bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Human Immunodeficiency Virus and Immune Status on Magnetic Resonance Imaging of the Brain in Hemophilic Subjects: Results From the Hemophilia Growth and Development Study
Authors: Mitchell Wendy G. , Nelson Marvin D. , Contant Charles F. , Bale James F. , Wilson Don A. , Bohan Timothy P. , Fenstermacher Marc J.
Published: December 2021

To determine the effects of hemophilia and human immunodeficiency virus (HIV) infection on the nervous system, the authors examined the relationship of brain magnetic resonance imaging (MRI) findings to immunologic function and neurologic examination findings. Baseline examinations included physical and neurologic examination, immunologic and virologic testing, and MRI of the brain. On neurologic examination, muscle atrophy was considered to be related to hemophilia if adjacent joints had arthropathy due to bleeding. Muscle atrophy was considered non-hemophilia-related if unrelated to arthropathy or if muscle atrophy was diffuse. Subjects were boys aged 6 to 19 years, enrolled in a multicenter study of the effects of hemophilia and HIV infection on growth and development, all with congenital coagulopathies requiring factor infusions. Three hundred ten subjects had complete data including neurologic examination, T-cell subsets, HIV antibodies, and MRI. Subjects with HIV infection whose CD4+ counts were <200/µL were compared with subjects with HIV infection and CD4+ counts ≥200/µL and with HIV-negative subjects, all of whom had CD4+ counts >200/µL. MRI studies were normal in 230. Abnormal MRI studies were more frequent in HIV-positive subjects with CD4+ counts <200 (29.4% abnormal compared with 17% in HIV-positive subjects with CD4+ counts ≥200 and 15.3% in HIV-negative subjects). Diffuse atrophy accounted for most of the excess abnormalities in HIV-positive subjects with CD4+ counts <200 (77.3% of abnormal scans). Diffuse atrophy on MRI was associated with decreased muscle bulk on neurologic examination, but not with abnormal tendon reflexes. Four of six subjects with non-hemophilia-related diffuse muscle atrophy had cerebral atrophy on MRI. All 6 were HIV-positive and had CD4+ counts <200. Congenital abnormalities (primarily arachnoid cysts) were present in 12 subjects, not related to HIV or CD4+ status. Acquired focal abnormalities including both old hemorrhagic lesions (12 subjects) and nonhemorrhagic lesions (66 subjects) were equally frequent in HIV-positive and HIV-negative groups and did not differ by CD4+ count. Multifocal white-matter lesions, hyperintense on T2-weighted images, seen in both HIV-positive and HIV-negative subjects, are of uncertain significance. Of the multiple MRI abnormalities found, only diffuse cerebral atrophy appears to be associated with HIV infection, and only in subjects with compromised immunologic function.
Safety and Immunogenicity of an Acellular Pertussis Vaccine Booster in 15- to 20-Month-Old Children Previously Immunized With Acellular or Whole-Cell Pertussis Vaccine as Infants
Authors: Pichichero Michael E. , Francis Anne B. , Marsocci Steven M. , Green John L. , Disney Frank A. , Meschievitz Carlton
Published: December 2021

The objective of this study was to evaluate reactogenicity and immunogenicity of the recently US-licensed Connaught/BIKEN (C/B) acellular DTP (ADTP) vaccine as a booster for children aged 15 to 20 months after they had received either the C/B ADTP or the US-licensed Connaught whole-cell DTP (WDTP) vaccine as infants. After infants had received either three doses of C/B ADTP (n = 109) or three doses of WDTP vaccine (n = 30) at 2, 4, and 6 months of age according to a 3:1, randomized, prospective design, they all received booster doses at 15 to 20 months of age with C/B ADTP. Fever >101°F (38.3°C), irritability, injection site redness ≥ 1 inch, injection site swelling, and injection site pain, among other reactions, were monitored for 14 days after vaccination. IgG antibody to pertussis toxin (PT) and filamentous hemagglutinin were analyzed by enzymelinked immunosorbent assay and neutralizing antibody to PT was measured by Chinese hamster ovary (CHO) cell assay. No significant differences were observed between the WDTP- and ADTP-primed infants following their ADTP booster for any of the monitored reactions within 72 hours of vaccine administration or in the 4 to 14 days after vaccination. Prior to the ADTP booster, antibody levels were higher in children who had received ADTP compared with those who had received WDTP vaccine as infants for PT antibody as measured by enzyme-linked immunosorbent assay and CHO cell assay. Higher levels of IgG antibody following the ADTP booster were observed to filamentous hemagglutinin and to PT in ADTP-primed compared with WDTP-primed children. It is concluded that C/B ADTP boosters in 15- to 20-month-old children produced reactions that were not significantly different whether infants had been primed with WDTP or C/B ADTP. Antibody responses were enhanced after a C/B ADTP booster in C/B ADTP-primed compared with WDTP-primed infants.
Oscillometric Blood Pressures in the Arm, Thigh, and Calf in Healthy Children and Those With Aortic Coarctation
Authors: Park Myung K. , Lee Da-Hae , Johnson Glory Ann
Published: December 2021

Comparing blood pressure (BP) obtained in the arm with that obtained in the thigh or calf is important in the diagnosis of aortic coarctation. However, normative mean and range of differences in BP between the arm and lower extremity sites are not available for normal children. It is also not known how accurately the differences in BP between the arm and the lower extremity sites predict the pulsed Doppler estimation of systolic pressure (SP) gradient across an aortic coarctation. To resolve these questions, the authors obtained two BP measurements by an oscillometric (Dinamap) method in the arm, thigh, and calf in 74 healthy children aged 4 to 16 years. Oscillometric BP was also obtained in 21 children aged 3 to 17 years with preoperative or postoperative aortic coarctation and BP gradients were compared with that estimated by the pulsed Doppler method. Overall, SP was higher in the thigh and calf than in the arm. The gradients in SP expressed as arm SP minus calf SP [S(A - C)] and arm SP minus thigh SP [S(A - T)] were significantly greater in children 4 through 8 years old than in those 9 to 16 years old. The S(A - C) was –9.3 (±7.4 SD) mm Hg in the 4- through 8-year group and –5.0 (±6.9 SD) mm Hg in the 9- to 16-year group. The S(A - T) was –7.1 (±6.8 SD) mm Hg in the 4- through 8-year group and –2.4 (±7.7 SD) mm Hg in the 9- to 16-year group. Diastolic and mean arterial BP levels were lower in the calf (9 and 1 mm Hg, respectively) and the thigh (11 and 4 mm Hg, respectively) than in the arm. The S(A - C) in all patients with preoperative aortic coarctation and those with significant residual coarctation was greater than the mean + 2 SD for healthy children. The S(A - C) and S(A - T) values in patients with preoperative or postoperative coarctation correlated well with the pulsed Doppler-based estimates of the gradient (r = .908 and .936, respectively). This correlation and the comparison of known cases of coarctation with the normative gradients suggest (1) if the Dinamap SP in the calf or thigh is lower than that in the arm, the presence of aortic coarctation is suspicious, and (2) if the S(A - C) and/or S(A - T) is greater than the mean + 2 SD for normal children, the diagnosis of aortic coarctation is likely. It appears that, in addition to testing for a delayed pulse in the leg, properly obtaining oscillometric values for systolic BP in the arm and the calf or thigh is important in the diagnosis, management, and postoperative evaluation of aortic coarctation.
Attention Deficit Hyperactivity Disorder, Creativity, and the Effects of Methylphenidate
Authors: Funk Jeanne B. , Chessare John B. , Weaver Michael T. , Exley Anita R.
Published: December 2021

Given that children with attention deficit hyperactivity disorder (ADHD) are more impulsive than peers, this study explored whether they are correspondingly more creative, and whether creativity declines when impulsivity is decreased through methylphenidate (Ritalin) therapy. A repeated-measures quasi-experimental design was used to compare the performance of 19 boys with previously diagnosed ADHD and 21 comparison boys aged 8 through 11 on two administrations of alternate forms of the Torrance Tests of Creative Thinking-Figural (nonverbal). Boys with ADHD received prescribed methylphenidate only for the first session. Overall, mean Torrance summary scores for comparison boys (mean = 115.1, SD = 16.1) were higher than for boys with ADHD (mean = 107.6, SD = 12.7). However, the difference between means was small (7%) and did not meet the 25% criterion for a clinically significant difference. No changes in performance over time (comparison group) or medication state (ADHD group) were observed. These data suggest that, when measured nonverbally, the creative thinking performance of boys with ADHD is not superior to that of peers who do not have ADHD. Regarding the effects of methylphenidate, prescribed therapy did not influence performance on this measure of creative thinking.
Appearance of the Hymen at Birth and One Year of Age: A Longitudinal Study
Authors: Berenson Abbey B.
Published: December 2021

The increase in the number of prepubertal girls who require evaluation of possible sexual abuse creates a need for detailed information, not previously available from cross-sectional studies, on the influence of aging on the hymen's appearance. This study was undertaken to evaluate and document, using a longitudinal design, changes in the hymen's morphology in 62 girls without a history of sexual abuse between birth and their first birthday. Labial agglutination extensive enough to obscure the inferior half of the hymen was observed in 5 girls (8%) at 1 year of age. Thirty-three (58%) of the remaining 57 infants experienced a marked decrease in the amount of their hymenal tissue between birth and 1 year. Significantly more infants at 1 year of age had a crescentic configuration (0% vs 28%), and significantly fewer had an external ridge (82% vs 14%) as compared to the newborn period. An annular hymen with a central or ventrally displaced opening progressed to a crescentic hymen in 13 children by 1 year, 77% (10/13) of whom were observed to have a notch (cleft) at the 12 o'clock position on the earlier study. A superior notch appeared for the first time in 9 girls. Lateral notches resolved in 5 cases and persisted in 2. Inferior notches between the 4 and 8 o'clock positions were not observed at birth or 1 year. Hymenal tags resolved in 2 instances, persisted in the same location in 2, and appeared for the first time in 4 cases. Three girls had a hymenal mound (bump) at 1 year, all of which could be traced back to a similar finding at birth. No change in the number of infants with longitudinal intravaginal ridges was observed. Clinicians should be aware of the influence of age and changing estrogen levels on the hymen's morphology in order to differentiate normal anatomical from posttraumatic or infectious changes.
Systemic Reactions to Measles-Mumps-Rubella Vaccine Skin Testing
Authors: PUVVADA LAKSHMI , SILVERMAN BERNARD , BASSETT CLIFFORD , CHIARAMONTE LAWRENCE T.
Published: December 2021

In this report, we describe our recent experience with measles-mumps-rubella (MMR) vaccine skin testing and desensitization, including the occurrence of systemic reactions to intradermal testing, which to our knowledge has not been reported previously. We also review the literature on MMR reactions and the controversies regarding testing and administration in the egg-sensitive individual, emphasizing the need for a cautious approach.

Ten children with history of egg allergy, ranging in age from 6 to 18 months, were referred to us for further evaluation regarding MMR vaccine administration. Six of 10 had a history of mild to moderate egg sensitivity, which consisted of pruritis, eczema, localized urticaria, on immediate vomiting.
Summary of the Annual Meeting of the Section on Urology, American Academy of Pediatrics
Authors: Roth David R.
Published: December 2021

The Section on Urology of the American Academy of Pediatrics met for 2½ days in conjunction with the 61st annual meeting of the American Academy of Pediatrics in San Francisco, CA, October 10 through 12, 1992.

As in the recent past, this conference was one of the premiere conferences for pediatric urology throughout the world. Participation was international and more than 500 individuals attended the sessions. The presiding officer for the meeting was Dr Edmond Gonzales, Jr, of Baylor College of Medicine, Scott Department of Urology, Houston, TX. All papers presented at the meeting are summarized in the following review, which is organized according to topic.

TESTIS

Several papers were presented by the group led by Hutson from Melbourne concerning the relationship of various substances to the gubernaculum and testicular descent. Their presentations stressed the importance of calcitonin gene-related peptide as a mediator in testicular descent by its relationship to the gubernaculum. Huff described a failure of maturation of Ad spermatogonia in undescended testes when compared to their normally descended partners. These changes were noted before the end of the first year of life. Hadziselimovic and Bica from Basel and Rio de Janeiro investigated the effects of hormonal treatment on the undescended gonad. Low-dose luteinizing hormone-releasing hormone increased both serum follicle-stimulating hormone and the number of Sertoli cells in cryptorchid testes. Human chorionic gonadotropin administration, on the other hand, induced Sertoli cell damage, which was reversed by the addition of luteinizing hormone-releasing hormone. Choi et al from the Seoul National University Children's Hospital looked at the effects of testicular torsion and subsequent detorsion on the contralateral testicle in rats.
Neonatal Genital Prolapse
Authors: PORGES ROBERT F.
Published: December 2021

To the Editor.—

In regard to the brief report in the September 1992 issue of Pediatrics on "Neonatal Genital Prolapse" by Dr Mahin Bayatpour et al,1 I offer a polyp, arising either from the cervix or vagina, as a more likely diagnosis. Figure 1 of the article fails to show any structure resembling a cervix. Ultrasonographic demonstration of a normal uterus and cervix, presumably in their normal location, is not consistent with the diagnosis of prolapse.
Neonatal Genital Prolapse
Authors: BAYATPOUR MAHIN , MCCANN JOHN , HARRIS TONI , PHELPS HOPE
Published: December 2021

In Reply.—

We appreciate Dr Porges's suggestion of a possible diagnosis of polyp for the case published in September. In considering a differential diagnosis of interlabial mass during neonatal period, the partial list includes polyps, urethral prolapse, paraurethral cyst, and rhabdomyosarcoma (Botryoid sarcoma). However, the clinical findings in our case were relatively clear, which unfortunately was not revealed clearly in the published photograph. The photograph showed the circumferential prolapse of vaginal wall through the introitus and was not the cervix.
Lead Screening
Authors: GOLDMAN LYNN R.
Published: December 2021

To the Editor.—

Dr Edgar J. Schoen does not like lead screening.1 In a letter to Pediatrics, "Lead Toxicity in the 21st Century: Will We Still Be Treating It?" he refers to a study my colleagues at the California Department of Health Services and I conducted in Oakland, California as "a vivid example of how poor methodology and biased selection of subjects can lead to greatly exaggerated prevalence rates," accusing me of having a "serious omission" in a submission to Morbidity and Mortality Weekly Report.
Lead and IQ
Authors: NEEDLES CARL F.
Published: December 2021

To the Editor.—

The article by Bellinger et al1 claims to show a dose-related toxicity of lead on intellectual functioning, ie, 5.8 IQ points and 8.9 K-TEA points per 10 µg% of blood lead (at 2 years). Yet the Figure (on page 858) shows nearly identical scores for subjects with blood leads of 10.0 to 14.9 and more than 15.0. This certainly is a surprise, because one would expect pronounced effect on the brain where the toxin levels are highest.
Controversies Concerning Vitamin K and the Newborn
Authors:   Vitamin K Ad Hoc Task Force
Published: December 2021

Vitamin K deficiency may cause unexpected bleeding (0.25% to 1.7% incidence) during the first week of life in previously healthy-appearing neonates (classic hemorrhagic disease of the newborn [HDN]). The efficacy of neonatal vitamin K prophylaxis (either oral or parenteral) in the prevention of classic HDN is firmly established. It has been the standard of care since the recommendation by the Committee on Nutrition was adopted as policy by the American Academy of Pediatrics in 19611

Late HDN, a syndrome defined as unexpected bleeding due to severe vitamin K deficiency in infants aged 2 to 12 weeks, occurs primarily in exclusively breast-fed infants who have received no or inadequate neonatal vitamin K prophylaxis. In addition, infants who have intestinal malabsorption defects (cholestatic jaundice, cystic fibrosis, etc) may also present with late HDN. The rate of late HDN (often manifested by sudden central nervous system hemorrhage) ranges from 4.4 to 7.2 per 100 000 births based on reports from Europe and Asia. When a single dose of oral vitamin K has been used as neonatal prophylaxis, the rate has decreased to 1.4 to 6.4 per 100 000 births. Parenteral neonatal vitamin K prophylaxis prevents the development of late HDN, with the rare exception of infants with severe malabsorption syndromes. Oral regimens that have a similar efficacy as parenteral vitamin K in prevention of late HDN include the repeated administration of oral vitamin K1 (Germany) or K2 (Japan) at birth, 1 week, and 2 to 4 weeks.

In 1990 Golding et al2 reported a study of a 1970 birth cohort in Britain in which they noted an unexpected association between childhood cancer and pethidine given in labor and the neonatal administration of vitamin K. Subsequently, Golding and others3 conducted a case-control study designed to examine the risk of cancer associated with intramuscular vitamin K administration among infants born in two hospitals in Avon between 1965 and 1987 and diagnosed with cancer between 1971 and 1989.
Role of the Pediatrician in Prevention and Management of Substance Abuse
Authors:   Committee on Substance Abuse
Published: December 2021

The past three decades have been marked by an increasing recognition of the responsibility of pediatricians to their patients and their patients' families regarding the diagnosis and management of abuse of tobacco, alcohol, and other substances of abuse including prescription drugs. Because of the harmful consequences, substance abuse is an obvious concern for all those who care for infants, children, adolescents, and young adults. When it occurs during pregnancy, it has been associated with an increased incidence of prematurity; congenital defects, including brain damage; and even death. The pediatrician must be prepared to address this commonplace issue as a part of routine health care, starting with the prenatal visit and continuing as a part of all anticipatory guidance. Familiarity with the extent and nature of drug use, as well as the health and social consequences, has become a necessary part of the body of pediatric knowledge.1-9 The pediatrician should possess or develop the skills necessary to determine which young patients are at risk for substance abuse and chemical dependence and should also be able to offer appropriate prevention or treatment counseling to the child, adolescent, and his or her family, or make a referral to a source where such counseling can be obtained.

PERVASIVENESS OF DRUG USE

The pattern of substance abuse among teenagers has undergone significant change during the past 25 years. Prior to the late 1960s, the abuse of psychoactive drugs and alcohol was predominantly an adult phenomenon. In the late 1960s and early 1970s, substance abuse became widespread among adolescents and, more recently, preadolescents.
Stewart Smiled
Authors: TOBIAS JOSEPH D. , PHIPPS SEAN , MULHERN RAYMOND K. , SMITH BRUCE
Published: December 2021

In Reply.—

When we published our recent study concerning the use of oral ketamine, we anticipated that the response would be mixed, and therefore we are thankful for the opportunity to respond to our advocates and our critics. The poignant essay "Stewart Smiled" eloquently demonstrates the benefits of sedation and stands alone without the need for further comment.

The criticisms and concerns of Drs Kibelbek, Schwartz, and Tenedios are welcomed. However, their major objection to our study does not seem to contradict our thoughts at all.
HIV and Smooth Muscle Tumors
Authors: MURPHY SHARON B. , CHADWICK ELLEN G.
Published: December 2021

To the Editor.—

We read the article by Mueller et al,1 which adds to the evidence confirming the remarkable association of tumors of smooth-muscle origin in children infected with the human immunodeficiency virus (HIV), an association we first reported in 1990.2

We wish to set the record straight with regard to the number of cases of leiomyosarcoma previously reported in children with HIV infections. Mueller et al quite understandably conveyed an error which was the result of duplicate publication of a case.
HIV and Smooth Muscle Tumors
Authors: MUELLER BRIGITTA U. , PIZZO PHILIP A.
Published: December 2021

In Reply.—

We appreciate the comments of Murphy et al, and we agree that a total of eight cases of leiomyomas/leiomyosarcomas in children with human immunodeficiency virus (HIV) infection (including a case published by Sabatino et al1) have been published, and there are several unpublished observations (personal communications with several centers). This is a more than 400-fold higher incidence than seen in the general pediatric population. Soft tissue tumors are thus the third most common malignancy, after non-Hodgkin's lymphomas and Kaposi's sarcomas, that can occur in the HIV-infected child.
General Comments
Authors: McPherson Merle
Published: December 2021

As the year 2000 approaches, we as a nation face unique challenges in facilitating the development of systems of services for children and their families which support and nurture our next generation in healthy, productive lives.

Title V of the Social Security Act has a proud history of leadership in response to needs of children and families and has worked to improve the health of underserved women, infants, children, and youth, including children with special health care needs.

In 1989, amendments were enacted to the Title V Maternal and Child Health Grant (MCH block grant). These amendments redefine the mission of the state Children With Special Health Care Needs programs (CSHCN programs). The MCH block grant mandates the state CSHCN programs to assume a leadership role in developing community-based systems of services for children with special health care needs and their families.

The mandate in the MCH block grant to the CSHCN programs to assume a leadership role with respect to systems development reflects the national goal of building systems of services for children with special health care needs and their families that are family-centered, community-based, and coordinated. This goal was first enunciated in 1987 by the US Surgeon General's office and the federal Bureau of Maternal and Child Health. In accordance with this national goal, the recently issued Year 2000 National Health Promotion and Disease Prevention Objectives includes objective 17.20, which specifically calls for the building of family-centered, community-based, coordinated systems of services for this population.

The national initiative to develop systems of services for children with special health care needs and their families can and should be seen as part of a larger national movement to develop community-based systems of services.
Race and Ethnicity: Issues for Adolescents With chronic Illnesses and Disabilities. An Annotated Bibliography
Authors: Geber Gayle , Latts Elizabeth
Published: December 2021

CULTURAL COMPETENCE RESOURCES

The following are selected resources providing general information about the issues of cultural competence and cultural diversity. While they are not specific to adolescents with chronic illness on disabilities, these resources are relevant across the age span and contain important information for health care professionals, educators, parents, and program planners.

Asbury CA, Walker S, et al. Disability prevalence and demographic association among race/ethnic minority populations in the United States: implications for the 21st Century

A study that examined the status of ethnic/racial minority persons with chronic health conditions; physical, sensory, and language impairments; and nervous disorders. Areas of focus include income level, education, geographic location, employment, health status, and future trends. Available from Howard University Research and Training Center, 2900 Van Ness St NW, Holy Cross Bldg, Ste 100, Washington, DC 20008.

Baca L, Bransford J. An appropriate education for handicapped children of limited English proficiency. Special education in America: its legal and governmental foundations series. The Council for Exceptional Children, 1982: 31 pages

One of a series of publications addressing the legal and governmental foundations of bilingual special education for children with handicaps. Also discussed are significant issues affecting the provision of bilingual special education. (EDRS: ED #224 265. To order, call 1-800-433-3742.)

Baca L. Policy options for insuring the delivery of an appropriate education to handicapped children who are of limited English proficiency. The Council for Exceptional Children, 1980: 58 pages

This article provides a historical overview of policy issues (litigation and legislation) involved in the provision of an appropriate education for bilingual children with handicaps.
Factors Associated With Condom Use by Sexually Active Male Adolescents at Risk for Sexually Transmitted Disease
Authors: Orr Donald P. , Langefeld Carl D.
Published: December 2021

Objective. The purpose of this study was to identify the predictors of condom use in a population of male adolescents at risk for sexually transmitted diseases (STDs).

Design. Cross-sectional cohort study.

Setting. Clinical sites (school-based, adolescent and STD clinics) providing reproductive health care to male adolescents in a midwestern city.

Participants. One hundred sixteen male adolescents 15 to 19 years of age were enrolled consecutively.

Outcome measures. Subjects completed a multi-instrument questionnaire examining sexual behaviors attitudes, and beliefs about STDs and condoms, cognitive maturity, and health risk behaviors; urethral specimens were cultured for Chlamydia trachomatis and Neisseria gonorrhoeae.

Results. The median age was 17; 31% were white and 69% were African-American. Thirty-seven percent had urethral infections: 21% were infected with C trachomatis, 11% with N gonorrhoeae, and 5% with both organisms. More than 60% reported some experience with condoms and 23% reported condom use at last coitus. Consistent with the Health Belief Model, condom use for STD prevention was less likely among those reporting other health risk behaviors (odds ratio [OR] = 0.53; 95% confidence interval [CI] = 0.36 to 0.78; P < .001) and more STD risk behaviors (OR = 0.65; CI = 0.45 to 0.96; P = .03). Adolescents who were more highly motivated (OR = 1.58; CI = 1.09 to 2.30; P = .02) and who were more positive about condoms (OR = 1.83; CI = 1.25 to 2.68; P < .001) were more likely to report condom use for contraception. Adolescents using condoms for acquired immunodeficiency syndrome (AIDS) protection engaged in fewer behavioral (OR = .62; CI = 0.42 to 0.92; P = .02) and STD risks (OR = .67; CI = 0.45 to 0.99; P = .04). Three specific reasons for condom use were highly predictive of condom use at last intercourse: STD prevention (OR = 8.9; CI = 3.13 to 25.4; P < .001), birth control (OR = 2.1; CI = 1.05 to 4.25; P = .03), and AIDS prevention (OR = 2.4; CI = 1.05 to 5.42; P = .03).

Conclusion. Condom use among adolescent males is influenced by perceived benefit, namely prevention of pregnancy & avoidance of STDs including AIDS. Non-use is associated with other risk-taking behavior.
Child Day Care, Smoking by Caregivers, and Lower Respiratory Tract Illness in the First 3 Years of Life
Authors: Holberg Catharine J. , Wright Anne L. , Martinez Fernando D. , Morgan Wayne J. , Taussig Lynn M. ,   Group Health Medical Associates
Published: December 2021

Background. Day-care attendance has been associated with an increased risk of hospitalization for lower respiratory tract illnesses (LRIs). This study examines, in a health maintenance organization population of children, the associations between child day care and the occurrence of LRIs in the first 3 years of life. Smoking by caregivers and a possible protective effect of longer day-care enrollment in relation to LRIs are also addressed.

Methods. Information on day-care arrangements was elicited from 1006 parents of infants for five age intervals in the first 3 years of life: birth through 3 months, 4 to 6 months, 6 to 12 months, 1 to 2 years, and 2 to 3 years. Data on LRIs in the first 3 years of life were recorded by pediatricians at the time of the acute illnesses.

Results. After controlling for other risk factors, the presence of three or more unrelated children in the care setting was associated with significant risks of LRI of up to twofold or more from 4 months of age to 3 years. Type of care setting was not a significant risk factor during this time period. In the third year of life, the risk of wheezing LRI in the presence of a smoking caregiver was more than threefold for those in another residential home setting. No significant protective effect against LRIs in the third year of life associated with longer prior day-care enrollment was demonstrated.

Conclusion. The presence of three or more unrelated children in the care setting and the presence of a smoking caregiver were significant independent risk factors for LRIs during the first 3 years of life. Prolonged day-care did not protect against LRIs in the third year of life.
Evaluation of Two Iron-Fortified, Milk-Based Formulas During Infancy
Authors: Bradley Christi K. , Cordano Angel , Hillman Laura ,   Pennridge Pediatric Associates, Sherman Adria Rothman , Leedy Donald ,   Caylor-Nickel Research Institute, Inc
Published: December 2021

Objective. Compare milk-based, ironfortified formulas containing 7.4 and 12.7 mg/L iron and breast-feeding during the first year of life.

Design. Partially randomized, double-blind trial: non-breast-fed infants randomly assigned to receive one of two coded formulas, identical except for iron content; infants discontinuing breast-feeding between 1 and 8 weeks of age randomly assigned to a formula late-start group.

Setting. Five general community pediatric practices in Missouri, Indiana, Illinois, and Pennsylvania.

Participants. Sample of 347 healthy, term infants, enrolled within 1 week after birth; 172 included in statistical analyses.

Outcome measures. Length, weight, and indicators of formula intolerance recorded at clinic visits; formula consumption, bowel movements, stool consistency, and other tolerance indicators recorded by parents on daily and weekly report forms; hemoglobin, hematocrit, and serum ferritin, iron, zinc, and copper measured at 6 and 12 months.

Results. No significant differences between formula-fed groups in growth, attrition, formula consumption, bowel movements, hematocrit, hemoglobin level, and serum iron, zinc, and copper levels (P > .05); first 6-month weight and length changes of the breast-fed group significantly less than in both formula-fed groups (P < .008); serum ferritin level of the formula-fed, high-iron group significantly higher than that of the low-iron and breast-fed groups (P < .008), although all groups' values were normal; no apparent differences between formula groups in formula tolerance and stool characteristics but data were not analyzed statistically.

Conclusions. Milk-based formulas containing either 7.4 or 12.7 mg/L iron support normal growth and iron status of healthy, term, normally fed infants during the first year and both are well tolerated and accepted.
New Postnatal Growth Grids for Very Low Birth Weight Infants
Authors: Wright Kelly , Dawson Joan P. , Fallis Donna , Vogt Elanita , Lorch Vichien
Published: December 2021

Objective. To generate contemporary postnatal growth curves for hospitalized very low birth weight infants.

Design. Retrospective survey.

Setting. Tertiary intensive care nursery.

Patients. All surviving singleton, appropriate-for-gestational age infants with birth weight ≤1500 g, born January 1, 1987, to May 31, 1991, who did not develop necrotizing enterocolitis (N = 205).

Measurements and results. Macronutrient intakes and body weights were recorded daily, with crown-heel length and occipital-frontal head circumference recorded weekly up to 105 days of age or hospital discharge, whichever occurred first. Growth curves were generated for four birth weight ranges: 501 through 750, 751 through 1000, 1001 through 1250, and 1251 through 1500 g. Compared to previously published growth curves, the current infants regained birth weight more quickly and exhibited larger average daily weight gains. These differences were most apparent in infants of lowest birth weight.

Conclusions. The "premature growth grid" constructed by Dancis et al more than 40 years ago may no longer be a useful standard of early postnatal growth for present-day very low birth weight, appropriate-for-gestational-age infants. The new weight curves are a more accurate reflection of current in-hospital growth trends, especially for infants weighing ≤1000 g at birth.
The Mystery Ingredients: Sweeteners, Flavorings, Dyes, and Preservatives in Analgesic/Antipyretic, Antihistamine/Decongestant, Cough and Cold, Antidiarrheal, and Liquid Theophylline Preparations
Authors: Kumar Ashir , Rawlings Rick D. , Beaman Dana C.
Published: December 2021

Objective. Pharmaceutical preparations may contain a variety of excipients ("inert ingredients"). These excipients are generally inactive; however, rare adverse effects caused by excipients have been reported. Information about the excipients in a particular preparation is not readily available.

Methods. The information about sweeteners, flavorings, dyes, and preservatives for the chewable and liquid preparations of over-the-counter and prescription products of antidiarrhea, cough and cold, antihistamine/decongestant, analgesic/antipyretic, and liquid theophylline medications was collected.

Results. Information about excipients in 102 chewable and liquid preparations was compiled. An average preparation contained two sweeteners. Saccharin and sucrose were the most common sweeteners found—each was present in 52 preparations—followed by sorbitol, glucose, fructose, and others. For 36 of the 102 preparations, type of flavoring was not specified. In the remaining preparations, cherry was the most common flavoring, followed by vanilla and lemon. Twenty-one different dyes and coloring agents were used. Red dye No. 40 was the most common (42/102), followed by yellow No. 6 (27 02). Of the eight preservatives used, sodium benzoate and methylparabens were present in 42 and 27 of the preparations, respectively. Tables detailing these excipients and adverse effects reported are presented.

Conclusions. The tables should be helpful to physicians in selecting preparations containing different excipients when an adverse reaction occurs. The mandatory labeling of excipients in all pharmaceutical preparations is the only way that physicians and patients can be fully informed.
Risk Factors and Outcomes for Failure to Thrive in Low Birth Weight Preterm Infants
Authors: Kelleher Kelly J. , Casey Patrick H. , Bradley Robert H. , Pope Sandra K. , Whiteside Leanne , Barrett Kathleen W. , Swanson Mark E. , Kirby Russell S.
Published: December 2021

Objective. To determine the epidemiology, clinical characteristics, and outcomes for low birth weight (LBW) infants with growth deficiency, or failure to thrive (FTT, the term commonly used by pediatric providers to describe growth deficiency or faltering in early childhood).

Design. Three-year prospective cohort study with matched case-control study of outcomes.

Setting. Eight large university hospital sites throughout the United States.

Sample. 914 LBW infants inborn at the sites and meeting study criteria.

Results. FTT was a common condition in this cohort, with 180 (19.7%) of 914 LBW infants meeting case criteria by 30 months. New cases of FTT peaked at 8 months gestation-corrected age. In addition to expected differences in growth between infants with and without FTT, infants with FTT had lower developmental indices and less stimulating home environments. At 36 months, FTT infants had lower IQ scores and were much smaller than infants without FTT.

Conclusions. Growth deficiency, or FTT, is a common clinical condition for those involved in the follow-up care of LBW infants. Worse cognitive and growth outcomes were observed for those meeting the restrictive case criteria employed in this study. More than 80% of the cases in this LBW cohort did not involve any chronic medical disorders, but several biological and environmental differences were found between those who developed FTT and those who did not.
Screening Urine of 3-Week-Old Newborns: Lack of Association Between Sudden Infant Death Syndrome and Some Metabolic Disorders
Authors: LEMIEUX BERNARD , GIGUERE ROBERT , CYR DENIS , SHAPCOTT DENIS , MCCANN MARK , TUCHMAN MENDEL
Published: December 2021

The only genetic metabolic disorder clearly linked thus far to sudden infant death syndrome (SIDS) is medium-chain acylcoenzyme A dehydrogenase (MCAD) deficiency. There has been no evidence for an association between SIDS and other hereditary metabolic disorders. A few studies, which were often carried out retrospectively on single subjects, have involved the measurement of various metabolites including organic acids, carnitine, free amino acids, and the enzymes implicated in the oxidation of fatty acids, and these have not linked SIDS to inborn errors of metabolism. The study of Harpey et al1 reported that 15% of SIDS infants have a fatty acid β-oxidation defect.
A Simplified Behavioral Treatment for Trichotillomania: Report of Two Cases
Authors: BLUM NATHAN J. , BARONE VINCENT J. , FRIMAN PATRICK C.
Published: December 2021

Trichotillomania is a behavioral disorder characterized by habitual hair pulling resulting in alopecia. Although once considered extremely rare, a recent survey study of college freshmen suggests a lifetime prevalence of more than 3% in females and more than 1% in males.1

The recent literature on trichotillomania has emphasized the pharmacologic treatment of adolescents and adults. Some studies have reported decreased hair pulling in response to treatment with the antiobsessional medications clomipramine and fluoxetine2,3 However, Christenson and colleagues4 failed to demonstrate benefit from fluoxetine, and in a preliminary report Rothbaum and Ninan5 found greater decreases in hair pulling with a behavioral intervention than with clomipramine.
Arginase Deficiency Presenting as Cerebral Palsy
Authors: SCHEUERLE ANGELA E. , MCVIE ROBERT , BEAUDET ARTHUR L. , SHAPIRA STUART K.
Published: December 2021

Arginase catalyzes the conversion of arginine to ornithine and urea in the final step of the urea cycle. The enzyme deficiency disease, argininemia, is a rare autosomal recessive disorder which presents with progressive psychomotor retardation, growth failure, seizures, and spasticity affecting the lower extremities more than the upper.1 It does not, however, commonly have the severe hyperammonemia seen with other urea cycle disorders.1,2 We describe two unrelated patients, previously thought to have cerebral palsy, who were later found to have arginase deficiency. This suggests that the condition may be underdiagnosed because of its relatively mild symptoms.

CASE REPORTS

Patient 1, a 9-year-old boy, was born at term after an uncomplicated pregnancy to nonconsanguineous African-American parents.
Diagnosing and Treating Health: Bright Futures
Authors: GREEN MORRIS , KESSEL SAMUEL S.
Published: December 2021

As pediatric historian Tom Cone, Jr, has pointed out, at the beginning of the 20th century "health supervision of children—if it existed at all—consisted of a cursory examination to detect contagious disease. Physicians confined their efforts to the child when sick rather than the child when well."1 Of course, there has been much progress since the early 1900s. Today, for example, the childhood mortality rate is nearly 25 times less than it was in 1900, when the principal cause of death was infection. While many of the serious childhood diseases have all but disappeared as the chief causes of death in the United States, we have come to appreciate what Robert Haggerty termed the "new morbidity" largely resulting from social, behavioral, economic, psychosocial, and contextual influences.
Antenatal Corticosteroids Appear to Reduce the Risk of Postnatal Germinal Matrix Hemorrhage in Intubated Low Birth Weight Newborns
Authors: Leviton Alan , Kuban Karl C. , Van Marter Linda , Pagano Marcello , Allred Elizabeth N.
Published: December 2021

Objective. To determine to what extent the reduced risk in preterm newborns of intracranial hemorrhage attributed to antenatal corticosteroids (ANCS) reflects reductions in the incidence of respiratory distress and its correlates.

Methods. In a sample of 239 very low birth weight newborns recruited for a clinical trial of phenobarbital prophylaxis of subependymal/intraventricular hemorrhage, we explored the relationship between ANCS, the occurrence of germinal matrix hemorrhage (GMH) that first became evident after the 12th postnatal hour, and putative intervening variables such as acidosis, elevated peak inspiratory pressure, pneumothorax-pulmonary interstitial emphysema, and elevated continuous positive airway pressure.

Results. In multivariate models adjusting for confounders, newborns exposed to ANCS were at approximately one third the risk of GMH experienced by newborns not exposed to a full course of ANCS. The additions of measures and correlates of respiratory distress severity to these models did not change the GMH risk associated with ANCS.

Conclusion. The GMH-protective effect of ANCS does not appear to be a consequence of enhanced pulmonary maturation.
Placebo-Controlled Evaluation of Ritalin Side Effects
Authors: Ahmann Peter A. , Waltonen Stuart J. , Theye Fred W. , Olson Kurt A. , Van Erem Alayne J.
Published: December 2021

Objective. To address the frequency of side effects of Ritalin therapy in children with attention deficit hyperactivity disorder (ADHD) using the Barkley Side Effects Questionnaire (BSEQ) in a clinical setting.

Design. Randomized double-blind placebo-controlled cross-over trial.

Setting. A large rural tertiary care clinic.

Patients. 234 consecutive children aged 5 through 15 years who met the Diagnostic and Statistical Manual of Mental Disorders (3rd ed, revised) criteria for ADHD were enrolled. Of these children, 206 had sufficient side effects data for analysis.

Interventions. 0.3 mg/kg per dose and 0.5 mg/kg per dose Ritalin compared to placebo in separate 2-week trials. Each treatment was given three times a day for 7 consecutive days.

Measurements and main results. Parents, blinded to the treatment assignment, assessed side effects via the BSEQ at baseline and at the end of each of the 4 treatment weeks. Univariate odds ratios (OR) were used to describe the magnitude of differences in observed side effects between Ritalin and placebo weeks of the trial for each of the items on the BSEQ. The frequency of the following side effects significantly increased with Ritalin therapy: insomnia (OR = 3.13, 95% confidence interval [CI] = (1.80,5.42)), appetite disturbance (OR = 19.00, 95% CI = (9.18,39.31)), stomachache (OR = 7.00, 95% CI = (3.29, 14.89)), headache (OR = 5.29, 95% CI = (2.51,11.15)), and dizziness (OR = 7.50, 95% CI = (1.93,29.13)). The frequency of the following side effects significantly decreased with Ritalin therapy: staring and daydreaming (OR = 0.47, 95% CI = (0.27,0.84)), irritability (OR = 0.33, 95% CI = (0.18,0.61)), anxiety (OR = 0.42, 95% CI = (0.23,0.76)), and nailbiting (OR = 0.19, 95% CI = (0.07, 0.53)). The incidence rates of the remaining BSEQ items did not differ significantly between the Ritalin and placebo weeks of the trial.

Conclusion. The BSEQ proved to be clinically effective in tracking Ritalin side effects and should be incorporated into the routine evaluation and monitoring of ADHD patients for whom stimulants are prescribed.
Accuracy and Precision of Low-Dose Insulin Administration
Authors: Casella Samuel J. , Mongilio Marilyn K. , Plotnick Leslie P. , Hesterberg M. Polly , Long Carol A.
Published: December 2021

Objective. To determine the lowest dose of concentrated (U100) insulin that can be reproducibly delivered.

Methods. A telephone survey was used to determine current practices in major pediatric hospitals regarding the administration of low doses of concentrated insulin. A sensitive gravitometric technique was used to determine the error in measurement of low doses of U100 insulin by pediatric nurses and parents of diabetic children.

Results. A telephone survey revealed that doses as low as 0.5 or 1.0 U (5 to 10 µL) are routinely administered in pediatric hospitals. In our study of pediatric nurses, attempts to deliver 0.5, 1.0, and 2.0 U resulted in delivered doses of 0.975 ± 0.315, 1.638 ± 0.376, and 2.153 ± 0.435 U (mean ± standard deviation of the mean), respectively. The use of 0.3-mL syringes compared to 0.5-mL syringes did not improve accuracy or precision. Taken as a group, parents of children with diabetes were more accurate (mean delivered dose of 1.063 ± 0.276 for the 1-U dose), but the individual means ranged from 0.641 to 1.300 and coefficients of variation ranged from 5% to 33%. Only three of the seven parents could deliver 1.0 U with acceptable precision and accuracy.

Conclusions. When currently available syringes are used, insulin injections of less than 20 µL (2 U of U100) have an unacceptably large error. It is recommended that, in the inpatient setting, diluted insulin be used if the prescribed dose is less than 2.0 U.