bluuebunny/crossref_metadata_2025_split huggingface dataset:
Education of Children with Human Immunodeficiency Virus Infection
Authors:   TASK FORCE ON PEDIATRIC AIDS
Published: December 2021

As the incidence of HIV infection in children increases, so will the school population of children with this disease. With the advent of new drug therapy, it is likely that these children will have a longer survival resulting in an increasing number of HIV-infected children entering school. An understanding of the effect of chronic illness and the recognition of neurodevelopmental problems in these children is essential to provide appropriate educational programs. The Academy recommends that:
1. All children with HIV infection should receive an appropriate education that is adapted to their evolving special needs. The spectrum of needs differs with the stage of the disease.
2. HIV infection should be treated like other chronic illnesses that require special education and other related services.
3.Continuity of education must be assured whether at school or at home.
4.Because of the stigmatization that still exists with this disease, it is essential that confidentiality be maintained by limiting disclosures and disclosing information only with the informed consent of the parents or legal guardians and age-appropriate assent of the student.
STUDIES ON ABNORMAL HEMOGLOBINS
Authors: CHERNOFF AMOZ I. , SINGER KARL 
Published: December 2021

Two hundred specimens of hemoglobin, prepared from the blood of children up to the age of 6 years, were investigated for their content of fetal hemoglobin. Fetal hemoglobin was usually absent after the age of 30 months, although an occasional hematologically normal individual was found to have minimal quantities of this pigment beyond this time.
The discrepancy between the results of the present investigation and data in the literature seem to be explained on the basis of the different methods used in identifying the embryonic pigment.
Biology and Clinical Applications of Hemopoietins in Pediatric Practice
Authors: Furman Wayne L. , Crist William M. 
Published: December 2021

The differentiation, proliferation, and viability of hemopoietic cells are regulated by glycoproteins variously referred to as colony-stimulating factors (CSFs), growth factors, or hemopoietins. To date, 12 interleukins, 3 CSFs, erythropoietin, and a stem cell growth factor (kit ligand, or mast cell growth factor) are known to regulate hemopoiesis. The identification and purification of human hemopoietic growth factors (cytokines) have recently permitted a more detailed analysis of their role in hemopoiesis. Cloning of the genes that encode these CSFs has led to largescale production of their protein products for clinical application. Recent clinical trials of these cytokines in adults and children with a variety of diseases affecting hemopoiesis have already yielded dramatic benefits. For example, patients with formerly serious or fatal diseases, such as cyclic neutropenia or Kostmann syndrome (congenital agranulocytosis), have shown striking reductions in infections, marked improvement in their quality of life, and no serious side effects during treatment with recombinant human granulocyte colony-stimulating factor (rhG-CSF).
Here we summarize what is known about the biology and clinical utility of five of these CSFs (recombinant human erythropoietin [rh-EPO], rhG-CSF, granulocyte-macrophage colony-stimulating factor [rhGM-CSF], macrophage colony-stimulating factor [rhM-CSF], and interleukin-3 [rhIL-3]), which are in clinical use in children. We also indicate future applications for these and other hemopoietins. Table 1 outlines characteristics of the five agents, and Table 2 lists their clinical applications.
HEMOPOIETINS AND HEMOPOIESIS
Hemopoiesis is a complex and dynamic process during which a relatively small number of stem cells with self-renewal capacity give rise to lineage-restricted progenitor cells that mature into red blood cells, leukocytes (white blood cells), or platelets (see Figure).
Basic Life Support Training in School
Authors:   Committee on School Health
Published: December 2021

The American Academy of Pediatrics recommends that high school students receive training in Basic Life Support (BLS) and Pediatric Basic Life Support (PBLS) as part of their health education program.
The skills taught, such as recognition of symptoms, establishment of an airway, and rescue breathing, will help prepare students to deal with individuals who need their assistance due to aspiration or cardiorespiratory emergencies. Individual efforts using only BLS/PBLS skills can be effective in rescuing patients in these circumstances.1-3 Prompt initiation of cardiopulmonary resuscitation (CPR) after early recognition of a cardiac arrest has limited success alone. This education must be supported by a community emergency response system. Immediate CPR coupled with access to the community emergency response team maximizes the impact of school education programs.4,5
School-based programs have been successful in training students to have BLS skills.6,7 The Academy does not expect that BLS/PBLS training will prepare students for all emergencies, nor does it intend that students should be made to believe they are solely responsible for rescuing victims or for the survival of individuals with life-threatening events in their school or community. Younger students should be reassured that their responsibility is limited during emergency events, particularly when adults are available. In addition to the potential benefits of BLS/PBLS, a realistic perspective of resuscitation abilities as only a link in the "chain of survival" should be provided. The limitations of BLS/PBLS and of all emergency services on the eventual outcome of cardiac arrests also should be explained.8 Students should be given information about avoiding the acquisition of transmissible diseases during CPR.
Enhanced Urinalysis as a Screening Test for Urinary Tract Infection
Authors: HOBERMAN ALEJANDRO , WALD ELLEN R. , PENCHANSKY LILA , REYNOLDS ELLEN A. , YOUNG STACEY 
Published: December 2021

Urinary tract infection (UTI) is a common and important clinical problem in infants and young children. UTI is often suspected on the basis of results of microscopic urinalysis; accordingly, it is important that its results be as reproducible, accurate, and easily interpretable as possible. A positive urinalysis allows early detection and treatment of UTI, while a negative urinalysis can potentially eliminate the cost of expensive hospitalization for intravenous administration of antibiotics, the current standard treatment of UTI in young febrile children.
In pediatric primary care facilities, microscopic urinalysis often is performed using centrifuged urine and reported as the number of white blood cells (WBCs) or bacteria per high-power microscopic field (hpf).
Neonatal Hyperbilirubinemia and Long-Term Outcome: Another Look at the Collaborative Perinatal Project
Authors: Newman Thomas B. , Klebanoff Mark A. 
Published: December 2021

Objective. To examine the association between neonatal bilirubin levels and subsequent neurodevelopmental outcome.
Design. Prospective cohort study.
Setting. 12 US medical centers from 1959 (first births) to 1974 (last follow-up).
Participants. 41 324 singleton white or black infants with birth weight ≥2500 g who had neonatal bilirubin measurements recorded and survived at least 1 year.
Main outcome measures. Wechsler Intelligence Scale for Children Intelligence Quotient (IQ) at age 7 years, blinded neurologic examination at age 7 years, and sensorineural hearing loss at age 8 years.
Results. There was no association between IQ and bilirubin. For example, comparing children who had maximum bilirubin levels ≥342 µmol/L (20 mg/dL) with those who had lower bilirubin levels, adjusted mean IQs were 105.0 and 103.4 in whites (difference + 1.6; 95% confidence interval [CI]: –0.4 to + 3.5) and 91.0 and 93.3 in blacks (difference –2.3; 95% CI: –4.8 to +0.2). Abnormal neurologic examination results were reported in 12 of 268 children (4.5%) with bilirubin ≥342 µmol/L (20 mg/dL) compared with 1249 of 33 004 children (3.8%) with lower levels (relative risk [RR] = 1.2; 95% CI: 0.7 to 2.1). The frequency of abnormal or suspicious neurologic examination results increased in a stepwise fashion with increasing bilirubin level (P &lt; .001), from 4346/29 258 (14.9%) of those with bilirubin levels &lt;171 µmol/L (10 mg/dL) to 60/268 (22.4%) of those with bilirubin levels ≥342 µmol/L (20 mg/dL), apparently due to increasing minor motor abnormalities at higher bilirubin levels. Sensorineural hearing loss was not associated with high bilirubin levels (RR = 1.0; 95% CI: 0.3 to 3.0).
Conclusions. Neonatal bilirubin levels seem to have little effect on IQ, definite neurologic abnormalities, or hearing loss. Higher bilirubin levels are associated with minor motor abnormalities, but the clinical importance of this finding is limited by the weakness of the association, the mild nature of the abnormalities, and the lack of evidence that they are prevented by treatment.
A Eutectic Mixture of Lidocaine and Prilocaine for Alleviating Vaccination Pain in Infants
Authors: UHARI MATTI 
Published: December 2021

The discomfort and pain caused by vaccination may prevent some parents from having their young children vaccinated. Immunization uptake is good among school-age children, but uptake rates average only about 70% in younger children and figures as low as 25% have been reported at 19 months.1-4 Yet it would be important to achieve as high an immunization uptake as possible, since if the vaccination coverage is good enough, even nonvaccinated individuals will be protected by the herd immunity that hinders the occurrence of epidemics.1,5
Painful procedures are frightening, especially in infancy, when children do not understand what is happening to them.
Fluoxetine Hydrochloride (Prozac) Toxicity in a Neonate
Authors: SPENCER MARY J. 
Published: December 2021

A case of fluoxetine toxicity in a newborn of 38 weeks' gestation has been presented. The total drug concentration in cord blood was 80 ng/mL. The fluoxetine level, 26 ng/mL, is below the adult therapeutic level; the norfluoxetine cord blood level, 54 ng/mL, is at the adult therapeutic level. At 96 hours the fluoxetine level was not measurable and the norfluoxetine level was 55 ng/mL. The parent compound is fluoxetine, which is metabolized in the liver to norfluoxetine. The half-life of fluoxetine is 2 to 3 days, and that of norfluoxetine is 7 to 9 days. Interestingly, in our patient the fluoxetine was absent in the blood at 4 days, but norfluoxetine was present. The most common side effects of Prozac in adult patients involve primarily the central nervous system and include nervousness, tremor, jitteriness, and occasionally seizures. Central nervous system symptoms were most prominent in this newborn. He also had an increased heart rate. Cardiovascular side effects are less prominent in adults who are taking Prozac.
The neonate in this case was asymptomatic at 96 hours of age, indicating that the parent compound, fluoxetine, may be the active part of the drug and side effects may be caused by the parent compound.
The Pediatrician and the "New Morbidity"
Authors:   Committee on Psychosocial Aspects of Child and Family Health
Published: December 2021

THE CHALLENGE
A decade has passed since the American Academy of Pediatrics (AAP) defined the role of the pediatrician in providing increased attention to the prevention, early detection, and management of the various behavioral, developmental, and social functioning problems encountered in pediatric practice.1 These problems, called the "new morbidity,"2 are not really "new"; they have always affected children, but many have become more prevalent. For example, the number of children and adolescents with activity limitation caused by a chronic health condition with attendant psychological problems currently approaches 8%.3 The number of children living with divorced mothers doubled between 1970 and 1986. The suicide rate for male adolescents has doubled since 1960.4 Because of the prevalance of these problems, the peditrician s being asked to expand the traditional role of health supervision and management of physical illnesses to address psychosocial and behavioral problems more effectively.
THE BARRIERS
To achieve this goal, pediatricians must overcome educational, economic, and time management obstacles, despite tremendous strides in the development of an educational blueprint,5 an ever-increasing knowledge base, and a growing cadre of educators. Pediatric residency training is focused on major physical illness in tertiary care hospitals and to a limited degree on behavioral issues. Training in ambulatory settings has expanded, although training in behavioral pediatrics remains limited in many residency programs. In 1987, the Residency Review Committee added a requirement for behavioral teaching, although the specific time requirement for training in behavioral pediatrics is undefined. Consequently many pediatricians have completed training with limited instruction in psychosocial issues.
Serum C-Reactive Protein, Erythrocyte Sedimentation Rate, and White Blood Cell Count in Acute Hematogenous Osteomyelitis of Children
Authors: Unkila-Kallio Leila , Kallio Markku J.T. , Peltola Heikki , Eskola Juhani 
Published: December 2021

Objective. The aim of this prospective study was to compare the clinical value of the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and white blood cell (WBC) count in diagnosis and follow-up of acute hematogenous osteomyelitis in children.
Design. Forty-four children aged 2 weeks to 14 years with bacteriologically confirmed acute hematogenous osteomyelitis were examined. Staphylococcus aureus was responsible in 39 cases (89%), Haemophilus influenzae type b in 3 cases (7%), pneumococcus in 1 case (2%), and a microaerophilic streptococcus in 1 case (2%). ESR was measured at the time of admission and on days 3, 5, 7, 10, 14, 19, and 29 of treatment, and CRP was measured on the same days as ESR but also on days 2, 9, 12, 17, and 23. WBC count was examined at the time of admission and on days 5, 10, 19, and 29.
Results. ESR was elevated (≥20 mm/h) initially in 92% of the cases; the mean value was 45 mm/h, and the peak values (mean 58 mm/h) were reached on days 3 to 5. After this the levels slowly returned to normal in approximately 3 weeks (mean 18 days). CRP was elevated (&gt;19 mg/L) at the time of admission in 98% of the cases, the mean value being 71 mg/L. The peak CRP value was reached on day 2 (mean 83 mg/L). The decrease was very rapid, normal values being reached within a week (mean 6.9 days). The WBC count was a poor indicator of acute hematogenous osteomyelitis, since only 35% of the children had leukocytosis (WBCs &gt; 12 x 109/L) at the time of admission.
Conclusions. In patients with acute hematogenous osteomyelitis, CRP increased and especially decreased significantly faster than ESR, reflecting the effectiveness of the therapy given and predicting recovery more sensitively than ESR or WBC count.
Does Prenatal and Infancy Nurse Home Visitation Have Enduring Effects on Qualities of Parental Caregiving and Child Health at 25 to 50 Months of Life?
Authors: Olds David L. , Henderson Charles R. , Kitzman Harriet 
Published: December 2021

Objective. To examine, during the 3rd and 4th years of life, the health, development, rates of child maltreatment, and living conditions of children who had been enrolled in a randomized trial of nurse home visitation during pregnancy and first 2 years of their lives.
Design. Prospective follow-up of families who had been randomly assigned to nurse-visited and comparison conditions.
Setting. Study conducted in semirural community in upstate New York. Families dispersed among 14 other states during 2-year period after children's second birthdays.
Participants. Four hundred women were recruited through a health department antepartum clinic and offices of private obstetricians and were registered before 30th week of pregnancy. All women had no previous live births and 85% were either teenaged (&lt; 18 years at registration), unmarried, or from Hollingshead social classes IV or V. Analysis focused on whites, who comprised 89% of sample.
Intervention. Nurse home visitation from pregnancy through second year of the child's life.
Main Results. There were no treatment differences in the rates of child abuse and neglect or children's intellectual functioning from 25 to 48 months of age. Nurse-visited children, nevertheless, lived in homes with fewer hazards for children; they had 40% fewer injuries and ingestions and 45% fewer behavioral and parental coping problems noted in the physician record; and they made 35% fewer visits to the emergency department than did children in the comparison group. Nurse-visited mothers were observed to be more involved with and to punish their children to a greater extent than were mothers in the comparison group. The functional meaning of punishment differed between the nurse-visited and comparison families.
Conclusions. The program does have enduring effects on certain aspects of parental caregiving, safety of the home, and children's use of the health care system, but it may be necessary to extend the length of the program for families at highest risk to produce lasting reductions in child abuse and neglect.
Distinguishing Sudden Infant Death Syndrome From Child Abuse Fatalities
Authors:   Committee on Child Abuse and Neglect
Published: December 2021

Public and professional awareness of sudden infant death syndrome (SIDS) has increased in the 28 years since the establishment of the National Sudden Infant Death Foundation, now called the National SIDS Alliance.1 Similarly, awareness of child abuse has increased in the 30 years since the publication of the first article on the battered child.2 In the majority of cases, when an infant younger than 1 year dies suddenly and unexpectedly, the cause is SIDS. Sudden infant death syndrome is far more common than infanticide. In a few difficult cases, legitimate investigations for possible child abuse have resulted in an insensitive approach to grieving parents or caretakers. This statement provides professionals with information and guidelines to avoid distressing or stigmatizing families of SIDS victims while allowing accumulation of appropriate evidence in the uncommon case of death by infanticide.
INCIDENCE AND EPIDEMIOLOGY
Sudden infant death syndrome, also called crib or cot death, is "the sudden death of an infant under 1 year of age which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and a review of the clinical history." 3 Sudden infant death is the most common cause of death between I and 12 months of age. Eighty percent of cases occur before age 5 months, with a peak incidence between 2 and 4 months of age. Sudden infant death syndrome occurs in 1.5 to 2 per 1000 live births, resulting in 6000 to 7000 infant deaths each year in the United States.4
Immunization Coverage and Its Relationship to Preventive Health Care Visits Among Inner-City Children in Baltimore
Authors: Guyer Bernard , Hughart Nancy , Holt Elizabeth , Ross Alan , Stanton Bonita , Keane Virginia , Bonner Nira , Dwyer Diane M. , Cwi Joan S. 
Published: December 2021

Objective. To provide empirical data on immunization coverage and the receipt of preventive health care to inform policy makers' efforts to improve childhood immunization.
Design and methods. We surveyed a random sample drawn from a birth cohort of 557 2-year-old children living in the inner-city of Baltimore. Complete information on all their preventive health care visits and immunization status was obtained from medical record audits of their health care providers.
Main outcome measures. Age-appropriate immunizations and preventive health care visits.
Results. By 3 months of age, nearly 80% made an age-appropriate preventive health visit, but by 7 months of age, less than 40% had a preventive visit that was age-appropriate. In the second year of life, 75% made a preventive health visit between their 12- and 17-month birthdays. The corresponding age-appropriate immunization levels were 71% for DTP1, 39% for DTP3, and 53% for measles-mumps-rubella vaccine. Infants who received their DTP1 on-time were twice as likely to be up-to-date by 24 months of age.
Conclusions. Our analyses focus attention on the performance of the primary health care system, especially during the first 6 months of life. Many young infants are underimmunized despite having age-appropriate preventive visits, health insurance coverage through Medicaid, and providers who receive free vaccine from public agencies. Measles vaccination coverage could be improved by initiating measles-mumps-rubella vaccine vaccination, routinely, at 12 months among high risk populations.
Multi-organ Disease Secondary to Sulfonamide Toxicity
Authors: Pickert Curtis B. , Belsha Craig W. , Kearns Gregory L. 
Published: December 2021

Hypersensitivity reactions modulated by reactive drug metabolites should be considered in the differential diagnosis of any patient receiving a sulfonamide who presents with disease of one or more organ systems and no other obvious cause. The presence of fever is characteristic of this process and should not mislead the clinician into assuming an infectious etiology for the multi-organ disease.
In institutions which can offer sophisticated biochemical laboratory procedures, the use of the in vitro lymphocyte cytotoxicity assay and acetylator phenotyping can augment diagnostic certainty and thus facilitate determination of management and prognosis for patients with idiosyncratic sulfonamide hypersensitivity. An index of suspicion for the presence of drug-induced disease, combined with the use of specific tests such as the lymphocyte cytotoxicity assay may enable the clinician to make this diagnosis with more certainty than has previously been possible. However, before these tests can be offered as a clinical diagnostic tool, it is important that appropriate assessment of sensitivity, specificity, and accuracy be documented.
Finally, following sulfonamide hypersensitivity reactions, toxicity can be expected to resolve following withdrawal of the drug. However, late complications such as hypothyroidism may occur months after drug exposure. Therapeutic rechallenge to the offending drug would be expected to cause similar and possibly worse disease in the same patient. Accordingly, patients experiencing serious adverse reactions to sulfonamides should not receive other antimicrobial agents of this same class again or, possibly, other aromatic amines such as dapsone and procainamide without laboratory verification to support the absence of drug or metabolite-induced hypersensitivity reactions.