bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effects of HIV on Cognitive and Motor Development in Children Born to HIV-Seropositive Women With No Reported Drug Use: Birth to 24 Months
Authors: Gay Caryl L. , Armstrong F. Daniel , Cohen Donna , Lai Shenghan , Hardy Marjorie D. , Swales Thomas P. , Morrow Connie J. , Scott Gwendolyn B. 
Published: December 2021

Objective. This study documents delays in the mental and motor functioning of infants perinatally infected with human immunodeficiency virus (HIV) while controlling for confounding effects of prenatal drug exposure, ethnicity, socioeconomic status, and maternal separation and death.
Methods. The cognitive and motor development of 126 infants born to nondrug-using, HIV-seropositive Haitian women was assessed at 3-month intervals through 24 months of age using the Bayley Scales of Infant Development. By 18 months of age, 28 of the infants were diagnosed as HIV-infected, and the 98 uninfected infants served as a control group. The infected and uninfected infants did not differ with respect to mean gestational age, birth weight, ethnicity, or rates of maternal separation and death.
Results. By 3 months of age, the mean mental and motor scores of the infected infants were significantly lower than those of the uninfected controls. Furthermore, the initial differences between the two groups increased over time, as many of the infected infants became increasingly delayed. Although the infected infants tended to perform more poorly than the uninfected infants, nearly one third of the infected infants exhibited relatively normal cognitive development and half demonstrated relatively normal motor development.
Conclusions. Over the first 24 months of life, the mean rate of development of HIV-infected infants is significantly slower than that of noninfected infants born to seropositive mothers. This occurs even when the effects are not confounded with those of prenatal drug exposure.
Voiding After Neonatal Circumcision
Authors: Perlmutter Deborah F. , Lawrence Janet M. , Krauss Alfred N. , Auld Peter A. M. 
Published: December 2021

Objective. To determine whether it is necessary to delay discharge of newly circumcised male neonates to observe voiding.
Subjects and Methods. A prospective study was conducted in 1992 and 1993 of 51 healthy male, newly circumcised neonates between 0 and 10 days of age. The neonates were observed for the time of first voiding after circumcision was performed.
Results. All neonates voided after circumcision at a mean age of 5.3 ± 2.5 hours, and there were no complications noted in the study population.
Conclusion. Healthy male infants who are circumcised without obvious complications can be expected to void, and it is unnecessary to delay hospital discharge to make this observation.
Health Supervision for Children With Turner Syndrome
Authors:   Committee on Genetics
Published: December 2021

This set of guidelines is designed to assist the pediatrician in caring for the child in whom the diagnosis of Turner syndrome has been confirmed by karyotype. Although the pediatrician's first contact with the child is usually during infancy, occasionally the pregnant woman who has been given the prenatal diagnosis of Turner syndrome will be referred for advice. Therefore, these guidelines offer advice for this situation as well.
Turner syndrome, as used here, refers to a condition in which there is short stature and ovarian dysgenesis in females because of the absence of a normal second sex chromosome. Nonchrornosomal gonadal dysgenesis is excluded. The birth prevalence of Turner syndrome has been estimated to be from 1:2000 to 1:5000 female live births. About 1% to 2% of all conceptuses have a 45,X chromosome constitution. Of these, the majority (99%) spontaneously abort, usually during the first trimester of pregnancy. With the more frequent use of ultrasound, it is recognized that some pregnancies with a fetal 45,X chromosome constitution progressing into the second trimester are associated with nuchal cysts, severe lymphedema, or hydrops fetalis. These pregnancies are associated with a high frequency of fetal death.
PHENOTYPE
Pediatricians are most familiar with the clinical findings that prompt the diagnosis in children, namely, short stature and the classic Turner syndrome features such as lymphederna, webbed neck, low posterior hair line, and cubitus valgus. A wide range of clinical abnormalities may be found (Table 1). Turner syndrome, however, is not always accompanied by distinctive features and most often is not diagnosed in infancy.
Clonidine and Sudden Death
Authors: Maloney Michael J. , Schwam Jeffrey S. 
Published: December 2021

Clonidine is used by pediatricians and child psychiatrists for tics, Tourette's syndrome, and attention deficit disorder with hyperactivity (ADHD) with aggressive behavior. However, recent evidence of sudden death and cardiac toxicity associated with clonidine raises concern about the widespread use of this medication.
There are three unpublished cases where the combination of clonidine and methylphenidate has been associated with unexplained sudden death in children ages 7,8, and 9 years (Frenia M.L., personal communication, September 21, 1995, Drug Surveillance and Information, Boehringer Ingelheim Pharmaceuticals).
Screening for Congenital Adrenal Hyperplasia: The Delfia Screening Test Overestimates Serum 17-Hydroxyprogesterone in Preterm Infants
Authors: Saedi Saad Al , Dean Heather , Dent William , Stockl Elizabeth , Cronin Catherine 
Published: December 2021

Objective. To compare 17-hydroxyprogesterone (17-OHP) levels measured by quantitative serum radioimmunoassay (RIA), including an extraction step, and by screening fluoroimmnoassay (FIA) on blood spots in preterm infants.
Methods. Subjects were 39 healthy infants born at less than 31 weeks' gestational age. Each infant had weekly blood sampling, and RIA and FIA were performed on each sample.
Results. Two hundred twenty-seven samples were taken at 28 to 41 weeks' postconceptional age. Mean ± SD 17-OHP measured by RIA was 11.4 ± 11.1 nmol/L (0.4 ± 0.4 µg/dL), and decreased over time. Mean ± SD 17-OHP measured by FIA was 38.96 ± 37.3 nmol/L, greater than 17-OHP (RIA). Log(δFIA-RIA) was inversely related to postconceptional age (R2 = .39).
Conclusion. Screening FIA of blood spots overestimates levels of 17-OHP in preterm infants and should not be used to determine the likelthood of congenital adrenal hyperplasia in this population. We have abandoned FIA screening for congenital adrenal hyperplasia in infants weiging less than 1500 g.
Extralobar Pulmonary Sequestration Masquerading as a Congenital Pleural Effusion
Authors: Boyer Joseph , Dozor Allen , Brudnicki Adele , Slim Michel , Paliotta Marco , Kwark Hyun Ellen 
Published: December 2021

Congenital pleural effusions are uncommon. The majority of cases are due to chylothorax, hydropsfetalis, and infection. Effusions of this nature are, for the most part, self-limited. When these factors are eliminated, an extensive evaluation seeking uncommon causes needs to be performed. We present a rare case of a congenital unilateral pleural effusion due to an extralobar sequestration with pulmonary lymphangiectasia.
CASE REPORT
M.T. was a female born to a 35-year-old woman G1P0 at 34 weeks gestation by caesarean section as a result of fetal bradycardia. The mother developed gestational diabetes and hypertension during pregnancy, requiring insulin, nifedipine, and methyldopa. A third trimester ultrasound performed at 29 weeks gestation revealed a left pleural effusion.
Vocal Cord Paralysis as a Presentation of Intrauterine Infection With Varicella-Zoster Virus
Authors: Randel Randy C. , Kearns Donald B. , Nespeca Mark P. , Scher Colin A. , Sawyer Mark H. 
Published: December 2021

The association of maternal varicella-zoster virus (VZV) infection during pregnancy and congenital anomalies has been previously reported.1,2 Pregnancies complicated by maternal VZV infection have resulted in asymptomatic infants, the fetal varicella syndrome, and otherwise asmptomatic infants with herpes zoster. We report an infant who presented with bilateral vocal cord paralysis.
CASE REPORT
This 3 kg, white female infant was the product of a term gestation to a 29-year-old gravida 4, para 3, therapeutic abortion (TAB) 1 single female who received prenatal care. The mother tested negative for hepatitis B surface antigen and was rapid plasma reagent nonreactive. Pregnancy was complicated by maternal cannabis use.
Postexposure Prophylaxis of Varicella in Children With Leukemia by Oral Acyclovir
Authors: Ishida Yasushi , Tauchi Hisamichi , Higaki Aki , Yokota-Outou Yoshiko , Kida Kaichi 
Published: December 2021

In the August 1993 issue of Pediatrics, Asano et al presented the successful experience in postexposure prophylaxis of varicella for healthy children by oral acyclovir (ACV).1 They discussed that postexposure prophylaxis by oral ACV has not been examined in immunocompromised patients. We experienced three children with acute lymphoblastic leukemia (ALL) exposed to varicella and tried postexposure prophylaxis by oral ACV with informed consent of their parents.
[See Table in PDF file]
The characteristics of the patients are listed in the Table.
Identification of Children At Risk for Lead Poisoning: An Evaluation of Routine Pediatric Blood Lead Screening in an HMO-Insured Population
Authors: Haan Mary N. , Gerson Marianne , Zishka B. Anne 
Published: December 2021

Objectives. To estimate the prevalence of elevated blood lead levels in children receiving well-care checkups; and to evaluate the effectiveness of certain key risk factors in detecting children at higher risk for elevated blood lead levels.
Design. Cross-sectional study.
Setting. Two facilities of the Kaiser Permanente Medical Care Program (KPMCP) health maintenance organization (HMO), northern California region.
Patients. Six hundred thirty-six children, aged 12 to 60 months, who were seen at four KPMCP facilities in two subregions for a well-care checkup from September 1991 through August 1992.
Interventions. Blood samples were collected from each child and analyzed for lead content. Participating parents completed a questionnaire that included questions recommended by the Centers for Disease Control and Prevention (CDC) about the child's and the parents' lead exposure via home, workplace, and hobbies.
Results. Ninety-six percent of the children had blood lead levels under 10 µ/dL. Blood lead levels declined with increasing age and were higher for black children compared with whites. Age of residential housing, mother's education, and residence in an old house with peeling paint had low sensitivity and positive predictive value for identifying children with blood lead levels over 10 µ/dL.
Conclusion. Universal routine screening for elevated blood lead levels in children in an employed, HMO-insured population is not warranted on grounds of prevalence. Responses to CDC questions do not effectively identify high-risk children in this population.
Evaluation of Clinical Competence: The Gap Between Expectation and Performance
Authors: Joorabchi Bahman , Devries Jeffrey M. 
Published: December 2021

Objective. To evaluate a 3-year experience with the Objective Structured Clinical Examinations (OSCEs) and to compare faculty expectations with resident performance.
Design. Descriptive analysis of measures of resident performance.
Setting. Community-based pediatric residency program in Michigan.
Participants. One hundred twenty-six pediatric residents at all levels of training.
Methods. The three examinations consisted of 36 to 42 5-minute stations, testing skills in physical examination, history, counseling, telephone management, and test interpretation. A committee of faculty and chief residents predetermined minimum pass levels for each resident level. Results were compared with other indices of resident performance.
Results. There was evidence for content, construct, and concurrent validity, as well as a high degree of reliability. However, 40% to 96% of residents scored below the minimum pass levels for their levels. In each examination, third-year residents had the highest failure rates, yet they scored well on the American Board of Pediatrics in-training examination and on their monthly clinical evaluations. Furthermore, for residents at all levels, the scores reflecting application of data were significantly lower than those assessing data gathering.
Conclusions. The gaps between expectations and performance, and between data gathering and application, have important implications for institutional educational philosophy, suggesting a shift toward more clinically oriented and learner-directed strategies in the design of instructional and evaluation methods.
Tuberculosis Infection in Human Immunodeficiency Virus—Positive Adolescents and Young Adults: A New York City Cohort
Authors: Hoffman Neal D. , Kelly Colleen , Futterman Donna 
Published: December 2021

Objectives. Adolescents with human immunodeficiency virus (HIV) infection are at increased risk for tuberculosis (TB), underscoring the importance of early identification of TB infection. The goals of this study were to assess the factors associated with the completion of evaluations for TB in a cohort of HIV-positive adolescents and young adults and to describe the prevalence of Mycobacterium tuberculosis infection and adherence to antituberculous treatment regimens.
Methods. A retrospective chart review was done for all HIV-positive adolescents and young adults, ages 13 to 21 years (n = 49), seen in a comprehensive care program from January 1991 through December 1992. Data collected included CD4 cell count, HIV clinical status, living situation, substance use history, and the completion of an annual evaluation for TB infection. The evaluation consisted of a tuberculin skin test (Mantoux test), using an intraepidermal injection of 0.1 mL of 5 tuberculin units of purified protein derivative (PPD) and a simultaneous Merieux multitest anergy panel. Chi-square analysis was used to assess the association between the completion of the evaluation for TB and both living status and substance use.
Results. Thirty-one (63%) of 49 patients completed evaluations for TB. Of the 31 completed evaluations, 18 were assessed by clinic staff on site, and 13 were assessed by other medical or trained nonmedical observers through community networking efforts. Neither homelessness nor illicit substance use were factors in the completion of the evaluation. Six (19%) of the 31 patients had positive PPD skin test results. Three had medical histories and chest radiographs suggesting active TB, and all were hospitalized for at least 2 weeks. Two had positive cultures for M tuberculosis, although the third also responded clinically to antituberculous therapy. All three were otherwise asymptomatic for HIV infection, with only moderately depressed CD4 cell counts. All three were homeless and used crack cocaine. After the initial treatment as inpatients, none completed treatment within the prescribed time period.
Conclusions. The completions of the evaluations for TB were greatly facilitated by community networking, but innovative strategies to enhance both screening and treatment programs, such as training youth service providers in the community to read PPD skin tests, expansion of directly observed therapy services, and youth-centered programs for housing and substance use, need further development. The high prevalence of TB in the cohort underscores the need for providers to increase efforts to identify cases of TB infection among adolescents and young adults and to incorporate HIV risk assessment, counseling, and testing into their practices routinely.
How Accurately Can Bruises Be Aged in Abused Children? Literature Review and Synthesis
Authors: SCHWARTZ ARI J. , RICCI LAWRENCE R. 
Published: December 2021

Unlike the severe abuse that was reported in early child abuse literature, more moderate injuries comprise 60% of physical child abuse. These less-severe abuse cases, many with limited, ill-defined bruising, may be more difficult to diagnose than a severe case with multiple-system injury or a child with specific, clearly imprinted bruising. Additionally, as the US Supreme Court observed, "Child abuse is one of the most difficult crimes to detect and prosecute in large part because there often are no witnesses except the victim.
Estimates of ages of bruises along with the aging of other injuries such as fractures and brain trauma may offer the only way to associate an injury with a particular perpetrator. Yet, as an aid to child abuse diagnosis and perpetrator identification, visual aging of bruises remains an inexact science, despite recent composite charts that suggest otherwise.
Even though it has been stated that it is not possible to age bruises accurately based on color, these opinions have not been represented in the child abuse literature. The study of Langlois and Gresham, to date the only research-based study of bruise aging by appearance, has not yet been cited in the medical literature (Science Citation Index search, August 1994).
The available literature does not permit the estimation of a bruise's age with any precision based solely on color. Even for the practitioner to state, as Wilson suggests, that a particular bruise is "consistent with" a specific age implies a level of certainty not supported by the literature.
Bruises may be described as "older" if yellow, brown, or green are present, but practitioners should note the limitations of bruise age analysis. Of course, the practitioner must continue to describe the size, shape, location, and color of each bruise accurately. This is best done by written description and drawings along with careful photographic representation. Photographs of a bruise, however, depending on available light and technique, may not represent color accurately. A standard color wheel in the photograph may help.
Future research should focus on a number of questions. A study of the aging of bruises, using contusions of known age and history-blinded examiners, could determine how accurate clinical estimates are. Interobserver reliability may also be assessed in such a study. The study of Langlois and Gresham should be repeated to confirm or to refute their findings. A photographic sequence of various bruises from appearance to resolution would give researchers and clinicians a reference of possible colors in different-aged bruises for standardized description.
The estimated age of a bruise should never be the sole criteria for a diagnosis of child abuse, but, rather, one component of a comprehensive assessment that incorporates a careful history of the injury, past medical history, family history, associated risk factors, a detailed physical examination, and appropriate laboratory testing.
Cognitive and Academic Functioning of Homeless Children Compared With Housed Children
Authors: Rubin David H. , Erickson Candace J. , Agustin Mutya San , Cleary Sean D. , Allen Janet K. , Cohen Patricia 
Published: December 2021

Background. During the past 10 years, the number of homeless families has increased in every region of the United States. Despite several studies of this population, there are few data regarding the cognitive functioning of these homeless children. The aim of this controlled study was to determine the effect of homelessness on cognitive and academic functioning of children aged 6 to 11 years.
Methods. Homeless children (N = 102) and their mothers living in shelters were compared with a housed group of children (N = 178) and their mothers selected from the homeless child's classroom in New York City between August 1990 and August 1992. Groups were compared using standardized cognitive and academic performance instruments.
Results. Controlling for child's age, sex, race, social class, and family status, verbal intelligence (estimated by the Peabody Picture Vocabulary Test) and nonverbal intelligence (estimated by the Raven's Progressive Matrices) were not significantly different between the groups. However, academic achievement (measured by the Wide Range Achievement Test-Revised [WRAT-R]) was significantly poorer in reading (75% of homeless children compared with 48% of housed children were below grade level), spelling (72.4% of homeless children compared with 50% of housed children were below grade level), and arithmetic (53.6% of homeless children compared with 21.7% of housed children were below grade level). These dramatic differences in academic performance did not appear to be related to the mother's report of the number of days missed from school or the length of homelessness, but were associated with: (1) the number of school changes for the WRAT-R reading subtest, and (2) grade repetition for the WRAT-R spelling subtest.
Conclusions. These data demonstrate no difference in cognitive functioning between homeless and housed children. However, homeless children performed significantly more poorly than housed children in tests of academic performance.
The Association Between Parental Smoking and the Diet Quality of Low-income Children
Authors: Johnson Rachel K. , Wang MinQi , Smith Melissa J. , Connolly Gregory 
Published: December 2021

Objective. To assess the association between parental smoking and the diet quality of children residing in low-income households in the United States.
Methods. Data from 515 low-income children (less than or equal to 185% of the poverty line), ages 2 to 17, who participated in the 1989 and 1990 United States Department of Agriculture Continuing Survey of Food Intakes of Individuals were examined. Diet quality was assessed by examining the average daily amount of nutrients consumed per 1000 kcal for protein, fiber, and 14 essential vitamins and minerals as well as total energy, percent of energy from total fat and saturated fat, and cholesterol and sodium intakes using the 3-day average of one 24-hour recall and 2 days of diet records. Parental smoking was categorized as four levels (nonsmoker; 1 to 10, 11 to 20, and more than 20) on the basis of the average number of cigarettes smoked per day by the sample child's parents. Analysis of covariance examined differences in the children's nutrient intake among the four smoking categories while controlling for race, mother's age and occupation, child age, and sex.
Results. Low-income children with parents who smoked (n = 235) were more likely to be white (P &lt; .001), had younger mothers (P &lt; .05), and were more likely to have mothers employed in blue-collar occupations (P &lt; .001) than children whose parents were nonsmokers (n = 280). Children whose parents smoked 11 or more cigarettes per day had lower vitamin A intakes and higher total energy and sodium intakes than children whose parents smoked ten or fewer cigarettes per day. Children whose parents smoked more than 20 cigarettes per day had a higher percentage of energy from saturated fat, and children whose parents smoked 11 to 20 cigarettes per day had the highest cholesterol intakes in comparison with the rest of the sample. Parental smoking was also related to total fiber intake per 1000 kcal, with children of smokers having lower fiber intakes than children of nonsmokers.
Conclusions. On average, low-income children of smokers had a poorer diet quality than low-income children of nonsmokers, thus increasing their future risk of chronic disease.