bluuebunny/crossref_metadata_2025_split huggingface dataset:
Financing Child Care: Public- and Private-Sector Approaches
Authors: Eichman Caroline 
Published: December 2021

Finding high-quality, affordable child care is of paramount concern for millions of American families. Child-care providers, concerned about the high costs associated with providing a quality service, are unable to access, through the traditional market mechanisms, the funding they need to support their start-up and operating costs. For providers to offer a high quality service—to hire trained professional staff, maintain group sizes and staff-to-child ratios at NAEYC-recommended standards, provide a curriculum that early childhood professionals view as developmentally appropriate, and provide a healthy and safe environment for children—additional resources are needed.
By properly targeting their resources, states can be an important catalyst for private sector initiatives. By designing programs that leverage taxpayer dollars with private investment, states can create new cost-effective approaches. Groups within the private sector such as employers, real-estate developers, lending institutions, and community development corporations are finding that investing in child care can be a good business decision.
Regulation and Guidelines Toward a Healthy Child-Care Setting
Authors: Koch Pauline D. 
Published: December 2021

States can make a strong investment in creating a healthy child-care setting by developing coordinated career development systems for child-care practitioners. The licensing agency must be involved and is the logical agency to administer the system. Through a project entitled "Delaware First. Again," Delaware became the first in the country to develop a plan for a comprehensive, coordinated statewide early care and education career system. The project is directed by the Office of Child Care Licensing with consultation from Gwen Morgan and Joan Costley of Wheelock College and Nancy Brown of North Carolina State University.
The focus on training and career development will prove to be a cost efficient and effective method for states to substantially improve the health and safety of children in child care and will provide advocacy for stronger licensing requirements. Long-term improvement will only accrue with corresponding substantial improvement in the wages and other employee benefits for the people who work with our children. In summary, regulation and guidelines can play an increasingly larger role in creating a healthy child-care setting. There is much to be done at the national, state, and local levels to accomplish this goal. With continued strong advocacy and a coordinated effort, the goal can be met.
Short Stature: A Psychosocial Burden Requiring Growth Hormone Therapy?
Authors: Sandberg David E. , Brook Amy E. , Campos Susana P. 
Published: December 2021

Background. Changes in the diagnosis of endocrine-based growth disorders and the advent of biosynthetic growth hormone have altered the long-standing policy of treating only those individuals with "classic" growth hormone deficiency. One justification for treating short children is to improve their psychosocial adaptation. The present investigation assessed the positive and negative behavioral adaptation, self-perceptions of domain-specific competencies, and global self-worth of a large, diagnostically heterogeneous sample of children and adolescents referred to pediatric endocrinologists for a growth evaluation.
Methods. All patients seen in a pediatric endocrine clinic (180 boys and 78 girls; 4 to 18 years) with a height at the fifth percentile or lower were included. Parents of all participating children completed the Child Behavior Checklist. Patients 8 years and older completed the Self-Perception Profile and those 11 years and older, in addition, completed the Youth Self Report. Short-stature (SS) subjects were compared with normative and psychiatric samples.
Results. The SS boys were described by parents as being significantly less socially competent and showing more behavioral and emotional problems than a normative sample selected for mental health. However, they were significantly more socially competent and showed fewer psychopathologic symptoms than a psychiatric referred sample of comparable age. The SS boys described themselves as less socially active but did not report more behavior disturbance than the normative sample. The SS boys' self-perceptions of domain-specific competencies and global self-worth were comparable to a normative comparison group with the exception that older subjects (13 years or older) described their athletic abilities more positively and their work competence more negatively. The SS girls were, with few exceptions, indistinguishable from the normal comparison groups on both parent- and self-report measures of social competency and behavior disturbance. Younger SS girls (ages 8 to 12 years) described their athletic competence and behavioral conduct more positively than the comparison group on the self-esteem questionnaire. Patient height deficit was unrelated to scores on the three questionnaires. Finally, no statistically significant differences in psychosocial functioning were detected between children with "normal-variant" SS and those with pathologic growth disorders.
Conclusions. Short-stature girls show more adaptive psychosocial functioning than SS boys. In either sex, SS does not appear to be associated with clinically significant psychosocial morbidity. Severity of the height deficit does not correlate with the level of behavioral adaptation. These observations challenge the justification of providing growth hormone therapy for all short children to improve their psychosocial functioning.
Homeopathy Study Questions
Authors: Layton Richard E. 
Published: December 2021

After reading the double blind control study regarding the treatment of acute childhood diarrhea with homeopathic medicine published in the May 1994 issue, I am pleased to see Pediatrics publish a practical clinical study that will help pediatricians utilize treatment previously thought to be useless. Specifically, homeopathy has been looked upon with skepticism for many years as a form of voodoo medicine.
As a board-certified pediatrician, I have practiced primary care pediatrics for 15 years and, for the past 7 years, have been evaluating children with problems such as attention deficit hyperactivity disorder and recurrent ear infections, but taking a different approach than is generally accepted.
Dexamethasone Therapy for Children With Bacterial Meningitis
Authors: Wald Ellen R. , Kaplan Sheldon L. , Mason Edward O. , Sabo Diane , Md Lawrence Ross , Arditi Moshe , Wiedermann Bernhard L. , Barson William , Kim Kwang Sik , Yogev Ram , Hofkosh Dena ,   Meningitis Study Grouo
Published: December 2021

Objective. To determine whether treatment with dexamethasone and ceftriaxone for children with bacterial meningitis reduces the frequency of either sensorineural hearing loss or other neurologic sequelae.
Design. This was a prospective, multicentered, placebo-controlled clinical trial. Subjects were followed for 1 year.
Setting. The study was conducted in six children's hospitals located in Pittsburgh, Houston, Los Angeles, Chicago, Washington, D.C., and Columbus, Ohio.
Patients. Enrolled were 173 children, 8 weeks to 12 years of age, with suspected bacterial meningitis; 143 children were evaluable. Eighty-seven percent of patients were followed for at least 6 weeks to 3 months, and 67% were followed for 1 year.
Interventions. Subjects were randomized to receive ceftriaxone with or without dexamethasone (0.15 mg/kg every 6 hours for 4 days). Auditory brainstem responses (ABR) were measured within 24 hours of admission.
Main outcome measures. Hearing, development, and neurologic sequelae were assessed at the time of discharge and 6 weeks and 1 year later.
Main results. One hundred forty-three patients (69 received dexamethasone and 74 received placebo) with bacterial meningitis were evaluable: Haemophilus influenzae type b (83), Streptococcus pneumoniae (33), Neisseria meningitidis (24), and three others. Overall, there was no significant difference in auditory outcome between dexamethasone and placebo recipients. Twenty-two children had bilateral moderate or more severe hearing loss at the time of the first ABR. At follow-up, the resolution of hearing impairment was nearly identical for each group. Nine of ten children who remained persistently deaf were deaf at the time of the first ABR. There were no differences in neurologic or developmental outcome between groups.
Conclusion. All but one child with persistent bilateral moderate or more severe hearing loss had demonstrable deafness at the time of the first ABR. Dexamethasone did not significantly improve audiologic, neurologic, or developmental outcome in children with bacterial meningitis.
Effect of Infant Formula on Stool Characteristics of Young Infants
Authors: Hyams Jeffrey S. , Treem William R. , Etienne Nancy L. , Weinerman Harry , MacGilpin Douglas , Hine Peter , Choy Karin , Burke Georgine 
Published: December 2021

Background. Many infants are switched between multiple formula preparations early in life because of perceived abnormalities in stooling pattern as well as gastrointestinal symptoms.
Objective. To investigate the relationship between the type of formula consumed and the stooling characteristics and gastrointestinal symptoms of young infants.
Methods. Healthy 1-month-old infants were fed one of four commercial formula preparations (Enfamil, Enfamil with Iron, ProSobee, and Nutramigen) for 12 to 14 days in a prospective double-blinded (parent/physician) fashion. Parents completed a daily diary of stool characteristics as well as severity of spitting, gas, and crying for the last 7 days of the study period. A breast-fed infant group was studied as well.
Results. Two hundred eighty five infants were enrolled and 238 completed the study. Infants receiving breast milk or Nutramigen had twice as many stools as other formula groups (P &lt; .001). Infants receiving ProSobee had hard/firm stools more often than breast-fed or other formula-fed groups (P &lt; .00001). Watery stools were more common in infants fed Nutramigen than other formula groups (P &lt; .04). Green stools were more common in 12 mg/L iron preparations (Enfamil with iron, ProSobee, Nutramigen) than in those with 1 mg/L (Enfamil, breast milk) (P &lt; .00001). Spitting, gassiness, and crying were of equal severity in all formula groups.
Conclusions. The interpretation of stool frequency, color, and consistency must take into account the infant's formula type as significant variations in normal infants occur. Parental education on the range of infant stooling characteristics as well as the common occurrence of spitting, gas, and crying may alleviate concern for formula intolerance and underlying gastrointestinal disease.
QUEBEC TO PAY MOTHERS TO BREAST-FEED
Authors: L. J. F. 
Published: December 2021

In a sharp departure from the traditional role of government, Quebec pays mothers to nurse their infants ... Since breast-fed babies tend to be healthier babies, encouraging nursing could ultimately save the publicly financed health care system millions of dollars a year.
Quebec has paid supplements to nursing mothers and subsidized the cost of some infant formula for the last quarter-century. What is new—and highly appreciated by nursing mothers on low incomes—is the policy shift in favor of breast milk. When the cash incentive for breast-feeding rose to $37.50 a month, the subsidy for formula was reduced.
... To prevent abuses, the ministry requires that a new mother present an affidavit from her doctor to the local office of the Income Security Ministry that confirms that she is nursing.
The Effects of Birth Condition on Infants' Cortisol Response to Stress
Authors: Ramsay Douglas S. , Lewis Michael 
Published: December 2021

Objective, design, and subjects. To examine the effects of nonoptimal birth condition on cortisol response to routine inoculation in a longitudinal sample of full-term healthy infants at 2, 4, and 6 months of age.
Measurement and main results. Optimal versus non-optimal birth condition was defined by a large versus small head circumference and a high versus low 1-minute Apgar score. An optimal birth condition was associated with a high cortisol response at 2 months, but a low cortisol response by 6 months of age.
Conclusions. The findings indicate a reversal in the meaning of high adrenocortical reactivity between 2 and 6 months of age: high cortisol response may index optimal functioning at 2 months, but nonoptimal functioning by 6 months of age. Together with other results, this reversal provides evidence for a developmental shift in adrenocortical functioning during this period. The findings also show that the effects of a nonoptimal birth condition in otherwise healthy full-term infants persist for at least the first 6 months of life.
Antenatal Steroids Are Associated With Less Need for Blood Pressure Support in Extremely Premature Infants
Authors: Moïse Alicia A. , Wearden Mary E. , Kozinetz Claudia A. , Gest Alfred L. , Welty Stephen E. , Hansen Thomas N. 
Published: December 2021

Objective. To determine if antenatal steroids decrease the amount of blood pressure support required by extremely premature infants between 23 and 27 weeks' gestation.
Design. Retrospective cohort study.
Setting. Texas Children's Hospital neonatal intensive care unit from January 1986 to December 1991.
Participants. Two hundred forty premature infants between 23 and 27 weeks' gestation who survived at least 48 hours.
Main outcome measures. The amount of blood pressure support received in the form of dopamine and colloid. Secondary analysis investigated differences in mortality, respiratory support requirements, the incidence of intraventricular hemorrhage, necrotizing enterocolitis, infection, retinopathy of prematurity requiring surgery, and the length of hospitalization.
Results. During the first 48 hours of life, premature newborns exposed to antenatal corticosteroids were less likely to receive dopamine for blood pressure support (47% vs 67%), and if they did, the amount of dopamine expressed as a dopamine score was less than that received by those infants not exposed to antenatal corticosteroids (281 ± 240 vs 407 ± 281). Those exposed to antenatal corticosteroids also had a lower mortality rate (8% vs 24%) and lower respiratory support requirements. The incidence of grade 3 or 4 intraventricular hemorrhage was 8% in infants exposed to antenatal corticosteroids and 17% in infants not exposed. No difference was found in the incidence of necrotizing enterocolitis, infection, or retinopathy of prematurity requiring surgery, or length of hospitalization.
Conclusion. Receipt of antenatal corticosteroids is associated with less need for blood pressure support during the first 48 hours after birth in premature infants between 23 and 27 weeks' gestation.
A Comparison of Cathartics in Pediatric Ingestions
Authors: James Laura Phillips , Nichols Michele H. , King William D. 
Published: December 2021

Objective. To compare the mean time to first stool, number of stools, and side effects of three commonly used cathartics in pediatric ingestions.
Design. This prospective clinical trial was a randomized, double-blinded comparison of sorbitol, magnesium citrate, magnesium sulfate, and water, administered with activated charcoal in the treatment of pediatric patients 1 to 5 years of age with acute ingestions. Outcome parameters were mean time to first stool, mean number of stools during 24 hours, and side effects.
Results. One hundred sixteen patients completed the study. Significant differences in mean time to the first stool were detected among cathartic agents (F = 9.29), with sorbitol-treated patients having a shortest mean time to the first stool (mean, 8.48 hours). Sorbitol produced a significantly higher number of stools (mean, 2.79) in the 24-hour follow-up period than other cathartics (F = 3.49). The most common side effect of cathartic administration was emesis, which occurred more commonly in sorbitol-treated patients.
Conclusion. Sorbitol, when administered with activated charcoal in the treatment of children with acute ingestions, produced a shorter time to first stool and more stools than magnesium citrate, magnesium sulfate, or water.
Health Supervision for Children With Neurofibromatosis
Authors:   Committee on Genetics, 1994 to 1995
Published: December 2021

This set of guidelines is designed to assist the pediatrician in caring for the child in whom the diagnosis of neurofibromatosis has been made. Although the pediatrician's first contact with the child is usually during infancy, occasionally the pregnant woman who has been given the prenatal diagnosis of neurofibromatosis will be referred for advice. Therefore, these guidelines offer advice for this situation as well.
At least two distinct types are recognized—neurofibromatosis 1, or NF-1 (previously known as von Recklinghausen disease or generalized neurofibromatosis), and neurofibromatosis 2, or NF-2 (previously known as bilateral acoustic neurofibromatosis). This discussion addresses only issues concerning the diagnosis and management of NF-1.1-8
Neurofibromatosis 1 is a progressive, multisystem disorder affecting about 1 in 3,000 individuals.9 A National Institutes of Health (NIH) Consensus Development Conference10 regarding NF-1 demarcated seven features, of which two or more are required to establish firmly the diagnosis of NF-1:
1. Six or more cafe-au-lait spots (CLS) or macules, greater than or equal to 5 mm in diameter in prepubertal patients and 15 mm in diameter in postpubertal patients;
2. Two or more neurofibromata of any type, or one plexiform neurofibroma;
3. Freckling in the axillary or inguinal region;
4. Optic glioma;
5. Two or more Lisch nodules (iris hamartomas);
6. A distinctive osseous lesion such as sphenoid dysplasia or cortical thinning of long bones, with or without pseudarthrosis; or
7. A first-degree relative (parent, sibling, or child) with NF-1 according to the preceding criteria.
Diagnosis in nonfamilial pediatric cases may be difficult because certain clinical features are age-pendent.
RISK FACTORS FOR ACUTE WHEEZING IN INFANTS AND CHILDREN: VIRUSES, PASSIVE SMOKE, AND IMMUNOGLOBULIN E (IgE) IgE ANTIBODIES TO INHALANT ALLERGENS
Authors: Kettelhat Brett , Lee Napoleon , Kobayashi Roger H. 
Published: December 2021

Study Population. Ninety-nine children from age 2 months to 16 years who presented to the Pediatric Emergency Room of the University of Virginia and received treatment for acute wheezing, were enrolled in this study. Fifty-seven control patients were enrolled from the same setting who did not previously or currently manifest wheezing/respiratory symptoms.
Method. Serum for immunoglobulin E (IgE) and radioallergosorbent test (RAST) IgE for D. Pteronyssinus/Farinae, cat epithelium, short ragweed, rye grass, and mixed Cockroach was collected. Nasal saline washes were obtained for respiratory syncytial virus (RSV) antigen detection and respiratory viral cultures. Nasal smears for eosinopils were obtained as well as saliva samples for the nicotine metabolite, cotinine.
Results. IgE RAST testing identified an increasing number of study patients with IgE specific antibodies. Nasal smears revealed similar but not identical findings. Patients over 2 years of age demonstrated a family history of atopy, IgE levels, and positive RAST significantly greater than control (P &lt; .001). Viral infections were more common in younger children &lt;2 years of age (positive in 90% vs 50% in the &gt;2 years 0.05). RSV isolates were greatest in children &lt;2 years old. Seventy five percent of patients compared with 58% of controls had one or more smokers at home. Children &lt;2 were more likely to have an elevated salivary cotinine level than children &gt;2 years old, despite the presence of smokers in the home. Combination risk factors found 66% of patients with two or more risk factors as compared with only 28% of controls (P &lt; .001).
THE USE OF PULSE OXIMETRY IN THE PREVENTION OF HYPEROXAEMIA IN PRETERM INFANTS
Authors: L. J. F. 
Published: December 2021

When deciding an appropriate upper limit for pulse oxygen saturation (SpO2) in preterm infants the usefulness of current data is limited by the fact that previous studies have examined a population of more mature infants and children or have applied various exclusion criteria that produce results unrepresentative of clinical practice. We tested the hypothesis of previous workers that maintaining the SpO2 below 98% would ensure an arterial oxygen tension (PaO2) less than 12 kPa. A total of 477 simultaneous measurements of PaO2 and SpO2 were made using Ohmeda Biox oximeters on 43 infants who were less than 33 weeks gestation and receiving supplementary oxygen. Of 435 measurements performed when the SpO2 was 97% or less, 26 (6%) had a PaO2 greater than 12 kPa. Further examination of the data showed that of 108 estimations performed when the SpO2 was less than 94%, none had a PaO2 greater than 12 kPa.
Conclusion. When using Ohmeda Biox pulse oximeters an upper limit of 97% for SaO2 is not effective in preventing hyperoxaemia; however, a limit of 93% is likely to maintain the PaO2 below 12 kPa.
Patterns of Care Received by Medicaid Recipients With Urinary Tract Infections
Authors: Fargason Crayton A. , Bronstein Janet M. , Johnson Victoria A. 
Published: December 2021

Background. Urinary tract infections (UTIs) occur commonly in children and may lead to substantial morbidity. Most experts recommend urine cultures for diagnosing UTIs in children. In addition, most experts recommend imaging studies in a portion of children diagnosed with UTIs.
Purpose. The purpose of this study was to assess how rates of performance of urine cultures and imaging studies for children in the Alabama Medicaid program diagnosed with a UTI vary by patient demographics, provider characteristics, and service locations.
Methods. The study design was a retrospective review of Alabama Medicaid claims data. Children were included as UTI cases if they had a Medicaid claim for urinary tract infections during 1991, were continuously enrolled in Medicaid for that year, and were younger than 8 years of age. Claims were grouped into episodes of care, and episodes were assigned to a diagnosing physician. Physician locations were classified as rural, suburban, or urban using demographic data. Specific laboratory and imaging procedures were identified using CPT codes (Physician's Current Procedural Technology Codes, 4th Edition).
Results. We identified 404 episodes of UTI occurring in 380 children. Only 47% of episodes were associated with claims for urine cultures. Claims for urine cultures were more frequently filed by pediatricians in urban locations. In the subset of 114 patients with multiple UTI episodes, only 68% had imaging studies specific for the urinary tract. Only 44% received both a voiding cystourethrogram and renal ultrasound.
Conclusions. Claims data suggest that physicians underuse urine cultures in diagnosing UTIs in Alabama pediatric Medicaid recipients. Urban-based pediatricians perform better than other types of physicians. Imaging studies are also used less frequently than is commonly recommended.