bluuebunny/crossref_metadata_2025_split huggingface dataset:
Urinary Tract Infection
Authors: Rapkin Richard H. 
Published: December 2021

The identification of urinary tract infection (UTI) is important in order to reduce its morbidity, to prevent its sequelae, and to identify underlying disease. This article will discuss methods of diagnosis and management of UTI, screening for UTI, and the importance of further evaluation and follow-up of children with UTIs. Much of what we know about UTI is controversial and rapid generation of new knowledge may make current recommendations passé.
CASE
V.M., a 4-year-old girl, was brought to the physician's office with the chief complaint of frequency of urination. Nine months before she had been seen because of frequency and dysuria and two consecutive midstream urine cultures grew &gt;100,000 colonies/ml of a Gramneative rod. Sulfisoxazole was begun and a urine culture was sterile 48 hours after therapy was begun. The dysuria and frequency disappeared; therapy was continued for ten days and a urine culture four days later was sterile. One week later a voiding cystourethrogram (VCU) and an intravenous pyelogram (IVP) were performed and were interpreted as normal. Repeat urine cultures at one, two, three, and six months after the episode were sterile.
Two days before the child was seen, she had become irritable and wet the bed during sleep (she had been successfully trained at 27 months of age), and she began to void frequently during the next 24 hours.
Editorial
Authors: Haggerty Robert J. 
Published: December 2021

THE EDITORIAL BOARD—WHO'S WHO
Editorial Board Members are usually names on a masthead who anonymously review articles. They add their expertise to the more general knowledge of an editor and assist in the selection of articles for publication. They also are used by the editor as the (usually unnamed) experts who have recommended disapproval of one's cherished paper! They are always hard working and are the backbone of any journal. The Editorial Boards of Pediatrics in Review serve all of these functions and more. Readers may be interested in their roles.
We have two Editorial Boards: A Policy Board and an Editorial Consulting Board. Both are made up of approximately equal numbers of practicing pediatricians and full-time teachers.
Editorial PREP Is For You!!!
Authors: SMULL NED W. 
Published: December 2021

A half life for the first year's curriculum will have passed as you read this commentary. Since thoughtful communication is fundamental to education, re-enforcement for the purposes of PREP seems most appropriate at this time.
The American Academy of Pediatrics in active cooperation and coordination with the American Board of Pediatrics has embarked upon a historic landmark in continuing medical education. While this may sound like a global term to some, I can assure you that PREP has been developed with the pediatric practitioner in mind. PREP is, indeed, designed for you!!!
The purpose of this discussion is not to dwell on the recertification issus—understandably sensitive and I would emphasize voluntary—but to try to communicate a realistic sense of purpose of why we feel this educational process is important.
Bleeding in the Newborn
Authors: Plunket Daniel C. 
Published: December 2021

The physician caning for newborns should master four objectives in the assessment and management of bleeding problems in that age group. They are: (1) to recall the neonate's hemostatic peculiarities, (2) to perform a meaningful clinical assessment, (3) to order and interpret appropriate diagnostic tests, and (4) to formulate a treatment plan.
NEONATE'S HEMOSTATIC PECULIARITIES
Table 1 lists the components of the hemostatic mechanism comparing older patient normal values and the neonate's similarities and differences. Certain laboratory tests commonly available are also noted. Several important points should be emphasized. Differences between neonates and older children, in general, are accentuated in direct proportion to the degree of immaturity.
Platelet counts vary little with age. Big platelets (diameter more than one third the size of a red cell's diameter) are young platelets and suggest active thrombocytopoiesis. The blood vessel and platelet function contributions to hemostasis may be suboptimal by older patient standards, but are not of clinical significance unless such dysfunction has been aggravated by drugs or disease.
Most coagulation proteins (procoagulants) are derived from liver and thus are somewhat deficient in amount or function in the neonate whose liver is transiently functionally immature. In general, the more immature the infant the more deficient the procoagulant. This is particularly true of the vitamin K-dependent procoagulants (Factors II, VII, IX, X).
Foreign Bodies in the Air and Food Passages
Authors: Kenna Margaret A. , Bluestone Charles D. 
Published: December 2021

Foreign bodies of the aerodigestive tract have been recognized for centurles. Before the early 20th century, foreign body aspiration or ingestion often meant prolonged illness and death.1 Prior to the advent of modern endoscopy, bronchotomy was the primary method of laryngotracheo-bronchial foreign body removal, and blunt metallic hooks, wire nooses, esophageal forceps, and pieces of linen attached to a piece of whalebone were used to extract foreign bodies from the esophagus.2
Not surprisingly, Weist, in 1882 (as cited by Clerf2), reported a 27.4% death rate for patients undergoing bronchotomy v a 23.2% mortality for those who were not treated. In 1911, LeRoche (as cited by Clerf2) reported the use of a rigid esophagoscope for removal of sharp foreign objects. It was Chevalier Jackson, however, who developed and refined aerodigestive endoscopy. By 1936, he was able to report a decrease in mortality from foreign bodies from 24% to 2% and a 98% success rate for bronchoscopic removal.1
Although there have been marked changes in anesthesia, equipment, and endoscopic teaching since Jackson's time, his remarkable record of success has not been significantly improved upon. The mortality for all recent series is now well below 1%, mainly due to improved anesthesia, instrumentation, and medical therapy of the suppurative complications.
The Pediatrician and the Under Toad
Authors: Nazarian Lawrence F. 
Published: December 2021

We are introduced to the Under Toad in John Irving's novel. The World According to Garp. A small boy at the beach is warned of the danger of being pulled out to sea by the undertow. He conjures up the image of a malevolent amphibian, lurking unseen and intent on grabbing him. The Under Toad becomes his family's symbol for all the destructive forces waiting to pounce when least expected and disrupt the peace and security of everyday life.
In our work as pediatricians, we feel the presence of the Under Toad. Some days the threat is sensed barely or not at all. At other times we can almost feel the cold breath of something ominous on the backs of our necks.
Acquired Immunodeficiency in Children
Authors: Rubinstein Arye 
Published: December 2021

The acquired immunodeficiency syndrome (AIDS) in children is closely linked to infected adult family members, usually the mother. Thus, a brief analysis of the epidemiology of AIDS in adults is necessary for the understanding of future trends in pediatric AIDS.
AIDS was initially reported to occur in homosexual men. Subsequently, it was noted to occur in intravenous (IV) drug-abusing individuals, including women. The infection of women with the human immunodeficiency virus (HIV), the causative agent of AIDS, has, however, not been restricted to IV-drug abusing women. It was soon recognized that a bidirectional heterosexual transmission does occur, with male to female transmission apparently being more efficient than female to male transmission. This form of sexual transmission may occur in more than 40% of regular sexual partners. Nationwide, the percentage of women with AIDS has doubled in 2 years to nearly 7%. Whether the female to male ratio of patients with AIDS will reach 1:1, as in Africa, is yet to be seen. New demographic studies have shown that AIDS in women, especially in those of childbearing age, is increasing dramatically. In New York City the leading cause of death in 1987 for women between the ages of 24 and 35 years was AIDS.
Foster Care
Authors: Schor Edward L. 
Published: December 2021

A SYSTEM OVERLOADED: THE FOSTER CARE CRISIS
"The children are now buffeted by countless rejections and severe stress. They often become angry, depressed, and violent. Few of them understand that they are the littlest victims of a system that, by all accounts, has been overwhelmed" (The New York Times, March 15, 1987).
Seemingly on a daily basis, especially in our larger cities, newspapers report the crisis in foster care. State departments of social services are being sued for neglecting children in their care, caseworkers are being accused of malfeasance, and children placed in foster care for their own best interests are reported to have experienced further abuse and some have died. Pediatricians who care for foster children, and who need as well to be their advocates, should understand the foster care system—its origins, mandates, objectives, and how well it has fared.
Although its roots are in the English Elizabethan Poor Law of 1601, foster care as we know it today in the United States grew out of the federal initiative Aid to Dependent Children which was enacted as title IV-A of the Social Security Act of 1935. The objective of this entitlement program was to provide financial assistance to widows and widowers with children to avoid the breakup of families because of economic hardship.
Clumsy Child
Authors: Taft Lawrence T. , Barowsky Ellis I. 
Published: December 2021

It has been estimated that 6% to 7% of school-aged children manifest poor coordination.1 Clinicians will rarely identify the presence of this type of disability from their findings during routine physical and neurologic examinations. What is required is careful observation of the child during performance of fine and gross developmental motor tasks.
It is infrequent that parents will express concern to the pediatrician, unless they have clues from nursery school or grade school teachers, coaches, peers, or, occasionally, from the child him- or herself. The child is usually the first one to be aware of motor limitations, especially when he or she is in competition with children of the same age. Unfortunately, the child does not usually verbalize his or her concern but will refrain from participating in competitive motor activities to conceal motor inadequacies.
DEFINITION
The term "clumsy child" refers to a boy or girl who performs fine and/or gross motor tasks in an immature, disorganized, erratic, slow, irregular, or inconsistent fashion. The relevant motor skills are imprecise rather than grossly impaired and the neurologic examination does not reveal significant postural disabilities or involuntary movements.
SIGNIFICANCE
A pediatrician should not minimize the significance of clumsiness. It is frequently associated with other evidence of cerebral dysfunction, such as cognitive and/or perceptual impairments that may result in learning disabilities.
Nephrolithiasis in Children
Authors: Stapleton F. Bruder 
Published: December 2021

More than 325 000 Americans are hospitalized each year for the evaluation and treatment of calculi in the urinary tract. It is estimated that an equal number of unfortunate victims of urolithiasis are treated exclusively as outpatients. For years, the problem of urolithiasis was considered to be the scourge of the adult years. Recently, an increasing awareness of the importance of urolithiasis in children has developed. Clearly, urinary stones—or warning signs of future calculi—occur in children, especially in certain geographic regions and in high-risk populations. Recognition of children at greatest risk may allow early detection or prevention of calculus formation based on a laboratory evaluation directed at pathogenetic risk factors known to be important in the formation of nephrolithiasis.
CLINICAL MANIFESTATIONS OF UROLITHIASIS
The classical image of incapacitating flank pain associated with the passage of a urinary calculus is unusual in children. Abdominal or flank pain occurs in approximately 50% of children with urolithiasis; in infants, symptoms of stones may be confused with colic. In older children, abdominal pain may be vague and nonspecific, as well as severe and radiating into the groin. Hematuria, either microscopic or macroscopic, occurs in greater than 90% of children with urolithiasis. Urolithiasis should always be a consideration in children with nonglomerular hematuria especially in geographic regions where nephrolithiasis is common.
"It" Happens
Authors: Menna Vincent J. 
Published: December 2021

No matter how hard we try, "it" happens: the mistakes that all humans make, even doctors. Our friends, the lawyers, know this and that is why we are often their prey. During a recent conversation with a lawyer acquaintance, he mentioned that everyone is human and makes mistakes. He related that he almost missed the statute of limitations for one of his clients. Tears streamed down my face.
A pediatric office is ripe for mistakes because it is so busy. Every member of the office—doctors, nurses, receptionists, and secretaries—is anxious to resolve their own particular problems. Doing their jobs frequently entails interrupting a physician.
Pediatrician and School Readiness
Authors: Dworkin Paul H. 
Published: December 2021

Editor's note: A reader wrote to ask whether or not the battery of tests for school readiness he uses is appropriate and adequate. We asked Dr Dworkin to respond with the following commentary.
The pediatrician, as the professional concerned with monitoring the growth and development of children during the preschool years, is well suited to contribute to the assessment of children's readiness to begin the task of academic learning, as well as participate in the early identification of children at risk for school dysfunction. Pediatricians view the early identification of children with potential learning disabilities as an important component of primary care.
Nutritional Assessment of the Handicapped Child
Authors: Dietz William H. , Bandini Linda 
Published: December 2021

CASE HISTORY
G.R. is a 7-year-old boy with spastic quadriplegia evident since birth and a seizure disorder for which he currently is being treated with phenobarbitol and phenytoin (diphenylhydantoin). His medical history includes a pathologic fracture of his right femur. At the time of his fracture, a radiograph of his femur was described as "markedly osteoporotic." He is currently being treated with 1200 IU of vitamin D.
His diet as presented is balanced with respect to nutrients. Although spillage is not substantial, eating requires great effort, and each meal lasts approximately 1 hour. He is fed breakfast and supper at home by his mother and lunch in school. There is no history of pain with food intake, no vomiting, and no diarrhea.
He weighs 14 kg (far below the 5th percentile), and his length is 112 (at the 5th percentile). His weight for height is far less than the 5th percentile. His mother is 157.5 cm (5 ft 2 in) tall and his father is 167.5 cm (5 ft 6 in) tall. His midarm circumference is 154 mm (less than the 5th percentile), his triceps skinfold is 5 mm (5th percentile), and his midarm muscle circumference is 138 mm (less than the 5th percentile).
Cholelithiasis in Infants, Children, and Adolescents
Authors: Holcomb George W. , Holcomb George W. 
Published: December 2021

During the past two decades, cholelithiasis has been recognized in increasing numbers of pediatric patients. This diagnosis should be considered in the event of upper abdominal complaints, particularly when one or more risk factors are evident. The etiology may be unknown or may be related to risk factors, including hemolytic conditions. In recent years, it has become evident that approximately 80% of gallstones in children are not due to hemolytic disease and that the remaining 20% are related to recurring hemolysis. The diagnosis of gallstones is best confirmed with ultrasonography. Routine ultrasonographic evaluation should be performed at intervals for all children who received TPA for more than 4 weeks, particularly those who have had ileal resection or have had chronic enteritis (Crohn disease).
Cholecystectomy is the procedure of choice for symptomatic children with cholelithiasis, regardless of age. Cholecystectomy is recommended for the asymptomatic child younger than 3 years of age when echogenic shadows have been present for at least 12 months following resumption of oral feedings or when the gallstones are radiopaque. Also, cholecystectomy is advised for asymptomatic children who are older than 3 years of age if ultrasonographic studies confirm that echogenic foci with shadowing are true stones and not echogenic sludge. Complications of common bile duct obstruction, pancreatitis, perforation with bile peritonitis, and life-threatening sepsis may thus be prevented. Morbidity and mortality following cholecystectomy are expected to be relatively low in the pediatric age group.
Follow-up on "The Case of Donnie J"
Authors: H. R. J. 
Published: December 2021

Few review articles published in Pediatrics in Review have elicited such strong disagreements with the recommendations of the author as "The Case of Donnie J," published in our July 1990 issue. The disagreements were in three areas: (1) the extensiveness of the workup and large number of immunizations recommended by Dr Burg at the first visit; (2) the pejorative nature of descriptions of the mother, such as that she was a "dead head"; and (3) the practicality of treating such a patient in private practice. Dr Burg was asked to comment on these letters.
APPROPRIATENESS OF A COMPLETE WORKUP OF DONNIE J AT THE FIRST VISIT
Granulocyte Transfusions in Neonates
Authors: Hill Harry R. 
Published: December 2021

Human neonates, especially those born prematurely, are prone to developing overwhelming infections in response to bacterial pathogens. It is estimated that 1 to 8 per 1000 live births are complicated by such infections. Moreover, almost 30% of neonatal mortality and morbidity can be attributed to neonatal infection. Thus, in spite of all of the support measures offered in neonatal intensive care units and the use of new, potent antimicrobial agents, we continue to lose far too many infants to overwhelming infections. It is likely that we have come as far as we can with these accepted regimens for treating bacterial infection in the neonate. This has led many investigators to explore the possibility of using various forms of immunotherapy in neonates who have infections, because the neonatal host defense system is compromised significantly.
Most neonates who develop infection lack opsonic antibody to the infecting strain of bacteria. In addition, the infant complement system is compromised significantly with the concentration of most components being only approximately 50% of that of adults. Deficiency of antibody and complement lead to defective opsonization of most bacteria by neonatal serum. Additional consistent abnormalities in the neonatal host defense system are present in the cells that act as the first line of defense against bacterial invasion, polymorphonuclear leukocytes (PMNs), PMNs must arrive at the site of bacterial invasion within a very critical 2- to 4-hour period if infection is to be contained so that systemic spread does not occur.
Breast Milk Jaundice
Authors: Powers Nancy G. , Rosenthal Philip , Sinatra Frank R. 
Published: December 2021

A reader writes about the article on "Jaundice in Infancy" published in the September 1989 issue of Pediatrics in Review:
My first concern is that the authors do not distinguish "breast feeding jaundice" from "breast milk jaundice." This is an important distinction, and it is nicely outlined in a recent publication.1 Secondly, the issue of breast milk jaundice is covered only very superficially, and there is an unequivocal therapeutic suggestion to "interrupt breast feeding" in Table 2 on page 80. The third concern is that fatty acids are suggested as a possible mechanism for breast milk jaundice, when in fact there are several other current theories.1
Steroids: Breakfast of Champions
Authors: Dyment Paul G. 
Published: December 2021

Anabolic steroids (called "steroids" hereafter) have been used to enhance performance by athletes for almost three decades. Initially, they were used because of their ability to increase muscle size ("bulk-up") and were popular with football players who needed to increase their size and weight to compete successfully for line positions on a football team. Despite early scientific reports that steroids increased neither strength nor athletic performance, their use became widespread among nationally competitive athletes. Competition fosters all sorts of practices designed to enhance athletic performance. Many of them are valueless, including the widespread practice of taking amino acid supplements to build muscle size and strength. At least, however, amino acid supplements are harmless; the side effects of steroids can be fatal.
The initial reports indicating that steroids were not performance-enhancing were controlled studies using average athletes in whom continuing weight-training during the period of study caused an increase in strength regardless of whether or not steroids were being taken.1 These studies were then repeated on elite athletes, who were already at their peak strength and in whom further weight-training merely kept their strength performance stable; these athletes did increase their muscle strength in response to steroids.2 There is no evidence that steroids increase aerobic capacity or endurance, however.
Childhood Hodgkin and Non-Hodgkin Lymphomas
Authors: Leventhal Brigid G. , Kato Gregory J. 
Published: December 2021

Lymphomas were recognized originally by Virchow as swellings of lymph nodes that were unrelated to tuberculosis or to other recognized pathology in the drainage area of the lymph node group. Lymphomas were not recognized initially as malignancies; proof of this came only in this century. Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL), which together account for approximately 12% of childhood cancer, have become among the most curable of pediatric malignancies. Today, the projected cure rates for children in certain categories are as high as 90%. Recent advances in molecular biology have permitted immense strides in understanding the pathogenesis and biology of these two diseases.
FACTORS PREDISPOSING TO LYMPHOMAS
Of individuals with immune deficiency or defects of DNA repair function, 1% to 35% develop lymphomas. NHLs are highly associated with Wiskott-Aldrich syndrome, common variable immunodeficiency, severe combined immune deficiency syndrome, X-linked lymphoproliferative syndrome, and Bloom syndrome, and they are found in patients receiving immunosuppressive therapy following organ or bone marrow transplant. Both HLs and NHLs are seen with increased incidence in patients with ataxia-telangiectasia and acquired immunodeficiency syndrome.
Epstein-Barr virus, first strongly implicated epidemiologically in African Burkitt lymphoma, appears to have a role in the pathogenesis of at least 20% of B-cell lymphomas.