bluuebunny/crossref_metadata_2025_split huggingface dataset:
Serum and Bile Bilirubin Pigments in the Differential Diagnosis of Crigler-Najjar Disease
Authors: RUBALTELLI FIRMINO F. , NOVELLO ANTONELLA , ZANCAN LUCIA , VILEI MARIA TERESA , MURACA MAURIZIO 
Published: December 2021

Objective. To differentiate between Crigler-Najjar (CN) disease types 1 and 2.
Design. The patterns of serum bilirubins, bile pigment composition, and phenobarbital response were studied.
Patients. Three infants, affected by high serum unconjugated bilirubin concentrations, previously classified as type 1 CN.
Methods. Serum and bile bilirubin pigment composition, both before and after phenobarbital (PB) treatment, were determined by alkaline methanolysis and high-pressure liquid chromatography. PB was given for at least 3 weeks by oral administration (5 mg/kg bw per day).
Results. No diconjugated bilirubin was found either before or after PB treatment in the serum of the three studied infants. In two patients traces of monoconjugated bilirubin were detected before PB therapy, and the ratio of conjugated/total bilirubin (percent) was increased by the PB response. In the third patient, traces of monoconjugated bilirubin appeared only after PB administration. However, the serum unconjugated bilirubin concentration decreased significantly only in the second patient, following the second cycle of PB treatment, leading to the diagnosis of type 2 CN. The analysis of the methyl ester derivatives of bile pigments was also performed on bile samples obtained in two patients by Entero-Test (R) both before and after PB treatment. An absolute increment in monoesterified bilirubin concentration was found after PB administration, although the percent concentration increased in one case and decreased in the other. No diesterified bilirubin was detected in the bile samples.
Conclusions. The present results show that in types 1 and 2 CN disease it is possible to detect traces of monconjugated but not diconjugated bilirubin both in serum and in bile. Whereas PB treatment is effective in slightly increasing the serum monoconjugated bilirubin concentration even in type 1 CN disease, the diagnosis of type 1 or 2 is based on finding a substantial decrease of serum unconjugated bilirubin following PB administration.
An Infant in a Car Seat on a Washing Machine: Epidural Hematoma
Authors: HULKA FRIEDA , PIATT JOSEPH 
Published: December 2021

Desperate parents resort to imaginative and sometimes dangerous improvisations to pacify a crying infant. One measure that has actually received physician endorsement in popular parenting publications is to set the inconsolable baby, often suffering from colic, in a car seat on an engaged clothes dryer or washing machine. The warmth, rhythmic noise, and vibration together have the desired soporific effect. As the following case report illustrates, placement of car seats on vibrating elevated surfaces can have life-threatening side effects as well.
CASE REPORT
A 7-month-old male was brought by ambulance to the emergency room after suffering an apparent seizure.
Managing Otitis Media With Effusion in Young Children
Authors:   The Otitis Media Guideline Panel
Published: December 2021

This reference guide contains highlights from the Clinical Practice Guideline, Otitis Media with Effusion in Young Children. The Otitis Media Guideline Panel, a private-sector panel of health care providers, developed the Guideline after comprehensively analyzing the research literature and current scientific knowledge of the development, diagnosis, and treatment of otitis media with effusion in young children.
Specific recommendations are given for the management of otitis media with effusion in young children age 1 through 3 years with no craniofacial or neurologic abnormalities or sensory deficits. The natural history of otitis media with effusion, the functional impairments that may result from otitis media with effusion, and the difficulty of measuring the effects of medical and surgical interventions on long-term outcomes are included. The medical interventions studied involve antibiotic, steroid, and antihistamine/decongestant therapies. The surgical interventions studied involve myringotomy with insertion of tympanostomy tubes, adenoidectomy, and tonsillectomy. Short-term outcomes addressed are resolution of effusion and restoration of hearing.
Children's Deaths at Day-Care Facilities
Authors: Good Susan E. E. , Parrish R. Gibson , Ing Roy T. 
Published: December 2021

In the US, there is no mechanism readily available to identify children who die while attending day care. The National Center for Health Statistics (NCHS) uses the International Classification of Diseases 9th Edition (ICD-9) to categorize US mortality data; however, the International Classification of Diseases does not contain a category for "day care" as the place of death. Thus, researchers using NCHS mortality data are unable to count day-care deaths on a national basis. To identify children who died while in day care, it is necessary to review the records of those who investigated the deaths. In most counties and states, medical examiners or coroners (ME/C) are responsible for investigating unusual and sudden deaths. Their records often contain detailed information on the place and circumstances of death.
The Medical Examiners and Coroners Information Sharing Programs (MECISP) at the Centers for Disease Control and Prevention (CDC) works with state and local medical examiners and coroners to improve the availability of data on deaths that they investigate. Computerized data are gathered on all deaths investigated by participating ME/C offices; data are obtained from six state and seven county jurisdictions. These jurisdictions have a combined population of 37 million people and record 56 000 deaths per year. Of these jurisdictions, one state and three county offices have text within their computerized data that describes the circumstances, place, and cause of each death.
The objective of our study was to demonstrate the usefulness of ME/C death-investigation records as a means of identifying and characterizing the types of deaths that occur among children while attending day care facilities.
The Potential Health Benefits of Child Day Care
Authors: Randolph Linda A. 
Published: December 2021

Child day-care programs are a part of an ecologic formulation of the contribution of family and the community to improved children's health. How does the promise of the possible become a reality?
Head Start may provide some clues. As a large-scale national child-development program with integrated health, education, social services, and parent involvement components, Head Start assumes a responsibility for assuring access to needed health knowledge, health maintenance skills, and health services. It has standards for each component, a training and technical assistance capacity, and funding through bipartisan political support. It is not perfect; quality is uneven and it evolves as health standards are revised on the basis of new scientific information. Head Start places emphasis on community health advocacy.
The needs of children and families will largely determine the combination of functions child care might assume. Until this nation recognizes that access to primary health care for all its citizens, especially its children, is non-negotiable, all child-care programs including Head Start are still at a significant disadvantage in realizing their potential.16 As the nation embraces the Education 2000 goal of all children being ready to learn when they enter school, child-care programs can play a significant role in helping children attain the health benefits that will foster that success in school.17 This cannot be accomplished by the programs alone, however. Health professionals must form partnerships with child-care providers to assist them in using their considerable expertise to promote the health and well-being of families who use their services.
A Public Health Perspective on Child Care
Authors: Gensheimer Kathleen F. 
Published: December 2021

A child care provider is the mother of young life.
She nourishes the children, brings them up—gives them energy, her resources, her nerve and all the possibilities to come true—when needed or ready.
To not pay her a decent wage is undervaluing the care.
To over-regulate her can decrease the supply and raise the cost.
To under-regulate her can harm the quality.
To zone her out of residential neighborhoods does not fit in a society that "values" children.
And yet, all these misdeeds are committed state-wide.
Nobody is made really and effectively responsible.
Yet we all are!
That's why the misdeeds can go on and even increase.
Collective responsibility is hidden by our ignorance and greed.
At present we live in a world out of balance.
We work with no support for family and child care needs.
We live lives of turmoil because of a system unable to care.
We live lives that call for another way of living.
Can biotechnologists build a child who requires less nurturing, less loving? or
Can we foster conditions that help, rather than hurt, families using child care?
It will oblige all of us to assign a new value to families, children and child care.
It will oblige us to establish a strong public policy so that children and child care are valued as more than a mere "life style" option.1
On a personal level, as a mother of four young children and as a consumer of child-care services, I can well relate to the issue of child care.
Mortality and Growth of Low Birth Weight Infants on the Kangaroo Mother Program in Bogota, Colombia
Authors: Whitelaw Andrew , Liestøl Knut 
Published: December 2021

The kangaroo mother program was started by Drs Rey and Martinez at the Instituto Materno Infantile in Bogota, Colombia in 1978. Mortality was high among low birth weight infants when hospital care was attempted. Neonatal intensive care was virtually nonexistent, and nosocomial infection was common.
The essentials of the kangaroo mother program were: (a) educating and motivating the mother as the baby's main resource; b) discharge home regardless of weight as early as possible to minimize nosocomial infection; c) exclusive breast-feeding; d) encouraging bonding and keeping the baby warm by skin-to-skin contact inside the mother's clothes; and e) vertical position between the mother's breasts to minimize reflux and aspiration.
Letter to the Editor
Authors: Robinette Martin S. 
Published: December 2021

The importance of early identification of hearing loss is summarized in the report issued by the United States (US) Department of Health and Human Services,1 entitled "Healthy People 2000." The goal is to reduce the average age at which children with significant hearing impairment are identified to no more than 12 months. The report states:
The future of a child born with significant hearing impairment depends to a very large degree on early identification (ie, audiological diagnosis before 12 months of age) followed by immediate and appropriate intervention.
Inappropriate Discharge Instructions for Youth Athletes Hospitalized for Concussion
Authors: Genuardi Frank J. , King William D. 
Published: December 2021

Objective. To evaluate the medical care, especially the discharge instructions regarding return to participation, received by youth athletes hospitalized for a closed head injury.
Methods. We examined the records of all patients admitted over a 5-year period (1987 through 1991) to The Children's Hospital of Alabama for a sports-related closed head injury. Descriptive information was recorded and discharge instructions reviewed. Injury severity was graded according to guidelines current during the study period, as well as those outlined most recently by the Colorado Medical Society, which have been endorsed by a number of organizations including the American Academy of Pediatrics. Discharge instructions recorded for each patient were then compared with those recommended in the guidelines.
Results. We identified 33 patients with sports-related closed head injuries. Grade 1 concussions (least severe) occurred in 8 patients (24.2%), grade 2 in 10 (30.3%), and grade 3 (most severe) in 15 (45.4%). Overall, discharge instructions were appropriate for only 10 patients (30.3%), including all with grade 1 concussions, but only 2 with a grade 2 (20.0%) and none with a grade 3 concussion.
Conclusion. All who care for youth athletes must become familiar with the guidelines for management of concussion to provide appropriate care and counseling and to avoid a tragic outcome.
Abusive Head Trauma: The Relationship of Perpetrators to Their Victims
Authors: Starling Suzanne P. , Holden James R. , Jenny Carole 
Published: December 2021

Objective. Abusive head trauma is the most common cause of morbidity and mortality in physically abused infants. Effective prevention requires the identification of potential perpetrators. No study has specifically addressed the relationship of the perpetrators of abusive head trauma ("shaken baby syndrome") to their victims. The objectives of this study were to identify the abusers and their relationship to victims in these cases.
Methods. We reviewed the medical charts of 151 infants who suffered abusive head trauma to determine the perpetrator of the abuse. Caretakers were classified by level of certainty: confession to the crime, legal actions taken, or strong suspicion by the staff. The relationship of abusers to victims was analyzed.
Results. Male victims accounted for 60.3% of the cases. Twenty-three percent of the children died, although death rates for boys and girls did not vary significantly. Male perpetrators outnumbered females 2.2:1, with fathers, step-fathers, and mothers' boyfriends committing over 60% of the crimes. Fathers accounted for 37% of the abusers, followed by boyfriends at 20.5%. Female baby-sitters, at 17.3%, were a large, previously unrecognized group of perpetrators. Mothers were responsible for only 12.6% of our cases. All but one of the confessed abusers were with the child at the time of onset of symptoms.
Conclusions. Our data suggest male caretakers are at greater risk to abuse infants. Baby-sitters are a concerning risk group, because they represent a significant proportion of abusers, and they more easily escape prosecution. In addition, no prevention efforts have been directed at baby-sitters. These statistics could help change the focus of efforts to prevent abusive head trauma.
Vaccine Information Pamphlets: More Information Than Parents Want?
Authors: Fitzgerald Thomas M. , Glotzer Deborah E. 
Published: December 2021

Objective. To assess the information needs of parents regarding childhood immunizations, and their satisfaction with the Vaccine Information Pamphlets (VIPs).
Research design. Verbally administered, forced-choice survey of a representative sample.
Setting. Urban teaching hospital-primary care center (N = 73), neighborhood health center (N = 75), and a suburban private practice (N = 75).
Participants. Parents or guardians of children scheduled for routine checkups, aged 1 month to 18 years, presenting for routine health care maintenance visits.
Results. Of 227 parents, 223 completed the survey. Almost all (98%) had prior experience with their children's immunizations, and 7% reported a history of a "bad" experience. Most parents stated that it was "very important" to receive information about immunizations regarding: diseases prevented by the immunizations (89%); common side effects (91%); serious side effects (89%); contraindications (91%). Eighty percent of parents indicated they wanted immunization information discussed with each vaccination. Forty-three percent of the parents were familiar with the VIPs; of these, 88% reported that the amount of information was "just right," and 94% thought the VIPs were helpful. However, 29% thought the VIPs were either too long, or somewhat too long.
Conclusions. Parents indicate that they want information about many aspects of immunizations, and those familiar with the VIPs report high levels of satisfaction with the pamphlets.
Supplementary Carrying Compared With Advice to Increase Responsive Parenting as Interventions to Prevent Persistent Infant Crying
Authors: St. James-Roberts Ian , Hurry Jane , Bowyer Josephine , Barr Ronald G. 
Published: December 2021

Objective. To compare two interventions (supplementary carrying, increased parental responsiveness) introduced from birth for their effectiveness in reducing the amounts of crying in general community infants at 2, 6, and 12 weeks age.
Design and participants. Mothers and infants in newborn wards of maternity hospitals were assigned to carrying intervention, responsiveness intervention, or control groups. Follow-up measures were used to confirm that the interventions were implemented and to determine their effects on infant crying.
Setting and measurements. Diary measurements completed in the home were employed to measure the aspects of parental behavior targeted by the interventions. Audio recordings, diaries, and questionnaires assessed the amounts the infants cried and the impact of the crying on their mothers and the health services. Sample sizes at 6 weeks of age were 59 (carrying intervention), 57 (responsiveness intervention), and 94 infants (control group).
Results. The carrying intervention successfully increased the amounts the infants were carried, particularly while settled, to the target levels. The responsiveness intervention led to more limited increases in carrying and to a modest increase in feeding frequency, but did not affect measures of parental interactiveness and play. No differences in amounts of crying and fussing were found between the three groups of infants on any of the measures. Subsidiary analyses confirmed that the dependent variable (infant fuss\crying) and main independent variable (carrying while settled) were not significantly correlated.
Conclusions. It is not, at present, possible to recommend either supplementery carrying or increased parental responsiveness as primary, preventative interventions to reduce infant crying.
The Small for Gestational Age Infant: Accelerated or Delayed Pulmonary Maturation? Increased or Decreased Survival?
Authors: Tyson Jon E. , Kennedy Kathleen , Broyles Sue , Rosenfeld Charles R. 
Published: December 2021

Objective. Small for gestational age (SGA) neonates have been considered to have accelerated pulmonary maturation and thus a lower risk for respiratory distress syndrome (RDS) than appropriate for gestational age (AGA) neonates. This, however, has not been thoroughly examined. Therefore, we compared SGA infants with AGA infants of the same gestational age (GA) with respect to risk of RDS, respiratory failure, or death.
Population. An indigent population born in a large county hospital.
Methods. Multivariate analyses were performed controlling for GA alone or for GA, race, sex, and congenital anomalies. Because the proper method to identify SGA infants is unclear, we performed separate analyses using different GA estimates (obstetric or pediatric) and intrauterine growth grids (hospital-specific grids or grids for a healthy, geographically-defined population).
Results. SGA infants did not fare better than AGA infants in any analysis. SGA infants had significantly increased risk in some analyses of RDS and in almost all analyses of respiratory failure or death. The risk associated with being SGA was generally comparable to that associated with male sex or White race.
Conclusion. The concept that intrauterine growth retardation accelerates lung maturation and improves outcome is not supported in comparisons of SGA and AGA infants of the same GA, sex, and race. This widely accepted concept deserves critical re-evaluation.
Information Update on Achondroplasia
Authors: Hall Judith G. 
Published: December 2021

Last month guidelines for the care of children with Achondroplasia were published in Pediatrics (1995;95:443-451). They represent three years of work by the American Academy of Pediatrics (AAP) Committee on Genetics. They are already out of date!!
The field of molecular genetics is moving at an amazing pace. While the guidelines were being developed, the gene for Achondroplasia was mapped and sequenced and the specific defect identified. Because the mutation is very specific and very consistent in Achondroplasia [most diseases have many different mutations in the responsible gene(s)], it has been possible to develop an exquisitely precise diagnostic test very rapidly.
A Single Shot at Salmonella typhi: A New Typhoid Vaccine With Pediatric Advantages
Authors: Hall Breese 
Published: December 2021

A new typhoid vaccine has just been licensed, which is the third typhoid vaccine available in the United States.1,2 Since publication of the 1994 Red Book occurred before licensure, this new vaccine is not included. The recommendations concerning the two previously licensed typhoid vaccines in the 1994 Red Book remain unchanged.3
The new vaccine, Typhoid Vi, is manufactured by Pasteur Mérieux (Marnes-La-Coquette, France). This parenteral vaccine is composed of the purified Vi (virulence) antigen, which is the capsular polysaccharide (ViCPS) of Salmonella typhi. The two previously licensed typhoid vaccines are an oral live-attenuated vaccine, the Ty21a vaccine, manufactured by the Swiss Serum and Vaccine Institute, and the parenteral heat-phenol-inactivated vaccine (Berne, Switzerland), manufactured by Wyeth-Ayerst, which has been available for many years.
Phenylketonuria Screening: Effect of Early Newborn Discharge
Authors: Sinai Laura N. , Kim Susan C. , Casey Rosemary , Pinto-Martin Jennifer A. 
Published: December 2021

Objective. To determine the percentage of term newborns discharged by 24 hours of life and the actions taken by physicians and institutions to avoid false-negative phenylketonuria (PKU) screens in these infants.
Design. Descriptive cross-sectional survey.
Participants. One hundred forty term nurseries and 157 pediatricians.
Selection Procedure. Stratified sampling techniques were used to sample nurseries from the 1992 American Hospital Association guide to provide equal representation systematically sampled from a national list of practicing pediatricians supplied by Ross Laboratories to provide equal sampling from each state.
Results. The response rates were 95% (n = 133) for term nurseries and 83% (n = 131) for pediatricians. Twenty-four percent of healthy newborns are discharged by 24 hours of life. Ninety-three percent of nurseries screen all infants for PKU before discharge. In states without laws mandating rescreening, only 48% of institutions that discharge the majority of their infants (&gt;50%) by 24 hours of life rescreen. Also, in states without rescreening laws, 64% of pediatricians rescreen. The timing of this repeat screen ranges from less than 72 hours of life to 4 weeks. Determining which infants to rescreen varies by practitioner; some rescreen all infants, whereas others rescreen those discharged early. Just more than half of all pediatricians, whether practicing in a state requiring repeat PKU screening, claim to be familiar with the American Academy of Pediatrics recommendations regarding repeated PKU screening of infants discharged by 24 hours of life.
Conclusion. Twenty-four percent of term newborns in the United States are discharged by 24 hours of life. Most hospitals screen all infants for PKU before discharge regardless of age. The majority of states do not mandate rescreening; rescreening policies among pediatricians and institutions in those states vary widely. A significant number of infants do not receive repeated screening and are therefore at risk for delayed or missed diagnosis of PKU because of insensitive initial screens. Pediatrician awareness of the need to perform repeated PKU screens on infants discharged by 24 hours is poor.