bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of Calcium Disodium Versenate (CaNa2EDTA) Chelation in Moderate Childhood Lead Posioning
Authors: Markowitz Morri E. , Bijur Polly E. , Ruff Holly , Rosen John F. 
Published: December 2021

Background. For children with asymptomatic moderate lead poisoning (Blood lead level [BPb] 25 to 55 µg/dL [1.21 to 2.66 µmol/L]), treatment with the chelating agent calcium disodium versenate (CaNa2EDTA) is recommended for all those children with a BPb level &gt;45 µg/dL (2.17 µmol/L) and for those with a BPb level of 25 to 44 µg/dL (1.21 to 2.13 µmol/L) who also have a positive lead mobilization test. However, controlled studies demonstrating its efficacy at inducing a sustained reduction in BPb level or lead-related toxicity have not been performed in children with moderate lead poisoning. This study assesses the relationship between CaNa2EDTA chelation and measures of lead burden and toxicity in children with moderate lead poisoning.
Methods. Two hundred one children with moderate lead poisoning were enrolled. Sequential changes in BPb concentrations, bone lead level as measured by Lα-x-ray fluorescence, and lead-induced toxicity as assessed by erythrocyte protoporphyrin levels were determined over a 7-week period. From this group, children with a positive lead mobilization test received CaNa2EDTA chelation therapy.
Results. Children with positive lead mobilization tests had on average higher initial BPb, bone lead, and erythrocyte protoporphyrin concentrations. The chelated children decreased approximately 4.7 µg/dL (0.23 µmol/L), 41 corrected net counts, and 24 µg/dL (0.46 µmol/L) more than the unchelated children on BPb, bone lead, and erythrocyte protoporphyrin values, respectively. However, children with higher initial levels decreased the most, whereas children with lower initial levels showed the least decline, with or without treatment. When the initial values on the measures were controlled analytically, or when subgroups matched on initial levels were compared, there were no significant differences between the chelated and unchelated children.
Conclusions. The apparent effectiveness of CaNa2EDTA at reducing lead burden and toxicity is no longer observed when the pretreatment levels are considered. The findings suggest that sufficient doubt about CaNa2EDTA efficacy now exists to warrant a randomized controlled trial of chelation therapy in moderately lead-poisoned children. However, until such studies are performed, it would be premature to withhold chelation treatment on the basis of this study alone.
Consent for Medical Services for Children and Adolescents
Authors:   Committee on Pediatric Emergency Medicine
Published: December 2021

Major societal changes affecting the provision of child health care have occurred over the last few decades. In the area of emergency services, consent for medical treatment is an important issue. The purpose of this statement is to outline major considerations involving consent and provide the physician with practical guidelines concerning this issue.
Today fewer than one third of children live in two-parent families in which only the father works outside the home.1,2 Because of foster care placement, or temporary or permanent arrangements with relatives or friends, parents may not be available to give consent for treatment of their children.3-6
Unaccompanied minors may seek medical attention in any one of a number of locations. Some go to the emergency department, 14% of which have no policy regarding consent for the care of these patients.7 Unaccompanied minors younger than 18 years of age account for 3.4% of all emergency department visits.7 Twenty-two states and the District of Columbia now have laws concerning the "mture minor." Most other states have provisions in which competent minors may arrange for care involving contraceptives, pregnancy, abortion, sexually transmitted diseases, drug and alcohol abuse, and psychiatric disorders.8
The dilemma for emergency physicians and practicing pediatricians alike is whether to follow a strict interpretation of the law or to adopt a more practical approach. Clearly, consent is not required in life- or limb-threatening emergencies,8,9 although the definition of emergency varies from state to state. However, in most instances, only routine care, not emergency care, is needed. As a result, many physicians fear charges of battery or litigation should their judgement regarding treatment be questioned.8
SIDS and Homicide
Authors: REESE ROBERT M. 
Published: December 2021

In Reply.—
Drs Bass and Hass cite the progress being made in the training of scene-investigators and this is desirable. No one would disagree that there is a great need for improved, standardized death-scene investigation by competent and objective personnel in all cases of sudden unexpected death in children. The additional need, as pointed out in the article,1 is for Child Death Review Teams in all jurisdictions,2-5 providing interdisciplinary in-depth investigation of all aspects of the unexpected death.
Are the King County SIDS Data Generalizable?
Authors: HAAS JOEL E. 
Published: December 2021

In Reply.—
Dr Brooks aptly cautions that one may not appropriately base intergroup comparisons on criteria used to define the groups. We specifically indicated our intention not to do so in pointing out the folly of such "circular reasoning" in the manuscript's penultimate paragraph. We do not cite the statistical significance of SIDS intergroup differences. We do wish to emphasize the lack of differences in 5-minute Apgar score and growth velocity when the "classic SIDS" group is compared to appropriate controls.
Prenatal Detection of Neuroblastoma: A Ten-Year Experience From the Dana-Farber Cancer Institute and Children's Hospital
Authors: Ho Peter T.C. , Estroff Judy A. , Kozakewich Harry , Shamberger Robert C. , Lillehei Craig W. , Grier Holcombe E. , Diller Lisa 
Published: December 2021

Objectives. To assess the relative frequency of, the clinical and pathological correlates in, and the prognosis of the subset of infants with neuroblastoma who were identified initially by prenatal ultrasonography.
Design. Retrospective review of all patients with neuroblastoma evaluated between 1982 and 1992.
Setting. Large, urban, tertiary care children's hospital in Boston, Massachusetts.
Patients. Eleven infants with neuroblastoma initially detected with prenatal sonograms were identified.
Results. Nine patients had adrenal tumors; two had thoracic paraspinal tumors. Typical diagnostic evidence for neuroblastoma including a palpable abdominal mass and elevations in urinary catecholamines were not commonly seen postnatally. These patients had multiple favorable prognostic indicators including low stage of disease (10/11), favorable biological markers including cellular DNA content (5/5) and N-myc oncogene copy number (5/5), and histopathology suggestive for neuroblastoma in situ (7/11). All patients were treated by surgical resection. One patient exhibited progression of disease postoperatively, but demonstrated a complete clinical response to multiagent chemotherapy. Overall survival in our population was excellent with no deaths seen at a mean follow-up of 37 months (range 3 to 120 months).
Conclusions. Patients with neuroblastoma identified by prenatal ultrasonography generally, although not exclusively, follow a clinically favorable course in which surgical resection is curative. Chemotherapy is not indicated unless substantial progression of disease occurs.
The Treatment of Nocturnal Enuresis—Where Are We Now?
Authors: RAPPAPORT LEONARD 
Published: December 2021

Nocturnal enuresis is a common problem in childhood that occurs in approximately 8% of 8-year-olds. Although our knowledge about the etiology, treatment, and benefits of treatment in enuresis has grown, expert consensus in these three areas remains elusive. During the past several years pediatricians have been confronted with a considerable amount of publicity and advertising related to the treatment of enuresis with desmopressin acetate (DDAVP). The information surge regarding enuresis has left many pediatricians confused as to appropriate intervention strategies to be considered in the management of this very common childhood malady.
ETIOLOGY OF NOCTURNAL ENURESIS—WHAT DO WE KNOW?
Although there clearly are diseases and structural abnormalities that can cause enuresis, the etiology in most children with enuresis remains unclear.
Guidelines for the Administration of Medication in School
Authors:   Committee on School Health
Published: December 2021

Many children and adolescents are able to attend school because of the effectiveness of their medication. The health circumstances requiring medication are diverse. Medication may be essential for continued functioning, either as a component of an elaborate treatment plan for the student with a complex disability or as the only treatment necessary for a student to maintain or regain control of his/her chronic illness. In rare instances medications may be necessary for life-threatening emergencies. For most students, the use of medication will be a convenient benefit to control acute minor or major illnesses, allowing a timely return to the classroom with minimal interference to the student and to others. A student may also symptomatically benefit from nonprescription medications.
SCHOOL POLICY
The school board and the school superintendent, in conjunction with other school personnel and in collaboration with the physician or medical advisory committee for each school (district), should develop a policy for the administration of medication in the school setting. The guidelines should indicate what age and/or class levels are included, such as kindergarten through grade 12 or, alternatively, separate guidelines for different grades. Individual school districts also should seek the advice of counsel as they assume the responsibility for giving medication during school hours. Liability coverage should be provided for the staff, including nurses, teachers, athletic staff, principals, superintendents, and members of the school board. Any student who must take medication during regular school hours should do so in compliance with the school's regulations.
The American Academy of Pediatrics recommends that each school include or consider the following sections in its medication policy.
Ceftriaxone for Otitis Media
Authors: HOBERMAN ALEJANDRO , PARADISE JACK L. , KALEIDA PHILLIP H. 
Published: December 2021

To the Editor.—
Green and Rothrock have not made the case for their assertion that "a single intramuscular injection of ceftriaxone is as effective as 10 days of oral amoxicillin for the treatment of uncomplicated acute otitis media (AOM)."1,p28 Of the many methodological limitations that render their study results questionable, the most important follow.
First, given the study's overly general eligibility criteria, many of the children enrolled may not actually have had AOM. The criteria consisted of at least one symptom (fever, otalgia, or irritability), at least one sign ("discoloration," bulging, impaired mobility, or opacity of the eardrum), and an "abnormal" tympanogram, defined as any type other than NL or TR-s.2
Ceftriaxone for Otitis Media
Authors: GREEN STEVEN M , ROTHROCK STEVEN G 
Published: December 2021

In Reply.—
Dr Brauer worries that our report documenting the efficacy of single-dose ceftriaxone for acute otitis media (AOM) will result in widespread microbial resistance to this drug. We feel this exceedingly unlikely, because ceftriaxone has been in widespread use for a decade with no evidence of impaired efficacy. Additionally, single injections of low-dose ceftriaxone have been standard antigonococcal therapy for several years, again with no diminution in efficacy. Finally, ceftriaxone is recommended only for a limited number of AOM cases, ie, those in which compliance with 10 full days of oral antibiotics is believed to be unlikely.
Can Seizures Be the Sole Manifestation of Meningitis in Febrile Children?
Authors: Green Steven M. , Rothrock Steven G. , Clem Kathleen J. , Zurcher Raymond F. , Mellick Laura 
Published: December 2021

Objective. It is frequently taught that lumbar puncture is a mandatory procedure in many or all children who have fever and a seizure, because the convulsion may represent the sole manifestation of bacterial meningitis. We attempted to determine the incidence of this occult manifestation of meningitis.
Design. Retrospective case series.
Setting and patients. 503 consecutive cases of meningitis in children aged 2 months to 15 years seen at two referral hospitals during a 20-year period.
Main outcome measures. Signs and symptoms of meningitis in patients having associated seizures.
Results. Meningitis was associated with seizures in 115 cases (23%), and 105 of these children were either obtunded or comatose at their first visit with a physician after the seizure. The remaining 10 had relatively normal levels of consciousness and either were believed to have viral meningitis (2) or possessed straightforward indications for lumbar puncture: nuchal rigidity (6), prolonged focal seizure (1), or multiple seizures and a petechial rash (1). No cases of occult bacterial meningitis were found.
Conclusion. In our review of 503 consecutive children with meningitis, none were noted to have bacterial meningitis manifesting solely as a simple seizure. We suspect that this previously described entity is either extremely rare or nonexistent. Commonly taught decision rules requiring lumbar puncture in children with fever and a seizure appear to be unnecessarily restrictive.
Childhood Injury Prevention Counseling in Primary Care Settings: A Critical Review of the Literature
Authors: Bass Joel L. , Christoffel Katherine Kaufer , Widome Mark , Boyle William , Scheidt Peter , Stanwick Richard , Roberts Kenneth 
Published: December 2021

Objectives. The American Academy of Pediatrics (AAP) believes that health education, through office-based counseling, can contribute to childhood injury prevention. This report presents the results of a critical review of the scientific literature on the effectiveness of primary care-based counseling to prevent childhood unintentional injury.
Methods. A panel selected from the AAP Committee and the AAP Section on Injury and Poison Prevention searched the English-language scientific literature for all articles about childhood unintentional injury prevention counseling. A standardized format was developed to record data on each study. Two members of the panel independently reviewed each article. Articles that were original reports and in which unintentional injury prevention counseling took place in a primary care setting were included. Articles were encoded and analyzed by computer and then grouped by quality of evidence using the US Preventive Services Task Force (USPSTF) method of categorizing results of medical care evaluation. Articles were rated by strength of study design in order to compare studies within each USPSTF group.
Results. Twenty articles met the criteria for inclusion. Of these, 18 showed positive effects of injury prevention counseling including five randomized/controlled, 10 non-randomized/controlled, two multiple time series, and one descriptive study. In 15 of the positive studies, physicians performed the counseling. Positive outcomes as measured by increased knowledge, improved behavior, or decreased injury occurrence were reported for both motor vehicle and non-motor vehicle injuries.
Conclusions. The literature review supports the recommendation of the AAP to include injury prevention counseling as part of routine health supervision. This recommendation has implications for health care reimbursement and care content.
PLAN TO SPEED APPROVAL OF DRUGS: MAKERS WOULD PAY FEES TO U.S
Authors: L. J. F. 
Published: December 2021

WASHINGTON, Aug. 10—The Government and the drug industry are near an agreement to require the companies to pay fees that would be used by the Food and Drug Administration to hire 600 new examiners and speed approval of drugs, officials on both sides said today.
The agreement, being worked out by Congressional staff members, is intended to resolve what both the Government and industry have said for the last few years is a catastrophe waiting to happen: the number of drug applications is rapidly increasing, especially because of the boom in biotechnology products, some of which might save lives if they were available. But the F.D.A. has not had enough staff members to keep up.
Advocates of people with AIDS, cancer and rare diseases have all pressed for quicker approval of potentially life-saving drugs, for time can be crucial in treatment.
EVEN MT. EVEREST IS CROWDED
Authors: L. J. F. 
Published: December 2021

If the top of Mount Everest sounds a safe bet for those in search of solitude and tranquility, think again. On May 12th this year so many climbers were waiting to reach the summit that a queue formed. By the end of the day 32 people had stood on top of the world. More climbers conquered Everest this year than in the quarter century after Hillary and Tenzing's first ascent in 1953.
Base camp at the foot of the mountain was particularly crowded and squalid; unseemly fights broke out between mountaineers from different countries. Even halfway up the mountain the squabbling continued. Leaders of teams from New Zealand and America complained that a group of Russians had strayed from their designated route and cut in front of them.
Toward Improving the Outcome of Pregnancy, 1993: Perinatal Regionalization Revisited
Authors: LITTLE GEORGE A. , MERENSTEIN GERALD B. 
Published: December 2021

Toward Improving the Outcome of Pregnancy: The 90s and Beyond (TIOP II) was released by The March of Dimes Birth Defects Foundation (MOD) in May of this year. A predecessor, TIOP I, released in 1976 by the MOD, is considered to be the cornerstone document for the structure of the regional perinatal care system present in the United States today.
Revisitation of our approach to perinatal care took place because we know we have a persistent problem with perinatal outcomes in the United States. Our perinatal statistics lag behind those reported by many other nations. We know we should do better and are becoming frustrated with relative lack of progress. Infant mortality is an indicator that has attracted professional concern and national initiatives. It has been placed on local political agendas and discussed frequently in the media of cities such as Boston and Washington.
Pediatric Surgery: The Long Road to Recognition
Authors: Koop C. Everett 
Published: December 2021

Before 1946, when I completed my training in general surgery, I knew very little about the field that eventually became known as pediatric surgery. I knew that children did not get a fair shake in surgery; that was amply proved during my internship and residency. Surgical patients came from the adult world, and children had a difficult time competing with them. Surgeons in general were frightened of children, and they distrusted the ability of anesthetists to wake children up after putting them to sleep, a position not far from that of many anesthetists. The younger and smaller the patient, the more significant the hazard. I knew, also, that in the United States and in Europe, where some surgery of children was more successfully carried out, it fell usually into one of the specialties, especially orthopedics. In those days there was a need for such specialization in the treatment of diseases that are no longer problems: tuberculosis of the bone, osteomyelitis, and polio.
I wish I could say that my knowledge of the sad state of child surgery as I saw it in Philadelphia made me determined to bring about changes for the better. Actually, during the last year of my general surgery training at the Hospital of the University of Pennsylvania, I was invited to become surgeon in chief of the Children's Hospital of Philadelphia. Pediatric surgery was thrust upon me. Nevertheless, I was excited about the chance to make surgery safer for children, and I entered my career with that goal.
Adolescents and Human Immunodeficiency Virus Infection: The Role of the Pediatrician in Prevention and Intervention
Authors:   TASK FORCE ON PEDIATRIC AIDS
Published: December 2021

The incidence of human immunodeficiency virus (HIV) infection among adolescents is both significant and rising, and concern about this disease is increasingly evident among adolescents, their parents, and health professionals. Such concern evolves from multiple factors including not only the number of adolescents who have been reported to have the acquired immunodeficiency syndrome (AIDS), but also the uncertainty as to how many youths have been infected with the virus but remain asymptomatic; the risk of becoming infected through either heterosexual behavior, homosexual behavior, or substance abuse; and the need to implement effective preventive strategies.
EPIDEMIOLOGY
By the end of December 1992, a total of 946 cases of AIDS in persons aged 13 through 19 had been reported to the Centers for Disease Control. Although adolescents account for less than 1% of the total reported cases of AIDS, 20% of total cases occur in young adults aged 20 through 29.
The long latency period between infection with HIV and the emergence of clinical AIDS, often in excess of 5 years, suggests that many of these young adults were first infected during their adolescence. For others, who become infected as young adults, the sexual or drug use behaviors that placed them at risk for infection had their onset during adolescence.
Although national cross-sectional seroprevalence studies have not been conducted, data from selected populations of adolescents provide some information about the rate of infection among segments of the adolescent population. Since October 1985, the Department of Defense has tested applicants for military service for HIV infection. The Prevalance rate for 17- to 19-years-old screened between October 1985 and March 1989 was 0.34 per 1000.
In Reply: Hair Burning Syncope
Authors: LEWIS DONALD W. 
Published: December 2021

Doctors White and Toor help to expand the spectrum of "Hair-Grooming Syncope Seizures" with their report of "hair burning syncope" and once again show that history is the most sensitive diagnostic tool. Their patients might easily have been diagnosed as having complex partial seizures if limited histories had only included the report of foul odor followed by loss of consciousness. Clearly, the noxious stimulus of one's hair being on fire might be sufficient to precipitate a vasovagal event followed by an hypoxic seizure.
Although these cases are all from Virginia-North Carolina, I am confident that this is a widespread phenomenon, with certain cultural biases depending on hair-grooming customs.