bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Mystery Ingredients: Sweeteners, Flavorings, Dyes, and Preservatives in Analgesic/Antipyretic, Antihistamine/Decongestant, Cough and Cold, Antidiarrheal, and Liquid Theophylline Preparations
Authors: Kumar Ashir , Rawlings Rick D. , Beaman Dana C. 
Published: December 2021

Objective. Pharmaceutical preparations may contain a variety of excipients ("inert ingredients"). These excipients are generally inactive; however, rare adverse effects caused by excipients have been reported. Information about the excipients in a particular preparation is not readily available.
Methods. The information about sweeteners, flavorings, dyes, and preservatives for the chewable and liquid preparations of over-the-counter and prescription products of antidiarrhea, cough and cold, antihistamine/decongestant, analgesic/antipyretic, and liquid theophylline medications was collected.
Results. Information about excipients in 102 chewable and liquid preparations was compiled. An average preparation contained two sweeteners. Saccharin and sucrose were the most common sweeteners found—each was present in 52 preparations—followed by sorbitol, glucose, fructose, and others. For 36 of the 102 preparations, type of flavoring was not specified. In the remaining preparations, cherry was the most common flavoring, followed by vanilla and lemon. Twenty-one different dyes and coloring agents were used. Red dye No. 40 was the most common (42/102), followed by yellow No. 6 (27 02). Of the eight preservatives used, sodium benzoate and methylparabens were present in 42 and 27 of the preparations, respectively. Tables detailing these excipients and adverse effects reported are presented.
Conclusions. The tables should be helpful to physicians in selecting preparations containing different excipients when an adverse reaction occurs. The mandatory labeling of excipients in all pharmaceutical preparations is the only way that physicians and patients can be fully informed.
Risk Factors and Outcomes for Failure to Thrive in Low Birth Weight Preterm Infants
Authors: Kelleher Kelly J. , Casey Patrick H. , Bradley Robert H. , Pope Sandra K. , Whiteside Leanne , Barrett Kathleen W. , Swanson Mark E. , Kirby Russell S. 
Published: December 2021

Objective. To determine the epidemiology, clinical characteristics, and outcomes for low birth weight (LBW) infants with growth deficiency, or failure to thrive (FTT, the term commonly used by pediatric providers to describe growth deficiency or faltering in early childhood).
Design. Three-year prospective cohort study with matched case-control study of outcomes.
Setting. Eight large university hospital sites throughout the United States.
Sample. 914 LBW infants inborn at the sites and meeting study criteria.
Results. FTT was a common condition in this cohort, with 180 (19.7%) of 914 LBW infants meeting case criteria by 30 months. New cases of FTT peaked at 8 months gestation-corrected age. In addition to expected differences in growth between infants with and without FTT, infants with FTT had lower developmental indices and less stimulating home environments. At 36 months, FTT infants had lower IQ scores and were much smaller than infants without FTT.
Conclusions. Growth deficiency, or FTT, is a common clinical condition for those involved in the follow-up care of LBW infants. Worse cognitive and growth outcomes were observed for those meeting the restrictive case criteria employed in this study. More than 80% of the cases in this LBW cohort did not involve any chronic medical disorders, but several biological and environmental differences were found between those who developed FTT and those who did not.
A Simplified Behavioral Treatment for Trichotillomania: Report of Two Cases
Authors: BLUM NATHAN J. , BARONE VINCENT J. , FRIMAN PATRICK C. 
Published: December 2021

Trichotillomania is a behavioral disorder characterized by habitual hair pulling resulting in alopecia. Although once considered extremely rare, a recent survey study of college freshmen suggests a lifetime prevalence of more than 3% in females and more than 1% in males.1
The recent literature on trichotillomania has emphasized the pharmacologic treatment of adolescents and adults. Some studies have reported decreased hair pulling in response to treatment with the antiobsessional medications clomipramine and fluoxetine2,3 However, Christenson and colleagues4 failed to demonstrate benefit from fluoxetine, and in a preliminary report Rothbaum and Ninan5 found greater decreases in hair pulling with a behavioral intervention than with clomipramine.
Arginase Deficiency Presenting as Cerebral Palsy
Authors: SCHEUERLE ANGELA E. , MCVIE ROBERT , BEAUDET ARTHUR L. , SHAPIRA STUART K. 
Published: December 2021

Arginase catalyzes the conversion of arginine to ornithine and urea in the final step of the urea cycle. The enzyme deficiency disease, argininemia, is a rare autosomal recessive disorder which presents with progressive psychomotor retardation, growth failure, seizures, and spasticity affecting the lower extremities more than the upper.1 It does not, however, commonly have the severe hyperammonemia seen with other urea cycle disorders.1,2 We describe two unrelated patients, previously thought to have cerebral palsy, who were later found to have arginase deficiency. This suggests that the condition may be underdiagnosed because of its relatively mild symptoms.
CASE REPORTS
Patient 1, a 9-year-old boy, was born at term after an uncomplicated pregnancy to nonconsanguineous African-American parents.
Antenatal Corticosteroids Appear to Reduce the Risk of Postnatal Germinal Matrix Hemorrhage in Intubated Low Birth Weight Newborns
Authors: Leviton Alan , Kuban Karl C. , Van Marter Linda , Pagano Marcello , Allred Elizabeth N. 
Published: December 2021

Objective. To determine to what extent the reduced risk in preterm newborns of intracranial hemorrhage attributed to antenatal corticosteroids (ANCS) reflects reductions in the incidence of respiratory distress and its correlates.
Methods. In a sample of 239 very low birth weight newborns recruited for a clinical trial of phenobarbital prophylaxis of subependymal/intraventricular hemorrhage, we explored the relationship between ANCS, the occurrence of germinal matrix hemorrhage (GMH) that first became evident after the 12th postnatal hour, and putative intervening variables such as acidosis, elevated peak inspiratory pressure, pneumothorax-pulmonary interstitial emphysema, and elevated continuous positive airway pressure.
Results. In multivariate models adjusting for confounders, newborns exposed to ANCS were at approximately one third the risk of GMH experienced by newborns not exposed to a full course of ANCS. The additions of measures and correlates of respiratory distress severity to these models did not change the GMH risk associated with ANCS.
Conclusion. The GMH-protective effect of ANCS does not appear to be a consequence of enhanced pulmonary maturation.
Placebo-Controlled Evaluation of Ritalin Side Effects
Authors: Ahmann Peter A. , Waltonen Stuart J. , Theye Fred W. , Olson Kurt A. , Van Erem Alayne J. 
Published: December 2021

Objective. To address the frequency of side effects of Ritalin therapy in children with attention deficit hyperactivity disorder (ADHD) using the Barkley Side Effects Questionnaire (BSEQ) in a clinical setting.
Design. Randomized double-blind placebo-controlled cross-over trial.
Setting. A large rural tertiary care clinic.
Patients. 234 consecutive children aged 5 through 15 years who met the Diagnostic and Statistical Manual of Mental Disorders (3rd ed, revised) criteria for ADHD were enrolled. Of these children, 206 had sufficient side effects data for analysis.
Interventions. 0.3 mg/kg per dose and 0.5 mg/kg per dose Ritalin compared to placebo in separate 2-week trials. Each treatment was given three times a day for 7 consecutive days.
Measurements and main results. Parents, blinded to the treatment assignment, assessed side effects via the BSEQ at baseline and at the end of each of the 4 treatment weeks. Univariate odds ratios (OR) were used to describe the magnitude of differences in observed side effects between Ritalin and placebo weeks of the trial for each of the items on the BSEQ. The frequency of the following side effects significantly increased with Ritalin therapy: insomnia (OR = 3.13, 95% confidence interval [CI] = (1.80,5.42)), appetite disturbance (OR = 19.00, 95% CI = (9.18,39.31)), stomachache (OR = 7.00, 95% CI = (3.29, 14.89)), headache (OR = 5.29, 95% CI = (2.51,11.15)), and dizziness (OR = 7.50, 95% CI = (1.93,29.13)). The frequency of the following side effects significantly decreased with Ritalin therapy: staring and daydreaming (OR = 0.47, 95% CI = (0.27,0.84)), irritability (OR = 0.33, 95% CI = (0.18,0.61)), anxiety (OR = 0.42, 95% CI = (0.23,0.76)), and nailbiting (OR = 0.19, 95% CI = (0.07, 0.53)). The incidence rates of the remaining BSEQ items did not differ significantly between the Ritalin and placebo weeks of the trial.
Conclusion. The BSEQ proved to be clinically effective in tracking Ritalin side effects and should be incorporated into the routine evaluation and monitoring of ADHD patients for whom stimulants are prescribed.
Accuracy and Precision of Low-Dose Insulin Administration
Authors: Casella Samuel J. , Mongilio Marilyn K. , Plotnick Leslie P. , Hesterberg M. Polly , Long Carol A. 
Published: December 2021

Objective. To determine the lowest dose of concentrated (U100) insulin that can be reproducibly delivered.
Methods. A telephone survey was used to determine current practices in major pediatric hospitals regarding the administration of low doses of concentrated insulin. A sensitive gravitometric technique was used to determine the error in measurement of low doses of U100 insulin by pediatric nurses and parents of diabetic children.
Results. A telephone survey revealed that doses as low as 0.5 or 1.0 U (5 to 10 µL) are routinely administered in pediatric hospitals. In our study of pediatric nurses, attempts to deliver 0.5, 1.0, and 2.0 U resulted in delivered doses of 0.975 ± 0.315, 1.638 ± 0.376, and 2.153 ± 0.435 U (mean ± standard deviation of the mean), respectively. The use of 0.3-mL syringes compared to 0.5-mL syringes did not improve accuracy or precision. Taken as a group, parents of children with diabetes were more accurate (mean delivered dose of 1.063 ± 0.276 for the 1-U dose), but the individual means ranged from 0.641 to 1.300 and coefficients of variation ranged from 5% to 33%. Only three of the seven parents could deliver 1.0 U with acceptable precision and accuracy.
Conclusions. When currently available syringes are used, insulin injections of less than 20 µL (2 U of U100) have an unacceptably large error. It is recommended that, in the inpatient setting, diluted insulin be used if the prescribed dose is less than 2.0 U.
Newborn Screening for Congenital Hypothyroidism: Recommended Guidelines
Authors:   AAP Section on Endocrinology and Committee on Genetics, and American Thyroid Association Committee on Public Health
Published: December 2021

Congenital hypothyroidism (CH) represents one of the most common preventable causes of mental retardation. The fetal hypothalamic-pituitary-thyroid axis begins to function by midgestation and is mature in the term infant at delivery. If fetal hypothyroidism develops, untoward effects may be demonstrated in certain organ systems, including the central nervous system and skeleton. However, most infants with CH appear normal at birth. Recent data suggest that the hypothyroid fetus is protected to a certain extent by placental transfer of maternal thyroid hormone; serum thyroxine (T4) levels in the cord blood of athyroid fetuses approximate one third of maternal levels.1 In addition, studies in animal models of hypothyroidism demonstrate increased levels of brain iodothyronine deiodinase, the enzyme which converts T4 to triiodothyronine (T3). In the hypothyroid fetus, this increased enzyme acting on T4 of maternal origin is sufficient to produce near normal fetal brain T3 concentrations.2 Thus, it appears that early detection and treatment of congenital hypothyroidism should have the potential to completely reverse the effects of fetal hypothyroidism in all but the most severe cases, for example, athyreotic infants born to mothers with thyroid problems resulting in inadequate placental transfer of maternal thyroid hormone.
Since the development of pilot screening programs for CH in Quebec and Pittsburgh in 1974,3 newborn screening for CH has become routine in essentially all developed countries of the world and is under development in Eastern Europe, South America, Asia, and Africa. In North America it is estimated that more than 5 million newborns are screened, with approximately 1400 infants with congenital hypothyroidism detected annually.
Skeptical About Importance of Low Levels of Lead
Authors: CUNNINGHAM ROBERT D. 
Published: December 2021

To the Editor.—
Drs Cummins and Goldman1 lament that despite what they feel is "strong evidence of lead's neurotoxic effects, many remain skeptical that low-level, subclinical lead exposure in early childhood impacts subsequent cognition and that the Centers for Disease Control's (CDC) aggressive approach to eradicating lead poisoning, including universal screening, is warranted."
Recently Wasserman et al2 published the results of a study performed on the populations of two Yugoslav towns, one of which was the site of a lead smelter, whereas the other town was relatively "lead-free."
On the Association of Unilateral Thalamic Hemorrhage and Urinary Tract Infection
Authors: ROOMAN R. , VAN REEMPTS P. , VAN OVERMEIRE B. , MAHIEU L. 
Published: December 2021

To the Editor.—
Two years ago Roland et al reviewed a group of full-term newborns with late-onset thalamic hemorrhage/intraventricular bleeding.1 The pathogenesis of this condition remains unclear but in the series of patients described by Roland et al, we noticed that urinary tract infection was the most common complicating factor. We recently treated a full-term newborn with late-onset unilateral thalamic hemorrhage associated with a urinary tract infection.
The child was born after an uncomplicated pregnancy at 40 weeks of gestation.
Stepping Up the Treatment of Children With Asthma
Authors: FURUKAWA CLIFTON T. 
Published: December 2021

In response to the increase in asthma morbidity and mortality noted in the 1980s, the National Heart, Lung, and Blood Institute convened an expert panel and published its recommendations as the National Asthma Education Program in 1991.1 Comprehensive guidelines were developed focusing on four components of asthma management:
1. Objective measures of lung function
2. Pharmacologic therapy
3. Environmental measures to control allergens and irritants
4. Patient education
This commentary addresses issues related to pharmacologic therapy. The guidelines of this component of asthma management focus on treatment of inflammation, rather than on bronchodilation. Because corticosteroids are the most effective anti-inflammatory agents used to treat asthma, there has been a shift to using inhaled corticosteroids.
Surfactant Replacement Therapy: Prophylaxis or Treatment?
Authors: DUNN MICHAEL S. 
Published: December 2021

After extensive preclinical and clinical testing, surfactant replacement therapy for premature neonates has become routine in modern neonatal intensive care units. Even though "everyone's doing it," there is nevertheless wide variation in how this therapy is applied. Future studies will be needed to help sort out some of the unresolved issues such as the best preparation, optimal delivery method, how best to ventilate the surfactant-treated neonate, when to retreat with surfactant, and the role of adjunctive therapies such as indomethacin or corticosteroids.
Considerable controversy also exists over when surfactant should be administered. This issue has been studied in some depth, both in animals and premature neonates.
Bronchiolitis Obliterans: A Complication of Group B Streptococcal Disease Treated With Extracorporeal Membrane Oxygenation
Authors: MAYOCK DENNIS E. , O'ROURKE P. PEARL , KAPUR RAJ P. 
Published: December 2021

Group B streptococcus (GBS) is a common cause of severe infection in neonates. In the first days of life, GBS infection presents with sepsis, pneumonia, and cardiovascular collapse. Of those infected, between 25% and 75% will succumb to the disease.1 Nearly half of the children who survive neonatal GBS sepsis suffer significant long-term neurologic morbidity including seizures, mental retardation, hearing disorders, blindness, cerebral palsy, and developmental delays.1,2
The survivors of early-onset GBS pneumonitis appear to have a minimal risk of chronic pulmonary disease, but this has not been studied thoroughly. We describe a neonate with early-onset GBS sepsis and pneumonitis who developed severe respiratory failure requiring extracorporeal membrane oxygenation (ECMO) support.
Pediatric Services for Infants and Children With Special Health Care Needs
Authors:   Committee on Children With Disabilities
Published: December 2021

The discipline of infant and child development has expanded greatly during the last 3 decades.1 Much of this growth is due to new knowledge regarding special services that can improve early development of children with, or at risk for, disabilities.2 Passage of Public Law 101-476, the Individuals With Disabilities Education Act (IDEA) revising Public Law 99-457,3 particularly Part H, coupled with existing federal child care mandates and increasing public expression of concern regarding all forms of child care, shows a significant national commitment to the concept that early services are critical if children with disabilities are to reach their full potential.4
While there may be debate over the relative importance of environmental vs hereditary factors in a child's developmental outcome, any approach used to promote child development must consider how these factors interact. A child's intelligence, temperament, and motor skills combine in a complex fashion with family and peers, to influence his or her development. There is much to learn about how to positively influence child/caregiver/societal interactions. As work in the area of early intervention* grows, attempts to prove that such efforts can help a child with disabilities overcome innate cognitive and motor skill limitations have met with inconsistent and often controversial results.5 Improved outcomes are most likely to occur when services are based on the premise that parents or primary caregivers are the most important factors influencing a child's development. All services, even those as clear-cut as a specific health intervention, must follow this premise.6-8
Future studies documenting successful outcomes of programs influencing child development—namely measures of effects on cognitive and motor development—need to be expanded to include at least the following variables:
Guidelines and Levels of Care for Pediatric Intensive Care Units
Authors:   Committee on Hospital Care and Pediatric Section of the Society of Critical Care Medicine
Published: December 2021

Pediatric critical care medicine has matured dramatically during the past two decades. Knowledge of the pathophysiology of life-threatening processes and the technologic capacity to monitor and treat pediatric patients suffering from them have advanced rapidly during this period. Along with the scientific and technical advances has been the evolution of the pediatric intensive care unt (PICU), where the special needs of critically ill or injured children can be met by pediatric specialists.
In 1985, the American Board of Pediatrics recognized the new subspecialty of Pediatric Critical Care Medicine and established criteria for subspecialty certification. The American Boards of Medicine, Surgery, and Anesthesiology gave similar recognition to the subspecialty. In 1990, the Residency Review Committee of the Accreditation Council for Graduate Medical Education completed its first accreditation of Pediatric Critical Care Medicine Training Programs.
In view of these developments, the Pediatric Section of the Society of Critical Care Medicine and the American Academy of Pediatrics Section on Critical Care Medicine and Committee on Hospital Care believe that existing published1 guidelines should now be revised for the pediatric intensive care unit. This policy represents the consensus of the three above-mentioned groups who believe the recommendations that follow are current, necessary, and attainable in 1993. The guidelines are not intended as a statement of the ideal or ultimate requirements for PICUs. We expect standards for PICUs to rise as critical care medicine continues to develop and appropriately trained providers become more readily available.
In view of these developments, the Pediatric Section of the Society of Critical Care Medicine and the American Academy of Pediatrics Section on Critical Care Medicine and Committee on Hospital Care believe that existing published1 guidelines should now be revised for the pediatric intensive care unit.
Hypoxaemia in infants with bronchopulmonary dysplasia
Authors: POETS CHRISTIAN F. , SAMUELS MARTIN P. , SOUTHALL DAVID P. 
Published: December 2021

To the Editor.—
Singer et al recently described severe oxygen desaturation in infants with bronchopulmonary dysplasia (BPD) who were breathing room air. On average, Sao2 was &lt;80% for 37% of (post-feeding) time in their study.1 They concluded from these findings that the current clinical practice of weaning preterm infants from additional inspired oxygen when average Sao2 is at or more than 88% to 90% should be reassessed.
We wish to point out that, in addition to the data presented by Singer et al, there is further evidence to suggest that the practice of accepting an average Sao2 of 88% to 90% in preterm infants should be reviewed.
Antineuronal Antibodies in Movement Disorders
Authors: Kiessling Louise S. , Marcotte Ann C. , Culpepper Larry 
Published: December 2021

Objective. To determine whether children with recent onset of movement disorders (Tourette syndrome, motor and/or vocal tics, chorea, choreiform movements) show evidence of serological antibodies directed against the human central nervous system as previously documented in research on Sydenham's chorea.
Methods. Serum antibodies against previously frozen human caudate nucleus sections were analyzed using a blinded design and immunofluorescent staining methods. The sera of one group of 50 children referred for evaluation of attention deficit hyperactivity disorder, behavior disorders, and learning disabilities (24 with an associated movement disorder) seen between June 1989 and June 1990 were analyzed. The study was replicated in 33 children (21 with an associated movement disorder) seen between June 1990 and November 1990.
Results. In the original sample of 50 children, those with movement disorders were significantly more likely to have evidence of antineuronal antibodies than were those without movement disorders (odds ratio [OR] 4.80, 95% confidence interval [CI] 2.58 to 8.93). Results of the replication were similar (OR 6.00, 95% CI 2.56 to 14.03). For the total group, the OR was 5.50, (95% CI 3.54 to 8.99), which is highly significant. The percentage of children with a movement disorder whose sera were strongly positive for antineuronal antibodies (44%) was very similar to that previously found in children with Sydenham's chorea (46%). Children with movement disorders were also more likely than children without movement disorders to have at least one antistreptococcal titer elevated.
Conclusions. The data strongly suggest an association between antecedent group A β-hemolytic streptococcal infection as inferred from elevated antistreptococcal titers and the presence of serum antineuronal antibodies, which may, in turn, be linked to childhood movement disorders.