bluuebunny/crossref_metadata_2025 huggingface dataset:
Self-harm Behaviors (Carving)
Authors: Schwartz Richard H. , Cohen Peter , Hoffmann Norman G. , Meeks John E.
Published: November 2007

Deliberate self-lacerations by rebellious or delinquent adolescent girls, known by them as "carving," may be erroneously diagnosed as a suicide gesture. Carving is an important physical sign suggesting possible drug and alcohol abuse during adolescence. Eighty-five adolescent female patients in a long-term outpatient, self-payment, therapeutic community-type of adolescent drug treatment program, participated in a descriptive survey of "carving" behaviors. Forty-one girls (48%) admitted to deliberate cutting of their own wrists, arms, or other body parts without suicidal intent. Fifteen of the 85 girls (18%) cut themselves six or more times. Many girls had scarified their bodies with their boyfriends' initials as a visible means of demonstrating their affection and loyalty. They also carved rock group symbols or a Christian cross. Large and disfiguring scars were noted on 14 patients. The girls explained the behavior as a method of dealing with depressed affect, anger, emotional pain, or emptiness.

Suicide attempts, usually by purposeful overdose of medication, had been made by 24 (59%) of 41 girls who carved themselves. Multiple suicide attempts were associated with habitual carving. Epidemics of carving, led by one or more angry, depressed, or lonely adolescents, may occur in closed facilities such as correctional institutions and drug abuse treatment facilities.
A Marker for Language Disorders
Authors: Accardo Pasquale , Whitman Barbara
Published: November 2007

Toe walking unassociated with an autistic disorder or cerebral palsy generally has been considered a normal infant gait. The incidence of toe walking in various diagnostic subgroups of 799 developmentally disabled children presenting to a tertiary-level multidisciplinary assessment clinic was reviewed to investigate the authors' clinical impression that toe walking may be a marker for language dysfunction.

Toe walking was found to be more frequent in those diagnostic subgroups with more severe language disorders. Toe walking also correlated with lower IQ scores (p < 0.0001). The sensitivities, specificities, predictive validities and odds ratios all supported the hypothesized association between toe walking and language disorders.

Further prospective studies of the neurodevelopmental outcome of children with toe walking are needed to determine whether this behavior can identify children at risk for language disorders.
Lead Intoxication
Authors: Shannon Michael , Graef John W.
Published: November 2007

The lead found in drinking water can be a source of lead poisoning to young children, particularly those who consume large amounts of water. The authors describe a 13-month-old infant who was discovered to have plumbism during routine evaluation. The lead source was ultimately traced to the daily administration of powdered formula which was prepared with home tap water having a first-draw lead content of 130 parts per billion. This case suggests that whenever infants are fed powdered formula, consideration should be given to analysis of the home tap water for lead content.
Fusiform Bacterial Sepsis
Authors: Van Dyke Don C. , Alexander Randell C. , Perlman Stanley , Smith Wilbur J. , Dekowski Steven A.
Published: November 2007

Cases of fusiform bacteria sepsis have been reported infrequently in the pediatric literature. This case demonstrates the severe metastatic complications of fusiform bacterial sepsis including osteomyelitis, with multiple pathological fractures, sepsis, and abscesses of the liver. In the diagnostic evaluation of the etiology for this uncommon infection, child abuse was discovered in all children of this family. In children with uncommon infections and no underlying etiology, child abuse should be considered.
Elevated Serum Creatine Kinase
Authors: Lahat Eliezer , Eshel Gideon , Heyman Eli , Bar Josef , Katz Yitzchak , Aladjem Mordechay
Published: November 2007

Serum creatine kinase (CK) was determined in 52 children admitted following an episode of febrile convulsions. Enzyme levels correlated with the estimated duration of the seizure. Twenty-four hour values were significantly higher than those observed 1 hour after the convulsive episode. Serum CK levels are frequently used for diagnostic purposes, so the questionable validity of this test when drawn after a convulsive episode must be considered.
Development of Positive Feelings in Primiparous Mothers Toward Their Normal Newborns
Authors: Pascoe John M. , French Joyce
Published: November 2007

Though mothers' development of positive feelings about their newborns is the first step in maternal attachment, little research has described factors which may influence the process. This descriptive study reports normative data for primiparous mothers with normal newborns. The authors interviewed 100 primiparous mothers on the postpartum ward within 72 hours after delivery at a community hospital to ascertain factors associated with the development of positive feelings.

Over one third (39%) of mothers studied reported their first positive feeling during the prenatal period, 42 percent during birthing or the first day and 19 percent on the second or third day. A majority of mothers (70%) described their strong positive feelings toward their newborns (i.e., "love") as a sense of caring, commitment and concern.

Several demographic, biological and environmental factors were associated with the development of first positive feelings in primiparous mothers. One half of mothers who planned to become pregnant developed positive feelings prenatally, while 57 percent of mothers who did not plan to become pregnant reported their first positive feelings during birth or the first day. Delay in first positive feelings until after the first day was associated with labor longer than 8 hours, disappointment with the "bonding" experience, breast-feeding, and high depressive symptoms.
Transcultural Understanding of a Hereditary Disorder
Authors: Handelman Lauren , Menahem Samuel , Eisenbruch I. Maurice
Published: November 2007

A case study of a family referred for clarification of cultural issues illustrates how a transcultural psychiatric service developed in the pediatric hospital setting can be used to advantage. A Vietnamese family with an inherited disorder, Mucopolysaccharidosis type VI (Maroteaux-Lamy syndrome, MPS VI),1 resisted genetic counseling and contraception. Three out of their six children were affected, one with a fatal outcome. The transcultural consultation offered an understanding of their behavior and facilitated subsequent management.
Young Long Distance Runners
Authors: Nudel Dov B. , Hassett Irene , Gurian Anita , Diamant Shmuel , Weinhouse Elliott , Gootman Norman
Published: November 2007

This study presents the physiological and psychological characteristics and the running histories of 16 subjects who began long distance running at age 4-12 years. Running duration was 3-15 years (mean 8.4 ± 3.6 yrs). Seven children completed 41 marathons, seven 30-mile races, and eight 60-mile races. The other nine competed at shorter distances. All trained at 30-105 miles/week.

Two stress fractures, one back sprain and one knee injury occurred. Athletes who reported injuries from recollection may have underreported some injuries. At age 15.4 ± 4.2 years bone age was 15.3 ± 2.6 years and height was at 51 ± 26.0 percentile. Athletes had larger left ventricular diastolic diameter, higher max O 2 uptake, and delayed onset of anaerobic metabolism compared to controls.

Psychological profile: IQ = 121 ± 11, scholastic grade point average (GPA) (n = 13) was ≤3.0 in four, 3.6-3.9 in four, and 4.0 in five. Cattell 16 personality factor (PF): Seven scored above the 85th percentile on boldness, warmth, conformity, sensitivity, dominance, and high drive with tension. Eight scored above the 93rd percentile for self discipline and emotional stability. Human Figure Drawing showed a distorted body image in seven. Two developed anorexia nervosa, and another girl committed suicide.

Thus, high physical fitness and no growth retardation were observed. These runners, however, shared distinct positive and negative personality characteristics. The relatively high incidence of severe psychological disorders possibly suggests a need for psychological screening for young children entering a strenuous training program and for close monitoring for development of psychological problems during the program.
Infants with Apparent Life Threatening Events
Authors: Woolf Paul K. , Gewitz Michael H. , Preminger Tamar , Stewart Julian , Vexler David
Published: November 2007

The role of cardiac dysrhythmias in the pathogenesis of Sudden Infant Death Syndrome (SIDS) is uncertain, 1 but there have been several reports of infants with Apparent Life Threatening Events (ALTE) due to significant dysrhythmias.2-4 To further characterize the cardiac rhythm and conduction of these "at-risk for SIDS" infants, we performed 24-hour continuous (Holter) electrocardiograms on 100 full term, healthy infants with ALTE.

Sixty-two patients (62%) had one or more dysrhythmias on Holter monitor. Twenty-five patients (25%) had premature ventricular depolarizations (PVD), including five with couplets. Thirty (30%) had QTc > 2 SD above the mean, and, of these, 40 percent had PVD's. Fifteen (15%) had premature atrial depolarizations and 39 (39%) had evidence of moderate or marked sinus node irregularity. There was no prexcitation, supraventricular tachycardia, ventricular tachycardia, or atrioventricular block.

Two patients with marked sinus node dysfunction were treated with propantheline and did well. All patients were monitored at home, with no deaths or clinically significant dysrhythmias on follow-up (1-32 months (mean = 18)).

In summary, when Holter monitoring was performed, a high incidence of dysrhythmia was found in infants with ALTE. Most dysrhythmias were clinically insignificant. The incidence of ventricular dysrhythmias and long QTc are consistent with previously advanced theories of cardiac electrical instability in some of these patients, but no patient with ventricular dysrhythmias required therapy. The incidence of sinus node dysfunction requiring therapy was 2 percent. Although Holter monitoring of infants with ALTE only infrequently determines therapy, it may provide data linking theories of cardiac etiology of SIDS with actual clinical events.
Sudden-onset Deafness
Authors: Kline Mark W. , Frasch Carl E.
Published: November 2007

An 8.5-year-old boy was evaluated 3 weeks after the occurrence of a febrile illness associated with sudden-onset deafness. An extensive diagnostic evaluation was largely unrewarding. However, unusual epidemiologic features of the case and cerebrospinal fluid abnormalities suggested meningococcal meningitis as the probable etiology. Serologic studies confirmed recent meningococcal infection. The potential etiologies of sudden acquired deafness are diverse, but a thorough evaluation is warranted and may be rewarding, even if it is initiated weeks after onset of deafness.
Abnormal Sweat Chloride in Auto-immune Hypothyroidism
Authors: Squires Liza , Dolan Thomas F.
Published: November 2007

A case of an 11-year-old girl with autoimmune hypothyroidism and a positive sweat test is presented. When the hypothyroidism was corrected the sweat test reverted to normal.
Prolonged Hyperinsulinism and Hypoglycemia
Authors: Bhowmick Samar K. , Lewandowski Christopher
Published: November 2007

The authors describe a term female, asphyxiated, small for gestational age (SGA) infant with documented hyperinsulinism and hypoglycemia occurring at approximately 45 hours of age. The hypoglycemia was refractory to a high rate glucose infusion and steroid administration but responded to diazoxide. The subsequent hospital course was complicated by right-sided heart failure and sepsis. With the onset of sepsis, a transient hyperglycemia was noted that required intermittent insulin therapy for 10 days. Hypoglycemia and hyperinsulinism reemerged and responded to diazoxide therapy. An attempt to discontinue diazoxide at age 6 months was aborted at 2 weeks when hyperinsulinism and hypoglycemia recurred. The infant required diazoxide for 7 more months, then she recovered without having any sequalae. The review of this uncommon hypoglycemia etiology in an SGA and asphyxiated infant and the merits of long-term diazoxide treatment are discussed.
Pallid Breath-holding Spells
Authors: DiMario Francis J. , Chee Claire M. , Berman Peter H.
Published: November 2007

Excessive vagal tone has been implicated as the cause of pallid breath-holding spells (PBHS) in children. The following study was undertaken to test the hypothesis that children with PBHS have underlying autonomic nervous system (ANS) dysfunction. Five patients (age 29-79 months old) who had experienced PBHS were evaluated at a time when they were clear of spells for ANS dysfunction. A battery of clinical bedside tests were given. The results were compared with test results of a control group of children (age 18-104 months) who had not experienced PBHS. Data collected included blood pressure, pulse rate, mean arterial pressure, the 30:15 R-R ratio upon standing, the expiratory:inspiratory (E:I) R-R ratio, pupillary response to conjunctival pilocarpine instillation, and plasma norepinephrine levels upon standing.

Breath-holders displayed a statistically significant (p < 0.05) percent decrease in mean arterial pressure (-10.2% PBHS vs. -4.1% controls) and an unsustained increase in pulse rate during the lying to standing maneuver. Two children with PBHS had "positive orthostatic signs," and one child with PBHS had a plasma norepinephrine level of 94 pg/ml (60% below the mean for both groups). There is evidence to suggest a subtle, underlying, generalized autonomic dysfunction in children with PBHS.

A strong familial tendency toward syncope, breath-holding spells, and seizures was recognized in nine of ten subjects. Additionally, there was a strong influence from the maternal side of the family in seven of nine subjects.
The Hand as a Target Organ
Authors: Johnson Charles F. , Kaufman Keith L. , Callendar Cynthia
Published: November 2007

The authors reviewed the abuse reports submitted by the staff of The Children's Hospital, Columbus, Ohio, to determine the incidence and types of injuries inflicted to children's hands. The authors did not study hand injuries in children who were not reported as physically abused. The authors examined two time periods to ascertain changes in injury severity. Of the 631 abuse reports submitted from 1980 to 1982, there were 52 injuries (8.2%) involving the hands. From July 1987 to July 1988 there were 42 hand injuries (13.4%) among 313 reports.

In the 94 total cases, 19 (2%) children sustained injury to the hand only, including eight with burns, two with bruises, two with human bites, two with erythema, two with fractures, and one with a laceration. Children with burns to the hand alone were significantly younger than those with other types of injuries. Of the 94 children with hand and other injuries, 18 (20%) required hospital admission. Of the 19 with injuries to the hand only, five required hospital admission. A variety of instruments were used to injure these children.

The hand is a delicate organ, and it is frequently the primary or incidental target of child abuse. Familiarity with the patterns and types of hand injury suffered in child abuse is essential for early recognition, reporting, and child protection.
Acute Myocarditis in Infants
Authors: Press Shirley , Lipkind Reina S.
Published: November 2007

The authors reviewed the initial presentation of seven infants with acute myocarditis. All patients presented with respiratory distress including tachypnea (respiratory rate ≥ 40) and intercostal retractions. Other findings included tachycardia (heart rate ≥ 120) (7/7) and grunting (6/7). Lungs were clear to auscultation in six out of the seven patients. Cardiomegaly was seen in five of the initial chest roentgenograms. Each initial electrocardiogram had abnormal findings.

Initial diagnoses were sepsis and shock in three patients, pneumonia and asthma in two, and congestive heart failure in two. Six patients required tracheal intubation. All required admission to the Pediatric Intensive Care Unit (ICU). Two patients died.

Myocarditis should be suspected in a child presenting with severe respiratory distress, tachycardia, cardiomegaly, and/or an abnormal electrocardiogram. Prompt stabilization and admission to a pediatric intensive care unit for further evaluation and treatment is essential.
Severe Cow's Milk Induced Colitis
Authors: Wilson Nevin W. , Self Thomas W. , Hamburger Robert N.
Published: November 2007

Cow's milk induced eosinophilic colitis presenting in the first week of life has been reported, but is very rare. The authors describe a 4-day-old female infant who presented with profuse rectal bleeding resulting in a hematocrit fall from 38% to 30% within 8 hr after hospital admission. Sigmoidoscopy revealed colonic mucosa that was red, edematous, and friable, with punctate hemorrhages. Rectal biopsy showed marked eosinophilic infiltration with multifocal hemorrhage.

Further history indicated that while the infant had been exclusively breast-fed since birth, the nursing mother had been drinking 4-5 glasses of cow's milk per day since delivery. Prick puncture skin testing of the infant was positive for cow's milk protein. A serum radioallergosorbent test (RAST) for cow's milk protein was positive. The infant's serum IgE was 1.5 IU/ml. Rectal bleeding resolved when the patient was given a casein hydrolysate formula (Nutramigen, Mead Johnson Nutrition, Evansville, IN), and endoscopy one week later showed improvement, with only scattered areas of erythema, and no friability.

We conclude that since the infant was exclusively breast-fed, the milk protein must have passed into the breast milk antigenically intact. Prenatal sensitization probably occurred. Cow's milk induced allergic colitis should be considered in the differential diagnosis of colitis in breast-fed neonates.
Young Children in Recreational Sports
Authors: Stern H. Patrick , Bradley Robert H. , Prince Michael T. , Stroh Suzanne E.
Published: November 2007

More than 20 million children between ages 6 and 16 years participate in nonschool sports programs, with increasingly more programs being established for younger-age children. A questionnaire based on previous research with adolescent athletes was developed to determine participation motivation of 6- to 10-year-old children. Three hundred fourteen boys participating in a basketball program were interviewed privately with this instrument.

Of the 12 participation motivation items, "learn to do my best," "learn and improve skills," "have a coach to look up to," and "get stronger and healthier" were most highly rated, whereas "win games" and "become popular" were rated least important. When responses of 6 and 7 year olds were compared with those of 9 and 10 year olds, older children rated "feel part of a team", "have fun and excitement" and "be with and make new friends" higher at a statistically significant level (p < 0.05). Older children rated "win games" and "become popular" lower at a statistically significant level (p < 0.05).

The authors conclude that young children in this recreational sports program make significant distinctions in their participation motivation and that some aspects of participation that motivate them change as they grow older.
Duration of Breast-feeding Patterns Established in the Hospital
Authors: Ryan Alan S. , Wysong Jeffrey L. , Martinez Gilbert A. , Simon Stephen D.
Published: November 2007

Data from a national survey of new mothers were analyzed to determine the effect that demographic characteristics, breast-feeding instructions, and infant formula discharge kits had on breast-feeding patterns established in the hospital. Results indicated that mothers who exclusively breast-fed their infant were more likely to be affluent, college educated, and not working outside the home. Mothers who exclusively breast-fed their infants in the hospital and subsequently practiced partial breast-feeding or formula, or cow's milk feeding were more likely to return to the work force within the first 6 postpartum months. Mothers who partially breast-fed their infants in the hospital were more likely to have a low-birth-weight neonate.

Stepwise logistic regression analysis indicated that greater total family income, a better education, and having more than one child had positive significant effects on exclusive breast-feeding by the first and fourth month. Women who received a formula discharge kit compared with those who did not had a slightly higher probability of initiating partial breast-feeding (10 vs. 7% by the first month; 27 vs. 25% by the fourth month). Maternal employment had a large impact on duration of exclusive breast-feeding. By the fourth month, mothers who were employed had a higher probability of initiating partial breast-feeding (43 vs. 19%) compared with mothers who were not in the work force.
Congenital Tracheoesophageal Fistula (H-type) in a Six-year-old
Authors: Frates Mary C. , terMeulen Deborah C. , Yee William F. H.
Published: November 2007

The case of a six-year-old boy with newly diagnosed tracheoesophageal fistula of the H-type is presented. This diagnosis is usually made in the neonatal period, but since the symptoms may mimic other respiratory illnesses and radiologic diagnosis may be difficult, the condition may go undiagnosed for years. Since correction of a tracheoesophageal fistula is curative, the diagnosis should be entertained in any child with recurrent respiratory symptoms, especially when associated with meals. A brief discussion emphasizes the importance of good communication between the clinician and radiologist and of careful radiologic evaluation.
Public Law 99-457 and the Clinical Pediatrician
Authors: Downey William S.
Published: November 2007

Public Law 94-142 is a federal law, enacted in 1975, guaranteeing a free public education and related services for every handicapped child, from 5 to 21 years of age. In 1986, this act was amended by PL 99-457, where the age limit for mandated services was changed to include children 3-5 years of age. Moreover, in a section called Infants and Toddlers, states were given the option to extend these services, here called early intervention services, to children from birth to age 3. This latter section has profound ramifications for the practicing pediatric clinician when the law is implemented. These laws are reviewed with that focus in mind.

This article is a two-part presentation of the requirements and implications for the pediatrician of federal act PL 99-457. This first part defines the details of the law. The second part, to be printed in Clinical Pediatrics next month, will explore the implications for the pediatrician.
Parainfluenza Type 3 Meningitis
Authors: Arguedas Adriano , Stutman Harris R. , Blanding Jeanne G.
Published: November 2007

The authors present two immunocompetent children with parainfluenza type 3 meningitis. In each case, the outcome was favorable without detectable complications. The authors reviewed the literature, showing that central nervous system (CNS) involvement by parainfluenza viruses has rarely been described but may present with a variety of neurologic syndromes.

Pediatricians and laboratory personnel should recognize that these viruses, commonly known to produce respiratory syndromes, can also be a cause of CNS infections. If additional studies confirm these observations, clinicians and virology laboratories may consider whether early hemadsorption testing to detect myxoviruses is warranted.
The Schinzel-Giedion Syndrome
Authors: Pul Mehmet , Yilmaz Nuran , Komsuoglu Baki
Published: November 2007

The authors discuss a 1-day-old boy who had Schinzel-Giedion syndrome. This is the fifth case reported in the literature, and it presents additional abnormalities that have not been reported previously.

The Schinzel-Giedion syndrome includes facially dysmorphic, skeletal, cardiac, and genitourinary anomalies, but mainly congenital hydronephrosis. The diagnosis can be made by clinical and radiological examinations.
Reliability of the Dinamap Non-invasive Monitor in the Measurement of Blood Pressure of III Asian Newborns
Authors: Chia F. , Ang A.T. , Wong Tze-Wai , Tan K.W. , Fung Kam-pui , Lee J. , Khin Khin
Published: November 2007

Four hundred thirty-one paired sets of readings of systolic and diastolic blood pressure and 438 paired sets of readings of mean arterial BP from 49 ill newborns, including 21 very low birth weight infants, were analyzed for the extent and pattern of agreement and the linear relationship between the Dinamap oscillometric monitor and the direct intraarterial blood pressure readings. Agreement between the two methods was measured by the intraclass correlation, whereas the linear relationship was assessed by the product-moment correlation.

The intraclass correlations for systolic, diastolic and mean blood pressures were 0.696, 0.766, and 0.781, respectively. The product-moment correlations for systolic, diastolic and mean blood pressures were 0.706, 0.768, and 0.786, respectively.

BP measurements by the Dinamap monitor showed reasonably close agreement to those obtained by the intraarterial mean arterial pressure ranges above 40 mmHg. For mean arterial pressure of 40 mmHg and lower, BP readings by the Dinamap monitor tended to be higher than those obtained by the intraarterial method. These findings appeared to be consistent regardless of the birth weight of the newborn.
Chemoprophylaxis with Oral Trimethoprim-sulfamethoxazole In Otitis Media
Authors: Cunningham Michael J.
Published: November 2007

The author reviewed the potential risks of trimethoprim-sulfamethoxazole (TMP-SMX) treatment in children so that a more educated decision can be made in the choice of a prophylactic drug for recurrent acute otitis media, particularly in the penicillin (ampicillin, amoxicillin) allergic child.
Height Screening in the Community The Commercialization of Growth
Authors: Rosenbloom Arlan L.
Published: November 2007

The availability of unlimited but costly supplies of biosynthetic growth hormone has led to pressure for pharmacologic use (as opposed to replacement therapy in proven deficiency states). Commercial and altruistic motives have converged to promote community height screening among individuals who have been perceived by themselves or parents as short. This does not meet accepted criteria for health screening. Height screening of large populations of children yields few unrecognized medical conditions. If the goal of community screening is to identify abnormally short individuals (<3%) who might benefit from growth hormone treatment and if the unproven assumption is correct that stature correlates with success and happiness, then those less likely to appear for screening need to be recruited to avoid elitist domination. The annual cost of such growth promotion would be >$10 billion, with no evidence for substantial health benefits. Growth monitoring of all children through improved height measurement in schools and in physicians' offices, as part of health supervision, is a more sound community approach than height screening.
Prevalence and Etiology
Authors: Bhatia M.S. , Dhar N.K. , Singhal P.K. , Nigam V.R. , Malik S.C. , Mullick D.N.
Published: November 2007

Of a total of 800 children (aged 3-12 years) attending a pediatric outpatient department, 182 (22.8%) were found to be having temper tantrums (mean age, 4.7 years). Temper tantrums were found to be most common at 3-5 years (75.3%), less common at 6-8 years (20.8%), and least common at 9-12 years (3.9%). Children aged 3-5 years were more likely to be of a lower social class (p < 0.01), whereas in other age groups (6-8 years and 9-12 years) children were more likely to be of an upper social class. Boys dominated the study significantly: the ratio of boys to girls was 3.1:1. Boys having temper tantrums were more likely to be of an upper social class (p < 0.001) compared with girls, who tended to be of a lower social class (p < .01).

Children showed a higher incidence of history of postnatal trauma and seizure disorder compared with the control group (p < 0.05). Parental overprotection and marital discord were found to be stress factors in a significantly higher number of boys than girls (p < 0.01); parental negligence was a significant stress factor for girls (p < 0.01). Associated behavioral problems, such as thumb sucking, enuresis, tics, head banging, sleep disturbances, and hyperkinesis were found to be significantly higher among children with tantrums.
Spontaneous Perforation of the Extrahepatic Biliary Tree in Infancy
Authors: Saltzman Daniel A. , Snyder Charles L. , Leonard Arnold
Published: November 2007

Spontaneous perforation of the bile duct in infancy is rare, with less than 55 cases described in the literature to date. The authors report the case of a 30-day-old neonate who presented with a 2-week history of progressive abdominal distension and intermittent jaundice. Disofenin technicium 99m sequential scintiscanning provided a preoperative noninvasive confirmation of the diagnosis of biliary ascites secondary to spontaneous perforation of the extrahepatic biliary tract. Distal common bile duct atresia was identified intraoperatively, and end-to-side Roux-en-Y hepaticojejunostomy was performed, with an uneventful postoperative recovery. The etiology, diagnosis, and treatment of spontaneous neonatal biliary perforation is discussed.
Esophageal Stenosis Following Stevens-Johnson Syndrome
Authors: Rottermann E.M. , Julia M.V. , Rovira J. , Parri F.J. , Morales L.
Published: November 2007

A 5-year-old girl with Stevens-Johnson syndrome developed progressive dysphagia secondary to esophageal stenosis. The authors resolved this by treating the patient with balloon dilatation. She has remained symptom-free for 10 months post-treatment.
Relationship of Head Circumference to Measures of School Performance
Authors: Desch Larry W. , Anderson Sharon K. , Snow Jeffrey H.
Published: November 2007

To study the possible relationship of head circumference (HC) to learning problems in children, a retrospective study was done, using records from 360 subjects who had been evaluated between the years 1976 and 1981. The data selected from the records included standardized academic test results, e.g., IQ scores and school achievement test results, as well as determinations of visual motor abilities.

Statistical analyses demonstrated a positive correlation between full scale IQ (FSIQ) and HC (p < 0.005). The incidence of specific learning disabilities based on significant academic and achievement discrepancies was 54% in those with HC > 2 S.D., 39% for normocephalic, and 23% for those with HC < 2 S.D. Comparison of HC with results from the Wide Range Achievement Test (WRAT) demonstrated a tendency for those children with HC > 2 S.D. to have lower arithmetic scores when compared to results of children with normocephaly. Scores for spelling and reading ability did not demonstrate this tendency.

The results of this study were found to be somewhat incongruous to those of previous studies of similar children. Further studies using large unselected populations are needed to better define the risks to learning that may be related to the extremes of head circumference.
Cardiac Hydatid Cyst in a Child
Authors: Ben - Musa A.A. , Singh Harjit , Shembesh A.H. , Chugh J.C.
Published: November 2007

Presentation of hydatid disease is uncommon in children, and cardiac hydatid cyst is rare at any age. The authors discuss a pediatric patient with cardiac hydatid cyst in the posterior wall of the left ventricle. The cyst was diagnosed by two-dimensional echocardiography and by serology. A 3 month course of mebendazole therapy was only partially effective. The patient remains asymptomatic 2 years after diagnosis.

HYDATID DISEASE is endemic in the Middle East.1 In a study from a surgical hospital in eastern Libya,2 the disease accounted for 0.89 percent of all hospital admissions. The echinococcus cyst grows very slowly and unless located in a critical anatomic site, it takes many years to evolve. Consequently, presentation in pediatric patients is distinctly uncommon. In an epidemiologic study from Benghazi,2 only 11.7 percent of patients were under 10 years old.

Cardiac hydatid disease is rare at any age, accounting for less than 2 percent of all hydatid disease.3 Since the introduction of two-dimensional echocardiography, more cases are being diagnosed. All the reports in the recent literature are in adult patients. 4-8 We report here, however, a cardiac hydatid cyst in the left ventricular wall in a child.
Rhabdomyosarcoma of the Testicular Appendage
Authors: Goff Walter B. , Lawrence David P. , Deweese Robert A.
Published: November 2007

This is a case report of embryonal rhabdomyosarcoma of the epididymal appendage in a 15-month old infant. It is a rare tumor with a good prognosis when treated promptly. The ultrasound examination showed the testicle to be enlarged but hypo-echoic in comparison to the epididymis which was infiltrated with tumor. An inflammatory mass or enlargement of a testicle demands careful diagnosis and appropriate therapy with immediate referral to a urologist if the normal clinical course deviates. Representative images are included.
Febrile Infants Less than Eight Weeks Old
Authors: Broner Cynthia W. , Polk Sara A. , Sherman James M.
Published: November 2007

Febrile infants less than eight weeks old frequently are admitted and receive parenteral antibiotics for treatment of possible sepsis. The authors assess 52 infants less than eight weeks old with a rectal temperature of 38.1 °C or higher as having either a readily identifiable focus of infection by physical examination, appearing "toxic" without a focus, or appearing well. The authors screened patients by using white blood cell (WBC) counts, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and chest radiographs in addition to blood, cerebrospinal fluid and urine cultures.

The authors found a 9.6% incidence of bacteria in the 52 infants evaluated, with a 4.3% incidence in those febrile infants who appeared well. Five patients had positive blood cultures with Group B B Hemolytic streptococcus (four patients), and Viridans streptococcus (one patient). A clinical assessment of toxicity and a total band count ≥ 0.5 X 103 cells/uL together were sensitive indicators of bacteremia, as were toxicity and a positive CRP. A "toxic" appearance, a WBC count > 15X10 3cells/uL and an ESR >30 were specific indicators of bacteria.

Based on these data, identification of bacteremia in febrile infants may be possible with clinical assessment and screening laboratory tests. Because of the relatively small sampling size of this study, the authors feel that evaluation of a larger number of patients is warranted to evaluate these sensitivities in a more diffuse patient population.
Underlying Illness Associated with Failure to Thrive in Breastfed Infants
Authors: Lukefahr James L.
Published: November 2007

Over a four-year period in a suburban pediatric practice, 38 infants aged six months or less were identified with failure to thrive (FTT) while breast-feeding. In seven cases (18.4%), an associated organic illness was diagnosed. Only 2 of 28 breast-fed neonates (8%) were found to have FTT associated with another illness, as compared to 5 of 10 older infants (50%). Breast-fed infants with FTT, particularly those presenting after the first month of life, should be considered high risk for having other disease. Their clinical evaluation should include an appropriate search for organic illnesses.
Gastrointestinal Bleeding in a 15 Month Old Male A Presentation of Munchausen's Syndrome by Proxy
Authors: Mills R.W. , Burke Susan
Published: November 2007

Munchausen's syndrome by Proxy is a well-described entity that may not always be immediately considered in a complicated case. We describe this syndrome being portrayed through the guise of gastrointestinal bleeding in a 15 month old male and discuss not only the difficulty involved in solidifying this diagnosis but also the consequences that may occur should this diagnosis not be entertained. Failure to diagnose Munchausen's syndrome by proxy often results from failure to consider the diagnosis. These cases frequently have specific characteristics that allow seasoned clinicians to suspect the diagnosis.

Once the diagnosis is considered, it is crucial to take steps to protect not only the index patient but also siblings who not infrequently are also recipients of this life threatening form of child abuse.
Two Siblings with Phenotypes Mimicking Peroxisomal Disorders but with Discordant Biochemical Findings
Authors: Pietrzyk Jacek J. , Turowska-Heydel Dorota , Klimek Malgorzata , Kaczmarski Franciszek , Kaluza Jozef
Published: November 2007

The authors present a report on two siblings with a nearly identical phenotype mimicking peroxisomal disorder but with totally discordant biochemical findings. In an attempt to confirm the diagnosis of a peroxisomal disorder, plasma levels of very long chain fatty acids (VLCFA) and phytanic acid were determined. In addition, fibroblasts profile of VLCFA and plasmalogen levels were evaluated for Case 2. Pathomorphological examinations represented by lymph node and kidney biopsies as well as postmortem examinations of liver, adrenals and brain were performed in Case 1.

The phenotypes of both siblings showed marked resemblance to those observed in children with Zellweger syndrome. The results of biochemical tests performed in Case 1, together with abundant peroxisomes in the liver and the wide spectrum of clinical abnormalities suggest pseudo-Zellweger or Zellweger-like syndromes, but no conclusive data have been found. The plasmalogen level in fibroblasts as well as the fibroblasts profile of VLCFA noted in Case 2 were within the normal range, thus excluding the possibility of a peroxisomal disorder.

The striking phenotype resemblance of the siblings mimicking Zellweger, together with discordant biochemical findings, are difficult to explain on the basis of currently available tests.
Clinical Management of Port-Wine Stain in Infants and Young Children Using the Flashlamp-Pulsed Dye Laser
Authors: Stuart Nelson J. , Applebaum Jay
Published: November 2007

The flashlamp-pulsed dye laser (FLPDL) at 585 nm, a wavelength well absorbed by oxyhemoglobin, causes highly selective vascular injury. In addition, the 450 microsecond pulse duration produced by this laser approximates the thermal relaxation time for dermal blood vessels thereby confining the energy to the target.

This new laser effects excellent lightening of port-wine stain (PWS) in infants and young children without the adverse complications of hypertrophic scarring, permanent pigmentation abnormality, or textural changes, complications often seen with conventional laser systems. The FLPDL now permits treatment of this patient population expected to gain the most benefit from early laser therapy in a much safer manner, before the psychological complications of being a "marked" person develop.

The purpose of this report is to: (1) describe the theoretical considerations behind achieving selective removal of PWS that can be understood and used by a nonsurgically-oriented practitioner; and (2) describe the practical application of the device used in the clinical management of infants and young children.
The Indian Experience with Hypertrophic Pyloric Stenosis
Authors: Sharma Mahesh , Jain S.K. , Pathania O.P. , Taneja S.B.
Published: November 2007

A study of 58 consecutive Indian infants operated for congenital hypertrophic pyloric stenosis revealed an accentuated male predominance in the incidence of the disease and far less preoperative hemetemesis as compared to that in their Western counterparts. 'Pyloric tumor' was palpable in 89% of cases. Only 34.5% of these infants were first born. Postoperative vomiting occured in 13.8% of patients and wound sepsis was not encountered.

Air contrast radiography confirmed the diagnosis in clinically doubtful cases.
Once-Daily Intramuscular Ceftriaxone in the Outpatient Treatment of Severe Community-Acquired Pneumonia in Children
Authors: Leibovitz Eugene , Tabachnik Elvan , Fliedel Orna , Steinberg Shoshana , Miskin Avraham , Askenazi Asaria , Barak Yigal
Published: November 2007

Ceftriaxone, a broad spectrum third-generation cephalosporin with a half-life of six to eight hours, was evaluated prospectively in 147 children with severe community-acquired bacterial pneumonia during the period 11/15/88-5/15/89. Thirty-nine of the children had been successfully treated with various oral antibiotics prior to admission. All the patients were initially hospitalized and started on once a day intramuscular ceftriaxone. Mean duration of ceftriaxone therapy was five days. Pathogens were recovered from blood cultures of 17 (11.6%) patients and included S. pneumoniae (13 patients), H. influenzae (three, all resistant to ampicillin) and S. viridans.1 All isolates were sensitive to ceftriaxone. An additional patient had L. pneumophila diagnosed by serology. Cure was achieved in 142 (96.6%) patients; improvement was usually observed within 24-48 hours. After 48 hours, 121 (82.2%) children could be discharged and continued the therapy on ambulatory basis. Based on previous experience we estimated that 383 hospitalization days were saved. No serious side effects were observed. Five patients were considered therapeutic failures; two of them developed empyema and one of them required repeated drainage procedures. A third patient experienced a relapse of pneumonia shortly after completion of therapy. The other two remained febrile for more than seven days; their subsequent improvement was unrelated to the antibiotic therapy, suggesting a viral or mycoplasmal syndrome. Our data suggest that once daily intramuscular ceftriaxone can be successfully used for the outpatient treatment of most community-acquired severe bacterial pneumonias in children. In our opinion it represents the treatment of choice for patients who failed treatment with other antimicrobials and are clinically stable enough not to require hospitalization.
Optimal Dosing Interval for Penicillin Treatment of Streptococcal Pharyngitis
Authors: Krober Marvin S. , Weir Michael R. , Themelis Nicholas J. , van Hamont John E.
Published: November 2007

One-hundred-forty-two children with symptomatic pharyngitis had throat cultures positive for group A beta-hemolytic streptococci (GABHA). All were treated orally with penicillin V for ten days. Patients were randomly assigned to receive daily doses of 250 mg four times daily, 500 mg twice daily, or 1000 mg once daily. They were followed four weeks for either recurrent symptomatic pharyngitis or asymptomatic repeat positive throat culture. Patients treated two or four times daily had comparable outcomes. Children given penicillin once daily were more likely to have persistent positive culture after 48 hours treatment (5 of 48 or 10.4% vs. none of 94, p=.004) and more likely to have recurrent positive cultures after end of treatment (10 of 43 or 23% vs. 8 of 94 or 8%, p=.04). The treatment regime of penicillin V 500 mg twice daily is recommended for treatment of pharyngitis due to GABHS.
Very Low Birth Weight Infants-Educational Outcome at School Age from Parental Questionnaire
Authors: Schmidt Rosemary E. , Wedig Kathy E.
Published: November 2007

Educational outcome of former very low birth weight infants, ≤ 1250 g., were obtained by a questionnaire mailed to the families' last known address. Fifty-seven infants were known to have survived the first year of life and an address was available for 49 families, 51 infants (two sets of twins). Forty families (82%) responded regarding 42 of the 57 infants (74%). Only one child had a major health problem, cerebral palsy and epilepsy. All the children were in school. Thirty-nine (93%) were in a regular class and three (7%) were in special classes. Twenty-six children (67%) in a regular class did not require special educational assistance, 13 (33%) did. Using the Hollingshead Four Factor Index, socioeconomic status affected outcome P=0.0068 (Fischer's exact test). There were 20 children in Classes I-III, upper socioeconomic and three children Class IV-V, lower socioeconomic, requiring no special education and six children in Class I-III and eight children in Class IV-V requiring special education. The neonatal risk factors birth weight, gestational age, appropriateness of weight for gestation, Apgar score, time to regain birth weight, and time on mechanical ventilation did not affect outcome. The only neonatal risk which was significantly different between the respondents and non-respondents was birth weight, P<0.020 for the children in a regular class without assistance and P<0.005 for children in a regular class with assistance. Overall, 40 percent of the children had repeated a grade. It is suggested that such a high risk group should be tested prior to school entry in order to reduce the chance of school failure.
Nailbiting
Authors: Leung Alexander K.C. , Robson Lane M.
Published: November 2007

Nailbiting is a common oral habit in children and young adults. It is estimated that 28 to 33% of children between the ages of 7 to 10 years and 45% of adolescents are nailbiters. The etiologies suggested for nailbiting include stress, imitation of other family members, heredity, a transference from the thumb sucking habit, and poorly manicured nails. Nailbiting is usually confined to the fingernails and most nailbiters bite all 10 fingers equally rather than selectively. Complications of nailbiting include damage to the cuticles and nails, secondary bacterial infection and dental problems. Treatment should be directed at any precipitating causes of stress. Reminders should only be used with the consent of the child. Care of the nails and cuticles, behavioral modification techniques, positive reinforcement, and regular follow-up are important aspects of treatment.

Nailbiting, or onychophagia, is defined as the habit of biting one's nails and is a common oral habit in children and young adults. Nailbiting is embarrassing, unattractive, socially undesirable, and can predispose to the development of paronychia. Physicians are frequently consulted about nailbiting but not withstanding the prevalence of the problem, there is a surprising lack of literature on nailbiting. The purpose of this article is to familiarize the reader with the problem and to suggest appropriate approaches to treatment.
Correlates of Emergency Room Utilization in the First Year of Life
Authors: Feigelman Susan , Duggan Anne K. , Bazell Carol M. , Baumgardner Rosemary A. , Mellits E. David , DeAngelis Catherine
Published: November 2007

We conducted a case-control study to examine the correlates of emergency room use in the first year of life, particularly the role of parental health beliefs, among the families of inner-city children enrolled in a hospital-based primary care program. Data were collected by structured interviews and by medical record review. Emergency room users were more likely to have single mothers and to have acute, recurrent medical conditions than were non-users. Health beliefs differed between groups by maternal report of worry about the kinds of illnesses that her child acquires. Emergency room use was predicted by: maternal marital status, maternal worry and concern that illness interferes with her child's activity, acute recurrent illnesses, hospitalization. This model may be applicable to other populations in designing intervention strategies to modify emergency room utilization.