bluuebunny/crossref_metadata_2025 huggingface dataset:
Blood Pressure Standards for Normal Children
Authors: Londe Sol
Published: November 2007

Standards for auscultatory blood pressure determinations under office conditions in 120 three-year olds are given here, to supple ment standards published previously for children aged four through 15.

Discussed also are suggested thresholds for diagnosing hypertension; improved methods of obtaining reliable pressure readings in three-year olds; and some relationships of blood pressure to weight and height.
Velopharyngeal Incompetence
Authors: Stool Sylvan E. , Graham William , Randall Peter
Published: November 2007

Velopharyngeal incompetence (failure of the soft palate to affect closure of the nasopharynx) may result in hypernasal or unintelligible speech, chronic otitis media with secondary conductive hearing loss, or even pseudomental retardation. Such devastating consequences make early diagnosis mandatory.

Here is an excellent ca se illustration, review of the literature, and a diagnostic checklist for office use.
Management of the Newborn with Imperforate Anus
Authors: Touloukian Robert J. , Pickett Lawrence K.
Published: November 2007

The results of surgical care of 62 newborn infants with imperforate anus are summarized here in a 20-year retrospective study. Ninety per cent had anomalies in either formation of the urorectal septum or failure of posterior, "migration" of the rectum. The over-all mortality rate was 30 per cent, but most of the deaths were in untreated newborns having other severe congenital anomalies. Emphasis in diagnosis is placed on correlating physical findings with some abnormality during a specific phase of embryologic development. The value of upside-down lateral films of the pelvis in determining the initial treatment is de-emphasized. Roentgenograms of the chest, abdomen and lumbosacral spine, and intravenous pyelogram and cystogram, are important to detect the associated, anormalies.

The over-all results of perineal anoplasty for a low perineal fistula or obvious perineal bulging are good, which indicates that this is the procedure of choice with such newborns. A combined abdominoperineal pull-through operation following a preliminary colortomy is recommended for infants with high imperforate anus. Eventual function may be satisfactory if there is close supervision of the postoperative patient throghout infancy and childhood to prevent chronic fecal impactions and secondary megacolon.
Office Aid to Diagnosis of Severe Hearing Impairment
Authors: Jones Mary Carolyn
Published: November 2007

Young children with markedly defective hearing cry as much as children with normal hearing, but in their mothers' opinions seem to be less vocal with pleasure sounds than their mothers expect.
Children and Television
Authors: Faigel Harris C.
Published: November 2007

"Children's television concerns and affects all of us. Our chil dren watch it. Our children are watching us and the way we meet our responsibility in helping them grow up. If television can help us and help our children, it will truly fulfill its promise.''
Osteomyelitis of the Patella
Authors: Wadlington William B. , Hatcher Harold , Turner Dorothy J.
Published: November 2007

Osteomyelitis of the patella should be among the differential diag noses when a child presents with an acute or subacute cellulitis of the anterior knee or with a persistent effusion of the knee. This is the first case report of a child with acute osteomyelitis of the patella due to Pseudomonas aeruginosa. One adult and two children are known to have had generalized convulsions during or following intra venous gentamicin therapy for a Pseudomonas aeruginosa infection.
Sickle Cell Anemia in the Home Environment
Authors: Diggs L.W. , Flowers Ernestine
Published: November 2007

Because the natural history of sickle cell disease and of its variant forms has not been fully studied, because the disease is associated with ma jor socioeconomic problems and with poverty, and because sickle cell anemia and related hemoglobinopathies are frequent, reports of ob servations made in the home environment seem justified and necessary.
Hemothorax in a Child
Authors: Fleisher Gary R. , Fichman Kaye R. , Honig Paul J.
Published: November 2007

The pediatrician should search carefully in a child with chest pain for evi dence in the history or physical examination of an organic cause. Hemothorax is one of the pathologic processes that can present with this symptom. The dif ferential diagnosis of hemothorax in children is reviewed.
Hereditary Elliptocytosis
Authors: Pui Ching-Hon , Wang Winfred , Wilimas Judith
Published: November 2007

A 10-year-old black girl with hereditary elliptocytosis had a transient in crease in hemolysis and unusual red cell morphologic changes during an episode of acute hepatitis. Changes in membrane lipids of these elliptocytes with defective membrane skeletal protein and abnormal distribution of choles terol may be responsible for this phenomenon.
Adolescent Self-assessment of Sexual Maturation
Authors: Neinstein Lawrence S.
Published: November 2007

Pubertal changes correlate better with sexual maturity ratings than with chronological age. The applicability of sexual maturity ratings to research is impeded by the necessity to disrobe the adolescent. This study demonstrates that a mixed ethnic urban group of adolescent females can self-assess their own developmental stages by using standard photographs of sexual maturity stages. However, males do less well in self-assessment. Self-ratings by 22 female adolescents and 22 male adolescents aged 11 to 18 were compared to physicians' assessment. There was total agreement in 17/22 (r = 0.87) breast stage assessments, 16/22 (r = 0.86) female pubic hair assessments, 10/22 (r = 0.72) male genital assessments and 11/22 (r = 0.69) male pubic hair assessments. The mean differences in sexual maturity ratings between physician and adolescent were 0.32 for female pubic hair assessments, 0.64 for male pubic hair assessments, 0.68 for male genital assessments and 0.28 for breast assessments. This study suggests the feasibility of self-assessment of sexual maturity ratings among black, white, and Hispanic adolescent females, but the need for further research before it is used among adolescent males.
Bone and Joint Complications of Hemophilus influenzae Meningitis
Authors: DiLiberti John H. , Tarlow Stefan
Published: November 2007

Seven patients with a bone or joint complications were identified among 202 cases treated for Hemophilus influenzae meningitis between 1970 and 1980. All patients studied met the min imal diagnostic criteria of pleocytosis of the cerebrospinal fluid (CSF) and CSF culture positive for H. influenzae. The diagnosis of bone or joint complication was based on objective findings of physical examination: swelling, erythema and decreased range of motion, and either an increased number of granulocytes in aspirated joint fluid or radiographic and/or radionuclide scan evidence of bone or joint disease. The only significant difference between the control patients and those with bone or joint complications was duration of fever; in the control group 29 per cent of patients were febrile seven or more days, compared with 100 per cent of com plication group. Since a number of those patients who remain febrile beyond the sixth hospital day had presumptive evidence or bone or joint infection, we suggest a bone scan be considered for these patients.
Congenital Pulmonary Lymphangiectasis
Authors: Gardner Thomas W. , Domm Albert C. , Brock Carol E. , Pruitt Albert W.
Published: November 2007

A case is reported of an infant with features of Noonan Syndrome and con genital pulmonary lymphangiectasis. Soon after birth, persistent respiratory dis tress developed, and, at 4 months of age, a chylothorax was noted. Medium chain triglyceride therapy by the enteral route was tried, but parenteral alimentation and chest-tube drainage were required. Diagnosis of pulmonary lymphangiectasis was confirmed by biopsy.
Children's Assent for Participation in Pediatric Research Protocols
Authors: Kapp Marshall B.
Published: November 2007

A survey instrument was used to gather and evaluate data from medical schools and children's hospitals concerning prevailing national practice on the issue of whether pediatric researchers should be required to obtain informed assent from a minor subject, in addition to parental consent, as a precondition to the participation of the minor in the research protocol. Implications are drawn from the survey results.
Neonatal Hepatic Malignant Tumor
Authors: Lecklitner Myron L. , Potter Janet L.
Published: November 2007

We report the hepatobiliary study of a neonate with hepatomegaly. Biliary atresia was ruled out. Fortuitous demonstration of massive parenchymal lesions redirected the clinical management of the child. Other imaging modalities were employed to define further the nature of the lesions. Pediatric reports of non- biliary lesions demonstrated by hepatobiliary scintigraphy are uncommon. To our knowledge, the present case of multiple hepatoblastomas discovered by he patobiliary imaging is the first report in the literature.
Relapsing Neisseria meningitidis Infection Associated with C8 Deficiency
Authors: Liston Thomas E.
Published: November 2007

Infection due to serogroup Y of Neisseria meningitidis has many clinical manifestations, ranging from mild bacteremia to fatal sepsis and meningitis. N. meningitidis infection may coincide with several complement deficiencies. A child is described who suffered from recurrent disease due to N. meningitidis, group Y, attributed to deficiency of the eighth component of complement (C8). In a review of the literature, recurrent infection occurred in six of 13 children with complement deficiency, four of whom had serotyping positive for N. meningitidis, group Y. Screening for complement deficiency is recommended for all children with meningococcal disease due to N. meningitidis, group Y, and for any child with recurrent infection due to any Neisseria species.
Malignant Lymphoma Presenting with Nonoliguric Renal Failure
Authors: Laxer R.M. , de Chadarevian J-P. , Anderson R.J. , Kaplan B.S.
Published: November 2007

Nonoliguric renal failure was observed as a presenting complaint in a 14-year- old boy with a malignant lymphoma. The diagnosis was made by a renal biopsy, and the renal failure was treated successfully with peritoneal dialysis while the lymphoma was being treated with radiotherapy.
The Effect of Neonatal Hyperbilirubinemia on the Measurement of Plasma Creatinine
Authors: Feld Leonard G. , Langford Daniel J. , Schwartz George J.
Published: November 2007

Bilirubin interferes with the measurement of plasma creatinine by the kinetic colorimetric Jaffe reaction, the method currently used by many hospital laboratories. The purpose of the present study was to evaluate the influence of unconjugated bilirubin on the measurement of plasma creatinine by the AutoAnalyzer Jaffe end point method. This colorimetric method is slower but more precise and accurate in the range of 0.25 to 0.5 mg/dl. We found that bilirubin from jaundiced neonates and from stock solutions did not affect the determination of creatinine chro mogen in plasma or in saline, even at concentrations as high as 25 mg/dl. We conclude that the use of the Jaffe end point AutoAnalyzer method with a blank run before each sample will provide an accurate measurement of creatinine in the plasma of the neonate with unconjugated hyper bilirubinemia.
Theoretical Growth Evaluation (TGE)
Authors: Zachmann Milo , Nessi Pierre
Published: November 2007

A computerized screening system for growth disorders is presented. Its aim is to save time and to facilitate the decision of whether a patient with a suspected growth problem should be referred for specialized evaluation. It uses accepted methods and common sense, and has been shown to be effective. A radiography of the hand and wrist, and a completed data sheet (birth date, date of x-ray, height and weight, parental height, and in girls, whether menarche has occurred) are mailed for analysis. Bone age is rated according to Greulich and Pyle, and Tanner et al. by trained technicians, and the results are supervised by a consultant pediatric endocrinol ogist. The supplied data and bone age values are then processed by a computer, which compares them with normal values, calculates three different height predictions (Bayley and Pinneau, Roche et al., Tanner et al.), as well as "target height" (estimation of genetic potential), and prints an easy-to-read growth curve. Depending on the constellations of height (normal, below 3rd, above 97th percentile), bone age (normal, retarded, advanced in comparison with chronologic age), and height predictions vs. target height (predictions within, below, above target height range), different messages suggesting the most likely diagnostic possibilities are listed on a computer printout.
Computerized Tomography and Ultrasonographic Findings in Massive Thymic Hyperplasia
Authors: Parker L.A. , Gaisie G. , Scatliff J.H.
Published: November 2007

Massive thymic hyperplasia in the neonate and young infant can be difficult to diagnose. Differentiation from neoplastic lesions may require thoracotomy for a pathologic specimen. We review a case in a 15-month-old child referred to our institution and discuss the radiographic, ultrasound, and computerized tomographic features of hyperplastic thymic tissue. We review current concepts of the hyperplastic thymus as an anterior mediastinal mass in infancy.
Deciduous Tooth Eruption in Israeli Children
Authors: Shuper Avinoam , Sarnat Haim , Mimouni Francis , Mimouni Marc , Varsano Izhak
Published: November 2007

Deciduous tooth eruption (DTE) was studied in 366 Jewish Israeli children: 193 boys and 173 girls. The number of erupted teeth (NET) at different ages was similar in both sexes. No statistically significant correlation was found between NET and anthropometric measurements at birth (weight and length) or subsequently, after eliminating the influence of age, between NET and weight, height, and head circumference. The high normal variability in NET at a given age is demonstrated.
Weight Loss and Body Temperature Changes in Breast-fed and Bottle-fed Neonates
Authors: Podratz, Rosalyn O. , Broughton Daniel D. , Gustafson David H. , Bergstralh Erik J. , Melton L. Joseph
Published: November 2007

Among 1138 newborns in a Level II nursery, breast-fed and formula-fed infants were comparable in terms of sex, mode of delivery, gestational age, birth weight, and birth temperature. Breast-fed neonates subsequently lost more weight and a greater percentage of their birth weight (mean, 7.4% vs. 4.9%) than did formula-fed infants. Loss of more than 10 percent of birth weight was associated with short gestation and low birth weight and with breast feeding. Birth weight loss of ≥3 percent was associated with a risk of fever (≥37.5°C) among breast-fed and formula-fed infants, but there was no gradient of increasing risk of fever with increasing percentage weight loss beyond 3 percent. After weight loss and other significant variables were adjusted for in a multivariate analysis, breast feeding was not independently predictive of fever. Although breast feeding may be associated with weight loss, it is not prudent to assume that this is the cause of fever in a breast-fed neonate.
Hemorrhage Involving the Upper Airway in Hemophilia
Authors: Bray Gordon , Nugent Diane
Published: November 2007

Bleeding involving the upper airway is a rare, highly emergent complication of hemophilia. This report describes the occurrence of two distinct episodes in a patient with severe factor IX deficiency. Clinical data from other cases described in the literature is summarized with regard to predisposing factors, age of incidence, presenting symptomatology, diagnosis, and management. Pertinent features of this bleeding complication include: high prevalence involving the pediatric population, presentation with non-specific symptoms (e.g., sore throat, dysphagia) early in the course of the bleeding episode, progression to complete upper respiratory obstruction if not recognized and treated, and the need for relatively high levels of the deficient coagulation factor for a period of at least 7 days to ensure resolution of the hematoma. The diagnosis is confirmed by observing retropharyngeal soft-tissue widening on lateral neck x-ray or alternatively, via cervical computed tomography.
Laypeople's Attitudes Toward Drug Treatment for Behavioral Control Depend on Which Disorder and Which Drug
Authors: Summers Jane A. , Caplan Paula J.
Published: November 2007

One hundred four laypeople were asked to rate two vignettes describing the use of psychotropic medication to treat behavior problems in school-aged boys. These problems were described as a result of either an attention deficit disorder (ADD) with hyperactivity or a seizure disorder. Respondents considered the parents of the ADD child less justified in placing and continuing their child on medication than the parents of the epileptic child. They also thought that drug use would exacerbate the behavior problem more for the ADD child than for the epileptic child. It is suggested that by being aware of and acknowledging the existence of these attitudes, clinicians can better deal with concerns that parents may have regarding drug treatment for their children, possibly increasing the chances for a successful outcome.
Apparent Inconsistent Theophylline Absorption From Sustained Release Capsules
Authors: Uden Donald L. , Schaber Daniel E. , Wyatt Richard A.
Published: November 2007

Sustained release theophylline products can improve compliance and symptom control in children with asthma. This study examines theophylline serum concentration monitoring in pediatric patients. Fifteen children with documented asthma were randomized to receive either Slo-bid Gyrocaps® or Theo-dur Sprinkle® for 1 month, and then crossed over to the other product. On the last day of each study period, theophylline serum concentrations were obtained prior to the morning dose and 4 hours later. In two patients receiving Theo-dur Sprinkle® and six with Slo-bid Gyrocaps®, the 4-hour serum concentration was lower than the pre-dose concentration. The change between the pre-dose and post-dose serum concentrations for Theo-dur Sprinkle® ranged from a decrease of 2.8 mg/L to an increase of 4.9 mg/L, and, for Slo-bid Gyrocaps®, from a decrease of 4.6 mg/L to an increase of 10.5 mg/L. The inconsistent theophylline absorption with each product makes dosage adjustment difficult.
Malassezia furfur Fungemia in Infancy
Authors: Alpert Gershon , Bell Louis M. , Campos Joseph M.
Published: November 2007

Malassezia furfur was recovered from blood cultures obtained through an indwelling line in seven severely ill infants hospitalized in a neonatal intensive care unit. While two of the patients were asymptomatic, the other patients had signs and symptoms compatible with sepsis. One patient had evidence of endocarditis.
Dermatology Training During the Pediatric Residency
Authors: Prose Neil S.
Published: November 2007

The diagnosis and treatment of disorders of the skin and subcutaneous tissue represents a significant aspect of general pediatric practice. A study was carried out to assess the status of training in dermatology among residents in pediatrics. Sixty five pediatric residents in seven different training programs were asked to identify color transparencies of 20 common dermatoses. Their mean score of 53.2 percent was considerably lower than that of an equivalent group of residents in dermatology (86.4%). A survey of pediatric residencies throughout the United States indicated that 67 percent of those responding offer an elective in pediatric dermatology.
Efficacy and Safety of Two Oral Solutions as Maintenance Therapy for Acute Diarrhea
Authors: Leung Alexander K.C. , Taylor Paul G. , Geoffroy Louis , Darling Pauline
Published: November 2007

There is continuing uncertainty about the appropriate level of sodium in oral fluid therapy for children with acute gastroenteritis in developed countries. The present study was undertaken in order to assess whether an oral glucose/electrolyte solution designed for fluid replacement (Na+ concentration 75 mmol/l) and an oral glucose/electrolyte solution designed for maintenance of hydration (Na + concentration 45 mmol/1) would be safe and effective in the treatment of acute childhood diarrhea in a developed country. Children aged 3-24 months (n = 54) with acute diarrhea and less than 5 percent dehydration were randomized to receive either maintenance (n . = 27) or rehydration (n = 27) fluid. Outcome was assessed at 24 and 48 hours after entry to the study. Both solutions were found to be equally effective and safe. The fluid was refused by one child in each group. Analysis of efficacy showed that hydration status was maintained in all patients and 98 percent of children showed significant improvement in diarrheal status at 24 hours. We conclude that for well-nourished ambulatory children aged 3-24 months with acute diarrhea and minimal (<5%) or no dehydration, the use of an oral fluid containing 75 mmol/l of sodium is as safe and effective as the use of an oral fluid containing 45 mmol/1 of sodium.
Familial Achalasia, Microcephaly, and Mental Retardation
Authors: Khalifa M.M.
Published: November 2007

Two Libyan brothers with achalasia of the cardia, microcephaly, and mental retardation are described. The parents were first cousins and were normal, as were two other male siblings and the female twin of one of the affected brothers. This is the second family to be reported with this constellation of abnormalities. The literature is reviewed for achalasia associated with other pathological conditions.
Home Oxygen Therapy
Authors: Sauve R.S. , McMillan D.D. , Mitchell I. , Creighton D. , Hindle N.W. , Young L.
Published: November 2007

Forty-four oxygen-dependent infants were discharged home in oxygen from an NICU during an 8-year period. Survivors were followed for 3 years. The infants' discharge diagnoses were bronchopulmonary dysplasia (BPD) (39), sleep apnea (2), and congenital cardiac defects (3). The five infants who had diagnoses other than BPD all died, but 34 of 39 infants with BPD survived. Supplemental oxygen was discontinued at a mean age of 13.4 months.

The infants with BPD experienced health, growth, nutritional, neurodevelopmental and sensory problems that necessitated frequent rehospitalizations and utilization of a variety of medical and support services.
Kenny-Caffey Syndrome
Authors: Abdel-Al Yaser K. , Auger Louise T. , El-Gharbawy Fatma
Published: November 2007

Kenny-Caffey Syndrome is a rare syndrome characterized by growth retardation, uniformly small slender long bones with medullary stenosis, thickened cortex of the long bones, hypocalcemia possibly with tetany at an early age, hyperphosphatemia, ocular abnormalities, and normal intelligence. We report a child with Kenny-Caffey Syndrome and idiopathic hypoparathyroidism and present a review of the literature summarizing the reported cases of this rare syndrome.
Therapy of Acute Bronchospasm
Authors: Assadi Farahnak K.
Published: November 2007

Hypokalemia and lactic acidosis developed following correction of respiratory acidosis in a 5-year-old child who presented with respiratory failure secondary to severe asthma and treated with theophylline, inhaled albuterol, and parenteral methylprednisolone. Calculation of the "anion gap" that provided the clue to presence of lactic acidosis was confirmed by the measurement of serum lactate level.
Inborn Errors of Metabolism
Authors: Giugliani Roberto , Dutra-Filho Carlos S. , Barth Maria L. , Dutra Janice C. , Wajner Moacir , Wannmacher Clovis M. D. , Montagner Lenir T.
Published: November 2007

We estimated the sensitivity of a screening procedure (SP) for inborn errors of metabolism (IEM) in 566 referred, high-risk patients. The 143 (25.3% of the total sample) patients with initial abnormal results in at least one screening test (ST) were recalled for further investigations. An IEM was diagnosed in 40.6 percent of the 106 patients who came for reevaluation. In 114 of the remaining 423 patients who had normal initial ST, an IEM was still suspected on basis of clinical, radiological, and/or laboratory findings and was confirmed in 30 of such patients (5.3% of the total sample and 7.1% of the patients with normal results in the SP).

The sensitivity of the SP was estimated maximally as 67.4 percent and the efficiency as 80.4 percent. Twenty-five of the 30 cases undetected with the SP were patients with sphingolipidoses. The simple inclusion of thin-layer chromatography of urinary oligosaccharides in the SP should allow the detection of at least one half of these cases, increasing its sensitivity by 14.1 percent and its efficiency by 4.6 percent. In at least 7.1 percent of patients with an initial normal ST, an IEM was detected. These would have remained undiagnosed if the limitations of the SP employed had not been fully understood.
The Effects of Ipratropium Bromide and Fenoterol Nebulizer Solutions in Children with Asthma
Authors: Freeman Joel , Landau Louis I.
Published: November 2007

The effects of nebulized solutions of ipratropium bromide and fenoterol combined were compared with the response to either preparation alone in single dose and longer-term administration in children who had asthma. The combination produced a slightly greater response than either alone, especially in peak expiratory flow. Over a 1-month period, there were no significant differences in symptom scores or lung function parameters between the combination of ipratropium bromide and fenoterol and fenoterol alone in a group of children who had asthma. It is possible that the addition of ipratropium bromide to a sympathomimetic drug may be useful in a subgroup of asthmatics, particularly if there is a considerable large airway contribution to bronchial narrowing.
Enterobacter Cloacae Bacteremia in Children: A Review of 30 Cases in 12 Years
Authors: Bonadio William A. , Margolis David , Tovar Mauricio
Published: November 2007

A review was performed of the 30 cases of pediatric Enterobacter cloacae (EBC) bacteremia which occurred at our institution during a 12-year period. These 30 cases represented 88% of all cases in which EBC was isolated by blood culture (four other instances were considered contaminants); the rate of isolation of this organism relative to all positive blood cultures was 0.6%. There were 14 patients <12 months of age, with 10 <2 months of age. Infection was nosocomially-acquired in 17 cases. At the time the positive blood culture was obtained, 5 patients were afebrile, and 8 patients (five immunocompromised) had been receiving parenteral antibiotic therapy to which the organism exhibited in-vitro sensitivity for at least 24 hours. EBC was a constituent of polymicrobial bacteremia in 6 cases; in 5 instances the associated organisms were also gram-negative bacteria. There were a total of 33 underlying medical conditions or foci of infection associated with EBC bacteremia identified in 27 patients, the most common of which were immune-deficiency state (17) and gastrointestinal tract lesions (6). There were 3 patients who died.

EBC bacteremia is a relatively rare pediatric infection. It is commonly nosocomially-acquired, and afflicts children who are younger-aged or compromised by underlying medical problems.
The Effect of Beta Blockade on Stress-Induced Cognitive Dysfunction in Adolescents
Authors: Faigel Harris C.
Published: November 2007

Test anxiety is severely disabling to students whose fear of examinations causes cognitive dysfunction that paralyzes their thinking the way stage fright impairs actors ability to act. In studies using subjective evaluations among actors and musicians, beta-blockade relieved stage fright and has been used informally to treat test anxiety in students without objective measures of effectiveness.

The Scholastic Aptitude Test (SAT) was chosen as an objective test instrument to confirm the effect of beta-blockade on test anxiety and performance. Thirty-two high school students who had already taken the SAT before enrolling in this study and who had stress-induced cognitive dysfunction on exams were given 40 mg of propranolol one hour before they retook those tests. Mean SAT scores with beta-blockade were 130 points higher than on the initial SAT done before entering the study without medication (p=<.01). A single dose of propranolol immediately before the SAT permitted improved performance in students prone to cognitive dysfunction due to test anxiety.
No-Enema Therapy for Idiopathic Constipation and Encopresis
Authors: Gleghorn Elizabeth E. , Heyman Melvin B. , Rudolph Colin D.
Published: November 2007

Idiopathic constipation and encopresis of childhood are thought to occur when children volitionally withhold stool. Withholding may be prompted by social pressures or by episodes of painful defecation. Repetitive withholding may result in colonic dilatation and colorectal dysfunction. Therapy involves removal of impacted stool, stool softening, and behavioral therapy. The use of enemas in this therapy is widespread but may be counterproductive. A retrospective review of patients treated without enemas revealed 45 patients whose course could be followed for six months. Ninety-eight percent of these had successful initial cleanouts without enemas; 94% had continued success at six months. These results, comparable with other treatment programs, demonstrate that therapy without enemas is a reasonable alternative in the treatment of childhood constipation and encopresis.
Precise Quantification of Fever in Childhood Bacterial Meningitis
Authors: Anttila Marja , Himberg Jaakko-Juhani , Peltola Heikki
Published: November 2007

Precise quantity of fever was determined in 191 cases of childhood bacterial meningitis by calculating the areas between the line indicating 37.8°C or 39.5°C temperature and the line connecting all individual temperature values. Temperature measurements were performed rectally one to four times a day throughout the hospitalization. The obtained areas under the curves (AUC), expressed as degree-hours, proved to be a sensitive index for delineating each individual fever pattern and reflected the magnitude of fever more precisely than the traditional fever curves. Children under five had significantly (p <0.05) greater AUC than those at five to 15 years; similarly, patients with Haemophilus influenzae meningitis showed greater AUC (i.e., had more fever) than those with meningococcal disease ( p <0.05). The overall rates of secondary (14%), persistent (16%), and prolonged fever (8%) were virtually identical to previous reports; no drug fever was reported in this study. In cases with prolonged fever, a significantly higher rate (40%) of neurological complications was found compared to those who became afebrile earlier. This method is potentially utilizable in other diseases and conditions where precise measurement of fever is of clinical or scientific relevance.
Chemical Pneumonia And Dermatitis Caused By Kerosene
Authors: Nussinovitch Moshe , Amir Jacob , Varsano Itzhak
Published: November 2007

Hydrocarbons cause poisoning in humans through ingestion and aspiration, 1-8 but usually not by inhalation. Inhalation of kerosene as a cause of pneumonitis is reported in animals.9,10 We present a case of pneumonia combined with contact dermatitis caused by kerosene inhalation as a consequence of an unusual use of this substance as folk medicine for upper respiratory tract infection.
Accidental Intravenous Administration of Semi-Elemental Formula in an Infant
Authors: Lopez Garcia Maria José , Monrabal Ignacio Sorribes , Fernandez-Delgado Cerda Rafael
Published: November 2007

Continuous enteral nutrition (CEN) has some advantages in pediatrics when compared with total parenteral nutrition, namely, its greater feasibility and more physiologic approach to infant nutrition. The two types of nutrition are not substitutes for each other. Rather, they are complementary and can even be interassociated, thus allowing an earlier reintroduction of enteral nutrition and a decrease in the secondary effects of total parenteral nutrition.1

Like other techniques, CEN needs special care and attention, as well as some training; to guarantee the results. Continuous-perfusion systems capable of supplying exactly programmed enteral food may be similar to those used for intravenous infusion and used for the same patient. Catheters are easy to differentiate by checking their location in the child, but if the connections between infusion syringe and catheter are wide apart and the contents appear alike (lipid solution and milk), there may be mistakes and problems.

We have recently had the apportunity to see one of these rare complications in an infant who inadvertently received, through a scalp vein, 10 mL of semi-ele mental formula, which was being delivered through continuous enteral administration.
High-Dose Urokinase Therapy in Newborn Infants with Major Vessel Thrombosis
Authors: Giacoia George P.
Published: November 2007

The effectiveness of urokinase therapy for thrombosis in children, particularly in newborn infants, has not been established. We report our experience with the local administration of high-dose intrathrombus urokinase in two newborn infants. One infant had aortic thrombosis and the other, thrombosis of the right femoral artery. The known abnormalities in the newborn's fibrinolytic mechanism provide the rational basis for the therapeutic use of high doses of plasminogen activators. No significant abnormalities of our patients' fibrinolytic systems were found, and effective thrombolysis was achieved. A literature review of the use of urokinase therapy for thrombosis in children reveals great disparities in dosage and outcome. We believe that fixed-dose regimens should be replaced by individually adjusted thrombolytic therapy and that the need for higher doses of urokinase in newborns should be studied further.
Tepid Sponging to Reduce Temperature in Febrile Children in a Tropical Climate
Authors: Mahar A.F. , Allen S.J. , Milligan P. , Suthumnirund S. , Chotpitayasunondh T. , Sabchareon A. , Coulter J.B.S.
Published: November 2007

The effectiveness of tepid sponging, in addition to antipyretic medication, in the reduction of temperature in febrile children living in a tropical environment, was assessed in a prospective, randomized, open trial. Seventy-five children aged between 6 and 53 months who attended the casualty department of the Children's Hospital, Bangkok, Thailand, with fever (rectal temperature ≥38.5°C) of presumed viral origin were randomized to receive either tepid sponging and oral paracetamol (sponged group) or paracetamol alone (control group). Rectal temperature and the occurrence of crying, irritability, and shivering were recorded over the following 2 hours. A greater and more rapid fall in mean rectal temperature occurred in the sponged group than in the control group. Temperature fell below 38.5°C sooner in children in the sponged group than in control children ( P <0.001). At 60 minutes, 38 (95.0%) of the controls still had a temperature of 38.5°C or greater, compared with only 15 children (42.9%) in the sponged group ( P<1×10-5). Crying was associated with sponging, but shivering and irritability occurred in only one child who was being sponged. It is concluded that tepid sponging, in addition to antipyretic medication, is clearly more effective than antipyretic medication alone in reducing temperature in febrile children living in a tropical climate.
Insulin Syringe Disposal Practices of Pediatric Patients with Insulin-Dependent Diabetes Mellitus
Authors: Ancona Keith G. , Wolf Todd A. , Phillips Cathy , Goren Gail , Germak John , Wilson Thomas A.
Published: November 2007

Pediatric patients with insulin-dependent diabetes mellitus were surveyed over a 5-month period to determine disposal practices of insulin syringes. Eighty-nine (79.5%) of 112 patients surveyed responded. Thirty-three percent of the responders disposed of syringes in accordance with recommendations of the local health department and the American Diabetes Association, while the remaining patients did not. Fifty-two percent of the patients rendered the syringes useless before disposal. The study revealed a need to educate and inform patients on the proper procedures that should be followed when disposing of syringes in the home.
Early Outcome Determination of Low-Birth-Weight Infants Using the Neurodevelopmental Risk Examination
Authors: Lipkin Paul H. , Altshuler Lisa A.
Published: November 2007

A neonatal neurodevelopmental assessment, the Neurodevelopmental Risk Examination (NRE), was developed, through adaptation of the scoring of the Allen/Capute neonatal neurodevelopmental examination, for screening the development of low-birth-weight (LBW) infants in the newborn period. A pilot study was conducted of the NRE and its ability to predict motor and cognitive outcome in LBW infants. The NRE was performed on 92 LBW infants (mean birth weight 1,192 g; mean gestational age 29 weeks) at or near term and included assessments of sensory/behavioral response, axial tone, extremity tone, deep tendon reflexes, and primitive reflexes. Developmental outcome was assessed at a mean age of 13.7 months by neuromotor examination and by the mental scale of the Bayley Scales of Infant Development. The NRE total risk score, reflecting overall neurodevelopmental status, correlated well with motor and cognitive outcomes (r = .50, P=.0001 ; and r = -.38, P = .0001, respectively). When infants were clustered into risk groups based upon NRE score (69 infants were deemed low-risk, 20 moderate-risk, and three high-risk) , a strong relationship to outcome was maintained (motor outcome: χ2 = 43.6, P<.0001 ; cognitive outcome: analysis of variance (ANOVA) F = 6.78, df(2,89), P = .002). All subcategories of the examination, except primitive reflexes, were associated with outcome. Therefore, by using a simple method of scoring and interpretation, the NRE can validly predict motor and cognitive outcome in LBW infants.
History of In Utero Cocaine Exposure in Language-Delayed Children
Authors: Angelilli Mary Lu , Fischer Howard , Delaney-Black Virginia , Rubinstein Michelle , Ager Joel W. , Sokol Robert J.
Published: November 2007

To determine whether children with language delays are more likely to have been exposed to cocaine in utero than children with normal language development, a case-control study was undertaken. Based on routine office screening in our primary-care clinic over a 1-year period, we identified 29 consecutive children, aged 24 to 48 months, as language-delayed. They were compared with an approximate 2:1 match of children without language delay who had been seen in the clinic on the same days and who were of similar age. There was more reported cocaine use during pregnancy (six of 29, 21%) among the language-delayed children than among the controls (five of 71, 7%). This difference is statistically significant ( P < 0.05, χ2 = 3.92; odds ratio = 3.4 ± 2.2). Discriminant analysis revealed that both cocaine and nicotine exposure were associated with delayed language development — with an unexpected negative, i.e., an antagonistic, protective, interactive effect (F[3,96] = 4.66, R2 = 12.7%, P<.005); neither gender nor caretaker contributed to language development in this sample. These results suggest that children with language delay detected in a clinical setting are more likely to have been exposed in utero to cocaine than children with normal language development. Prenatal cocaine exposure should be a risk factor in monitoring development in children.
Neuropsychological Impairment in Children With Sickle Cell Anemia and Cerebrovascular Accidents
Authors: Cohen Morris J. , Branch Walter B. , McKie Virgil C. , Adams Robert J.
Published: November 2007

Neuropsychological functioning of children with sickle cell anemia (HbSS) who have experienced a single stroke has not been extensively investigated. In this study, the neuropsychological functioning of 10 children with HbSS who were receiving transfusion therapy following stroke with no identifiable recurrence was examined. The patients were subgrouped into children with only left hemisphere stroke (LCI), N = 4, and those with only right hemisphere stroke (RCI), N = 6. Results indicated that these youngsters experienced significant impairments of cognitive functioning following stroke. It was found that the LCI and RCI children tended to perform more like adult stroke patients than what has been typically reported in children with infantile hemiplegia. These findings support the need for periodic neuropsychological evaluation following stroke in order to identify patterns of higher cortical dysfunction and assist in the development of appropriate rehabilitation and special education programs. Further, pediatricians, child neurologists, and psychologists who care for these children must act as strong advocates on their behalf in order to ensure that they receive appropriate rehabilitation and the special education services necessary for maximal recovery and future educational success.
Perinatal Predictors of Duration and Cost of Hospitalization for Premature Infants
Authors: Jijon Caroline Reed , Jijon-Letort Francisco X.
Published: November 2007

The duration and cost of intensive care for premature infants are important concerns for parents and health providers. We developed a mathematical model to predict length of stay and hospital charges from perinatal information. Length of stay was found to decrease exponentially with gestational age. The equation predicted the length of stay within 10 days in 86% of the cases and had an R2=.765. Gestational age, the presence of respiratory distress syndrome, and pneumonia were the strongest predictors of hospital charges (R2 = .811). The gestational age threshold below which length and cost of hospitalization were significantly higher was 34 weeks.
Individualized Developmental Care for Very-Low-Birth-Weight Premature Infants
Authors: Fleisher Barry E. , VandenBerg Kathleen , Constantinou Janet , Heller Cherrie , Benitz William E. , Johnson Ann , Rosenthal Alan , Stevenson David K.
Published: November 2007

Forty very-low-birth-weight neonatal intensive care unit (NICU) infants with birth weights ≤1,250 g were randomly assigned to treatment or control groups. Behavior of the treatment infants was systematically evaluated, and individualized developmentally oriented care plans were implemented to enhance stability. Treatment babies required fewer days of intermittent mandatory ventilation and continuous positive airway pressure and achieved full enteral feedings sooner. Length of hospital stay and hospital charges were less for treatment than control infants. There were favorable effects on treatment infants' behavioral performance at 42 weeks' postconceptional age. These results support the hypothesis that behaviorally sensitive, developmentally oriented care improves medical and neurodevelopmental outcome in the NICU.
Parents' and Pediatricians' Views of Individuals with Meningomyelocele
Authors: Blaymore Bier Jo-Ann , Liebling Jill A. , Morales Yesenia , Carlucci Marianne
Published: November 2007

The parents of 63 individuals with meningomyelocele completed a scale examining the effects of their child's disability on their family. Eighty-six pediatricians also completed the scale as they predicted parents would respond. Medical and psychosocial data were also obtained. The results showed the following: (1) A higher level lesion was associated with parental reports of a more negative impact on the family ( p <.05), and (2) pediatricians predicted a more negative impact than was reported by the parents ( p <.001 ). We conclude that pediatricians overestimate the negative effects while also underestimating the positive effects of the disability on the family.
Effects of CLIA '88 on the Physician Office Laboratory: A Survey of Midsized Pediatric Practices Before and After CLIA '88
Authors: Benjamin John T.
Published: November 2007

A survey of midsized pediatric groups before and after the implementation of the Clinical Laboratory Improvement Amendments of 1988 (CLIA '88) was done to determine what effects this legislation has had on pediatric office laboratory testing. The pediatric groups in the two time periods were similar in geography, numbers of doctors per group, and number of years in private practice. Despite increased administrative costs of running an office laboratory, there were no significant differences in the test menus offered ( p >.05), the most commonly offered tests being streptococcal antigen test, urinalysis with microscopy, urine culture, mono spot test, automated complete blood count (CBC), and cholesterol. The numbers of these tests performed in the two time periods also did not differ significantly except for the automated CBC (mean 20/MD/month in 1990 versus 32/MD/month in 1995, p <.05). No laboratory failed inspection or incurred a fine. Although overhead has risen to comply with CLIA '88, the pediatric practices surveyed did not restrict their test menus, reduce their volume of testing, or fail inspection.
Femoral Vascular Catheterization in Critically Ill Infants and Children
Authors: Venkataraman Shekhar T. , Thompson Ann E. , Orr Richard A.
Published: November 2007

The success rate and complications from femoral arterial and venous catheterization in infants and children in a university affiliate pediatric intensive care unit were determined prospectively over a 2-year period. We also performed a meta-analysis from published literature to determine the combined estimates of noninfectious and infectious complications (with 95% con fidence limits) using the inverse variance-weighted method. Success rates were 94.5% and 94.4% for femoral arterial (n=110) and venous (n=89) catheterizations, respectively, and were related to operator expertise, age, and hemodynamic status. Median age was 2.4 years and 1.1 year for arterial and venous catheterizations, respectively. Immediate complications were hematoma (10.9% arterial, 16.8% venous) and minor bleeding (13.6% arterial, 13.5% venous). Decreased pulses occurred with 7.7% of arterial catheterizations, and lower limb swelling occurred in 9.5% of venous catheteriza tions. Vascular complications occurred only in infants and resolved within 7-14 days. Catheter- related infections occurred in 1.9% of arterial and 3.6% of venous catheterizations. The mean dura tion of catheterization was 5.3 days and 6.3 days with femoral arterial and venous catheterizations, respectively. Meta-analysis of published studies shows that the estimates for noninfectious compli cations were 5.0%, 10.1 %, 1.1%, and 1.8% for femoral arterial, femoral venous, axillary arterial, and nonfemoral venous catheters, respectively. The estimates for catheter-related infection were 2.5%, 3.7%, and 3.0% for femoral arterial, femoral venous, and nonfemoral venous catheters, respectively. The meta-analytic estimates for complication rates from published literature are not significantly different from the rates observed in our study. Femoral arterial and venous cathe terization in infants and children are safe with an expected high success rate and acceptably low complication rates.
Life Expectancy and Social Adaptation in Individuals with Down Syndrome with and Without Surgery for Congenital Heart Disease
Authors: Hijii Takayuki , Fukushige Junichiro , Igarashi Hisaji , Takahashi Noboru , Ueda Kohji
Published: November 2007

Life expectancy and social adaptation in 373 children with Down syndrome with and without congenital heart disease (CHD) were assessed retrospectively. Survival at age 24 years was 92.2% for patients without CHD (n=200), and 74.6% for those with CHD (n=173). Survival for those who underwent operation for cardiovascular lesions (n=95) was 87.8%, and for those not operated on despite hemodynamically significant cardiovascular lesions (n=39), it was 41.4%. Cardiac functional capacity was better in the children without congenital heart disease and in the group operated on, where most patients also attained good social adaptation. We conclude that children with Down syndrome with congenital heart disease should undergo early cardiac evaluation and surgery if indicated.