bluuebunny/crossref_metadata_2025_split huggingface dataset:
Aerosol Beclomethasone Dipropionate Compared With Theophylline as Primary Treatment of Chronic, Mild to Moderately Severe Asthma in Children
Authors: Tinkelman David G. , Reed Charles E. , Nelson Harold S. , Offord Kenneth P. 
Published: December 2021

Objective. To compare the benefits and adverse reactions of theophylline and beclomethasone (BDP) in the long-term control of mild to moderate chronic asthma in children.
Design. Multicentered, double-blind, double-placebo, randomized, controlled trial.
Patients. One hundred ninety-five children between the ages of 6 and 16 years with mild to moderate asthma.
Intervention. Treatment with either BDP, 84 µg four times a day, or sustained-release theophylline administered twice daily in doses adjusted for optimum control of symptoms.
Main outcome measures. Daily diary record of symptoms, peak flow rates, supplemental bronchodilator and glucocorticoid treatment, doctor and hospital visits, absence from work and school, and side effects.
Results. Aerosol BDP and sustained-release theophylline were effective primary treatments for mild to moderate chronic asthma. Beclomethasone resulted in comparable symptom control with less bronchodilator use and fewer courses of systemic steroids than did theophylline. Side effects were observed significantly more frequently with theophylline than with BDP. Growth velocity suppression was noted with BDP and was more pronounced in boys. Suppression was not associated with alterations in cortisol measurements either at baseline or following stimulation.
Conclusions. Both theophylline and BDP are effective therapy for mild to moderate asthma. Caution must be used with the administration of BDP in children because of possible growth velocity suppression.
Malaria in Children in Chicago
Authors: Emanuel Benjamin , Aronson Neil , Shulman Stanford 
Published: December 2021

Objective. To review the experience of a large children's hospital and two community hospitals in Chicago in which malaria was diagnosed in children during a recent 6-year period.
Methods. Retrospective medical record review covering the years 1985 to 1990.
Results. Twenty cases of childhood malaria were diagnosed, generally in patients hospitalized for fever unresponsive to oral antibiotics also associated with splenomegaly, with presumptive diagnoses of malignancy, typhoid fever, acute appendicitis, or urinary tract infection. History of recent immigration to the United States or travel to a malaria-endemic area was frequently not elicited until several days into hospitalization, thus delaying diagnosis and therapy.
Conclusions. Because malaria in the United States pediatric population has increased as a result of foreign immigration and overseas travel, pediatricians must be alert to the possibility of malaria in febrile children, and the importance of antimalarial prophylaxis should be communicated to parents of children traveling to endemic areas.
Cerebral Oxygen Metabolism in Newborns
Authors: Altman Denis I. , Perlman Jeffrey M. , Volpe Joseph J. , Powers William J. 
Published: December 2021

Objective. A better understanding of the developmental changes in brain energy metabolism that occur in human neonates is critically important for designing rational treatment strategies that ensure an adequate supply of nutrients to the brain and minimize deleterious side effects of therapeutic interventions in sick newborns.
Methods. Cerebral metabolic rate for oxygen (CMRO2) was measured with positron emission tomography in 11 sick newborns of different gestational ages.
Results. In five preterm infants, mean hemispheric CMRO2 was 0.06 to 0.54 mL 100 g-1 min-1. Two of these preterm infants with virtually absent CMRO2 (0.06 mL 100 g-1 min-1) had minimal or no evidence of parenchymal brain injury detected in the newborn period. In six term infants, mean hemispheric CMRO2 was 0.0 to 1.3 mL 100 g-1 min-1. Two with no neurological disease had mean hemispheric CMRO2 of 0.4 and 0.7 mL 100 g-1 min-1 and were normal at 6 and 7 months, respectively.
Conclusions. CMRO2 in four newborns who had minimal or no detectable brain injury was considerably below the threshold for brain viability in adults of 1.3 mL 100 g-1 min-1. This indicates that energy requirements in fetal and newborn brain are minimal or can be met by nonoxidative metabolism.
Decreasing Mortality Associated With the Introduction of Surfactant Therapy: An Observational Study of Neonates Weighing 601 to 1300 Grams at Birth
Authors: Horbar Jeffrey D. , Wright Elizabeth C. , Onstad Lynn ,   Members of the National Institute of Child Health and Human Development Neonatal Research Network
Published: December 2021

Objective. To determine whether the introduction of surfactant therapy was associated with decreased mortality for high-risk preterm neonates weighing 601 to 1300 g at birth.
Design. Before-after observational study.
Setting. Eight tertiary care neonatal intensive care units participating in the National Institute of Child Health and Human Development Neonatal Research Network.
Patients. The outcomes for neonates with birth weight 601 to 1300 g admitted in the 2 years before surfactants became available (n = 2780) were compared with those of neonates admitted in the year beginning 2 months after surfactants became available (n = 1413).
Main outcome measures. The primary outcome measure was in-hospital mortality; secondary outcome measures included durations of assisted ventilation, length of hospitalization, and neonatal morbidity.
Results. Forty percent of neonates in the postsurfactant group received surfactant (range 28% to 69% at the centers). Mortality decreased from 27.8% before to 19.9% after surfactant therapy was introduced (Mantel-Haenszel x2 = 31.4, P = .001). The adjusted odds ratio for mortality after surfactants became available was 0.73 (95% confidence interval 0.55 to 0.95). The duration of assisted ventilation and length of hospitalization increased after surfactants were introduced (P = .0001 for both outcomes).
Conclusion. Mortality for neonates weighing 601 to 1300 g decreased after surfactant therapy was introduced, suggesting that the efficacy of surfactants demonstrated in randomized controlled trials will translate into effectiveness in routine clinical care.
Driving-Related Risks and Outcomes of Attention Deficit Hyperactivity Disorder in Adolescents and Young Adults: A 3- to 5-Year Follow-up Survey
Authors: Barkley Russell A. , Guevremont David C. , Anastopoulos Arthur D. , DuPaul George J. , Shelton Tern L. 
Published: December 2021

Objective. To determine whether teenagers and young adults with attention deficit hyperactivity disorder (ADHD) have more motor vehicle citations and crashes and are more careless drivers than their normal peers.
Design. A comparison of two groups of teenagers and young adults (ADHD and normal) followed up 3 to 5 years after original diagnosis.
Setting. A university medical center clinic for ADHD patients.
Patients. Thirty-five subjects with ADHD and 36 control subjects between 16 and 22 years of age, all of whom were licensed drivers.
Main outcome measures. Parent ratings of current symptoms of ADHD, oppositional defiant disorder, and conduct disorder, a survey of various negative driving outcomes, and a rating scale of driving behavior.
Results. Subjects with ADHD used less sound driving habits. This deficiency was associated with greater driving-related negative outcomes in all categories surveyed. Subjects with ADHD were more likely than control subjects to have had auto crashes, to have had more such crashes, to have more bodily injuries associated with such crashes, and to be at fault for more crashes than control subjects. They were also more likely to have received traffic citations and received more such citations than control subjects, particularly for speeding. The subgroup of teenagers with ADHD having greater comorbid oppositional defiant disorder and conduct disorder symptoms were at highest risk for such deficient driving skills/habits and negative driving-related outcomes.
Conclusions. ADHD, and especially its association with oppositional defiant disorder/conduct disorder, is associated with substantially increased risks for driving among teenagers and young adults and worthy of attention when clinicians counsel such patients and their parents.
Postexposure Prophylaxis of Varicella in Family Contact by Oral Acyclovir
Authors: Asano Yoshizo , Yoshikawa Tetsushi , Suga Sadao , Kobayashi Ikuko , Nakashima Toshihiko , Yazaki Takehiko , Ozaki Takao , Yamada Akira , Imanishi Jiro 
Published: December 2021

Objective. To determine whether varicella can be prevented by administration of oral acyclovir (ACV) during the incubation period of the disease.
Subjects and methods. ACV (40 or 80 mg/kg daily in four divided doses) was given orally to 25 exposed infants and children for 7 days, starting 7 to 9 days after exposure from the index case in their families. Their clinical features were compared with those of 25 age-matched control subjects who had been exposed in their families but did not receive ACV. A fluorescent antibody to membrane antigen assay was used for determination of the antibody to varicella-zoster virus, and a nested polymerase chain reaction method was used for detection of viremia.
Results. Among the 25 who received ACV, 4 (16%) developed the disease and 1 (4%) had a fever. On the other hand, all of 25 control subjects developed the disease and 17 (68%) had a fever. The incidence of fever and the severity of skin rashes were significantly lower (P &lt; .01) in the subjects who received oral ACV than in the control group. Seroconversion was observed in 84% of subjects who received ACV In some cases, varicella-zoster virus DNA was detected by polymerase chain reaction amplification in peripheral blood mononuclear cells from blood drawn approximately 14 days after exposure.
Conclusions. Varicella can be prevented or modified by administration of oral ACV late in the incubation period.
Effect of Dietary Fiber (Soy Polysaccharide) on the Severity, Duration, and Nutritional Outcome of Acute, Watery Diarrhea in Children
Authors: Brown Kenneth H. , Perez Fernando , Peerson Janet M. , Fadel James , Brunsgaard Grete , Ostrom Karin M. , MacLean William C. 
Published: December 2021

Objective. To assess the effects of dietary fiber (soy polysaccharide) on the severity, duration, and nutritional outcome of acute, watery childhood diarrhea.
Methods. A total of 34 hospitalized Peruvian male infants between 2 and 24 months of age were randomly assigned to receive a soy-protein isolate, lactose-free formula with added soy polysaccharide (group SF, n = 19) or the same diet without added fiber (group S, n = 15). The consumption of formulas, stool amount and consistency, absorption of macronutrients, and change in anthropometric status were measured.
Results. Children in both groups were initially similar with regard to age, nutritional status, and prior duration and severity of diarrhea. Four patients in group SF (21%) and two in group S (13%) failed therapy because of recurrent dehydration or severe purging (P = .67). Formula intakes increased slightly during hospitalization (P = .03), but did not vary by dietary group (P = .73). Stool outputs declined significantly (P &lt; .001) during hospitalization, but there were no significant differences by dietary group in either stool wet weight (P = .83) or dry weight (P = .87). Estimated median durations of liquid stool excretion after hospitalization were 43 hours in group SF and 163 hours in group S (P = .003). There were no significant differences in fractional or net absorption of macronutrients or change in anthropometric status by dietary group.
Conclusions. Soy polysaccharide, while not affecting stool output, macronutrient absorption, or nutritional status during acute, watery childhood diarrhea, significantly and markedly reduced the duration of liquid stool excretion.
Correlation Between Clinical Diagnoses and Autopsy Findings in Critically Ill Children
Authors: Stambouly Joseph J. , Kahn Ellen , Boxer Robert A. 
Published: December 2021

Study objective. To examine the correlation between clinical diagnoses and autopsy findings in children who die in the pediatric intensive care unit (PICU).
Design. Retrospective chart review.
Setting. PICU of a university-affiliated hospital.
Patients. A consecutive sample of patients who died in the PICU and had autopsies performed.
Measurements and main results. Of 193 patients who died during the 7½year study period, 50 (6%) had autopsies performed. The mean age was 34.7 months (range 15 hours to 17 years), and the mean length of stay in the PICU was 12.2 days (range 2 hours to 60 days). Major admitting diagnoses included postoperative cardiac surgery (19), nonoperative cardiac disease (7), hematologic/malignant disorder (5), and acquired immunodeficiency syndrome (5). There were 5 cases (10%) where autopsy revealed a major finding that, if known prior to death, would have altered clinical management and might have resulted in cure or prolonged survival. In another 9 patients (18%) the autopsy revealed major findings that, if known prior to death, would not have altered management. Eight of these findings related to the cause of death and 2 of them involved the basic disease. There was no correlation between new findings and either patient age or length of stay in the PICU.
Conclusions. Despite modern diagnostic techniques, the autopsy continues to reveal valuable and unsuspected information.
Effectiveness and Safety of an Haemophilus influenzae Type b Conjugate Vaccine (PRP-T) in Young Infants
Authors: Vadheim Constance M. , Greenberg David P. , Partridge Susan , Jing Jennie , Ward Joel I. ,   Kaiser-UCLA Vaccine Study Group
Published: December 2021

Objective. To study the safety, immunogenicity, and protective efficacy of the Haemophilus influenzae capsular polysaccharide tetanus conjugate vaccine (PRP-T).
Design. Randomized, double-blind, controlled clinical trial.
Setting. Southern California Kaiser-Permanente Health Plan.
Participants. 10 317 infants 6 to 15 weeks of age, with no known immune dysfunction, exposure to hepatitis B, or contraindication to diphtheria-tetanus-pertussis (DTP) vaccination were enrolled between August 1989 and September 1990.
Intervention. Infants were randomized to receive either PRP-T or a recombinant hepatitis B control vaccine (in addition to DTP at approximately 2, 4, and 6 months of age.
Outcome measures. Adverse reactions occurring during the first 72 hours and between doses (including hospitalizations and outpatient visits) were measured using parental reporting/interviews and review of records. Invasive disease caused by H influenzae was ascertained from the time of enrollment until December 31, 1990.
Results. In October 1990, the study was prematurely terminated because of licensure of other H influenzae vaccines recommended for routine infant use. The rates of systemic and local reactions occurring within 72 hours of each vaccine dose were generally similar for infants given PRP-T and hepatitis B, but some reaction rates (local reactions, fever ≥ 120°F, irritability, crying) were significantly higher in the PRP-T group. In the month following receipt of vaccine, PRP-T-vaccinated infants experienced five definite seizures compared with three in the hepatitis B control group. Within 48 hours of vaccination, three seizures (two definite and one possible), which were thought to be related to vaccination, occurred in the PRP-T group, compared with none in the control group (P &lt; .13). Overall morbidity, mortality and hospitalization rates were similar in the two vaccine groups. Three cases of invasive disease caused by H influenzae occurred in the control group; none occurred in the PRP-T group.
Conclusions. The PRP-T vaccine is safe and appears to be effective in preventing invasive disease caused by H influenzae type b.
Steroids and Varicella
Authors: REICHES NANCY A. , JONES JAMES F. 
Published: December 2021

Reasons for adverse outcomes of infectious diseases are always under scrutiny. We expect infectious illnesses to have a specific course and outcome. Outcomes outside of the expected range are unacceptable, although the natural course of each infection includes them. Adverse outcomes that are products of medical invention are of particular import because they imply changes inpractice.
One such situation is corticosteroid-induced fatal or severe varicella-zoster virus (VZV) infections. This topic, although not new, has received considerable interest because of recent warnings by the Food and Drug Administration.1 Case reports, retrospective studies, and reviews that have appeared since the 1950s suggest that high-dose (&lt;1 to 2 mg/kg per day) but not low-dose (5 to 20 mg/day) systemic use of corticosteroids in both immunocompetent and particularly in immunosuppressed patients may be associated with severe or fatal outcome, particularly if the drugs are given immediately prior to or during the incubation period.
Guidelines for Ophthalmologic Examinations in Children With Juvenile Rheumatoid Arthritis
Authors:   Section on Rheumatology and Section on Ophthalmology
Published: December 2021

Chronic, nongranulomatous iridocyclitis is an important complication of juvenile rheumatoid arthritis (JRA).1-3 First reported by Ohm in 1910, the association between iridocycitis and JRA has become well established. The intraocular inflammation referred to as iridocyclitis primarily affects the iris and ciliary body. Overall, the reported incidence of iridocyditis varies from 2% to 21% in children with JRA.4 The morbidity of iridocydlitis includes cataracts, glaucoma, band keratopathy, and loss of vision.5,6 Diagnosis of early iridocycitis is usually not possible by routine direct ophthalmoscopy. Sitlamp examination detects the signs of active anterior chamber inflammation. Guidelines for the schedule of routine serial sitlamp examination are suggested for early detection of iridocycitis.
The presentation of eye involvement in JRA may be asymptomatic or of an insidious onset. The outcome has improved in the past 20 years. The majority of children have a relatively good visual prognosis if the iridocycitis is detected and treated early.6
RISK FACTORS FOR IRIDOCYCLITIS
Articular Features
The diagnosis of JRA describes a heterogeneous group of arthritic conditions with onset of disease before age 16 years. There are three major subtypes of JRA: systemic onset, polyarticular onset, and pauciarticular onset, defined by the clinical manifestations in the first 6 weeks of the disease.7 Fewer than 2% of children with systemic-onset JRA have iridocycitis.4,5 Children with polyarticular disease are at moderate risk, with 7% to 37% incidence of iridocyditis. The majority of children with iridocycitis have pauciarticular disease.1-3,5 The onset of the iridocyclitis may precede the onset of the arthritis in approximately 6% of cases.
Nipple Confusion
Authors: MULFORD CHRIS 
Published: December 2021

To the Editor.—
In their recent artide "Single Daily Bottle Use in the Early Weeks Postpartum and Breast-Feeding Outcomes,"1 Cronenwett et al report that many American women who want to breast-feed choose partial breast-feeding rather than exclusive breast-feeding. The reasons the authors give are: (1) mothers intending to work outside the home, (2) fathers wanting to feed the baby, (3) mothers wanting to avoid 24-hour responsibility for feedings, and (4) fear that the baby will refuse to take a bottle at some later time if not taught early and kept in practice.
Nipple Confusion
Authors: HEERY LEE B. 
Published: December 2021

To the Editor.—
I read with interest the article by Cronenwett et al on the effect of early bottle supplementation on breast-feeding outcome.1 That article made the important point that motivated, breast-feeding mothers can use supplemental bottles to allow them more freedom to be away from their infants, to give the father the opportunity to feed, and to facilitate return to work.
However, I am concerned about the impact that article may have on advice given by health care providers who do not read the article carefully, particularly the excellent discussion of the limitations of the study.
Nipple Confusion
Authors: FREDRICKSON DOREN 
Published: December 2021

To the Editor.—
I wish to comment on the study reported by Cronenwett et al,1 which was a fascinating prospective study among married white women who planned to breast-feed. Women were randomly selected to perform either exdusive breast-feeding or partial breast-feeding with bottled human milk supplements to determine the impact of infant temperament and limited bottle-feeding on breast-feeding duration.
The authors admit that small sample size and lack of statistical power make a false-negative possible.
Artifacts Causing Artifacts
Authors: KAPLAN MICHAEL , GLUSTEIN JOSEPH Z 
Published: December 2021

To the Editor.—
Neonatologists frequently contend with artifacts produced by medical equipment causing unwanted shadows on chest and abdominal radiographs. These artifacts are frequently caused by monitoring equipment and respiratory tubing. We have not yet encountered cases of religious artifacts causing such distorting images.
Recently, two infants being ventilated on open radiant warmer incubators and x-rayed on the same day, were found to have rectangular semiopaque outlines on their radiographs (Fig 1). A search of all the medical and radiographic equipment did not reveal the origin of these artifacts.
SIDS and Homicide
Authors: BASS MILLARD , HASS RITA 
Published: December 2021

To the Editor.—
Dr Reece's discussion on differentiating between unexpected death due to the sudden infant death syndrome (SIDS) and one due to homicide1 focuses on the medical literature regarding this topic. May we comment on this diagnostic dilemma based on our experience in pediatric forensic pathology? It is certainly true that the recently expanded definition of SIDS now includes a negative death-scene investigation as an integrated part of this diagnosis.2 However, from a historical perspective, there has been a fundamental misunderstanding about the term "death-scene investigation" in sudden, unexplained infant death.
Questions Improvement!
Authors: STRASBURGER VICTOR C. 
Published: December 2021

To the Editor.—
Cheers to Dr Wender et al1 for having the good sense to update the survey of pediatricians originally undertaken by the 1978 American Academy of Pediatrics Task Force on Pediatric Education, but their concept of what constitutes "significant improvement" leaves me mystified! In their sample of graduates of pediatric residency training programs since 1984, the following percentages of physicians found their residency training experiences to be insufficient:
Care of adolescents, 50.9%
Psychosocial problems, 50.1%
Interviewing and counseling, 33.3%
Questions Improvement!
Authors: WENDER ESTHER H. 
Published: December 2021

In Reply.—
Dr Strasburger is correct to be appalled at the continuing high rates of perceived inadequacy of pediatric residency training in psychosocial issues and in adolescent medicine, as was documented in our recent article.1 But our study did reveal that there has been movement in the right direction during the 10 years of pediatric training since the Task Force report, especially in the five most recent years of training. Our figures showed, for example, that in 1978, when pediatricians were surveyed for the Task Force report, 66% felt that their training in adolescent medicine was insufficient.