bluuebunny/crossref_metadata_2025 huggingface dataset:
Adverse Effects of Meperidine, Promethazine, and Chlorpromazine for Sedation in Pediatric Patients
Authors: Nahata Milap C. , Ootz Michael A. , Krogg Elizabeth A.
Published: November 2007

A combination of meperidine (M) 25 mg/ml, promethazine (P) 6.5 mg/ml, and chlorpromazine (C) 6.5 mg/ml is widely used to produce sedation in pediatric patients. A dose of MPC 0.1 ml/kg is recommended for cardiac catheterization, but no specific guidelines for dosing or frequency of monitoring have been established for patients undergoing other types of procedures. The adverse effects of MPC were studied prospectively in 95 patients undergoing various procedures. MPC was given parenterally at a dose of 0.07-0.11 ml/kg. Four patients developed respiratory depression. In these patients, the lowest respiratory rate ranged from 12 to 20 per minute. The lowest pulse rate ranged from 92 to 102 per minute. Three patients had received recommended or lower than recommended doses of MPC. One who received MPC 0.07 ml/kg developed respiratory arrest within 30 minutes; another required naloxone, and all recovered within 10 hours. These cases suggest the need for frequent monitoring and specific dosing guidelines for MPC use in pediatric patients.
Growth of Cavernous Hemangioma with Puberty
Authors: Baker Elizabeth R. , Manders Ernest , Whitney Charles W.
Published: November 2007

There is a clinical impression among physicians that puberty may prompt growth of hemangiomas. We observed significant growth of a large cavernous hemangioma in a patient at the onset of puberty despite absent estrogen and progesterone receptors in the hemangioma tissue.
Legg-Calve-Perthes Disease Following Transient Synovitis
Authors: Mukamel Masza , Litmanovitch Menahem , Yosipovich Zvi , Grunebaum Michael , Varsano Izhak
Published: November 2007

Forty-one children with transient synovitis of the hip and 10 children with Legg-Calve-Perthes disease were followed. All 41 cases of transient synovitis had a benign outcome. In this series, nine of the 10 children with Legg-Calve-Perthes disease were diagnosed upon their first roentgeno graphic examination. One child whose first diagnosis was transient synovitis remained symptomatic for 4 months, when he developed roentgenologic changes consistent with Perthes disease.

The literature is reviewed and 455 cases of transient synovitis analyzed. Only one patient with transient synovitis developed Legg-Calve-Perthes disease after having been asymptomatic for a period of 3 months. In 17 other cases, symptoms persisted until Legg-Calve-Perthes was diagnosed. It is suggested that transient synovitis is a benign disease and that only children with protracted symptoms are at risk to develop Perthes disease.
Benign Intracranial Hypertension Following Severe Hyponatremic Dehydration in Congenital Adrenal Hyperplasia
Authors: Reynolds M.A. , Murphy N.P. , Harris F.
Published: November 2007

A case of salt-losing congenital adrenal hyperplasia with severe hyponatremic dehydration is presented. Clinical signs and symptoms of cerebral edema with el evated intracranial pressure were present. Conventional treatment was started, and after initial concern regarding future head growth and development, there was a good outcome with normal development at 1 year of age. This course is suggestive of benign intracranial hypertension. Possible mechanisms are discussed with a re view of the relevant literature.
Eczema Herpeticum of the Child
Authors: Ingrand D. , Briquet I. , Babinet J.M. , Reinert Ph. , Huraux J.M.
Published: November 2007

Two children aged 7 months with eczema herpeticum received treatment consisting of intravenous acyclovir and human plasma with a high titer of herpes simplex virus antibodies. One recovered following two recurrences, but the other died rapidly, suffering both septicemia due to Pseudomonas aeruginosa and herpetic encephalitis. In both cases, the virus involved was a herpes simplex virus type 1 (HSV 1). The various isolates obtained before, during and after treatment remained equally sen sitive to acyclovir. These observations highlight three points: (1) the unpredictable and sometimes dramatic development of eczema herpeticum in the young child; (2) the urgency of early diagnosis and treatment; (3) the role of environment in viral contamination.
Short Stature as the Major Manifestation of Celiac Disease in Older Children
Authors: Rosenbach Yoram , Dinari Gabriel , Zahavi Ilan , Nitzan Menachem
Published: November 2007

Celiac disease was diagnosed by jejunal biopsy and response to gluten elimination in 11 of 23 children with short stature referred after negative endocrine evaluation. The mean age of the group was 11 years, with a range of 5-16. All had been followed for a mean of 2.5 years at a large pediatric endocrine clinic for the evaluation of growth retardation.

Bone age retardation of more than 25 percent of the chronologic age was found in all children. Microcytic anemia and past history of gastrointestinal problems were typical of the celiac group but were not documented in the nonceliac patients. Stool fat excretion was a specific but insensitive test, while the 1-hour blood xylose test was of no value in differentiating between the two groups.

Close cooperation between pediatric endocrinology and gastroenterology clinics may be fruitful in the identification of celiac patients, especially in a group of older children with short stature, bone age retardation, and microcytic anemia.
Effect of Water Supplementation of Full-term Newborns on Arrival of Milk in the Nursing Mother
Authors: Schutzman David L. , Hervada Arturo R. , Branca Paul A.
Published: November 2007

It has been suggested that water supplementation of breast-fed newborns may delay the arrival of true milk. A total of 136 healthy term neonates were divided into two groups. Seventy-eight nursed exclusively on demand, and 58 received in addition supplemental water ad lib. Mean time for arrival of milk in the unsupplemented group was 54.9 hours and in the supplemented group 56.6 hours. This difference was not significant, indicating that water supplementation to the normal term newborn does not affect or disrupt the establishment of lactation.
Inheritance of Familial Primary Endocardial Fibroelastosis
Authors: Hanukoglu Aaron , Fried Daniel , Somekh Eli
Published: November 2007

Two related families with 15 children, seven of whom developed endocardial fibroelastosis (EFE) are described. Three of the children died during infancy, and the disease was confirmed in one of them at autopsy. The survivors, two sisters age 5 years and 15 months (Family A) and two sisters age 17 and 14 years (Family B), are now symptomless and show a decrease in left ventricular hypertrophy. The mode of inheritance of EFE in our two families appears to be either autosomal or X-linked dominant with reduced penetrance.
Duchenne Muscular Dystrophy in a 46 XY Female
Authors: Wulfsberg E.A. , Skoglund R.R.
Published: November 2007

The most common muscular dystrophy, Duchenne muscular dystrophy (DMD), is an X-linked disorder that ordinarily has full clinical expression only in males. Reports of typical clinical features in females are rare but have occurred with a phenotypically identical autosomal recessive muscular dystrophy as well as in females with X-chromosome abnormalities such as the Turner syndrome. A girl with full expression of DMD due to a 46 XY karyotype is reported, and other clinical conditions in which expression of the DMD gene occurs in females are reviewed.
Transient Erythroblastopenia of Childhood Presenting with Papilledema
Authors: Green Nancy S. , Garvin James H. , Chutorian Abe
Published: November 2007

A 4-year-old boy with transient erythroblastopenia of childhood (TEC) presented with papilledema and transient hemiparesis. Upon spontaneous hematologic recovery, the papilledema resolved. It is concluded that TEC, like other forms of anemia, may present with papilledema and even focal neurologic deficit, from which spontaneous recovery may be anticipated.
Salivary Gland Disease in Children: A Review
Authors: Myer Charles , Cotton Robin T.
Published: November 2007

This is the second of a two-part review of salivary gland disease in children. Part 1, on acquired non-neoplastic disease appeared on pages 314 through 322 in the June issue of this volume.
Psychosomatic Illness in Childhood and Adolescence
Authors: Stark Trisha , Blum Robert
Published: November 2007

We describe a methodology for systematically approaching patients with difficulties of a psychological and social nature. Definitions are given for various types of psychosomatic difficulties, and their origins are linked to two theoretical perspectives; namely, the sick role model and family systems theory. An approach to the assessment of the individual with regard to school, peer, and family relationships is offered, and methods of gathering information associated with the presenting complaint are described. Approaches to treatment are reviewed, and appropriate applications are suggested.
Intrauterine Growth Retardation and Early Adolescent Growth Spurt in Two Sisters
Authors: Arisaka Osamu , Arisaka Madoka , Kiyokawa Nobutaka , Shimizu Tosiaki , Nakayama Yuko , Yabuta Keijiro
Published: November 2007

Two sisters who presented with a similar growth pattern are described. They delivered with idiopathic intrauterine growth retardation and had an early adolescent growth spurt. The physical and endocrine findings suggested a potential relationship between intrauterine growth retardation and early puberty.
Transient Erythroblastopenia of Adolescence
Authors: Zwerdling Theodore , Finlay Jonathan , Glader Bertil E.
Published: November 2007

This case report describes a 16-year-old girl with pure red cell aplasia of 7 months duration. The erythrocyte characteristics and in vitro culture of erythroid progenitors was similar to that found in transient erythroblastopenia of childhood (TEC), a disorder most commonly seen in children 2 to 6 years of age. This case may represent the adolescent equivalent of TEC.
Relapse Markers in Childhood Thyrotoxicosis
Authors: Tan Siok-Hoon , Lee Bee-Wah , Wong Hock-Boon , Uma Rajan
Published: November 2007

Childhood thyrotoxicosis is not an uncommon illness, but there is a considerable relapse rate in these patients on medical treatment. An attempt is made in this study to identify those markers that are predictive of a tendency to relapse in childhood thyrotoxicosis. A total of 32 patients with Graves' disease were included in the study. Several features were correlated with a tendency to relapse. Of these features, sex, family history, and antibody status were not significantly correlated to relapse. However, of 17 patients with goiter size two times normal or larger, 16 relapsed in comparison with seven relapses of 15 patients with goiter size less than two times normal (p = 0.0039). Of eight patients without ophthalmopathy, only two relapsed, while 21 patients of 24 patients with ophthalmopathy, relapsed (p = 0.002). Of 13 patients with serum thyroxine levels below 20 mcg/dl, six relapsed; of the 19 patients with serum thyroxine levels above 20 mcg/dl, 17 relapsed (p = 0.039). Among 24 patients with a previous relapse, only one achieved a remission with a second course of treatment. The remaining 23 patients had recurrent relapses.

Hence it was found that goiter size, presence of ophthalmopathy, total thyroxine levels, and a previous relapse correlated significantly with a further relapse.
Progressive Neuronal Degeneration of Childhood (PNDC) with Liver Disease
Authors: Egger J. , Harding B.N. , Boyd S.G. , Wilson J. , Erdohazi M.
Published: November 2007

Thirteen children with progressive neuronal degeneration and liver disease are reported. Clinical features included developmental delay after a normal initial period with later onset of intractable epilepsy. The EEG showed an unusual but characteristic pattern, and visual evoked responses (VER) were abnormal. Rapidly progressive cerebral atrophy was seen on computerized axial tomography (CAT). Inheritance was consistent with an autosomal recessive trait. Pathological findings were neuronal degeneration and spongy change of the cerebral cortex. The calcarine cortex was more severely affected than other areas. Hepatic lesions included severe fatty change and cirrhosis. In six patients liver disease was detected before the onset of epilepsy and exposure to anticonvulsants. Two others were reported to have died from sodium valproate (SV) toxicity, but both had abnormal liver enzymes before treatment with SV, and in both the neuropathological findings were indicative of PNDC. During life, PNDC may be indicated by the characteristic clinical course, abnormal liver function tests, and abnormalities of EEG, VER, and CAT.
Neonatal Retropharyngeal Cellulitis Due to Group B Streptococcus
Authors: Asmar Basim I.
Published: November 2007

Two neonates who presented with histories of poor feeding, irritability and noisy breathing had group B streptococcal (GBS) bacteremia and retropharyngeal cellulitis. One infant also had submandibular cellulitis. Retropharyngeal cellulitis has not been recognized as a manifestation of GBS disease. Evaluation of the upper airway should be part of the workup of any sick infant with noisy breathing and/or grunting. Retropharyngeal tissue enlargement may be an early indicator of GBS disease.
Visually Impaired Infants in the 1980s
Authors: Williamson W. Daniel , Desmond Murdina M. , Andrew Leora P. , Hicks Rose N.
Published: November 2007

To identify etiologic factors and ophthalmologic diagnoses related to visual impairment in young infants, a survey was carried out within the 22 school districts providing educational services to all visually impaired infants, birth to 3 years of age, in Harris County, Texas. Review of 102 records revealed that 51 percent had impaired vision associated with prenatal factors, and 31 percent were associated with perinatal events. The most frequent ophthalmologic diagnoses were lesions of the optic nerve, optic pathway, and visual centers of the brain (cortical blindness). A majority of the infants had multiple handicaps: 17 percent had hearing loss, 48 percent had cerebral palsy, 46 percent had seizures, and 78 percent had severe developmental delay. The high incidence of multiple handicaps and significant medical problems indicates the necessity for interface between physicians and educators who serve the visually impaired infant.
Germs
Authors: Wilkinson Simon R.
Published: November 2007

A study of Scottish nursery school children shows how they construct their world of illness using the images provided in the nursery and home. An awareness of children's perceptions of the world of illness enables professionals to establish helpful clinical relationships. The ways in which children handle images and respond to the questions of adults suggest that health education strategies should be reviewed.
Strangulation of the Uvula By Hair Wrapping
Authors: McNeal Richard M. , Cruickshank James C.
Published: November 2007

A 13-month-old male presented with a hair wrapped around his uvula. The entwined hair subsequently caused autoamputation of the distal uvula. Although a non-accidental etiology has been suggested for some cases of hair strangulation of appendages, this case indicates accidental strangulation of body parts is possible.
Bacterial Meningitis in Children Whose Cerebrospinal Fluid Contains Polymorphonuclear Leukocytes Without Pleocytosis
Authors: Bonadio William A.
Published: November 2007

A retrospective study was performed of 424 children who received diagnostic lumbar puncture for analysis of cerebrospinal fluid during evaluation of an acute illness. In 106 children, the CSF contained polymorphonuclear leukocytes without pleocytosis. Of these 106 patients, 90 percent had a CSF differential cell count with 20 percent or less PMN's and 88 percent had glucose and protein concentrations within the range of normal limits. All patients had a Gram-stained smear of CSF that revealed no organisms. In no instance was a CSF culture positive for a bacterial pathogen.

In most instances, cerebrospinal fluid that contains total white cell count and glucose/protein concentrations within limits of normal, Gram-stained smear which reveals no organisms, and a differential cell count with less than 20 percent PMN's is not indicative of risk for bacterial meningitis. If the clinical situation warrants, the majority of children with this profile do not require hospitalization and initiation of empiric antibiotic therapy pending CSF culture results.
Ecological Breastfeeding and Child Spacing
Authors: Jackson Robert L.
Published: November 2007

Until the 2nd and 3rd decades of this century, breastfeeding was essential for infant survival. In that period, spacing of children was generally about 2 years. Later, improved modified cow's milk preparations became commercially available and were well tolerated by most infants. As a result, near cessation of ecological breastfeeding occurred toward the middle of the century. The decline in ecological breastfeeding was associated with early postpartum ovulation and shortened child-spacing of about 1 year.

The endocrinology of breastfeeding is now known in considerable detail. Prolactin is secreted promptly in response to nipple stimulation and is a reliable marker of the endocrine alterations occurring postpartum. Success of lactation in suppression of ovulation was found to occur when infants sucked frequently and when only small amounts of selected foods were introduced gradually after the infants were about 6 months of age.
Cocaine Exposure in a Term Neonate
Authors: Telsey Aimee M. , Merrit T. Allen , Dixon Suzanne D.
Published: November 2007

Cocaine use has increased dramatically in the past several years, and multiple medical complications associated with its use have been reported in adults, including bowel infarction and colitis. Maternal use of cocaine during pregnancy has been associated with complications in the fetus and newborn infant, including spontaneous abortions, preterm labor, cerebral infarctions, seizures, renal anomalies, and neurobehavioral and neurophysiologic abnormalities. This paper presents a case of necrotizing enterocolitis at birth in a term newborn exposed to cocaine antenatally. Cultures of the bowel grew two types of Clostridia organisms, Escherichia coli and group B streptococcus. It is suggested that bowel ischemia was secondary to the vasoconstrictive properties of the maternally abused cocaine and that secondary invasion of the bowel by multiple bacteria ensued. This case presents another possible complication to the newborn of maternal cocaine exposure in utero, namely ischemic infarction of the bowel.
Bulimia, Tricyclic Antidepressants, and Mania
Authors: Siegel David M.
Published: November 2007

Anorexia nervosa and bulimia are common conditions that are difficult to treat effectively. Psychopharmacologic agents, particularly tricyclic antidepressants, are now being used as adjunctive therapy in bulimia. The case of a 15-year-old girl with bulimia who was treated with imipramine and had a severe (and first) manic episode is presented. The complication of drug-induced mania observed in patients treated with tricyclic antidepressants is discussed.
Nail Size in Normal Infants
Authors: Seaborg Barbara , Bodurtha Joann
Published: November 2007

The nails of 48 healthy infants of 39 to 41 weeks' gestation were measured with dial calipers to establish both a method for measurement of nails and standards of nail size. Nail width and length were measured directly, and an estimated area was calculated. Nail area was compared between sexes and races and was not found to differ significantly except between races for the first fingernail. A description of the term newborn nail is presented.
Treatment of an Enteric Fistula with Somatostatin in a Premature
Authors: Julia M.V. , Parri F.J. , Albert A. , Figueras J. , Rovira J. , Morales L.
Published: November 2007

The authors present the case of an extremely premature baby affected by severe Necrotizing Enterocolitis (NEC) needing intestinal resection and ileostomy.

An enteric fistula developed 3 days after ostomy closure. The baby was started on Total Parenteral Nutrition (TPN), and 7 days later the fistula output remained constant. Somatostatin (SM) was then given intravenously (3.0 μg/Kg/hr) and the fistula closed on the 3rd day of treatment.

Since SM was introduced in 1986 as an adjunct treatment to TPN in enteric fistulas, the authors believe that theirs is the first report of a successful SM treatment in a premature.
Neonatal Group B Streptococcal Osteomyelitis and Suppurative Arthritis
Authors: Perkins Mark D. , Edwards Kathryn M. , Heller Richard M. , Green Neil E.
Published: November 2007

ORAL ANTIBIOTIC TREATMENT of acute staphylococcal osteomyelitis in toddler and school-age children has proven a cost-effective and efficacious alternative to intravenous therapy. 1,2 Oral antibiotic regimens, however, have not been carefully studied in neonatal osteomyelitis. We recently treated an infant with oral antibiotics for multifocal group B streptococcal (GBS) osteomyelitis and suppurative arthritis and report our experience.
Used by Physicians During Routine Examinations
Authors: Siegel Lawrence J. , Smith Karen E.
Published: November 2007

Parents of 316 children seen in the outpatient clinics of a large pediatric teaching hospital completed a questionnaire regarding their attitudes toward the use of infection control procedures by doctors during the routine examination and treatment of their children.

Results revealed that the majority of parents held favorable attitudes toward the wearing of gloves and masks during patient care activities. Parents who agreed that gloves and masks should be worn also tended to believe that diseases could be spread through cross-infection, that protective wear would prevent such infection, and that their children generally would benefit from these precautions. Parents of preschool-aged children felt that such procedures might make their children more fearful.

These data indicate that many parents are basically supportive of the use of infection control procedures with their children and that such techniques do not appear to be an obstacle to effective relationships between health-care professionals and their patients.
Measures of Attention Deficit
Authors: Blondis Thomas A. , Accardo Pasquale J. , Snow Jeffrey H.
Published: November 2007

After a detailed behavioral and developmental history has been supplemented by the use of formal questionnaires, the diagnosis of an attentional disorder can be further clarified by the judicious selection of psychoeducational and pediatric physical and neurodevelopmental examinations. The most common difficulty in the interpretation of psychoeducational test subscores and profiles is the significant overlap between the patterns generated by attentional deficits and those associated with memory-based learning disabilities.

Certain other medical and behavioral conditions need to receive careful consideration prior to finalizing the diagnosis of Attention Deficit Hyperactivity Disorder (ADHD). A thorough but focused general examination coupled with the pediatric neurodevelopmental examination can contribute to this differentiation.
Vomiting as a Presenting Sign
Authors: Squires Robert H.
Published: November 2007

Vomiting is seen as a symptom in patients with brain tumors, but it rarely leads to the diagnosis in the absence of a recognized neurologic deficit. Five patients were referred to a pediatric gastroenterologist for outpatient evaluation of persistent vomiting and were subsequently found to have an intracranial mass lesion. The paucity of neurologic findings and the absence of headaches in most of these patients caused the referring physicians to focus on the gastrointestinal tract and not the central nervous system as the cause of the patients' vomiting. The pathophysiology of vomiting and evaluation of these patients is discussed; recognizable patterns of vomiting in these patients are described.
Hepatitis B Virus Vaccine
Authors: Hicks Ralph A. , Cullen John W. , Jackson Mary Anne , Burry V. Fred
Published: November 2007

A cost-benefit analysis of routine active immunization against hepatitis B virus (HBV) for 500 nursing personnel at The Children's Mercy Hospital in Kansas City, Missouri, is described. Based on outcomes of HBV infection, local charges for medical care and wages lost from illness, the authors calculate the average cost per case of HBV infection to be $1,990. Including the current system of postexposure prophylaxis and an annual attack rate of 1 percent the current annual cost of HBV infection in The Children's Mercy Hospital is $12,630.

The HBV immunization program would have to continue for 15 years before its cumulative costs ($189,133) were exceeded by those of the current system ($189,450). Therefore routine immunization of nurses would not be cost effective in the near future. If, however, a subset of high-risk employees with a 2 percent attack rate is identified, or the cost of the HBV vaccine series fell from the current $103 to $27, then routine immunization would become cost beneficial within 6 years.
Mycobacterium tuberculosis Cervical Adenitis
Authors: Talmi Yoav P. , Cohen Avner H. , Finkelstein Yehuda , Versano Itzhak , Zohar Yuval
Published: November 2007

Cervical adenopathy as the sole presentation of tuberculosis is seen infrequently in the pediatric age group. Despite modern treatment and public health measures, tuberculous cervical adenitis persists, and its prompt diagnosis and treatment are important from both a clinical and preventive health perspective. The authors report five cases of children with ages ranging from 8 to 17 years, in whom cervical adenitis was the only presentation of infection with Mycobacterium tuberculosis. The clinical presentation and methods of diagnosis and treatment are described, and the difficulty of differentiation between infections with M. tuberculosis and non-tuberculous mycobacterial infections is stressed. Tuberculous cervical adenitis should be considered in cases of an elusive diagnosis of a cervical mass in the pediatric patient.
paranasal Sinus Mucocele in Cystic Fibrosis
Authors: Guttenplan Michael D. , Wetmore Ralph F.
Published: November 2007

The relationship between cystic fibrosis, nasal polyposis and chronic sinusitis is clearly defined. Mucoceles of the paranasal sinuses, however, are a well-described complication of chronic sinusitis in adults; but they rarely occur in the pediatric age group. We report a three-year-old who presented with epiphora and fullness at the right medial canthus. Computed tomography confirmed a right ethmoid mucocele which was surgically drained, with resolution of symptoms.

Approximately 12 other cases of mucoceles have been reported in the pediatric age group. Although many of these patients had recognized cystic fibrosis, some were previously undiagnosed. Only after presentation with a mucocele, did sweat testing reveal their underlying pathology. No pediatric patients in the literature were found with mucoceles and normal sweat tests. Paranasal sinus mucoceles may be diagnostic of cystic fibrosis and may be the presenting sign in some patients.
Thumb Sucking: Pediatricians' Guidelines
Authors: Friman Patrick C. , Schmitt Barton D.
Published: November 2007

Thumb sucking is a common, generally harmless child behavior whose persistent practice occasionally leads to dental, dermatological, orthopedic, and psychological problems. When to treat thumb sucking should be determined by risk potential. With a few rare exceptions (e.g., hair pulling), thumb sucking related problems do not occur until after the age of four years and therefore, treatment is rarely necessary before then. Even after this age, treatment is not recommended unless physical and/or emotional sequelae are imminent or a thumb sucking child requests help in quitting. Thus, in most cases parents should be instructed to ignore thumb sucking. When intervention is necessary, it should be preceded by a 1-month moratorium on parental attention. Treatment should include a combination of monitoring with charts, incentives for successful days and various external cues to remind the child who forgets.
Breast-feeding of Term Infants
Authors: Gale Rena , Dollberg Shaul , Branski David , Stevenson David K. , Seidman Daniel S.
Published: November 2007

On those maternity wards where "rooming in" is not practiced, infants are fed according to fixed schedules. The purpose of this study was to investigate possible differences between two common feeding regimens, three-hourly vs. four-hourly feeds during the first 3 days of life. A group of 152 singleton, full-term infants with birth weights 2,500-2,990 g, born at Bikur Cholim Hospital in Jerusalem from February 1988, to August 1988, were randomly assigned to one of two breast-feeding groups and followed prospectively. The study group (62 infants) was breast-fed every 4 hours, and the control group (90 infants) every 3 hours. The two groups were statistically similar for mean maternal age, parity, ethnic origin, social class, neonatal Apgar scores, birth percentile, and mean birth weights. Infants who breast-fed every 4 hours did not have greater transitional weight loss or higher serum bilirubin levels compared to infants fed at 3 hour intervals.
Triglycerides, Cholesterol, HDL, LDL, and VLDL Cholesterol in Serum of Phenylketonuric Children Under Dietary Control
Authors: Schulpi Kleopatra H. , Scarpalezou Astrinia
Published: November 2007

Phenylketonuria is currently treated by a special diet to avoid elevated blood concentration of the essential amino acid phenylalanine.

The authors examined 20 phenylketonuric children in the Inborn Error of Metabolism Department of Institute of Child Health in Athens. The children had simultaneous clinical and laboratory investigations. Blood cholesterol levels of these children were low in comparison with the levels of healthy children of the same age, but the triglyceride levels were higher as a result of a special diet containing a large amount of carbohydrates. Because of the triglyceride elevation the authors recommend supplementary vegetable fat intake, such as in olive oil, for their patients' dietary control.
Adolescent Cocaine Abuse
Authors: Estroff Todd W. , Schwartz Richard H. , Hoffmann Norman G.
Published: November 2007

Four hundred seventy-nine drug abusing adolescent patients enrolled in seven Straight, Inc. Adolescent Drug-Abuse Treatment Programs in five geographic regions across the United States were studied to determine the severity and patterns of cocaine abuse. Of these, 341 admitted to cocaine use and became part of this survey. Cocaine use was categorized as heavy, intermediate, or light. Areas examined were the addictive spectrum, psychosocial dysfunction, and psychiatric symptoms.

Intermediate and heavy users of cocaine abused significantly less marijuana and inhalants than light cocaine abusers. Heavy and intermediate users were more likely to use cocaine intravenously and to use crack. They developed tachyphylaxis more frequently, progressed to weekly use in less than 3 months more frequently, and became preoccupied with obtaining and using cocaine significantly more frequently. They used more sedative hypnotics to calm themselves and engaged in more criminal behavior, such as stealing from parents and stores and passing bad checks. They had more arrests for possession of drugs, stole more cars, sold more drugs, and were more likely to trade sexual favors to obtain the drug.

Heavy and intermediate users were significantly more psychiatrically disturbed than light users, becoming more suspicious, nervous, aggressive, and demonstrating increased symptoms of fatigue, sleeplessness, decreased appetite, and increasing cocaine dysphoria. All of these symptoms could be mistaken for psychiatric disorders.

This study suggests that cocaine is as addictive in adolescents as in adults; possibly more so. It also causes psychosocial dysfunction and psychiatric symptoms. Further research into cocaine addiction among adolescents is indicated.
Postoperative Analgesia
Authors: Tobias Joseph D. , Deshpande Jayant K. , Wetzel Randall C. , Facker James , Maxwell Lynne G. , Solca Maurizio
Published: November 2007

The identification of opiate receptors in the spinal cord gave rise to the suggestion that the use of intrathecal and epidural narcotics may provide effective and safe postoperative analgesia. The authors retrospectively reviewed the records of ten children who received intrathecal morphine as part of their anesthetic care over the last 2 years. Preservative-free morphine (Duramorph®) in a dose of 0.02 mg/kg was administered to all patients in the lumbar intrathecal space before the start of the surgical procedure. Adequate postoperative analgesia was achieved in the ten children. No patient required supplemental analgesic agents for the initial 15-hour postoperative period. Surgical procedures included exploratory laparotomy, laryngotracheoplasty, and craniofacial reconstruction. As with narcotics administered by any route, intrathecal morphine can cause respiratory depression, and such depression may be delayed for up to 24 hours after the dose. Therefore, the postoperative respiratory status of these children should be monitored for 24 hours after the dose, preferably in an intensive care unit. With this caveat, the use of intrathecal morphine provides safe and effective postoperative analgesia in children undergoing major surgery.
Sickle Cell Disease
Authors: Powars Darleen R. , Brown Mary
Published: November 2007

A summer camp for children with sickle cell disease (SCD) and other hemoglobinopathies has been in operation for 22 consecutive years (1,556 camper weeks). Two thirds of the campers had sickle cell anemia (SS). With the exception of 1 year, SCD-related medical problems occurred in 10 percent of the children. Episodes of illness were increased during the year when the camp was held at a site 2,200 feet above sea level.

Children with SCD can enjoy a remote, physically challenging, and emotionally enriching program. Success requires an experienced and prepared medical staff who leave the organization and "on site" management of camp activities to expert recreational professionals.
Malignant Tumors
Authors: Fischer Philip R. , Ona Ahuka Longombe , Wood Philip B. , Lucas Sebastian
Published: November 2007

In an effort to better understand the epidemiology of cancer in Zaire, a retrospective review of biopsy-proven malignant tumors was undertaken. Of 188 biopsies taken from children aged 0-15 years over a 4.5 year period, 73 (39%) revealed malignancy. Fifty-six percent of patients with malignant tumors were boys. Lymphoma was the most common tumor (28 patients, 15 with Burkitt's Lymphoma). Sarcoma (15 patients), carcinoma (8 patients), Wilms' Tumor (6 patients), and retinoblastoma (5 patients) were also seen. Lymphomas were most heavily represented in the first 5 years of life, while sarcoma and carcinoma accounted for most of the malignancies in children after 10 years of age.

Lymphomas and sarcomas are relatively more common in Zaire than in North America and Europe, while leukemia and central nervous system tumors are notably less common in Zaire.

In view of current limitations on health care in rural Zaire, cancer care should be directed toward early diagnosis, quick referral for appropriate surgical care, and use of the limited arsenal of chemotherapy.
Late Presenting, Prolonged Hypocalcemia in an Infant of a Woman with Hypocalciuric Hypercalcemia
Authors: Powell Berkley R. , Buist R.M.
Published: November 2007

Familial hypocalciuric hypercalcemia (FHH) is a benign autosomal dominant disorder. Infants affected with FHH however, born to unaffected mothers may develop life-threatening autonomous hyperparathyroidism, the mechanism of which is not clearly understood. There is little information recorded in the literature regarding the opposite scenario, i.e., unaffected infants born to affected mothers. Because fetal parathyroid suppression presumably occurs secondary to high maternal calciums, neonatal hypocalcemia would be expected. The authors present a case of an infant with the latter circumstances who presents with late onset, life-threatening hypocalcemia secondary to relative hypoparathyroidism. The authors explored the possibility that vitamin D deficiency and/or acute environmental stress facilitated the decompensation. The patient required therapy for 2 months.
Childhood Obesity
Authors: Unger Rebecca , Kreeger Lisa , Christoffel Katherine K.
Published: November 2007

The prevalence of obesity in U.S. children is rising. Etiologic studies have focused on infants and school age children but little is known about obesity in early childhood. To study the development of childhood obesity and its medical correlates, the authors reviewed 175 charts of obese children seen in a nutrition clinic.

The 61 study subjects (37% of charts reviewed) had growth records for ages 7 years and less and were without developmental delay syndromes. Thirty-nine (64%) of 61, were girls; ages at presentation were 1 to 14 years. Data collection included previous and presenting weights, heights, medical problems, and evidence of parental and sibling obesity.

Study subjects' mean percent of ideal body weight for height (%IBWH) at presentation was 160 percent. Many study subjects had medical problems considered to be related to obesity: 30 percent had asthma, 25 percent elevated blood pressure, and 28 percent hyperlipidemia. Thirty (63%) of 48, study subjects with data on maternal weight and height, had obese mothers and 14 (31%) of 45 had obese fathers. Fourteen (50%) of 28 had one or more obese siblings.

Among all study subjects, the proportion of obese (% IBWH >120%) and severely obese children (% IBWH>140%) increased between ages 1 and 7 years. For example, the proportion >140% IBWH was zero percent at 1 year and 3 years; 0.1 at 2 years; 0.2 at 4 years; 0.5 at 5 to 6 years; and 0.6 at 7 years. Of the 29 study subjects obese beyond 7 years, 0.1 were obese at 1 year; 0.2 at 2 years; 0.4 at 3 years; 0.6 at 4 years; 0.8 at 5 to 6 years; and 0.9 at 7 years.

In these 61 study subjects 1.) of those who were obese by age 7, most became obese by age 4 years and severely obese by age 5 years; 2.) most children had obese family members; and 3.) obesity in early childhood was associated with nontrivial medical problems. The data imply that prevention of persistent, severe childhood obesity will require a family-oriented approach aimed at preschool children and suggest specific testable hypotheses related to early childhood obesity.
The Importance of Parents' Concerns About Their Child's Behavior
Authors: Glascoe Frances P. , MacLean William E. , Stone Wendy L.
Published: November 2007

Parents often complain about children's behavior. Pediatricians may be unsure whether to ignore these complaints, counsel parents in-office or refer them to mental health services. This study shows a close relationship between parents' concerns and measurably significant behavior problems. Methods are provided for responding to parents' concerns. These should be useful to pediatricians who are often criticized for failing to detect and refer children with mental health problems including behavior disturbances.
Health and Safety in Day Care: Parental Knowledge
Authors: Rassin Glennda M. , Beach Patricia S. , McCormick David P. , Niebuhr Virginia N. , Weller Susan
Published: November 2007

Because injuries and illnesses occur among children, even in licensed child care facilities, parents need to be aware of existing hazards. We developed a questionnaire to assess parental knowledge of 16 health and safety features in their child's care facility. These health and safety features were identified by parents, in a pilot study, as being the most important features in a child care facility. This questionnaire was completed by 91 parents who use day care. Parents were well-educated employees of a health care institution. Our results indicate that even well-educated parents often do not check child care facilities for health and safety features. Parents tolerated a mean of 9.3% of 16 unsafe features and did not know the status of 22.4% of the features. Fifteen percent of the children had been removed from their child care facility because of health and safety concerns, 7.7% reported an injury. Our results suggest that it is important that physicians, during well child visits, include discussions about health and safety issues in the day care environment.
Sun Protection in Childhood
Authors: Truhan Andrew P.
Published: November 2007

There is compelling evidence that childhood is a particularly vulnerable time for the photocarcinogenic effects of sun exposure on the skin. Studies indicate that excessive sun exposure during the first 10-20 years of life greatly increases the risk of skin cancer. Nonmelanoma skin cancer (basal cell and squamous cell carcinoma) has been associated with cumulative sun exposure, whereas melanoma has been associated with short, intense sun exposure or blistering sunburn. Under normal circumstances, children receive three times the annual sun exposure of adults; most of one's lifetime sun exposure occurs in childhood. Depletion of the earth's protective ozone layer adds to the photodamage problem.

It is clear that sun protection is most vital in the early years. Those with fair skin are at highest risk. Photoprotective measures including sunscreen, clothing, and sun avoidance in childhood may significantly reduce the occurrence of melanoma and other skin cancer in later life. Regular use of sunscreen with a sun protection factor of 15 during the first 18 years of life could reduce the lifetime incidence of nonmelanoma skin cancer by 78%. Pediatricians can play a major role in educating parents and children.
Relationship of Fever Magnitude to Rate of Serious Bacterial infections in Infants Aged 4-8 Weeks
Authors: Bonadio William A. , McElroy Kimberly , Jacoby Patricia L. , Smith Douglas
Published: November 2007

We correlated the height of fever with underlying infectious etiology in 683 consecutive febrile infants aged four to eight weeks who received outpatient evaluation for sepsis during a five-year period. The relative number of infants with fever was inversely proportional to fever height, as 51 % had a temperature 38.1 - 38.9°C, 45% had a temperature 39 - 39.9°C, and 4% had a temperature >40°C [hyperpyrexia]. There were 34 cases of serious bacterial infections [SBI], including 16 cases of urinary tract infection, 8 cases of bacteremia, 6 cases of bacterial meningitis, and 4 cases of Salmonella enteritis. The rate of SBI increased in direct proportion to fever height, being 3.2% in those with a temperature 38.1-38.9°C, 5.2% in those with a temperature 39-39.9°C, and 26% in those with a temperature >40°C. The 6.8% rate of SBI in those with fever >39°C was significantly greater than the 3.2% rate in those with fever <39°C [p <0.035]; and the 26% rate of SBI in those with hyperpyrexia was significantly greater than the 4.1 % rate in those with fever <40°C [p <0.000004]. In identifying those with SBI, the presence of hyperpyrexia had a sensitivity of 21 %, specificity of 97%, positive-predictive value of 25%, and negative-predictive value of 96%.

The rate of SBI in febrile infants aged four to eight weeks is proportional to the height of fever documented at the time of evaluation; yet the predictive-value of hyperpyrexia in identifying individual infants with SBI is low. It is important that all febrile infants aged four to eight weeks receive complete evaluation for sepsis, regardless of height of fever.
Maternal Parenting Stress in Physicians' Families
Authors: Olsen Richard D. , Sande Jonathan R. , Olsen Gayle P.
Published: November 2007

The families of 16 male staff physicians and 26 male residents were studied. All spouses completed the Abidin Parenting Stress Index (PSI) prior to a well-child visit. Home interviews were conducted to identify factors contributing to stress. PSI scores were similar in both groups. The interviews suggested that physician fathers had limited time and energy for parenting. Resident fathers were twice as likely as staff fathers to participate in child care when home. Parenting stress tended to stay the same in 25% of families or increased in 50% of families after residency training.
Stridor in Infants and Children
Authors: Tunkel David E. , Zalzal George H.
Published: November 2007

The presence of stridor in the young child suggests a congenital or acquired abnormality of the large diameter airways. The diagnostic evaluation of the stridulous child is discussed. Emphasis is placed on those outpatient examination techniques and radiographic studies which can define the nature of the offending airway lesion (s).
The Old and New of Acute Laryngotracheal Infections
Authors: Cunningham Michael J.
Published: November 2007

Laryngotracheal infections in childhood frequently result in airway obstruction, the major symptom of which is stridor. The primary aims of management are to establish a diagnosis rapidly and to maintain or secure the child's airway. Medical treatment and airway stabilization measures vary for the three most prevalent laryngotracheal infections — supraglottitis, laryngotracheitis, and bacterial tracheitis — as well as for older and newer infectious airway entities.
Should All Children Receive Two Measles Vaccinations?
Authors: Tesoro Louis J. , Levin Mark B. , Atkin M. David , Katz Norman S. , Cotton John M. , Patrick-Miller Timothy , Langer Mindy S.
Published: November 2007

Because of the rising incidence of rubeola, we tested all our patients who were vaccinated prior to 15 months of age and those vaccinated after 15 months, if requested, for susceptibility to measles (IgG, ELISA). Those found to be susceptible were revaccinated. Of 1,228 tested, 264 (21.5%) were susceptible. In the group vaccinated before 1980, 237 of 901 (26.3%) were susceptible, whereas only 27 of 327 (8.3%) vaccinated after 1980 were not immune. Susceptibility was sharply divided by month of age at vaccination at the 14-month mark. Less than 5% of those vaccinated after age 15 months in the 1980s (one of 22, or 4.5%) were susceptible. Waning immunity (secondary vaccine failure) was not found to be a factor in our patients. Despite outbreaks of measles in surrounding communities and in our area, none of our patients developed measles. Identification of high-risk groups and selective measles revaccination should be considered as an alternative to universal revaccination in populations such as ours, since it is more cost-effective and may prove equally successful.
Bronchioalveolar Carcinoma in a 15-Year-Old Girl
Authors: Dosanjh Amrita
Published: November 2007

This report describes a 15-year-oldfemale from Venezuela who has bronchioalveolar carcinoma. She is one of the youngest patients with this particular diagnosis reported in the literature. The postulated age of onset in this case was 13 years, when the first lesion was noted. Bronchioalveolar carcinoma is an extremely rare diagnosis in the pediatric population. The paucity of symptoms in this disease can lead to a delay in diagnosis. Malignancy should be con sidered in all cases of pediatric pulmonary lesions. Bronchoscopy and transbronchial biopsy in cases of alveolar carcinoma are not particularly useful because of the peripheral location of the lesions.
Recurrent Parotitis in Childhood
Authors: Park Jay W.
Published: November 2007

Recurrent parotitis is characterized by a cyclic swelling of the parotid glands associated with discomfort and/or pain in the absence of external inflammatory changes or progression to frank suppuration.1 Recurrent parotitis is hardly a common problem, but when it does present itself, it is most perplexing. Its etiology and the pathogenesis remain an enigma and, as a consequence, consensus on proper management is still lacking.2,3