bluuebunny/crossref_metadata_2025 huggingface dataset:
Guidelines for Expert Witness Testimony
Authors:   COMMITTEE ON MEDICAL LIABILITY
Published: December 2021

The American Academy of Pediatrics joins with other specialty organizations in emphasizing the obligation of objectivity when its members respond to requests to serve as expert witnesses in the judicial system. Regardless of the source of the request, such testimony ought to embody the relevant facts and the expert's knowledge, experience, and best judgment regarding the case. At the same time, the AAP reiterates that it cannot condone participation of its members in legal actions in which their testimony will impugn some performances that clearly fall within the accepted standards of practice or, conversely, will endorse some obviously deficient practices. Because experts are relied upon to help courts and juries understand the "standards of practice" as applicable to a given case, care must be exercised that such "expert testimony" does not narrowly reflect the experts' views about applicable standards to the exclusion of other acceptable choices. The Academy considers it unethical for any expert to provide testimony that does not adhere scrupulously to the goal of objectivity.

The AAP also recognizes its responsibility and that of its Fellows for continued efforts to improve health care for children. However, the Academy believes that many claims of medical malpractice represent the response of a litigation-oriented society to a technologically advanced form of health care that has, unfortunately, fostered some unrealistic expectations and often unexpectedly high risks. As technology continues to become more complex, risks as well as benefits continue and sometimes increase, making a complication-free practice of medicine less and less probable.
Substance Use Among Eighth-Grade Students Who Take Care of Themselves After School
Authors: Richardson Jean L. , Dwyer Kathleen , McGuigan Kimberly , Hansen William B. , Dent Clyde , Johnson C. Anderson , Sussman Steven Y. , Brannon Bonnie , Flay Brian
Published: December 2021

This investigation focused on substance use among children who regularly care for themselves after school (latchkey children). The data, collected from 4932 eighth-grade students, indicated that self-care is an important risk factor for alcohol, tobacco, and marijuana use. Data collected from 2185 parents validated these findings. Eighth-grade students, who took care of themselves for 11 or more hours a week, were at twice the risk of substance use as those who did not take care of themselves at all. This relationship held at all levels of sociodemographic status, extracurricular activities, sources of social influence, and stress. Of the 186 stratified tests of the relationship, 90% were significant; even those not found to be significant were in the direction expected. Path analyses suggest that risk-taking, having friends who smoke, and being offered cigarettes may partially explain the relationship between self-care and substance use. Those eighth-grade students who select friends who smoke and place themselves in situations in which they are offered cigarettes may be manifesting a desire to display their sense of maturity and independence. The fact that the increase in substance use occurred among almost all strata tested and the fact that mediation was not complete suggest that more than one mechanism may account for the associated increase in substance use. It is also possible that more time in self-care results in more unnoticed solitary trials of substances, as well as trials motivated by peer offers or peer pressure to use substances.
Potential Hazard of Hypoalbuminemia in Newborn Babies After Exchange Transfusions With ADSOL Red Blood Cell Concentrates
Authors: TUCHSCHMID P. , MIETH D. , BURGER R. , DuC G.
Published: December 2021

To the Editor.—

During the preparation of packed red blood cells for blood transfusions, plasma is partially removed. The recent introduction of ADSOL as additive allows the removal of more than 80% of the plasma. The use of plasma-poor packed red blood cells in exchange transfusions for neonatal hyperbilirubinemia represents a potential hazard, as the excess of bilirubin is not optimally removed and the patient's plasma is depleted from albumin (Arch Dis Child. 1988;63:104). The effect of exchange transfusions using ADSOL-packed red blood cells on plasma proteins was studied in nine newborn babies (gestational age 31 to 40 weeks; birth weight 1735 to 3750 g) who needed exchange transfusions because of hyperbilirubinemia (total bilirubin exceeding 250 to 350 µmol/L) at the age of 0 to 3 days.
Quantifying Language Development From Birth to 3 Years Using the Early Language Milestone Scale
Authors: Coplan James , Gleason John R.
Published: December 2021

A point-scoring technique for the Early Language Milestone Scale is described. Normative data based on the original 1982 cross-sectional sample and validation data based on a separate longitudinal sample are presented. Mean Early Language Milestone Scale point scores, standard deviations, and percentile equivalents for raw point scores are presented for all ages from birth to 36 months. Correlations between point scores on the Early Language Milestone Scale and scores on other standardized developmental tests such as the Stanford-Binet Intelligence Scale, the Peabody Picture Vocabulary Test, and the Illinois Test of Psycholinguistic Abilities are presented. The clinical and research advantages of this point-scoring technique are presented and compared with the original pass/fail scoring method.
Congenital Abnormalities of the Lymphatic System: A New Clinical Classification
Authors: HILLIARD ROBERT I. , MCKENDRY JAMES B.J. , PHILLIPS M. JAMES
Published: December 2021

The numerous clinical presentations of congenital abnormalities of the lymphatic system in children and the confusing terminology used to describe their pathologic diagnoses impede the physician's understanding of the condition. The clinical classification based on the actual symptoms of the congenital problems we have presented here should help the physician identify the specific abnormality and a potential treatment. Future research should concentrate on the specific causes and the treatment of these congenital abnormalities.
Education of Children with Human Immunodeficiency Virus Infection
Authors:   TASK FORCE ON PEDIATRIC AIDS
Published: December 2021

As the incidence of HIV infection in children increases, so will the school population of children with this disease. With the advent of new drug therapy, it is likely that these children will have a longer survival resulting in an increasing number of HIV-infected children entering school. An understanding of the effect of chronic illness and the recognition of neurodevelopmental problems in these children is essential to provide appropriate educational programs. The Academy recommends that:

1. All children with HIV infection should receive an appropriate education that is adapted to their evolving special needs. The spectrum of needs differs with the stage of the disease.

2. HIV infection should be treated like other chronic illnesses that require special education and other related services.

3.Continuity of education must be assured whether at school or at home.

4.Because of the stigmatization that still exists with this disease, it is essential that confidentiality be maintained by limiting disclosures and disclosing information only with the informed consent of the parents or legal guardians and age-appropriate assent of the student.
Management of Jaundice in the Well Baby
Authors: GARTNER LAWRENCE M.
Published: December 2021

The special article by Newman and Maisels1 provides an important new perspective on the management of jaundice in the full-term, otherwise healthy newborn. As with so many changes in medical care, what at first seems radical is, in fact, often the natural evolution of thinking based on a fresh look at data which has been under our noses for many years. Newman and Maisels' effective application of this method has led to a codification of thinking which many of us in this field of inquiry and practice have gradually moved toward in recent years. Newman and Maisels have provided a data-based framework on which these changes in management can be supported.
Acellular Pertussis Vaccination of 2-Month-Old Infants in the United States
Authors: Pichichero Michael E. , Francis Anne B. , Blatter Mark M. , Reisinger Keith S. , Green John L. , Marsocci Steven M. , Disney Frank A.
Published: December 2021

This is the first study in children from the United States that evaluates the immunogenicity of and adverse reactions to the Connaught/Biken two-component acellular pertussis vaccine compared with whole-cell pertussis vaccine when given as a primary immunization series at 2, 4, and 6 months of age. Three hundred eighty infants were studied; 285 received acellular diphtheria-tetanus toxoids-pertussis (DTP (ADTP)) and 95 received whole-cell DTP (WDTP). Following the third dose, ADTP vaccination produced higher antibody responses than WDTP to lymphocytosis-promoting factor (enzyme-linked immunosorbent assay IgG geometric mean titer (GMT) = 131 vs 9 and Chinese hamster ovary cell assay GMT = 273 vs 16) and to filamentous hemagglutinin (IgG GMT = 73 vs 10) (all P < .0001). Agglutinin responses were higher in WDTP compared with ADTP recipients (GMT = 50 vs 37; P=.02). Local reactions were fewer for all three doses following ADTP vaccination. Fever, irritability, drowsiness, anorexia, vomiting, and unusual crying all occurred less frequently in ADTP compared with WDTP recipients for one or more of the three doses. We conclude that this two-component ADTP vaccine when given as a primary series produces greater immunogenicity and fewer adverse effects than the currently licensed WDTP vaccine.
A Longitudinal Study of Atlanto-Dens Relationships in Asymptomatic Individuals with Down Syndrome
Authors: Pueschel Siegfried M. , Scola Francis H. , Pezzullo John C.
Published: December 2021

This study was designed to investigate the natural history of atlantoaxial instability in individuals with Down syndrome and to determine whether significant changes in C1-C2 relationship are taking place over time. Although more than 400 patients with Down syndrome who are presently followed at the Child Development Center had cervical spine radiographic examinations in the past, only 141 patients who had serial radiological examinations and whose radiographs were available for reevaluation participated in this study. The results of our investigations revealed that there were only minor changes (1 to 1.5 mm) of atlanto-dens interval measurements over time in 130 (92%) patients with Down syndrome. Eleven patients (8%) had changes of atlanto-dens interval measurements between 2 and 4 mm over time; however, none of these patients had any clinical symptoms. The analyses of data obtained from several subgroups (males and females, various age groups, and patients with and without atlantoaxial instability) did not show any significant changes of atlanto-dens interval measurements of successively obtained radiographs. Our recommendations for and rationale of routine screening for atlantoaxial instability and follow-up examinations are discussed in detail.
STUDIES ON ABNORMAL HEMOGLOBINS
Authors: CHERNOFF AMOZ I. , SINGER KARL
Published: December 2021

Two hundred specimens of hemoglobin, prepared from the blood of children up to the age of 6 years, were investigated for their content of fetal hemoglobin. Fetal hemoglobin was usually absent after the age of 30 months, although an occasional hematologically normal individual was found to have minimal quantities of this pigment beyond this time.

The discrepancy between the results of the present investigation and data in the literature seem to be explained on the basis of the different methods used in identifying the embryonic pigment.
TERATOMA OF THE NECK IN A NEWBORN INFANT
Authors: WHITE ROBERT R. , GOSSELIN RUTH S.
Published: December 2021

The case history of a three day old infant with a huge teratoma of the neck, endangering the infant's life and demanding immediate surgical attack, is presented. This report illustrates still another condition amenable to operative relief at an early age.
A New Perspective on the Natural History of Vesicoureteric Reflux
Authors: Steele B. T. , De Maria J.
Published: December 2021

Vesicoureteric reflux is most commonly recognized in girls after urinary tract infection. Increasing recognition of vesicoureteric reflux in neonates, detected after an abnormal prenatal sonogram, shows a marked male predominance: 80% boys. Vesicoureteric reflux in children may be both a congenital abnormality, more common in boys, and an acquired abnormality, more common in girls with voiding dysfunction.
Biology and Clinical Applications of Hemopoietins in Pediatric Practice
Authors: Furman Wayne L. , Crist William M.
Published: December 2021

The differentiation, proliferation, and viability of hemopoietic cells are regulated by glycoproteins variously referred to as colony-stimulating factors (CSFs), growth factors, or hemopoietins. To date, 12 interleukins, 3 CSFs, erythropoietin, and a stem cell growth factor (kit ligand, or mast cell growth factor) are known to regulate hemopoiesis. The identification and purification of human hemopoietic growth factors (cytokines) have recently permitted a more detailed analysis of their role in hemopoiesis. Cloning of the genes that encode these CSFs has led to largescale production of their protein products for clinical application. Recent clinical trials of these cytokines in adults and children with a variety of diseases affecting hemopoiesis have already yielded dramatic benefits. For example, patients with formerly serious or fatal diseases, such as cyclic neutropenia or Kostmann syndrome (congenital agranulocytosis), have shown striking reductions in infections, marked improvement in their quality of life, and no serious side effects during treatment with recombinant human granulocyte colony-stimulating factor (rhG-CSF).

Here we summarize what is known about the biology and clinical utility of five of these CSFs (recombinant human erythropoietin [rh-EPO], rhG-CSF, granulocyte-macrophage colony-stimulating factor [rhGM-CSF], macrophage colony-stimulating factor [rhM-CSF], and interleukin-3 [rhIL-3]), which are in clinical use in children. We also indicate future applications for these and other hemopoietins. Table 1 outlines characteristics of the five agents, and Table 2 lists their clinical applications.

HEMOPOIETINS AND HEMOPOIESIS

Hemopoiesis is a complex and dynamic process during which a relatively small number of stem cells with self-renewal capacity give rise to lineage-restricted progenitor cells that mature into red blood cells, leukocytes (white blood cells), or platelets (see Figure).
Basic Life Support Training in School
Authors:   Committee on School Health
Published: December 2021

The American Academy of Pediatrics recommends that high school students receive training in Basic Life Support (BLS) and Pediatric Basic Life Support (PBLS) as part of their health education program.

The skills taught, such as recognition of symptoms, establishment of an airway, and rescue breathing, will help prepare students to deal with individuals who need their assistance due to aspiration or cardiorespiratory emergencies. Individual efforts using only BLS/PBLS skills can be effective in rescuing patients in these circumstances.1-3 Prompt initiation of cardiopulmonary resuscitation (CPR) after early recognition of a cardiac arrest has limited success alone. This education must be supported by a community emergency response system. Immediate CPR coupled with access to the community emergency response team maximizes the impact of school education programs.4,5

School-based programs have been successful in training students to have BLS skills.6,7 The Academy does not expect that BLS/PBLS training will prepare students for all emergencies, nor does it intend that students should be made to believe they are solely responsible for rescuing victims or for the survival of individuals with life-threatening events in their school or community. Younger students should be reassured that their responsibility is limited during emergency events, particularly when adults are available. In addition to the potential benefits of BLS/PBLS, a realistic perspective of resuscitation abilities as only a link in the "chain of survival" should be provided. The limitations of BLS/PBLS and of all emergency services on the eventual outcome of cardiac arrests also should be explained.8 Students should be given information about avoiding the acquisition of transmissible diseases during CPR.
Psychiatric Disorders Associated With Fragile X in the Young Female
Authors: Freund Lisa S. , Reiss Allan L. , Abrams Michael T.
Published: December 2021

Seventeen females with the fragile X mutation and 17 non-fragile X females group-matched on age (range 4 to 27 years), IQ (range 34 to 126), and socio-economic status were compared on Diagnostic and Statistical Manual of Mental Disorders (3rd ed, revised) criteria for selected psychiatric disorders. Additional comparisons were made on level of social development and parent and teacher ratings of maladaptive behaviors. Correlations of genetic testing data with psychiatric and behavioral variables were investigated. Consistent with hypotheses, females with the fragile X mutation showed a greater frequency of avoidant disorder and mood disorders compared with control subjects. Females with the fragile X mutation also showed greater frequency of stereotypy/habit disorder when compared with control subjects. Contrary to predictions, females with the fragile X mutation did not show higher frequencies of attention deficit hyperactivity disorder or undifferentiated attention deficit. They showed greater deficits in their interpersonal socialization skills and were rated by their parents and teachers as significantly more withdrawn and depressed when compared with control subjects. The size of the DNA insertion associated with the genetic abnormality was correlated with IQ, severity of attention problems, and anxiety/withdrawal symptoms. Evidence from this study points to an association between a specific genetic syndrome and characteristic developmental and psychiatric difficulties. Implications for the clinician are discussed.
National Survey of Neonatal Transfusion Practices: I. Red Blood Cell Therapy
Authors: Levy Gary J. , Strauss Ronald G. , Hume Heather , Schloz Lynn , Albanese Mark A. , Blazina Janice , Werner Alice , Sotelo-Avila Cirilo , Barrasso Christine , Blanchette Victor , Warkentin Phyllis I. , Pepkowitz Samuel , Mauer Alvin M. , Hines Deanna
Published: December 2021

Neonatal blood component transfusion practices during 1989 were surveyed via a questionnaire developed by the Pediatric Hemotherapy Committee of the American Association of Blood Banks. Of 1790 questionnaires mailed, 452 were selected to form the database for this analysis because they were from institutions in which neonates were transfused. Nearly all institutions contained intensive care units directed by neonatologists and were involved in the management of high-risk infants. Results from institutions serving as the primary pediatric teaching hospital of a medical school were compared with those with no medical school affiliation. Thirty-six percent of primary pediatric teaching hospitals and 52% of hospitals with no medical school affiliation performed pretransfusion testing in excess of that required, resulting in additional blood loss in neonates. Sixty-six percent of primary pediatric teaching hospitals used fresh frozen plasma to adjust the hematocrit of red blood cell concentrates prior to transfusion (a practice increasing donor exposure), compared with only 29% of hospitals with no medical school affiliation. The usual indication for small-volume red blood cell transfusions in severely ill neonates was to maintain a desired hematocrit level, whereas for stable infants, red blood cell transfusions were given to treat symptomatic anemia, rather than to maintain a predetermined hematocrit. As found in 1985, neonatal transfusion practices in 1989 were variable. However, improvements have occurred since 1985 to suggest that further research and educational efforts may serve to promote even better neonatal transfusion therapy.
Enhanced Urinalysis as a Screening Test for Urinary Tract Infection
Authors: HOBERMAN ALEJANDRO , WALD ELLEN R. , PENCHANSKY LILA , REYNOLDS ELLEN A. , YOUNG STACEY
Published: December 2021

Urinary tract infection (UTI) is a common and important clinical problem in infants and young children. UTI is often suspected on the basis of results of microscopic urinalysis; accordingly, it is important that its results be as reproducible, accurate, and easily interpretable as possible. A positive urinalysis allows early detection and treatment of UTI, while a negative urinalysis can potentially eliminate the cost of expensive hospitalization for intravenous administration of antibiotics, the current standard treatment of UTI in young febrile children.

In pediatric primary care facilities, microscopic urinalysis often is performed using centrifuged urine and reported as the number of white blood cells (WBCs) or bacteria per high-power microscopic field (hpf).
Neonatal Hyperbilirubinemia and Long-Term Outcome: Another Look at the Collaborative Perinatal Project
Authors: Newman Thomas B. , Klebanoff Mark A.
Published: December 2021

Objective. To examine the association between neonatal bilirubin levels and subsequent neurodevelopmental outcome.

Design. Prospective cohort study.

Setting. 12 US medical centers from 1959 (first births) to 1974 (last follow-up).

Participants. 41 324 singleton white or black infants with birth weight ≥2500 g who had neonatal bilirubin measurements recorded and survived at least 1 year.

Main outcome measures. Wechsler Intelligence Scale for Children Intelligence Quotient (IQ) at age 7 years, blinded neurologic examination at age 7 years, and sensorineural hearing loss at age 8 years.

Results. There was no association between IQ and bilirubin. For example, comparing children who had maximum bilirubin levels ≥342 µmol/L (20 mg/dL) with those who had lower bilirubin levels, adjusted mean IQs were 105.0 and 103.4 in whites (difference + 1.6; 95% confidence interval [CI]: –0.4 to + 3.5) and 91.0 and 93.3 in blacks (difference –2.3; 95% CI: –4.8 to +0.2). Abnormal neurologic examination results were reported in 12 of 268 children (4.5%) with bilirubin ≥342 µmol/L (20 mg/dL) compared with 1249 of 33 004 children (3.8%) with lower levels (relative risk [RR] = 1.2; 95% CI: 0.7 to 2.1). The frequency of abnormal or suspicious neurologic examination results increased in a stepwise fashion with increasing bilirubin level (P < .001), from 4346/29 258 (14.9%) of those with bilirubin levels <171 µmol/L (10 mg/dL) to 60/268 (22.4%) of those with bilirubin levels ≥342 µmol/L (20 mg/dL), apparently due to increasing minor motor abnormalities at higher bilirubin levels. Sensorineural hearing loss was not associated with high bilirubin levels (RR = 1.0; 95% CI: 0.3 to 3.0).

Conclusions. Neonatal bilirubin levels seem to have little effect on IQ, definite neurologic abnormalities, or hearing loss. Higher bilirubin levels are associated with minor motor abnormalities, but the clinical importance of this finding is limited by the weakness of the association, the mild nature of the abnormalities, and the lack of evidence that they are prevented by treatment.
A Eutectic Mixture of Lidocaine and Prilocaine for Alleviating Vaccination Pain in Infants
Authors: UHARI MATTI
Published: December 2021

The discomfort and pain caused by vaccination may prevent some parents from having their young children vaccinated. Immunization uptake is good among school-age children, but uptake rates average only about 70% in younger children and figures as low as 25% have been reported at 19 months.1-4 Yet it would be important to achieve as high an immunization uptake as possible, since if the vaccination coverage is good enough, even nonvaccinated individuals will be protected by the herd immunity that hinders the occurrence of epidemics.1,5

Painful procedures are frightening, especially in infancy, when children do not understand what is happening to them.
Fluoxetine Hydrochloride (Prozac) Toxicity in a Neonate
Authors: SPENCER MARY J.
Published: December 2021

A case of fluoxetine toxicity in a newborn of 38 weeks' gestation has been presented. The total drug concentration in cord blood was 80 ng/mL. The fluoxetine level, 26 ng/mL, is below the adult therapeutic level; the norfluoxetine cord blood level, 54 ng/mL, is at the adult therapeutic level. At 96 hours the fluoxetine level was not measurable and the norfluoxetine level was 55 ng/mL. The parent compound is fluoxetine, which is metabolized in the liver to norfluoxetine. The half-life of fluoxetine is 2 to 3 days, and that of norfluoxetine is 7 to 9 days. Interestingly, in our patient the fluoxetine was absent in the blood at 4 days, but norfluoxetine was present. The most common side effects of Prozac in adult patients involve primarily the central nervous system and include nervousness, tremor, jitteriness, and occasionally seizures. Central nervous system symptoms were most prominent in this newborn. He also had an increased heart rate. Cardiovascular side effects are less prominent in adults who are taking Prozac.

The neonate in this case was asymptomatic at 96 hours of age, indicating that the parent compound, fluoxetine, may be the active part of the drug and side effects may be caused by the parent compound.
The Pediatrician and the "New Morbidity"
Authors:   Committee on Psychosocial Aspects of Child and Family Health
Published: December 2021

THE CHALLENGE

A decade has passed since the American Academy of Pediatrics (AAP) defined the role of the pediatrician in providing increased attention to the prevention, early detection, and management of the various behavioral, developmental, and social functioning problems encountered in pediatric practice.1 These problems, called the "new morbidity,"2 are not really "new"; they have always affected children, but many have become more prevalent. For example, the number of children and adolescents with activity limitation caused by a chronic health condition with attendant psychological problems currently approaches 8%.3 The number of children living with divorced mothers doubled between 1970 and 1986. The suicide rate for male adolescents has doubled since 1960.4 Because of the prevalance of these problems, the peditrician s being asked to expand the traditional role of health supervision and management of physical illnesses to address psychosocial and behavioral problems more effectively.

THE BARRIERS

To achieve this goal, pediatricians must overcome educational, economic, and time management obstacles, despite tremendous strides in the development of an educational blueprint,5 an ever-increasing knowledge base, and a growing cadre of educators. Pediatric residency training is focused on major physical illness in tertiary care hospitals and to a limited degree on behavioral issues. Training in ambulatory settings has expanded, although training in behavioral pediatrics remains limited in many residency programs. In 1987, the Residency Review Committee added a requirement for behavioral teaching, although the specific time requirement for training in behavioral pediatrics is undefined. Consequently many pediatricians have completed training with limited instruction in psychosocial issues.
Serum C-Reactive Protein, Erythrocyte Sedimentation Rate, and White Blood Cell Count in Acute Hematogenous Osteomyelitis of Children
Authors: Unkila-Kallio Leila , Kallio Markku J.T. , Peltola Heikki , Eskola Juhani
Published: December 2021

Objective. The aim of this prospective study was to compare the clinical value of the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and white blood cell (WBC) count in diagnosis and follow-up of acute hematogenous osteomyelitis in children.

Design. Forty-four children aged 2 weeks to 14 years with bacteriologically confirmed acute hematogenous osteomyelitis were examined. Staphylococcus aureus was responsible in 39 cases (89%), Haemophilus influenzae type b in 3 cases (7%), pneumococcus in 1 case (2%), and a microaerophilic streptococcus in 1 case (2%). ESR was measured at the time of admission and on days 3, 5, 7, 10, 14, 19, and 29 of treatment, and CRP was measured on the same days as ESR but also on days 2, 9, 12, 17, and 23. WBC count was examined at the time of admission and on days 5, 10, 19, and 29.

Results. ESR was elevated (≥20 mm/h) initially in 92% of the cases; the mean value was 45 mm/h, and the peak values (mean 58 mm/h) were reached on days 3 to 5. After this the levels slowly returned to normal in approximately 3 weeks (mean 18 days). CRP was elevated (>19 mg/L) at the time of admission in 98% of the cases, the mean value being 71 mg/L. The peak CRP value was reached on day 2 (mean 83 mg/L). The decrease was very rapid, normal values being reached within a week (mean 6.9 days). The WBC count was a poor indicator of acute hematogenous osteomyelitis, since only 35% of the children had leukocytosis (WBCs > 12 x 109/L) at the time of admission.

Conclusions. In patients with acute hematogenous osteomyelitis, CRP increased and especially decreased significantly faster than ESR, reflecting the effectiveness of the therapy given and predicting recovery more sensitively than ESR or WBC count.
Does Prenatal and Infancy Nurse Home Visitation Have Enduring Effects on Qualities of Parental Caregiving and Child Health at 25 to 50 Months of Life?
Authors: Olds David L. , Henderson Charles R. , Kitzman Harriet
Published: December 2021

Objective. To examine, during the 3rd and 4th years of life, the health, development, rates of child maltreatment, and living conditions of children who had been enrolled in a randomized trial of nurse home visitation during pregnancy and first 2 years of their lives.

Design. Prospective follow-up of families who had been randomly assigned to nurse-visited and comparison conditions.

Setting. Study conducted in semirural community in upstate New York. Families dispersed among 14 other states during 2-year period after children's second birthdays.

Participants. Four hundred women were recruited through a health department antepartum clinic and offices of private obstetricians and were registered before 30th week of pregnancy. All women had no previous live births and 85% were either teenaged (< 18 years at registration), unmarried, or from Hollingshead social classes IV or V. Analysis focused on whites, who comprised 89% of sample.

Intervention. Nurse home visitation from pregnancy through second year of the child's life.

Main Results. There were no treatment differences in the rates of child abuse and neglect or children's intellectual functioning from 25 to 48 months of age. Nurse-visited children, nevertheless, lived in homes with fewer hazards for children; they had 40% fewer injuries and ingestions and 45% fewer behavioral and parental coping problems noted in the physician record; and they made 35% fewer visits to the emergency department than did children in the comparison group. Nurse-visited mothers were observed to be more involved with and to punish their children to a greater extent than were mothers in the comparison group. The functional meaning of punishment differed between the nurse-visited and comparison families.

Conclusions. The program does have enduring effects on certain aspects of parental caregiving, safety of the home, and children's use of the health care system, but it may be necessary to extend the length of the program for families at highest risk to produce lasting reductions in child abuse and neglect.
Follow-up Phone Calls After an Emergency Department Visit
Authors: Chande Vidya T. , Exum Vanessa
Published: December 2021

Follow-up care of patients treated in an emergency department (ED) is an important component of patient care. Previous studies suggest that follow-up phone calls may improve patient compliance with discharge instructions.1-4 Most of these studies have used nurses to contact the families of children with relatively mild illnesses, such as otitis media or nonspecific viral illness. The families who received follow-up phone calls were more likely to keep their scheduled follow-up appointments than those who did not. We studied patients discharged from the Pediatric Emergency Department (PED) with moderate to severe illness for whom close follow-up is essential. We hypothesized that physician-initiated follow-up phone calls to parents of moderately ill children seen in the PED would improve parental compliance with primary care follow-up.
Distinguishing Sudden Infant Death Syndrome From Child Abuse Fatalities
Authors:   Committee on Child Abuse and Neglect
Published: December 2021

Public and professional awareness of sudden infant death syndrome (SIDS) has increased in the 28 years since the establishment of the National Sudden Infant Death Foundation, now called the National SIDS Alliance.1 Similarly, awareness of child abuse has increased in the 30 years since the publication of the first article on the battered child.2 In the majority of cases, when an infant younger than 1 year dies suddenly and unexpectedly, the cause is SIDS. Sudden infant death syndrome is far more common than infanticide. In a few difficult cases, legitimate investigations for possible child abuse have resulted in an insensitive approach to grieving parents or caretakers. This statement provides professionals with information and guidelines to avoid distressing or stigmatizing families of SIDS victims while allowing accumulation of appropriate evidence in the uncommon case of death by infanticide.

INCIDENCE AND EPIDEMIOLOGY

Sudden infant death syndrome, also called crib or cot death, is "the sudden death of an infant under 1 year of age which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and a review of the clinical history." 3 Sudden infant death is the most common cause of death between I and 12 months of age. Eighty percent of cases occur before age 5 months, with a peak incidence between 2 and 4 months of age. Sudden infant death syndrome occurs in 1.5 to 2 per 1000 live births, resulting in 6000 to 7000 infant deaths each year in the United States.4
Immunization Coverage and Its Relationship to Preventive Health Care Visits Among Inner-City Children in Baltimore
Authors: Guyer Bernard , Hughart Nancy , Holt Elizabeth , Ross Alan , Stanton Bonita , Keane Virginia , Bonner Nira , Dwyer Diane M. , Cwi Joan S.
Published: December 2021

Objective. To provide empirical data on immunization coverage and the receipt of preventive health care to inform policy makers' efforts to improve childhood immunization.

Design and methods. We surveyed a random sample drawn from a birth cohort of 557 2-year-old children living in the inner-city of Baltimore. Complete information on all their preventive health care visits and immunization status was obtained from medical record audits of their health care providers.

Main outcome measures. Age-appropriate immunizations and preventive health care visits.

Results. By 3 months of age, nearly 80% made an age-appropriate preventive health visit, but by 7 months of age, less than 40% had a preventive visit that was age-appropriate. In the second year of life, 75% made a preventive health visit between their 12- and 17-month birthdays. The corresponding age-appropriate immunization levels were 71% for DTP1, 39% for DTP3, and 53% for measles-mumps-rubella vaccine. Infants who received their DTP1 on-time were twice as likely to be up-to-date by 24 months of age.

Conclusions. Our analyses focus attention on the performance of the primary health care system, especially during the first 6 months of life. Many young infants are underimmunized despite having age-appropriate preventive visits, health insurance coverage through Medicaid, and providers who receive free vaccine from public agencies. Measles vaccination coverage could be improved by initiating measles-mumps-rubella vaccine vaccination, routinely, at 12 months among high risk populations.
Multi-organ Disease Secondary to Sulfonamide Toxicity
Authors: Pickert Curtis B. , Belsha Craig W. , Kearns Gregory L.
Published: December 2021

Hypersensitivity reactions modulated by reactive drug metabolites should be considered in the differential diagnosis of any patient receiving a sulfonamide who presents with disease of one or more organ systems and no other obvious cause. The presence of fever is characteristic of this process and should not mislead the clinician into assuming an infectious etiology for the multi-organ disease.

In institutions which can offer sophisticated biochemical laboratory procedures, the use of the in vitro lymphocyte cytotoxicity assay and acetylator phenotyping can augment diagnostic certainty and thus facilitate determination of management and prognosis for patients with idiosyncratic sulfonamide hypersensitivity. An index of suspicion for the presence of drug-induced disease, combined with the use of specific tests such as the lymphocyte cytotoxicity assay may enable the clinician to make this diagnosis with more certainty than has previously been possible. However, before these tests can be offered as a clinical diagnostic tool, it is important that appropriate assessment of sensitivity, specificity, and accuracy be documented.

Finally, following sulfonamide hypersensitivity reactions, toxicity can be expected to resolve following withdrawal of the drug. However, late complications such as hypothyroidism may occur months after drug exposure. Therapeutic rechallenge to the offending drug would be expected to cause similar and possibly worse disease in the same patient. Accordingly, patients experiencing serious adverse reactions to sulfonamides should not receive other antimicrobial agents of this same class again or, possibly, other aromatic amines such as dapsone and procainamide without laboratory verification to support the absence of drug or metabolite-induced hypersensitivity reactions.
Lupus Nephritis in Children—A Review of 167 Patients
Authors: Yang Ling-Yoeu , Chen Wei-Perng , Lin Ching-Yuang
Published: December 2021

Background. Relatively few studies have been made of children with lupus nephritis. The prognosis of children with lupus nephritis is ominous for those with diffuse proliferative glomerulonephritis and active interstitial inflammation. Up to now few studies have been made on this subject.

Objectives. To evaluate the clinical course, histopathology, and prognosis of lupus nephritis in children, to identify the risk factors for renal failure and mortality, and to share our experience in treating lupus nephritis in children.

Methods. Retrospectively, 167 children under 18 years of age with lupus nephritis at Veterans General Hospital-Taipei, Taiwan from 1979 to 1991 were studied. All patients received renal biopsy and follow-up biopsies were performed in 36 children. The clinical and serologic parameters at the time of renal biopsy were recorded.

Results. There were 55 (33%) patients with class II, 30 (18%) with class III, 69 (41.3%) with class IV, and 13 (7.8%) with class V nephritis based on initial biopsy. The mean follow-up time was 59 months. Follow-up biopsies were histologically stationary in 29 patients, progressive in five, and regressive in two. The results revealed that those with persistent hypertension, anemia, increased serum creatinine concentration, and decreased creatinine clearance rate at initial biopsy were more prone to develop renal failure. Low titer of CH50 hemolytic assay appeared to be a poor prognostic indicator. The overall renal and patient 5-year survival rates were 93.1% (135/145) and 91.08% (143/157), respectively. They were 87.7% (50/57) and 82% (55/67), respectively, of patients with class IV proliferative glomerulonephritis.

Conclusions. The prognosis of children with class IV nephritis in this study was better than that reported previously. All children surviving without renal failure were maintaining their normal lives with little organ dysfunction. The improved results may be due to earlier renal biopsy for precise histopathologic definition, better supportive care, and selective use of aggressive therapy, including methylprednisolone pulse therapy, intravenous cyclophosphamide, intravenous prostaglandin E1 therapy, high-dose intravenous gammaglobulin therapy, and cyclosporin A for those with high risk factors.
Violence Prevention in Schools and Other Community Settings: The Pediatrician as Initiator, Educator, Collaborator, and Advocate
Authors: Wilson-Brewer Renee , Spivak Howard
Published: December 2021

Attention to the problem of youth violence has resulted in a proliferation of violence prevention and intervention strategies. Examined in this paper are those strategies that can be categorized as educational, environmental/technological, and recreational. In the educational category are conflict resolution and mediation, crime prevention and law-related education, handgun violence education, life skills training, self-esteem development, public education, and media education. The environmental/technological category covers a range of strategies: metal detectors, school police, concrete barriers, dress codes, and safe corridor programs, among othens. The rather broad recreational category is based upon the importance of physical activity as an outlet for stress and anger and as a component of a multicomponent program. Multi-intervention programs are described as well as some of the major gaps in current violence prevention programming.

The suggested role of the pediatrician in violence prevention efforts is described as both initiator and collaborator, as counselor, and as advocate. Because of their great credibility with respect to issues related to children and youth, pediatricians can influence not only parents in their contacts with them in the health care setting, but also school administrators and community leaders. Pediatricians have access to the media, and they can speak to the issue in public forums as well. Furthermore, pediatricians can join existing community efforts to determine ways in which violence prevention and intervention strategies can be incorporated into agency activities.
Eating in Preschool Children With Cystic Fibrosis and Healthy Peers: Behavioral Analysis
Authors: Stark Lori J. , Jelalian Elissa , Mulvihill Mary M. , Powers Scott W. , Bowen Anne M. , Spieth Leslie E. , Keating Kristen , Evans Sylvia , Creveling Susan , Harwood Ivan , Passero Mary Anne , Hovell Melbourne F.
Published: December 2021

Study objective. To investigate calorie intake, behavioral eating styles, and parent perception of eating behavior of preschool children with cystic fibrosis (CF) compared with healthy peers.

Design. A two group comparison study.

Setting. A clinical sample of 32 preschool children with CF (aged 2 to 5 years) and a community sample of 29 healthy peers matched for age and socioeconomic status.

Measurements and main results. The two groups did not differ on the total number of calories consumed per day or the percentage of calories derived form fat. The CF sample achieved a significantly higher percent of the recommended daily allowance (RDA) of energy (95% RDA) than the control group (84% RDA), P < .05, but did not achieve the CF dietary recommendations of 120% RDA. On measures of behavioral eating style, the CF sample had significantly longer meals (24.63 min) than the control group (18.57 min), P < .01, but did not differ on pace of eating or calories consumed per bite. On a measure of parent report of mealtime behavior, parents of the CF sample identified mealtime behaviors of "dawdles" and "refuses food" as more problematic (M = .93) than parents of control children (M = .22), P < .05.

Conclusions. While preschool children with CF consume as much or more than healthy peers, they are not achieving the CF dietary recommendations. Furthermore, there appear to be behavioral differences in eating and parent perception of CF children's eating that may contribute to the failure to achieve dietary recommendations.
The Relationship Between Vigilance Deficits and Traffic Injuries Involving Children
Authors: Pless I. B. , Taylor H. G. , Arsenault L.
Published: December 2021

Objective. This study was designed to determine whether there is an increased frequency of deficits in impulse control, vigilance, or both, among child bicyclists or pedestrians who have been injured in traffic accidents, as assessed using objective measures and parent and teacher reports.

Research design. This was a case-control study, in which cases were children injured as pedestrians or bicyclists (excluding those with severe head injuries) and controls were those injured as passengers or in some other manner in which the child's behavior was unlikely to be a factor.

Setting. Children ages 5 to 15 years presenting to the emergency room of the Montreal Children's Hospital.

Participants. For each of 286 cases, two controls were selected, making a total of 848 subjects Among the cases, 172 were injured as pedestrians and 114 as bicyclists.

Measures. Children were assessed using the Continuous Performance Task and the Delayed Response Test, both parts of a computerized test battery. Parents and teachers completed the Conners Abbreviated Symptom Questionnaire to assess hyperactivity.

Results. Cases and controls were similar on most sociodemographic and clinical measures but showed statistically significant differences in mean scores on the Continuous Performance Task measures of omissions and commissions, pointing to differences in vigilance, and on the Delayed Response Test measures of impulsivity. Mean Conners scale scores of both parent and teacher were significantly higher for cases than controls, and those of parents were higher than those of teachers.

Conclusions. Among children whose behavior may have been a factor in the occurrence of an injury, there is subjective evidence of increased hyperactivity and objective evidence of deficits in vigilance and attention when compared with closely matched controls. These findings have important implications for prevention.