bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cardiopulmonary Resuscitation of the Newborn
Authors: Sinkin Robert A. , Davis Jonathan M. 
Published: December 2021

Approximately 3.5 million babies are born each year in approximately 5000 hospitals in the United States. Only 15% of these hospitals have neonatal intensive care facilities. Six percent of all newborns require life support in the delivery room or nursery, and this need for resuscitation rises to 80% in neonates weighing less than 1500 g at birth.
Personnel who are skilled in neonatal resuscitation and capable of functioning as a team and an appropriately equipped delivery room must always be readily available. At least one person skilled in neonatal resuscitation should be in attendance at every delivery. Currently, a joint effort by the American Academy of Pediatrics and the American Heart Association has resulted in the development of a comprehensive course to train appropriate personnel in neonatal resuscitation throughout the United States. Neonatal resuscitation is also taught as part of a Pediatric Advanced Life Support course offered by the American Heart Association. In concert with the goals of the American Academy of Pediatrics and the American Heart Association, we strongly urge all personnel responsible for care of the newborn in the delivery room to become certified in neonatal resuscitation.
The practical approach to neonatal resuscitation is the focus of this article.
Inpatient Care: The General Pediatrician's Future
Authors: Menna Vincent J. 
Published: December 2021

In my 22 years as a general pediatrician, I have practiced at an isolated military post as well as in a wealthy suburb, a rural area, and a combination small town-suburb. In addition, I trained in a major urban area. As a result of these travels, I feel that I have some insight into the problems of pediatricians in different areas and the future we face.
A significant problem facing present-day pediatricians is how to care for sick inpatients as well as maintain a busy office practice. Although many of our medically interesting and challenging problems are inpatients, most of a general pediatrician's income is generated from his or her outpatient practice.
Surfactant Replacement Therapy
Authors: Soll Roger F. , Lucey Jerold F. 
Published: December 2021

Despite medical and technological advances, respiratory distress syndrome (RDS) remains a major cause of morbidity and mortality in premature infants. Thirty years have passed since Avery and Mead demonstrated that infants dying of RDS were deficient in pulmonary surfactant. In those three decades, advances in our understanding of the composition, function, and metabolism of pulmonary surfactant have finally led to clinical trials of surfactant replacement therapy in thousands of premature infants. This article reviews the current status of surfactant replacement therapy.
BACKGROUND
Pulmonary surfactant is essential for normal lung function. Surfactant forms a film at the alveolar surface, which prevents the lung from collapsing at the end of expiration. Surfactant may have other functions as well, including the prevention of pulmonary edema, the prevention of infection, and the prevention of lung injury from toxic substances, such as oxygen (Table 1)
CHEMICAL MAKEUP
The chemical makeup of pulmonary surfactant has been well defined (Table 2). Lipids are the major component, comprising up to 80% to 90% of surfactant by weight. The majority of the lipids in pulmonary surfactant are highly polar phospholipids, predominantly phosphatidylcholine. Three proteins associated with surfactant have been these surfactant proteins may play a critical role in surfactant function by improving the adsorption of surfactant at the alveolar surface and by aiding in surfactant re-uptake and metabolism.
Consultation with the Specialist
Authors: Healy Gerald B. 
Published: December 2021

Otitis media with effusion (OME) offers the primary care physician both a diagnostic and a therapeutic challenge. The tympanic membrane of a child frequently is difficult to assess, especially in the uncooperative patient whose ear canal is partially occluded by cerumen. However, if the ear canal can be cleared to allow an unobscured view of the tympanic membrane, then pneumatic otoscopy and tympanometry can be extremely valuable in both the diagnosis and follow-up after initiation of treatment.
Patient Groups
The pediatrician usually is faced with two groups of patients in this disease process. The first group includes the young child who has recurrent episodes of acute otitis media. Frequently, affected patients can be subdivided into those who clear their middle ear space of fluid between episodes and those who do not. The second group consists of children who have asymptomatic chronic effusion, usually leading to persistent hearing loss. These children tend to be slightly older but are no less troublesome for the clinician.
Treatment
Controlled clinical trials have been extremely important in providing information about both of these groups. These studies have shown that chemoprophylaxis is extremely useful in managing the patient who has recurring acute suppurative episodes not complicated by persistent effusion during the interval periods.
Lumps and Bumps in Children
Authors: Putnam Thomas C. 
Published: December 2021

Many lesions involving the skin or subcutaneous tissues alarm parents and, often fearing cancer, they bring their child to a physician. Most lesions are benign and rarely life-threatening. The physician faces the problem of determining which characteristics suggest only observation of a lesion and which make biopsy necessary.
Because many lesions have a predilection for certain areas of the body, this is a useful form of categorization (Table 1). On first inspection of a superficial lesion, several questions must be asked, including the known duration, change in size, presence of pain or other signs of inflammation, and any noted multiplicity. The examination includes an accurate measurement of the size and, most importantly, a determination of the level of the lesion. This will help establish the diagnosis and help to determine whether the possibility of malignancy exists.
Essentially all lesions originating in the skin of children are benign. Some are obvious, such as a wart, while others may not be so clear-cut, especially if the epidermis is not altered in appearance. Upon palpation of a cutaneous mass, the skin does not move over the surface and puckers when the adjacent skin and tissues are compressed and elevated. If the skin moves freely over the mass, the nature of the lesion is not so readily apparent.
INDEX OF SUSPICION
Authors: Berera Geeta , Dixon Robert H. , Koenig Willaim J. 
Published: December 2021

This section of Pediatrics in Review reminds clinicians of those conditions that can present in a misleading fashion and require suspicion for early diagnosis. Emphasis has been placed on conditions in which early diagnosis is important and that the general pediatrician might be expected to encounter, at least once in a while. The reader is encouraged to write possible diagnoses for each case before turning to the discussion, which is on the following page.
We invite readers to contribute case presentations with discussions.
Case 1 Presentation
A 24-mo-old boy is seen with a 2-d history of cough and fever. His past medical history includes recurrent vomiting and poor weight gain since 3 mo of age, and he has been hospitalized five times for dehydration. The child sat independently at 7 mo of age but is not yet walking.
On examination, he appears to be small and thin and is irritable. His temperature is 39.5°C(103.1°F), pulse is 150 beats/mm, and respiratory rate is 35 breaths/mm. The child's height, weight, and head circumference are all below the 5th percentile, but proportional. Except for nasal congestion and mild dehydration, the remainder of his examination is normal. Serum sodium is 140 mEq/L, potassium 3.5 mEq/L, chloride 117 mEq/L, and bicarbonate 11 mEq/L.
Childhood Asthma: Update
Authors: Shapiro Gail G. 
Published: December 2021

Definition and Pathophysiology
Asthma is a reversible airways disease characterized by both smooth muscle hyperreactivity and airway inflammation. During the 1970s and early 1980s the focus was on smooth muscle constriction, and it was believed that better bronchodilators would greatly diminish our difficulties in controlling this condition. This, unfortunately, was not the case. The emphasis of therapy today has turned to airway inflammation. Lung biopsies from patients who have asthma show destruction of respiratory epithelium, basement membrane thickening, and inflammatory cellular infiltrate. Among the infiltrating cells are eosinophils, macrophages, and neutrophils that are called to the site of inflammation by the chemotactic products released by activated mast cells. Upon their arrival, these cells release their own products of inflammation, which amplify this immunologic response. A variety of neuropeptides also play a role, some serving to stabilize and others to destabilize the airway. One result of this airway inflammation is airways reactivity, also known as bronchial hyperresponsiveness.
A common example of this scenario is the child who has allergic asthma and encounters a problematic allergen. This child has immunoglobulin E (IgE) to this allergen bound to mast cells in his or her airway. Upon exposure to the allergen, the binding of IgE and antigen triggers mast cell mediator release within minutes.
Pediatric Ocular Injuries
Authors: Klein Betty R. , Sears Marvin L. 
Published: December 2021

Although an ophthalmologist should be consulted for virtually all eye injuries, the first person to see the patient or talk to the parents can be of enormous value in preventing or limiting the sequelae of the injury and subsequent visual loss. This article provides a practical guide to the management of pediatric ocular injuries resulting from trauma and addresses the incidence of ocular trauma in children and the potential for preventing these injuries.
Potential Injuries
The eye is an anatomically and physiologically complex system that is easily disrupted by sharp or blunt trauma. For this reason, subtle signs of external trauma may indicate serious intraocular injury. The cornea and vitreous are avascular and can be the sites of fulminant infection by even the most indolent of organisms introduced by injury. The crystalline lens is readily dislocated or may opacify after blunt or penetrating trauma. The diaphanous retina is attached to the inner surface of the eye by hydrostatic and osmotic forces. The smallest perforation can lead to total retinal detachment. The highly vascular uvea, which lies beneath the retina, can undergo massive hemorrhage after sharp or blunt trauma. The retinal arteries may occlude after sudden increases in intraocular pressure, which sometimes accompany intraocular or intraorbital hemorrhage.
INDEX OF SUSPICION
Authors: Green John L. , Tejeda David M. 
Published: December 2021

This section of Pediatrics in Review reminds clinicians of those conditions that can present in a misleading fashion and require suspicion for early diagnosis. Emphasis has been placed on conditions in which early diagnosis is important and that the general pediatrician might be expected to encounter, at least once in a while. The reader is encouraged to write possible diagnoses for each case before turning to the discussion, which is on the following page.
We invite readers to contribute case presentations and discussions.
Case 1 Presentation
You are seeing an 8-year-old boy with the complaint of left knee pain and limp during the previous week. His mother reports that at times he plays well and seems fine, and at other times he limps noticeably on his left side and walks stiff-begged with his left knee aching. He has had a low temperature of 100°F to 101°F (37.7°C to 38.3°C) intermittently over the last few days, but generally has slept and eaten well.
On examination, he is cooperative, pleasant, and comfortable at rest, but looks noticeably pale. He does walk rather stiff-legged on the left side, with a mild limp both on walking and running. His knees are symmetrical al and equal in circumference, with full range of motion.
The Pediatric Hospital Consultant
Authors: Drutz Jan E. 
Published: December 2021

Most pediatricians have been asked at one time or another to be a consultant or have been the primary care physician asking for a consultation. We or our consultant colleagues, however, often fail to appreciate the subleties inherent in our respective roles.
Although communication among physicians, both written and verbal, is essential for optimal patient care, communication between individual physician, parent, and patient not only extends common courtesy but also remains crucial in our present medicolegal climate. How often have we failed to tell a parent that we have asked for a consultant's opinion or, more embarrassingly, been asked to be the consultant and then walked in on the patient only to discover that no member of the family had ever been told by the patient's physician who we were or why we were there?
Consultation with the Specialist
Authors: Klein Betty R. , Sears Marvin L. 
Published: December 2021

Optimal management of eye trauma requires a careful history, a controlled examination, protective measures to limit the damage and prevent infection, and swift triage to an ophthalmologist. Personnel in the emergency department or office can accomplish these goals and save the patient permanent visual disability.
How Does One Evaluate Trauma to the Eye?
A systematic approach emphasizing history, visual acuity, and external examination are essential in the evaluation of eye injuries.
The history should be detailed and should note the mechanism of injury, the events following the injury, preexisting eye disorders, systemic disorders, drug allergies, contraindications to anesthesia, when the patient last ate, and prior tetanus immunization. If ocular perforation, laceration, or intraocular foreign body is suspected, treat the patient as if preoperatively, allowing nothing by mouth, and consider intravenous antibiotics to protect against exogenous endophthalmitis.
Visual acuity examination must be performed in every case. Measure the visual acuity in each eye separately with corrective lenses in place. A near card may be used for examination at bedside. Picture cards and charts are available for measuring acuity in children age 3 to 6 years. Preverbal children can be tested grossly by allowing them to reach for a small toy with one or the other eye covered.
Henoch-Schoenlein Purpura
Authors: Lanzkowsky Shelley , Lanzkowsky Leora , Lanzkowsky Philip 
Published: December 2021

The distinctive syndrome of Henoch-Schoenlein purpura (HSP) was first described by Heberden before 1800, and in 1808 English physician Robert Willan described a patient who had swollen, painful joints and a rash.
The syndrome owes its name to two German physicians. In 1837, Johan Schoenlein described several cases of purpura associated with arthritis, which he termed "peliosis rheumatica." In 1868, Edouard Henoch pointed out that the term "peliosis rheumatica" was inappropriate and restrictive because patients who had urticarial purpura and acute arthritis also manifested gastrointestinal symptoms, such as vomiting, colicky abdominal pain, and melena. He described four children who had purpura, colicky abdominal pain, gastrointestinal hemorrhage, and joint pain as well as renal involvement.1 Since these first descriptions, HSP also has been referred to as anaphylactoid, allergic, or rheumatoid purpura; leukocytoclastic vasculitis; and allergic vasculitis.1,2
Epidemiology
Seventy-five percent of all cases of HSP occur in children between 2 and 11 years of age, with younger children rarely affected. Children younger than 2 y experience a milder course of illness, with less frequent renal and gastrointestinal manifestations.3 HSP is exceedingly rare in adults, among whom other causes of vasculitis should be considered more likely.
The incidence of HSP is greater in males, with a male-to-female ratio of 1.5 to 2.0:1.
Children, Adolescents, and Television
Authors: Strasburger Victor C. 
Published: December 2021

No parents in their right minds would invite a stranger into their home to teach their children for 3 to 5 hours per day; yet the television set is doing precisely that.1 Television is a powerful teacher of children. Children and adolescents spend more time watching television than in any other activity except sleeping, and more time from age 2 to 18 in front of the television set (15 000 to 18 000 h) than in the classroom (12 000 h).2 By the time today's children reach age 70, they will have spent a total of 7 y of their lives watching television. During an average year, an American youngster will be exposed to:3,4
• More than 14 000 sexual references, innuendos, and jokes—yet &lt;175 will deal with birth control, self-control, abstinence, or sexually transmitted disease;
• Between 1000 and 2000 beer and wine commercials;
• More than 1000 murders, rapes, assaults, and armed robberies, and
• Nearly 20 000 commercials.
These figures notwithstanding, many parents and pediatricians underestimate the power of television to influence attitudes and behavior. Television is an equal opportunity teacher, capable of conveying prosocial messages just as easily as harmful ones. Because television is such a pervasive and influential medium that can affect a variety of health-related behaviors, pediatricians should familiarize themselves with its effects on children and adolescents.
INDEX OF SUSPICION
Authors: Goldbloom Richard B. , Bracikowski Andrea C. , Goldbloom Richard B. 
Published: December 2021

This section of Pediatrics in Review reminds clinicians of those conditions that can present in a misleading fashion and require suspicion for early diagnosis. Emphasis has been placed on conditions in which early diagnosis is important and that the general pediatrician might be expected to encounter, at least once in a while. The reader is encouraged to write possible diagnoses for each case before turning to the discussion, which is on the following page.
We invite readers to contribute case presentations with discussions.
Case 1 Presentation
A 3-mo-old girl is admitted to the hospital for investigation of generalized swelling of 1 week's duration. The swelling involves her face and extremities. Her 2-y-old sister is healthy and her parents are not related.
The baby was born at term following an uncomplicated pregnancy and delivery and was breast fed during the first month of life. She fed eagerly but cried a lot, usually beginning 30 to 60 min after each feeding. Suspecting that she was not providing sufficient milk, her mother weaned her to a standard prepared infant formula at 1 mo of age. Although she took the formula well, the baby continued to cry excessively and had loose, foul-smelling stools. On the advice of her physician, she was changed to a soy-based formula, which she again took eagerly.
Vitamin Update
Authors: Udall John N. , Greene Harry L. 
Published: December 2021

Pediatricians should be aware of the recommended daily allowances (RDAs) for vitamins. They also should have knowledge of the symptoms and signs of vitamin deficiencies and excesses so as to be able to institute treatment before severe and permanent functional impairment of vital organs occurs. In this article, the RDAs for vitamins will be discussed, followed by an update of fatsoluble and water-soluble vitamins.
Recommended Daily Allowances (Table 1)
In principle, the RDAs are based on various kinds of evidence: 1) nutrient intakes of fully breast-fed infants and of apparently healthy people from their food supply; 2) studies of subjects maintained on diets containing low or deficient levels of a nutrient, followed by correction of the deficit with measured amounts of the nutrient; 3) nutrient balance studies that measure nutrient status in relation to intake; 4) biochemical measurements of tissue saturation or adequacy of molecular function in relation to nutrient intake; 5) epidemiologic observations of nutrient status in populations in relation to intake; and 6) in some cases, extrapolation of data from animal experiments. In practice, there are limited data on which to base the RDAs.1 It should be recognized that all RDAs are somewhat arbitrary and generally on the high side.
Developmental Dyslexia: An Update
Authors: Nass Ruth 
Published: December 2021

Definitions
Developmental dyslexia, also known as specific reading disability, is an unexpected difficulty in learning to read that occurs in the otherwise normal child. Rudel1 suggests it be defined by both exclusionary and inclusionary criteria. Her strict definition requires that five criteria be met: 1) The child must have no major neurologic abnormalities, such as overt cerebral palsy. Affected children may and often do have "soft" signs on neurologic examination, however. 2) The major sensory functions must be normal; the child cannot be blind or deaf. Practically speaking, children who are blind or deaf or who have cerebral palsy may be dyslexic if they have reading difficulties disproportionate to their other academic and intellectual abilities. 3) The child should have no major psychiatric problems. Problems with self-esteem are often, however, a reactive secondary issue in the child who has a learning disability. 4) Normal intelligence is required, using either a verbal or nonverbal measure. Children who have dyslexia often also have language problems. Hence, verbal intelligence scores may not reflect overall intellectual abilities accurately. 5) Finally, the dyslexic child must have been in a social and educational environment conducive to learning to read. Several studies of inner-city school children have demonstrated that enrichment programs help some nonreaders become readers, demonstrating the importance of teaching techniques.
Viral Hepatitis: A, B, C, D, and E—Prevention
Authors: Krugman Saul 
Published: December 2021

The article in the June 1992 issue of Pediatrics in Review included a detailed discussion of the etiology, pathogenesis, clinical manifestations, course, complications, epidemiology, and prognosis of hepatitis A, B, C, D, and E. This second section reviews prevention and treatment of these infections.
Prevention of Hepatitis A
GENERAL MEASURES
Procedures designed to prevent fecaloral spread of hepatitis A virus should be used for control. These include scrupulous handwashing, proper sterilization of food utensils, fly abatement, and exclusion of potentially infectious food handlers. Although close contact is the most common mode of transmission, common source epidemics stemming from contaminated food, milk, and water supplies may occur.
PASSIVE IMMUNIZATION
Postexposure prophylaxis with standard immune globulin is recommended for all individuals who have had intimate exposure to a person with the disease. Immune globulin also is indicated for persons living in the same household because they are likely to have contact with the virus. However, routine use of immune globulin in schools, offices, and factories is not warranted; disease spread is unlikely under the conditions existing in these open facilities. The recommended 0.02-mL/kg dose of immune globulin should be given within 48 h, if possible, but not later than 1 wk after exposure.
Preexposure prophylaxis with standard immune globulin is recommended for persons traveling to or working in areas where type A hepatitis is highly endemic.