bluuebunny/crossref_metadata_2025 huggingface dataset:
PREVENTION OF ASTHMA WITH KETOTIFEN IN PREASTHMATIC CHILDREN: A THREE-YEAR FOLLOW-UP STUDY
Authors: Bollinger Mary E. , Wood Robert A.
Published: December 2021

This study suggests that early and prolonged administration of ketotifen to preasthmatic children significantly decreases their risk of developing asthma in early childhood.
CORRELATION OF CLINICAL PROGRESSION IN HUMAN IMMUNODEFICIENCY VIRUS-INFECTED CHILDREN WITH IN VITRO ZIDOVUDINE RESISTANCE BY A DIRECT QUANTITATIVE PERIPHERAL BLOOD LYMPHOCYTE ASSAY
Authors: Sinclair Jan P. , Hanson I. Celine
Published: December 2021

The DQPBL assay has a number of advantages over the consensus ACTG assay, being faster and less costly. The reliability of the DQPBL in comparison to the current standard is demonstrated (67% concordance, 29% enhanced sensitivity and 5% discordance). In this study, there was a correlation between AZT resistance and disease progression requiring change in antiretroviral therapy. Whether early identification of resistance to AZT will enable timely change in antiretroviral therapy, and slowing of clinical and immunologic deterioration remains to be demonstrated.
HEPATITIS C INFECTION IN PATIENTS WITH PRIMARY HYPOGAMMAGLOBULINEMIA AFTER TREATMENT WITH CONTAMINATED IMMUNE GLOBULIN
Authors: Wood Robert A.
Published: December 2021

Patients with hypogammaglobulinemia had a high rate of HCV infection after treatment with contaminated immune globulin. These patients experienced a severe and rapidly progressive course with their HCV infection and responses to interferon were poor.
DISSEMINATED CANDIDAL INFECTIONS AND INTRAVENOUS HYDROCORTISONE IN PRETERM INFANTS
Authors: Tracy James M. , Kobayashi Roger H.
Published: December 2021

Administration of IV HC significantly increases the risk of DCI in susceptible preterm infants younger than 35 days of age. The potential serious risks of DCI should be considered particularly in the patient selection process for the administration of IV HC.
INFECTION WITH CHLAMYDIA PNEUMONIAE IN INFANTS AND CHILDREN WITH ACUTE LOWER RESPIRATORY TRACT DISEASE
Authors: Greos Leon S.
Published: December 2021

Although C pneumoniac infection has recently been demonstrated to play an important role in respiratory tract infections in the adult population, it appears to have a minor role in the etiology of acute lower respiratory tract infection in children.
Pain in Pediatric Human Immunodeficiency Virus Infection: Incidence and Characteristics in a Single-institution Pilot Study
Authors: Hirschfeld Steven , Moss Howard , Dragisic Katherine , Smith Wendy , Pizzo Philip A.
Published: December 2021

Objective. Children with human immunodeficiency virus (HIV) infection have multiple complications associated with the disease process. Many of these complications are potentially painful and could affect the patient's quality of life. We examined the incidence and characteristics of the perception of pain in a cohort of families with children with HIV infection.

Methodology. A questionnaire was developed and validated with a cohort of families with children with cancer. In a survey of families at the Pediatric Branch of the National Cancer Institute, 61 children with HIV infection and their care givers, along with 19 children with cancer and their care givers, were interviewed to determine the incidence and impact of pain.

Results. Fifty-nine percent of the HIV-infected children and 55% of their care givers described pain as a component of their illness that impacted on their lives. Younger children and girls tended to report more pain. There was also a tendency for biological parents to expect and to treat more pain than foster parents, although there was no difference in the incidence of pain that biological and foster parents reported for their children. No differences were found between parents who were HIV posifive and those who were not. In addition, no correlations were noted in incidence, expectation, or impact of pain with disease progression or surrogate markers such as CD4 counts. Pain in HIV-infected patients tended to be either in the gastrointestinal tract or limbs and usually responded to nonsteroidal anti-inflammatory therapy. The patients with cancer reported an incidence (47%) and impact of pain similar to those of previously reported studies on pediatric patients with cancer.

Conclusion. Pain is common among children infected with HIV and can adversely impact on their lives, and its management should be a component of the general care of these patients.
Hypoglycemia and Cortisol Deficiency Associated With Low-dose Corticosteroid Therapy for Asthma
Authors: Carrel Aaron L. , Somers Stephanie , Lemansne Robert F. , Allen David B.
Published: December 2021

In the article by Carrel et al entitled "Hypoglycemia and Cortisol Deficiency Associated With Low-dose Corticosteroid Therapy for Asthma," reference #18 was incomplete. The correct citation is (boldface type indicates the correction):

18. Lemanske RF, Allen DB. The safety of chronic asthma treatments: continuous beta agonist therapy and prolonged inhaled corticosteroids in childhood asthma. In: Middleton E, Reed CE, Ellis EF, Adkinson NF, Yuninger JW, Busse WW, eds. Allergy: Principles and Practice. 4th ed. (Update #15). St Louis: Mosby; 1993
Paternity After Unilateral Cryptorchidism: A Controlled Study
Authors: Lee Peter A. , O'Leary Leslie A. , Songer Nancy J. , Coughlin Michael T. , Bellinger Mark F. , LaPorte Ronald E.
Published: December 2021

Objective. To determine if paternity is decreased among formerly unilateral cryptorchid men compared with a control group of men.

Subjects and Methods. Formerly unilateral cryptorchid men who had orchiopexy between 1955 and 1971 at the Children's Hospital of Pittsburgh and a group of control men have had their medical records reviewed and have been surveyed by questionnaire.

Results. Among the men who had ever married and had attempted paternity, significantly more of the unilateral cryptorchid men had been unable to father children (10.5%) than among the control group (5.4%). No difference was found when the groups were compared for the duration of regular intercourse without contraception to conception of their first child. There was no relationship between the age of orchiopexy or lifestyle factors and paternity or between the age of orchiopexy and months of regular unprotected intercourse to conception. Paternity among both groups was related to femalerelated infertility factors and to the presence of vericoceles.

Conclusion. When compared with a control group, paternity was compromised after unilateral cryptorchidism. Infertility is about twice as frequent among the unilateral group. There was no evidence of subfertility requiring a longer exposure of regular intercourse without contraception among the fertile subgroup. No correlation was found between age of orchiopexy and paternity.
Neonatal Cranial Ultrasound Abnormalities in Low Birth Weight Infants: Relation to Cognitive Outcomes at Six Years of Age
Authors: Whitaker Agnes H. , Feldman Judith F. , Van Rossem Ronan , Schonfeld Irvin Sam , Pinto-Martin Jennifer A. , Torre Carolyn , Blumenthal Suzannah R. , Paneth Nigel S.
Published: December 2021

Objective. To assess the independent relation of neonatal cranial ultrasound (US) abnormalities in low birth weight (LBW) infants to cognitive outcomes at 6 years of age.

Design. Prospective cohort study.

Sample and Methods. Six-year follow-up data were obtained on a regional birth cohort of LBW infants (<2 kg) systematically screened as neonates with serial US. US abnormalities were dichotomized into isolated germinal matrix/intraventricular hemorrhage (GM/IVH) and parenchymal lesions/ventricular enlargement (PL/VE). Global cognitive outcomes (mental retardation, borderline intelligence, and normal intelligence) and selected specific cognitive abilities were assessed at 6 years of age with standardized instruments. Multivariate techniques were used to assess the effects of US independent of maternal social disadvantage at birth and other perinatal and neonatal risk factors.

Results. The sample as a whole had a significantly elevated rate of mental retardation (MR; 5%), almost all moderate to profound in severity. PL/VE was independently related to MR (odds ratio [OR], 65.8; confidence interval [CI], 19.1 to 22.4) and borderline intelligence (OR, 3.7;CI, 1.3 to 10.8); isolated GM/IVH was more modestly related to MR (OR, 4.6; CI, 1.2 to 18.6) but not related to borderline intelligence. Approximately half of the cases of MR were attributable to PL/VE independent of other factors. Of non-US factors, the number of days receiving mechanical ventilation increased the risk for MR. Maternal social disadvantage increased the risk for borderline intelligence but not MR. Among children of normal intelligence, those with PL/VE, but not isolated GM/IVH, performed more poorly than those without US abnormalities on tests of visual perceptual organization but not on tests of language, memory, or quantitative skills.

Conclusion. Prevention of white matter injury would substantially improve cognitive outcomes for LBW infants.
Letter To The Editor
Authors: Katz Samuel L.
Published: December 2021

Drs Terry and Schneider raise legitimate questions regarding changes in polio immunization recommendations. In response to the former, although two doses of inactivated polio vaccine provide humoral immunity that will protect an individual against central nervous system invasion by wild or revertant attenuated polioviruses, they do not provide intestinal immunity, a valued asset of oral polio vaccine (OPV). Because we live in a global community where jet transportation enables one to move from a polio-endemic area to a polio-free area in less than one day, the introduction of wild polio viruses from sub-Saharan Africa or Southeast Asia poses a legitimate threat and concern to those who wish to maintain community protection, in addition to individual protection, against possible reintroduction of wild virus to the United States.
Letter To The Editor
Authors: Durand Manuel , Sardesai Smeeta , McEvoy Cindy
Published: December 2021

We thank Dr Zecca and associates for their interest in our paper.1 Their concerns regarding possible cardiac side effects during steroid therapy in very low birth weight (VLBW) infants are quite appropriate and, we feel, further emphasize the benefits of an "early" (mean postnatal age, 9 to 10 days) and "short" (7 days) course of dexamethasone therapy for this group of infants at risk for long-term pulmonary morbidities. The prior studies they have referenced2-5 and another recent study6 applied longer courses of steroid therapy (up to 42 days) to infants with well-established chronic lung disease (CLD).
Using Research to Change Public Policy: Reflections on 20 Years of Effort to Eliminate Corporal Punishment in Schools
Authors: Hyman Irwin A.
Published: December 2021

In the past 20 years, over half of the states have abolished corporal punishment in schools. Without the use of ethically questionable, experimental studies in which students were randomly assigned to paddlings, advocacy researchers were able to integrate the literature and experimental research on reward, punishment, and motivation, and conduct enough studies to provide sufficient data for policy changes. Further, every popular school discipline training program promotes well-proven positive and preventive techniques and punishments that do not inflict physical pain24. Research on alternatives, naturalistic evidence from schools that eliminated corporal punishment, and survey research prove that schools do not need to use corporal punishment.2

The movement to eliminate parental spanking is at a stage similar to the beginning of the school corporal punishment debate in 1976. Even though some studies may show that moderate parental spanking may do no short-term harm, there is little scientific evidence that it is necessary.30 There are no data to indicate that schools which eliminated corporal punishment became any worse.18

The same demographic factors and political polarizations that have kept about half of American school children from the protections against paddling afforded students in almost all other Western democracies also impede the movement to eliminate parental spanking. Since we know that corporal punishment too often leads to excesses, and since we have a multitude of effective positive approaches, what is the worst thing that would happen if all Americans stopped hitting children in any setting?

The same children who are hit for misbehavior would continue that misbehavior and other ineffective punishments would be used.
A Blanket Injunction Against Disciplinary Use of Spanking Is Not Warranted by the Data
Authors: Baumrind Diana
Published: December 2021

As Dr Larzelere's review of quality studies documents, a blanket injunction against disciplinary spanking by parents is not scientifically supportable. My brief commentary will consist of seven propositions that pertain to his conclusions.

PROPOSITION 1

The effects of parents' disciplinary methods are mediated by children's perception of their legitimacy. Reasoning with a child helps to legitimate parental authority, but to be maximally effective when a child disobeys, reasoning must be backed up periodically by consequences.

Reasoning used in conjunction with power-assertive methods clarifies the behavioral contingencies for the child by specifying what is acceptable and unacceptable behavior. When compliance cannot be obtained by repeating the directive, the addition of aversive consequences, which can include a couple of smart spanks, may be indicated. With defiant children, an additional aversive consequence enhances the effectiveness of time-out.1 Brief explanations prior to or subsequent to punishment convey the purpose behind the rules, simultaneously reinforce their inevitability, and allow the child to evaluate the reasons given. Reasoning broadens the context in which compliance is expected by generalizing from a specific act to a rule governing the larger class of behavior expected of the child. By explaining the objectives of discipline, parents enable their children to control punishment by controlling the behavior on which punishment is contingent.

PROPOSITION 2

The use of reasoning in conjunction with power-assertive methods, including physical punishment, can encourage internalization.

The judicious and limited use of power-assertive methods, including punishment, does not prevent children from internalizing parents' values.2 For example, power assertion together with explanations has been shown to increase rather than to decrease the likelihood that children will share even after instructions to do so are discontinued.3
Subabusive Violence in Child Rearing in Middle-class American Families
Authors: Graziano Anthony M. , Hamblen Jessica L. , Plante Wendy A.
Published: December 2021

This article will summarize the results of our recent study of subabusive violence in child rearing in middle-class families, and will then discuss the implications of the findings for the questions before us—"What are the short and long term effects of corporal punishment of children?"; "Should we try to reduce its use?"; "If so, can we be advised by these results on how to accomplish that?"

Subabusive violence against children1 consists of those ordinary, everyday acts of violence—spanking, hitting, slapping, etc—that do not rise to the common definitions of abuse. Most parents accept these as proper acts of discipline in the children's best interests.

The pervasiveness of subabusive violence in child rearing is not in doubt. It is rooted solidly in American traditions2 and is supported by commonly held religious beliefs.3 Surveys4-6 indicate that some 90% of parents use corporal punishment in child rearing, and its continued use in public schools has been well-documented.7

Although its pervasiveness is not in doubt, there are questions about its effects on children—intended and unintended, positive and negative effects. Is it an effective set of disciplinary tools? Does it harm children? Do its costs outweigh its benefits? There is no doubt that abusive violence against children has harmful effects, but what about subabuse? It has been argued that subabusive violence may have direct negative effects on child development, may be a risk factor for abuse, may escalate to abuse under some still unknown conditions, may violate humanitarian values, and may contribute to maintaining a general culture of violence.1
Effects of Hypocarbia on the Development of Cystic Periventricular Leukomalacia in Premature Infants Treated With High-frequency Jet Ventilation
Authors: Wiswell Thomas E. , Graziani Leonard J. , Kornhauser Michael S. , Stanley Christian , Merton Daniel A. , McKee Linda , Spitzer Alan R.
Published: December 2021

Background and Objective. Previous data from our institution indicate that mechanically ventilated premature Infants are at increased risk for cystic periventricular leukomalacia (CPVL), particularly if hypocapnia occurs. High-frequency jet ventilation (HFJV) may produce substantial hypocapnia. We sought to investigate whether hypocapnia during HFJV is associated with the development of CPVL.

Methods. Sixty-seven premature infants (mean gestational age, 27.2 weeks; mean birth weight, 1001 g) underwent HFJV for a mean of 44 (range, 8 to 70) hours during the first 3 days of life. All infants were followed with serial neurosonograms at least weekly until 6 to 8 weeks of age and every 2 to 4 weeks thereafter until discharge. To assess the cumulative effects of hypotension, acidosis, hypoxemia, and hypocarbia during the first 3 days of life on the development of PVL, we developed a quantitative assessment in which we assigned threshold levels at particular critical values of these parameters (such as a mean Paco2 of 20 mm Hg) and calculated an area above the curve between longitudinally connected values of these parameters and the threshold levels.

Results. Nine of the 67 infants died before 21 days of life. Of the 58 who survived beyond 21 days, large CPVL (> 5 mm in size) developed in 18 infants. Infants with cysts were similar in birth weight, gestational age, and virtually all other antepartum, intrapartum, and postpartum parameters compared with the 40 neonates in whom CPVL did not develop. However, infants with CPVL were significantly more likely to have moderate or severe periventricular echodensities preceding development of CPVL and periventricular echodensities that persisted for a longer period. We did not find an effect of hypotension, acidosis, or hypoxemia on the development of CPVL There were no differences in the mean Paco2, the absolute low Paco2 values, the ranges of low Paco2 between groups, or area above the curve measurements at threshold levels of 15 and 20 mm Hg, respectively. However, logistic regression analysis revealed that infants with CPVL were independently significanfly more likely to have greater cumulative hypocarbia below a threshold level of 25 mm Hg during the first day of life (odds ratio, 5.43; 95% confidence interval, 1.33 to 22.2).

Conclusions. Hypocarbia produced by treatment with HFJV during the first 3 days of life is associated with the subsequent development of CPVL. The mechanisms for the development of CPVL among premature infants treated with HFJV need to be established.
Continuity of Pediatric Ambulatory Care in a Universally Insured Population
Authors: Mustard Cameron A. , Mayer Teresa , Black Charlyn , Postl Brian
Published: December 2021

Objective. To describe the prevalence of continuity of care over a 5-year period in a complete cohort of urban children universally insured for medical care provided under fee-for-service reimbursement.

Method. All children enrolled in the study were born to women living in metropolitan Winnipeg between July 1,1987 and December 31, 1988 (N = 12 590). All ambulatory physician services for this group were enumerated from computerized administrative databases for the period from birth through 60 months. Continuity of care, defined as the proportion of total care provided by the most frequently seen physician or physician practice over time, was calculated for each child. Descriptive analyses include an examination of maternal and household characteristics associated with children receiving 80% or more of total ambulatory care from a single provider source.

Results. From birth to 24 months, 51% of children received at least 80% of ambulatory visits from a single provider practice. This proportion of the children declined to 28% at 25 through 60 months. Children living in low-income neighborhoods had poorer continuity profiles. Other household factors associated with poor continuity included young maternal age, single maternal marital status, residential mobility, and inadequate maternal use of prenatal medical care. Households affiliated with pediatric practices had better continuity profiles than households affiliated with general medical practices.

Conclusion. Despite universal medical insurance, barriers to a longitudinally continuous relationship with a primary care provider remain in this setting. Although this study has emphasized the description of those barriers associated with household characteristics, there is evidence that factors related to the organization and delivery of medical care are also relevant.
FUN ON TV
Authors: Student
Published: December 2021

Real life is filled with serial killers, mass murderers, and sickos of all degrees. Much of the twentieth century, it could be argued, has been devoted to the ingenious production and disposal of human corpses. But the scary thing is not that eye-gougings and vivisections and meals of human flesh may occasionally happen. The scary thing, the thing that ought to make the heart pound and the skin go cold and tingly, is that somehow we find this fun to watch on the small and large screens.
The Pediatric Internet
Authors: Spooner S. Andrew
Published: December 2021

The Internet is a set of rules for computer communications that has created easy access to electronic mail, electronic mailing lists, and the World Wide Web. The "pediatric Internet" consists of a growing collection of Internet resources that deal specifically with the health care of the young. Locating this information, judging its quality, and determining its appropriate use presents difficulties, but the ubiquity of the Internet makes it imperative for child health professionals to learn the skills necessary to access and provide information via this medium. The Internet will be used increasingly for scientific publishing, the original purpose of the World Wide Web. This article presents basic definitions for the Internet, some characteristics of the pediatric Internet, guidance on how to locate information, and what the future of the pediatric Internet holds.
Employment in Nursing and Preterm Birth: Are They Linked?
Authors: LUMLEY JUDITH
Published: December 2021

The possibility that employment itself, with all its rewards, both intrinsic and monetary, could be harmful to maternal and fetal health is always a matter for concern. When that suggestion is made about an archetypical female form of employment (nursing), and a specialist group devoted to the health care of women and infants, it is deeply alarming. So the recent publication which states, "our results show that strenuous working conditions are an important risk factor for preterm birth among US nurses," has been widely reported and discussed.

The study was a case-control study with cases and controls drawn from respondents to a cross-sectional mailed survey of members of the Association of Women's Health, Obstetric and Neonatal Nurses.
Prevention of Hepatitis A Infections: Guidelines for Use of Hepatitis A Vaccine and Immune Globulin
Authors:   COMMITTEE ON INFECTIOUS DISEASES
Published: December 2021

This Policy Statement was retired January 2004.

The licensing of two inactivated hepatitis A vaccines for persons 2 years or older necessitates development of recommendations for pediatric use, as well as a review of the current indications for immune globulin (IG) in hepatitis A prophylaxis. Both vaccines are immunogenic and protective in children and adults. A single dose of vaccine induced antibody in 88% to 96% of subjects by 2 weeks and 97% to 100% by 1 month, and protected against subsequent hepatitis A virus (HAV) disease occurring 21 days after receipt of the dose in a community with endemic hepatitis A infection. However, completion of the full vaccine schedule is recommended to assure high antibody titers and likely long-term protection. The major pediatric indications for vaccine are: (1) travelers to areas with intermediate to high rates of endemic hepatitis A, (2) children living in defined and circumscribed communities with high endemic rates or periodic outbreaks of HAV infection, and (3) patients with chronic liver disease. Immune globulin is recommended for postexposure prophylaxis, as vaccine has not yet been demonstrated to be protective for this purpose. Except for travelers, recommendations for IG use are not changed from those in the current edition of the Red Book, and include contacts of cases in the home, child care centers, and other selected sites.
Financing Pediatric Education in Community Settings
Authors: Weitzman Michael , Garfunkel Lynn C. , Connaughton Suzanne
Published: December 2021

Increasingly, hospital-based pediatric outpatient departments are recognized as settings that attempt to combine two critical, but not always compatible, mandates: (1) education of medical students and pediatric residents in outpatient pediatrics, and (2) service, often with inadequate resources, to a socially highrisk population with a disproportionately high prevalence of social, family, and psychological dysfunction. Coexistence of these two mandates has raised a number of concerns, because pediatric ambulatory care education and training have historically been based almost exclusively in a hospital setting. Trainees often get a false impression of the types of problems they will be dealing with in pediatric primary care and of how an efficient pediatric practice is managed. In addition, they often are supervised by full-time faculty who have little if any experience in community settings and who practice only part time or not at all. These problems have led to a widespread desire to train pediatric residents outside the hospital, in settings that more closely approximate the places in which they will practice in the future. Residency programs that address this issue also provide residents with the opportunity to be trained by seasoned practitioners whose primary professional responsibility is the outpatient care of children.

To date, little has been written about the cost or the financing of such educational efforts. This article summarizes what is known about the costs. We also attempt to specify the costs that should be anticipated for the various components and steps involved in devising and implementing pediatric community-based educational programs and to describe potential sources of funding for such programs.
Birthmarks: I. Vascular Nevi
Authors: Jacobs Alvin H.
Published: December 2021

Features of:

—Salmon patch-no treatment necessary

—Port-wine stain-cosmetics best therapy when on upper face associated with Sturge-Weber syndrome

—Raised vascular nevi-no therapy necessary unless interfering with vital functions.
Advice for Young Travelers
Authors: Barrett-Connor Elizabeth
Published: December 2021

Children who live or travel in developing countries are at a small but definite risk of acquiring certain diseases that they would be unlikely to encounter had they remained in North America. Pediatricians who counsel such children and their famailies need to give competent and current advice about immunizations, chemoprophylaxis, and other maneuvers designed to maintain health. This review has outlined a general disease prevention program appropriate for children who travel to developing countires.
Editorial Pediatrics in Review
Authors: H R. J.
Published: December 2021

First issues of new journals are something like first children. We work harder on them, we expect more of them and we blame ourselves for failures. The first issue of PEDIATRICS IN REVIEW is no exception. The authors, Editorial Board, staff at the Academy and I have worked hard to bring to our readers a new type of review publication. Our goal is simple: to help improve child health by providing information useful to those professionals who provide health services to children. The methods to achieve this goal are more complex.

THE METHODS

In each 32-page edition, which will come with your copy of PEDIATRICS, there will be four to six review articles, and a number of abstracts.
Group B Streptococcal Infections in Neonates
Authors: Baker Carol J.
Published: December 2021

β-Hemolytic streptococci of Lancefield group B have been causally linked to neonatal disease since 1938, but only in the last decade has the group B Streptococcus become the leading etiologic agent for bacteremia and/or meningitis occurring during the first two months of life. Neither the reasons for the emergence of this organism nor the shifts over the past 40 years in the prevalence of various bacteria responsible for neonatal infection has been adequately explained. However, the importance of the group B Streptococcus as a frequent cause of neonatal mortality and morbidity demands a thorough understanding of the epidemiology and pathogenesis, clinical features, diagnostic methods, and management of these infections by physicians caring for newborn infants.

INCIDENCE

The common occurrence of neonatal group B streptococcal septicemia and meningitis in several geographically distant centers since 1970 has allowed the relatively precise determination of attack rates for early onset type (≤5 days) infection. Reported attack rates have been surprisingly uniform, varying from 1.3/1,000 to 4.0/1,000 live births (Table 1). Because the attack rates for serious neonatal infections associated with Escherichia coli and other maternally acquired coliform organisms have been constant since 1960, the appearance of the group B Streptococcus resulted in an absolute increase in the incidence of neonatal bacterial disease during the past decade in many hospitals in this country.
Imipramine Poisoning
Authors: Nghiem Quang X. , Randel Randy C. , Leach Thomas L.
Published: December 2021

The incidence of imipramine poisoning in adults and children is increasing. Toxic effects include an anticholinergic syndrome in the early phase and direct cardiotoxicity that produces abnormalities in rhythm, conduction, and depression of contractility in later phases. In fatal cases, the cardiotoxicity is the most common cause of death. Electrocardiographic changes are so characteristic of imipramine poisoning that the diagnosis can be made or at least suspected on the basis of electrocardiographic alteration. This is illustrated by the case report. Treatment includes induced emesis and/or gastric lavage to remove unabsorbed drug. Diazepam followed by phenobarbital is used to control seizures. Physostigmine is a good agent for treatment of the anticholinergic syndrome, including supraventricular hyperexcitability. Lidocaine is useful for ventricular hyperexcitability. As shown in the case presentation, epinephrine can be effective in reversing the most advanced manifestation of cardiac toxicity, cardiogenic shock.
Kanamycin and Gentamicin Dosage in Newborn Infants
Authors: H. R. J.
Published: December 2021

An abstract, in the August issue of PIR (1:61, 1979) was entitled Kanamycin and Gentamicin, and yet the dosage schedule was only for kanamycin. The point of the abstract was to indicate that the aminoglycosides can be given safely and effectively by the intravenous route to newborn infants, but should not be given by "push" infusion since this may result in peak serum concentrations, which may result in respiratory depression. What was unclear is that the dose of gentamicin should be lower than that of kanamycin. It should have been made clear that in the newborn the dose of gentamicin is 5 mg/kg/24 hr divided into two doses.

After 7 days of age the dose is 7.5 mg/kg/24 hr divided into three doses every eight hours. The dose given for kanamycin is correct, and is about 3 times what the dose of gentamicin is for the newborn.
Adoption and Foster Care—The Pediatrician' Role
Authors: Sokoloff Burton
Published: December 2021

The United States now has approximately 2,500,000 adoptees under the age of 21—representing nearly 2% of the population in that age-group. In addition, about 350,000 children live with foster families in this country during any given year. These children and their families have inherent vulnerabilities and problems that pediatricians may overlook. Significant numbers of foster children and adoptees are seen with behavioral, learning, and psychiatric problems. It is important that continuing counseling be available to the adoptive family, commencing prior to the adoption procedure and following throughout the early adulthood of the adoptee.

ADOPTION

Uniqueness of Adoptio

Adoption is a situation with emotions which can be best comprehended by those in the adoptive triad itself: the birth-parents, the adoptee, and the adoptive-parents. In the adoptive procedure a mother has given up a child she has borne; parents adopt the child of an unfamiliar background, and, unlike his peers, the child knows that he was not born to the parents who have reared him. Many adoption agencies have in the past advised the adoptive-parents to raise the child as their own, love him as their own, and concurrently remind him periodically that he is not their own! Frequently no further counseling would be suggested for these families.
Scabies in Childhood
Authors: Hurwitz Sidney
Published: December 2021

Scabies is an extremely contagious disorder caused by an itch mite, Sarcoptes scabiei, which attacks infants and children as well as adults. Infestation begins with a newly fertilized female mite. She tunnels into the stratum corneum and lives in cutaneous burrows which may measure several millimeters to a few centimeters in length. The parasite favors areas with a low concentration of pilosebaceous follicles and a thin stratum corneum. This seems to account for a difference in the distribution of lesions in infants and young children compared to older children and adults.1

INCIDENCE

Epidemics of scabies occur in 30-year cycles, each one lasting about 15 years. We presently are near the end of a world-wide pandemic which began in 1964 and, if estimates are correct, should last until or beyond 1979 or 1980.2

CASE HISTOR

A 3-month-old white female infant started with a pruritic eruption at 2 months of age. She had a scaly erythematous papular eruption on the trunk, the postauricular areas, and extremities (Fig 1) and was otherwise healthy.3 Microscopic examinations of skin scrapings and fungal cultures were performed, and the eruption was treated as a seborrheic dermatitis with frequent shampoos and topical fluocinolone acetonide cream.

Two weeks later the rash had spread to the back of the head and neck, the entire trunk, and all extremities including the palms and soles.
Pediatric Nuclear Medicine II
Authors: Treves S. , Heyman S.
Published: December 2021

GENITOURINARY SYSTEM

Radionuclide studies of the genitourinary system have wide application in pediatric patients. They include renal scintigraphy, radionuclide cystography, and testicular scintigraphy.

Renal Scintigraphy

Early diagnosis and treatment of urinary abnormalities in children have made it possible to reduce the morbidity and mortality associated with these disorders. Radionuclide studies of the kidneys have become valuable diagnostic methods which complement radiology and ultrasonography of the genitourinary system. While information about the size, position, and shape of the renal units is available in scintigraphy, its most unique contribution is that of providing quantitative information regarding renal function. The radionuclide evaluation is done with an intravenous injection of a very small volume of radiopharmaceutical and recording with a gamma camera-computer system. Several radiopharmaceuticals can be used. The technetium-99m labeled compounds include those excreted by glomerular filtration, such as 99mTc-Sn-diethylenetriamine pentaacetic acid (DTPA), and also agents Showing varying degrees of retention by tubular cells. These include 99mTc-iron ascorbate DTPA, 99mTc-gluco-heptonate and 99mTc-dimercapto-succinic acid (DMSA). Orthoiodohippurate, labeled with 123I or 131I, is eliminated primarily by tubular excretion and is not normally retained by the kidney (Table 1). The study carries no risk and the radiation dose to the patient is lower than that of intravenous urography.

Perfusion studies are obtained by rapid imaging of the kidneys following the intravenous injection of any of the technetium radiopharmaceuticals.
Acetaminophen Toxicity
Authors: Lovejoy Frederick H. , Goldman Peter
Published: December 2021

Acetaminophen (paracetamol in the United Kingdom), first used in clinical medicine in 1893, has gained wide usage in recent years as an analgesic and an antipyretic.1 Currently popular proprietary forms of the drug in the United States are Tylenol, Liquiprin, and Datril, but an additional 300 prescription and non-prescription drugs contain acetaminophen. The names of most of these products give no indication that they contain acetaminophen. With its increased therapeutic usage in reducing fever and in relieving pain,1 a large number of serious poisonings due to acetaminophen have been reported. In the last year, one major poison control center reported that calls concerning possible acetaminophen overdose were exceeded in frequency only by those relating to aspirin and Valium. The majority of these exposures were in young children, but a sizable fraction involved adolescents.

TOXICITY

Mechanism of Toxicity of Acetaminophen

Hepatic injury is the most important manifestation of acetaminophen toxicity. There is good evidence that it is not acetaminophen itself but its metabolites that are hepatotoxic. Fig 1 is a schematic representation of the fate of acetaminophen and its postulated mode of toxicity. At therapeutic doses acetaminophen is mainly eliminated, conjugated to sulfate or glucuronic acid; a small amount appears in the form of a mercapturic acid.
Recurrent Bacterial Infections in Children
Authors: Jones James F. , Fulginiti Vincent A.
Published: December 2021

Recurrent bacterial infections in children are a source of great concern to parents and physicians and range from relatively trivial infections to illnesses that may be indicative of underlying serious disease. Parental concern is often reflected by the seeking of definitive reasons for the child's recurrent illnesses and a definitive form of therapy to terminate them. Professional and parental concern often leads to excessive diagnostic maneuvers or to therapy instituted more from frustration than from the data presented by the child. When confronted with parental concern about repetitive infections, one must evaluate the emotional reactivity of the parents, the nature and severity of the individual episodes, and the environment as well as specific immunodeficiency disease.

The most common recurrent infectious episodes are otitis media, recurrent pharyngitis, repeated episodes of pneumonia, multiple skin infections, or recurrent or persistent urinary tract infection (UTI). (Recurrent UTI will not be addressed in this article.) On rare occasions more serious recurrent infections such as meningitis, bacteremia, septic arthritis, osteomyelitis, draining lymphadenitis, or significant diarrhea may occur.

The most frequent question confronting the physician is that of adequacy of immune function in a child with recurrent infections. It is desirable to identify children with congenital or acquired immunodeficiency states at an early stage in order to provide appropriate therapy and lessen morbidity and mortality.
Screening for Urinary Tract Infection in Childhood
Authors: ASSCHER A. W.
Published: December 2021

As pointed out by Dr Rapkin in this issue (p 133), urinary tract infections are a common cause of morbidity in childhood. In the Swedish town of Göteborg, with about 500,000 inhabitants, all new urinary tract infections were studied over a seven-year period, and it was shown that the risk of acquiring symptomatic infections for boys up to the age of 11 was 1.1% and for girls 3%. Naturally the question arises whether screening for symptomless infection could prevent this high morbidity. To answer this question it is essential to know whether symptomless infections lead to symptomatic infection and if so whether treatment, suitable for use on a large scale, could prevent the development of symptoms.
Urinary Tract Infection
Authors: Rapkin Richard H.
Published: December 2021

The identification of urinary tract infection (UTI) is important in order to reduce its morbidity, to prevent its sequelae, and to identify underlying disease. This article will discuss methods of diagnosis and management of UTI, screening for UTI, and the importance of further evaluation and follow-up of children with UTIs. Much of what we know about UTI is controversial and rapid generation of new knowledge may make current recommendations passé.

CASE

V.M., a 4-year-old girl, was brought to the physician's office with the chief complaint of frequency of urination. Nine months before she had been seen because of frequency and dysuria and two consecutive midstream urine cultures grew >100,000 colonies/ml of a Gramneative rod. Sulfisoxazole was begun and a urine culture was sterile 48 hours after therapy was begun. The dysuria and frequency disappeared; therapy was continued for ten days and a urine culture four days later was sterile. One week later a voiding cystourethrogram (VCU) and an intravenous pyelogram (IVP) were performed and were interpreted as normal. Repeat urine cultures at one, two, three, and six months after the episode were sterile.

Two days before the child was seen, she had become irritable and wet the bed during sleep (she had been successfully trained at 27 months of age), and she began to void frequently during the next 24 hours.
Mitral Valve Prolapse
Authors: Fink Burton W.
Published: December 2021

The syndrome of the mitral valve prolapse is being recognized more frequently in the pediatric age range. The presence of an apical midsystolic click and a late systolic murmur should suggest the diagnosis. When the diagnosis is made, a chest roentgenogram, an electrocardiogram, and an echocardiogram should be performed as a baseline. Activity can be normal. Prophylactic antibiotics are essential before oral surgery. Periodic reexaminations with an electrocardiogram, and, if indicated, a dynamic Holter tracing should be performed. Long-term prognosis remains uncertain, and some caution should be exercised in predicting the future. Because of the known familial incidence of the syndrome, echocardiograms on members of the family should be done and genetic counseling offered to the affected individuals.
Lessons Learned from Patients: Two Cases
Authors: BENNETT JAMES W.
Published: December 2021

A 15-year-old white girl was examined because of a six-day history of pain in the right medial ankle which was sharp in nature with subsequent swelling and increased heat in the affected joint. The pain remained localized to the right ankle and was persistent. The pain also radiated up the medial aspect of the right leg when she attempted to walk. Temperature elevations were 99-100 F. There were no other myalgias or arthralgias. Medications at home included aspirin and codeine without relief. The patient reported having had a sore throat about two weeks prior to admission which lasted for several days and resolved without therapy.
Editorial
Authors: Haggerty Robert J.
Published: December 2021

THE EDITORIAL BOARD—WHO'S WHO

Editorial Board Members are usually names on a masthead who anonymously review articles. They add their expertise to the more general knowledge of an editor and assist in the selection of articles for publication. They also are used by the editor as the (usually unnamed) experts who have recommended disapproval of one's cherished paper! They are always hard working and are the backbone of any journal. The Editorial Boards of Pediatrics in Review serve all of these functions and more. Readers may be interested in their roles.

We have two Editorial Boards: A Policy Board and an Editorial Consulting Board. Both are made up of approximately equal numbers of practicing pediatricians and full-time teachers.
Patient Management Problem: Arthritis with a Rash
Authors: Ziai Mohsen
Published: December 2021

A 16-year-old black girl was admitted to the hospital with the complaint of painful right knee and skin lesions. Three weeks prior to admission the patient had felt somewhat fatigued and had had a sore throat, and the next day she developed a temperature of 102 F with shaking chills. At that time she had pain in both wrists and in back of both knees. On the following day while still somewhat febrile she noted the onset of sores on her skin which began as flat, red, painful spots over the hands and subsequently over both feet. These eventually desquamated and were on both wrists and palms, the left elbow, and over both soles and feet. Pain in her extremities was intermittent lasting about two or three days at a time in any one location. It involved the wrists, the knees, and the ankles; these pains were not accompanied by frank swelling but did interfere with proper movement of the joints. New crops of skin lesions continued to appear while the old ones desquamated. She did not measure her body temperature but did not feel feverish. Two days prior to admission she noted intense pain in her right knee which at this time appeared swollen and tender.
Editorial PREP Is For You!!!
Authors: SMULL NED W.
Published: December 2021

A half life for the first year's curriculum will have passed as you read this commentary. Since thoughtful communication is fundamental to education, re-enforcement for the purposes of PREP seems most appropriate at this time.

The American Academy of Pediatrics in active cooperation and coordination with the American Board of Pediatrics has embarked upon a historic landmark in continuing medical education. While this may sound like a global term to some, I can assure you that PREP has been developed with the pediatric practitioner in mind. PREP is, indeed, designed for you!!!

The purpose of this discussion is not to dwell on the recertification issus—understandably sensitive and I would emphasize voluntary—but to try to communicate a realistic sense of purpose of why we feel this educational process is important.
Differential Diagnosis of Wheezing in Children
Authors: Howard William A.
Published: December 2021

Wheezing is a common symptom in infants and children, engendered by anatomic and developmental features as well as innate susceptibility to infection. Congenital anomalies also may involve the air passages, still further complicating differential diagnosis. From the foregoing discussion it is apparent that history and clinical evaluations remain of paramount importance in establishing the proper diagnosis with support from radiology and the laboratory. Because of the potentially serious import of wheezing in the child, early diagnosis and treatment are of utmost importance.