bluuebunny/crossref_metadata_2025_split huggingface dataset:
Chronic Pain in Cystic Fibrosis
Authors: Ravilly Sophie , Robinson Walter , Suresh Santhanam , Wohl Mary Ellen , Berde Charles B. 
Published: December 2021

Objective. The objective of this study was to examine the incidence and therapy of chronic pain in a group of older patients with cystic fibrosis (CF).
Patients. We identified two groups of patients followed at the CF Center at Children's Hospital (Boston); the first group consisted of all patients above the age of 5 years who died between 1984 and 1993, and the second was a cohort of 23 additional CF patients who had been referred to the Pain Treatment Service.
Design. Medical charts were reviewed for the etiology and therapy of all pain episodes requiring medical intervention.
Results. The incidence of chronic pain in this population increased sharply in the last 6 months of life. Headaches (55% of patients) and chest pain (65%) were frequently reported, although back pain (19%), abdominal pain (19%), and limb pain (16%) were also reported. In patients with headache, the main etiologies were hypercarbia or hypoxia, migraine, and sinusitis. The majority of chest pain was musculoskeletal, with pleuritis, pneumothorax, and rib fracture also reported as the cause of chest pain.
Interventions. A variety of nonpharmacological and pharmacological therapies were reported. Forty-one patients (53%) had pain severe enough to require opioid treatment, and 10 patients (13%) received opioids for more than 3 months. In eight patients with more severe pain, regional analgesia was found to be particularly effective.
Conclusions. Chronic pain is a common problem in CF, particularly as the patient population ages. When administered with caution, opioids have proven to be effective and safe in this population; regional anesthesia can be used to preserve pulmonary toilet while adequately treating severe pain.
Predictors of Weight Loss in Children With Attention Deficit Hyperactivity Disorder Treated With Stimulant Medication
Authors: Schertz Mitchell , Adesman Andrew R. , Alfieri Nancy E. , Bienkowski Robert S. 
Published: December 2021

Objective. A retrospective study was undertaken to examine predictors of weight loss in children with attention deficit hyperactivity disorder (ADHD) treated with stimulant medication.
Design. Children diagnosed with ADHD and treated with methylphenidate hydrochloride (MPH) or dextroamphetamine sulfate (DEX) for at least 5 months were identified by retrospective chart review. Analyses were performed on 32 children (29 boys) treated with MPH and 28 children (25 boys) treated with DEX. Variables examined included pretreatment weight, pretreatment body mass index (BMI), duration of treatment, total daily dose, and weight-adjusted dose.
Results. The MPH-treated group was initially seen at a mean age (± standard deviation) of 7.5 years (±2.1). Mean duration of follow-up was 11.2 months (±3.8). Mean total daily dose was 25.5 mg (±8.2) and mean weight-adjusted dose was 1.0 mg/kg/day (±.5). Mean change in weight as expressed in z scores was -0.4 SD (±.7). The DEX-treated group was initially seen at a mean age of 9.3 years (±2.7). Mean duration of follow-up was 10.8 months (±4.1). Mean total daily dose was 14.9 mg (±8.2) and mean weight-adjusted dose was .5 mg/kg/day (±.3). Mean change in weight was -0.6 SD (±.6). Although the MPH group was younger than the DEX group, there were no between-group differences in weight or height either before treatment or at follow-up when adjusted for age and gender. Using linear regression analysis, significant correlations were found between pretreatment weight and change in weight for both the MPH-treated group (r = .63) and the DEX-treated group (r = .47). Stepwise multiple-regression analysis indicated that pretreatment age, weight-adjusted dose, and duration of follow-up did not significantly contribute to the variance in change of weight for either the MPH- or DEX-treated groups. To adjust for height, changes in BMI were also analyzed. For both medication groups, no differences were found between the heavier (BMI≥50%) and thinner (BMI &lt;50%) children in duration of follow up, total daily dose, or weight-adjusted dose. When the medication groups were combined, a greater proportion of heavier children experienced a decrease relative to their predicted BMI compared with thinner children (80% vs 52%). Comparisons of mean BMI slopes revealed that the heavier group experienced an absolute decrease in their BMI (-.139) in contrast to the thinner group (+.014) (t = 2.70).
Conclusions. Pretreatment weight, adjusted for age, gender, and height, is a significant predictor of weight loss in children with ADHD treated with either MPH or DEX. In contrast, pretreatment age, duration of treatment, and weight-adjusted dose were not found to be significant predictors.
Introduction
Authors: Friedman Stanford B. , Schonberg S. Kenneth , Sharkey Mary 
Published: December 2021

Pediatricians routinely advise parents on a wide range of child earing issues. Among the most difficult and controversial topics included in professional guidance is the use of corporal punishment and, in particular, spanking. There are those who believe that corporal punishment contributes to later violence, whereas others believe spanking is a legitimate component of the overall process of discipline. Most of us base our views about the appropriateness and effectiveness of corporal punishment on our own previous experiences when we were disciplined as children and/or how we raise (or plan to raise) our own children. In contrast, advice offered to parents regarding discipline is seldom based on an appraisal of the relevant behavioral literature. Consequently, there is no agreement among the members of the American Academy of Pediatrics regarding the use of spanking. A recent attempt at evolving a policy statement addressing this issue failed to achieve consensus among the members of the Board of the Academy. Thus, disagreement persists regarding whether the Academy should recommend that pediatricians advise parents as to whether they should, or should not, spank their children. And if so, under what circumstances?
The planners of this conferences were in search of data-based scientific answers to these questions. Towards this end, recognized investigators were invited to present and discuss research findings, and develop a series of consensus statements reflecting the current state of our scientific knowledge on the short- and long-term consequences of corporal punishment.
In February 1996, 24 participants met at the Academy offices in Elk Grove Village, Illinois.
Outcomes of Extremely Low Birth Weight Infants
Authors: Hack Maureen , Friedman Harriet , Fanaroff Avroy A. 
Published: December 2021

Background. Our goal was to determine the effects of recent changes in delivery room and neonatal care, including surfactant and dexamethasone therapy, on survival, neonatal morbidity, and 20-month neurodevelopmental outcome of infants with birth weights of less than 750 g.
Methods. We compared the outcomes of 114 infants of 500 to 750 g birth weight delivered at our perinatal center between January 1990 and December 1992 (period II), when surfactant and postnatal dexamethasone were used, with the outcomes of 166 such infants born between July 1982 and June 1988 (period I).
Results. The rate of cesarean section increased from 17% to 27% and delivery room intubation increased from 54% to 72% during periods I and II, respectively. Survival increased from 23% during period I to 43% during period II. The increase in survival was significant at birth weights of 600 to 700 g and at 24 weeks' gestation and greater. During period II fewer infants died at less than 24 hours of age and more died at more than 28 days of life. Neonatal morbidity did not change appreciably; neither did 20-month neurodevelopmental outcomes. Twenty percent of the infants had subnormal cognitive function (Mental Development Indices &lt; 70) and 10% had cerebral palsy during period II.
Conclusions. Despite an increase in survival during 1990 to 1992, the neonatal and early childhood outcomes of the survivors were unchanged. Physicians and parents anticipating the delivery of extremely low birth weight infants must be aware of these outcomes to make informed decisions as to the advisability of aggressive care at birth and thereafter.
Status Epilepticus in Children With Epilepsy: The Role of Antiepileptic Drug Levels in Prevention
Authors: Maytal Joseph , Novak Gerald , Ascher Catherine , Bienkowski Robert 
Published: December 2021

Objectives. To determine the association between subtherapeutic antiepileptic drug (AED) levels or AED withdrawal and status epilepticus (SE) in children with epilepsy.
Methods. We studied the AED levels at the time of SE in 51 consecutive children with epilepsy. Information about prior AED levels, possible etiology of seizures, and acute precipitants was extracted from medical records.
Results. The mean age at the time of SE was 5.7 years (range, 3 months through 18 years). Forty-three patients had history of remote insult, five had history of progressive encephalopathy, and three patients were classified as idiopathic. At the time of SE all AED levels were therapeutic in 34 (66%) patients and at least one level was therapeutic in 42 (82%) patients. All levels were subtherapeutic in 9 (18%) patients. Four patients had their AED reduced or discontinued less than 1 week before SE. Twelve patients with therapeutic AED levels on their most recent clinic visit had at least one subtherapeutic level at the time of SE. Eight (16%) patients were febrile and one was hyponatremic. Of the 51 patients, 31 (61%) had no obvious explanation for the development of SE, as all known AEDs were therapeutic and there were no known acute insults.
Conclusions. Neurologically abnormal children with preexisting epilepsy are at high risk for development of SE despite having therapeutic AED levels at that time. Acute precipitants of SE, such as fever or AED withdrawal, may play a role in inducing SE only in a minority of patients.
Thyroiditis in Children
Authors: Bachrach Laura K. , Foley Thomas P. 
Published: December 2021

Thyroiditis ranks with diabetes as the most common of the endocrine disorders of childhood. The term encompasses all forms of thyroid gland inflammation and infection, although chronic lymphocytic thynoiditis is overwhelmingly the most frequent. Thyroiditis may appear as a mass in the neck of an asymptomatic child or it may be a painful, erythematous goiter in a sick child. The affected thyroid gland may be small on large, with varying degrees of dysfunction. Most commonly, thyroiditis causes euthyroid function, although the disease process can result in transient or permanent thyroid dysfunction. The causes of thyroiditis in childhood, as well as the less common thyroid disorders in the differential diagnosis of goiter, are listed in Table 1. Thyroid physiology and pathophysiology will be discussed briefly to explain the rationale for diagnostic studies and treatment strategies. The more recent diagnostic techniques and therapeutic controversies regarding thyroiditis will be included. The goal is to provide the clinician with renewed awareness of this most common pediatric problem.
THYROID PHYSIOLOGY
Thyroid hormone production is regulated by a classical negative feedback system (Fig 1). Hypothalamic thyrotropin-releasing hormone (TRH) stimulates the synthesis and secretion of thyroid-stimulating hormone (TSH) from the pituitary. TSH, in turn, stimulates production and release of thyroxine (T4) and triiodothyronine (T3).
Quality Improvement: Buzz Words or Boon?
Authors: Bergman David A. 
Published: December 2021

Background
Assessment of quality in health care has a long history, dating back to the works of E.A. Codman, who wrote in 1914 about improving the quality of care by evaluating the results of treatments.1 These views were not widely accepted at the time. Codman experienced considerable frustration in persuading his colleagues to keep accurate records and note the outcomes of their treatment. Ultimately, he resigned from the staff of the Massachusetts General Hospital and formed his own hospital, where he diligently kept records of his surgical procedures and patients' outcomes. Codman's ideas concerning outcome-based quality improvement were not considered seriously again until the 1980s. In the interim, many physicians regarded the quality of care they provided to be high, but they could neither define nor measure it exactly. This attitude toward quality perhaps is illustrated by a quotation from Pirsig's Zen and the Art of Motorcycle Maintenance: "Quality.... you know what it is, yet you don't know what it is....But when you try to say what quality is, apart from the things that have it, it all goes poof! There is nothing to talk about. But if you can't say what quality is, how do you know what it is, or how do you know that it even exists?"2
Consultation with the Specialist
Authors: Seidel James 
Published: December 2021

Case Report
Bobbi, a 5-year-old, was playing "catch" on the lawn of his surburban home. When he went to fetch the ball that had rolled into the street, he was struck by an automobile traveling about 25 miles per hour. Witnesses reported that Bobbi's body was lifted up by the car and thrown about 12 feet onto the pavement. A neighbor responded immediately and noted that Bobbi was responsive to verbal commands and had a large bump on the front of his head and a swollen right thigh. The Emergency Medical Services System was activated, and within 10 minutes he was transported to the emergency department at the local community hospital.
Bobbi was in obvious pain but was awake and responded to questions. He knew his sister's and teachers' names, but did not remember being struck by the car. His vital signs were: respirations 35/min; pulse, 100/min; blood pressure, 98/68 mm Hg; and temperature, 36.5°C. Physical examination was remarkable for a large hematoma on the right frontal and parietal areas of the skull and a swollen tender right thigh.
Bobbi's spine was normal upon physical examination, and the neurologic examination was normal except for some retrograde amnesia. There was no spinal swelling or tenderness, and cervical spine radiographs were normal
Allergic Contact Dermatitis in Children
Authors: Hogan Peter A. , Weston William L. 
Published: December 2021

Definition
Allergic contact dermatitis (ACD) is an inflammatory reaction of the skin that follows percutaneous absorption of antigen from the skin surface and recruitment of previously sensitized, antigen-specific T lymphocytes into the skin.
Epidemiology
In the pediatric age group, ACD can involve either sex and manifest as early as the first week of life. A recent review of several European and US studies found that ACD may account for up to 20% of cases of dermatitis in the 0- to 14-year-old age group. Although the incidence and prevalence of the disease in the general pediatric population is unknown, epicutaneous patch testing of randomly selected and otherwise healthy children revealed that 13% to 20% were allergic to one or more common antigens, suggesting that at least 20% of children in the general population theoretically are at risk of developing ACD. When one considers poison ivy or poison oak as contact allergens prevalent in certain areas of North America, the likelihood of allergic contact dermatitis may be much higher. Pediatricians should recognize that children are sensitized to contact allergens early in life, with most children being sensitized by age 5 years. The allergens most commonly responsible for allergic contact dermatitis in North American children are listed in Table 1.
Gastrointestinal Endoscopy in Infants and Children
Authors: Wyllie Robert , Kay Marsha H. 
Published: December 2021

Introduction
The earliest gastrointestinal (GI) endoscopies were performed in the late 1880s by using rigid instruments to examine the esophagus and rectum. The semiflexible gastroscope was developed in the early 1930s by Schindler and Wolf, and fiberoptic endoscopes were popularized in the late 1960s and early 1970s. The first small-diameter instrument used for esophagogastroduodenoscopy (EGD) in a child was a fiberoptic bronchoscope. Video endoscopy has only developed over the past 2 decades, with the first mass-produced video instruments introduced in the 1980s. Parts or all of the procedure can be recorded for later review. Pediatric GI endoscopists can perform most of the endoscopic techniques of their adult counterparts. The referring physician and endoscopist should be familiar with the risks and benefits of endoscopy as well as clinical situations in which it is most useful.
Personnel
Specially trained pediatric endoscopy assistants are an important component of the endoscopy team. Preprocedure anxiety may be reduced by a physician, nurse, or play therapist explaining the procedure to the patient. One assistant can hold and reassure the child throughout the procedure while a second can help to obtain and process tissue and assist with other equipment and patient monitoring.
Physicians performing GI endoscopy on infants and children should have completed a pediatric gastroenterology fellowship or have experience with pediatric gastrointestinal diseases and adequate training in pediatric endoscopy.
Consultation with the specialist
Authors: Young Richard S.K. 
Published: December 2021

History and Physical Examination
More than 10 000 individuals suffer spinal cord injury each year. This article will focus on those mass lesions of the spinal cord that should prompt neurosurgical consultation: epidural abscesses, neoplasms, and hematomas. The presence of pain and spinal cord dysfunction (paralysis, loss of sphincters) makes neurosurgical consultation mandatory.
Because of the anatomy of the spinal cord, it has several classical patterns of involvement (see Table). When obtaining a history, inquire about pain over the spine or pain that radiates down the legs. The presence of paresthesiae suggests involvement of the posterior roots or posterior columns of the spinal cord. Inquire whether the patient's sphincter function is normal. Difficulty in ambulation or refusal to walk are hallmarks of spinal cord disease.
Observe the patient's gait for limp, waddling, or circumduction. Inspect the spine carefully for scoliosis or for neural tube defects. Examine the skin for signs of neurologic disease (café au lait spots, axillary freckles, cutaneous hemangiomas). If cutaneous hemangiomas are present over the spine, auscultate for the presence of arteriovenous malformations. Percuss the spine to elicit pain suggestive of abscesses or radicular disease.
Infections of the Spinal Cord
Case Report: A 4-year-old child who had been adopted from a Korean orphanage was brought to her pediatrician for evaluation of a limp.
Persistent Vomiting
Authors: Ramos Asuncion G. , Tuchman David N. 
Published: December 2021

Vomiting is forceful expulsion of gastric contents through the mouth. The diagnostic challenge for the clinician is to determine whether vomiting occurs as part of a benign, self-limited process or whether it is the presenting symptom of a major underlying disorder. The following discussion provides an overview of the pathophysiology of vomiting, the major conditions that cause chronic vomiting, and principles of management.
Definitions
Vomiting is a highly integrated, chiefly somatic motor event that often is preceded by nausea, increased salivation, and retching. Vomiting is distinct from regurgitation, which is defined as passive movement of gastric contents into the esophagus. Regurgitation often is considered synonymous with gastroesophageal reflux (GER), although vomiting, too, may be a symptom of reflux. Vomiting and regurgitation can be distinguished through a careful history. This difference is important to establish because conditions associated with chronic regurgitation generally are less severe than those that occur with chronic vomiting.
During fluoroscopy, regurgitation appears as a "to-and-fro" movement of contrast material from the stomach into the esophagus. In contrast, vomiting is seen as an active phenomenon and involves simultaneously occurring events. There is a rapid increase in intra-abdominal and intragastric pressure that occurs secondary to contraction of the diaphragm and the abdominal muscles.
Quality Improvement: An ACQIP Exercise on Vaccine Administration—Part 1
Authors: Smith-Ross Shannon ,   Staff of the Division of Quality Care
Published: December 2021

As part of Pediatrics in Review's ongoing focus on quality improvement, we present for the use of our readers this self-assessment exercise taken from the American Academy of Pediatrics' Ambulatory Care Quality Improvement Program (ACQIP). ACQIP is an educational program for pediatricians that embodies the concept of continuous quality improvement. It has been implemented successfully in physicians' offices, health maintenance organizations, and hospitals.
Currently, more than 2000 physicians worldwide are enrolled in ACQIP. The program is designed to help pediatricians evaluate their practices by comparing themselves with other physicians in similar practices and communities. Pediatricians in groups can use ACQIP to analyze practice variations within the group. Three aspects of care are addressed:
• Practice management
• Delivery of preventive care
• Patient satisfaction
Each year, a theme is selected. In 1992-1993, the first year, the theme was immunizations. The 1993-1994 program focused on telephone management, developmental assessment, and management of asthma. ACQIP is being used by the American Academy of Pediatrics (AAP) as a vehicle to disseminate and implement its new practice parameters on asthma, neonatal hyperbilirubinemia, otitis media, gastroenteritis, head trauma, febrile seizures, and urinary tract infections. This year's exercises (September 1994 to August 1995) will be on otitis media and hyperbilirubinemia and will be based on the parameters.
INDEX OF SUSPICION
Authors: Dvorak Mary D. , Mazur Britta , Pascual A. George 
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 6-day-old girl is brought into the clinic having a 12-hour history of fever to 101°F(38.3°C), irritability, and refusal to breastfeed. The child's mother is a bright, articulate woman who is very concerned about providing the best for this baby, her first, and is dedicated to breastfeeding. She notes that the child previously had been "a very good baby" - quiet, pleasant, and nondisruptive. Since birth, the child has slept for much of the day and night, awakening every 5 to 7 hours to feed. The baby usually wets her diapers after each feeding. However, her mother says that the last wet diaper was noted 6 hours ago, and it was barely wet.
Upon physical examination, the child appears quiet but awake.