bluuebunny/crossref_metadata_2025_split huggingface dataset:
Neurologic Manifestations of In Utero Cocaine Exposure in Near-Term and Term Infants
Authors: King Terri A. , Perlman Jeffrey M. , Laptook Abbot R. , Rollins Nancy , Jackson Gregory , Little Bertis 
Published: December 2021

Objective. To determine whether the incidence of neurosonographic and neurologic abnormalities is higher in cocaine-exposed infants at birth.
Methods. In utero exposure to cocaine was investigated in 39 term and near-term infants with positive urine screens for cocaine only and 39 matched control infants without drug exposure admitted to the regular term newborn nursery. Serial evaluations were performed on each infant on postnatal days 1 and 2 and included a cranial sonogram, a neurologic and behavioral assessment for drug withdrawal, and Doppler interrogation of the anterior and middle cerebral arteries.
Results. There were no differences between groups in neurosonographic abnormalities. Grade I or II intraventricular hemorrhage occurred in 11% of cocaine-exposed and 11% of control infants. There were no cases of grade III intraventricular hemorrhage, cystic periventricular leukomalacia, or neonatal stroke. Head size was smaller in cocaine-exposed infants, ie, 32.7 ± 0.1 cm versus 33.8 ± 0.1 cm. The neurologic examination was similar between groups with regard to tone, reflexes, and cranial nerves. Behavioral scores were higher on both days, in cocaine-exposed versus control infants, ie, 4.4 ± 0.5 versus 2.7 ± 0.3 on day 1 and 5.0 ± 0.5 versus 1.71 ± 0.31 on day 2. Cerebral blood flow velocity measurements in the anterior cerebral artery were similar between groups on both days of examination. However, cocaine-exposed infants demonstrated a significant increase in flow velocity from day 1 to day 2, ie, 0.48 ± 0.03 to 0.57 ± 0.04. There was a concomitant decrease in the pulsatility index from day 1 to day 2 in the cocaine-exposed, ie, 0.74 ± 0.02 to 0.69 ± 0.02, but not in the control infants. No differences were noted in the flow velocities in the middle cerebral arteries between groups.
Conclusions. Term and near-term infants admitted to a regular nursery who are exposed to cocaine in utero: (1) do not exhibit an increased incidence of neurosonographic abnormalities; (2) do exhibit altered behavior consistent with drug withdrawal; and (3) do demonstrate changes in flow velocity in the anterior cerebral artery consistent with the vasoconstrictive effects of the drug. However, these changes were not accompanied by changes in the neurologic examination or altered care. The long-term neurodevelopmental implications of these subtle abnormalities in the neonatal period remain to be determined.
A UNIVERSITY AND FOUR SCIENTISTS MUST PAY FOR PILFERED WORK
Authors: L. J. F. 
Published: December 2021

A Federal judge in Baltimore today ordered the University of Alabama and four of its scientists to pay the Government and a researcher a total of $1.9 million for stealing her work and using it as their own to obtain Federal grants.
The case, decided by a jury, was unusual because the researcher, Dr Pamela A. Berge, an epidemiologist who now works for Pfizer Inc, had gone to court under the Federal False Claims Act, a Civil War-era statute rarely used in cases involving scientific misconduct.
...Officials at Alabama, speaking for the university and the four scientists, said in a statement that the verdict was "not consistent with or supported by the evidence" and would likely be appealed.
The jury found that each of the scientists had individually committed malicious acts of fraud against Dr Berge by claiming her work as his own, by using it to gain grants, and by publishing it in a scientific journal without crediting her. The university was held liable for aiding the fraud. The jury said the Government had been harmed by the fraudulent claims in applications for grants.
The university was ordered to pay $1.66 million, of which Dr Berge's share would be $498 000 and the remainder the Federal Government's. The scientists—Drs Robert F. Pass, Sergio B. Stagno, Charles Alford, and Karen B. Fowler—were ordered to pay collectively $50 000 in compensatory damages to Dr Berge and $215 000 in punitive damages.
A Population-Based Study of Severe Firearm Injury Among Children and Youth
Authors: Zavoski Robert W. , Lapidus Garry D. , Lerer Trudy J. , Banco Leonard I. 
Published: December 2021

Background. Firearm injuries are a major cause of pediatric mortality and morbidity in the United States. To date, population-based studies describe the epidemiology of firearm-related deaths; however, the patterns of severe, nonfatal pediatric firearm-related injuries are not as well defined.
Objectives. To determine the epidemiology of severe firearm-related deaths and injuries among a statewide population of children and youth ages birth to 19 years.
Methods. Demographic, geographic, and cost data were analyzed from Connecticut death certificates for 1988 through 1992 and hospital discharge data for 1986 through 1990 for firearm-related unintentional, self-inflicted, and assaultive injury among children and youth ages birth to 19 years.
Results. There were 219 firearm deaths: 68% homicides, 25% suicides, 6% unintentional, and 1% of undetermined intent, resulting in an annual age-specific death rate of 6.6 per 100 000 persons. There were 533 hospitalizations for gunshot wounds (16 per 100 000); 41% were assaults, 1% suicide attempts, 39% unintentional gunshot wounds, 1% legal interventions, and 18% of undetermined intent. More than 80% of deaths from gunshot wounds and hospitalizations occurred among 15- to 19-year-old males, most occurring in Connecticut's five largest cities. Most firearm homicides occurred among urban residents; most firearm suicides occurred among nonurban residents; and unintentional shootings were evenly distributed between urban and nonurban residents. The total cost of firearm-related hospitalizations averaged $864 000 per year.
Conclusions. Firearms are a major cause of mortality and morbidity of Connecticut children and youth, exceeded only by motor vehicles as a cause of death among those 1 to 19 years of age. Handguns were responsible for a disproportionate amount of trauma compared with other firearm types. The epidemiology of pediatric gunshot injuries requires a range of strategies for prevention. Physicians caring for families with children must include firearm injury prevention counseling as a routine part of anticipatory guidance.
The Hair Collar Sign: Marker for Cranial Dysraphism
Authors: Drolet Beth Ann , Clowry Lawrence , McTigue M. Kathleen , Esterly Nancy B. 
Published: December 2021

Objective. To call attention to a cutaneous marker for neural tube closure defects of the scalp, the "hair collar" sign. This finding consists of a ring of long, dark, coarse hair surrounding a midline scalp nodule.
Methods and Results. Four children with small congenital scalp nodules and the hair collar sign were studied from the standpoint of clinical findings, radiologic scans, and histology of the excised nodules. All four had an overlying vascular stain in addition to the hair collar. Patients 1 and 2 were found to have encephaloceles, and one had heterotopic brain tissue. The fourth family refused surgery, but the clinical and radiologic findings were consistent with a diagnosis of atretic encephalocele. One infant had agenesis of the corpus callosum and a Dandy-Walker malformation as associated findings.
Conclusions. The "hair collar" sign should alert the pediatrician to the possibility of ectopic neural tissue in the scalp and/or underlying central nervous system malformations.
Disciplining Young Children: The Role of Verbal Instructions and Reasoning
Authors: Blum Nathan J. , Williams George E. , Friman Patrick C. , Christophersen Edward R. 
Published: December 2021

Pediatricians are often asked to advise parents who are having difficulty managing the oppositional behaviors of their toddlers and preschool-age children. A large number of articles provide advice to pediatricians and parents on effective disciplinary strategies. However, despite the fact that verbal explanations, reasoning, and instructions are commonly used by parents, few articles directly address the use of these strategies to affect children's behavior.
In this paper, we review studies that explicitly investigate the ability of adults' verbal explanations or instructions to alter the behavior of young children. These studies suggest that under most circumstances, verbal explanations and instructions are not effective in changing young children's problem behaviors. We then discuss how theories in developmental and behavioral psychology help explain the limitations of using verbal reasoning and instructions to change young children's problem behaviors. Finally, we provide some recommendations for parents on the use of verbal explanations and instructions in disciplining young children.
MILESTONES MARKING THE KNOWLEDGE OF ADVERSE REACTIONS TO FOOD IN THE DECADE OF THE 1980s
Authors: Miller Betty 
Published: December 2021

Purpose of the Study. This study outlines the significant advances made to our understanding of adverse reactions to foods and food additives in the last decade.
The milestones are listed in order of overall importance and are discussed in depth in the review.
1. Establishing double-blind, placebo-controlled food challenge (DBPCFC) as the "gold-standard" for defining specific patient population to be used in scientific studies. (VanMetre, May, Bock)
2. Recognition of the key role food allergy plays in the pathogenesis of atopic dermatitis. (Sampson, May)
3. Identifying the group of foods most likely to be associated with true allergic reactions.
Analysis of DBPCFC in children has shown that 93% of allergic reactions occurred to eight foods (in order of frequency): egg, peanut, milk, soy, tree nuts, crustacean-type shellfish, fish, and wheat. Corn and chocolate allergy was rarely found. (Bock, Sampson, Atkins)
4. Food allergy has a natural history.
In a prospective study of 501 children, Bock found that, of 15 cases of allergy proven by DBPCFC in the first year of life, none of the 15 cases was reactive beyond 24 months of age. In contrast, long-term follow-up of patients who have experienced peanut anaphylaxis revealed that clinical sensitivity lasts for at least 14 years. (Bock, Atkins)
5. Food allergy cross-sensitivity (clinical reactivity) does not extend equally to all members of a biologic food family.
Although immunologic cross-reactivity between peanut, soy, and other peas/beans could be regularly found in allergic patients, clinically important cross-reactions demonstrated by DBPCFC were rare. (Bernhisel -Broadbent, Sampson)
SENSITIVE DETECTION AND EARLY PROGNOSTIC SIGNIFICANCE OF p24 ANTIGEN IN HEAT-DENATURED PLASMA OF HUMAN IMMUNODEFICIENCY VIRUS TYPE 1-INFECTED INFANTS
Authors: Cotton Mark E. 
Published: December 2021

Purpose of Study. To investigate the effect of heat-dissociated release of complexed antigen on the sensitivity of commercial p24 antigen assays, to compare it with polymerase chain reaction (PCR) and viral culture, and to examine its prognostic utility in HIV-1 infected infants. Acid-mediated release of antigen from immune complexes is inefficient in the presence of high titers of antibody to p24 antigen.
Study Population. Six hundred ninety banked serum or plasma samples from 305 patients of a cohort were studied (median age, 11 months), including 142 samples from 53 infected patients. In addition, 113 samples from cohort children were analyzed prospectively.
Methods. Standard commercial p24 enzyme immuno-assay (EIA) with and without heat dissociation of serum prior to assay. Positive results were subjected to confirmatory neutralization. PCR and culture were performed by standard techniques.
Results. In the retrospective cohort study, the specificity of heat dissociation was 96.9% in 390 uninfected samples after initial testing and 100% after neutralization. Sensitivity among 125 postnatal infected samples was, at a detection level of 2 pg/mL, 96% (97% neutralizable) compared with 47.7% for nonheat-dissociated antigen (76% neutalizable), 96% for PCR, and 77% for viral culture. These results were confirmed in the prospective study. Symptomatic children had heat-dissociated p24 antigen levels twice that of asymptomatic patients, most noticeable in the first 2 years of life (P = .004). Four of five patients with a heat-dissociated p24 assay absorbance greater than 0.9 in the first 6 months of life died (range, 5 to 18 months of age), while only four of 15 with lower absorbance within the first 6 months died (range, 5 to 26 months), suggesting a prognostic use for this test.
Perinatal Regionalization Versus Hospital Competition: The Hartford Example
Authors: Richardson Douglas K. , Reed Kate , Cutler J. Christopher , Boardman Robert C. , Goodman Karen , Moynihan Timothy , Driscoll Jane , Raye John R. 
Published: December 2021

Objectives. The increasingly competitive health care environment may undermine effective traditional regional organizations. It is urgent to document the benefits of perinatal regionalization for the emerging health care system. We present a case study that illustrates many of the challenges to and benefits of perinatal regionalization in the 1990s.
Background. The controversy in Hartford was sparked by a proposed merger of two major pediatric services into a full-service children's hospital. Community hospitals reacted with plans to upgrade their obstetrics/neonatal facilities toward level II (intermediate) or II+ (intensive) neonatal intensive care units (NICUs). The fear that unrestricted competition would drive up overall health care costs prompted the hospital association and Chamber of Commerce to retain consultants to evaluate the number and location of regional NICU beds.
Methods. The consultant team interviewed stake-holders in area hospitals, health maintenance organizations, insurance companies, businesses, state agencies, and community groups, and analyzed quantitative data on newborn discharges.
Results. The existing system worked remarkably well for clinical care, training, referrals, and provider and patient satisfaction. There was a high level of inter-hospital collaboration and regional leadership in obstetrics and pediatrics, but strong and growing competition between their hospitals. Hospital administrators enumerated the competitive threats that obligated them to compete and the financial disincentives to support the regional structures. Business leaders and insurance executives emphasized the need to control costs. Analysis of discharge data showed marginal adequacy of NICU beds but maldistribution between NICUs, particularly between level III and level II units. The consultants recommended no new beds based on population projections, declining lengths of stay nationally, and substantial gains available from aggressive back-transport of convalescing infants. The consultants emphasized the need for all stakeholders to support the regional infrastructure (referral, transport, education, evaluation, quality assurance) and to modify competition when it impaired effective regionalization.
Conclusions. Regionalization permits better care at lower cost, yet competition may disrupt this effective system. Active cooperation by stakeholders is vital. Substantial new research is required to define optimal regional organization.
Nucleated Erythrocytes and Intraventricular Hemorrhage in Preterm Neonates
Authors: Green, David W. , Hendon Barbara , Mimouni Francis B. 
Published: December 2021

Objectives. Increased circulating nucleated erythrocytes (NRBCs) in the newborn period can be markers of chronic fetal hypoxia, which in turn may be a risk factor for intracranial hemorrhage (IVH). To evaluate the relation between chronic intrauterine hypoxia and IVH, we compared the courses of the absolute NRBC (ANRBC) count in preterm newborns with and without intracranial hemorrhage.
Methods. We measured ANRBC counts in the first 6 days of life in appropriate for gestational age newborns at 32 weeks' gestation or earlier with (n = 46) and without (n = 103) IVH, who were not at risk for altered erythropoiesis.
Results. The ANRBC counts at birth were higher in infants who developed severe IVH than in control infants without IVH (P &lt; .03). The ANRBC counts peaked on day 2 or 3 in newborns with IVH, but declined continuously from a peak on day 1 in the control group. Stepwise regression analysis of multiple variables revealed that the grade of IVH had the greatest impact on ANRBC counts. An ANRBC count of at least 2.0 x 109/L on day 1 of life had a sensitivity of 63% and a specificity of 79% in predicting grade III or IV IVH.
Conclusion. An elevated or increasing ANRBC count in a preterm newborn is a potential marker for an impending or present severe IVH, respectively, and may reflect a state of altered prenatal or postnatal erythropoiesis.
Guidelines for Pediatric Emergency Care Facilities
Authors:   Committee on Pediatric Emergency Medicine
Published: December 2021

This Policy Statement was retired January 2004.
Emergency care for life-threatening pediatric illness and injury requires specialized resources including equipment, drugs, trained personnel, and facilities. The American Medical Association Commission on Emergency Medical Services has provided guidelines for the categorization of hospital pediatric emergency facilities that have been endorsed by the American Academy of Pediatrics (AAP).1 This document was used as the basis for these revised guidelines, which define:
1. The desirable characteristics of a system of Emergency Medical Services for Children (EMSC) that may help achieve a reduction in mortality and morbidity, including long-term disability.
2. The role of health care facilities in identifying and organizing the resources necessary to provide the best possible pediatric emergency care within a region.
3. An integrated system of facilities that provides timely access and appropriate levels of care for all critically ill or injured children.
4. The responsibility of the health cane facility for support of medical control of pre-hospital activities and the pediatric emergency care and education of pre-hospital providers, nurses, and physicians.
5. The role of pediatric centers in providing outreach education and consultation to community facilities.
6. The role of health cane facilities for maintaining communication with the medical home of the patient.
Children have their emergency care needs met in a variety of settings, from small community hospitals to large medical centers. Resources available to these health care sites vary, and they may not always have the necessary equipment, supplies, and trained personnel required to meet the special needs of pediatric patients during emergency situations.
Behavioral and Cognitive Effects of Anticonvulsant Therapy
Authors:   Committee on Drugs
Published: December 2021

In 1985, the Committee on Drugs reviewed evidence, primarily from adult studies, indicating that anticonvulsant therapy may have detrimental effects on behavior and cognition.1 It was recommended that pediatricians judiciously review indications for the use of antiepileptic medications, weigh the efficacy versus the side effects of specific drugs, and be alert to reported changes in patient behavior, mood, or cognitive function. Furthermore, the Committee noted the need for the development of brief neuro-psychologic screening tests to identify subtle intellectual and behavioral side effects as well as the need for the delineation of behavioral and cognitive effects of specific antiepileptic medications in children.
This commentary presents an overview of current pediatric studies of antiepileptic drugs and cognitive/behavioral function.
Behavioral Effects
Behavioral disturbances, reported in 20% to 30% of children with epilepsy,2 are frequently unrelated to the anticonvulsant drug regimen, but may result from disordered cerebral function or occur as a secondary reaction to the illness.3 Some children with seizures differ behaviorally from healthy controls both before the initiation of treatment and after its cessation. Behavioral differences are most prominent with absence and partial seizures.4
The most comprehensive incidence data on the behavioral side effects of antiepileptic drugs derive from a study of 392 children receiving long-term monotherapy with phenobarbital, primidone, phenytoin, carbamazepine, on valprnoate for treatment of epilepsy on febrile convulsions.5 As shown in the Table, behavioral effects were most commonly reported in patients treated with phenobarbital, and were relatively uncommon in children treated with primidone, phenytoin, on valproate. Drowsiness and longer sleep were associated with higher plasma levels of phenobarbital, whereas signs of excitation tended to occur at lower dosages and resolved when higher on stable plasma levels were achieved.
Cow's Milk and the Diabetes Debate
Authors: Elliott Robert B. 
Published: December 2021

I write to you concerning the recommendations from a special advisory group of the American Academy of Pediatrics (Pediatrics. 1994;94:752-754). These recommendations concern infant feeding practices and the risk of subsequent type I diabetes.
The wording of these recommendations may be misunderstood by practicing pediatricians. At the moment, the epidemiologic and animal experimental data provide reasonable grounds for suspicion that some cow's milk components may be diabetogenic at least in some individuals, but this suspicion has not been subjected to scientific confirmation as of yet.
Concern About Guidelines
Authors: Lallier Chuck 
Published: December 2021

I enjoyed reading Dr Paul Young's article "The Management of Febrile Infants by Primary-Care Pediatricians in Utah: Comparison With Published Practice Guidelines" in the May 1995 issue of Pediatrics.
It seems we, as general pediatricians, are barraged with an increasing number of "guidelines" for the management of everything from fever to hyperbilirubinemia. These guidelines are very useful in helping one think of diagnostic/treatment options, but need to leave a lot of room for variation with the individual patient.