bluuebunny/crossref_metadata_2025_split huggingface dataset:
Adverse Outcomes of Bacterial Meningitis in School-Age Survivors
Authors: Grimwood Keith , Anderson Vicki A. , Bond Lyndal , Catroppa Cathy , Hore Robyn L. , Keir Eddie H. , Nolan Terry , Roberton Don M. 
Published: December 2021

Objective. To determine the outcomes of bacterial meningitis in school-age survivors.
Design. Prospective cohort study.
Setting. Teaching pediatric hospital.
Children. During 1983 through 1986, 158 meningitis survivors, ages 3 months to 14 years, treated at a single center were enrolled. Between 1991 and 1993, 130 children, 82% of the original cohort, were evaluated at a mean age of 8.4 years and a mean of 6.7 years after their meningitis.
Outcome measures. Blinded neurologic, neuropsychologic, audiologic, behavior, and socio-demographic assessments were compared with those from grade- and sex-matched control children. Multivariate analyses adjusted for age at testing and socio-demographic variables.
Results. There was a systematic increase in risk of abnormality or poorer functioning for children with meningitis, compared with control children, across all categories tested, which was significant for fine motor function, Intelligence quotient (IQ) scores, and tests of school behavior, neuropsychologic function, and auditory figure-ground differentiation. Eleven children who had experienced meningitis (8.5%) had major deficits (IQ &lt;70, seizures, hydrocephalus, spasticity, blindness, or severe to profound hearing loss); a further 24 (18.5%) cases and 14 (10.8%) control children had minor deficits (IQ 70 to 80, inability to read, mild to moderate hearing loss, abnormalities in speech discrimination, or school behavior problems). Overall, children who had meningitis were at greater risk (26.9%) for disability. Children with acute neurologic complications had more adverse outcomes than those with uncomplicated meningitis and control children (39% vs 18% vs 11%, respectively).
Conclusions. One in four school-age meningitis survivors has either serious and disabling sequelae or a functionally important behavior disorder, neuropsychologic or auditory dysfunction adversely affecting academic performance. As a group, survivors function less well than their classroom peers, and risk is greatest for, but not confined to, those who had acute neurologic complications. All survivors require careful follow-up, at least until school age.
Passive Smoke Exposure and Otitis Media in the First Year of Life
Authors: Ey John L. , Holberg Catharine J. , Aldous Michael B. , Wright Anne L. , Martinez Fernando D. , Taussig Lynn M. ,   Group Health Medical Associates
Published: December 2021

Objective. This study examined, in a health maintenance organization population of children, the associations between parents' smoking and otitis media (OM) in their children while controlling for other known risk factors.
Methods. Healthy newborns (1246) in a large health maintenance organization were enrolled at birth, and 1013 (81%) were followed prospectively for the first year of life. Their medical records were reviewed for the diagnosis of otitis media. Information on risk factors for recurrent OM (ROM) was collected, including a number of variables related to parental smoking.
Results. After controlling for other known risk factors for ROM including gender, day care, other siblings in the home, parental history of hay fever, and method of feeding, it was found that heavy maternal smoking of 20 or more cigarettes per day was a significant risk factor for ROM but not for nonrecurrent otitis. Heavy maternal smoking was associated with a threefold risk for ROM if the infant weighed less than the mean at birth (3.5 kg) after controlling for other risk factors. No association was found with paternal smoking.
Conclusions. Heavy maternal smoking is a significant risk factor for ROM in the first year of life. This smoking effect seems to be stronger among infants of lower birth weight.
Unrecognized Human Immunodeficiency Virus Type 1 Infection in a Cohort of Transfused Neonates: A Retrospective Investigation
Authors: Lieb Loren E. , Mundy Thomas M. , Goldfinger Dennis , Pepkowitz Samuel H. , Brunell Philip A. , Caldwell M. Blake , Ward John W. 
Published: December 2021

Objective. To retrospectively identify unrecognized human immunodeficiency virus type 1 (HIV-1) infection among a cohort of children transfused as neonates before donated blood was routinely screened for HIV-1 antibody.
Methods. Records at a large, private, metropolitan hospital were reviewed to identify children who were transfused as neonates between January 1980 and March 1985 and discharged alive from the hospital. Multiple data sources were used to locate these children. Parents or guardians were contacted, and their children were offered HIV-1 antibody testing and physical examination.
Results. Of the 775 children identified as having received transfusions during the project period, 644 (83%) were located, and 443 (69%) were evaluated for HIV-1 infection. Among those evaluated, 33 (7%) had antibody to HIV-1, including 14 whose infections had not been previously diagnosed. At the time of enrollment, 13 children infected with HIV-1 were asymptomatic an average of 63 months after transfusion.
Conclusion. HIV-1 antibody testing should be considered for all children, regardless of clinical status, who were transfused before routine blood donor screening was implemented in March 1985, particularly in areas with a high incidence of acquired immunodeficiency syndrome during those years.
Cardiopulmonary Evaluation of Exercise Tolerance After Chest Irradiation and Anticancer Chemotherapy in Children and Adolescents
Authors: Pihkala Jaana , Happonen Juha-Matti , Virtanen Kari , Sovijärvi Anssi , Siimes Martti A. , Pesonen Erkki , Saarinen Ulla M. 
Published: December 2021

Objective. The aim of the study was to evaluate the cardiopulmonary exercise tolerance in children and adolescents after chest irradiation and anticancer chemotherapy.
Methods. We studied 30 subjectively asymptomatic patients aged 8 to 25 years treated for pediatric malignancies with chest irradiation (XRT) ± chemotherapy. The median interval since XRT was 7 (range, 2 to 13) years. The median XRT dose for mediastinum and/or lungs was 2550 (range, 1000 to 5100) cGy. The median cumulative dose of anthracyclines was 250 (range, 0 to 480) mg/m2. Cardiac function and exercise tolerance were evaluated by electrocardiography, echocardiography, radionuclide cineangiography, and exercise test with gas exchange analysis.
Results. The patients differed from normal controls in systolic indices of myocardial function. In echocardiography, the left ventricular contractility was abnormal in 14/30 patients. In radionuclide cineangiography, the left ventricular ejection fraction was subnormal in 6/30 patients, and in 9/30 patients the rise in ejection fraction during exercise was inadequate (&lt;5%). In exercise testing, the mean (±SD) maximum workload attained was 2.7 (±0.7) watts/kg, and the mean (±SD) maximum oxygen consumption was 35.4 (±9.7) mL/min/kg. Both variables were &lt;80% of predicted values in 11 patients.
Conclusions. XRT and anticancer chemotherapy very often lead to late cardiopulmonary toxicity and impaired exercise tolerance. Although in most cases this toxicity seemed to be mild and subclinical, the long-term clinical sequels merit further evaluation.
Children's Health: Racial and Ethnic Differences in the Use of Prescription Medications
Authors: Hahn Beth A. 
Published: December 2021

Objectives. Although racial and ethnic differences in the use of hospital and physician services have been well established, research has not examined the relationship between minority status and the use of prescription medications for children with some access to the health care system. This study examines differences in probability and number of prescribed medications by race and ethnicity, and whether the differences remain if socioeconomic factors, indicators of need, and number of physician visits are taken into account.
Methods. Using data from the 1987 National Medical Expenditure Survey, multivariate regression analysis was used to examine the probability of receiving a prescription medication and number of medications for two samples of children, ages 1 to 5 (N = 1347) and ages 6 to 17 (N = 2155).
Results. Descriptive statistics indicate that compared with white children, black and Hispanic children are less likely to receive a prescribed medication and have on average, fewer medications. The multivariate results of this analysis show that those differences persist, depending on age group of the child, after adjusting for socioeconomic factors, health conditions, and number of physician visits.
Conclusions. The relationship between racial and ethnic status and the use of prescription medication mirrors other types of services, such as physician visits, and affirms that minorities receive fewer services than whites.
Fluoride Supplementation for Children: Interim Policy Recommendations
Authors:   Committee on Nutrition
Published: December 2021

The Committee on Nutrition of the American Academy of Pediatrics (AAP) last issued a statement in 1986 on the topic of fluoride supplementation for children. The recommendations made at that time recently have been reassessed because of what seems to be an increased incidence of dental fluorosis in children living in the United States. Dental fluorosis appears during tooth formation and is caused by excessive fluoride ingestion, which leads to enamel protein retention, hypomineralization of the dental enamel and dentin, and disruption of crystal formation. The effect is cosmetic only, ranging from barely perceptible white striations or specks to confluent areas of pitting or brownish gray staining. Teeth affected by fluorosis seem to continue to be resistant to dental caries.
The main sources of fluoride include fluoridated water, foods or drinks reconstituted or prepared with fluoridated water, dentifrices, and fluoride supplements. Water is not fluoridated to a uniform level throughout the United States, and young children ingest significant but variable amounts of fluoride while brushing their teeth with fluoride-containing toothpaste. Because both of these sources of fluoride are difficult to control, attention has been directed again at the dosage of fluoride supplements to attempt to prevent dental fluorosis.
In January 1994, a Dietary Fluoride Workshop sponsored by the American Dental Association was convened to address the issue of dental fluorosis. Although children can receive substantial amounts of fluoride from beverages and dentifrices, the experts at this workshop thought the only source of fluoride that could be easily altered was the supplement prescribed by physicians and dentists.
Kernicterus in a Full-Term Infant: The Need for Increased Vigilance
Authors: Moneit William 
Published: December 2021

I read the article, "Kernicterus in a Full-Term Infant," in the June 1994 issue of Pediatrics, and wish to comment on the conclusions drawn by Penn et al.
On the point of follow-up care after infants are discharged at 24 hours of life or sooner: I have found it to be good clinical practice to bring these infants into the office for their first examination at 3 days of life. The number of times that I have seen problems with newborns and especially those born to first time mothers are countless.
The Role of Parents in the Detection of Developmental and Behavioral Problems
Authors: Glascoe Frances Page , Dworkin Paul H. 
Published: December 2021

Objective. The success of early identification of children with developmental and behavioral problems is influenced by the manner in which pediatricians elicit, recognize, and select clinical information and derive appropriate impressions. Parents are ready sources of clinical information, and they can be asked to provide two broad types of data: appraisals, including concerns, estimations, and predictions; and descriptions, including recall and report. The purpose of this article is to help pediatricians make optimal use of clinical information from parents to increase the accuracy of clinical judgment in detecting children with developmental and behavoral problems.
Design. Review of 78 research articles and tests relying on parent information from pediatric, psychological, and education literature.
Results and Conclusion. There are several formats for eliciting parental information that are superior in terms of accuracy and ease of evocation. Specifically, parents' concerns and good-quality standardized parent report measures such as the Child Development Inventories capitalize best on parents' observations and insights into their children. In combination, these two types of parental information offer an effective method for the early detection of behavioral and developmental problems in primary-care settings.
Province-Based Study of Neurologic Disability of Children Weighing 500 Through 1249 Grams at Birth in Relation to Neonatal Cerebral Ultrasound Findings
Authors: Aziz Khalid , Vickar David B. , Sauve Reginald S. , Etches Philip C. , Pain Kerrie S. , Robertson Charlene M. T. 
Published: December 2021

Background. Adverse neurodevelopmental outcome in premature infants is more common in the presence of certain ultrasonographically detectable intracranial lesions. Present nomenclature and classifications of parenchymal changes in preterm infants of varying gestations have led to some confusion. Descriptive definitions may be clinically useful. Regionalized perinatal and neonatal care enables population-based studies of these lesions and subsequent outcomes.
Methods. Two- to 3-year outcomes of neonates weighing 500 through 1249 g born in Alberta to Alberta residents during 1987 through 1990 were reviewed in relation to neonatal cerebral ultrasound lesions. Odds ratios and confidence limits for disability were calculated.
Results. Of 960 live births in this weight group, 669 (70%) survived to 1 year adjusted age; 646 (96.6%) were assessed at follow-up, and 80 (12.4%) of these were disabled: cerebral palsy, 8.7%; vision loss, 2.9%; hearing loss, 1.3%; epilepsy, 0.6%; mental retardation, 4.8%; more than one disability per child, 3.6%; and projected dependent disability, 1.4%. Lesions considered to be predictive of disability on ultrasound (excluding germinal layer hemorrhage) were found in 79 (11.8%), parenchymal lesions in 63 (9.4%) of 1-year survivors: intraventricular hemorrhage (IVH) (n = 59), persistent or transient cerebral ventriculomegaly (n = 50), persistent or transient intraparenchymal periventricular echodensity (n = 29), and cystic periventricular leukomalacia (n = 7). All lesions except isolated IVH were associated with adverse outcome; 37% of disabled children, 61% of multiply disabled children, and all children projected to become dependently disabled had parenchymal lesions with or without IVH. Triple lesions of IVH, cerebral ventriculomegaly, and intraparenchymal periventricular echodensity gave an odds ratio for disability of 50. Transient lesions had significant risk.
Conclusions. This province-based study provides a descriptive scheme of serial neonatal cerebral ultrasound lesions and outcome considered useful for clinicians caring for newborns of lowest gestational ages. The overall incidence of parenchymal lesions was lower than frequently reported. Combinations of lesions were linked to increased incidence, complexity, and severity of childhood disability.
Prolonged Episodes of Hypoxemia in Preterm Infants Undetectable by Cardiorespiratory Monitors
Authors: Poets Christian F. , Stebbens Valerie A. , Richard David , Southall David P. 
Published: December 2021

Objective. To determine whether episodes of prolonged hypoxemia occur without prolonged apneic pauses (≥20 seconds) and without bradycardia (pulse rate, ≤100 beats per minute) in apparently well preterm infants.
Methods. Long-term recordings of arterial oxygen saturation as measured by pulse oximetry (SpO2), photoplethysmographic (pulse) waveforms from the oximeter, and breathing movements were performed in 96 preterm infants (median gestational age at birth, 34 weeks; range, 28 to 36 weeks) who were breathing room air. Recordings started at a median age of 4 days (range, 1 to 60 days).
Results. During a median duration of recording of 25 hours, 88 episodes in which SpO2 fell to 80% or less and remained there for 20 seconds or longer were identified in 15 infants. The median duration of these prolonged desaturations was 27 seconds (range, 20 to 81 seconds). In 73 episodes (83%), SpO2 continued to fall to 60% or less. Twenty-three desaturations were associated with prolonged apneic pauses and 54 with bradycardia; 19 of these were associated with both apnea and bradycardia. Thirty desaturations (34%; 10 infants) occurred without bradycardia and without prolonged apnea.
Conclusions. These results indicate that a proportion of apparently well preterm infants exhibit episodes of severe prolonged hypoxemia unaccompanied by prolonged apneic pauses or bradycardia. Such episodes, therefore, would be difficult to detect if only breathing movements and heart rate are monitored. Indications for the use of oxygenation monitors in preterm infants should be reconsidered.
Decreased Carbon Dioxide Sensitivity in Infants of Substance-Abusing Mothers
Authors: Wingkun Janet G. , Knisely Janet S. , Schnoll Sidney H. , Gutcher Gary R. 
Published: December 2021

Objective. To determine whether there is a demonstrable abnormality in control of breathing in infants of substance-abusing mothers during the first few days of life.
Methods. We enrolled 12 drug-free control infants and 12 infants of substance abusing mothers (ISAMs). These infants experienced otherwise uncomplicated term pregnancies and deliveries. The infants were assigned to a group based on the results of maternal histories and maternal and infant urine toxicology screens. Studies were performed during quiet sleep during the first few days of life. We measured heart rate, oxygen saturations via a pulse oximeter, end-tidal carbon dioxide (ET-CO2) level, respiratory rate, tidal volume, and airflow. The chemoreceptor response was assessed by measuring minute ventilation and the ET-CO2 level after 5 minutes of breathing either room air or 4% carbon dioxide.
Results. The gestational ages by obstetrical dating and examination of the infants were not different, although birth weights and birth lengths were lower in the group of ISAMs. Other demographic data were not different, and there were no differences in the infants' median ages at the time of study or in maternal use of tobacco and alcohol. The two groups had comparable baseline (room air) ET-CO2 levels, respiratory rates, tidal volumes, and minute ventilation. When compared with the group of ISAMs, the drug-free group had markedly increased tidal volume and minute ventilation on exposure to 4% carbon dioxide. These increases accounted for the difference in sensitivity to carbon dioxide, calculated as the change in minute ventilation per unit change in ET-CO2 (milliliters per kg/min per mm Hg). The sensitivity to carbon dioxide of control infants was 48.66 ± 7.14 (mean ± SE), whereas that of ISAMs was 16.28 ± 3.14.
Conclusions. These data suggest that ISAMs are relatively insensitive to challenge by carbon dioxide during the first few days of life. We speculate that this reflects an impairment of the chemoreceptor response.
Evaluation of a Portable Infrared End-Tidal Carbon Dioxide Monitor During Pediatric Interhospital Transport
Authors: Bhende Mananda S. , Karr Valerie A. , Wiltsie Drew C. , Orr Richard A. 
Published: December 2021

Purpose. Critically ill children often require endotracheal intubation before transport to a tertiary care center. Correct endotracheal tube (ETT) placement (trachea versus esophagus) and maintenance during transport are of the utmost importance. We evaluated a portable, qualitative, infrared end-tidal carbon dioxide monitor during transport of critically ill children.
Methods. Fifty patients, ages 1 day to 19 years (median, 1 year), weighing 1.6 to 70 kg (median, 10 kg) who were intubated and transported by ground ambulance (n = 25) or rotorcraft (n = 25) were enrolled. ETT position was confirmed by physical examination, arterial blood gas or pulse oximetry, and sometimes by a chest radiograph. The instrument was attached, and readings were obtained before and during transport by transport nurses or respiratory therapists who also completed a brief questionnaire about the monitor. A moving bar indicator with a light-emitting diode display on the instrument indicates the presence of expired carbon dioxide.
Results. All three esophageal tube positions and 48 of 50 tracheal tube positions were correctly identified (sensitivity, 96%; specificity, 100%; positive predictive value, 100%; and negative predictive value, 60%). There were two false-negative results: in one case, there was instrument malfunction because of blood backing up into the tubing because of traumatic intubation, and in the second case, the patient had a chest tube that was leaking air. The device was evaluated as "too large" (30 of 50), "hard to secure" (25 of 50), and "not convenient" (29 of 50). Tube kinking was a problem (n = 7) when used in small infants in isolettes. The instrument was considered helpful in assuring ETT position when clinical evaluation was not possible because of noisy conditions.
Conclusions. We conclude that this carbon dioxide monitor was useful during transport of critically ill children in confirming ETT position. Further improvements in this noninvasive technology might be helpful in making the device more practical for use during interhospital transport.
Low Levels of Selenium in Mothers and Their Newborns in Pregnancies With a Neural Tube Defect
Authors: Güvenç Hüseyin , Karataş Fikret , Güvenç Müzehher , Kunç Şeref , Aygün A. Denizmen , Bektaş Sirri 
Published: December 2021

Objective. Very few data are presented in the literature about selenium (Se) in human fetal development. The aim of this paper was to study the relationship between maternal and neonatal Se status and neural tube defects (NTDs).
Patients and methods. Serum and hair samples were obtained from 20 nonpregnant women, 32 healthy mothers with normal newborns, and 28 mothers who had a newborn with NTD, and their newborns at delivery. Serum Se levels, as ng/mL, and hair Se levels, as µg/g, were determined on a Perkin-Elmer 1000 spectrophotometer (United Kingdom) by fluorometry.
Results. The mean maternal serum and hair Se concentrations in the NTD group (42.9 ± 1.75 ng/mL, 277 ± 7.73 ng/g, respectively) were significantly lower than those of the control healthy mothers (50.2 ± 2.35 ng/mL, 300 ± 6.10 ng/g, respectively) and the nonpregnant women (58.1 ± 3.12 ng/mL, 315 ± 7.64 ng/g, respectively). A significant decrease in concentrations of Se in serum and hair was observed in newborns with a NTD (26.0 ± 1.55 ng/mL, 181 ± 3.71 ng/g, respectively) compared with healthy newborns (32.6 ± 1.70 ng/mL, 204 ± 4.43 ng/g, respectively).
Conclusions. Maternal Se deficiency during pregnancy was thought to be one of the factors responsible for NTDs. However, the lowered serum and hair Se concentrations may be secondary manifestations of an abnormal pregnancy and did not contribute to its production. More studies on maternal Se status during the antenatal period, especially early gestation and neonatal Se status including normal newborns and NTD infants, are needed.