bluuebunny/crossref_metadata_2025_split huggingface dataset:
Short-Term Efficacy of Oral Dimercaptosuccinic Acid in Children With Low to Moderate Lead Intoxication
Authors: Besunder James B. , Anderson Roberta L. , Super Dennis M. 
Published: December 2021

Objective. To determine the short-term efficacy of meso-2,3-dimercaptosuccinic acid (DMSA) in mild to moderately lead poisoned children.
Methods. Medical records of all pediatric patients receiving 19 days of DMSA between June 1991 and May 1993 were reviewed retrospectively. Patients were included if their pretreatment blood lead concentration (BPb) was 1.21 to 2.36 µmol/L (25 to 49 µg/dL) and excluded if they: received DMSA through participation in a pharmaceutical company-sponsored drug study; underwent chelation therapy in the previous 28 days; or received another chelating agent concomitantly with DMSA; or if noncompliance was documented. Homes were inspected and abated of major hazards before chelation therapy. BPb and blood zinc protoporphyrin concentration (ZnP) were obtained at baseline. DMSA was administered in a dose approximating 10 mg/kg per dose every 8 hours for 5 days, followed by 10 mg/kg per dose every 12 hours for 14 days. Baseline laboratory studies were repeated weekly while the patients were receiving therapy and for 2 weeks after therapy, then monthly unless chelated again.
Results. Of the 46 children who were treated with DMSA, 18 were excluded from the analysis. In the remaining 28 children, the mean ± SD pretreatment BPb and ZnP were 1.79 ± 0.33 µmol/L (37 ± 6.9 µg/dL) and 1.26 ± 0.64 µmol/L (71 ± 36.1 µg/dL), respectively. The percent reduction (mean ± SD) in BPb compared with baseline was -43% ± 20.8%, -26% ± 16.9%, and -31% ± 20.2% on mean days 18, 30, and 80, respectively, whereas the changes in ZnP were -12% ± 21.7%, -20% ± 18.1%, and -32% ± 21.9%, respectively. Eighty percent of patients had 20% or more reduction in their pretreatment BPb and/or ZnP after completion of DMSA therapy (95% confidence interval, 61, 92%). No significant adverse effects were observed except for neutropenia (absolute neutrophil count of 0.752 x 109/L) in one patient.
Conclusion. Our findings support the short-term efficacy of DMSA in children with BPb of 2.36 µmol/L (49 µg/dL) or less.
Iodine-Induced Hyperthyroidism in a Newborn
Authors: Bryant William P. , Zimmerman Donald 
Published: December 2021

In the article entitled Iodine-Induced Hyperthyroidism in a Newborn that appeared in the March 1995 issue of Pediatrics, the iodine content of povidone-iodine is estimated at 10 mg/mL rather than the estimate that we employed which was 10% or 10 g/dL. Thus, we are in agreement that the neonate in our report received 2.88 g rather than 28.8 g, which we reported.
Donald Zimmerman, MD
Mayo Clinic & Mayo Foundation
Pediatric Endocrinology
Rochester, MN 55905
Psychological Changes in Parents Eight Months After the Loss of an Infant From Stillbirth, Neonatal Death, or Sudden Infant Death Syndrome—A Longitudinal Study
Authors: Vance J. C. , Najman J. M. , Thearle M. J. , Embelton G. , Foster W. J. , Boyle F. M. 
Published: December 2021

Objective. We proposed to measure part of the natural history of grief by determining the changes in the psychological symptoms experienced by bereaved parents over the 8 months after the loss of an infant from sudden infant death syndrome (SIDS), neonatal death (NND), or stillbirth (SB). Parents were interviewed twice, at 2 and 8 months after the loss.
Methodology. A total of 220 bereaved families (45 SIDS, 93 NND, and 82 SB) were compared with 226 control families who had a live born child. Comparison was based on responses to a standardized measure of anxiety and depression (Delusions-Symptoms-States Inventory).
Results. For separate cross-sectional comparison at both 2 and 8 months, significant differences were noted in the frequency of maternal symptoms of anxiety and depression between bereaved and control groups (P &lt; .001). Such differences were present for paternal anxiety and depression at 2 months, but not 8 months.
A second series of analysis examined longitudinal changes in symptom frequency between 2 and 8 months for each bereaved group. For mothers, the changes were significant for anxiety and depression: SIDS and NND (P &lt; .001), SB (P &lt; .01). For fathers, the changes for anxiety and depression in SIDS were P &lt; .01; NND, P &lt; .05 for anxiety and P &lt; .01 per depression; changes were not significant for SB.
At 2 months, relative risks for symptoms of maternal anxiety were significant for all three bereaved groups: SIDS, 22.4; NND, 5.4; and SB, 5.1. Comparable significant figures at 8 months were: SIDS, 5.5; NND, 3.9; and SB, 3.0, respectively. For depression the results for 2 months were: SIDS, 8.6; NND, 5.9; and SB, 6.7 (all significant) while at 8 months the results were: SIDS, 5.1; NND, 3.8; and SB, 2.4 (SB group not significant). For fathers the relevant risks were generally lower. At 2 months, anxiety levels were higher than controls in all three groups, and for depression in the SIDS and SB groups. At 8 months, significant results persisted only in the SB group.
Conclusion. These data indicate that bereaved parents have a marked reduction in the symptoms of mental illness over the first 8 months after the loss. Although the changes over time are significant for both mothers and fathers, mothers at 8 months still demonstrated higher levels of anxiety and depression when compared with controls. These levels of symptoms are far less evident for fathers at 8 months.
Children's Medicaid Entitlement: What Have We Got to Lose?
Authors: Flint Samuel S. , Yudkowsky Beth K. , Tang Suk-fong S. 
Published: December 2021

Medicaid's efficacy as a safety net for children has been lost in the heated health policy debates of the last 2 years. The second year of the last Congress was dominated by competing proposals that would have cast aside Medicaid and assured universal coverage through comprehensive private health insurance plans. The first year of the current Congress has been spent debating legislation designed to reduce the federal government's role in the provision of health care services through constrained funding, regulatory rollback, and broadened latitude for state programs dependent on federal dollars, (eg, Medicaid).
Over the past 2 years, taking the position that the Medicaid program should be exempt from proposed changes (at least with respect to children) has not been in vogue.
Parents' Recollection of the Initial Communication of the Diagnosis of Cystic Fibrosis
Authors: Jedlicka-Köhler Ilse , Götz Manfred , Eichler Irmgard 
Published: December 2021

Background. The diagnosis of a chronic disease in children challenges parents' emotional coping abilities and cognitive capacities.
Objective. To study parents' emotional and cognitive reactions to the diagnosis of cystic fibrosis (CF) in their children.
Methods. Postal survey by means of a written questionnaire.
Participants. Forty-six parents of 29 children with a median age of 2 months at diagnosis.
Results. Most parents initially lacked knowledge of CF (76%) and were provided only oral information (96%). Parental estimates of how much of the information given they had understood and retained were 77% and 76%, respectively, with 15 parents (33%) having understood and remembered less than 50% of what the physicians had told them. The most frequent stressing feelings were fear (83%) and despair (56%). Fifty-four percent of parents had initial shocklike reactions. In this group, a significant decrease in the understanding and recall of information was noted compared with parents who had less-emotional responses.
Conclusions. Parents learning the diagnosis are, in effect, receiving a kind of lecture, which contains more information than they can possibly assimilate. Because of the incompatibility of emotional distress and optimum learning, impairment of early comprehension and retention of information about CF is unavoidable. Repeated interviews with both parents and the provision of written and audiovisual materials should be mandatory.
"DOCTORS SAY HMOs RESTRICT OPEN DISCUSSION OF PATIENT CARE AND PAYMENT POLICIES" "DOCTORS SAY HMOs LIMIT WHAT THEY CAN TELL PATIENTS"
Authors: L. J. F. 
Published: December 2021

Doctors across the country say that health maintenance organizations (HMOs) routinely limit their ability to talk freely with patients about treatment options and HMO payment policies, including financial bonuses for doctors who save money by withholding care.
In interviews over the last 3 weeks, many doctors said such restrictions interfered with their ethical and legal duty to provide patients with information about the benefits, risks, and costs of various treatments.
Ill feeling over the restrictions is growing as more and more Americans join HMOs and employers encourage their use to control costs.
The doctors' complaints illustrate the tension between them and HMOs as health plans try to monitor and regulate the doctors' behavior.
Dr Daniel A Gregorie, president of Choice Care in Cincinnati, defended the confidentiality clause as a way to prevent doctors from sharing their frustrations with patients.
"Physicians are angry, frustrated and, to some extent, depressed because the world as they've known it is changing rapidly and radically," Dr Gregorie said.
"But physicians should not take out that frustration in a nonconstructive way by sharing it with patients. That does not help the patients. It just makes them more anxious about the care they are receiving."
STUDY COMPARES DOCTORS' EFFICACY IN HEART ATTACKS
Authors: L. J. F. 
Published: December 2021

A new study raised questions about the trend of managed-care plans to rely on family doctors as the first physicians to treat heart attack victims.
Researchers at Duke University found that elderly heart attack patients who were immediately treated by a cardiologist were 15% less likely to die within a year than those who were treated by a family doctor. When general internists, who undergo more training than family doctors, were considered, the reduction in mortality for patients treated by a cardiologist was 5%.
The findings come as managed-care organizations, in an effort to control medical costs, increasingly ask primary care physicians to limit referrals to specialists and shoulder more responsibility for specialty care. In a hospital, this can influence whether a patient complaining of chest pain is seen by a generalist or admitted to a unit that specializes in coronary care.
High-dose Corticotropin (ACTH) Versus Prednisone for Infantile Spasms: A Prospective, Randomized, Blinded Study
Authors: Baram Tallie Z. , Mitchell Wendy C. , Tournay Anne , Snead O. Carter , Hanson Rebecca A. , Horton E. J. 
Published: December 2021

Objective. To compare the efficacy of corticotropin (ACTH) (150 U/m2/day) and prednisone (2 mg/kg/day), given for 2 weeks, in suppressing clinical spasms and hypsarrhythmic electroencephalogram (EEG) in infantile spasms (IS). ACTH and prednisone are standard treatments for IS. ACTH at high doses causes severe dose- and duration-dependent side effects, but may be superior to prednisone, based on retrospective or uncontrolled studies. Blinded prospective studies have shown equal efficacy of prednisone and low-dose ACTH, and low versus high-dose ACTH.
Design. A prospective, randomized, single-blinded study.
Subjects and Methods. Patient population consisted of consecutive infants fulfilling entry criteria, including the presence of clinical spasms, hypsarrhythmia (or variants) during a full sleep cycle video-EEG, and no prior steroid/ACTH treatment. Response required both cessation of spasms and elimination of hypsarrhythmia by the end of the 2-week treatment period, as determined by an investigator "blinded" to treatment. Treatment of responders was tapered off over 12 days; those failing one hormone were crossed-over to the other.
Results. Of 34 eligible infants, 29 were enrolled. Median age of patients was 6 months. Twenty-two infants were "symptomatic" with known or suspected cause, and seven were cryptogenic (two normal). Of 15 infants randomized to ACTH, 13 responded by both EEG and clinical criteria (86.6%); seizures stopped in an additional infant, but EEG remained hypsarrhythmic (considered a failure). Four of 14 patients given prednisone responded (28.6%, with complete clinical-EEG correlation), significantly less than with ACTH, (x2 test).
Conclusions. Using a prospective, randomized approach, a 2-week course of high-dose ACTH is superior to 2 weeks of prednisone for treatment of IS, as assessed by both clinical and EEG criteria.
Technical Report Abstract: The Management of Acute Gastroenteritis in Children—Technical Report for the American Academy of Pediatrics Practice Parameter
Authors: BROWN GAIL R. , MARGOLIS PETER 
Published: December 2021

This technical report describes the process followed in the development of the AAP practice parameter on acute gastroenteritis, as well as the evidence used to formulate the final recommendations.
An evidence model that defined acute gastroenteritis and identified diagnostic tests and interventions used in its management and outcomes of importance was used to identify topics to include in the guideline. The three topics selected were: (1) methods of rehydration, (2) refeeding after rehydration, and (3) the use of antidiarrheal agents. Primary outcomes of interest were duration of disease, complications of therapy, parental satisfaction, and cost.
Multiple bibliographic sources were searched to identify articles related to these areas; the sources included MEDLINE, reports on gastroenteritis from the Centers for Disease Control and Prevention and the World Health Organization, the Federal Register, a report to the Food and Drug Administration, and files of the expert panel. More than 4000 articles were initially reviewed, of which 230 were identified as being potentially related to the three topics. Qualitative aspects of the literature reviewed were summarized in evidence tables. Sufficient data for quantitative summary were available only for refeeding after rehydration. In this analysis, the weighted difference across studies between treatment and control groups in the mean duration of diarrhea was used as the measure of the relative benefit of one form of therapy over another.
Methods of Rehydration
Evidence comparing oral rehydration and intravenous therapy was limited to five reports of randomized trials conducted in developed countries. It was not possible to perform a quantitative synthesis of this information because of a lack of similar outcomes.
Letter To The Editor
Authors: Kohl Steve 
Published: December 2021

Dr May's letter raises the important question of the use of varicella vaccine in households with high-risk hosts such as neonates of varicella-susceptible mothers, varicella-susceptible pregnant women, HIV-positive individuals, or individuals receiving immunosuppressive therapy. The manufacturer warns that vaccine recipients avoid such hosts.
On the basis of low to absent levels of transmission of vaccine from healthy recipients to others, the Committee on Infectious Diseases feels this is a very unlikely occurrence. In the Weibel study, using a vaccine with ten times the current vaccine viral load, there were no symptomatic transmissions to unvaccinated siblings, and only 3/439 seroconversions attributed to vaccine transmission (although these actually may have been attributed to wild virus).1
Rapid Placement of Transpyloric Feeding Tubes: A Comparison of pH-assisted and Standard Insertion Techniques in Children
Authors: Krafte-Jacobs Brian , Persinger Melody , Carver Jeannean , Moore Lori , Brilli Richard 
Published: December 2021

Objective. To compare transpyloric feeding tube placement using a pH-assisted placement technique versus a standard placement technique in pediatric patients requiring enteral nutrition.
Methods. Critically ill children younger than 4 years were prospectively and randomly assigned to either a pH-assisted or a standard feeding tube placement group. Identical pH-assisted feeding tubes were used in both groups; however, feeding tubes in the standard group were not attached to a portable pH meter. Successful transpyloric placement was confirmed by radiography before beginning feedings. If placement was not successful, a second placement attempt was made after metoclopramide administration. Information regarding tube placement success, number of radiographs, time to initiaction of feedings, and daily caloric intake was collected. A cost comparison between the two groups was performed.
Results. Thirty-four patients were enrolled in the pH-assisted group, and 34 were enrolled in the standard feeding tube group. Ninety-seven percent of patients in the pH-assisted group had successful placement after the first attempt, compared with 53% of patients in the standard group. The average time to successful placement of pH-assisted feeding tubes was 6 minutes. All patients in the pH-assisted group had successful placement after the second attempt, compared with 78% of patients in the standard group. A pH of greater than 5.6 accurately predicted transpyloric placement in 97% (33 of 34) of individuals in the pH-assisted group. Children in the pH-assisted group required significantly fewer radiographs than those in the standard group. Hospital costs were $114 per patient in the pH-assisted group and $135 per patient in the standard group.
Conclusions. Our findings indicate that bedside transpyloric placement of pH-assisted feeding tubes can be accomplished rapidly and with a high success rate. This method is associated with decreased radiation exposure and economic savings when compared with a standard placement technique.
African-American Adolescents Residing in High-risk Urban Environments Do Use Condoms: Correlates and Predictors of Condom Use Among Adolescents in Public Housing Developments
Authors: DiClemente Ralph J. , Lodico Mark , Grinstead Olga A. , Harper Gary , Rickman Richard L. , Evans Patricia E. , Coates Thomas J. 
Published: December 2021

Objective. African-American adolescents living in high-risk inner-city environments have been disproportionately affected by the epidemics of human immunodeficiency virus (HIV) and other sexually transmitted diseases. Understanding the factors that influence the use of condoms by adolescents is critical for developing effective behavioral interventions. The present study examined the demographic, psychosocial, and behavioral correlates of condom use among African-American adolescents residing in public housing developements in an HIV epicenter (San Francisco) and prospectively evaluated the stability of these significant cross-sectional variables to predict consistent condom use.
Design. A prospective study.
Setting. Two public housing developments in San Francisco.
Participants. African-American adolescents and young adults between 12 and 21 years of age were recruited though street outreach and completed a theoretically derived research interview assessing HIV-related knowledge, attitudes, and behaviors. After a 6-month period, adolescents completed a follow-up interview similar to the baseline measure. Among adolescents reporting sexual activity in the 6 months before completing the baseline interview (n = 116), logistic regression analysis evaluated the influence of demographic, psychosocial, and behavioral factors on consistent condom use.
Results. Adolescents who had high assertive self-efficacy to demand condom use (adjusted odds ratio [OR], 11), perceived peer norms as supporting condom use (OR, 4.2), had greater impulse control (OR, 3.7), were male (OR, 4.7), and were younger (OR, 2.9) were more likely to report consistent condom use. Frequency of sexual intercourse was inversely related to condom use; adolescents with higher numbers of sexual episodes were less likely to use condoms consistently. Prospective analyses identified the baseline level of condom use as the best predictor of condom use at the 6-month followup Adolescents who were consistent condom users at baseline were 7.4 times as likely to be consistent condom users during the follow-up period. Of those adolescents changing their frequency of condom use during the follow-up interval, significantly more engaged in risky behavior; 33.3% changed from consistent to inconsistent condom use, whereas 20.6% changed from inconsistent to consistent use (OR, 1.6).
Conclusions. The findings suggest that HIV prevention programs need to be implemented early, before high-risk behaviors are established and may be more difficult to modify.
Nosocomial Infections Among Neonates in High-risk Nurseries in the United States
Authors: Gaynes Robert P. , Edwards Jonathan R. , Jarvis William R. , Culver David H. , Tolson James S. , Martone William J. ,   National Nosocomial Infections Surveillance System
Published: December 2021

Background. Nosocomial infections result in considerable morbidity and mortality among neonates in high-risk nurseries (HRNs).
Purpose. To examine the epidemiology of nosocomial infections among neonates in level III HRNs.
Methods. Data were collected from 99 hospitals with HRNs participating in the National Nosocomial Infections Surveillance system, which uses standard surveillance protocols and nosocomial infection site definitions. The data included information on maternal acquisition of and risk factors for infection, such as device exposure, birth weight category (≤1000, 1001 through 1500, 1501 through 2500, and &gt;2500 g), mortality, and the relationship of the nosocomial infection to death.
Results. From October 1986 through September 1994, these hospitals submitted data on 13 179 nosocomial infections. The bloodstream was the most frequent site of nosocomial infection in all birth weight groups. Nosocomial pneumonia was the second most common infection site, followed by the gastrointestinal and eye, ear, nose, and throat sites. The most common nosocomial pathogens among all neonates were coagulase-negative staphylococci, Staphylococcus aureus, enterococci, Enterobacter sp, and Escherichia coli. Group B streptococci were associated with 46% of bloodstream infections that were maternally acquired; coagulase-negative staphylococci were associated with 58% of bloodstream infections that were not maternally acquired, most of which (88%) were associated with umbilical or central intravenous catheters.
Conclusions. Bloodstream infections, the most frequent nosocomial infections in all birth weight groups, should be a major focus of surveillance and prevention efforts in HRNs. For bloodstream infections, stratification of surveillance data by maternal acquisition will help focus prevention efforts for group B streptococci outside the HRN. Within the nursery, bloodstream infection surveillance should focus on umbilical or central intravenous catheter use, a major risk factor for infection.
Accidental Administration of an Ergot Alkaloid to a Neonate
Authors: Baum Carl R. , Hilpert Pamela L. , Bhutani Vinod K. 
Published: December 2021

We describe a neonate with altered splanchnic arterial blood flow after accidental substitution of an ergot alkaloid, methylergonovine maleate (MEM), for vitamin K1.
CASE REPORT
A 2977-g female product of a full-term pregnancy was born in a hospital birthing suite via spontaneous vaginal delivery to a 26-year-old gravida 6, para 5 mother. Apgar scores were 9 at 1 minute (–1 for color) and 9 at 5 minutes (–1 for color). At approximately 90 minutes of age, the neonate was inadvertently administered 0.5 mL (0.1 mg) of MEM instead of phytonadione (vitamin K1) via intramuscular injection. The error was recognized during administration of a 1-mL premeasured adult dose of the ergot derivative, intended for control of postpartum uterine hemorrhage.