bluuebunny/crossref_metadata_2025_split huggingface dataset:
Infant Botulism
Authors: Glatman-Freedman Aharona 
Published: December 2021

Infant botulism was first described in 1976. It is caused by Clostridium botulinum, a gram-positive anaerobic bacillus found most commonly in soil and agricultural products. The organism forms spores and during growth and germination releases a potent neurotoxin that is responsible for the illness. Eight neurotoxins have been recognized, but infant botulism is caused primarily by organisms producing toxin types A and B.
Although adult-type botulism occurs by ingesting food contaminated with botulinus toxin, infant botulism seems to result from ingestion of spores that germinate and release the toxin inside the infant's colon. The toxin is absorbed from the gastrointestinal tract, travels via the blood stream, and binds irreversibly to peripheral cholinergic nerve synapses, where it prevents the release of acetylcholine.
The Pediatrician's Role in Caring for the Developmentally Disabled Child
Authors: Liptak Gregory S. 
Published: December 2021

Definition
The term "developmental disabilities" is used to describe a broad array of conditions that delay development and includes individuals who have "mental retardation." In 1992, the American Association on Mental Retardation defined mental retardation as an intelligence quotient (IQ) less than 70 or 75, with onset before age 18 years and limitations in two or more of the following adaptive skills: communication, self-care, home living, social skills, community use, self-direction, health and safety, functional academics, leisure, and work. This definition assumes that the testing performed was sensitive to differences in culture, language, communication, and behaviors and that the child's broadly defined environment was considered. Developmental disabilities may be isolated, as in the child whose vision is impaired, or may be multiple, as in the child whose fine motor, gross motor, and social functioning are delayed.
Epidemiology
Mental retardation has a prevalence of 10 in 1000 children. Specific common conditions and their prevalence per 1000 children include: cerebral palsy, 2; Down syndrome, 1; hearing impairment, 1; visual impairment, 1; and fragile X syndrome, 1. Delayed development is more frequent among children from low socioeconomic conditions. Developmental disabilities are encountered commonly in pediatric practice: Horwitz et al found that 5.3% of the patients encountered in a study of pediatric practices had cognitive and language disorders and that 4.0% had motor abnormalities.
Quality Improvement: An ACQIP Exercise on the Management of Otitis Media
Authors: Sebring Robert H. ,   Staff of the Division of Quality Care
Published: December 2021

As part of Pediatrics in Review's ongoing focus on quality improvement, we present a self-assessment exercise taken from the American Academy of Pediatrics' Ambulatory Care Quality Improvement Program (ACQIP). Tabulated responses of pediatricians who completed this exercise as part of the ACQIP program are presented on pages 253 to 254, allowing readers to see how their own answers compare and providing material for thought and discussion. Readers are encouraged to participate in the ACQIP program. Additional information can be obtained by calling or writing the Division of Quality Care, American Academy of Pediatrics, Box 927, Elk Grove Village, IL 60009-0927.
Monitoring Otitis Media
EDUCATIONAL OBJECTIVES
This exercise and the follow-up materials should help you identify areas of improvement in how your practice monitors and documents information for children with acute or chronic otitis.
INSTRUCTIONS
Beginning with tomorrow's appointments, answer the questions below for the most recent, but not the current episode of otitis media in the first 10 patients you see who are younger than 4 years of age and experiencing at least their second episode of otitis. You will need to review charts to answer the questions. Put a check in each box in which you find the information in your medical record listed.
Consultation with the Specialist
Authors: Brooks John G. 
Published: December 2021

Infants who experience apparent life-threatening events (ALTEs) usually generate enormous anxiety among family members and other caretakers and present diagnostic, management, and counseling challenges for the pediatrician. Important considerations for the primary care provider include the following:
1. What is the prognostic significance of the frightening event, particularly in relation to sudden infant death syndrome (SIDS)?
2. Which mechanisms and specific diagnoses should be considered as possible causes of ALTEs?
3. Which infants who present after an ALTE require hospitalization, and what diagnostic evaluation is appropriate?
4. What is the role for home cardiorespiratory monitors, and what is appropriate follow-up for infants who have suffered an ALTE?
Definition
ALTE should be considered a chief complaint rather than a specific diagnosis. In the standard established in 1986 by the National Institutes of Health (NIH) Consensus Development Conference on Infantile Apnea and Home Monitoring, ALTE is defined as "an episode that is frightening to the observer and is characterized by some combination of apnea (central or occasionally obstructive), color change (usually cyanotic or pallid but occasionally erythematous or plethoric), marked change in muscle tone (usually marked limpness), choking, or gagging. In some cases the observer fears that the infant has died." Previously used terminology, such as "aborted crib death" or "nearmiss SIDS," should be abandoned because it implies a possibly misleading close association between this type of event and SIDS.
Extending the Boundaries of Medicine
Authors: H R J 
Published: December 2021

Readers may be surprised to see the article "Separation or Synthesis: A Holistic Approach to Therapeutics" in this issue. There are no core content statements related to this article. Yet, from time to time, I exercise my editorial prerogative to publish something that is outside the usual—to stimulate, to look ahead to what may be important in the future, and to provoke our readers.
There is a great deal of interest today in alternative medicine. An article in The New England Journal of Medicine reports that nearly one third of Americans use some form of alternative medical therapy.1 There is now an Office of Alternative Medicine at the National Institutes of Health supporting grants in this field, and some health insurance companies recently began providing (for an added premium) coverage for these therapies.
Tracheomalacia
Authors: Paston Francine , Bye Michael 
Published: December 2021

Tracheomalacia (TM) is flaccidity of the tracheal wall caused by defective cartilaginous rings, resulting in reduced anterior posterior airway caliber. A relatively uncommon and usually benign lesion, TM manifests as a wheeze, stridor, and occasionally respiratory difficulty.
TM can result from either primary or secondary defects. Primary defects are intrinsic to the tracheal wall and most often are idiopathic, although some may result from endotracheal intubation. In preterm infants, primary TM may occur from positive pressure ventilation, and pathology distal to the endotracheal tube may be observed while the infant still is intubated.
Secondary TM results from external compression of the airway by a mass, such as a mediastinal tumor or a vascular ring.
Dosing Errors in the Use of Antiepileptic Drug Suspensions
Authors: Bunch Bonnie L. , Shelov Steven P. 
Published: December 2021

Liquid forms of antiepileptic drugs (AEDs) may be syrups or elixirs (in which the AED is in solution in water or alcohol, respectively) or suspensions. Suspensions consist of finely divided medication dispersed in an inactive carrier.
The following are common reasons for the use of liquid forms of AEDs: 1) ease of measurement of doses that do not correspond to available tablet or capsule form; 2) ease of administration to children or adults who are unable to swallow or chew capsule, tablet, or chewable tablet forms of the drug; and 3) for persons who must receive all enteral medications through nasogastric or gastrostomy tubes.
Behavioral Problems and Their Prevention
Authors: Chamberlin Robert 
Published: December 2021

In this article we will review two broad areas of knowledge (individual differences and parenting) that are directly or indirectly related to behavioral problems in young children and one specific problem area (toilet training).
INDIVIDUAL DIFFERENCES
One of the major advances in preventive pediatrics over the last ten years has been the recognition of how individual differences in the behavior and temperament of children affect parents and parenting. Although most parents with more than one child have intuitively recognized that all children are not alike, it is only fairly recently that many of us, as physicians, have acknowledged the fact that difficult children are not necessarily the result of bad parenting.
One of the most clinically useful ways of looking at individual differences has come from the research of Thomas and Chess. These investigators became interested in why, in many families, only one child would get into difficulty while the others were doing fine. Preliminary studies strongly suggested that environmental variables alone could not account for the range of variation in behavior seen within a single family context.
These observations led to a formal research project in which 136 children were followed from 3 months of age into adolesence. The study focused on how these babies differed from one another in the earliest months of life and the implications of these differences for the parents taking care of these infants.
Precursors of School Failure
Authors: Oberklaid Frank , Levine Melvin D. 
Published: December 2021

School failure is pervasive. Its impact extends beyond the classroom and can contribute to emotional turmoil, social difficulties, delinquent behavior and lifelong maladjustment. School failure does not qualify as a disease, a syndrome, or a unique pathogenetic process. It is rather the product of constitutional predispositions that have interacted with environmental factors and life events in an ongoing process. Intrinsic handicaps may be subtle. Their outward manifestations are likely to vary from child to child and evolve with age, shaped by neurologic maturation, experience, and changing external expectations.
Children with school problems form a heterogeneous group with diverse etiologies, symptom complexes, diagnostic findings and service needs. Nine common precursors of school failure are suggested in this review. Although presented individually, these precursors are not necessarily discrete, nor are they mutually exclusive; they may themselves stem from multiple factors. They are conceptualized as "risk factors" that may predispose to or foreshadow later failure. These, in turn, interact with a set of variables we have characterized as sources of "developmental buoyancy." The latter may neutralize or counteract early susceptibility to academic problems. Individual children may have one or multiple identifiable precursors of variable severity and differ in the extent to which they can minimize or overcome these potential predispositions to school failure.
Skin Tests in the Diagnosis of Allergic Conditions
Authors: Kravis Lillian P. 
Published: December 2021

Allergic disorders may be classified into four main categories of immunologic hypersensitivity reactions: type I, immediate or anaphylactic; type II, cytotoxic; type III, involving immune complexes; and type IV, delayed or cell mediated. Type I reactions are those most commonly encountered in clinical allergy. They may be well defined by skin testing, provided the patients to be tested are carefully selected and the tests are applied properly and interpreted critically.
Major indications for direct skin testing are: (1) to separate atopic from nonatopic patients; (2) to help in identifying specific allergens in atopic persons; and (3) to reassess the allergic profile in patients receiving immunotherapy. Other indications for skin-testing, of more limited applicability, include: (1) screening for hypersensitivity to vaccines; (2) testing for reactivity to drugs (and particularly penicillin); (3) testing for immediate and delayed reactions in such conditions as bronchopulmonary aspergillosis; and (4) in evaluation of patients with reactions to insect stings.
Skin-testing has limited usefulness in early infancy, in chronic urticaria, in the investigation of food allergies, in atopic dermatitis not accompanied by other manifestations of atopy, or in allergic reactions to drugs other than penicillin.
A checklist to be consulted prior to performing or interpreting skin tests should include: (1) assurance of the potency of the extract used in testing; (2) knowledge of the nonspecific irritant properties of any extracts used for testing; (3) history of administration of antihistamine drugs or epinephrine prior to testing; and (4) the correlation of skin test results with clinical history.
The help of a qualified allergist should be sought if: (1) skin test results are at variance with the historical data; or (2) systemic reactions are induced by skin testing; or (3) the patient fails to respond to the therapy dictated by the skin test results.
Alternatives or supplements to skin-testing include RAST testing and measurement of histamine release from sensitized leukocytes. These have rendered passive transfer testing (PK or Prausnitz-Küstner) substantially obsolete.
Direct allergy skin testing remains the most sensitive, most specific, and most reliable method presently available to the physician for investigation of IgE-mediated allergic disorders.
Editorial: Further Comments on the Evaluation of Febrile Children
Authors: MCCARTHY PAUL L. 
Published: December 2021

In a recent review in PIR, a sequence for the clinical and laboratory evaluation of Children ≤24 months with high fever was detailed.1 A key skill in assessing febrile children was described and termed "optimal observation." This assessment is performed prior to physical examination and, combined with laboratory evaluation, supplements data gathered from the physical examination. The review stimulated many comments from readers who questioned the need for such a vigorous approach. This interest is not surprising since fever in the young child is a common pediatric problem and also a diagnostic challenge.
Most discussion focused on three issues: (1) the occurrence of bacteremia in patients seen in private practice: most practitioners doubt that it occurs as frequently among private patients as among clinic patients; (2) the cost of a laboratory evaluation of a young, febrile child; (3) the data on which optimal assessment is based.
Persistence of the Fetal Circulation
Authors: Goetzman Boyd W. , Riemenschneider Thomas A. 
Published: December 2021

Persistence of the fetal circulation (PFC) was initially described as a syndrome of central cyanosis in term newborn infants resulting from right-to-left shunting of blood via persisting fetal channels which mimicked structural heart disease. Subsequently, this abnormal hemodynamic pattern has been recognized as a complication of a spectrum of neonatal disease. The designation PFC has achieved wide acceptance; however, other terminology may be encountered, including persistence of the transitional circulation and persistent pulmonary hypertension of the newborn.
PATHOPHYSIOLOGY
Muscular pulmonary arterioles are constricted in the term fetus. If these vessels fail to dilate at birth, or if constriction recurs, pulmonary hypertension (PHN) ensues, with consequent elevation of right ventricular and right atrial pressures. Right-to-left (R→L) shunting of blood across the foramen ovale occurs when right atrial pressure exceeds left atrial pressure. R→L shunting through the ductus arteriosus requires pulmonary arterial pressure to exceed systemic pressure, as well as patency of the ductus (see Fig 1).
PHN may independently be responsible for myocardial dysfunction by imposing an abnormal workload on the right ventricle or by adversely affecting right coronary artery blood flow with consequent subendocardial ischemia. The physiology of PFC is presented schematically in Fig 2.
There are two potential pathways to PFC (see Fig 3).
Mental Retardation: Biologic Aspects of Concern to Pediatricians
Authors: Opitz John M. 
Published: December 2021

1. Approximately 3% of the population (6 to 7 million persons in the United States) is mentally retarded. Of these, severe mental retardation (IQ &lt;50) occurs in about 10% (3 or 4 per 1,000 persons) and mild mental retardation (IQ 50 to 70) in 90%.
2. The high familial occurrence, the continuously variable phenotype shading into normality, and various genetic studies suggest that most of mild mental retardation represents the left end of the normal IQ distribution curve. Virtually no such cases can be found in the group of the severely retarded, either within or outside the institutions, suggesting that the majority of severe mental retardation represents discontinuous phenotypes due to chromosomal, environmental, mendelian, and multifactorial causes.
3. Some mild mental retardation represents syndromal occurrence (ie, mild PKU, rubella syndrome, Klinefelter syndrome); however, in most cases no anomalies are found, chromosomes are normal, height and head circumference fall within normal limits, and few have neurologic deficits, such as cerebral palsy and/or seizures. In the mildly retarded, personal, emotional and psychosocial problems predominate. The severely retarded are a biologically different group with a high incidence of gross neurologic disturbances, growth failure, abnormal head circumference, single or multiple malformations, and metabolic diseases.
4. The severely retarded are generally infertile, the mild retarded less fertile than average; however, a small minority among the latter contributes a disproportionately large number of retarded offspring to the next generation.
5. Most mental retardation can be evaluated on an outpatient basis for causal, pathogenetic, and prognostic factors. The evaluation can be economic, quick, reliable, painless, and efficient in most instances; however, CNS degenerative diseases may require a brief inpatient stay for biochemical evaluation. By all odds the most informative items in the work-up of the retarded are the (family and past) history and the (physical and neurologic) examination. Metabolic screening is usually not indicated in the malformed, neither are cytogenetic studies in the nonmalformed.
6. All patients with mental retardation deserve a diagnostic/causal evaluation and their families prognostic/genetic counseling.
7. Some 70% of mental retardation in the general population can be attributed to genetic causes. Genetic counseling in severe mental retardation is to prevent recurrence in siblings; in the mildly retarded much greater emphasis is placed on the prevention of retarded offspring.
Neural Tube Defects
Authors: GOLDEN GERALD S. 
Published: December 2021

A reader of the article "Neural Tube Defects" (PIR 1:187, December 1979) raised three questions: (1) Is there not newer information to indicate that the risk of recurrence is half of what has been previously quoted in the literature? (2) Does the sensory level defect follow the motor function? (3) Does not intermittent catheterization and drug therapy in the management of urologic problems produce a higher percentage of continence than is presented in this paper?
Dr Golden responds as follows: The question of recurrence risk in this country is not clean. Although it is generally recognized that the incidence is lower than in England, data for recurrence risk are not available.
Viral Hepatitis in Pregnancy: Problems for the Clinician Dealing with the Infant
Authors: Stevens Cladd E. , Krugman Saul , Szmuness Wolf , Beasley R. Palmer 
Published: December 2021

Stokes and colleagues first described transmission of hepatitis B virus (HBV) infection from a mother who was an HBV carrier to an infant born by cesarean section in 1954. Evidence of clinical hepatitis with jaundice, detected at 2 months of age, was later complicated by chronic active hepatitis. The infant died at 18 months of age with advanced cirrhosis of the liver.
In the past decade tests have been developed that are specific for hepatitis B antigens and antibodies and they have enabled physicians to identify acute hepatitis B infection during pregnancy, as well as the presence of a chronic carrier state. Thus it has been possible to assess the effect of maternal HBV infection on the newborn infant. The attack rate of HBV infection in infants has been reported to range between 10% and 70%. Infection is usually detectable by 1 to 3 months of age. Although most infections are asymptomatic, fulminant hepatitis is seen on rare occasions. Of major significance is the tendency for the infected infants to become chronic HBV carriers with possible progression to chronic active hepatitis, cirrhosis, and rarely hepatoma.
Hepatitis A virus (HAV) infection has not been a problem in the newborn. Hepatitis A is now an uncommon infection among adults in Western countries while in developing areas it is primarily a disease of childhood.
Intraventricular Hemorrhage in Premature Infants
Authors: Volpe Joseph J. 
Published: December 2021

Four major varieties of intracranial hemorrhage can be recognized in the neonatal period: (1) subdural hemorrhage, (2) primary subarachnoid hemorrhage, (3) intracerebellar hemorrhage, and (4) periventricular-intraventricular hemorrhage.1 Subdural hemorrhage, often related to obstetrical trauma, now is an uncommon lesion in most medical centers. Primary subarachnoid hemorrhage, although very common, is rarely of major clinical importance, because of its venous origin and self-limited course. Intracerebellar hemorrhage, commonly observed at postmortem examination of the small premature infant but rarely documented during life, is of uncertain clinical significance. Periventricular-intraventricular hemorrhage is the most common and serious variety of neonatal intracranial hemorrhage. The enormous importance of this lesion is linked to the remarkable improvements in recent years in neonatal intensive care and, as a consequence, in survival rates for small premature infants. Because periventricular-intraventricular hemorrhage is characteristic of the premature infant (particularly the infant less than approximately 32 weeks gestation), the lesion has reached nearly epidemic proportions in modern neonatal intensive care facilities.
INCIDENCE
The remarkably high incidence of periventricular-intraventricular hemorrhage is demonstrated dramatically by studies in which premature infants were subjected to computed tomography (CT) scan routinely within the first week of life (Table 1). Thus, 40% to 45% of all such infants exhibited periventricular-intraventricular hemorrhage.2,3