bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early Discharge of Newborns and Mothers: A Critical Review of the Literature
Authors: Braveman Paula , Egerter Susan , Pearl Michelle , Marchi Kristen , Miller Carol 
Published: December 2021

Objective. To determine whether research supports the advisability of early discharge of healthy newborns and mothers.
Methods. Critical review of English-language literature cited in the Index Medicus or the International Nursing Index.
Findings. No adequately designed studies have examined discharge before 48 hours after delivery without additional postdischarge services. Few studies have examined the consequences of recommending a clinic visit within the first days after discharge; studies of this practice among low-income populations found high no-show rates. Some small studies suggest that early discharge is likely to be safe for selected populations at low psychosocial, socioeconomic, and medical risk, with careful antenatal screening and preparation and multiple postpartum home visits. Some studies suggested adverse outcomes associated with early discharge even with early follow-up.
Conclusions. Published research provides little knowledge of the consequences of short maternal/newborn hospital stays or varying postdischarge practices for the general population. The studies that have concluded that early discharge was safe were applied under restricted circumstances or were too small to detect clinically significant effects on important outcomes. Further research is needed to inform clinical and reimbursement policy on health services in the first days of life and parenting. Rigorous studies of sufficient size are needed to examine the impact of different hospital stays and different postdischarge practices on a range of outcomes for mothers and newborns in diverse populations and settings. Given a priori concerns, decisions on neonatal/obstetric discharge planning should be made cautiously.
Kernicterus in Otherwise Healthy, Breast-fed Term Newborns
Authors: Maisels M. Jeffrey , Newman Thomas B. 
Published: December 2021

Objective. To document the occurrence of classical kernicterus in full-term, otherwise healthy, breast-fed infants.
Methods. We reviewed the files of 22 cases referred to us by attorneys throughout the United States during a period of 18 years, in which neonatal hyperbilirubinemia was alleged to be responsible for brain damage in apparently healthy, nonimmunized, full-term infants. To qualify for inclusion, these infants had to be born at 37 or more weeks' gestation, manifest the classic signs of acute bilirubin encephalopathy, and have the typical neurologic sequelae.
Results. Six infants, born between 1979 and 1991, met the criteria for inclusion. Their peak recorded bilirubin levels occurred 4 to 10 days after birth and ranged from 39.0 to 49.7 mg/dL. All had one or more exchange transfusions. One infant had an elevated reticulocyte count (9%) but no other evidence of hemolysis. The other infants had no evidence of hemolysis, and no cause was found for the hyperbilirubinemia (other than breast-feeding).
Conclusions. Although very rare, classic kernicterus can occur in apparently healthy, full-term, breast-fed newborns who do not have hemolytic disease or any other discernible cause for their jaundice. Such extreme elevations of bilirubin are rare, and we do not know how often infants with similar serum bilirubin levels escape harm. We also have no reliable method for identifying these infants early in the neonatal period. Closer follow-up after birth and discharge from the hospital might have prevented some of these outcomes, but rare, sporadic cases of kernicterus might not be preventable unless we adopt an approach to follow-up and surveillance of the newborn that is significantly more rigorous than has been practiced. The feasibility, risks, costs, and benefits of this type of intervention need to be determined.
Recommended Guidelines for Uniform Reporting of Pediatric Advanced Life Support: The Pediatric Utstein Style
Authors: Zaritsky Arno , Nadkarni Vinay , Hazinski Mary Fran , Foltin George , Quan Linda , Wright Jean , Fiser Debra , Zideman David , O'Malley Patricia , Chameides Leon , Cummins Richard O. 
Published: December 2021

This consensus document is an attempt to provide an organized method of reporting pediatric ALS data in out-of-hospital, emergency department, and in-hospital settings. For this methodology to gain wide acceptance, the task force encourages development of a common data set for both adult and pediatric ALS interventions. In addition, every effort should be made to ensure that consistent definitions are used in all age groups. As health care changes, we will all be challenged to document the effectiveness of what we currently do and show how new interventions or methods of treatment improve outcome and/or reduce cost. Only through collaborative research will we obtain the necessary data.
For these reasons, and to improve the quality of care and patient outcomes, it is the hope of the task force that clinical researchers will follow the recommendations in this document. It is recognized that further refinements of this statement will be needed; these recommendations will improve only when researchers, clinicians, and EMS personnel use them, work with them, and modify them. Suggestions, emendations, and other comments aimed at improving the reporting of pediatric resuscitation should be sent to Arno Zaritsky, MD, Eastern virginia Medical School, Children's Hospital of The King's Daughter, Division of Critical Care Medicine, 601 Children's Lane, Norfolk, VA 23507.
Water-Ski Douche Injury in a Premenarcheal Female
Authors: Perlman Sally E. , Hertweck S. Paige , Wolfe Walter M. 
Published: December 2021

In the last 15 years, seven cases of deep vaginal lacerations after the so-called water-skiing douche have been reported.1-4 We report the first such case in the premenarcheal girl.
CASE REPORT
A 9-year-old girl, Tanner stage 2, in otherwise excellent health, was transferred to Kosair Children's Hospital (Louisville, KY) after falling while water skiing and sustaining an injury producing persistent vaginal bleeding. This young girl was on her fifth trial of being up on water skis. She was wearing a single-layer, one-piece cloth bathing suit. The boat was traveling approximately 40 to 50 mph. She never was able to reach a full standing position.
Response to Drs Pappelbaum and Nazarian
Authors: Green John L. 
Published: December 2021

I liked Dr Pappelbaum's presentation a lot. My response? Read it; reread it; understand it; adjust to its doctrines; follow its prescriptions and program plan and be flexible and resilient. I totally concur with Dr Pappelbaum's belief that managed care need not be an end to one's pediatric career, but a program that can and must continue to work for our patients. Managed care will not go away; it is chronic, and we must adapt to it.
The theme of both Dr Pappelbaums's article and of this meeting—as a whole and for every part of it—is that change is the "here and now," and that we must adapt to it. The constant message is that pediatricians must go forward in their communities with all the peer help and all the consultative help that each can muster. They must work within the structure and boundaries of change, striving for the most benefit for the patients they care for and for themselves.
Dr Nazarian, whose presentation was equally excellent, has a good view of medicine now and medicine in the future. I have no challenge to his views or conclusions.
Like Dr Nazarian and like Dr Elsa Stone, who spoke yesterday, I employ pediatric nurse practitioners (PNPs) in my clinical practice. I am the senior partner of an eight-physician (four male and four female) practice in an academic community. We have two full-time PNPs and one physician assistant associated in our practice. As valued and contributing members of our health care team, they are true physician extenders.
Thriving in the 21st Century: Outcome Assessment, Practice Parameters, and Accountability
Authors: Bergman David A. 
Published: December 2021

The past two decades have brought about major health care changes that have been driven by an ever-increasing cost of health care, practice variability, and medical malpractice litigation. These changes pose a challenge to pediatricians to contain costs, to reduce inappropriate use of health care services, and to demonstrate improved health care outcomes. To meet this challenge, a new "clinical tool kit" is required, one that will allow the pediatrician to analyze current practices and to document effective interventions. Two of the major tools in this kit are practice guidelines and outcomes assessment instruments.
Practice guidelines are optimal care specifications that provide an analytic framework for defining high-quality care and measuring health care outcomes. Ideally, these guidelines should be developed from scientific evidence. In practice, however, scientific evidence to support the majority of recommendations made in guidelines is insufficient. Consequently, these recommendations are instead developed by expert consensus.
Measurement of health outcomes includes clinical outcomes, patient satisfaction, cost and use, and quality of life. Health care organizations have become very sophisticated in measuring cost and use, but considerably less work has been done in the patient-centered areas of satisfaction and quality of life. This is particularly true for children, because measures are dependent on the viewpoint chosen (parent, child, or teacher), the age of the child, and the adjustment for severity of illness.
Analyzing practice patterns and improving health outcomes will not be easy tasks to accomplish. For the pediatrician to use these tools in an efficient and effective manner, a new research agenda and new skills will be required.
Is a High-fiber Diet Safe for Children?
Authors: Williams Christine L. , Bollella Marguerite 
Published: December 2021

Objectives: Although dietary fiber is associated with important health benefits in childhood, there have been concerns that very high fiber diets may result in adverse health effects. This report reviews the major safety concerns associated with consumption of very high fiber diets, estimates the amount of fiber that may cause adverse physiologic effects in children, and proposes safe levels of dietary fiber intake for children and adolescents.
Methods. Published studies on dietary fiber intake in childhood were reviewed to determine major safety concerns, to document adverse effects, to characterize subjects involved and the dose and type of fiber consumed, and to estimate potential relevance to US children and adolescents. Levels of dietary fiber reported to have adverse health effects were compared with recommended levels of fiber intake for children older than 2 years of age.
Results and Conclusions. A review of the scientific literature suggests that a small loss of energy, protein, and fat may occur with a high intake of dietary fiber. However, this small loss of energy is unlikely to be significant to children consuming adequate levels of major nutrients, especially at conservative fiber intakes as recommended by the American Health Foundation's age plus 5 formula. In addition, it is estimated that even with a doubling of current dietary fiber, there is unlikely to be an adverse effect on serum vitamin and mineral concentrations in healthy US children consuming a balanced diet containing adequate levels of nutrients. Thus, evidence suggests that for US children, a moderate increase in dietary fiber is more likely to be healthful than harmful.
Effect of Urine Latex Agglutination Tests on the Treatment of Children at Risk for Invasive Bacterial Infection
Authors: Adcock Penny M. , Paul Ronald I. , Marshall Gary S. 
Published: December 2021

Background. Identifying febrile children with invasive bacterial infection is difficult in the absence of telltale physical findings. Urine latex agglutination (ULA) tests have been used for rapid, on-site identification of such children.
Objectives. To study the performance of ULA tests in identifying children with Haemophilus influenzae, Streptococcus pneumoniae, and group B streptococcus infection and to examine how the results of ULA tests affect patient treatment.
Design. Retrospective review.
Setting. Urban children's hospital.
Patients. All emergency department and hospital patients tested by ULA in 1990, excluding patients in the neonatal units.
Results. Of 1629 patients, 36 had positive tests (20 H influenzae, 5 S pneumoniae, and 11 group B streptococcus). Thirteen of these were false positive based on culture results. Although ULA tests demonstrated excellent specificity, their sensitivity was poor. Positive predictive values for bacteremia ranged from 0.346 to 0.600, and negative predictive values ranged from 0.972 to 0.997. The decision to treat with antibiotics was made before ULA test results were available in 19 (53%) of the 36 patients with positive test results. Of 1593 patients with negative test results, 1211 (76%) were admitted to the hospital, and approximately 81% were empirically treated with parenteral antibiotics.
Conclusions. In clinical practice, treatment and disposition decisions are frequently made without regard to ULA test results.
Lack of Autoantibody Expression in Children Born to Mothers With Silicone Breast Implants
Authors: Levine Jeremiah J. , Lin Hun-Chi , Rowley Merrill , Cook Andrew , Teuber Suzanne S. , Ilowite Norman T. 
Published: December 2021

Objective. We determined systematically the prevalence of autoantibodies in children born to mothers with silicone breast implants and the relationships with clinical symptoms and methods of exposure.
Methods. Autoantibody expression was determined in 80 children born to mothers with silicone implants and in 42 controls. A clinical assessment score was assigned to each patient. Antinuclear antibodies as well as antibodies to mitochondrial, smooth muscle, striational, myocardial, parietal cell, reticulin tissues, or subcellular compartments were measured by indirect fluorescent assay. Antibodies to nRNP (U1-RNP/snRNP); Sm; SS-A; SS-B; Scl-70; thyroid microsome; immunoglobulin (Ig)G, IgM, and IgA antibodies to cardiolipin; and antibodies to native and denatured human types I and II collagen were measured by enzyme-linked immunosorbent assay. Serum complement components C3 and C4 and IgM rheumatoid factor were measured by nephelometry.
Results. Autoantibody prevalence was not significantly different between children born to mothers with silicone implants and controls. The presence of autoantibodies was not related to the children's clinical symptoms or to the method of exposure.
Conclusions. Determination of autoantibody production is of limited clinical utility in the evaluation of children born to mothers with silicone breast implants.
The Role of 131 Iodine-Metaiodobenzylguanidine Scanning in the Correlative Imaging of Patients With Neuroblastoma
Authors: Andrich Mary P. , Shalaby-Rana Eglal , Movassaghi Nasser , Majd Massoud 
Published: December 2021

Objective. Metaiodobenzylguanidine (MIBG) scans were studied to determine the impact of the scan results on the clinical treatment of pediatric patients with neural crest tumors.
Methods. Serial scans were reviewed retrospectively for 27 patients with neural crest tumors: 25 with initial diagnoses of neuroblastoma (NB), 1 with ganglioneuroblastoma, and 1 with ganglioneuroma (GN). Results were compared with bone scans and computed tomography scans, as well as surgical pathologic findings.
Results. At initial diagnosis, when compared with bone and computed tomographic scans, MIBG imaging did not identify any unsuspected lesions that resulted in a change in staging. Thirteen patients with NB who had initially positive MIBG scan results had serial studies that normalized during therapy. However, after completion of therapy, 8 of 13 had relapses of the disease. Although areas of active disease were well delineated by other standard imaging modalities for all 8, only 4 (50%) had MIBG study results that were positive in sites of relapse. There were 4 cases of GN (1 at diagnosis and 3 after therapy for NB) demonstrating an uptake of MIBG that was similar in appearance to that in NB.
Conclusions. MIBG imaging did not change the staging or alter treatment during therapy for any patient. Normalization of positive study results was an unreliable indicator of outcome for children with NB. Furthermore, when relapse occurred, MIBG scans identified only 50% of those with active NB. The uptake of MIBG in GN was indistinguishable from that in NB. In this series, the results of serial MIBG studies did not have a significant impact on patient treatment.
Use of Health Services by Children Who Were Identified During the Postpartum Period as Being at High Risk of Child Abuse or Neglect
Authors: Leventhal John M. , Pew M. Catharine , Berg Anne T. , Garber Richard B. 
Published: December 2021

Objective. To examine the rates of hospitalizations of children identified as being at high risk of maltreatment compared with a sociodemographically similar comparison group.
Design. Retrospective study comparing a high-risk cohort with a sociodemographically matched comparison group at Yale-New Haven Hospital (New Haven, CT).
Patients. One hundred fourteen children who were identified from January 1979 through December 1981 by clinicians on the postpartum ward as being at high risk of abuse or neglect and 114 sociodemographically similar comparison children who were matched according to date of birth, race, gender, and method of payment for the hospitalization.
Main Outcome Measurer. During the first 4 years of life, the number of hospitalizations, reasons for admissions, and appropriateness of days in the hospital using the Pediatric Appropriateness Evaluation Protocol.
Results. Significantly more high-risk children were hospitalized (40% vs 22%; risk ratio, 1.84; 95% confidence interval, 1.23-2.74). High-risk children were hospitalized for 649 (mean, 9.0) days versus 124 (mean, 3.8) days in comparison children. For admissions for medical problems, 28% of hospital days in the high-risk group were considered inappropriate by the Pediatric Appropriateness Evaluation Protocol versus 8% in the comparison group.
Conclusions. There are substantial differences in the rates of hospitalizations, lengths of stay, and appropriateness of days in children identified as being at high risk of maltreatment compared with a sociodemographically similar, non-high-risk group. Preventive programs that are aimed at reducing rates of child maltreatment in high-risk young children also should examine the program's effects on the use of hospital care.
Effects of Polychlorinated Biphenyl/Dioxin Exposure and Feeding Type on Infants' Mental and Psychomotor Development
Authors: Koopman-Esseboom Corine , Weisglas-Kuperus Nynke , de Ridder Maria A. J. , Van der Paauw Cornelis G. , Th. Tuinstra Louis G. M. , Sauer Pieter J. J. 
Published: December 2021

Objective. To evaluate the effects of in utero and lactational exposure to polychlorinated biphenyls (PCBs) and dioxins on the mental and psychomotor development of infants.
Design. Prenatal PCB exposure was estimated from the levels in maternal plasma during the last month of pregnancy. Postnatal PCB and dioxin exposure of breastfed infants was calculated from levels in human milk samples and the duration of breastfeeding. Infants were examined at 3, 7, and 18 months of age with the Bayley Scales of Infant Development.
Setting. General community.
Participants. Voluntary sample of 207 mother-infant pairs. One hundred five infants were breastfed and 102 were bottle-fed.
Interventions. None.
Results. Higher in utero exposure to PCBs was associated with lower psychomotor scores at 3 months of age: a doubling of the PCB load resulted in a decrease of 3 points. Breastfed infants scored significantly higher on the psychomotor score at 7 months of age, compared with formula-fed infants. However, when corrected for confounders, the psychomotor score of the 66% highest-exposed breastfed infants (&gt;756 pg total PCB-dioxin toxic equivalent) was negatively influenced by this postnatal exposure to PCBs and dioxins, and was comparable to the psychomotor score of the formula-fed infants. Breastfed infants also scored higher on the mental scale at 7 months of age in a dose-dependent way. There was no significant influence of the perinatal PCB and dioxin exposure on the mental outcome at 3 and 7 months of age. At 18 months of age neither the mental nor the psychomotor score was related to perinatal PCB or dioxin exposure, nor to the duration of breastfeeding.
Conclusions. Prenatal PCB exposure has a small negative effect on the psychomotor score at 3 months of age. PCB and dioxin exposure through breastfeeding has an adverse effect on the psychomotor outcome at 7 months of age. The mental outcome at 7 months of age is positively influenced by breastfeeding per se; the perinatal exposure to PCBs and dioxins does not influence this outcome. At 18 months of age the development is affected neither by PCB and dioxin exposure nor by feeding type.
Recent Epidemiology of Group A Streptococcal Infections in North America and Abroad: An Overview
Authors: Kaplan Edward L. 
Published: December 2021

Feared for centuries as a major cause of infection-associated morbidity and mortality among infants, children, and adults, infections caused by the Group A beta-hemolytic streptococcus (Streptococcus pyogenes) and the associated public health problems declined remarkably by the close of the decade of the 1960s. Rather than hospitals being filled with children and adults with rheumatic heart disease or with suppurative sequelae such as mastoiditis, serious Group A streptococcal infections and their sequelae declined to the point where they have almost been considered a "nuisance". There have been relatively rare instances of surgical infections and there have been infrequent epidemics of pharyngitis. However, in North America, Europe, and most of the industrialized countries of Asia, epidemics of serious Group A infections and their sequelae essentially are unheard of. These infections and their suppurative and nonsuppurative sequelae have been much more of a medical and public health problem in many of the developing countries of the world, where few significant changes in their epidemiologic patterns have been evident. The primary manifestations of Group A streptococcal infections have been pharyngitis and superficial skin infections (impetigo) for most industrialized countries.
During the past 10 years, however, this has changed remarkably. Serious Group A infections and their suppurative and nonsuppurative sequelae have re-emerged as significant problems for physicians and for public health authorities. For example, mortality has been greater than 30% in some reported series. This fact has placed increasing pressure on primary care physicians to appropriately diagnose and treat these infections. Understanding the epidemiology can beneficially impact patient care and public health policies.