bluuebunny/crossref_metadata_2025_split huggingface dataset:
Freshwater Submersion Injuries in Children: A Retrospective Review of Seventy-Five Hospitalized Patients
Authors: Noonan Lindsay , Howrey Rick , Ginsburg Charles M. 
Published: December 2021

Objective. To determine whether or not selected victims of submersion accidents can be safely managed as outpatients.
Design. Retrospective chart review.
Setting. Children's Medical Center of Dallas.
Patients. One hundred forty-eight charts reviewed, comprising all hospital admissions after submersion accidents from April 1987 to April 1994.
Results. Of the 148 patient charts that were reviewed, 73 patients were excluded from the study for the following criteria: endotracheal intubation before initial medical evaluation; transfer form an inpatient unit of another medical facility; history of preexisting neurologic, neurodevelopmental, and/or pulmonary disease. Of the 75 evaluable patients, 3 were directly admitted to the inpatient service with no documented initial medical evaluation reported in the medical record. Of the remaining 72 patients, 62 (86%) were symptomatic at the time of the initial medical evaluation in the emergency department; 10 patients (14%) were asymptomatic. Seventy percent of the initially asymptomatic patients and 57% of patients who were symptomatic at the time of initial medical evaluation were asymptomatic by 8 hours after the submersion event. By 18 hours postsubmersion, all patients who were initially asymptomatic and 72% of initially symptomatic patients were normal. Thirty-five percent and 80% of patients who had abnormal initial physical examinations and abnormal chest x-rays had a normal physical examination by 8 hours and 18 hours, respectively, and all remained normal.
Conclusions. Routine hospital admission of all children who have had immersion accidents is unnecessary.
Pain and Human Immunodeficiency Virus Infection in Children
Authors: Yaster Myron , Schechter Neil 
Published: December 2021

There are remarkably few studies of the clinical presentation of pain syndromes and pain management in children infected with the human immunodeficiency virus (HIV). In a report that should serve as a clarion wake-up call to all physicians who treat HIV-infected children, Hirschfeld et al1 report in this issue of Pediatrics that the prevalence of pain in HIV-infected children approaches 60%.
As physicians, we have a fundamental obligation to manage pain and relieve patient suffering as a crucial element of our professional commitment to patient care.2,3 These are not merely lofty ideals; effective pain management produces myriad patient benefits, including reduced morbidity and mortality, early mobilization, and shortened hospital stays.4
Neonatal Group B Streptococcal Vertebral Osteomyelitis
Authors: Barton Leslie L. , Villar Rodrigo G. , Rice Sydney A. 
Published: December 2021

Neonatal osteomyelitis is an uncommon entity with major involvement of lower- and upper-extremity long bones. Vertebral osteomyelitis represents only 1% to 2% of such cases1,2 and may pose a diagnostic conundrum, with disastrous consequences if diagnosis and therapy are delayed. We report a neonate with the unique association of vertebral osteomyelitis and group B streptococcal infection. The dual medical and surgical approach to this disease, necessary for successful outcome, is described.
CASE REPORT
A 1-month-old boy was admitted to the hospital for evaluation of a posterior thoracic mass. He was born to a 25-year-old gravida 2, para 2 woman after a full-term pregnancy.
Dear Colleague
Authors: Sahler O. J. , Couto Jim 
Published: December 2021

The American Academy of Pediatrics Department of Education and the Division of Sections are pleased to present this supplement to PEDIATRICS. This is the first supplement devoted entirely to abstracts of presentations given at the Academy's Annual Meeting. It contains a vast array of subspecialty information in a structured abstract format, which will be indexed in the journal and be retrievable through all of the document delivery systems which feature PEDIATRICS. It will also be available on the yearly CD ROM update of PEDIATRICS. In addition this publication will serve as a guide and timetable for the Academy's Section programs which will be offered at the AAP 1996 Annual Meeting to be held October 25-30 in Boston. Please remember to bring this, your complimentary copy, to the meeting! A limited number of additional copies for your personal use or distribution to colleagues will be available at the meeting.
Sections are arranged alphabetically. A Section's educational schedule appears first, followed by the complete text of the abstracts. Abstracts are identified by a number that appears in the left column of the schedule; this same number will identify the expanded text. Abstracts are numbered consecutively within each Section. Please note that the Section on Allergy, Section on Emergency Medicine, and Section on Surgery have elected to print their schedule only.
A great deal of time and effort has been volunteered by Academy Section members to develop these programs and to write and coordinate the abstracts for this special supplement.
In particular, we would like to acknowledge the contributions of Kathleen Ozmeral (editor); Michael Welch, MD (Allergy); Derek Fyfe, MD (Cardiology); Mitch Feldman, MD (Computers and Other Technologies); Brahm Goldstein, MD (Critical Care); Milton Tenenbein, MD, and Jennifer Pratt Cheney, MD (Emergency Medicine), David Aronsson, MD, and Randall Loder, MD (Orthopaedics); William Engle, MD, and Tom Wiswell, MD (Perinatal Pediatrics); N.
Nicotine Patch Therapy in Adolescent Smokers
Authors: Smith Todd A. , House Roy F. , Croghan Ivana T. , Gauvin Thomas R. , Colligan Robert C. , Offord Kenneth P. , Gomez-Dahl Leigh C. , Hurt Richard D. 
Published: December 2021

Objective. To evaluate the safety, tolerance, and efficacy of 24-hour nicotine patch therapy in adolescent smokers who were trying to stop smoking.
Design. Nonrandomized, open-label, 6-month clinical trial.
Setting. Five public high schools in the Rochester, MN, area.
Subjects. Twenty-two adolescent smokers, aged 13 through 17 years, with current smoking rate of 20 or more cigarettes per day (cpd).
Intervention. Daily nicotine patch therapy for 8 weeks (22 mg/d for 6 weeks followed by 11 mg/d for 2 weeks). Weekly individual behavioral counseling and group support continued for 8 weeks with follow up visits at 3 and 6 months and a mailed survey at 1 year.
Main Outcome Measures. Self-reported smoking abstinence verified by expired air carbon monoxide of 8 ppm or less, nicotine withdrawal symptoms, adverse experiences, and blood cotinine levels.
Results. Subjects had a mean ± SD smoking rate of 23.3 ± 5.0 (range, 20 to 35) cpd at study entry and 2.6 ± 1.6 years of smoking; the mean age was 15.9 ± 1.2 (range 13 through 17) years, and 68% were girls. Of the 22 participants, 19 (86%) completed patch therapy, 3 (14%) had biochemically validated smoking cessation at week 8, and 1 continued to be smoke free at 3 and 6 months after patch initiation. There was a significant decrease from baseline in the mean nicotine withdrawal scores for days 4 and 7 of week 1 and the mean for weeks 2 through 8. Skin reactions were the most common adverse event. As the worst skin reactions, 55% had erythema only, 5% had erythema and edema, and 9% had erythema and vesicles, whereas 32% had no skin reactions. Other reported adverse events were headaches (41%), nausea and vomiting (41%), tiredness (41%), dizziness (27%), and arm pain (23%). None of these were considered serious, life threatening, or led to the discontinuation of patch therapy. In adults with comparable smoking rates, we found that the adolescents had lower blood cotinine levels. Those smoking 20 to 25 cpd had cotinine levels of 146 ± 84 (adolescents) vs 260 ± 98 (adults) ng/ml, and those smoking 26 to 35 cpd had levels of 169 ± 73 vs 276 ± 110 ng/ml, respectively.
Conclusion. Nicotine patch therapy seems safe in adolescent smokers. Placebo-controlled trials are needed to establish the efficacy of nicotine patch therapy in adolescents.
Iodine, Thyroid Function, and Very Low Birth Weight Infants
Authors: Parravicini Elvira , Fontana Corinna , Paterlini Giuseppe L. , Tagliabue Paolo , Rovelli Franco , Leung Kenneth , Stark Raymond I. 
Published: December 2021

Objective. Research was undertaken to test two hypotheses. First, during the early neonatal period, thyroid function of very low birth weight (VLBW) infants is suppressed by exposure to iodine-containing antiseptic solutions and/or iodized contrast media. Second, this suppression is more pronounced in small for gestational age (SGA) infants.
Methods. Urinary iodine concentration and thyroid function measurements were obtained prospectively from 44 VLBW infants with gestational ages at birth of 30 ± 2.3 weeks and weights of 1223 ± 231 g. Eleven of these infants were SGA. The infants were grouped according to iodine exposure: 18 infants had no increased exposure and served as control infants; 9 infants were exposed to an iodine-containing antiseptic (povidone iodine); 12 infants were exposed to an iodized contrast medium (iopamidol); and 5 infants were exposed to both agents. Urinary iodine and serum free triiodothyronine, free thyroxine, and thyrotropin were measured on days 1, 7, 14, 21, and 28 of life.
Results. During the period of maximum exposure (days 1 to 7), the concentration of iodine in the urine of study infants was 2 to 4 orders of magnitude greater than that in the urine of control infants (123 ± 141 µg/L). During the subsequent 3 weeks, levels of urinary iodine in study infants returned to levels that were not significantly different from controls. On day 7 of life, iodine-exposed infants had a significantly higher mean thyrotropin level than control infants, whereas on day 28, free triiodothyronine and thyroxine levels were lower. Of the 26 iodine-exposed infants, 6 had transient hyperthyrotropinemia and 2 had transient hypothyroidism. When exposed to iodine, SGA infants had more labile thyroid function than normally grown iodine-exposed or control infants. These SGA infants had significantly lower levels of thyroid hormones in umbilical cord blood, increased production of thyroid hormones on day 14 of life, and lower levels again at 1 month.
Conclusion. In VLBW infants, the use of iodine-containing antiseptic solutions and iodized contrast media results in massive uptake of iodine that is associated with alterations in thyroid function. It is reasonable to suggest that, whenever possible, iodized products should be avoided in VLBW infants, because their routine use results in exposure to excessive loads of iodine, which can be associated with hyperthyrotropinemia and hypothyroidism.
Methylphenidate Dosing: Twice Daily Versus Three Times Daily
Authors: Stein Mark A. , Blondis Thomas A. , Schnitzler Eugene R. , O'Brien Tara , Fishkin Julie , Blackwell Brad , Szumowski Emily , Roizen Nancy J. 
Published: December 2021

Objective. To evaluate the short-term efficacy and side effects associated with two methylphenidate hydrochloride (MPH) dosing patterns.
Methods. Twenty-five boys with attention deficit hyperactivity disorder (ADHD) participated in a 5-week, triple-blind, placebo-controlled, crossover evaluation of MPH administered twice (b.i.d.) versus thrice (t.i.d.) per day (mean dose 8.8 ± 5 mg, .30 ± .1 mg/kg/dose). Four dosing conditions (placebo, titration [gradual increase to target dose], b.i.d., and t.i.d.) were used. Dependent measures obtained on a weekly basis included: parent and teacher ratings of child behavior, parent-child conflicts, parent report of stimulant side effects, child self-report of mood symptoms, a sleep log, laboratory measures of attention, and actigraphic recording of sleep activity.
Results. All dosing conditions resulted in significant effects on ADHD symptoms when compared with baseline. Relative to placebo, t.i.d. dosing was characterized by improvement on the greatest number of behavioral measures, and both b.i.d. and t.i.d. were generally more effective than titration. Direct comparisons of b.i.d. and t.i.d. dosing revealed that t.i.d. was associated with greater improvement on the Conners Parent Rating Scale Impulsivity/Hyperactivity factor, with a similar marginally significant effect for the ADD-H Teacher Rating Scale Hyperactivity factor. The analysis of clinically significant change favored a three-times-a-day dosing schedule over placebo on both parent and teacher ratings of impulsivity/hyperactivity and attention. Compared with placebo, appetite suppression was rated, on average, as more severe in the t.i.d. and titration conditions, but not in the b.i.d condition. However, the number of subjects who exhibited any or severe appetite suppression did not differ significantly between the b.i.d. and t.i.d. schedules. Although there was no difference in sleep duration for children on b.i.d. and t.i.d. schedules, total sleep time appeared to decrease slightly on t.i.d. relative to placebo according to both parent ratings and actigraphic assessment. There were no significant differences between b.i.d. and t.i.d. on any other side effects or sleep variables.
Conclusions. For many children with ADHD, t.i.d. dosing may be optimal. There are few differences in acute side effects between b.i.d and t.i.d. MPH dosing. The dosing schedule should be selected according to the severity and time course of ADHD symptoms rather than in anticipation of dosing schedule-related side effects.
What Clinicians Want to Know About Teaching Families New Disciplinary Tools
Authors: Wissow Lawrence S. 
Published: December 2021

NOT ALL FAMILIES HAVE THE SAME EDUCATIONAL NEEDS
Dr Howard's paper points out that punishment (one way of decreasing undesired behaviors) is only part of a larger system for helping children develop adaptive interpersonal skills and culturally acceptable patterns of conduct. Parents also rely on promoting a close relationship with their child, reinforcing positive behaviors, and helping children learn a set of basic behavioral rules that are adaptable to changing situations. One of the things that we don't know about families using corporal punishment is the extent to which they lack skills in all of these areas or whether, at the risk of gross oversimplification, we would suggest that they change nothing except to replace one form of punishment (spanking) for another. In some families, corporal punishment occurs in the context of poor parent-child relationships and other forms of emotionally harsh punishment, and in other families it does not.1,2
WHAT ROLE DO PRIMARY CARE PROVIDERS HAVE IN PARENTING EDUCATION?
Dr Howard shows that a variety of behavioral interventions are available, that they have demonstrable effects, and that they work for a variety of populations. Most of the studies she described, however, would have to be classified as efficacy studies. We now know these interventions work in the hands of clinical psychologists in laboratory conditions with selected patients. What do we know about how to build these into routine pediatric practice, especially those that require several training sessions and specialized training materials?3 Research in adult mental health services suggests one direction to pursue—the development of novel collaborative arrangements between behavioral specialists and primary care providers.
The Ribavirin Debate
Authors: Granger Colin D. 
Published: December 2021

The Committee on Infectious Diseases of the American Academy of Pediatrics, in its recent reassessment of the use of ribavirin (Virazole) in the treatment of respiratory syncytial virus (RSV) infections, raises questions regarding the evidence supporting the drug's clinical effectiveness.1
The clinical utility of ribavirin was well-documented and endorsed in the Committee's 1993 recommendations.2 In the current statement, however, the Committee has emphasized that individual practitioners are in the best position to determine the appropriate use of ribavirin, based on the particular clinical situation and their own preference.
Measles Vaccination During the Respiratory Virus Season and Risk of Vaccine Failure
Authors: Edmonson M. Bruce , Davis Jeffrey P. , Hopfensperger Daniel J. , Berg Jeffrey L. , Payton Leonard A. 
Published: December 2021

Objective. To determine whether measles vaccine failure is more common in persons who were vaccinated during the respiratory virus season, when they were more likely to have had concurrent minor illnesses.
Design. Population-based case series and case-control study.
Setting. Wisconsin and Ohio.
Subjects. The case series included all 545 of the states' residents who had confirmed measles reported during 1985 through 1990 and a history of receiving a single dose of measles vaccine during 1975 through 1988 at 15 to 59 months of age. In a case-control study restricted to 1984 through 1988 vaccinees, season of vaccination was compared in 170 case children and 6070 control students.
Main Outcome Measure. Risk of clinical vaccine failure after measles vaccination during the respiratory virus season (September through May) or the peak season (November through March) compared with summertime (June through August), after adjustment for age at vaccination and place of residence.
Results. In the case series of persons with vaccine failure, the proportion who had been vaccinated during the respiratory virus season (74.7%) was no greater than expected (September through May = 74.8% of the year). In the case-control study, vaccination during the respiratory virus season (odds ratio, 0.92; 95% confidence interval, 0.66 to 1.30) or the peak season (odds ratio, 0.93) did not increase the risk of vaccine failure.
Conclusion. Despite the high and strongly seasonal prevalence of viral respiratory illness in young children, routine childhood measles vaccination during the respiratory virus season does not increase their risk of vaccine failure. Findings provide epidemiologic support for recently strengthened recommendations that measles vaccination not be deferred in children with minor respiratory illnesses.
Multiple Organ Failure After Ingestion of Pennyroyal Oil From Herbal Tea in Two Infants
Authors: Bakerink James A. , Gospe Sidney M. , Dimand Robert J. , Eldridge Marlowe W. 
Published: December 2021

Background Hepatic and neurologic injury developed in two infants after ingestion of mint tea. Examination of the mint plants, from which the teas were brewed, indicated that they contained the toxic agent pennyroyal oil.
Methods. Sera from each infant were analyzed for the toxic constituents of pennyroyal oil, including pulegone and its metabolite menthofuran.
Results. Fulminant liver failure with cerebral edema and necrosis developed in the first infant, who died. This infant was positive only for menthofuran (10 ng/mL). In the other infant, who was positive for both pulegone (25 ng/mL) and menthofuran (41 ng/mL), hepatic dysfunction and a severe epileptic encephalopathy developed.
Conclusions. Pennyroyal oil is a highly toxic agent that may cause both hepatic and neurologic injury if ingested. A potential source of pennyroyal oil is certain mint teas mistakenly used as home remedies to treat minor ailments and colic in infants. Physicians should consider pennyroyal oil poisoning as a possible cause of hepatic and neurologic injury in infants, particularly if the infants may have been given home-brewed mint teas.
Policy Update: Medical Staff Appointment and Delineation of Pediatric Privileges in Hospitals
Authors:   Committee on Hospital Care
Published: December 2021

The review and verification of credentials and the granting of clinical privileges are required of every hospital to ensure that all members of its medical staff are competent and fully qualified to provide specified levels of patient care. The credentialing process involves: (1) a detailed assessment of the professional and personal backgrounds of each practitioner seeking privileges; (2) the assignment of privileges appropriate for the clinician's training and experience; (3) ongoing monitoring of the professional activities of each staff member through the hospital's quality assessment and performance programs; and (4) the penodic reappointment of the medical staff based on performance objectively measured by published standards.
Credentialing must be thorough, fair, timely, confidential, and clearly described in the medical staff bylaws. Criteria used for delineation of clinical pnivileges must be well defined, based on realistic national and local standards, regularly updated to reflect advances in medicine, and uniformly used for all applicants. The process should include reviews by peers and at least three of the following individuals or groups: department chairperson, department credentialing committee, hospital medical staff credentialing committee, medical staff executive committee, medical director, and the governing board of the hospital.
The statement examines, in depth, the essential elements of a credentials review for both initial and subsequent medical staff appointments along with suggested criteria for the delineation of clinical privileges in pediatrics. For ease of reference, credentialing checkoff lists and a sample form for the delineation of privileges are included. Because of the significant differences in individual hospitals (ie, size, services offered, location, population served, and organization of the medical staff) no one method of credentialing is universally applicable.