bluuebunny/crossref_metadata_2025_split huggingface dataset:
Renal and Absorptive Hypercalciuria: A Metabolic Disturbance With Varying and Interchanging Modes of Expression
Authors: Aladjem Mordechay , Barr Joseph , Lahat Eliezer , Bistritzer Tzvy 
Published: December 2021

Background. In previous studies, the oral calcium loading and deprivation test has been used to distinguish between children with renal (fasting) hypercalciuria (RH) and absorptive hypercalciuria (AH).
Objective. We evaluated the long-term clinical course of 30 children with idiopathic hypercalciuria and investigated the influence of urinary sodium excretion, as a reflection of its intake, on urinary calcium excretion.
Methods. Thirty normocalcemic, normophosphatemic children (21 boys and 9 girls) with urinary calcium to creatinine ratios greater than 0.57 mmol/L/ mmol/L (&gt; 0.21 mg/dL/mg/dL) on three consecutive examinations participated in this study. They were divided according to their responses to calcium deprivation and loading into AH (16 patients) and RH (14 patients).
Results. When restudied 3 to 7 years later, 6 of the 16 children with AH were normocalciuric and three demonstrated characteristics compatible with RH. The remaining seven patients maintained their initial AH pattern. Of the 14 children with RH, four were normocalciuric and four demonstrated AH. The remaining six children maintained their initial RH pattern. A significant positive correlation was observed between urine sodium and calcium excretion in children with AH or RH. Children who were normocalciuric at the second study had significantly lower values of urine sodium excretion when compared with those in whom hypercalciuria persisted.
Conclusions. We suggest that AH and RH constitute a continuum. The change in characteristics observed during the second study suggests that any attempt to divide these patients into two physiologically distinct subtypes may be artificial. The main factor influencing urinary excretion of calcium in our patients seemed to be sodium intake.
Carbohydrate and Alcohol Content of 200 Oral Liquid Medications for Use in Patients Receiving Ketogenic Diets
Authors: Feldstein Thomas J. 
Published: December 2021

Objective. The ketogenic diet is used in patients with intractable seizure disorders. To maintain a ketotic state, patients on this diet must maintain a strict low-carbohydrate intake. Because these patients often require medication, and because many pharmaceutical products (especially liquid formulations) contain significant quantities of carbohydrates, it is important that each drug product be evaluated before proceeding with the ketogenic diet. The purpose of this study was to compile the carbohydrate content of oral liquid products for patients on or considering a ketogenic diet.
Methods. A list of 200 oral liquid drug products and their manufacturers was compiled using the Children's Health Care-Minneapolis pharmacy purchasing database, the Physicians' Desk Reference, and previously published lists of oral liquid medications. Manufacturers were contacted either by telephone or by letter and asked specifically about the sucrose, fructose, sorbitol, glycerin, and alcohol content of these liquid formulations.
Results. The carbohydrate and alcohol content of 200 oral liquid products was determined and shown in an accompanying table.
Conclusions. Many oral liquid medications contain significant amounts of carbohydrate. Tablet and capsule formulations are preferred when possible. To date, it has been difficult to quantify the carbohydrate content of liquid medications because of unavailability of this information. The carbohydrate content of 200 oral liquid medications is provided here to assist health care practitioners, patients, and care givers in designing drug regimens low in carbohydrates for patients on or considering a ketogenic diet.
Prenatal Cocaine and Neonatal Outcome: Evaluation of Dose-Response Relationship
Authors: Delaney-Black Virginia , Covington Chandice , Ostrea Enrique , Romero Al , Baker Dawn , Tagle Maria-Theresa , Nordstrom-Klee Beth , Silvestre Maria A. , Lu Angelilli Mary , Hack Cheryl , Long Jacqueline 
Published: December 2021

Objective. The aim of this study was to evaluate the hypothesis that prenatal cocaine exposure would negatively affect newborn behavior.
Methods. A prospective observational study of term infants recruited from the low-risk nursery used a structured, standardized interview to obtain maternal data. Cocaine exposure was determined by radioimmunoassay of the infant's meconium stool. An examiner blinded to the infant's cocaine status administered the Brazelton Neonatal Behavioral Assessment Scales.
Results. The sample was composed of 23 exposed and 29 nonexposed infants. On six of the seven Brazelton Neonatal Behavioral Assessment Scale clusters, cocaine-exposed infants performed less well than control infants, with significant differences observed for autonomic stability. In addition, a dose-response relationship was suggested. Significant negative, within-group relationships were evident in the exposed group, indicating poorer performance with increasing meconium cocaine concentration for orientation (r = -.40) and regulation of state (r = -.40). Regression model testing of the influence of meconium cocaine concentration on neurobehavioral outcomes, after controlling for significant confounders, identified a significant independent, negative effect of meconium cocaine concentration on two clusters—motor and regulation of state.
Conclusion. In otherwise healthy full-term infants, prenatal cocaine exposure identified by quantitative analysis of cocaine concentration in meconium had a significant, independent negative association with motor and regulation of state that remained after controlling for other significant confounders. A dose-response relationship was evident.
Pediatric Education in Community Settings: Where Do We Go From Here?
Authors: Charney Evan 
Published: December 2021

Pediatric education in community settings is an idea whose time has come. The board of the Johnson & Johnson Pediatric Institute recognized this reality, and they deserve great credit for bringing together this impressive group of people for what I believe to be a watershed event. The conference includes, for the first time in my experience, participants from community practice and academic societies such as the Ambulatory Pediatric Association (APA), the American Board of Pediatrics, the Association of Pediatric Program Directors (APPD), and the American Academy of Pediatrics (AAP), including members of its resident section. At least half of residency program directors are here, as are many chairs of pediatric departments in university and community hospitals. Representatives of funding agencies—the Maternal and Child Health Bureau and the Health Resources and Services Administration—are here as well; one of our speakers heads the Center for the Future of Children of the David and Lucile Packard Foundation.
This conference is a pivotal event in medical education. Like those who remember another pivotal event, Woodstock '69, we will look back with nostalgia and pride and say that we were here.
I consider a meeting successful if I leave with one good new idea. At this conference, we have heard many creative and provocative ideas about community-based education, and we will be thinking about them on our way home and during the next several months. One of my favorite quotations, however, is from Alfred North Whitehead: "Ideas won't keep. Something must be done about them.
Editorial One Year's Experience
Authors: H. R. J. 
Published: December 2021

This is the last issue of the 1979-1980 PEDIATRICS IN REVIEW. The reason we schedule only ten issues per year (July through April) is to allow two full months from receipt of the April issue until the June Self-Administered Graded Examination (SAGE), or the recertification examination.
What have we learned in this first year? By and large the comments have been very positive. Most readers like the mixture of review articles and abstracts. Some want only new material, some only "cold dope," and others controversies. I believe that by providing a mixture in each issue we can meet more of these individual preferences.
Children and Funerals
Authors: Schowalter John E. 
Published: December 2021

Death is the most inevitable and irrevocable problem that we face as physicians and human beings. Although many people seldom think about death, when the death of a close friend or relative does occur, everyone is confronted with a feeling of loss and reminder of his or her own mortality. The emotional reaction triggered by such a loss is called mourning. While in decades past it was debated whether or not children mourned, the consensus now is that they do, but not as completely or satisfactorily as adults. The manner in which children mourn is based on their level of development and on the emotional climate provided them.
Almost without exception in our society, when a person dies, there is a funeral. More often than not parents do not know whether children should attend funerals. Because of this, they often ask pediatricians, but there is little published data that can be used as a guide for an intelligent response. The purpose of this review is to provide practical guidelines and suggestions that can be discussed with parents when this question arises.
FUNERALS IN GENERAL
The funeral is the most ancient rite known. Much of what we know about prehistoric cultures comes from burial customs that favored including everyday objects with the corpse.
Editorial PIR and CME
Authors: H. R. J. 
Published: December 2021

In using initials as the title of this editorial, I am not resorting to bureaucratic gobbledygook, but to shorthand. PIR is the name of this journal; CME, as everyone concerned with credits for relicensing knows, is Continuing Medical Education. We hope that readers will be familiar with each.
CME is not new. In 1907, the AMA called on county medical societies to provide systematic review of medical school curriculum to be able, then, to acquaint practitioners with recent advances as being taught in medical schools. Today, the CME effort is much more extensive. But the principle of local implementation of national educational developments seems especially appropriate for the Academy's CME program, and especially for PIR.
Birthmarks: II. Melanocytic and Epidermal Nevi
Authors: Jacobs Alvin H. 
Published: December 2021

—Acquired moles—very rare malignancy during childhood
—Congenital moles—10% chance of malignancy
—Café-au-lait spots—associated with neurofibromatosis, Albright's syndrome, tuberous sclerosis, pulmonary hypertension, and temporal lobe dysrhythmias
Neural Tube Defects
Authors: Golden Gerald S. 
Published: December 2021

The term "neural tube defects" refers to a biologically interrelated series of malformations of the central nervous system and overlying tissues. There is an abnormality in morphogenesis of the brain and/or spinal cord, associated with varying degrees of absence or malformation of the meninges, bone, muscle, and skin. In addition to morphologic similarities, these lesions are related epidemiologically and probably genetically.
The terminology is complex, but the lesions can be placed in a simple framework. The Table outlines the most common defects.
The malformation occurs early in embryonic development, since the gross structure of the central nervous system has been completed by the 26th gestational day. There are numerous theories of pathogenesis and there is a good deal of subprimate teratologic research, but no single etiologic hypothesis is widely accepted or rigorously proven. Despite this, clinical risk factors have been clearly defined and empiric techniques for prenatal diagnosis have been developed.
FREQUENCY AND EPIDEMIOLOGY
Neural tube defects represent one of the most common groups of major congenital malformations. Each year approximately 6,000 to 8,000 infants are born with these conditions in the United States. Incidence rates vary among different groups from 0.6 to 4.1/1,000 total births for anencephaly. The risk is not uniformly spread over the entire population; a number of factors are related to initial occurrence and recurrence.
Food Fads: Safe Feeding of Children
Authors: Forbes Gilbert B. 
Published: December 2021

... in some important aspects, our rational scientific approach fails to fulfill the desperate needs of suffering people, and it is to these needs that quacks and cultists address themselves.
Strong emotions have a profound effect fect on one's well-being ... if they are aroused in a setting of massive human and supernatural encouragement, and in a context of hopefulness, they can be healing ....A cult gains its power from its culturally determined symbolic meaning.1
When it comes to food, variety is literally the spice of life. It is the large variety of foods available, taken together with our efficient transportation and storage facilities, and food fortification techniques that render the average American diet so nutritious. Young infants will thrive if they are provided with sufficient milk, and dietary deficiencies are rare in children whose diets include the "basic four" food groups: (1) meat, fish, poultry, and eggs; (2) milk, cheese, and milk products; (3) fruits and vegetables; (4) cereal grains, potatoes, and rice.
Dietary surveys have shown that the vast majority of Americans have a varied diet and are free of overt nutritional deficiencies, with the possible exception of iron deficiency anemia. Americans consume large quantities of meat, milk, and eggs.
Set in the midst of this sea of abundance are growing numbers of citizens who have chosen to deviate from modern dietary norms by adopting so-called "fad diets."
Day Care
Authors: Loda Frank A. 
Published: December 2021

The fundamental and noncontroversial fact about day care is that increasing numbers of children will be in some form of day care during the next decade as their mothers join the work force. Only a major unforeseen economic or social upheaval will prevent this trend from continuing. More than 37% of women who have children under the age of 6 years—more than 5 million—now work. One third of mothers of children under 2 years of age are in the work force.
REASONS WOMEN WORK
Most women work because of economic need.1 For some women, such as those in single parent families, economic need means providing the basic necessities. For other women, the economic need is to maintain a middle class living standard or to finance educational programs for their children. Other considerations are important. Many women feel the need to escape the constant responsibility of child care. Many find the work-related social contacts and achievements fulfilling. The latter are particularly important to middle and upper class women who possess the job skills appropriate to achievement of professional or managerial status. Most women who lack specific job skills are limited to low-paying and low-status positions. Women also join the work force because of the growing belief in our society that homemaking and child care are not a worthwhile, full-time task.
Eating Disorders in Adolescents
Authors: Comerci George D. 
Published: December 2021

Anorexia nervosa and bulimia nervosa must be understood and appreciated to be chronic disorders. Too often pediatricians and other health care providers expect that the patient with an eating disorder will be quickly cured. We anticipate and readily accept patient relapses in other chronic conditions such as diabetes, cystic fibrosis, or rheumatoid arthritis, but we do not expect, nor do we tolerate, relapses in patients with eating disorders! Rather, we perceive the relapse as a treatment failure, often blaming ourselves and our lack of knowledge and skills, our treatment team, and, of course, the patient and his or her family.
During medical school and residency training there are few good role models for the care of chronically ill patients. We have not learned to enjoy caring for people who do not rapidly improve and recover, especially when the illness is their "personal choice." Little wonder that so many pediatricians reject the responsibility to care for patients with an eating disorder and elect to refer them to others.
Foreign Body Aspiration: Potential Cause of Coughing and Wheezing
Authors: Holroyd H. James 
Published: December 2021

As many as half of routine ill-patient visits in pediatrics practice involve respiratory symptoms. It is not surprising that we see so much coughing and wheezing when we consider that children are still developing immunologically and are, therefore, more susceptible to infection. In early life, most of these infectious diseases occur in the respiratory and gastrointestinal tracts. In addition, the gradual exposure of the constitutionally allergic child to environmental allergens pre-disposes to the development of respiratory symptoms. Childhood is also a time for congenital defects of the cardiopulmonary system to become apparent.
A sometimes overlooked cause of respiratory symptoms in infants and young children—and one that can become rapidly and severely complicated if misdiagnosed—is the aspiration of foreign bodies. Aspiration or ingestion of foreign bodies remains a significant cause of morbidity and mortality in the pediatric population. Children between 8 months and 4 years of age are at highest risk. Not all cases of aspiration are of the acute, obstructive variety, and pediatricians should consider a foreign body as a possible cause of coughing and wheezing even when no definite history of aspiration is obtained.
Children of course are curious and their natural tendency is to reach out and explore new objects. Bringing objects to their mouths to taste and to test textures is common.
Stimulation of Preterm Infants
Authors: Field Tiffany 
Published: December 2021

Preterm neonates are deprived of their final weeks in utero and may also be deprived of appropriate extrauterine stimulation. The environment of the incubator features bright light and continuous noise, and the neonates are handled infrequently and only briefly. Although the effects of this environment are virtually unknown, some have suggested that the neonatal intensive care nursery may constitute a source of sensory deprivation. Others have suggested that preterm neonates may be overstimulated or, at the very least, may experience inappropriate patterns, rather than inadequate amounts, of stimulation. Despite the limited data regarding the effects of routine stimulation in the intensive care nursery environment, a number of clinicians and researchers have provided stimulation experiences for preterm neonates and have investigated the effects of these.
STIMULATION STUDIES
The types of interventions provided for preterm neonates have included those that are thought to mimic the environment of the womb or the outside world. Some have viewed the preterm neonate as an extrauterine fetus, whereas others consider that the preterm neonate differs from the fetus insofar as sensory systems undergo physiologic changes at birth. Different forms of stimulation may be necessary for extrauterine development than for intrauterine maturation regardless of gestational age.
Stimulation is usually begun as soon as possible after birth and continues until the infant approximates term gestational age, regains birth weight, or is discharged.
Cystitis and Urethritis
Authors: Parrott Thomas S. 
Published: December 2021

CLASSIFICATION
Although the terms cystitis, urethritis, and pyelonephritis are useful to the clinician for describing different clinically encountered varieties of urinary tract infection, one must not be limited only to site of localization when classifying urinary infections. Two other helpful schemes of classification (Table 1) have evolved based on pathogenesis1 and management.2
FREQUENCY OF OCCURRENCE
Children and adolescents with cystitis or urethritis have urinary symptoms suggestive of urinary tract infection. In fact, not all symptomatic patients have true bacteriuria. Of all patients less than 15 years of age with urinary symptoms, only 9% were bacteriuric, and only 18% with dysuria had positive cultures for a pathogen.3 The incidence of true urinary tract infection from these data is 1.7 per 1,000 boys and 3.1 per 1,000 girls per year. The incidence of apparent first symptomatic urinary tract infection declines with increasing age, the decline being more rapid in boys (Figure).
Patients with nonsymptomatic infections often feel more comfortable after treatment or more commonly may report loss of characteristic odor after appropriate therapy has been initiated for the positive culture results obtained for surveillance purposes. Data from large screening surveys of so-called healthy populations demonstrate a prevalence of unrecognized bacteriuria in 0.5% to 1.6% of school-aged girls.
Undescended Testis and Orchiopexy: Recent Observations
Authors: Hawtrey Charles E. 
Published: December 2021

Within the past two decades, observations from a number of sources have expanded our understanding of undescended testes in children. As neonatology has grown, the observations of infants with low birth weight and knowledge of the implications of this condition for undescended testes have also increased. Information obtained from biopsy, including that from studies using electron microscopy, has suggested decreased spermatogonia in children with abdominal testes with age, indicating a need for medical or surgical intervention soon after 1 year of age. The effects of orchiopexy and hormonal manipulations to assure fertility in adulthood have been clarified to the extent that an algorithm for patient management can be constructed.
ANATOMY
An undescended testis has been identified in 0.8% of male infants at 1 year of age1 and in about 0.2% of adult male military recruits. The incidence rises to 21% in premature neonates weighing less than 2,500 g. Even more striking, nearly 100% of profoundly low-birth-weight neonates (weighing approximately 900 g) exhibit bilateral undescended testes. With weight gain and age, the testes of infants who weighed 900 g at birth proceed toward descent and at 1 year of age have the same incidence as their peers.
Many authors in Europe and the United States have noted that scrotal descent of the testis by 3 years of age preserves spermatogonia, implying a beneficial effect on adult fertility.
Cures in Childhood Cancer
Authors: Chauvenet Allen R. , Wofford Marcia M. 
Published: December 2021

Dramatic advances have been made in the treatment and potential cure of childhood cancer in the past two decades. In the case of the most common childhood malignancy, acute lymphoblastic leukemia, Mauer wrote in 1969 that he did "not think that the attempt to encourage parents by discussion of the possibility of a cure being found is any real help to the parents in facing the inevitable consequences of this disease." By 1973, Pochedley, while noting that the great majority of patients would die from disease, commented that "remissions can last five or more years and in a few patients they seem to be permanent." In 1989, Poplack stated that "about 60% of children with this disease achieve prolonged disease-free survival (over 5 years from diagnosis) and most of these patients are considered to be cured."
In this review, data are presented in support of the conclusion that cures can be found for oven half of the children in this country in whom the diagnosis of cancer is made. The focus is not on clinical presentations but on staging systems, treatment principles, and outcomes for the most common pediatric malignancies.
DATA ANALYSIS AND POTENTIAL BIAS IN DATA
In the United States, the great majority of children with cancer are treated by pediatric hematologists/oncologists who are members of a cooperative study group (the Pediatric Oncology Group and the Children's Cancer Study Group); major reports of treatment results are based on data concerning children participating in groupwide, multi-institution studies, in single large institutions (usually with affiliates), or in intergroup studies.