bluuebunny/crossref_metadata_2025 huggingface dataset:
Neonatal Diabetes Mellitus in First Cousins
Authors: Mathew Puthenpurackal M. , Hann Richard W. , Hamdan Jahed A.
Published: November 2007

The cases of two first cousins with neonatal diabetes mellitus are presented in this report. In one child the condition was transient, whereas the other has permanent diabetes mellitus. It seems unlikely that the difference in outcome was related to the degree of diabetic control early in the course of the disorder. The possibility of genetic influence in the etiology of neonatal diabetes is stressed. Chlorpropamide was not useful in curing neonatal diabetes mellitus in one case.
Henoch-Schönlein Syndrome
Authors: McCrindle Brian W. , Wood Robert A. , Nussbaum Anna R.
Published: November 2007

Henoch-Schönlein Syndrome (HSS) is characterized by the presence of purpuric skin lesions, colicky abdominal pain, renal manifestations, and arthritis. We report a case complicated by several unusual manifestations, including hydrops of the gallbladder and extreme thrombocytosis. Gallbladder hydrops has been known to occur in association with several conditions including Kawasaki syndrome, scarlet fever, and leptospirosis, but no previous report of this occurring in a patient with HSS could be found. The hydrops in our patient resolved spontaneously without specific medical or surgical treatment.
Use of the Haemophilus influenzae Type b Vaccine Among Preschool Attendees
Authors: Gilsdorf Janet R.
Published: November 2007

Use of the Hib vaccine during the first 15 months after licensure was studied in a university-based preschool program. Questionnaires were sent to the parents of the 176 children, ages 29-82 months, enrolled; 115 questionnaires (65.3%) were returned. Fifty seven children (49.6%) had received the Hib vaccine; the mean age at immunization was 40.6 months (range, 22-70 months). Of the 17 children who were under age 24 months at the time of vaccine licensure (April 1985), 14 (82%) were ultimately immunized. One child (age 22 months) received the vaccine before age 24 months. At 15 months after licensure, 80 percent of the 2-year-old children were immunized; 78 percent of 3 year olds; 55 percent of 4 year olds; 15 percent of 5 year olds; and 17 percent of 6 year olds.

Thus, although the vaccine was underused as defined by the current recommendations for this group of children, the majority of children at greatest risk for disease—those under age 4 years—were immunized.
Relationships Between Laterality of Congenital Upper Limb Reduction Defects and School Performance
Authors: Dlugosz Lawrence J. , Byers Tim , Msall Michael E. , Marshall James , Lesswing Allen , Cooke Robert E.
Published: November 2007

Eighty children (34 males, 46 females) with congenital upper limb reduction defects who attended a regional amputee clinic between 1956 and 1986 were classified as to whether they exhibited learning difficulties in school, as indicated by grade failure or by placement in learning disability classrooms. Children with right-sided defects were more likely to encounter learning difficulties than were children with left-sided defects (Chi-square = 6.8; df = 1; p < 0.01). Children with right-limb defects also were more likely than children with left-limb defects to experience reading problems (Chi-square = 5.9; df = 1; p < 0.05). These results suggest the need for neuropsychological and neurophysiological study of children with limb reduction defects.
Recurrent Hypothermia and Thrombocytopenia After Severe Neonatal Brain Infection
Authors: Holm Ingrid A. , McLaughlin John F. , Feldman Kenneth , Stone E. Franklin
Published: November 2007

Two children with multiple severe disabilities due to brain destruction by neonatal infection had recurrent hypothermia (<34°C) with associated thrombocytopenia (<50,000), and clinical hemorrhage. They also had milder, less consistent erythroid and myeloid cell line abnormalities. The hypothermia was presumed to be due to hypothalamic dysfunction. Rewarming was always followed by correction of hematologic problems, but normal temperature was difficult to maintain. Recognition of this entity may improve long-term management of some severely disabled children.
Athletic Overuse Injuries in Children
Authors: Kannus Pekka , Niittymäki Seppo , Järvinen Markku
Published: November 2007

A 30-month prospective follow-up study of children's overuse injuries at an outpatient sports clinic was carried out to determine the number, profile, and specific features of these injuries compared with those of young adults. During this period 74 athletically active boys (≤15 years), 83 girls, 255 men (21-30 years), and 77 women visited the station because of an overuse sports injury of the musculoskeletal system. About one-third of the patients of each group did not seek medical help until more than 6 months after the onset of the symptoms.

The injuries most commonly affected the lower extremities, with the knee joint involved in about one third of patients. In girls and women, the lower back (13%) was significantly more frequently affected than in boys and men (6%) (p < 0.01). Thirty two percent of all boys' overuse problems were classified as exercise-induced growth disorders and osteochondritic pains (apophysitides, etc.), but in girls only 13% had a similar basis. The most common diagnosis among boys was Osgood-Schlatter's disease (13 patients, 18%); in girls it was nonspecific synovitis of the knee (9, 16%).
Necrotizing Fasciitis as a Complication of Chickenpox
Authors: Falcone Philip A. , Pricolo Victor E. , Edstrom Lee E.
Published: November 2007

Necrotizing fasciitis is a rapid, potentially fatal soft tissue infection. Chickenpox is a common childhood illness not usually associated with severe complications. We present the case of an 8-year-old girl with necrotizing fasciitis of the upper back arising from superinfection of varicella skin lesions. Necrotizing fasciitis may have devastating sequelae, including septic shock, which mandate vigorous fluid resuscitation, appropriate antimicrobial therapy, and early aggressive surgical debridement.
Aldosterone-producing Adenoma Presenting with Hypokalemic Myopathy
Authors: Dickson Bryan A. , Franks Robert C.
Published: November 2007

A 9-year-old boy who complained of fatigue, myalgias, and progressive weakness was found to have a markedly elevated serum creatine phosphokinase (CPK). He developed polyuria with polydipsia and was noted to be hypertensive and severely hypokalemic. Treatment with potassium and spironolactone alleviated his signs and symptoms and normalized the blood pressure and CPK.

Initial studies revealed low plasma renin activity that did not increase with change from supine to upright position. Plasma aldosterone was consistently elevated in the supine position, decreased with upright posture, and was not suppressed by administration of dexamethasone. Plasma 18-hydroxycorticosterone also was elevated.

Enhanced computerized tomography (CT) revealed a mass in the left adrenal that had not been seen on the initial unenhanced scan. Adrenal vein catheterization confirmed elevated plasma aldosterone on that side. Adrenalectomy was performed, and a well-encapsulated adenoma was found at examination of the surgical speciman. Postoperatively, suppression of plasma renin activity continued for many months without signs of aldosterone deficiency.
Severe Anemia Caused by Human Parvovirus in a Leukemia Patient on Maintenance Chemotherapy
Authors: Smith Malcolm A. , Shah Narayan R. , Lobel Jeffrey S. , Cera Peter J. , Gary G. William , Anderson Larry J.
Published: November 2007

A 6-year-old boy on maintenance chemotherapy for acute lymphocytic leukemia developed severe hypoplastic anemia during chemotherapy previously well tolerated. The hypoplastic episode persisted for approximately 30 days. Human parvovirus (B19), the etiologic agent of aplastic crisis in persons with underlying hemolytic syndromes, was detected in the patient's serum 25-30 days after onset of hemoglobin decrease, and B19 IgM seroconversion occurred 1 week later. The patient's hypoplastic anemia was presumably caused by prolonged B19 infection resulting from a blunted immune response. An immune response to the B19 infection and resolution of the illness were temporally associated with brief cessation of chemotherapy.
Intracranial Tuberculoma
Authors: Bagga A. , Kalra V. , Ghai O.P.
Published: November 2007

We used computerized tomography (CT) to screen 83 patients with partial seizures who had 1) increased intracranial pressure; 2) evidence of systemic tuberculosis; or 3) focal neurological deficit. We found intracranial tuberculoma in 20 (24%). In addition, of 55 patients with tuberculous meningitis, 12 had associated tuberculoma.

The image morphology on CT scans showed ring lesions (14), discs (10), and irregular coalescing masses (8). Perilesional edema frequently was present. After appropriate antitubercular therapy, clinical outcome for seizures, neurological deficit, and increased intracranial pressure was satisfactory. CT lesions regressed within 12 weeks of inauguration of medical therapy in most patients. Medical management of tuberculoma is advocated, with surgery limited to those in whom such treatment is ineffective.
Infectious Episodes Following Diphtheria-Pertussis-Tetanus Vaccination
Authors: Jaber Lutfi , Shohat Mordechai , Mimouni Marc
Published: November 2007

Eighty two infants, aged 2-12 months, were prospectively studied for infectious episodes following diphtheria-pertussis-tetanus (DPT) immunization. The occurrence of infectious episodes during the month following vaccination was compared to that during the month prior to its administration. The 3 days following vaccination were not included. In comparison to the month prior to immunization, during the month following there were significantly more infants with fever (6.1% vs. 24.4%, p < 0.001), with diarrhea (7.3% vs. 23.1%, p < 0.005), and with cough (37.7% vs. 52.4% p N.S.).

After the first month of the study, there was an increase in morbidity in the region, so we reevaluated those cases who had been seen during the latter 3 months. The same trend was found: in the month following immunization there were significantly more infants with fever (5.3% vs. 25%, p < 0.005), with diarrhea (10.5% vs. 28%, p < 0.02), and with cough (26% vs. 54%, p < 0.01). There was no correlation between the incidence of these episodes and the age at vaccination.

In addition to reactive fever during the first 3 days following DPT immunization, an increase in infectious episodes seems to occur in infants during the month following administration of this vaccine.
Prophylactic Cryoprecipitate in Congenital Afibrinogenemia
Authors: Rodriguez Raul C. , Buchanan George R. , Clanton Mark S.
Published: November 2007

Two siblings with congenital afibrinogenemia received prophylactic infusions of cryoprecipitate in order to prevent serious hemorrhage during early childhood. Three bags (units) of this fibrinogen-containing blood product were administered every 7-10 days for 15 months in one case and 24 months in the other. Hemorrhage was nearly completely prevented during the period of prophylaxis. Side effects from cryoprecipitate were not observed. Prophylactic infusion of cryoprecipitate, made practical by the relatively long half-life of fibrinogen, should be considered in other patients with this disorder.
Enhancing Child Compliance with Nebulized Respiratory Treatment
Authors: Reimers Thomas M. , Piazza Cathleen C. , Fisher Wayne W. , Parrish John M. , Page Terry J.
Published: November 2007

A 2.7-year-old developmentally delayed boy diagnosed as having chronic lung disease, severe hyaline membrane disease, and persistent pulmonary hypertension with interstitial emphysema was referred in hopes of modifying his refusal to wear a mask during nebulized administrations of Chromolyn. The child was prescribed four 20-minute nebulized treatments daily but resisted treatment and removed the mask by turning his head and pushing the mask away with his hands.

A procedure was implemented to gradually teach the child that turning his head and pushing the mask would not result in mask removal, and that by wearing the mask he would receive positive attention. By the end of treatment, the child was consistently wearing his mask for the required 20-minute intervals. Follow-up at 3 months confirmed maintenance of treatment effects.
Astasia-Abasia
Authors: Stickler Gunnar B. , Cheung-Patton Alice
Published: November 2007

Twenty-seven children and adolescents were diagnosed as having astasia-abasia on the basis of a conversion reaction between 1965 and 1979. Follow-up information was obtained by questionnaire or a telephone interview from all but one patient over periods ranging from 5 to 22 years. Twenty-two patients thought that they were in good health, but nine patients had some minor complaints, such as leg weakness or stomach pains. Major symptom substitution had not occurred. No organic illness had been missed. One patient was in psychiatric care, two additional patients seemed to have continued mental problems, and one patient was in jail after having killed his parents.
In a Neonate with Down Syndrome
Authors: Cook James A. , Raney Beverly , Innes Donald J. , Normansell David
Published: November 2007

This report describes the results of bone marrow leukocyte immunophenotypic studies, DNA index measurement, and chromosome analysis in a newborn with Down syndrome and transient myeloproliferative disorder. The infant's initial leukocytosis with immature cells in the peripheral blood and thrombocytopenia resolved without treatment by 6 months of age, and he was well at 2 years of age. The lack of specific reactivity between the patient's morphologically immature cells and multiple monoclonal antibodies directed against lymphoid and myeloid leukemia cells may be characteristic of this disorder. Other cases should be examined for immunophenotype to correlate the results with chromosomal analysis and to provide a basis for comparison in those who subsequently develop true acute leukemia.
Thyroiditis
Authors: Szabo Susan M. , Allen David B.
Published: November 2007

Acute suppurative thyroiditis is rarely seen during childhood. The classic clinical features of this illness (fever, neck pain, and a swollen, tender mass over the thyroid gland) can differentiate acute thyroiditis from the more common subacute thyroiditis. In less typical cases, however, this distinction can be difficult. An adolescent male presented with a swollen, tender thyroid gland. Atypical laboratory findings and the lack of fever and toxicity delayed the diagnosis and treatment of acute suppurative thyroiditis. A review of the pediatric literature summarizes clinical and diagnostic features valuable in the differential between acute suppurative thyroiditis and subacute thyroiditis in childhood.

The important contribution of fistulae between the piriform sinus and thyroid gland to the pathogenesis and acute suppurative thyroiditis is emphasized. Such a fistula should be sought in every patient in whom this entity is diagnosed.
Hyperactivity and Inattentiveness
Authors: Safer Daniel , Krager John M.
Published: November 2007

The school health folders of all students receiving stimulant medication for hyperactivity/inattentiveness from five public elementary and two middle schools in Baltimore County were evaluated to 1) record pre-treatment teacher ratings of those on stimulant medication; 2) assess, using the rating scales, the initial and subsequent effectiveness of the medication; and 3) to identify treatment subgroups.

Major findings were 1) three-fourths of the 176 students on stimulant medication in 1987 had pre-treatment ratings consistent with moderate to severe hyperactivity /inattentiveness; 2) over 90 percent of the students evidenced at least 50 percent improvement initially following stimulant treatment by teacher ratings; 3) 76 percent of the medicated students continued to show this level of improvement at the end of the 1987 school year; 4) medication improvement and compliance declined in middle school; 5) 15 percent of the students on stimulant medication in 1987 were inattentive but not hyperactive on baseline teacher ratings, but their degree of improvement with stimulants was equivalent to that of hyperactives; 6) in the county-run hyperkinetic clinic, the subpopulation of inattentive/non-hyperactive students on stimulants rose from 7 percent to 18 percent of the total between 1976 and 1987.
Use in Newborn Infants
Authors: Taylor John , Shannon Reaner , Kilbride Howard W.
Published: November 2007

The heparin lock technique has been available for parenteral access in older children and adults but has not yet been described for use in newborns. We randomized 39 newborns who needed parenteral medication in the intermediate care nursery to receive a heparin lock catheter (17) or an intravenous line kept patent by continuous low infusion rate (22). There were no differences between study groups with regard to birthweight, gestational age, or distribution of diagnoses. Infants in the heparin lock group were enrolled in the study on average 1 day longer than the continuous intravenous group (p < 0.05).

Subcutaneous infiltration occurred twice as frequently with the continuous intravenous line (p = 0.0015), and the life span was significantly less than heparin lock (1.0 ± 0.5 days versus 2.1 ± 1.0 days, p = 0.0003). Infants with continuous intravenous lines received approximately 20 ml/kg/day greater quantity of fluid (p < 0.0001). There was no difference between groups with regard to mean heparin activity level. None of the infants developed hemorrhagic complications, thrombophlebitis, or documented nosocomial infection. Nurses significantly favored heparin locks over continuous intravenous lines for ease of use.

The heparin lock technique is a safe and reasonable alternative to a continuous low infusion intravenous line for administering parenteral medications to intermediate care newborns.
Pediatric Bronchoscopy
Authors: Puhakka Heikki , Kero Pentti , Valli Päivi , Iisalo Eila , Erkinjuntti Matti
Published: November 2007

Data for this article were obtained from a retrospective analysis of 386 pediatric bronchoscopies from 1979 through 1986. Endoscopic procedures were carried out under general anesthesia using a rigid open bronchoscope. There were 235 boys (61 %) and 151 girls (39%). The mean age was 2 years, 3 months.

Eight percent of the girls were under 1 month of age, compared with only 4 percent of the boys. The lightest patient weighed 650 g.

In children under 1 year of age, the most common indications were dyspnea (32%) and anomaly or suspicion of anomaly (20%). In children over 1 year of age suspected foreign body (32%) and recurrent respiratory infections (30%) were the most common indications. In 15 percent of patients, laryngomalacia and/or an abnormal epiglottis was confirmed. Subglottic stenosis, congenital or acquired, was confirmed in 9 percent and tracheal compression in 12 percent of cases. Seventeen percent of the children showed totally normal findings. There were only eight complications in the whole series and no death or cardiac arrest.

The authors confirm the safety of bronchoscopy when careful attention is paid to preoperative investigations, selection of the instruments used, and postoperative care.
Clinical Characteristics in Children
Authors: Friesen Craig A. , Roberts Charles C.
Published: November 2007

Thirty-five cases of cholelithiasis diagnosed at a children's hospital over a 7.5-year period are reviewed and compared to 693 cases of pediatric gallstones reported in the literature. Symptomatology and associated medical history are more important in diagnosing cholelithiasis than are laboratory tests. Hemolytic disease is the most common associated condition in our series (46%) as well as in the literature (30%), but the frequency of the various associated conditions varies with age. Isolated gallstone disease does occur, particularly in the young infant. Jaundice is the most common symptom in children less than 1 year of age, being present in greater than 90 percent of symptomatic patients previously reported. Overall, the most common symptom in our series is vomiting (60%). Right upper quadrant pain in the absence of vomiting does not appear to be significant, as this occurred in only one patient (3%) in our series.
Child Abduction
Authors: Forehand Rex , Long Nicholas , Zogg Carolyn , Parrish Elizabeth
Published: November 2007

The functioning of 17 children who had been abducted by one parent but subsequently returned was examined. The parent to whom the child was returned completed a behavior rating scale on the child for each of three time periods: pre-abduction, immediately post-abduction, and follow-up (the present time). The parents also completed a measure regarding the coping strategy they utilized while the child was missing and a measure of their own functioning at each of three times: pre-abduction, during the abduction, and follow-up.

The results indicated that the child was rated as functioning worse immediately post-abduction than at pre-abduction and at follow-up was functioning between that reported at pre-abduction and post-abduction. However, the level of maladjustment was not in the severe range at any of the assessments. Parents reported using a problem-focused or action style of coping. Parents also reported that their psychological functioning decreased during abduction and then improved at follow-up. Again, functioning was not in the severe range at any assessment. Variables such as age at the time of abduction and length of abduction were only minimumally related to parent or child functioning.
Initial Treatment of Cystic Fibrosis
Authors: Roach E.S. , Sinal Sara H.
Published: November 2007

Four infants with newly diagnosed cystic fibrosis developed a bulging anterior fontanel within days of starting enzyme replacement treatment. In the same time period, 41 hospitalized patients less than 1 year of age were diagnosed as having cystic fibrosis and treated, suggesting that increased intracranial pressure is common in this setting (9.7%).

The clinical course of the four infants was similar: the bulging fontanel became apparent 1-6 days after initiation of pancreatic enzyme replacement and resolved within 1 week in three patients and within 4 months in the other patient. Two patients became mildly irritable. Computed cranial tomography and lumbar puncture were done in three patients, with completely normal findings except elevated cerebrospinal fluid pressure in two infants. There was no apparent difference in the treatment or clinical course before diagnosis between the four infants who developed a transient bulging fontanel compared with the overall group of cystic fibrosis patients.
Failure to Thrive
Authors: Wilcox W.D. , Nieburg P. , Miller D.S.
Published: November 2007

The term "failure to thrive" (FTT) has been used for more than 50 years to describe the infant or young child whose growth falls substantially behind that of his or her peers. Currently, the predominant use of FTT is to describe a child's growth failure resulting from caloric or maternal deprivation or both. Despite widespread use, the term FTT lacks a clarified definition.

In this study the authors review 22 current reference texts in general pediatrics, pediatric nutrition, and pediatric gastroenterology and 13 recent journal articles addressing FTT. Only 9 of the 22 texts and 9 of the 13 journal articles describe FTT in quantitative terms, but even these references lack consensus on the anthropometric indices used and their criteria for abnormality.

The absence of a standard, scientifically credible definition for FTT, which reflects the dynamic nature of this syndrome, continues to produce an ambiguous body of literature on the subject.
Evaluating Child Sexual Abuse
Authors: Claytor Risa N. , Barth Kristen L. , Shubin Charles I.
Published: November 2007

The records of 944 children who had been examined by one pediatrician for alleged sexual abuse were analyzed. Sixty-four percent of the females and 34 percent of the males had positive findings suggestive of ano-genital injury. The data indicated that in girls with no evidence of injury, the hymenal opening diameter varied directly with age, but in those with evidence of injury, the opening size could not be correlated with age.
Brucellosis of the Central Nervous System
Authors: Drutz Jan E.
Published: November 2007

Brucellosis in early infancy is unusual and reports of congenitally acquired infection are extremely rare. The patient presented at the age of 8 months with high fever and signs of meningitis. He had a previous history of hydrocephalus undergoing shunt alleviation at I month of age. A diagnosis of central nervous system (CNS) brucellosis was subsequently made. Trans-placental transmission is offered as a possible explanation for the acquisition of this child's brucellosis infection.
Catheter-induced Aortic Thrombus Masquerading as Coarctation of the Aorta
Authors: Rodriguez Maria , Sosenko Ilene
Published: November 2007

The placement of an umbilical artery catheter is firmly established as an essential technique in the care of ill neonates. This simple procedure involves well recognized risks. Thrombotic complications are frequently seen with umbilical artery catheter (UAC) placement. The occurrence, however, of an aortic thrombus presenting as classical aortic coarctation has not been reported previously. This report describes two infants with classical symptomatology of coarctation of the aorta who were found instead to have aortic thrombus formation in association with umbilical artery catheter placement.
The Infant Feeding Decision in Low and Upper Income Women
Authors: Grossman Lindsey K. , Fitzsimmons Sharon M. , Larsen-Alexander Janet B. , Sachs Larry , Harter Christina
Published: November 2007

Few studies have described the woman who chooses breast-feeding by more than simple demographics. The purpose of our study was to characterize new mothers by their infant feeding decisions, by demographic and obstetrical data, and by sources of personal support they received during their pregnancies and in making their infant feeding decisions. To this end, 220 were interviewed, including 116 who chose to breastfeed.

Breast-feeding women were more likely to be older, more educated, married, more affluent, experienced with breast-feeding, to have demonstrated good prenatal habits, and to have received support from other sources than those who chose bottle feeding. Participation in Lamaze classes, previous successful breast-feeding, and maternal education were significant predictors of feeding choice, and mode of delivery predicted duration of breastfeeding.

Low income women who chose breastfeeding resembled low income bottle feeders in certain medical/social factors, but they showed support patterns similar to middle to upper income women.
Early Diaphragmatic Paralysis
Authors: Sivan Yakov , Galvis Antonio
Published: November 2007

Three infants with recently diagnosed genetic diseases presented with respiratory failure and required assisted ventilation. One infant had spinal muscular atrophy (Werdnig-Hoffmann disease), and two had acid maltase deficiency. The cause of the respiratory failure in all was diaphragmatic paralysis, and they became ventilator dependent. Early diaphragmatic paralysis must be considered as a manifestation of genetic neuromuscular disorders.
In Chinese Newborn Infants
Authors: Leung Alexander K. C. , Ma Kenneth C. H. , Oswald Siu T. , Robson W. Lane M.
Published: November 2007

The palpebral fissure length was measured in 60 normal Chinese term infants in the first 48 hours of life. The measurement of the palpebral fissure length was performed with a vernier caliper by placing it across the greatest horizontal axis of the eye from the medial to the lateral canthus. The head circumference was measured by placing a tape anteriorly just above the eyebrows and posteriorly at the maximum point of the occiput. There was no difference according to sex or between the measurements in the right and the left eye. The palpebral fissure length was 1.94 ± 0.17 cm (mean ± standard deviation (SD)) and the head circumference was 34.0 ± 1.3 cm (mean ± SD).

These data suggest that Chinese neonates have a shorter palpebral fissure length than do black American neonates and a longer palpebral fissure length than do white American and Turkish neonates.
Chronic, Episodic Thrombocytopenia
Authors: McClain Kenneth L.
Published: November 2007

A male patient with chronic idiopathic thrombocytopenic purpura (ITP) did not fit into any of the known risk groups for chronic ITP. He was unique in that he manifested a cyclic increase of platelet counts each winter followed by a nadir in the summer, without having other hematologic abnormalities.
Epidemiologic Aspects of Toilet Training
Authors: Berk Lawrence B. , Friman Patrick C.
Published: November 2007

Toilet training is becoming an increasingly important child care issue as child raising becomes an institutional enterprise. This paper reviews the literature of the last 40 years, focusing on the epidemiology of the development of day and night bladder control. The studies indicate that bladder control is usually obtained between 24 months and 48 months of age. Many variations exist between studies, especially the endpoint used to indicate completion of training. Modifying the endpoint used and the related training practices could decrease the age at which children are trained.
Mammalian Bites
Authors: Wiley James F.
Published: November 2007

Mammalian bites account for a large number of emergency department and doctor's visits. Children are the victims in more than half of reported cases. Dogs account for the majority of wounds, and almost all fatalities in these cases are due to dog bites. Human bites and cat bites account for the majority of infected wounds. Basic wound care, combined with appropriate antibiotic coverage in high risk wounds, is the most important principle of management.
The Ability of Mothers to Read a Thermometer
Authors: Banco Leonard , Jayashekaramurthy Shantha
Published: November 2007

The ability of 100 mothers in a suburban private pediatric practice and 100 mothers in an urban hospital-based practice to read a mercury glass thermometer accurately was assessed. Ninety-three percent of suburban practice parents could read three pre-set thermometers correctly, but only 10% of urban practice parents could perform the same task. Education level only partially explained the inability of most urban parents to read successfully. Because certain clinical situations require accurate fever assessment at home, simplified methods of fever assessment should be considered in populations with low competence in reading a thermometer by traditional methods.
Mental Status Changes in Children Receiving Glucocorticoids
Authors: Satel Sally L.
Published: November 2007

Glucocorticoid preparations are used commonly in the treatment of many diseases in children and adolescents. Although their physiologic side of effects have been described well, the psychiatric side effects of these medications have received little attention. Limited data suggest that disturbances of affect and behavior may occur in 25-50% of children receiving glucocorticoid. These steroid-induced mental changes may be underrecognized in children, and yet these changes can have considerable impact on social and psychological functioning and treatment outcome. An enhanced awareness and reporting of this phenomenon by clinicians, parents, and teachers would likely lead to better compliance with treatment, improved outcomes, and greater understanding of emotional concomitants of illness.
Diabetic Ketoacidosis
Authors: Rogers Brian , Sills Irene , Cohen Michael , Seidel F. Glen
Published: November 2007

Diabetic Ketoacidosis (DKA) remains the leading cause of death in children with type I diabetes mellitus. Complications occurring during DKA treatment include cerebral edema and neurologic collapse. Developmental outcomes following neurologic deterioration during DKA have varied from no sequelae to severe developmental disabilities.

A total of three children developed neurologic deterioration during treatment of DKA at Buffalo Children's Hospital between 1984 and 1987. The authors treated aggressively for cerebral edema. Characteristic findings on the computed tomography (CT) scans and magnetic resonance imaging (MRI) of the brain included hemorrhagic infarctions of the thalami, basal ganglia and lentiform nuclei.

The authors conducted developmental follow-up examinations between 1-1/2 - 3 years following recovery from DKA coma. Although they noted significant recoveries over time, developmental disabilities persisted.

The clinical courses and neuroradiographic findings of these patients are compatible with sequelae of central brain stem herniation and cytotoxic brain injury. Continued efforts are needed in the prevention and early detection of clinically significant cerebral edema during treatment of DKA.
Management of Smooth-Blunt Gastric Foreign Bodies in Asymptomatic Patients
Authors: Bendig Donald W. , Mackie G. Gary
Published: November 2007

Guidelines for management in the asymptomatic patient with a smooth-blunt gastric foreign body are not well established in the pediatric literature. Questionnaires were sent to pediatricians, family practitioners, pediatric gastroenterologists and pediatric surgeons with an over-all response rate of 62.2%. There was no agreement in regard to how long one should observe such patients before recommending intervention. There was no correlation of years of clinical experience and length of observation recommended either. Review of the pre-endoscopic literature revealed spontaneous evacuation in 93-99% of all types of foreign bodies in 1477 pediatric patients. An observation period of at least eight weeks should be strongly considered in an asymptomatic patient with a smooth-blunt gastric foreign body. Exceptions would include an anatomic abnormality of the gastric outlet, previous gastric outlet surgery as well as a possibly toxic object.
Child Maltreatment Histories Among Runaway and Delinquent Children
Authors: Famularo Richard , Kinscherff Robert , Fenton Terence , Bolduc Suzanne M.
Published: November 2007

The records of 378 children presenting to a juvenile court were reviewed for histories of child maltreatment, based on evidence from a formal investigative process by the Department of Social Services. The children came from two groups: delinquents, who had engaged in criminal activity, and status offenders, whose legal involvement was due to non-criminal behavior, such as running away and truancy. Fifty-five percent of the status offenders and 45% of the delinquents had substantiated histories of maltreatment. The percent of status offenders who had been sexually abused was seven times higher among runaways (35%) than among the other members of the group (5%). The percent of delinquents who had been physically maltreated was significantly greater among those convicted of committing violent crimes (27%) than among the non-violent delinquents (14%). Thus, maltreatment may contribute significantly to delinquent behavior.
"Clear For Surgery": Current Attitudes and Practices of Pediatricians
Authors: Fisher Quentin A.
Published: November 2007

Two thousand five hundred pediatricians, constituting 10% of active, US-based members of the American Academy of Pediatrics, were randomly selected to receive a survey of attitudes and practices in the preoperative evaluation of children, and communication with anesthesiologists. Of the 790 respondents, 30% routinely examine children prior to elective surgery at present, although 60% felt they should ideally do so. Only 7.6% had training contacts with anesthesia during residency, and only 17% felt their expertise was appreciated by the operating team in preparing children for surgery. In clinical management situations, most agreed on the anesthetic risks of a recent-onset upper respiratory infection, but varied in assessing the risks to a growing premature infant, of a patient with Trisomy 21, or of an asthmatic on chronic theophylline. The results suggest that pediatricians see their role as important in preoperative preparation of children, but lack appropriate training and experience. If "clear for surgery" is to be a meaningful activity, greater communication between anesthesiologists and pediatricians must be developed.
Normative Data of Hemoglobin Concentration and Free Erythrocyte Protoporphyrin in a Private Pediatric Practice: A 1990 Update
Authors: Benjamin John T. , Dickens Michael D. , Ford Raymond F. , Hawkes David L. , Machen Charles W. , Perriello Vito A. , Reynolds David N.
Published: November 2007

Free erythrocyte protoporphyrin (FEP) and hemoglobin (Hgb)concentrations were tested in 790 children in a private pediatric office; results were compared to those obtained in 1984. Only 16 children (2%) had abnormal FEPs in 1990 compared to 76 children (9.6%) in the earlier study. The mean FEP in the normal group also decreased significantly in each age group studied. The hemoglobin concentrations were not significantly different in most of the age groups studied. Screening for iron deficiency in our pediatric practice by determining hemoglobin and FEP concentrations had a much lower yield in 1990 than in 1984.
Clinical Evaluation of a New Chest Tube Used in Neonates
Authors: Jung August L. , Nelson James , Jenkins M. Bruce , Hodson W. Alan
Published: November 2007

We report preliminary experience with a newly designed chest tube (JCT), for evacuation of neonatal pneumothorax. The catheter has a unique pigtail configuration at the distal end, intended to simplify placement and minimize chest wall and lung trauma by reduced tube size and depth and insertion.

Thirty-eight JCTs were placed in neonates with pneumothoraces. Neonates' birth weights ranged from 400 to 3,595 grams. All 38 tubes immediately relieved clinical signs of pneumothoraces. Thirty-five (92%) tubes immediately fully evacuated the pneumothoraces as evidences on chest radiograph. Twelve pneumothoraces partially reoccurred at a mean of 24 hours following JCT placement. These tubes were either irrigated or replaced. This newly configured chest tube functions effectively in the treatment of neonatal pneumothorax.
The Outcome of Renal Transplantation in Children Without Prolonged Pre-Transplant Dialysis
Authors: Fitzwater Douglas S. , Brouhard Ben H. , Garred Dawn , Cunningham Robert J. , Novick Andrew C. , Steinmuller Donald
Published: November 2007

Controversy in the literature exists over whether or not it is beneficial to maintain a patient on dialysis for a prolonged time before transplantation. Because no data exist comparing children who have had prolonged dialysis before transplantation to those who have none, we reviewed the charts of all children transplanted at the Children's Hospital of The Cleveland Clinic Foundation. Of those, we selected three groups for analysis: group one (n=12) consisted of patients who had had less than or equal to 10 weeks of dialysis before transplantation (6.8 ± -2.2 weeks, ± = SD); group two (n=21) were patients who had had more than 10 weeks of dialysis (142 +±-148 weeks). Both groups had two years of follow-up data. Group three (n=13) consisted of patients who had had less than two years of follow-up (18.7 ±/-7 months) but no dialysis before transplantation. There were no differences in mode of dialysis between groups one and two nor in the type of transplant (living-related donor vs. cadaveric). Significantly, the patients in group three received more cyclosporine A and less anti-lymphocyte globulin than the other two groups (p< 0.05). Patients in group two received more transfusions (11.9 ± 14.3) than patients in group one (4.0± 2.7) and group three (3.5 ± 7.3). There were no differences in number of patients who experienced at least one rejection episode among the three groups. Although the mean serum creatinine concentration at two years of follow-up was higher in group two (3.6 ± -3.9 mg/dl), this was not significantly different from group one (1.7 ± -0.7 mg/dl) or group three (1.9 ± -0.5, n=7). Sixty-three percent of patients in group one, 60% of patients in group two and 91 % in group three had functioning allografts at two years follow-up. Although there may be other considerations, our data do not indicate any increase in rejection or decrease in graft survival in children who do not receive prolonged dialysis.
A Comparison of Three Desktop Chemistry Analyzers for the Pediatric Practice
Authors: Hicks Jocelyn M. , Iosefsohn Mariet , Greenberg Larrie
Published: November 2007

Three desktop chemistry analyzers most frequently utilized in physicians' offices are compared for performance and precision: the DT60 (Kodak), Vision™ (Abbott), and Reflotron® (Boehringer-Mannheim). The manufacturers' instructions were followed for all the reagents, calibrators and controls provided with each analyzer used. Precision, stability, dynamic range, interferences, and comparison of analyses of 50-100 patient samples with standard laboratory instruments were evaluated. Within-run precision on all three instruments was acceptable, the coefficient of variation (% CV) ranging from 0.8-5.4% and run-to-run precision CV of 1.1-7.3%. Within-run precision for glucose, blood urea, nitrogen, cholesterol and sodium for an experienced technologist, a clerk without any laboratory experience and a physician with no recent laboratory training were compared: the total CV varied between 1.1 and 6.3%. There are differences in the way bilirubin and hemoglobin interfere with the chemistries on the analyzers. Instrument size, available analyses, reagent cost and ease of operation were also assessed. The data suggest that all three analyzers performed well and would be suitable for the pediatric office setting.
The Effect of the Initial Family Interview on a Pediatric Practice
Authors: Karofsky Peter S. , Rice Richard L. , Hoornstra Lois L. , Slater Cathy J. , Kessinich Cheryl A. , Goode Joel R.
Published: November 2007

To examine the effect of initial family interviews by health care providers on patients' use of health services, 177 patients and their families were randomly assigned to an interviewed (I) or a non-interviewed (NI) subgroup.

Initial interviews would encourage families to bring their children in for health supervision visits, but discourage families from making after-hour telephone calls, using the emergency room and bringing the children to the clinic frequently for problem visits.

The I families had an initial interview, attended by all family members. Both a physician and a nurse elicited patient histories and explained use of the emergency room, when to make after-hour calls, how to schedule appointments and other information about the clinic. If I families failed to have an initial interview, they were deleted from the study. In the NI subgroup, patient histories were elicited during a routine health supervision visit without the entire family in attendance, and information about emergency room visits, after-hour calls and appointment scheduling was provided during the same visit.

After one year (1987) into the study and two years (1988) into the study, all patient charts were examined. Data analysis was performed using analysis of variance for repeated measures (ANOVA) and step-wise multiple regression of Statistical Analysis System. For 1987, the interview intervention explained a significant (p=0.01) amount of variance in the number of problem visits (less in I) after controlling for months in the study and age of the child. Time produced a significant effect on the total number of problem visits for both subgroups, which decreased significantly (p=0.005) between 1987 (4.2 ± .36) and 1988 (2.9 ± .40). For 1988 the intervention explained a significant (p=0.02) amount of variance in health supervision visits (more in I) after controlling for months in the study and age of the child. Time did not produce a significant effect on the health supervision visits.

These data suggest that initial family interviews decrease problem visits and increase health supervision visits in a pediatric practice.
Multiple Personality Disorder: A Risk Indicator, Diagnostic Marker and Psychiatric Outcome for Severe Child Abuse
Authors: Whitman Barbara Y. , Munkel Wayne
Published: November 2007

Recent studies suggest that multiple personality disorder (MPD) is not as rare as previously believed. Indeed, it may represent a relatively common (as many as 25% of cases) outcome of severe physical and sexual abuse of children. Because diagnosis and treatment offer the best prognosis, it is important for the pediatric clinician to become familiar with both the at risk situations (such as cult practices and multigenerational sexual abuse) as well as the more unusual behavioral presentations of this disorder.
Delay in Obstetrical Care in Newly Diagnosed Teenage Pregnancy
Authors: Pomeranz Albert J. , Matson Steve C. , Nelson David B.
Published: November 2007

A retrospective study of 42 adolescent patients diagnosed as being pregnant between June 1987 and February 1990 at the Downtown Health Center (DHC), an inner city pediatric primary care clinic, was conducted to determine whether patients referred to a hospital-based Teen Pregnancy Clinic (TPC) were seen within a reasonable period of time. The frequency of sexually transmitted diseases (STDs) was also determined when these women were initially seen at TPC. Only 5 of the 42 patients seen at DHC had a pelvic exam prior to referral. Of the 40 patients seen at TPC, 20% were not seen until four weeks or more after initial diagnosis. Fifty percent had a STD.

Pediatricians should recognize that pregnant teenagers may have a significant delay between diagnosis of pregnancy and entry into obstetrical care. Pelvic exam including cultures for STDs is recommended prior to referral.
Nasal Obstruction in the Neonate and Infant
Authors: Coates Harvey
Published: November 2007

The neonate is a preferential nasal breather; therefore, nasal obstruction in the neonatal period may cause significant sequelae. Although the uncommon choanal atresia is the main condition to be excluded, many other possible causes exist. A systematic approach to the workings of nasal obstruction in the neonate and infant is outlined so that appropriate management can be instituted.
The Current Management of Sinusitis in Children
Authors: Lazar Rande H. , Younis Ramzi T.
Published: November 2007

The paranasal sinuses are common sites of infection in children. The diagnosis of sinusitis may be challenging because the sinus cavities are small and variably contoured, the clinical manifestations are often nonspecific, and the radiologic findings may be equivocal. Because many local and systemic factors contribute to sinusitis in children, the therapeutic regimens vary. In addition to conventional medical approaches, new surgical procedures and improved anesthetic techniques have made functional endonasal sinus surgery an excellent management tool for selected patients with chronic or recurrent disease.
Needle Aspiration of Neck Abscesses In Children
Authors: Brodsky Linda , Belles William , Brody Alan , Squire Roly , Stanievich John , Volk Mark
Published: November 2007

Needle aspiration of neck abscesses with CT-scan guidance was studied in 17 children with 18 abscesses from 1986 to 1991. Clinical and radiologic findings were analyzed according to treatment outcome. A majority of abscesses (55.6%) resolved after treatment with one to two attempts at needle aspiration and parenteral antibiotics. Unilocular abscesses were more likely than multilocular abscesses to resolve with needle aspiration. In general, abscesses in younger children who presented with smaller neck masses on physical examination and smaller abscess cavities on CT scan resolved with needle aspiration. The data support the use of needle aspiration as an effective initial treatment for pediatric neck abscesses. CT scan was found beneficial in documenting the abscesses and in guiding treatment. A treatment protocol is suggested for the use of needle aspiration in the management of neck abscesses in children.