bluuebunny/crossref_metadata_2025 huggingface dataset:
The Impact of Early Literacy Guidance on Language Skills of 3-Vear-Olds
Authors: Theriot Judy A. , Franco Sofia M. , Sisson Barbara A. , Metcalf Sharon C. , Kennedy Mary A. , Bada Henrietta S.
Published: June 2007

The objective of this prospective study was to determine the impact of early literacy anticipatory guidance (AG) with provision of books on language development in 3-year-olds in an early literacy program at a University-affiliated inner-city pediatric clinic. The Peabody Picture Vocabulary Test (PPVT-III) and the Expressive One Word Picture Vocabulary Test (EOWPVT-R) were administered to 33-39-month-old children exposed to an early literacy program, which included AG and provision of an age-appropriate book at each well-child visit starting at 2 months old. Children with developmental delays were excluded. Parental surveys on literacy and demographic data were obtained. Univariate and multivariate analyses were performed. Sixty-four children were evaluated; 88% African American, 89% Medicaid recipients. Fifty-eight percent of families reported familycentered literacy orientation. The PPVT-III scores directly correlated with the number of AG visits with book given x number of books purchased (r2 = 0.025, p = 0.0006). Higher scores in EOWPVT-R were predicted by race and the number of visits with books given x number of books purchased (r2 = 0.182, p = 0.0009). All families reported reading together, half reporting positive familycentered literacy. Given the same number of books purchased for each child, the outcome scores were higher the greater the number of clinic visits wherein AG included early literacy and provision of books.
Occurrence of Epstein-Barr Virus Illness in Children Diagnosed with Group A Streptococcal Pharyngitis
Authors: Rush M. Carol , Simon Michael W.
Published: June 2007

Epstein-Barr virus mononucleosis and group A streptococcal pharyngitis are acute infectious processes similar in both their clinical manifestations. Coinfections may occur and be a direct result of a synergistic effect on inflamed pharyngeal and tonsillar tissue. It was our observation that a population of children diagnosed with group A streptococcal pharyngitis and not responding to appropriate antimicrobial therapy had Epstein-Barr virus illness.
Temporal Artery Temperature Measurements in Healthy Infants, Children, and Adolescents
Authors: Roy Sumita , Powell Keith , Gerson Lowell W.
Published: June 2007

A noninvasive temporal artery thermometer that uses arterial heat balance technology has been compared to rectal and ear thermometry and is available in the marketplace. This study was undertaken to establish mean temperatures and temperatures 2 standard deviations above the mean for healthy infants, children, and adolescents. Temperatures were measured in healthy patients 0 to 18 years of age using a noninvasive temporal artery thermometer. Temperatures were measured in 2,346 patients. Mean temperatures and temperatures 2 standard deviations above the mean were: 37.1°C (38.1°C) for 383 infants 0 to 2 months; 36.9°C (37.9°C) for 860 children 3 to 47 months; 36.8°C (37.8°C) for 680 children 4 to 9 years; and 36.7°C (37.8°C) for 423 adolescents 10 to 18 years. There were no significant differences in temperatures in white compared to African-American children, children with or without perspiration on their forehead, or between measurements taken on the left compared to the right side of the forehead. This study provides information about temporal artery temperatures in healthy infants and children that can serve as a basis for interpreting temperature measurements in ill children when the same instrument is used.
A Review of Common Pediatric Lip Lesions: Herpes Simplex/Recurrent Herpes Labialis, Impetigo, Mucoceles, and Hemangiomas
Authors: Bentley Janna M. , Barankin Benjamin , Guenther Lyn C.
Published: June 2007

Lip lesions are a common presentation to the pediatrician's office. These lesions are often benign in children, without significant functional morbidity. However, owing to the prominent placement of lips and their role in communication, lip lesions can be alarming to patients as well as to their parents. For these reasons the pediatrician has an important role in recognizing, diagnosing, and treating the various types of labial dermatoses that commonly present to a pediatric practice. Four of the most common lip lesions a pediatrician will see are herpes simplex/recurrent herpes labialis, impetigo, mucoceles, and hemangiomas. This paper reviews the current literature on the diagnosis, treatment, and management of these 4 lesions.
Efficacy of a Pre-thickened Infant Formula: A Multicenter, Double-Blid, Randomized, Placebo-Controlled Parallel Group Trial in 104 Infants with Symptomatic Gastroesophageal Reflux
Authors: Vanderhoof Jon A. , Moran J. Roberto , Harris Cheryl L. , Merkel Kimberly L. , Orenstein Susan R.
Published: June 2007

To evaluate a pre-thickened formula (Enfamil AR1/2) for regurgitant gastroesophageal reflux, 104 infants were enrolled in a 5-week, multi center, double-blind, randomized, place bo controlled parallel group trial. The Enfamil AR group showed greater symptom reduction by the end of the first week: percent feedings with any regurgitation (p=0.045), total regurgitation volume score (p=0.035), and percent feedings with choke-gag-cough (p=0.004). The most symptomatic infants at baseline had a reduction in trouble sleeping significantly with Enfamil AR by the end of the study (p=0.030). This formula flows through a standard nipple, reduces regurgitation and choking-gagging-coughing within a week, and improves sleep in the most symptomatic babies by 5 weeks, without causing constipation.
Attention Deficit Hyperactivity Disorder in Elementary School Children in Rhode Island: Associated Psychosocial Factors and Medications Used
Authors: Harel Ephat H. , Brown William D.
Published: June 2007

This study was undertaken to explore psychosocial factors associated with referral for attention deficit hyperactivity disorder (ADHD) evaluation or ADHD diagnosis among elementary school children in Rhode Island, as well as to examine the extent of drug therapy among this population. A survey was distributed to parents/guardians of 2,800 3rdto 5th-grade public school students in 4 Rhode Island school districts. The average age of the children was 9.0 + 1.0 years with 52% girls. Approximately 12% of the students had been referred for ADHD evaluation (RFE). Of these, 52% (6% of all children in the survey) were receiving psychoactive prescription medications daily. While the male: female ratio in the non-RFE group was almost 1:1, there were more boys than girls in the RFE group (male/female ratio of 3:1, p<0.0001) and in the medicated group (male/ female ratio 4:1, p<0.0001). RFE children and medicated children were older than classroom peers (p<O.OOOl), and had a greater degree of school misconduct (p<0.0001). RFE children and medicated children were significantly less likely to have parents who completed college (p<0.05), were significantly more likely to have stepparents (p<0.05), and to be only children (p<0.05) when compared with their peers. Amphetamine was the most commonly prescribed drug (used by 54% of the medicated children) followed by methylphenidate (43%). Nearly 18% of the medicated children were receiving 1 to 3 additional psychoactive prescription medications on a daily basis. In conclusion, RFE children and children medicated for ADHD were more likely to have a stepparent, have no siblings, and have parents that had not completed college. Amphetamine rather than methylphenidate accounted for the majority of medications used in this study, and simultaneous use of multiple psychoactive medications was reported in 18% of the medicated children.
Effect of Obesity Status on Heart Rate Peak in Female Youth
Authors: Loftin Mark , Sothern Melinda , Van Vrancken Connie , O'Hanlon Ann , Udall John
Published: June 2007

The purpose of this study was to compare heart rate peak in obese (n=43) and normal weight (n=45) female youth. Heart rate (HR) peak was significantly lower (p<0.05) in the obese group as compared to the normal weight group (192.3±29.3, 203.4±27.6), and V02 (L min-) peak similar between groups (1.77±20.53, 1.97±0.60). Bivariate correlations for heart rate peak with body weight, percent fat, and body mass index yielded the following: -0.53, -0.54, and -0.57. These findings agree with the adult data indicating low HR peak in obese individuals. Further research is needed to explore physiologic factors that may lead to reduced HR peak in obese female youth.
Outcome of Overactive Bladder in Children
Authors: Hellerstein Stanley , Zguta Amy Ajans
Published: June 2007

One hundred forty-four children with a clinical diagnosis of overactive bladder were observed for a mean of 3.15 ± 1.92 years. Initial management consisted of a behavioral modification program that included increased fluid intake, a timed voiding schedule and, if applicable, treatment of constipation. Those who failed to improve with the preceding intervention within 10 days to 2 weeks received an anticholinergic medication. Follow-up information was obtained by telephone. Caretakers and/or patients were asked a standard set of questions. The outcome with respect to urinary urgency, urinary frequency, daytime incontinence, posturing and urinary tract infections was recorded. After an average follow-up period of 3 years, 68 (47.2%) of the 144 children recovered from all symptoms of overactive bladder and 61 (42.4%) had decreased symptoms. Fifteen of the children, or 10.4%, still had all of the symptoms originally associated with overactive bladder. Children who had posturing as one of their symptoms had a significantly increased risk of urinary tract infection.
A Case of Satoyoshi Syndrome: A Multisystem Disorder
Authors: Kamat Deepak , Petry Laura , Berry Susan
Published: June 2007

A 14-year-old boy with Satoyoshi syndrome is reported. Less than 50 patients with Satoyoshi syndrome have been reported in the world literature. This patient had alopecia, muscle spasms, and skeletal abnormalities, which are three of the most common clinical features of Satoyoshi syndrome. Despite extensive laboratory evaluation, an alternate explanation was not documented for the cluster of clinical findings in this patient. Immune dysregulation is believed to be an underlying mechanism for the development of Satoyoshi syndrome. In contrast to some reports, this patient failed to respond to intravenous immunoglobulin therapy. However, he responded dramatically to steroids.
Long-term Efficacy of Polyethylene Glycol 3350 for the Treatment of Chroni Constipation in Children with and without Encopresis
Authors: Pashankar Dinesh S. , Bishop Warren P. , Loening-Baucke Vera
Published: June 2007

Seventy-four children (43 with chronic constipation, 31 with constipation and encopresis) treated with polyethylene glycol 3350 (PEG) for longer than 3 months were studied to assess long-term efficacy. The mean duration of PEG therapy was 8.4 months (range, 3-30). Weekly stool frequency, stool consistency, and symptoms associated with constipation improved significantly with PEG therapy in all 74 patients. In 31 children with encopresis, soiling ceased completely in 16 patients and frequency of soiling decreased significantly in all others. The average effective long-term dose of PEG was 0.7 g/kg/day. Long-term PEG therapy is effective for the treatment of chronic constipation with and without encopresis in children.
Family Structure and Child Abuse
Authors: Oliver William J. , Kuhns Lawrence R. , Pomeranz Elaine S.
Published: June 2007

Knowledge of the characteristics of family structure may be helpful to the pediatrician for predicting child abuse. During the past several decades progressive shifts from the classic family unit of two biological parents and their children to a variety of parental living arrangements have occurred. Most notable are the increases in teenage pregnancies, unmarried motherhood, divorce rates approximating 50% of marriage rates, and frequency of unrelated surrogate parents, most often male, cohabitating in the home. In these settings, identifiable characteristics of the mother, the father or surrogate, the child, the family history, and the immediate neighborhood of the family have been associated with a greater likelihood of child and/or spousal abuse. The accumulated information may be used for preventative intervention.
Improving Influenza Vaccination Rates in a Pediatric Asthma Management Program by Utilization of an Electronic Medical Record
Authors: Martin Elmer
Published: June 2007

An electronic medical record was implemented between 2000 and 2001, and a function of the electronic medical record was utilized as a tool to facilitate improving influenza vaccination rates among moderate to severe asthmatics in the pediatric population in 2002 and 2003. This objective was attempted in order to increase influenza vaccine compliance in the pediatric population. Influenza vaccination levels in this select population were increased 80% in 2002 to 2003 over baseline 2001 levels. Correspondingly, pediatric asthma admissions declined 50% in 2002 to 2003 from a plateau level between 1999 and 2001. All of these results were statistically significant to 95% confidence levels.
Pediatric Prescribing Practices for Clonidine and Other Pharmacologic Agents for Children With Sleep Disturbance
Authors: Schnoes Connie J. , Kuhn Brett R. , Workman Elizabeth F. , Ellis Cynthia R.
Published: June 2007

The prescription rates of clonidine have risen dramatically and the extent to which these increases can be attributed to treatment of sleep disturbance is unknown. Surveys were mailed to 800 pediatricians across four geographically diverse states to assess prescribing practices specific to sleep disturbance. Ninety-six percent of the respondents treated sleep disturbance. More than one third of the sample reported using clonidine specifically for sleep disturbance including sleep onset, sleep schedule, nighttime awakening, and early morning awakening problems and parasomnias. Clonidine ranked second only to antihistamines as the most commonly used medication for treating sleep disturbance.
Concordance between Neurologic Screening Test and Neurologic Examination in Newborns
Authors: Pereira Carmen L. , Aguilar Ana M. , Rivera Felipe , Cruz Leonardo , Santos Isela , Poblano Adrián
Published: June 2007

The aims of this study were to calculate concordance among results of the assessment of a population of neonates by using a screening version of neurologic assessment developed by our group with the Amiel-Tison examination, to evaluate distribution of the findings for each item in the studied population, and to develop an optimality score to aid in the detection of possible deviations in infants. Infants in this report include 107 infants born consecutively; they were mainly at-term infants, or preterm infants who, when reaching at-term corrected age, were suspected to be abnormal with a wide spectrum of complications. Newborns were tested by neurologic screening and neurologic examination. Agreement, correlations among tests, sensitivity, and specificity were calculated. Correlation among results from Neurological Screening and Neurological Examination was significant (rho = 0.759, p = 0.01), and Cronbach’s alpha concordance had an acceptable value (0.83). Sensitivity and specificity of neurologic screening after Amiel-Tison examination comparison were 0.98 and 0.82, respectively. Our results support the use of the neurologic screening proposed.
Increase in Invasive Pneumococcal Disease in Children Associated With Shortage of Heptavalent Pneumococcal Conjugate Vaccine
Authors: Abuelreish Motasem , Subedar Asad , Chiu Thomas , Wludyka Peter , Rathore Mobeen
Published: June 2007

The authors investigated the impact of heptavalent pneumococcal conjugate vaccine (PCV7) shortage on the rate of invasive pneumococcal disease (IPD). Vaccination status and number of doses delivered was determined. Regression analysis using an exponential decay model was used to predict the expected rate of IPD in the shortage period if IPD continued to decline at the same rate as in the availability period. The rate of IPD decreased from 15.5 to 6.5 with vaccine availability ( P < .00001) and increased to 7.2 with shortage ( P = .69). Based on the model, IPD rate would have been 3.6 if the decrease continued at the same rate when there was no shortage; this was statistically significant (95% prediction interval, 2.7-4.1). The rate of IPD correlated directly with the number of PCV7 doses delivered, r = -.98. Continuous availability of the PCV7 would have resulted in a statistically significant lower IPD rate compared to the measured IPD rate in the vaccine shortage period.
Epidemiologic, Socioeconomic, and Clinical Factors Associated with Severity of Respiratory Syncytial Virus Infection in Previously Healthy Infants
Authors: Somech Raz , Tal Guy , Gilad Eli , Mandelberg Avigdor , Tal Asher , Dalal Ilan
Published: June 2007

We prospectively quantified disease severity associated with epidemiologic and socioeconomic parameters as well as the clinical factors in 195 previously healthy infants with confirmed respiratory syncytial virus (RSV) infection. Infants were enrolled into three subgroups according to disease severity: outpatients (82 patients), inpatients (100 patients), and intensive care unit patients (13 patients). Epidemiologic parameters such as gestational age, birth weight, chronologic age at presentation, and gender as well as socioeconomic factors such as ethnic origin, family history of asthma, exposure to cigarette smoke, number of family members, presence of pets at home, breast-feeding, and day-care attendance were not found to predict the severity of RSV illness in previously healthy infants. Our results emphasize the complexity of predicting disease severity in previously healthy infants with RSV infection and suggest that other parameters such as host genetic background might explain the clinical variability.
Child Assessment of Dextromethorphan, Diphenhydramine, and Placebo for Nocturnal Cough Due to Upper Respiratory Infection
Authors: Yoder Katharine E. , Shaffer Michele L. , La Tournous Susan J. , Paul Ian M.
Published: June 2007

This study sought to investigate the efficacy of dextromethorphan (DM), diphenhydramine (DPH), and placebo (PL) for symptoms attributed to upper respiratory infections as determined by children, and to evaluate the concordance of perception of nocturnal symptoms between children and parents. A total of 37 children age 6 to 18 years of age were randomized in a double-masked fashion to receive a single bedtime dose of DM, DPH, or PL. Children found no significant difference in the effect of DM, DPH, or PL for any study outcome, and responses by parents and children were significantly correlated.
Comparative Tolerability, Safety and Efficacy of Tablet Formulations of Twice-Daily Clarithromycin 250 mg versus Once-Daily Extended-Release Clarithromycin 500 mg in Pediatric and Adolescent Patients
Authors: Block Stan L.
Published: June 2007

Clarithromycin is widely used to treat respiratory tract and superficial skin infections in pediatric and adult populations. Using clinical endpoints and 7-day therapy, we compared the efficacy of clarithromycin 250 mg tablets given twice daily versus clarithromycin 500 mg extendedrelease tablets given once daily in ambulatory children and adolescents 6 to 16 years old. Of the 199 evaluable patients, 124 were infected with group A streptococcal pharyngitis, 39 with sinusitis, 21 with ambulatory pneumonia, and 15 with superficial skin infections. The overall cure rate exceeded 90% for each treatment group. Discontinuation rates and adverse events were 4.5% and 24.6%, respectively.
Career Goals in the High Risk Adolescent
Authors: Fleming Charlene , Woods Charles , Barkin Shari L.
Published: June 2007

Possessing a career goal might serve as a protective factor for an adolescent’s healthy development. This could be especially important in adolescents who engage in high risk behaviors. The relationship between high risk adolescents’ future career goals and selected predictor variables were examined. Almost half (49%) the students indicated a career goal. Students who reported a job were 5.1-fold more likely to have listed a future career goal. Females, those aged 18 years, and those whose mothers were employed were twice as likely to have a career goal. Considerations for fostering career goals for high risk students are warranted.
Melatonin Treatment in Adolescents With Delayed Sleep Phase Syndrome
Authors: Szeinberg Amir , Borodkin Katy , Dagan Yaron
Published: June 2007

This retrospective study describes the effects of long-term treatment with melatonin in 33 adolescents (age range, 10-18 years) with delayed sleep phase syndrome (DSPS). Patients were treated with oral melatonin, 3 to 5 mg/day for an average period of 6 months. During the treatment, sleep onset was advanced and sleep duration was longer. Treatment was also associated with a decrease in the proportion of patients reporting school difficulties. No adverse effects of melatonin were noted. This study indicates that long-term treatment with melatonin can be beneficial for adolescents with DSPS in terms of sleep-wake schedule and school performance.
Rationale for Use of Tdap Booster Vaccines for Adolescent Immunization: Overview of Efficacy, Safety, and Clinical Use
Authors: Hitchcock William P.
Published: June 2007

Pertussis is one of the only vaccine-preventable diseases with increasing incidence in the United States. The incidence of pertussis infection in adolescents is a growing concern; it can be a severe disease that may lead to significant morbidity and mortality when transmitted to susceptible populations (eg, infants). Experts have conceded that booster vaccination of adolescents may considerably decrease the incidence of pertussis infections in previously immunized, partially immunized, and nonimmunized populations. Studies in 2 tetanus, diphtheria, and acellular pertussis (Tdap) booster vaccines licensed by the Food and Drug Administration (FDA) have shown efficacy against pertussis disease and have demonstrated a safety profile comparable to tetanus and diphtheria vaccine (Td) in adolescents. Immunization schedules now include use of Tdap vaccines for preadolescent and adolescent populations to counter the increase in pertussis outbreaks. Challenges for clinicians include prompt recognition of pertussis symptoms, proper diagnosis using appropriate tools, and timely reporting of pertussis infections to surveillance bodies. Additional studies are needed to monitor trends of pertussis incidence after implementing the new vaccination schedule for adolescents.
Catheterization of the Bladder in Infants and Children
Authors: Robson Wm. Lane M. , Leung Alexander K. C. , Thomason Michael A.
Published: June 2007

Catheterization of the urinary bladder is a common procedure that can be emotionally and physically traumatic for the child and family. The purpose of this review is to familiarize readers with the procedure and techniques that will minimize the physical and emotional discomfort, and complications.
Severe Hypernatremia and Hyperosmolality Exacerbated by an Herbal Preparation in a Patient With Diabetic Ketoacidosis
Authors: Bhowmick Samar K. , Hundley Olivette T. , Rettig Kenneth R.
Published: June 2007

This article reports a case of severe reversible hypernatremia exacerbated by an herbal agent “goldenseal” ( Hydrastis canadensis) in an 11-year-old girl with new onset type I diabetes mellitus presented with diabetic ketoacidosis. A literature review is presented and possible mechanism of hypernatremia caused by this herbal preparation is discussed.
Orgasm Without Organisms
Authors: Genuis Stephen J. , Genuis Shelagh K.
Published: June 2007

The worldwide epidemic of sexually transmitted diseases (STDs) presents a major public health challenge to medical practitioners and educators as they seek to implement preventive educational strategies in the adolescent population. The serious consequences of many STDs and the insufficient impact of condom promotion in this high-risk group have led to increasing recognition that sexual intercourse is medically unwise for young adolescents. As a result of this recognition, some educators have proposed that adolescent sexuality education focus on the explicit teaching of noncoital sexual activities, sometimes called outercourse. This paper explores the emergence of this educational strategy, the assertion that noncoital sexual activities will positively impact the rising incidence of STDs and unplanned pregnancy in teenagers, and the hypothetical benefits of adolescent noncoital sex.
Nongynecologic Causes of Unexplained Lower Abdomiinal Pain in Adolescent Girls
Authors: Cavanaugh Robert M.
Published: June 2007

Unexplained lower abdominal pain in young women can present a challenge for even the most experienced clinicians. Although the cause is usually benign and self-limited, occasionally a serious underlying disorder exists. Clinicians should have an organized approach for diagnosis and management in an effort to avoid any unnecessary tests or referrals. The most important elements of the evaluation are a thorough history, careful physical, and sequential follow-up as needed. Selective use of the laboratory and radiographic studies should be considered on an individual basis. This paper describes four disorders in adolescent girls that may present with pain in the lower abdominal region and closely resemble pathologic conditions within the gynecologic tract. Practitioners who provide services to young women should be aware of these entities so that the correct diagnosis is established as soon as possible and appropriate therapy initiated in a timely fashion.
Special Considerations in the Treatment of Seasonal Allergic Rhinitis in Adolescents: The Role of Antihistamine Therapy
Authors: Kemp James P.
Published: June 2007

The symptoms of seasonal allergic rhinitis often develop during adolescence. Teen-age students with seasonal allergic rhinitis may experience decreased academic performance and productivity from the disease or because of the sedative effects of some antihistamines. The pharmacologic effects of nonsedating second-generation antihistamines are compared with those of classical antihistamines. The effects of antihistamines on sedation and motor and cognitive function are discussed. The role of antiinflammatory agents, decongestants, and combination products is reviewed. Potential drug interactions must be considered along with factors such as drug-induced weight gain and the use of antihistamines in potentially pregnant patients in selecting appropriate antihistamine therapy for adolescent patients.
Ranitidine Therapy for Esophagitis in Children with Developmental Disabilities
Authors: Kaufman Stuart S. , Loseke Candace A. , Young Rosemary J. , Perry Deborah A.
Published: June 2007

Esophagitis is common in children with cerebral palsy. Because histamine2-receptor antagonists such as ranitidine have not been uniformly effective, we treated disabled children with esophagitis with greater than usual doses. Endoscopy and pH monitoring were used to monitor dose and response to treatment. A dose of 9.3 ± 0.9 mg/kg/day did not improve visual or microscopic esophagitis after 3 months. A dose of 14.8 ± 3.9 mg/kg/day resulted in only slight microscopic improvement, but symptoms were improved. There was no correlation between esophageal reflux index at enrollment and either severity of esophagitis or response to treatment. Elevation of gastric pH by ranitidine was infrequent. These results affirm that pH monitoring does not reliably identify disabled children with reflux esophagitis nor does ranitidine reliably heal this disorder.
Evaluation and Treatment of the Deformed and Malformed Auricle
Authors: Ruder Robert O. , Graham John M.
Published: June 2007

Auricular malformations begin within the first few weeks of intrauterine growth. Less severe deformational abnormalities occur from abnormal fetal positioning. They can be corrected early after birth by simple reshaping and molding. No longer should the pediatrician wait for minor deformities to resolve spontaneously. The protruding ear may not be present at birth but may develop and worsen during the first year. The most severe anomalies require complex multistage reconstructions after other concomitant anomalies are excluded. The pediatrician must be an integral part of this reconstructive team.
Neurofibromatosis Type 1—An Update and Review for the Primary Pediatrician
Authors: Goldberg Yael , Dibbern Kurt , Klein Jana , Riccardi Vincent M. , Graham John M.
Published: June 2007

With an incidence of 1 in 3,000, neurofibromatosis type 1 (NFl), or von Recklinghausen disease, is one of the most common genetic disorders encountered by primary care physicians. NFI is a multisystem disease that affects more than one million people worldwide (more than 80,000 in the United States). Although most pediatricians have patients with NFl in their practices, many affected individuals go undiagnosed as children. This article is intended to facilitate the diagnosis and management of young patients with NFl.
Maternal Assessment of Infant Development: Associations with Alcohol and Drug Use in Pregnancy
Authors: Seagull F. N. , Mowery J. L. , Simpson P. M. , Robinson T. R. , Martier S. S. , Sokol R. J. , McCarver-May D. G.
Published: June 2007

Surveillance by parental concern has been advocated to assess whether formal child developmental testing is needed. To determine whether alcohol intake or illicit drug use in pregnancy is associated with differences in maternal perception of infant development, mothers with acknowledged alcohol and drug habits during pregnancy (N=120) were interviewed at 11 months' postpartum, within 1 month before infant testing by use of the Bayley Scales of Infant Development. Women with heavy alcohol intake during pregnancy (>3.5 oz absolute alcohol per week) were 15-fold more likely to overestimate their infant's mental development ( P<0.05), whereas mothers using illicit drugs were 4-fold more likely to overestimate their infant's physical development ( P=0.02). Given the frequent denial of substance abuse, we suggest that health care providers be cautious in accepting a lack of parental concern about a child's development and rely more heavily on formal testing, particularly in high-risk populations.
Risk Factors for Penicillin-Resistant Systemic Pneumococcal Infections in Children
Authors: Doone Jana L. , Klespies Sandra L. , Sabella Camille
Published: June 2007

The purpose of this study was to identify risk factors that may differentiate children who develop systemic infections with resistant strains of Streptococcus pneumoniae from those who develop penicillin-susceptible pneumococcal infections. A retrospective case-controlled study was performed of all patients with positive blood and/or cerebrospinal fluid isolates for S. pneumoniae over a 13½-month period. Patients with penicillin-susceptible strains of S. pneumoniae were compared with those with penicillin-resistant infections in terms of age, race, gender, diagnosis, underlying conditions, antibiotic therapy within 1 month prior to systemic infection, treatment, and outcome. Sixty-nine patients with systemic pneumococcal infections were identified over the study period. Nine (13%) of these patients had infection with a penicillin-resistant isolate. Six of these patients were infected with a relatively resistant strain (MIC 0.1-1.0 μg/mL) while three were infected with a fully resistant strain (MIC ≥ 2.0 μg/mL). There was no difference between the two groups in terms of age, race, gender, underlying diagnosis, treatment, or outcome. Sixty-seven percent of the patients who developed a penicillin-resistant pneumococcal infection had received antibiotics in the month prior to systemic illness versus 4% of those infected with a penicillin-susceptible strain (P <0.0000097). In conclusion, when compared with children who develop systemic infection with a penicillin-susceptible strain of S. pneumoniae, children who develop infection with a penicillin-resistant strain are significantly more likely to have received antibiotics within 1 month prior to their illness.
A Double-Blind Taste Comparison of Pediatric Antibiotic Suspensions
Authors: Steele Russell W. , Estrada Benjamin , Begue Rodolfo E. , Mirza Ayesha , Travillion David A. , Thomas Mathew P.
Published: June 2007

This study examined the palatability of 22 antimicrobial suspensions by using five independent categories for scoring: appearance, smell, texture, taste, and aftertaste. The likely overall influence on patient compliance was also evaluated. Drugs were compared within their respective classes. The only antibiotics judged to be so unpalatable as to potentiallyjeopardize compliance were dicloxacillin, oxacillin, erythromycin/sulfisoxazole, and cefpodoxime. Among the penicillins, amoxicillin and ampicillin were preferred. Azithromycin was slightly superior to erythromycin and clarithromycin within the macrolide class. Many cephalosporins were ranked quite high, the best being loracarbef, cefadroxyl, cefprozil, and cefixime.
Parental Issues in Selection of Antimicrobial Agents for Infants and Children
Authors: Bauchner Howard , Klein Jerome O.
Published: June 2007

The traditional American family has changed during the past several decades with increases in the number of single-parent households and working mothers. These changes have led to increased stress in the family when children become ill. Infectious diseases are the most common reasons parents seek care for ill children, and parents want effective and convenient treatment regimens so the child can recover quickly and return to day care or school. Issues that affect parental compliance and satisfaction with antimicrobial treatment regimens include efficacy, safety, cost, convenience, and previous experience. Parents are more involved in medical decision making than ever before and often want to be included in the selection of an antibiotic for their child. Physicians should be aware of the many issues impacting on parents' opinions about antibiotic therapy.
Neonatal Severity of Illness Scorinng Systems: A Comparison
Authors: Fleisher Barry E. , Murthy Lakshmi , Lee Suk , Constantinou Janet C. , Benitz William E. , Stevenson David K.
Published: June 2007

Several different scoring systems have been developed to predict neonatal morbidity and mortality. In this investigation we compared the utility of four severity of illness scoring systems (SISS) as predictors of days on ventilator (DOV), length of hospital stay (LOS), and mortality in very-low-birth weight (VLBW) premature infants who required mechanical ventilation. The SISS assessed were the Score for Neonatal Acute Physiology (SNAP); the Score for Neonatal Acute Physiology—Perinatal Extension (SNAP+PE); Clinical Risk Index for Babies (CRIB), and the Sinkin Score at 12 hours (SS12). Results revealed significant correlations among the SS12, SNAP, SNAP+PE, CRIB, birth weight (BW), DOV, and LOS. However, none of the systems we assessed offered striking advantage over BW in a VLBW ventilated group.
The First Chest Radiograph in Neonates Exhibiting Respiratory Distress at Birth
Authors: Kurl Sangita , Heinonen Kirsti M. , Kiekara Olavi
Published: June 2007

The aim of the present study was to assess the diagnostic accuracy and clinical utility of the first anteroposterior chest radiograph taken within the first hours of life from 99 neonates admitted consecutively from the delivery room to the neonatal intensive care unit because of mild to moderate respiratory distress. Before the radiograph was taken, all necessary emergency life support measures were undertaken. These included intubation, if indicated, and placement of intravenous and intra-arterial cannulae and nasogastric tubes. Intratracheal surfactant was never, however, administered before the radiograph. We examined the agreement between the clinicians' and the pediatric radiologist's opinion regarding the pulmonary and cardiac findings in these radiographs. Seventy-four radiographs exhibited definite pulmonary or cardiac pathology. In 66 patients the initial assessment was in agreement with the radiologic reevaluation. Clinicians' and radiologist's diagnoses of respiratory distress syndrome (RDS) agreed in 95%, of pneumothoraces in 78%, but, ultimately, of transient tachypnea of the neonate (TTN) in only 48%. The benefits of having the chest radiographs reviewed by a consultant radiologist experienced in neonatology are evident. The first chest radiograph taken early during the course of the disease had the greatest impact in the care of neonates with mild respiratory distress. In such cases, potentially dangerous conditions (e.g., pneumothoraces) could be detected before severe clinical deterioration occurred.
Nontuberculous Mycobacterial Cervical Adenitis
Authors: Suskind Dana L. , Handler Steven D. , Tom Lawrence W. C. , Potsic William P. , Wetmore Ralph F.
Published: June 2007

Granulomatous inflammation is a common finding in pathologic evaluation of surgically excised chronic lymphadenopathy in children. Confusion exists regarding diagnosis and management of these lesions. Over a 10-year period at The Children's Hospital of Philadelphia, a total of 81 children were identified with biopsy-confirmed granulomatous lesions of the head and neck, with nontuberculous mycobacteria (NTM) accounting for 67 of the cases. The typical presentation was that of a nontender mass in the cervicofacial area present for weeks to months, unresponsive to antimicrobials. All underwent surgical excision, which was curative in 54 patients; 13 children required additional procedures. This paper reviews NTM, its typical clinical presentation, difficulty in diagnosis, and the methods of treatment.
Congenital Malaria: An African Survey
Authors: Fischer Philip R.
Published: June 2007

Even in malaria-endemic areas, congenital malaria has been considered to be rare. Some recent reports suggest, however, that up to one fourth of newborns in some areas may be parasitemic. In an effort to determine current prevalence rates of congenital malaria, malaria smears were done on peripheral blood from 100 peripartum mothers and on cord blood from their offspring at each of seven sites spanning sub-Saharan Africa. The prevalence rate of maternal parasitemia was 15% overall and varied from 4% to 30% at the different sites. Congenital malarial infection was found in 7% of newborns, the prevalence rate varying from 0% to 23% at the different sites. There was no apparent relationship between the season of sampling and either the prevalence rates of parasitemia or the penetrance of malaria from mother to offspring. In summary, congenital malarial infection is not rare in sub-Saharan Africa, but the prevalence rate of neonatal parasitemia varies from site to site.
Long-Term Treatnent of Nocturnal Enuresis withi Desmopressin Intranasal Spray
Authors: Uygur Mehmet Cemil , Özgü Işik Hasan , Özen Haluk , Özen Seza , Toklu Cem , Ergen Ali , Tekgül Serdar , Remzi Doğgan
Published: June 2007

The purpose of this study was to determine the efficacy and safety of long-term treatment of nocturnal enuresis with desmopressin intranasal spray. Sixty-five children with primary nocturnal enuresis with a mean age of 11.3 years (range 7-17) underwent a 2-week observation period followed by dose titration period of 1 week. Those children completely dry with desmopressin entered a randomized, placebo-controlled, double-blind phase lasting 2 weeks, followed by a 6-month open treatment. The enuretic status of the children was documented for 2 weeks after the treatment was stopped. Eleven children had no change from baseline wetting with desmopressin. Thirty-two children receiving 20 mg and 9 children with 40 mg desmopressin were completely dry. Thirteen children were wet 1-2 nights per week, which was better than in the pretreatment period. During the 6-month open-treatment period, the effect of desmopressin was found to be stable. No side effects or adverse reactions were encountered. Two weeks after the treatment was stopped, 25 children were still completely dry (38% of the initial study population, 50% of the responders). The cure rate appeared to continue beyond 18 months after discontinuation of the treatment.
Symptomatic Blunt Head Injury in Children—A Prospective, Single-Investigator Study
Authors: Fisher Jay D.
Published: June 2007

The goal of this study was to describe a single emergency physician's experience with symptomatic blunt head injury in children and prospectively assess the sensitivity and predictive value of the neurologic examination. The author utilized a prospective patient series comparing neurologic examination with computed tomography (CT) of the head. Nine of 42 patients had intracranial injury for a prevalence of 21%; two patients (5%) had intracranial injury with only subtle neurologic examination findings. Twenty-six patients had a negative neurologic examination, and all had normal-appearing CT scans. Sixteen patients had a positive neurologic examination, of whom nine had a positive CT scan. The properties of the neurologic examination as a diagnostic test, with CT as the gold standard, were as follows: sensitivity = 100%, specificity = 78%, positive predictive value = 56%, negative predictive value = 100%. Normal findings from neurologic examination can be used in some children with symptomatic blunt head injury to delay or eliminate the need for CT of the head.
Assessing Parental Utilization of the Poison Center: An Emergency Center-Based Survey
Authors: Kelly Nancy R. , Kirkland Rebecca T. , Holmes Susan E. , Ellis Michael D. , Delclos George , Kozinetz Claudia A.
Published: June 2007

The purpose of this study was to identify and characterize caretakers who fail to utilize the poison center for unintentional poisonings involving children. We interviewed 210 caretakers of children evaluated for unintentional poisoning in the emergency center of an urban, universitybased teaching hospital to determine (1) whether demographic differences exist between those caretakers who contacted a poison center prior to the emergency center visit and those who did not and (2) whether differences exist in prevalence of poison prevention knowledge and behaviors between the two groups. Ninety-six (46%) of caretakers did not contact the poison center prior to the emergency center visit. Significant differences were found between the two groups for the following caretaker variables: race/ethnicity, language preference, age, level of education, country in which schooling occurred, and type of insurance coverage for the child. When logistic regression was used to control for confounding, the two variables associated with failure to use the poison center were black race and schooled outside the United States (primarily in Mexico). Poison center callers reported a higher prevalence of poison prevention knowledge and behaviors than noncallers. Educational interventions should be targeted to the groups of caretakers identified who do not use the poison center.
Tuberculosis of the Ankle in Childhood: Clinical, Roentgenographic and Computed Tomography Findings
Authors: Ruggieri Martino , Pavone Vito , Polizzi Agata , Smilari Pierluigi , Di Fede Giovanni F. , Sorge Giovanni , Musumeci Salvatore
Published: June 2007

We report on three Italian children who presented with unilateral ankle tuberculosis (TB) consecutively during a short time period and in the same geographical area. A 6-year-old-girl with a family history of TB had limited mobility of the right leg at age 9 months; Mantoux test and radiographs at that age yielded normal findings. When severe right tibiotarsal swelling, reddening, pain and restriction of motion became apparent at age 4.6 years, the typical lesions of TB were evident on radiographs and computed tomographic (CT) scans. Mantoux test and synovial biopsy confirmed TB. A three-drug regimen of treatment proved useless: articular cartilage destruction and diffuse osteosclerosis ensued. Only a four-drug prolonged regimen of treatment proved to be somewhat effective. A 5-year-old girl had a 6-month history of painless swelling and limited mobility of the ankle; radiographs and CT showed osteopenia with marginal erosion of cartilages. A 14-month-old boy presented with a 2-week history of painless swelling ankle. Radiographs showed decreased bone density of talocalcanear bones. Mantoux test and synovial biopsy confirmed TB in both patients; treatment with a three-drug regimen greatly reduced symptoms. A careful suspicion of the diagnosis of tuberculosis is paramount in children with chronic or subacute monoarticular arthritis, even in absence of a positive tuberculin test or abnormalities on chest radiograph. When negative early on, the tuberculin test should be repeated after 6 weeks of arthritis, and a needle biopsy of the synovium is required in those children with monoarticular arthritis and a positive tuberculin test. Careful therapy is necessary to avoid sequelae that may lead to severe osteoarticular damage.
Bioethical Aspects of HIV Infection in Children
Authors: Davis J. K. , Shah Kiran
Published: June 2007

The care of HIV-infected children is fraught with many bioethical conflicts and dilemmas that require careful attention if care is to be provided appropriately. Understanding of the interplay of such general principles as autonomy, nonmaleficence, confidentiality, and veracity helps to clarify the nature of specific conflicts. This article addresses both general principles and their specific applications to pediatric patients with HIV infection. It addresses these matters from the points of view both of patients and parents. It shows why conflict is practically inevitable, and it points the way toward prevention and resolution of conflict. Practical guidelines are provided in relation to the critical problem of disclosure of diagnosis to the patient.
The Moral Challenge of Children at Risk: Protective Policies and Pediatrics
Authors: Post Stephen G. , Frutig Patricia R. , Bennett James
Published: June 2007

Social workers and pediatricians are among the professionals who share a society-wide concern with current public policies regarding the placement of children at extreme risk. A healthcare professional may successfully treat a child, only to learn later that this same child was the victim of a tragic incident of domestic violence after returning home. Such events are not uncommon, create considerable frustration for pediatricians, and demand an integrated interprofessional and interdisciplinary response. This report emerged from 6 months of task force dialogue with leaders of children's services programs, healthcare professionals, clergy, ethicists, and other community leaders in one major urban environment. It indicates innovative directions in children's protective services with regard to family preservation, foster care, residential care, and adoption. The latter two options could be used much more creatively than is the case currently. The report also asserts that far too few resources are being directed to this problem area.
Foreign Body in the Tracheobronchial Tree
Authors: Cataneo Antonio José Maria , Reibscheid Samuel Marek , Ruiz Raul Lopes , Ferrari Giesela Fleischer
Published: June 2007

A 20-year experience with the treatment of 74 patients (83.8% children) for foreign body aspiration is reviewed. The object of this review is to show the clinical manifestations, the radiological findings, the nature and distribution in the bronchial tree, and complications due to longstanding (months or years) foreign bodies in the bronchial tree. The most common foreign bodies found were peanuts (13.5%), corn (13.5%), and beans (13.5%). The most frequent clinical manifestation was choking (67.5%), and the most frequent radiological finding was atelectasis (41.8%). The most serious complication was bronchiectasis needing resection in six patients who had the foreign body retained for years in the bronchial tree. In conclusion, in spite of an obvious foreign body in the tracheobronchial tree many cases are not diagnosed, and a longstanding foreign body in the airway may be responsible for irreversible complications.