bluuebunny/crossref_metadata_2025 huggingface dataset:
Radiological Follow-up of Pediatric Pneumonia: Principle and Practice
Authors: Mahmood Dhia , Vartzelis George , McQueen Paula , Perkin Michael R.
Published: June 2007

A study was undertaken to evaluate the trends in radiological follow up of childhood pneumonia among consultant pediatricians throughout the United Kingdom. A questionnaire was sent to 120 consultant pediatricians. Among the 88 respondents, 18% would carry out a repeat chest radiograph on follow-up of all their patients admitted with pneumonia, whereas 78% would perform the investigation selectively. Among the criteria for selection, persistence of symptoms and collapse or effusion were cited, although a considerable number would repeat a chest radiograph in children with lobar pneumonia. The mean timing of a repeat chest radiograph was 5.5 weeks after presentation (range 2-12 weeks). Only 23% of the respondents worked in units with written guidelines for the follow-up of children with pneumonia. Written guidelines, specifying the categories of children who would benefit from follow-up chest radiographs, should be present and implemented in all pediatric departments.
A Safety-Net Antibiotic Prescription for Otitis Media: The Effects of a PBRN Study on Patients and Practitioners
Authors: Siegel Robert M. , Bien James , Lichtenstein Philip , Davis James , Khoury Jane C. , Knight Jamie E. , Kiely Michele , Bernier Jeralyn
Published: June 2007

Pediatricians can decrease antibiotic use by treating acute otitis media (AOM) with a safety-net antibiotic prescription (SNAP). This study assessed whether the practitioners of the Practice-Based Research Network who participated in the study continued to use the SNAP and report a 60-day follow-up of the study patients. Charts were reviewed of study patients for 60 days following study enrollment. A survey on antibiotic use for AOM was mailed to the 17 study practitioners (SP) and 30 randomly selected community pediatricians (CP). Eight of the SP used the SNAP more than 20 times over the year following the study vs 1 of the CP. Sixty-two percent of patients never received antibiotics. The recurrence/relapse rate was greater in children younger than 2 years old compared to those older, 34% vs 10%. Practitioners who participate in a Practice-Based Research Network study are more likely to use a study intervention than others.
C-Reactive Protein and Leukocytes Do Not Reliably Indicate Severity of Influenza A Infection in Childhood
Authors: Edelbauer Monika , Würzner Reinhard , Jahn Beate , Zimmerhackl Lothar Bernd
Published: June 2007

Influenza in children may mimic other infections leading to insufficient treatment. Determination of parameters that facilitate diagnosis and indicate severity would be useful to optimize treatment modalities. We prospectively screened 432 children for influenza infection. Forty-six children at the age of 4 weeks to 14 years (median, 18 months) with confirmed influenza A infection were analyzed. A clinical score of illness severity was calculated from the symptoms presented. To evaluate the dependency of the clinical score on C-reactive protein value, leukocyte count, age, and days of hospitalization, correlation and regression analyses were carried out. Neither the C-reactive protein values (median, 0.85 mg/dL; range, 0.2-18.6; r=0.14; p=0.35) nor the leukocyte counts (median, 7.95 G/L; range, 3.5-17.6; r=-0.14, p=0.34) correlated significantly with the clinical score of influenza severity. Thus, in daily clinical practice, C-reactive protein and leukocytes seem to be insufficient parameters to describe the clinical severity of influenza A infection in children.
Analysis of Children with Peripheral Lymphadenopathy
Authors: Yaris Nilgun , Cakir Murat , Sözen Emin , Cobanoglu Umit
Published: June 2007

In this study, the clinical and laboratory features of children with lymphadenopathy were evaluated. Over a 3-year period, 126 patients were referred to the clinic for lymphadenopathy. Twenty-eight of cases have diseases mimicking lymphadenopathy; 98 (mean age: 86 ± 55 months) have lymphadenopathy. Localized, limited, and generalized involvement was found in 52%, 30%, and 18% of patients. The most common localization was the head and neck region. The causes of lymphadenopathy were benign diseases in 75 patients. Sixty percent were reactive lymphadenopathy, 39% were lymphadenitis. Lymphadenitis was more frequently localized and bigger than 3 cm compared with reactive adenopathy (p = .02, p = .004). Twenty-three patients have malignant diseases whose mean age was higher than others (p = .002). The enlargement of supraclavicular nodes was more likely due to malignant disease (p = .001). The risk of malignant disease was higher in patients who had generalized lymphadenopathy, lymph nodes bigger than 3 cm, hepatosplenomegaly, and high lactate dehydrogenase levels. In conclusion, this study pointed out the important clues for the differential diagnosis, which were present in the history, physical, and laboratory findings.
Plasma Glucose Concentrations in Profound Neonatal Hypoglycemia
Authors: Alkalay Arie L. , Flores-Sarnat Laura , Sarnat Harvey B. , Farber Sergio J. , Simmons Charles F.
Published: June 2007

The study goal was to define low thresholds of plasma glucose concentrations that constitute profound hypoglycemia. Population analysis was performed on research publications on neonatal hypoglycemia ascertained by a Medline search. Eligible patients had neurological sequelae associated directly and primarily with hypoglycemia (profound hypoglycemia). Of 89 infants, more than 95% had plasma glucose levels of less than 25 mg/dL that were first detected at more than 10 hours of age. A breakdown of study patients according to those with or without neurological sequelae, who were exposed to a similar degree of hypoglycemia, showed a combined incidence of neurological injury of 21%, with 95% confidence interval from 14% to 27%.
Hearing Screening Practices Among a National Sample of Primary Care Pediatricians
Authors: Wall Terry C. , Senicz Emily , Evans H. Hughes , Woolley Audie , Hardin J. Michael
Published: June 2007

The objective of this study was to describe variations in hearing screening using a survey mailed to a national sample of primary care pediatricians prior to the 2003 American Academy of Pediatrics (AAP) hearing screening guidelines. Of the 390 primary care respondents, only 303 (78%) performed audiometry, routinely beginning at age 3 (32%), 4 (44%), or 5 (17%); 81% defined abnormal audiometry primarily as failure to hear at a specified decibel level: 15 dB hearing level (HL) (<1%), 16 to 20 dB HL (10%), 21 to 25 dB HL (23%), 26 to 30 dB HL (44%), 31 to 40 dB HL (16%), and more than 40 dB HL (6%). This study serves as a baseline for comparison with postguideline practices.
A Model for Training Pediatricians to Expand Mental Health Services in the Community Practice Setting
Authors: Goodfriend Marlene , Bryant Thomas , Livingood William , Goldhagen Jeffrey
Published: June 2007

A model of training pediatricians in mental health diagnosis and intervention was developed to increase the pediatrician's competency in dealing with the increasing number of children with these problems. The model consisted of a pediatric psychiatrist working in collaboration with community pediatricians and training pediatricians in mental health interview and evaluation techniques, recognition and diagnosis of behavioral and mental disorders, and intervention and treatment. Following implementation of this model, the community pediatricians demonstrated an increase in mental health diagnoses in their practices. This model represents one approach in preparing pediatricians to respond to the increasing number of children with mental health and behavioral problems.
Determinants of Parental Discipline Practices: A National Sample From Primary Care Practices
Authors: Barkin Shari , Scheindlin Benjamin , Ip Edward H. , Richardson Irma , Finch Stacia
Published: June 2007

National guidelines urge pediatricians to address discipline as part of anticipatory guidance, yet pediatricians know little about what leads parents to use different discipline approaches. Parents seen in Pediatric Research in Office Settings practices participated in an office-based survey before the well-child visit for children 2 to 11 years old (N = 2134). Parents reported using the following discipline approaches frequently: time-outs (42%), removal of privileges (41%), sent to bedroom (27%), yelling (13%), and spanking (9%). A third of parents believe their discipline approach to be ineffective. This directs the pediatric provider to help families develop effective discipline practices tailored to their context.
Multicenter, Randomized, Double-Blind Study Comparing 20 and 40 mg of Pantoprazole for Symptom Relief in Adolescents (12 to 16 Years of Age) with Gastroesophageal Reflux Disease (GERD)
Authors: Tsou V. Marc , Baker Robert , Book Linda , Hammo Abdel-Hai , Soffer Elaine F. , Wang Wenjin , Comer Gail M. ,   Members of the 326 Study Group
Published: June 2007

An age-appropriate questionnaire (GASP-Q) was used to assess the frequency and severity of the gastroesophageal reflux disease (GERD) symptoms: abdominal/belly pain, chest pain/heartburn, pain after eating, nausea, burping/belching, vomiting/regurgitation, choking when eating, and difficulty swallowing, in adolescents age 12 to 16 years. The primary objective was to compare the mean composite symptom score (CSS) at week 8 with baseline after treatment with 20 or 40 mg of pantoprazole. Statistically significant (p < 0.001) improvement in CSS occurred in both groups. Safety was comparable between the 2 groups. Pantoprazole was safe, well tolerated, and effective in reducing symptoms of GERD in adolescents.
Clinician Practice Patterns: Linking to Community Resources for Childhood Aggression
Authors: Barkin Shari , Ip Edward H. , Finch Stacia , Martin Kathleen , Steffes Jennifer , Wasserman Richard “Mort”
Published: June 2007

Creating links to community resources for childhood aggression is one component of office-based violence prevention. Evidence is lacking regarding the effect of training clinicians to make these referrals and families’ responses to them. Clinicians who received training (n=47) and parents (1093) were queried on the provision of referrals immediately after the visit. Fewer than half of clinicians (45%) reported making a community referral. A third of providers (37%) noted difficulty in identifying local resources. Training clinicians to utilize community resources for childhood aggression does not often result in creating community links for this purpose.
Pigmented Villonodular Synovitis Causing Painless Chronic Knee Swelling in an Adolescent
Authors: Brenner Joel S.
Published: June 2007

It is uncommon for an adolescent to present with a painless chronic knee effusion without a history of trauma. Acute knee effusions are usually caused by internal derangement, patellar dislocations, or fractures. The differential diagnosis of a chronic knee effusion must include the more uncommon diagnoses of juvenile rheumatoid arthritis, septic arthritis, reactive arthritis, synovial osteochondromatosis, synovial hemangioma, synovial sarcoma, or pigmented villonodular synovitis. Radiographic imaging, plain radiographs, and magnetic resonance imaging in addition to a biopsy specimen are most helpful in differentiating these diagnoses. Pigmented villonodular synovitis is an uncommon diagnosis that is rarely seen in an adolescent. Treatment includes synovectomy via arthroscopy or open arthrotomy.
Lead in Your Child’s Lunch Box
Authors: Daluga Mimi , Miller Kelly
Published: June 2007

The Illinois Public Health Lead Poisoning Prevention Act states that “no person shall use or apply lead bearing substances: (d) in or upon any toys, furniture, or other articles used by and chewable by children.” Yet the Center for Environmental Health claimed that some lunch box manufacturers were endangering the health of children by making lunch boxes with materials that contained lead. The purpose of this study was to determine whether or not children’s lunch boxes commonly contained lead. Forty lunch boxes were tested with a rapid lead test solution and 14 (35%) were positive, confirming the frequent presence of this potentially toxic metal.
Atomoxetine in the Management of Children with ADHD: Effects on Quality of Life and School Functioning
Authors: Brown Ronald T. , Perwien Amy , Faries Douglas E. , Kratochvil Christopher J. , Vaughan Brigette S.
Published: June 2007

The purpose of this study was to examine in a controlled trial the effects of atomoxetine on the management of attention deficit-hyperactivity disorder (ADHD) symptoms and functional impairments at school and at home. Participants were 153 children (age 8 to 12 years) diagnosed with attention-deficit hyperactivity disorder who were randomized to double-blind treatment with either atomoxetine (n = 101) or placebo (n = 52). Findings revealed significant improvements both for parent and teacher ratings of behavior for children receiving atomoxetine therapy. Children also were reported to evidence a trend toward better response to active medication than to placebo for health-related quality of life as rated by parents. No significant effects were revealed for the teacher ratings of academic productivity. Data were interpreted to provide support for the efficacy of atomoxetine on the symptoms associated with ADHD. The effects of atomoxetine on other functional outcomes including academic performance and health-related outcomes are of interest, albeit less compelling for this particular investigation, than for the effects on overt symptom display.
The Safety of Mineral Oil in the Treatment of Constipation—A Lesson from Prolonged Overdose
Authors: Gal-Ezer Sharon , Shaoul Ron
Published: June 2007

There have been concerns regarding the interference in the absorption of fat-soluble vitamins in long-term treatment with mineral oil; however, there is no clear evidence in the literature to support this claim. We present a case report illustrating the effect of prolonged (5 months) large doses of mineral oil on the fat-soluble vitamin absorption in a 17-year-old girl.
Mollaret’s Meningitis Due to Human Herpesvirus 6 in an Adolescent
Authors: Capouya Jared D. , Berman David M. , Dumois Juan A.
Published: June 2007

We report the first pediatric case of Mollaret meningitis in an adolescent female with acute lymphoblastic leukemia in remission. This patient had signs and symptoms consistent with meningitis, with three episodes over a 3-month period. Human herpesvirus 6 (HHV-6) was identified during her last episode from polymerase chain reaction assay of a cerebrospinal fluid specimen. She was treated successfully with foscarnet, after which HHV-6 was undetectable in her cerebrospinal fluid.
Consistency of Diagnostic Criteria for Acute Otitis Media: A Review of the Recent Literature
Authors: Chandler Stephanie M. , Garcia Shawn M. S. , McCormick David P.
Published: June 2007

Clinicians use various criteria to diagnose acute otitis media (AOM). Using American Academy of Pediatrics (AAP) guidelines, we reviewed the consistency of AOM diagnosis in clinical trials (1994-2005). Eighty-one percent of the studies required at least one of the three AAP criteria. Only 20% of the 88 studies met all three AAP criteria for a diagnosis. We found no association between the number of criteria met and study quality or industry sponsorship. Better agreement on the definition of AOM using AAP criteria could facilitate a more accurate clinical diagnosis and provide standardization of research and patient care practices.
Immunization Status of Children on School Entry: Area Analysis and Recommendations 1991
Authors: Bradford Bradley J. , Benedum Karen J. , Heald Pamela A. , Petrie Shirley E.
Published: June 2007

The objective of the study was to examine the immunization status of children entering school as of September 1990 in two selected school districts in the Pittsburgh area. Immunization levels were determined by review of the students' school health/immunization records using AAP recommendations for age-appropriate vaccines for these children at the onset of the study. A telephone survey of parents was then conducted. Reasons for lack of adequate immunizations and demographic data were examined in the survey. Two hundred eighty-one records were reviewed. Only 122 (43%) of children were fully immunized (FI) according to the recommendations used. From the total, 237 (84%) families were successfully contacted by telephone; 109 (46%) children from this subset were FI. Both districts were similar for immunization status and demographic data. Seventy-one percent of the children were missing DTP, 48% HIB, and 44% OPV. All children had at least one MMR. The mean age of the children was 5.4 years (SD=0.35). Potential missed opportunities for immunization were identified. Ninety-six percent (n=237) of students not fully immunized (NFI) had seen a physician at least once within the past year and 65% within the past six months. Parental lack of knowledge for the need for vaccines was the reason most often identified by parents (58%) for their child's missing vaccine(s). A significant number of children in this study were found to be lacking recommended immunizations for age at entry to school despite a recent physician visit. Although many were still within the recommended age range for receiving needed immunizations, a large number of their parents stated that they did not know further vaccines were needed. Contrary to previous reports, cost, access, illness, and mobility were not identified by parents as reasons for missing vaccines in their children. Future efforts targeting immunization must emphasize better education of parents and physicians.
Mastoiditis in Children
Authors: Bitar Camille N. , Kluka Evelyn A. , Steele Russell W.
Published: June 2007

Fifty-seven children were seen over a 10-year period, 1984-1994, at two large pediatric referral centers with a diagnosis of mastoiditis. Twelve had acute infection and 45 had chronic manifestations. Clinical presentations and recovered bacterial pathogens were identical to those reported in earlier literature although the incidence of both acute and chronic mastoiditis has decreased markedly since 1950. The availability of computed tomographic (CT) scans during this decade has improved the management of chronic disease by defining the location of cholesteatomas and the extent of disease as well as possible anatomic variations and potential complications encountered during surgery. CT scanning is indicated in acute disease when there is suspicion of chronic suppuration or destruction of the mastoid.
Etiology and Outcome of Outpatient Fevers in Pediatric Heart Transplant Patients
Authors: Crandall Wallace V. , Norlin Chuck , Bullock Emily A. , Shearrow Marian E. , Tani Lloyd Y. , Orsmond Garth S. , Shaddy Robert E.
Published: June 2007

We reviewed 74 outpatient febrile episodes in 22 pediatric heart transplant patients in order to determine etiologies, rates of serious and nonserious illness, and factors predictive of serious disease. Twenty-two febrile episodes (30%) resulted in hospital admission. Only three variables were predictive of serious illness: longer duration of fever, shorter time since transplant, and lower febrile episode number. We conclude that at least 70% of outpatient febrile episodes are nonserious and can be managed safely in an outpatient setting. The duration of fever may be predictive of serious disease but is not useful at initial presentation.
Renal Manifestatións of Tuberous Sclerosis Complex
Authors: O'Hagan A. R. , Ellsworth R. , Secic M. , Rothner A. , Brouhard B. H.
Published: June 2007

Patients with tuberous sclerosis complex (TSC) are at increased risk of renal disease, predominantly angiomyolipomas and renal cysts. We retrospectively reviewed clinical data of 71 patients diagnosed with TSC. Progression of renal lesions was noted. TSC patients with renal lesions were compared with TSC patients without renal disease. Fifteen of 38 patients had renal abnormalities by imaging at presentation. Six of 9 with initially normal kidneys subsequently developed new lesions. Although not of statistical significance, there was a trend toward increased retinal hamartomas, cardiac rhabdomyomas, and skin lesions in those patients who also had renal abnormalities. Renal disease should be considered and sought in all patients with TSC, both at initial presentation and subsequently, since renal disease is a very significant cause of morbidity and mortality.
Documented Home Apnea Monitoring: Effect on Compliance, Duration of Monitoring, and Validation of Alarm Reporting
Authors: Gibson Eric , Spinner Susan , Cullen James A. , Wrobel Heidi A. , Spitzer Alan R.
Published: June 2007

The objectives of this study were to: (1) measure patient compliance with monitoring, (2) validate parental reports of alarms at home, (3) examine monitoring duration, and (4) compare documented monitor records with the traditional pneumogram to evaluate patients for monitor discontinuation. During the 1-year period fromJanuary through December, 1992, 114 infants were followed up with documented monitoring. Simultaneously, 113 infants were followed up with conventional monitors. Infants were premature, or victims of apparent life-threatening episodes (ALTE), or siblings of SIDS victims. Monitors recorded all episodes of apnea greater than 15 seconds and bradycardia loss than 80 beats per minute. All families were contacted biweekly by telephone. Downloads were performed at regular intervals. Monitor downloads were compared with simultaneous pneumograms to assess the accuracy of a long-term, intermittent event-recording system versus short-term (6-to 12-hour) continuous recording. All families were highly compliant with the use of home monitoring. Although Caucasian families used the monitors more often than non-Caucasian families, all groups used the monitor >75% of the time. True episodes were verified in 38% of patients by monitor downloads. Only 7.4% of all recorded events were true events. Of the real events, 51.2% were apneas of 16-20 seconds. No significant differences were found in overall duration of monitoring between documented and nondocumented monitors. In the premature infants, the duration of monitoring was significantly reduced in those infants found to have no true episodes over those with real events at home. Readmission for ALTE was reduced in infants with documented monitors. Premature infants without events were monitored an average of 24 fewer days (P=0.03). Computerized monitor downloads were found to be equally, if not more, sensitive than pneumograms in evaluating infants for monitor discontinuation. Documented monitoring offers a viable alternative to traditional monitoring and pneumograms in assisting clinicians and families in evaluating their infant's progress. By accurately assessing compliance, distinguishing true from false alarms, and decreasing the need for pneumograms, these devices provide valuable information to clinicians and families.
Persistent School Dysfunction: Unrecognized Comorbidity and Suboptimal Therapy
Authors: Kube David A. , Shapiro Bruce K.
Published: June 2007

To determine reasons for continued school dysfunction in children previously diagnosed as having attention deficit hyperactivity disorder (ADHD) or enrolled in a special education program (spec. ed.), a retrospective chart review of patients referred for interdisciplinary evaluations at a tertiary center for hyperactivity and learning problems was completed. Interdisciplinary clinical recommendations were used to define reasons for treatment failure in 116 children with a prior diagnosis of ADHD or spec. ed. placement. Results showed 45% of children enrolled in spec. ed. had previously undiagnosed ADHD. Thirty-one percent of those with ADHD, 55% of those in spec. ed., and 55% of those diagnosed with ADHD and in spec. ed. (Both) received a new educationally handicapping diagnosis. Psychiatric comorbidity was present in 28% of those with ADHD, 18% of those in spec. ed., and 23% of Both subjects. Thirteen percent of those in spec. ed. had significant coexisting medical conditions. Special education services were insufficient in 55% of children in spec. ed. and 55% of Both subjects. A significant difference (P<0.01) in medication use was noted between the groups with 56% of the ADHD group, 55% of the Both group, and none of the spec. ed. group treated with medication. Of all subjects with ADHD, 76% were receiving insufficient or no medication. This review suggests the following: (1) Comorbidity in children with school dysfunction is frequently not recognized. (2) Educational therapy alone may not be sufficient treatment for school dysfunction, and in cases where the treatment program is failing, the appropriateness of the program should be reviewed. (3) ADHD is commonly seen in conjunction with other educationally handicapping conditions. Therefore, in cases of continuing school dysfunction, children previously diagnosed as having ADHD should be assessed for other educationally handicapping conditions; those previously diagnosed as educationally handicapped should be assessed for ADHD. (4) Suboptimal medication use may be associated with treatment failure.
Primary Care Physician Access and Gatekeeping: A Key to Reducing Emergency Department Use
Authors: Franco Sofia M. , Mitchell Charlene K. , Buzon Rosalia M.
Published: June 2007

Use of the Emergency Department (ED) for nonurgent conditions results in increased cost and discontinuous health care. This prospective study evaluated a program (KenPAC) that required 24-hour access to a primary care physician (PCP) with ED gatekeeping responsibility. Following established criteria, medical records were reviewed for appropriateness of ED use by an urban indigent pediatric population. Emergency Department visits declined (10% to 7.6% (P=0.00005) and inappropriate visits dropped (41% to 8%) (P<0.00001) before KenPAC and after KenPAC, respectively. Parental experience, as judged by age and number of children, played a significant role in ED use. The institution of gatekeeping activity contributed to the reduced overall and inappropriate use of the ED.
Leg Cramps in Children
Authors: Leung Alexander K. C. , Wong Byron E. , Cho Helen Y. H. , Chan Paul Y. H.
Published: June 2007

Most leg cramps are benign and self-limited. Idiopathic nocturnal leg cramp is the most common form of cramps. Occasionally, leg cramps may signify a significant systemic disorder. Investigations are usually not necessary unless indicated by the history or physical examination. Symptomatic treatment consists of stretching the affected calf muscle by forcible dorsiflexion of the foot.
A Fast Hemoglobin Variant on Newborn Screening is Associated with α - Thalassemia Trait
Authors: Miller Scott T. , Desai Ninad , Pass Kenneth A. , Rao Sreedhar P.
Published: June 2007

Alpha thalassemia trait (a-thal-1) is a common cause of microcytosis in black and Asian populations. A small amount of hemoglobin Barts (2-8%) is transiently present in affected infants at birth and detectable in many newborn screening laboratories; it is a fast-moving hemoglobin on electrophoresis. In order to determine whether a report of a “fast hemoglobin variant” on newborn hemoglobinopathy screening is associated with a diagnosis of alpha thalassemia trait, hemoglobin concentration, red blood cell indices, and peripheral blood smear examination were performed on 18 infants referred for hematologic evaluation of a “fast hemoglobin variant” on newborn screening. All 18 infants with this diagnosis referred for consultation were black; ages ranged from 24 to 86 days (median 40 days). Six of 18 infants (33%) were mildly anemic for age and all 18 were microcytic. The prevalence of a “fast variant” among infants born at our institution is 2.5%. In that conditions other than oc-thal-I that cause microcytosis in early infancy are very uncommon, we conclude that all 18 of our infants with a fast hemoglobin on newborn screening likely have a-thal-1. The newborn screening result is thus a commonly and readily available laboratory report that specifically supports a diagnosis of oc-thal-1, a diagnosis with significant clinical and genetic implications that is usually made only by exclusion.
Fulminating Subacute Scierosing Panencephalitis: Case Report and Literature Review
Authors: PeBenito Rhandy , Naqvi Shehia H. , Arca Marilyn M. , Schubert Romaine
Published: June 2007

We describe a young urban boy with atypically fulminant subacute sclerosing panencephalitis (SSPE). He had measles at 3 years of age despite receiving measles immunization in infancy. The literature describing acute SSPE is reviewed and summarized. This report reiterates the need to include SSPE as a diagnostic possibility in acute encephalopathic processes. The dismal prognosis of SSPE further emphasizes the need for measles vaccination and revaccination of all children who are initially immunized at an age of less than 15 months.
Comparing a Computer-based Childhood Vaccination Registry with Parental Vaccination Cards: A Population-based Study of Delaware Children
Authors: Ortega Alexander N. , Andrews Stephen F. , Katz Solomon H. , Dowshen Steven A. , Curtice W. Scott , Cannon Mary E. , Stewart Denice C. L. , Kaiser Kyra
Published: June 2007

We conducted a population-based study in Delaware to examine the reliability of childhood vaccination data in a comprehensive computer-based record system versus parental vaccination cards. We sampled 1,005 children born betweenJanuary, 1991, and September, 1993. We oversampled for children whose mothers received Medicaid or were uninsured at the time of delivery. Of the survey responders, 276 (56%) had access to written records, and 409 (83%) records were located in the Delaware immunization computer database. The kappa coefficient was 0.18. The observed agreement was 59.8%. When the two databases were combined, the up-to-date rate for 2-year-olds was 58.4%, an increase of 12.7% and 24.2% from the computer database and the parental records, respectively. The computer database was 78.1% sensitive and the parental records were 54.9% sensitive. These results indicate that a comprehensive computer-based record system, with adequate provider participation and proper data management, can be more reliable than parental vaccination cards.
Influence of Cholesterol Screening and Nutritional Counseling in Reducing Cholesterol Levels in Children
Authors: Fitch Jill , Garcia Richard E. , Moodie Douglas S. , Secic Michelle
Published: June 2007

The purpose of this study was to determine whether cholesterol screening and nutritional counseling can reduce cholesterol concentrations in populations of otherwise unrecognized hypercholesterolemic children. A large pediatric practice in Parma Heights, Ohio, has conducted cholesterol surveillance of children over 2 years of age since 1986. The importance of cholesterol and other recognized risk factors for the progression of atherosclerosis is discussed with all families, and the American Heart Association's Step-One diet is recommended. The present study examines data from a cohort of 894 children (473 boys, 421 girls) who had cholesterol concentrations above 185 mg/dL (4.79 mmol/L) (the 90th percentile) at baseline and, after counseling, had a repeat measurement an average of 2.2 years later. Their mean ages were 7 years at the first testing and 9.2 years at the second. Children who had cholesterol concentrations above 200 mg/dL (5.18 mmol/L) (the 95th percentile) had lipoprotein profiles done, and if their LDL cholesterol exceeded 130 mg/dL (3.37 mmol/L) (the 95th percentile), they were referred to a nutritionist, and family members were advised to have their blood lipids analyzed.

Mean cholesterol concentration for all 894 children over this time period decreased by 9.4% (19.5 mg/dL [0.51 mmol/L]; 95% CI = 17.5 mg/dL [0.45 mmol/L] to 21.5 mg/dL [0.56 mmol/L]; P<0.001). A similar decrease of 8.6% (16.6 mg/dL [0.43 mmol/L]; 95% CI = 14.0 mg/dL [0.36 mmol/L] to 19.3 mg/dL [0.50 mmol/L]; P<0.001) was observed for the 463 children who had initial cholesterol concentrations between 185 and 200 mg/dL (4.79 and 5.18 mmol/L) and who therefore received a less intense intervention. Cholesterol concentrations in groups of otherwise unidentified hypercholesterolemic children can be significantly reduced as a result of cholesterol screening and nutritional counseling in a pediatric practice setting.
The 1996 U.S. Preventive Servlces Task Force Report: What's No Longer Worth Doing?
Authors: Gascoigne G. Bradley
Published: June 2007

How often does a report tell clinicians what they no longer need to do? In this era of increasing managed care, primary care physicians are seemingly being asked to do more and more. Therefore, it's worth taking note of the new U.S. Preventive Services Task Force Report and the 11 interventions pertaining to pediatrics this document suggests could be dropped without sacrificing quality of care. In addition, a listing is included of the newly added chapters in this report that are of potential interest to pediatricians.
Bodyfat Analysis and Perception of Body Image
Authors: Sisson Barbara A. , Franco Sofia M. , Carlin Wendy M. , Mitchell Charlene K.
Published: June 2007

Obesity is a common nutritional problem among children. Using the Futrex 5000A method of bodyfat measurement, this prospective study determined the percentage bodyfat in a self-selected, indigent, predominantly black population and the accuracy of perceived body image. Bodyfat exceeded the optimal range in 39% and 67% of female and male children, respectively. Females tended to view themselves as fatter and males perceived themselves as thinner than their actual composition. Parents were more accurate in their perception of obesity in their daughters (88%) than in their sons (52%). Children did not recognize the importance of exercise in preventing obesity. Bodyfat measurement and counseling should be done at an early age to improve this remarkable lack of perception about obesity.
A Comparison of Ciprofloxacin and Tobramycin in Bacterial Conjunctivtis in Children
Authors: Gross Robert D. , Hoffman Robert O. , Lindsay Rob N.
Published: June 2007

A study was conducted to determine the safety and efficacy of topically applied ciprofloxacin ophthalmic solution in a pediatric population experiencing acute bacterial conjunctivitis. Topically applied ciprofloxacin (3mg/mL) is known to be a safe and effective treatment for adults suffering from bacterial conjunctivitis; however, the safety and effectiveness of this broad-spectrum fluoroquinolone in pediatric patients is not well established. Ciprofloxacin was evaluated in a double-blind, randomized, controlled study of 257 patients ranging from 0 (i.e., less than 1 year) to 12 years of age from 33 geographically diverse medical centers. The children received either 0.3% ciprofloxacin ophthalmic solution (CiloxanTM, Alcon Laboratories, Fort Worth, TX) or tobramycin ophthalmic solution (TobrexTM, Alcon Laboratories, Fort Worth, TX). Both test medications were administered topically every 2 hours on days 1 and 2 followed by every 4 hours on days 3 through 7. Eyes were cultured prior to enrollment and again on day 7. Treatment efficacy as determined by microbiological culture data and physicians' judgment of overall resolution was similar for the ciprofloxacin and tobramycin groups. Microbiological eradication was observed in 90.1% of the ciprofloxacin group and 84.3% of the tobramycin group (P= 0.29). Physicians judged 87.0% of the ciprofloxacin patients and 89.9% of the tobramycin patients clinically cured on day 7 (P>0.5) There were no serious adverse medical events attributable to either treatment. This study showed that topically applied ciprofloxacin ophthalmic solution is safe and effective in a pediatric population experiencing acute bacterial conjunctivitis.
Endotoxemia Following Enteral Refeeding in Children
Authors: Ravindranath Thyyar , Yoshioka Toyokazu , Goto Masakatsu , Isaac Ronald M. , Goldman Gilbert , Young Rita I. , Zeller W. Patrick
Published: June 2007

Plasma endotoxin-like activity, tumor necrosis factor α (TNFα) concentrations, core body temperature, and liver functions were measured before and after enteral feeding in children who had been deprived of enteral feeding for 5 days because of their illness. Transient endotoxemia and elevations in plasma TNFα concentrations occurred. Core body temperature, aspartate aminotransferase, alamine aminotransferase, and bilirubin concentrations were normal in patients who had elevated plasma endotoxin-like activity. Transient endotoxemia following enteral feeding may be due to the translocation from the gastrointestinal (GI) tract as a result of increased mesenteric circulation and peristalsis. No clinical consequences were noted despite transient endotoxemia. The transient endotoxemia is not due to the immature GI tract; instead, it results from enteral feeding following the deprivation of enteral feeds.
The Plantar Response in Normal Newborn Infants
Authors: Jaynes Margaret E. , Gingold Monique K. , Hupp Ashley , Mullett Martha D. , Bodensteiner John B.
Published: June 2007

The neonatal plantar response has been reported as extensor in 90% of newborns and flexor in 93% of newborns, leading to uncertainty about its reliability and significance. To determine the normal neonatal plantar response we examined 349 healthy newborn infants, >32 weeks gestation within 24 hours of birth. A supramaximal noxious stimulus was applied in a standardized manner to the lateral plantar surface of each foot. The plantar response was extensor in 90%, equivocal in 7%, and flexor in 3%. With proper physiologic technique, the normal neonatal plantar response is extensor.
Resident Documentation of Diagnostic Impression in Sexual Abuse Evaluations
Authors: Parra Juan M. , Huston Rebecca L. , Foulds D. Michael
Published: June 2007

In sexual abuse evaluations, the documentation of the examiner's diagnostic impression is essential. If the diagnostic impression is not documented, the examiner will have to rely on memory rather than the medical record when called to testify. The purpose of this study was to determine whether pediatric residents adequately document their diagnostic impression in child sexual abuse evaluations. We performed a three-year retrospective chart review from patients 0-17 years of age who were evaluated at our emergency room for suspected sexual abuse. We reviewed 1,487 charts for historical information, physical findings, and diagnostic impression. Physical findings were categorized as normal, nonspecific, suggestive, or indicative of penetration. In 77% of cases (N=256) with hymenal findings indicative of penetration and 84% of cases (N=31) with vaginal findings indicative of penetration, residents recorded no impression or a nonspecific impression. Results were similar for vulvar and rectal findings indicative of penetration. Residents fail to document an adequate interpretation of their physical examinations in sexual abuse evaluations.
Mold Allergyisa is a sk Factor for Persistent Cold-Like Symptoms in Children
Authors: Huang Shih-Wen , Kimbrough James W.
Published: June 2007

In winter, children with mold allergy may develop persistent cold-like symptoms (PCLS) that often defy conventional therapy. To investigate the cause of PCLS, we enrolled 44 children (25 with PCLS and 19 controls) in a 2-year study to compare their clinical symptoms and the mold count in their homes. Children with PCLS had a higher percent of eosinophils in nasal smears as compared with those without PCLS (32% vs 26%). On a scale of 0 to 3, the PCLS group had higher symptom scores (P<0.001 for all symptoms): bloodshot eyes (2.92 vs 0.79), mouth breathing (2.04 vs 0.68), rhinorrhea (2.48 vs 0.89), nasal voice (2.68 vs 1.00), postnasal drip (2.64 vs 0.47), and headache (2.72 vs 0.53) than the non-PCLS group. The clinical scores also correlated significantly with the mold count in the home (the rvalue ranged from 0.6716 to 0.7450). We conclude that management of children with PCLS should include decreasing humidity and enforcing environmental control to eradicate mold from inside the homes.
Neonatal Hypoglycemia, Part II: Pathophysiology and Therapy
Authors: Halamek Louis P. , Stevenson David K.
Published: June 2007

Contemporary research is elucidating both the molecular mechanisms of hypoglycemiainduced neuronal injury and its corresponding clinical manifestations. Recognizing and screening those neonates at highest risk of hypoglycemia-induced injury is an important skill for all physicians responsible for the care of newborns. Appropriate therapy, consisting of either oral or intravenous glucose, should never be delayed while one is awaiting laboratory confirmation of a “low” glucose level.
Comparative Study of the Clinical Effectiveness of a Pyrethrin-Based Pediculicide with Combing Versus a Permethrin-Based Pediculicide with Combing
Authors: Bainbridge C. V. , Klein G. L. , Neibart S. I. , Hassman H. , Ellis K. , Manring D. , Goodyear R. , Newman J. , Micik S. , Hoehler F. , Walicke P.
Published: June 2007

In a randomized, evaluator-blinded clinical trial, 190 patients were treated for Pediculus humanus capitis infestations with a pyrethrin-piperonyl-butoxide pediculicide (RID®; Py-PB) and a permethrin pediculicide (NIX®; PM). A total of 160 patients were evaluable for nit-combing speed, 156 patients were evaluable for efficacy at day 7, and 150 patients were evaluable for efficacy at day 14. Both Py-PB and PM showed 100% efficacy at day 7. At day 14, one patient in the PM group had an apparent reinfestation. The Py-PB group had significantly lower mean combing times (P=0.04), but because the PM group had more nits, the two groups were not significantly different in combing speed expressed as seconds per nit. Multiple regression and covariance analyses suggested that the greater speed of the Py-PB comb might have been masked by this baseline difference. Three patients had mild adverse experiences (Py-PB: erythema, PM: erythema and tingling sensation). No patients were removed from the study because of adverse events. In conclusion, this controlled clinical study demonstrated that both Py-PB and PM provided 100% efficacy following a single application. Differences attributable to comb design favored the Py-PB “rake” comb, but this requires additional evaluation and confirmation.
The Web, Communication Trends, and Children's Health Part 2: The Web and the Practice of Pediatrics
Authors: Izenberg Neil , Lieberman Debra A.
Published: June 2007

This article, Part 2 of a five-part series on The Web, Commmunications Trends, and Children's Health, describes how the Web's “virtual library” lets pediatricians tap into an ever-growing body of resources, including the latest medical information and online Continuing Medical Education. In addition, the Web creates new ways to practice pediatrics and share patient information.
Gastrointestinal Complications of Chronic Granulomatous Disease: Case Report and Literature Review
Authors: Barton Leslie L. , Moussa Sosan L. , Villar Rodrigo G. , Hulett Rebecca L.
Published: June 2007

Chronic granulomatous disease (CGD), an inherited disorder of phagocytic leukocyte function, is characterized by recurrent infections with catalase-positive organisms. Gastrointestinal (GI) tract involvement, present in the majority of affected individuals, may be present initially and recurrently, mimics other entities such as inflammatory bowel disease, and causes substantive morbidity and mortality. Disorders of motility, ulceration, obstruction, and infection (e.g., abscesses) occur from the mouth to the anus and stereotypically manifest with vomiting, diarrhea, abdominal pain, weight loss, and fever. Careful physical examination, in concert with appropriate diagnostic studies, is necessary to delineate intraabdominal pathologic processes. Abdominal radiographs, ultrasonography, computerized tomography, and endoscopy are useful ancillary diagnostic procedures. Drainage of accessible abscesses, antimicrobial therapy based on organisms cultured from blood and tissue, and interferon gamma may lead to suppression or eradication of infections and resolution of symptoms. Corticosteroids are useful for gastric outlet obstruction and sulfasalazine and cyclosporine for large bowel disease. Gallbladder dysfunction may be ameliorated, as in our pa tient, with administration of cholestyramine.
Suspecting Lumbar Spondylolysis in Adolescent Low Back Pain
Authors: Ralston Shawn , Weir Michael
Published: June 2007

Spondylolysis in the athletic adolescent and preadolescent is common enough that primary care practitioners should be familiar with its frequency and its progression from pars interarticulatis stress fracture to spondylolysis and to spondylolisthesis. One-half of all pediatric back pain in athletic patients is related to disturbances of the posterior elements including spondylolysis, which presenrts as low back pain aggravated by activity, frequently with minimal physical findings. Failure to suspect, hence to diagnosis, a pars stress fracture or early spondylolysis is common and a misdiagnosis of lumbosacral strain is often made. A complicating factor in early diagnosis is the fact that plain radiographs, even with oblique films, may not be helpful at the stress fracture stage, and other imaging techniques (bone scan possibly with single photon emission computed tomography [SPECT]) must be used early in the diagnostic process. In the primary care setting, an early diagnosis of posterior element involvement in low back pain either at the stage of pars stress fracture or early spondylolysis can prevent progression of the disease and the need for aggressive intervention for a more significant defect. We present three adolescent and preadolescent athletes with low back pain in whom a high index of suspicion led to the early diagnosis of pars stress fracture or spondylolysis. All three had different stages of spondylolysis, and one illustrates the clinical utility of the one-legged hyperextension test. The ease with which early disease may be treated further supports efforts by primary care practitioners to suspect and diagnose pars stress fracture and early spondylolysis.
Characterization of Failure to Imbibe in Infants
Authors: Gremse David A. , Lytle J. Mark , Sacks Alan I. , Balistreri William F.
Published: June 2007

The term failure to imbibe is proposed to describe infants with failure to thrive due to poor feeding. Feeding assessment was performed in 128 patients: 43 healthy controls, 53 diseased controls, 12 with nonorganic failure to thrive, and 20 with failure to imbibe. Infants with failure to imbibe required a significantly longer time to feed compared with other infants. In contrast to other infants with nonorganic failure to thrive, patients with failure to imbibe were more likely to need pediatric subspecialty care and nasogastric or gastrostomy tube feeding. Since these patients may have treatable conditions, infants with failure to imbibe merit further investigation.
Earlier Discharge of Infants from Neonatal Intensive Care Units: A Pilot Program of Specialized Case Management and Home Care
Authors: Spinner Susan S. , Girifalco Renee B. , Gibson Eric , Stavis Robert L. , Greenspan Jay S. , Spitzer Alan R.
Published: June 2007

A multidisciplinary approach using a neonatology independent physicians association, affiliated hospitals, a pediatric home care company, and a health maintenance organization was designed to promote earlier safe discharge of infants from intensive care. This pilot project involved 43 infants who received case management and early discharge home with home oxygen, monitoring, intravenous antibiotics, gavage feedings, phototherapy, or nutritional management for poor weight gain. A staff neonatologist remained the primary physician until the patient would have been discharged according to standard criteria. Two patients had unscheduled readmissions and all infants survived. This approach resulted in an estimated savings of 456 hospital days and $329,982; 89% of parents rated the care as good to excellent, and 83% were satisfied with the program and outcome. This study suggests that a prospectively designed program can be designed to promote safe earlier discharge of infants in intensive care.