bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pregnancy Experience after Delivery of a Child with a Major Birth Defect: A Population Study
Authors: Davis Margarett K. , Khoury Muin J. , Erickson J. David 
Published: December 2021

Objective. Data from a large population-based, case-control study were analyzed to determine whether women giving birth to children with major birth defects have different subsequent pregnancy patterns than those giving birth to live-born babies without defects. Other studies examining this phenomenon have been smaller, have not been population-based, or have not addressed the different effects that a wide range of major defects might have on mothers' subsequent pregnancy rates.
Methods. Mothers of 4918 infants with major birth defects born from 1968 through 1980 in metropolitan Atlanta were compared with mothers of 3029 control infants, frequency-matched on birth year, birth hospital, and race.
Results. The pregnancy rate in the first 3 years after the index birth was higher among case mothers (36%) than among control mothers (30%, P &lt; .0001). This excess was seen for mothers of stillborn case infants (64%) and mothers of case infants who died in infancy (58%), but not for mothers of case infants who survived the first year of life (31%). Pregnancy rates varied by birth defect type. Maternal and infant factors varied among case and control subjects and influenced subsequent pregnancy rates.
Conclusion. The reproductive behavior observed in this study supports the theory that mothers of nonsurviving children with birth defects compensate by acting to "replace" the lost child. Reproductive behavior was also strongly associated with having completed a previous pregnancy and by the type of birth defect.
The Treatment of Attention-Deficit Hyperactivity Disorder in Tourette's Syndrome: A Double-Blind Placebo-Controlled Study With Clonidine and Desipramine
Authors: Singer Harvey S. , Brown Janice , Quaskey Shirley , Rosenberg Leon A. , Mellits E. David , Denckla Martha B. 
Published: December 2021

Objectives. Because psychostimulants can exacerbate preexisting motor/phonic tics in individuals with Tourette's syndrome (TS), a clinical trial was performed to examine the ability of clonidine and desipramine to modify attention-deficit hyperactivity disorder (ADHD) behaviors in children with TS + ADHD.
Methods. A double-blind, placebo-controlled protocol was used in which each subject served as his or her own control and received, in a randomly assigned fashion, 6-week medication cycles with clonidine (0.05 mg four times daily), desipramine (25 mg four times daily), and placebo.
Results. Thirty-seven children with TS + ADHD between the ages 7 to 13 years and of normal intellect were recruited, and 34 (31 males, 3 females) completed the entire protocol. Outcome measures for ADHD included Parent and Teacher Child Behavior Checklists (CBCL), continuous performance tests, and neuropsychologic tests of executive function. Several markers for ADHD were shown to improve significantly (P &lt; .05) after treatment with desipramine (parent linear analogue rating, parent CBCL "hyperactivity" subscale, and teacher CBCL subscales "nervous/overactive," "anxious," and "unpopular"). Improvement with desipramine was always superior to that noted with clonidine. Clinical improvement did not correlate with drug blood levels. On measures of tic severity, neither drug made tics worse. Desipramine showed a statistically significant improvement on a global linear analogue scale, but not on the Hopkins Motor/Vocal Tic Severity Scale, the Tourette Syndrome Severity Scale, or the Yale Global Tic Severity Scale. Clonidine did not significantly alter tic severity on any measure.
Conclusion. The results of this study suggest that desipramine may be a useful alternative for the treatment of symptoms of ADHD in children with TS.
Cranial Ultrasound Prediction of Disabling and Nondisabling Cerebral Palsy at Age Two in a Low Birth Weight Population
Authors: Pinto-Martin Jennifer A. , Riolo Stephanie , Cnaan Avital , Holzman Claudia , Susser Mervyn W. , Paneth Nigel 
Published: December 2021

Objective. To employ multivariate analytic techniques to assess the association between neonatal cranial ultrasound (US) abnormalities and subsequent cerebral palsy (CP), defined as disabling CP (DCP) or nondisabling CP (NDCP) depending on the level of motor dysfunction.
Design. Prospective cohort study.
Subjects and methods. The Neonatal Brain Hemorrhage Study enrolled a geographically representative sample of 1105 newborns 501 to 2000 g and obtained follow-up data on 777 (86%) of the 901 survivors at age two. One hundred thirteen children (14.6%) had motor findings severe enough to classify them as having CP. The 61 (7.9%) of these children who were disabled by their motor impairment we classified as having DCP. The remaining 52 (6.7%) who had definite neurologic findings (usually mild spastic diplegia) but without evidence of interference with daily living, we classified as having NDCP.
Results. In a multivariate logistic regression model of perinatal and postnatal variables, the following factors were found to be significant risk factors for DCP: parenchymal echodensities/lucencies or ventricular enlargement (PEL/VE) on cranial US (OR = 15.4; 7.6, 31.1), germinal matrix/intraventricular hemorrhage (GM/IVH) (OR = 3.5; 1.7, 6.9) and mechanical ventilation (OR = 2.9; 1.2, 7.1). Fully 93.4% of infants were correctly classified as to presence or absence of DCP on the basis of this model. Birth weight, gestational age, length of hospital stay, gender, race, plurality, presence of labor and Apgar score were not significant independent predictors of DCP. For NDCP, the only risk factor significant in the multivariate model was PEL/VE (OR = 5.3; 2.2, 12.6).
Conclusions. Among perinatal and postnatal factors, cranial US abnormalities are by far the most powerful predictors of disabling CP in low birth weight infants. Although PEL/VE was the strongest predictor, GM/IVH also appeared to independently contribute to the risk of DCP. NDCP in low birth weight infants appears to have a different risk profile than DCP. In particular, it is less closely related to US evidence of perinatal brain injury.
The Education of Pediatricians for Primary Care: The Score After Two Score Years
Authors: Charney Evan 
Published: December 2021

In a 1973 monograph on the education of physicians for primary care, Joel Alpert and I wrote, "There are two interrelated and serious problems in our present educational structure—not enough physicians enter primary care and those who do so are not adequately prepared for the job."1 Twenty years and many task forces and exhortatory editorials later, much the same could be said. But that conclusion would not be entirely fair: changes have indeed occurred in the subsequent two score years.
There is now clear consensus that a strong primary care system should be the linchpin of our nation's health care system, with 50 to 60% of physicians as generalists, 2,3 and the medical profession has at least professed to agree with that strategy.4
Efficacy of Albuterol in the Management of Bronchiolitis
Authors: Serwint Janet 
Published: December 2021

I read with interest the article by Gadomski et al entitled Efficacy of Albuterol in the Management of Bronchiolitis.1 It is a thoughtful study regarding an important question with careful attention to the inclusion and exclusion criteria. However, I have the following three concerns.
First of all, I am curious as to why the authors chose to measure outcomes at 30 and 60 minutes. The peak impact of nebulized albuterol is 1 to 2 hours after treatment while that of oral albuterol is 2 to 3 hours after the dose.
The Diagnostic Utility of Bronchoalveolar Lavage in Immunocompetent Children With Unexplained Infiltrates on Chest Radiograph
Authors: Rock Michael J. 
Published: December 2021

Objective. To assess the diagnostic utility of bronchoalveolar lavage (BAL) in a heterogeneous group of immunocompetent children with unexplained infiltrates on chest radiograph.
Design. This was a retrospective case series.
Setting. The setting was a tertiary care referral center in an urban children's hospital.
Patients. Twenty-five consecutive children, median age 4 years 6 months, had flexible bronchoscopy with BAL. Preprocedure diagnoses were right middle-lobe syndrome (3 patients), granulomatous lung disease (3 patients), adult respiratory distress syndrome (3 patients), and persistent infiltrate on chest x-ray (16 patients). The majority of patients were receiving parenteral antibiotics before bronchoscopy. BAL fluid was sent for bacterial, viral, fungal, and, if indicated, mycobacterial cultures.
Results. Twenty-seven procedures were performed in 25 patients. A specific diagnosis was made in eight (30%) of the procedures. Four patients had viral infections, two had fungal infections, one had a bacterial infection, and one had a mixed fungal and bacterial infection.
Conclusion. Submitting BAL fluid for bacterial, viral, and fungal culture can be helpful in diagnosing infection in immunocompetent children. Empiric antibiotic therapy remains the standard treatment for pneumonia in children. Bronchoalveolar lavage may yield a diagnosis in patients unresponsive to empiric antibiotics. Careful selection of patients, a bronchoscopist skilled in the procedure, and the risk/benefit ratio all must be considered.
Predictors of Failure of High-Frequency Oscillatory Ventilation in Term Infants With Severe Respiratory Failure
Authors: Paranka Michael S. , Clark Reese H. , Yoder Bradley A. , Null Donald M. 
Published: December 2021

Objective. To identify clinical factors in term neonates with severe respiratory failure that predict which neonates are unlikely to respond to high-frequency oscillatory ventilation (HFOV).
Design. This was a retrospective review of patient charts and medical records.
Patients. We studied 190 newborns treated with HFOV between July 1985 and December 1992. All patients were at least 35 weeks' estimated gestational age and had severe respiratory failure, defined as arterial to alveolar oxygen ratio (a/A ratio) of less than 0.2 or the need for peak inspiratory pressure greater than 35 cm H2O on conventional ventilation.
Results. Of the 190 patients, 111 (58%) responded to HFOV (HFOV responders), and 79 (42%) were placed on extracorporeal membrane oxygenation (ECMO) after HFOV failed to improve gas exchange (nonresponders). The two groups were similar in gender and birth weight. Factors associated with failure of HFOV to produce a sustained improvement in gas exchange were a diagnosis of congenital diaphragmatic hernia and more severe respiratory compromise as assessed by admission blood gas. Stepwise logistic regression analysis showed that a diagnosis of congenital diaphragmatic hernia/lung hypoplasia (CDH/LH) and the a/A ratio at initiation of and after 6 hours of HFOV were the only significant independent predictors of the need for ECMO. Among all the patients, the presence of CDH/LH or an initial a/A ratio of 0.05 or lower yielded a sensitivity of 74% and specificity of 77% in correctly identifying neonates in whom HFOV failed to produce a sustained improvement in oxygenation. When neonates with CDH/LH were excluded from analysis, the most significant predictor of failure of HFOV was the a/A ratio after 6 hours of HFOV. In neonates without CHD/LH, a 6-hour a/A ratio of 0.08 or lower discriminated responders from nonresponders (ie, treatment with ECMO) with a sensitivity of 77% and specificity of 92%.
Conclusions. In our patients, the presence of CDH/LH, severe respiratory failure (a/A ratio 0.05 or lower) at initiation of HFOV, and lack of improvement in oxygenation (a/A ratio 0.08 or lower after 6 hours of HFOV) were associated with failure of HFOV and treatment with ECMO. This information should help other centers to identify neonates who are at the greatest risk for requiring ECMO support and thus allow prompt transfer to an ECMO center.
Bacillus Calmette-Guérin Complications in Children Born to HIV-1-Infected Women With a Review of the Literature
Authors: O'Brien Katherine L. , Ruff Andrea J. , Louis Marie Albert , Desormeaux Julio , Joseph Delourdes Jules , McBrien Maureen , Coberly Jacqueline , Boulos Reginald , Halsey Neal A. 
Published: December 2021

Objective. To compare the risk of complications following Bacillus Calmette-Guérin(BCG) vaccination among children by maternal and infant HIV-1 infection status as part of an investigation of an outbreak of BCG complications.
Methods. A nonconcurrent cohort study of BCG complications among 125 infants born to HIV-1 seropositive and 166 infants born to HIV-1 seronegative mothers was conducted in Cité Soleil, Haiti. Infants were examined at regular intervals until 15 months of age, and complications from BCG were documented. An investigation of BCG vaccination practices was conducted.
Results. Mild or moderate complications occurred among 16 of 166 (9.6%) infants born to HIV-1 seronegative mothers compared with 4 of 13 HIV-1-infected infants (30.8%, P = .04) and 10 of 75 (13.3%, P = .39) uninfected infants born to HIV-1-infected mothers. No serious complications were noted. The outbreak of complications was associated with administration of 2.0 to 2.5 times the recommended dose of BCG vaccine.
Conclusions. This and five other cohort studies indicate that there may be a small increased risk of complications following BCG vaccination among HIV-1-infected children, but the reactions are usually mild and the risk does not outweigh the benefits of BCG vaccination in populations at high risk of tuberculosis during infancy and childhood.
Child Abuse Law
Authors: Frader Joel 
Published: December 2021

Pediatrics deserves congratulations for publishing the article by Clark1 on decisions to withdraw or withhold medical treatment in pediatrics. Clark is right to point out the disturbing discrepancy between federal and state standards on this important matter. A number of other important points deserve emphasis.
First, the American Academy of Pediatrics (AAP) policy statement, "Guidelines on Forgoing Life-Sustaining Medical Treatment,"2 developed by its Committee on Bioethics, was published earlier this year. Although guidelines do not constitute a standard of medical care, they do provide a useful approach that pediatricians might follow when faced with these difficult situations.
Direct Comparison of Sn-Mesoporphyrin, An Inhibitor of Bilirubin Production, and Phototherapy in Controlling Hyperbilirubinemia in Term and Near-Term Newborns
Authors: Kappas Attallah , Drummond George S. , Henschke Claudia , Valaes Timos 
Published: December 2021

Background. Sn-mesoporphyrin (SnMP) is a potent inhibitor of bilirubin production. In our previous studies a single dose (6 µmol/kg birth weight) significantly moderated hyperbilirubinemia and reduced phototherapy (PT) time by &gt;75% when administered within 24 hours of birth to preterm infants.
Objective. To directly compare the efficacy of SnMP and PT for controlling hyperbilirubinemia in term and near-term infants.
Methods. Two randomized, sequentially analyzed trials (Study I: male term infants; Study II: infants of both sexes and gestational age [GA] 245-265 days) were conducted. SnMP (6 µmol/kg birth weight) or PT (Phillips F20T12/BB lamps) was administered to paired infants according to strict criteria of plasma bilirubin levels and age. Time of enrollment and closure of cases and crossover, if necessary, of SnMP infants to PT or all infants to exchange transfusion were precisely defined in each pair. SnMP or PT was considered superior if the time between enrollment and closure of the case was reduced by &gt;24 hours over the alternative treatment or if crossover had occurred.
Results. None of the 44 SnMP-treated infants required supplemental PT. Of the 22 pairs of term infants enrolled in Study I, SnMP proved superior to PT in 20 and equal in two. Of the 20 pairs of near-term infants enrolled in Study II, SnMP was superior in 12 and PT in two; six were tied. Two SnMP-treated infants were unpaired. The PT-treated infants in Study I required an average of 33 hours of treatment; those in Study II, 48 hours. None of the enrolled infants required exchange transfusion or interruption of breast-feeding.
In both studies, times between case enrollment and closure were reduced by &gt;30 hours in SnMP compared with PT infants; requirements for additional days of medical observation and bilirubin measurements were also significantly less in SnMP infants.
Conclusion. A single dose of SnMP entirely supplanted the need for PT in jaundiced term and near-term newborns and significantly reduced medical resource use to monitor hyperbilirubinemia.
Information Processing and Developmental Assessments in 3-Month-Old Infants Exposed Prenatally to Cocaine
Authors: Mayes Linda C. , Bornstein Marc H. , Chawarska Katarzyna , Granger Richard H. 
Published: December 2021

Objective. To determine the effect of prenatal cocaine exposure on 3-month infant information processing and developmental assessments.
Methods. One hundred and eight infants, 61 cocaine-exposed and 47 controls, participated at 3 months of age in an infant-control habituation and novelty responsiveness procedure and in a developmental assessment using the Bayley Scales of Infant Development both administered by experimenters blind to the drug exposure status of the infant.
Results. Compared to the non-drug-exposed group, infants exposed prenatally to cocaine were significantly more likely to fail to start the habituation procedure and, for those who did, significantly more likely to react with irritability early in the procedure. The majority of infants in both groups reached the habituation criterion, and among those who did there were no significant difference between cocaine and non-cocaine-exposed infants in habituation or in recovery to a novel stimulus. Infants who were cocaine-exposed showed comparatively depressed performance on the motor (Psychomotor Developmental Index) but not the mental (Mental Developmental Index (MDI)) scales of the Bayley. These results obtained for habituation and Bayley MDI controlling for both perinatal and sociodemographic factors.
Conclusions. Differences in reactivity to novelty but not in information processing between cocaine-exposed and non-cocaine-exposed infants suggest that the effects of prenatal cocaine exposure may be on arousal and attention regulation rather than early cognitive processes.
Inter-Hospital Transport of Neonatal Patients on Extracorporeal Membrane Oxygenation: Mobile-ECMO
Authors: Heulitt Mark J. , Taylor Bonnie J. , Faulkner Sherry C. , Baker Lorrie L. , Chipman Carl W. , Harrell James H. , VanDevanter Stephen H. 
Published: December 2021

Objective. To describe the equipment, personnel requirements, training, management techniques, and logistic problems encountered in the design and implementation of a mobile extracorporeal membrane oxygenation (ECMO) program.
Design. This is a report of a technique for the transport of patients on ECMO and a description of our retrospective case series.
Settings. The study was conducted at a regional referral children's hospital and ECMO unit.
Patients. Thirteen neonatal medical patients with acute respiratory failure were transported with mobile-ECMO.
Results. Over a 24-month period, we transported 13 neonatal patients with mobile-ECMO. The reason for transport with mobile-ECMO was inability to convert from high-frequency ventilation (4 of 13), patient already on ECMO (1 of 13), and patient deemed too unstable for conventional transport (8 of 13). Eleven of the 13 patients were transported from other ECMO centers. Of the 13, 9 survived. No major complications during transport were reported for any of the patients. Follow-up data were available on all nine survivors of neonatal mobile- ECMO. Eight of these had normal magnetic resonance imaging scans of the brain; the ninth had a small hemorrhage in the left cerebellum.
Conclusion. Our limited series shows that patients can be safely transported with mobile-ECMO. This program does not replace the early appropriate transfer for ECMO-eligible patients to an ECMO center.
PROFIT LEVELS STAGNATING AT HOSPITALS
Authors: L. J. F. 
Published: December 2021

Profit margins at most hospitals across the country declined or stagnated last year, reflecting growing pressure on them to reduce costs. And health care executives said many hospitals would be under even greater pressure in 1995 if Congress enacted proposals that would slash spending for medical care for the elderly and the poor.
At investor-owned hospitals, the outlook is brighter, because many of them have moved aggressively to merge and cut costs. Profit at these hospitals has risen in the 1990s.
Why Supplemental Security Income Is Important for Children and Adolescents
Authors:   Committee on Children With Disabilities
Published: December 2021

The Supplemental Security Income (SSI) program for children is an important part of the federal government's social benefits program for children with special needs. The SSI program is a nationwide program administered by the Social Security Administration (SSA) that does the following:
• provides monthly cash payments based on family income,
• qualifies the child for Medicaid health care services in many states, and
• assures referral of SSI child beneficiaries into the state Title V Children With Special Health Care Needs program's system of care.
The SSA considers a child to be disabled if:
• the impairment-physical or mental, or chronic medical condition-is as severe as a condition that would keep an adult from working,
• the condition is expected to last a long time or is life threatening, and
• the child is unable to engage in the everyday activities that most children the same age can do.
Congress implemented the children's component of the SSI program in 1974 in recognition that disabled children who live in low-income households are among the most disadvantaged of all Americans and therefore deserve special assistance. The cost of caring for a child with special needs is an especially heavy burden for families with limited resources. The intent of the SSI program is to reduce the additional deleterious environmental effects that a low family income can have on the growth and development of the disabled child and thereby help these children become self-supporting members of society.
The SSI program provides cash benefits.
ON WAITING LIST BEFORE BIRTH
Authors: L. J. F. 
Published: December 2021

In May 1991, an ultrasound examination revealed that a 17-week fetus had a potentially fatal heart malformation. Thirteen weeks later, doctors at the University of Pittsburgh put the fetus on a list of patients awaiting human hearts for transplant.
At 35 weeks, when the fetus was mature enough to live outside the womb, the baby was delivered and became the world's youngest heart transplant patient. But the baby died when she was 3 1/2 months old...
Last year, there were just 71 heart transplants in babies in the United States, and 18 percent to 37.5 percent of babies die before a heart can be found. So, Dr. Frager said, in listing a fetus before it was even mature enough for a transplant, the doctors "wanted to give their patient a leg up."