bluuebunny/crossref_metadata_2025 huggingface dataset:
Teenage Fathers
Authors: Elster Arthur B. , Panzarine Susan
Published: November 2007

To determine the nature of the stresses experienced by teenage fathers, 20 youths (mean age, 17.6 years) were interviewed from one to four times during the prenatal period and at four to six weeks following delivery. While all conceptions had occurred premaritally, most couples had married by the time of delivery. A total of 44 interviews were performed: four during first trimester, 12 during second trimester, 17 during third trimester, and 11 postpartum. Stressors reported by the subjects were grouped into four categories: vocational-educational concerns, concerns about the health of the mother and/or the baby, concerns about future parenthood, and problems with relationships. It was found that the intensity of these concerns changed throughout pregnancy and the neonatal period. Subjects who had expected the pregnancy to occur tended to report less stress during the third trimester than did teens who had not antic ipated conception.
The Choking Chitd—A Life-threatening Emergency
Authors: Torrey Susan B.
Published: November 2007

Recently, there has been much controversy in the pediatric literature concerning the appropriate emergency treatment of the choking child. The current recommendations of the American Academy of Pediatrics suggest a series of back blows followed by several chest thrusts. The research literature supporting these recommendations is reviewed. In addition, the data of investigators who disagree with this approach are presented. It is concluded that; although there are inadequacies in all of the existing research, there are no contraindications to the AAP recommendations. It is suggested that our focus, as pediatricians, should be on educating the lay public in the performance of a series of routine maneuvers that may be life-saving.
Wilson's Disease in Childhood
Authors: Nazer Hisham , Ede Roland J. , Mowat Alex P. , Williams Roger
Published: November 2007

Although Wilson's Disease is a treatable disorder, 9 of 15 cases referred with undiagneased liver disease in the present series died in 3 to 53 days of admission. We have reviewed these cases to identify features that would allow earlier diagnosis and improvement in management. The presenting symptoms were lethargy and malaise (11 cases), jaundice (11), abdominal pain (9), and deteriorating school performance (4). At diagnosis, all fatal cases had jaundice and ascites, while only one of the 6 survivors had ascites and two had jaundice. Evidence of hemolysis was found in 3 fatal cases and 5 survivors. Serum bilirubin concentrations, aspartate trans aminase, and prolongation of prothrombin time were significantly more abnormal in the fatal cases (p < 0.01) as compared with the survivors. Cirrhosis was present in all fatal cases and in 2 off the 6 survivors. Wilson's Disease must be excluded in children presenting with frank liver disease as well as those with hemolytic anemia, persisting lethargy, abdominal pain, or dete riorating school performance.
Early Prediction of the Need for Hospitalization in Children with Acute Asthma
Authors: Silver Richard B. , Ginsburg Charles M.
Published: November 2007

We studied 133 asthmatic children in the emergency room who were aged 4 to 17 years and who were not receiving ongoing training in pulmonary function testing, to determine whether spirometry correlated with the outcome of the emergency treatment of the acute attack and with relapse during the next four days. A clinical score derived from the physical exam was obtained at the time of spirometry. Patients were hospitalized or discharged home based solely on their clinical response to therapy. The pediatrician making that decision was blinded to the results of the spirometry. The initial pretreatment clinical score or spirometry alone identified the majority of patients hospitalized, but each falsely identified many discharged patients who did not relapse, 20 percent and 15 percent, respectively. Predictive criteria for hospitalization, combining spirometry with a careful clinical evaluation prior to the start of emergency treatment, substantially reduced the number of falsely identified patients. With use of the predictive criteria, the majority of children admitted to the hospital would have been identified hours before that decision was made on clinical grounds alone (5.5 ± 0.7 hrs). This study suggests a role for spirometry as an adjunct to clinical evaluation in the early identification of the need for hospitalization of acutely ill asthmatic children.
Cardiovascular Malformations Associated with Extracardiac Anomalies and Malformation Syndromes
Authors: Greenwood Ronald D.
Published: November 2007

Infants with extracardiac anomalies or malformation syndromes frequently have associated cardiovascular malformations. Knowledge of these predictable patterns of associations allow rapid diagnosis and treatment of these infants.
Esophagitis Associated with Candida Infection in a Neonate
Authors: Petru Ann , Azimi Parvin H.
Published: November 2007

A 14-day old infant with stomatitis due to Candida albicans presented with frequent emesis and was found to have esophagitis by barium esophagram. She responded promptly to oral Mycostatin suspension: her emesis subsided and the stomatitis resolved. Repeat esophagram on the seventh day of therapy showed complete res olution of the esophageal mucosal abnormalities. Although Candida stomatitis is common in infants, the incidence and appropriate therapy of Candida esophagitis as a complication in otherwise normal infants are unknown. This patient responded well to frequent therapy with an oral, nonabsorbable antifungal agent.
Chorea as an Initial Manifestation of Systemic Lupus Erythematosus
Authors: Arisaka Osamu , Obinata Kaoru , Sasaki Hidekuni , Arisaka Madoka , Kaneko Kenichiro
Published: November 2007

Neurological complications of systemic lupus erythematosus (SLE) are relatively common, but isolated chorea as the initial manifestation of SLE is very rare. We report a 10-year-old girl presenting with chorea, who developed clinical and lab oratory findings of SLE 10 months after the onset of chorea. In this case, mild depression of complement levels in serum, which had already been found in the early stage of the chorea, was the only abnormal laboratory datum. The low serum complement levels that precede the appearance of other clinical and laboratory findings may be helpful for the diagnosis of isolated chorea involvement in SLE.
Chest Pain in Pediatric Patients Presenting to a Cardiac Clinic
Authors: Fyfe Derek A. , Moodie Douglas S.
Published: November 2007

Records of 67 pediatric patients with a primary complaint of chest pain were reviewed to determine the frequency of associated cardiac disease. Only four of 67 (6%) had chest pain associated with cardiac diseases that usually cause chest pain. Fifty-seven (85%) patients had chest pain in which no clear cause could be determined. Of these 57, 20 patients also had isolated congenital cardiac anomalies, i.e., atrial septal defect. A causal relationship of these lesions to the chest pain could not be established.

Thirty-four of the 37 patients with chest pain and no cardiac abnormalities were evaluated by telephone at a mean of 13 months after their clinic assessment. Twenty-nine of the 34 were either asymptomatic or had reduced symptoms. There was no correlation between duration of symptoms prior to their clinical study and the persistence of chest pain at follow-up.

From this study, we conclude that chest pain in pediatric patients is infrequently due to cardiac disease even when associated with previously unsuspected, isolated congenital cardiac lesions. Idiopathic chest pain tends to be self-limited.
Psychiatric Manifestations of Systemic Lupus Erythematosus in Children and Adolescents
Authors: Silber Tomas J. , Chatoor Irene , White Patience H.
Published: November 2007

The purpose of this article is to review the psychiatric conditions associated with systemic lupus erythematosus (SLE) in children and adolescents. Emphasis is placed on clinical presentation and the differential diagnosis between organic psychiatric disorder, toxic psychiatric disorder, and functional psychological symptoms.
Serum Levels of C-reactive Protein in Neonatal Respiratory Distress Syndrome
Authors: Dyck Roland F. , Bingham William , Tan Leonard , Rogers Susan L.
Published: November 2007

Serum levels of C-reactive protein (CRP) were measured within 96 hours of birth in 55 neonates with respiratory distress syndrome (RDS), 19 neonates with no significant medical illness other than an unstable cardiovascular state, and 13 neonates with a variety of pulmonary and extra pulmonary problems either alone or in combination with RDS. The median serum CRP level in patients with RDS (2 μg/ml) was neither elevated nor different from CRP levels in infants with unstable cardiovascular systems (median CRP level, 2 μg/ml); however, neonates with other prob lems including pneumonia, aspiration, and extrapulmonary sepsis had significantly elevated serum CRP values (median 24 μg/ml). CRP levels are not elevated in neonatal RDS. Measurement of this acute phase reactant provides a rapid and reliable means of helping to distinguish infants with uncomplicated RDS from those with other serious pulmonary and extrapulmonary disease.
Fatal Adenoviral (Type 7) Respiratory Disease in Neonates
Authors: Bhat Abdul M. , Meny Robert G. , Aranas Epifania A. , Yehia Fatima
Published: November 2007

Two cases of fatal neonatal adenoviral type 7 respiratory disease are described. The clinical, laboratory, x-ray, and pathological features of these two neonates and those reported in the literature are highlighted. Suggestions are made regarding how to diagnose this disease early so that the patients can be isolated and further spread of the disease prevented.
The Effect of the Tylenol Scare on Parent's Use of Over-the-counter Drugs
Authors: Dershewitz Robert A. , Levin Gerald S.
Published: November 2007

We administered a questionnaire to determine changes in parental use and administration of over-the-counter (OTC) drugs after cyanide-laced Extra-Strength Tylenol capsules caused the deaths of at least seven people in Illinois in 1982. Three hundred area parents were studied and divided into three equally sized groups on the basis of economic, educational, and professional criteria.

After the Tylenol murders, all groups became anxious about the safety of OTC drugs, but intergroup differences were highly significant (p = 0.001). Attitude changes, however, did not necessarily precipitate a change in behavior. Similar percentages of each of the groups who claimed to be adversely affected by the Tylenol scare gave OTC drugs as before.
Circumcision Using the Mogen Clamp
Authors: Kaweblum Yosef Aaron , Press Shirley , Kogan Leib , Levine Mauricio , Kaweblum Moises
Published: November 2007

The purpose of this study was to analyze the results of 313 circumcisions using the Mogen clamp. This procedure was done between 1 day and 2 years of age in all but four patients. The complication rate was low (1.6%). Two patients had local infection, one mild hemorrhage, one concealed penis, and one postcircumcision phimosis. Circumcision using the Mogen clamp is a simple, quick, and safe procedure.
The Pediatrician's Approach to the Preschool Child with Language Delay
Authors: Whitman Randal L. , Schwartz Ellen R.
Published: November 2007

A systematic approach to the child with suspected language disorder includes screening of expressive language, receptive language, general development, and hearing. Various screening approaches and tools are discussed. Diagnostic categories and associated referral patterns are recommended.
Hemolytic Anemia Following Postnatally Acquired Rubella During the 1975-1977 Rubella Epidemic in Japan
Authors: Ueda Kohji , Shingaki Yoshikiyo , Sato Tadashi , Tokugawa Ken , Sasaki Hideaki
Published: November 2007

Hemolytic anemia following postnatally acquired rubella first was reported by Sato et al. in 1977. Thirteen cases of hemolytic anemia (including two cases of hemolytic uremic syndrome) following postnatally acquired rubella infection reported in a nationwide epidemic of rubella in Japan in 1975-1977 are reviewed in this article, and another case is added. Clinical symptoms of hemolytic anemia occurred 2 to 6 days from the onset of rubella rash. Direct Coombs test was positive in three of the 11 cases tested, and the indirect test was positive in two of the 13 cases. Hemolytic anemia should be considered as a complication of postnatally acquired rubella, though to date, it has only been reported in Japan.
The Long-term Outcome of Nonsuppurative Otitis Media with Effusion
Authors: Dusdieker Lois B. , Smith Gary , Booth Brenda M. , Woodhead Jerold C. , Milavetz Gary
Published: November 2007

Seventy-four children were enrolled in a double-blind placebo-controlled study to define the outcome of nonsuppurative otitis media with effusion (OME) over a 12-week period. Participants were randomly assigned to one of three treatment groups: pseudoephedrine (4 mg/kg/day), chlorpheniramine (0.35 mg/kg/day), or placebo. The children were reexamined at 2, 4, 8, and 12 weeks after enrollment unless earlier dismissed from the study because OME resolved or acute suppurative otitis media developed. Of the 66 children completing the study protocol, 44 percent had resolved OME, 38 percent developed acute suppurative otitis media, 14 percent had unresolved OME, and 4 percent developed severe hearing loss or medication side effects by the end of 12 weeks. The greatest incidence of both suppurative otitis media and resolution of OME occurred by 2 weeks of follow-up. There was no significant difference in resolution of effusion between treatment groups. Children who were 18 months of age or older with unilateral effusion had the best likelihood of resolution.
Asymptomatic Varicocele in an Infant
Authors: Sawczuk Ihor S. , Burbige Kevin A. , Hensle Terry W.
Published: November 2007

Varicoceles are a common cause of male infertility. The incidence of varicoceles at puberty is approximately 16 percent, but in prepubertal males, they are rare. We present a case of a varicocele in a 1½-year-old male and discuss whether early recognition and surgical correction may preserve male fertility potential.
Nutritional Consequences of Drugs Used in Pediatrics
Authors: Oiness Karen N.
Published: November 2007

Pediatric drugs may have significant nutritional consequences via their effects on appetite, nutrient absorption, nutrient metabolism, and nutrient excretion. Examples of common drugs and effects on nutrition include the inhibition of vitamin C storage by aspirin; impairment of folic acid utilization by phenobarbital; phenylalanine accumulation by trimethoprim; and lipolysis caused by caffeine. Nutritional consequences of drugs are of greater clinical significance in children who are malnourished and in those on drugs for prolonged periods. It is important that physicians consider possible deleterious consequences of drugs in making therapeutic choices.
Nonparametric Methods
Authors: Brown George W. , Hayden Gregory F.
Published: November 2007

In clinical research, "samples" are studied in order to get ideas about the characteristics of the larger populations from which the samples are taken. Population characteristics are called parameters (the population mean and standard deviation are examples). Parametric statistical methods are those that require estimates of parameters and assumptions about the source populations. Familiar examples of parametric methods are the t test, analysis of variance, and Pearson's correlation coefficient.

Nonparametric (NP) methods do not require estimates of population parameters. These methods are sometimes called "distribution-free" because the samples of interest can be evaluated without concern for the shape (distribution) of the values in the populations providing the samples. NP methods also are called "ranking" or "ordering" tests, because the relative size or order of the observations may be evaluated, rather than requiring actual measurements.

More than 30% of the research reports that appeared between July 1982 and June 1983, in four pediatric journals, employed at least one nonparametric method. The commonly used tests were chi-square, the Fisher exact test, and various "ranking" methods.

An alphabetical list of common nonparametric tests is presented, with brief comments about each. Tables are presented, arranged by types of observations, so that the nature of the data guides the user to the method that might be used.
Acute Leukemia Presenting as Arthritis in Children
Authors: Saulsbury Frank T. , Sabio Hernan
Published: November 2007

The clinical and laboratory features of six children with arthritis as the presenting manifestation of acute leukemia are reviewed. Asymmetric arthritis involving the large joints of the extremities was the dominant clinical feature in all patients. Despite the presence of antinuclear antibody in three patients, other laboratory features, particularly hematologic abnormalities, served as clues to the diagnosis of leukemic arthropathy in most patients.
Questionnaire Use in Pediatric Practice
Authors: Sturner Raymond A. , Eisert Debra C. , Mabe Alex , Thomas Patricia
Published: November 2007

A sample of members of the American Academy of Pediatrics were surveyed to determine the nature and extent of questionnaire use in pediatric practice and to assess practitioners' attitudes toward questionnaires. Thirty-eight percent of 169 respondents (of 300 contacted) reported that they were using a questionnaire in their clinical practice and an additional 36 percent indicated interest in possible future use. Most (89%) questionnaires were constructed by the practitioners themselves. Questionnaire use was associated with group practice and prepaid fee plans. Effitciency was the most common reason given for questionnaire use and impersonality was the most commonly cited objection. Practitioners' attitudes toward questionnaires are discussed.
Actinomycosis Meningitis in a Girl with Incontinentia Pigmenti
Authors: Diamantopoulos Nicholas , Bergman Ira , Kaplan Sandra
Published: November 2007

A 7-year-old girl with incontinentia pigmenti and a history of multiple bacterial infections developed chronic meningitis with Actinomycosis odontolyticus, which was successfully treated with long-term penicillin administration. Although all tests of immunologic function were normal in this patient, her history of recurrent and unusual infections is consistent with previous suggestions of an undefined immu nodeficiency state associated with incontinentia pigmenti.
Iron Fortification of Infant Foods
Authors: Rees Jane Mitchell , Monsen Elaine R. , Merrill Judith E.
Published: November 2007

A survey of iron-fortified commercial foods commonly marketed for consumption by infants was conducted in 1972 and again in 1982. Positive changes had occurred in infant formulas and cereals during that decade, in availability of fortifying iron, level of fortification, and label infor mation. Miscellaneous iron-containing products, cookies, and crackers were unreliable sources of dietary iron in both 1972 and 1982. Availability of fortifying iron in regular cereals had improved by 1982, though 10 percent lacked the label information. Fortified infant formulas and cereals contribute iron of high bioavailability to the typical infant diet in amounts equal to the USRDA. Food manufacturers need to continue to apply knowledge gained through research to sustain the lessened but still highly prevalent incidence of anemia in 1-2-year old children.
A Retrospective Evaluation of Psychosocial impact of Long-term Growth Hormone Therapy
Authors: Mitchell C.M. , Joyce Susan , Johanson Ann J. , Libber Samuel , Plotnick Leslie , Migeon Claude J. , Blizzard Robert M.
Published: November 2007

Fifty-eight growth hormone (hGH) deficient adults who had received long-term hGH therapy and their families were contacted to assess their past and current status regarding peer relationships, educational and vocational achievements, and self-concepts. Both heterosexual and same-sex peer relationships were reported as troublesome; most reported problems with having been treated as younger than their chronologic ages. The majority reported average or above average academic performance; there were no significant differences between academic achievements of the expatients and their siblings; the greatest portion of the sample were employed at least part-time and were satisfied with their employment status. On self-concept measures, the sample rated themselves higher in self-satisfaction, personal work, and sociality, but lower on physical self and self-criticism than norms; most of the parents reported no significant differences between the patients' adjustment and that of their siblings. In addition, the recommendations from the group to others considering hGH treatment and to medical personnel working with such families are noted; implications for hGH intervention are discussed.
Adrenocortical Suppression by Topical Application of Glucocorticosteroids in Infants with Seborrheic Dermatitis
Authors: Shohat M. , Mimouni M. , Shuper A. , Varsano I.
Published: November 2007

Fifteen infants with seborrheic dermatitis were treated with topical glucocorticosteroids (flumethasone pivalate 0.02%). Early morning plasma cortisol levels were determined prior to treatment, during the 10-day treatment period, and 2 days after its termination. The mean plasma cortisol level prior to treatment was 8.8 ± 3.4 μg%; after 2 days of application there was a significant decrease of the mean to 2.5 ± 1.3 μg% that persisted throughout the treatment period. Two days after termination of treatment, the mean plasma cortisol level rose to 7.1 ± 3.7 μg% but in five infants was still less than 5 μg% and in two less than 2 μg%, the latter two having shown the greatest involvement of the skin. The possibility of pituitary/adrenocortical inhibition similar to that observed with the systemic administration of glucocorticosteroids and the potential associated risks should be considered when treating cases that would require extensive application of flumethasone pivalate in infants.
Nutritional Vitamin B12 Deficiency in a Breast-fed Infant of a Vegan-diet Mother
Authors: Sklar Ronald
Published: November 2007

A 7-month-old male presented with lethargy and failure to thrive. The child was exclusively breast-fed from birth by a mother who was a strict vegetarian. Laboratory data revealed macrocytic anemia and methylmalonic acid in the urine, consistent with vitamin B12 deficient anemia. The patient responded well to supplementation with B12 alone and was developmentally normal by 11 months of age. This study emphasizes the need for assuring maternal dietary adequacy during pregnancy and after birth.
Acquired Epileptic Aphasia
Authors: Msall Michael , Shapiro Bruce , Balfour Patricia B. , Niedermeyer Ernst , Capute Arnold J.
Published: November 2007

A case of acquired epileptic aphasia presenting as language delay and hyperactivity is presented and clinical aspects reviewed. Acquired epileptic aphasia is a diffuse neurologic process of unknown etiology that presents in preschool children. Although progressive language loss and seizures are the major manifestations, deficits in attention and socialization may be noted. The electroencephalogram is usually diagnostic. While almost all (80%) children develop seizures, approximately half present as language delay without seizures. Recognition of the progressive and global nature of the language dysfunction may permit earlier diagnosis and intervention.
Maternal Diabetic Control and Hypertrophic Cardiomyopathy in Infants of Diabetic Mothers
Authors: Sheehan Pauline Q. , Rowland Thomas W. , Shah Bhavesh L. , McGravey Vincent J. , Reiter Edward O.
Published: November 2007

Hypertrophic cardiomyopathy has been well documented in infants of diabetic mothers (IDMs). If this asymmetric septal enlargement is an anabolic result of fetal hyperinsulinemia triggered by maternal hyperglycemia during the third trimester, maternal glycosylated hemoglobin (HbA1) levels, an indicator of glycemic control, should then correlate positively at delivery with newborn ventricular septal thickness. In this study of 20 infants of well-controlled diabetic mothers, no relationship was observed between echocardiographic evidence of hypertrophic cardiomyopathy and maternal HbA1 levels. Seven babies (35%) exhibited exaggerated septal thickening, but none had cardiac-specific symptoms. Although 60 percent of the IDMs were large for gestational age and 45 percent demonstrated neonatal hypoglycemia, neither of these complications correlated with maternal HbA 1. In this group of babies of well-controlled diabetic women, echocardiographic indicators of cardiomyopathy were common, but clinical evidence of cardiac embarrassment was not observed. Moreover, these data do not support third trimester maternal hyperglycemia as instrumental in the etiology of cardiomyopathy and other complications of IDMs.
Leukocyte and Neutrophil Counts in Healthy Puerto Rican Children and Children with Acute Appendicitis
Authors: Iosub Silvia , Naik Maheschandra , Bhalani Kirit , Gromisch Donald S.
Published: November 2007

Blood counts were performed on 107 healthy Puerto Rican children aged 1 to 5 years to establish normal ranges of leukocyte and neutrophil counts and were compared with preoperative counts in 30 Puerto Rican children with acute appendicitis and also with values published in healthy black and white children of the same age. In healthy Puerto Rican patients and in patients with acute appendicitis, the mean leukocyte and neutrophil counts were significantly higher than in blacks.
Developmental Regression as an Early Manifestation of Vitamin B12 Deficiency
Authors: Sadowitz P. David , Livingston Anne , Cavanaugh Robert M.
Published: November 2007

Loss of previously attained developmental milestones in an infant is often associated with central nervous system tumor, neuromuscular disease, or an inborn metabolic error. An infant with developmental regression and involuntary movements who was found to be vitamin B12 deficient on the basis of unrecognized maternal vitamin B12 deficiency is described. The infant had a dramatic neurologic recovery after receiving vitamin B12. The case and a review of similar cases is presented.
The Use of a Rapid Theophylline Assay in the Ambulatory Setting
Authors: Munzenberger Paul J. , Massoud Neil , Papaioanou Helen A.
Published: November 2007

The Seralyzer reflectance photometer was evaluated in three ambulatory settings. Of the total 99 assays in the pediatric general medicine clinic, 47 were below the therapeutic range, and 20 patients were noncompliant. There were 13 low and nine high levels along with 22 noncompliant patients detected from a total of 109 in the allergy clinic. The physician's office documented 43 low and four high levels along with 10 noncompliant patients from 105 assays. The mean time required for Seralyzer results in both the allergy and pediatric general medicine clinic was 13 minutes. Regression analysis of both finger-stick and venipuncture split samples indicated a strong correlation between Seralyzer results and traditional methods of assay (r = 0.94 and 0.99, respectively). The Seralyzer proved accurate, timely, and simple to operate.
"Latchkey"
Authors: Kelly Patrick C. , Weir Michael R. , Atkinson A.W. , Lampe Richard M. , Schydlower Manuel , Fearnow Ronald G.
Published: November 2007

Two to five million children, 6 through 13 years old, are unsupervised at home after school. This practice, called "latchkey," involves issues of children without adult supervision for periods of time and questions of safety and social isolation. There are no published age guidelines for "latchkey" or data on actual practice. To investigate age guideline opinions and the factors that influence them, a survey of pediatricians (the professional voice), military police (the legal voice), and parents (the popular voice) was undertaken. Solicited opinions concerned ages at which children can be left alone for brief or extended periods and can be allowed to babysit younger chidren. The three "voices" expressed similar mean ages and distributions for each of the "latchkey" questions. For less than 15 minutes without supervision, the means approximated 9 years; for periods of 1 hour or longer, 12 years; and for babysitting, 14 years. The data presented do not address actual or appropriate practice, but instead provide a basis to begin investigation.
Clinical Associations of Aeromonas spp. in Fecal Specimens from Children
Authors: Nazer Hisham , Price Elizabeth H. , Hunt George H. , Walker-Smith John A.
Published: November 2007

Human infections caused by Aeromonas spp. are being reported with increased frequency. We examined 1012 unselected stool specimens from 799 children for various pathogens, including Aeromonas spp., to evaluate the clinical associations of Aeromonas spp. in the stools of children in the East End of London. A total of 33 children had positive cultures for Aeromonas spp. These were identified as: Aeromonas hydrophila (16), A. sobria (9), A. caviae (8). Aeromonas spp. were identified by being oxidase positive in character, a property that distinguishes Aeromonas spp. from Enterobacteriaceae. Associated pathogens included Salmonella typhimurium (1), Campylobacter spp. (3), Enteropathogenic Escherichia coli (2), and Giardia lamblia (1). Electron microscopic examination of the stool of 13 children revealed viral particles in two, rotavirus (1), and coronavirus-like particles (1). The associated clinical features in the 25 children with only Aeromonas excretion were diarrhea (21), vomiting (10), abdominal pain (9), fever (4), and mild dehydration (2). Five patients had macroscopic blood loss in the stools. The illness was generally mild and lasted only a short time.
Reliability of Plasma Creatinine Measurement in Infants and Children
Authors: Clermont Marie Jose , Brion Luc P. , Schwartz George J.
Published: November 2007

Plasma creatinine (Pcr, mg/dl) is often used to estimate glomerular filtration rate (GFR) in children. To establish whether the clinician can rely on the commonly used methods for measuring Pcr, the authors analyzed data from their own modified Technicon Autoanalyzer reference method and compared them to those obtained simultaneously from a Beckman Astra 8 kinetic Jaffe technique or a Technicon continuous flow Jaffe endpoint SMAC method. The SMAC method consistently overestimated Pcr by 0.1 mg/dl, whereas the kinetic method resulted in a large spread around the reference values. Neither laboratory gave consistent results for Pcr below 0.55, the normal range for infants and young children. The SMAC technique tended to underestimate GFR by 20 to 30 percent, whereas the kinetic method resulted in a great deal of scatter (only 37% of the measurements fell within ±25% of the values for GFR obtained by the reference method).

The results suggest that the subtraction of 0.1 mg/dl from the Pcr measured on the SMAC system would give a value similar to that obtained with the reference method. This correction would permit the use of an estimate of GFR from kL/Pcr, where L is body length in cm and k is a constant (equalling 0.45 in term infants, 0.55 in children, and 0.7 in adolescent boys). The kinetic method requires repetitive determinations of Pcr before any firm conclusions can be drawn about GFR because of the scatter. The reliability of the clinician's laboratory can be tested by sending half the plasma to the laboratory on one day and the other half the next; the values should usually differ by <0.1 mg/dl or <15 percent, otherwise another laboratory should be consulted. It is suggested that both the kinetic and SMAC methods may lead to inaccuracies in the measurement of Pcr and therefore in the estimation of GFR in children from kL/Pcr.
Responders, Nonresponders, and Placebo Responders Among Children with Attention Deficit Disorder
Authors: Ullmann Rina K. , Sleator Esther K.
Published: November 2007

The responses to methylphenidate of 118 children with attention deficit disorder (ADD) were studied under double-blind conditions. Three distinct types of response to medication and placebo were found, as determined by teacher ratings. One group, called "responders," improved dramatically in attention and hyperactivity ratings on active medication but showed essentially no change from baseline when on placebo. The group called "nonresponders" showed minimal change in ratings on either placebo or medication. The third group, "placebo responders," showed almost as much improvement as the responders on medication, but their ratings were not very different from medication ratings during the placebo trial. The placebo responders, 18 percent of the group, would have been considered responders in a nonplacebo-controlled study. Double-blind placebo evaluation of ADD children can and should be done by practitioners to avoid medicating children who are responding to nonspecific effects of drugs.
Abnormal Sweat Electrolytes in a Case of Celiac Disease and a Case of Psychosocial Failure to Thrive
Authors: Ruddy Richard M. , Scanlin Thomas F.
Published: November 2007

Sweat electrolytes were initially elevated in a child who was diagnosed as having celiac disease and also in one with psychosocial failure to thrive. Subsequent sweat tests were normal after nutritional status of the patients had improved with therapy. The reports of elevated sweat electrolytes in conditions other than cystic fibrosis are discussed. It is emphasized that sweat test methods other than the quantitative pilocarpine iontophoresis method are not reliable. The occurrence of false-positive sweat tests demonstrates the need for care in the interpretation of elevated sweat electrolytes and the necessity of performing repeat quantitative pilocarpine iontophoresis for the establishment of the diagnosis of CF. Celiac disease and malnutrition from other causes may cause sweat electrolytes to be elevated.
Dermatophytosis of the Diaper Area
Authors: Kahana Michael , Levi Ahron , Cohen Michael , Schewach-Millet Miriam , Shalish Lea
Published: November 2007

Six cases of dermatophytosis of the diaper area due to either Epadermophyton floccosum or Trichophyton rubrum are described herein. The clinical and laboratory features of these patients and those reported in the literature are highlighted. Dermatophytosis should be considered in the differential diagnosis of rashes in the diaper area. Most standard remedies for diaper rash will not be effective or may exacerbate diaper dermatophytosis. Recognition of this condition by the clinician will lead to earlier rational treatment and may avoid the delay caused by therapy.
Experience of Families with Very Low Birthweight Children with Neurologic Sequelae
Authors: Rivers Ann , Caron Blanche , Hack Maureen
Published: November 2007

To describe the quality of life for surviving very low birthweight (VLBW, <1.5 kg) children and their families, the authors interviewed the parents of 22 neurologically abnormal VLBW children, 3 to 7 years after their birth and compared them to the parents of 15 neurologically normal VLBW children. The infants were born between 1976 and 1979, (mean birthweight, 1.2 kg; mean gestational age, 30 weeks). They included three with spastic quadriplegia, 14 with spastic diplegia, and five with hydrocephalus. Eight children were not walking. Seven families rated their child's neurologic problem as severe, while 15 rated the problem as mild.

Neurologically abnormal children tended to display more screaming and crying than the normal children. Cost of ongoing medical care was a problem for families of nine neurologically abnormal as compared with two families of normal children. The abnormal children required a total of 61 postneonatal rehospitalizations versus 11 in the normal group. Families of neurologically abnormal children reported on significant major changes in their personal lives for the care of their child. Both groups of parents reported heightened appreciation of their child. Plans for future children were affected in both.

Parents identified an urgent need for better medical information, education of pediatricians regarding preterm development and neurologic sequelae, and better contact and support among parents themselves.
Grief Reaction to Sudden Unexpected Cardiorespiratory Arrest in a Normal Newborn Nursery
Authors: Sheagren Thomas G. , Puppala Bhagya L. , Mangurten Henry H.
Published: November 2007

The authors report two cases of sudden unexpected cardiorespiratory arrest occurring in a normal newborn nursery. They discuss the impact on the families and hospital personnel. The nursing and medical staff demonstrated many of the reactions experienced by families of sudden infant death syndrome (SIDS) victims, including shock, anger, guilt, disbelief, fear, and doubt. The manner in which hospital personnel were supported and counseled is discussed. Specific clinical implications of these cases, including the need to provide for appropriate monitoring and resuscitation in normal newborn nurseries, are presented.
Meningococcal Conjunctivitis in Neonates
Authors: Kenny Jean F.
Published: November 2007

Three neonates were admitted with purulent conjunctivitis, and an initial diagnosis of gonococcal ophthalmia was made because gram-negative diplococci were seen on gram stains of conjunctival exudates. Meningococci were grown from eye exudates of all three infants and from the blood of one. Since Neisseria species other than gonococci can sometimes cause neonatal ophthalmia, an etiologic diagnosis should not be made until microbiologic identification is complete. Before the results of definitive bacteriologic studies are known, care should be taken in discussing the cause of the infection with family members and in planning their medical management. Since systemic infections may occur in some infants with ophthalmia due to Neisseria species, blood and spinal fluid in addition to eye exudate cultures may be indicated, and patients should be managed with parenteral antibiotics.
The Effect of Lumbar Puncture Procedure on Blood Glucose Level and Leukocyte Count in Infants
Authors: Shohat M. , Goodman Z. , Rogovin H. , Nitzan M.
Published: November 2007

Blood glucose level, urea concentration, and total white blood cell count were determined both before and 10-15 minutes after lumbar puncture (LP) procedure in 26 infants suspected of having meningitis. There was a significant (p < 0.001) increase in the peripheral white blood cell (WBC) count (mean ± standard deviation) from 10,960 ± 3,500 cells/μl before to 13,300 ± 3,970 cells/μl following the LP procedure, due to relative rise in the neutrophils and lymphocytes. Blood glucose levels did not change significantly following this procedure (85.3 ± 13.4 mg/dl and 84.1 ± 12.6 mg/dl respectively). An LP procedure does not impair correct cerebrospinal fluid glucose/blood glucose determination but may cause elevation of peripheral WBC count.
Family Interactions Surrounding Feedings of Infants With Nonorganic Failure to Thrive
Authors: Fosson Abe , Wilson John
Published: November 2007

Family interactional processes surrounding infant feedings in 34 consecutive cases of nonorganic failure to thrive (NFT) admitted to a university teaching hospital are reported. Observations of family interactions for 90 minutes, including one feeding, yielded clinically useful information not readily available from other sources. Behaviors that supported inadequate feedings were reliably identified in 79 percent of the families. Failure of mothers to appropriately respond to their infants' cues, coupled with few signs of emotional attachment, were present in only 26 percent of cases, and inadequate child-care knowledge and skills in only 6 percent. Thus, widely held conceptual models explained perpetuation of inadequate feedings in only 32 percent of cases. Instead, sibling rivalry, displaced maternal anger, and undermined mother were among the problems found. Assessments of family members' interactions surrounding feedings have the potential to enhance the current management of NFT.
Chronic Pigmented Purpura: A Case Report of Schamberg's Disease
Authors: Kerem Eitan , Branski David , Gross-Kieselstein Eva , Hurvitz Haggit , Abrahamov Abraham
Published: November 2007

The syndrome of chronic pigmented purpura (CPP) consists of pigmented macular lesions, predominantly involving the lower extremities. An 11-year-old girl was diagnosed initially as suffering from vasculitic purpura, but the clinical course and the skin histology proved to be consistent with CPP. This syndrome should be included in the differential diagnosis of childhood purpura.
Vitamin B12 Deficiency Due to a Strictly Vegetarian Diet in Adolescence
Authors: Ashkenazi S. , Weitz R. , Varsano I. , Mimouni M.
Published: November 2007

A 14-year-old white girl suffered from severe neurologic disturbances caused by vitamin B12 deficiency, due to failure to provide vitamin B12 supplementation to a strictly vegetarian diet. The disturbances resolved completely following treatment with vatamin B12. Physicians should be alert to the necessity for vitamin B12 supplementation for strict vegetarians, who eat no meat, fish, eggs, or dairy products.
Congenital Ocular Motor Apraxia
Authors: PeBenito Rhandy , Cracco Joan B.
Published: November 2007

Two children with congenital ocular motor apraxia (C-OMA) associated with congenital malformations of the central nervous system (CNS) are presented, and the literature is reviewed. C-OMA is an abnormality of ocular motility characterized by defective or absent voluntary horizontal gaze, associated with a characteristic head thrust. Although not rare, it is infrequently recognized. C-OMA is not a specific disease entity, but a sign. It may be associated with other static congenital CNS disorders and must be distinguished from acquired ocular motor apraxias (A-OMA) seen in progressive brain disorders and in certain serious systemic diseases. Therefore, when movements typical of C-OMA are observed, a careful systemic and neurologic examination should be performed, including immunoglobulin screening, cranial computerized tomography scanning, and adequate follow-up. Close relatives also should be examined.
Long-term Prognosis for Children With Nephrotic Syndrome
Authors: Wynn Susan R. , Stickler Gunnar B. , Burke Edmund C.
Published: November 2007

Follow-up survival and health information were obtained, after a median of 27.5 years, from 132 patients who had been seen originally as children with nephrotic syndrome between 1951 and 1967. Ninety seven patients were alive. Recurring edema or proteinuria, or both, persisted in 15 percent of those still alive. Eight of 11 parous women reported relapses during pregnancy. There was no apparent increase in malignancies, atopic diseases, clinical defects in cell-mediated immunity, or cardiovascular diseases.

Twenty two patients (17%) died of renal causes between 3 months and 8 years after the onset of nephrotic syndrome. Steroid resistance was the presenting feature universally predictive of a poor outcome; nine of the 11 such patients died and the other two are now receiving hemodialysis. Hematuria was present initially in 41 percent of the patients who died of renal causes, compared with 14 percent of those still alive. Hypertension was noted on the first examination in 22 percent of those who died of renal causes, compared with 10 percent of those alive.
Postnatal IgG Levels in Very-low-birth-weight Infants
Authors: Sasidharan P.
Published: November 2007

We studied the gammaglobulin levels (IgG) postnatally, serially, in 42 infants of very low birthweight (mean ± SD 971 ± 225 g) with gestational ages ranging from 23 to 31 weeks. Eighteen infants (42.8%) had IgG levels of less than 100 mg/dl by a mean postnatal age of 71.2 ±16 days. The lowest level was 22 mg/dl in an infant whose birthweight was 700 g. Sixteen of the 42 infants (mean birthweight 946.8 ± 260 g) also had cord blood IgG levels determined. The mean cord blood IgG was 413.5 ± 163 mg/dl. This had dropped to 140.3 ± 87 mg/dl by 57 days, a drop of 66 percent. As expected, the lowest IgG levels postnatally was a reflection of the degree of prematurity and the length of postnatal age. Such extremely low levels of IgG have not been reported previously.
Bone Status in Nonambulant, Epileptic, Institutionalized Youth
Authors: Fischer Milton H. , Adkins William N. , Liebl Birgit H. , VanCalcar Sandra C. , Marlett Judith A.
Published: November 2007

This study was conducted to determine if the adverse effects of anticonvulsant drug therapy and nonambulancy on bone status could be overcome with vitamin D therapy in severely handicapped individuals. Six male and five female gastrostomy fed, nonambulant, epileptic, profoundly mentally retarded individuals ranging in age from 7 to 17 years were given vitamin D therapy at a dosage of 4,000 IU/m2 body surface area/day for 6 months. Photon absorptiometry and biochemical indices of bone status were measured to follow the effects of therapy.

Bone mineral content expressed as a percentage of normal improved by 11 percent (p < 0.01), from 59.6 to 66.1 percent. Tartrate-resistant acid phosphatase, total alkaline phosphatase, and the bone isoenzyme activities declined 11 percent, 18 percent, and 11 percent respectively. These reductions were not statistically significant but they were consistent with the improvements observed by photon absorptiometry.

The results of our study suggest that a conservative supplement of vitamin D will improve the bone status of severely disabled youths.
Carving a Niche—The General Academic Pediatrician as Consultant
Authors: Listernick Robert , Tanz Robert R. , Davis A. Todd
Published: November 2007

The role of the general pediatrician as a specialist is often unclear to the majority of physicians and patients. The role of the general academic pediatrician (GAP) as a consulting subspecialist also is in need of definition. We surveyed a consultation service staffed primarily by three GAPs in our tertiary care children's hospital. During the 12-month survey, 275 patients with a mean age of 5.6 years were evaluated. The mean duration of the chief complaint prior to the initial visit was 12.3 months. A total of 254 (92%) were evaluated initially as outpatients; of these, 20 (8%) were eventually hospitalized. Only 29 percent of the patients were referred to pediatric subspecialists. GAPs acting as consultants in a tertiary care setting most often see patients with long-standing complaints that do not require hospitalization or subspecialist referral, but their role at times is expanded to include more acute and more complex problems. Referrals may come from primary care physicians or from tertiary care subspecialists, particulary surgeons, or by self-referral from the patients' families.