bluuebunny/crossref_metadata_2025_split huggingface dataset:
Persistent Pulmonary Hypertension of the Newborn and Smoking and Aspirin and Nonsteroidal Antiinflammatory Drug Consumption During Pregnancy
Authors: Van Marter Linda J. , Leviton Alan , Allred Elizabeth N. , Pagano Marcello , Sullivan Kathleen F. , Cohen Aaron , Epstein Michael F. 
Published: December 2021

Objective. Prenatal causation of persistent pulmonary hypertension of the newborn (PPHN) is suggested by a specific pattern of pulmonary vascular remodeling observed immediately after birth in some infants with fatal PPHN. The goal of this study was to determine whether PPHN is associated with fetal exposure to: (1) tobacco and marijuana smoking (ie, contributors to fetal hypoxemia), (2) consumption of aspirin and other nonsteroidal antiinflammatory drugs (ie, inhibitors of prostaglandin synthesis), and (3) cocaine use (ie, a contributor to vasospasm).
Design. Case-control interview study.
Setting. Two Harvard-affiliated newborn intensive care units.
Participants. Mothers of case infants who had PPHN or who met criteria for the referent group.
Interventions. During July 1985 through April 1989, we interviewed mothers of 103 infants with PPHN and 298 control infants. Because of potential selection bias that might result from recruiting only inborn control infants even though two-thirds of cases were outborn, separate analyses compared the 103 total and 35 inborn infants with PPHN with the 298 inborn control infants. Multivariate analyses were used to adjust for potential confounding factors, including maternal education and Medicaid health insurance (ie, two markers of socioeconomic status), other antenatal factors found to be associated with PPHN (ie, maternal urinary tract infection and diabetes mellitus), and the infant's sex.
Main Outcome Measures. Self-reported use or consumption of tobacco, marijuana, cocaine, aspirin, and other nonsteroidal antiinflammatory drugs during pregnancy.
Results. The adjusted odds ratios (and 95% confidence intervals) for maternal pregnancy exposures to the factors of principal interest among the total study population were: aspirin, 4.9 (1.6-15.3); and nonsteroidal antiinflammatory drugs, 6.2 (1.8-21.8); for the inborn group they were: aspirin, 9.6 (2.4-39.0); and nonsteroidal antiinflammatory drugs, 17.5 (4.3-71.6). Although the association between tobacco smoking during pregnancy and PPHN was elevated in univariate analyses, with odds ratios (and 95% confidence intervals) of 2.0 (1.2-3.4) and 1.3 (0.6-3.3) for total and inborn populations, respectively, the relationship was not significant after adjustment for all other factors in the final logistic regression model. Acknowledged illicit drug use was too infrequent (3.2%) to evaluate.
Conclusion. Maternal consumption of nonsteroidal antiinflammatory drugs and aspirin during pregnancy or the reasons these drugs were ingested seem to contribute to an increased risk of PPHN.
MULTIPLE BIRTHS: A WAKE-UP CALL
Authors: L. J. F. 
Published: December 2021

Miss Helen can recall when the Dionne quints were born in 1934, an event as rare and heralded as the birth of a white buffalo. But today, in the United States alone, there are 42 sets of quintuplets with all members living, including the three little girls and two boys born recently at Long Island Jewish Medical Center to Pnina and Shmuel Klaver of Flatbush. Triplets are more plentiful still. About 2500 sets are born annually.
Twins and other multiples often delight their families, but they also present challenges for them and society as a whole.
Multiples are much more prone to premature birth, a situation that can produce a whopping first-year health care tab—more than $1 billion for all low birth weight multiples, 35% of it borne by Medicare and Medicaid. Birth defect rates are also elevated in multiples. The rate of cerebral palsy, for example, is six times that for singletons, according to one study. And financial and child care burdens are heavier. One side effect: studies show child abuse is more common in families of multiples.
. . . There is no data about how many multiple births are the result of fertility treatment. But it is estimated that 25% of pregnancies resulting from fertility treatment are multiple pregnancies.
Safety and Pharmacokinetics of Recombinant Human Superoxide Dismutase Administered Intratracheally to Premature Neonates With Respiratory Distress Syndrome
Authors: Rosenfeld Warren N. , Davis Jonathan M. , Parton Lance , Richter Susan E. , Price Anita , Flaster Edith , Kassem Nadim 
Published: December 2021

Objective. As a first step in the evaluation of recombinant human CuZn superoxide dismutase (rhSOD) in the prevention of neonatal lung injury, safety and pharmacokinetics of intratracheally (IT) administered rhSOD were studied.
Methods. Twenty-six preterm infants weighing 750 to 1250 g with respiratory distress syndrome were studied in three sequential groups (placebo, 0.5, and 5 mg/kg). Placebo or rhSOD was administered IT 30 minutes after the first surfactant dose. Serial blood and urine studies, rhSOD levels, tracheal aspirate fluid (TAF) markers of acute inflammation, radiographs, and ultrasounds were performed over the 28-day study period.
Results. Serum SOD concentrations were similar at baseline for all three groups (geometric mean 0.2, upper-lower limit 0.1 to 0.2 µg/mL). In the 0.5-mg/kg group, levels were highest at 12 hours (geometric mean 0.7, upper-lower limit 0.5 to 0.8, µg/mL) and returned to baseline by day 3. In the 5-mg/kg group, levels were highest at 6 hours (geometric mean 3.0, upper-lower limit 2.3 to 4.0 µg/mL) and returned to baseline by day 4. Concentrations of SOD in TAF were also similar at baseline for all three groups (geometric mean 0.2, upper-lower limit 0.2 to 0.3 µg/mL). There were no significant increases in the placebo group, but levels in the 0.5-mg/kg group were highest when first sampled at 24 hours (geometric mean 1.1, upper-lower limit 0.8 to 1.4 µg/mL) and returned to baseline by day 3. In the 5-mg/kg group, levels were also highest when sampled at 24 hours (geometric mean 1.4, upper-lower limit 0.9 to 2.1 µg/mL) and returned to baseline by day 4. Urine levels were highest at 12 hours in both the 0.5-mg/kg (geometric mean 1.3, upper-lower limit 1.0 to 1.7 µg/mL) and 5-mg/kg infants (geometric mean 6.4, upper-lower limit 3.9 to 10.4 µg/mL) and decreased significantly by days 2 to 3. rhSOD activity assays (serum, TAF, and urine) demonstrated that the enzyme still possessed significant activity. No adverse effects of rhSOD were found. TAF neutrophil chemotactic activity and albumin concentrations, important acute lung injury markers, were significantly lower in the high-dose rhSOD group compared with the other groups.
Conclusions. Data suggest that a single IT dose of rhSOD results in significant increases in both concentration and activity of the antioxidant in serum, TAF, and urine for 2 to 3 days. The enzyme appears to be well tolerated, and TAF inflammatory markers are reduced after administration. This has important implications in rhSOD trials to prevent acute and chronic lung injury in preterm neonates.
Cardiac Effects of Dexamethasone in Very Low Birth Weight Infants
Authors: Bensky Andrew S. , Kothadia Jamanadas M. , Covitz Wesley 
Published: December 2021

Objective. To characterize the cardiac effects of dexamethasone in very low birth weight infants.
Design. Prospective, randomized, placebo-controlled, double-blind trial. Enrolled subjects were randomized to receive either a 42-day tapering course of dexamethasone or a saline placebo. Echocardiographic measurements were obtained on days 0, 7, 14, 28, and 42.
Subjects. Thirteen infants received dexamethasone and 13 a saline placebo. The two groups were similar in birth weight, gestational age, age at enrollment, and sex/race composition.
Results. Patients receiving dexamethasone had a significantly larger increase in septal thickness on days 7, 14, and 28 and left ventricle (LV) posterior wall thickness on day 14. A significantly lower left ventricular enddiastolic dimension in the dexamethasone group was initially noted on day 7 and persisted until day 42. With the reduced left ventricular end-diastolic dimension, no significant differences in LV mass were noted, despite the increased wall thickness. No differences in LV systolic function, as assessed by area shortening, were seen. Assessment of diastolic function showed a significant increase in the atrial portion of mitral inflow in dexamethasone patients on day 14, as well as a significant prolongation in isovolumic relaxation time on days 7, 14, and 28.
Conclusions. Infants receiving dexamethasone developed evidence for impaired LV filling with a larger increase in wall thickness but no increase in LV mass, asymmetric septal hypertrophy, or augmented systolic function. This suggests that alterations in left ventricular filling play an important role in the development of hypertrophy seen with dexamethasone administration.
Cognitive Functioning and Brain Magnetic Resonance Imaging in Children With Sickle Cell Disease
Authors: Armstrong F. Daniel , Thompson Robert J. , Wang Winfred , Zimmerman Robert , Pegelow Charles H. , Miller Scott , Moser Franklin , Bello Jacqueline , Hurtig Anita ,   Kerstin Vass for the Neuropsychology Committee of the Cooperative Study of Sickle Cell Disease
Published: December 2021

Objective. Brain magnetic resonance imaging (MRI) and neuropsychological evaluations were conducted to determine whether neuroradiographic evidence of infarct in children with sickle cell disease between ages 6 and 12 years would result in impairment in cognitive and academic functioning.
Method and Design. Children enrolled in the Cooperative Study of Sickle Cell Disease were evaluated with brain MRI and neuropsychological evaluation. Completed studies were obtained for 194 children, 135 with HbSS. MRIs were categorized according to the presence of T2-weighted, high-intensity images suggestive of infarct and were further categorized on the basis of a clinical history of cerebrovascular accident (CVA). An abnormal MRI but no clinical history of CVA was classified as a silent infarct. Neuropsychological evaluations included assessment of both global intellectual functioning and specific academic and neuropsychological functions.
Results. Central nervous system (CNS) abnormalities were identified on MRI in 17.9% of the children (22.2% of children homozygous for HbS), and a clinical history of CVA (N = 9, 4.6%) was identified in only children with HbSS disease. Subsequent analyses examined only children with HbSS. Children with a history of CVA performed significantly poorer than children with silent infarcts or no MRI abnormality on most neuropsychological evaluation measures. Children with silent infarcts on MRI performed significantly poorer than children with no MRI abnormality on tests of arithmetic, vocabulary, and visual motor speed and coordination.
Conclusions. These results substantiate the importance of careful evaluation, educational planning, and medical intervention for CNS-related complications in children with sickle cell disease.
Observations on a Recent Increase in Plagiocephaly Without Synostosis
Authors: Kane Alex A. , Mitchell Laura E. , Craven Kathleen P. , Marsh Jeffrey L. 
Published: December 2021

Objective. To verify and determine the cause of an increase in the referral of infants with plagiocephaly without synostosis (PWS) to a single tertiary craniofacial center.
Design. A chart review was performed for 269 infants with a diagnosis of PWS who presented to a single tertiary craniofacial center between 1979 and 1994. The pattern of referral for PWS was analyzed using both simple linear regression and time series regression analyses. In addition, the referral pattern for PWS was compared with that for infants seen at the same center who received a diagnosis of synostotic plagiocephaly. Changes in the distribution of several demographic, perinatal, and clinical variables during the study period were also assessed. Finally, in an effort to identify correlates of the risk of PWS developing, characteristics of patients who were Missouri residents and presented between 1992 and 1994 were evaluated and compared with those of the 1993 Missouri live birth cohort.
Setting. The Cleft Palate and Craniofacial Deformities Institute, St Louis Children's Hospital, Washington University Medical Center.
Results. The average annual number of referrals to our center for PWS in the period 1992 to 1994 was more than sixfold greater than that for the preceding 13 years. There was a statistically significant increase in the annual number of referrals to our center during the 16-year study period. Moreover, there was evidence that the average annual increase in referrals was significantly greater during the last 3 years (1992 through 1994) of the study than in the first 13 years. This shift in the referral patterns is roughly contemporaneous with the American Academy of Pediatrics recommendations regarding infant sleep position. There was no evidence that either the mean number of referrals or the average annual increase in referrals for patients with synostosis changed during the study period. Among patients with PWS, the average age at presentation did not change during the study period. There were also no significant changes in the distribution of other demographic, perinatal, and clinical variables. When compared with the Missouri birth cohort, infants with PWS were significantly more likely to be boys and to have been delivered by forceps. There was also some evidence that patients with PWS were more likely to be born prematurely and to be products of multiple-gestation pregnancies. These associations were, however, of only borderline statistical significance.
Conclusion. Referrals to our center for PWS increased markedly in 1992 relative to previous years. The temporal coincidence of this increase with the American Academy of Pediatrics recommendation to avoid the prone sleeping position, to reduce the risk of sudden infant death syndrome, suggests a possible causal relationship. If this association is causal, education regarding the need for head position rotation coupled with that for sudden infant death syndrome should obviate positional PWS.
Renal Bicarbonate Excretion in Extremely Low Birth Weight Infants
Authors: Ramiro-Tolentino Susan B. , Markarian Katherine , Kleinman Leonard I. 
Published: December 2021

Objective. To test the hypothesis that due to the immaturity of their kidneys extremely low birth weight infants lose large amounts of bicarbonate in their urine.
Methods. Urine and blood samples collected every 8 to 12 hours for the first 4 days of life from 22 preterm infants 23 to 29 weeks' gestation weighing 540 to 982 g at birth were prospectively studied.
Results. As described previously, three phases of fluid homeostasis were identified. The first phase (prediuresis) was a period of low urine output followed by a period of spontaneous diuresis/natriuresis (diuretic phase) and then by a phase when urine output varied according to fluid intake (postdiuresis). Sodium, potassium chloride, and bicarbonate excretion rates and bicarbonate balance (bicarbonate or acetate infused minus bicarbonate excreted) were calculated for each of the three phases. Urinary excretion of sodium, potassium, chloride, and bicarbonate increased from the prediuretic to the diuretic phase and decreased from the diuretic to the postdiuretic phase. During the diuretic phase 88% of renal sodium excretion was accompanied by excretion of chloride. Bicarbonate balance was positive in all three fluid phases. Cumulative renal bicarbonate loss over the first 4 days of life was 1.9 ± 0.5 meq/kg (SD) and the cumulative bicarbonate balance was +4.4 ± 4.1 meq/kg (SD). The glomerular filtration rate, filtered load of bicarbonate, and absolute tubular reabsorption of bicarbonate significantly increased from the prediuretic to the diuretic phase, while fractional reabsorption of sodium and chloride decreased between these two phases. The fractional reabsorption of bicarbonate did not change from prediuresis to diuresis, but increased from diuresis to postdiuresis and consequently from prediuresis to postdiuresis.
Conclusions. Contrary to our original hypothesis, the total renal bicarbonate excretion of extremely low birth weight infants in the first 4 days of life is low and the net bicarbonate balance is positive. The anion predominantly accompanying the excretion of sodium in all three phases is chloride and not bicarbonate. Bicarbonate excretion appears to be independent of sodium excretion during these phases. The increase in renal tubular bicarbonate reabsorption during the first week of life may be associated with extracellular volume contraction.
Protective Eyewear for Young Athletes
Authors:   American Academy of Pediatrics Committee on Sports Medicine and Fitness,   American Academy of Ophthalmology Committee on Eye Safety and Sports Ophthalmology
Published: December 2021

The American Academy of Pediatrics and the American Academy of Ophthalmology recommend mandatory protective eyewear for all functionally one-eyed individuals and for athletes who have had eye surgery or trauma and whose ophthalmologists recommend eye protection. Protective eyewear is also strongly recommended for all other athletes.
BACKGROUND
More than 41 000 sports-related and recreational eye injuries were treated in hospital emergency departments in 1993.1 Seventy-one percent of the injuries occurred in individuals younger than 25 years; 41% occurred in individuals younger than 15 years; and 6% occurred in children younger than 5 years. Children and adolescents are particularly susceptible to injuries because of their fearless manner of play and their athletic immaturity.2-4
Ten sports or sports groupings are highlighted in this statement based on their popularity and the high incidence of eye injuries (see Table 1).1 Baseball and basketball are associated with the most eye injuries in athletes 5 to 24 years old.5 Participation rates and information on the severity of the injuries are unavailable, however; therefore, the relative risk of significant injuries cannot be determined for various sports.
The high frequency of sports-related eye injuries in young athletes indicates the need for an awareness among athletes and their parents of the risks of participation and of the availability of a variety of approved sports eye protectors. When properly fitted, appropriate eye protectors have been found to reduce the risk of significant eye injury by at least 90%.4,6,7
EVALUATION
It would be ideal if all children and adolescents wore appropriate eye protection for all sports and recreational activities.
Prevalence and Impact of Exposure to Interpersonal Violence Among Suburban and Urban Middle School Students
Authors: Campbell Carla , Schwarz Donald F. 
Published: December 2021

Objective. The purpose of this study was to determine the prevalence of exposure to violence in preadolescent children in communities that vary by family income and to determine patterns of physical symptomatology and communication after exposure to a traumatic event.
Methods. Two hundred twenty-eight sixth-grade students from a suburban middle school (school A) and 209 sixth-grade students from an urban middle school (school B) in the Philadelphia metropolitan area were surveyed by a group-administered anonymous questionnaire.
Results. Two hundred two students (89%) from school A and 200 students (96%) from school B reported knowing someone who had been robbed, beaten, stabbed, shot, or murdered. One hundred twenty-nine students (57%) and 183 students (88%), respectively, witnessed a robbing, beating, stabbing, shooting, or murder. Ninety-one students (40%) and 141 students (67%) had been personally robbed, beaten up, stabbed, shot, or caught in gun cross fire. One hundred thirty-four (59%) and 152 (73%) reported hearing gunfire in their neighborhood. One hundred eighty-eight (82%) and 202 (97%) had at least one positive response in all three categories: knowing a victim, witnessing an event, and being a victim of violence.
The proportion of positive responses from school B was significantly greater than the proportion from school A for all of these results. Many students reported symptoms associated with somatization syndromes, depression, and posttraumatic stress disorder; the school B group had significantly more symptoms than the school A group. Both student groups had discussed episodes of witnessing an event or victimization with others, mostly family members and friends, and expressed feelings of fear, anger, sadness, and frustration about these episodes. A very low percentage of the students (from 1% to 8% in the different analyses) consulted a medical or mental health professional.
Conclusions. These data support a substantial prevalence of exposure to violence for suburban and, even more dramatically, for urban middle school-aged children. The higher-prevalence group reported a higher incidence of symptoms sometimes seen after traumatic stress. Many students in both groups expressed multiple feelings about their exposure to violence, and most talked to someone about their exposure; rarely was this person a health professional.
Perianal Lymphangioma Circumscriptum Mistaken for Genital Warts
Authors: Darmstadt Gary L. 
Published: December 2021

Genital warts are common relative to other verrucous lesions of the anogenital region. Consideration of the differential diagnosis of verrucous anogenital lesions is necessary, however, to make a correct diagnosis consistently and to avoid futile, painful, and possibly traumatic attempts at treatment. In this report, I describe a child with a history suspicious for sexual abuse who was treated with inappropriate measures because of misdiagnosis of perianal lymphangioma circumscriptum as genital warts. The pathogenesis, differential diagnosis, and treatment of lymphangioma is presented.
CASE REPORT
A 5-year-old Hispanic boy was referred by his pediatrician to the Dermatology Service with an eruption of red papules on the left buttock and perianal region.
Maternal Smoking and Pulmonary Neuroendocrine Cells in Sudden Infant Death Syndrome
Authors: Cutz Ernest , Perrin Donald G. , Hackman Richard , Czegledy-Nagy Elinor N. 
Published: December 2021

Background. Maternal smoking is a well-recognized risk factor for sudden infant death syndrome (SIDS), but the precise mechanism is unknown. We tested a hypothesis that maternal smoking affects pulmonary neuroendocrine cells (PNECs) and neuroepithelial bodies (NEBs), which are innervated PNEC clusters and presumed airway chemoreceptors.
Methods. Lung sections from infants who died of SIDS and whose mothers smoked during pregnancy (n = 22), infants who died of SIDS and whose mothers were nonsmokers (n = 17), and age-matched control infants (n = 15) who died of other causes were immunostained for bombesin (a PNEC and NEB marker) and assessed morphometrically.
Results. The frequency of PNEC (the percentage of airway epithelium immunoreactive for bombesin) was increased up to twofold in the lungs of infants who died of SIDS (7.7 ± 0.4%) compared with controls (4.9 ± 0.4%), as was the frequency (40 ± 3.5 vs 23 ± 3.7/cm2) and size (748 ± 46.5 vs 491 ± 25.8,µm2) of NEBs. In infants who died of SIDS and who were born to smoking mothers, PNEC frequency was increased significantly compared with that in those born to nonsmoking mothers, but the frequency and size of NEBs were not significantly different between the two groups.
Conclusion. Our findings suggest that maternal smoking potentiates hyperplasia of the PNEC system in the lungs of infants who die of SIDS and that a dysfunction of these cells may contribute to the pathophysiology of SIDS.