bluuebunny/crossref_metadata_2025_split huggingface dataset:
Update on Timing of Hepatitis B Vaccination for Premature Infants and for Children With Lapsed Immunization
Authors:   Committee on Infectious Diseases
Published: December 2021

The American Academy of Pediatrics (AAP) and the United States Public Health Service have recommended immunization of all infants with hepatitis B vaccine.1,2 Although several immunization schedules have been shown to be effective in infants and children, the AAP recommends that the first dose be administered to newborns before they leave the hospital. Alternative schedules beginning between birth and 2 months of age also are acceptable and have been adopted in many practices. These recommendations were based on studies performed in numerous populations demonstrating high immunogenicity when the vaccines were administered in accordance with the manufacturers' approved doses and schedules.
In the previous AAP recommendations, similar latitude was given in the initiation of vaccine schedules for premature infants born to women who were hepatitis B surface antigen (HBsAg)-negative. For premature infants and other infants with illnesses in the first few days of life, pediatricians were advised that administration of hepatitis B vaccine could be delayed until hospital discharge, although it was implied that premature infants should receive hepatitis B vaccine at the same chronologic age as recommended for term infants.3
HEPATITIS B VACCINE IN PREMATURE INFANTS
Studies have revealed, however, that the percentage of infants that develop protective levels (≥10 mIU/mL) of antibody to HBsAg (anti-HBs) and the final anti-HBs concentrations may be lower in premature infants given the recombinant hepatitis B vaccines beginning at birth than if the initial dose is delayed until they are older or weigh more than 2000 g.4-6 In one study,4 the response rate for premature infants who received their first dose of Engerix-B vaccine at a weight of either 1000 to 1999 g or 2000 g or more was 79% and 91 %, respectively; the response rate was 100% for normal term infants.
The Challenge of Day-Care Health Among Children With Disabilities
Authors: Parrino Sandra S. , Thacker Stephen B. 
Published: December 2021

It is not enough that people know of their responsibilities and the opportunities offered by laws and regulations; they must have information about the best way to meet their responsibilities. We do not want employers, businesses, schools, and others to feel frustrated because they are unable to get clear answers to their questions on because the kind of information needed to make successful accommodations have not been developed. Thus, we must identify and use the best ways to provide information about helping the day-care community to help our children with disabilities and their families.
We believe prevention in persons with disabilities is a moral issue. Simply stated, if we keep people alive from fatal conditions, then we must assume an obligation to promote the quality of their lives and this must begin with the quality of their health. It is no exaggeration to say that the way a society treats its citizens with disabilities is a valid measure of the quality of life in that society.
The end of the United Nations Decade of Disabled Persons should mark the beginning of a new and sustained effort to translate words into action, worldwide, as we approach a new century when disability rights become the norm in all nations throughout the world.
Never before in history have human actions so directly shaped the future, both intentionally and unintentionally, for good and for ill. And there is no better example than disability. We have the opportunity to create the future we desire—to use our best efforts to invent a future that is humane and empowering both for people with disabilities and for people at risk for disabilities, which together includes us all. An international vision for the prevention of disability and for the care of our children with disabilities in day-care settings will not come into being without sustained effort and commitment of the global public health community.
The Role of the Public Health System in Child Day-Care Health
Authors: Novello Antonia C. 
Published: December 2021

Why have we not convinced our citizens that day-care for children warrants greater attention, given the demonstrated needs in day care and the importance of this issue for the future of the world? Some reasons are obvious; other issues compete for our attention. Still, our children are our future, and we increasingly depend on day-care providers to nurture and protect this investment. If that is the case, then we must empower them for the benefit of the children. Yet, before high-quality day care can even be considered for the nation's children, before appropriate resources can be brought to bear on this issue, our society must first recognize that there is a problem—the solution for which requires collective involvement of the people in your community, your state, and in your country.
Researchers must continue to do excellent science. Clinicians must continue to provide the best-quality patient care. Day-care providers must seek to continue giving the best possible care to the children entrusted to them. At the same time, if we focus only on what directly relates to our immediate responsibilities, many years will pass before high-quality day care for children becomes an integral part of our global society. The consequences of such inaction are frightening; the children deserve better.
The time has come to move forward. I challenge the CDC to convene a workshop that includes the cosponsors of this conference to begin establishing a global agenda for preventing disease and injury and promoting health in child day-care settings. All of us are eager to work with other members of the global community to continue this critical effort on behalf of our children.
When all of us go back to our states, to our communities, to other countries, to our families, our impressions will be that we came together because we had a purpose, because we had a mission, but most importantly, because we care for our children.
Natural History of Vertically Acquired Human Immunodeficiency Virus-1 Infection
Authors:   The European Collaborative Study
Published: December 2021

Objective. To describe the natural history of vertically acquired human immunodeficiency virus (HIV) infection.
Design. This was a prospective follow-up study.
Setting. Ten centers of the European Collaborative Study participated.
Subjects. One hundred twenty-four HIV-infected children were born to women known to be infected at or before the time of delivery since 1986.
Main outcome measures. Deaths, acquired immunodeficiency syndrome (AIDS), and HIV-related symptoms and signs were assessed.
Results. In this cohort, treatment before the onset of AIDS was not universal. Less than 10% of children were treated with Zidovudine or intravenous gamma globulin before 6 months of age, with a steady increase to about 40% after 3 years of life. An estimated 23% (95% confidence interval: 15% to 31%) of infected children develop AIDS before the age of 1 year, and nearly 40% (27% to 50%) by 4 years. Ten percent (5% to 16%) die before age 1 year and 28% (16% to 41%) before age 5 years. Twenty-four months after the AIDS diagnosis, an estimated 48% (36% to 70%) of the children are still alive. Although after the age of 1 year immunologic abnormalities became increasingly common, the proportion of infected children with significant HIV-related symptoms or signs declined.
Conclusion. The progression of disease in this cohort of vertically infected children was not as fast as previously suggested, even though treatment was not widespread. Although infected children have a high risk of developing some manifestation of HIV infection early in life, serious HIV-related symptoms became less frequent with increasing age. This has important implications for health planning and care provision.
Pediatric Thyroid Nodules: Disease Demographics and Clinical Management as Determined by Fine Needle Aspiration Biopsy
Authors: Raab Stephen S. , Silverman Jan F. , Elsheikh Tarik M. , Thomas Patricia A. , Wakely Paul E. 
Published: December 2021

Objective. The prevalence of thyroid nodularity in children has been estimated to be 1.8%. The reported prevalence of specific diseases which comprise these nodules is conflicting as evidenced by a reported range of malignancy of 2 to 50% in solitary nodules. In order to better classify pediatric (&lt;18 years old) thyroid disease and evaluate the utility of fine needle aspiration biopsy (FNAB) in this patient population, we retrospectively reviewed 66 FNABs from 64 thyroid nodules and 2 perithyroid lymph nodes from 57 patients.
Methodology. Patients: The study was composed of 8 males and 49 females who ranged in age from 1 to 18 years old (mean = 13.1). Design: Surgical and/or clinical follow-up was obtained in all patients. The 66 FNAB diagnoses were initially classified into specific diseases. However, for the purpose of this review, the cases were classified as: 3 insufficient, 51 benign, 8 suspicious, and 4 malignant.
Results. There were no "false positives" and one "false negative" (a papillary carcinoma was misdiagnosed as a benign nodule). Overall, 10 patients (18%) had malignant thyroid lesions, including 8 papillary carcinomas and 2 follicular carcinomas. Benign diagnoses included benign nodule, cyst, lymphocytic thyroiditis, granulomatous thyroiditis, hyperplasia, and abscess.
Conclusions. The prevalence of malignancy in pediatric patients with thyroid nodules was 18%. We conclude that, because of its high diagnostic accuracy and minimal invasiveness, FNAB is useful in the management of pediatric thyroid nodules.
Energy Expenditure and Body Fat Distribution in Mohawk Children
Authors: Goran Michael I. , Kaskoun Mary , Johnson Rachel , Martinez Charlene , Kelly Benson , Hood Virginia 
Published: December 2021

Objective. Epidemiologic studies suggest that Native Americans, including the Mohawk people, have a high prevalence of obesity, diabetes, and cardiovascular risk. However, current information on alterations in related variables such as energy metabolism and body composition in Native Americans is almost exclusively limited to already obese Pima adults living in the Southwest. The aim of this study was to characterize energy metabolism and body composition in young Mohawk children (17 girls, 11 boys; aged 4 to 7 years) as compared to Caucasian children (36 girls, 34 boys; aged 4 to 7 years). Total energy expenditure was measured by doubly labeled water, postprandial resting energy expenditure by indirect calorimetry, and activity energy expenditure was derived from the difference between total and resting energy expenditure. Fat and fat free mass were estimated from bioelectrical resistance, and body fat distribution was estimated from skinfolds and circumferences.
Results. There were no significant effects of ethnic background or sex on body weight, height, or body mass index. Fat free mass was significantly higher in boys and fat mass was significantly higher in girls, with no effect of ethnic background. Chest skinfold thickness, the ratio of trunk skinfolds:extremity skinfolds, and the waist:hip ratio were significantly higher in Mohawk children by 2.5 mm, 0.09 units, and 0.03 units, respectively, independent of sex and fat mass. Total energy expenditure was significantly higher in Mohawk children compared to Caucasian (100 kcal/day in girls, 150 kcal/day in boys), independent of fat free mass and sex, due to a significantly higher physical activity-related energy expenditure.
Conclusion. These data suggest that: 1) body fat is more centrally distributed in Mohawk relative to Caucasian children, and this effect is independent of sex and body fat content; 2) Mohawk children have a greater total energy expenditure than Caucasian children, independent of fat free mass, due to greater physical activity-related energy expenditure.
Thermophilic Amylase-Digested Rice-Electrolyte Solution in the Treatment of Acute Diarrhea in Children
Authors: Lebenthal Emanuel , Khin-Maung-U  , Rolston David D.K. , Khin-Myat-Tun  , Tin-Nu-Swe  , Thein-Thein-Myint  , Jirapinyo Pipop , Visitsuntorn Nualanong , Firmansyah Agus , Sunoto Sunoto , Bakri Achirul , Ismail Rusdi , Shin Kenji , Takita Hitoshi , Boatwright Doyle , Monte Woodrow 
Published: December 2021

Objective. To compare the efficacy of an oral rehydration solution (ORS) containing short polymers of glucose derived from rice (Amylyte-ORS) and five times the caloric density of current ORS to the standard glucose-ORS (World Health Organization [WHO] = ORS) in the treatment of acute diarrhea in children.
Methods. The rice ORS (Amylyte-ORS) was obtained by adding thermophilic amylase (252 500 MW units) and salts (1.5 g NaCl, 600 mg KCl, and 150 mg CaCl2) to 100 g rice and boiling for 10 minutes in 500 mL water. This yields 250 mL Amylyte-ORS, which contains 92% to 96% short-chain glucose polymers, three to nine molecules in length, and provides 425 kcal/L, compared to 80 kcal/L for the WHO-ORS. One hundred forty-four male children, 4 months to 3 years of age, presenting with acute diarrhea and mild, moderate, or severe dehydration, were assigned by random allocation to receive either WHO-ORS or Amylyte-ORS. Data from 127 children were analyzed (57 received the WHO-ORS and 70 the Amylyte-ORS). Two children given Amylyte-ORS and 15 given the WHO-ORS were not included in the analysis because of improperly collected data or lost urine or fecal specimens. None were given antibiotics during the study. Free water and feeding were allowed after the children were rehydrated.
Results. The clinical characteristics of the children in the two treatment groups were comparable. Five children who received the WHO-ORS and three children given Amylyte-ORS were treatment failures. Amylyte-ORS reduced diarrhea duration by 15% (41.4 ± 2.5 vs 34.7 ± 1.8 hours; P &lt; .03) compared to the WHO-ORS, regardless of the severity of dehydration. In the Amylyte-treated group, ORS requirements were significantly less (234 ± 15.2 vs 295 ± 17.6 mL/kg P &lt; .01) and weight gain was significantly more (367.7 ± 45.1 vs 199.2 ± 38.2 g; P &lt; .01) than in those given the WHO-ORS. The net intestinal fluid balance and total body fluid balance were similar in the two groups.
Conclusions. Amylyte-ORS efffectively rehydrates children with acute diarrhea, reduces diarrhea duration, decreases ORS requirements, and improves weight gain compared to the WHO-ORS.
Guidelines for the Ethical Conduct of Studies to Evaluate Drugs in Pediatric Populations
Authors:   Committee on Drugs
Published: December 2021

These guidelines are designed to provide a format allowing for the protection of child subjects in drug research. Research involving children carries with it additional responsibilities for the investigator, IRB, and sponsor. The additional responsibilities should not be reasons for the pharmaceutical company, IRB, or the investigator to exclude children from drug research and its potential benefits. It is hoped that these guidelines foster an increase in the number of drug investigations carried out in children, thereby improving their health care.
The AAP believes it is unethical to deny children appropriate access to existing and new therapeutic agents. It is the combined responsibility of the pediatric community, pharmaceutical industry, and regulatory agencies to conduct the necessary studies; it is the responsibility of the general public to support the necessary research in order to assure that all children have access to important medications and receive optimal drug therapy.
Medication Dispensing in Pediatric Office Practice
Authors:   Committee on Practice and Ambulatory Medicine
Published: December 2021

The changing practice of dispensing medication in pediatric offices needs ongoing evaluation to determine the extent to which patients' and practice's needs are being met. Research should assess the extent to which in-office dispensing enhances patient compliance and patient education or whether it increases or decreases patient medication errors. Pediatricians choosing to dispense medication should monitor such research carefully, review state and federal laws periodically, and evaluate recommendations from professional organizations.
The American Academy of Pediatrics holds that the practice of medication dispensing is acceptable and appropriate provided that it is legally permissible and that it is structured primarily to serve the best interests of the patient.
HOW TO PUT HYPED STUDY RESULTS UNDER A MICROSCOPE
Authors: L. J. F. 
Published: December 2021

Every week medical science makes headlines with a promising new study or cure. Scientific reputations, corporate fortunes and a tide of human hopes rise and fall on such news. Studies can also stoke the general debate on this or that health benefit or risk.
Often it's hard to tell ephemeral findings from epochal breakthroughs...
A major problem arises when "things get taken out of context," says Oxford University professor Richard Peto.
When researchers tease out selective results from a small subgroup, funny results can pop up. You can prove just about anything by slicing and dicing the data. Here is Peto's Proof:
Taking a landmark study of 17 000 patients that proved aspirin as an effective treatment for heart attack, Dr. Peto shows you can reach a vastly different conclusion if you simply separate patients by their astrological sign. "Aspirin appeared totally ineffective for those born under Libra or Gemini," he concludes.
STUDIES REVEAL SUGGESTIBILITY OF VERY YOUNG WITNESSES
Authors: L. J. F. 
Published: December 2021

The testimony of small children has usually been considered truthful unless proved otherwise. Over the past decade such testimony has led to convictions in many child abuse cases, and the younger the child, the less likely psychologists have thought it was that information could have been fabricated. But now a series of recent studies has turned this conventional wisdom on its head.
Researchers have found new evidence that persistent questioning can lead young children to describe elaborate accounts of events that never occurred, even when at first they denied them...
Children Concoct Stories
Certain techniques often used by investigators with young children increase the likelihood of false reports, the findings show. One is persistent, repeated questioning over periods of several weeks. When sexual abuse is suspected, children are typically asked the same questions by case workers, police investigators and to results of a study by Dr. Ceci and colleagues reported last month at a meeting on emotional memory at the University of Chicago.
In the study of children from 4 to 6, parents helped researchers make a list of two events that had occurred in each child's life and eight that had not. In weekly sessions, the researchers reviewed the list with each child, asking for each event, "Has this every happened to you?"...
...By the 11th week, 56 percent of children reported at least one false event as true, and some children reported all the false events as true, Dr. Ceci said.
"The more often you ask young children to think about something, the easier it becomes for them to make something up that they think is a memory," he said.
INTERNATIONAL LACTATION CONSULTANT ASSOCIATION ANNOUNCES 1996 MANUSCRIPT COMPETITION
Authors: Auerbach K. G. 
Published: December 2021

The International Lactation Consultant Association is sponsoring a competition designed to identify outstanding manuscripts relating to human lactation or breast-feeding in 1996. Authors may enter one of two categories: a Literature Review competition or a Research Paper competition. The winner in each category will receive $500 (US currency); winning manuscripts will be published in the Journal of Human Lactation. Entrants need not be members of the International Lactation Consultant Association. Students are encouraged to enter.
Competition in the Research Paper competition is open to published on unpublished authors; the Literature Review competition is limited to currently unpublished authors. The postmark deadline for entry in the 1996 competition is January 5, 1996.
To obtain guidelines for submitting a manuscript for consideration in the competition, send a self-addressed (and stamped if US) envelope to:
United States Supreme Court Rules on Expert Testimony
Authors: McAbee Gary N. 
Published: December 2021

Many medical and legal commentators have expressed concern about the validity of scientific evidence that is proffered by expert witnesses at depositions and in courts of law.1,2 The sparse research that is available on the testimony of medical expert witnesses suggests that it is frequently flawed and erroneous.3
On June 28, 1993, the United States (US) Supreme Court ruled on the proper standard for admissibility of scientific evidence in the courtroom.4 Although the ruling establishes guidelines that are binding only in federal courts, it is expected that many state courts will follow the Court's ruling. This commentary reviews the Court's guidelines for admissibility of expert testimony, and expresses concern about their applicability in future cases involving scientific testimony.
A HOUSEWIFE IS CONVICTED OF MURDERING HER FIVE CHILDREN
Authors: L. J. F. 
Published: December 2021

For nearly a quarter century, the fact that Waneta Hoyt, a housewife in rural New York, had lost five babies to sudden deaths was taken as medical evidence that sudden infant death syndrome (SIDS) had a genetic basis.
A leading SIDS expert, Dr Alfred Steinschneider, had studied Mrs. Hoyt's last two children, and in a pioneering research article in 1972 (Pediatrics, Vol 50, Number 4, page 646) he cited them as evidence that SIDS ran in families. His study offered hope that children at risk could be identified and saved.
But some doctors found the odds of five siblings dying of SIDS impossible. For years one skeptic, Dr Linda Norton, a forensic pathologist from Dallas, mentioned the case to every district attorney she met.
Finally, one of them, Robert Simpson, listened. In 1994, Mrs. Hoyt was confronted by state troopers, and she confessed to smothering the infants with a pillow to still their crying.
On Friday a jury in Tioga County, in upstate New York, accepted Mrs. Hoyt's belated explanation of her babies' deaths and convicted the 48-year-old woman of five murders.
Sudden infant death is real, but the import of multiple deaths can be badly misinterpreted. These deaths were certainly familial, "but not because of genetics," Dr Norton said. "It's because there was a murderer in the family."