bluuebunny/crossref_metadata_2025_split huggingface dataset:
Safety and Immunogenicity of PRP-T Combined with DTP: Excretion of Capsular Polysaccharide and Antibody Response in the Immediate Post-Vaccination Period
Authors: Miller Melanie A. , Meschievitz Carlton K. , Ballanco Gerard A. , Daum Robert S. 
Published: December 2021

Objective. To evaluate whether combining Haemophilus influenzae type b capsular polysaccharide covalently linked to tetanus toxoid (PRP-T) and diphtheria-tetanus-pertussis (DTP) in one syringe produced a vaccine that was safe and immunogenic.
Design. Randomized clinical trial.
Setting. Suburban New Orleans pediatric population.
Participants. Convenience sample of 150 healthy infants.
Methods. Enrollees were randomized to receive DTP and PRP-T in one injection (Group 1), DTP and PRP-T separately (Group 2), or DTP and H influenzae type b capsular saccharide coupled to a nontoxic variant of diphtheria toxin, CRM197, (HbOC) separately (Group 3) at 2, 4, and 6 months of age. All infants received oral polio vaccine at 2 and 4 months of age. Parents were instructed to record side effects on a standardized form after each vaccine administration. Blood was drawn before each immunization and at 7 months of age; an additional blood and a urine specimen was obtained 2 to 3 days after one of the vaccination visits. Serum was assayed for H influenzae anticapsular antibody (anti-PRP), anti-pertussis toxoid, anti-fimbrial hemagglutinins, anti-diphtheria and anti-tetanus toxoid antibodies, and antibody to polio viruses. Urine was assayed for H influenzae type b capsular polysaccharide.
Results. The rate of occurrence of fever did not differ significantly between groups. Local swelling and erythema occurred more often at the administration site in Group 1 infants than at the DTP administration sites of infants in Groups 2 and 3 after the first and second vaccinations. The mean concentration of all antibodies we assayed did not differ significantly when Group 1 and 2 infants were compared. HbOC recipients (Group 3) had lower mean anti-H influenzae anticapsular antibody and higher mean anti-diphtheria and anti-tetanus antibody concentrations after two and three doses compared with Group 1 and Group 2 infants. No group had a significant change in mean anti-PRP antibody concentration 2 to 3 days after vaccination with any dose. After vaccination, antigenuria occurred less frequently in Group 1 infants (54%, 78%, and 72% in Groups 1, 2, and 3, respectively, P &lt; .01).
Conclusions. Combining PRP-T and DTP produced a combination vaccine associated with a slight increase in the rate of erythema and swelling but with similar immunogenicity of the vaccine components and oral polio vaccine.
Contribution of Asphyxia to the Induction of Hearing Impairment in Jaundiced Gunn Rats
Authors: Silver Sarah , Kapitulnik Jaime , Sohmer Haim 
Published: December 2021

Objectives. This study was designed to determine whether asphyxia contributes to the induction of hearing impairment during neonatal jaundice.
Methods. Asphyxia was induced in jaundiced and nonjaundiced Gunn rats on postnatal days 1 (low bilirubin levels) and 10 (elevated bilirubin levels). Auditory nerve-brainstem evoked response thresholds were assessed in 21- and 28-day and 3-month-old rats.
Results. Asphyxia by itself or jaundice by itself did not lead to any type of hearing impairment. However, the combination of both high plasma bilirubin levels and asphyxia in 10-day-old rats but not in 1-day-old rats was accompanied by a progressive hearing loss in these rats.
Conclusions. The contributory effect of asphyxia on neonatal jaundice may have important clinical relevance if asphyxia, for example, respiratory distress, accompanies neonatal jaundice.
Effects of Early Dexamethasone Therapy on Pulmonary Mechanics and Chronic Lung Disease in Very Low Birth Weight Infants: A Randomized, Controlled Trial
Authors: Durand Manuel , Sardesai Smeeta , McEvoy Cindy 
Published: December 2021

Objective. To determine the changes in pulmonary mechanics before and during early dexamethasone therapy, and to evaluate the effect of dexamethasone on the duration of mechanical ventilation in very low birth weight (VLBW) ventilator-dependent infants at risk for chronic lung disease (CLD).
Methods. A prospective randomized trial was conducted. Forty-three patients (birth weight 600 to 1500 g, gestational age 24 to 32 weeks) who failed to be weaned from the respirator at 7 to 14 days of age were enrolled; 23 infants received a 7-day course of dexamethasone (0.5 mg/kg/day intravenously for 3 days, 0.25 mg/kg/day for 3 days, and 0.1 mg/kg/day for 1 day), and 20 patients were in the control group. At similar mean airway pressure (MAP) and fractional inspired oxygen concentration (FiO2), respiratory system mechanics were measured before and on days 2, 5, and 7 of the study. Airway pressure, flow and tidal volume (VT) were recorded and only mechanical breaths were analyzed. Respiratory compliance (Crs) and respiratory resistance (Rrs) were calculated by two factor least mean square analysis.
Results. Eighty-three percent of infants in the dexamethasone group and 90% in the control group received surfactant in the first 24 hours of life. There was a significant increase in Crs and VT in the dexamethasone group as compared with the control group (P &lt; .001). No major changes in Rrs were observed. Dexamethasone therapy significantly decreased FiO2 and MAP P &lt; .001) and facilitated successful weaning from mechanical ventilation. In addition to a shorter duration of mechanical ventilation (P &lt; .01), the occurrence of CLD (FiO2 &gt; 0.21 at 36 weeks of corrected gestational age, chest radiograph changes) was significantly decreased in the dexamethasone group (P &lt; .01). Except for a transient increase in blood pressure and serum glucose, there were no significant differences in infection rates, intraventricular hemorrhage, or retinopathy of prematurity. Thirteen patients in the control group received dexamethasone at a later age.
Conclusions. Our findings indicate that: 1) early dexamethasone therapy in VLBW infants markedly improves respiratory compliance and tidal volume, reduces FiO2 and MAP requirements, and facilitates extubation in these infants; 2) early dexamethasone therapy reduces the duration of mechanical ventilation and decreases CLD (at 28 days and 36 weeks) in a population of VLBW infants largely treated with surfactant.
Bilirubin Guidelines are a Setback!
Authors: Rabinovitz Jeffery J. , Washburn Earl R. 
Published: December 2021

Our hearts sunk when we read "Practice Parameter: Management of Hyperbilirubinemia in the Term Newborn," which appeared in the October 1994 issue of Pediatrics.1 This document represents a terrible setback for those who wish to manage healthy, jaundiced infants in a more conservative and less invasive manner than had been traditional 20 years ago.
The algorithm presented describes a detailed and rigorous thought process that should be considered when treating any jaundiced infant, and we applaud this.
Use of a Single Solution for Oral Rehydration and Maintenance Therapy of Infants With Diarrhea and Mild to Moderate Dehydration
Authors: Cohen Mitchell B. , Mezoff Adam G. , Laney D. Wayne , Bezerra Jorge A. , Beane Bernadette M. , Drazner Dana , Baker Ray , Moran J. Roberto 
Published: December 2021

Objective. To compare the efficacy of two commonly used solutions in the rehydration of infants with mild to moderate dehydration caused by acute diarrhea in the United States.
Design and setting. Double-blind, parallel-group, randomized study performed at Children's Hospital Medical Center.
Patients. Sixty infant boys (≤2 years old), with mild (≤5%) or moderate (6 to 9%) dehydration caused by acute diarrhea of less than 1 week's duration were included in the study.
Interventions. Infants were randomly assigned to receive treatment with either a glucose-based oral rehydration solution (ORS) (Pedialyte, Ross Laboratories, Columbus, OH) or a rice syrup solids-based ORS (Infalyte, Mead Johnson Nutritional Group, Evansville, IN). After rehydration was achieved, patients entered a maintenance phase during which, in addition to a maintenance ORS, breast milk or a soy-based formula was offered infants older than 1 year were also given a lactose-free diet.
Outcome measures. Rehydration was judged clinically. Infants remained on a metabolic bed during the study in to separate and quantitate urine and stool output. Therefore, in addition to clinical outcome, we compared intake, output and apparent absorption and retention of fluid, sodium, and potassium between groups.
Results. All patients were successfully rehydrated using an ORS without the use of intravenous fluids. No differences were detected between treatment groups in time to rehydration, percentage of weight gain after rehydration, consumption of ORS to achieve rehydration, or stool output. However, the apparent sodium absorption (net intake less fecal output) was greater in the Infalyte group than the Pedialyte group during the first 24 hours.
Conclusion. The two maintenance oral electrolyte solutions (Pedialyte and Infalyte) most commonly used in the United States are effective as rehydration solutions for infants with mild to moderate dehydration. We speculate that a strategy for oral rehydration therapy in the United States, based on the use of a single solution during the rehydration and maintenance phase, might gain additional acceptance by practicing pediatricians and family physicians.
MANAGEMENT STRATEGIES HAVE LITTLE IMPACT ON FINANCIAL PERFORMANCE OF RURAL HOSPITALS
Authors: L. J. F. 
Published: December 2021

Management strategies adopted in response to a changing hospital market apparently have little impact on the financial performance of rural hospitals in the United States, concludes a study supported by the Agency for Health Care Policy and Research (HS05998). Stephen S. Mick, PhD, of the University of Michigan, and colleagues examined the effect of thirteen management strategies on the financial performance of a national sample of 797 US rural hospitals from 1983 to 1988. Examples of these strategies are group purchasing; multihospital, HMO, or nursing home affiliation; and adoption of outpatient services either inside or outside of the hospital service area.
The researchers found no widespread or consistent connection between a hospital's strategic action and positive financial performance ... The researchers conclude from these findings that implementing strategic activities may not be sufficient for rural hospitals to maintain viable networks of acute care facilities in rural areas ...
Older Children and Adolescents Living With Perinatally Acquired Human Immunodeficiency Virus Infection
Authors: Grubman Samuel , Gross Elaine , Lerner-Weiss Nancy , Hernandez Myriam , McSherry George D. , Hoyt Laura G. , Boland Mary , Oleske James M. 
Published: December 2021

Objective. To describe the clinical, immunologic, and psychosocial characteristics of children living with perinatally-acquired human immunodeficiency virus (HIV) infection beyond the age of 9 years.
Methods. This is a descriptive cohort study of 42 surviving perinatally infected children older than 9 years followed at the Children's Hospital Acquired Immunodeficiency Syndrome (AIDS) Program (part of a university-based inner city medical center) as of June 1993. The study is based on medical record data of clinical, immunologic, and psychosocial parameters.
Results. The cohort includes 20 boys and 22 girls with a mean age of 136 months. The mean age at diagnosis of HIV infection was 88 months, and 59.5% were asymptomatic at the time of diagnosis. Currently, after a mean follow-up period of 48 months from diagnosis, 23.8% remain asymptomatic, 19.1% have non-AIDS-defining HIV-related symptoms, and 57.1% have AIDS; 85.7% of the cohort did not develop HIV-related symptoms until after 48 months of age (late-onset prolonged survivors). There was an average annual decline of 71.4 CD4+ cells/µL in the cohort from the ages of 7 to 16 years, and 21.4% have a current CD4+ lymphocyte count of greater than 500 cells/µL, 28.6% between 200 and 500 cells/µL, and 50% less than 200 cells/µL; 76% are orphaned as a result of maternal death, with the majority of the cohort (60%) cared for by extended family members. Disclosure of diagnosis has occurred in 57.1%. The vast majority of the cohort (76%) are attending regular school, with the remainder in special education.
Conclusions. Although close to one quarter of the children and adolescents ages 9 to 16 years living with perinatally acquired HIV infection described in this cohort remain asymptomatic and have a relatively intact immune system, the remainder are living with significant HIV-related symptoms, many of which are chronic in nature and have an impact on daily living. The children in this cohort had both significant immunologic deterioration and symptomatic disease progression during the mean follow-up period of 48 months from the time of diagnosis with HIV infection.
INTERNATIONAL LACTATION CONSULTANT ASSOCIATION ANNOUNCES 1996 MANUSCRIPT COMPETITION
Authors: Auerbach K. G. 
Published: December 2021

The International Lactation Consultant Association is sponsoring a competition designed to identify outstanding manuscripts relating to human lactation or breastfeeding in 1996. Authors may enter one of two categories: a Literature Review competition or a Research Paper competition. The winner in each category will receive $500 (US currency); winning manuscripts will be published in the Journal of Human Lactation. Entrants need not be members of the International Lactation Consultant Association. Students are encouraged to enter.
Competition in the Research Paper competition is open to published or unpublished authors; the Literature Review competition is limited to currently unpublished authors. The postmark deadline for entry in the 1996 competition is January 5, 1996.
To obtain guidelines for submitting a manuscript for consideration in the competition, send a self-addressed (and stamped if US) envelope to:
Latex Hypersensitivity in Children: Clinical Presentation and Detection of Latex-Specific Immunoglobulin E
Authors: Kwittken Pamela L. , Sweinberg Sharon K. , Campbell Donald E. , Pawlowski Nicholas A. 
Published: December 2021

Objective. To better understand the clinical characteristics, diagnosis, and possible prevention of immediate hypersensitivity reactions to latex in a hospitalized, pediatric patient population.
Methods. We performed a retrospective case analysis of the first 35 patients with latex allergy evaluated by our service over a 2-year period at our institution. Characteristics of patients and clinical reactions were analyzed and the presence of latex-specific immunoglobulin E was assessed using in vitro methods. In a limited group of
Objective. To better understand the clinical premedication with steroids and antihistamines was evaluated for the prevention of latex allergic reactions.
Results. The majority of our patients had life-threatening reactions. In previous reports, most pediatric patients underwent reactions in the perioperative period and belonged to two well-recognized "high-risk" patient groups (spina bifida and genitourinary malformations). In our series, 21 patients (60%) had reactions outside of the operating room setting, and 14 patients (40%) had primary diagnoses outside of the previously recognized "high-risk" groups. Many patients had a history of multiple surgical procedures, and a history of a surgical procedure in the first year of life was very common. A pre-existing clinical history of latex allergy was present in only 18 of the 35 patients, and a severe or life-threatening allergic reaction was the presenting feature of latex allergy in 11 of the 35 patients. Using in vitro assays, we were able to detect latex-specific immunoglobulin E in the sera of all but two of our patients. Latex gloves and latex-containing intravenous sets were common triggers for reactions. When exposure to latex occurs systemically, as through an intravenous line, premedication with steroids and antihistamines may fail to protect against anaphylaxis.
Conclusions. Our experience indicates that the incidence of latex hypersensitivity in children is increasing, that the circumstances (patient profile, hospital location, route of exposure) in which life-threatening reactions may occur are more broad than previously reported, and that a better understanding of both environmental sources of latex antigens and host responses to latex exposure are needed for improved prevention of serious reactions.
Prospective Evaluation of Complications of Dorsal Penile Nerve Block for Neonatal Circumcision
Authors: Snellman Leonard W. , Stang Howar J. 
Published: December 2021

Objective. To evaluate the complications of the dorsal penile nerve block (DPNB) when used for routine neonatal circumcisions.
Methods. All male newborns born in a community hospital between November 1, 1989 and August 31, 1990, and circumcised after DPNB were evaluated. Questionnaires were completed at the time of hospital discharge and at a health supervision visit 2 weeks later.
Results. Questionnaires were returned for 491 (85%) eligible patients. The only complication of DPNB found was bruising at the site of injection in 54 patients (11%). All bruising had resolved by the 2-week visit, and none was thought to have any clinical significance.
Conclusion. DPNB is a safe method of decreasing the pain and stress of neonatal circumcision.
Telephone Calls to an Infectious Diseases Fellow
Authors: Cotton Mark F. 
Published: December 2021

Objective. There is no information on the impact and nature of telephone calls directed to subspecialists. The main objective was to document prospectively all calls directed to a first-year infectious diseases fellow, to determine their content, origin, educational value, and time allocation.
Results. Three hundred fifty-nine calls were received over a 71-day period from March 24 through May 20, 1992. The mean number of daily calls was 5.1 ± 3.3. Mean time per call was 7 ± 5.4 minutes. Cumulatively, 41.7 hours were spent responding to telephone calls. The subgroup with the most calls (44.3%) was from pediatricians in practice. Seventy percent of calls were for advice about case management. Forty percent of calls were considered educational to the fellow.
Conclusions. This study confirms the importance of the infectious disease subspecialist as a resource for primary care physicians.
Cardiac Dysrhythmias and Sports
Authors:   Committee on Sports Medicine and Fitness
Published: December 2021

This Policy Statement was retired October 2008.
Sudden unexpected death during athletic participation is the overriding consideration in advising individuals with dysrhythmias about participation in sports. The incidence of sudden death is 1 to 2 per 200 000 athletes per year and approximately 12 per year in US high school athletes.1 Between 5 and 22% of these deaths occur during sports or physical activities that include basketball, racquetball, jogging, football, soccer, and golf.2 The remainder occur during sedentary activities.2 Another potential risk for the athlete with a dysrhythmia is injury to self or others from syncope or near syncope while playing sports.
The leading cause of sudden unexpected cardiac death is hypertrophic cardiomyopathy.1 A dysrhythmia of ventricular or supraventricular origin may be a significant factor in the sudden unexpected death of these individuals.1 Myocarditis is also a cause of sudden cardiac death. Severe dysrhythmia may be a prominent feature of myocarditis even in the absence of significant cardiac dysfunction.1 This diagnosis should be considered in an individual who has a recent sudden onset of a symptomatic dysrhythmia.3 Ventricular dysrhythmias with exercise are a potential cause of death in individuals with arrhythmogenic right ventricular dysplasia (a rare muscle disorder of the right ventricle).1
Sudden death resulting from dysrhythmia can occur with exertion or excitement in individuals who have hereditary syndromes that include prolongation of the QTc interval.3 Sudden death has also been associated with mitral valve prolapse (rarely) and with Wolff-Parkinson-White syndrome.3
MEDICAL HISTORY
The patient's medical history is of critical importance. Dysrhythmias may be episodic and not apparent at the time of physical examination.
ADMINISTRATIVE COSTS IN U.S. HOSPITALS
Authors: L. J. F. 
Published: December 2021

Background. Previous estimates of administrative costs in U.S. hospitals have been based on figures in California, and nationwide extrapolation has been controversial. If the costs of bureaucracy are high, major policy reforms may yield substantial savings.
Methods. We obtained detailed data on hospital expenses for fiscal year 1990 from reports submitted to Medicare by 6400 hospitals. We calculated each hospital's administrative costs by summing expenses in the following Medicare cost-accounting categories: administrative and general, nursing administration, central services and supply (excluding the purchase cost of supplies), medical records and library, utilization review, and the salary costs of the employee benefits department. We classified costs in most other categories as clinical. Some small categories of expenses (e.g., gift shop) were excluded from both our clinical and administrative groupings, and for others (e.g., plant operations), a proportional share was allocated between the two groupings.
Results. Nationwide, administration accounted for an average of 24.8 percent of each hospital's spending in fiscal 1990. Average hospital administrative costs ranged from 20.5 percent in Minnesota to 30.6 percent in Hawaii. Administrative salaries accounted for 22.4 percent of the average hospital's salary costs. Administrative costs were similar in states with high and low rates of enrollment in health maintenance organizations (HMOs).
Conclusions. Hospital administrative costs in the United States are higher than previous estimates and more than twice as high as those in Canada. Greater enrollment in HMOs, with more competitive bidding by hospitals for managedcare contracts, an important element of proposed managed-competition health care reforms, does not seem to lower hospital administrative costs. N Engl J Med. 1993;329:400-3.
$45 MILLION MALPRACTICE VERDICT
Authors: L. J. F. 
Published: December 2021

... A Fairburn family has been awarded $45 million after their son had to have his hands and legs amputated following an HMO's decision to have him treated at a hospital 42 miles from his home.
On March 26, 1993, Lamona Kaye Adams called the company's emergency line about 3:50 a.m. to report that her 6-month-old son, James, was moaning, panting, limp, and running a 104-degree temperature.
After telling her to place the child in a tepid bath, the emergency line nurse checked with a doctor and directed that the child be taken to Scottish Rite Hospital, north of Atlanta. Kaiser Permanente receives a 15% discount for patients at Scottish Rite.
On the way to Scottish Rite, James' heart stopped. He was revived with CPR at another hospital, but circulation ceased to his extremities and he developed gangrene. A blood infection was later diagnosed.
During a nine-day trial in Fulton State Court, Kaiser's lawyers contended that it would have made no difference if James had been sent to the nearest emergency room.
"Our issue is quality," said the Kaiser Permanente medical director for Georgia. "Quality pediatric care was most available at Scottish Rite."
But the Adamses' lawyer called the case an example of what happens when cost-conscious managed-care providers try to cut corners.