bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Role of the Physical and Traffic Environment in Child Pedestrian Injuries
Authors: Agran Phyllis F. , Winn Diane G. , Anderson Craig L. , Tran Cecile , Del Valle Celeste P. 
Published: December 2021

Objective. To identify environmental risk factors on residential streets for pediatric pedestrian injuries.
Method. The sample consisted of 39 Latino children 0 to 14 years of age injured as pedestrians on a street in the same block as their home and 62 randomly selected neighborhood control subjects matched to the case by city, age or year of birth, ethnicity, and gender. The cases were identified from a population-based hospital and coroner's office surveillance system established in north-central Orange County, CA. Neighborhood assessments were performed from 3:45 PM to 5 PM, a fairly active time for young pedestrians. The cases were compared with the controls using conditional logistic regressions; in this study design, the odds ratios were interpreted as estimates of the incidence rate ratios.
Results. Children living in a multifamily residence had an incidence of injury greater than that of children living in single-family residence on a single lot (odds ratio [OR] 3.1, 95% confidence interval [CI] 1.3-7.6). The ORs in the highest category were several times those in the lowest category for both parked vehicles (OR 9.6, 95% CI 2.6-36) and total number of pedestrians observed (OR 4.7, 95% CI 1.4-16). Vehicle parking, total pedestrians, vehicular traffic volume, and speed were examined in a multivariate model. The association of vehicles parked on the street with pedestrian injury risk remained significant. Unlike the crude results, progressively greater vehicular speed was associated with a marked increase in risk. Progressively higher vehicular traffic volume was associated with a progressively lower adjusted OR.
Conclusion. The results of this analysis would indicate that residential streets with a high proportion of multifamily residences, over 50% of the curb occupied with parked vehicles, and a large number of pedestrians observed in unenclosed areas should receive high priority for intervention programs to reduce pediatric pedestrian injuries. The analysis suggests that on these streets, measures to reduce the amount of street parking (thus increasing visibility) and reductions in vehicular speed should be considered to decrease pedestrian injuries.
Effect of Zinc Supplementation on Observed Activity in Low Socioeconomic Indian Preschool Children
Authors: Sazawal Sunil , Bentley Margaret , Black Robert E. , Dhingra Pratibha , George Sherly , Bhan Maharaj K. 
Published: December 2021

Objectives. To investigate whether supplementation of zinc in preschool children is associated with improvement in observed activity levels.
Methods. On 2 consecutive days, we performed 5-hour observations with momentary time sampling (instant activity every 10 minutes) in children selected from an ongoing double-blind, randomized trial of zinc supplementation. The study was conducted in Kalkaji, a low-socioeconomic urban population of New Delhi with high diarrheal incidence and rates of malnutrition. A total of 93 children (48 zinc and 45 control) 12 to 23 months of age from an ongoing community-based, randomized, controlled trial received supplements for at least 1 month before study; 71% had received supplementation for more than 120 days. Zinc gluconate (10 mg of elemental zinc) was given daily, with both zinc and control groups receiving vitamins A, B1, B2, B6, D3, and E and niacinamide in addition.
Results. Outcomes were percentages of time spent in each of five activity levels and two groups representing high and low movement and overall rating by two activity scores. Children in the zinc group spent 72% more time performing activities in the high-movement group. Among the zinc-supplemented children, the activity rating by the children's activity rating score was 12% higher and by the energy expenditure score was 8.3% higher than in the control group.
Conclusions. In conclusion, zinc supplementation, given along with selected vitamins, was associated with significantly greater activity levels in children. The relationship between the activity increase and locomotor development needs to be investigated, as do the long-term implications of zinc supplementation in terms of developmental status and school performance.
Use of Diet History in the Screening of Iron Deficiency
Authors: Boutry Mireille , Needlman Robert 
Published: December 2021

Objective. To determine the relationship between diet history and microcytic anemia, a proxy for iron deficiency, and the utility of a brief dietary history in screening for microcytic anemia.
Design. Cross-sectional study based on review of clinical records.
Setting. Urban academic primary care clinic.
Subjects. A total of 305 healthy, African-American inner-city children, presenting for well child care at 15 to 60 months of age. Children with recent minor illness or medicinal iron intake, hemoglobinopathies, chronic illnesses, failure to thrive, or elevated lead levels were excluded.
Method. A brief dietary history was taken in the course of primary care visits. Dietary deficiency was defined as: (1) less than five servings each of meat, grains, vegetables, and fruit per week; (2) more than 16 oz of milk per day; or (3) daily intake of fatty snacks, sweets, or more than 16 oz of soft drink. Hematologic indices were obtained.
Results. The prevalence of microcytic anemia (hemoglobin, &lt; 11 g/dL; mean corpuscular volume, &lt;73 fL) was 8% (24 of 305). The prevalence of low hemoglobin (&lt;11 g/dL) with or without microcytosis was 12% (38 of 305). Dietary deficiency was associated with microcytic anemia (x2 = 26.8). As a screening test for microcytic anemia, dietary deficiency had a sensitivity of 71% (17 of 24), specificity of 79% (222 of 281), and negative predictive value of 97% (222 of 229).
Conclusion. Microcytic anemia was associated with a deficient diet among low-income African-American children. A brief dietary history correctly identified children at low risk for microcytic anemia 97% of the time.
Serial Assessment of Ductus Arteriosus Hemodynamics in Hyaline Membrane Disease
Authors: Phillipos Ernest Z. , Robertson Murray A. , Byrne Paul J. 
Published: December 2021

Objectives. To assess the efficacy of Doppler echocardiography (DE) in the quantification of patent ductus arteriosus (PDA) shunt volume and to correlate PDA shunt volume with clinical outcome in infants with hyaline membrane disease.
Methods. Ninety-eight DE studies were performed in 30 preterm ventilated infants with hyaline membrane disease within the first 24 hours of age and then at 48-hour intervals to a maximum of three studies while ventilated with a final study after extubation. Right and left ventricular outputs (QRV and QLV, respectively) and PDA flow were calculated using cross-sectional area and flow velocity integrals. Left atrial-to-aortic root diameter measurements were also taken. Clinical outcomes were correlated with the shunt fraction (QLV/QRV).
Results. QLV/QRV demonstrated a linear relationship with the left atrial-to-aortic root diameter ratio (n = 92; r = .79). In the absence of a PDA (n = 33 studies), QRV versus QLV demonstrated a linear relationship (r = .88). In the presence of a PDA (n = 64 studies) the mean QLV (334 ± 133 ml/kg per minute) was significantly greater than the mean QRV (237 ± 84 ml/kg per minute). There was a linear relationship between QLV - QRV (PDA shunt volume) and PDA flow (n = 60; r = .84). In studies with exclusive left-to-right shunting at the PDA (n = 48), the mean QLV - QRV (112 ± 83 ml/kg per minute) was significantly higher than in those with bidirectional shunting (n = 16; mean QLV - QRV = 50 ± 27 ml/kg per minute). Two infants with severe intraventricular hemorrhage (IVH grade 3) and two infants with periventricular leukomalacia (PVL) had significantly higher QLV/QRV (2.09 ± 0.36 and 1.67 ± 0.02 respectively) than those with no IVH (n = 6; QLV/QRV = 1.31 ± 0.18) or those with IVH grades 1 and 2 (n = 8; QLV/QRV = 1.48 ± 0.27). There was no difference in QLV/QRV in infants with or without bronchopulmonary dysplasia retinopathy of prematurity. Necrotizing enterocolitis did not develop in any of the 30 infants.
Conclusion. PDA shunt volume can be quantified by DE. Larger studies are needed to correlate clinical outcome with QLV/QRV.
Cognitive and Neurologic Development of the Premature, Small for Gestational Age Infant Through Age 6: Comparison by Birth Weight and Gestational Age
Authors: McCarton Cecelia M. , Wallace Ina F. , Divon Michael , Vaughan Herbert G. 
Published: December 2021

Objective. To compare the neurologic and cognitive outcomes of 129 premature small for gestational age (SGA) infants with 300 premature appropriate for gestational age (AGA) infants through 6 years of age.
Design. Infants born at ≤37 weeks gestational age and ≤2500 g with birth weight 2 standard deviations or more below the mean birth weight for gestational age were categorized as SGA. Cognitive and neurologic outcomes of SGA and AGA prematures at 1, 2, 3, and 5 and/or 6 years of age were compared when the infants were stratified by gestational age in 2-week intervals or by birth weight in 500-g intervals. The association between SGA/AGA and neurologic status on cognitive outcomes at each age was also examined.
Results. SGA infants had significantly poorer cognitive scores at each age when compared with AGA infants of similar gestational ages. Normal neurologic status was more likely at all assessments for the AGA than for SGA infants of comparable gestational age. There were no differences between SGA and AGA children in cognitive or neurologic outcomes at any age when grouped by birth weight. Cognitive impairment was closely associated with neurologic abnormality in both SGA and AGA groups. There was, nevertheless, a significant effect of SGA on cognitive outcome independent of neurologic status at all ages except 3 years.
Conclusions. Irrespective of degree of prematurity, SGA infants are at greater risk for neurodevelopmental impairment than are equally premature AGA infants. The cognitive impairment can be largely, but not entirely, attributed to a higher incidence of neurologic abnormalities in the SGA infants at each gestational age.
The Pediatrician's Role—Shrinking and Shrinking!
Authors: BURKE BRYAN L. 
Published: December 2021

The article entitled "Physician Experience With Pediatric Inpatient Care in Washington State" that appeared in the January 1996 issue of Pediatrics disturbs me. The trend toward the deemphasis of the primary care pediatrician in the care of hospitalized children is one with which I disagree for the following reasons.
First, as the article acknowledges, pediatricians who practice in a rural setting need to know how to care for a critically ill child. If we elect to teach pediatric residents only the skills necessary for outpatient care, we will either be sending incompletely trained pediatricians to rural areas, or we will be worsening the trend toward pediatrician and physician geographical maldistribution by training pediatricians who will not feel comfortable practicing in rural areas, thereby virtually ensuring their choice of an urban area in which to practice.
Does Adenosine Infusion Improve Oxygenation in Term Infants With Respiratory Failure?
Authors: LEBLANC MICHAEL H. 
Published: December 2021

I read with interest the article by Dr. Konduri et al in the March 1996 issue of Pediatrics entitled "Adenosine Infusion Improves Oxygenation in Term Infants With Respiratory Failure."
This article demonstrated that at 50 µg/kg/min adenosine infusion improved the oxygenation of term infants with persistent pulmonary hypertension. My concern is whether this dose of adenosine is, in fact, safe. A dose of 50 µg/kg/min of adenosine amounts to 72 mg/kg/day.
Neonates typically excrete only about 5 mg/kg/day of uric acid, which corresponds to approximately 8 mg/kg/day of adenosine.
Comments of a Reactor Panel
Authors: Applebaum Michael 
Published: December 2021

First, let me just say that managed care means different things to different people. I want to give you my personal perspective on pediatric residency training in community settings based on my own experiences in a nonprofit, physician-directed managed care system, Kaiser Permanente Health Care Plan, that has a 50-year history. My experience is, therefore, probably somewhat unusual and different from that of many other physicians throughout the country.
As I wandered back and forth among the various workshops during this conference, managed care was a prominent theme in most. I am going to restrict my comments to three areas: recruitment, evaluation, and financing.
With regard to recruitment, managed care systems are likely to have a strong interest in developing strategic alliances with academic teaching centers, but this interest is based on a reciprocity of needs. These kinds of alliances can only flourish when there is mutual trust that emerges after a variety of discussions at several levels.
Managed care systems can be encouraged, then, to participate actively in teaching programs, and they may be significant sources for recruiting teaching faculty. Some managed care systems can provide stable, multicultural patient populations that are derived from the communities in which they practice. Continuity experiences provided to residents focus on health and prevention issues as opposed to disease orientation. Managed care systems can be rich resources for population research in which residents can participate.
Another issue has not been raised here to any major extent, as far as I know. Teaching residents in a community setting can also involve inpatient care in a community hospital.
Editorial 2 Pediatrics in Review
Authors: Kendig Edwin L. 
Published: December 2021

With this first issue of PEDIATRICS IN REVIEW the American Academy of Pediatrics' sponsored pediatric review and education program (PREP) has been launched. The program is multifaceted and will be coordinated with the American Board of Pediatrics program for recertification in pediatrics. Medical education (continuing education) has always been the Academy's highest priority and PREP is the most recent and most comprehensive of all Academy education programs.
Maintaining professional competence is a responsibility of every pediatrician and PREP is a coordinated program of continuing education designed to help pediatricians maintain and assess their own competency. The objectives for PREP (and for the American Board of Pediatrics recertification program) are: (1) To help pediatricians acquire new abilities in the management of acute and chronic illness in infants, children and adolescents; these abilities include attitudes (work habits), knowledge and clinical judgment, interpersonal (communication) skills, and technical skills; (2) To help pediatricians, through a program of self-assessment procedures, set their own priorities for professional advancement and to determine when their goals have been met.
Fluid and Electrolyte Therapy in Low Birth Weight Infants
Authors: Oh William 
Published: December 2021

Infants with respiratory distress syndrome (RDS) often require parenteral fluid therapy during the course of acute respiratory illness due to difficulty giving oral feedings. Errors in prescribing the fluid treatment may lead to either dehydration or fluid overload, partly due to the limitations in renal compensatory mechanism in these infants. Therefore, inappropriate fluid and electrolyte management in infants with RDS may lead to metabolic complications, dehydration, poor nutritional support, and additional cardiopulmonary complications because of the fluid overload. This article provides a brief review on the principles of fluid and electrolyte management in infants with RDS with the aim of minimizing the complications of such therapy.
MAINTENANCE FLUID REQUIREMENT
The maintenance fluid requirement should consist of allowances for (1) insensible water loss, (2) water for urine formation, (3) water loss through the stool, and (4) in a growing infant, water required for tissue growth. In low birth weight infants, insensible water loss is higher than in term infants.1,2 The water required for urine formation is dependent on solute excretion which in turn is dependent on the amount of solute given exogenously (primarily electrolytes and protein) and those endogenously derived from normal body metabolism. The amount of water excreted through the stool is minimal in the first days of life particularly in low birth weight infants simply because of smaller amounts of stool in these subjects during the first week of life.
The Febrile Infant
Authors: SMITH ARNOLD L. 
Published: December 2021

Sorting out the child at risk, from those with illness that is not a threat to their health, is a fundamental goal of pediatrics. One of the most common complaints, which prompts us to initiate the sorting process, is fever. In the article by McCarthy (p 51), guidelines to aid in the sorting process are suggested.
Fever, an abnormal increase in core body temperature, results primarily from a decrease in heat loss; decreased trunk and extremity skin blood flow decreases the surface area available for convection and body heat loss decreases—mom feels the forehead or the face for increased temperature, areas less affected by thermoregulatory vasoconstriction.
Adolescent Pregnancy—A Multifaceted Problem
Authors: McAnarney Elizabeth R. , Greydanus Donald E. 
Published: December 2021

Adolescent pregnancy is a major child health problem in the United States. Nearly one million adolescents became pregnant in 1977. Adolescent pregnancies result from earlier biologic maturity and sexual activity.
The average age of menarche in the United States is approximately 12.6 years and has declined four months during each decade in the last century. Boys also mature earlier than their peers of previous generations. As a result of better nutrition, the minimum age of biologic maturity has probably been attained. More young people are sexually active now than they were 25 years ago. In the late 1940s, 20% of unmarried women between 16 and 20 years of age reported having had intercourse. In 1971, 46% of unmarried women aged 19 years reported having had intercourse at least once and in 1976, 55%.1 In 1975, 69% of a sample of adolescent males were sexually experienced with black and Hispanic youth having had their first coital experience at the earliest ages.2
Of the approximately one million adolescents who became pregnant, 570,622 delivered children and approximately 370,000 had abortions. Birth rates to adolescents decreased between 1965 and 1975 for all ages, except for blacks and whites under 15 years and whites 15 to 17 years of age.
Epiglottitis: Diagnosis and Treatment
Authors: Bates Jonathan R. 
Published: December 2021

Epiglottitis is a rapid and potentially fatal infection of the supraglottic larynx that causes death by upper airway obstruction and Gram-negative bacteremia with Haemophilus influenzae type B (HIB). The majority of patients (80%) are less than 5 years of age, and the remaining 20% are scattered over the remaining life span. Although sporadically recognized since the early 16th century, the disease has only become well-described since the late 1940s. Initial mortality rates approaching 100% have steadily declined to about 2% with the use of artificial airways and antibiotics.
The key to obtaining a good outcome with available effective therapy in this disease is prompt recognition and rapid initiation of therapy. Delays of even a few minutes can be disastrous. Advanced planning for the handling of such patients in the office, clinic, or emergency room has been effective in avoiding death from such delays. Decisive action can make the difference between death or anoxic damage as an outcome, and complete recovery without sequelae.
CLINICAL PICTURE
The disease typically begins abruptly with the onset of fever greater than 102° F (rectal) and sore throat or difficulty swallowing. These two features of epiglottic inflammation signal the onset of this illness and occur simultaneously or within a few hours of each other.
Interstitial and Hypersensitivity Pneumonitis and Their Variants
Authors: Hilman Bettina C. 
Published: December 2021

INTRODUCTION, DEFINITION, INCIDENCE, AND CLASSIFICATION
Interstitial pneumonitis (IP) in children is now being recognized earlier and with increased frequency as a cause of chronic respiratory symptoms. Confirmation of the diagnosis, histologic classification, and management depend on studies of tissues obtained from lung biopsy. Since physicians are reluctant to utilize invasive procedures such as lung biopsy in children, the exact incidence of this entity is not accurately known. There are no pathognomonic clinical or laboratory features of interstitial pneumonitis other than histologic findings on lung biopsy. Since therapy depends upon accurate diagnosis this procedure is justified when symptoms and findings suggest this diagnosis. The timing of the biopsy must be individualized depending on the severity and progression of the clinical and/or roentgenographic findings. The diagnosis of IP in the immunocompromised host calls for a prompt aggressive approach to differentiate infectious causes from drug-induced pulmonary disease. Recently a rapid and safe technique, thoracoscopy, has been reported to provide accurate histologic and bacteriologic diagnosis in immunosuppressed children (Rodgers et al).
IP is a broad, inclusive term used to describe tissue response which takes place predominately in the supporting structures (interstitium) of the lung rather than within the alveoli. Multiple etiologies may result in similar clinical, histologic, and roentgenographic manifestations.
Recent Advances in the Care of Patients with Juvenile Diabetes Mellitus
Authors: Spack Norman P. 
Published: December 2021

GENETICS AND ETIOLOGY: IMPLICATIONS FOR COUNSELING
Until recently, diabetics were classified into juvenile- or maturity-onset categories on the basis of the age at onset of disease. We now consider diabetes to be a syndrome in which various factors, diminished or absent beta cell secretory capacity, increased levels of gluconeogenic hormones, or altered insulin receptor binding, can produce the common denominator of hyperglycemia.
Although a rare form of mild diabetes has been characterized in children and appears to be inherited in autosomal dominant fashion (termed MODY-Maturity Onset Diabetes of the Young)1, the overwhelming majority of diabetic children and adolescents develop the insulin-dependent variety of the disease. Recent studies in Michigan define the prevalence of the latter form to be 1.89 cases per 1000 school-aged children (ages 5 to 18 years), with an annual incidence of 1.6 cases per 100,000 children (ages 5 to 18 years). Whereas increased risk has long been observed in relatives of insulin-dependent diabetics, several factors have confounded the geneticists: patients sharing the same genetic blueprint do not share equal likelihood for developing the disease. When one member of a monozygotic twinship develops diabetes under age 45, his twin has but a 50% chance of becoming diabetic. On the other hand, if a twin develops the disease over the age of 45, the risk to the other twin approaches 100%.
Changes in 1988/1989
Authors: H. R. J. 
Published: December 2021

Relatively few changes will occur in the format for Pediatrics in Review in 1988/1989, its tenth year of publication. Dr Alden's commentary preceeding this expresses the very exciting and challenging tasks that lie ahead to make PIR most useful in the continuing education of pediatricians, especially for those who will receive a time-limited certification in 1988 and the future.
You will note questions at the beginning of each article, with the question and multiple choice answers at the end of each article. Answers remain on the inside front cover. The reason for this change is to help focus the reader's attention on what the author and our question writers believe to be most important points in the article.