bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pediatrician—The Rodney Dangerfield of Medicine
Authors: Menna Vincent J. 
Published: December 2021

As an intern in the distant past, I remember a gynecologist who regularly made rounds at 2 PM. Approximately 1 hour before his appearance on the floor, the nurses began to scramble and prepare. At 2 PM, they were "standing tall." General Patton and certainly Waldo Nelson would not have precipitated such activity. As pediatricians, do we need or desire that kind of sycophantic behavior? Of course not, but I believe that we deserve more respect than we are currently receiving.
At the risk of being superfluous, I note that we are on the low end of the pay scale. Those of you who have perspired over the 2-week-old infant with fever or the apneic newborn wonder why.
Recent Advances in the Management of the Infant, Child, and Adolescent With Chronic Renal Failure
Authors: Fine Richard N. 
Published: December 2021

The prognosis of the infant, child, or adolescent with chronic renal failure, defined as an irreversible reduction in glomerular filtration rate, has improved during the past quarter century because of the use of dialysis and renal transplantation. These have prolonged lives in previously fatal situations. Because the potential not only to sustain life but also to effect full rehabilitation exists with the introduction of these treatments, it is now imperative that the multisystem consequences of uremia be either minimized or totally avoided in the pediatric patient with chronic renal failure.
The role of the pediatrician in managing the infant, child, or adolescent with chronic renal failure should be directed toward minimizing the potentially devastating consequences of uremia so that the patient is in optimal clinical condition when end stage renal disease occurs.
INCIDENCE
It is difficult to know the incidence and prevalence of chronic renal failure and end stage renal disease in children. Surveys in Europe and North America have been conducted to obtain precise information regarding these issues; not only have the definitions included in these surveys differed, but the upper and lower age limits defining pediatric patients have not been uniform.
The available data suggest a prevalence of chronic renal failure of 18.5 per 1 million child population and an incidence of end stage renal disease of from 3 to 6 children per 1 million total population.
Perinatal Blood Loss
Authors: Molteni Richard A. 
Published: December 2021

In recent years a great deal of attention has been paid to the evaluation and treatment of conditions characterized by red blood cell excess (polycythemia). The debatable practice of routine newborn hematocrit screening was initiated and perpetuated by the still uncertain short-term and long-term complications of polycythemia and its commonly associated state of hyperviscosity. Previously unsuspected anemia is often identified during this same screening process. Unless profound (leading to hypovolemic shock) or associated with more visible signs of hemolysis (jaundice), the etiology of this state of diminished red blood cell mass is often ignored or evaluated incompletely. This review focuses on the effects of anemia in the fetus and neonate, discusses mechanisms of fetal red blood cell production, and provides a basic diagnostic approach for the clinician when anemia is recognized in the neonatal period.
PHYSIOLOGIC EFFECTS OF RED CELL REDUCTION
Tissue Oxygen Delivery
Maintenance of adequate red blood cell numbers can be even more critical during fetal life than during the postnatal period. The fetus, dependent upon maternal oxygen sources, cannot raise tissue oxygen delivery acutely by increasing placental oxygen transfer, even when its red blood cell numbers are decreased. Total oxygen content (sum of oxygen dissolved in plasma and bound to hemoglobin) of the blood is dependent upon both the partial pressure of oxygen (Pao2) and the quantity of hemoglobin available.
Health Supervision for the High-Risk Preschooler
Authors: Rivara Frederick P. , Kemper Kathi J. 
Published: December 2021

Guidelines for the well child care of the high-risk preschooler differ from those for the average middle class patient. Such a child can be defined as one who by virtue of medical, family, or social history is at increased risk of health problems during the preschool years. Two particular, special types of high-risk children are specified in the educational objectives: the child who is a recent immigrant to the United States and the child who has repeated injuries. The focus of this article is on assessment of growth and development; immunization; screening for tuberculosis, parasitic infections, and anemia; injury prevention; and general counseling issues.
CHILDREN FROM OTHER COUNTRIES
A 3-year-old Laotian girl is brought into the clinic for her first health supervision visit. Her mother speaks little English, but indicates that she is being treated with isoniazid; her physician has recommended she bring the child to a pediatrician for a complete checkup. She says that her physician was concerned about the child's short stature and limited speech. The mother doesn't know which "shots" or tests the child has had in the past, but the child has always seemed healthy to her.
Children immigrating from other countries may have important unmet medical problems (eg, growth delay, nutritional anemia, parasitic and other infectious diseases) at the same time they are confronting the psychological upheavals of moving, learning a new language, meeting new cultural expectations and behaviors, and recovering from the horrors they left behind in their country of origin.
"1-800:Please Admit"
Authors: Menna Vincent J. 
Published: December 2021

During my internship on medicine rotation I made daily rounds with an internist. One of his female patients had a different pain daily that radiated to all parts of her body. I was impressed at how patiently he listened to her symptoms and was amazed that he was taking notes. One day I looked over his shoulder to discover that while she was complaining, he was making a list of his inpatients.
That patient along with others who were in the hospital for a "rest" justifiably would have a great deal of difficulty being admitted in 1990. However, I feel that the pendulum has swung too far in the opposite direction from the days of the lady with total body pain.
Clinical Disorders of Neutropenia
Authors: Roskos Rudolph R. , Boxer Laurence A. 
Published: December 2021

Not uncommonly, during the course of a workup for fever, the pediatrician will find that a patient has neutropenia. Neutropenia is defined as an absolute decrease in the number of circulating neutrophils in the blood. The lower limit for normal neutrophil counts is 1000/mm3 in infants between 2 weeks and 1 year of age; after infancy the corresponding value is 1500/mm3. Blacks have lower neutrophil counts, and the lower limit is 100 to 200/mm3 less than those cited for whites. These lower counts probably reflect a relative decrease in the storage pool of the bone marrow.
CLASSIFICATION OF NEUTROPENIA
Neutropenia can be classified as mild (neutrophil counts of 1000 to 1500/mm3), moderate (neutrophil counts of 500 to 1000/mm3), or severe (neutrophil counts less than 200/mm3). This stratification is useful in predicting risk of infection, but it provides no etiologic information. On the other hand, it is useful to classify patients as having an abnormality either in production or in destruction of neutrophils, because each of these processes is now frequently amenable to distinct therapies if needed.
Susceptibility to bacterial infection, even in the face of severe neutropenia, is variable. Most patients with chronic neutropenia do not experience as many serious infections as those patients receiving cancer chemotherapy or those infected with human immunodeficiency virus who develop comparable degrees of neutropenia.
INDEX OF SUSPICION
Authors: DeAngelis Catherine , Robertson William O. , Chapman Daniel D. 
Published: December 2021

Clinicians often form a diagnostic impression at the time of a patient's first presentation. Usually the initial impression is correct because commonly encountered illnesses come to mind and are, of course, most likely to be responsible. Sometimes, however, a less familiar disorder is responsible and will not be detected or will be diagnosed after a prolonged delay unless the physician maintains a suspicion of the unusual.
This section reminds clinicians of those conditions that can present in a misleading fashion and require suspicion for early diagnosis. Emphasis has been placed on conditions in which early diagnosis is important and that the general pediatrician might be expected to encounter, at least once in a while. The reader is encouraged to put in writing possible diagnoses for each case before turning to the discussion, which is on the following page.
We invite readers to contribute case presentations with discussions.
Case 1 Presentation
A 4-year-old black boy known to have sickle cell disease is brought to your office by his mother, who is concerned because he has become listless and weak during the past 12 hours. He has been complaining of abdominal pain and is breathing "harder and faster" than usual. On examination, a greatly enlarged, tender spleen is palpated.
Fetal Environmental Toxins
Authors: Holmes Lewis B. 
Published: December 2021

The pediatrician often is asked by concerned parents whether their child's medical problems could be due to some type of exposure during pregnancy. Unfortunately, there seems to be an endless number of new and disturbing possibilities, such as video display terminals and electromagnetic fields, which are suggested regularly in newspaper articles, magazines, and the television news to be harmful. Experience has shown that many of these possibilities are false alarms, but much work is required before reassuring evidence becomes available. This review will summarize the current knowledge of "fetal environmental toxins" or human teratogens—terms that encompass an exposure during pregnancy that has a harmful effect on the developing fetus.
Many different types of fetal environmental toxins have been identified (Table), including:
• drugs taken by the pregnant woman,
• infections during pregnancy,
• maternal diseases,
• hypoxia,
• heat, and
• heavy metals.
The pediatrician evaluating the child who is reported to have had a harmful exposure in utero should be aware of the variety of potential effects of these exposures, including:
• spontaneous abortion;
• growth retardation, before and/or after birth;
• microcephaly;
• distinctive patterns of major and minor malformations;
• isolated major malformations;
• metabolic dysfunction, such as the diabetes mellitus that occurs in 30% of adults who had congenital rubella syndrome1;
• cognitive dysfunction;
• mental retardation;
Herpes Simplex Virus Infections: The Genital Tract and the Newborn
Authors: Arvin Ann M. , Prober Charles G. 
Published: December 2021

There are six recognized members of the human herpes group of viruses. These include type 1 and type 2 herpes simplex viruses (HSV-1 and HSV-2), cytomegalovirus (CMV), Epstein-Barr virus (EBV), varicellazoster virus (VZV), and human herpes virus type 6 (HHV-6). These ubiquitous double-stranded DNA viruses are relatively large and lipid-enveloped. The capacity to induce a state of latency in the infected host has been proved for all of the herpes viruses. That is, after primary infection, the viruses remain forever with the host with the possibility for subsequent reactivations. The mechanisms of these reactivations are not understood completely. Both primary infections and recurrences may be associated with clinical illness or may be asymptomatic. To a large extent, the status of the host immune system determines the severity of the infection and the likelihood of recurrences. In general, infections are more severe and recurrences are more frequent in the most compromised hosts. This review focuses on HSV-1 and HSV-2, with emphasis on neonatal infections and maternal genital infections as a source of infection in the newborn.
The clinical illnesses caused by HSV-1 and HSV-2 are usually quite distinct. HSV-1 is the predominant cause of oral, ocular, and central nervous system infections occurring after the neonatal period, and HSV-2 is the predominant cause of genital and neonatal infections.
Cutaneous Fungus Infections in Children
Authors: Rasmussen James E. 
Published: December 2021

Cutaneous fungus infection in children may be either superficial or deep. The most common superficial infections include tinea versicolor, tinea capitis, tinea corporis, tinea cruris, tinea pedis, and candidiasis. "Ringworm" is a common term used to describe these infections, stemming from the fact that "tinea" is Latin for "worm" or "moth." The only deep fungal infection discussed in this review is sporotrichosis.
Diagnostic Methods
All forms of superficial fungal infection can be diagnosed easily with a variety of quick, simple, and inexpensive diagnostic methods. Once mastered, the tests need not be used on patients with obvious diagnoses; nevertheless, confirmation of one's clinical impression is personally satisfying and often important.
POTASSIUM HYDROXIDE
Superficial fungal infections of the skin involve the outer portion of the epidermis, including the hair and nails. Hyphae and spores are visible easily with low-to-moderate microscopic magnification. With the exception of mucous membranes or eroded surfaces (as often found in the case of candidiasis), skin and hair for sampling should be moistened with a drop of water or an alcohol swab. The skin should be abraded gently with the round belly of a 15 blade at the active margin of tinea corporis or, in the case of tinea capitis, any place where alopecia is visible.
Viral Hepatitis: A, B, C, D and E—Infection
Authors: Krugman Saul 
Published: December 2021

Viral hepatitis is caused by at least five etiologically and immunologically distinct viruses: hepatitis A (HAV), hepatitis B (HBV), hepatitis C (HCV), hepatitis D (HDV), and hepatitis E (HEV). The clinical, epidemiologic, and immunologic features of these five forms of viral hepatitis may be similar or different. Hepatitis also may occur during the course of disease caused by cytomegalovirus, Epstein-Barr virus, herpes simplex virus, varicella-zoster virus, adenoviruses, enteroviruses, rubella virus, arboviruses, and other agents.
Hepatitis A is synonymous with "infectious hepatitis," an ancient disease described by Hippocrates and formerly known as epidemic jaundice, acute catarrhal jaundice, and other designations. The fulminant form of the disease was called acute yellow atrophy of the liver.
Hepatitis B is synonymous with "serum hepatitis," a disease with a more recent history. The first known outbreak occurred during 1883 among a group of shipyard workers who were vaccinated against smallpox with glycerinated lymph of human origin. Later, an increased incidence of the disease was observed among patients attending venereal disease clinics, diabetes clinics, and other facilities where multiple injections were given with inadequately sterilized syringes and needles contaminated with the blood of a viral carrier. The most extensive outbreak occured in 1942, when yellow fever vaccine containing human serum caused 28 585 cases of hepatitis B infection with jaundice among United Stated military personnel.
Decision Making and the Child with Febrile Seizures
Authors: Freeman John M. , Vining Eileen P. G. 
Published: December 2021

Seizures, both febrile and nonfebrile, are the most common neurologic problem seen in children. Most seizure problems can, and should, be managed by the pediatrician. This article, along with the following one, represents a dialogue—one we often have with pediatricians about the evaluation and management of seizures in children.
A seizure is defined as a paroxysmal electrical discharge of neurons in the brain resulting in alteration of function or behavior. A febrile seizure is defined as a seizure caused by fever. The diagnosis of a febrile seizure is one of exclusion. Before the diagnosis is made definite, it must be established that there was not another cause for the seizure.
Factors Important in the Diagnosis of Febrile Seizures
AGE
Febrile seizures are most common between the ages of 6 mo and 5 y. Beyond this range, seizures are more likely to have another etiology. However, this does not mean that every child outside of this age range needs a brain scan and an extensive initial evaluation.
TEMPERATURE
The height of the fever at the time of the seizure is helpful to know. Anyone can have a seizure if his or her temperature is sufficiently high. Therefore, in the absence of other demonstrable causes, the higher the fever, the more likely that an initial seizure, occurring in the typical age range, was precipitated by the fever.
Allergic Rhinitis
Authors: Virant Frank S. 
Published: December 2021

Epidemiology
Allergic rhinitis affects as many as 8% to 10% of children in the United States. Many of these children suffer significant morbidity, leading to millions of lost school days annually. Morbidity is amplified when these children concurrently suffer from complications of allergic rhinitis, such as recurrent otitis media or chronic sinus disease.
Typically, children who have allergic rhinitis have a family history of atopic disorders. Upper airway allergy may become manifest at any age, but the appearance of symptoms is most common during childhood or young adulthood. Clinical signs of rhinitis may be perennial, seasonal, or episodic, and the primary focus of complaints may relate to secondary problems, including ear, sinus, or lung disease.
Pathophysiology
In the allergic patient, disease is mediated by the production of antigenspecific IgE by the patient's B lymphocytes. Current research suggests that the primary defect may be the excessive production of interleukin 4 (IL-4) or a deficient level of gamma interferon (γ-INF) when a T-cell is presented with an antigen. This constellation of immunomodulators directs the B-cell to produce IgE rather than the IgG response of the non-allergic patient.
Clinical disease occurs when an allergen reacts with antigen-specific IgE on the patient's nasal mast cells. When these factors combine, the mast cell is activated to release a variety of preformed and newly produced mediators, including histamine, leukotrienes, and prostaglandins (Fig 1).
School Readiness: An Overview for Pediatricians
Authors: Casey Patrick H. , Evans Larry D. 
Published: December 2021

Pediatricians historically have played a role in determining whether a child is prepared for school entry by performing preschool physical examinations. Recent trends, including a tendency among some middle-class families and school districts to delay entry of typical kindergarten-age children until the next school year, the increased use of school readiness tests in schools, and the emphasis of federal legislation to identify preschool (P.L. 99-457) and school-age (P.L. 94-142) handicapped children, have placed a greater burden on pediatricians to assess the "school readiness" of their patients.
Much controversy exists among educators about how to define school readiness, measure it, and manage children who may not be ready for school. Some of these controversies will be presented in this article. In light of these issues, a cautious role for pediatricians in assessing and making recommendations for school readiness, commensurate with the pediatricians' developmental perspective and awareness of the child's family and environment, will be described.
What is School Readiness?
All schools arbitrarily set a date by which children must reach their fifth birthday to enter kindergarten, and this date has moved ahead considerably during the past decades to the current typical September 1 to October 1 cutoff. Although this age approach may be the most equitable method of allowing access to public education, the earlier age of entry results in a younger group of children who are potentially less ready to participate in school.
Foot and Leg Problems
Authors: Craig Clifford L. , Goldberg Michael J. 
Published: December 2021

Metatarsus Adductus
Forefoot adduction, a common deformity in infants, can present a spectrum of severity. Unfortunately, the terminology used in the literature is confusing. Congenital metatarsus adductus is an intrauterine postural deformity of the forefoot. Congenital metatarsus varus is an intrauterine subluxation of the tarsometatarsal joint, with adduction of the metatarsals. The distinction is important because metatarsus adductus usually corrects spontaneously, whereas metatarsus varus will progress without active intervention.
INCIDENCE AND ETIOLOGY
Metatarsus varus occurs in about 1 per 1000 live births. There is no definable inheritance pattern. The risk of a second occurrence within a family is about 1 in 20. Pathogenesis has been studied by dissecting the feet of stillborn infants. This supports the concept of medial subluxation of the tarsometatarsal joints occurring while the foot is dorsiflexed. Adaptive changes of the bone and soft tissues occur secondarily. The incidence of congenital metatarsus adductus is unknown but is far more frequent than 1 per 1000 live births. The etiology is presumed to be a "packaging problem," with the forefoot compressed into adduction. Greater utilization and expertise with fetal ultrasound will help resolve these issues.
DIAGNOSIS
In congenital metatarsus adductus, the forefoot easily can be corrected passively to line up parallel to the heel and frequently can be overcorrected into abduction.
Feeding the Very Low-Birth-Weight Infant
Authors: Romero Rene , Kleinman Ronald E. 
Published: December 2021

Unfortunately, premature birth occurs commonly in the United States. Improving the survival of very low-birth-weight (VLBW) infants depends in large part upon understanding the physiologic capabilities of their immature organ systems and providing appropriate support as they mature. Advances in the nutritional support of these infants have contributed to the better outcomes we have come to expect today, even for the smallest infants. In this review, we will discuss the limitations of gastrointestinal function and the unique nutritional requirements of very low-birth-weight infants and describe the current methods of enteral and parenteral nutrition support used to meet these requirements.
Developmental Physiology
By 24 to 26 weeks of gestation, the fetal gastrointestinal tract is morphologically similar to that of the full-term infant; however, functional development is far from complete. Maturation of gastrointestinal motility, digestion, and absorption continues through much of the first year of life, even in full-term infants, as a result of an interplay between the preprogrammed "biological clock" and environmental influences. The decision to feed the VLBW infant must take into account the developmental limitations as well as the potential for enhancing intestinal maturation at each stage of development (Table 1).
Fetal swallowing is evident at the beginning of the second trimester.