bluuebunny/crossref_metadata_2025_split huggingface dataset:
Relationship Between Blood Lead and Nutritional Factors in Preschool Children: A Cross-sectional Study
Authors: Lucas Susan R. , Sexton Mary , Langenberg Patricia 
Published: December 2021

Objective. The purpose of this study was to assess the relationships between selected nutritional factors and blood lead levels of preschool children.
Methodology. Data on 296 children, aged 9 to 72 months, who were cared for at the University of Maryland at Baltimore Pediatric Ambulatory Center were examined in this cross-sectional study. Nutritional status, socioeconomic aspects, medical history, and potential sources of lead exposure were assessed. Blood samples were evaluated for levels of blood lead, serum iron (ferritin), free erythrocyte photoporphyrin, calcium, and hematocrit.
Results. The average blood lead level was 11.4 µg/dL. Multicollinearity of nutritional factors was addressed using regression techniques. After adjusting for confounders, significant positive associations with blood lead were found for total caloric intake (P = .01) and dietary fat (P = .05).
Conclusions. The findings of this study suggest that even when behavioral and environmental exposures to lead were statistically controlled, total caloric intake and dietary fat each had an independent and significant association with the level of blood lead.
DOCTORS' INCOMES FALL AS MANAGED CARE GROWS
Authors: L. J. F. 
Published: December 2021

For the first time in the 14 years that the American Medical Association (AMA) has been keeping track, doctors' incomes are falling as managed care organizations tighten their grip on the nation's health care system.
The median earnings of all physicians, from front-line general practitioners to highly-paid specialists like brain surgeons, dropped 3.8% last year to $150,000, from $156,000 in 1993, according to preliminary results from the AMA's latest annual survey.
The pressure on pay comes mostly from outside the profession: employers are demanding lower insurance premiums, and insurers are leaning on health care providers to cut costs.
But another factor is at work from within: an explosion in America's doctor population over the last 30 years. The number of physicians has soared to 660,582 today, or 252 for each 100,000 Americans—not counting federal government doctors—compared with 266,045, or 139 for each 100,000 in 1965.
Decreased Cardiac Responses to Auditory Stimulation During Prone Sleep
Authors: Franco Patricia , Groswasser Jose , Sottiaux Martine , Broadfield Ema , Kahn A. 
Published: December 2021

Objective. To evaluate the relationship between body position during sleep and the infants' cardiac responses to auditory stimulation.
Methods. Thirty healthy infants with a median age of 11 weeks were studied polygraphically for one night, while sleeping successively prone and supine, or vice versa. Their behavioral and cardiac responses were recorded during rapid eye movement (REM) sleep, both before and after exposure to 90 dB (A) of white-noise.
Results. Ten infants were excluded from the study, because they woke up during the challenge. For the 20 infants included in the analysis, no significant difference was seen between the prone and the supine position for total sleep time, sleep efficiency, percent of REM and nonrapid eye movement sleep, number of gross body movements, transcutaneous oxygen saturation levels, mean cardiac rate, heart rate variability, number of heart rate drops; mean respiratory rate, and number or duration of central or obstructive apneas. Auditory challenges induced significantly less overall changes in heart rate, less heart rate drops, less heart rate variability, as well as fewer and shorter central apneas in the prone than in the supine position. Autoregressive power spectral analysis of the heart rate was consistent with a possible increase in orthosympathetic tone in the prone position.
Conclusion. Prone sleeping was associated with a decrease in cardiac responses to auditory stimulation and a possible increase in orthosympathetic activity. Prone positioning could favor a reduced reactivity to danger-signaling stimuli during REM sleep.
Oral Manifestations of Pediatric Human Immunodeficiency Virus Infection: A Review of the Literature
Authors: Kline Mark W. 
Published: December 2021

Oral lesions are the source of substantial HIV-associated morbidity in both adults and children. In addition, certain oral lesions are markers for progressive immunologic dysfunction and HIV disease progression. For these reasons, careful and continuous assessment of oral health is an integral part of comprehensive HIV disease treatment.
Available information suggests that HIV-infected children have many of the same oral manifestations observed in HIV-infected adults, but distinguishing features have been noted. Prospective pediatric studies are needed to determine the prevalence and natural history of oral lesions, to examine the relationships between immunologic and virologic markers of HIV disease status and the occurrence of oral manifestations, to evaluate changes in the oral microbial flora of HIV-infected children over time, and to assess the causative nature of oral lesions comprehensively.
A Single-sample, Subcutaneous Gonadotropin-releasing Hormone Test for Central Precocious Puberty
Authors: Eckert Kathryn L. , Wilson Darrell M. , Bachrach Laura K. , Anhalt Henry , Habiby Reema L. , Olney Robert C. , Hintz Raymond L. , Neely E. Kirk 
Published: December 2021

Objective. We compared a rapid, subcutaneous (SQ), single-sample gonadotropin-releasing hormone (GnRH) stimulation test with the standard multiple-sample, intravenous (IV) GnRH stimulation test used in the evaluation of central precocious puberty (CPP).
Methods. We evaluated 22 patients presenting with evidence of precocious puberty. GnRH (100 µg) was administered subcutaneously in the clinic setting with single serum luteinizing hormone (LH) measured 40 minutes after injection. A standard IV GnRH stimulation test was performed within 2 weeks, with serum LH obtained at 0, 20, 40, and 60 minutes. LH was assayed by immunochemiluminometric assay.
Results. The mean peak LH levels after IV and SQ testing were identical. A significant correlation (r = .88) was found between the LH determined by SQ stimulation and the peak LH determined by IV GnRH testing. CPP was diagnosed (LH, ≥8 IU/L) by both SQ and IV testing in 7 of 22 patients and was excluded by both tests in 14 of 22 patients. A diagnostic discrepancy between peak IV and SQ results was seen in 1 patient.
Conclusions. We conclude that mean GnRH-stimulated LH levels from rapid SQ and standard IV testing are indistinguishable and that individual LH levels by each method are strongly correlated. A rapid SQ GnRH test is a valid tool for laboratory confirmation of CPP.
CHILDREN OF THE ATOMIC BOMB: AN AMERICAN PHYSICIAN'S MEMOIR OF NAGASAKI, HIROSHIMA, AND THE MARSHALL ISLANDS
Authors: Yamazaki J. N. 
Published: December 2021

This book was written especially for all those concerned for the welfare of children, but it also serves as a compendium for pediatricians to the hazards of atomic radiation and other effects of the bomb. In a sense the text may be considered a continuation of the Academy's endeavor to communicate related information to its membership in which I have participated in the past.
This effort began in 1957 when the Academy created a Committee of Radiation Hazard and Epidemiology of Malformations that subsequently became the Committee on Environmental Hazards. My assignments included updating the information on the ongoing studies of the children in Hiroshima, Nagasaki, and the Marshall Islands and related studies, which the Committee reported in Pediatrics.
It has been my privilege to serve on the Committee especially with Drs Robert Aldrich, Lee Farr, Fred Silverman, and Paul Wehrle, most of whom successively chaired the Committee. They have encouraged the writing of the narrative and have reviewed the manuscript.
Facilitated Communication
Authors: Hostler Sharon L. 
Published: December 2021

The optimistic side of FC, that nonspeaking children could miraculously become competent communicators, is unfortunately a myth. The dark side of the phenomenon of FC includes false hope, false communication, family disruption, losses of job and reputation, and inappropriate use of scarce resources.14 Unwitting pediatricians have accepted transcripts of FC that described sexual abuse by family members. The result was removal of the child from the family and prosecution of the alleged perpetrator even though the evidence suggested that the communication came from the facilitator and not from the child.16
As more families seek alternative health care for themselves29 and for their children,30 we pediatricians have the following responsibilities: 1) to become informed about our own community's offerings; 2) to develop a framework for our own evaluation (What is the theory or proposed mechanism? What is the research evidence? What is the cost in money and time? What is the potential harm?);)31 3) to support parents as they evaluate the risks and benefits of nontraditional interventions for their children;32 4) to advocate strongly for controlled evaluations of alternative therapies;33 and 5) to remember the unfortunate consequences of therapies such as facilitated communication when inclined to dismiss a nontraditional treatment as "not doing any harm."
Apnea as a Presenting Sign of Hydrocephalus
Authors: Nitahara Jim , Dozor Allen J. , Schroeder Scott A. , Rifkinson-Mann Stephanie 
Published: December 2021

The differential diagnosis for apnea in newborns and infants is extensive and includes, but is not limited to, central nervous, gastrointestinal, metabolic, and respiratory system disorders.1 Frequently no cause is found for the apnea. We present a case in which an unusual cause was found and only after many months.
CASE REPORT
S. K. was a healthy infant with a normal birth history and no significant problems until the age of 13 months when, while playing with his mother, he suddenly collapsed, becoming apneic and cyanotic. Cardiopulmonary resuscitation was administered for 10 minutes before the child began to breathe spontaneously.
Pertussis Deaths: Report of 23 Cases in the United States, 1992 and 1993
Authors: Wortis Naomi , Strebel Peter M. , Wharton Melinda , Bardenheier Barbara , Hardy Iain R. B. 
Published: December 2021

Objective. To characterize pertussis deaths and to identify possible risk factors and prevention strategies.
Methods. A retrospective review of all deaths attributed to pertussis with disease onset during 1992 and 1993 reported to the Centers for Disease Control and Prevention. Hospital discharge summaries and autopsy reports were reviewed, and additional clinical information was provided by physicians involved in the care of the children.
Results. During 1992 and 1993, 23 deaths attributed to pertussis were reported to the Centers for Disease Control and Prevention. Cultures for Bordetella pertussis were positive in 18 (90%) of the 20 cases in which it was performed. Twenty (87%) of the 23 children who died were younger than 1 year of age, and 18 (78%) of the children had received no doses of pertussis vaccine. Among 20 children for whom gestational ages were known, 12 (60%) were born at 36 weeks' gestation or earlier; in contrast, 10.7% of live births in the United States in 1992 were at 36 weeks' gestation or earlier. The median age of mothers whose children had fatal pertussis was 20 (range, 14 to 37) years in the 15 cases in which ages were known, compared with the national median age of 26.3 years in 1992. Pneumonia was a complication in all but 1 (96%) of the cases. Seizures occurred in 4 cases (17%), and acute encephalopathy occurred in 3 cases (13%).
Conclusions. Pertussis continues to cause serious illness and death in the United States, particularly among infants who are not vaccinated. Preterm delivery and young maternal age may place infants at increased risk of death because of pertussis. Under the current pertussis vaccination schedule, three fourths of the infants who died were too young to have received three doses of pertussis vaccine, the minimum number of doses considered necessary for adequate protection against clinical pertussis. Additional strategies to prevent deaths caused by pertussis in young infants, such as starting infant vaccination at an earlier age and booster doses to adolescents and adults, need to be evaluated.
Pediatric Care for Children Whose Parents Are Gay or Lesbian
Authors: Perrin Ellen C. , Kulkin Heidi 
Published: December 2021

Background. A growing number of children have at least one parent who is gay or lesbian. There is no evidence that these children experience any particular difficulties as a result of their parents' sexual orientation. Considerable evidence suggests that the provision of health care may not address the special needs and concerns of gay men and lesbians adequately. No research has been done regarding the pediatric care of children whose parents are gay or lesbian. It is likely that there are predictable challenges and developmental transitions for these children and parents for which pediatricians and other health care providers might be helpful advisers.
Objective. This exploratory project sought to describe the experiences that lesbian and gay parents and their children have had with the pediatric health care system. We were interested in describing experiences that had been especially affirming and others that had been troublesome and in gathering suggestions regarding changes in the structure and process of care.
Methodology. Two hundred fifty-five parents completed an open-ended questionnaire. Responses were coded and tabulated.
Results. Most parents described considerable success in obtaining pediatric care that was affirming, supportive, and satisfactory. On the other hand, many parents noted deficiencies in pediatric offices, clinics, emergency departments, and hospitals, many of which could be corrected easily.
Conclusions. We have summarized the accumulated advice to pediatric health care providers and have described some of the developmental transitions that are potentially appropriate opportunities for pediatric intervention.
Henna: A Potential Cause of Oxidative Hemolysis and Neonatal Hyperbilirubinemia
Authors: Zinkham William H. , Oski Frank A. 
Published: December 2021

Objective. To evaluate the in vitro oxidative potential of lawsone (2-hydroxy-1,4 naphthoquinone). Lawsone is a chemical present in henna, the crushed leaves of which are used worldwide as a cosmetic agent to stain the hair, skin, and nails.
Methodology. Venous blood from glucose-6-phosphate dehydrogenase (G6PD)-normal and G6PD A- subjects were incubated with various amounts of lawsone for 2 hours at 37°C. Reduced glutathione and methemoglobin (MHb) levels were measured before and after incubation.
Results. Final molar concentrations of lawsone in normal blood of 1.4, 2.8, 5.7, and 8.6 x 10-3 mol/L increased MHb percentages from 0.5% to 2.2%, 8.3%, 9.5%, and 12.5%, respectively. In a G6PD A- blood, MHb percentages were 19.8%, 32.2%, 44.9%, and 53.9%. At a lawsone concentration of 2.8 x 10-3 mol/L, blood from 15 healthy adults formed MHb percentages of 7.4% ± 3.3% (±1 SD); in blood from 4 G6PD A- adults, percentages were 44.5%, 40.6%, 41.3%, and 42.8%. Simultaneous measurements of reduced glutathione revealed preincubation values of greater than 40 mg/100 mL of red cells in blood of healthy and G6PD A- subjects. Postincubation values were greater than 40 in blood of healthy subjects and less than 40 in blood of G6PD A- subjects.
Conclusions. These in vitro observations indicate that lawsone is an agent capable of causing oxidative hemolysis. In regions of the world where there is a high incidence of G6PD deficiency and unexplained hyperbilirubinemia, oxidative hemolysis secondary to the cutaneous application of henna could be the initiating event.
Nebulized Budesonide Is as Effective as Nebulized Adrenaline in Moderately Severe Croup
Authors: Fitzgerald Dominic , Mellis Craig , Johnson Mark , Allen Hugh , Cooper Peter , Van Asperen Peter 
Published: December 2021

Objective. Nebulized budesonide and nebulized adrenaline have been shown to be effective in the treatment of moderately severe croup. However, there has been no direct comparison of these therapies. We undertook a multicenter, randomized, double-blind, parallel group study in 66 hospitalized children with viral or spasmodic croup.
Methods. Children 0.5 to 6 years of age were assessed using a validated croup symptom score (stridor, 0 through 4; cough, 0 through 3; retractions, 0 through 3; dyspnea, 0 through 3; and color, 0 through 4) at 0.5, 1, 1.5, 2, 12, and 24 hours after nebulization. Patients received either budesonide (2 mg/4 mL) or L-adrenaline (4 mg/4 mL) via nebulization. The primary outcome measure was change in the total croup symptom score.
Results. Thirty-five children received budesonide and 31 received adrenaline. There was no significant difference in baseline features, including croup score (mean [95% confidence interval]: budesonide, 7.1 [6.7- 7.5]; adrenaline, 7.7 [7.3-8.1]). All patients had significant improvement from baseline, and there was no significant difference between the two treatments, as measured by change in croup scores, change in oxygen saturation, duration of hospitalization, number of subsequent treatments with systemic steroids or adrenaline, and adverse events. No child required intubation.
Conclusion. This study does not show any difference in efficacy and safety between nebulized budesonide and nebulized adrenaline in the treatment of acute upper airway obstruction in patients with moderately severe croup.
GAG CLAUSES IN DOCTOR CONTRACTS
Authors: L. J. F. 
Published: December 2021

U. S. Healthcare, Inc. said it removed controversial provisions from its physician contracts that have prompted doctors to complain that they are hampered in treating patients.
Called "gag clauses" by critics, they are common in contracts of many managedcare companies. Doctors charge that such clauses prevent them from giving patients complete information about treatment options, for instance, or that they are forbidden from telling patients that health maintenance organization (HMO) financial arrangements may penalize doctors for making referrals to specialists.
HMOs counter that some doctors have waged campaigns against managed care with their patients, and that such clauses are intended to prevent such campaigns and any anxiety among patients about their care that may result.
Technical Report Summary: The Neurodiagnostic Evaluation of the Child With a First Simple Febrile Seizure
Authors: Baumann Robert J. , D'Angelo Sandra L. 
Published: December 2021

Febrile seizures are a common problem in clinical practice, occurring in 2.7% of children in the British Birth Cohort Study.1 The subcommittee's efforts were focused on the large subgroup of children (88%)1 who have simple febrile seizures, because in the view of most clinicians and on the basis of the epidemiologic evidence, this is a relatively homogeneous clinical grouping2 in terms of age, clinical presentation, course, and outcome.1-3
DEFINITION OF THE PROBLEM
Children younger than 5 years who have their first seizure in association with a fever are commonly divided into three groups. Children with simple febrile seizures make up the largest group. The second group includes children whose seizures are secondary to central nervous system (CNS) infection (symptomatic febrile seizures). In the third group, children whose seizures are neither simple nor secondary to CNS infection are classified as having complex febrile seizures.
The definition of a simple febrile seizure in this practice parameter corresponds to that in usual clinical practice and is also supported by the analysis of data from the Collaborative Perinatal Project of the National Institute of Neurological and Communicative Disorders and Stroke.4 In that project, Nelson and Ellenberg4 analyzed the data of 1706 children 7 years of age who had had one or more febrile seizures. The risk of epilepsy (afebrile seizures) was significantly higher for children whose neurological development was not normal before the seizures, whose seizures occurred before 6 months of age, whose seizure lasted longer than 15 minutes, or who had more than one febrile seizure per day.
Homeopathic Treatment of Childhood Diarrhea
Authors: Fisher Peter , Dantas Flavio , Reilly David 
Published: December 2021

Sampson and London's critique1 of Jacobs et al's2 double-blind, placebo-controlled clinical trial of homeopathic treatment of childhood diarrhea in Nicaragua misrepresents the scientific evidence.
Sampson and London place great emphasis on possible contamination of the homeopathic medicines, citing three references. Of these three references, two do not, in fact, involve contamination or adulteration. The first (which is incorrectly quoted) reports a case of pancreatitis that followed a proprietary homeopathic preparation, but no contamination was demonstrated and no causal relationship proved.3
Isoniazid Neurotoxicity
Authors: Lewin Peter K. 
Published: December 2021

I read with great interest the article entitled "Acute Isoniazid Neurotoxicity in an Urban Hospital" in the May 1995 issue of Pediatrics.1
As noted by the authors, there has been a resurgence of tuberculosis in North America that is affecting increasing numbers of children and adolescents. Isoniazid (INH) is still the medication of choice in the management of early primary tuberculosis. However, because INH therapy interferes with pyridoxine metabolism, chronic INH neurotoxicity is also becoming much more prevalent.
Combination Therapy With Stavudine and Didanosine in Children With Advanced Human Immunodeficiency Virus Infection: Pharmacokinetic Properties, Safety, and Immunologic and Virologic Effects
Authors: Kline Mark W. , Fletcher Courtney V. , Federici Marianne E. , Harris Alice T. , Evans Kim D. , Rutkiewicz Victoria L. , Shearer William T. , Dunkle Lisa M. 
Published: December 2021

Objectives. To obtain preliminary information on the pharmacokinetic properties, tolerance, safety, and antiviral activity of combination therapy with stavudine and didanosine in children with advanced human immunodeficiency virus (HIV) infection.
Methods. Eight children (median age, 6.6 years; range, 2.8 to 12 years) with advanced HIV disease (median CD4+ lymphocyte count at baseline, 42 cells/µL; range, 8 to 553 cells/µL) were treated with stavudine (2 mg/kg per day in two divided doses) and didanosine (180 mg/m2 per day in two divided doses) for 24 weeks. Seven children had histories of prior zidovudine therapy. All children had received stavudine alone for 19 to 33 months before the addition of didanosine to the treatment regimen. Children were assessed clinically and with laboratory studies at baseline, weekly through week 4 of combination therapy, and every 4 weeks thereafter.
Results. Analysis of stavudine and didanosine plasma half-life values, clearances, and area under the plasma concentration-versus-time curves revealed no obvious clinical pharmacokinetic interaction between the drugs through study week 12. Combination therapy was well tolerated, and there were no drug-associated clinical or laboratory adverse events. Signs and symptoms of peripheral neuropathy were not observed. All three children with baseline CD4+ lymphocyte counts greater than 50 cells/µL had greater than 20% increases in their counts within the first 12 weeks of therapy; CD4+ lymphocyte count increases were not observed in the other children. Plasma HIV RNA concentrations showed median declines of 0.88 log10 (range, -3.41 log10 to 0.31 log10) and 0.30 log10 (range, -0.63 log10 to 0.89 log10) at study weeks 12 and 24, respectively.
Conclusions. Combination therapy with stavudine and didanosine was well tolerated and safe in this small group of children with advanced HIV disease. Plasma HIV RNA concentration declines suggest a favorable effect of therapy on virus load. These findings should be confirmed, and the regimen's clinical efficacy should be examined, in controlled studies of HIV-infected children with less-advanced disease.