bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pediatric Understanding of Child Abuse and Neglect
Authors: Bittner Stephen , Newberger Eli H. 
Published: December 2021

When C. Henry Kempe and his colleagues coined the term "battered child syndrome" in 1961, the attention of the American medical community was focused on one of the most dramatic manifestations of family violence. Since then family violence has been perceived as a major social problem, and the eyes of pediatricians have been opened to familial causes of morbidity and mortality.
In this paper the term "child abuse" is used to encompass all the symptom indicators of maltreatment of children, including physical injury, physical neglect, sexual abuse, and some ingestions of harmful substances. We address these problems not as discrete illness entities or syndromes, but as symptoms of different issues and risks for particular children in individual families.
Kempe noted that notwithstanding a long history of concern with child welfare, the pediatric community ignored the implications of injury and neglect of children because of a "process of denial that was unequal to anything ... previously seen in pediatrics." This denial continues today in spite of an increasing and visible literature on child abuse.
The task of this paper is to summarize current knowledge about the causes, differential diagnoses, and management of child abuse in a fashion accessible to pediatricians and members of the colleague disciplines.
Febrile Seizures: A Consensus of Their Significance, Evaluation, and Treatment
Authors: Freeman John M. 
Published: December 2021

The National Institutes of Health recently convened experts from this country and abroad to present current knowledge about febrile seizures and their consequences, and about the risks and benefits of therapy. This information was presented to a panel under the chairmanship of Dr Edwin Kendig, former president of the American Academy of Pediatrics. The panel consisted of both academicians and practitioners. The preceding statement represents the consensus of that panel.
The statement bears reading in its entirety, for it should influence the way that pediatricians think about the child who has had a seizure with fever, how he evaluates and treats that child, and what he tells the parents.
Lamellar Ichthyosis
Authors: Sandberg Nils Olof 
Published: December 2021

Congenital ichthyoses represent a heterogeneous group of rare skin diseases. The disorders are heritable and have in common a varying degree of hyperkeratosis. During the years there has been much confusion regarding the classification of the ichthyoses. Today we have a classification based on clinical, genetic, cellular, and kinetic observations (Table). 1,2 Most patients fit into one of the four major types of ichthyoses. Beside those major types, congenital ichthyosis may be seen as part of several uncommon syndromes. The most often seen congenital ichthyosis is the lamellartype which is inherited as an autosomal recessive trait.3
Lamellar ichthyosis was first described by Seeligmann under the title of "epidermal desquamation of the newborn" in 1841.4 Lentz and Altman reviewed the literature in 1968 and found a total of 103 cases.5
CASE HISTORY
A.S., a 2,720-gm infant was born at 37 weeks of gestation. His parents and a brother are healthy. Pregnancy and labor were uncomplicated. Apgar scores at one and five minutes were 10.
At birth the infant was encased in a shiny collodion membrane. Because of the tight envelope his nose, ears, fingers, and toes were whitish, and the baby could hardly move. The lips and eyelids were everted. The diagnosis of collodion baby was made immediately (Figs 1 and 2).
Cytomegalovirus Infections
Authors: Hanshaw James B. 
Published: December 2021

It has been 25 years now since the first strains of cytomegalovirus (CMV) were isolated. At that time, and for several years thereafter, the infection was recognized as the cause of a rare and severe congenital infection referred to as cytomegalic inclusion disease (CID). More recently the virus has been associated with a wide range of clinical abnormalities.1 It is the most common congenital infection of man and even inapparent infections are now known to have long term CNS sequelae.2,3 This review will focus on information that the child health clinician must be aware of in dealing with CMV infections acquired at different stages of development.
EPIDEMIOLOGY
It is probable that most individuals in every society are infected with a strain of CMV at some time in life. Much of the early seroepidemiologic data in the literature were based on the complement fixation test, a relatively insensitive method compared to the immunofluorescent and indirect hemagglutination tests for CMV antibody. The frequency of congenital infection ranges from 0.2% to 8.0% with an average in the United States of about 1%. The highest rate of infection is in infants born to teenaged mothers from lower socioeconomic groups. Not all the infants born excreting the virus are infected as a result of primary infection in the mother.
Hyperventilation
Authors: MCNIEL JAMES B. 
Published: December 2021

Educational Objective 92 relates to appropriate recognition and management of hyperventilation syndrome. The evaluation largely deals with psychological causes in adolescents. The following case reminds us of another very common cause of hyperventilation, especially in young children.
R.J.H.
Case Presentation
The patient is a 2½-year-old boy who was referred because of hyperventilation. He had been well until two weeks before admission when he developed a fever. Four days before admission the child developed ulcers in his mouth. He had a low fever, and two days before admission the mother gave the child 16 grains of aspirin throughout the day, four 1-grain aspirins at a time, four times a day.
Role of the General Pediatrician in Genetics
Authors: Nadler Henry L. 
Published: December 2021

The pediatrician must be knowledgeable regarding the general principles of genetics and their application to common diseases; should recognize the importance of an accurate family history, which, in most instances, need not be more than two or three generations of immediate relatives, and be able to obtain and interpret such; should recognize unusual clusters of disease, such as early onset coronary artery disease or cancer, and question the possible implications; should be aware of the fact that specific genetic diseases may be more common in certain ethnic and racial groups; should be able to counsel patients, including families, for common disorders and refer complicated cases to appropriate experts; should recognize the possibility of a genetic disorder and obtain appropriate specimens for analysis or refer such patients to experts; should be knowledgeable regarding
[See figure in the PDF file]
genetic screening in general and be aware of specific recommendations including newborn screening and carrier detection; should be familiar with indications for intrauterine diagnosis; and should be aware of the back-up resources for diagnosis, counseling, and treatment in the community.
Should HBsAg Carriers Breast-feed?
Authors: KRUGMAN SAUL 
Published: December 2021

A thoughtful pediatrician has written questioning Dr Krugman's assertion that "HBsAg carrier mothers in developed countries should avoid breast-feeding, if possible"(PIR 2: 121, 1980/81). He worries that with the lack of evidence that there is any risk from breast-feeding by a HBsAg carrier mother, this situation would be used by pediatricians and mothers who take the position, "Yes, breast-feeding is fine but when in doubt about anything, stop it." We asked Dr Krugman to comment on this point, and he has responded as follows:
Regarding the issue of breastfeeding by HBsAg carrier mothers in developed countries of the world the following facts are known:
1. Infants born of HBsAg-positive mothers may be infected in utero, or at the time of birth, or several weeks or months after birth if there is continous exposure to the virus.
Chlamydial Infections
Authors: Hammerschlag Margaret R. 
Published: December 2021

Chlamydia trachomatis was first described by Halberstadter and Von Prowazek in 1907, as a characteristic intracytoplasmic inclusion in the conjunctival scrapings from a patient with trachoma. Although the organism was identified as the etiologic agent of trachoma and inclusion conjunctivitis in the neonate, a full understanding of its nature was not feasible until C trachomatis was first successfully propagated in cell cultune in 1965. This technical innovation greatly facilitated investigation of the biology and the epidemiology of chlamydial infections in man.
C trachomatis is now recognized to be one of the most prevalent sexually transmitted diseases in the United States today. It is responsible for 40% to 50% of cases of nongonococcal urethritis (NGU) in men and a large reservoir of genital infection, largely asymptomatic, in women. In the United Kingdom, where NGU is a reportable disease, NGU is now more prevalent than gonorrhea and is considered to be the most important male veneral disease. The cervical infection in women is of special importance to pediatricians as the infection may be transmitted to the infant during parturition, leading to both ocular and respiratory disease. A thorough understanding of the microbiology and epidemiology of C trachomatis is an important prerequisite for appreciating the clinical features, diagnostic methods, and management of these infections by pediatricians.
Neutropenia in Children
Authors: Oski Frank A. 
Published: December 2021

Neutropenia, a decrease in the number of circulating neutrophilic leukocytes, often provides a diagnostic challenge to the pediatrician. When the pediatrician is unable to ascertain the cause of the neutropenia, pediatric hematologists are also frequently frustrated in their attempts to uncover a satisfactory explanation for the finding.
The total white cell count and the absolute granulocyte count vary as a function of age as depicted in Table 1. The while blood cell count and the absolute granulocyte count are characteristically increased in the normal newborn and both rapidly decrease during the first week of life. After the first year of life, the normal neutrophil count generally ranges between 1,500 to 8,000/cu mm. Although neutropenia is conventionally defined as the presence of an absolute granulocyte count (neutrophilic leukocytes and band forms) of less than 1,500 cu mm, an increase in the incidence of infections is rarely observed until the absolute granulocyte count remains persistently below 1,000/cu mm.
The black population and possibly Yemenite Jews characteristically have lower total white cell counts than age-matched control subjects. Approximately 30% to 40% of black male adults have a total white blood cell count of less than 5,000/cu mm as compared with only 7% of white males.2 Presumably the same difference in distribution of white cell counts exists in the pediatric population as well.
Treatment of Dehydration in Infancy
Authors: Finberg Laurence 
Published: December 2021

NORMAL CHEMICAL ANATOMY AND PHYSIOLOGY
Before discussing dehydration it is worthwhile to review the normal features of an infant with respect to content and distribution of water and mineral. Approximately 70% of the lean body mass is water. The distribution of this water is shown in Fig 1. The plasma volume owes its integrity to its protein content, which is a relatively impermeable species of molecule. The extracellular fluid composition differs strikingly from the intracellular fluid despite the movement of most ions across cell membranes because of an active transport system (Na+, K+, ATPase) in the membrane that extrudes sodium. The compositional differences are diagrammed in Fig 2.
The second consideration necessary to handle any problem is that of obligatory water requirements to replace losses. Table 1 gives the relationship between caloric expenditure and water loss with the basal state as the point of reference. For ordinary clinical circumstances requirements are about 1½ times basal state. Electrolyte requirements have a wide range. Practical considerations make it necessary to provide solute in an intravenous solution, when one is needed, to prevent hemolysis. All conditions may be met by allowing 2 to 3 mEq/kg/day of both sodium and potassium. Chloride and bicarbonate (or other base) ions for the healthy infant awaiting surgery, for example, should be divided about 3:1.
Use of Echocardiography in Evaluation of General Pediatric Diseases
Authors: Williams Roberta G. , Bierman Fredrick Z. 
Published: December 2021

A variety of general pediatric diseases cause secondary cardiovascular abnormalities. Echocardiography and other noninvasive techniques have provided a better understanding of the incidence, time course, and degree of cardiac involvement in these disorders. Echocardiography yields anatomic and physiologic information with little patient discomfort and a relatively small investment in medical personnel and equipment and therefore offers a practical means for both population screening and serial evaluation of individual patients.
When an ultrasound beam, produced by the rapid expansion and contraction of a rare earth crystal, is directed through the soft tissues of the body, some of the acoustical energy is absorbed and a portion is reflected back to the transducer. The depth and intensity of the returning signal can be displayed on an oscilloscope (A mode), or the signal can be swept across an oscilloscope or strip chart to record both depth and time (M-mode) as seen in Figs 1 and 2. Cardiac structures are identified by their characteristic motion and distance from the transducer. The transducer can be rotated or scanned from one structure to another in order to gain spatial information.
Obesity in Children
Authors: Weil William B. 
Published: December 2021

Over the last few decades our national concern has been shifting from undernutrition to obesity as the major nutritional problem of the country. Concern about the health risks created by obesity is shared by health professionals and large segments of society. Public attention has been directed to obesity because it has been identified as a risk factor for many diseases, particularly those of the cardiovascular system. In addition, the public image of the desirable body form is culturally determined and strongly influenced by factors such as advertisements depicting lean individuals, especially lean women, as sexually attractive, intelligent, and popular models for owning everything from beautiful clothing to expensive automobiles. The social bias that is generated is so powerful and widespread among middle and upper middle class Americans that there is well documented discrimination against the obese in education at all levels and in most professional and social organizations.
For pediatricians, the problem of obesity creates four major concerns: (1) obesity in the adult may have its origin in infancy and/or childhood; (2) feeding practices, especially in early life, may be a major etiologic factor in the ultimate development of obesity; (3) obesity in children may be associated with illness during childhood; and (4) discrimination against obese children is inherently serious and may be devastating to long-term personality development.
Infective Endocarditis
Authors: Newburger Jane W. , Nadas Alexander S. 
Published: December 2021

Infective endocarditis is one of the most serious complications of structural heart disease. It occurs primarily in children and adolescents with preexisting anatomic abnormalities of the heart, with an incidence that varies with the specific cardiac lesion. An identifiable potential source of bacteremia precedes infective endocarditis in approximately one fifth of cases in children. The high mortality (19% to 25%), morbidity, and prolonged treatment course of infective endocarditis make its diagnosis, management, and prevention a matter of great importance to pediatricians.
PREDISPOSING FACTORS
Structural Heart Disease
Cardiac malformations are the major predisposing factor to infective endocarditis. Although rheumatic heart disease has gradually declined as a substrate for endocarditis, the increased survival of children with congenital heart disease in the past two decades has increased the number and age of children susceptible to infective endocarditis. In general, lesions leading to a high velocity of blood flow through a heart valve, septal defect, or blood vessel are associated with increased susceptibility to endocarditis (Table 1). Children at highest risk are those with cyanotic congenital heart disease (eg, tetralogy of Fallot), ventricular septal defect with aortic regurgitation, left-sided valvar regurgitation or obstruction, prosthetic valves, and recent cardiac surgery. Endocarditis is exceedingly uncommon in individuals with isolated atrial septal defect secundum and with mild pulmonic valve stenosis.
Male Pseudohermaphroditism
Authors: Levy Donna J. , Levine Lenore S. , New Maria I. 
Published: December 2021

Male pseudohermaphroditism is the condition of incomplete male differentiation of the external genitalia in an individual with a Y chromosome. The gonads of the male pseudohermaphrodite, when present, are either streak gonads or testes.
A wide range of disorders and phenotypic presentations are encompassed by the term male pseudohermaphroditism. The following case describes a male pseudohermaphrodite who presented with ambiguous genitalia. However, as will be discussed in greater detail below, the external genitalia of male pseudohermaphrodites may be unambiguously female or may appear to be almost completely masculinized.
CASE HISTORY
The infant, a 9 lb 3 oz product of a full-term gestation, was born to a 23-year-old gravida 1, para O mother via normal spontaneous vaginal delivery. Pregnancy was uncomplicated and there was no history of maternal ingestion of medication. At birth, ambiguity of the external genitalia was noted with a 1-cm phallus, one opening on the perineum, and a small palpable mass in each of the large unfused labia. No uterus was palpable on rectal examination. Serial serum electrolytes remained normal. Genetic evaluation revealed a chromatinnegative buccal smear, with Y fluorescence. Karyotype analysis of peripheral lymphocytes revealed a 46, XY chromosomal complement. Radiologic studies included an excretory urogram revealing normal functioning kidneys with intact pelvocalyceal systems, ureters, and bladder, and a blind-ending vagina, with no evidence of cervical indentation. Base line 24-hour urinary 17-ketosteroid and 17-hydroxycorticosteroid determinations were all normal.
Preparticipation Health Evaluation for Competitive Sports
Authors: Strong William B. , Linder Charles W. 
Published: December 2021

The large population of young people combined with the current popularity of sports has produced the largest number of sports participants in the history of our country. In 1978, the number of young people participating in high school athletics alone was cited to be 5.5 million.1 Although encouraging from both a sociologic and preventive health standpoint, an undesirable consequence of this level of participation is the high rate of injuries and death. Increasing attention is being paid to these problems, and as a result the "specialty" of sports medicine is emerging and utilizing modern epidemiologic and research methodologies. Because many serious athletic injuries and some deaths are preventable, much attention has been given to identifying risk factors in athletes and aspiring athletes.
The preparticipation health evaluation (PHE) for competitive sports should be an integral component of all strenuous sports programs. The major purpose of the preparticipation evaluation is to attempt to reduce life-threatening or disabling injuries by identifying predisposing factors, recommending preparatory and/or rehabilitative measures, and assisting in matching the participants with an appropriate sport or position. The purpose of the PHE should not be to exclude youths from participation but to guide them into more appropriate activities because of a medical problem. A secondary benefit is the direct association of sports participation with good prevention health care.
The Pediatrician's Role in Drug Education
Authors: Parcel Guy S. 
Published: December 2021

Pediatricians involved with local schools are often asked to help in dealing with child and adolescent drug use. Most states have mandated schools to provide drug education programs; the use of drugs has become endemic to American life. The pediatrician is likely to be considered a resource in the area of drug education because of his or her knowledge of pharmacology and the potential detrimental effects of drugs. School personnel may not be aware of the pediatrician's interest and expertise in related areas such as child development and human behavior.
PROBLEM OF CHILD AND ADOLESCENT DRUG USE
Prior to 1960, most illicit drug use was confined to inner city poverty groups or isolated fringe groups. During the late 1960s, the American public became alarmed by increasing illicit drug use by the middle and upper class, especially among the young. The spread of illicit drug use was first apparent in the urban middle-class college students and eventually spread to high school students and rural populations. The use of drugs also spread in terms of the numerous types of drugs used.
Marijuana became a popular drug and, in some communities, tended to be used like alcohol, as a social drug. LSD and other hallucinogens hit their peak use in the late sixties and early seventies.
Delinquency and the Pediatrician
Authors: Copoulos Ella , Hein Karen 
Published: December 2021

CASE OF PAUL S.
Upon arrival at the office, you receive a telephone call from Mrs S. Over the weekend her normally "well-behaved" 14-year-old son Paul, together with a group of school friends, were found by the police at a construction site in the process of spray-painting nicknames, slogans, and "obscene language" on a newly built concrete wall. Several bottles of beer, cigarette papers, loose tobacco, and a small quantity of marijuana were found nearby. Although he began to cry when his parents arrived at the police station to arrange his release, Paul has been "uncommunicative and sullen" ever since, refusing even to attend school today. Paul and his parents must appear before the Juvenile Court in two days, and Mrs S. would like you, as Paul's pediatrician for 14 years, to "see what's wrong" with Paul before then.
Among the various options that you might initially choose, how would you decide whether or not to:
—refer Paul to a teenage drug rehabilitation program,
—arrange an adolescent psychiatric consultation for Paul because of his sudden change in behavior,
—have Paul come to see you at the office, to be followed by a meeting with his parents,
—reassure Mrs S. over the telephone that Paul is a normal healthy teenager,
—inform the school guidance counselor of the reason for Paul's absence and request information concerning his school performance and activities.