bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effect of Nutritional Additives on Anti-Infective Factors in Human Milk
Authors: Quan Richard , Yang Christine , Rubinstein Steven , Lewiston Norman J. , Stevenson David K. , Kerner John A.
Published: November 2007

It has become a common practice to supplement human milk with a variety of additives to improve the nutritive content of the feeding for the premature infant. Twenty-two freshly frozen human milk samples were measured for lysozyme activity, total IgA, and specific IgA to Escherichia coli serotypes 01, 04, and 06. One mL aliquots were mixed with the following: 1 mL of Similac, Similac Special Care, Enfamil, Enfamil Premature Formula, and sterile water; 33 mL of Poly-Vi-Sol, 33 mg of Moducal, and 38 mg of breast-milk fortifier, and then reanalyzed. Significant decreases (41 % to 74%) in lysozyme activity were seen with the addition of all formulas; breast-milk fortifier reduced activity by 19%, while no differences were seen with Moducal, sterile water, or Poly-Vi-Sol. No differences were seen in total IgA content, but some decreases were seen in specific IgA to E. coli serotypes 04 and 06. E. coli growth was determined after 3 1/2 hours of incubation at 37°C after mixing. All cow-milk formulas enhanced E. coli growth; soy formulas and other additives preserved inhibition of bacterial growth. Nutritional additives can impair anti-infective properties of human milk, and such interplay should be considered in the decision on the feeding regimen of premature infants.
Neurodevelopment in Pediatric HIV Infection
Authors: Wachtel Renee C. , Tepper Vicki J. , Houck Debra , McGrath Cathleen J. , Thompson Christine
Published: November 2007

Pediatric neuro-AIDS may be the first clinical manifestation of HIV infection in children born to HIV infected mothers. As part of the neurodevelopmental examination of children, the Clinical Adaptive Test/Clinical Linguistic and Auditory Milestone Scale (CAT/CLAMS) was investigated as a tool for pediatricians to use to monitor the development of children at risk for HIV infection. The CAT/CLAMS was found to detect neurodevelopmental differences between HIV-infected and uninfected children at 12 and 18 months of age. Good correlations were found between the CAT/CLAMS and concurrently administered Bayley Scales of Infant Development. These findings suggest that the CAT/CLAMS should be considered as a part of the neurodevelopmental examination of children at risk for pediatric neuro-AIDS.
Sclerosis of the Mastoid Air Cells as an Indicator of Undiagnosed Otitis Media in Children With Down's Syndrome
Authors: Roizen Nancy J. , Martich Vesna , Ben-Ami Tamar , Shalowitz Madeleine U. , Yousefzadeh David K.
Published: November 2007

We hypothesized that many children with Down's syndrome have undiagnosed otitis media. In a 1989 study of lateral neck radiographs of 22 children with Down's syndrome, we found that 64% had sclerosis of the mastoid air cells, indicating untreated or inadequately treated otitis media. We reviewed the lateral neck radiographs of 53 children with Down's syndrome and interviewed their parents regarding the diagnosis of otitis media. Mastoid air cells were found to be sclerotic in 22 (42%) of study subjects; 32% of these had no known history of otitis media. For the 68% of children diagnosed as having had otitis media, the most common symptoms were fever (61 % ) and cough or coryza (58%). Sclerosis of the mastoid processes was not associated with a high frequency of otitis media (>20 episodes) or a higher frequency of hearing loss, but was associated with subsequent myringotomy and insertion of a ventilatory tube (P= .038). Our finding of sclerotic mastoids in 42% of children with Down's syndrome raises the possibility that children with Down's syndrome have unidentified or inadequately treated episodes of otitis media.
The Use of Zinc Protoporphyrin in Screening Young Children for Iron Deficiency
Authors: Siegel Robert M. , LaGrone Don H.
Published: November 2007

The common practice of screening children for iron deficiency with hematocrit (HCT) or hemoglobin detects only those children with iron deficiency severe enough to cause anemia. At 40 cents per test, zinc protoporphyrin (ZPP) can be measured in the physician's office and identify iron deficiency before anemia develops. The purpose of our study was to evaluate ZPP screening in young children by hematofluorimetry. All children between 9 and 36 months old were enrolled over a 1-year period. All children with HCT<33% or iron deficiency (ZPP ≥50 μmoles per mole-heme) were treated with ferrous sulfate at 3 mg-Fe/kg/day for 3 months. Four hundred and fifty-eight children were screened with a blood ZPP and spun HCT at entry. Two hundred and forty-three children (53%) had both a normal ZPP and HCT, 155 (34%) had a ZPP ≥50 and normal HCT, 26 (6%) had a ZPP ≥50 with HCT<33%, and 34 (7%) had a normal ZPP and HCT <33%. Of those with an elevated ZPP and normal HCT, 76% had a therapeutic response to iron therapy, with a 10% decrease in ZPP (P<0.005). ZPP had a greater sensitivity (81 %) than HCT (16%) in identifying children with iron deficiency. ZPP proved to be an effective and inexpensive addition to HCT in identifying children with iron deficiency.
Prenatal Counseling in Heterozygotes for Ornithine Transcarbamylase Deficiency
Authors: Fries Melissa H. , Kuller Jeffrey A. , Jurecki Elaina , Packman Seymour
Published: November 2007

X-linked ornithine transcarbamylase deficiency (OTCD) often leads to fatal neonatal hyperammonemia in affected males (hemizygotes). In prenatal management of subsequent pregnancies, families carrying female fetuses are often reassured of the low risk of clinically overt disease. We suggest that such reassurance may be misleading. While OTCD heterozygotes may show no symptoms or only mild protein intolerance, the clinical course in a fraction of children can include manifestations similar to those in affected males. We present three cases of symptomatic and previously undiagnosed OTCD heterozygotes to illustrate the potential severity of this condition. Significant improvement in function and growth followed diagnosis and treatment; however, two of the three children remain significantly developmentally delayed. While a quantitative risk estimate cannot be derived from these data, the cases are indicative of an adverse outcome in manifesting heterozygotes. Accordingly, OTCD carrier families should be counseled regarding the possibility of significant hyperammonemia, neurologic deficit, and the need for pharmacologic and dietary intervention in their heterozygote daughters.
Diagnostic Evaluation of Short Children with Height 3 SD or More Below the Mean
Authors: Kaplowitz Paul , Webb Jennie
Published: November 2007

Most children who are more than 2 SD below the mean in height (less than third percentile) have no definable cause and are considered short-normal, but for children who are 3 SD below the mean (the lowest 0.13%), the prevalence of organic disease is known to be considerably greater. To better define the frequency of different diagnoses in this subgroup and to identify useful clinical findings, we reviewed the charts of all children referred for growth evaluation over a 10-year period who were ≥-3 SD in height, >2 years old, and prepubertal. Of 60 patients (36 males and 24 females), 22% had constitutional growth delay (CGD), 23% had growth hormone deficiency (GHD), 13% had Turner syndrome, and 22% had various forms of primary growth failure (mostly associated with intrauterine growth retardation). Eight percent had very slow growth over a prolonged period but no definable cause, and 12% did not fall into any of the above groups. For differentiating GHD from CGD, a subnormal height velocity for age during a 4- to-12-month observation period, a low insulin-like growth factor-1/somatomedin C (IGF-1/Sm-C), and low total or free T4, with normal TSH, were all highly predictive of a diagnosis of GHD.
Knowledge of Gonorrhea in Adolescent Females With a History of STD
Authors: Biro Frank M. , Rosenthal Susan L. , Stanberry Lawrence R.
Published: November 2007

The purpose of this study is to examine how a previous infection with gonorrhea or another sexually transmitted disease (STD) will impact on patients' knowledge of gonorrhea. Adolescent girls were recruited from a primary-care adolescent clinic. Those with a history of an STD were overrecruited. Participants were given a standardized questionnaire regarding several symptoms and sequelae of STD. The results of this study revealed that girls (N = 248, mean age = 16.9 years) with a personal history of gonorrhea had more correct responses than those with no history of an STD, but they were not statistically different from those with a nongonococcal STD. No group had a mean correct score greater than 6.66 out of 13. Nearly two out of three participants reported that an individual had to always have one of four symptoms (discharge, pain on urination, rash, or sores) when there is a gonococcal infection. Overall, adolescents have an inaccurate foundation of knowledge regarding symptoms and sequelae of gonorrhea. Although those with a previous history of gonorrhea had higher mean scores than those with no history of an STD, they still identified the correct responses only half the time. Additionally, adolescents with a history of gonorrhea or another STD were no more likely to have identified the possibility of asymptomatic infection, despite several having only a history of asymptomatic infection.
Scleredema Revisited
Authors: Cron Randy Q. , Swetter Susan M.
Published: November 2007

Scleredema is a rare connective disease which must be differentiated from scleroderma in childhood. Scleredema is characterized by thickening of the dermis of the neck, head, and upper trunk. We report a case of scleredema in an 8-year-old boy with coincident streptococcal colonization. The patient report demonstrates many of the common features of scleredema, including an associated streptococcal infection, a relatively benign presentation of illness, and the characteristic mucopolysaccharide intradermal staining on skin biopsy. The literature on scleredema is reviewed, focusing on the disease course, differential diagnosis, and an overview of the proposed three subgroups of scleredema. The association of scleredema to a prior streptococcal infection is explored, and a proposed autoimmune pathophysiology of the disease, as it relates to streptococcal infection, is presented.
The Overdiagnosis of Lyme Disease in Children Residing in an Endemic Area
Authors: Rose Carlos D. , Fawcett Paul T. , Gibney Kathleen M. , Doughty Robert A.
Published: November 2007

The medical records of 227 children ages 1 to 19 years referred to the Lyme disease pediatric clinic over a 32-month period since May 1990 were reviewed. Clinico-serologic criteria for a positive diagnosis were applied. One hundred thirty-eight of 227 referred children did not fulfill those criteria and became the study population. Four subsets of patients emerged: (1) 54 patients with predominantly subjective symptoms; (2) 52 patients with objective evidence for an alternative diagnosis; (3) eight patients who had documented infection in the past and continued with symptoms after antibiotic treatment; and (4) 24 patients with a history of tick attachment or prenatal/family history of Lyme disease. Serologic testing data from commercial laboratories were available for the 54 children from the "predominantly subjective" group; 50% were negative, and 50% were borderline or positive. Ninety-two percent of these patients were negative at retesting by our enzyme-linked immunosorbent assay (ELISA) and 100% were negative by Western blot. Fifty-seven percent of these patients had received treatment prior to our evaluation. Children residing in an endemic area who present with vague symptoms are being diagnosed with and treated for Lyme disease without clinical or serologic documentation. In addition, fear in the lay community may be inducing doctors to diagnose Lyme disease in patients with symptoms that may be suggestive of an alternative diagnosis.
Carotid Blood-Flow Velocity Changes Detected By Doppler Ultrasound in Determination of Brain Death in Children
Authors: Jalili Mehrdad , Crade Michael , Davis Alan L.
Published: November 2007

To investigate the value of Doppler ultrasonography of the carotid arteries as a diagnostic test for the determination of brain death in children, we enrolled 17 patients in a blinded fashion in the pediatric intensive care unit of Memorial Miller Children's Hospital of Long Beach between the period of December 1990 and October 1992. After institutional review board approval and parental consent, children who sustained severe brain injury underwent Doppler ultrasonography study of their carotid arteries. Seven of 17 patients were diagnosed as having brain death by clinical criteria (complete loss of cerebral and brainstem functions) and electroencephalogram (EEG). Five of seven (71%) patients with the diagnosis of brain death had bilateral reverse flow (characteristic of increased cerebrovascular resistance and absent cerebral circulation) on their Doppler ultrasonography, yielding a specificity of 100% and sensitivity of 71.4% (P= 0.01). All surviving patients (five) and the five who did not fulfill the brain-death criteria at the time of Doppler ultrasonography and were later taken off life supportive measures had normal Doppler findings. These data indicate that Doppler ultrasonography of the carotid arteries is a very specific test and can be used as an adjunctive modality for determination of brain death in children.
Phototherapy for Neonatal Jaundice in Infants With Cephalhematomas
Authors: Tan K.L. , Lim G.C.
Published: November 2007

The efficacy of phototherapy in a group of infants with nonhemolytic hyperbilirubinemia and no cephalhematomas was compared with a second group of infants with large cephalhematomas (> 7 cm across), but similar in all other aspects. The cephalhematoma group demonstrated significantly lower hemoglobin (Hb) and hematocrit (hct) values (P < .0001, P < .002 respectively) than the standard group, even after the latter group had been adjusted by stratification (P<.0001, P<.005) such that the starting bilirubin concentration, birth weight, and gestational age were highly comparable to the cephalhematoma group. The bilirubin concentrations of the cephalhematoma, original, and adjusted groups were 277.8 ± 5.8 μmol/L ( 16.24 ± 0.03 mg/dL) , [mean ± sem], 265.2 ± 0.5 μmol/L (15.50 ± 0.03 mg/dL) , and 275.2 ± 0.9 μmol/L (16.09 ± 0.05 mg/dL) , respectively. The postnatal age at the start of phototherapy in the cephalhematoma group was comparable with that of the standard group before and after adjustment. Phototherapy was equally effective in the cephalhematoma and standard (original and adjusted) groups of infants, in terms of duration, 24-hr decline, and overall decline/hr for the duration of exposure. The proportionate 24-hr decline was 24.02 ± 1.90% vs 20.99 ± 0.23% and 22.61 ± 0.48% and overall decline/hr was 0.83 ± 0.06% vs 0.74 ± 0.01 % and 0.78 ± 0.01 %. We conclude that the sequestrated blood in the cephalhematomas did not significantly interfere with the efficacy of phototherapy.
Cephalhematomas Revisited
Authors: LeBlanc Claire M. A. , Allen Upton D. , Ventureyra Enrique
Published: November 2007

The purpose of this article is to review the most appropriate method for investigating cephalhematomas for possible infection and to clarify the indications for diagnostic aspiration. MEDLINE searches were conducted for the period from 1972 to 1993, and all English-language reports were obtained. A summary of the findings from the reports identified was supplemented by a patient report. Eleven articles reporting 13 infected cephalhematomas were identified in the literature from 1972 to 1993. Escherichia coli was isolated from approximately 50% of the cephalhematomas that were aspirated. Most patients presented with obvious clinical signs of scalp infection, sepsis, meningitis, and/or osteomyelitis. Plain radiographs, bone scans, and enhanced CT scans were limited in their ability to determine if a cephalhematoma was infected unless associated osteomyelitis existed. Aspiration is the diagnostic procedure of choice for cephalhematomas suspected of being infected, as indicated by an increase in size, development of erythema, development of fluctuance, relapse of systemic infection, or a delay in the resolution of clinical symptoms of infection.
Identification of Sepsis in Neonates Following Maternal Antibiotic Therapy
Authors: Heimler Ruth , Nelin Leif D. , Billman Daniel O. , Sasidharan P.
Published: November 2007

To examine the value of current diagnostic tests identifying neonatal sepsis related to intrapartum treatment with antibiotics, we reviewed the charts of 219 mother-infant pairs, of which 139 mothers received intrapartum antibiotics (group 1) and 80 mothers did not (group 2). When compared with group 2 infants, group 1 infants had fewer positive blood cultures (4.3% vs 20%, P<0.003), blood cultures positive for group B streptococci (GBS) (P<0.001), and positive urine GBS latex agglutination (LA) tests (P <0.001). Although the sensitivity of the white blood cell count (WBC) was 81 %, the specificity was <60% in both groups. The specificity of the urine GBS LA test was 92%. These results suggest (1) the WBC will neither confirm nor rule out neonatal septicemia; (2) blood cultures are indicated in suspected neonatal sepsis even if there was maternal intrapartum treatment with antibiotics; and (3) a urine GBS LA test is a useful adjunct in the diagnosis of neonatal GBS septicemia.
Failure to Clinically Predict NICU Hearing Loss
Authors: Eavey Roland D. , Bertero Maria do Carmo C. , Thornton Aaron R. , Herrmann Barbara S. , Joseph Janet M. , Gliklich Richard E. , Krishnamoorthy Kalpathy S. , Todres I. David
Published: November 2007

Neonatal intensive care unit (NICU) survivors demonstrate handicapping sensorineural hearing loss up to 50 times more frequently than normal newborns, yet little is known about the etiology of the hearing loss. Theoretically, accurate identification and triage of a particular infant based on a clinical profile would be useful. Forty NICU graduates of The Massachusetts General Hospital were selected for a detailed retrospective chart review evaluating prenatal, perinatal, and NICU medical conditions and treatment. Twenty-three patients identified with hearing loss and 17 infants with normal hearing were compared clinically. Univariate and multivariate analysis was performed on a subpopulation of patients (20 with hearing loss and 16 with normal hearing). A history of ventilation was associated with hearing loss (P=.0023), but this factor was not absolute. No other clinical parameters were convincingly linked to hearing loss. We conclude that reliance on risk factors is an inadequate clinical method to select a patient for a hearing test and that each NICU survivor deserves audiometric evaluation.
Prediction of 12-Month Neurodevelopmental Outcome From a 6-Month Neurologic Examination in Premature Infants
Authors: Wildin Susan R. , Anderson Anne , Woodside Marilyn , Swank Paul , Smith Karen , Denson Susan , Landry Susan
Published: November 2007

This study examined whether a neurologic examination at 6 months of age is predictive of neurodevelopmental outcome at 12 months in very-low-birth-weight (VLBW) infants. A neurologic examination and the Bayley Scales of Infant Development were performed at 6 and 12 months with VLBW infants and full-term (FT) controls. VLBW infants were categorized based on early medical complications. High-risk (HR) infants had diagnoses of bronchopulmonary dysplasia, pulmonary immaturity, grade III or IV intraventricular hemorrhage, and/or periventricular leukomalacia. VLBW infants with other diagnoses were placed in the low-risk (LR) group. Total neurologic scores (NS) improved over time for all three groups but improved more for HR infants, who had more abnormal NS at both time points; NS at 6 months predicted neurologic and developmental scores at 12 months for all three groups, but the relation between 6-and 12-month outcomes was strongest for the HR infants. The neurologic examination may be helpful in assessing VLBW infants' need for referral to early childhood intervention programs.
Gambling Amon Adolescents
Authors: Buchta Richard M.
Published: November 2007

Gambling onset during adolescence has been the subject of recent articles in the lay press. This study reports on the incidence of gambling in adolescents. There were 97 males (48.7%) and 102 females (51.3%) between the ages of 12 and 18 years. The mean age of the gamblers was 15.12 ± 1.83 (SEM), and of the nongamblers 14.36 ± 1.78. Eighty-three percent of the males and 61 % of the females reported gambling. Forty-four percent of those who gambled, but only 26% of the nongamblers, reported having at least one parent who gambled. Our study confirms the high incidence of gambling by teenagers. Of concern is the potential link between gambling and other risk-taking or addictive behaviors. Perhaps we should include gambling as part of our anticipatory guidance for adolescents.
The Management of Prepubertal Children with Gonorrhea
Authors: Christian Cindy W. , Pinto-Martin Jennifer A. , McGowan Karin L.
Published: November 2007

To determine whether test-of-cure cultures are necessary for prepubertal children diagnosed with Neisseria gonorrhoeae, we examined the records of all 66 patients <10 years old seen at Children's Hospital of Philadelphia over a 7.5-year period (1987-1994) diagnosed with gonorrhea. Ninety-eight percent had genital discharge on examination. All children with genital gonorrhea were symptomatic, but only 10% of children with rectal gonorrhea and 20% with pharyngeal infection were symptomatic. Seventy-seven percent of children were treated with ceftriaxone. Of these, 72% returned for test-of-cure cultures. Ninety-three percent of children had complete resolution of physical symptoms at test-of-cure, and all follow-up cultures were negative for N. gonorrhoeae. Our data suggest that most prepubertal children with gonorrhea are symptomatic at initial presentation and are cured after recommended treatment with ceftriaxone. The Centers for Disease Control and Prevention recommendations for obtaining test-of-cure cultures in young children with gonorrhea are unnecessary, potentially harmful, and should be revised.
Intravenous Theophylline in Pediatric Status Asthmaticus
Authors: Bien James P. , Bloom Miriam D. , Evans Robert L. , Specker Bonny , O'Brien Kevin P.
Published: November 2007

This study was conducted to determine whether intravenous theophylline, added to inhaled albuterol and intravenous methylprednisolone, provides a clinically significant benefit in the treatment of pediatric status asthmaticus. Patients aged 2 to 10 years were randomized to receive either intravenous theophylline or placebo. All patients received aerosolized albuterol and intravenous methylprednisolone. There was no difference between groups in the improvement of a clinical asthma score over time, in oxygen requirement, or in the number of albuterol treatments required. Theophylline group patients experienced more nausea, emesis, and insomnia. We conclude that there is no benefit in adding theophylline to treatment with methylprednisolone and albuterol for pediatric status asthmaticus. Furthermore, there are significantly more adverse effects associated with the use of theophylline.
Talking to Teens About Family Problems An Opportunity for Prevention
Authors: Cavanaugh Robert M. , Henneberger Paul K.
Published: November 2007

Most pediatricians do not screen for family problems as part of routine adolescent health care.1 This study documents fears, worries, and concerns about family issues expressed by 147 teenagers on a confidential questionnaire during consecutive initial visits to an adolescent medicine clinic in a university hospital setting. Among the salient findings, 44% had thought about running away from home, 42% reported having been subjected to some form of abuse, and 33% had felt like hurting themselves or someone else. Twenty-eight percent reported conflict in their home, 27% were having problems with their family, and 20% were concerned about their parents' relationship. In addition, 27% worried about the physical or mental health of family members and 22% believed that a family member had a problem with alcohol or other drugs. Twelve percent did not have a confidant with whom to discuss their innermost concerns. The data demonstrate a high frequency of stressful and anxiety-provoking family situations as reported by adolescents on a confidential questionnaire. Pediatricians who wish to provide comprehensive services to their young adult patients must be prepared to discuss such issues on a routine basis.
Worries of Parents and Their Children
Authors: Stickler Gunnar B.
Published: November 2007

Parents' major concerns were bicycle and car accidents, head injuries, abduction, exposure to environmental poisons, appropriate discipline, values and morals, affection, finances, too much television, and eating properly. Schoolchildren's concerns differed from their parents' and, for boys, included having to eat food they did not like, finances, people telling lies about them, and other issues about failure and criticism. Girls were more concerned about such dangers as abduction, burglars, strange people following them, and death. Major concerns shared by both sexes were looking foolish, people telling lies about them, being in a big crowd, and failing tests. Parents have many often unfounded or exaggerated fears about their children that are fanned by news media. This has led to the speculation that parents' insecurity about raising children has made them less effective. Continued reassurances by health professionals are needed to help parents believe more in themselves and become more secure in bringing up their children.
Screening for Psychosocial Problems in 4-5-Year-Olds During Routine EPSDT Examinations: Validity and Reliability in a Mexican-American Sample
Authors: Pagano Maria , Murphy J. Michael , Pedersen Maren , Mosbacher Dee , Crist-Whitzel Janet , Jordan Pat , Rodas Carla , Jellinek Michael S.
Published: November 2007

The effectiveness of the Pediatric Symptom Checklist (PSC) as a psychosocial screening measure to meet Federal Medicaid/Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) requirements was examined in 117 low-income preschool (aged 4—5 years old) Hispanic children during well-child examinations in three clinics over an 8-month period. The PSC identified 7% of the sample as at risk for psychosocial problems. The PSC was significantly associated with parental ratings of the children's problems in functioning, with pediatric clinicians' decisions to make mental health referrals, with degrees of associations similar to those found between PSC scores, and with the same measures with school-aged children in the same clinics. Cronbach's alpha was high ( r=.87) and virtually identical in English, Spanish, oral, and written formats. Although it identified a slightly lower rate of psychosocial problems in 4-5-year-olds than it had in school-aged children, the PSC appeared to provide an effective method of screening for psychosocial problems during EPSDT examinations.
Outcome of Respiratory Failure: A Case-Control Study
Authors: Caballero Roberto , Clark Reese H. , Wright Jean A.
Published: November 2007

Despite the availability of ECMO (extracorporeal membrane oxygenation) services for nearly a decade, the criteria for the institution of ECMO for pediatric respiratory failure are still not clearly defined. Therefore, a chart review was performed on children who were mechanically ventilated more than 48 hours in 1989-1990 in order to evaluate possible predictors of death from pediatric respiratory failure. Twenty-three children died as a consequence of respiratory failure. Nonsurvivors in both years were compared with the 78 survivors in 1990, and potential predictors were subjected to multivariate analysis. After 4 days of mechanical ventilation, an alveolar-arterial oxygen gradient (AaD02) greater than 400 torr (53.3 kPa) was a weak predictor of death due to respiratory failure, and yet an AaD02 less than 400 torr (53.3 kPa) was a stronger predictor of survivability. Combination of variables did not yield a better predictor than any single variable. Early prediction of mortality from respiratory failure in this population was not found.
Special Properties of Human Milk
Authors: Wagner Carol L. , Anderson Diane M. , Pittard William B.
Published: November 2007

In this review, several nutritional and nonnutritive differences between mothers' milk and formula and their relationship to neonatal gastrointestinal and immune processes are discussed. The dynamic relationship of human milk as evidenced by its changing composition, unique bioactive and immunologic properties, and specialized cellular components is further delin eated. The clinical significance and relevance of these findings to the clinician are then presented. Lastly, educational strategies, their effectiveness in promoting breastfeeding, and an approach that might be taken by the clinician to encourage breastfeeding are outlined.
Differences in Health Care Utilization Between Parents Who Perceive Their Child as Vulnerable versus Overprotective Parents
Authors: Thomasgard Michael , Metz W. Peter
Published: November 2007

While a parental perception of child vulnerability to illness/injury is often used interchangeably with parental overprotection, research suggests that they are independent constructs. We hypothesized more frequent pediatric nonwell-child visits for perceived child vulnerability, but not for parental overprotection. The parents of 300 children, ages 2-5 years, enrolled in a health maintenance organization, were sampled. For children without medical conditions, there were no differences in nonwell-child care visits between the high perceived vulner ability and high parental protection groups (Wilcoxon Rank Sum Test, WRST, P =.31 ). As expected, high parental protection was not significantly associated with increased nonwell-child care visits compared with the low parental protection group (WRST, P=.14). These findings suggest that markers other than health care utilization are required to identify these forms of parent-child relationship disorders.
What Went Wrong: Multiple Perspectives on an Adolescent's Decision to Refuse Blood Transfusions
Authors: Lawry Kathleen , Slomka Jacquelyn , Goldfarb Johanna
Published: November 2007

Persons with religious beliefs that conflict with mainstream medical practice create a tension for clinicians between honoring the different religious perspectives of the individual or carrying out what they believe to be their professional obligation. This is a patient presentation of an adolescent Jehovah's Witness who refuses blood transfusions. The major issue in this patient is the conflict among three values (1) respect for religious beliefs, (2) respect for a competent person's right to refuse treatment, and (3) the ability of an adolescent to make good decisions for himself. Other dilemmas presented by this patient are the lack of a coordinated plan of care, the lack of communication with the patient and family, and the lack of attention to social factors that influence the patient's situation and his resulting care.
Febrile Seizures: Is the EEG a Useful Predictor of Recurrences?
Authors: Kuturec M. , Emoto S.E. , Sofijanov N. , Dukovski M. , Duma F. , Ellenberg J.H. , Hirtz D.G. , Nelson K.B.
Published: November 2007

We examined the predictive value of a paroxysmal EEG in children with febrile seizures seen at the University Pediatric Clinic, Skopje, Macedonia, between 1982 and 1984. This was the only facility providing EEG or neurologic consultation for children in Macedonia, and almost all children in the area who experienced a febrile seizure were referred to this facility. EEGs were classified as epileptiform if they contained spikes and sharp waves or spike wave complexes, which were either focal or generalized, and were considered abnormal for age and state. Nonspecifically abnormal was defined as focal or generalized slowing excessive for age and state. Follow-up visits were scheduled at 6-month intervals; mean follow-up time was approximately 23 months. In order to determine whether clearly abnormal EEG features would predict recurrences, we compared the recurrences in 170 children with inital normal-appearing EEGs with 99 children with initial paroxysmal EEGs. There was no significant difference in risk of recurrence of febrile seizures between the two groups; increase in recurrence risk was determined primarily by younger age. The EEG did not add information regarding the likelihood of recurrence of febrile seizures.
Does Early Supplementation Affect Long-Term Breastfeeding?
Authors: Hill Pamela D. , Humenick Sharron S. , Brennan Mary L. , Woolley Deborah
Published: November 2007

The purpose of this secondary data analysis from two different samples was to examine the effect of early supplementation with manufactured milks on breastfeeding status at 20 weeks postpartum in mothers of healthy term infants. In two convenience samples of 120 and 223, respectively, breastfeeding mothers were followed up for 20 weeks postpartum or until weaning occurred. The breastfeeding rate at 20 weeks postpartum was significantly greater for mothers who reported feeding exclusively mother's milk the second week after delivery compared with mothers who breastfed and simultaneously supplemented with manufactured infant milks. Of the mothers in samples one and two who exclusively fed human milk during week 2 postpartum, 63.0% and 59.7%, respectively, were still breastfeeding at week 20, compared with 28.1 % and 24.2 %, respectively, who supplemented with artificial milks. There was no significant difference between these two groups of mothers and their intended duration of breastfeeding. Early introduction of supplemental bottles of artificial milks is associated with a decrease in the amount of human milk the infant receives as well as with early weaning.
Acanthosis Nigricans as a Risk Factor for Non-Insulin Dependent Diabetes Mellitus
Authors: Stuart Charles A. , Gilkison Charles R. , Smith Michele M. , Bosma Anna M. , Keenan Bruce S. , Nagamani Manubai
Published: November 2007

The prevalences of obesity and of non-insulin dependent diabetes mellitus (NIDDM) have increased in the United States population over the past two decades, and thus diabetes preven tion has become a major concern of public health agencies such as the National Institutes of Health. Identification of individuals at risk for diabetes is an essential first step in designing and implementing intervention programs. Insulin resistance is the hallmark of the pathophysiology of NIDDM. Subjects with hyperinsulinemia, impaired glucose tolerance, or gestational diabetes are well accepted as being at high risk for diabetes. We propose that the easily identifiable skin lesion, acanthosis nigricans, is common in the major minority groups in the United States and that its presence is a surrogate for laboratory-determined hyperinsulinemia. Clin Pediatr. 1998;37:73-80
Acute or Subacute Cranial Computed Tomography Findings in Patients with Congenital Lactic Acidemia
Authors: Breningstall Galen N.
Published: November 2007

Two patients with congenital lactic acidemia of unknown etiology developed striking and extensive cranial computed tomography abnormalities of acute or subacute onset. In addition to Leigh syndrome and MELAS (mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes), other lactic acidemia disorders may produce evolving cerebral radiographic abnormalities. An aggressive effort should be made in such patients to obtain a specific diagnosis through biochemical and molecular genetic studies. Clin Pediatr. 1999;38:381-385
Use of the Child Development Inventory to Screen High-Risk Populations
Authors: Montgomery Margaret L. , Saylor Conway F. , Bell Nancy L. , Macias Michelle M. , Charles Jane M. , Pappu Katikaneni Lakshmi D.
Published: November 2007

This study examined the validity of a parent-report inventory, the Child Development Inventory (CDI), as a developmental screening instrument in high-risk toddlers and preschoolers. Seventy-six children, aged 15-70 months, were assessed in a neonatal high-risk developmental follow-up clinic. The data included the completion of CDIs by parents/caregivers and developmental evaluations by a physician using either the Clinical Adaptive Test/Clinical Linguistic Auditory Milestone Scale (CAT/CLAMS) (15-35 months) or Slosson Intelligence Test (36-70 months). Analysis revealed a good level of sensitivity (true "abnormals"—73%) and specificity (true "normals"—87%) for the CDI General Development score. The findings suggested that the CDI is a valid and useful screening instrument for high-risk infants. Clin Pediatr. 1999;38:535-539
What Would Happen If We Treated Students as Those With Opinions That Matter? The Benefits to Principals and Teachers of Supporting Youth Engagement in School
Authors: Cook-Sather Alison
Published: November 2007

The author discusses a project that a fords high school principals an opportunity to create collaborative relationships between members of their school communities and college-based teacher education programs. In its 13 years, this collaboration has been shown to increase student and teacher engagement: Students gain perspective on what goes into teaching and learning, develop a voice to talk about the experiences they have and would like to have in school, and work toward creating more productive schooling experiences, and teachers are a forded time to engage in conversations with students about what matters to and a fects them and to strengthen their relationships with students. The author o fers concrete recommendations to principals on initiating partnerships with colleges, universities, or departments of teacher education, integrating such partnerships into the culture of their schools, and recruiting and rewarding teachers committed to student voice and engagement.
Unraveling The Knot
Authors: Engstrom Erika
Published: November 2007

This article examines the hegemonic messages about weddings, gender roles, and consumption in modern society disseminated by The Knot, a bridal media company that claims to be the “#1 wedding website,” with brand extensions into magazines, books, and in partnership with the cable outlet Oxygen, the reality television program Real Weddings from The Knot. Analyses of The Knot's media alliances and its reality television program illustrate that as an example of political economy of the media, The Knot and its media synergy create for its female audience the image of the perfect wedding, which maintains a status quo reinforcing femininity and consumerism.
Explanation and phonological remediation
Authors: Ingram David
Published: November 2007

This paper explores the relationship between research on a theory of phonological acquisition and the development of remedial programmes for phonological remediation. In particular, it examines the cyclical approach proposed by Hodson and Paden (1983) for the remediation of English- speaking children. This approach, while apparently successful, has been developed with relatively little theoretical justification. Preliminary results from crosslinguistic research on children acquiring Quiché, French, Swedish, Estonian, and Bulgarian are reported which have led to theoretical claims about the acquisition of phonology. It is shown that these same claims provide a rationale for the success of the cyclical approach.
'Can you put the blocks away?' Language-impaired children's comprehension of indirect requests
Authors: Conti-Ramsden Gina
Published: November 2007

Despite the frequent use of indirect requests in the assessment and intervention of language disorders, the study of language-impaired children's comprehension of these forms is only just emerging. The present investigation aims to further our knowledge in this area by examining language-impaired children's understanding of indirect requests in two situations: (a) one situation in which the experimenter gives the instructions to the child in a structured way, presenting each instruction once only, and (b) another situation where the mother gives the instructions to the child in an unrestricted, more natural way. The results suggest that language- impaired children, unlike normal language learners of the same language stage, behave significantly differently in the two situations.
The development of sentence comprehension as a creative process
Authors: Chipman Harold H.
Published: November 2007

Recent research has shown that young children's understanding of language is a complex process in which a high degree of linguistic creativity is evidenced at a very early age. This has important consequences both for language teaching and therapy as well as for assessment, and some guidelines for teachers are proposed.
Picture-book reading with a child with severe learning disability: a case study
Authors: Smith Liane , Durkin Kevin
Published: November 2007

Interactions between parent and child in joint picture-book reading have received considerable interest in studies of normal language acquisition. Less attention has been paid to the language-disabled child in this context. This single case study looks at the interaction between a severely impaired language learner and his professional caregiver during an episode of joint book reading. An examination is made of the nature of the interaction, the incidence of labelling, and the types of clarification requests used. It is shown that this context provides a framework within which a dialogue is developed between child and adult, with both contributing to the initiation of topics. These are then extended by means ofpredominantly open-ended question forms on the part of the caregiver. Future case studies are recom mended of individuals with different levels of language disorder, and the implications for practice are discussed.
From communication to speech in deaf children
Authors: Tait D.M. , Wood D.J.
Published: November 2007

This paper presents the results of a longitudinal study of 12 severely and profoundly deaf children aged between 3;6 and 5. Interactions between the children and their teacher in one-to-one 'conversation' sessions 'were filmed at 3-monthly intervals over a period of approximately 18 months. Analyses of these recordings led to the identification of five stages that children pass through in making the transition from pre-verbal communication to the beginnings of conversational competence. The nature of these stages and the implications both for the education of young deaf children and for theories of early language development are explored.
Analysis of the experimental adequacy of alternative and augmentative communication training studies
Authors: Udwin Orlee
Published: November 2007

A total of 133 augmentative communication training studies conducted up to December 1984 were rated on nine criteria of adequate research design. The majority of studies were found to have serious methodological flaws in terms of descriptions of subjects and training procedures, reliable and objective assessment of behavioural change, and the use of control pro cedures, thereby bringing into question the generality and reliability of their results. Of particular concern is the finding that Blissymbolics and signing within the framework of the Makaton Vocabulary, which are the most widely used augmentative systems in the UK, are backed by very few research data.
Motherese as therapy
Authors: Weistuch Lucille , Brown Betty Byers
Published: November 2007

This paper describes a programme designed to teach mothers to facilitate their children's language development. Three sequential processes are discussed. The rationale upon which the programme has been based is explained. The programme is presented together with preliminary evidence of its success. Finally, strategies for dissemination are mentioned and one successful avenue of dissemination is described.
Some strategies for developing reflective language in Year 1 children
Authors: Zubrick Ann
Published: November 2007

The transition from oral language to early literacy is associated in part with the development Of REFLECTIVE language: language for planning, monitor ing and evaluating experiences. Reflective language is often coded through the use of propositions incorporating cognitive verbs such as think, know, remember, and understand - verbs which occur frequently in all teacher talk, especially teachers' questions. Observations of young children beginning school revealed that many did not either understand or use cognitive verbs. Strategies used in Year 1 classrooms to help children understand and use cognitive verbs in appropriate contexts are described and briefly evaluated.
A review of techniques for naturalistic language training
Authors: Schwartz Ilene S.
Published: November 2007

Recently, a number of language training procedures have been developed to teach language to handicapped children in everyday settings. This paper describes the language training strategies of mand-model, time-delay, and incidental teaching. The current research that has been conducted to validate these procedures is discussed. Additionally, research describing naturalistic language training procedures that contain components of these techniques is discussed, and the author calls for an integration of these procedures. Directions for future research in this burgeoning field are suggested.
Reading problems and ocular anomalies
Authors: Bicknell P.G. , Ripley K.M.
Published: November 2007

Children at Moor House School for speech and language disorders were screened for minor ocular anomalies which might have affected their progress with reading. Ophthalmic investigation showed that 17 of the 23 children included in the initial screening had difficulties which merited intervention. The children with exophoria were introduced to a programme of eye exercises. The children with esophoria and those with miscellaneous ocular problems were given appropriate optical corrections. The treatment of minor ocular anomalies was found to have had a beneficial effect upon the rate of reading progress in a speech and language disordered population, and it may be an equally relevant form of intervention for some of the cases of specific literacy problems which are found in the main stream school population.
Observations and speculations on the emotional responses of the aphasic child
Authors: Stroh Katrin , Robinson Thelma
Published: November 2007

The paper discusses several ideas about the way language is integrated in the whole personality of the developing child, particularly focusing on the intensive gazing between the dyadic couple in the early months. In the aphasic child, this gazing remains at the intense pre-verbal level and does not become an adaptive response, as in the normal child. Without the subtlety of the adaptive response, body language is often the only way aphasic children can express their own innermost feelings. Through our cueing-in and interpretation of these non-verbal affective states, the child learns that these feelings are understood and accepted, so establishing trust and mutual reciprocity — the raw material which serves as a base for the development of early learning, verbal understanding, and growth of language.
Developing a phonological system: a case study
Authors: Grunwell Pamela , Yavas Mehmet , Russell Jane , Le Maistre Helene
Published: November 2007

This paper describes the development of the phonological system of English by a child over a four-month period during which the child was attending weekly speech therapy sessions. The factors which promoted and facilitated progressive phonological changes are discussed. Suggestions are made as to how the observations recorded in this case study can contribute to the development of explicitly principled decision-making in the devising of treatment rationales.