bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acute Isoniazid Neurotoxicity in an Urban Hospital
Authors: Shah Binita R. , Santucci Karen , Sinert Richard , Steiner Phillip 
Published: December 2021

Objectives. To describe the presentation and treatment of acute isoniazid (INH) neurotoxicity appearing at an inner-city municipal hospital.
Design. Case series.
Participants. Seven patients (eight patient visits) with an age range of 5 days to 14.9 years.
Results. At our institution, no children appeared with acute INH neurotoxicity in the period 1985 through 1990, whereas seven patients were treated from 1991 through 1993. This paralleled the rise in the number of children with tuberculous infection and disease seen at our institution, from an average 96 per year to 213 per year during these two time periods. All seven patients were receiving INH daily for tuberculosis (TB) prophylaxis. Accidental ingestion (five episodes) and suicidal attempts (three episodes) accounted for these visits. The total amount ingested range from 14.3 to 99.3 mg/kg (mean, 54 mg/kg). All but one patient presented with afebrile seizures. One patient presented twice with seizures. Acute INH neurotoxicity was not suspected on the first admission; however, when readmitted 4 weeks later with another seizure, the diagnosis of acute INH neurotoxicity was made.
Intervention. Intravenous pyridoxine was used in five episodes. Because it was not a stocked item in our pediatric emergency cart (as well as at another hospital, necessitating a transfer of a patient with refractory seizures to our hospital), the average delay was 5.8 hours (range, 1.3 to 13 hours) before it was given. Two patients with refractory seizures failed to respond to anticonvulsants, and their seizures were controlled only after parenteral pyridoxine.
Conclusions. We have seen an increased incidence of acute INH neurotoxicity because of the resurgence of TB in New York City. Others as well may see a similar rise based on local trends in TB infection and disease. Acute INH toxicity should be suspected in children presenting with seizures with or without fever. In patients with a known access to INH, seizures should be considered to be caused by INH toxicity unless proved otherwise. Parenteral pyridoxine, the specific antidote for INH-induced refractory seizures, should be readily available in every emergency department in the areas similarly experiencing increasing trends of TB.
Buffered Lidocaine: Analgesia for Intravenous Line Placement in Children
Authors: Klein Eileen J. , Shugerman Richard P. , Leigh-Taylor Kate , Schneider Carol , Portscheller Dawn , Koepsell Thomas 
Published: December 2021

Objectives. To evaluate the effectiveness of intradermal buffered lidocaine as analgesia before intravenous line (IV) placement in children.
Methods. This was a randomized clinical trial undertaken in the emergency department (ED) of a regional children's hospital. Participants were children 8 to 15 years old, seen in the ED and in need of IV lines. They were enrolled by three ED nurses. Participants were randomized to receive either intradermal buffered lidocaine or no analgesia. Before placement of the IV line, patients recorded the amount of pain they were in (baseline pain) on a visual analog pain scale. The primary outcome measure was amount of pain caused by the initial IV attempt, even if that attempt was unsuccessful. This was recorded by the participant on a visual analog scale. Demographic characteristics, the number of attempts to successful placement, and the time required to place the IV line were also recorded. Differences in pain of initial IV attempt and time to place the IV line were evaluated with the Mann-Whitney U test. Differences in success of IV line placement were evaluated with the χ2 test.
Results. Fifty-nine patients completed the study. Thirty received buffered lidocaine, and 29 received no analgesia before IV line placement. There was no significant difference between the two groups with regard to baseline pain or demographic characteristics. The median level of pain of the initial IV attempt as measured by the visual analog scale was 2.3 in the buffered-lidocaine group and 4.4 in the no-lidocaine group. Thirty-three percent of patients in the lidocaine group and 28% percent in the no-lidocaine group required more than one IV attempt. The median time to IV line placement was 10 minutes in the lidocaine group and 6 minutes in the no-lidocaine group.
Conclusions. Use of intradermal buffered lidocaine is an effective way to diminish the pain of IV line placement in children 8 to 15 years of age. There was no difference in IV success rate in this study; however, larger numbers of patients would be required to detect statistically significant differences. We recommend the routine use of intradermal buffered lidocaine for analgesia before IV line placement in older children in all but emergent situations.
Does Hunger Cause Obesity?
Authors: Dietz William H. 
Published: December 2021

Both hunger and obesity occur with an increased frequency among poorer populations in the United States.1-6 Because obesity connotes excessive energy intake, and hunger reflects an inadequate food supply, the increased prevalence of obesity and hunger in the same population seems paradoxical. Although a variety of environmental, social, behavioral, or physiologic mechanisms could cause both problems independently, an alternative possibility is that hunger and obesity are causally related. The following case report supports this hypothesis.
CASE REPORT
A.B. (not her real initials) was a 7-year-old African American girl first brought to the Weight Control Program of the Boston Floating Hospital in December 1992.
Fatal Intramuscular Bleeding Misdiagnosed as Suspected Nonaccidental Injury
Authors: Wetzel Randall C. , Slater Anthony J. , Dover George J. 
Published: December 2021

The syndromes of child abuse or non-accidental injury (NAI) are readily recognized. The frequency of NAI requires that it be considered in any child who has been, or appears to have been, traumatized. Nevertheless, great care must be exercised to avoid the parental anxiety and stress that may result from the mistaken diagnosis of child abuse.1 Many conditions mimic NAI, and even well-described ones may be overlooked due to their present rarity.
CASE REPORT
This 10-week-old female infant was comatose, hypotensive, with poorly perfused extremities, and had received cardiopulmonary, resuscitation (CPR). She was the first-born child of a 24-year-old Hispanic mother and a 32-year-old Jewish father.
Injuries Associated With Infant Walkers
Authors:   Committee On Injury And Poison Prevention
Published: December 2021

Infant walkers, or baby walkers, generally consist of a wheeled base supporting a rigid frame that holds a fabric seat with leg openings and usually a plastic feeding/play tray. The two basic types of walkers include the X frame, in which the steel support bars form an X, and the circular frame, in which the support bars rise vertically from the circular base to the tray. The device is designed to support a preambulatory infant, with feet on the floor, and allow mobility while the infant is learning to walk. Some walkers are equipped with bouncing mechanisms, activity toys, or locking devices that keep them from moving, and some fold flat for storage.
Estimated annual sales of walkers are over 3 million.1(pp72-86) Studies have found that between 55% and 92% of infants between 5 and 15 months of age use walkers.2-6 Parents give various reasons for using walkers-to keep the infant quiet and happy, to encourage mobility and promote walking, to provide exercise, and to hold the infant during feeding.4,5,7 One third of parents in one study used walkers because they believed that walkers would keep their infant safe.5
According to the National Electronic Injury Surveillance System (NEISS) of the United States Consumer Products Safety Commission (CPSC), 25 000 children, almost all between the ages of 5 and 15 months, were treated in hospital emergency departments in 1993 for injuries associated with the use of infant walkers, at an estimated cost of $90 000 000 annually.1(pp72-86),8 Eleven deaths occurred during the years 1989 through 1993.8
Mitral Valve Prolapse and Athletic Participation in Children and Adolescents
Authors:   Committee on Sports Medicine and Fitness
Published: December 2021

Mitral valve prolapse (MVP) is generally a benign condition characterized by the protrusion of the mitral valve leaflets into the left atrium during systole. The prevalence of MVP in individuals under the age of 18 years is estimated to be 5% but is higher in those with Marfan's syndrome and other collagen vascular disorders.1 A midsystolic nonejection click with or without a late systolic murmur is the auscultatory hallmark of this syndrome. The diagnosis of MVP in children and adolescents should be based primarily on auscultatory findings and not on minor echocardiographic findings.1
The prognosis in children and adolescents with isolated MVP appears to be excellent and complications are rare. In 553 children, aged 15 days to 18 years, who were involved in studies with a follow-up period of 6 to 9 years, the following were reported: subacute bacterial endocarditis (one case), cerebral vascular accidents (two cases), migraine headaches (four cases), and chest pain (12 cases).2,3 Only four cases of sudden death have been reported in patients younger than 20 years of age.1-4
In a study of 103 patients with MVP, 16% were found to have premature ventricular beats during exercise electrocardiography (ECG) (exercise test).3 Thirty-eight percent were found to have premature ventricular contractions (PVCs) on 24-hour ECG (Holter) monitoring. This study, however, does not report the true prevalence of dysrhythmias because all these subjects had been referred to a pediatric cardiologist for evaluation. It is likely that these reported numbers are high because asymptomatic patients are less often referred.
A Note of Caution About the Continuous Use of Colorimetric End-Tidal CO2 Detectors in Children
Authors: Bhende Mananda S. , LaCovey David 
Published: December 2021

Colorimetric end-tidal CO2 (ETCO2) detectors (Easy Cap, Nellcor Inc, Hayward, CA) are extremely useful in determining the position of the endotracheal tube (ETT) in the airway and have been validated in animals, children, and adults.1-6 They have not been labelled for use in children weighing 15 kg because of their large dead space of 38 mL.1-3
We have demonstrated in numerous studies that the ETCO2 detector accurately verifies the ETT position in infants weighing &gt;2 kg with spontaneous circulation.1-3
MINNESOTA UNIVERSITY DOCTOR IS CONVICTED OF FALSIFYING DATA IN DRUG STUDY
Authors: L. J. F. 
Published: December 2021

MINNEAPOLIS, Aug. 7—A nationally known child psychiatrist has been convicted by a Federal jury of falsifying data in a $250,000 drug study at the University of Minnesota.
Dr. Barry Garfinkel, who is widely respected for his work on suicide among teen-agers, was found guilty on Thursday after a two-week trial in which a former assistant testified that he had told her to "make up" data. The verdict makes him one of the few American scientists ever convicted of a crime in connection with a study of an experimental drug regulated by the Food and Drug Administration.
Dr. Garfinkel, 46, was accused of falsifying reports during a study of Anafranil, an anti-depressant that he tested from 1986 to 1989 on patients with obsessive-compulsive disorders. His research was part of a national study to prove that Anafranil was safe and effective enough to be sold in the United States ...
Prosecutors admit it is rare to seek criminal charges against a scientist in such a case. Since 1978, only 24 doctors, including Dr. Garfinkel, have been convicted of crimes involving tests of new drugs, said Mark Brown, the associate chief counsel for the Food and Drug Administration, which oversees all such research.
Neonatal Immunization: Response to Haemophilus influenzae Type b-Tetanus Toxoid Conjugate Vaccine
Authors: Kurikka Sari , Käyhty Helena , Peltola Heikki , Saarinen Leena , Eskola Juhani , Mäkelä P. Helena 
Published: December 2021

Objective. To study the immunogenicity and tolerability of Haemophilus influenzae type b (Hib) conjugate vaccine administered in the neonatal period.
Design. Hib capsular polysaccharide (PS)-tetanus toxoid conjugate vaccine (PRP-T) was given to 120 neonates at 2 days of age, followed by PRP-T or the Hib PS vaccine at 4 months and a PRP-T booster at 14 months. Their anti-Hib PS concentrations were compared with those in children receiving PRP-T at 2 and 4 months or at 4 months.
Results. No serious adverse reactions were noted. The geometric mean concentration of anti-Hib PS at the age of 2 days was 0.34 µg/mL and at 4 months was 0.12 µg/mL. This was significantly more than the concentration in unimmunized infants at this age and 3.5 times more than expected, taking into account the natural decay of transplacentally acquired antibodies. Such a response was not seen in infants with a high (greater than 3.0 µg/mL) neonatal antibody concentration. The PRP-T vaccine given at 4 months elicited an antibody response in all infants and Hib PS in 62%, indicating immunologic priming. At 14 months a higher percentage of the infants who had received PRP-T at 2 days and 4 months than of those who had received PRP-T at 4 months only had anti-Hib PS concentrations greater than 0.15 µg/mL. All infants responded well to the booster at 14 months. There was no evidence of immunologic tolerance.
Conclusions. Neonatal immunization with PRP-T was safe and well tolerated in Finnish infants, and it would be worthwhile to further study its effects in higher risk populations.
Carbon Dioxide Protects the Perinatal Brain From Hypoxic-Ischemic Damage: An Experimental Study in the Immature Rat
Authors: Vannucci Robert C. , Towfighi Javad , Heitjan Daniel F. , Brucklacher Robert M. 
Published: December 2021

Background and Objective. Clinical investigations suggest that premature infants who require mechanical ventilation from respiratory distress syndrome are at increased risk for periventricular leukomalacia if hypocapnia occurs during respiratory management. The question remains as to the contribution of hypocapnia to hypoxic-ischemic brain damage and whether or not hypercapnia is neuroprotective.
Methods. Seven-day postnatal rats underwent unilateral common carotid artery ligation followed thereafter by exposure to systemic hypoxia with 8% oxygen (O2) combined with either 0, 3, 6, or 9% carbon dioxide (CO2) for 2.5 hours at 37°C. Survivors underwent neuropathologic examination at 30 days of postnatal age, and their brains were categorized as follows: 0 = normal; 1 = mild atrophy; 2 = moderate atrophy; 3 = atrophy with cystic cavitation &lt;3 mm; 4 = cystic cavitation &gt;3 mm of the cerebral hemisphere ipsilateral to the carotid artery ligation. The width of the ipsilateral hemisphere also was determined on a posterior coronal section and compared with that of the contralateral hemisphere to ascertain the severity of cerebral atrophy/cavitation. Data were analyzed by linear models.
Results. CO2 tensions averaged 26, 42, 54, and 71 mm Hg in the 0, 3, 6, and 9% CO2 exposed animals, respectively, during systemic hypoxia. Blood O2 tensions during hypoxia were not different among the four groups and averaged 34.7 mm Hg. Neuropathologic results showed that 30/38 (79%) rats exposed to 3% CO2 showed either no or mild brain damage compared with 13/33 (39%) controls (0% CO2). Cystic cavitation occurred in only four CO2 exposed rat pups compared with 14 controls (P = .001). At 6% CO2 exposure, all of 20 rat pups showed either no damage or mild atrophy compared with controls (P &lt; .001); and at 9% CO2 exposure, 19/23 (83%) rat pups showed no or mild damage compared with controls (P &lt; .001). The data also showed that the greatest reduction in brain damage occurred in immature rats exposed to 6% CO2 with slightly less protection at 9% CO2 (P = .012), the latter comparable with the severity of brain damage sustained by animals inhaling 3% CO2. Analyses of coronal width ratios at each CO2 exposure provided results comparable with those of the gross neuropathology scores.
Conclusions. The results indicate that in an immature rat model normocapnic cerebral hypoxia-ischemia is associated with less severe brain damage than in hypocapnic hypoxia-ischemia and that mild hypercapnia is more protective than normocapnia. The findings in an experimental model merit further animal investigations as well as a clinical reappraisal of the ventilatory management of sick newborn human infants.
Disseminated Candidal Infections and Intravenous Hydrocortisone in Preterm Infants
Authors: Botas Carlos M. , Kurlat Isabel , Young Shirley M. , Sola Augusto 
Published: December 2021

Background. Intravenous (IV) hydrocortisone (HC) has been used recently in selected preterm infants for hypotension soon after birth. During the same time period that HC was used, there was a marked increase in the incidence of disseminated candidal infections (DCIs).
Objective. To determine whether there is an association between DCI in the first 35 days of life and IV HC in preterm infants.
Research design. A hospital case-control study comparing the exposure of HC between preterm infants with DCI and matched infants without DCI.
Setting. A tertiary level intensive care nursery in a major teaching hospital in San Francisco, CA.
Patients. Seventeen preterm infants with DCI and 25 infants without DCI, with gestational age younger than 28 weeks and birth weight less than 1000 g, inborn and outborn admitted to the intensive care nursery between January 1992 and September 1993.
Methods. All preterm infants diagnosed with DCI at younger than 35 days of age were identified using a perinatal and neonatal database. DCI was defined as a blood, cerebrospinal fluid, or two urine cultures positive for Candida requiring antifungal therapy. A control group of uninfected infants matched for the major risk factors for DCI (gestational age, birth weight, duration of intubation, broad-spectrum antibiotics, and IV alimentation, including lipids and central venous catheters) admitted during the same period was identified using the same database. Postmatching comparison was performed for several other factors to detect any other differences between the groups.
Results. The infants with DCI (n = 17) and control infants (n = 25) had no statistical difference in exposure to the major risk factors for DCI or in postmatching comparison. Ten (59%) of the infants with DCI were receiving HC at the time of infection, whereas four (16%) of the control infants received HC during the first 35 days of life. Infants with DCI were 7.5 times as likely as control infants (95% confidence interval, 5 to 11) to have received IV HC before the onset of fungal infection.
Conclusion. We conclude that the administration of IV HC significantly increases the risk of DCI in susceptible preterm infants younger than 35 days of age. The potentially serious risks of DCI should be considered particularly in the patient selection process for administration of IV HC.
A Controlled Trial of High-Intensity Double-Surface Phototherapy on a Fluid Bed Versus Conventional Phototherapy in Neonatal Jaundice
Authors: Garg A. K. , Prasad R. S. , Al Hifzi I. 
Published: December 2021

Objective. To evaluate a simple, relatively inexpensive method using the fluid bed to provide high-intensity double-surface (HIDS) phototherapy and to confirm that the method described is more effective than conventional phototherapy (CPT) in the treatment of neonatal hyperbilirubinemia.
Design. Prospective controlled study.
Method. HIDS phototherapy (26 to 30 µW/cm2 per nanometer) on the fluid bed (n = 22) versus conventional (7 to 10 µW/cm2 per nanometer) phototherapy (n = 28) was used to treat neonates weighing more than 1500 g with hyperbilirubinemia.
Results. After 24 hours of therapy, the bilirubin in the group receiving HIDS phototherapy was significantly lower. The mean rate of fall of bilirubin was 5.34 µmol/L per hour in the group receiving HIDS phototherapy versus 0.7 µmol/L per hour in the group receiving CPT. HIDS phototherapy on a fluid bed was well tolerated.
Conclusion. HIDS phototherapy on the fluid bed is significantly more effective in reducing bilirubin than CPT. It can be easily and economically provided using equipment currently available in most neonatal units.
The Pediatric Report Card for Preventive Services
Authors: Bauchner Howard 
Published: December 2021

Health care reform and consolidation within the health care industry has led to greater interest in measuring the quality of care that children receive. Remarkably little is known about measuring the quality of ambulatory services in pediatrics, but nevertheless there is growing interest in "grading" the services provided by health delivery systems. Health care "report cards" are a cornerstone of managed competition—a set of quality indicators that will allow consumers to select the health care plan that best meets their needs.1,2
What should a report card for pediatric preventive services include? Traditionally, many insurers have reported immunization rates, but little else with respect to children.3,4
Letters to the Editor
Authors: Anderson Philip O. 
Published: December 2021

The Committee on Drugs' revised statement on drugs and chemicals in breast milk1 will undoubtedly be widely used as an authoritative source of information for counseling nursing mothers. However, it has some noteworthy shortcomings:
Discussion of the effects of drugs on lactation is inadequate. For example, combination oral contraceptives (none of which contain progesterone as is stated) are accompanied by the somewhat misleading comment, "... decrease in milk production and protein content (not confirmed in several studies)."
Retinopathy of Prematurity and Cortical, Blindness
Authors: Good William V. , Silverman William A. , Johnson-Kuhn Jenna , Murphy Dennak 
Published: December 2021

We read with great interest the article by Keith and Doyle,1 "Retinopathy of Prematurity in Extremely Low Birth Weight Infants." We are writing to ask the authors to comment on whether any babies who graduated from their nursery suffered cortical visual impairment.
In northern California in a registry maintained by the Blind Babies Foundation, we found that 7% of the visually impaired children with extremely low birth weight had cortical visual impairment as the etiology of their low vision.