bluuebunny/crossref_metadata_2025_split huggingface dataset:
Breast-Feeding and the Risk of Life-Threatening Rotavirus Diarrhea: Prevention or Postponement?
Authors: Clemens J. , Rao M. , Ahmed F. , Ward R. , Huda S. , Chakraborty J. , Yunus M. , Khan M. R. , Ali M. , Kay B. , van Loon F. , Sack D. 
Published: December 2021

Purpose. To assess the relationship between breast-feeding and the risk of life-threatening rotavirus diarrhea among Bangladeshi infants and children younger than 24 months of age.
Design. Case-control study.
Setting. A rural Bangladesh community.
Participants. One hundred two cases with clinically severe rotavirus diarrhea detected in a treatment centerbased surveillance system during 1985 and 1986, and 2587 controls selected in three surveys of the same community during the same calendar interval.
Outcomes. Cases and controls were compared for the frequency of antecedent breast-feeding patterns.
Results. Compared with other feeding modes, exclusive breast-feeding of infants was associated with significant protection against severe rotavirus diarrhea (relative risk (RR) = 0.10; 95% confidence interval [CI] = 0.03,0.34). However, during the second year of life, the risk of this outcome was higher in breast-fed than in non-breast-fed children (RR = 2.85; 95% CI = 0.37,21.71), and no overall protection was associated with breast-feeding during the first 2 years of life (RR = 2.61; 95% CI = 0.62,11.02).
Conclusions. Although exclusive breast-feeding appeared to protect infants against severe rotavirus diarrhea, breast-feeding per se conferred no overall protection during the first 2 years of life, suggesting that breast-feeding temporarily postponed rather than prevented this outcome. While not detracting from efforts to promote breast-feeding to alleviate the burden of diarrhea due to nonrotaviral enteropathogens, our findings cast doubt on whether such efforts will impact on the problem of severe rotavirus diarrhea.
Preventing Developmental Delays: Is Developmental Screening Sufficient?
Authors: Frankenburg William K. 
Published: December 2021

Developmental screening, a secondary form of prevention, is designed to facilitate early identification and treatment of children in whom a developmental problem has been diagnosed. Ideally, this is accomplished through the administration of a quick, simple, economical procedure that is designed to identify children having a high probability of being delayed. Unfortunately, no single, brief developmental screening test exists that has equal accuracy in identifying the wide gamut of developmental problems in areas such as cognition, language, speech, motor, and social development. In addition, the child's changing development over time limits the predictive accuracy of any such test.
Despite these limitations, developmental screening, like a growth measurement, has value as an aide in developmental surveillance, because it enables its user to combine its results with those of parent concerns, child observations, immunizations, and anticipatory guidance to promote the child's development. This process, rather than waiting for the child to be deviant, is a primary prevention approach that aims to assure that every child receiving such surveillance develops to his or her maximum potential. The DENVER II is designed to assist in this program.
Selective Intrapartum Prophylaxis for Group B Streptococcus Colonization: Management and Outcome of Newborns
Authors: Pylipow Mary , Gaddis Monica , Kinney Janet S. 
Published: December 2021

Objective. Intrapartum antibiotic prophylaxis (IAP) in mothers with group B streptococcus (GBS) colonization presents difficult neonatal management decisions. IAP was instituted in response to an increased incidence of early-onset GBS sepsis (EOGSS), and a study was conducted to evaluate the outcome of these newborns.
Methods. A study was undertaken at Truman Medical Center-East, a county hospital with a level 1 nursery. During the 20-month study period, prenatal GBS cultures were obtained on all mothers in their third trimester of pregnancy. At time of delivery, GBS-positive women who had at least one risk factor were to receive IAP. Risk factors included fever and/or amnionitis, premature labor, and prolonged rupture of membranes defined as &gt;6 hours. Screening laboratory tests were performed on all newborns whose mothers received IAP. Only the newborns with positive screening laboratory tests or symptoms of sepsis received further laboratory evaluation and antibiotic treatment.
Results. During the study, 2040 mothers gave birth to 2054 newborns. Three hundred thirty-two mothers (16.3%) were colonized with GBS and 122 (37.0%) had at least one risk factor. IAP was given to 70 GBS-positive mothers. Thirty-three (27%) GBS-positive mothers with risk factors did not receive IAP for logistical reasons. Eleven full-term newborns had EOGBSS. For case newborns, the mean duration of ruptured membranes was 13.7 hours (range 2.5 to 28 hours). Vertical transmission occurred as follows: Cutaneous colonization was found in 33 (12.5%) newborns born to 261 mothers who received no IAP, and symptomatic EOGBSS was diagnosed in 9 (3.4%). Mothers who received one dose (n = 43) had three (6.9%) newborns with GBS colonization and two (4.7%) asymptomatic newborns with EOGBSS. No newborns born to 28 mothers who received two doses IAP had GBS colonization or were ill. Cutaneous vertical transmission was reduced (P = .03). Newborns born to GBS-positive mothers with one or more risk factors who received IAP had significantly less EOGBSS (P &lt; .05) than those who did not receive IAP.
Conclusions. Selective IAP was administered safely to 21% of GBS-positive women, or 3.5% of all deliveries. IAP prevented EOGBSS when it could be given to GBS-positive mothers with a risk factor. Accurate identification of mothers with GBS colonization and their risk factors is essential for effective use of IAP. Earlier institution of IAP after rupture of membranes may reduce the risk of EOGBSS and the need for extensive infant evaluation.
Drug Trafficking Among African-American Early Adolescents: Prevalence, Consequences, and Associated Behaviors and Beliefs
Authors: Stanton Bonita , Galbraith Jennifer 
Published: December 2021

Objective/Methodology. Drug trafficking by minority youths in low-income, urban areas has received considerable publicity from the mass media in the past half-decade. However, there has been correspondingly little exposition of this problem in the medical literature. This review was undertaken to provide an overview of the epidemiology and consequences of drug trafficking among urban youths and to describe factors associated with drug trafficking.
Results. Existing data indicate that approximately 10% of male, urban, African-American early adolescents report having engaged in drug trafficking, with a higher percent of youths reporting having been asked to sell drugs and/or indicating that they expect to become involved in drug trafficking. Rates increase with advancing age. Reported rates of drug trafficking are comparable with rates of tobacco and alcohol use among early adolescents and are substantially higher than use rates of illegal drugs. Drug trafficking is associated with increased mortality, accounting for one third to one half of homicide-related deaths in some studies. The practice is also associated with other health-risk behaviors, including nonfatal violence, substance use, and incarceration. Perceived social pressures by family members and/or peers to engage in drug trafficking and the belief that a youth's wage-earning potential is limited to drug trafficking are highly correlated with involvement in this activity.
Conclusions. Drug trafficking is a prevalent risk behavior among adolescents that has several negative health consequences.
Pediatric Subspecialty Training, Certification, and Practice: Who's Doing What
Authors: Brotherton Sarah E. 
Published: December 2021

Objective. To examine the extent of pediatric subspecialty training, certification, and practice among general and subspecialty pediatricians and to determine how the diversity of pediatric careers may affect physician workforce supply estimates.
Method. A sample of 4 000 sell-designated pediatricians and pediatric subspecialists from the American Medical Association's Physician Masterfile were surveyed in 1991 by the American Academy of Pediatrics. Seventy-six percent of the sample responded to the 6-page questionnaire on practice characteristics, training, and demographic information.
Results. Two-thirds of pediatricians are not subspecialty trained (66.3%), 15.1% are certified subspecialists, 11.3% are trained but not subboard certified, and 7.3% are subspecialty trained in an area with no certification exam. Subspecialty training did not always predict subspecialty practice; 19% of pediatricians without subspecialty training spend some time in a subspecialty, and 13% of those who are subspecialty trained practice general pediatrics exclusively. Certified subspecialists and those who cannot as yet become certified are most likely to practice their subspecialty. One-fourth of those trained in a certifiable subspecialty but who remain uncertified practice general pediatrics exclusively. The proportion of direct patient care time spent overall, and the proportion of direct patient care time spent in the subspecialty are also related to subspedalty certification and training/practice consistency.
Conclusion. Pediatric workforce supply projections should incorporate more than certification and training information in calculating estimates, as the practice of general and subspecialty pediatrics is very diverse and accommodating of integrative styles.
Pediatricians and Sleep Disorders: Training and Practice
Authors: Mindell Jodi A. , Moline Margaret L. , Zendell Steven M. , Brown Lawrence W. , Fry June M. 
Published: December 2021

Objective. A series of studies were conducted to investigate pediatricians' training, knowledge, and practices regarding sleep and sleep disorders in children and adolescents.
Method and results. Study 1, a national survey of 156 pediatric residency programs, found that pediatricians receive a mean of 4.8 hours of instruction on sleep and sleep disorders, although the mode and median hours of instruction is 0 hours. In Study 2, 88 pediatricians completing a questionnaire concerning general knowledge about sleep disorders in children and adolescents received a mean score of 71.8% (range, 40% to 93%). Pediatricians appear to know the most about developmental issues and sleep hygiene and the least about specific disorders such as narcolepsy and parasomnias. In the third study, 183 pediatricians were surveyed about their actual beliefs and practices regarding young children's sleep problems. Together, those surveyed reported that approximately 25% of their patients experience some type of sleep problem. Most pediatricians recommend behavioral interventions, although 14.8% of pediatricians report prescribing pharmacological treatments, and 48.9% inform parents that their child is likely to outgrow the problem.
Conclusions. The results of these studies support the need for more education in sleep and sleep disorders in children and adolescents within medical schools, pediatric residency programs, and the practicing pediatric community.
Aminohydroxy Propylidene Bisphosphonate (APD) Treatment Improves the Clinical Skeletal Manifestations of Gaucher's Disease
Authors: Samuel Ruth , Papapoulos Socrates E. , Liberman Uri A. , Katz Kalman , Yosipovitch Zvi , Zaizov Rina 
Published: December 2021

Objective. To evaluate the long-term effects and safety of aminohydroxy propylidene bisphosphonate (APD) treatment on the frequency and severity of the clinical skeletal manifestations of Gaucher's disease.
Methodology. Five adolescents who suffered from recurrent bone crisis episodes and atraumatic bone fractures due to Gaucher's disease were treated with APD for 14 to 83 months.
Results. During the 6 years before treatment, the patients suffered from 6 to 17 bone crisis episodes, or 1 to 2.8 episodes per patient per year. Three patients were free from bone crisis episodes during 14 to 32 months of ADP treatment, while two patients had two such episodes during 60 and 83 months of APD treatment (these represent a decrease in bone crisis episodes from 1 and 2.8 per year to 0.4 and 0.3 per year, respectively). Although four patients suffered from 1 to 3 atraumatic bone fractures during the 6 years preceding treatment (a total of 10 fractures), only one patient sustained a fracture on APD treatment (total of 219 months of treatment). Using APD was not associated with clinical side effects, biochemical aberrations, significant changes in liver and kidney function, or changes in serum levels of the hormones regulating mineral metabolism. In all patients, a band-like metaphyseal sclerosis appeared on radiography of the long bone. However, APD did not interfere with bone growth.
Conclusions. The marked clinical improvement in the clinical skeletal manifestations of Gaucher's disease and the absence of toxic side effects in adolescent patients treated with APD support previous findings in three adult patients on the efficacy of APD and indicate possibilities for its use in inducing prolonged remissions in affected patients.
Integrated School Health Services
Authors:   Task Force on Integrated School Health Services
Published: December 2021

When integrated school health services are implemented according to an assessment of community needs and resources, and with adequate attention to quality assurance and evaluation, they may be a way to expand access to health care services for under-served populations. They can also become a coordinated extension of an ongoing medical care home. This approach may be an effective vehicle for integrating psychosocial care and education with medical care.
Pediatricians practicing in public and private sectors should become actively involved in any community effort to develop an integrated school health services initiative. The well-designed integrated health services program, when coupled with comprehensive school health education, could significantly advance the state of health of the nation's children, youth, and families.
Inhaled Nitric Oxide in Congenital Hypoplasia of the Lungs Due to Diaphragmatic Hernia or Oligohydramnios
Authors: Karamanoukian Hratch L. , Glick Philip L. , Zayek Michel , Steinhorn Robin H. , Zwass Maurice S. , Fineman Jeffrey R. , Morin Frederick C. 
Published: December 2021

Objective. We determined whether inhaled nitric oxide (NO) could improve systemic oxygenation in human neonates with hypoplastic lungs.
Methods. A multicenter nonrandomized investigation was performed to study the efficacy of short-term NO inhalation. Inhaled NO was administered at 80 ppm to nine neonates without evidence of structural cardiac disease by echocardiography. Lung hypoplasia was due to congenital diaphragmatic hernia (CDH) in eight patients and to oligohydramnios in one patient. A total of 15 trialS of NO inhalation were performed in these nine patients. Eight trials in seven patients were performed before extracorporeal membrane oxygenation ((ECMO); one patient had two trials) and seven trials were performed in five patients after decannulation from ECMO (two patients had two trials each).
Results. NO inhalation before ECMO did not change postductal Pao2 (42 ± 3 mmHg vs 42 ± 4 mmHg), oxygen saturation (Spo2; 89% vs 88%) or oxygenation index (31 ± 4 cm H2O/torr vs 31 ± 4 cm H2O/torr) for the group. All patients required ECMO support, which lasted from 5 to 17 days (mean 9). After decannulation from ECMO, NO inhalation increased postductal Pao2 from a median of 56 mm Hg (range 41 to 94) to a median of 113 mm Hg (range 77 to 326), P &lt; .05. It decreased the oxygenation index from a median of 23 cm H2O/torr (range 11 to 70) to a median of 11 cm H2O/torr (range 4 to 21), P &lt; .05. It increased SPO2 from 91% to 96% (P &lt; .05) and pH from 7.48 ± .03 to 7.50 ± .03.
Conclusion. In our patients with hypoplastic lungs, inhaled NO was effective only after ECMO. This could be due to maturational changes such as activating the endogenous surfactant system. Inhaled NO may be effective in neonates with hypoplastic lungs who have recurrent episodes of pulmonary hypertension after ECMO, even if they were previously unresponsive.
Screening for Developmental Disabilities: A Suggestion!
Authors: Chesky Robert H. 
Published: December 2021

As a private practitioner with some interest in periodic, standardized preschool developmental screening, I appreciated the recent position statement on this subject (Pediatrics, May 1994) by the Committee on Children with Disabilities.
At least in my locale, it doesn't seem to me that we practicing pediatricians (myself included) have exactly covered ourselves with glory with respect to this important area of health supervision. Thus, perhaps pediatricians may benefit from "regular," "periodic," "formal" American Academy of Pediatrics reminders that inaccurate developmental assessments may deny preschool children needed (and now often publicly funded) early intervention and special education services.
Training Pediatric Residents to Prevent Tobacco Use
Authors: Klein Jonathan D. , Portilla Maria , Goldstein Adam , Leininger Linda 
Published: December 2021

Objective. To assess the effectiveness and acceptability of incorporating the National Cancer Institute (NCI) Guide to Preventing Tobacco Use During Childhood and Adolescence into pediatric training.
Design. Preintervention and postintervention self-reported surveys for residents receiving training and postintervention baseline surveys for those residents not receiving training. Measures include: (1) a self-reported knowledge, attitude, and behavior survey of residents; and (2) physician behavior reports from parent exit interviews.
Setting. A hospital-based pediatric residency program and continuity clinic.
Subjects. Pediatric residents and parents of pediatricpatients seen for well child examinations.
Interventions. Structured NCI smoking cessation curriculum modified for delivery during scheduled teaching activities.
Results. The NCI training was acceptable and perceived as important by residents. Many did not recall receiving the materials or training. Trained residents who remembered the intervention improved their smoking cessation counseling effectiveness. Most patients' parents think it appropriate for physicians to ask; however, most reported not having been asked about smoking or environmental smoke exposure.
Conclusions. For residents to learn effective prevention counseling strategies, systematic, reinforced preventive educational curricula must become an institutionalized part of residency training.
The Prevention of Coronary Artery Aneurysm in Kawasaki Disease: A Meta-analysis on the Efficacy of Aspirin and Immunoglobulin Treatment
Authors: Durongpisitkul Kritvikrom , Gururaj Vymutt J. , Park Joon M. , Martin Clyde F. 
Published: December 2021

Objective. Varying observations have been made concerning the use of aspirin (ASA) and/or intravenous immunoglobulin (IVIG) in the prevention of coronary artery aneurysm (CAA) in children with Kawasaki disease. A meta-analysis of published articles on the subject was conducted to evaluate the reported efficacy of these therapies.
Methods. All published studies in all languages from 1967 through 1993 obtained from MEDLINE and EMBASE were considered, and a defined set of inclusion and exclusion criteria selected the studies for analysis. These studies were grouped based on whether the children in the studies received: (1) ASA alone, (2) low IVIG (≤1 g/kg) and ASA, (3) high IVIG (&gt;1 g/kg) and ASA, (4) single IVIG (&gt;1 g/kg) and ASA, (5) high IVIG and low ASA (≤80 mg/kg), or (6) high IVIG and high ASA (&gt; 80mg/kg). Studies that satisfied the test for homogeneity were subjected to further analysis. The best estimate of the true proportion of CAA as well as the 95% confidence interval for each group were calculated at 30 and 60 days. Hypothesis testing was conducted to determine the statistical significance of the calculated difference in each compared treatment group.
Results. The best estimate of true proportion of CAA and the 95% confidence interval in each group at 30 and 60 days were: (1) ASA group, 30 days, 22.8% (20.6%, 25%); 60 days, 17.1% (13.6%, 20.7%); (2) low-IVIG group, 30 days, 17.3% (14.3%, 20.2%); 60 days, 11.1% (8.7%, 13.6%); (3) high-IVIG group, 30 days, 10.3% (8.3%, 12.3%); 60 days, 4.4% (2.8%, 6%); (4) single-IVIG group, 30 days, 2.3% (0.5%, 4.2%); 60 days, 2.4% (0.5%, 4.2%); (5) high-IVIG-low-ASA group, 30 days, 13% (9%, 17%); 60 days, 4.8% (2.3%, 7.4%); and (6) high-IVIG-high-ASA group, 30 days, 9.1% (6.9%, 11.4%); 60 days, 4% (2%, 6.1%).
Conclusion. The incidence of CAA both at 30 and 60 days was significantly lower in low-IVIG than in ASA and in high-IVIG than in low-IVIG groups. Also, the incidence was lower in the single-IVIG than in the high-IVIG group, but this was noted at 30 days and not at 60 days. There was no statistically significant difference in the incidence of CAA both at 30 and 60 days between the high-IWIG-low-ASA and high-IVIG-high-ASA groups.
Benefit of Primary Prophylaxis Before 18 Months of Age in Reducing the Incidence of Pneumocystis carinii Pneumonia and Early Death in a Cohort of 112 Human Immunodeficiency Virus-infected Infants
Authors: Thea Donald M. , Lambert Genevieve , Weedon Jeremy , Matheson Pamela B. , Abrams Elaine J. , Bamji Mahrukh , Straus Walter L. , Thomas Pauline A. , Krasinski Keith , Heagarty Margaret ,   New York City Perinatal HIV Transmission Collaborative Study Group
Published: December 2021

Objective. To determine the effectiveness of primary prophylaxis in preventing Pneumocystis carinii pneumoni (PCP) in children with perinatally acquired human immunodeficiency virus 1 (HIV-1) infection.
Methods. We conducted a retrospective analysis of a cohort of infants followed from birth at six metropolitan hospitals and one outpatient clinic for pregnant, drugusing women in New York City. Outcomes measured were histologically confirmed PCP and/or death. The potential confounding effect of the infant's stage of illness, as determined by CD4 count, was controlled by including all CD4 determinations as time-dependant covariates in a Cox proportional hazards analysis. Cases were censored at PCP onset, death, loss to follow-up, and 18 months of age.
Results. One hundred twelve HIV-infected children were enrolled at birth between 1986 and 1993. Sixty of these were tracked beyond 18 months of age; of the others, 21 died before this age, 4 were considered lost to follow-up, and 27 had not reached 18 months of age at the last visit. Only 3 cases (4%) of confirmed PCP occurred among the 70 children who received primary PCP proprophylaxis before 18 months of age, compared with 12 cases (28%) among 42 children not receiving PCP prophylaxis at any point before 18 months of age. The Kaplan-Meier estimated incidence of PCP in the first year among children not receiving prophylaxis was 25% (95% confidence interval [CI], 12 to 39). Using Cox methods, the unadjusted risk of PCP among infants not receiving prophylaxis, relative to those receiving it, was 4.1 (95% CI, 1.1 to 15); the relative risk was 4.4 (95% CI, 1.2 to 17) adjusting for the percentage of CD4-positive lymphocytes and 5.1 (95% CI, 1.3 to 20) adjusting for the absolute number of CD4-positive cells. Eight of 26 deaths were caused by PCP, and the likelihood of early death was significantly diminished if PCP prophylaxis was given (relative risk controlling for absolute CD4 cells, 2.57; 95% CI, 1.1 to 6.1).
Conclusions. We report evidence that primary antimicrobial PCP prophylaxis is highly effective in decreasing the frequency of PCP and early death in infants with perinatal HIV infection. These findings support the evised National Pediatric HIV Resource Center and Centers for Disease Control and Prevention guidelines for PCP prophylaxis in children.