bluuebunny/crossref_metadata_2025_split huggingface dataset:
Investigation and Review of Unexpected Infant and Child Deaths
Authors:   Committee on Child Abuse and Neglect and Committee on Community Health Services
Published: December 2021

A significant proportion of infant and child deaths are preventable. Of the 55 861 deaths of children aged 14 and younger in the United States in 1989, more than three fourths occurred in children under the age of 2 years.1 Approximately one third of the latter were unexpected, including those due to sudden infant death syndrome (SIDS) or trauma, or deaths that were otherwise unexplained. Child abuse deaths occur in greatest numbers among infants, followed by those in toddlers and preschool children.2 Children younger than 6 years of age are most vulnerable to abuse because of their small size, incomplete verbal skills, and often limited contact with adults other than their primary caretakers.3
With few exceptions, throughout the United States there is no uniform system for the investigation of infant and child deaths. Many jurisdictions lack appropriately trained pathologists, interagency collaboration hat would facilitate sharing of information about the family, and a surveillance system to evaluate data regarding infant deaths. As a result, progress in the understanding of SIDS is inhibited, cases of child abuse and neglect may be missed, familial genetic diseases go undiagnosed, public health threats may be unrecognized, and inadequate medical care may be undetected. Lack of adequate infant and child death investigation is an impediment to preventing illness, injury and death of other children at risk.
Adequate death investigation requires the participation of numerous individuals including medical examiner/coroner, public health officials, the patient's physician, the pathologist, and personnel from agencies involved with child welfare and social services and law enforcement.
Hearing Loss Not Associated With DTP Vaccination or Fever
Authors: Nuss ROGER C. , EAVEY ROLAND D. , EVANS GEOFFREY 
Published: December 2021

To the Editor.—
The Vaccination Injury Compensation (VIC) Program is a federal effort to fairly and quickly settle injury and death claims after vaccinations. Should a recognized vaccine side effect be present and the petitioner is able to satisfy various statutory requirements, an automatic payment is made by the government without litigation against the physician or vaccine manufacturer. However, should a claim be made that is not a previously recognized vaccine injury, a decision is made by a special master of the US Court of Federal Claims with the help of experts but without a jury.
Circumcision in Children Beyond the Neonatal Period
Authors: Wiswell Thomas E. , Tencer Heather L. , Welch Catharine A. , Chamberlain John L. 
Published: December 2021

Objective. Although many boys are circumcised after the newborn period, there are limited data concerning the proportion of uncircumcised infants who subsequently have the procedure, as well as minimal information about characteristics of this population.
Population. Data and medical records of boys born in Us Army hospitals from 1985 through 1992 were reviewed. General information regarding a portion of the 32 072 boys who were not circumcised during their neonatal hospitalization, but subsequently had the procedure, is reported. In addition, specific details are presented about 476 boys who were circumcised after their birth hospitalization.
Results. The postneonatal circumcision frequency rate of these children increased significantly over this period (P &lt; .0001), particularly after the 1989 American Academy of Pediatrics statement on circumcision. In general, most boys were not circumcised as neonates because of parental choice (55%) or because of a complicated neonatal course (32%). "Sleeve" and "freehand" resection were the most common methods of circumcision (93%), and general anesthesia was used in 91% of the boys. The mean age at postneonatal circumcision was 2.92 years. Common reasons for the ensuing procedure included parental choice (39%), coincidence with other surgery (27%), recurrent balanoposthitis (23%), and urinary tract infections (7%). Complications occurred in 8 of the 476 boys whose specific records were reviewed. These included excessive bleeding (3), malignant hyperthermia (2), aspiration pneumonia (1), large hematoma development (1), and postoperative fever (1).
Conclusions. An increasing number of boys are circumcised beyond the neonatal period, and the procedure performed at this time can be associated with substantial complications. This information may be of use when performing informed-consent counseling for neonatal circumcision.
Left-handedness as a Risk Factor for Unintentional Injury in Children
Authors: Graham Charles J. , Dick Rhonda , Rickert Vaughn I. , Glenn Robert 
Published: December 2021

Objective. To determine whether left-handedness is a risk factor for unintentional injury among children and adolescents.
Design. Case-control study.
Setting. Pediatric emergency department of Arkansas Children's Hospital.
Patients. 265 patients sustaining unintentional trauma aged 6 to 18 years and 494 control patients who did not have trauma were given a questionnaire to determine handedness, past unintentional injury, and parental perception of injury proneness.
Results. The frequency of left-handedness in the trauma group (18.1%) was significantly greater than frequency of 10.5% in the control group (P &lt; .003, odds ratio = 1.80, 95% confidence interval 1.20 to 2.72). Multivariate analysis revealed handedness as the only significant vanable between trauma and control (P &lt; .04). The proportion of left-handers who had been hospitalized previously for injury treatment (20.0%) was larger than the proportion of right-handers, (12.0%) (P &lt; .026, odds ratio = 1.84, 95% confidence interval 1.03 to 3.27). More parents of left-handens rated their child as "more clumsy than average' than parents of right-handens (26.0% vs 15.2%, P &lt; .007).
Conclusions. Left-handedness appears to be a risk factor for unintentional injury in children and adolescents in a pediatric emergency department population.
Clinical Survey of Natural Varicella Compared With Breakthrough Varicella After Immunization With Live Attenuated Oka/Merck Varicella Vaccine
Authors: Bernstein Henry H. , Rothstein Edward P. ,   Pennridge Pediatric Associates, Watson Barbara M. , Reisinger Keith S. , Blatter Mark M. , Wellman Catherine O. , Chartrand Stephen A. , Cho Iksung , Ngail Angela , White C. Jo 
Published: December 2021

Objective. To prospectively characterize varicella occurring in children previously immunized with a live attenuated varicella vaccine (breakthrough varicella) through daily observation by medical personnel and to compare it with natural varicella followed in the same manner.
Design. A blinded clinical survey.
Setting. Four pediatric practices (two private; two hospital-based).
Participants. Healthy 12-month-old through 17-year-old children with chickenpox were studied; 92 had natural varicella and 58 had breakthrough varicella.
Selection procedures and interventions. Study personnel, unaware of vaccination status, documented the clinical characteristics of each patient in the office or at the patient's home each day from enrollment until the day after the total number of lesions increased less than 10%. A standard form documenting number and description of lesions, temperature, duration of illness, and associated clinical complaints was completed each day by the same study personnel. Acute and convalescent sera were obtamed on breakthrough cases.
Measurements and results. Antibody to varicellazoster virus was measured by the glycoprotein-based enzyme-linked immunosorbent assay. Of those with sera available, 85% were serologically confirmed. Eighty-seven percent of enrollees had a known exposure to chickenpox, with at least two thirds of each group having a greater than 4-hour or a household exposure. The numbers of total and vesicular lesions were significantly higher in the natural varicella group, regardless of exposure status (P = .021 to &lt;. 001). The group with break-through varicella had a significantly lower incidence of fever (P &lt; .001) and a significantly shorter duration of illness (P &lt; .001). Other associated constitutional complaints and complications were not significantly different between groups.
Conclusion. Varicella in vaccine recipients is clinically modified and significantly less severe than natural disease.
Henoch-Schönlein Purpura in Infants
Authors: AMITAI YONA , GILLIS DAVID , WASSERMAN DROR , KOCHMAN RONIT HAIMOV 
Published: December 2021

Henoch-Schönlein purpura (HSP) usually affects children older than 2 years. Its occurrence in infants is considered rare.1 Infantile HSP has distinct features. Previous reports emphasized the presence of edema2-8 and the paucity of gastrointestinal and renal symptoms.2 Facial purpura has been reported by some authors.3-8 We describe seven infants with HSP, where the most common features were edema and diffuse purpura involving the face and ears, and discuss the possible mechanisms for this unusual site of the purpura.
PATIENTS AND METHODS
During 1978 through 1992, 145 children with HSP were hospitalized at the Departments of Pediatrics of the Hadassah University Hospitals at Mount Scopus and Ein Karem, Jerusalem.
Provision of Related Services for Children With Chronic Disabilities
Authors:   Committee on Children With Disabilities
Published: December 2021

Since 1975 all children with disabilities specifically delineated by law have had available to them "a free, appropriate public education that includes special education and related services to meet their unique needs." This access has been made possible by the passage of Public Law 94-142,1 The Education for All Handicapped Children Act of 1975. This law was amended in October 1990 with passage of Public Law 101-476, The Individuals With Disabilities Education Act (IDEA). Part B of Public Law 101-476 primarily details the identification and provision of services for children with disabilities. Unfortunately, the implementation of Part B of this law has been limited for many children by a number of significant and complex issues.
The term "related services" as currently defined in Part B of the IDEA includes the following:
... transportation and such developmental, corrective, and other supportive services (including speech pathology and audiology, psychological services, physical and occupational therapy, recreation and social work services, and medical and counseling services, including rehabilitation counseling, except that such medical services shall be for diagnostic and evaluation purposes only) as may be required to assist a child with a disability to benefit from special education.
Health care providers frequently view the related services listed above as medically necessary and/or helpful for children with disabilities without the proviso that these services must be necessary for special education. This difference in perspective and interpretation by pediatricians and parents often leads to misunderstandings, frustrations, conflicts, and problems in the development and implementation of related services within school programs for children with disabilities.
Statistics and Swedish `Sambos'
Authors: WEGMAN MYRON E. 
Published: December 2021

In Reply.—
Family stability has a strong influence on infant mortality. Dr Allen has a valid point in drawing attention to the differences between Sweden and the United States. On the other hand, quantifying such differences is not easy. There is evidence that the US too has a significant number of couples living together without a marriage certificate. indeed, the Census Bureau, beginning with the 1980 census, I believe, introduced the term POSSLQ "person of opposite sex sharing living quarters" as an alternative to single or married.
Bike Dangers
Authors: SCHUBERT JOHN 
Published: December 2021

To the Editor.—
The excellent article, "The Bicycle: A Developmental Toy versus a Vehicle"1 is a much-needed look at the causes of, and misconceptions concerning, bicycle accidents. However, one statement requires comment.
The authors say, "Environmental modifications such as bicycle lanes [and] separating bicyclists from traffic...are proven injury reduction measures..."1,p755 Not! Although that statement may seem so obviously true that there would be little need to justify it, it is in fact a dangerous mistake.
Bike Dangers
Authors: AGRAN PHYLLIS , WINN DIANE 
Published: December 2021

In Reply.—
It's refreshing that a bicycle accident reconstruction expert took the time to review and comment on our recent publication. In the public health and medical fields, separating children from traffic is frequently recommended as a measure to minimize contact between children and motor vehicles. Mr Schubert's comments, however, illustrate the need for multidisciplinary approaches to injury prevention. Traffic engineers and others involved in bicycle safety issues, for example, can provide expertise in this area of injury control.
Near Infrared Spectroscopy Research
Authors: DELPY D. T. , FERRARI M. 
Published: December 2021

To the Editor.—
In a recent issue of this journal (Pediatrics. 1993;91:414-417), Dr Deborah Hirtz reported on a Workshop on Near Infrared Spectroscopy (NIRS), organized by the National Institute of Neurological Disorders and Stroke (NINDS).
NIRS is becoming increasingly accepted as a method for noninvasive monitoring of cerebral hemodynamics and oxygenation in the newborn and recently in the fetus during labor. However, as Dr Hirtz carefully pointed out there are still many technical problems to be solved, and considerable controversy about the quantitation and interpretation of MRS data especially the redox state of cytochrome oxidase.
Think Globally; Act Locally
Authors: HARDY JANET B. , DUGGAN ANNE K. 
Published: December 2021

In Reply.—
Dr Fischer's letter makes a valid point. Many of us do not provide an adequate description of the populations from which our data are derived. Also, we need to be cognizant that health conditions may differ greatly from one country to another and, within a given country, from one ethnic group and social class to another. That said, it does not seem to us appropriate to try to frame all presentations in a global context.
Office Lab Regulations vs Research
Authors: Murray Patrick E. 
Published: December 2021

As a pediatrician in a private group practice, published reports of new or different office laboratory screening techniques pose some problems for us that may not be readily apparent to hospital-or medical center-based physicians. I would like to use the recent, and I think excellent article by Hoberman et al,1 on a enhanced urinalysis technique as an example to point out these difficulties.
I feel certain that all pediatricians in private practice are now aware of the regulation of office laboratories by Federal law under the Clinical Laboratory Improvement Act (CLIA) and the work-place requirements of the Occupational Safety and Health Administration (OSHA).
‘New’ Diapers and Vaginal Discharge
Authors: Goldweber Robert T. 
Published: December 2021

Twice during the past 2 years I have examined infants with what appeared to be a clear gelatinous vaginal discharge of unsure etiology. Recently I discovered the cause when I examined the contents of a swollen diaper lining after my child had spent some time in a pool.
Since 1987 the newest generation of disposable diapers contain a substance called Absorbant Jelly Material that when dry is a granule similar in appearance to salt. It is a polyacrylate cross-linked polymer of acrylic acid and sodium acrylate and is widely found in the lining of diapers in the US, Japan, and Europe.
Children's Household Exposure to Guns: A Pediatric Practice-Based Survey
Authors: Senturia Yvonne D. , Christoffel Katherine Kaufer , Donovan Mark 
Published: December 2021

Guns in the home are a factor in pediatric unintentional and intentional firearm injuries, yet the patterns of ownership and use are unclear.
Objectives. To describe the prevalence of firearms in households containing children who go to pediatricians, the types of firearms owned, the purposes of such ownership, the conditions of firearm storage, and the social correlates of ownership.
Methods. Survey of parents attending 29 (urban, suburban, and rural) pediatric practices in Chicago, New Jersey, Houston, Utah, Georgia, Iowa, and South Carolina for well or sick child care during a 1-week study period. The main outcome measure was ownership of rifle/shotgun and/or handgun.
Results. Gun ownership was reported by 37% of 5233 respondent families: rifles (26%), handguns (17%), and powder firearm (32%). Ownership varied significantly across practices and geographical locations. Thirteen percent of 823 handguns and 1% of 1327 rifles were reported both unlocked and loaded. Recreation was the most common reason for both rifle (75%) and handgun (59%) ownership; 48% of handguns were kept for self-protection versus 21% of rifles. In logistic regression models, predictor variables for firearm ownership included rural area, single family dwelling, at least one adult male, and fewer preschool children (for handgun and rifle); mother with at least 12 years education (for handgun), and white mother (for rifle).
Conclusions. The data presented suggest that US pediatricians routinely see children in families that own firearms, including a worrisome number that keep loaded and unlocked handguns. Until more detailed information becomes available, it is reasonable for pediatricians to be guided by these data, and so to counsel routinely about gun exposure.
A Comparison of Diagnostic Methods in Adolescent Girls With and Without Symptoms of Chlamydia Urogenital Infection
Authors: Biro Frank M. , Reising Shirley F. , Doughman Jeff A. , Kollar Linda M. , Rosenthal Susan L. 
Published: December 2021

Objective. To evaluate the clinical utility of various diagnostic tests, two enzyme immunoassays and a chemiluminescent DNA probe were compared with cell culture (with monoclonal antibody confirmation) for the diagnosis of endocervical Chlamydia trachomatis infection.
Design. The clinical performance of four diagnostic methods for Chlamydia trachomatis urogenital infections were compared, using specimens generated from consecutive pelvic examinations.
Setting. Subjects were recruited from an urban adolescent clinic that provides primary and referral care.
Participants. A total of 479 adolescent female subjects were enrolled. The order of sample collection was randomized. Subjects were stratified according to whether they were asymptomatic (n = 228) or symptomatic (n = 251).
Measurements and results. Discrepant analysis was performed when culture was negative and nonculture technique was positive. The subject was considered to have chlamydia if culture was positive, or if one or more nonculture techniques, with that test's confirmatory assay, were positive (consensus-positive). Prevalence of chlamydia was 11.0% in the asymptomatic, and 20.7% in the symptomatic, group. Overall, 32.5% of the infected subjects were asymptomatic. Sensitivity of diagnostic methods varied from 52% to 80% in the asymptomatic subjects, compared with 65% to 81% in symptomatic subjects. Culture sensitivity was 75% to 80%. The specificities of all tests were 96% or greater. Accuracy of nonculture methods varied from 89.5% (DNA probe, symptomatic subjects) to 96.9% (enzyme immunoassay asymptomatic subjects).
Conclusions. There are significant differences in symptomatic subjects when evaluating accuracy of test outcome, using a consensus-positive criterion. Asymptomatic infections account for nearly one third of adolescent females infected with chlamydia. The prevalence of chlamydia urogenital infections are underestimated by any single diagnostic test, particularly in the asymptomatic patient.
Interferon-Associated Refractory Status Epilepticus
Authors: Miller Van S. , Zwiener R. Jeff , Fielman Barbara A. 
Published: December 2021

Interferons have been used since the early 1980s for their antiviral, antiproliferative, and immunomodulatory actions to treat a variety of oncologic, infectious, and autoimmune disorders. Although many patients experience mild neurologic adverse effects with the administration of interferon, serious neurologic adverse effects are uncommon.1 We report on a child with severe postinfantile giant cell hepatitis in whom interferon α-2b seemed to induce status epilepticus with focal seizures and focal abnormalities on electroencephalogram (EEG).
CASE REPORT
Our patient was healthy until 11 months of age when she developed fever, jaundice, vomiting, and elevated liver function tests. The results of liver biopsy at 14 months of age showed severe giant cell hepatitis with bridging fibrosis, but an extensive anatomic, metabolic and infectious evaluation failed to reveal a specific etiology, and electron microscopy did not reveal viral particles.
Hemothorax in a Child as a Result of Costal Exostosis
Authors: Tomares Stuart M. , Conrad Carol K. , Phoon Colin K. , Carroll John L. , Jabra Amal A. , Beauchamp Norman 
Published: December 2021

Chest pain in pediatric patients is uncommon. Chest pain due to hemothorax is rare. Although hemothorax is usually a result of trauma, it has been reported as a complication of costal exostoses.1-6 The youngest such patient reported, to our knowledge, was 7 years old. We report a case of hemothorax in a 3½-year-old boy with hereditary multiple exostoses.
CASE HISTORY
A 3½-year-old boy was referred for evaluation of an asymptomatic, right-sided pleural effusion. The child, who was adopted from Romania at 1 year of age, was a known chronic hepatitis B carrier. He had been malnourished when he was first adopted, but he was currently thriving, with height and weight at the 50th percentile for age.
Burn From Hairdryer: Accident or Abuse?
Authors: Sudikoff Stephanie , Young Richard S.K. 
Published: December 2021

We believe the following experience should be shared with your readers.
A child was born to a 16-year-old primigravida. At the age of 2 years, she was brought to the emergency department by her grandmother for evaluation of a burn mark on the back. The grandmother had witnessed multiple episodes of abuse during the past 2 years, including seeing the child being beaten, stepped on, and locked in a bathroom, but had never reported any of these incidents.