy was evaluated in a group of children, aged 1 month through 10 years, by comparing it with either rectal (n = 65), or oral (n = 48) temperatures obtained with a standard electronic thermometer, IVAC (San Diego, CA). The average elapsed time between readings was 11 minutes. Overall, 60 rectal and 40 oral temperatures (88.5%) were higher with IVAC than with the aural sensor. The difference ranged from -0.7°C to +2.5°C. The correlations between the infrared ear-probe values and the rectal and oral temperature readings were 0.77 and 0.75, respectively. Because the average reading using the aural sensor was lower than that using the IVAC, the sensitivity of the aural sensor for detecting clinically important levels of fever was low. None of seven patients with a rectal temperature of 39°C or more and only 7 of 27 with a rectal temperature of 38°C or more were identified by the aural sensor as having temperatures above these cutoff levels. Similarly, none of three patients with an oral temperature of 39°C or more and only three of eight with an oral temperature of 38°C or more were identified correctly by the aural sensor. The authors conclude that the aural sensor is unsatisfactory for detecting clinically significant fevers in a pediatric outpatient setting.
Computed Tomography Versus Magnetic Resonance Imaging -
Authors: Gusnard Debra A. , Zimmerman Robert A.
Published: November 2007

The techniques for computed tomography and magnetic resonance imaging are described. Indications are given for the two procedures as well as the rationale for selection of one or the other in evaluation of the pediatric central nervous system. The benefits derived from each one are illustrated by a series of representative reproductions.
Public Law 99-457 and the Clinical Pediatrician
Authors: Downey William S.
Published: November 2007

This is the second of a 2-part presentation of the requirements and the implications for the pediatrician of Federal Law PL 99-457. Part 1, printed in March 1990, defined the details of the law.
Organic Diseases Mimicking Atypical Eating Disorders
Authors: Wright Kathryn , Smith Mark Scott , Mitchell Jeff
Published: November 2007

The authors present three case studies of patients referred to Children's Hospital and Medical Center, Seattle, Washington, for evaluation of possible eating disorders. The atypical manifestations of the cases warranted further investigation, which revealed an organic basis for their weight loss. The authors summarize the typical findings of bulimia and anorexia nervosa and discuss the clues from the case studies that mandated further evaluation.
Down Syndrome Complicated by Hemoglobin S/Beta+ Thalassemia
Authors: Melnyk Andrew R. , Wright Adams Billie
Published: November 2007

The chance occurrence of Down syndrome and sickle cell disease is an extremely rare event. The patient presented in this article is the only reported case, based on medical literature review, of Down syndrome coexisting with sickle cell disease due to hemoglobin S/beta+ thalassemia. He had multiple recurrent aplastic crises and severe psychomotor and growth retardation. The physiologic basis for the atypical manifestations of both of his disorders is the subject of this report.
Prolonged Headache After Lumbar Puncture
Authors: Robbins Kenneth B. , Prentiss Jerry E.
Published: November 2007

A case is presented of a 12-year-old boy with a post-lumbar puncture headache of 6 weeks duration that was treated successfully with an epidural blood patch. Post-lumbar puncture headache in children is an uncommon event. The incidence can be reduced by using a spinal needle no larger than 22 gauge to minimize the size of the dural puncture and subsequent leak of CSF. When a post-lumbar puncture headache occurs, conservative treatment with bedrest, hydration, analgesics, and psychologic support is usually all that is required. When a post-lumbar puncture headache lasts more than 1 week and other diagnoses have been excluded, an epidural blood patch performed by an experienced physician usually provides prompt and complete relief of symptoms with minimal risk.
"Abandoned" Parents
Authors: Porter Basil
Published: November 2007

Maternal incompetence in childrearing is described in three widely different cultural settings in the southern Negev area of Israel. It is suggested that this incompetence stems from "abandonment" of the parents by traditional family support systems and is reinforced by the inability or lack of readiness of the health system to supply the missing support mechanisms. This picture of parental "abandonment" in widely different cultural settings in Israel may represent an end result of cultural and social upheaval common to other communities in the world.

Techniques for prevention include improving awareness of health workers to this problem, teaching appropriate strategies for improving parental confidence and competence, and ensuring that maternal and infant care focuses appropriately on issues of infant behavior and parental concerns.
Neurologic Complications in Chronic Renal Failure: A Restrospective Study
Authors: Uysal Serap , Renda Yavuz , Saatci Umit , Yalaz Kalbiye
Published: November 2007

We have retrospectively examined 324 patients with chronic renal failure and evaluated the probable underlying causes of neurologic complications, laboratory data and therapeutic interventions. The common neurologic problems in our patients were alterations in consciousness (40.7%) and convulsions (35.1%). When BUN concentration was above 135 mg/dl and creatinine clearance was below 8 m/min/1.73 m2, alteration of consciousness was observed and when BUN concentration was 200 mg/ dl and creatinine clearance was below 7 m/min/1.73 m2, abnormal convulsives appeared. Changes in deep tendon reflexes and pathologic reflexes were associated with hypertension. All of the patients with cortical atrophy using computerized cranial tomography aluminum hydroxide at least for 18 months, and six of them had hemodialysis. Fourteen patients who underwent dialysis developed convulsions and were thought to have disequilibrium syndrome.

These findings are consistent with the suggestion that the metabolic and biochemical derangements associated with CRF may be particularly detrimental to the still developing CNS of the child.
Long Term Follow-Up of Children with Down Syndrome with Cardiac Lesions
Authors: Mathew Prasad , Moodie Douglas , Sterba Richard , Murphy Daniel , Rosenkranz Eliot , Homa Andrea
Published: November 2007

Two hundred and eighty four patients with Down Syndrome (DS) were seen between 1951-1989 with 114 (40.1%) having a cardiac murmur at presentation. A definitive cardiac diagnosis was established in 47 (41%) patients, of which 38 had long term follow-up. Fifteen (33%) patients had atrioventricular canals. There were 21 males and 17 females, with a mean age of 5.3 years. Fifteen (39%) patients were in functional class (FC) I, 16 (42%) in FC II, six (15%) in FC III, and one patient in FC IV at the time of presentation. There were 18 survivors (13 in the surgical group and five in the nonsurgical group) and 20 nonsurvivors (four in the surgical group and 16 in the nonsurgical group). Causes of death in the nonsurgical group included congestive heart failure, pneumonia, and pulmonary vascular disease, and occured at a mean age of 8.4 years. Post-operative complications accounted for deaths in three of the four surgical patients. The survivors in the surgical group are presently in FC I/II. In the nonsurgical group, there was increased mortality, especially in those who presented in an earlier era, and a deterioration in functional class on follow-up due to the development of pulmonary vascular disease. Our data suggest that a) patients with Down syndrome and heart disease are helped by cardiac surgery with stabilization and improvement of their functional class; b) deterioration in functional class is seen in patients with Down syndrome with cardiac lesions who are managed surgically and c) mortality remains high in such patients treated nonsurgically due to development of pulmonary vascular disease and congestive heart failure. Therefore, early diagnosis and surgical correction where appropriate is a key issue in the management of children with Down syndrome.
Serum Carotene Concentrations in Normal Infants and Children
Authors: Leung Alexander K.C. , Siu T. Oswald , Chiu Anthony S.K. , Robson Wm. Lane M. , Larsen Trygve E.
Published: November 2007

The blood of 444 healthy Canadian children (246 males and 198 females) aged 6 days to 18 years was analyzed to determine the concentration of serum carotene. The serum carotene concentration was very low in the first six months of life. In the first three months of life, breast fed infants had significantly higher serum carotene concentration than infants who were formula fed. Infants 7 to 12 months of age had the highest serum carotene concentration. The serum carotene concentration dropped off after the age of one year and remained low until two years of age. After two years of age, the serum carotene concentration showed a progressive and small rise until the age of six to seven years and then fell until the age of 14 to 18 years. The serum carotene concentration did not appear to vary according to the sex of the child except for infants 7 to 12 months of age. In infants 7 to 12 months of age, girls had a higher serum carotene concentration. The measurement of the serum carotene concentration is a simple screening test for fat malabsorption. Our study provides the normal range of serum carotene concentration for children of various age groups.
Screening for Biotinidase Deficiency in Children with Unexplained Neurologic or Developmental Abnormalities
Authors: Sutherland Steven J. , Olsen Richard D. , Michels Virginia , Schmidt Michael A. , O'Brien John F.
Published: November 2007

To test the hypothesis that the frequency of biotinidase deficiency is greater in children with unexplained developmental delay or neurologic abnormalities than in the general population, we studied children seen at a large outpatient clinic over a four-year period who had one or more of these neurologic abnormalities and for whom no specific cause for their abnormalities could be found. The group totaled 274 children (163 boys; 111 girls) whose ages ranged from 2 weeks to 17 years. Characteristics were IQ/DQ, 30 to 70 in the 115 for whom scores were available; 41% had seizures; 15% had sensorineural hearing loss; 54% showed gross motor delay or ataxia; and 27% had decreased muscle tone. One patient with a classical clinical picture of biotinidase deficiency was diagnosed during the study period and was not included in the study.

None of the patients with nonclassic findings had a deficiency of biotinidase activity. Our results suggest that biotinidase deficiency does not account for a large proportion of children with unexplained neurologic abnormalities or developmental delay. This does not negate the importance of biotinidase testing in children with clinical patterns specifically suggestive of the deficiency.
Underdiagnosis and Undertreatment of Chronic Sinusitis in Children
Authors: Richards Warren , Roth Richard M. , Church Joseph A.
Published: November 2007

A review of outpatients diagnosed with sinusitis during the previous year by the allergy services of Childrens Hospital of Los Angeles and Kaiser Permanente, Orange County, revealed 34 patients who had protracted discomforting and debilitating symptoms. The mean duration of symptoms was approximately six months (range 1-14 months). None had been previously diagnosed as having sinusitis or received appropriate treatment. Although all were referred for evaluation of allergic rhinitis and/or asthma, approximately 1/3 were found to have neither of these conditions. Among patients who had asthma, their asthmatic symptoms were aggravated by the sinusitis. All patients eventually responded favorably to appropriate antibiotic therapy. Earlier diagnosis and appropriate therapy would have foreshortened the course of this very discomforting condition.

In recent years, we have observed a marked increase in the number of patients referred with the chief complaint of "worsening allergy" and who were subsequently found to have sinusitis. Most of the patients experienced significant incapacitation for protracted periods before a correct diagnosis was made and treatment instituted. In all but a few cases, prompt and sustained improvement followed appropriate therapy. The purpose of this report is to present a retrospective review of 34 illustrative cases.
Growth Hormone Deficiency in Children Has Psychological and Educational Co-Morbidity
Authors: Stabler Brian , Siegel Patricia T. , Clopper Richard R.
Published: November 2007

Growth delay caused by growth hormone deficiency (GHD) is a condition presented with increased frequency to pediatricians. Recent evidence suggests these patients should be evaluated developmentally for behavioral and educational problems. Such assessment would assure a comprehensive approach to treatment and increase the likelihood of a satisfactory outcome in young adulthood. This article briefly reviews what is known about the behavioral and educational difficulties experienced by growth hormone deficient patients. Specific recommendations for educational assessment and anticipatory guidance are presented.
Cholesterol Screening Management of Florida's Pediatric Population
Authors: DeClue Terry J. , Schocken Dawn M.
Published: November 2007

The current cholesterol screening and management of Florida's pediatric population is evaluated utilizing a questionnaire mailed to 1,534 pediatric health care providers. Twenty percent of the physicians responded. Of the respondents, 65% do not routinely screen for the presence of hypercholesterolemia. Only 28% of the respondents obtain serum total cholesterol measurements in accordance with the American Academy of Pediatrics Committee on Nutrition recommendations. The serum total cholesterol concentration prompting treatment was 240 mg/dL (6.2 mM). Dietary counseling alone, or in combination with exercise, was the initial treatment approach recommended by 98% of the responding physicians. Dietary education for the hypercholesterolemic patient was provided by both dieticians (46%) and physicians (42%). If the initial dietary intervention was unsuccessful, 48% of the physicians would begin medical therapy. The most commonly prescribed medication was a bile acid sequestrant (70%), with the majority (52%) referring their patient to a subspecialist for evaluation and care.
Encephalopathy and Brain Stem Dysfunction in an Infant With Non-Accidental Carbamazepine Intoxication
Authors: Kalaawi Malak H. , Auger Louise T. , Carroll James E. , Angelo-Khattar M.
Published: November 2007

Despite its extensive use, few reports of carbamazepine (CBZ) poisoning in the pediatric age group have been published.1-3 We describe such a patient, in whom brain stem dysfunction was prominent.
Primary Empty Sella Syndrome in Childhood: Association with Precocious Puberty
Authors: Rapaport Robert , Logrono Roberto
Published: November 2007

Primary empty sella syndrome has been considered an infrequent finding in childhood. One hundred and twelve cases have been reported in children ages 0.7 to 18 years. The frequency of primary empty sella ranged from 1% to 58%. Endocrine abnormalities were described in nearly all , children while visual abnormalities were noted in only 6%. Growth hormone deficiency was the single most common hormonal dysfunction noted in children with primary empty sella. Precocious puberty has been rarely reported in association with primary empty sella. We report the case of a 7-1/2 year old girl with gonadotropin dependent central precocious puberty and a partially empty sella who had no other hypothalamic-pituitary dysfunction. We suggest that pubertal abnormalities be included among the endocrine disorders potentially associated with the primary empty sella syndrome.
Diaper Choice
Authors: Rockney Randy M. , Culpepper Larry , Figueira Gracinda Cristina , Mize William L.
Published: November 2007

"In the coming year, it is expected that the Fresh Kills Landfill on Staten Island, NY will become the largest man-made object on earth, nosing in front of the Great Wall of China, which has held that honor for the last 5000 years."1

Diaper choice (cloth vs. disposable) has become a controversial issue with increased public concern for the environment. One hundred and twenty-four consecutive mothers were surveyed during the postpartum period about diaper choice. Six percent reported physician/nurse discussion of diaper choice during prenatal care. Seventy-seven percent planned to use disposable diapers only. Twenty-two percent planned to use cloth diapers or a combination of cloth and disposable diapers. Major reasons for choice of disposables included convenience, avoidance of safety pins and cleanliness. Mothers selecting cloth or a combination cited environmental concerns, low cost and cleanliness as reasons for their choice. Factors found to be significantly associated with choice of cloth or combination were older maternal age, use of cloth with other children, and perception that disposables are more expensive. No significant association could be demonstrated between diaper choice and several demographic variables, breastfeeding, or knowledge of the environmental impact of disposables. An educational intervention promoting the use of cloth diapers did not influence diaper choice at two months. Most mothers have made a diaper choice by the time an infant is born. Providers of prenatal care seldom discuss diaper choice with pregnant women. An educational intervention to promote choice of cloth diapers had no effect on the diaper choices made by our population.
Circumcision
Authors: Chessare John B.
Published: November 2007

Recent information regarding the increased risk of urinary tract infections in the first year of life for uncircumcised boys has created confusion regarding the appropriate guidance to be given to parents confronting the circumcision issue. A decision model was built that addressed the question of whether or not to circumcise a newborn male considering the probability of a non-circumcised boy having a UTI in the first year of life (0.041), the probability of a circumcised boy having a UTI in the first year of life (0.002), and the likelihood of renal scarring from a UTI (0.075). After considering the morbidity associated with the procedure, all possible outcomes were ranked from worst to best (circumcised-renal pathology to uncircumcised-no infection) and given a value on a 0 to 1 scale. For the set of values assigned to the outcomes, the choice of no circumcision yielded the highest expected utility. For the set of assigned utilities, sensitivity analysis showed that unless the probability of a UTI in the first year of life for an uncircumcised male was ≥ 0.29, then non-circumcision was still the preferred choice. The decision was most sensitive to the degree of aversion to the morbidity associated with the procedure (pain, bleeding, inflammation).
Hyponatremia in Hospitalized Children
Authors: Wattad Ahmad , Chiang Myra L. , Hill L. Leighton
Published: November 2007

To determine the frequency, causes, and clinical significance of hyponatremia in hospitalized children, we reviewed the clinical and laboratory data of all hyponatremic children in Texas Children's Hospital over a 12-month period. One hundred sixty-one patients from among 11,702 hospital admissions were found to have hyponatremia, defined as serum sodium value of less than 130 mEq/L, an overall frequency of 1.38%. Sixty-nine patients (43%) had hyponatremia on admission, and 92 patients (57%) had hospital-acquired hyponatremia. Thirty-seven (23%) were previously healthy children, and 124 (77%) had chronic illnesses. Acute gastroenteritis was the leading cause of hyponatremia present on admission, and diuretic therapy was the leading cause of hospital-acquired hyponatremia. Only four patients (2.5%) had a serum sodium concentration of less than 120 mEq/L. Six patients (3.7%) had neurologic impairment on discharge, and 19 patients (12%) ultimately died long after their hyponatremia was corrected. Each patient who had neurologic sequelae and each patient who died had underlying medical conditions which could explain their morbidity and/or mortality. The prognosis appears to be more clearly related to the underlying medical disorder rather than to the hyponatremic state or its correction.
Once-Daily Ceftriaxone to Complete Therapy of Uncomplicated Group B Streptococcal Infection in Neonates A Preliminary Report
Authors: Bradley John S. , Ching Donna L.K. , Wilson Thomas A. , Compogiannis Lisa S.
Published: November 2007

Newborn infants minimally symptomatic with non-central nervous system (CNS) infections due to Streptococcus agalactiae (group B streptococcus [GBS]) and other pathogens may not require skilled nursing care during the entire course of parenteral antibiotic therapy. In 1985, treatment guidelines were made available to private practitioners in Oregon for therapy of newborn infants at low risk of complications from their infections. In 1988, patient data were collected and analyzed retrospectively. Outpatient management during convalescence of 51 infants (21 with culture-positive infections due to GBS) was accomplished with once-daily physician follow-up examinations and IM injection of ceftriaxone. Long-term (≥ two months) follow-up data were available for 67% of GBS-infected infants, with no complication of infection or significant complication of therapy reported. Outpatient parenteral antibiotic management of selected, low-risk infants may offer the clinician an alternative to hospitalization for a portion of the duration of parenteral antibiotic therapy.
Growth and Academic Achievement in Inner-City Kindergarten Children
Authors: Karp Robert , Martin Roy , Sewell Trevor , Manni John , Heller Arthur
Published: November 2007

Measures of height, weight, nonverbal cognitive ability (Ravens progressive matrix), visual-motor-perceptual ability (Beery-Buktenica test of Visual Motor Integration [VMI]), the imitation-of-gestures technique, and academic achievement (Stanford Early Achievement) were obtained for a sample of 82 children from a poor inner-city community. In contrast to prior reports from the United States and about other developed countries, anthropometric measures were related both to academic achievement and to these measures of neurodevelopment. They were not consistently related to measures of nonverbal cognitive ability. Regression analyses revealed that general cognitive ability contributed more variance (39%) to predictions of achievement than all other variables, including weight for age (13%) and VMI (6%). Children with reduced somatic growth were likely to do poorly in school, but the data do not show that undernutrition causes learning failure. Rather, they suggest that environmental problems affecting the development of thought processes and nutrient intake precede both growth and learning failure.
Acute Acalculous Cholecystitis Complicating Mycoplasma Pneumoniae Infection
Authors: Horii Yoshihiro , Sugimoto Tohru , Sakamoto Izumi , Sawada Tadashi
Published: November 2007

Mycoplasma pneumoniae infection has been associated with extrarespiratory manifestations. Gastrointestinal manifestations, gastroenteritis, hepatitis, and pancreatitis have also been reported.1,2 There have been no previous reports of acute cholecystitis complicating Mycoplasma pneumoniae infection. Acute acalculous cholecystitis is uncommon in childhood. We report on a child with acute cholecystitis during the course of Mycoplasma pneumoniae infection.
Behavioral Antecedents of Pediatric Poisonings
Authors: Brayden Robert M. , MacLean William E. , Bonfiglio J. Frank , Altemeier William
Published: November 2007

To determine how the behavior of 3-to 7-year-olds might contribute to pediatric poisoning, a taxonomy of pediatric ingestions was conceptualized and tested. Thirty-nine of 50 caretakers who called the Middle Tennessee Poison Center about poison ingestions by a child in this age group provided details of the poisoning history and family characteristics. Histories were coded by a psychologist according to the 14 antecedent conditions of the poisoning taxonomy. Improper storage, noncompliant behavior, curiosity, misinterpretation of the substance, improper child monitoring, and imitative behavior were judged the most common antecedent conditions of these ingestions. Lack of knowledge of poison prevention methods was infrequently coded. Noncompliant behavior as a condition of the poisoning was associated with parental reports of general child behavioral problems. Ingestions involving imitative behavior were associated with parental report of poor social supports. The findings highlight the need to address behavior in designing poison prevention programs.
Indications and Application of Epidural Anesthesia in a Pediatric Population Outside The Perioperative Period
Authors: Tobias Joseph D.
Published: November 2007

The techniques of spinal and epidural anesthesia have been key components of anesthetic care for the past 100 years. Although commonly used in the operating room, their use in children outside the perioperative period has been limited. The author presents his experience with the use of epidural anesthesia to provide analgesia in five children when parenteral narcotics were ineffective in treating pain associated with burns, sickle cell crisis, trauma, and malignancies. Additionally, the principles and adverse effects of epidural anesthesia are discussed.
Difficult Parents
Authors: Sunde Elizabeth R. , Alex Mabe P. , Josephson Allan
Published: November 2007

The pediatrician's job becomes frustrating when it is necessary to deal with difficult parents. Some physicians may not have the training or inclination to engage such parents in a therapeutic partnership. This paper discusses tools available to physicians which will help them develop an effective partnership that includes uncovering the hidden meaning behind a child's illness; understanding the reciprocal nature of partnerships; and the importance of determining each party's goals, roles, and expectations. Negotiating these steps enables physicians to develop a productive relationship with difficult parents of sick children. This strategy can facilitate the child's medical care and improve the parents' and physician's satisfaction with the services rendered. This paper also discusses steps to take when these attempts are not sufficient to handle the situation.
Exercise-Induced Bronchospasm in Nonasthmatic Obese Children
Authors: Kaplan Ted A. , Montana Eduardo
Published: November 2007

The frequency, degree, and pattern of bronchial reactivity to exercise were compared in 13 obese and 14 control children, ages 6 to 10 years, with no history of asthma. Spirometry was performed before and every three minutes after a seven-minute exercise challenge on a treadmill. There were 11 obese children and 6 controls who had at least a 15% fall in at least one of three monitored pulmonary function parameters ( P<.05). The group mean percentage falls in FEV1 and FEF25%-75% were significantly greater in the obese group than in the controls. The pattern of bronchospasm, occurring soon after the exercise challenge, is consistent with that found in the known asthmatic population. A significant correlation was found between triceps skin-fold thickness and degree of fall in FEF25%-75% ( r= .55, P<.005). This study demonstrated that significantly greater frequency and degree of bronchospasm of the smaller airways occur in obese children, partially related to the amount of subcutaneous fat. Whether exercise-induced bronchospasm leads to exercise avoidance and obesity or whether obesity causes or enhances bronchial hyperreactivity to exercise requires further study.
Cerebrospinal Fluid Pleocytosis In Children with Pneumonia but Lacking Evidence Of Meningitis
Authors: Nussinovitch Moshe , Cohen Herman A. , Frydman Moshe , Varsano Itzhak
Published: November 2007

Headache, nuchal rigidity, positive Kernig's sign, and even convulsions may be observed during severe bacterial infections such as pneumonia, pyelonephritis, typhoid fever, and bacillary dysentery. In such cases, meningitis can be excluded only by documentation of normal cerebrospinal fluid (CSF).1 The authors describe four children with lobar pneumonia in whom the clinical signs of meningeal irritation wene associated with a mild increase in the white blood cell count in the CSF (pleocytosis) although there was no other evidence of meningeal infection.
Reliability and Validity of an Infant Gastroesophageal Reflux Questionnaire
Authors: Orenstein Susan R. , Cohn Jeffrey F. , Shalaby Theresa M. , Kartan Roopa
Published: November 2007

To improve history-taking of infants with suspected gastroesophageal reflux, we developed an Infant Gastroesophageal Reflux Questionnaire consisting of 161 items covering demographics, symptoms (regurgitation, weight deficit, respiratory difficulties, fussiness, apnea, and pain or bleeding of esophagitis), and possible causes (feeding volume and frequency, allergy, infection, colic, central nervous system abnormalities, positioning, and smoke exposure). The questionnaire was completed by primary caretakers of 69 infants aged 1 to 58 weeks suspected of having reflux. Median time to complete the questionnaire was 20 minutes. The median internal consistency of 29 pairs of redundant questions was 0.94. Median test-retest consistency of 110 items for nine respondents was 0.88. Median interobserver consistency, evaluated for 129 items in 35 questionnaires also filled out by secondary caretakers, was 0.85. The median accuracy of four externally validated items was 1.00. This questionnaire can aid pediatricians in making decisions regarding diagnoses and treatment in this common but complex disorder.
Physicians' Attitudes Toward and Knowledge of Child Care
Authors: Wirth Barbara S. , Hausman Cheryl L.
Published: November 2007

A questionnaire designed to elicit information about training in child-care issues, frequency of discussion during office visits, and attitudes regarding specific medical and developmental issues of child care was sent to randomly chosen board-certified family practitioners and pediatricians in District 3 of the American Academy of Pediatrics. Among respondents, 39% said they felt uncomfortable discussing child-care issues and 85% felt that their training in this area was inadequate. Forty-three percent reported rarely or never discussing child care during an initial visit. More formal training is needed to address issues of child care.
Subcutaneous Fat Necrosis of the Newborn: Link to Maternal Use of Cocaine During Pregnancy
Authors: Carraccio Carol , Papadimitriou John , Feinberg Paul
Published: November 2007

Cocaine has received much attention in the literature for its effects on the mother/infant pair when used during pregnancy. We describe a neonate who presents with widespread subcutaneous fat necrosis (SCFN), an as-yet-unreported finding that appears to be related to maternal use of cocaine during pregnancy.
Intravenous Immunoglobulin in the Treatment of Salmonella Typhimurium Infections in Preterm Neonates
Authors: Gökalp Ayse Sevim , Toksoy Hayri Bozkurt , Türkay Sadi , Bakici Mustafa Zahir , Kaya Rafet
Published: November 2007

The purpose of this study was to determine the role of intravenous immunoglobulin (IVIG) administration in preterm neonates with S. typhimurium infection. A randomized trial of 47 preterm neonates with intestinal or extraintestinal S. tymphimurium infection was performed. Neonates were randomly divided into two groups: 22 neonates were only given cefoperazone (group 1); 25 neonates were given cefoperazone plus IVIG (group 2). IVIG was given at a dose of 500 mg/kg on days 1, 2, 3, and 8 after entry into the study. Following treatment, bacteremia, complications, mortality rate, recovery time, and duration of antimicrobial therapy were evaluated in two groups. Bacteremia was found in 31.4% in group 1 and 8% in group 2 ( P<.05); complications developed in 81.8% in group 1 and 16% in group 2 ( P<0.01); mortality was 40.9% in group 1 and 12% in group 2 ( P<.05). Recovery took 15 days in group 1 and 8 days in group 2 (P < .01). The duration of antimicrobial therapy was 20 days in group 1 and 14 days in group 2 ( P<.01). We conclude that IVIG treatment in combination with antibiotics in preterm neonates with S. typhimurium infection reduces the complications, mortality rate, and duration of therapy.
CAT/CLAMS
Authors: Wachtel Renee C. , Shapiro Bruce K. , Palmer Frederick B. , Allen Marilee C. , Capute Arnold J.
Published: November 2007

The American Academy of Pediatrics recommends regular developmental screening as a part of routine child health supervision. However, the pediatrician has a limited number of tools available to further evaluate a child who is found to be suspect or abnormal on a developmental screening test. The Clinical Adaptive Test/Clinical Linguistic and Auditory Milestone Scale (CAT/CLAMS) was therefore developed to provide pediatricians with a technique to assess infants and toddlers with suspected developmental delay. The CAT/CLAMS demonstrated strong psychometric properties. Concurrent validity with the Bayley Scales of Infant Development (BSID) was demonstrated in 43 children ages 12 to 19 months who were tested on three occasions with both instruments (correlation coefficient ranging between 0.63 and 0.87; P<.001). Predictive validity 6 and 12 months later was also demonstrated in this population with correlation coefficients ranging between 0.73 and .077, significant at the P=.001 level. Utilizing the CAT/CLAMS as part of the pediatrician's evaluation of children with developmental concerns would allow the pediatrician to compare language and nonlanguage problem-solving abilities and, therefore, aid in diagnosis and appropriate referral.
The Functional Independence Measure for Children (WeeFIM)
Authors: Msall Michael E. , DiGaudio Kathleen , Rogers Brian T. , LaForest Suzanne , Catanzaro Nancy L. , Campbell Jeanette , Wilczenski Felicia , Duffy Linda C.
Published: November 2007

Few tools are available to pediatricians for tracking and monitoring disability status in children. We describe the conceptual basis and pilot use of the Functional Independence Measure for Children (WeeFIM) . Our pilot use of this instrument in children with limb deficiency, Down's syndrome, spina bifida, cerebral palsy, and extreme prematurity demonstrates that the WeeFIM is a valid measure for tracking disability in preschool age and middle childhood. The WeeFIM measures the impact of developmental strengths and difficulties on independence at home, in school, and in the community. This allows the pediatrician to prioritize interventions for enhancing comprehensive functional outcomes and supporting families.
Preventive Care for Patients With Chronic Illness
Authors: Borowitz Drucy , Wegman Theresa , Harris Margaret
Published: November 2007

Routine supplementation with multivitamins is recommended for all patients with cystic fibrosis (CF). The purpose of this study was to investigate how well patients at a large CF clinic follow recommendations for taking multivitamins and what factors affect use. A questionnaire was developed and sent to the 150 patients actively followed at our center. Of the 80 patients who returned the survey, only 47% followed clinic recommendations. Of those patients not taking extra supplements, serum vitamin A and E levels varied widely, although most were within the normal range (vitamin A 11 - 87 μg/dL, tocopherol 0.4 - 2.3 mg/dL, tocopherol/cholesterol 3.0 - 9.6 mg/g). Only 25% of respondents had known insurance coverage for vitamins. Gender or educational level did not affect adherence; however, those with minimal pulmonary disease (forced vital capacity [FVC] greater than 70% of predicted) were more likely to take vitamins than those with moderate or severe disease (P <.05) . In addition to malabsorption, poor adherence should be considered by both CF specialists and primary-care providers as a cause of low serum vitamin A and E levels, especially in patients with moderate to severe lung disease.
Human Tails and Associated Spinal Anomalies
Authors: James Hector E. , Canty Timothy G.
Published: November 2007

Human tails have been described intermittently in the literature, typically as isolated cases with varying forms of malformation. Attempts have been made to differentiate "true" tails from "taillike" appearances. Unless identified, underlying occult spinal disorders, mass effect, and/or tethering of the spinal cord may lead to progressive neurologic damage. We report three patients with "tails" and the associated spinal anomalies.
Amphotericin-Induced Heart-Rate Decrease in Children
Authors: Levy Maurice , Domaratzki Jeanette , Koren Gideon
Published: November 2007

We describe six children with acute decreases in heart rate temporally related to amphotericin B administration. All patients had achieved their maximal dose within 3 to 4 days. Heart-rate drops occurred as early as day 3 but could be delayed up to day 7 after start of therapy. The mean heart rate dropped from 104 ± 8/min (range 96 to 114) to 62 ± 8/min (range 48 to 72) (P= 0.0001). A slower heart rate than baseline was noted during the entire duration of drug administration, from 60 minutes of starting the infusion to 220 minutes (mean 120 ± 40) after discontinuation of the infusion. This reaction was noted in six of 90 (6.7%) patients who had amphotericin. These six children were compared with six age-matched children who received the drug but in whom such changes in heart rate did not develop. The method of administration of amphotericin B was similar in both patients and controls, starting with 0.25 mg/kg/day and increasing by 0.25 mg/kg/day up to 1 mg/kg/day. Children with heart-rate drop received amphotericin for 4.6 ± 1.8 days, significantly shorter than their controls (12.6 ± 6.9 days) ( P= 0.02), suggesting that this adverse effect has led to early discontinuation of amphotericin therapy. Physicians and nurses caring for children receiving amphotericin B should be aware of this potential adverse effect, which can be serious in a patient with an underlying heart condition or in a patient who is already on heart-rate-lowering drugs.
Congenital Midline Nasofrontal Mass
Authors: Allah Bakhsh Haafiz  , Sharma Renu , Faillace Walter J.
Published: November 2007

Because of aberrant embryologic development, encephalocele, nasal dermoid, and glioma may present as a nasofrontal midline mass in a newborn infant. Though uncommon, vascular malformation or hemangioma in the nasofrontal region may present similarly. The correct diagnosis and early management of a nasofrontal mass is imperative because complications such as brain herniation, hypertelorism, or cerebrospinal fluid rhinorrhea may ensue, resulting in poor facial or visual development, recurrent meningitis, and brain abscess. Nasofrontal encephalocele and midline frontal vascular malformation are rare congenital abnormalities presenting as a midline nasofrontal mass. We report two neonatal cases, one a frontoethmoidal encephalocele and another, a frontal vascular malformation. Both had uncomplicated surgical interventions. The physical findings and clinical review are presented. The diagnostic approach toward midline nasofrontal mass is discussed.
Long-Term Follow-Up of Medically Treated Childhood Constipation
Authors: Sutphen James L , Borowitz Stephen M. , Hutchison Rachel L. , Cox Daniel J.
Published: November 2007

We describe the long-term (mean 6.8 years) follow-up of 43 children treated medically for chronic constipation and encopresis. Overall outcome was quite good. Thirty children (70%) were entirely asymptomatic at follow-up. Intermittent mild constipation persisted in 13 patients; only two required persistent but infrequent laxative therapy. Encopresis persisted in three of 17 children who initially reported this symptom, and was associated with significant behavioral problems.