bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of Drugs on the Fetus
Authors: Berlin Cheston M. 
Published: December 2021

The tragic consequences for the fetuses of pregnant women using the sedative thalidomide destroyed the theory that the placenta was a type of barrier protecting the fetus from the effects of maternal pharmacology. It now is known that virtually all drugs and chemical compounds cross the placenta. Because such compounds have to cross several lipoprotein barriers in vascular walls to travel from the maternal to fetal circulation, certain physicochemical characteristics of drugs and chemicals favor transport to the fetus: low molecular weight, lipid solubility, and nonionization at a pH of 7.4. Most drugs in current use (prescription and over-the-counter) cross the placenta. Most environmental toxins also cross the placenta and present a special problem; they are very lipid-soluble and may be stored in the woman's body fat, even from childhood until pregnancy occurs. With pregnancy may come mobilization and passage to the fetus. Details of when compounds are transferred across the placenta in pregnancy in humans are not available. Because we are unable to obtain more than the single simultaneous maternal and fetal samples available from the cord blood at delivery, our knowledge of maternal-fetal partitioning and pharmacokinetics remains fragmentary.
Drug exposure can occur at any time from conception through labor and delivery.
INDEX OF SUSPICION
Authors: Smith Summer , Green John L. , Lynch Susan K , Polak Mark J. 
Published: December 2021

This section of Pediatrics in Review reminds clinicians of those conditions that can present in a misleading fashion and require suspicion for early diagnosis. Emphasis has been placed on conditions in which early diagnosis is important and that the general pediatrician might be expected to encounter, at least once in a while. The reader is encouraged to write possible diagnoses for each case before turning to the discussion, which is on the following page.
We invite readers to contribute case presentations and discussions.
Case 1 Presentation
A 17-year-old boy is admitted to the hospital for evaluation and management of recently diagnosed diabetes mellitus. His mother expresses concern about his acting-out behavior and about frequent difficulties in drinking from a glass due to tremors. On examination he is found to be 68.5 inches tall, and he has a mild scoliosis. Evaluation of sexual development reveals axillary hair at Tanner stage III, pubic hair at stage V, penile length of 8 cm, left testicular volume of 3.0 x 1.8 cm, and an undescended right testicle. No breast tissue is palpable.
Case 2 Presentation
A 16-year-old girl is seen at your office with a history of prolonged fatigue and weakness. She has missed school frequently over the past 4 to 5 months, having had many vague complaints of "no energy," headaches, sore throats, aching knees, and the feeling that she will almost "pass out" if she does gymnastics or physical exertion of any kind.
Child Sexual Abuse
Authors: Berkowitz Carol D. 
Published: December 2021

Child sexual abuse has been recognized with increasing frequency since the early 1980s, a trend attributable to a number of factors. Increased public awareness has led to programs, particularly in schools, facilitating disclosure by children about abuse. Likewise, parents are more likely now than previously to believe allegations children make about being abused by trusted extrafamilial friends and advisors. Additionally, the medical community is more knowledgeable about both the behaviors that may indicate abuse and the possible physical changes in the anogenital area of sexually abused children.
Definition
Child sexual abuse is the involvement of children and adolescents in sexual activity that they do not understand and to which they cannot give consent by virtue of their developmental level. There is chronological and developmental asymmetry between the individuals, and the activity is for the sexual gratification of the older individual. Incest involves sexual activities between individuals in whom such activity is prohibited by virtue of societal taboos. These restrictions involve individuals related by blood or by marriage.
Sometimes physical abuse may result in injuries in the genital area. Such injuries are not sexual in intent.
Epidemiology
More than 2 million cases of child abuse are reported annually. Approximately 40% of these cases involve sexual abuse.
Menstrual Disorders in the Adolescent: Amenorrhea
Authors: Polaneczky Margaret M. , Slap Gail B. 
Published: December 2021

The menstrual history is an integral part of the evaluation of the adolescent femaie. Abnormal menstrual flow or timing may be the first sign of systemic illness or sexually transmitted disease. Amenorrhea may signal an endocrine or genetic disorder or may suggest structural abnormalities of the genital tract. Most importantly, any abnormality in menstruation should alert the clinician to the possibility of pregnancy.
Normal Menstrual Cycle
The average age of menarche in the United States is 12.8 years and ranges from 9 to 16 years. Menarche usually occurs 2 to 2.5 years after breast budding and 1 year after the growth spurt. Consequently, the absence of menarche at 15 years of age may be normal in an adolescent who just passed her growth spurt but abnormal in an adolescent who completed puberty 2 years earlier. Most early menstrual cycles are anovulatory. As a result, menses in the young adolescent often are irregular and may be prolonged or heavy. Dysmenorrhea and premenstrual symptoms tend to accompany ovulatory cycles and, therefore, are more common in the older adolescent.
Regular ovulatory cycles usually are established within 1 to 2 years of menarche. Although normal cycle length ranges from 21 to 45 days, the length for a given individual is fairly constant.
Consultation with the Specialist
Authors: Pakula Lawrence C. 
Published: December 2021

Among the most frequent questions pediatricians must address are those related to sibling rivalry, which is important regarding both behavior and development.1 The parents' concerns often begin before the next child is born and may be the result of their own personal experience or family situation. They need guidelines for managing this situation. Parents often find it difficult to understand the concept of innate competition between siblings and to accept some conflict as common in healthy families regardless of how loving, clever, persistent, and available adults may be. The pediatrician is in a unique position to intervene because of the frequent contacts with the family.
Many potential situations should alert both parents and physicians to a potential problem, including: the sibling reaching significant milestones (eg, walking); change in status (eg, no longer being the oldest, only, or youngest child); change in health status of sibling (eg, injury, malignant illness, identification of disabilities); and change involving a significant adult (eg, illness, death, divorce, job loss, change in caregiver).
History taking is essential and can be therapeutic as well as diagnostic. It should include inquiry about who is involved (both children and adults) and their perceived roles; the reporter and most frequent observer; time, situation, and place of occurrence; significance attached to the problem by each of the parents; other occurrences in the entire household regarding relationships; why this problem is receiving attention now and not earlier; and any long-term concerns.
Menstrual Disorders in the Adolescent: Dysmenorrhea and Dysfunctional Uterine Bleeding
Authors: Polaneczky Margaret M. , Slap Gail B. 
Published: December 2021

Dysmenorrhea
Dysmenorrhea, or painful menstruation, is the most common gynecologic problem that occurs during adolescence. It is estimated that 75% of menstruating women experience dysmenorrhea, making it the leading cause of school and work absenteeism among young women.
Primary dysmenorrhea is defined as painful menses with no identifiable pelvic pathology. Secondary dysmenorrhea refers to painful menses resulting from a pelvic abnormality, such as endometriosis or fibroids. This is an important distinction because treatment is based on the cause of the dysmenorrhea.
Evaluation of the adolescent who has dysmenorrhea begins with questioning about the timing, character, and location of the pain as well as the presence of associated systemic symptoms. A history of pelvic infection, menorrhagia, or intermenstrual bleeding suggests that the dysmenorrhea is secondary to pelvic pathology. Pelvic pain at times other than menstruation (eg, mid-cycle, during intercourse, with defecation) may indicate endometriosis. The onset of dysmenorrhea soon after menarche with rapid worsening over several cycles suggests an outlet obstruction, which may result from a partially imperforate hymen or uterine malformation.
A pelvic examination should be performed before initiating treatment for dysmenorrhea. Abnormal uterine size, position, or shape suggest uterine malformation rather than fibroids, which are uncommon during adolescence. Cervical cultures for gonorrhea and chlamydia should be performed because chronic pelvic inflammatory disease (PID) may appear as dysmenorrhea.
Bleeding Disorders in Neonates
Authors: Pramanik Arun K. 
Published: December 2021

The newborn infant is particularly susceptible to bleeding complications for a variety of reasons: physiologic deficiencies of coagulation factors (both quantitative and qualitative), influences of maternal disease or drugs, immaturity of blood vessels, vulnerability to birth trauma, and other conditions associated with bleeding, such as sepsis and asphyxia.1-5
Physicians caring for newborn infants frequently must manage sick neonates who have either obvious or occult bleeding, the latter often masquerading as unexplained anemia or hypotension.1-4 It is crucial to identify the underlying disease(s) in such cases because these infants require vigorous support with blood products as well as aggressive therapy for the underlying disorders. Clinicians often care for well neonates who have abnormalities in coagulation without obvious bleeding; such abnormalities usually represent primary coagulation defects that are either hereditary or immune-mediated.1-5 In these cases, therapy is designed to correct the specific coagulation defect.
Thrombotic complications, which may be either congenital (in the form of homozygous protein-C deficiency or antithrombin III deficiency) or acquired (via catheters, infection, or renal-vein thrombosis), also may present with bleeding in the neonate. Their diagnosis and management is discussed elsewhere.1,3-5
Physiology of Neonatal Coagulation and Hemostasis
The initial defense mechanism against bleeding is the vascular endothelium, which is developed inadequately in the neonate.
INDEX OF SUSPICION
Authors: Green John L. , Shannon Michael , Lovejoy Frederick H. , DeAngelis Catherine 
Published: December 2021

This section of Pediatrics in Review reminds clinicians of those conditions that can present in a misleading fashion and require suspicion for early diagnosis. Emphasis has been placed on conditions in which early diagnosis is important and that the general pediatrician might be expected to encounter, at least once in a while. The reader is encouraged to write possible diagnoses for each case before turning to the discussion, which is on the following page.
We invite readers to contribute case presentations and discussions.
Case 1 Presentation
A 12-y-old boy is seen several hours after the onset of rather severe scrotal discomfort. The pain began shortly after the gym class in which an errant basketball pass struck him squarely in the scrotal area. He is in obvious pain, complains of nausea, and vomited on the car ride to your office. On examination, there is swelling and erythema of the left hemiscrotum and any movement or palpation of the left testis causes great pain; gentle elevation of the testis brings no pain relief. The testis is of firm consistency and quite tense. A cremasteric reflex cannot be elicited on the left side.
Case 2 Presentation
A 12-y-old boy is brought to the office with a 3- to 4-d history of intermittent headache and lethargy.
Children Who Have Attentional Disorders: Diagnosis and Evaluation
Authors: Reiff Michael I. , Banez Gerard A. , Culbert Timothy P. 
Published: December 2021

Attentional disorders (ADs) are among the most common chronic biobehavioral problems encountered during childhood and adolescence. Children who have attention problems represent a very diverse, heterogeneous population who exhibit a broad spectrum of symptom severity and a wide range of associated diagnoses. ADs are approximately six times more frequent in boys than in girls. Symptoms persist into adulthood in 40% to 60% of individuals who were hyperactive as children. The prevalence of these disorders is estimated at 3% to 5% of the school-age population. In spite of this, ADs remain some of the least understood and most commonly reconceptualized constructs in pediatric practice. Labels for these problems have included minimal brain dysfunction (MBD), hyperkinesis, hyperactivity, attention deficit disorder (ADD), attention deficit disorder with hyperactivity (ADDH), and presently, attention deficit hyperactivity disorder (ADHD). In this review, AD often will be used as a generic term for these entities.
Clinically, children who have AD exhibit core symptoms of inattention, impulsivity, and overactivity that are inappropriate for their developmental level and interfere with their optimal functioning. Difficulty with adhering to rules and instructions and excessive day-to-day variability in performing tasks or following directions also are thought by some investigators to be primary deficits in these disorders.
Sudden Infant Death Syndrome
Authors: Carroll John L. , Loughlin Gerald M. 
Published: December 2021

The causes of SIDS are unknown, and there are no tests that predict which infants will die of SIDS. Home monitoring, while it may prevent death in some high-risk infant populations, has not altered the overall incidence of SIDS. Studies have identified several important risk factors, such as prematurity, low birth-weight, inadequate prenatal care, maternal smoking, maternal anemia, and poor socioeconomic conditions. Other recent studies have raised important questions about child care practices, such as infant sleeping position. Still others raise equally important questions about the role of neglect or intentional injury, which now must become the subject of proper scientific investigation. The possibility that underlying metabolic defects may account for a substantial proportion of cases has been raised but requires verification. A common thread is evident: There are risk factors, such as maternal smoking and infant sleeping position, that could be subject to preventive intervention strategies.
Approximately 200 new articles are published on the topic of SIDS every year. The pediatrician must have the necessary perspective to incorporate these into the "big picture." Because the main role of the pediatrician involves support, advice, and counseling of parents of present SIDS victims and future siblings, a strong knowledge base is essential. The pediatrician also can serve as an advocate for future children by insisting
[See table in the PDF file]
on the full and proper investigation of every SIDS case. Although we will never eliminate sudden unexplained death during childhood, we can at least hope, through better diagnosis of treatable conditions and improved preventive intervention strategies, to whittle away this diagnosis of exclusion to its minimum possible incidence.
INDEX OF SUSPICION
Authors: Rivera Juan A. , Taubman Bruce , Walsh-Kelly Christine M. 
Published: December 2021

This section of Pediatrics in Review reminds clinicians of those conditions that can present in a misleading fashion and require suspicion for early diagnosis. Emphasis has been placed on conditions in which early diagnosis is important and that the general pediatrician might be expected to encounter, at least once in a while. The reader is encouraged to write possible diagnoses for each case before turning to the discussion, which is on the following page.
We invite readers to contribute case presentations and discussions.
Case 1 Presentation
A 12-year-old girl is brought to you by her grandmother with a variety of complaints. The child has been overweight all of her life, and she tends to be constipated. She describes recurrent, colicky mid-abdominal pain after eating fatty meals and has had recurrent bouts of vomiting associated with cough and hiccups dating back to her infancy. There is no recent history of fever, asthma, or jaundice.
On examination, the girl is obese, weighing 105 kg (231 lb). Chest and abdominal examinations are normal, with no masses or organomegaly. No focal tenderness is demonstrated. Formed soft stool is noted on rectal examination; the stool is hemocultnegative. Urinalysis is normal; urine culture is negative. The results of screening blood chemistry tests are normal except for a cholesterol level of 267 mg/dL and triglycerides of 280 mg/dL.
Adult Respiratory Distress Syndrome
Authors: Fiser Debra H. 
Published: December 2021

Definition
The adult respiratory distress syndrome (ARDS) was first defined by Ashbaugh et al in 1967. It is a syndrome of acute parenchymal lung dysfunction characterized by the following clinical presentation: 1) a major antecedent precipitating event, 2) the sudden onset of tachypnea and hypoxemia refractory to high concentrations of inspired oxygen, 3) the presence of diffuse patchy infiltrates on the chest radiograph, 4) a decrease in static lung compliance, and 5) the exclusion of cardiogenic pulmonary edema and chronic pulmonary disease as the sole causes of pulmonary dysfunction.
Etiology
A wide variety of major antecedent events may precipitate ARDS. Common triggering events include trauma, sepsis, shock, pulmonary aspiration of gastric contents, near-drowning, diffuse intravascular coagulation, pulmonary contusion, severe pneumonia, massive transfusion of blood products, fat embolism, burns, and cardiopulmonary bypass surgery. Despite the diversity of these predisposing conditions, the similarity in pulmonary pathology and physiology among patients who have ARDS implicates a final common pathway for alveolar injury.
Pathogenesis
ARDS is characterized histologically by diffuse alveolar epithelial and endothelial damage. Subsequently, water, solutes, protein, cellular elements, and collagen may be deposited in the interstitium and air spaces, resulting in decreased compliance and hypoxemia.
Large gaps remain in our knowledge of the pathophysiologic alterations at the cellular and molecular levels, and many mediators have been suspected of playing a role in causing ARDS.
Sexually Transmitted Diseases in Adolescents
Authors: Gittes Elissa B. , Irwin Charles E. 
Published: December 2021

Introduction
Sexually transmitted diseases (STDs) are the most common reported infectious diseases among sexually active adolescents. The acquisition of an STD by the adolescent may result in significant morbidity, including eventual death from human immunodeficiency virus (HIV) infection. Serious medical sequelae for the adolescent female include pelvic inflammatory disease (PID), tubo-ovarian abscess, ectopic pregnancy, infertility, anogenital cancer, acquired immunodeficiency syndrome (AIDS), and morbidity and mortality of her off-spring. For the adolescent male, serious sequelae include epididymitis, proctitis, anogenital cancer, impaired fertility, and AIDS. The adolescent often begins his or her sexual career while under the care of a pediatrician, who, therefore, plays a crucial role in the evaluation and treatment of STDs in the adolescent patient. Of paramount importance is the clinician's role in education about and prevention of STDs in both the abstinent and the sexually active adolescent.
Prevalence
During the past 2 decades, the age of onset of heterosexual intercourse has been decreasing, with a resultant increase in the prevalence of STDs. Data from the 1988 national survey on adolescent sexual debut indicate that by age 15 years, 25% of black and white females and white males and 69% of black males have initiated coitus. By age 19 years, 76% of white females, 85% of white males and black females, and 96% of black males report having had sexual intercourse at least once.1
Consultation with the Specialist
Authors: Poland Ronald L. , Watterberg Kristi L. 
Published: December 2021

Recognizing neonatal bacterial sepsis early is one of the most difficult problems that pediatricians encounter. Only 1 in 500 to 1 in 1600 newborns have proven bacterial sepsis. Prematurely born and stressed infants exhibit sepsis more frequently than do unstressed term infants. Therefore, the general pediatrician confronts proven neonatal sepsis uncommonly and needs to be alert to the early signs of sepsis because of the great danger of this potentially treatable condition. Prior to the introduction of antibiotics, mortality from neonatal bacterial sepsis was greater than 90%. Antibiotics and supportive therapy have reduced this mortality to 13% to 50%. There remains much room for improvement. Good outcomes depend on early diagnosis, appropriate treatment, and host factors that still are being explored.
Neonatal sepsis tends to appear as either "early onset" or "late onset" syndromes, but some cases are difficult to classify. Early onset disease is seen in the first few days of life, tends to be fulminant, and is associated more often with maternal or perinatal risk factors, such as maternal fever, prolonged rupture of the membranes, and fetal distress. On the other hand, late onset disease usually occurs after 1 week of age, tends to develop more gradually, and is less likely to be associated with the previously mentioned risk factors.
Nicotine Dependence: Diagnosis, Chemistry, and Pharmacologic Treatments
Authors: Miller Norman S. , Cocores James A. 
Published: December 2021

Columbus brought tobacco to the Old World, and in the following centuries, tobacco smoking spread throughout the world, despite vigorous opposition. The tobacco plant was named Nicotiana tabacum after Jean Nicot, who promoted his belief that the plant had medicinal value.
Nicotine, the basic addicting drug contained in cigarettes, may be the deadliest drug known to humans in terms of overall morbidity and mortality. The morbidity and mortality from nicotine addiction is greater than that from World Wars I and II, the Vietnam War, AIDS (Acquired Immune Deficiency Syndrome), and heroin and cocaine addiction combined. Tobacco use is linked to more than 390 000 deaths per year in the United States alone. The powerful lobbying forces of the tobacco industry have managed to keep supplies of nicotine available to the public despite efforts from medical and legal bodies to reduce advertising and educate the public about the adverse consequences of nicotine use.
The addictive potential of cigarettes and the extent to which nicotine is the active ingredient in generating and sustaining addiction has been debated. The reasons for the resistance to considering whether nicotine is addictive have origins in attitudes toward addiction. Free will and personal choice have prevailed as explanations for why a 20-cigarette per day smoker will receive more then 70 000 boluses of nicotine per year despite the high rate of morbidity and mortality associated with this drug.