bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acute Conjunctivitis
Authors: Gigliotti Francis 
Published: December 2021

Conjunctivitis, or inflammation of the conjunctiva, usually occurs as a result of infection or allergy. It is an exceedingly common occurrence, certainly the most common acute disease of the eye seen by primary care physicians of children. When it occurs in the neonatal period, it has been given the appellation ophthalmia neonatorum; in older infants and children, it sometimes is called "pink eye." This review covers the etiology, epidemiology, pathogenesis, diagnosis, and therapy of conjunctivitis in infants and children.
Etiology
Neonatal conjunctivitis occurs in 1.6% to 12% of newborns during the first month of life. The chemical irritation from antimicrobial prophylaxis against bacterial infection is the most frequent cause, followed by Chlamydia trachomatis infection. Other important pathogens in this setting are Haemophilus influenzae and Streptococcus pneumoniae. It is unusual to isolate any of these organisms from healthy eyes. Various streptococci and Staphylococcus aureus have been isolated not only from significant numbers of infected eyes, but also from a substantial number of healthy eyes, leaving their exact role less clear. Rarely, gram-negative organisms such as Escherichia coli, Klebsiella, or Pseudomonas sp have been implicated as causes of neonatal conjunctivitis, especially in infants in intensive care units.
Neisseria gonorrhoeae no longer is a major cause of neonatal conjunctivitis in this country because of the mandated use of neonatal ocular prophylaxis.
Neonatal Seizures
Authors: Stafstrom Carl E. 
Published: December 2021

Definitions and Epidemiology
A seizure is a sudden, paroxysmal discharge of a population of neurons that causes a transient alteration in neurologic function. This alteration may involve abnormal motor activity, sensory symptoms, a change in the level of alertness, alteration in autonomic function, or any combination of these. When a seizure occurs in the neonatal period, several special considerations arise (Table 1). A seizure in a newborn almost always reflects significant nervous system pathology, and recognizing and treating seizures properly may prevent subsequent chronic neurologic impairment. It is important not to confuse seizures with epilepsy. A seizure is a single event and may be due to a transient abnormality that will not recur (eg, hypoglycemia). Epilepsy is the condition of unprovoked recurrent seizures. Many neonatal seizures are transient events that will not progress to epilepsy. Ictal refers to clinical (based on visual observation) or electrical (based on the electroencephalogram [EEG]) activity occurring during a seizure (Table 2).
Seizures occur in about 0.2% to 1.4% of all newborns. However, the incidence is much higher among certain high-risk groups. About 20% of newborns whose birthweight is less than 2500 g have seizures, with a higher incidence among sicker preterm infants. Incidence also depends on etiology; as many as 50% of newborns who have severe hypoxic-ischemic encephalopathy (HIE) develop neonatal seizures.
Poststreptococcal Acute Glomerulonephritis
Authors: Simckes Ari M. , Spitzer Adrian 
Published: December 2021

Postinfectious glomerulonephritis (PIGN) is by far the most common cause of acute glomerulonephritis (AGN) in children. Numerous infectious agents, including bacteria, viruses, fungi, and parasites, have been implicated in PIGN. However, nephritogenic strains of group A betahemolytic streptococci are the most frequent culprits. Clinical manifestations of this syndrome, including hematuria, proteinuria, oliguria, fluid overload, and azotemia, are the result of proliferative and inflammatory changes of the renal glomeruli secondary to immunologic injury.
In addition to PIGN, the differential diagnosis of a child who has AGN must include primary glomerular diseases such as membranoproliferative glomerulonephritis (MPGN), hereditary nephritis (Alport syndrome), and immunoglobulin (Ig)A nephropathy, as well as systemic diseases such as systemic lupus erythematosus, Henoch-Schönlein purpura, and hemolytic-uremic syndrome.
Developmental Dislocation of the Hip: A Clinical Overview
Authors: Mooney James F. , Emans John B. 
Published: December 2021

Introduction
The most common musculoskeletal evaluation in the neonatal period and infancy is assessing the child's hips. Treatment of hip dislocation is most successful when begun early, making it imperative that all children undergo repeated, careful hip examinations beginning in infancy until walking age. Those physicians entrusted with the initial examination should have a clear understanding of the etiology, prevalence, and presentation of developmental dysplasia of the hip as well as the appropriate physical examination for this entity.
Historically, the term "congenital dislocation/dysplasia of the hip" (CDH) has been used. Reports illustrating cases of late diagnosis of hip abnormalities in patients who previously have had normal clinical and/or radiographic examinations as well as recognition of the wide spectrum of abnormalities from dislocation to dysplasia have led the orthopedic and pediatric communities to adopt the term developmental dislocation/dysplasia of the hip (DDH). This term now is preferred.
Definitions and Categorization
Hip dislocation can be categorized as "typical" or "teratologic." Teratologic dislocations are uncommon and usually are associated with neuromuscular abnormality, arthrogryposis, or myelomeningocele and typically are high, fixed dislocations. In contrast, "typical" DDH occurs in neurologically normal infants and encompasses a wide spectrum of deformity and presentation. It is important to recognize that previously stable hips may become unstable during infancy, and repeated examinations are needed until the child is of walking age.
Quality Improvement: An ACQIP Exercise on the Management of Acute Asthma—Part 2
Authors: Smith-Ross Shannon , Honigfeld Lisa ,   Staff of the Division of Quality Care
Published: December 2021

Last month's issue of Pediatrics in Review contains the questions asked of participants in the Ambulatory Care Quality Improvement Program (ACQIP) exercise on the management of acute exacerbations of asthma in children. The answers of those who completed that exercise, which was part of the 1993-1994 program, are summarized in this article. In addition, pointers for clinicians are presented as well as practical "pearls of wisdom" from subscribers. Readers who wish to evaluate their own practices may use this exercise and should consider enrollment in the ongoing ACQIP program. Further information may be obtained through the Division of Quality Care of the American Academy of Pediatrics.
[See table in the PDF file]
Quality Pointers for the Office Management of Acute Exacerbations of Asthma in Children
TREATMENT
Goals of Treatment: General treatment goals include helping patients to maintain "normal" pulmonary function rates, maintain normal activity levels, prevent chronic and troublesome symptoms (eg, nocturnal coughing or dyspnea), prevent recurrent exacerbations of asthma, and avoid adverse effects from asthma medications.
The principal goal of management for the acute exacerbation is the recognition of early indicators, such as a worsening peak expiratory flow rate or forced expiratory volume over 1 second or an increase in symptoms, and early treatment to reverse these symptoms.
Consultation with the Specialist
Authors: Poland Ronald L. 
Published: December 2021

The specialized care that very-low-birthweight (VLBW) infants (&lt; 1500 g or &lt; 3 lb, 5 oz) need at birth is facilitated best by prior maternal transfer to a tertiary center. However, we cannot always anticipate preterm births soon enough to allow for safe transfer. Accordingly, attending pediatricians should be prepared to evaluate and stabilize such infants prior to transfer to a neonatal intensive care unit. Evaluation starts with the maternal history and the Apgar scores and continues until transfer is accomplished. It consists of frequent assessment of cardiorespiratory function, glucose homeostasis, and the infant's potential for serious infection. Stabilization includes controlling the infant's temperature, supporting cardio-respiratory functions as needed, supplementing glucose, and initially managing potentially life-threatening infections, when applicable. Other problems, such as central nervous system depression or serious malformations, also may require attention.
Clinical Evaluation
The clinical evaluation of the VLBW infant differs from that of the term infant in several ways. For instance, the Apgar score generally has a range narrower than 0 to 10. Because of neurologic immaturity, Apgar scores greater than 6 in VLBW infants are unusual. This difference is due primarily to decreased tone and reactivity compared with that of term infants, but skin color also is less uniform and respiratory effort more variable in this group.
Staphylococcal Scalded Skin Syndrome
Authors: Pollack Shoshannah 
Published: December 2021

Staphylococcal Scalded Skin Syndrome (SSSS) is the most severe manifestation in the spectrum of Staphylococcus aureus exotoxin-mediated disease in skin. The disease is characterized by erythema and exfoliation and is mediated by exotoxins elaborated primarily by phage group II S aureus.
SSSS affects children, especially infants. Both sporadic and epidemic cases occur. Older children and adults rarely are affected. Immature renal function, leading to a reduced ability to clear bacterial exotoxin, may account for the increased susceptibility of neonates, according to Elias and Fritsch. Renal and immunologic dysfunction predispose to the disease in older individuals.
SSSS begins abruptly with tender erythema of the skin. Within 12 to 14 hours, the attachment between the stratum corneum and underlying epidermis becomes weak.
Blunt Trauma to the Abdomen
Authors: Haller J. Alex 
Published: December 2021

Serious injuries remain the number one cause of death among American children. Major trauma is responsible for more than 50% of the mortality in children between the ages of 1 and 14 years. The majority of these life-threatening injuries result from blunt trauma rather than from penetrating injuries, which are much more common in adults. The most common causes of blunt trauma to children are: motor vehicle crashes when a child is either a pedestrian, bicycle rider, or automobile occupant; falls from windows or farm buildings and machinery; and house fires. Children die in motor vehicle crashes as a result of multiple systems injuries, of which the most serious is to the head.
Major blunt trauma to the abdomen frequently is associated with this series of injuries. This is a difficult injury to evaluate because often there are few signs of external damage to reflect the life-threatening trauma to internal abdominal organs. In addition, as noted previously, children commonly have associated head injuries and are unconscious at the time of evaluation, which makes early diagnosis and definitive treatment even more difficult, often resulting in disastrous delays in specific treatment.
The pathophysiology of blunt injuries to the abdomen results from energy transfer of compression and crush forces or from rapid deceleration/acceleration forces, which cause shearing stresses within the abdomen.
Hypnosis: Teaching Children Self-Regulation
Authors: Sugarman Laurence I. 
Published: December 2021

Hypnosis applies and strengthens a child's naturally enhanced ability to focus his or her concentration and imagination to change symptoms, physiology, and behavior. This field of naturalistic psychology is supported both experimentally and clinically. It can be incorporated into all clinical encounters, increasing therapeutic rapport, the young person's self-esteem, and efficiency. It is most effective when introduced before fearful responses become conditioned, and it can reduce the amount of medication required for relief of symptoms. This capacity can grow with the child, allowing him or her to approach future challenges with equanimity.
It has been said, "All hypnosis is not therapy, but all therapy is hypnosis."30 Hypnosis training teaches us the sensitivity to language, to our patients' states of awareness, and to the power of our own positive expectancy and rapport that underlies what we call the "art of medicine."
Multicultural Issues in Pediatric Practice
Authors: Kinsman Sara B. , Sally Mitchell , Fox Kenneth 
Published: December 2021

A Gap?
NT, an 11-year-old Vietnamese female, presented to the adolescent clinic with a 1-month history of dysfunctional uterine bleeding. She was accompanied by her older sister and grandfather. Although her grandfather was the most proficient English speaker in the home, the older sister was asked to help translate questions regarding her younger sister's menstrual and sexual history. The most likely diagnosis appeared to be anovulatory dysfunctional uterine bleeding. The appropriate laboratory evaluation was undertaken to exclude other etiologies, and oral hormonal therapy was prescribed to stop the vaginal bleeding. To assure that the patient understood the need for hormonal therapy, the health-care team asked if the grandfather could be present when directions for the medications were reviewed. The patient agreed. She asked no questions as the treatment plan was discussed.
One week later at a follow-up visit, the patient continued to experience vaginal bleeding and admitted to not having taken her oral contraceptive medication. She was admitted to the hospital with a significantly decreased hemoglobin level. During her hospital admission, nurses noted that the patient was pleasant and congenial, but she refused to take the hormonal therapy and secretly would hide the medication in her mouth so that she could throw it away later.
PERIPHERAL BRAIN
Authors: Pysher Theodore J. , Bach Phillip R. 
Published: December 2021

Historical Perspective and Current Status of the Multitest Chemistry Profile
The development of a single instrument that could reproducibly sample a specimen, mix it with the required reagents at appropriate intervals, and analyze the resulting reaction revolutionized the chemical analysis of clinical specimens. Not long after its development, several of these Auto AnalyzersTM, each dedicated to measuring a different analyte, were linked, and the Sequential Multiple Analyzer (SMATM) was born. Because these systems were automated, they could perform the analyses for which they were designed at less expense, with greater precision, and in less time than when the tests were performed by hand. Moreover, it was claimed that the integration of the measurement of these chemical markers of disease into the routine health maintenance examination would lead to earlier detection of disease and improved patient care.
These early multitest analyzers had only limited application in pediatrics because they required so large a specimen. The SMA-12TM, for example, required 3 mL of serum for each 12-test panel. Two developments, however, made the multitest chemistry analyzer accessible to pediatric-sized samples-microcomputes and ever smaller components. The early multitest analyzers were marvels of creative plumbing in which each specimen ran the full course of the instrument and, therefore, the same amount had to be sampled whether one or all of the 6, 12, or 24 available tests were requested.
Movement Disorders in Childhood
Authors: Pranzatelli Michael R. 
Published: December 2021

Clinical Aspects
Dyskinesias are abnormal involuntary movements. The common dyskinesias include tics, chorea, tremor, dystonia, myoclonus, and hyperactivity (Table 1). Several other less common dyskinesias also are important to recognize. The diagnosis of the type of movement disorder is clinical. When the movements are episodic and not seen by the pediatrician, obtaining a home videotape is recommended. Most patients who have movement disorders, with the exception of tic disorders, should be referred to a neurologist, but it is important for the pediatrician to be able to identify them and to be informed on issues relevant to management.
THE MOST COMMON DYSKINESIAS
Tic disorders include motor (myoclonic and dystonic), vocal (phonic), and sensory tics. Tics may be simple or complex (Table 2). Myoclonic tics are jerks; dystonic tics are postures. Children who have vocal tics such as throat clearing, coughing, or sniffing may be referred to allergists or ear, nose, and throat specialists before the correct diagnosis is made. Sensory tics are peculiar sensations. Tics are increased by stress, decreased by activities that require concentration, exhibit a fluctuating pattern, and are less noticeable during sleep. The patient can suppress the movements or vocalizations voluntarily for minutes or hours, but then is unable to control the movements or the vocalizations.
INDEX OF SUSPICION
Authors: Conners Gregory P. , Lin Angela E. , Rivera Juan A. 
Published: December 2021

This section of Pediatrics in Review 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 write possible diagnoses for each case before turning to the discussion, which is on the following page.
We invite readers to contribute case presentations and discussions.
Case 1 Presentation
An 18-year-old girl comes to your office complaining of a sore nose. She reports that the tip of her nose has been red and tender for the past few days and seems to be worsening. Because of the erythema, she was not allowed to do her usual volunteer work at a local nursing home. Her health has been good and she denies having any recent upper respiratory infections. She has not had fever and is taking no medication. She recalls having a similar nasal condition at least once before; it was not as uncomfortable and cleared up without treatment.
On physical examination, she is afebrile, and all other vital signs are normal. The tip of her nose is slightly but noticeably swollen, and the medial margin of her right nostril is moderately erythematous.
Acute Epididymitis and Orchitis in Children
Authors: Tennenbaum Steven , Kim Daniel 
Published: December 2021

Acute epididymitis and orchitis result in pain and swelling of the contents of the scrotal sac. The differential diagnoses include torsion of the spermatic cord, torsion of the appendix testis, hernia, hydrocele, and trauma. All providers of pediatric health care should understand the etiology and recognize the presenting signs and symptoms of epididymitis and orchitis, conditions that must be distinguished promptly in the emergency setting to avoid the risk of gonadal loss or unnecessary scrotal exploration.
Epididymitis results from inflammation of the epididymis with resultant pain, swelling, and redness of the scrotal skin. Most often a specific cause cannot be identified, although it has been hypothesized that both viral and coliform bacterial infections can inflame the epididymis.
Consultation with the Specialist
Authors: Smith Sherilyn , Sweetser Marianne T. , Wilson Christopher B. 
Published: December 2021

Infections are the most frequent illness encountered in children by the pediatrician and, for most patients, represent normal life events. However, the child who has unduly frequent, persistent, or severe infections or who has infection(s) due to microbes that normally are nonpathogenic may represent the exceptional patient who has an immunologic defect. The causative organisms and the age at which the infections begin to occur may provide clues to the nature of the immunologic defect.
Components of the Immune System and Their Function in Host Defense
The immune system can be divided into two components based on the specificity with which microbes are discriminated from self. The innate or natural immune system is responsible for a rapid, efficient, and nonspecific response to invading microbes. It can be viewed as the first line of defense and is comprised of epithelial barriers, the spleen, phagocytic cells, natural killer (NK) cells, the complement system, and other proteins that aid with opsonization. Abnormalities in this part of the immune system generally predispose to infections from organisms that are ubiquitous and usually of low virulence. The second part of the immune system, the inducible or adaptive portion, is responsible for specific, amplifiable, and long-lived responses to foreign antigens.
Chronic Asthma: An Update
Authors: Kemper Kathi J. 
Published: December 2021

Case Scenario
Having just changed insurance carriers, a mother brings her 13-year-old son to your office for a routine physical examination. He has no current complaints except for chronic asthma. His past medical history is significant for several hospitalizations for asthma. His only current medication is an albuterol inhaler that he uses two to three times daily. Further questioning about home remedies reveals that in an effort to cut down on his chronic use of medication, he recently started taking the herbal remedies Ma huang and Dong quai as well as vitamin and mineral supplements. He wants to know how safe and effective these therapies are and if you have any other suggestions to help him with his symptoms and avoid another hospitalization.
Because of its severity and complexity, asthma and its treatment are often frustrating for patients, families, and clinicians. Out of desperation, many patients and families turn to alternative therapies, such as nutrition, herbs, and Chinese medicine. With the growing interest in and use of alternative therapies, practitioners would do well to become familiar with them, their side effects, and potential benefits. Traditional medical management also has changed; modern therapy emphasizes anti-inflammatory rather than bronchodilator medication. This review focuses on modern management of chronic asthma symptoms and highlights recent evidence about the effectiveness and side effects of alternative treatments.
Enhancing Patient Compliance in Pediatrics
Authors: Liptak Gregory S. 
Published: December 2021

The Challenge
Pediatric care has become exceedingly complex, but no matter how technologically advanced treatments become, they can be only as effective as compliance with their use. Compliance, or adherence, defined as the extent to which a person's behavior coincides with medical or health advice, is crucial for the treatment of illness, the prevention of disease, and the promotion of health.
Unfortunately, noncompliance is extremely common. For example, in a study of the use of penicillin for acute otitis media and "strep" throat, Charney et al1 found that only 43% of the children complied with the regimen. Gordis and associates2 found that compliance with penicillin used for chronic rheumatic fever prophylaxis was only 36%. Eney and Goldstein3 showed that compliance with theophylline in children being evaluated in an emergency department for asthma was only 11%.
Compliance decreases over the course of treatment, not only for long-term interventions, but for brief ones as well. For example, Bergman and Werner4 found that 56% of individuals being treated with penicillin for streptococcal pharyngitis had stopped taking the medication by day 3, 71% by day 6, and 82% by day 9 of the treatment course.
Although compliance is so important, it is largely neglected in medical education, including pediatric residency training.