bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Provo Multicenter Early High-frequency Oscillatory Ventilation Trial: Improved Pulmonary and Clinical Outcome in Respiratory Distress Syndrome
Authors: Gerstmann Dale R. , Minton Stephen D. , Stoddard Ronald A. , Meredith Keith S. , Monaco Frank , Bertrand Jean Marie , Battisti O. , Langhendries J. P. , Francois A. , Clark Reese H. 
Published: December 2021

Objective. To compare the hospital course and clinical outcome of preterm infants with respiratory distress syndrome treated with surfactant and managed with high-frequency oscillatory ventilation (HFOV) or conventional mechanical ventilation (CV) as their primary mode of ventilator support.
Design. A prospective randomized clinical trial.
Setting. Three community-based level III neonatal intensive care units.
Subjects. A total of 125 neonates who were 35 weeks or less estimated gestation requiring intubation and assisted ventilation for respiratory distress syndrome with arterial to alveolar oxygen ratio less than .50.
Interventions. Patients were randomized to continue CV (61 patients) or be changed to HFOV (64 patients) after exogenous surfactant administration (100 mg/kg). HFOV was used in a strategy to promote lung recruitment and maintain lung volume. Protocol respiratory care guidelines were followed; otherwise routine care was provided by each neonatal intensive care unit.
Measurements and Main Results. No differences were noted in demographic features between the two study groups. The study population birth weight was 1.51 ± .47 kg (mean ± SD), gestational age was 30.9 ± 2.5 weeks, and study entry age was 2 to 3 hours. Patients randomized to HFOV demonstrated the following significant findings compared with CV-treated patients: vasopressor support was less intensive; surfactant redosing was not as frequent; oxygenation improved more rapidly and remained higher during the first 7 days; fewer infants required prolonged supplemental oxygen or ventilator support; treatment failure was reduced; more patients survived without chronic lung disease at 30 days; need for continuous supplemental oxygen at discharge was less; frequency of necrotizing enterocolitis illness was lower; there were fewer abnormal hearing tests; and hospital costs were decreased. No differences were seen between the two study groups in the frequency or severity of patent ductus arteriosus, air leak, retinopathy of prematurity, or intraventricular hemorrhage. Length of hospital stay and survival to discharge were similar for HFOV- and CV-treated infants.
Conclusions. When used early with a lung recruitment strategy, HFOV after surfactant replacement resulted in clinical outcomes consistent with a reduction in both acute and chronic lung injury. Benefit was evident for preterm infants both less than or equal to 1 kg and more than 1 kg. In addition, early HFOV treatment may have had a more global effect on patient health throughout the hospitalization, resulting in reduced morbidity and decreased health care cost.
Efficacy of Milk-based Diets in Persistent Diarrhea: A Randomized, Controlled Trial
Authors: Bhatnagar Shinjini , Bhan Maharaj K. , Singh Kiran D. , Saxena Shailendra K. , Shariff Malini 
Published: December 2021

Objective. Previous studies have shown increased stool output when children with persistent diarrhea (PD) received milk as the predominant source of nutrition.
Methods. We evaluated the efficacy of milk given in modest amounts as a part of a mixed diet in children with PD. One hundred sixteen children 3 to 24 months of age with diarrhea for between 14 days and 12 weeks were allocated to milk-based (n = 60) or milk-free (n = 56) cereal dietary regimens. The two diets were isocaloric (86.9 calories/100 g for ≤9 months; 95.6 cal/100 g for &gt; 9 months) consisting of puffed rice cereal, sugar, and oil differing in only their source of protein, which was either milk or egg white, respectively. An average of 30% of the calories were constituted by milk in the milk-cereal diet. Both diets were offered at the rate of 150 kcal/kg per day. Children receiving milk-cereal consumed an average of 1.9 g/kg lactose per day.
Results. The baseline characteristics in the two groups were similar. Comparable amounts of diet were consumed in both groups. The milk-cereal group did not have higher median (range) stool output (g/kg/h) compared with the milk-free group during a 0- to 48-hour (milk-cereal, 1.7 [0.2 to 8.7]; milk-free, 1.5 [0.1 to 6.6]) or 0- to 120-hour (milk-cereal, 1.6 [0.4 to 7.2]; milk-free, 1.3 [0.1 to 7.6]) period. The percentage of weight gain was similar in the two groups, and there were no significant differences in the duration of diarrhea. Overall, 23 children had treatment failures, 10 (17%) in the milk-cereal and 13 (23.6%) in the milk-free groups.
Conclusions. Our findings suggest that modest intakes of milk are well tolerated as a part of mixed diet during PD.
Home Therapy With Subcutaneous Immunoglobulin Infusions in Children With Congenital Immunodeficiencies
Authors: Abrahamsen Tore G. , Sandersen Heidi , Bustnes Alfhild 
Published: December 2021

Objectives. Patients with congenital, humoral immunodeficiencies are usually treated with intravenous immunoglobulin infusions. Subcutaneous infusions have emerged as an alternative treatment modality also in children. Our institution has run a subcutaneous infusion home therapy program for 6 years, and the purpose of this report is to describe our experience with this regimen.
Methods. The subcutaneous therapy of eight patients with immunodeficiency (three with agammaglobulinemia, one with common variable immunodeficiency, one with severe combined immunodeficiency and bone marrow transplantation, and three with hyper-immunoglobulin M syndrome) was evaluated by chart review and a questionnaire answered by all the families. The infusions were given for at least 3 hours each week by a small syringe driver at home after the family had attended an intensive educational course at the hospital.
Results. The children were given a total of approximately 1100 infusions. They started at the age of 2 to 8 (mean, 4.5) years and received these infusions for 1.5 to 6 (mean, 3) years. By administering immunoglobulin doses from 58 to 149 (mean, 97) mg/kg per week, trough serum immunoglobulin G values from 5.2 to 9.6 (mean, 7) g/L were obtained. No serious infections occurred. Short-lasting, local side effects such as swelling and redness were frequently reported, but pain or systemic adverse reactions during or after the infusions were never encountered.
Conclusions. Home therapy with subcutaneous immunoglobulin infusions in children with congenital immunodeficiencies is a feasible and safe treatment alternative.
A Controlled Trial of Nurse Practitioners in Neonatal Intensive Care
Authors: Mitchell-DiCenso Alba , Guyatt Gordon , Marrin Michael , Goeree Ron , Willan Andrew , Southwell Doris , Hewson Sheila , Paes Bosco , Rosenbaum Peter , Hunsberger Mabel , Baumann Andrea 
Published: December 2021

Objective. To compare a clinical nurse specialist/neonatal practitioner (CNS/NP) team with a pediatric resident team in the delivery of neonatal intensive care.
Design. Randomized, controlled trial.
Setting. A 33-bed tertiary-level neonatal intensive care unit.
Patients. Of 821 infants admitted to the neonatal intensive care unit between September 1991 and September 1992, 414 were randomized to care by the CNS/NP team, and 407 were randomized to care by the pediatric resident team.
Intervention. Infants assigned to the CNS/NP team were cared for by CNS/NPs during the day and by pediatric residents during the night. Infants assigned to the pediatric resident team were cared for by pediatric residents around the clock. Neonatologists supervised both teams.
Measures. Outcome measures included mortality; number of neonatal complications; length of stay; quality of care, as assessed by a quantitative indicator condition approach; parent satisfaction with care, measured using the Neonatal Index of Parent Satisfaction; long-term outcomes, measured using the Minnesota Infant Development Inventory; and costs.
Results. There were 19 (4.6%) deaths in the CNS/NP group and 24 (5.9%) in the resident group (relative risk [RR], 0.78; confidence interval [CI], 0.43 to 1.40). In the CNS/NP group, 230 (55.6%) neonates had complications, in comparison with 220 (54.1%) in the resident group (RR, 1.03; CI 0.91 to 1.16). Mean lengths of stay were 12.5 days in the CNS/NP group and 11.7 days in the resident group (difference in means, 0.8 days; CI, -1.1 to 2.7). The performance on the indicator conditions was comparable in the two groups except for two instances, jaundice and charting, both of which favored the CNS/NP group. Mean scores on the Neonatal Index of Parent Satisfaction were 140 in the CNS/NP group and 139 in the resident group (difference in means, 1.0; CI, -3.6 to 5.6). In the CNS/NP group, 6 (2.6%) infants performed 30% or more below their age level in the Minnesota Infant Development Inventory, in comparison with 2 (0.9%) in the resident group (RR, 2.87; CI, 0.59 to 14.06) The cost per infant in the CNS/NP group was $14 245 and in the resident group $13 267 (difference in means, $978; CI, -1303.18 to 3259.05).
Conclusions. CNS/NP and resident teams are similar with respect to all tested measures of performance. These results support the use of CNS/NPs as an alternative to pediatric residents in delivering care to critically ill neonates.
Abdominal Masses in the Newborn
Authors: Schwartz Marshall Z. , Shaul Donald B. 
Published: December 2021

The presence of an abdominal mass in the neonatal period is common, occurring in approximately 1 infant in 1000 live births. Despite this relatively high incidence, the finding of an abdominal mass in a neonate can be alarming for both parents and physicians. Until recently, the identification of an abdominal mass was made by physical signs (ie, abdominal distention, palpable mass). However, in the past decade, fetal ultrasound has become technically refined and is more widely practiced. As a result, the presence of an abdominal mass in the fetus may be known long before birth, allowing for the formation of a specific diagnosis and treatment plan. In addition to fetal ultrasonography, a wide array of sophisticated imaging techniques have become available to aid in the diagnosis of an abdominal mass. However, in the cost-conscious environment in which health care must be provided, it is the physician's responsibility to evaluate an abdominal mass as cost effectively as possible. Early consultation among the pediatrician, pediatric radiologist, pediatric surgeon, and, in the case of prenatal diagnosis, the obstetrician can expedite this process.
Many abdominal masses are of the nonsurgical variety (ie, organomegaly or bladder distention). Most masses requiring surgical intervention are benign (87%), and the prognosis for neonates with an abdominal mass is good.
INDEX OF SUSPICION
Authors: Sehgal Neeru 
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 4-year-old boy is brought to the office because of bruising that his mother had noticed while bathing him 2 days previously. He has not had nosebleeds or noticeable blood in his stool or urine, and he has been well except for a bout of gastroenteritis 2 weeks earlier. His parents are separated, and his mother states that the youngster's father spanked and kicked him and his brother during a visit last weekend. An 11-year-old sister is present and says that the father grabbed the boy's arm and "kicked his rear with his boot."
On examination, the child has multiple bruises—some appearing fresh, some apparently several days old—on his back, anterior torso, arms, and anterior thighs.
Immunodeficiency Disorders
Authors: Iseki Mikiro , Heiner Douglas C. 
Published: December 2021

Introduction
Immunodeficiency diseases are a group of disorders that increase susceptibility to infection, malignancy, and autoimmunity. Deficiencies of the immune system may be congenital or acquired. They may be secondary to a developmental anomaly or an enzymatic defect or be of unknown etiology. Recently it has become clear that immune responses are comprised of a large number of discrete steps, and there may be a breakdown at any point in this process. It is likely that hundreds of different lesions lead to immunodeficiency diseases. It is important to remember that it was from studies of patients who had abnormalities of the immune system that many of the functions and components of the normal immune system have been elucidated. There are two broad categories of immunodeficiencies: those that are primary and those that are secondary to another disorder.
Classification and Incidence
The immune system has four major components: 1) antibody-mediated (B cell) immunity, 2) cell-mediated (T cell) immunity, 3) phagocytosis (polymorphonuclear and mononuclear cells), and 4) the complement system. This division provides a practical way to classify the immunodeficiencies (Table 1). Common secondary immunodeficiencies are listed in Table 2. A more complete classification of primary immunodeficiencies is that of the 1986 WHO Scientific group (see Suggested Reading).
Assessment and Treatment of Childhood Obesity
Authors: Dietz William H. , Robinson Thomas N. 
Published: December 2021

Childhood obesity is among the most difficult problems that confront pediatricians. Its rising prevalence and its increasingly recognized risk of morbidity heightens our concern and increases our frustration when families appear unmotivated or when treatment fails. Because childhood obesity is so difficult to treat and because obesity is viewed widely as a form of social deviancy, we are tempted to blame patients and families for our lack of successful therapy. In this review we consider the identification of childhood obesity, explore its potential etiologies and consequences, and outline an approach to therapy.
Identification
The identification of childhood obesity and its severity clarifies the degree of risk and represents the first step of therapy. The two indices used most commonly to determine the degree of adiposity in humans are the body mass index (BMI, weight in kg/height in m2) and the triceps skinfold thickness. Each has advantages and limitations.
The advantage of the BMI is that height and weight are measured easily and reliably in a variety of settings by personnel who have had minimal training. A BMI in excess of the 85th percentile has been used arbitrarily to define obesity. However, the BMI does not measure fatness directly. Variations in frame size as well as increases in fatness will increase the BMI.
Sinusitis
Authors: Wald Ellen R. 
Published: December 2021

Upper respiratory infections (URIs) are the most common organic condition presenting to the primary practitioner who cares for children. It recently has been estimated that approximately 5% to 10% of URIs in early childhood are complicated by acute sinusitis. Because children average six to eight colds per year, sinusitis is a very common problem in clinical practice.
When considering a diagnosis of sinusitis in a child or an adult, the major problem is to distinguish simple URI or allergic inflammation from secondary bacterial infection of the paranasal sinuses. The diagnosis of URI or allergy may prompt consideration of symptomatic treatment, while patients who have sinusitis will benefit from specific antimicrobial therapy. Both URI and allergic inflammation are recognized risk factors for acute sinusitis, with URI being the more common.
Anatomy and Physiology
A brief review of the anatomy and physiology of the paranasal sinuses will help clarify certain clinical features of sinus infection. The Figure shows a coronal and two sagittal views demonstrating the relationship between the nose and the paranasal sinuses. The nose is divided in the midline by the nasal septum. From the lateral wall of the nose are projected three shelf-like structures designated according to their anatomic position as the inferior, middle and, seen best on the sagittal view, superior turbinates.
INDEX OF SUSPICION
Authors: Marino Elizabeth R. , Baker Robert B. , Devries Jeffrey M. , Amin Sanjiv B. 
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
You are seeing a 16-year-old male who has had nasal congestion that began a few months ago. The congestion was intermittent at first but has become constant. He denies sneezing, itchy eyes, or other respiratory difficulty. His mother is concerned because he often is awakened by his congestion. He frequently is irritable in the mornings, and she believes the sleep disturbance is responsible for the decline in his grades, which had been very good. Except for one uncle, no family members have complained of allergies.
He is a slim boy whose pulse is 90 beats/min, blood pressure is 136/80 mm Hg, and temperature is 98.8°F (37.1°C). Physical examination otherwise is normal except for mildly reddened, edematous nasal mucous membranes that have a small amount of thin white mucoid discharge.
Conflict Resolution
Authors: Deutsch Morton , Brickman Ellen 
Published: December 2021

An Orientation to Conflict
Conflict is like sex: it is an important and pervasive aspect of life. It should be enjoyed and should occur with a reasonable degree of frequency, and after a conflict is over the people involved should feel better than they did before.
Some psychiatrists and social scientists have given conflict a bad reputation by linking it with psychopathology, social disorder, and war. Conflict can be dysfunctional, but it also can be productive. It has many positive functions, including preventing stagnation and stimulating interest and curiosity. It is the medium through which problems can be aired and solutions developed. It is the root of personal and social change. The practical and scientific issue is not how to eliminate or prevent conflict but rather how to have lively controversy rather than deadly quarrels.
A conflict exists whenever incompatible activities occur. The incompatible actions may originate in one person, group, or nation (intrapersonal, intragroup, or intranational) or they may reflect incompatible actions of two or more persons, groups, or nations (interpersonal, intergroup, or international). An action that is incompatible with another action prevents, obstructs, interferes, injures, or in some way makes the latter less likely or effective. A potential conflict exists when the parties involved perceive themselves to have incompatible values, interests, goals, needs, or beliefs.
INDEX OF SUSPICION
Authors: McCarthy Dennis J. , Garcia Juan J. Jiménez , Swanson Holly 
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
As you finish examining a 14-year, 11-month-old girl for an upper respiratory infection, she asks when she might expect to stop growing. When told that most girls stop growing after menarche, she explains that she has never had a menstrual period.
On examination, her height is 69 1/2 in (above the 95th percentile) and her weight is 119 lb (50th percentile). Her breast development is at Tanner stage IV, and she says that her breasts have remained at their present state of development for at least 3 years. She lacks both pubic and axillary hair. Her external genitalia are normal, as is the remainder of her physical examination.
Case 2 Presentation
A 9-year-old girl is brought to your office having a 1-week history of bilateral neck swelling.
Guess Who's Going to Medical School!
Authors: Scheiner Albert P. , Sahler Olle Jane Z. 
Published: December 2021

Both Pediatrics in Review (PIR) and CompuPREP are rich resources that can be incorporated into the clinical curricula designed for medical students. Although both are geared to meet the needs of the practicing pediatrician, in our experience they have served as excellent adjuncts to self-study syllabi, lecture presentations, and small group discussions for students, as well.
Creative Use of PIR
At the University of Massachusetts, the review articles and their associated quizzes, the section entitled "Index of Suspicion," and the Guides for Record Review all have been used for a variety of instructional purposes. The review articles are especially adaptable to seminars using a problem-based or clinical problem-solving model.
Antimicrobial Prophylaxis
Authors: Schutze Gordon E. , Jacobs Richard F. 
Published: December 2021

The issue of antimicrobial prophylaxis in preventing infections in infants and children is important in the practice of pediatrics. Children are especially prone to certain infections, and pathogens are amenable to prophylaxis. Chemoprophylaxis may be used to prevent primary disease (eg, ophthalmia neonatorum) or recurrent infections (eg, otitis media). Individuals exposed to certain micro-organisms (eg, Neisseria meningitidis) or immunosuppressed patients (eg, those who are asplenic) may benefit from prophylaxis in certain situations. The duration of chemoprophylaxis may be as short as two doses (eg, endocarditis prophylaxis) or may last a lifetime (eg, rheumatic fever prophylaxis).
Questions concerning the potential benefits of antimicrobial prophylaxis are quite common, and many of the answers are controversial. Because the list of specific pathogens and conditions for prophylaxis is quite long, this review will encompass only the more common conditions encountered in a busy general pediatric practice (Table 1).
Otitis Media
Acute otitis media is the most common diagnosis made in children when visits to the physician are prompted by illness. For every three children who have acute otitis media with effusion, one will suffer from recurrent acute otitis media: antimicrobial prophylaxis, tympanostomy tube placement, and adenoidectomy. Of these options, only chemoprophylaxis can be managed by the primary physician.