bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exercise Assessment of Cardiac Function in Children and Young Adults Before and After Bone Marrow Transplantation
Authors: Larsen Ranae L. , Barber Gerald , Heise Charles T. , August Charles S. 
Published: December 2021

Cardiac toxicity is a potential complication of bone marrow transplantation because recipients frequently receive cardiotoxic chemotherapy and/or irradiation before transplantation. Most studies indicate that transient cardiac toxicity occurs within weeks of transplantation, but few studies have evaluated either cardiac status before or late after transplantation.
Cardiac performance was assessed via cycle ergometry in 20 children and young adults before transplantation and 31 other children and young adults after transplantation. Mean survival time in the group post-transplantation was 3.9 years with a range of 11 months to 12.1 years. Left ventricular size and shortening fraction at rest were assessed via echocardiography. Data were compared to those of 70 healthy subjects from our laboratory.
Patients before and after transplantation had normal oxygen consumptions and cardiac indices at rest. During exercise, however, patients treated for cancer both before and after bone marrow transplantation had reduced exercise times, reduced maximal oxygen consumptions, and reduced ventilatory anaerobic thresholds. Cardiac reserve, as judged by the response of the cardiac output during exercise, was reduced severely. There were no significant differences between the groups tested before and after transplantation. Patients who had been treated for aplastic anemia, who had received less intensive therapy before transplantation, performed significantly better than did patients treated for cancer. Despite these findings, only four patients had abnormalities by echocardiography.
In conclusion, before transplantation patients with oncologic diagnoses had serious limitations in exercise performance, most likely as a result of the effects of the cardiotoxic therapy given as part of their conventional cancer therapy. Long-term survivors of bone marrow transplantation also had similar abnormalities. Since the same patients were not studied before and after transplantation, one cannot draw definite conclusions about the effect of the transplantation itself upon cardiac function. However, exercise testing is a sensitive, noninvasive method of assessing patients at risk for cardiac dysfunction secondary to potentially cardiotoxic agents.
Ingestion of Cylindrical and Button Batteries: An Analysis of 2382 Cases
Authors: Litovitz Toby , Schmitz Barbara F. 
Published: December 2021

During a 7-year period, 2382 cases of battery ingestion were reported to a national registry. Button cells were ingested by 2320 of these patients; 62 patients ingested cylindrical cells. These cases are analyzed to reassess current therapeutic recommendations, hypotheses about battery-induced injury, and strategies for prevention and intervention. Hearing aids were the most common intended use of ingested cells (952 cases, 44.6%); and in 312 (32.8%) of these cases, the battery actually was removed by a child from the child's own aid.
Overall, 9.9% of patients were symptomatic. Two children experienced severe esophageal injury following the ingestion of large diameter cells and required repeated dilatation. In this series and in prior reports, most batteries which lodged in the esophagus and caused esophageal injury were large diameter (20 to 23 mm). However, neither battery diameter nor symptom occurrence could be used to detect all patients with esophageal battery position.
Outcome was not affected by battery discharge state, but was influenced by chemical system. Lithium cells, with their larger diameters and greater voltage, were associated disproportionately with adverse effects. Mercuric oxide cells were substantially more likely to fragment, compared with other chemical systems. No clinical evidence of mercury toxicity occurred in this series, although one patient demonstrated minimal elevation of blood mercury levels. In this series and 10 prior reports, all patients with elevated blood mercury levels had ingested batteries which fragmented and showed evidence of radio-opaque droplets in the gut. Special monitoring may be advisable for individuals who have ingested 15.6-mm-diameter mercuric oxide cells.
Ipecac was administered in 37 cases of button cell ingestion, causing battery expulsion in only one patient. Retrograde battery movement from the stomach to the esophagus necessitating emergent endoscopic retrieval occurred as a complication of ipecac administration in another patient. The use of endoscopic and surgical intervention declined more than fivefold during the study period. Endoscopic retrieval success was a function of battery location, with batteries in the esophagus more readily retrieved than those in more distal gastrointestinal locations (90.0% vs 46.7%, respectively). A current management protocol is presented advocating a noninvasive approach for most cases of button cell ingestion where an esophageal position is excluded. Manufacturers are urged to provide more securely fastened, child-resistant battery compartments on hearing aids as well as other battery-powered products in household use.
Neurotoxicity of Lorazepam in a Premature Infant
Authors: CRONIN CATHERINE M. G. 
Published: December 2021

To the Editor.—
Recently, I have observed several cases of stereotypic movements following injection of lorazepam in premature infants and wish to alert my colleagues to a potential cause of neurotoxicity.
Case 1
CASE REPORTS
A male neonate was born in a peripheral hospital at 24 weeks gestation. Apgar scores were 2 at 1 minute and 6 at 5 minutes. He weighed 680 g and was transferred to a tertiary care institution at 20 hours of life.
Child Care for Children With Special Needs
Authors: Fewell Rebecca R. 
Published: December 2021

Most children with special needs are more like normally developing children than they are different from them. They share the same zest for discovery, love for stories and music, and delight in dressing in adult clothes. They, too, need to learn to run and play, solve problems, have conversations with friends, and attend to their personal needs.
Finding an opening in a child care center can be a long, frustrating experience for families, particularly when employment is essential to cover basic needs. The problem of locating a satisfactory place increases tenfold when children have special needs. After learning that a prospective child has special needs, a child care center director will turn his or her attention to the impact the child's needs might have on center operations. The director fails to recall the commonalities these children share with other enrolled children. Multiple, abortive efforts to locate placement exacerbate family stress. In desperation, parents may drop the criteria they had believed to be important in selecting placement, feeling relieved and grateful that, at last, they can go to work.
To address this problem, we will first examine the characteristics of young children with special needs and indicate the prevalence of the problem. The traditional delivery models for early intervention and for child care will be reviewed, and barriers that inhibit provision for children with special needs in child care facilities will be noted. Some current models and practices that are effective will be reviewed. Finally, recommendations will be made for policy makers and providers of services.
Cost-Effectiveness of Screening and Cryotherapy for Threshold Retinopathy of Prematurity
Authors: Javitt Jonathan , Cas Ronald Dei , Chiang Yen-pin 
Published: December 2021

Background. Retinopathy of prematurity (ROP) is the leading cause of blindness among premature infants. A recent National Eye Institute-sponsored prospective, multicenter trial investigating the use of cryotherapy for treatment of ROP demonstrates a significant reduction in blindness and low vision for patients with sight-threatening (stage 3+) ROP.
Method. A microsimulation model is presented to determine the cost-effectiveness of cryotherapy for ROP. Simulations are performed for three subpopulations of premature infants with birth weights 500 through 749 g, 750 through 999 g, and 1000 through 1249 g, and for three screening strategies—weekly, biweekly, and monthly.
Results. Appropriately timed screening for and treatment of ROP is predicted to result in a gain of 3899 to 4648 quality-adjusted-life-years and a net governmental budgetary savings of $38.3 to $64.9 million for each annual US birth cohort of 28 321 premature infants (500 through 1249 g). The cost per quality-adjusted-life-year gained is $2488 to $6045, depending on different screening strategies.
Conclusions. Of greatest importance is the finding that properly timed screening and treatment for ROP is not only cost saving but may save approximately 320 infants per year from a lifetime of blindness.
Prevalence of Rotavirus on High-Risk Fomites in Day-Care Facilities
Authors: Butz Arlene M. , Fosarelli Patricia , Dick James , Cusack Timothy , Yolken Robert 
Published: December 2021

Study objective. The objective of this study was to determine the prevalence of rotavirus contamination on environmental surfaces in day-care environments, using the polymerase chain reaction technique.
Design. High-risk fomites were identified in two day-care centers and sampled biweekly during a 6-month study period. Water samples from water-play tables in each center were also collected during the study period. During an infectious disease outbreak, fomites were sampled from the rooms in which the outbreak occurred. Reverse transcriptase/polymerase chain reaction was carried out for viral detection of rotavirus from the fomites, and standard bacteriologic measures were used to detect bacteria in samples from water-play tables.
Results. A total of 96 fomite samples were tested for presence of rotavirus from the two centers, of which 18/96 (19%) tested positive for rotavirus. The timing of the positive samples differed between the two centers. In the center that housed infants, a peak of rotavirus-positive fomites coincided with two enteric outbreaks. Rotavirus contamination was found on the telephone receiver, drinking fountain, water-play table, and toilet handles in both centers. Bacteria in large quantities were also identified in water-play table samples.
Conclusions. Moist surfaces including the telephone, water fountains, and water-play tables are common sources of rotavirus contamination within the day-care environment. Until a safe and affordable drug or vaccine against rotavirus is available for general use, avoidance of rotaviral infections is the most effective method for the prevention of rotavirus gastroenteritis.
Aseptic Meningitis in Infants Younger Than 2 Years of Age: Acute Illness and Neurologic Complications
Authors: Rorabaugh Mary Lou , Berlin Linda E. , Heldrich Frederick , Roberts Kenneth , Rosenberg Leon A. , Doran Timothy , Modlin John F. 
Published: December 2021

Objective. We report the clinical features and cerebrospinal fluid (CSF) laboratory values for 277 children younger than 24 months of age with aseptic meningitis who were prospectively evaluated at three Baltimore hospitals between July 1986 and December 1990. A major objective was to define the incidence, etiology, and outcome of neurologic complications occurring during the acute illness.
Methods. Cases were identified by surveillance in the ambulatory care departments of each of the three hospitals, pertinent historical and clinical data were obtained by interview of the parents and by review of the medical records, initial CSF laboratory values were recorded, and appropriate specimens were submitted to determine the viral etiology. A subset of 216 children who participated in a long-term natural history study were followed periodically with neurologic examinations and formal neurodevelopmental testing.
Results. Most cases occurred in very young infants; 63.5% of patients were 8 weeks of age or younger, and 84.1% were younger than 16 weeks of age. In this very young cohort, the dominant symptoms were fever and irritability; only 8.7% had evidence of meningeal irritation at the initial examination. The acute illness was complicated by either complex seizures, physical evidence of increased intracranial pressure, or coma in 25 (9.0%) cases. Within the age group under study, these complications were each significantly more likely to occur in patients older than 12 weeks of age than in younger infants. The risk of neurologic complications was similar among infants infected with group B coxsackieviruses and echoviruses, the two major enterovirus classes observed to cause disease. Acute central nervous system (CNS) complications could not be correlated with extremely abnormal CSF laboratory indices. Importantly, there was no risk of long-term neurologic sequelae attributable to acute CNS complications.
Conclusions. While approximately 9% of infants and children younger than 2 years of age with aseptic meningitis experience acute CNS complications in the form of complex seizures, increased intracranial pressure, or coma, the prognosis for long-term cognitive development appears to be as favorable as the prognosis for children with aseptic meningitis who do not experience these complications.
Parents in Jail
Authors: Kemper Kathi J. , Rivara Frederick P. 
Published: December 2021

Objective. To determine the number of children in the United States with parents incarcerated in jail and to describe the characteristics of these parents and their criminal histories.
Setting. Inmates of local jails accounting for 36.5% of the incarcerated population of the US in 1989.
Participants. Personal interviews with 5675 inmates randomly selected from 393 553 inmates of 3312 local jails in 1989.
Results. 44 263 (36%) inmates had children younger than the age of 15. Fathers outnumbered mothers 10-fold; the majority were in their 20s or 30s, unmarried, and poorly educated. The vast majority of parents had a record of prior offenses, and substance abuse accounted for one third of the incarcerations. Substance abuse was reported by 84% of inmates and 95% had sought prior treatment for alcohol, drug, or other mental health problems.
Conclusions. Nearly 1 of 50 children in the US has a parent in jail. Parental imprisonment is not rare, is often chronic, and is strongly associated with other psychosocial and health problems in the family. Screening for parental imprisonment potentially should be included as part of a comprehensive biopsychosocial assessment.
Desmopressin Acetate and Nocturnal Enuresis: How Much Do We Know?
Authors: Moffatt M. E.K. , Harlos S. , Kirshen A. J. , Burd L. 
Published: December 2021

Objectives. Desmopress in acetate (DDAVP) is promoted to treat nocturnal enuresis but indications for its use are unclear. We reviewed all randomized controlled trials to determine (1) short- and long-term efficacy, (2) responders, (3) dose-response curve, (4) side effects, and (5) comparative efficacy with other treatments.
Methods. A Medline search of the English language literature from January 1966 to August 1992, supplemented by contact with the drug companies, yielded 18 articles which were true randomized controlled trials (11 cross-over and 7 parallel studies).
Results. The 18 randomized controlled trials included 689 subjects for most of whom some other type of treatment had failed. All studies found decreased mean frequency of wetting ranging from 10% to 91%, but only 24.5% of subjects achieved short-term dryness. One study of DDAVP responders directly tested long-term dryness and 21% stayed dry. In three studies that incidentally reported on long-term effects 5.7% stayed dry after stopping DDAVP. There was wide variation in the type of patient included. Seven studies addressed prognostic factors. Children more than 9 years old and with fewer initial wet nights do better. Four studies seem to include almost exclusively monosymptomatic children with nocturnal enuresis (ie, primary nocturnal enuresis, positive family history, and no urinary symptoms). Results were no better than those which included mixed symptoms. Five studies attempted to address the dose-response issue. Despite some methodological issues, there is probably some dose-response effect. Side effects were infrequent in the 589 subjects who received DDAVP as opposed to placebo. No cases of water intoxication and no significant shifts in electrolytes were reported in the four studies which measured them. Nasal stuffiness, headache, epistaxis, and mild abdominal pain seem to be the only side effects noted, and these were uncommon. Only one study compared DDAVP with conditioning alarms. Alarm patients had 10% fewer wet nights and a better long-term result.
Conclusions. DDAVP reduces wet nights in children for whom other treatments have failed but it produces complete dryness in a minority, and this is often a temporary effect. The literature focuses on short-term efficacy. The true role of DDAVP will be known when samples are carefully selected, prognostic factors are examined, and more comparisons with other treatments are conducted focusing on long-term outcomes. On the basis of current knowledge, DDAVP is inferior to conditioning alarms as a primary therapy.
Use of Chloral Hydrate For Sedation in Children
Authors:   Committee on Drugs and Committee on Environmental Health
Published: December 2021

Publicity about the possible carcinogenicity of chloral hydrate along with the suggestion that alternative sedatives should be used in children has generated concern among physicians, dentists, and their patients.1,2 Replacement of chloral hydrate with other sedatives would represent a major change in practice because it is one of the drugs most widely employed to sedate young children undergoing dental and medical procedures and imaging studies. This statement will assist the practitioner in making an informed decision regarding the use of chloral hydrate by summarizing (1) information pertaining to the potential for carcinogenesis associated with use of chloral hydrate, (2) the risk/benefit considerations of available sedatives, and (3) risks associated with prolonged sedation with chloral hydrate.
EVIDENCE FOR CARCINOGENESIS OF CHLORAL HYDRATE
Some of the concern regarding potential carcinogenicity of chloral hydrate is based on the assumption that chloral hydrate is a reactive metabolite of trichloroethylene, an industrial solvent, and is responsible for the carcinogenicity of trichloroethylene.1,2 However, the validity of this assumption is open to question. Although chloral hydrate is a metabolite of trichloroethylene, there is evidence that the carcinogenicity of trichloroethylene is due to a reactive intermediate epoxide metabolite rather than chloral hydrate.3 As is the case for most chemical carcinogens, trichloroethylene is carcinogenic in some laboratory animal species but not in others.4 Multiple epidemiologic studies in humans have failed to document an increase in cancer incidence associated with trichloroethylene exposure,5-10 although the ability of these studies to detect small increases in risk of cancer is limited.
There are no studies pertaining to chloral hydrate-associated carcinogenicity in humans.
Routine Evaluation of Blood Pressure, Hematocrit, and Glucose in Newborns
Authors:   Committee on Fetus and Newborn
Published: December 2021

It is the practice in many newborn nurseries to measure routinely, upon admission, each neonate's blood pressure by cuff oscillometry, blood glucose level by Dextrostix or Chemstrips, and hematocrit value via heel stick. Blood pressure is measured to screen for hypertension or hypotension; blood glucose, for hypoglycemia; and hematocrit, for anemia or polycythemia.
The routine testing of all newborns for a particular disorder before clinical manifestations are evident (universal screening) should result in a positive benefit-cost ratio. The following criteria should be considered in evaluating the benefit-cost ratio for any universal screening.
Incidence. There should be a high enough incidence of the disorder to justify screening for it unless the outcome of the disorder, if left undetected and untreated, would result in such significant morbidity that even with a relatively low incidence the benefit-cost ratio of screening would be positive (eg, phenylketonuria screening).
Methodology. The screening methodology should have a very high sensitivity so that there will be no, or a very low percentage of, subjects reported as being negative who are actually positive. The methodology should also have a high specificity so that there will be relatively few infants who are reported as being positive who are actually negative. The specificity need not be as high as the sensitivity since a true-positive test can be confirmed using a more specific methodology. In addition, the methodology should be relatively simple, cost-effective, accurate, and reproducible.
Natural History. The disorder for which infants are being screened should be a clearly defined entity with a well-described natural history.
The Futility of the Chest Radiograph in the Febrile Infant Without Respiratory Symptoms
Authors: Bramson Robert T. , Meyer Theo L. , Silbiger Martin L. , Blickman Johan G. , Halpern Elkan 
Published: December 2021

Objective. Major pediatric textbooks advocate a chest radiograph as part of the diagnostic evaluation for a sepsis workup for febrile infants less than 3 months old. Very few studies have addressed the value of performing a chest radiograph in this situation. Two studies previously published lack the numbers to statistically justify a conclusion about the need to perform a chest radiograph in the febrile infant.
Methods. Evaluated were 197 febrile infants 3 months old or less with a history, physical examination, chest radiograph, and other laboratory studies to determine the cause of their fever. This group of infants was combined with the group of infants from two similar studies published previously in the literature using cumulative meta-analysis. The combined group resulted in 617 infants.
Results. The combined group of infants had 361 infants who had no clinical evidence of pulmonary disease on history or physical examination. All 361 infants had normal chest radiograph. These results gave a 95% confidence interval that the chance of a positive chest radiograph in a patient with no pulmonary symptoms would occur less than 1.02% of the time.
Conclusions. The generally advocated policy of obtaining a chest radiograph as part of the sepsis workup in febrile infants should be discontinued, and chest radiographs should be obtained only in febrile infants who have clinical indications of pulmonary disease.