bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fever in Children
Authors: Nizet Victor , Vinci Robert J. , Lovejoy Frederick H. 
Published: December 2021

Fever is the most common presenting complaints in pediatric practice, accounting for 10% to 20% of office and emergency room visits.
Pathophysiology of Fever
Three pathophysiologic bases exist for fever. The first involves the raising of the hypothalamic set point in the central nervous system. Infection, collagen vascular disease, and malignancies are most commonly responsible. This type of fever is lowered by antipyretics and physical removal of heat. A second type of fever is a result of heat production exceeding heat loss as, for example, in salicylate overdose, hyperthryroidism, excessive environmental temperature, and malignant hyperthermia. The third type of fever is caused by defective heat loss, as seen with ectodermal dysplasia, heat stroke, and poisoning via anticholinergic drugs. Antipyretics are ineffective for the second and third types of fever.
Biologic Process of Fever Reduction
Fever occurs as a result of a number of complex biologic interactions. Exogenous pyrogens, including viruses, bacteria, fungi, antigen-antibody complexes, and drugs, are engulfed by phagocytic leukocytes, leading to the production of an endogenous pyrogen called interleukin-1 (Fig. 1). This compound (also known as lymphocyte-activating factor), in conjunction with interleukin-2, is responsible for increasing the number of helper T cells and initiating the production of prostaglandins in the hypothalamus. Helper T cells are instrumental in fighting infections; prostaglandins are responsible for producing fever.
Neonatal Resuscitation
Authors: Wimmer John E. 
Published: December 2021

Introduction
Prompt, skillful resuscitation of distressed neonates in the immediate postpartum period is one of the most important responsibilities of the practicing pediatrician. The potential for death or life-long morbidity is high in these Vulnerable infants, but it can be reduced dramatically by effective intervention. Because many of these situations are unpredictable, all deliveries should be attended by at least one person skilled in neonatal resuscitation, and additional help should be readily available.
Although a certain amount of practice is needed to master and maintain the necessary manual dexterity skills, the vast majority of neonatal resuscitations are relatively simple procedures. Most depressed infants respond to ventilation with oxygen; only a few require chest compressions or medication. Vascular access usually is not needed, and most infants can be ventilated adequately by bag and mask. Advance preparation and adherence to a few basic principles are the keys to effective intervention.
The role of the pediatrician should go beyond maintaining expertise in neonatal resuscitation and responding to emergencies. Pediatricians should be teachers and role models for obstetricians, nurses, and other health professionals involved in perinatal care. They should be participate in planning for and monitoring the performance of neonatal resuscitation. They also must provide acute care and follow-up for resuscitated infants.
INDEX OF SUSPICION
Authors: Leopold John C. , Sirotnak Andrew P. , Ryan Joseph , Menna Vincent 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 and discussions.
Case 1 Presentation
A 13-year-old boy who has been in good health previously comes to the pediatric clinic with a history of a pruritic red rash that comes and goes for several hours after he has been swimming. This rash has been a problem for the last 5 days.
Two days ago, after swimming, he developed a diffuse rash together with periorbital edema and a burning sensation on his back. He suddenly became lightheaded and collapsed into his mother's arms, losing consciousness briefly. By the time he arrived at the emergency department, the rash was gone and his examination was normal. No treatment was prescribed.
Yesterday, while washing the family car with cold soapy water, his right arm and hand swelled and turned solidly red in a "glove" distribution.
Intestinal Obstruction in the Newborn
Authors: Ross Arthur J. 
Published: December 2021

Obstruction of an infant's gastrointestinal (GI) tract can occur anywhere from the esophagus to the anus. For purposes of this review, the newborn infant will be defined as an infant from birth to 30 days of age. Both congenital and acquired obstructions will be addressed. In each instance, the epidemiology, pathogenesis, clinical aspects, and management of the disorder will be considered.
Esophageal Atresia
EPIDEMIOLOGY AND PATHOGENESIS
Esophageal atresia, or interruption of the esophagus, generally occurs in association with a tracheoesophageal fistula (EA - TEF). The most common anatomic arrangement is a blind proximal esophageal pouch that has a distal tracheoesophageal fistula (Figure 1). This is seen in 85% to 90% of infants who have this anomaly. Seen less commonly is pure esophageal atresia that does not have a tracheoesophageal fistula and tracheoesophageal fistula that does not have an esophageal atresia (H-type tracheoesophageal fistula). These latter two conditions occur in approximately 10% of newborns who have these types of anomalies. Other anatomic arrangements, such as an esophageal atresia that has a fistula between the upper pouch and trachea or esophageal atresia that has a fistula to both pouches, are seen in only a tiny fraction of these infants.
EA - TEF occurs in approximately 1 in 4000 live births.
Consultation with the Specialist
Authors: Neilson Ian R. 
Published: December 2021

Witnessing the ingestion of a foreign body by a toddler is alarming and immediately raises several questions. What are the risks of aspiration and airway obstruction? Where do foreign bodies get stuck? Are investigations necessary in the absence of symptoms? How long can objects be watched at different locations? What complications can result? When should objects be removed and which procedure should be used? When can cathartics or enemas be given safely?
Predisposing Factors
The peak age range for foreign body ingestion is 6 months to 3 years. There are underlying social, developmental, or psychiatric risk factors in up to 30% of cases. Ingestions in older children usually are accidental. Symptoms occasionally can suggest an underlying abnormality such as an esophageal stricture or might be related to a previous surgical procedure such as the repair of an esophageal atresia or a pyloromyotomy for pyloric stenosis. Children who have had esophageal atresia repaired also have associated dysmotility of the distal segment.
The Need For Radiologic Investigations
The nature of the ingested foreign body obviously influences management. Directed questions or a search of the home for missing objects often will reveal the nature of the ingested object. The presence of symptoms such as choking, dysphagia, substernal discomfort, persistent cough, or of physical findings such as drooling mandates a radiologic search for foreign bodies from oropharynx to anus.
INDEX OF SUSPICION
Authors: Conners Gregory P , Sheeran Paul W. , Miller Harry S. 
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
A 16-year-old right-handed girl comes to you complaining of a "funny bend" in her left ring finger. She first noticed it 2 days ago, after a martial arts practice session during which she was blocking kicks with her bare hands. After practice, she had pain and considerable ecchymosis in the distal portion of her finger and was unable to extend her distal interphalangeal joint (DIP) fully. The finger has not improved after 2 days of rest, ice, and ibuprofen. She denies other medical or orthopedic problems and has been taking no other medications.
On physical examination, the DIP joint of her left ring finger assumes a position of 30 degrees of flexion at rest; she can flex the joint fully but is unable to extend it beyond the resting position.
Amphotericin B
Authors: Abadi Jacobo 
Published: December 2021

There are many circumstances in which pediatricians today may be involved in the care of patients at risk for systemic fungal infection. Among those at risk are children receiving chemotherapy for neoplastic disease, children infected with human immunodeficiency virus (HIV), and children undergoing immunosuppressive therapy for chronic illnesses or after transplantation. Available since 1960, amphotericin B (Am B) remains the treatment of choice for most serious fungal infections.
A fermentation product of the soil actinomycete Streptomyces nodosus, Am B binds selectively to ergosterol in the cell membrane of susceptible fungi, inducing changes in permeability that can produce lethal cell injury. Pharmacokinetic studies have sown that Am B is absorbed poorly when taken orally, necessitating intravenous administration.
Osteomyelitis
Authors: Roy Dennis R. 
Published: December 2021

Osteomyelitis, defined as an inflammation of bone generally caused by a pyogenic organism, is a common disorder of childhood. Infection most commonly is caused by blood-borne bacteria that localize in the metaphysis. Trauma or surgery also may result in direct inoculation or implantation of bacteria into the bone, or an adjacent focus of infection might extend directly to the bone, resulting in osteomyelitis.
The etiology of acute hematogenous osteomyelitis is not understood completely. Bacteremia in childhood occurs frequently, if not daily; thus, the presence of bacteria alone may not explain why infection begins. Recent trauma coincidental with a bacteremia has been postulated. The presence of an intercurrent illness (ie, chicken pox) or infection may introduce a larger number of organisms or different pathogenic bacteria into the system or alter the immune system, making the host more susceptible.
An understanding of the anatomy of bone and the pathogenesis of osteomyelitis is essential to appreciate the protean manifestations of the disorder.
Pathogenesis
In acute hematogenous osteomyelitis, infection is localized in the metapahysis. The circulation of the bone predisposes this region to the infection. Epiphyseal and metaphyseaal blood supplies generally are separate. The blood supply to the metaaphysis originagtes when the nutrient arteries send small terminala branches that end at the growth plate.
Poverty and Health
Authors: Racine Andrew D. 
Published: December 2021

The effect of poverty on the health of children is profound and enduring. Although the United States ranks seventh in per capita income among the world's industrial societies, at least one in five American children currently lives in a family whose income is below the federal poverty level. The extent to which material deprivation of this magnitude harms these children can be measured through a variety of instruments, including vital statistics, population surveys based on parental report, and health examination surveys.
Wise and Meyers provided a recent overview of the relationship between poverty and child health. They characterized a dual mechanism by which poverty may increase the risk of ill health among children: It can increase the probability of adverse events occurring and it can augment the impact that these events have on the children to whom they occur.
Cerebral Palsy
Authors: Taft Lawrence T. 
Published: December 2021

To be classified as cerebral palsy (CP), there must be difficulty in neuromotor control, a nonprogressive brain lesion, and an injury to the brain that occurred before it was fully mature. The term "cerebral palsy" should be used only if a static encephalopathy exists. If there is any question that a progressive central nervous system disorder exists, the term "cerebral palsy" should not be used diagnostically until the status of the lesion is clarified.
Although the primary abnormality must be a motor deficit, often there are many associated symptoms of cerebral dysfunction present.
Incidence and Prevalence
The prevalence of CP has changed very little over the past 40 years, in spite of many technological advances that have decreased mortality in compromised preterm and full-term infants. The prevalence rate has been estimated to be between 2 and 5 per 1000 live births. At 12 months of age, the prevalence rate was estimated to be 5.2 per 1000, but at 7 years of age, the rate was estimated to be 2 per 1000 live births. This indicates that many children who showed signs or experienced symptoms suggesting a motor disorder did not have CP on follow-up.
The past 3 decades have seen an increased survival rate of very small preterm infants, resulting in a change in the percentage rates of the different clinical types of motor disabilities among patients classified as having CP.
Consultation with the Specialist
Authors: Vadasz Andrew G. , Epstein Leon G. 
Published: December 2021

Many general pediatricians feel that the assessment of an infant or child who has a developmental delay and possible neurologic impairment is one of their most difficult challenges. Frequently the parents or relatives, during the course of a well-child visit, first voice concerns about the failure to attain or master one or more expected developmental milestones. Other times the pediatrician is the first to note a problem with development in one or more areas. One of the most important tasks for the pediatrician is to be able to identify the subset of patients who may have a progressive rather than a static neurologic process and to refer them promptly for further evaluation of a possible neurodegenerative disorder.
In the past, the diagnosis of a childhood neurodegenerative disease was associated with a sense of hopelessness; frequently, the need for a definitive diagnosis was questioned. Breakthroughs in our understanding of the genetic and biochemical basis of many of these disorders, together with advances in enzyme replacement and gene therapy, have made antenatal diagnosis, treatments, and even cures a reality.
The numerous types of central nervous system (CNS) degenerative diseases encountered in children go beyond the scope of a few pages and are covered well in the standard texts (see the excellent chapter by Johnson and Rapin in Rudolph's Pediatrics, 19th ed, 1991).
Antibiotic Drug Levels
Authors: Rosenberg Michael G. 
Published: December 2021

In the past, efficacy, as defined by controlled clinical trials, was the primary factor in the selection of a particular antibiotic regimen. Today, as the number of antimicrobial agents approved for clinical use has grown almost exponentially, efficacy rarely is emphasized in published clinical trials. More commonly they demonstrate therapeutic equivalence rather than superiority of new compounds to previously accepted regimens. For this reason, the two criteria that now factor most prominently into the selection of equally effective antibiotics are relative toxicity and cost.
Three major classes of antibiotics used throughout the world in the treatment of serious pediatric infectious diseases are chloramphenicol (CAP) and its derivatives, aminoglycosides (AGs), and vancomycin and related glycopeptides.
The Child Who Has A Limp
Authors: Renshaw Thomas S. 
Published: December 2021

A limp is defined generically as any deviation of child's walking pattern from the expected normal pattern for the child's age. Limping more commonly is unilateral than bilateral, and its many causes range in severity from malfitting shoes to highly malignant bone tumors.
Specific reasons for limping fall into one or more of three categories: pain, weakness, and structural abnormalities. An antalgic gait may be caused by such painful conditions as synovitis of a major weight-bearing joint; infection of bone, joint, or soft tissue; neoplasia; or trauma from such things as repetitive microtrauma, a torn knee cartilage, or a chronic stress fracture. Musclle weakness can result from disuse atrophy or from a neurologic or a primary muscle disease. The structural or mechanical causes include limb length inequality, joint stiffness, and articular surface deformity.
The anatomic origin of the limp may be the foot, ankle, leg, knee, thigh, hip, spine, or even the abdomen. It follows, therefore, that a careful and thorough history and physical examination are mandatory for the child who has a limp and that all of theses anatomic areas be evaluated carefully.
The history should include the duration of the limp, the child's or parents' perception of its site of origin, if possible, and whether pain is associated.
Preparing for Pediatric Emergencies
Authors: Seidel James 
Published: December 2021

• A 2-week-old infant stops breathing in your waiting room.
• A frantic mother comes to the office carrying her 2-year-old son, who has just aspirated a balloon.
• A 6-year-old is brought to the office with a partial thickness burn of the right arm.
• A mother calls the office and states that her 15-month-old child bit into an electrical cord.
• A 5-year-old boy falls from a tree at school and is brought into the office.
• A 9-year-old girl has an anaphylactic reaction to a penicillin injection.
• A 5-year-old boy cuts his foot on a piece of rusty metal in a barnyard and has only had two tetanus immunizations.
These scenarios all can occur in the office. The literature, as well as a periodic survey done by the American Academy of Pediatrics, suggests that many offices are not prepared to manage these and other emergencies. In some practices, the staff have not received formal training in cardiopulmonary resuscitation (CPR), even though ill patients are seen regularly and injectable medications are dispensed.
Staff and Office Preparation
The issues that are important in preparing for an emergency involve: staff education; equipment and supplies; management guidelines, protocols, and procedures; and resuscitation practice sessions.
STAFF EDUCATION
All office staff should be trained in basic life support, including foreign body removal, rescue breathing, and chest compressions.
Choanal Atresia
Authors: Menasse-Palmer Lisa , Bogdanow Anna , Marion Robert W. 
Published: December 2021

Choanal atresia is an abnormality of canalization during development of the nasal passages. It involves bone and/or soft tissue and may result in either partial (choanal stenosis) or complete obstruction of the posterior nasal airway. The most widely accepted mechanism for the development of choanal atresia is the persistence of the oronasal membrane beyond the sixth week of gestation, but abnormal migration of cephalic neural crest cells following neural tube closure also has been implicated.
The incidence of choanal atresia is 1 in 7000 to 8000 live births. It is more common in females (2:1), more likely to be bony or cartilaginous than membranous (9:1), and more commonly unilateral and right-sided (2:1).
Separation Anxiety
Authors: Jellinek Michael S. , Kearns M. Elyce 
Published: December 2021

Fear in reaction to danger potentially leads to life-saving "fight or flight." Anxiety is intrinsic to fear, and the young infant experiences anxiety during the earliest inevitable separations from caretakers. Over time, a child learns to experience anxiety in anticipation of fear, whether this fear is based on a true impending danger or a separation (eg, being left to fall asleep at bedtime).
Bowlby, recognizing the infant's life and death dependency on a caretaker, defined separation as the "basic anxiety of infancy." The mother's leaving is so potentially dangerous that the infant responds with a piercing cry that reflects both protest and anxiety while calling forth the mother's return. This cry is a paradigm for what we all face when we experience the inevitable losses of loved ones or even our own hopes.
Anxiety secondary to separation can continue beyond the expected age and interfere with a child's ability to function. Separation anxiety disorder may prevent a child from achieving critical developmental milestones, such as leaving his or her parent to play with friends or go to school. The early recognition of unwarranted or excessive separation anxiety may help limit potentially serious dysfunction.
Separation anxiety can be expected to begin to ease for most children at 18 months of age with the cognitive mastery of object permanence and the growing security of consistent caretaking.
Antifungal Drugs
Authors: Cross J. Thomas , Hickerson Steven L. , Yamauchi Terry 
Published: December 2021

Introduction
Fungi have been recognized as pathogens for many years. However, the incidence of fungal infections in the pediatric population has increased substantially due to the increased use of broad-spectrum antibiotics, immunosuppressive agents, hyperalimentation products, and central venous catheters in addition to the acquired immunodeficiency syndrome (AIDS) epidemic. The physician involved with the care of children should know the agents effective against these pathogens (Table 1). Amphotericin B has a long history of both efficacy and toxicity because it was the only available systemic agent for many years. With the introduction of ketoconazole, fluconazole, and itraconazole over the past decade, the decision of which agent to use has become much more difficult. Clinical trials are underway to help answer these questions, but until these are completed, the clinician must weigh the risks and benefits of therapy for each patient individually.
Amphotericin B
BACKGROUND
Amphotericin B is entering its fourth decade as an antifungal agent. Since its introduction in the mid-1950s, it has been the cornerstone of management of systemic fungal infections. Even with the introduction of the azoles, it continues to be the treatment of choice for many conditions.
CHEMISTRY, MECHANISM OF ACTION
Streptomyces nodosus, a soil actinomycete, is the source of the amphotericins A and B. Amphotericin B is the commercially available product, and it may contain a small amount (&lt;5%) of amphotericin A.