bluuebunny/crossref_metadata_2025_split huggingface dataset:
Increased Plasma Levels of Pancreatic Polypeptide and Decreased Plasma Levels of Motilin in Encopretic Children
Authors: Stern H. Patrick , Stroh Suzanne E. , Fiedorek Stephen C. , Kelleher Kelly , Mellon Michael W. , Pope Sandra K. , Rayford Phillip L. 
Published: December 2021

Objective. Abnormalities of hormones affecting gastrointestinal motility have been found in "functional" disorders of the gastrointestinal system in adults. One such disorder of childhood, encopresis, is frequently associated with constipation, the treatment of which often eliminates the soiling. We hypothesized that hormones affecting gastrointestinal motility were different between encopretic patients and matched controls.
Methods. Ten encopretic patients were matched by age, race, and sex with controls who had no history of encopresis or constipation. After an overnight fast, each child consumed a meal of Ensure, the amount of which was based on body weight. Plasma levels of gastrin, pancreatic polypeptide, cholecystokinin, motilin, thyroxine, estrogen, and insulin were measured 20 and 5 minutes before the meal, and 5, 10, 15, 30, 45, 60, 90, 120, 150, and 180 minutes after the meal.
Results. Postprandial levels of pancreatic polypeptide remained consistently higher and peaked earlier (P &lt; .05) for encopretic patients. The motilin response was lower (P &lt; .03) for encopretic children than for controls.
Conclusions. We conclude that pancreatic polypeptide and motilin responses to a meal are different in encopretic children than in children in the control group. These gastrointestinal hormone findings may in part explain and/or be the result of the severe constipation that frequently underlies the fecal soiling found in these patients. These findings also suggest the motility of the stomach and small intestine may be abnormal in encopresis.
COMPARISON OF INTRAMUSCULAR AND INTRAVENOUS QUININE FOR THE TREATMENT OF SEVERE AND COMPLICATED MALARIA IN CHILDREN
Authors: Schapira A , Solomon T , Julien M 
Published: December 2021

Intravenous (IV) quinine is the standard treatment for severe malaria where chloroquine resistant Plasmodium falciparum is found. Because of the advantages of intramuscular (IM) administration, a study was performed to compare these methods of administration in children with severe and complicated malaria. The study population was children from 6 months to 7 years of age, all of whom had asexual Plasmodium falciparum in the blood smear and at least one of the following: rigorously defined cerebral malaria; probable cerebral malaria; hyperparasitemia; or severe malaria. Exclusions included those who had: received quinine within a week; received an excessive dose of chloroquine within 48 hours; a history of quinine intolerance; or signs of circulatory shock or hemorrhagic diathesis.
Patients were randomly allocated to one of two treatment groups: 1) quinine dihydrochloride administered intravenously with an initial loading dose of 20 mg/kg in 5% glucose, 20 mL/kg over 4 hours, followed by 10 mg/kg in 5% glucose, 10 mL/kg intravenously over 2 hours every 8 hours; 2) quinine dihydrochloride 10 mg/kg by deep IM injection at alternating sites every 8 hours. A loading dose was applied by repetition of the initial dose after 2 hours. Treatment was changed to oral medication 10 mg/kg every 8 hours when they were well enough to do so.
There were 47 patients in the IV group and 57 in the IM group. The two groups were comparable in all aspects including malnutrition, anemia, and splenomegaly. Seventeen percent (17%) of the IV group died and 7% of the IM group died. The mean parasite clearance, fever clearance, and coma clearance times were similar in both groups. There were two sterile abscesses in the IM group.
The authors conclude that IM quinine is as effective as IV in children with severe and complicated malaria.
Ribavirin Therapy: Implementation of Hospital Guidelines and Effect on Usage and Cost of Therapy
Authors: Feldstein Thomas J. , Swegarden Jon L. , Atwood Gerald F. , Peterson Charles D. 
Published: December 2021

Objective. The American Academy of Pediatrics (AAP) recommends that ribavirin be reserved for infants who are severely ill and who are at high risk of morbidity and mortality, based on underlying clinical conditions. The purpose of this study was to evaluate current ribavirin use in our institution, implement hospital-specific guidelines for use, develop a prospective surveillance system to monitor ribavirin therapy, and evaluate the impact of these guidelines on subsequent use and cost of therapy.
Methods. Ribavirin use was compared with the recommendations of the AAP. Results were presented to the professional staff, and hospital guidelines were implemented. Ribavirin therapy was reevaluated in a 2-year period after hospital guidelines were implemented.
Results. In the initial evaluation period, only 67% of the ribavirin recipients met the AAP guidelines for use, and 19% received an inappropriate treatment regimen. The total cost and billed patient charges for ribavirin recipients who did not meet the guidelines for use in period 1 was $60 638 and $127 940, respectively. Over the next 2 years (period 2) after the implementation of hospital guidelines, the percentage of patients who received ribavirin decreased 35%, and approximately 96% of ribavirin recipients met the established criteria. Based on the decrease in the percentage of patients who received ribavirin in period 2 (41% versus 63%), the estimated cost avoidance and reduction in billed patient charges in period 2 was $55 540 and $117 334, respectively. This represents an estimated reduction in hospital costs and billed patient charges of $46 283 and $97 778 per 100 admissions for acute bronchiolitis.
Conclusions. Before the implementation of hospital guidelines for use, a substantial percent of patients received ribavirin not consistent with the recommendations of the AAP. Following the adoption of a modified version of the AAP guidelines for our institution and the use of a multidisciplinary surveillance system for monitoring ribavirin therapy, we observed a substantial decrease in the overall ribavirin use. This has resulted in a significant savings in terms of cost avoidance and reduced billed patient charges.
Letters to the Editor
Authors: Little George A. , Brooks John G. 
Published: December 2021

We thank Drs DiMaio and Southall for drawing our attention to their publications; they and their associates obviously accept the unthinkable.1 We are quite sure that not everyone does as readily; murder is not a nice thought.
Dr DiMaio's letter2 was followed with a reply by Dr Kelly.3 Both refer to the 1978 paper by Steinschneider,4 but with different emphasis. The first, speaking from the perspective of a forensic pathologist, concluded that infanticide was the most likely cause of death.
Selection Bias in Case-Control Studies of Severe Varicella Infection
Authors: Weiss Noel S. 
Published: December 2021

Two features of the case-control study by Dowell and Bresee1 on severe varicella as a possible adverse consequence of using corticosteroids limit the inferences that can be drawn from the results:
1. The investigators identified only 19 children with severe varicella who did not have leukemia or a history of renal transplantation, conditions associated with substantial immune suppression;
2. Other conditions associated with immune suppression may have been present in those 19 children to a greater extent than in control children.
Cerebrospinal Fluid Analysis in Systemically Ill Children Without Central Nervous System Disease
Authors: Carraccio Carol , Blotny Krystyna , Fisher Margaret C. 
Published: December 2021

Objective. Experience led us to question the applicability of standards for normal cerebrospinal fluid (CSF), originally developed in healthy children, to children with systemic illness but without central nervous system (CNS) infection. The purpose of this study was to test our hypothesis that systemically ill children, in the absence of CNS infection, have an elevated CSF white blood cell count and a greater percentage of neutrophils than accepted norms.
Methods. We enrolled 345 patients in the following diagnostic categories: infants 1 month of age or younger with possible sepsis (n = 95), patients older than 1 month of age with possible sepsis (n = 155), patients with a focus of infection in close proximity to the CNS (n = 51), and patients presenting with seizures and fevers (n = 45). Sociodemographic data and results of CSF examination were abstracted from the medical records. Statistical analysis systems were used for data processing.
Results. The CSF white blood cell count did not significantly differ from standards except for a lower mean count in the group presenting with seizures. The percent of CSF neutrophils was significantly greater than standards, however, for those patients older than 1 month of age with possible sepsis, those with a focus of infection in close proximity to the CNS, and those presenting with seizures. Data analysis by quantiles shows only 25% to 50% of patients, in each of the diagnostic categories, meeting the current definition of normal CSF neutrophil count.
Conclusions. Our results show that a mean of at least 5% neutrophils may be present in the CSF with a diagnosis of fever without a source, a focus of infection in close proximity to the CNS, or a seizure with fever in the absence of CNS infection. These data support tailoring treatment based on clinical assessment rather than what is considered an abnormal CSF neutrophil count by current standards.
Newborn Acoustic Cry Characteristics of Infants Subsequently Dying of Sudden Infant Death Syndrome
Authors: Corwin Michael J. , Lester Barry M. , Sepkoski Carol , Peucker Mark , Kayne Herbert , Golub Howard L. 
Published: December 2021

Objective. To test the hypothesis that the occurrence of a neonatal cry exhibiting a high first formant is a risk factor for sudden infant death syndrome (SIDS) and to evaluate the association between SIDS and other acoustic cry variables.
Method. We recorded cries and obtained medical and demographic data for 21 880 apparently healthy term newborns. Two cries were recorded between days 2 and 7 of life, after a painful stimulus at the time of routine blood drawing. Acoustic variables were measured with an automated computer-based analysis system. Twelve infants died of SIDS. Age at death ranged from 19 days to 6.5 months. Autopsies were performed in all cases. At least one cry was analyzed for all 12 infants who died of SIDS and 20 167 infants without SIDS. Two cries were analyzed for 9 infants who died of SIDS and 14 235 infants without SIDS.
Results. Newborns whose first cries exhibited a high first formant were more likely to die of SIDS than infants whose first cries did not have this characteristic (relative risk, 3.5; 95% confidence interval [CI] 1.1 to 12). The relative risk for SIDS increased to 8.8 (95% CI, 2.2 to 35) for newborns whose second cries showed that this characteristic persisted. Newborns with the combination of both a high first formant and a high number of mode changes on both of two cries had a relative risk of 32 (95% CI, 8.7 to 120).
Conclusions. We have shown an association between alterations in neonatal cry acoustics and SIDS. Cry analysis represents a potentially important research tool that, when studied in relation to other physiologic measures, may lead to an improved understanding of SIDS.
Implementation of the Community Outpatient Practice Experience in a Large Pediatric Residency Program
Authors: Recchia Kimberlee C. , Petros Teresa M. , Spooner S. Andrew , Cranshaw Janet L. 
Published: December 2021

Objectives. To determine the feasibility of implementing the Community Outpatient Practice Experience (COPE), a community-based continuity program, in a large, tertiary-care-oriented pediatric residency; to assess the impact of the continuity program on pediatric residents' experience; and to compare the experience in a variety of community practice settings.
Settings. Continuity clinic settings included a hospital-based residents' group practice (RGP) clinic (1989 through 1991) and a community-based program in which each resident was paired with a practicing pediatrician in the community (1991 through 1993). Community practice types included publicly funded clinics (n = 9), private practices (n = 38), and managed-care practices (n = 14). In all settings, residents spent half a day per week in continuity activity.
Methods. Measures of residents' experience (patient encounters, patient age distribution, and diagnostic mix) were compared in both settings and among community practice types. RGP data were derived from a patient scheduling database, and COPE data were obtained from patient encounter records submitted by each resident.
Results. Residents in RGP (108.5 resident years) had 5294 encounters with 1568 patients. In COPE (102.5 resident years), 21 978 encounters with 19 235 patients occurred. COPE residents saw significantly more patients per session (6.2 vs 1.7) than residents in RGP. The mean patient age in COPE was significantly higher than RGP (5.3 vs 2.6 years). A greater proportion of encounters in RGP were for health supervision (61% vs 30%), but a greater number of health supervision encounters per resident occurred in COPE. There was a higher proportion of patients with chronic disease in RGP (38% vs 7%), but a greater number of patients with chronic disease was seen per resident in COPE. Analysis of COPE data by practice type showed fewer patient encounters per session and a younger patient age in publicly funded sites than in private- or managed-care practices. The proportion of health supervision encounters was greatest in publicly funded sites, but the greatest number of health supervision encounters per resident occurred in managed-care practices.
Conclusions. We successfully integrated a large-scale community-based continuity experience into a large, tertiary-care-oriented pediatric residency program. We present COPE as an alternative to the hospital-based continuity clinic and suggest it as a model for improving residents' primary-care experience.
Adolescent Development and Transitions to Motherhood
Authors: Flanagan Patricia J. , McGrath Margaret M. , Meyer Elaine C. , Coll Cynthia T. Garcia 
Published: December 2021

Objective. To use both qualitative and quantitative methods to examine the experience of motherhood during adolescence and to evaluate developmental influences on the concept of maternal role.
Design. (1) A grounded theory approach was initially used to generate a hypothesis. Focus groups and individual interviews were analyzed for concept and theme. (2) A quantitative method using correlational analysis was used to test the hypothesis generated by qualitative study. A structured interview using five specific, scored questions about self and about motherhood was used to examine the relationship between developmental complexity of responses to questions about self and questions about motherhood.
Setting and Participants. The qualitative study involved group and individual interviews with 42 teenage mothers. The quantitative study involved individual interviews with 25 mothers, ages 14 to 18 years, at an innercity clinic for young parents and their infants. Race and ethnicity were heterogeneous, and 100% received Aid to Families With Dependent Children.
Results. The major hypothesis generated from the qualitative analysis was that an adolescent mother's conceptualization of her maternal role is related to her own psychosocial and cognitive development. The quantitative study revealed a strong correlation between the developmental complexity of responses to questions about self and the complexity of responses to questions about motherhood (r2 = .81).
Conclusion. The experience of motherhood and the conceptualization of the maternal role in adolescence is related to young mothers' psychosocial cognitive development.
Acute and Chronic Intestinal Motor Activity Responses to Two Infant Formulas
Authors: Jadcherla Sudarshan R. , Berseth Carol Lynn 
Published: December 2021

Objective. Preterm formulas are nutritionally better for preterm infants; however, it has been observed that these formulas cause more feeding intolerance than do regular formulas. Because intestinal motor activity is responsible for the aboral movement of intraluminal nutrients, the purpose of this study was to evaluate intestinal motor activity responses to two infant formulas: 84 and 100.8 J/oz.
Study Design and Results. Intestinal motor activity was recorded in 52 preterm infants who had never been fed and who were randomly assigned to receive small enteral feedings (24 mL/kg per day) for 10 days with one of two commonly used infant formulas. In a subset of 26 of these infants, acute motor responses to both formulas were also evaluated. At the end of the study period, motor activity during fasting did not differ between the two groups of infants. However, motor responses during feeding to the two formulas differed significantly. When infants were fed for the first time, their motor activity increased compared with fasting when they were fed the 84-J/oz formula but decreased when they were fed the 100.8-J/oz formula. These differences in motor responses to the two formulas were not present 10 days later. These differences in motor responses to the 100.8- and 84-J/oz formulas were even more pronounced among the 7 infants who subsequently developed feeding intolerance to the 100.8-J/oz formula during the 10-day study period.
Conclusion. Inhibition of motor responses to calorically denser formulas during active feeding in a subset of preterm infants may underlie the feeding intolerance they experience when they are fed these formulas. However, this inhibitory response diminishes with age, suggesting that denser formulas can be reintroduced later in life to these infants.
Extraordinarily High Eosinophilia and Elevated Serum Interleukin-5 Level Observed in a Patient Infected With Paragonimus westermani
Authors: Kan Hiroaki , Ogata Takayuki , Taniyama Akihiko , Migita Masahiro , Matsuda Ichiro , Nawa Yukifumi 
Published: December 2021

Objective. Although eosinophilia is one of the typical clinical features of some helminth infections, the degree of eosinophilia in helminthiasis is usually 10% to 30% with a total white blood cell count of 10 000 to 20 000/mm3. Here we report a case of extraordinarily high eosinophilia (91%; absolute eosinophil count, 84 000/mm3) caused by Paragonimus westermani infection. To determine the mechanisms of eosinophilia, the levels of several eosinophilopoietic cytokines in the patient's sera were measured during the course of treatment.
Methods. Serum levels of three cytokines, granulocyte-macrophage colony-stimulating factor, interleukin-3 (IL-3), and IL-5 were measured by enzyme-linked immunosorbent assay using commercial kits or our own assay system for IL-5.
Results. Although the kinetic changes of IL-5 correlated well with eosinophilia, the serum IL-3 level remained below the detection level throughout the period examined. Although the granulocyte-macrophage colony-stimulating factor level was twofold to threefold higher than the normal bevel, its kinetics did not parallel the degree of eosinophilia.
Conclusions. These results show that Paragonimus westermani infection can induce an extraordinarily high level of eosinophilia with an associated increase in IL-5 production. Immunoserologic diagnosis for parasitic diseases should be included in the differential diagnosis of eosinophilia.
Fruit Juice
Authors: Lifschitz Carlos H. 
Published: December 2021

In their article "Carbohydrate Absorption From Fruit Juice in Young Children," Smith et al1 confirm the fact that the mix of carbohydrates, rather than the type or concentration alone, have an overriding effect in determining their degree of intestinal absorption. In his commentary, Dr Klish suggests that "if used in reasonable amounts...it probably makes no difference what fruit juice is fed."2
Dietary fiber is defined as "nondigestible carbohydrates and lignins." The American Academy of Pediatrics3 states that high-fiber diets effectively treat constipation...and that "possibly 75% of children in the United States eat less than the recommended amounts of fruits and vegetables."
A PROSPECTIVE RANDOMIZED STUDY OF CONTINUOUS VERSUS INTERMITTENT NEBULIZED ALBUTEROL FOR SEVERE STATUS ASTHMATICUS IN CHILDREN
Authors: Chipps Bradley E. 
Published: December 2021

Purpose of the Study. Comparison of continuously nebulized albuterol (0.3 mg/kg/hour) to intermittent hourly albuterol (0.3 mg/kg/dose) in the treatment of status asthmaticus.
Population. Seventeen patients (average, 5 years; range, 1.8 to 16 years) admitted to the Pediatric Intensive Care Unit (PICU) with severe status asthmaticus (asthma scored &gt;5, range 0 to 10) who were nonresponsive to outpatient management with β-agonist, oxygen, corticosteroid, and theophylline.
Methods. Randomized, nonblinded trial using small volume nebulizer for both modalities of treatment. The minimum albuterol dose was 5 mg/hour and maximum dose was 10 mg/hour.
Results. The two groups did not differ in demographics, vital signs, or blood gas results. Improvement in clinical score was significant (8 to 6) in the continuous group as compared with the intermittent nebulized group (7 to 6.8) during the first 4 hours of therapy. The mean time to reach an asthma score of &lt;5 was 12 hours (range, 4 to 24 hours) for continuous group compared with 18 hours (range, 12 to 24 hours) for the intermittent group. One patient in the intermittent group failed to respond after 12 hours and was removed from the protocol. Another patient in the intermittent group was readmitted to the PICU 60 hours after discharge for a severe episode of status asthmaticus. No significant changes in electrocardiogram, vital signs, on lab data occurred except for hypokalemia in one patient in the continuous group who was not given supplemental potassium. The respiratory therapist's time commitment for the continuous group was approximately 50% less than for intermittent therapy group.