bluuebunny/crossref_metadata_2025_split huggingface dataset:
Low-Dose Indomethacin and Prevention of Intraventricular Hemorrhage: A Multicenter Randomized Trial
Authors: Ment Laura R. , Ehrenkranz Richard A. , Duncan Charles C. , Scott David T. , Taylor Kenneth J.W. , Katz Karol H. , Schneider Karen C. , Makuch Robert W. , Oh William , Vohr Betty , Philip Alistair G.S. , Allan Walter 
Published: December 2021

Objectives. Parenchymal involvement of intraventricular hemorrhage (IVH) is a major risk factor for neurodevelopmental handicap in very low birth weight neonates. Previous trials have suggested that indomethacin would lower the incidence and severity of IVH in very low birth weight neonates.
Methods. We enrolled 431 neonates of 600- to 1250-g birth weight with no evidence for IVH at 6 to 11 hours of age in a prospective, randomized, placebo-controlled trial to test the hypothesis that low-dose indomethacin (0.1 mg/kg intravenously at 6 to 12 postnatal hours and every 24 hours for two more doses) would lower the incidence and severity of IVH. Serial cranial ultrasound examinations and echocardiographs were performed.
Results. There were no differences in the birth weight, gestational age, sex, Apgar scores, and percent of neonates treated with surfactant between the indomethacin and placebo groups. Within the first 5 days, 25 (12%) indomethacin-treated and 40 (18%) placebo-treated neonates developed IVH (P = .03, trend test). Only one indomethacin-treated patient experienced grade 4 IVH compared with 10 placebo-treated neonates (P = .01). Sixteen indomethacin-treated neonates and 29 control neonates died (P = .08); there was a difference favoring indomethacin with respect to survival time (P = .06).
Eighty-six percent of all neonates had a patent ductus arteriosus on the first postnatal day; indomethacin was associated with significant ductal closure by the fifth day of life (P &lt; .001). There were no differences in adverse events attributed to indomethacin between the two treatment groups.
Conclusions. Low-dose prophylactic indomethacin significantly lowers the incidence and severity of IVH, particularly the severe form (grade 4 IVH). In addition,indomethacin closes the patent ductus arteriosus and is not associated with significant adverse drug events in very low birth weight neonates.
Assessing the Health Status of Children Entering Foster Care
Authors: Chernoff Robin , Combs-Orme Terri , Risley-Curtiss Christina , Heisler Alice 
Published: December 2021

Objective. Most research on health problems of children in foster care has been cross-sectional, resulting in overselection of children who have been in care long-term and underrepresentation of children who are in care for a short time.
Methodology. This paper reports on the health of a large cohort of children who had complete health examinations at the time of entry into foster care in a middle-size city during a 2-year period.
Results. Results indicate that &gt;90% of the children had an abnormality in atleast one body system, 25% failed the vision screen, and 15% failed the hearing screen. The children were also lighter and shorter than the norm. Mental health screening revealed that 75% had a family history of mental illness or drug or alcohol abuse. Of children older than 3 years of age, 15% admitted to or were suspect for suicidal ideation and 7% for homicidal ideation. Of the children younger than 5 years of age, 23% had abnormal or suspect results on developmental screening examinations. At the time of entry into foster care, 12% of the children required an antibiotic. More than half needed urgent or nonurgent referrals for medical services and, for children &gt;3 years of age, more than half needed urgent or nonurgent referrals for dental and mental health services. Just 12% of the children required only routine follow-up care.
Conclusions. The high prevalence and broad range of health needs of children at the time they enter foster care necessitate the design and implementation of better models of health care delivery for children in foster care.
Comparison of a Three-Component Acellular Pertussis Vaccine With a Whole-Cell Pertussis Vaccine in 15- Through 20-Month-Old Infants
Authors: Bernstein Henry H. , Rothstein Edward P. ,   Pennridge Pediatric Associates, Long Sarah S. , Reisinger Keith S. , Blatter Mark M. , Arbeter Allan M. , Fontana Mary E. , Jacobs Jeanine M. , Rathfon Hal , Crayne Olivia , Krause David S. 
Published: December 2021

Objective. To compare the immunogenicity and reactogenicity of a diphtheria and tetanus toxoids and three-component acellular pertussis vaccine (DTaP) with a diphtheria and tetanus toxoids and whole-cell pertussis vaccine (DTwP) when administered as a booster dose to infants 15 through 20 months of age.
Design. Randomized, double-blind, comparative study.
Setting. Three pediatric practices (two private; one hospital-based).
Participants. One hundred and sixty-five healthy 15-through 20-month old infants.
Selection procedures and interventions. Infants were randomly assigned in a 2:1 ratio to receive vaccine from a single lot of DTaP or from commercially available DTwP. DTaP contained 25 µg of pertussis toxoid, 25 µg of filamentous hemagglutinin, 8 µg of pertactin (69-kilodalton outer membrane protein), 25 flocculating units of diphtheria toxoid, and 10 flocculating units of tetanus toxoid per 0.5-mL dose. DTwP contained one half the concentrations of diphtheria and tetanus toxoids compared with DTaP and a pertussis component with a potency of 4 U/0.5-mL dose. Serum samples were obtained on the day of immunization and 4 weeks later. Adverse reactions were recorded by parents for 7 days after immunization. An interval history was obtained 4 weeks after immunization.
Measurements and results. IgG antibody to pertussis toxoid, filamentous hemagglutinin, pertactin, diphtheria toxoid, and tetanus toxoid was measured by an indirect enzyme-linked immunosorbent assay (ELISA) method. One month after immunization, the geometric mean antibody levels after DTaP compared with DTwP were: pertussis toxoid, 70.6 vs 28 ELISA U/mL (P = .003); filamentous hemagglutinin, 183.4 vs 43 ELISA U/mL (P &lt; .001); pertactin, 216 vs 49.9 ELISA U/mL (P &lt; .001); diphtheria, 14.1 vs 14.9 IU/mL (P = .74); and tetanus, 11.9 vs 14.8 IU/mL (P = .089). After immunization with DTaP, most local and systemic adverse experiences were significantly fewer compared with DTwP (P &lt; .05).
Conclusions. This three-component DTaP vaccine demonstrates significantly greater immune responses to pertussis toxoid, filamentous hemagglutinin, and pertactin, equivalent immune responses to diphtheria and tetanus toxoids, and significantly less reactogenicity compared with a licensed DTwP.
Physical Activity, Fitness, and Health in Children: A Close Look
Authors: Rowland Thomas W. , Freedson Patty S. 
Published: December 2021

The available research information suggests, then, that the best primary strategy for improving the longterm health of children and adolescents through exercise may be creating a lifestyle pattern of regular physical activity that will carry over to the adult years rather than promoting childhood physical fitness.26 This implies that it is of primary importance to discover behavioral approaches that will be effective in increasing activity levels of children. It is an approach that raises critical questions in future research efforts: What are the factors that make exercise enjoyable for children? What settings (family, school physical education, physicians, community programs) are most effective in "turning children on" to physical activity? How can interest in exercise be sustained as children grow into adulthood? Furthermore, this conclusion bears implications for the design of physical education curricula, the role of families in the early molding of exercise habits, and the important function of physicians in identifying sedentary patients and introducing them to the fun of physical activity.
This viewpoint does not assume the importance for children of a critical threshold of activity or fitness. Instead, it emphasizes the significance of establishing a physically active lifestyle during the pediatric years; this is best achieved by exposing children to the enjoyment of physical exercise early. This strategy is based on the concept that health outcomes may relate more to the persistence of exercise throughout life rather than its quantity during the pediatric years.
A Unique Complication of Nonsteroidal Anti-inflammatory Drug Use
Authors: Wattad Ahmad , Feehan Tammy , Shepard Frank M. , Youngberg George 
Published: December 2021

We read with great interest the two case reports by McIntire et al 1 on "Acute Flank Pain and Reversible Renal Dysfunction Associated with Nonsteroidal Anti-Inflammatory Drug Use."
We also treated a 14-year-old healthy girl who had acute severe bilateral flank pain and nonoliguric acute renal failure. The patient's flank pain and vomiting started 4 days before admission. A diagnosis of possible urinary tract infection was made and amoxicillin therapy was instituted. Her past medical history was unremarkable except for an uncomplicated urinary tract infection 6 years earlier.
Letter to the Editor
Authors: Seashore Margretta R. 
Published: December 2021

The American Academy of Pediatrics Committee on Genetics thanks Dr Herbert for his comments, and would like to address his concerns as follows.
Pernicious anemia. There are few data in the literature that address the issue of folic acid and vitamin B12 deficiency. Estimates suggest that the masking of pernicious anemia by folate rarely takes place with an intake of folate &lt; 5 mg per day. On the other hand, there is evidence that a number of individuals with vitamin B12 deficiency have neurological symptoms without any anemia.
Universal Hepatitis B Immunization of Infants: Reactions of Pediatricians and Family Physicians Over Time
Authors: Freed Gary L. , Bordley W. Clayton , Clark Sarah J. , Konrad Thomas R. 
Published: December 2021

Objective. In November 1991 the Advisory Committee on Immunization Practice (ACIP) recommended universal hepatitis B immunization of infants. In February 1992 the American Academy of Pediatrics (AAP) and in August 1992 the American Academy of Family Physicians (AAFP) issued similar recommendations. The purpose of this study was to assess over time the effectiveness and impact of the dissemination efforts of the ACIP, AAP, and AAFP regarding this new recommendation and to determine the factors affecting its adoption.
Design. Cohort survey over time.
Setting. North Carolina.
Participants. All 778 pediatricians and a random sample of 300 family physicians in North Carolina were surveyed by mail 3 months after publication of the ACIP recommendation (January/February 1992), but before the AAP and AAFP recommendations. Response rate was 78%. Of these, 83% responded to a follow-up survey 8 months later (October 1992).
Main outcome measures. Rates of agreement and adoption of the recommendation for universal infant immunization with hepatitis B vaccine; factors affecting agreement and adoption of the recommendation.
Results. In the first survey (3 months after the ACIP recommendation) more pediatricians than family physicians were aware of the new recommendation (82% vs 48%), yet only 37% of pediatricians and 23% of family physicians agreed that immunization of all newborns in their practice was warranted. Eight months later, after the AAP and AAFP recommendation, 66% of pediatricians and 32% of family physicians agreed universal immunization was warranted, but still only 53% of pediatricians and 23% of family physicians had adopted it into practice. Factors associated with these low rates of adoption include physician and practice characteristics, cost, perceived need for the vaccine, and aversion to multiple injections.
Conclusions. Federal, AAP, and AAFP efforts have not been effective thus far in fostering widespread agreement and adoption of this recommendation. If this and future vaccine programs are to succeed, research is needed to determine influences on implementation of new recommendations and to address the economic and noneconomic concerns of physicians and parents.
Effect of Dietary Fat on Cardiovascular Risk Factors in Infancy
Authors: Fuchs George J. , Farris Rosanne P. , DeWier Marianne , Hutchinson Sharon , Strada Russell , Suskind Robert M. 
Published: December 2021

Objective. To determine the effects of feeding regimens of varying fat composition on dietary intake and serum lipid and lipoprotein concentrations in older infants.
Design, setting, and participants. One hundred four healthy infants aged 4 to 6 months were enrolled from private pediatric practices or public health clinics and were randomly assigned to one of four feeding groups until 12 months of age.
Interventions. Infants received whole cow milk or a standard infant formula (48% to 49% of energy as fat from butterfat or a soy-coconut oil blend, respectively) or one of two nearly identical investigational lower fat follow-up formulas (36% kcal from a fat blend of palm olein, corn, and safflower oils) as their primary food source in addition to table foods.
Main outcome measures. Nutrient intakes during the study period were characterized qualitatively and quantitatively. Serum lipids, lipoprotein concentrations, and anthropometrics were determined at baseline and at 12 months of age (study completion).
Results. Total energy intake was equivalent among feeding groups. Infants fed cow milk had higher mean daily intakes of total fat, saturated fat, monounsaturated fat, and cholesterol. Linoleic acid intake by infants fed cow milk, including that from table foods, was insufficient to meet current recommendations. Mean serum total cholesterol was significantly higher in the infants fed cow milk at age 12 months, whereas mean low density lipoprotein and apolipoprotein B were lower in the infants fed the follow-up formulas. Infants consuming the infant formula or whole cow milk demonstrated greater increases in mean serum total cholesterol, low density lipoprotein, and apolipoprotein B by 12 months of age compared with infants ingesting follow-up formula. Ponderal, linear, and head circumference growth was equivalent among feeding groups.
Conclusions. (1) Older infants fed lower fat formula have adequate total energy intake and normal growth. (2) The fat composition of the diets fed to the infants influenced serum lipid and lipoprotein profiles. (3) The fat composition of cow milk is inferior compared with commercial formulas. (4) The optimal fat blend for older infants including the consequences of the standard practice of adding high percentage of coconut oil to infant formulas should be defined further.
The Clinical Usefulness of Breast Milk Sodium in the Assessment of Lactogenesis
Authors: Morton Jane A. 
Published: December 2021

Objective. A study was undertaken to assess the value of breast milk sodium concentration (BM [Na+) during early lactogenesis in predicting nursing outcome.
Methods. Samples of breast milk from 130 nursing mothers were obtained between the 3rd and 8th postpartum day for analysis of BM [Na+]. Approximately half the mothers were referred for nursing problems, although no problems were anticipated in the other primiparous mothers. A BM [Na+] of ≤16 mmol/L was considered normal. For women with normal BM [Na+], follow-up was scheduled at 1 month, whereas those with high [Na+] were evaluated more frequently with repeated [Na+] determinations.
Results. Of the 65 women with normal BM [Na+] (excluding five mothers who had experienced breast surgery), 95.4% were exclusively and successfully breast-feeding at 1 month without intervention. Of 60 women with high BM [Na+], all of whom received intervention, 55% were ultimately successful. In general, those who failed tended to have higher initial [Na+] determinations; additionally, the longer the [Na+] remained elevated, the lower the success rate. Infant weight gain was greater if the initial BM [Na+] was normal. Infants of mothers with normal BM [Na+] gained an average of 994 g above birth weight by 1 month in contrast to the average weight gain of 818 g in infants of mothers with initially elevated [Na+].
Conclusion. This study suggests that a normal drop in [Na+] is highly predictive of successful lactation, although a prolonged elevation of [Na+] signifies impaired lactogenesis with a high risk of failure. The clinical usefulness and limitations of this determination are discussed.
Successful Medical Therapy of Aspergillus Osteomyelitis of the Spine in an 11-Year-Old Boy With Chronic Granulomatous Disease
Authors: Kline Mark W. , Paul Mary E. , Rosenblatt Howard M. , Shearer William T. , Bocobo Florante C. 
Published: December 2021

Aspergillus is one of the most common causes of serious infection and death in individuals with chronic granulomatous disease (CGD).1 Clinically evident infection often begins in the lung with pneumonia; contiguous spread or dissemination of infection may occur. Vertebral osteomyelitis in individuals with CGD usually is caused by Aspergillus.2 Unfortunately, despite aggressive medical and surgical therapy of this condition, reported cases have been associated with treatment failure, recurrence, severe disabling orthopedic or neurologic complications and death.2-5
In this report we describe a unique case in which therapy with intravenous amphotericin B lipid complex (AmBLC), oral itraconazole, and granulocyte transfusions resulted in complete clinical and radiographic resolution of Aspergillus fumigatus osteomyelitis of the spine.
Health Supervision for Children With Down Syndrome
Authors:   Committee on Genetics
Published: December 2021

These guidelines are designed to assist the pediatrician in caring for the child in whom the diagnosis of Down syndrome has been confirmed by karyotype. Although the pediatrician's initial contact with the child is usually during infancy, occasionally the pregnant woman who has been given the prenatal diagnosis of Down syndrome will be referred for advice. Therefore, these guidelines offer advice for this situation as well.
Children with Down syndrome have multiple malformations and mental retardation due to the presence of extra genetic material from chromosome 21. Although the phenotype is variable, usually there is enough consistency to enable the experienced clinician to suspect the diagnosis. Among the more common physical features are hypotonia, small brachycephalic head, epicanthic folds, flat nasal bridge, upward slanting palpebral fissures, Brushfield spots, small mouth, small ears, excess skin at the nape of the neck, single transverse palmar crease, and short fifth finger with clinodactyly. A wide space, often with a deep fissure, between the first and second toes is also common. The degree of mental retardation is variable, ranging from mild (IQ, 50 to 70) to moderate (IQ, 35 to 50), and only occasionally to severe (IQ, 20 to 35). There is an increased risk of congenital heart disease (50%); leukemia (&lt;1%); deafness (75%); serous otitis media (50% to 70%); Hirschsprung disease (&lt;1%); gastrointestinal atresias (12%); eye disease (60%), including cataracts (15%) and severe refractive errors (50%); acquired hip dislocation (6%); and thyroid disease (15%). Social quotient may be improved with early intervention techniques.
How Aggressive Should Delivery Room Cardiopulmonary Resuscitation Be for Extremely Low Birth Weight Neonates?
Authors: Clark Frank I. 
Published: December 2021

The article by Dr Davis1 regarding cardiopulmonary resuscitation for extremely low birth weight neonates provides a useful example of easily collected and thoughtfully analyzed data. I agree that birth weights would be helpful. However, I have a question and two critical observations:
1. The text states "resuscitation was attempted" for 62 infants weighing 501 to 750 g. In Fig 1, under the heading ACTIVE INTERVENTION? this cohort is split into NO, N = 4 and YES, N = 58.
Letter to the Editor
Authors: Wiswell Thomas E. 
Published: December 2021

I agree with Dr Setzer's thought that the number of boys with malignant hyperthermia (2/476) was greater than the expected frequency (1/15 000).1 Nonetheless, both boys had received succinylcholine and halothane and had the classical symptoms of malignant hyperthermia (tachycardia, hyperthermia, combined metabolic and respiratory acidosis, elevated creatine phosphokinase levels, and myoglobinuria) and responded to dantrolene therapy. I believe the diagnosis of malignant hyperthermia is accurate.
The dorsal penile nerve block appears to be a safe and effective method of anesthesia among neonates.
The "Hustle": Socioeconomic Deprivation, Urban Drug Trafficking, and Low-Income, African-American Male Gender Identity
Authors: Whitehead Tony Larry , Peterson James , Kaljee Linda 
Published: December 2021

Objective. Drug trafficking seems to be both prevalent and associated with considerable morbidity and mortality among inner-city African-American males. Survey data has indicated the possible importance of economic need in the rapid emergence of drug trafficking in this population. In the present study, an historical-cultural approach is used to examine this economic relationship further and to explore the role that drug trafficking plays in a society that has permitted its successful and rapid growth.
Methodology. Data were obtained from interviews of approximately 600 African-Americans residing in inner-city neighborhoods in Washington, DC and Baltimore during nine drug- and acquired immunodeficiency syndrome-related studies conducted over 4 years.
Results and conclusions. From the perspective of the study participants, the need to provide economic support for one's family as well as to achieve some sense of status, respect, and reputation among one's peers are two core constructs of masculine identity in the United States. The historical and worsening inequities in access to economic resources and power by African-American males are viewed as significantly reducing the opportunity for economic success through more social or legal enterprises. Pursuit of nonmainstream activities (such as drug trafficking) is perceived as offering an opportunity for economic advancement and for establishing a power base for individuals who have been denied access to mainstream opportunities.