bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lumbar Cerebrospinal Fluid Opening Pressure Measured in a Flexed Lateral Decubitus Position in Children
Authors: Ellis Robert 
Published: December 2021

Objective. Lumbar punctures in children are generally performed in a flexed position. Published normal ranges for cerebrospinal fluid (CSF) opening pressure require measurement in an extended position, and flexion is known to increase lumbar CSF pressure. This study sought to determine a normal range (mean ± 2 SD) for lumbar CSF opening pressure measured in a flexed lateral decubitus position in children.
Methods. Opening pressure was measured in 33 children receiving diagnostic lumbar punctures or prophylactic intrathecal chemotherapy. Measurements were performed in a flexed lateral decubitus position. Patients with medical conditions affecting CSF pressure were excluded.
Results. Opening pressure (mean ± SD) was 19.0 ± 4.4 cm H2O. Opening pressure was not significantly affected by patient age or sex. Intrathecal chemotherapy and sedation also did not affect CSF pressure.
Conclusions. The normal range for lumbar CSF opening pressure measured in a flexed lateral decubitus position in children is 10 to 28 cm H2O.
Rural-Urban Blood Lead Differences in North Carolina Children
Authors: Norman Edward H. , Bordley W. Clayton , Hertz-Picciotto Irva , Newton Dale A. 
Published: December 2021

Objective. To examine the prevalence of and risk factors for having a blood lead elevation among young children in a predominantly rural state.
Methods. 20 720 North Carolina children at least 6 months and &lt;6 years of age were screened between November 1, 1992 and April 30, 1993 using either capillary or venous measurements of blood lead. Children were tested through routine screening programs that target low-income families and, hence, were not randomly selected. Eighty-one percent of the children were screened through local public health departments, and 19% were tested at private clinics.
Results. The estimated prevalences of having an elevated blood lead level among those tested were: 20.2% (≥10 µg/dL), 3.2% (≥15 µg/dL), and 1.1% (≥20 µdL). Black children were at substantially increased risk of having a blood lead ≥15 µ/dL (odds ratio (OR) 2.1, 95% confidence interval (CI) 1.7 to 2.5). Children aged 2 years old had an elevated risk (OR = 1.4, 95% CI 1.1 to 1.7) compared to 1-year-olds, and males were at slightly increased risk (OR = 1.2, 95% CI = 1.0 to 14). Living in a rural county was nearly as strong a risk factor as race (OR = 1.9, 95% CI = 1.6 to 24). The effect of rural residence was even greater among certain subgroups of children already at highest risk of having an elevated blood lead. The type of clinic (public vs private) where a child was screened was not associated with blood lead outcome. These same trends were seen for children with blood lead levels ≥20 µ/dL.
Conclusions. Among children screened from rural communities, the prevalence of elevated blood lead is surprisingly high. Though few physicians have embraced universal lead screening, these data support the need for greater awareness of lead exposure in children living outside of inner-cities.
Risk Factors for Delayed Immunization Against Measles, Mumps, and Rubella in Colorado Two-Year-Olds
Authors: Miller Lisa A. , Barón Anna E. , Marine William M. , Hoffman Richard E. , Melinkovich Paul 
Published: December 2021

Objectives. 1) To examine a wide range of potential risk factors for delayed childhood immunization against measles, mumps, and rubella and 2) to determine the parental response to proposed solutions regarding the problem of delayed childhood immunization.
Design. A case-control study in which subjects had (controls) or had not (cases) received measles, mumps, and rubella vaccine (MMR) by 2 years of age. Parents of subjects were also surveyed to find out whether they thought selected proposals to improve immunization rates would be successful.
Results. Maternal education of high school or less at the time of the child's birth, more than or equal to two moves between birth and age 2, maternal age &lt;21 years of age at the time of the child's birth, more than or equal to two older siblings, participation in The Special Supplemental Food Program for Women, Infants, and Children (WIC), participation in the federal food stamp program, and incorrect knowledge of the recommended age for MMR significantly elevated the odds ratio (OR) for delayed immunization. At least two older siblings (OR = 3.2), maternal age &lt;21 years of age at the time of the child's birth (OR = 2.8), and incorrect knowledge of the recommended age for MMR (OR = 2.7) remained significant risk factors in a multivariate logistic regression model. Insurance status and cost factors were not significant risk factors for delayed immunization. Parents thought that reminders for immunizations and a central record system would have made obtaining immunizations easier.
Conclusions. Based on our findings of the importance of immunization knowledge and demographic characteristics as risk factors for delayed immunization, we suggest that a message (the recommended age for immunizations) and a target group for that message (families who move frequently, have older children, and are headed by younger parents) be evaluated as an intervention to improve immunization rates.
Sedation Protocols—Why So Many Variations?
Authors: Coté Charles J. 
Published: December 2021

The Committee on Drugs (COD) of the American Academy of Pediatrics (AAP), along with its many consultants, has spent considerable time addressing the difficult issue of appropriate care for sedated pediatric patients. The Committee's concern has been the continued appearance of reports, nearly always from nonmedical journal sources ("word of mouth", newspapers), of children suffering adverse events (morbidity and mortality) after sedation for procedares that in themselves should not result in any such complications, eg, radiologic investigations.1-4
The original "Guidelines for the Elective Use of Conscious Sedation, Deep Sedation, and General Anesthesia in Pediatric Patients" were published in 1985.5 These were constructed because of concern regarding a number of deaths that occurred in the dental office.6
Challenges to Implementing the Current Pediatric Cholesterol Screening Guidelines Into Practice
Authors: Dennison Barbara A. , Jenkins Paul L. , Pearson Thomas A. 
Published: December 2021

Objective. The Expert Panel on Blood Cholesterol Levels in Children and Adolescents of the National Cholesterol Education Program (NCEP) recommends selective screening of children for high blood cholesterol. We determined the number of children, who, according to the guidelines, should be targeted for cholesterol screening.
Design. Population survey.
Setting. Permanent household residents in Otsego County, NY.
Participants. Total population-based sample of 17 444 households (86.6% response rate) including 44 565 participants, of whom 10 457 were children, aged 2 through 19 years.
Main outcome measures. Percent of children qualifying for cholesterol screening under the NCEP Children's Panel guidelines.
Results. Children from two-parent families were more likely to have known family history of coronary heart disease (CHD) before 60 years of age (41.8% vs 25.8%, P &lt; .001), and twice as likely as children from single-parent families to have known parental hypercholesterolemia (18.8% vs 9.5%, P &lt; .001). Only 39% of parents reported having had their cholesterol level checked; they were better educated and more likely to have health insurance. Parents with a first-degree relative with CHD before 60 years of age were more likely to report having their cholesterol level checked and to report a high cholesterol level. We calculated that 27% of children (18% of children from single-parent households and 29% of children from two-parent households) would report a known family history of premature CHD (ie, CHD before 55 years of age) and qualify for lipoprotein analysis, and that 11% of children would qualify for total cholesterol screening because of known parental hypercholesterolemia without a family history of premature CHD. Thirty-five percent of children had incomplete or unavailable family health history and/or unknown parental cholesterol status.
Conclusions. In this population, 38% of children would be targeted for cholesterol screening, exceeding the estimate of the NCEP Children and Adolescents Panel. The selection process, however, would tend to miss children from single-parent families, children with incomplete family health history, and children whose parents have not had their cholesterol levels measured. The currently recommended pediatric cholesterol screening policy needs to be evaluated further in additional communities and population settings. Alternative cholesterol screening strategies are needed when family health history is incomplete and/or parental cholesterol status is unknown.
UCONN DEVISES A POINT SYSTEM TO RATE PROFESSORS' PRODUCTIVITY
Authors: L. J. F. 
Published: December 2021

STORRS, Conn., Jan. 9 (AP)—The University of Connecticut has devised a system that intends to measure how productive its professors are ...
The plan would give each academic department a set of scores. The departments would be scored on a scale of zero to five in each of 10 categories, including research productivity, service to the state, national reputation, undergraduate teaching and graduate teaching. Progress in the categories would be measured over several years against goals set by the professors themselves and would be taken into account in budget decisions...
Higher education experts said UConn's point system is part of a larger movement to make professors at public universities account for the hours they work and the research, teaching and service they perform.
Meeting the Challenges of Vaccine-Preventable Diseases in Child Day Care
Authors: Cochi Stephen L. , Atkinson William L. , Dini Eugene F. , Adams William G. , Gershon Anne A. 
Published: December 2021

Recent advances in the development of new and improved vaccines have resulted in both the prospect of additions to the list of vaccine-preventable childhood diseases and opportunities to more effectively prevent diseases that are already vaccine-preventable.1 The recently revised schedule of routine vaccinations for all children as recommended by the Advisory Committee on Immunization Practices (ACIP) of the US Public Health Service is shown in the Table. The challenges of applying these new or improved vaccines, in light of our current understanding of the epidemiology of the diseases and a more efficient monitoring system for ensuring age-appropriate vaccination, is to more effectively control vaccine-preventable diseases in child day-care settings.
BACKGROUND
The nation experienced a marked increase in measles cases during 1989 and 1990. From 1980 to 1988, a median of 3124 measles cases was reported annually. During 1989 to 1991, a major resurgence of measles occurred, with a total of 55 622 cases reported during this period.
The resurgence of measles was associated with a change in the epidemiology of reported cases. From 1980 to 1988, a median of 29% of cases occurred among children under 5 years of age.2 However, during 1989-1991, preschool-age children accounted for 37% to 49% of all reported cases.2,3 Many of these cases were reported from areas with large outbreaks of measles among predominantly unvaccinated black and Hispanic children living in large urban areas such as Los Angeles, New York City, Chicago, and Dallas. These cases among preschool-age children were associated with a large number of complications of measles.
Hepatitis Infections in the Day-Care Setting
Authors: Hurwitz Eugene S. , Deseda Carmen C. , Shapiro Craig N. , Nalin David R. , Freitg-Koontz M. Jayne , Hayashi Jun 
Published: December 2021

The hepatitis session reviewed current knowledge of the epidemiology and public health importance of hepatitis A (HAV) and hepatitis B virus (HBV) in day care centers (DCCs), current recommendations and prevention measures, areas that need additional research, and the potential for new preventive measures.
HEPATITIS A
The clinical characteristics, modes of transmission, risk factors for day-care-related outbreaks, and characteristics of hepatitis A virus outbreaks have been well described previously.1 Within the day-care setting, HAV is transmitted via the fecal-oral route, either person to person (between children and staff); via contaminated food (often in association with individuals who prepare food and care for diapered children); or possibly via fomites on contaminated surfaces or toys. In young children, in contrast to adults, hepatitis A may be difficult to recognize, as clinical illness is frequently nonspecific and mild, consisting primarily of malaise, nausea, fever, and diarrhea. Fewer than 5% of children under 3 years of age and only about 10% of those 4 to 6 years of age develop jaundice and are thus easily recognized as having hepatitis. Consequently, recognition of hepatitis A outbreaks in the day-care setting is often dependent upon recognizing hepatitis A in adults (parents or staff) who have had contact with day-care centers (DCCs).
The initial recognition of DCCs as important sources of hepatitis A virus transmission both within the centers and in the communities they serve occurred in the mid-1970s.2,3 Early studies focused on describing the characteristics of DCCs in which hepatitis A outbreaks occurred, including DCCs with large numbers (≥50) of children in diapers and centers that are open more than 15 hours per day.2
Concurrent Session on Health Promotion: A Summary
Authors: Taras Howard L. , Trahms Cristine M. , Mangu Pamela B. , Wong Faye L. 
Published: December 2021

Health promotion in child care encompasses components of environmental health and safety, individual and group preventive health practices, medical care, and health education. Child-care providers, children in child day care, and their families have all been appropriate targets for such efforts. It is not surprising, therefore, that goals for health promotion have been vast, complex, and difficult to reach. The purposes of this session are to outline specific and essential elements of health promotion in child day care and to identify realistic ways to make progress toward achieving them.
HEALTH EDUCATION AND CHILD DAY CARE
To achieve a healthier environment in child day care, it is essential to raise the sense of awareness about the importance of preventive health practices. This is important for child day-care providers, parents of children attending child care, and children. Packaged health curricula for preschool-age children and toddlers have been designed specifically for child day-care settings. Although their ability to improve child health practices is still under investigation, these curricula serve to intensify awareness among children and providers about the importance of safety and hygiene. Health education for preschoolers can also be taught more informally and without a set curriculum. Child day-care providers can add a health component to other activities during the day. A few extra words added to statements made to preschoolers can transform routine instructions into health-promotion messages. "Let's wash our hands before we eat, so that we don't eat the germs that are on our hands after playing outside" is an example.
Rey-Martinez Kangaroo Mother Program: An Alternative Way of Caring for Low Birth Weight Infants? One Year Mortality in a Two Cohort Study
Authors: Charpak Nathalie , Ruiz-Peláez Juan G. , Charpak Yves 
Published: December 2021

Objectives. To assess the effectiveness and safety of the Kangaroo mother intervention (KMI).
Design. Observational, analytic, prospective (two cohorts) study.
Setting. Two large tertiary care obstetric hospitals, one offering "traditional" care and the other KMI.
Patients. Newborn infants with birth weights ≤ 2000 g, who survive the neonatal period and are eligible for an in-patient minimal care unit (MCU) (having overcome major adaptation problems to extra uterine life).
Interventions. "Kangaroo infants" (KI) were discharged as soon as they were eligible for MCU, regardless of weight or gestational age. Infants were kept 24 hours a day in an upright position, in skin-to-skin contact and firmly attached to the mother's chest until the KMI was not tolerated anymore. Control babies (from the other facility) were kept in incubators at the MCU until they satisfied usual discharge criteria for the control hospital. Both groups were followed periodically up to the age of 1 year.
Results. Three hundred thirty-two eligible infants were recruited, 162 at the Kangaroo hospital and 170 at the control hospital. KI came from a much lower socioeconomic class and were more ill before eligibility. Relative risk of death was higher for KI (RR 1.9), although this figure was reversed after adjusting for weight at birth and gestational age (RR 0.5). KI grew less in the first 3 months and had a higher proportion of developmental delay at 1 year, and a multivariate analysis failed to control for the large baseline differences in socioeconomic levels and babies' health status between the two cohorts.
Conclusions. In spite of major baseline differences between studied cohorts, the survival of LBW infants in Bogotá is similar between the KMI and the "traditional care". Questions remain about quality of life, especially regarding weight gain and neurodevelopment, that may be answered by a Randomized Controlled Trial.
Evaluating the Accuracy of Transcribed Computer-Stored Immunization Data
Authors: Wilton Richard , Pennisi Alfred J. 
Published: December 2021

Objective. To evaluate the accuracy of immunization records transcribed into a computer-based immunization tracking system and to assess factors that contribute to inaccurate or incomplete immunization record keeping.
Design. Computer-stored immunization records were analyzed for 2098 children up to 2 years of age at the time of their most recent well-child visit to the UCLA Children's Health Center over a 12-month period. For children whose immunizations were not up to date, the computer-stored records were analyzed for sources of inaccuracy by comparison with the handwritten records from which the computer-stored data were transcribed.
Results. An underimmunization rate of 22.5% (472 of 2098) was observed based on analysis of the computer-stored records. Comparison of the computer-stored and handwritten records revealed an overall transcription error rate of at least 10.2%. In addition, 38.4% of these apparently underimmunized children had received unrecorded immunizations from providers outside UCLA. When transcription errors were corrected and other available sources of immunization data were taken into account, the estimated rate of underimmunization decreased from 22.5% to 10.9%.
Conclusion. Unavoidable inaccuracies can diminish the utility of the data recorded in an immunization tracking system. Some inaccuracies are related to the process of transcription, but failures to record and communicate immunization data consistently also contribute to the inaccuracy of computer-stored immunization records.
Letter to the Editor
Authors: Miller Anton R. 
Published: December 2021

Drs Bess and Paradise are to be commended on their timely, intelligent, and well-informed response1 to the National Institutes of Health (NIH) Consensus Statement2 that advocates universal screening for infant hearing impairment. I share their concerns and have been arguing along similar lines since the release of the statement.
It is lamentable that so many of the recommendations we make as dinicians involved in the care and habilitation of children with permanently impaired hearing are based on theoretical assumptions, anecdotal evidence, and impressions informed by "clinical experience."
Clinical Features and Viral Excretion in An Infant with Primary Human Herpesvirus 7 Infection
Authors: Asano Yoshizo , Suga Sadao , Yoshikawa Tetsushi , Yazaki Takehiko , Uchikawa Takashi 
Published: December 2021

Objective. To find clinical features of a virologically-confirmed patient with primary human herpesvirus 7 (HHV-7) infection and a relationship of the excretion of viruses between HHV-7 and human herpesvirus 6 (HHV-6).
Patient and Methods. A 13-month-old boy who had a known prior history of exanthem subitum at 6 months of age developed fever for 3 days and a skin rash appeared as the fever was resolving. The course was accompanying with nonspecific signs and symptoms such as anorexia, irritability, mild diarrhea, palpebral edema, mild inflammation of pharynx, and mild occipital and cervical lymphadenopathy. Heparinized blood samples were used for isolation of HHV-6 and HHV-7 and detection of both virus DNA sequences by a nested polymerase chain reaction (PCR) amplification. Samples from other body sites were also tested for their DNA sequences using the PCR. Both virus antibody activity was measured by an indirect immunofluorescent assay or a neutralization test.
Results. Cultured mononuclear cells from the patient at the acute stage of the disease produced morphologic changes, which reacted only with the monoclonal antibody to HHV-7 but not with the antibody to HHV-6. Both viruses were not isolated from blood obtained at the convalescent stage. An antibody response of the patient indicated a seroconversion to HHV-7 but not to other microbial agents including HHV-6 and Mycoplasma pneumoniae. Both virus DNA sequences were detected in peripheral blood mononuclear cells at acute and convalescent stages. HHV-7 DNA was excreted into saliva and transiently into stool at an early convalescent stage followed by HHV-6 excretion into saliva. No HHV-7 and HHV-6 was excreted into urine.
Conclusions. Clinical features of a virologically confirmed patient with primary HHV-7 infection were comparable with those of primary HHV-6 infection and HHV-7 infection may reactivate HHV-6.
Can Magnesium Sulfate Reduce the Risk of Cerebral Palsy in Very Low Birthweight Infants?
Authors: Nelson Karin B. , Grether Judith K. 
Published: December 2021

Objectives. To investigate whether in utero exposure to magnesium sulfate (MgSO4) was associated with a lower prevalence of cerebral palsy (CP) in infants born weighing &lt;1500 g.
Design. Singleton infants weighing &lt;1500 g at birth (very low birthweight, VLBW) and surviving to 3 years with moderate or severe congenital CP were identified among 155 636 children born 1983 through 1985 in four California counties. VLBW children with CP were compared with randomly selected VLBW control survivors with respect to whether their mothers received MgSO4 to prevent convulsions in preeclampsia or as a tocolytic agent, and other information abstracted from labor and delivery records.
Results. During the admission for delivery, 7.1% of the 42 VLBW infants with later CP and 36% of the 75 VLBW controls were exposed to MgSO4 (odds ratio (OR) .14, 95% confidence interval (CI) .05, .51). The overall association of MgSO4 with reduced risk of CP was also observed in the subgroup of infants born to women who were not preeclamptic (OR .25, CI .08, .97). Infants with CP were less often exposed antenatally to MgSO4 whether or not there was cotreatment with non-MgSO4 tocolytics (other tocolytics administered, OR for MgSO4 exposure .23, CI .06, 1.2; other tocolytics not administered, OR for MgSO4 .08, CI .02, .68), or antenatal corticosteroids (steroids given, OR for MgSO4 exposure .24, CI .06, 1.3; steroids not given, OR for MgSO4, .08, CI .02, .72). Apparent benefit of magnesium was observed in the presence or absence of a variety of characteristics of pregnancies, births, and infants.
Conclusion. In this observational study, in utero exposure to MgSO4 was more frequent in controls than in children with CP, suggesting a protective effect of MgSO4 against CP in these VLBW infants.