bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tracking of Serum Cholesterol and Lipoprotein Levels From the First Year of Life
Authors: Kallio Markku J. T. , Salmenperä Leena , Siimes Martti A. , Perheentupa Jaakko , Miettinen Tatu A. 
Published: December 2021

Objective. To examine the development of tracking of serum cholesterol concentration from birth to childhood.
Design. In a longitudinal study of healthy children, concentrations of total serum cholesterol and triglyceride were determined at birth (n = 193); at 2 (n = 192), 4 (n = 192), 6 (n = 190), 7.5 (n = 118), 9 (n = 188), and 12 months (n = 196); and at 5 years of age (n = 162). Concentrations of cholesterol—very-low-density lipoprotein, low-density lipoprotein, high-density lipoprotein-2 (HDL2), and HDL3—were determined at 2, 6, 9, and 12 months (n = 36) and at 5 years (n = 162).
Results. The correlation coefficients of total cholesterol levels during the first year of life with the level at 5 years of age were as follows: at birth .04, at 2 months .36 (P &lt; .001), at 4 months .26 (P &lt; .001), at 6 months .28 (P &lt; .001), at 7.5 months .25 (P &lt; .001), at 9 months .35 (P &lt; .001), and at 12 months .48 (P &lt; .001). The correlation for exclusively breast-fed children between 6 months and 5 years of age was r = .37, P &lt; .001, while that for children receiving partially breast milk, formula, or solid foods was r = .12, P = not significant (NS), and between 9 months and 5 years r = .38, P &lt; .01, and r = .28, P &lt; .05, respectively. The correlation coefficients of the lipoprotein levels between ages 12 months and 5 years were as follows: low-density lipoprotein cholesterol .58 (P &lt; .001), total HDL cholesterol .30 (P &lt; .05), HDL2 cholesterol .34 (P &lt; .05), HDL3 cholesterol .17 (P = NS), very-low-density lipoprotein cholesterol .24 (P = NS), total triglyceride .37 (P &lt; .05), and triglyceride-very-low-density lipoprotein .37 (P &lt; .05). Of the children whose total serum cholesterol level was above the 90th percentile at birth, or at 2, 4, 6, 7.5, 9, or 12 months, 6%, 35%, 29%, 30%, 31%, 33%, and 45%, respectively, were above the 90th percentile at 5 years of age. In retrospect, 45% of the children whose serum cholesterol level was above the 90th percentile at 5 years were above the 90th percentile at the age of 12 months and 80% were in the highest quartile.
Conclusions. The results indicate that tracking of serum cholesterol concentration during the first year of life is stronger when examining children who are receiving a relatively homogenous diet, such as exclusive breast-feeding, and weaker as children are weaned to formula and solid foods. After the weaning process is completed, children's relative serum cholesterol levels have become established and the tracking of serum cholesterol is of the same magnitude as for older children and adolescents.
Impact of Improved Survival of Very Low Birth Weight Infants on Recent Secular Trends in the Prevalence of Cerebral Palsy
Authors: Bhushan Vidya , Paneth Nigel , Kiely John L. 
Published: December 2021

Objective. To review recent secular trends in the prevalence of cerebral palsy in industrialized countries that have population-based cerebral palsy registries and to estimate such time-trends for the United States, where until recently such registries were absent.
Data sources. Recent epidemiologic studies of cerebral palsy published in peer-reviewed journals in English, and US vital data bearing on the principal demographic determinants of cerebral palsy—birth rates, the birth weight distributions, birth weight-specific mortality risk, and cerebral palsy risk among survivors.
Results. Most epidemiologic studies from industrialized countries show a rise in the childhood prevalence of cerebral palsy in recent decades, largely because of the increasing contribution of children of low and very low birth weight to its prevalence. The only demographic determinant of cerebral palsy prevalence that is changing rapidly in the United States is survival of low birth weight and very low birth weight infants. Based on the magnitude of change in the survival of low and very low birth weight infants, it is estimated that childhood prevalence of cerebral palsy rose about 20% between 1960 and 1986 in the United States.
Conclusion. An apparently unavoidable side effect of the increasing success of newborn intensive care is a moderate rise in the childhood prevalence of cerebral palsy.
Prone or Supine Body Position and Sleep Characteristics in Infants
Authors: Kahn A. , Groswasser J. , Sottiaux M. , Rebuffat E. , Franco P. , Dramaix M. 
Published: December 2021

Objective. To evaluate the potential relation between body position and sleep characteristics in normal infants.
Patients. Two groups of 3-month-old healthy infants were evaluated: 40 infants who usually slept supine, and 40 who usually slept prone. The two groups were matched for gender, gestational age, postnatal age, birth weight, and total recording time.
Recording techniques. The 80 infants were studied polygraphically during one night in the pediatric sleep laboratory. They were allowed to fall asleep in their usual sleep position, and every 3 hours were gently turned from prone to supine, or from supine to prone.
Results. In each group, 6 infants were excluded from the analysis, because they woke up after having been turned over. In both groups, no significant difference was seen between the prone and the supine body positions for the following variables: number of sleep state changes; number of gross body movements; percent of rapid eye movement sleep; saturation with oxygen, arterial blood levels; number and duration of acid esophageal reflux; rectal temperature; mean respiratory rates; water evaporation rates from the forehead skin; and number or duration of central or of obstructive apneas. In both groups of infants, prone body position was associated with a significant increase in sleep duration (+ 6%) and in non-rapid eye movement sleep (+25%) and a significant decrease in number of arousals (–40%) and in their duration (–43%).
Conclusions. No explanation has been found for the sleep-promoting effect of prone body positioning. The finding could be of interest to the study of infants' sleep quality, as well as to the potential relation between body positions and sudden death during sleep.
Estimation of Central Osteopenia in Children With Chronic Polyarthritis Treated With Glucocorticoids
Authors: Kotaniemi Antero , Savolainen Anneli , Kautiainen Hannu , Kröger Heikki 
Published: December 2021

Study objective. To investigate the degree and determinants of osteopenia in juvenile chronic polyarthritis.
Design. Retrospective case-control study of central bone mineral density.
Setting. Rheumatism Foundation Hospital and Kuopio University Hospital, Finland.
Subjects. A sample of 43 girls aged 7 to 19 with juvenile chronic polyarthritis treated with systemic glucocorticoids and a control sample of 44 healthy girls matched for age.
Main outcome measures. Bone mineral density and bone size (width) measured by dual-energy x-ray absorptiometry and bone volumetric density calculated as an approximation of true bone density at both the lumbar spine and femoral neck.
Results. The girls with juvenile chronic arthritis had reduced bone mineral density, bone size, and bone volumetric density at both the lumbar spine and femoral neck (statistically significant findings, P = .022 for the bone size of the femoral neck and P &lt; .001 for the other parameters). At the spine, the mean bone mineral density was 80%, the mean bone size 89%, and the mean bone volumetric density 89% of the values in the control group. At the femoral neck, the values were 78%, 93%, and 83%, respectively. The groups were matched for age, but the girls with arthritis were smaller and lighter. In the juvenile arthritis group, the femoral bone mineral density and bone volumetric density and the spinal bone width correlated negatively with the mean glucocorticoid dose.
Conclusion. Axial bone mineral density is clearly reduced in severe juvenile polyarthritis and is mediated by both decreased bone volumetric density and diminished growth.
Coagulopathy Screening in Children With Heparinized Central Venous Catheters
Authors: Ellis Robert 
Published: December 2021

Objective. To develop a method of screening for coagulopathy using blood drawn through heparinized central venous catheters.
Methods. Prothrombin time (PT) and activated partial thromboplastin time (APTT) were determined in paired blood samples with and without the addition of protamine, using an automated photo-optical method. A concentration of 4 µg/mL of citrated whole blood was chosen, based on preliminary experiments. This is sufficient to neutralize the expected heparin contamination in samples drawn through heparinized catheters while causing only a slight prolongation in APTT (due to the anticoagulant effect of protamine). Seventeen paired samples were drawn by venipuncture in patients without known coagulopathy. Twenty-five samples were drawn through heparinized central venous catheters. The first 5 mL of blood drawn from a catheter was discarded to avoid gross heparin contamination. Four samples from patients with coagulopathy were also analyzed with and without the addition of 2.5 µg/mL of heparin.
Results. Protamine increased PT by 9.0 ± 0.8% and APTT by 9.0 ± 3.4% (mean ± SD) in the samples drawn by venipuncture. For samples drawn through heparinized catheters, 52% had a prolonged APTT 44% a prolonged PT, and 68% had at least one prolonged test. With the addition of protamine, and after correction for the 9% mean increase in PT and APTT, 4% of samples had a prolonged APTT, 12% had a prolonged PT, and 16% had at least one prolonged test (P = .00006, .014, and .0001). All four samples from patients with coagulopathy were correctly identified as abnormal after the addition of protamine, with or without added heparin.
Conclusions. A protamine-supplemented APTT test on blood drawn through a heparinized catheter may be an adequate screening test for coagulopathy. This procedure reduces discomfort in patients with an indwelling catheter by avoiding venipuncture.
Phenolphthalein-Induced Fixed Drug Eruption: A Cutaneous Complication of Laxative Use in a Child
Authors: ZANOLLI MICHAEL D. , MCALVANY JOANNE , KROWCHUK DANIEL P. 
Published: December 2021

Drug eruptions are a common dermatologic problem faced by pediatricians. Among the most distinctive of these is the fixed drug eruption, a cutaneous inflammatory reaction manifested by solitary or multiple, well-defined, erythematous macules that may become bullous.1,2 Lesions usually occur within a few hours of ingesting the drug, characteristically recur in the same location with each subsequent dose, and leave residual hyperpigmentation. To illustrate the importance and unique features of this unusual reaction, we report the case of a child who experienced a recurrent fixed drug eruption induced by phenolphthalein-containing, nonprescription laxatives.
CASE REPORT
An 8-year-old African-American girl was brought to the Dermatology Clinic for evaluation of pruritic and occasionally swollen "dark spots" that had been present on her face and arms for months.
The Lead Debate Goes On
Authors: BANNER WILLIAM , VUIGNIER BARBARA I. , PAPPAS JANNETTE B. 
Published: December 2021

In Reply.—
I am glad that Dr Marcus has pinched himself and woken up to 1993 hope he will now review some of the literature that he alludes to in his letter.
Although I also believe that the intentions of the CDC in publishing their Guidelines are honorable, they have placed us in an untenable position. Early drafts of the CDC statement1 on "Preventing Lead Poisoning in Young Children" provided some guidance on the issue of screening in low-risk areas.
Surfactant Therapy in Full-term Neonates With Severe Respiratory Failure
Authors: Khammash Hatem , Perlman Max , Wojtulewicz Julian , Dunn Michael 
Published: December 2021

Objective. In light of the paucity of published data on the use of surfactant in full-term infants with respiratory failure due to meconium aspiration syndrome and respiratory distress syndrome, we report our experience with this therapy. Our goal was to explore possible justification for randomized controlled trials of surfactant treatment in similar patients at an earlier, less severe stage of the disease.
Methods. Retrospective consecutive case series of 20 infants with severe meconium aspiration syndrome and 29 infants with severe respiratory distress syndrome who received bovine surfactant between March 1990 and December 1992 in three neonatal intensive care units in a regionalized setting. Outcome of treatment was assessed by comparing changes in several respiratory indices including the oxygenation index, between 4 and 6 hours and 1 and 3 hours before and after the first dose of surfactant. Differences were analyzed using analysis of variance for repeated measures, with treatment and time as co-variates.
Results. In the meconium aspiration group the mean oxygenation index decreased from 36 ± 12 at 1 to 3 hours presurfactant to 24 ± 14 at 1 to 3 hours postsurfactant (P &lt; .001). In the patients with respiratory distress syndrome the mean oxygenation index fell from 30 ± 17 at 1 to 3 hours presurfactant to 12 ± 6 at 1 to 3 hours postsurfactant (P = .0001). Three of 20 patients with meconium aspiration syndrome and 3 of 29 patients with respiratory distress syndrome received extracorporeal membrane oxygenation.
Conclusions. Surfactant therapy in full-term infants with respiratory failure due to the meconium aspiration and respiratory distress syndromes is often effective in improving gas exchange. A randomized controlled trial of surfactant therapy at an earlier stage in the course of the illness should be performed.
Prevalence of Undetected Tinea Capitis in Household Members of Children with Disease
Authors: VARGO KAREN , COHEN BERNARD A. 
Published: December 2021

The epidemiology of tinea capitis has changed over the past 40 years. The major organism responsible for tinea capitis today is Trichophyton tonsurans. This dermatophyte accounts for more than 90% of ringworm infections of the scalp in the United States and replaces Microsporum audouinii and to a lesser extent Microsporum canis, which were associated with the ringworm epidemics of the 1940s.1-4
Trichophyton tonsurans is an anthropophilic organism producing endothrix invasion of the hair shaft that does not fluoresce on Wood's light examination.5 Tinea capitis is epidemic in black school-age children, but only rarely in whites. The reason for this racial predilection is not known.1
Hepatitis B Immunization
Authors: FARBER JON MATTHEW 
Published: December 2021

To the Editor.—
As a practicing pediatrician, I have two major reservations with the current recommendations of the Committee on Infectious Diseases for universal Hepatitis B Virus (HBV) immunization. The first reservation is practical; the second is theoretical.
The Committee realized that administering three injections of different vaccines at the same time is something most parents and pediatricians would wish to avoid, and also that requiring an extra office visit for HBV vaccination was not attractive.
Movies, Guns, and Kids
Authors: BOEN JAMES R. , SAMPSON DEBORAH L. 
Published: December 2021

To the Editor.—
Professionals in pediatric medicine can be effective in preventing firearm injuries to children. In addition to influencing gun control legislation, pediatricians can promote gun safety awareness through counseling and education, and we believe that a pediatrician counseling adolescents or parents of younger children regarding handgun policy will be more persuasive by being more authoritative.
It has been suggested that pediatricians counseling patients about home safety issues include education about the risks of keeping guns in the home.1
Clinical Trials and P Values
Authors: LANTOS JOHN D. 
Published: December 2021

In Reply.—
Here is the question: Are randomized trials so superior to other knowledge-generating techniques that we should not consider a fact to have been established unless it has been established by such a trial? If so, then the use of clinical interventions which have not been studied using randomized trials is wrong. if not, then we need to determine how such trials should be combined with other techniques, and how results of different techniques should be interpreted to lead to the best possible patient care, the incorporation of new therapeutic interventions into practice, and the timely discarding of techniques which are no longer sufficiently efficacious.
Appointment-Keeping Behavior in Adolescents: Factors Associated With Follow-up Appointment-Keeping
Authors: Irwin Charles E. , Millstein Susan G. , Ellen Jonathan M. 
Published: December 2021

Study objectives. To identify the sociodemographic and Health Belief Model predictors of follow-up appointment-keeping behavior.
Design. Prospective observational study.
Settings. General adolescent medical clinic.
Patients and measurements. Sequential sample of 166 adolescents (aged 12 to 20 years, mean = 15.9 years) enrolled in the clinic. The population was 75% female; the racial-ethnic distribution of the sample was 37.9% black, 29.8% white, 11.2% Asian, 14.3% Hispanic, and 6.8% "other" background. Subjects' social class was primarily lower-middle (60.5%) and middle class (28.6%). A subsample was randomly assigned to be interviewed about their beliefs concerning their follow-up appointment and the constructs of the Health Belief Model.
Results. Forty-eight percent of the total sample failed to keep their follow-up appointment. There was a significant positive correlation between social class and appointment keeping (F = 5.07; df = 5,110; P = .026). Neither race-ethnicity nor who made the appointment were found to be associated with follow-up appointment-keeping. The only construct of the Health Belief Model found to be significantly associated with appointment keeping was the number of potential negative outcomes resulting from noncompliance perceived by the subject (F = 6.85; df 1,74; P = .011).
Conclusions. Clinicians must work with adolescents to improve their understanding of the potential negative outcomes associated with noncompliance to improve appointment-keeping behavior.
Infant Mortality Statistics Do Not Adequately Reflect the Impact of Short Gestation
Authors: Carver Jane D. , Tan Lukas H. , MCDermott Robert J. , Jacobson Howard N. , Sherin Kevin M. , Kanarek Keith , Pimentel Bernardo 
Published: December 2021

Objective. To determine the accuracy of National Center for Health Statistics cause-specific infant mortality data. The National Center for Health Statistics compiles these data by applying World Health Organization (WHO) selection rules to death certificate data. The WHO rules arrange medical entities into a hierarchical order and select a single underlying cause of death (ULCD).
Design. A comparison was made between ULCD assigned to a cohort of 335 infant death certificates by (1) a neonatologist panel, and (2) application of WHO selection rules by the Florida State Office of Vital Statistics (OVS).
Results. Among the 146 infants with birth weights 1500 to 4649 g, agreement between neonatologists and OVS was 88%, while among the 189 infants with birth weights 0 to 1499 g (very low birth weight), agreement was just 41%. Neonatologists selected short gestation as the underlying cause of death for 82% of very low birth weight infant records, vs 25% by OVS. Due to the application of specific WHO selection rules, OVS frequently selected immediate causes of death, such as "cardiac arrest," as the ULCD, even when the medical certifier had indicated short gestation as the ULCD. In vital statistics reports, many of these immediate causes are reported as "other respiratory conditions of newborn," or "all other perinatal conditions."
Conclusion. WHO ULCD selection rules should be modified to allow short gestation to have a higher priority over immediate causes of infant death.
Atopic Dermatitis: Role of Food and House Dust Mite Allergens
Authors: Casimir G. J. A. , Duchateau J. , Gossart B. , Cuvelier Ph. , Vandaele F. , Vis H. L. 
Published: December 2021

Objective. The aim of this study was to evaluate the humoral immune response to cow milk (CM) protein, soya protein, and house dust mites in a group of 64 CM-fed infants, who had atopic dermatitis as the sole atopic manifestation, by measuring not only IgE but also specific IgG antibodies (Ab) against bovine β-lactoglobulin, soya flour aqueous extracts, and Der P1 antigens.
Methods. A CM-free diet (Nan HA, Nestle) was given to these 64 CM-fed infants and the sensitivity to CM proteins was established by a positive challenge test with the offending food in improved infants. The serum was obtained just before the start of the CM-free diet, at the first consultation. The patients were classified into two groups according to their clinical response to the hypoallergenic formula.
Results. Thirty-one infants (group 1) improved dramatically (positive challenge test), and 33 (group 2) did not improve with the exclusion diet but did improve after eviction of dust-producing items in the environment. The two groups were different in terms of their total IgE immunoglobulin concentration (higher in group 1, P &lt; .05) and concentration of specific IgE Ab against CM protein (more frequent in group 1, P &lt; .01). The IgG Ab concentrations against β-lactoglobulin, the major CM antigen (P &lt; 10-4), and against soya protein (P &lt; .01) were significantly more elevated in the group improved by the diet, with a threshold above which the response to the exclusion diet could be predicted as positive. On the contrary, the level of specific IgG Ab against house dust mites was four times higher in group 2 than in group 1. Twenty-nine of the 33 infants of group 2 improved after eviction of dust-producing items in the environment.
Conclusions. It is proposed that specific IgG Ab concentrations against β-lactoglobulin, soya protein, and Der P1 antigen be determined in infants and children suffering from atopic dermatitis as a means of predicting the response to an exclusion diet, and a possible role of house dust mites in the pathogenicity of the disease is suggested.
Drowning in Infants, Children, and Adolescents
Authors:   Committee on Injury and Poison Prevention
Published: December 2021

Drowning and near-drowning are major causes of childhood mortality and morbidity from injury. From 1980 to 1985, drowning was the second leading cause of injury death of infants and children younger than 15 years of age in the United States.1 In 18 of the 50 states, drowning was the number one cause of unintentional injury death of children 1 to 4 years of age.1 Children less than 5 years of age and young people aged 15 to 24 years have the highest drowning rates.2 Drowning, by definition, is fatal; near-drowning is sometimes fatal. Drowning has been defined as a death resulting from suffocation within 24 hours of submersion in water; victims of near-drowning survive for at least 24 hours.3 For every child who drowns, four children are hospitalized for near-drowning.4 One third of those who are comatose on admission but survive suffer significant neurologic impairment.4 The annual lifetime cost attributable to drowning and near-drowning in children less than 15 years of age is $384 million.3 The annual cost of care per year in a chronic care facifity for an impaired survivor of a near-drowning event is approximately $100 000.4
There is no national surveillance system that defines the circumstances surrounding a drowning event well enough to enable the development of effective preventive strategies for children. A need exists to establish uniform state or local surveillance systems that consider developmental age groupings and geographic location and that account for environmental and behavioral factors that place children at risk. To design preventive strategies aimed at specific risk factors, such surveillance systems must define in sufficient detail the circumstances under which the drowning event occurred, preventive measures used, rescue efforts made, and the outcomes.