bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lupus Nephritis in Children—A Review of 167 Patients
Authors: Yang Ling-Yoeu , Chen Wei-Perng , Lin Ching-Yuang 
Published: December 2021

Background. Relatively few studies have been made of children with lupus nephritis. The prognosis of children with lupus nephritis is ominous for those with diffuse proliferative glomerulonephritis and active interstitial inflammation. Up to now few studies have been made on this subject.
Objectives. To evaluate the clinical course, histopathology, and prognosis of lupus nephritis in children, to identify the risk factors for renal failure and mortality, and to share our experience in treating lupus nephritis in children.
Methods. Retrospectively, 167 children under 18 years of age with lupus nephritis at Veterans General Hospital-Taipei, Taiwan from 1979 to 1991 were studied. All patients received renal biopsy and follow-up biopsies were performed in 36 children. The clinical and serologic parameters at the time of renal biopsy were recorded.
Results. There were 55 (33%) patients with class II, 30 (18%) with class III, 69 (41.3%) with class IV, and 13 (7.8%) with class V nephritis based on initial biopsy. The mean follow-up time was 59 months. Follow-up biopsies were histologically stationary in 29 patients, progressive in five, and regressive in two. The results revealed that those with persistent hypertension, anemia, increased serum creatinine concentration, and decreased creatinine clearance rate at initial biopsy were more prone to develop renal failure. Low titer of CH50 hemolytic assay appeared to be a poor prognostic indicator. The overall renal and patient 5-year survival rates were 93.1% (135/145) and 91.08% (143/157), respectively. They were 87.7% (50/57) and 82% (55/67), respectively, of patients with class IV proliferative glomerulonephritis.
Conclusions. The prognosis of children with class IV nephritis in this study was better than that reported previously. All children surviving without renal failure were maintaining their normal lives with little organ dysfunction. The improved results may be due to earlier renal biopsy for precise histopathologic definition, better supportive care, and selective use of aggressive therapy, including methylprednisolone pulse therapy, intravenous cyclophosphamide, intravenous prostaglandin E1 therapy, high-dose intravenous gammaglobulin therapy, and cyclosporin A for those with high risk factors.
Violence Prevention in Schools and Other Community Settings: The Pediatrician as Initiator, Educator, Collaborator, and Advocate
Authors: Wilson-Brewer Renee , Spivak Howard 
Published: December 2021

Attention to the problem of youth violence has resulted in a proliferation of violence prevention and intervention strategies. Examined in this paper are those strategies that can be categorized as educational, environmental/technological, and recreational. In the educational category are conflict resolution and mediation, crime prevention and law-related education, handgun violence education, life skills training, self-esteem development, public education, and media education. The environmental/technological category covers a range of strategies: metal detectors, school police, concrete barriers, dress codes, and safe corridor programs, among othens. The rather broad recreational category is based upon the importance of physical activity as an outlet for stress and anger and as a component of a multicomponent program. Multi-intervention programs are described as well as some of the major gaps in current violence prevention programming.
The suggested role of the pediatrician in violence prevention efforts is described as both initiator and collaborator, as counselor, and as advocate. Because of their great credibility with respect to issues related to children and youth, pediatricians can influence not only parents in their contacts with them in the health care setting, but also school administrators and community leaders. Pediatricians have access to the media, and they can speak to the issue in public forums as well. Furthermore, pediatricians can join existing community efforts to determine ways in which violence prevention and intervention strategies can be incorporated into agency activities.
Eating in Preschool Children With Cystic Fibrosis and Healthy Peers: Behavioral Analysis
Authors: Stark Lori J. , Jelalian Elissa , Mulvihill Mary M. , Powers Scott W. , Bowen Anne M. , Spieth Leslie E. , Keating Kristen , Evans Sylvia , Creveling Susan , Harwood Ivan , Passero Mary Anne , Hovell Melbourne F. 
Published: December 2021

Study objective. To investigate calorie intake, behavioral eating styles, and parent perception of eating behavior of preschool children with cystic fibrosis (CF) compared with healthy peers.
Design. A two group comparison study.
Setting. A clinical sample of 32 preschool children with CF (aged 2 to 5 years) and a community sample of 29 healthy peers matched for age and socioeconomic status.
Measurements and main results. The two groups did not differ on the total number of calories consumed per day or the percentage of calories derived form fat. The CF sample achieved a significantly higher percent of the recommended daily allowance (RDA) of energy (95% RDA) than the control group (84% RDA), P &lt; .05, but did not achieve the CF dietary recommendations of 120% RDA. On measures of behavioral eating style, the CF sample had significantly longer meals (24.63 min) than the control group (18.57 min), P &lt; .01, but did not differ on pace of eating or calories consumed per bite. On a measure of parent report of mealtime behavior, parents of the CF sample identified mealtime behaviors of "dawdles" and "refuses food" as more problematic (M = .93) than parents of control children (M = .22), P &lt; .05.
Conclusions. While preschool children with CF consume as much or more than healthy peers, they are not achieving the CF dietary recommendations. Furthermore, there appear to be behavioral differences in eating and parent perception of CF children's eating that may contribute to the failure to achieve dietary recommendations.
The Relationship Between Vigilance Deficits and Traffic Injuries Involving Children
Authors: Pless I. B. , Taylor H. G. , Arsenault L. 
Published: December 2021

Objective. This study was designed to determine whether there is an increased frequency of deficits in impulse control, vigilance, or both, among child bicyclists or pedestrians who have been injured in traffic accidents, as assessed using objective measures and parent and teacher reports.
Research design. This was a case-control study, in which cases were children injured as pedestrians or bicyclists (excluding those with severe head injuries) and controls were those injured as passengers or in some other manner in which the child's behavior was unlikely to be a factor.
Setting. Children ages 5 to 15 years presenting to the emergency room of the Montreal Children's Hospital.
Participants. For each of 286 cases, two controls were selected, making a total of 848 subjects Among the cases, 172 were injured as pedestrians and 114 as bicyclists.
Measures. Children were assessed using the Continuous Performance Task and the Delayed Response Test, both parts of a computerized test battery. Parents and teachers completed the Conners Abbreviated Symptom Questionnaire to assess hyperactivity.
Results. Cases and controls were similar on most sociodemographic and clinical measures but showed statistically significant differences in mean scores on the Continuous Performance Task measures of omissions and commissions, pointing to differences in vigilance, and on the Delayed Response Test measures of impulsivity. Mean Conners scale scores of both parent and teacher were significantly higher for cases than controls, and those of parents were higher than those of teachers.
Conclusions. Among children whose behavior may have been a factor in the occurrence of an injury, there is subjective evidence of increased hyperactivity and objective evidence of deficits in vigilance and attention when compared with closely matched controls. These findings have important implications for prevention.
Score for Neonatal Acute Physiology: Validation in Three Kaiser Permanente Neonatal Intensive Care Units
Authors: Escobar Gabriel J. , Fischer Allen , Li De Kun , Kremers Robert , Armstrong Mary Anne 
Published: December 2021

Background. Measurement of the severity of illness is a research area of growing importance in neonatal intensive care. Most severity of illness scales have been developed in tertiary care settings. Their applicability in community neonatal intensive care units has not been tested.
Objectives. Our goal was to assess the operational characteristics of the score for neonatal acute physiology (SNAP): the relationship to birth weight, the length of total hospital stay, and in-hospital mortality.
Methods. We assigned SNAP scores prospectively to all inborn admissions at three community neonatal intensive care units during an 11-month period. Data on other neonatal predictors (eg, birth weight and the presence of congenital heart disease) were also collected. We measured in-hospital mortality, the experience of interhospital transport to a higher level of care, and total hospital stay.
Results. We found that the SNAP's relationship to birth weight was similar to previous reports. The SNAP's perinatal extension is a reliable predictor of newborn in-hospital mortality, with an area under the receiver operator characteristic curve of 0.95. The SNAP is also a good predictor of total hospital length of stay, whether by itself (by which it can explain 31% of the total stay) or in combination with other variables. Its predictive ability is better among infants of low birth weight (&lt;2500 g) than among those of normal birth weight (≥2500 g). The SNAP's predictive power was most limited among infants admitted to rule out sepsis. The predictive ability of a model containing birth weight, the SNAP, and transport status was not improved by the inclusion of two major diagnostic categories, the presence of congenital heart disease or complex illness.
Conclusion. Although it has definite limitations among infants who weigh 2500 g or more, the SNAP is a potent tool for outcomes research. Modification of some of its parameters could result in a multifunctional scale suitable for use with all birth weights.
Comparison of Diphtheria-Tetanus-Two Component Acellular Pertussis Vaccines in United States and Japanese Infants at 2, 4, and 6 Months of Age
Authors: Rothstein Edward P. , Kamiya Hitoshi , Nii Ritsue , Matsuda Tadashi , Bernstein Henry H. , Long Sarah S. , Hosbach Philip H. , Meschievitz Carlton K. ,   PENNRIDGE PEDIATRIC ASSOCIATES
Published: December 2021

Objective. We compared the diphtheria and tetanus toxoids and bicomponent acellular pertussis vaccine (DTaP) responses in Japanese and United States infants.
Design. This was a double-blind, comparative study.
Setting. Private pediatric practices in Japan and the U.S. participated.
Subjects. One hundred eighty-nine healthy 2-month-old infants were tested.
Interventions. Infants were immunized at 2, 4, and 6 months of age. The Japanese formulation (DTaP-J) contained 20 µg of pertussis toxin (PT) and 20 µg of filamentous hemagglutinin (FHA); the U.S. formulation (DTaP-US) contained 23.4 µg of each antigen. Parents used a standard form to record adverse experiences. Serum was obtained before the first immunization, 2 months after the second immunization, and 1 month after the third immunization.
Measurements. Differences in DTaP-J and DTaP-US were evaluated in Japanese infants immunized subcutaneously (SC). Differences due to ethnicity and to route of administration were compared in U.S. infants immunized with DTaP-US SC or intramuscularly (IM). An indirect enzyme-linked immunosorbent assay was used to determine immunoglobulin G antibody responses to PT, FHA, and tetanus toxoid. Neutralizing antibody to PT was measured by a Chinese hamster ovary cell assay. Diphtheria antitoxin was assayed by serum neutralization on VERO cells.
Results. Statistical differences (P &lt; .05) in adverse events included less fatigue after immunization with DTaP-US compared with DTaP-J. Erythema of more than 2.5 cm was more frequent, but erythema less than 2.5 cm was less frequent in Japanese infants compared with U.S. infants. Fewer Japanese infants were febrile (&gt; 38°C), tired, or irritable. Subcutaneous immunization resulted in a greater frequency of erythema and induration. The DTaP-US resulted in an equivalent response to PT and a greater response to FHA. More Japanese infants demonstrated at least a fourfold response over preimmunization antibody values to FHA. In U.S. infants, antibody responses to the contained pertussis antigens were equivalent after IM and SC administration. Compared with Japanese infants receiving DTaP-J SC, U.S. infants receiving DTaP-US IM had equivalent responses to PT and a greater response to FHA.
Conclusions. United States infants receiving an IM injection of a U.S.-produced bicomponent DTaP vaccine produced antibody responses to the contained pertussis antigens at least equal to those of Japanese infants receiving a similar bicomponent DTaP vaccine shown to be effective in older Japanese children.
Differentiating Cyclic From Chronic Vomiting Patterns in Children: Quantitative Criteria and Diagnostic Implications
Authors: Pfau Brad T. , Li B U.K. , Murray Robert D. , Heitlinger Leo A. , McClung H. Juhling , Hayes John R. 
Published: December 2021

Objective. To establish criteria to differentiate two patterns of vomiting and to identify the predominant diagnoses for each one.
Methods. All children 2 to 18 years of age referred to a pediatric gastroenterology service who presented with recurrent vomiting (three episodes of vomiting within a 3-month period) as a primary complaint from 1985 to 1991 were retrospectively reviewed (n = 106). The vomiting pattern (emeses per hour and episodes per month), diagnostic studies, and therapeutic responses were compared by Mann-Whitney U and x2 tests.
Results. Based on the criteria of peak intensity (four or more emeses per hour) and frequency (nine or fewer episodes per month), two subgroups were differentiated: children with a cyclic pattern (n = 34), who vomited at a higher peak intensity (12.6 ± 1.6 vs 1.5 ± 0.1 emeses per hour) but at a lower frequency (1.9 ± 4.8 vs 36.6 ± 0.3 episodes per month) than those with a chronic pattern (n = 72). Among children with a cyclic pattern, nongastrointestinal (65%) causes, especially abdominal migraine, predominated over gastrointestinal ones (12%), whereas among those with a chronic pattern, gastrointestinal disorders (76%), especially peptic and infectious disorders, predominated over nongastrointestinal ones (10%).
Conclusions. On the basis of quantitative historical criteria, children with recurrent vomiting can be classified into two subgroups that seem to be clinically and etiologically distinct. Abdominal migraine was the dominant diagnosis in those with cyclic vomiting, whereas peptic and infectious gastrointestinal disorders predominated in those with chronic vomiting. This differentiation between cyclic and chronic patterns of vomiting may be a useful diagnostic clue to the clinician.
Internet List Servers and Pediatrics: Newly Emerging Legal and Clinical Practice Issues
Authors: ELLIOTT STEPHEN J. , ELLIOTT ROBYN C. 
Published: December 2021

The Internet is an electronic communications network that spans the globe, and is commonly used to disseminate information relevant to medicine. Many issues resulting from the use of the Internet for medical purposes have never required consideration before. For example, citations that refer to Internet sources (eg, References 3-5 below) have yet to be standardized by the American Medical Association or the British Medical Association.
The Internet list server devoted to topics in neonatology has been operational for more than 1 year. A useful analogy to a list server might be the editorial correspondence section of a journal. In the case of list servers, however, a message posted by an author to the list server is electronically and automatically mailed to all subscribers and is neither peer reviewed nor edited.
Bilateral Cystic Periventricular Leukomalacia in the Premature Infant: Associated Risk Factors
Authors: Perlman Jeffrey M. , Risser Rick , Broyles R. Sue 
Published: December 2021

Background. Bilateral cystic periventricular leukomalacia (PVL) is a major cause of neurodevelopmental delay in the premature infant. Thus, early identification of the preterm infant at highest risk for the subsequent development of this lesion is critical.
Objectives. The three objectives of this case-control study were: (1) to determine the basic characteristics of cystic PVL, (2) to assess the relationship of perinatal clinical events and PVL, and (3) to ascertain the feasibility of identifying early those preterm infants at highest risk for the development of PVL.
Methods. The medical records and cranial ultrasound scans (HUSs) were reviewed for 632 infants weighing less than 1750 g who were admitted to the neonatal intensive care unit between January 1992 and December 1993. PVL developed in 14 infants of 1285 ± 301 g birth weight (BW) and 29.4 ± 1.5 weeks' gestational age (GA); severe intraventricular hemorrhage (n = 21) and intraparenchymal echodensity (n = 12) developed in 33 infants of 904 ± 248 g BW and 26.6 ± 1.8 weeks' GA; and 585 infants of 1315 ± 324 g BW and 29.7 ± 2.4 weeks' GA with normal HUS findings (n = 473) or grade I or II intraventricular hemorrhage (n = 112) served as a comparison group.
Results. Cystic PVL was observed in 14 (2.3%) of 632 infants weighing less than 1750 g, more specifically, in 3.2% of infants weighing less than 1500 g. Cysts were noted from the 7th to 14th days of life in 10 infants and from the 20th to 46th days of life in 4 infants. Ten (70%) of the infants had relatively benign clinical courses, and most cases were detected by routine HUS surveillance. Overt hypotension in the immediate perinatal period was noted in 3 (21%) infants; late hypotension developed in 1 additional infant. Univariate analysis indicate that two clinical indicators, prolonged rupture of membranes (PROM) and chorioamnionitis, were significant predictors of PVL. For PROM, the odds ratio estimate and the 95% confidence limit are 6.59 and 1.96 to 22.10, with a sensitivity of 28.6% and positive predictive value of 11.5%. Similar values for chorioamnionitis are 6.77 (1.77 to 25.93), with a sensitivity of 21.4% and positive predictive value of 11.5%.
Conclusions. (1) Most cases of symmetric cystic PVL occurred in infants with relatively benign clinical courses and were only detected by routine ultrasound screening. (2) Postnatal systemic hypotension seems to be an uncommon associated event. (3) Preterm infants born to mothers with PROM and/or chorioamnionitis seem to be at an increased risk for the development of PVL and should be carefully evaluated.
Cocaine-exposed Preterm Neonates Show Behavioral and Hormonal Differences
Authors: Scafidi Frank A. , Field Tiffany M. , Wheeden Abigail , Schanberg Saul , Kuhn Cynthia , Symanski Robert , Zimmerman Eugene , Bandstra Emmalee S. 
Published: December 2021

Objective. Prematurity has been associated with prenatal cocaine exposure, but most studies on the behavioral effects of prenatal cocaine exposure have been restricted to full-term infant samples. The current study focused on behavioral and hormonal responses in preterm cocaine-exposed infants compared with a cohort of non-cocaine-exposed infants of similar gestational age.
Methodology. A comparison between 30 cocaine-exposed and 30 non-cocaine-exposed preterm neonates suggested that the cocaine-exposed neonates were born to mothers who had higher parity and more obstetric complications. In addition, mothers of cocaine-exposed preterm neonates visited, touched, held, and fed their infants less frequently than mothers of nonexposed infants.
Results. The cocaine-exposed infants had smaller head circumferences at birth, spent more time in the neonatal intensive care unit, and had a greater incidence of periventricular-intraventricular hemorrhages. They also had inferior Brazelton cluster scores, including lower state regulation and range-of-state scores, and greater depression. During sleep-wake behavior observations, they showed difficulty maintaining alert states and self-regulating their behavior, and they spent more time in indeterminate sleep and had decreased periods of quiet sleep and increased levels of agitated behavior, including tremulousness, mouthing, multiple limb movements, and clenched fists. Finally, higher urinary norepinephrine, dopamine, and cortisol levels and lower plasma insulin levels were noted in the cocaine-exposed preterm neonates.
Conclusions. These findings highlight the need for follow-up assessments and early intervention.
A Controlled Trial of Dexamethasone to Prevent Bronchopulmonary Dysplasia in Surfactant-treated Infants
Authors: Rastogi Alok , Akintorin Subuola M. , Bez Michelle L. , Morales Pablo , Pildes Rosita S. 
Published: December 2021

Background. Surfactant therapy now has a well-established role in the treatment of neonates with respiratory distress syndrome but has failed to reduce the incidence of bronchopulmonary dysplasia (BPD). We conducted a double-blind, placebo-controlled trial to test the hypothesis that dexamethasone therapy given during the first 12 days of life to very low birth weight infants would be synergistic to surfactant in preventing BPD.
Methods. Seventy surfactant-pretreated infants (700-1500 g) who had severe respiratory distress syndrome (a/A ratio, 0.18 ± 0.10; mean airway pressure, 11.1 ± 1.9 cm H2O; fraction of inspired oxygen, 0.81 ± 0.22) were enrolled to receive a 12-day course of dexamethasone (n = 36) or saline placebo (n = 34) starting within the first 12 hours after birth. The starting dose of dexamethasone was 0.5 mg/kg per day, and it was tapered progressively.
Results. Ventilator variables at 5 to 14 days were significantly improved in those infants who received dexamethasone compared with those who received the placebo. The effect seem to be more marked in infants weighing less than 1250 g at birth. Significantly more infants could be extubated by 14 days of age in the dexamethasone group (26 of 32 vs 14 of 32). Dexamethasone therapy reduced the incidence of BPD at 28 days (odds ratio, 0.1; 95% confidence interval, 0.03 to 0.3) and eliminated BPD at 36 weeks' postconceptional age. Dexamethasone-treated infants had greater weight loss at 14 days (12.9 ± 6.4% vs 3.7 ± 8.6%, respectively) and higher blood pressures from days 3 to 10. However, no differences were seen in time to regain birth weight, hypertension (1 infant in each group), or incidence of intraventricular hemorrhage.
Conclusions. We found an additive effect between dexamethasone and surfactant in improving pulmonary status and reducing the incidence of BPD. Compared with the placebo, dexamethasone therapy was more effective in reducing the incidence of BPD in surfactantpretreated very low birth weight infants.