bluuebunny/crossref_metadata_2025_split huggingface dataset:
Maternal Perceptions of Weight Status of Children
Authors: Maynard L. Michele , Galuska Deborah A. , Blanck Heidi M. , Serdula Mary K. 
Published: December 2021

Objective. We quantified maternal misclassification of child weight status and examined determinants associated with maternal perceptions of child weight status.
Methods. Data from the Third National Health and Nutrition Examination Survey (1988–1994) were used. The sample included 5500 children (aged 2–11 years) with maternal interview data. Maternal perceptions of children’s weight status were compared with measured weights and statures from which body mass index (BMI; weight/stature2; kg/m2) percentiles and z scores were determined. Frequency analyses determined the percentages of mothers considering their child to be “overweight,” “underweight,” or “about the right weight.” Multivariable logistic regression analyses determined predictors of maternal misclassification of overweight children (≥95th BMI-for-age percentile) and those at risk for overweight (≥85th to &lt;95th BMI-for-age percentile).
Results. Nearly one third (32.1%) of mothers reported their overweight child as “about the right weight.” Younger children and those with lower BMI-for-age z scores had significantly greater odds of maternal underclassification of child overweight status. For children at risk for overweight, 14.0% of mothers reported sons to be “overweight,” whereas 29.0% considered daughters to be “overweight.” Odds of maternal misclassification of at-risk children as “overweight” were significantly greater for daughters, older children, children with higher BMI-for-age z scores, and children whose mothers had a lower BMI. Race/ethnicity was not a significant predictor in either model.
Conclusions. Nearly one third of mothers misclassify overweight children as being lower than their measured weight status. Mothers are more likely to identify daughters who are at risk of overweight as being “overweight” than they are sons.
The Maternal Phenylketonuria International Study: 1984–2002
Authors: Koch Richard , Hanley William , Levy Harvey , Matalon Kim , Matalon Reuben , Rouse Bobbye , Trefz Frederick , Güttler Flemming , Azen Colleen , Platt Larry , Waisbren Susan , Widaman Keith , Ning Jiaping , Friedman Eva G. , de la Cruz Felix 
Published: December 2021

Objective. The purpose of this report is to review the obstetric medical, psychological, and nutritional aspects and outcome of the women and offspring enrolled in the Maternal Phenylketonuria Study, which was established to assess the efficacy of a phenylalanine (Phe)-restricted diet in preventing the morbidity associated with this disorder.
Methods. A total of 382 women with hyperphenylalaninemia (HPA) were enrolled in the study and completed 572 pregnancies. Outcome measures were analyzed with χ2, Fisher exact text, analysis of variance, t test, Wilcoxon nonparametric test, and multiple logistic regression. Outcome measures were stratified according to maternal HPA classification and the time when dietary control was achieved.
Results. Optimal birth outcomes occurred when maternal blood Phe levels between 120 and 360 μmol/L were achieved by 8 to 10 weeks of gestation and maintained throughout pregnancy (trimester averages of 600 μmol/L). Mothers with mild HPA achieved similar birth outcomes as mothers who were in control preconceptually and those in control by 8 to 10 weeks of pregnancy.
Conclusions. Before conception, counseling and early entrance into a prenatal care program is essential in achieving optimal fetal outcome in women with HPA. The achievement of pre- and periconceptional dietary control with a Phe-restricted diet significantly decreased morbidity in the offspring of women with HPA.
Pregnancy Experiences in the Woman With Mild Hyperphenylalaninemia
Authors: Levy Harvey L. , Waisbren Susan E. , Güttler Flemming , Hanley William B. , Matalon Reuben , Rouse Bobbye , Trefz Friedrich K. , de la Cruz Felix , Azen Colleen G. , Koch Richard 
Published: December 2021

Objective. A major issue in maternal phenylketonuria (MPKU) has been whether maternal non-PKU mild hyperphenylalaninemia (MHP) is teratogenic. Such untreated pregnancies and their outcomes are presented on this report.
Methods. Enrolled pregnancies in which the untreated prepregnancy assigned phenylalanine level (APL) was no more than 600 μmol/L were included in the Maternal PKU Collaborative Study and were followed according to protocol.
Results. Forty-eight enrolled women with non-PKU MHP had mean APL 408 ± 114 μmol/L. They had a total of 58 pregnancies that resulted in live births. Fifty were untreated. Maternal phenylalanine (Phe) levels in the untreated pregnancies decreased during pregnancy for average Phe exposure of 270 ± 84 μmol/L, virtually identical to the level of 269 ± 136 μmol/L in the 8 treated pregnancies. Birth measurements in the 50 offspring from untreated pregnancies were within normal limits with z scores of −0.25 for weight, 0.28 for length, and −0.63 for head circumference, although birth head circumference was negatively correlated with maternal APL (r = −0.30). Only 1 offspring had congenital heart disease. Offspring IQ was 102 ± 15 compared with 96 ± 14 in the mothers with untreated pregnancies and with 109 ± 21 in control offspring.
Conclusion. Maternal non-PKU MHP no more than 600 μmol/L does not require dietary therapy. The naturally lower Phe level during pregnancy seems to protect against teratogenesis.
Providing a Medical Home: The Cost of Care Coordination Services in a Community-Based, General Pediatric Practice
Authors: Antonelli Richard C. , Antonelli Donna M. 
Published: December 2021

Objective. To determine the cost of unreimbursable care coordination services for children with special health care needs (CSHCN) in 1 community-based, general pediatric practice.Methods. A measurement tool was developed to quantify the precise activities involved in providing comprehensive, coordinated care for CSHCN. Costs of providing this care were calculated on the basis of time spent multiplied by the average salary of the office personnel performing the care coordination service. In addition, data were collected regarding the complexity level of the patient requiring the service, the type of service provided, and the outcome.Results. During the 95-day study period, 774 encounters that led to care coordination activities were logged, representing service provision to 444 separate patients. When these encounters were examined on the basis of clinical complexity of the patient, the most complex patients constituted 11% of the population of CSHCN yet accounted for 25% of the encounters. In addition, care coordination activities for these clinically complex CSHCN engaged office staff 4 times as long when compared with less clinically complex CSHCN. Overall, 51% of the encounters were attributable to coordinating care for problems not considered typically medical and included activities such as processing referrals with managed care organizations, consulting with schools or other educational programs, and providing oversight for psychosocial issues. On the basis of national salary and benefits data, the annual cost of the time spent coordinating care for CSHCN in this medical home model ranged from $22 809 to $33 048 (representing the 25th and 75th percentiles, respectively).Conclusions. The costs of providing care coordination services to CSHCN in a medical home are appreciable but not prohibitive. Standardization of care coordination practices is essential because it makes the medical home more amenable to quality improvement interventions. Mechanisms to finance unreimbursable care coordination activities must be developed to achieve the Healthy People 2010 objective that all CSHCN have access to a medical home.
Parents’ Discipline of Young Children: Results From the National Survey of Early Childhood Health
Authors: Regalado Michael , Sareen Harvinder , Inkelas Moira , Wissow Lawrence S. , Halfon Neal 
Published: December 2021

Objective. To examine the use and predictors of different discipline practices by parents of very young children using data from the 2000 National Survey of Early Childhood Health (NSECH).Methods. NSECH is a nationally representative telephone survey of 2068 parents of young children between the ages of 4 and 35 months conducted by the National Center for Health Statistics. The survey includes questions about parents’ use of 5 discipline practices: yelling, spanking, time out, toy removal, and explanations. χ2 analyses and logistic multivariate regression were used to examine associations between discipline practices and child, parent, and demographic factors.Results. Among young children aged 19 to 35 months, frequent parental use of discipline strategies ranged from 26% (spanking) to 65% (taking away toy or treat), 67% (yelling), 70% (using time out), and 90% (providing explanations). In multivariate analyses, child age predicts reports of more frequent spanking and yelling, and child developmental risk is associated with increased reports of yelling. Parent frustration predicts frequent use of every discipline practice, including a greater inclination to use aversive practices. Lower parental emotional well-being is associated with reports of frequent yelling and spanking. Black ethnicity and maternal age predict more frequent spanking, and Spanish-speaking parents reported less frequent use of time out and taking away a toy.Conclusion. Child age and developmental risk and parents’ ethnicity, emotions, and mental health are closely associated with discipline practices in the first 3 years of life. These factors are important for pediatricians to recognize in providing anticipatory guidance about discipline.
N.T.A. CELEBRATES 50TH ANNIVERSARY
Authors: HILL LEE FORREST 
Published: December 2021

ON JUNE 6, 1904, approximately 100 persons met in Atlantic City and organized the National Association for the Study and Prevention of Tuberculosis (shortened in 1918 to National Tuberculosis Association). This year, from May 17 to 21, the Association is returning to Atlantic City for a Golden Jubilee meeting and celebration. Pediatrics is pleased to have this opportunity of paying tribute to the accomplishments of this great organization during its 50 year history.
Tuberculosis has been a tough foe of mankind for centuries. It has the dubious distinction of being the first specific disease to have a nation-wide group of men and women join together for the purpose of effecting its control and eventual eradication. In this combat between man and microbe the National Tuberculosis Association has played a leading role. Its original constitution stated its purposes to be "the study of tuberculosis in all its forms and relations; the dissemination of knowledge about the causes, treatment, and prevention and scientific treatment of tuberculosis."
ON THE PRESENCE OF POLIOMYELITIS VIRUS IN REGIONAL LYMPH NODES
Authors: Wenner Herbert A. , Kamitsuka Paul 
Published: December 2021

Fifteen fatal human illnesses caused by poliomyelitis viruses were studied in an effort to evaluate the position of lymphatic tissue in the pathogenesis of poliomyelitis. Poliomyelitis virus was detected in various regional lymph nodes obtained from 12 of 15 fatal cases.
Evidence that poliomyelitis virus multiplied in lymphatic tissue was not obtained. The findings indicated that the quantity of available virus was significantly less in lymph nodes than in CNS tissues or in the contents of the gastrointestinal tract. The data obtained in 5 patients indicated that substantial amounts of virus were not bound in situ by homotypic antibody.
GLYCOGEN DISEASE OF THE LIVER (VON GIERKE'S DISEASE) WITH HEPATOMATA
Authors: Mason Howard H. , Andersen Dorothy H. 
Published: December 2021

A case of glycogen disease of the liver (von Gierke's disease), followed from the age of 6 months to death at 10½ years, is reported. The child was dwarfed and mentally retarded. The diagnosis is supported by blood sugar concentrations following the administration of monosaccharides and following epinephrine injection as well as by post-mortem anatomical and chemical studies.
Hypoglycemia was controlled by frequent feedings which contained glucose or starch. Levulose and galactose were restricted because low tolerance tests suggested that these substances were rapidly removed from the blood by the liver; after phosphorylation and conversion in the liver their release as glucose was evidently blocked by the same mechanism that blocked the release of glucose from glycogen.
Blood lactic acid was consistently elevated, the degree of elevation bearing an inverse relationship to blood sugar levels. It is suggested that excess blood lactic acid contributes to the acidosis and so therapy of the acidosis with lactates would be illogical.
The concentration of total serum lipids was always high but fluctuated widely, reaching a peak of 7.45 gm./100 ml., higher during periods of prolonged hypoglycemia and probably reflecting the mobilization of body fat during these periods.
The terminal illness was marked by 2 unexplained complications: multiple hepatomata and congestive right heart failure.
The severity of the disease varies from patient to patient, in the present case appearing to decrease with advancing age.
TOTAL BODY EXCHANGEABLE WATER, SODIUM AND POTASSIUM IN "HOSPITAL NORMAL" INFANTS AND CHILDREN
Authors: Corsa Leslie , Gribetz Donald , Cook Charles D. , Talbot Nathan B. 
Published: December 2021

Total body exchangeable potassium is approximately 40 mEq./kg. of body weight in infants, children and young adults alike, in contrast to exchangeable water and sodium which are high per unit of body weight at birth and decrease to adult levels during the first 2 years of life.
"Cell potassium concentration" calculated from exchangeable water, sodium and potassium and serum sodium concentration changes little during the period of growth and development despite other large alterations in body composition.
These measurements are suggested as a further means of investigating cellular potassium status in vivo.
MULTIPLE SCLEROSIS IN CHILDREN
Authors: Low Niels L. , Carter Sidney 
Published: December 2021

Reference to textbooks on pediatrics and neurology, individual case reports and review articles on multiple sclerosis showed that multiple sclerosis can occur in childhood in typical form and has been occasionally confirmed by necropsy.
During the past year 3 children were seen at the Neurological Institute in New York in whom the diagnosis of multiple sclerosis seemed reasonably certain. Four additional patients are presented in whom that diagnosis was suspected. In the latter group years of observation will be required for confirmation of the diagnosis.
EFFECT OF EXTRACTS OF HEMOPHILUS PERTUSSIS ON LEUKOCYTE COUNTS IN NORMAL AND SENSITIZED MICE
Authors: Bradford William L. , Scherp Henry W. , Tinker Mary R. 
Published: December 2021

Mice, sensitized by intranasal infection with sublethal doses of H. pertussis, were injected intra-abdominally 3 weeks later with extracts of the organism in order to observe their leukocytic response compared with that of normal mice.
After injection of an extract prepared by sonic disruption of the organism, a significantly greater increase of the total leukocyte count, particularly of the polymorphonuclear cells occurred in the sensitized animals. A similar, though somewhat lesser, response followed injection of this extract previously freed of agglutinogen by absorption with a specific antibacterial rabbit serum.
No significant increase occurred after injection of the extract after heating, after heating and absorption, or after injection of physiological salt solution.
Under the conditions of the experiments leukocytosis, chiefly caused by an increase of the polymorphonuclear cells, appeared to be associated with the heat-labile component of the extracts tested.
EXCHANGE TRANSFUSION IN THE TREATMENT OF OIL OF WINTERGREEN (METHYL SALICYLATE) POISONING
Authors: Done Alan K. , Otterness Larry J. 
Published: December 2021

A case of oil of wintergreen (methyl salicylate) poisoning treated by exchange transfusion is reported. This procedure resulted in the rapid removal of a relatively large amount of salicylate and in prompt clinical improvement.
The favorable results presented in this report suggest that the use of exchange transfusion deserves further evaluation in this and in other selected types of poisoning in infants and small children.
ENDOCARDIAL FIBRO-ELASTOSIS
Authors: Andersen Dorothy H. , Kelly Janice 
Published: December 2021

The site and degree of endocardial fibrosis has been estimated and recorded in 129 hearts with relatively uncomplicated congenital malformations. The great majority showed endocardial thickening.
Mechanical factors, including increased pressure and abnormal currents of intracardiac blood, are of importance in the production of endocardial fibrosis, because the sites of fibrosis follow the same pattern in various examples of the same defect and occur where general increase in intracardiac pressure may be presumed to occur on where localized jets may impinge on cause vibration. The degree of fibrosis increases with age.
Deficiency of oxygen in the coronary blood supply is also of importance, especially in cases of severe aortic stenosis or atresia and in hearts with a coronary artery arising from the pulmonary artery.
A hypothesis is offered that the warty valvular vegetations occasionally seen with aortic stenoss represent the reaction of fetal valvular endocardium to mechanical factors combined with hypoxia.
Elastic tissue stains show that proliferation of elastic fibers occurs in association with proliferation of the collagen in the thickened endocardium found in congenitally malformed hearts and in other types of heart disease. It is concluded that elastic tissue is a normal component of endocardial fibrosis.
CONGENITAL ENDOCARDIAL FIBRO-ELASTOSIS
Authors: Kelly Janice , Andersen Dorothy H. 
Published: December 2021

Seventeen cases of congenital endocardial fibro-elastosis without associated cardiac malformations or other known cause have been reported. Seventy-nine similar cases have been collected from the literature.
Evidence is presented that these cases represent a disease entity with the following characteristic features:
a. The disease is familial.
b. Nonspecific symptoms begin in the first 6 months of life in the majority of cases, consisting of failure to gain and cough, over a few days or weeks. A sudden attack of labored breathing and tachycardia with vomiting or abdominal pain may lead to death within 1 or 2 days or to recovery followed by repetition of similar attacks. Death within a day of onset of an attack occurs in half of the cases.
c. Bradycardia before birth and congenital heart block occurred in two cases.
d. The heart is grossly enlarged mainly because of dilatation and hypertrophy of the left ventricle.
e. The endocardial fibro-elastosis increases with age and is most marked in the left ventricle.
f. Non-cardiac malformations are rarely present.
A hypothesis is presented that the disease is based on a familial metabolic defect leading to myocardial weakness and that the endocardial changes are secondary.
CLINICAL CONFERENCE
Authors: Buchanan Douglas 
Published: December 2021

(E.W., 63 07 34) This girl is 8 months old. She has a brother 2 years old. Her mother and father are young and have had no recognized illness. Her mother was well after the birth of her first child in November of 1953. She had no change in weight and no evidence of anemia, and took no medicine. During her second pregnancy she had no feverish illness and no rash. She believes that the patient moved in utero more than her first child, but with both children she could feel the movements of the different parts of their bodies. The patient was born at term after a spontaneous onset of labor. She was delivered head first after 2 hours without anesthetic or sedation. She breathed at once. She had no cyanosis, no jaundice, and no convulsions.
On the day of her birth her tongue was large and protruded, and in the 8 months of her life it has never been completely within her mouth. The muscles of her arms and legs were unusually distinct, not only because of their size, but also because of the lack of fat beneath the skin. Her skin was thin, and the blood vessels were easily seen. Her abdomen was distended. There was a separation between the two recti muscles and the liver was slightly enlarged. These physical peculiarities have not changed or disappeared.
On examination now at the age of 8 months the optic discs and the retina in both eyes are normal. The other cranial nerves are all normal in their action. There is no strabismus or limitation of movement of the eyes in any direction. The deep reflexes are present, symmetrical, and brisk. The plantar responses are extensor.
TRACHEO-ESOPHAGEAL FISTULA WITHOUT ESOPHAGEAL ATRESIA—CONGENITAL AND RECURRENT
Authors: Sieber William K. , Girdany Bertram R. 
Published: December 2021

The clinical problems presented by 10 infants with congenital and recurrent tracheo-esophageal fistulas are discussed.
A roentgenographic technique of identification of tracheo-esophageal fistulas, using the aqueous solution Dionosil®, is described.
The intermittent patency of the fistula is stressed. Recurrent tracheo-esophageal fistula may be a complication in infants operated upon for esophageal atresia with tracheo-esophageal fistula.
The results in this series demonstrate the urgency of early recognition and prompt therapy.
HYPOCHROMIC MICROCYTIC ANEMIA OF INFANCY: IRON DEPLETION AS A FACTOR
Authors: Josephs Hugh W. 
Published: December 2021

In this work the author has attempted to gain insight into the significance of iron depletion by the use of 4 simple calculations, justification for which is found in recent articles. These are: (a) iron with which the infant is born; (b) iron retained from the food; (c) iron being used by the tissues and therefore unavailable for hemoglobin, and (d) iron combined with the total mass of hemoglobin. With these 4 figures it is possible to estimate the iron still potentially available for use (the "reserves" or "stones"). When the difference between a + b and c + d has reached about zero, depletion is considered to exist.
The following characteristics of depletion may be emphasized:
Depletion is the result of gain in weight and maximum possible usage of iron. It is therefore a normal result of growth and need not be associated with anemia.
As soon as depletion has occurred, the organism is thereafter dependent on current absorption of iron. This is ordinarily sufficient, even with a diet of milk alone, to maintain an adequate concentration of hemoglobin after about 8 to 10 months of age.
Severe anemia due to depletion alone is practically confined to premature babies whose relative gain in weight is rapid.
Severe anemia in other than premature babies is the result of a number of factors by which iron becomes unavailable or is actually diverted from hemoglobin to storage.
Response to iron medication is considerably better in infants with depletion than in those in whom some factor is present that interferes with iron utilization, and which is not connected by the mere giving of iron.
The dependence on current absorption, whether the result of depletion or non-availability, introduces a certain precariousness which is apparently characteristic of this time of life. The organism gets along from day to day if nothing happens, but may not be able to meet an emergency, whether this appears as a rapid gain in weight, or a necessity to repair damage done by severe infection.
If we consider iron deficiency as the cause of anemia, we can think of deficiency as due to a number of factors of which depletion is only one. The development and characteristics of depletion have been considered in this paper; other factors in iron deficiency will be considered in subsequent papers.