bluuebunny/crossref_metadata_2025_split huggingface dataset:
Human Immunodeficiency Virus Seropositivity in Adolescents With Syphilis
Authors: McCabe Edward , Jaffe Leslie R. , Diaz Angela 
Published: December 2021

Objective. The purpose of this study was to assess the relationship between syphilis and human immunodeficiency virus (HIV) infection among innercity, minority group adolescents.
Methods. From August 1989 through June 1990, serum from all positive serologic tests for syphilis, obtained from patients attending a comprehensive adolescent health center in an acquired immunodeficiency syndrome epicenter and its two school-based clinics, were frozen without patient identifiers and were subsequently screened for HIV by enzyme-linked immunosorbent assay with confirmatory Western blot for positives. In addition, a retrospective chart review was performed for all patients with a positive serologic test for syphilis during the study period.
Results. Of the 59 specimens with a positive syphilis serologic test, 9 (15.3%) were HIV seropositive. Of the patients with syphilis, 57.4% were black and 42.6% were Hispanic; 16.4% were male (mean age 18.1) and 83.6% were female (mean age 17.8). Only 1 subject (female) was an injection drug user; 4 of the male subjects self-identified as having had sex with other males. Of the subjects, 27.8% had primary, 19.7% had secondary, and 52.5% had latent syphilis at the time of diagnosis. A prior or concurrent sexually transmitted disease was present in 90% of the males and 80% of the females; gonorrhea was the most prevalent sexually transmitted disease in the males (89%) and chlamydia was most prevalent in the females (35%). A history of chancroid and/or herpes was present in 16.4% of the subjects.
Conclusions. It is concluded that the diagnosis of syphilis in an adolescent is a risk factor for HIV infection. All sexually active adolescents should be routinely screened for syphilis, regardless of sexual practices. Those with syphilis should be specifically counseled about their increased risk for HIV infection and the importance of consistent condom use, and they should be referred for formal HIV pretest counseling.
Capillary Refill: Is It a Useful Clinical Sign?
Authors: BARAFF LARRY J. 
Published: December 2021

Capillary refill is a clinical sign popularized in the past 15 years. Intuitively it is a measure of peripheral perfusion which is likely to be a function of cardiac output and peripheral vascular resistance. It is a semiquantitative test, with a value of &lt; 2 seconds generally considered to be normal.
In 1980, Champion et al1 proposed capillary refill as one of five elements of the Trauma Score. Two seconds was defined as the upper limit of normal. After the publication of the Trauma Score and the inclusion of capillary refill as a formal means of evaluation of not only trauma patients but of many other classes of patients, including children,2,3 my colleagues and I made the bedside observation that capillary refill was not a reliable clinical sign.
Unlisted Ingredients
Authors: KAO NEIL L. 
Published: December 2021

To the Editor.—
Studies by Kumar et al1,2 demonstrate clearly the number and potential importance of unlisted ingredients. Reactions triggered by these excipients may in fact account for many reported adverse drug reactions, including reactions to antihistamines and corticosteroids, originally thought to be caused by the primary medications. When patients suspected of having a hypersensitivity disease are evaluated for the etiologic factor, excipients should be included among the suspected causative agents. For example, in a patient evaluated recently for the etiology of urticaria, we determined that his toothpaste was the etiologic agent.
Comparison of Prophylaxis and Rescue Treatment With Curosurf in Neonates Less than 30 Weeks' Gestation: A Randomized Trial
Authors: Egberts Johannes , de Winter J. Peter , Sedin Gunnar , de Kleine Martin J.K. , Broberger Ulf , van Bel Frank , Curstedt Tore , Robertson Bengt 
Published: December 2021

Objective. The aim of this randomized clinical trial was to evaluate the immediate effects of prophylactic administration of Curosurf and to compare outcomes after prophylactic or expectant management.
Study design. Porcine surfactant (Curosurf, 200 mg/kg body weight) was administered intratracheally within 10 minutes of birth to preterm neonates with a gestational age of 26 to 29 weeks (n = 75); rescue-eligible neonates (n = 72) were initially subjected to a sham maneuver. The primary end points of the trial, evaluated at the age of 6 hours, were to obtain (1) a 40% decrease in the ratio between transcutaneous oxygen tension (tcPo2) (kPa) and fraction of inspired oxygen (Fio2), and (2) a 50% decrease in the incidence of radiologically verified respiratory distress syndrome (RDS). After 6 to 24 hours, a similar dose of surfactant was given to the neonates of both the prophylaxis and the rescue-eligible group, if they needed mechanical ventilation with an Fio2 ≥ 0.6.
Results. At 6 hours the prophylaxis group had, in comparison with the rescue-eligible group, significantly higher tcPo2/Fio2 ratios (mean ± SD: 39.7 ± 15.3 vs 28.1 ± 18.1; P &lt; .001) and less severe RDS by radiological scoring (χ2 = 14.9; P = .005). Severe RDS was present in 19% of the prophylactically treated neonates versus 32% in the rescue-eligible group (P &lt; .05). The prophylaxis group needed shorter periods of Fio2 &gt; 0.40 than the rescueeligible neonates (P &lt; .01), and eight neonates of the prophylaxis group (11%) versus 23 of the rescue-eligible group (32%) qualified for rescue treatment with surfactant in the interval 6 to 24 hours (P &lt; .01). There were no differences in the incidence or severity of pneumothorax, pulmonary interstitial emphysema, cerebral hemorrhage, periventricular leukomalacia, patent ductus arteriosus, in the duration of mechanical ventilation or time in supplemental oxygen, or in mortality.
Conclusions. Subgroup analysis revealed (1) that administration of corticosteroids reduced the risk of developing neonatal RDS as effectively as did surfactant prophylaxis at birth, and (2) that prophylaxis was effective especially in neonates with gestational age &lt;28 weeks or birth weight &lt;1000 g, in male neonates, and in neonates who had received no antenatal treatment with corticosteriods. Our data indicate that prophylactic treatment with surfactant should be considered in high-risk neonates fulfilling these latter criteria.
Ocular Sequelae in Premature Infants
Authors: Page Jacqueline M. , Schneeweiss Suzan , Whyte Hilary E. A. , Harvey Patricia 
Published: December 2021

Objective. The authors report on the incidence of myopia and strabismus at 12 and 24 months postterm in a cohort of 190 premature infants with birth weights of less than 1251 g born in 1986 and 1987.
Methods. The neonatal and follow-up eye charts of a cohort of 190 premature infants were retrospectively reviewed. All 138 children who survived the neonatal period had at least one eye examination between day 28 and 42 of life that documented the presence and staging of retinopathy of prematurity (ROP) according to the International Classification of ROP. No infants received cryotherapy. Eye examinations conducted at 12 and 24 months postterm included assessment of vision, fundus, ocular motility, anterior segment abnormality, and refractive error. Eyes were refracted using cycloplegic retinoscopy. Strabismus was detected using the Hirschberg and cover tests. Eye reports were available for 80% (n = 110) at 12 months and 36% (n = 50) at 24 months.
Results. Fifty-three percent of the cohort exhibited ROP in the neonatal period; 12% of these progressed to stage 3 or 4 ROP. Myopia was observed in 16% (18/110) of the cohort at 12 months of age; 4.5% (5/110) measured more than 4.0 diopters of myopia. Children with birth weights of less than 751 g were 3.2 times more likely than those with birth weights between 751 and 1000 g and 10 times more likely than those with birth weights between 1001 and 1250 g to develop myopia in the first year of life. The likelihood of myopia at 12 months doubled with each increment in ROP stage. Of the 50 children reexamined at 24 months postterm, more than 80% demonstrated deteriorating vision. The incidence of myopia increased to 38% (19/50) overall, with 24% (12/50) of the cohort showing severe myopia. Astigmatism and anisometropia were highly correlated with severe myopia. Strabismus was seen with increasing frequency through the second year of life. All children with grade III or IV intraventricular hemorrhage in the neonatal period developed esotropia.
Conclusion. This study emphasizes the significant roles of low birth weight, ROP, and intraventricular hemorrhage in the development of myopia and strabismus. Follow-up to 2 years of life is recommended given the demonstrated deterioration our cohort.
Adolescent Gestational Weight Gain and Birth Weight
Authors: Stevens-Simon Catherine , MCAnarney Elizabeth R. , Roghmann Klaus J. 
Published: December 2021

Objective. To examine the relationship among maternal age, prepregnancy weight, gestational weight gain, and birth weight in 141 low-income black adolescents and their infants.
Study sample. One hundred forty-one consecutively enrolled, low-income, black adolescents who entered prenatal care prior to their 23rd week of gestation, were free of chronic diseases, took no regular medications, had no known uterine anomalies, and gave birth to one live neonate.
Results. After controlling for prepregnancy weight and other potentially confounding variables, we found a significant relationship between gestational weight gain and infant birth weight among younger adolescents (&lt;16 years old at conception), but not among older adolescents (16 through 19 years old at conception); younger adolescents contributed more of their gestational weight gain to their fetuses than did older adolescents. Among younger adolescents the rate of maternal weight gain during the entire gestation was significantly correlated with birth weight (r = .40; P &lt; .01), whereas for older adolescents only maternal weight gain during the second half of gestation was significantly correlated with birth weight (r = .25, P &lt; .05).
Conclusions. The data do not support the thesis that younger adolescents compete with their fetuses for nutrients; in fact, younger study adolescents transferred more of their gestational weight gain to their fetuses than did older adolescents.
Maternal Smoking Before and After Pregnancy: Effects on Behavioral Outcomes in Middle Childhood
Authors: Fergusson David M. , Horwood L. John , Lynskey Michael T. 
Published: December 2021

Objective. The aim of this research was to examine the extent to which maternal smoking before and after pregnancy was associated with childhood disruptive behaviors when due allowance was made for potentially confounding factors which may have been associated with both maternal smoking habits and childhood problem behaviors.
Methods. During the course of a 15-year longitudinal study of a birth cohort of 1265 New Zealand children, the following measures were obtained: (1) measures of daily cigarette intake during pregnancy and after pregnancy; (2) measures of childhood disruptive behaviors including conduct problems and attention deficit behaviors based on both maternal and teacher report data; and (3) measures of a series of potentially confounding family, social, parental, and related factors.
Results. Before adjustment for confounding, maternal smoking both before and after pregnancy was found to be associated with significant increases in rates of childhood problem behaviors: children whose mothers smoked in excess of 20 cigarettes per day had mean problem behavior scores that were between 0.16 and 0.56 standard deviations higher than those of children whose mothers were nonsomkers. The results were then adjusted using regression methods to take account of (1) correlations between pregnancy and postpregnancy smoking and (2) potentially confounding factors. The results of regression adjustment suggested that maternal smoking during pregnancy was associated with small but statistically detectable increases in rates of childhood problem behaviors, with children whose mothers smoked in excess of 20 cigarettes per day having mean scores that were 0.10 to 0.36 standard deviations higher than those of the offspring of nonsmokers, even after adjustment for a series of confounding factors. However, smoking after pregnancy was not significantly associated with increased rates of childhood problem behavior after adjustment for sources of confounding.
Conclusion. The results are generally consistent with the hypothesis that smoking during pregnancy may be associated with small but detectable increases in the risks of problem behaviors in childhood. This suggests that possible adverse effects on childhood behavioral adjustment should be added to the growing list of adverse consequences of parental smoking for childhood health and well-being.
Safety and Immunogenicity of a Combined Diphtheria, Tetanus, Pertussis and Haemophilus influenzae Type b Vaccine in Young Infants
Authors: Paradiso Peter R. , Hogerman Deborah A. , Madore Dace Viceps , Keyserling Harry , King James , Reisinger Keith S. , Blatter Mark M. , Rothstein Edward , Bernstein Henry H. ,   Pennridge Pediatric Associates, Hackell Jill 
Published: December 2021

Objective. To study the safety and immunogenicity of a combined diphtheria-tetanus-pertussis (DTP)-Haemophilus influenzae type b (HbOC) vaccine (TETRAMUNE) in infants as young as 2 months of age as compared to separate administration of DTP and HbOC.
Methods. Two-month-old infants were randomized to receive three doses 2 months apart of either DTP-HbOC as a single 0.5-mL injection or to receive 0.5 mL of DTP and HbOC concurrently in separate legs. Local and systemic adverse reactions were monitored within 72 hours of each immunization, and immunogenicity of each of the four vaccine components was measured.
Results. The incidence of both local and systemic adverse events following the tetravalent vaccine was similar to the incidence following separate vaccine administration. After three doses of vaccine, the response to each of the vaccine components was higher in the combined vaccine when compared to separate administration. In the case of the Haemophilus influenzae type b component, this enhancement was also seen after two doses. The response to the combined vaccine was consistent among the three lots tested as was the enhancement over separate administration.
Conclusions. The DTP-HbOC vaccine was safe and immunogenic in young infants and was generally more immunogenic than separate vaccination with DTP and HbOC. The use of such a combined vaccine reduces the number of injections given to young infants by half and is an important step toward improving vaccine delivery.
Varicella-Zoster Virus Infection in Romanian Children Infected With the Human Immunodeficiency Virus
Authors: Leibovitz Eugene , Cooper David , Giurgiutiu Dana , Coman Gabriela , Straus loanna , Orlow Seth J. , Lawrence Robert 
Published: December 2021

Objective. Varicella-zoster virus (VZV) infections can cause severe disease in immunocompromised individuals. To evaluate the spectrum of VZV infections in human immunodefidency virus (HIV)-infected children, we retrospectively analyzed all the cases of VZV infection in a cohort of children cared for at a hospital for infectious diseases in Bucharest, Romania.
Methods. The records of 391 HIV-infected children admitted to the acquired immunodeficiency syndrome pavilion of Colentina Hospital during the period January 1, 1991, through March 31, 1992, were reviewed for evidence of VZV infection. The diagnosis of varicella or zoster was made clinically and information was collected concerning course of the illness, number of skin lesions, and clinical evidence of complications. Lymphocyte subpopulation typing, as an estimate of immune function, was performed by either a standard fluorescent activated flow cytometric method or by immunofluorescent technique.
Results. Thirty-eight cases of varicella (9.7%) and seven cases of zoster (1.8%) were adequately documented among the 391 records reviewed. The duration of varicella was prolonged; in 57% of the children it was greater than 10 days. Forty percent of children with varicella developed a complication, including superinfection of the skin, pneumonia, or thrombocytopenia. None of the children developed clinical hepatitis or encephalitis. Two children (5%) died during varicella, both of respiratory failure. None of the 7 children with zoster had chronic, recurrent, or disseminated lesions. Lymphocyte subset analysis was available for 22 of 38 children with varicella and 3 of 7 children with zoster. Fifteen of the 22 children had normal, age-adjusted, absolute CD4 counts within 3 months of the diagnosis of varicella. All 3 children with zoster who had lymphocyte subset analysis had low CD4 counts and absolute numbers. None of the 45 children received antiretroviral therapy and only 1 child with varicella and 1 with zoster received acyclovir.
Conclusions. The spectrum of VZV infection in this hospitalized group of HIV-infected children was broad. The majority (57%) experienced a prolonged course of disease and a higher rate of complications than normal children hospitalized with varicella.
ΔF508 Genotype Does Not Predict Disease Severity in an Ethnically Diverse Cystic Fibrosis Population
Authors: Lester Lucille A. , Kraut Jerome , Lloyd-Still John , Karrison Theodore , Mott Carol , Billstrand Chris , Lemke Amy , Ober Carole 
Published: December 2021

Objective. As part of a study to determine population-based frequencies of CFTR mutations in an ethnically diverse, midwestern cystic fibrosis (CF) population, clinical histories were studied in 119 CF patients.
Methodology. We sought to examine the association between genotype as characterized by the ΔF508 and 11 other commonly occurring mutations and clinical parameters including age at diagnosis, clinical presentation, sweat chloride level, chest roentgenogram score, clinical scores, pulmonary function test results, percent weight for height, and presence of associated CF complications.
Results. Age at diagnosis of CF was significantly associated with homozygosity for ΔF508 (mean age at diagnosis ± SE: 1.7 ± 0.3 years for ΔF508/ΔF508 vs 3.9 ± 0.9 years for ΔF508/other and other/other; P = .03). No other age-adjusted clinical parameter was significantly associated with ΔF508 or any other genotype.
Conclusion. These data suggest that in this sample of CF patients, ΔF508 genotype is not predictive of disease severity. The lack of association between disease severity and genotype in this ethnically diverse sample may reflect the presence of more severe undetected mutations in our sample, or the effects of modifying genes at other, non-CF loci.
Screening for Tuberculosis in Infants and Children
Authors:   Committee on Infectious Diseases
Published: December 2021

CURRENT STATUS OF INFECTION AND DISEASE
In 1992 the reported number of cases of tuberculosis (TB) was increased to 26 673 in the United States, an increase of 1.5% from 1991. Although a decline of approximately 5% to 6% occurred from 1981 to 1984, during the period of 1985 to 1992 the number of reported cases increased by 20.1%. The largest increase in TB cases by age group occurred in the 25- to 44-year-old cohort (54.5% increase in 1985 to 1992), whereas cases increased 36.1% among children 0 to 4 years old and 34.1% among children 5 to 14 years old.1 This recent increase in the number of reported cases of tuberculosis and the changing epidemiology of this disease in children have necessitated a reevaluation of the appropriate use and type of skin test for the diagnosis.2
Within the general population there are groups at varying risk for infection and for progression to disease (Table 1). To achieve significant progress toward reducing the number of future cases of TB, it is necessary to have the following: 1) identification of high-risk groups, with Mantoux tuberculin skin testing of persons in those groups; 2) evaluation to determine the actual presence of disease in those persons identified as infected; and 3) provision of appropriate therapy for both those with positive Mantoux tests and those with active disease.3 Therefore, the emphasis should be to identify targeted high-risk populations for annual skin testing rather than routinely screening all persons. Routine screening would indude a vast number of individuals at low risk.
Medicaid Policy Statement
Authors:   Committee on Child Health Financing
Published: December 2021

The American Academy of Pediatrics recognizes the achievements of the Medicaid program in improving access to health care services for poor children. Despite recent legislative expansions to extend eligibility to more poor and disabled children and to broaden the scope of preventive and treatment services in all states, several additional program improvements are needed to eliminate the following barriers to access:
1. Federal and state fiscal crises are creating major roadblocks to Medicaid program implementation and expansion.
2. Thousands of poor children will not be eligible for Medicaid until October 1, 2001.1
3. Only a portion of those who are potentially eligible for Medicaid apply for coverage, and many eligible children do not utilize services.
4. Fewer Medicaid funds are available for primary and preventive care because of the increasing need for long-term care services.
5. Early and periodic screening, diagnosis and treatment (EPSDT)/preventive health services are being received by too few children and the implementation of expanded service coverage under EPSDT, granted in 1989, is subject to a great deal of inconsistent state interpretation.
6. Inadequate provider reimbursement reduces children's access to health care services.
The Academy has developed the "Children First" proposal which calls for the elimination of Medicaid and replaces it with a one-class, private insurance system of universal access to health care for all children through age 21 and for all pregnant women.2 However, until the "Children First" proposal, or a similar health care reform initiative is implemented, the Academy recommends the following policy actions to improve the current Medicaid program.