bluuebunny/crossref_metadata_2025_split huggingface dataset:
Near Drowning
Authors: Brooks John G. 
Published: December 2021

Drowning is the third most common cause of death for children between the ages of 1 and 14 years. Despite increasing understanding of the pathophysiology of drowning and continuing advances in cardiopulmonary resuscitation and support, efforts at cerebral resuscitation have been less successful, and it is estimated that only about half of the children who are apparently lifeless when removed from the water will survive. Prevention, effective on-scene resuscitation, and optimal inpatient care are the keys to reducing the morbidity and mortality of submersion accidents.
EPIDEMIOLOGY
Approximately 8,000 deaths due to drowning occur each year in the United States, and approximately 40% of the victims are less than 4 years of age. Drowning is second only to motor vehicle accidents as a cause of accidental death in children. Within the pediatricage range there are three particularly high-risk groups: toddlers, teenage boys, and children with seizure disorders. Special efforts should be devoted to educating parents of these children and to the older children themselves regarding water safety and their own particular risks. Parents of ambulatory infants and young children must be reminded that continuous, responsible supervision is absolutely essential around water or when the young child might wander away to a nearby body of water.
Athletic Injuries
Authors: Dyment Paul G. 
Published: December 2021

Sports medicine was for many years considered to be the preserve of the orthopedic surgeon, and it consisted primarily of the management of musculoskeletal injuries. With the recognition that primary care physicians can adequately care for more than 80% of athletic soft tissue injuries, there has been a corresponding increase in the number of pediatricians incorporating sports medicine into their practices, and many are actively pursuing further training in this field by attending continuing medical education courses. Many pediatric residencies offer at least an elective experience in sports medicine.
The number of children and adolescents taking part in sports programs in the United States is enormous: 30 million in nonschool-organized athletics and more than 3 million in interscholastic sports. Therefore, it is not surprising that athletic injuries occur frequently in our patients. One study at a health maintenance organization indicated that more than 2% of all visits to that pediatric clinic were for recreational injuries.1 Another study of school-aged children found that each year 6% sustained an athletic injury requiring at least first aid.2 Pediatricians, because of their interest in preventive and behavioral medicine, can not only care for most injuries but, more important, can play a role in the prevention of injuries by becoming team physicians.
Cardiac Transplantation in Children
Authors: Parness Ira A. , Nadas Alexander S. 
Published: December 2021

HISTORICAL OVERVIEW
In 1967, Dr Christian Barnard1 captured the imagination of the world's lay and medical communities when he performed the first human orthotopic cardiac allotransplant. Although the recipient survived for only 17 days, even this limited success spurred many centers around the world to attempt heart transplantation in the late 1960s and early 1970s. Interestingly, Dr Adrian Kantrowitz2 in Brooklyn, NY, had attempted a human neonatal cardiac transplantation nearly coincidentally with Dr Barnard's historic operation; the neonate survived only a few hours. Because of poor results secondary to rejection, infection, and donor shortage, most centers had abandoned their heart transplantation programs by the middle 1970s. Experience at the few centers that persisted with heart transplantation, Stanford University being the most notable, led to improved candidate selection and improved immunosuppression. The introduction of endomyocardial biopsy in 19733 for the diagnosis of rejection also contributed substantially to improved understanding and management of this complication.
In the late 1970s, encouraging results from Stanford prompted renewed interest in the procedure. However, pediatric experience, even at Stanford, was limited to a small number of adolescents during the 1970s. In 1980, the introduction of a new maintenance immunosuppressive drug, cyclosporine A, led to improved survival because of less infection and better management of the rejection process.
Health-Related Fitness as Preventive Medicine
Authors: Jopling R. Joe 
Published: December 2021

The decline of health-related fitness among children in the United States has brought about an interest in the topic by both professionals and the general public. The problem is pervasive and has seemed refractory to change.
In a recent survey, fewer than half the children taking the fitness test of the President's Council on Physical Fitness and Sports passed. In 1984, only 2% of all children taking the "President's Challenge" could qualify for the award that required them to uniformly do well in performing chin-ups, sit-ups, a 1 mi run/walk, and a shuttle run. Only 60% of boys aged 6 to 12 years and only 30% of girls aged 6 to 12 years and only 30% of girls aged 6 to 17 years could do more than one chin-up. Similarly, only 64% of boys aged 6 to 12 years and only 50% of girls aged 6 to 12 years could run/walk 1 mi in less than ten minutes.
Declining fitness can result in an increase in cardiovascular risk factors such as obesity, hypertension, elevated serum cholesterol level, and physical inactivity. In a recent Centers for Disease Control epidemiologic study, physical inactivity was shown to be as strong a risk factor for coronary heart disease as the traditional risk factors of smoking, hypertension, and a high serum cholesterol level, and physical inactivity was three to six times more prevalent than the other risk factors.
Inguinal Hernia and the Acute Scrotum in Infants and Children
Authors: Nakayama Don K. , Rowe Marc I. 
Published: December 2021

INGUINAL HERNIA AND OTHER INGUINAL SCROTAL PROBLEMS
Inguinal Hernia
Inguinal hernia and hydrocele develop because the processus vaginalis remains open after birth. When fluid passes distal to the internal ring, a hydrocele forms. An intraabdominal structure entering the processus produces a hernia. The processus, first seen during the third month of gestation at a time when the developing testis lies within the abdomen, extends into the scrotum by the seventh month. As the testis completes its descent, the processus begins to obliterate, a process that continues after birth. Data from autopsy studies reveal that most infants have an open processus for several months after birth. The incidence in the newborn period is 80% to 94% and decreases to 57% in the 4- to 12-month age group. A patent processus persists in 20% of adults without clinically apparent hernias. These rates far exceed the incidence of hernia or hydrocele; therefore, a patent processus may persist undetected throughout life. Excess fluid within the peritoneal cavity, typically from ventriculoperitoneal shunts and peritoneal dialysis, tends to maintain patency of the processus.
Inguinal hernia is one of the most common surgical conditions in infancy, with an incidence of 0.8% to 4.4% that varies with gestational age and birth weight.
Congenital Cardiovascular Defects in Infants With Down Syndrome
Authors: Clark Edward B. 
Published: December 2021

Editor's note: In response to a reader's question about cardiac evaluation of patients with Down syndrome, we asked Dr Clark for a review and recommendation for workup by the general pediatrician. RJH
Infants with Down syndrome are at 50% risk for congenital cardiovascular malformations1 compared with a 0.3% (3 of 1000) risk for infants with normal chromosomes.2 These data confirm the original estimates of Rowe and Uchida3; other estimates have ranged from 20% to 70%.
The types of heart defects found in persons with Down syndrome are severe: complete atrioventricular canal, ventricular septal defect, partial atrioventricular canal, atrial septal defect, tetralogy of Fallot, and patent ductus arteriosus.4
Progress in Understanding the Pathophysiology of Otitis Media
Authors: Giebink G. Scott 
Published: December 2021

Otitis media is one of the most common diseases of infants and young children, and its complications and sequelae may persist into adult years. The disease affects at least 7 of every 10 children, with one third of those affected having repeated episodes, and chronic middle ear disease, commonly called otitis media with effusion, developing in 5% to 10% of them.
The management of childhood otitis media has changed considerably during the past five decades. Before the introduction of antimicrobial drugs, myringotomy was, and in some countries remains today, the treatment of choice. The introduction of sulfonamides and penicillin four decades ago and their widespread use in treating acute otitis media led to a great reduction in the incidence of suppurative complications. Of the new orally administered antibiotics, many have been found to be efficacious in treating acute otitis media. Sophisticated methods of measuring treatment outcome suggest, however, that there are differences in rates of bacteriologic response to these drugs. Moreover, adjunctive therapies such as decongestants, antihistamines, steroidal and nonsteroidal anti-inflammatory drugs, and topical drugs, in addition to myringotomy and adenoidectomy, have been advocated by some in treating acute and recurrent otitis media. These newer therapeutic interventions have led to controversies regarding management of the disease.
PREP and Time-Limited Certification
Authors: Alden Errol R. , Dow Jean 
Published: December 2021

The following statement was developed by the Advisory Group of the Pediatrics Review and Education Program (PREP) as part of an effort to inform the Academy membership about plans currently underway for the future of the program.
Although planning is still in the early stages, the Department of Education is enthusiastic about the projected changes, including the publication of 12 (instead of 10) issues per year of Pediatrics in Review starting in July 1990, the expansion of the journal to 40 (from 32) pages in 1992, the development of a new section in the journal devoted to practice management, and the availability of computerized diagnosis and management problems in addition to the Self-Assessment exam.
Inborn Errors of Metabolism of Acute Onset in Infancy
Authors: Ward Jewell C. 
Published: December 2021

Pediatricians and neonatologists are frequently presented with ill neonates or older infants whose symptoms have an acute onset and a severe and/or recurrent character. The clinician faced with symptoms that are frequently nonspecific must differentiate among many disorders, usually considering infection, cardiac defects, central nervous system insults, or gastrointestinal problems. Not infrequently, an inborn error of metabolism (IEM) will mimic these more common conditions. Although each individual IEM is rare, throughout the course of a practice the clinician will cumulatively see many patients with such disorders, with various findings. According to a recent estimate, IEM account for as much as 20% of disease among full-term neonates not known to have been at risk.1 The neonatologist and/or pediatrician will be the first to evaluate an acutely ill neonate or infant, and he or she must be alert to the possibility of an IEM. The implications of failing to entertain such a diagnosis may be formidable. An IEM should be considered early and appropriate screening tests obtained concurrently with assessment of the likelihood of more common causes.
The exact incidence with which IEM occur in the neonatal period or with acute symptoms in early to late infancy is not known. Cumulatively, IEM may represent more than 1 in 5000 live births.
The Case of Donnie J
Authors: Burg Fredric D. 
Published: December 2021

Mrs J has brought her 4-1/2-year-old son Donnie to your office for a first visit. She and her son have moved recently into your community, and she heard that you were the best pediatrician in town.
At present, Donnie has no complaints. He looks healthy and is comfortable with both his mother and you during the interview. You learn that Donnie has had no medical care since he was 2 years old, when he was hospitalized for a broken arm after he fell out of a tree. His mother has lost his immunization records, but thinks he has had all of his shots. Donnie was the product of a normal full-term pregnancy with no complications at the time of delivery.
His mother reports that she is unmarried and has been a "dead head" (a follower of the musical group "The Grateful Dead") for 14 years. She says that she has had many sexual partners and has used a variety of drugs before, during, and after pregnancy. She is presently living only with Donnie.
In reviewing the patient's history to this point, what points should alert you to potential problems with Donnie?
1. Immunization status.
2. Previous serious accident.
3. Potential prenatal exposure to human immunodeficiency virus.
Caring for the Child with Cancer and the Family: Lessons Learned From Children With Acute Leukemia
Authors: Sahler Olle Jane 
Published: December 2021

In a report appearing in 1951, Southam et al1 reported on the natural history of 173 patients with acute leukemia treated supportively at Memorial Center for Cancer and Allied Diseases in New York City from 1926 to 1948. The study population included 65 children less than 10 years of age. The average length of survival of these patients was 19.3 weeks after the onset of symptoms attributable to leukemia. Of the entire sample of patients irrespective of age, only 4 (2.3%) survived 52 weeks or beyond.
In 1948, Memorial Center began treating patients with folic acid or purine antagonists and steroids.
The Pediatrician and Early Intervention for the Developmentally Disabled or Handicapped Child
Authors: Katcher Avrum L. , Haber Julian S. 
Published: December 2021

New federal legislation involving infants at risk for handicaps and their families, in the form of Public Law 99-457, will rely on interaction between pediatricians and other professionals to maximize health and social benefits. Involvement in early identification and remediation of infants at risk is a role well suited to the primary care pediatrician.
Early Intervention Programs offer remediation and enhancement of development for children at biologic or environmental risk. Pediatricians should be alert to screen, identify, and assess children who may be helped by Early Intervention Programs. The primary care pediatrician should work with children who have these problems, help coordinate care, and serve as an advocate for the child and family.
Complications of Leukemia
Authors: Berg Stacey L. , Poplack David G. 
Published: December 2021

Approximately 2000 children, or 4 per 100 000 younger than 15 years of age, are diagnosed as having leukemia in the United States every year. Three quarters of these children have acute lymphoblastic leukemia; the remainder have acute nonlymphocytic or chronic leukemia. Before the development of modern chemotherapy, virtually all children having any kind of leukemia died within a few months of diagnosis. With the effective forms of therapy now available, however, long-term disease-free survival for children who have acute lymphoblastic leukemia has improved to approximately 60% to 70%. As a result, pediatricians are seeing more children in their practices who either are undergoing antileukemic therapy or are long-term survivors of the disease. To provide optimal care for these children, the pediatrician not only must be familiar with the pathophysiology and treatment of childhood leukemia, but also must be aware of those complications that may occur during and after therapy. This review focuses on common complications of childhood leukemia, particularly those associated with acute lymphoblastic leukemia.
INFECTION
Because children who have acute leukemia are immunocompromised due to both the disease and its treatment, they are at high risk for infection. The pediatrician caring for these children must be aware of common infectious complications and their management.
Use of Growth Hormone in the Treatment of Short Stature: Boon or Abuse?
Authors: Saenger Paul 
Published: December 2021

Growth hormone (GH) was isolated approximately 30 years ago. Since then, we have witnessed major advances in understanding the regulation and pattern of GH secretion and its many metabolic actions.1
With the advent of recombinant DNA-generated growth hormone (rhGH) in 1985, the opportunities to treat children who have organic or idiopathic GH deficiencies are now, for the first time, unlimited.
DEFINITION OF GROWTH HORMONE DEFICIENCY
Although a role for GH in the treatment of certain children deficient in GH is established, the definition of GH deficiency remains controversial. The controversy surrounding the diagnosis of GH deficiency was highlighted recently when it was shown that, among the many commercial assay kits available, the same serum sample yielded GH concentrations that differed by as much as 100% for the same sample. Using different GH assay kits, a child who has short stature could be determined to be deficient in GH in the view of one endocrinologist but to have sufficient GH (ie, to be normal) by another endocrinologist.2,3
Despite these obvious limitations, GH testing has an important role in the clinical evaluation of the child who is short. When a child fails a simple screening test (ie, serum GH level of &lt;10 ng/mL following vigorous exercise, such as running for 20 minutes), more definitive GH testing is the next step.
Limb Pain in Childhood
Authors: Sherry David D. 
Published: December 2021

Limb pain during childhood is common, and its causes range from the benign, such as joint hypermobility, to the potentially fatal, such as infection or tumor. Clues to the diagnosis are usually evident in the history, which can then give direction to the physical examination and, if necessary, laboratory investigations. Children with limb pain may be either ill or well (Table 1).
ILL CHILDREN WITH LIMB PAIN
Severe Joint Pain
The majority of ill children with severe limb pain experience an acute onset and may have associated symptoms, such as rash, fever, previous infection (especially skin infection, sore throat, or diarrhea), conjunctivitis, dysuria, or weakness (frequently interpreted by the family as tiredness). The severe nature of the pain usually renders the limb immobile or prevents even light weight-bearing. Erythema over the joint is an important sign because it is rare in chronic arthritic conditions (Table 2). The most important possible diagnoses include: infection, neoplasia, gastrointestinal disorders, rheumatic diseases, and cardiopulmonary disease.
Infection: Septic arthritis (with or without osteomyelitis) is the most common cause of severe monarticular pain. The absence of fever does not exclude a bacterial process. This is particularly true of septic sacroilitis and osteomyelitis of the pelvic and vertebral bones. Sudden onset of severe joint pain with marked swelling (and frequently erythema) is characteristic and typically involves the knee, hip, and ankle.
Toxoplasmosis
Authors: Freij Bishara J. , Sever John L. 
Published: December 2021

Toxoplasma gondii is an obligate intracellular parasite capable of infecting humans and a variety of other warm-blooded animals. The organism is distributed widely in nature and may infect as many as 1 of 3 persons worldwide. Most Toxoplasma infections are either asymptomatic or otherwise benign; notable exceptions include the infections of the developing fetus whose mother acquires an acute T gondii infection during gestation and of immunosuppressed patients, such as those with the acquired immunodeficiency syndrome (AIDS), in whom the illness may be severe or even fatal. The cat and other felines (such as the lynx) appear to be the only definitive hosts for this protozoan.
The name Toxoplasma is derived from the Greek word toxon (meaning arc or bow) and is a reference to the shape of the organism. The gondi is a North African desert rodent related to the gerbil in whose splenic and hepatic mononuclear cells the parasite was observed initially.
This article briefly reviews the biology of T gondii and its epidemiology in man and other animals, as well as its pathogenesis, clinical manifestations, methods for accurate diagnosis, and preventive strategies. Information on prenatal diagnosis and treatment modalities is emphasized.
THE ORGANISM
T gondii is a protozoan parasite that exists in three developmental stages: tachyzoite, tissue cyst, and oocyst.
MEDICAL RECORD DOCUMENTATION OF INDIRECT NEONATAL HYPERBILIRUBINEMIA
Authors: Schwartz K. 
Published: December 2021

December 12, 1990. Nursery Nurse
Dr Schwartz in to do examination and talk with mother. Normal examination. Baby doing well. Formula feeding and routine newborn orders. R. Dunn, RN
December 13, 1990. Nursery Nurse
Baby taking 30 mL of formula every 4 hours. Vigorous with strong cry. One transitional stool this shift; urinated twice. Jaundice noted; total bilirubin 11.8 at 9:00 AM. Dr Schwartz notified; ordered total and direct bilirubin, hematocrit, blood smear, and reticulocyte count for 7:00 PM. R. Dunn, RN
December 13, 1990. Nursery Nurse
Total bilirubin 13.2, with direct of 0.1 at 7:00 PM. Phoned to Dr Schwartz, along with other lab results.
The Limping Child
Authors: MacEwen G. Dean , Dehne Robert 
Published: December 2021

Evaluation of a limping child requires careful consideration and a basic knowledge of potential problems affecting the child. The most important point is not to miss or delay diagnosis of the septic hip. This is truly an orthopedic emergency. Complaints of knee pain should not throw the physician off the track of a diagnosis of hip disease.
It is also important to be aware of how the medical history affects the musculoskeletal system. Many causes of limp are best analyzed by repeat examination and stepwise laboratory and radiographic evaluation. One should realize that a painful limp can be caused by something as mundane as a thorn in the heel or as serious as a tumor of the spine: Be suspicious.
Hemophilia
Authors: Lusher Jeanne M. , Warrier Indira 
Published: December 2021

Hemophilia is a hereditary bleeding disorder characterized by Factor VIII (F-VIII) or Factor IX (F-IX) deficiency, bleeding into joints and soft tissues, and an X-linked mode of inheritance. Approximately one third of new cases occur as spontaneous mutations, with no family history of hemophilia. The incidence of hemophilia is about one per 20 000 persons, and one per 10 000 males.
DIAGNOSIS
Hemophilia A (characterized by F-VIII deficiency) and hemophilia B (characterized by F-IX deficiency) are clinically indistinguishable. Both affect males almost exclusively; both have the same type of bleeding; and, if the usual coagulation screening tests are performed, both are characterized by a prolonged partial thromboplastin time and normal prothrombin time. The template bleeding time is usually normal; this is expected, because the bleeding time is a reflection of platelet numbers, platelet function, capillary integrity, and von Willebrand factor activity, all of which are normal in the case of hemophilia. Hemophilia A and hemophilia B can be separated by assaying F-VIII and F-IX. Because neither F-VIII nor F-IX crosses the placenta, the diagnosis can be made at birth by obtaining a cord blood sample for assay.
CARRIER DETECTION AND PRENATAL DIAGNOSIS
Carriers of the hemophilia gene may be "obligate" carriers, in the sense that the family pedigree indicates that a particular female must be carrying the gene for F-VIII (or F-IX) deficiency.