bluuebunny/crossref_metadata_2025 huggingface dataset:
Management of Attention Deficit Hyperactivity Disorder (ADHD)
Authors: Rebecca Campbell L. , Cohen Morris
Published: November 2007

The American Academy of Pediatrics (AAP) has recommended that the initial treatment of attention deficit hyperactivity disorder (ADHD) should be educational and behavioral. The authors surveyed the directors of special education in the United States to determine whether these services are available to children with ADHD. They determined that the diagnosis of ADHD qualifies a child for services in only 1 out of 51 departments of special education surveyed. ADHD and classroom underachievement qualifies a child for special education services in 2 out of 51 departments. Thus, in most areas of the United States, special educational services are not available to meet the guidelines of the AAP.
Spinal Dysraphism
Authors: Tracy Patrick T. , Hanigan William C.
Published: November 2007

Three cases of children with spinal dysraphism are reported. Magnetic resonance imaging (MRI) was used as a primary diagnostic examination. The ages of the patients were 2 days, 4 years, and 16 years. In all instances the scan gave a precise diagnosis as well as an accurate delineation of the structural abnormalities before surgical treatment. Plain radiographs and ultrasound analysis may not be helpful, and invasive procedures can be associated with morbidity. Technical ease, safety, and anatomic precision suggest that MRI should be performed as a primary radiologic examination in the diagnostic workup of spinal dysraphism.
Diseases That Mimic Meningitis
Authors: Levy Maurice , Wong E. , Fried D.
Published: November 2007

A retrospective review of charts for 650 children who had lumbar puncture for suspected meningitis was undertaken to determine the characteristics of patients with and without meningitis, identify other conditions suggesting meningitis, and evaluate the predictive value of signs and symptoms of meningitis.

The incidence of positive lumbar punctures increased with patient age. Younger infants did not present with classical features of meningitis. Bulging fontanel, lethargy, and irritability were nonspecific symptoms. Vomiting and headache, although not specific, proved to be more sensitive indicators of meningeal infection. Most patients with meningitis (75%) had at least one sign of meningeal irritation, but so did 25% of patients without meningitis. Brudzinski's sign was not specific. In contrast, nuchal rigidity and Kernig's sign had high predictive value. Up to age five, the diseases most often suggesting meningitis were right-sided pneumonia, gastroenteritis, otitis, tonsillitis, exanthema subitum, and urinary tract infections. Of 171 patients with febrile convulsion, one (0.5% ) had bacterial meningitis and four had aseptic meningitis.
Utilizing the Phone Appointment for Adolescent Follow-up
Authors: Cavanaugh Robert M.
Published: November 2007

Fifty young women were given 126 telephone appointments as a supplement to follow-up care in a university hospital adolescent clinic. Eighty (64%) calls were placed on the appropriate day, 71 (89%) of which were within 20 minutes of the assigned time. Patients with one or two clinic visits honored 39 of 52 (75%) of their phone appointments, whereas those with 11 or more visits kept only 8 of 17 (47%). Telephone appointments scheduled directly in the clinic were kept on 66 of 98 (67%) occasions as compared to 14 of 28 (50%) for those made over the phone. Sixty-four of 93 (69%) calls were made when the interval from the time the phone appointments were given to date of appointment was 7 days or less, while 16 of 33 (48%) responded when this period was 8 days or longer. The data document the compliance of adolescent girls with telephone appointments and suggest that this technique may be a useful adjunct for monitoring patients requiring close medical follow-up.
Superficial Cultures in Neonatal Sepsis Evaluations
Authors: Zuerlein Terrance J. , Butler Jay C. , Yeager Thomas D.
Published: November 2007

The authors performed a retrospective analysis of neonatal superficial cultures and their effect on antimicrobial decision making during a nine-month period at Nashville General Hospital. They obtained and reviewed charts of infants (n=66) having paired superficial (skin and/or gastric aspirate) and deep (blood and cerebrospinal fluid) cultures for the evaluation of early-onset sepsis. Superficial cultures were positive for pathogens (any streptococcus or enteric gram-negative) in 15% (10/66) of cases. Antimicrobial decision making was affected in only one of these cases, and in a seemingly inappropriate manner. In summary, there was no evidence or review that superficial cultures used in sepsis evaluation influenced physician antimicrobial decision making; in one case they may have led to unnecessary antibiotic exposure.
Ultrasound Guidance
Authors: Rosenberg Henrietta Kotlus , Sherman Nancy H.
Published: November 2007

Since the advent of improved realtime ultrasound (US) imaging and the availability of the needle biopsy attachment, US-guided percutaneous biopsy and the drainage procedure can be performed safely in the pediatric patient. The authors review their experience over 3 years using US-guided interventional techniques in 96 children aged 5 days to 21 years. A wide variety of procedures were performed and included renal biopsy, nephrostomy tube placement, renal mass biopsy, puncture of bladder sinus tract and pancreatic pseudocyst, ventriculoperitoneal shunt placement and intraoperative localization of brain or renal tumor and renal calculi. No complication occurred.

US can be safely and accurately used as guide for interventional procedures in children as long as the area of interest can be clearly demonstrated and the depth and necessary angle of needle insertion can be predetermined as feasible.
Serum immunoglobulin G Subclasses in Patients During Acute Hepatitis A
Authors: Muller Christian , Godl Irene , Leibl Heinz , Eibl Martha M.
Published: November 2007

IgG subclasses were measured in sera of 47 patients with acute hepatitis A during the course of the disease. IgG1 and IgG3 serum levels were found to be elevated, whereas IgG2 and IgG4 subclass concentrations did not differ from that found in healthy control individuals. These findings indicate that, similar to the specific antiviral antibody, the polyclonal increase of serum concentrations of IgG in acute hepatitis A is not equally distributed to all IgG subclasses but is restricted to IgGl and IgG3.
*Immune Functions During Treatment of Growth Hormone-Deficient Children with Biosynthetic Human Growth Hormone
Authors: Rapaport Robert , Petersen Bruce , Skuza Kathryn A. , Heim Melinda , Goldstein Steven
Published: November 2007

Immune functions, including cell surface markers, interieukin-2 receptor levels and responses of lymphocytes to mitogenic stimulation were evaluated in seven growth hormone deficient children ages 4-15 years, during treatment with biosynthetically derived human growth hormone. Treatment resulted in a decrease in % B cells and in % T total cells and also decreases in most individual patients' mitogen responses and interleukin-2 receptor levels. Most of the changes noted were transient and similar to those previously demonstrated during pituitary-derived human growth hormone treatment. Although not resulting in overt clinical manifestations in our patients, we think that potential interactions between growth hormone and immune functions need to be considered by physicians treating children with growth hormone.
Neonatal Diagnosis of Spinal Cord Transection
Authors: Lasker Michelle R. , Torres-Torres Maritiza , Green Robert S.
Published: November 2007

Cervical spinal cord injury is an uncommon clinical entity in the present day. Transection of the spinal cord was first recognized as a clinical entity in 1870, after Parrot described this insult following a breech delivery.1 In the early 20th century, there were multiple reports of spinal injury at birth, all diagnosed at autopsy. We report the earliest case to date of an infant with a cervical spinal cord transection diagnosed by magnetic resonance imaging (MRI).
The Spectrum of Eosinophilic Gastroenteritis
Authors: Steffen Rita M. , Wyllie Robert , Petras Robert E. , Caulfield Maureen E. , Michener William M. , Firor Hugh V. , Norris Donald G.
Published: November 2007

Eosinophilic gastroenteritis is an inflammatory disease of unknown etiology characterized by infiltration of the gastrointestinal tract with eosinophilic leukocytes, accompanied by varying abdominal symptoms and usually by peripheral blood eosinophilia. We report our experience with six pediatric cases presenting to the Cleveland Clinic Foundation over the past eight years. Unusual findings in our patients included ascitic fluid without eosinophilia and eosinophilic pericarditis (one patient), and eosinophilic cholecystitis (one patient). Endoscopic examination and biopsy helped to establish the diagnosis in all patients. Bone marrow aspiration supported the diagnosis by demonstrating eosinophilia and identifying reactivation of the disease, even in cases without peripheral eosinophilia. All six patients responded promptly to prednisone. Diagnosis is challenging and eosinophilic gastroenteritis may be more common than is recognized. This series of cases significantly expands the spectrum of the disease in children, and documents the usefulness of diagnostic endoscopy in this condition.
Gastroesophageal Reflux in the Older Child: Presentation, Response to Treatment and Long-Term Follow-Up
Authors: Treem William R. , Davis Patricia M. , Hyams Jeffrey S.
Published: November 2007

Much attention has been focused on the natural history of gastroesophageal reflux (GER) in neurologically normal infants which generally resolves by two years of age. In contrast, little is known of the outcome of GER diagnosed in normal older children. The charts of 32 children (21 males) without neurologic or esophageal anatomic abnormalities, age 3.5 to 16 years (mean = 9.8) at the time of diagnosis, were reviewed. Diagnosis was based on suggestive presenting symptoms and evaluation of prolonged intraesophageal pH monitoring. Esophagitis was diagnosed by histologic criteria in 16 of the 32 patients. Medical treatment consisted of prokinetic agents (metoclopramide, bethanechol) and H2-receptor antagonists.

After a one to eight year follow-up period (mean ± SD - 3.4 ± 2.1), the symptoms in 13 children had resolved or were sufficiently improved to discontinue medication. In 13 patients, symptoms were improved but medication was required for adequate control. Four children were symptomatic without improvement in spite of medical therapy and two others required fundoplication for continued severe symptoms and refractory esophagitis. In summary, less than 50% of otherwise normal older children with GER undergo spontaneous resolution of marked improvement in symptoms and the remainder require continued long-term medical and/or surgical management.
Screening for Psychosocial Dysfunction in Pediatric Dermatology Practice
Authors: Rauch Paula K. , Jellinek Michael S. , Murphy J. Michael , Schachner Lawrence , Hansen Ronald , Esterly Nancy B. , Prendiville Julie , Bishop Sandra J. , Goshko Marilyn
Published: November 2007

The Pediatric Symptom Checklist, a brief psychosocial screening questionnaire, was used in a multi-center study of pediatric dermatology clinics (n=377). Overall rates of positive screening indicated that approximately 13% of patients screened positive, a rate similar to findings in primary care pediatric settings. Examining the sample in greater detail demonstrated that children whose dermatologic disorder is perceived to have a greater impact on their appearance are at higher risk for psychosocial dysfunction.
Pseudoreflux Syndrome-Increased Periodic Breathing During the Neonatal Period Presenting as Feeding-Related Difficulties
Authors: Spitzer Alan R. , Newbold Mary , Alicea-Alvarez Norma , Gibson Eric , Fox William W.
Published: November 2007

Sixteen infants who presented with symptoms suggestive of gastroesophageal reflux (GER)-associated apnea were evaluated at the Breathing Disorder Center of the Children's Hospital of Philadelphia. These neonates had a history of occasional emesis and an apparent life-threatening event (ALTE) that occurred while awake which was similar to the presentation of a group of infants previously described. Evaluation of the present group of infants however, revealed increased periodic breathing (12.1 ±1.8 SEM% of total sleep time) as opposed to the obstructive apnea that was typically seen with GER. Pathologic gastroesophageal reflux could not be diagnosed in relationship to apneic events. Infants who present during the first month of life with symptoms suggestive of GER-associated apnea should have careful evaluation of reflux and respiratory patterns to confirm the correct diagnosis. Because of the similarities of these infants to the GER group, we have called their disorder pseudoreflux.
Differential Diagnosis and Treatment of Conversion Disorder and Guillain-Barre Syndrome
Authors: Wherry Jeffrey N. , McMillan Susan L. , Hutchison H. Terry
Published: November 2007

Three cases are presented which illustrate the possible difficulties in differentiating between the diagnoses of Guillain-Barre Syndrome and conversion disorder. Accepted criteria are specified for each condition, as well as some associated features often characteristic of similar cases. Supportive interdisciplinary treatment for Guillain-Barre Syndrome is reviewed, and an interdisciplinary multi-modal approach to treatment of conversion disorder is described.
Ingestion of Flouride from Dentrifices by Children Aged 12 to 24 Months
Authors: Simard P.L. , Naccache H. , Lachapelle D. , Brodeur J.M.
Published: November 2007

The increase of dental fluorosis is largely imputable to the ingestion of dietary fluoride supplements and fluoride toothpastes. However, the toothbrushing habits of very young children is poorly documented. The purpose of this pilot study was to determine the toothbrushing habits of 12- to 24-month-old children and to estimate the quantity of fluoride ingested during toothbrushing. Fifty-nine parents completed a questionnaire regarding the toothcleaning habits of their children. When a dentifrice was used, a dental hygienist scheduled a meeting with the parents in order to observe and measure the amount of toothpaste used. Of the 36 parents who cleaned the teeth of their children, 69% used a toothpaste. Furthermore 20% of the children ingested more than 0.25 mg of fluoride per day by toothbrushing alone. Therefore the practice of toothbrushing and the use of fluoridated dentifrices are widespread among 12- to 24-month old children, and the amount of fluoride ingested from toothpaste could constitute a substantial proportion of the total daily intake of fluoride. Several measures are suggested to enhance the safe use of fluoride dentifrices.
Neonatal Vein of Galen Malformations: Experience in Developing a Multidisciplinary Approach Using an Embolization Treatment Protocol
Authors: Friedman Deborah M. , Madrid Mary , Berenstein Alejandro , In Sup Choi  , Wisoff Jeffrey H.
Published: November 2007

A multidisciplinary team approach using a staged transcatheter embolization and neurosurgical protocol was applied to 22 patients with neonatal presentation of vein of Galen malformations over a 12 year period. Aggressive medical therapy was combined with interventions including: ventricular shunting, transcatheter embolization, retrograde transtorcular embolization, and neurosurgical obliteration. There was a high frequency of high output cardiac failure, multiple organ system dysfunction, seizures, hydrocephalus, visual, developmental and neurological disability. Of the first 11 patients, five survived; four with seizures and three with marked retardation. Of the last 11 patients, six survived; five with seizures but only one with retardation. Despite persistently high morbidity and mortality, our continuously evolving protocol offers these otherwise hopeless patients some chance of survival.
Normal and Pathologic Laughter in Children
Authors: Nirenberg Sheryl A.
Published: November 2007

Laughter is a partly involuntary act involving complex pathways in the central nervous system. Laughter normally has positive effects on emotions; however, pathologic laughter is not related to emotion and occurs independent of a stimulus in the environment. This paper outlines normal laughter and the etiology of pathologic laughter, considering both congenital and acquired causes.
Head and Neck Manifestations of Epidermolysis Bullosa
Authors: Schaffer Scott R.
Published: November 2007

Although considerable attention has focused on the pathophysiology and external dermatologic consequences of epidermolysis bullosa (EB), head and neck mucosal manifestations pose specific management problems. The otolaryngologic aspects of EB, with emphasis on involvement and treatment of the ears, oral cavity and teeth, larynx and trachea, and pharynx and esophagus, are reviewed. Guidelines are presented for specialized dental, anesthetic, and nutritional management in patients with this potentially fatal disease.
Therapy of Renal Anemia in Children and Adolescents with Recombinant Human Erythropoietin (rHuEPO)
Authors: Campos Alfonso , Garin Eduardo H.
Published: November 2007

Eleven anemic children and adolescents with a median age of 14 years (range six months-20 years) on chronic hemodialysis were treated with recombinant human erythropoietin (rHuEPO) intravenously three times a week for an average of 9.2 months. After eight weeks of therapy, hematocrit rose from 20.3 ± 1.4% to 31.7 ± 0.7% (0.20 ± 0.01 to 0.31 ± 0.007, p <0.001, mean ± SEM). After reaching the target hematocrit of 30% to 33% (0.30 to 0.33), doses were adjusted individually. Blood transfusions were eliminated in all but one patient. All patients experienced an increase in appetite and energy level. Serum ferritin concentrations decreased in all patients who reached target hematocrit and seven required iron supplementation. Hypertension worsened in two patients and developed in two others. One patient's vascular access clotted. Dialysis efficiency and heparin requirements during dialysis did not change significantly. We conclude that rHuEPO is safe, effective, and should be recommended as treatment for anemia in children and adolescents on hemodialysis, but close monitoring for the development of hypertension and/or iron deficiency is necessary
Is AIDS Education Related to Condom Acquisition?
Authors: Rickert Vaughn I. , Gottlieb Anita A. , Jay M. Susan
Published: November 2007

The acquisition and subsequent use of condoms are two important behaviors that sexually active adolescents must adopt to reduce the transmission of human immunodeficiency virus (HIV). The aims of this study were: first, to evaluate whether combining prescriptions for free condoms with anticipatory guidance would increase the number of adolescents actually using the prescription-redemption plan; and second, to see if education about acquired immunodeficiency syndrome (AIDS) might make adolescents more willing to obtain an HIV blood test. Adolescents were randomly assigned to one of three groups, but only those who were sexually active were included in the data analyses. Each participant was given a prescription to be redeemed for free condoms at the hospital pharmacy, and each was privately offered a confidential, free HIV blood test. Education about AIDS did not increase the likelihood that adolescents would take the blood test, since only seven subjects did so. Our logistic regression model showed the most significant variables influencing a teenager to obtain condoms were gender, socioeconomic status, lifetime number of partners, and experimental condition. Anticipatory guidance concerning HIV promoted the use of the prescription-redemption plan especially among more sexually active males who come from middle-class families.
Compliance with Breast Self-Examination Instruction in High School Students
Authors: Cromer Barbara A. , Frankel Margaret E. , Hayes John , Brown Robert T.
Published: November 2007

In a prospective study, we measured compliance with breast self-examination, using an anonymous questionnaire, in suburban high school students three months (n = 85) and eight months (n = 54) after group instruction. Post-instruction proficiency in performing the procedure and personal health beliefs regarding breast cancer were also evaluated. At three months, 40% of the group reported practicing breast self-examination at some time since instruction; 12% had performed the procedure timed correctly with their menstrual cycle. At eight months, only two girls (4%) had practiced breast self-examination at least once since the three-month evaluation. Proficiency scores overall were high, with 77% scoring 12 points or above on a 15-item questionnaire; however, scores were significantly lower in the 15-year-olds than in the older adolescents. No significant relationships were found between compliance and most personal health beliefs, previous instruction, or level of knowledge of the procedure. Attention should be directed toward assessing the ability and willingness to practice preventive health behaviors before instruction programs are instituted in this age group.
A Comparison of Silver Nitrate with Erythromycin for Prophylaxis Against Ophthalmia Neonatorum
Authors: Zanoni Diana , Isenberg Sherwin J. , Apt Leonard
Published: November 2007

Although prophylactic eyedrops to treat ophthalmia neonatorum is mandated nationwide, states and hospitals are free to choose specific drugs. To compare two of these agents, we studied the incidence and characteristics of ophthalmia neonatorum in two UCLA teaching hospitals over a five-year period. One, which used 1% silver nitrate solution exclusively, had 50 cases in 34,772 births, a frequency of 0.14%. The other used 0.5% erythromycin ointment exclusively and had 43 cases in 12,652 births, a frequency of 0.34%. Ophthalmia neonatorum was more frequent in the hospital using erythromycin (p < 0.001), as was chlamydial conjunctivitis (p < 0.02). Although not statistically significant, gonococcal conjunctivitis was found in four infants, all in the hospital using silver nitrate. Because silver nitrate was found more effective in decreasing the total frequency of all cases of ophthalmia neonatorum, and cases caused by Chlamydia and gram-negative bacteria specifically, this drug still should be considered as a primary prophylactic agent against ophthalmia neonatorum.
Gonococcal Scalp Abscess: A Risk of Intrauterine Monitoring
Authors: Asnis Deborah S. , Brennessel Debra J.
Published: November 2007

Internal fetal monitoring was introduced into clinical practice in the 1960s.1 Intrauterine fetal scalp electrodes are commonly used to evaluate the condition of the fetus. Fetal scalp abscesses are a well-recognized but uncommon complication of intrauterine electrode monitoring. We report a case of neonatal gonococcal scalp abscess occurring after scalp electrode and pH monitoring were performed. The infant showed no signs of sepsis. The mother was asymptomatic and had a normal pregnancy.
Mucocutaneous Lesions in Hemolytic-Uremic Syndrome
Authors: Robson Lane M. , Leung Alexander K.C.
Published: November 2007

We read with interest the report by Ehlayel et al1 on the mucocutaneous manifestations of hemolytic-uremic syndrome. We reviewed a series of cases of this syndrome with attention to mucocutaneous lesions.
Postcircumcision Urinary Tract Infection
Authors: Cohen Herman A. , Drucker Moshe M. , Vainer Sorin , Ashkenasi Arie , Amir Jacob , Frydman Moshe , Varsano Itzhak
Published: November 2007

The possible association of urinary tract infection (UTI) with ritual circumcision on the eighth day of life was studied by analyzing the epidemiology of urinary tract infections during the first year of life in 169 children with UTI (56 males and 113 females) born in Israel from 1979 to 1984. Forty-eight percent of the episodes of UTI occurring in males appeared during the 12 days following circumcision, and the increased incidence during that period was highly significant. The median age of the males at the time of the UTI was 16 days, compared with seven months in females. Ritual Jewish circumcision as practiced in Israel may be a predisposing factor for UTI during the 12-day period following that procedure.
The Death of a Child With Diabetes from Neglect
Authors: Geffken Gary , Bennett Johnson Suzanne , Silverstein Janet , Rosenbloom Arlan
Published: November 2007

This case report of a child with insulin-dependent diabetes mellitus (IDDM) describes a naturally occurring ABABCA design. The A condition represents poor diabetes management provided in the home setting, and the B and C conditions represent improved diabetes management in residential treatment (condition B) or foster care (condition C). The A condition was consistently associated with episodes of diabetic ketoacidosis, high glycosylated hemoglobin percentage, and school failure. In contrast, the B/C conditions were consistently associated with improved health status and school performance. On two occasions, the child was returned to condition A by the state's protective service agency (HRS) in direct conflict with the recommendations of the child's psychological and medical treatment staff. During her last condition A placement, the youngster died. Chronically ill children who are neglected may not receive the protection they need because of lack of awareness about the psychosomatic aspects of their problem.
Fractures in the Under-3-Year-Old Age Cohort
Authors: Kowal-Vern Areta , Paxton Thomas P. , Ros Simon P. , Lietz Helen , Fitzgerald Mary , Gamelli Richard L.
Published: November 2007

One hundred twenty-four urban children under 3 years of age admitted for fractures were retrospectively reviewed to determine the frequency of accidental and nonaccidental causes in this population. The fractures were categorized according to their mechanisms: motor-vehicle passenger or pedestrian accident, other accidents, or child abuse. There were no differences in the frequency of fractures by race, date of birth, or season in which the injury occurred. Skull fractures were most frequent (62%), followed by femur fractures (11%). There was a 26% increase in fractures between 1987 and 1989, especially in the non-motor vehicle cohort. Caretaker ignorance and/or carelessness was a common cause of fractures in the infant and toddler age group. Injuries were still occurring in spite of infant car seat use. The American public must be educated in preventive medicine and safety to decrease the senseless morbidity of our greatest resource.
Gentian Violet Toxicity
Authors: Piatt Janice P. , Bergeson Paul S.
Published: November 2007

Currently, the use of 1 % and 2 % aqueous solutions of gentian violet (GV) is an acceptable treatment of thrush in infants. GV is generally considered efficacious; in fact, one study found GV superior to nystatin in treating thrush in infants. 1 Oral nystatin is usually prescribed as the first-line drug for this infection, while GV is commonly reserved for nystatin failures. Although GV is widely regarded as an essentially harmless medication, we present a case of GV toxicity and review the literature on this subject.
Group D Streptococcal Bacteremia In Children
Authors: Bonadio William A.
Published: November 2007

A review was conducted of 72 cases of pediatric group D streptococcal (GDS) bacteremia treated at our institution during a 12-year period. These 72 cases represented 90% of all instances in which this organism was isolated by blood culture (in eight others, GDS was considered a contaminant); the rate of isolation of this organism relative to all positive blood cultures during this time period was 1.3%. Infection was nosocomially acquired in 25 cases; 18 occurred in an intensive care unit. At the time their positive blood culture was obtained, 25 patients were afebrile and 10 patients were receiving parenteral antibiotic therapy to which the isolate exhibited in vitro susceptibility. In 31 cases, GDS was isolated by blood culture in conjunction with another organism, most frequently Staphylococcus epidermidis. Underlying medical conditions or foci of infection associated with GDS bacteremia were identified in 65 patients; the most common were the presence of an indwelling central venous catheter (23), a variety of lesions of the gastrointestinal tract (21), and pulmonary infiltrate (15). Bacteremia was associated with GDS meningitis in three patients who had had no prior neurosurgical procedure. The overall mortality rate was 20%; nearly two thirds of all deaths occurred in patients younger than 1 year of age.
Propylthiouracil Hepatotoxicity
Authors: Levy Maurice
Published: November 2007

Propylthiouracil (PTU) is widely used to treat patients with hyperthyroidism. In rare cases, this drug has been found to have severe toxic effects on the liver. The case of a 14-year-old girl treated with PTU for hyperthyroidism who developed jaundice, severe hepatocellular dysfunction, and hepatomegaly is reported. Her condition gradually deteriorated, and she developed paranoid ideation, profound lethargy, and peripheral edema. After three weeks of prednisone therapy, clinical and laboratory signs of improvement were observed. This patient was one of only five pediatric cases among the 16 reported cases of PTU liver toxicity reported to date. Her history and the fatal outcome in some reported cases demonstrate the high degree of sensitivity required to recognize this potential complication in patients treated with PTU, particularly since its immediate discontinuance and steroid-therapy intervention may lead to recovery.
Family Experiences, Attitudes, and Household Safety Practices Regarding Firearms
Authors: Wiley Catherine C. , Casey Rosemary
Published: November 2007

To assess families' experiences with shootings and firearm ownership and attitudes, 208 children aged 5 to 12 years were interviewed and 242 parents filled out a questionnaire, all at an urban hospital. Forty-three percent of the parents and 25% of the children had personal knowledge of shootings. Of the parents, 10% owned guns, of which only 21 % were stored safely. Gun ownership was more common in homes with resident adult males (14%) than in those with no adult males (3%). Most children (81%) played with guns, and 20% to 25% preferred violent TV shows, games, and toys. Parents' and children's attitudes toward firearms and children's gun play did not differ by level of mother's education; method of payment for, or site of, health care; income; or exposure to shootings. Children with personal knowledge of shootings more often expressed fears of being shot than did other children (52% vs 31%). The children in our study population were similar in their gun play and attitudes about gun use despite disparate socioeconomic backgrounds and exposure to shootings.
What Is Fever?
Authors: Herzog Lynn W. , Coyne Lauren J.
Published: November 2007

To determine the normal temperature of healthy infants, we studied 691 infants less than 3 months of age being seen for regularly scheduled well-baby visits. All temperatures were taken rectally with an electronic thermometer. The mean temperature was 37.5°C ± 0.3°C. Using a cutoff of 2 standard deviations (SD) above the mean, fever would be defined as a temperature ≥ 38.1°C. The 95th percentile was 38.0°C, and ≥38.1°C would correspond to values above the 95th percentile. The most widely used definition of fever at present is a temperature ≥38.0°C; by this definition, 6.5% of these well infants would be considered to have a fever. A significant rise in temperature with age was noted. For infants from birth to 30 days old, 2 SD above the mean was 38.0°C; for those 31 to 60 days old, it was 38.1°C; and for those 61 to 91 days old, it was 38.2°C. Similarly, the 95th percentile was 37.9°C, 38.0°C, and 38.1°C, respectively. Temperature also varied significantly with the season of the year, being higher in the summer (2 SD above a mean = 38.3°C) than in the winter (2 SD above a mean = 38.0°C). Fever should be defined as a temperature ≥38.0°C in infants less than 30 days of age, ≥38.1°C in 1-month-olds, and ≥38.2°C in 2-month-olds.
Third-Degree Burn Following Use of Microwave-Heated Cryogel Pack
Authors: Davé Amar L.
Published: November 2007

It is common nursing practice to apply warm soaks to an area where extravasation of intravenous (IV) fluid has occurred.1 Here we report an adverse outcome due to the use of a microwave-heated, commercially available hot-cold cryogel pack to treat an extravasation of IV fluid in a patient.
The Usefulness of the Developmental Profile-II in Developmental Screening
Authors: Page Glascoe Frances , Byrne Karen E.
Published: November 2007

Timely provision of early developmental intervention depends on accurate developmental screening tests. The Developmental Profile-II (DP-II) relies on parent report to assess children from birth to 7 years old. One of its subtests, the Academic scale, is designed for developmental screening. To test its accuracy in detecting children with problems, the scale was administered to parents of 94 children between 6 and 75 months old. Each child was also given a battery of tests, such as the Bayley Scales of Infant Development and the Stanford-Binet Intelligence Scale. The Academic scale detected only 21 % of the 19 children thus determined as having developmental problems, while 85% of the nondiagnosed children received normal or advanced scores on DP-II. Analysis revealed that DP-II scoring criteria are far too lenient and that many items are poorly placed in relation to age expectations. Alternative cutoff scores greatly improved sensitivity. DP-II is a potentially accurate measure that needs updating and restandardizing. Alternative tests include the Minnesota Child Development Inventory and the Battelle Developmental Inventory Screening Test.
Pancreatic and Islet Replacement Therapy For Insulin-Dependent Diabetes Mellitus
Authors: Brouhard Ben H. , Rogers Douglas G.
Published: November 2007

The only known cure for insulin-dependent diabetes mellitus is transplantation of functioning islet cells, either alone or via transplantation of the entire pancreas in sufficient mass to restore normal carbohydrate metabolism. Such therapy may also ameliorate or eliminate certain long-term consequences of diabetes. More than 3,000 patients have received pancreas transplants at 150 centers worldwide since 1966. Urinary drainage of pancreatic exocrine secretions has dramatically improved long-term survival, especially when a kidney was transplanted at the same time. Metabolic control then resumes normal function for up to six years, in some cases preventing or reversing long-term complications of diabetes. While nephropathy and neuropathy can be prevented and even somewhat reversed, retinopathy and neuropathy resist improvement. The large number of islets that must be harvested makes islet cell transplantation difficult to achieve, although the process has been accomplished in humans with limited success.
Thoracic Organ Transplantation in Children
Authors: Moodie Douglas S. , Stillwell Paul C.
Published: November 2007

Heart, heart-lung, and lung transplantation have become accepted modalities for treatment in children with serious cardiopulmonary disease. Although early deaths secondary to infection and/or acute rejection have been reduced dramatically, there is still an early mortality related to cardiac complications and a late mortality related to rejection and infection. The management of hypoplastic left heart syndrome remains a special problem and is outlined in the review. There is much less experience in the newer modalities of heart-lung and lung transplantation in children and the results of these operative procedures are similar to what was seen in heart transplantation some 10 years ago. Ongoing and significant improvement continues, however, in all forms of transplantation dealing with the lung.
Efficacy of a Protocol to Distinguish Risk of Serious Bacterial Infection in the Outpatient Evaluation of Febrile Young Infants
Authors: Bonadio William A. , Hagen Elizabeth , Rucka Jennifer , shallow Kathleen , Stommel Peggy , Smith Douglas
Published: November 2007

A study of 534 febrile infants ages 4 to 8 weeks evaluated for sepsis assessed the efficacy of the Milwaukee Protocol (MP) for selecting patients at low risk for serious bacterial infection (SBI) who might benefit from outpatient management. Two groups were compared: 1) Infants with uncompromised presentation (UP) who met all MP criteria received ceftriaxone 50 mg/kg and were discharged, then reevaluated within 24 hours. 2) Infants with compromised presentation (CP) who did not meet MP criteria were hospitalized for antibiotic therapy pending culture results. Of 391 CP patients, 23 (5.9%) had SBI; of 143 UP patients, 1 (0.7%) had SBI (P <.02). The MP criteria had a sensitivity of 96% and a 99% negative predictive value for distinguishing SBI outcome. The only UP patient with SBI was afebrile and had a negative repeat blood culture after 24 hours, and recovered with no complications. Managing UP infants as outpatients avoided 48 to 72 hours of hospitalization, decreasing health-care costs by an estimated total of $465,170.
Estimating the Predictive Value Of a Diagnostic Test
Authors: O'Marcaigh Aengus S. , Jacobson Robert M.
Published: November 2007

The diagnostic process consists of a series of steps in which the estimated probability of particular disease is increased or decreased until either treatment can be instituted or the diagnosis excluded. The history and physical exam play an important role. If a therapeutic decision cannot confidently be made on clinical grounds alone, a diagnostic test may confirm or exclude a diagnosis or clearly indicate the need for further testing. An inappropriately chosen test or misinterpreted test result, however, may mislead the clinician and possibly harm the patient or simply be wasteful. Estimating the predictive values of a diagnostic test will help to avoid these pitfalls. This article shows the clinician a simplified way to do this.
Is Treatment of Acute Otitis Media With Once-a-Day Amoxicillin Feasible?
Authors: Murph Jody R. , Dusdieker Lois B. , Booth Brenda , Murph William E.
Published: November 2007

We report a study of the feasibility of once-a-day amoxicillin to treat acute otitis media (AOM). Seventy-seven children between ages 7 months and 12 years with AOM participated in a double-blind, placebo-controlled trial. Subjects received amoxicillin 40 mg/kg/day for 10 days. They were similar in age, sex, history of ear infections, and presenting symptoms. Group I received one total dose of amoxicillin and two doses of placebo daily. Group II received three divided doses of amoxicillin daily. Parents kept a daily diary of symptoms related to the child's illness and possible medication side effects. Ten children were lost to follow-up. In the remaining 67, pneumatic otoscopy and tympanometry after 10 to 14 days revealed that AOM had resolved in 82% of group I and 68% of group II. Groups showed no significant differences in persistence of middle ear effusion; 39% in group I and 24% in group II still had fluid. Diaries showed no significant differences between groups in medication side effects. Thus, reduced-frequency dosing for AOM seems feasible and more realistic than current regimens.
Anticipatory Guidance for the Adolescent
Authors: Cavanaugh Robert M. , Hastings-Tolsma Marie , Keenan Deirdre , Buser Bess , Henneberger Paul K.
Published: November 2007

Parents' opinions regarding anticipatory guidance for adolescents have not been adequately investigated. In this study, 932 parents of adolescents completed a computerized questionnaire listing 30 common psychosocial-medical concerns of adolescence. Respondents were asked how important it is for private pediatricians to discuss these topics with their teenagers during regular checkups. Ten items were rated important by ≥ 90% of parents, 22 items by ≥ 80%, and 29 items by ≥ 66%. Heeding parents' expectations and concerns, pediatricians should incorporate discussions of psychosocial-medical issues as a meaningful component of routine adolescent health care.
Pilomatrixoma: Patient Report of a Common Childhood Tumor
Authors: Toppare Mete F. , Kitapci Fusun , Senses Dursun A. , Safa Kaya I. , Dilmen Ugur , Gedikoglu Gökhan
Published: November 2007

Pilomatrixomas are common skin appendage tumors of hair matrix cell origin that usually present as a slowly growing dermal or subcutaneous mass.1 The lesion is well known to dermatologists and pathologists but has received infrequent attention in the pediatric lit erature in spite of the fact that it has a distinct age distribution, occurring most commonly in children and adolescents.2 This report presents a case in which the preliminary clinical diagnosis was atypical mycobacterial cervical adenitis, with review of the literature to demonstrate the diagnostic dilemma that can occur.
Severe Hemolytic Anemia Associated With Vitamin E Deficiency in Infants With Cystic Fibrosis
Authors: Wilfond Benjamin S. , Farrell Philip M. , Laxova Anita , Mischler Elaine
Published: November 2007

Three infants are described with cystic fibrosis (CF) and malnutrition leading to severe anemia beginning as early as 6 weeks of age. Laboratory studies demonstrated high reticulocyte counts, negative Coombs' tests, abnormal peroxide hemolysis test results, and biochemical evidence of vitamin E deficiency. Oral administration of α-tocopherol resulted in rapid correction of the in vitro hemolysis and improvement of in vivo hematologic indices. Investigation of these patients supports the conclusion that the hemolytic anemia of infancy in CF is caused by vitamin E deficiency and should be treated promptly with 50 IU/day of vitamin E. Because two of the three patients were identified in a CF screening/surveillance program, we can estimate that the frequency of clinically significant anemia in CF infants is 4%. Our observations demonstrate a potential advantage of CF neonatal screening for individual patients susceptible to vitamin E-deficient hemolytic anemia and suggest that confirmatory follow-up diagnostic studies, such as sweat tests, should be performed by 4 to 6 weeks of age.
Pneumocephalus and Exophthalmos Secondary To Acute Sinusitis and Nasopharyngeal Oxygen Catheter
Authors: Scarpellini Campos Joao Maurício , Boechat Márcia Cristina Oliveira , Azevedo Zina Maria , Garrido José Roberto , Rodrigues Susana Lopes , Pone Marcos Vinicius
Published: November 2007

Pneumocephalus is a well-known complication of skull trauma, certain neurosurgical procedures, and sinus neoplasms.1,2 The association between pneumocephalus and infection is very rare, usually occurring in patients with mastoiditis, chronic otitis media, and sinusitis.1,3 In a recent report, pneumocephalus and exophthalmos developed secondary to administration of oxygen by a nasopharyngeal catheter in a patient without sinusitis.4 We describe an infant admitted for treatment of bacterial pneumonia and maxillary and ethmoid sinusitis, in whom pneumocephalus and right-sided severe exophthlalmos developed while the patient was receiving oxygen by a nasopharyngeal catheter.
Blue Water
Authors: Duldner John E. , Davis James B. , Borchers Deborah
Published: November 2007

We present evidence supporting the negative effect of television on a child and discuss its implications and intervention.
First Febrile Seizures
Authors: Farwell Jacqueline R. , Blackner Gregary , Sulzbacher Stephen , Adelman Lee , Voeller Mary
Published: November 2007

Through interviews with parents, data were gathered about 910 first febrile seizures in children aged 8 to 34 months. A male preponderance of 57% was found ( P <.001). In 29% of cases, there was a family history of febrile seizures. Eighteen percent of seizures were focal, and 7% lasted 15 minutes or more. Focal seizures were much more likely to be of long duration ( P <.001). Otitis media was diagnosed in 32% of cases, and tonsillitis or upper respiratory infection in 12%. When compared to febrile seizures after the first birthday, febrile seizures in children aged 8 to 11 months were more than twice as likely to be longer than 15 minutes (P= .015). They were also much more likely to be followed by further seizures in the same illness ( P <.001). Thus, febrile seizures in children younger than 1 year are more likely to have the characteristics known to increase the risk of later nonfebrile seizures.
Screening for Maternal Experiences of Physical Abuse During Childhood
Authors: Kemper Kathi J. , Carlin Albert S. , Buntain-Ricklefs Joanne
Published: November 2007

Because a parental history of abuse during childhood is a documented risk factor for child abuse, pediatricians have been urged to assess parents' childhood discipline experiences. A brief set of questions was developed to detect a maternal history of childhood physical abuse that could be incorporated into a comprehensive psychosocial screening questionnaire. A criterion-based definition was used as the measure for physical abuse. In phase I, four screening questions were developed in a cross-sectional survey of 284 middle-class women attending a family medicine clinic, of whom 32% met the criteria definition for physical abuse. In phase II, the screening questions were tested in 428 mothers seen in Salt Lake City- and Seattle-area pediatric clinics. The four screening questions had a sensitivity of > 90%, a specificity of > 85%, a positive predictive value of >75%, and a negative predictive value of ≥ 90% — as compared with the criteria-based definition in both pediatric settings. These four screening questions compared favorably to a criteria-based definition of physical abuse during childhood and may be useful additions to psychosocial questionnaires.
Tuberculous Arthritis in Children
Authors: Jacobs Jerry C. , Li Suzanne C. , Ruzal-Shapiro Carrie , Kiernan Howard , Parisien May , Shapiro Alan
Published: November 2007

In two children ages 8 months and 4 years, tuberculous synovitis of the knee was suggested by pathologic examination of synovial tissue obtained through needle biopsy. Culture of the biopsy material was positive for Mycobacterium tuberculosis in one case. In this child, the tuberculin test was negative, in the absence of anergy, at the time the child was first evaluated, and the primary lung lesion was not identified by the radiologist.Tuberculous synovitis has not previously been recognized as part of primary tuberculosis during the early weeks when the tuberculin skin test may be negative. Magnetic resonance imaging (MRI) is a sensitive modality for demonstrating joint fluid, synovial hypertrophy, and associated osteomyelitis, if present. With the increasing frequency of cases of tuberculosis in the population, greater awareness of the risk of tuberculous arthritis in childhood is important in order to recognize this unusual presentation. If negative early on, the tuberculin skin test should be repeated after 6 weeks of arthritis. A needle biopsy of the synovium is helpful and appropriate in all children with monoarticular arthritis who have a positive tuberculin skin test.
A Tribute to Arnold J. Capute, M.D., M.P.H
Authors: Accardo Pasquale
Published: November 2007

"When Arnold Capute goes through the spastic motions of a child with cerebral palsy (CP), an initial impression is that he is dramatizing his comments with rather callous mimicry. But no, he is not imitating a CP child. For the moment, as his head snaps backward and his arms flex uncontrollably, he is a CP child, just as later in discussing the primitive reflexes of infants (of which the fencing position is most common), he momentarily becomes a newborn infant. Dr. Capute is a man of unabashed empathy and enthusiasm and he is wholly convinced that medical therapy can do much more than previously to overcome developmental disabilities in children. So keen and articulate is Dr. Capute in elaborating on his subject matter that the Hopkins pediatric house staff chose him to receive the Alexander Schaffer Award this past June for excellence in clinical teaching. "