bluuebunny/crossref_metadata_2025 huggingface dataset:
The Relationship of Lactic Dehydrogenase to Epithelial Cells in the Urine of Normal Neonates
Authors: Carvajal Hugo F. , Puckett Christina G. , Adcock Eugene W. , Krudy George A.
Published: November 2007

Urinary lactic dehydrogenase (LDH) isoenzyme assays in 20 female and 15 male normal newborn infants during the first 3 days of life revealed higher levels than in older populations and a tendency toward a "slow zone pattern" (predominance of isoenzymes 4 and 5). Total LDH and LDH-5 activities were higher in the female (33.2 ± 5.2 and 12.4 ± 2.8 mU/mL, respectively), than in the male population (9.7 ± 2.2 and 1.0 ± 0.3 mU/mL, respectively). The amount of LDH correlated with the presence of epithelial cells in the urine that also were prominent in female patients and were apparently derived from the vagina. Separation of epithelial cells by centrifugation and filtration decreased total LDH and isoenzyme activities in the remaining sample, while sonification of the resuspended cells increased TLDH and LDH-5 activities by 6- and 12-fold respectively.

Saline washings of the perineum and vagina revealed large numbers of epithelial cells and similar LDH isoenzyme patterns suggesting that contamination of the urine with these cells is a frequent occurrence during collection of voided and/or bag urine samples, and that these cells are responsible for much of the LDH activity found in the urine.

We conclude that epithelial cells can increase both total LDH and isoenzyme activity in voided urine samples from otherwise normal female neonates. In this age group, urine collected by other methods (catheterization or suprapubic aspiration) must be studied to minimize the possiblity of contamination of the sample with epithelial cells from the vagina or the perineum or both.
Splenic Infarction at Low Altitude in a Child with Hemoglobin S-C Disease
Authors: Alvarado Carlos S. , Wyly Brad , Buchanan Iris , Fajman William A.
Published: November 2007

We describe a 15-year-old black boy with hemoglobin S-C disease living in Atlanta (altitude 1,034 ft), with no prior history of aircraft or mountain travel, who developed splenic infarction. The clinical picture was characterized by severe left upper quadrant abdominal pain, fever, splenomegaly, and hematologic and scintigraphic evidence of functional asplenia. The diagnosis was suggested by liver/spleen scintigraphy and further confirmed by ultrasonography and computerized tomography (CT) of the spleen. Treatment consisted of analgesics, intravenous fluids, and short-term antibiotic therapy. The child recovered without sequelae.
Encopresis Responsive to Non-psychiatric Interventions
Authors: Stern H. Patrick , Prince Michael T. , Stroh Suzanne E.
Published: November 2007

A case report of an adolescent with primary encopresis is presented in which the patient responded to standard medical interventions despite apparent significant psychopathology in the child and family. Psychological symptoms proved to be secondary and resolved with successful medical treatment and with attending to other concerns, such as this patient's school problems. Behavioral and medical literature related to encopresis is reviewed. It indicates that encopresis is associated more consistently with physiological abnormalities of the bowel rather than definable psychological disorders.
Juvenile Rheumatoid Arthritis
Authors: Marek-Szydlowska T. , Uracz W. , Ruggiero I. , Pietrzyk J.J. , Zembala M.
Published: November 2007

The in vitro parameters of cell-mediated immunity were studied in 20 children with an established diagnosis of Juvenile rheumatoid arthritis (JRA) (age range 4-15 years) and 23 age- and sex-matched healthy children. (No attempt was made to correlate the observed changes with clinical course or treatment.) We are not certain, at this time, of clinical relevancy or the generalizability of the findings. The normal level of T-lymphocytes (CD3+) and normal proportions of CD4+ and CD8+ lymphocytes were seen in children with JRA. The in vitro response of lymphocytes to T-cell mitogen phytohemagglutinin (PHA) also was normal. The suppressor activity of JRA monocytes was essentially the same as controls. In contrast, monocytes from patients with JRA showed the following: decreased expression of receptors for Fc part of IgG immunoglobulin (FcR), diminished nitro blue tetrazolium (NBT) reduction activity, and depressed expression of Ia.7 major histocompatibility complex (MHC) class II determinants. This indicates that certain monocyte functions in selected patients with a variety of manifestations of JRA are depressed.
Neurodevelopmental Assessment of Behaviorally Disordered Inner City Boys
Authors: Landman Gary B. , Carpenter Richard O.
Published: November 2007

The purpose of this study was to assess the usefulness of a recently developed neurodevelopmental instrument (Pediatric Early Education Exam "PEEX") for evaluating inner city boys thought to be "hyperactive" by their teachers. Thirty-nine boys (age x = 102.5 months, sd = 11.9; IQ x = 98, sd = 10; 97%, black) were evaluated. No relationship was found between overflow movements and neurodevelopmental subtest performance, intelligence, or educational functioning. The development of laterality was positively related to success in reading (t = 2.21, p < 0.05). A sentence-copying task was related to success in reading (r = .38 p < 0.01). The ability to answer questions about complex sentences was related to mathematical success (r = .32 p < 0.05). A task involving the ability to follow verbal directions proved most sensitive to educational, intellectual, and social functioning.
Congenital Lobar Emphysema
Authors: Markowitz Richard I. , Mercurio Mark R. , Vahjen Glen A. , Gross Ian , Touloukian Robert J.
Published: November 2007

An infant with congenital lobar emphysema of the left upper lobe presented with unusually severe mediastinal shift and underwent computed tomography (CT) and radionuclide V/Q scans. The V/Q scan confirmed the non-functioning nature of the hyperinflated lobe while the CT scan depicted the abnormal anatomy as well as the normal morphologic characteristics of the remaining lung thus allowing for safe and appropriate surgical management.
Crisis Intervention for Bereavement Support
Authors: Schonfeld David J.
Published: November 2007

A crisis intervention consultation service to the schools for bereavement support for children is described. Examples are offered of the author's experience in providing this service to children from the pre-kindergarten to senior high level, at private, parochial, and public schools. These requests were generally in response to tragic deaths of fellow students and significant adults, including teachers, parents, and friends. Suggestions are outlined for pediatric and mental health consultants who may wish to offer similar services within their communities, with particular emphasis on issues to address in program planning and implementation.
Coaches' Goals for Young Children in a Recreational Sports Program
Authors: Stern Patrick , Prince Michael T. , Bradley Robert H. , Stroh Suzanne E.
Published: November 2007

Almost all children participate in sports at some time, and programs are being established for even younger children. Adults who coach the children largely determine what the children's sports experience will be. Coaches' perceptions of what is important for the young children they instruct have not yet been carefully investigated. This study was designed, therefore, to determine coaches' goals for young children.

Data were gathered by use of an attitude questionnaire administered to 29 coaches of a recreational basketball program of children ranging in age from 6 to 10 years old. Of the 12 goals, feeling part of a team, learning to do my best, and having fun and excitement were most highly rated as extremely important, while becoming popular was lowest rated as not important. Results revealed that coaches in general are able to clearly define their goals and priorities, and these goals seem developmentally appropriate for the children. However, coaches make little differentiation in goals based on age.
Growth of Abused Children
Authors: Karp Robert J. , Scholl Theresa O. , Decker Edmund , Ebert Eileen
Published: November 2007

While the identification of a growth-retarded or otherwise undernourished child suggests a diagnosis of child abuse or neglect, it is not certain that abused children from poor communities are less well nourished than children living in similar environments. The setting of this study -day care centers in an urban poor city—provided an opportunity to make this comparison with appropriate community-based controls.

Measures of height, weight, and weight/height2 (Body Mass Index (BMI)) were compared for 196 children, 2 to 6 years of age, 53 of whom were victims of physical abuse. The data was adjusted for age, sex, and ethnicity using logistic regression analysis to determine occurence of wasting (weight for height <5th percentile) and stunting (height for age <5th percentile). Significantly more abused children (16.3%) showed wasting as compared to non-abused (0.7%) with abused children 16.6 times more likely to show wasting than non-abused (95% confidence limits on the Odds Ratio 1.9-145.0). While 11.6 percent of abused children showed stunting compared to 5.6 percent of non-abused, this difference was not significant when the data was adjusted for demographic factors. The BMI (15.02 kg/m2) for abused children was significantly less than that (15.9 kg/m2) for non-abused children (F = 8.11; p = 0.0049).

In the present study, significant wasting as seen in acute malnutrition was found among abused children at diagnosis, suggesting that within an urban poor community the growth of children so identified does differ from the growth of children who are not abused.
Children with Juvenile Rheumatoid Arthritis at School
Authors: Whitehouse Rosanne , Shope Jean T. , Sullivan Donita B. , Kulik Chen-Lin
Published: November 2007

Parents of 135 children with juvenile rheumatoid arthritis (JRA) completed a mailed questionnaire about problems at school. Writing was the most frequently reported difficulty, with hand involvement causing more problems than decreased mobility. Compared to children with pauciarticular JRA, those with polyarticular or systemic JRA were significantly more likely to miss school, experience problems, participate less in physical education, have an Individualized Educational Plan (IEP) developed, and receive related services.

Only 39 parents had heard of PL 94-142, and only 21 of those could define the federal law. Twenty children had an IEP within the previous two years. Possible deficiencies in the implementation of PL 94-142 were discovered.

This study demonstrates that the treatment of children with JRA should include efforts to: 1) identify and remediate potential performance limitations before they become problematic at school; 2) communicate this information to parents and school personnel; 3) and improve parents' awareness and understanding of PL 94-142.
Peripheral Limb Gangrene Following Rectal Biopsy
Authors: Jani B.R. , Brereton R.J. , Dillon M.J.
Published: November 2007

After a rectal biopsy, a 3-week-old boy developed centripetally progressive distal limb gangrene. This was accompanied by transient hypertension and high levels of circulating immune complexes. The ischemia was reversed by prostacyclin infusion, oral corticosteroids and multiple exchange transfusions.
Diazepam Abuse in Pregnant Women on Methadone Maintenance
Authors: Sutton Lawrence R. , Hinderliter Stacey A.
Published: November 2007

The authors found that the course and treatment of narcotic withdrawal in two neonates was complicated by prenatal exposure to high doses of diazepam, or Valium (Roche Laboratories, Nutley, NJ). Both of the mothers were on methadone maintenance for narcotic dependency prior to the diagnosis of pregnancy. The authors documented maternal intake of diazepam in the range of 40-60 mg/day for a duration of 4-27 weeks prior to delivery. Both infants initially responded well to medical therapy for narcotic withdrawal, but at 7-14 days of age, withdrawal symptoms intensified, requiring an increase in the dosages of Paregoric (UDL Laboratories, Rockford, IL) and opium tincture in both infants and the addition of phenobarbital therapy in one infant. Both infants continued on medical therapy until they reached 1 month of age.

Diazepam use by pregnant women can be associated with a later presentation of withdrawal symptoms in the neonate than that induced by the use of other drugs. Close follow-up during the first month of life is warranted for infants exposed to diazepam prenatally.
Detection of Young Children in Need of Reading Help
Authors: Shapiro Bruce K. , Palmer Frederick B. , Antell Sue E. , Bilker Stacey , Ross Alan , Capute Arnold J.
Published: November 2007

To determine whether formula-based definitions of specific reading disability (SRD) were related to the actual classroom performance of children aged 7½, the authors applied five definitions of SRD to a cohort of 243 children. The children were followed from birth and not selected on the basis of cognitive, reading, or academic performance criteria. The authors determined the concurrent validity of each of the formulas by comparing the prediction of each definition to whether the child received additional reading help in the classroom. Although the years behind method was significantly better than other approaches, no method identified more than 48 percent of the children who were given additional reading help. This study questions the ability of formula-based definitions adequately to identify young children with reading dysfunction.
Neonatal ABO Incompatibility
Authors: Merlob Paul , Litwin Aviva , Lazar Leora , Zaizov Rina
Published: November 2007

The authors present two infants with isoimmune hemolytic disease due to ABO incompatibility complicated by massive hemoglobinuria and secondary acute renal failure. This represents an incidence of 0.36% of all neonates with ABO hemolytic disease in the author's newborn population. Only two patients have been reported previously to have similar complications.

Analysis of data of these four infants revealed the clinical characteristics of this complication of ABO incompatibility: 1) very low frequency ; 2) early onset of hemoglobinuria (first voided urine) and of acute renal failure (first 2 days of life); 3) lack of correlation between the clinical presentation of hemolytic disease and appearance and severity of renal failure; 4) complete recovery of renal functions following intravenous fluid administration; and 5) normal renal radiologic investigations.
Musculoskeletal Injuries
Authors: Risser William L.
Published: November 2007

Tens of thousands of U.S. children, adolescents, and young adults are using weights either recreationally, to train for sports, or to compete in weight lifting, power lifting, or body building contests. Weight use may cause significant musculoskeletal injury. This review summarizes for the clinician the best available information on injury risks and prevention.
Assessment of Management Guidelines
Authors: Klein-Schwartz Wendy , Oderda Gary M. , Gorman Richard L. , Favin Fran , Rutherfoord Rose S.
Published: November 2007

A review of 339 treated acute iron ingestions was conducted to define treatment guidelines better. According to the poison center protocol, ingestions of 20-40 mg/kg of elemental iron required only home treatment, and ingestions of ≥40 mg/kg required hospital referral.

Gastrointestinal symptoms developed in 23% of patients. There were no seriously ill patients. No serious toxicity developed in patients ingesting 40-60 mg/kg. In 199 cases in which the dose ingested was known, the mean dose was 39.5 mg/kg. The peak measured serum iron levels ranged from 12 to 539 μg/dl. In 129 cases with serum iron levels reported, increasing serum iron levels were associated with vomiting (p = 0.006). Of 88 patients who received deferoxamine, 14 had urine color change. Urine color change was associated with symptoms (p = 0.005) but not with iron dose or peak serum iron level.

The poison center protocol was changed to home management for ingestions of 20-60 mg/kg unless significant symptoms developed and hospital referral for ingestions ≥ 60 mg/kg.
Presenting with Prolonged Fever
Authors: Berlin Cheston M. , Boal Danielle K. , Zaino Richard J. , Karl Stephen R.
Published: November 2007

A patient is described who presented with a 1-month history of daily fever to 38.8°C. There was no sign of joint pain or swelling and no skin rash. The patient had impressive hepatomegaly without splenomegaly. The only abnormal laboratory test was a sedimentation rate of 120 mm/hr. Ultrasound examination showed hypoechoic foci throughout the liver. These foci were confirmed by CT scan, which showed multiple well-marginated lesions of decreased attenuation and variable size throughout the right and left lobes of the liver. A liver biopsy specimen showed large nodules that were yellow and gritty in texture. Microscopic examination of biopsy specimens of these nodules showed extensive areas of necrotizing granulomatous inflammation with palisading histiocytes and occasional giant cells surrounded by necrotic foci. There was an associated fibroinflammatory infiltrate. The patient was treated with a nonsteroidal anti-inflammatory agent with prompt cessation of fever. A repeat CT examination of the liver after 14 months of treatment showed only mild hepatomegaly and a normal liver parenchyma. The focal lesions had disappeared. This is a case of hepatic granulomata in a child showing features of necrotizing inflammation.
Chest Pain in Children
Authors: Selbst Steven M. , Ruddy Richard , Clark B.J.
Published: November 2007

During a 1-year period, 407 children with chest pain were seen in the Emergency Department of Children's Hospital of Philadelphia. Analysis of the clinical data of these children was reported previously. The authors successfully followed 149 of these children for 6 months or more, and 51 for 2 years or more. These patients returned for an average of 3.4 visits during the follow-up period.

Thirty-four percent of the initial diagnoses were altered. Usually, during the follow-up period, the authors concluded that chest pain resulted from nonorganic causes. A new organic etiology was uncovered in only 12 of 149 cases. Only 1 child was found to have a heart abnormality (mitral valve prolapse), and 3 were found to have asthma.

Chest pain did not resolve during the follow-up period in 43 percent of those followed. Children with chest pain should have follow-up care because of the persistence of symptoms, but serious disease is unlikely to be found over time.
Neonatal Mitral Valve Endocarditis
Authors: Bullaboy Charles A. , Coulson John D. , Jennings Rufus B. , Johnson David H.
Published: November 2007

Although still considered to be a rare and mostly fatal illness, the reported incidence of neonatal bacterial endocarditis has increased during the past decade.1 This parallels the establishment of intensive supportive management of severely ill newborns with multiple medical problems. An extremely difficult diagnostic problem with protean manifestations, the presence of neonatal endocarditis should be vigorously sought in the at risk neonate.2 The authors report the first known case in America of successfully diagnosed and treated neonatal endocarditis involving the mitral valve.
Reinforcement of Incontinent Stools in the Treatment of Encopresis
Authors: Piazza Cathleen C. , Fisher Wayne , Chinn Shawn , Bowman Lynn
Published: November 2007

In this paper, fecal incontinence and constipation were treated in two mentally retarded individuals using a novel intervention wherein incontinent stools were first rewarded in order to increase the frequency of bowel movements. This intervention was implemented only after more traditional pediatric and behavioral treatments were unsuccessful. The reinforcement of incontinent stools procedure resulted in an increase in both the frequency and the number of continent stools for both individuals. Hypotheses regarding the failure of previous treatments and the success of the current treatment are discussed as well as directions for future research.
Mycoplasma Pneumoniae Infections and Stevens-Johnson Syndrome
Authors: Levy Maurice , Shear Neil H.
Published: November 2007

On the basis of a literature review and eight cases of our own, we analyzed 37 cases of Mycoplasma pneumoniae (MP) infection and Stevens-Johnson syndrome (SJS). Our clinical and laboratory findings do not differ from those reported in the literature for MP infection with no exanthem or for SJS of various etiologies. Eighty percent of the children presented with symptoms of upper respiratory tract infection (URTI) (cough, fever, sore throat, malaise, headache), with a mean of 10 days (range 1 to 30) before skin rash broke out. Skin manifestations occurred in 94.2% of the patients after 3 to 21 days (mean 10.3 days) of fever. The exanthem, composed predominantly of maculopapular and vesicular, was distributed chiefly on the trunk and extremities and lasted less than 14 days in 87.8% of the patients. Stomatitis was observed in 91.6% of the patients and conjunctivitis in 50%. No consistent pattern seems to emerge by which one could predict the existence of MP infection causing SJS. The complications of SJS associated with MP seem less frequent (2.7%) and much less severe than in cases where SJS arises from other reported causes. Because coincidence cannot be excluded from the assessments of the degree and rate of improvement for the few patients treated with corticosteroid, from the low frequency of complications, and from the mortality rate of zero in this series of patients, the use of corticosteroids for SJS associated with MP infection is questionable.
Evaluation and Management of Stridor in the Newborn
Authors: Simon Neal P.
Published: November 2007

Stridor in a newborn should necessitate an immediate work-up to rule out a life-threatening airway obstruction. Three cases of newborns with stridor are presented. These cases emphasize the need for an immediate and thorough physical examination of any stridorous newborn, followed by radiologic studies and direct laryngoscopy. While other invasive procedures are frequently required for a precise diagnosis, a careful examination with special attention to the quality of the stridor often permits a more effective diagnostic approach in an atmosphere of appropriate urgency.
An Investigation Into the Etiology of Irritable Hip
Authors: Bickerstaff Derek R. , Neal Lesley M. , Brennan Patricia O. , Bell Michael J.
Published: November 2007

A prospective review has been made of 111 children who presented with acute hip pain to determine it's etiology and assess the need for multiple investigations at presentation. There was no clinical hematological, serological or bacteriological evidence to identify positively patients with an irritable hip, neither was there good correlation with a history of infection. An effusion was diagnosed by ultrasound in 71% but there were no factors, either clinically or by investigation, to differentiate between patients with or without an effusion. We conclude that multiple investigations to find a source of infection in patients with irritable hip are not warranted as they are rarely positive, seldom affect management and are of no help in investigating the etiology of irritable hip.
Pain in Neonatal Circumcision
Authors: Schoen Edgar J. , Fischell Anne A.
Published: November 2007

Because newborn circumcision is a quick and safe surgical procedure, any method to relieve pain must be almost risk-free in order to be acceptable. General anesthesia and narcotic analgesia are not appropriate. Dorsal penile nerve block (DPNB) with lidocaine hydrochloride is probably the most effective and safest form of anesthesia for newborn circumcision currently available, but it can cause significant local and systemic reactions. Only a limited number of cases of DPNB have been reported and we feel that this procedure should be used cautiously until there is more published evidence of its safety. Alternative methods of pain relief including oral acetaminophen and topical anesthesia should also be studied. Of special interest is recent evidence that a sucrose-flavored pacifier is an effective analgesic during newborn circumcision.
Postural Sway Analysis of a Teenager with Childhood Lead Intoxication - A Case Study
Authors: Bhattacharya A. , Linz D.H.
Published: November 2007

We had an opportunity to study a 15-year-old boy, evaluating the long-term effect of early childhood lead (Pb) poisoning on the maturation of postural balance. Postural balance (or sway) was quantified using a microprocessor-based Force Platform System along with four postural tasks specifically designed to indirectly challenge and/or minimize the effect of vision, proprioception and vestibular systems relevant for postural stability. The Pb-intoxicated patient showed increased postural sway compared to those of non-poisoned young adults and a 14-year-old boy for postural tasks requiring input from higher centers. A review of historical information and results of the physical and neurological examinations did not reveal an alternative explanation for this patient's postural sway abnormalities. These responses are also comparable to those noted in younger children with chronic Pb-exposure histories. In summary, this case study gives suggestive evidence that early excessive exposure to Pb can have long-term, detrimental neurological effects as reflected by postural stability. Measurement of postural balance appears to be a sensitive research methodology to assess subclinical neurological effects of remote lead intoxication.
Methylphenidate Protocol: Feasibility in a Pediatric Practice
Authors: DiTraglia John
Published: November 2007

This report examines the feasibility of double blind individual trials of methylphenidate versus placebo in a general pediatric practice to assess benefit of this medication in the treatment of attention deficit disorder.

Children presenting with the diagnosis of attention deficit disorder were enrolled in a three-week protocol. The first week was a baseline week during which teachers and parents completed the Connors rating scales. During the second and third weeks of each trial, placebo or methylphenidate was given for a week each in an unknown order to parents, teachers or the investigator. Respective Connors rating scales were also completed for each of these weeks. At the end of the third week, the three parent questionnaires and the three teacher questionnaires were returned to the investigator for scoring and disclosure about findings.

During a pilot period, 53% of the trials were improperly completed. Reasons for this were addressed and with simple measures the rate of successful completion was raised to 83%. During the study phase, 43% of the children were found to be hyperactive but they did not benefit from medication. In six trials there was disagreement between teachers and parents. The completed trials and many of the incompleted trials were helpful in the assessment of the children with attention deficit disorder and their response to medication. It is felt that this approach is suitable for a private general pediatric practice.
Ohio's Infant Hearing Screening and Assessment Program
Authors: Ruppert Elizabeth S. , Buhrer Kit
Published: November 2007

The early detection of hearing impairments in infants is essential to the initiation of medical and educational services which will enhance optimal development of communication and social skills. Ohio has successfully implemented a legislatively mandated two-tiered Infant Hearing Screening and Assessment Program. This statewide screening program is in accordance with the child find and early intervention services requirements of P.L. 99-457.
Removal of Phenytoin by Plasmapheresis in a Patient with Thrombotic Thrombocytopenia Purpura
Authors: Tobias Joseph D. , Baker Donald K. , Hurwitz Craig A.
Published: November 2007

Phenytoin removal by plasmapheresis was evaluated in a 17 year-old girl with thrombotic thrombocytopenia purpura. Free and total phenytoin concentrations were measured in the patient's serum and in the plasma removed by plasmapheresis. Plasmapheresis was performed on three separate days with the removal of 4.7%, 3.3%, and 2.7% of total body stores. Free phenytoin concentration was similar in both the plasma removed by plasmapheresis and the patient's serum. Plasmapheresis did not significantly alter the serum concentration of phenytoin; dosage adjustments of phenytoin are therefore unnecessary
The Changing Spectrum of Neonatal Meningitis Over a Fifteen-Year Period
Authors: Shattuck Karen E. , Chonmaitree Tasnee
Published: November 2007

One hundred seventy-seven cases of neonatal meningitis treated at the University of Texas Medical Branch at Galveston over a 15-year period (1974-1988) were reviewed. Over this period, the incidence of bacterial meningitis decreased, the incidence of aseptic meningitis remained stable, and the diagnosis of enteroviral meningitis increased in frequency. During 1984-1988, enterovirus was the most common cause of meningitis in neonates older than seven days and accounted for one third of all cases of neonatal meningitis. Half of all neonates with bacterial meningitis had negative blood cultures. We recommend that 1) diagnostic lumbar puncture remain part of the routine assessment of the neonate with suspected sepsis, and 2) CSF be cultured for enterovirus as well as for bacteria when a neonate older than seven days presents with suspected sepsis.
Low-Dose DDAVP in Nocturnal Enuresis
Authors: Key David W. , Bloom David A. , Sanvordenker Jill
Published: November 2007

A five-year experience with the vasopressin analogue desmopressin acetate (DDAVP) for nocturnal enuresis is described in 59 children. The initial starting dose of 5 μg at bedtime is lower than that reported in other series. Eighty-one percent of patients required 10 μg or less to achieve improvement or resolution of bedwetting.
Abdominoscrotal Hydrocele in the Infant
Authors: Ross Jonathan H. , Kay Robert
Published: November 2007

Hydroceles are common in children, with a frequency of 6% in term male infants.1 Abdominoscrotal hydroceles, however, are extremely rare in infants, with only nine cases reported in the English literature.2-10 Herein we report an additional case of an abdominoscrotal hydrocele in an infant and review the literature.
Perinatal Loss
Authors: Leon Irving G.
Published: November 2007

Dramatic improvements in the hospital management of perinatal loss have taken place in the past 20 years. However, there has been no critical examination of current approaches. Four possible hazards of current hospital practice are described: 1) Institutionalization of bereavement: Instead of offering parents an empathic awareness of the unique dimensions of their perinatal loss, caregivers often interact according to detailed behavioral protocols. 2) Idealization of contact with the dead baby: This approach may equate actual physical contact with the dead child with the more complicated and variable process of mourning. 3) Homogenization of grief: Counselors tend to denigrate different grief responses by focusing on a preconceived grief reaction. Thus, they may mistakenly label many such reactions pathologic if they deviate from the rigidly prescribed "norm." 4) Lecturing the bereaved: Telling parents the "right" thing to do may deprive them of a crucial aspect of the process that empowers parents after they experience the helplessness associated with perinatal loss — that of making their own decisions. These problems are illustrated by a clinical vignette, and alternative approaches are explored.
A Probability Nomogram to Predict Rectal Temperature in Children
Authors: Don Brown R. , Kearns Gregory , Eichler Valarie F. , Wilson John T.
Published: November 2007

The relationship between rectal and peripheral-site temperature was investigated to achieve two objectives: 1) to evaluate a prevailing practice of intersite adjustment by use of an invariant temperature difference; and 2) to develop a statistical method for intersite temperature predictions in the individual child, especially for fever as defined by rectal measurement. Rectal, oral, axillary, left abdomen skin, and forehead skin temperatures (°F) were measured with an electronic thermometer in 257 children. Objective 1 was not achieved because a simple temperature difference between a peripheral site and the rectal site could not be used to predict rectal temperature reliably. For objective 2, intersite differences met three statistical criteria so that normal distribution theory could be used to derive the probabilities for occurrence of each difference. Accordingly, cumulative probability nomograms were constructed to estimate rectal-site fever from measurements at peripheral sites. This nomogram method produces a clinically reliable prediction of rectal-site fever from temperature measurement at peripheral sites, especially the oral and axillary sites. These predictions offer useful assessments of febrile illness severity when rectal temperature is not available.
Tuberculous Iridocyclitis in a Three-Year-Old Girl
Authors: Asensi F. , Otero M.C. , Perez-Tamarit D. , Martinez-Gil E. , Marco M.
Published: November 2007

The increase in tuberculous infection frequency in certain populations1 may be responsible for some clinical forms of extrapulmonary tuberculosis that were thought to have disappeared. We present a 3-year-old girl with tuberculous indocyclitis, which was the first clinical manifestation of a tuberculous infection and responsible for the loss of an eye.
Explanations and Therapies for Penicillin Failure in Streptococcal Pharyngitis
Authors: Pichichero Michael E.
Published: November 2007

A disturbing trend toward penicillin failure has developed in the treatment of streptococcal pharyngitis in some parts of the United States and abroad. A variety of explanations has been proposed to account for these penicillin-treatment failures. With the resurgence of serious complications from streptococcal infection, successful bacteriologic eradication has regained importance. In communities with a high incidence of penicillin failures, alternative antimicrobials should be considered. Cephalosporins, amoxicillin/clavulanate, and the extended-spectrum macrolides represent logical options under such clinical circumstances.
Taking It to the Streets
Authors: Winn Gary L. , Jones D. Floyd , Bonk Curtis Jay
Published: November 2007

A three-week bicycle safety module (BSM) featuring helmet use was developed for an inner-city, comprehensive youth development program in East Wheeling, West Virginia. Prior to BSM intervention, no helmet use had been observed in the test neighborhood. After a three-week program focusing on safety behaviors and helmet use, students demonstrated significant improvements in knowledge, a positive relationship between skill and knowledge, and nearly 100 percent helmet usage rates. Unfortunately, neighborhood helmet use rates fell to nearly zero after the summer camp was over. The data suggest that helmet use and improved knowledge and skills could become the norm in an inner-city day-camp context, but periodic, model-oriented reinforcement of the BSM is recommended for maintenance of observed knowledge and usage improvements.
Inadequate Immunizations
Authors: Hymel Terri J. , Sherman Joseph , Pope Sandra K. , Kelleher Kelly J.
Published: November 2007

Immunizations are cost-effective measures for assuring public health. However, recent outbreaks of measles, mumps, and pertussis underscore the inadequacy of current immunization programs. A model identifying those children who are likely to be inadequately immunized could focus the use of limited health funds. A retrospective examination of the medical charts of 101 children in a large inner-city clinic was undertaken to determine if specific factors were associated with inadequate immunization status. Fifty percent of the children were inadequately immunized by 18 months of age (no measles-mumps-rubella or fewer than three diphtheria-pertussis-tetanus vaccinations). Logistic regression analyses showed that older maternal age, no recurrent or chronic illnesses, and vaginal delivery were independently associated with inadequate immunization status. However, on many charts, information on maternal, social, and environmental variables was incomplete. The increasing use of structured medical charts will enhance data collection and the determination of an appropriate index. A prospective study of the variables identified, along with standardization of medical records and inclusion of social history data, is necessary to further investigate the utility of screening criteria for inadequate immunizations.
Comparison of Two Kits for Measuring Ferritin in Blood
Authors: Matthew Derek , Long David , Andrews Wayne , Friel James
Published: November 2007

Ferritin concentrations in blood are a good indicator of iron stores1 and can be measured in plasma or serum with commercial kits. We have measured plasma ferritin content in infants ranging from 3 to 15 months of age. During the first three years of a four-year study, plasma samples drawn from these infants were shipped to Abbott Laboratories in Chicago and assayed using the Ferrizyme immunoassay technique (Abbott Laboratories, Chicago, Illinois). For the last year of the study, we analyzed the remaining samples in St. John's using the radioimmunoassay GammaDab 125I Kit (Baxter Travenol Diagnostics, Inc., Cambridge, Massachusetts). Both kit manufacturers report inter-and intra-assay variability of ≤ 5 %. Results for samples analyzed by the second method were higher than earlier results from infants of the same age with the same intakes of iron; thus, we decided to analyze subsequent samples with both kits.
Removal of Nasal Foreign Bodies in Children
Authors: Cohen Herman A. , Goldberg Elliott , Horev Ze'ev
Published: November 2007

Among the foreign bodies most often found in children's nostrils are hair, beads, toy parts, paper wads, and food.1 Sometimes extraction of nasal foreign bodies can be difficult, especially if they are spherical. The classical presentation is a unilateral, persistent, foul-smelling; purulent, or bloody nasal discharge. Ulceration, dislodgement of the foreign body into the nasopharynx, and aspiration of the foreign body can complicate the problem.
Phototherapy for Neonatal Nonhemolytic Hyperbilirubinemia
Authors: Lazar Leora , Litwin Aviva , Merlob Paul
Published: November 2007

Phototherapy, an effective treatment for neonatal indirect hyperbilirubinemia, has guidelines for its initiation but none for its discontinuation. In our study, phototherapy was begun at a mean age of 90 hours in 28 full-term and 30 preterm infants with indirect nonhemolytic hyperbilirubinemia. After three days, phototherapy was halted at a mean bilirubin concentration of 13.0 ± 0.7 mg/dL in term and 10.7 ± 1.2 mg/dL in preterm infants, levels higher than those used by other investigators. Bilirubin rebound then occurred at a mean of 12.5 hours to a level of 0.86 ± 1.0 mg/dL in term and at a mean of 14.1 hours to a level of 0.83 ± 0.56 mg/dL in preterm infants. No complications were observed nor was there a need for reinstitution of phototherapy. Based on these data, discontinuation of phototherapy at higher bilirubin concentrations and earlier home discharge than previously described appear harmless for both term and preterm neonates.
The Value of Ultrasound in the Diagnosis of Congenital Hypertrophic Pyloric Stenosis
Authors: Kovalivker Marcos , Erez Ilan , Shneider Nina , Glazer Ernesto , Lazar Ludwig
Published: November 2007

The charts of 103 children with a clinically and surgically confirmed diagnosis of congenital hypertrophic pyloric stenosis were retrospectively reviewed. We found a significant correlation between sonographic and surgical measurements of the muscular thickness of the pylorus ( r = .987, P<.001). In 73.7% (76 cases), the clinical picture of gastric outlet obstruction was present when the thickness of the enlarged pyloric muscle was 3.0 mm or more. In 26.3% (27 cases), the pyloric muscle was less than 3.0 mm wide. For 10 patients in whom the muscle width was less than 2.5 mm by sonography, a barium meal was necessary to confirm the diagnosis. The width of the pyloric muscle is the most important factor in the sonographic diagnosis of pyloric stenosis, and even a width of less than 3.0 mm may be associated with clinically significant obstruction.
Overall Function in Rural Childhood Cancer Survivors
Authors: Olson Ardis L. , Boyle William E. , Evans Megan W. , Zug Laura A.
Published: November 2007

This study compared the functioning of 20 rural cancer survivors, aged 6 to 16 years, with that of 40 age- and gender-matched school peers. Social competence and emotional health were evaluated, along with academic performance and physical limitations. Eight measures were used: the teacher and parent Child Behavior Check Lists, the Health Resources Inventory, the Vineland Revised Scale of Social Maturity, the Piers-Harris Child's Self-Concept Scale, the Parcel and Meyers' Health Locus of Control, the Moos' Family Environment Scale, and the Functional Status II (r) . Cancer survivors and controls had similar attitudes about self-esteem, family conflicts, physical functioning, social skills, independence, and sense of control over health. Both parents and teachers noted poorer social competence among the cancer survivors than among controls, but parents of survivors reported more behavior problems, whereas teachers stressed poorer school performance. Routine screening for emotional health, social competence, and academic performance should be part of the follow-up care of pediatric cancer survivors.
Early Hospital Discharge and the Timing Of Newborn Metabolic Screening
Authors: Coody Deborah , Yetman Robert J. , Montgomery Diane , van Eys Jan
Published: November 2007

Cost containment measures have reduced dramatically the length of stay for normal newborns, in some cases jeopardizing the ability to obtain appropriate newborn screens. In our hospital, we found that an unacceptable number of patients had mistakenly been screened before 24 hours of age. As pressures to shorten hospitalization increase, health-care providers must examine the impact of such changes on their ability to obtain adequate newborn screens. Potential solutions include continued vigilance in gathering specimens after 24 hours of age, interpretation of time-sensitive tests in an age-adjusted manner, and repeating newborn screens after 24 hours of age.
A Prospective Evaluation of Pediatric Patients With Syncope
Authors: Lerman-Sagie Tally , Lerman Pinchas , Mukamel Masza , Blieden Leonard , Mimouni Marc
Published: November 2007

Fifty-eight children with syncope were evaluated prospectively to determine the characteristics of syncope in the pediatric age group and the yield of various diagnostic tests. The age at first syncope ranged from 0.5 to 15 years. Twenty-five children presented after a single episode and 33 after multiple episodes. Ten had a history of breath-holding spells. Nineteen had a family history of syncope. A diagnosis was established in 53 patients (91%): vasodepressor (31), cardioinhibitory (13), tussive (3), hyperventilation (2), and mixed syncope (4). In five patients (9%), the cause remained unknown. The diagnosis was established from the history in 45 cases, by a positive oculocardiac reflex in 11, and by the head-up tilt test in four. We conclude that the cause of most cases of pediatric syncope is vasodepressor or cardioinhibitory and can be diagnosed by good history-taking. Costly evaluations are rarely necessary.
Use of Community Health Workers With Inner-City Children who Have Asthma
Authors: Butz Arlene M. , Malveaux Floyd J. , Eggleston Peyton , Thompson Lera , Schneider Susan , Weeks Kathy , Huss Karen , Murigande Charles , Rand Cynthia S.
Published: November 2007

Use of community health workers (CHWs) to obtain health, social, and environmental information from African-American inner-city children with asthma was one component of a larger intervention study designed to reduce morbidity in African-American children with asthma. A subset of 140 school-aged children with asthma was recruited and enrolled in a program to receive home visits by CHWs for the purposes of obtaining medical information and teaching basic asthma education to the families. Data obtained by the CHWs revealed low inhaled steroid use, high β2 agonist use, frequent emergency-room visits, decreased primary-care visits, and increased allergen and irritant exposure. Appropriately recruited and trained CHWs are effective in obtaining useful medical information from inner-city families with children with asthma and providing basic asthma education in the home.
Urinary Cotinine as a Measure of Passive Smoke Exposure in Asthmatic Children
Authors: Ogborn C. Jean , Duggan Anne K. , DeAngelis Catherine
Published: November 2007

This study sought to determine (1) the association between passive smoke exposure and acute symptoms in asthmatic children and (2) the association between parental report and objective measures of passive smoke exposure. Asthmatic children ages 3 to 11 were eligible for the study, which involved measurement of smoke exposure by questionnaire and by urine sample at a time of an acute asthma attack and then later when the child was symptom-free. High levels of passive smoke exposure were detected at both times in most children. Parental report of passive smoke exposure correlated with urinary measure of exposure.
Radiographic Inversion of Pulmonary Blood Flow in Acute Asthma
Authors: Joorabchi Bahman , Hammoude Emad , Khalid Mahmood A.
Published: November 2007

Chest radiographs are obtained routinely in children hospitalized with asthma but are considered to be of low utility. We describe a previously unreported radiographic inversion of pulmonary artery flow patterns in the chest films of a majority of children and young adults hospitalized for asthma. Seventy-five hospital records of 65 patients aged 2 to 25 years (mean 9.2) admitted for asthma during the calendar year 1991 were reviewed. As compared with the normal pattern, patients with inverted vascularity were younger (mean age 6.75 years), tended to be admitted through the emergency department, and had significantly more signs of labored breathing, such as tachypnea, retractions, nasal flaring, and tachycardia. We propose that the exaggerated respiratory effort in these children raises the transmural pulmonary artery pressure, impeding pulmonary blood flow. This results in distension of the right ventricle, which then compresses the left ventricle in the confines of the pericardium by posterior displacement of the interventricular septum. The resultant loss of left-sided compliance raises the left atrial and pulmonary venous pressures, leading to inversion of vascular markings through the same mechanism as seen in left-heart failure. We conclude that attention to this easily recognized sign will detect presence of the hemodynamically significant respiratory obstruction in asthmatic patients.
Infant Positioning and SIDS
Authors: Rainey David Y. , Lawless Michael R.
Published: November 2007

In April 1992, the American Academy of Pediatrics recommended that healthy infants not be placed prone to sleep because of the association between the prone sleeping position and sudden infant death syndrome (SIDS). We determined the awareness and acceptance of this recommendation among 190 mothers attending a community health center pediatric clinic in the first year after the recommendation. Ninety-seven women (51.1 %) had heard the recommendation. The compliance with the recommendation among women who had heard it was 63.9% (62 of 97). Fifty-three percent of all the mothers worried that their infant would choke in the supine position. More education is necessary in this population to improve acceptance of this new recommendation and to correct misinformation about the supine position.