bluuebunny/crossref_metadata_2025_split huggingface dataset:
Alteration in the Proportion of CD4 T Lymphocytes in a Subgroup of Human Immunodeficiency Virus-Exposed-Uninfected Children
Authors: Gesner Matthew , Papaevangelou Vana , Chen Song-He , Moore Tiina , Krasinski Keith , Borkowsky William , Kim Mimi 
Published: December 2021

Objective. The age-related changes in the proportion of CD4 and CD8 lymphocytes in human immunodeficiency virus (HIV)-seronegative children born to HIV-infected mothers (seroreverters) were compared with the changes in these lymphocyte subsets in children born to seronegative women to assess a possible effect of exposure to HIV without infection.
Design. There were 146 seroreverter and 72 seronegative children. The median CD4 and CD8 percentages for each of these two groups of children were compared retrospectively at 3-month intervals from birth through 27 months and at a tenth interval for the time beyond 27 months. The weighted average of the within-subject rate of change of CD4 and CD8 percentages were also compared between the two groups. Finally, for each subject, the proportion of the subject's CD4 percentage assays which were &lt;10th percentile of the entire study population (30%) was calculated, and the distributions of the subject-specific proportions were then compared between the seronegative and seroreverter groups using the Wilcoxon rank sum test. The proportion of CD8 assays &lt;10th percentile (12%) or &gt;90th percentile (26%) were also computed for each subject, and the distributions of the proportions were compared similarily.
Results. The median CD4 percentage for seroreverter children was lower than that for the seronegative children at every interval from birth through 27 months and for the last interval for values obtained at greater than 27 months, although the comparison was statistically significant only at the 4- to 6-month period. The weighted average of the within-subject rate of change of CD4 percentage was -0.09 and -3.0 per year (P .04), and of CD8 percentage was 1.3 and 1.0 (P = .67), for the seroreverter and seronegative children, respectively. There were significantly more children in the seroreverter group than in the seronegative group who had repeated assays in which the CD4 percentage was &lt;10th percentile for age (P &lt;.00005). In addition, there was a subset of 10 seroreverter children (6.8%) who had CD4 percentages &lt;30% on &gt;50% of their assays, as compared with only one (1.4%) seronegative child. The proportion of CD8 assays &lt;10th percentile or &gt;90th percentile were not significantly different between the two groups of children.
Conclusions. The CD4 proportions were persistently lower in the seroreverter than in the seronegative population, although only reaching statistical significance in 1 of 10 3-month intervals. This finding may be due to a subgroup of seroreverter children who have persistently low CD4 lymphocyte percentages.
Evaluation of Recurrent Pediatric Syncope: Role of Tilt Table Testing
Authors: Strieper Margaret J. , Auld Debbie O. , Hulse J. Edward , Campbell Robert M. 
Published: December 2021

Objective. To determine the current practice and effectiveness of evaluating recurrent syncope in pediatric patients, and to establish the role of tilt table testing in the evaluation.
Design. Retrospective analysis of 54 pediatric patients with the history of syncope referred to cardiologists. Group I consisted of 27 patients examined without tilt table testing group II consisted of 27 patients whose examination included tilt table testing.
Results. Group I had an average of 5.4 studies and group II, 6.6 studies performed per patient. Studies included chest radiograph (16 vs 13), electrocardiogram (24 vs 27), echocardiography (21 vs 27), 24-hour electrocardiogram (14 vs 16), transtelephonic monitor (7 vs 8), electrophysiology study (1 vs 3), complete blood cell counts (11 vs 12), chemistries (10 vs 11), thyroid function test (3 vs 3), neurology consult (12 vs 6), electroencephalogram (12 vs 5), and head computed tomographic scan (5 vs 3). Of the 298 non-tilt studies, the results of only 5 (1.6%) were abnormal. Diagnoses were made in 5 (18.5%) of 27 group I patients (Wolff-Parkinson-White syndrome, 1; conversion reaction, 2; hyperventilation, 1; migraines, 1), whereas diagnosis was made in 27 (100%) of 27 group II patients (neurocardiogenic syncope, 25; conversion reaction, 2).
Conclusion. An extensive workup is not routinely indicated in syncopal patients with a history consistent with neurocardiogenic syncope. Tilt table testing performed early in the evaluation will increase the probability of a diagnosis, and will often prevent the need for further extensive, expensive anxiety-producing tests.
Risk of Injury From Baseball and Softball in Children 5 to 14 Years of Age
Authors:   Committee on Sports Medicine and Fitness
Published: December 2021

Baseball is one of the most popular sports in the United States, with estimates of 4.8 million children 5 to 14 years of age participating annually in organized and recreational baseball and softball. Interest in and fascination with the sport have grown since the beginning of the 20th century, but it was not until 1965 that the issue of "Little League elbow" raised concern about the safety of the game. Recently, highly publicized catastrophic impact injuries from contact with a ball or bat have raised new safety concerns. These injuries provided the impetus for this review of the safety of baseball for 5- to 14-year-old participants. The discussion focuses principally on baseball, but softball is considered in accord with the availability of relevant literature. This statement mainly concerns injuries during practices and games in organized settings; players and bystanders also can be injured in casual play.
The term Little League elbow was used in 1965 to denote radiologic evidence of fragmentation of the medial epicondylar apophysis and osteochondrosis of the head of the radius and capitellum.1,2 Subsequent studies of children 12 years old and younger3,4 have found a substantially lower incidence of abnormalities than originally described.1,2 Early detection and intervention seem to permit the complete resolution of symptoms and underlying structural abnormalities.5 More serious abnormalities become more common after the age of 13 years.6-8 The role that repetitive throwing in 5- to 14-year-old children may play in the evolution of elbow overuse injuries at an older age remains to be determined.
Parents' Versus Physicians' Values for Clinical Outcomes in Young Febrile Children
Authors: Kramer Michael S. , Etezadi-Amoli Jamshid , Ciampi Antonio , Tange Susan M. , Drummond Keith N. , Mills Elaine L. , Bernstein Mark L. , Leduc Denis G. 
Published: December 2021

Objective. To compare how parents and physicians value potential clinical outcomes in young children who have a fever but no focus of bacterial infection.
Methods. Cross-sectional study of 100 parents of well children aged 3 to 24 months, 61 parents of febrile children aged 3 to 24 months, and 56 attending staff physicians working in a children's hospital emergency department. A pretested visual analog scale was used to assess values on a 0-to-1 scale (where 0 is the value of the worst possible outcome, and 1 is the value for the best) for 22 scenarios, grouped in three categories according to severity. Based on the three or four common attributes comprising the scenarios in a given group, each respondent's value function was estimated statistically based on multiattribute utility theory.
Results. For outcomes in group 1 (rapidly resolving viral infection with one or more diagnostic tests), no significant group differences were observed. For outcomes in groups 2 (acute infections without long-term sequelae) and 3 (long-term sequelae of urinary tract infection or bacterial meningitis), parents of well children and parents of febrile children had values that were similar to each other but significantly lower than physicians' values for pneumonia with delayed diagnosis, false-positive diagnosis of urinary tract infection, viral meningitis, and unilateral hearing loss. For bacterial meningitis with or without delay, however, the reverse pattern was observed; physicians' values were lower than parents'. In arriving at their judgment for group 2 and 3 scenarios, parents gave significantly greater weight to attributes involving the pain and discomfort of diagnostic tests and to diagnostic error, whereas physicians gave significantly greater weight to attributes involving both short- and long-term morbidity and long-term worry and inconvenience. Parents were significantly more likely to be risk-seeking in the way they weighted the attributes comprising group 2 and 3 scenarios than physicians, ie, they were more willing to risk rare but severe morbidity to avoid the short-term adverse effects of testing.
Conclusions. Parents and physicians show fundamental value differences concerning diagnostic testing, diagnostic error, and short- and long-term morbidity; these differences have important implications for diagnostic decision making in the young febrile child.
Early Prediction of the Development of Microcephaly After Hypoxic-Ischemic Encephalopathy in the Full-Term Newborn
Authors: Cordes Isabel , Roland Elke H. , Hill Alan , Lupton Brian A. 
Published: December 2021

The development of microcephaly after significant hypoxic-ischemic cerebral injury in the full-term newborn has major prognostic significance. However, the onset of microcephaly in this context may be delayed more than 12 months.
Objectives. To determine whether serial head circumference measurements and decreased rate of head growth in asphyxiated full-term newborns during the first few months of life may predict the development of eventual microcephaly.
Methodology. Serial head circumference measurements at 4, 8, and 18 months of age were obtained in 54 full-term newborns who had acute, hypoxic-ischemic encephalopathy. The rate of head growth was determined on the basis of changes in head circumference ratios which are calculated as follows: actual head circumference/mean head circumference for age x 100%. Head circumference ratios were correlated with severity of newborn encephalopathy and outcome at 18 months.
Results. A decrease in head circumference ratios of &gt;3.1% between birth and 4 months of age was highly predictive of the eventual development of microcephaly before 18 months (sensitivity 90%, specificity 85%).
Conclusions. These data demonstrate that serial head circumference measurements during the first 4 months of life and calculation of decreased rate of head growth in full-term newborns with hypoxic-ischemic encephalopathy may predict microcephaly before its actual occurrence.
Treatment of Acute Childhood Diarrhea With Homeopathic Medicine: A Randomized Clinical Trial in Nicaragua
Authors: Jacobs Jennifer , Gloyd Stephen S. , Gale James L. , Jiménez L. Margarita , Crothers Dean 
Published: December 2021

Objective. Acute diarrhea is the leading cause of pediatric morbidity and mortality worldwide. Oral rehydration treatment can prevent death from dehydration, but does not reduce the duration of individual episodes. Homeopathic treatment for acute diarrhea is used in many parts of the world. This study was performed to determine whether homeopathy is useful in the treatment of acute childhood diarrhea.
Methodology. A randomized double-blind clinical trial comparing homeopathic medicine with placebo in the treatment of acute childhood diarrhea was conducted in León, Nicaragua, in July 1991. Eighty-one children aged 6 months to 5 years of age were included in the study. An individualized homeopathic medicine was prescribed for each child and daily follow-up was performed for 5 days. Standard treatment with oral rehydration treatment was also given.
Results. The treatment group had a statistically significant (P &lt; .05) decrease in duration of diarrhea, defined as the number of days until there were less than three unformed stools daily for 2 consecutive days. There was also a significant difference (P &lt; .05) in the number of stools per day between the two groups after 72 hours of treatment.
Conclusions. The statistically significant decrease in the duration of diarrhea in the treatment group suggests that homeopathic treatment might be useful in acute childhood diarrhea. Further study of this treatment deserves consideration.
Extracorporeal Membrane Oxygenation for Refractory Septic Shock in Children
Authors: Beca John , Butt Warwick 
Published: December 2021

Objective. To review demographic data and outcome of children who received extracorporeal membrane oxygenation (ECMO) for refractory septic shock.
Method. Review of medical charts of nine children receiving ECMO for culture-proven refractory septic shock treated in a multidisciplinary pediatric intensive care unit.
Results. Median age was 12 years and median weight was 45 kg. Median inotrope requirements (µg/kg per minute) before ECMO were dopamine, 15; dobutamine, 12.5; epinephrine, 4; and norepinephrine, 3.5. Four children received two inotropes concurrently, and five received three or more. All nine patients had severe respiratory failure; eight had evidence of other organ system dysfunction, with six having five or more organ system dysfunctions. Median PRISM score was 27. Median duration of ECMO was 137 hours. Within 24 hours of starting ECMO, 7 of 9 children had all inotropes stopped. Four patients died and five survived, all of whom are leading normal lives.
Conclusion. In this small group of children with probably fatal septic shock, ECMO was successfully supported the circulation and 5 of the 9 children survived. We suggest that septic shock should not be considered a contra-indication to ECMO.
Noninvasive Monitoring of Oxygenation in Infants and Children: Practical Considerations and Areas of Concern
Authors: Poets Christian F. , Southall David P. 
Published: December 2021

Objective. To review the technical principles of transcutaneous Po2 (tcPo2) monitors and pulse oximeters and to discuss methodological and practical issues related to the use of these devices in infants and children.
Design. Literature review and summary of personal experience.
Results. tcPo2 measurements are influenced by skin thickness, sensor temperature, amount of contact gel used, and state of peripheral perfusion. The average in vivo response time to a rapid decrease in Pao2 is approximately 16 seconds. Sensitivity to both hypoxemia (Pao2 &lt; 50 mm Hg) and hyperoxemia (Pao2 &gt; 80 to 100 mm Hg) is approximately 85%. Pulse oximeters require careful sensor placement (to avoid optical shunts) and adequate pulse pressures (&gt; 20 mm Hg). They are prone to movement artifact. There are considerable differences in bias and precision between different brands, resulting, for example, in quite different upper alarm limits required to detect hyperoxemia reliably. The normal range of oxygen saturation measured by pulse oximetry, measured with one brand of pulse oximeter (Nellcor) during regular breathing, is 95% to 100% in preterm infants and 97% to 100% in full-term infants and children.
Conclusions. Because both devices have their specific shortfalls, they should ideally be used in combination, particularly in critically ill preterm neonates. Where this is not feasible or necessary, clinicians must be aware of the limitations of the device they are using.
REPORT CARDS: SOME SAY THERE MUST BE A BETTER WAY
Authors: L. J. F. 
Published: December 2021

Despite decades of improvements in education, report cards have hardly changed; educators see them as necessary evils that add little to a student's education but fear. Increasingly, though, some schools are trying new ways of communicating with parents that can reduce violence at home and actually enhance learning.
In Attleboro, report cards now include a warning to parents not to let their frustration over grades turn into violence. In Baltimore, middle-school students earn "improvement points" and compete against themselves, not their peers.
Setting Their Own Goals
A school in Manhattan, Kan., has replaced report cards with triangular parent-student-teacher conferences in which the children set their own educational goals and then assess how well they have done ...
While scattered schools around the country are experimenting with alternatives to the report card—portfolios of work, evaluations by the teacher or parent conferences—report cards remain the most important communication between school and home in a vast majority of schools ...
The biggest problems arise when parents overreact. Child advocates in several cities say that when report cards are issued, reports of child abuse go way up. The National Committee for Prevention of Child Abuse, a group in Chicago, has a national awareness campaign, with advertisements that read, "Stop the Report Card Reflex."
Summary of the Urologic Section
Authors: Kaplan William E. 
Published: December 2021

A meeting of the Section on Urology of the American Academy of Pediatrics was held in conjunction with the annual meeting of the American Academy of Pediatrics in Washington, DC, October 30 through November 1, 1993. This meeting continues to be the most significant scientific program for pediatric urology. Two hundred ninety-three abstracts were submitted worldwide, and the competition was fierce for the 91 accepted podium and poster presentations. Chairperson, Casimir F. Firlit, MD, PhD, of North-western University Medical School and Children's Memorial Hospital in Chicago, IL, presided over the meeting. The papers that were presented at this meeting and that are of interest to the practicing pediatrician are summarized in this article according to topic.
URETEROPELVIC JUNCTION OBSTRUCTION
This group of papers investigated both clinical management of ureteropelvic junction obstruction as well as some basic research concerns, all to determine what is the best method of management for newborns and young children with ureteropelvic junction obstruction. Early diagnosis by prenatal ultrasonography has only complicated decision-making processes relative to appropriate therapy. The combination of research protocols to evaluate the effects of obstruction as well as appropriate methods of management were presented.
Thomas et al, from Leeds, determined that the renal pelvic diameter measured on a 16- to 24-week fetus could help to determine ultimate renal function. If the in utero ultrasonograph revealed a renal pelvic diameter of &gt;15 mm, impaired renal function was the determination. However, those kidneys that had a renal pelvic diameter &lt;5 mm would have normal renal function even though hydronephrosis would be present at the time of birth.
Letter to the Editor
Authors: Marks Melvin I. , Hall Caroline B. 
Published: December 2021

Dr Zucker's letter describes concern about the American Academy of Pediatrics (AAP) Committee on Infectious Diseases statement on the use of ribavirin for the treatment of respiratory syncytial virus (RSV) infections (Pediatrics 1993;92:501-504).
The Committee developed its recommendations on the basis of the available placebo-controlled prospective double-blind studies. Although these studies contained relatively small numbers of patients, they were controlled and prospective, and all showed a favorable response. The variable course of RSV illnesses and the relatively low mortality rates make clinically meaningful end-points difficult to define and quantitate.
The Application of Health and Safety Guidelines to Out-of-Home Child Care Programs
Authors:   Committee on Early Childhood, Adoption, and Dependent Care
Published: December 2021

In the United States, the structure, espoused purpose, and quality of child care vary widely. Community programs that provide out-of-home care for infants and preschool children have evolved either with no community regulation or with a variety of different institutional or governmental supports and regulations.1 In general, infant and preschool programs are designed either to provide substitute care when parents work and/or to promote socialization and early education. Frequently, these programs serve children only for a portion of the day and for part of the week and year. Programs that primarily provide substitute care are usually called "day care." Included in this grouping are "family day care" and "large family day care," programs in which children are cared for in someone's home, and "center day care," programs in which children receive care in settings specifically intended for that purpose. The labels traditionally applied to early education programs are "nursery school" or "preschool." These labels are not necessarily mutually exclusive.
The American Academy of Pediatrics believes that education, in the broad sense, and the care of infant and preschool children are inseparable.1 In fact, the new terminology applied to these services for young children is "early childhood education/care programs." Young children are constantly learning while they play and while they engage in everyday activities.2,3 Also, young children in educational settings require "care" in the sense of needing to be comforted and to be instructed in the development of health behaviors such as hand washing and controlling their own excretions. In all settings, the safety of children should be assured.
Family-Centered Care
Authors: Cunningham Robert D. 
Published: December 2021

I read "The Principles for Family-Centered Neonatal Care" with great interest. As a physician who has worked in a state government-operated neonatal intensive care unit follow-up clinic, I agree wholeheartedly with the principle of open and honest communication between parents and professionals, especially regarding poor developmental outcomes. Unfortunately, physicians, despite their own feelings about this issue, may come under pressure from third parties to withhold certain information from families.
In my own experiences, I have been drawn aside in private conversations and told that if I continue to tell parents that their child is mentally retarded or has cerebral palsy, it might have an adverse impact on my career.
Does Carnitine Administration Improve the Symptoms Attributed to Anticonvulsant Medications?: A Double-Blinded, Crossover Study
Authors: Freeman John M. , Vining Eileen P. G. , Cost Scott , Singhi Pratibha 
Published: December 2021

Objective. This study was designed to assess the reported improvement in "well-being" perceived by parents when children who are taking anticonvulsant medications are administered carnitine.
Methodology. Forty-seven children with seizures who were taking either valproic acid or carbamazepine were enrolled in a placebo-controlled, double-blinded, crossover study of the effects of oral carnitine administration (100 mg/kilo) on their well-being as perceived by their parents. The well-being scores were assessed weekly by phone and in person at the start and end of each 4-week phase.
Results. The children's well-being scores improved weekly when either placebo or carnitine were administered. None of the analyses of improved well-being achieved statistical significance.
Conclusion. We believe this study documents the necessity for controlled trials when assessing the subjective, beneficial effects of medications. Carnitine is expensive, costing approximately $.30/kilogram of body weight per day ($6 per day for a 20 kilo child). It would not appear warranted to administer carnitine prophylactically to children on anticonvulsant medications for alleviating common, nonspecific symptoms. Because there are no reliable clinical or laboratory tests of symptomatic carnitine deficiency caused by anticonvulsant administration, how to identify children in need of carnitine, and when to administer carnitine therapeutically to children receiving valproate or other anticonvulsants is unclear.