bluuebunny/crossref_metadata_2025_split huggingface dataset:
Increased Incidence of Severe Breastfeeding Malnutrition and Hypernatremia in a Metropolitan Area
Authors: Cooper William O. , Atherton Harry D. , Kahana Madelyn , Kotagal Uma R. 
Published: December 2021

Objective: To identify common characteristics among infants with breastfeeding malnutrition in a region with an increasing incidence of breastfeeding malnutrition.
Design. Retrospective case series.
Setting. A 361-bed regional tertiary care children's hospital in a 1.7 million population metropolitan area.
Patients. Case series: five infants with severe breast-feeding malnutrition and hypernatremia admitted to a tertiary care children's hospital over a 5-month period. Retrospective case review: 166 infants admitted between 1990 and 1994 with the diagnosis of dehydration, hypernatremia, or malnutrition.
Main Outcome Measures. Maternal characteristics, age at presentation, percent loss from birth weight, serum sodium, average age at birth hospital discharge, neurologic, or cardiovascular complications.
Results. Five infants were admitted to a children's hospital over a 5-month period with severe breastfeeding malnutrition and hypernatremia. The average weight loss at time of readmission was 23% (± 8%) from birth weight. The average presenting sodium was 186 ± 19 mmol/L. Three suffered significant complications. From 1990 through 1994, there was a statistically significant (P &lt; .05) annual increase in the number of infants admited with breastfeeding malnutrition and hypernatremia.
Conclusions. While breastfeeding malnutrition and hypernatremia is not a new problem, this cluster of infants represents an increase in frequency and severity of the problem and could be a consequence of several factors, including inadequate parent education about breastfeeding problems and inadequate strategies for infant follow-up.
Ultrasound Screening for Congenital Dysplasia of the Hips
Authors: Schimmer Michael 
Published: December 2021

I strongly disagree with the conclusion of Rosendahl et al1 concerning the efficacy of ultrasound screening of the hip (USH) in neonates.
I am engaged in a neonatal unit in a small hospital here (about 600 births per annum). In 1990 we started USH for all newborns. Nearly all babies are controlled after 6 to 12 weeks by an experienced orthopedist. There was a clear discrepancy between clinical and sonographic diagnoses in both directions (false positive and false negative by clinical investigation).
Antiphospholipid Antibodies in Pediatric Systemic Lupus Erythematosus
Authors: Seaman David E. , Londino A. Vincent , Kwoh C. Kent , Medsger Thomas A. , Manzi Susan 
Published: December 2021

Objective. Antiphospholipid antibodies (aPLs) have been extensively studied in adults with systemic lupus erythematosus (SLE) and have been associated with arterial and venous thrombosis, thrombocytopenia, neurologic disorders, and recurrent fetal loss. In contrast, very little is known about the frequency and clinical significance of aPLs in pediatric SLE. This study was designed to determine the frequency of aPLs in pediatric SLE and the temporally associated clinical manifestations.
Design. We studied 29 consecutive patients with onset of SLE in childhood seen in the Pediatric Rheumatology Clinic at the University of Pittsburgh, Children's Hospital, between 1985 and 1992. We defined aPL as the presence of a lupus anticoagulant (LAC), immunoglobulin G or immunoglobulin M anticardiolipin antibodies (aCLs), or a biologic false-positive serologic test for syphilis determined by a VDRL test. Clinical manifestations were temporally correlated to the presence of aPLs if they occurred within 6 months.
Results. Overall, 19 (65%) of 29 children with SLE had one of the three laboratory abnormalities defining aPL. LAC was detected in 16 (62%) of 26, aCL in 18 (66%) of 27, and false-positive VDRL test results in 11 (39%) of 28. Twenty-five of the 29 patients had all three tests performed. In 10 patients, all three tests were abnormal. The presence of thrombosis in 7 patients (4 venous, 2 arterial, and 1 both) was associated with a positive aPL, specifically aCL. The presence of an aPL was significantly associated with anti-double-stranded DNA antibodies, but not with neuropsychiatric manifestations or with thrombocytopenia. The presence of an aCL was significantly associated with hemolytic anemia. A prolonged prothrombin time, in the setting of an LAC (all with a prolonged activated partial thromboplastin time), was associated with life-threatening disease in 6 of 15 patients.
Conclusion. Sixty-five percent of 29 consecutive pediatric patients with SLE had evidence of aPL. The presence of aPL, specifically aCL, was significantly associated with thrombotic events. The presence of a prolonged prothrombin time in the setting of an LAC may be a marker of more serious disease in pediatric SLE.
Partial Deficiency of Surfactant Protein B in an Infant With Chronic Lung Disease
Authors: Ballard Philip L. , Nogee Lawrence M. , Beers Michael F. , Ballard Roberta A. , Planer Benjamin C. , Polk Lori , deMello Daphne E. , Moxley Michael A. , Longmore William J. 
Published: December 2021

Objective. To evaluate components of pulmonary surfactant and identify mutations in the surfactant protein B gene (SP-B) of a term infant with severe respiratory distress and chronic lung disease.
Patient and Testing. Respiratory distress developed in an infant delivered at term, and he required extracorporeal bypass support for 2 weeks. Until his unexpected death at 9.5 months, he was ventilator and oxygen dependent and required continual dexamethasone therapy. Tracheobronchial lavage samples were analyzed for content of surfactant proteins (SPs), and DNA from blood samples were sequenced and analyzed by polymerase chain reaction restriction analysis for the presence of SP-B gene mutations. Surfactant lipid composition and function, the contents of SPs and their messenger RNAs (mRNAs), and the immunostaining pattern for SPs were determined in postmortem lung tissue.
Results. The lavage sample contained SP-A but not SP-B, and DNA restriction analysis indicated that the patient and his mother were heterozygous for the previously described 121ins2 mutation of SP-B. Postmortem lung tissue contained normal levels of SP-A and its mRNA, a low but detectable level of SP-B, and near normal content of SP-B mRNA. SP-C was abundant on staining, and some 6-kd precursor was present in tissue. A surfactant fraction was deficient in phosphatidylglycerol and was not surface active. On DNA sequencing, a point mutation was found in exon 7 of the patient's SP-B gene allele without the 121ins2 mutation, resulting in a cysteine for arginine substitution, and the father was a carrier for the same mutation.
Conclusions. We describe a patient who is a compound heterozygote with a new mutation and only a partial deficiency of SP-B. Some forms of inherited SP-B deficiency may have low expression of immunoreactive and possibly functional SP-B with milder lung disease and longer survival. These infants may benefit from glucocorticoid therapy and may not develop antibodies to SP-B after either lung transplant or gene therapy.
Life Events, Cardiovascular Reactivity, and Risk Behavior in Adolescent Boys
Authors: Liang Sai-Woon , Jemerin John M. , Tschann Jeanne M. , Irwin Charles E. , Wara Diane W. , Boyce W. Thomas 
Published: December 2021

Background. Risk behavior contributes to injuries, one of the most important sources of morbidity and mortality in adolescents. Although research has shown that environmental stress makes adolescents more likely to engage in risk behavior and to sustain injuries, the magnitude of these associations has been small. Little is known about the role of individual differences in psychobiologic reactivity to stress in moderating the impact of stressful events. In this study, we examined associations among environmental stressors, cardiovascular reactivity to stress, and the level of risk behavior in adolescent boys.
Methods. Twenty-four 14- to 16-year-old boys underwent a laboratory protocol designed to measure responses to psychologically and physically stressful tasks. Changes in heart rate and mean arterial blood pressure were measured serially at standard points in the protocol, and levels of positive and negative life events and recent risk behavior were measured using self-report questionnaires.
Results. Neither life events nor cardiovascular reactivity were independently associated with risk behavior. Positive life events and mean arterial blood pressure reactivity significantly interacted, however, in predicting risk behavior (R2 increment = .25). Boys with high reactivity who reported numerous positive life events engaged in markedly less risk behavior than their peers.
Conclusion. We conclude that adolescents with exaggerated cardiovascular responses to laboratory stressors are associated with less risk behavior in a setting of positive life circumstances. This result suggests that reactivity may exert protective, rather than harmful, influences in some environments.
Prognosis With Preoperative Pulmonary Function and Lung Volume Assessment in Infants With Congenital Diaphragmatic Hernia
Authors: Antunes Michael J. , Greenspan Jay S. , Cullen James A. , Holt William J. , Baumgart Stephen , Spitzer Alan R. 
Published: December 2021

Objectives. To determine whether fatal pulmonary hypoplasia, as assessed by functional residual capacity (FRC), can be distinguished from other reversible causes of respiratory failure in infants with congenital diaphragmatic hernia (CDH).
Methods. In the present study, 25 term neonates having CDH without other anomalies (mean birth weight ± SD, 3.25 ± 0.50 kg) were enrolled prospectively into a protocol evaluating pulmonary function. Lung compliance (CL) and FRC were measured before diaphragmatic repair and compared with the highest oxygenation index (OI) and lowest PaCO2, also obtained preoperatively. Pulmonary function assessment was repeated after diaphragm repair on postoperative days 3 and 7. CL was determined by esophageal manometry and pneumotachography, and FRC was determined by helium dilution.
Results. Fifteen infants (60%) survived to hospital discharge. Eighteen (72%) required extracorporeal membrane oxygenation (ECMO) for support, and of these, 8 (44%) survived. PaCO2 was similar preoperatively in infants grouped as survivors without ECMO, survivors with ECMO, and nonsurvivors. In nonsurvivors (all of whom received ECMO), the preoperative OI was significantly higher (51 ± 21), CL was less (0.11 ± 0.04 mL/cm of water per kg), and FRC was smaller (4.5 ± 1.0 mL/kg) than in the survivors who required ECMO (26 ± 18, 0.18 ± 0.08 mL/cm of water per kg, and 12 ± 5 mL/kg, respectively), as well as in the survivors without ECMO, (6 ± 2, 0.32 ± 0.16 mL/cm of water per kg, and 15.8 ± 4 mL/kg, respectively). The group surviving with ECMO had a higher OI than the infants surviving without ECMO. All nonsurviving infants had FRCs of less than 9.0 mL/kg preoperatively. In contrast, only 2 of the 15 survivors had preoperative FRCs less than 9 mL/kg.
Conclusions. The results of this study suggest that preoperative assessment of FRC may predict fatal pulmonary hypoplasia in most infants with CDH.
Fasting Insulin Concentration Is Related to Cardiovascular Reactivity to Exercise in Children
Authors: Gutin Bernard , Islam Syed , Treiber Frank , Smith Clayton , Manos Tina 
Published: December 2021

Objective. One mechanism through which hyperinsulinemia is linked to hypertension is through its stimulation of sympathetic nervous activity. Thus, insulin concentration may be correlated with indices of sympathetic activity before it is associated with resting blood pressure. We tested this hypothesis by determining the relationship of insulin concentration and sympathetically mediated cardiovascular reactivity to exercise in children.
Design. Survey.
Setting. General community.
Participants. Volunteer sample of 46 black and white boys and girls, 9 to 11 years of age.
Interventions. None. Fasting insulin concentration was the main independent variable.
Main outcome measures. Systolic blood pressure and heart rate during a standard submaximal bout of treadmill exercise, and systolic blood pressure at peak effort.
Results. The hypothesis was tested by multiple regression analyses controlled for resting values. Insulin contributed significantly to the regression models for submaximal heart rate (P &lt; .001), submaximal systolic blood pressure (P = .001), and peak systolic blood pressure (P = .006).
Conclusions. Fasting insulin concentration is associated with cardiovascular reactivity to exercise in young children. This supports the hypothesis that the relationship between hyperinsulinemia and hypertension is mediated by sympathetic nervous tone and that the process begins in childhood. Because percent body fat was positively associated with both insulin and cardiovascular reactivity to exercise, prevention of childhood obesity may be a valuable prophylactic measure for these health problems.
Using Characteristic Changes in Laboratory Values to Assist in the Diagnosis of Hemorrhagic Shock and Encephalopathy Syndrome
Authors: Jardine David S. , Bratton Susan L. 
Published: December 2021

Objectives. (1) To determine whether the laboratory abnormalities in hemorrhagic shock encephalopathy syndrome (HSES) follow a characteristic pattern of evolution; and (2) to describe the clinical characteristics and outcome of this group of children.
Design. Retrospective review of hospital records.
Setting. Pediatric intensive care unit in an academic children's hospital.
Patients. Seventeen children who received the diagnosis of HSES.
Measurements. (1) To support the diagnosis of HSES, the following laboratory tests were obtained: creatine phosphokinase, alanine aminotransferase, aspartate aminotransferase, blood urea nitrogen, creatinine, anemia, thrombocytopenia, coagulation abnormalities, and a metabolic acidosis; and (2) patient characteristics at the time of admission and during the illness and patient outcome were recorded.
Results. The median time for laboratory abnormalities in HSES to reach the most aberrant levels was 1.2 to 1.4 days. After reaching maximal deviation, the laboratory values gradually returned to normal. The severity of laboratory abnormalities was not predictive of mortality. All patients were comatose, had seizures, and required fluid resuscitation. Respiratory failure occurred in 12 (71%) of 17 patients. Vasopressor infusions were used for 8 (47%). Viral cultures were performed in 15 patients and were positive in 8 (53%). Eleven (64%) patients survived.
Conclusions. The laboratory abnormalities that are characteristic of HSES follow a distinctive pattern of evolution during the course of the illness. Although the sensitivity, specificity, and predictive value of this pattern of laboratory abnormalities are not known, it might provide a useful tool in diagnosing HSES and excluding other illnesses. Viral illness is common in HSES. The severity of illness and mortality in this group of patients is similar to other descriptions of HSES.
HOW TO ASK THE RIGHT QUESTIONS IN ASSESSING AN ACADEMIC JOB OFFER
Authors: L. J. F. 
Published: December 2021

The relief and excitement afforded by a firm employment offer after at least 15 years of preparation account for the reluctance of many young scholars and scientists to examine the details critically. They are simply afraid that probing too deeply will ruin the deal and leave them without a job. So, perhaps some excessively cynical overkill is needed at this point to set the tone for the discussion to follow.
Naturally, once you are the recipient of such an offer, you want to assume that you were offered the position because you were the most meritorious candidate. Nothing could be farther from the truth. At best, you are the cheapest of several alternatives. Why is recruiting not being done at a higher level, say, full professor? Of course, cost is a factor; any competent department chairperson or director will seek to satisfy institutional requirements with the smallest possible outlay. At worst, you are seen as a potential sucker who might fall for a deal that no one else will accept. Intermediate possibilities are also distasteful—but you get the picture.
... Chairpersons come in innumerable styles, but only a few sources of motivation are strong enough to induce anyone to take such a thankless job. These are altruism, greed, ego, and survival instinct: corresponding chairperson types are Altruist, Parasite, Egoist, and Survivor. A leader motivated by one or another of these drives can affect departmental atmosphere and staff career development so strongly that this individual's personality must be considered part of the offer package.
Esotropia in a Child Treated With a Scopolamine Patch for Drooling
Authors: Good William V. , Crain Lucy S. 
Published: December 2021

Drooling in children who have neurodevelopmental disabilities can pose a substantial problem. Recent studies have indicated that, because of its anticholinergic effect, the use of a scopolamine patch may help eliminate drooling.1,2 The ease of administration of the patch, coupled with its very low side-effect Profile, adds to its desirability. However, we want to alert care givers to a problem we attribute to the scopolamine patch. Esotropia developed in one of our patients when scopolamine transdermal patching was done. The esotropia resolved shortly after cessation of patching.
CASE REPORT
This 4-year-old boy has spastic quadriplegia, a significant developmental delay, a well-controlled seizure disorder, and microcephaly secondary to a neonatal cerebrovascular hemorrhage associated with a protein C deficiency clotting disorder.
Recommended Childhood Immunization Schedule
Authors:   Committee on Infectious Diseases
Published: December 2021

The Recommended Childhood Immunization Schedule for 1995 was developed by the Committee on Infectious Diseases (COID) of the American Academy of Pediatrics in collaboration with the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) and the American Academy of Family Physicians (AAFP).1 Since the January 1995 publication, the AAP, ACIP, and AAFP have agreed on the following revisions:
1. The revised schedule is dated January-June 1996 and will be reprinted in July 1996 with any indicated changes. Incorporating dates in the chart will assure health care providers that they are using the most current schedule.
2. A column has been added to indicate that the second dose of hepatitis B vaccine can be administered at 1 month of age, provided that at least 1 month has elapsed since the first dose was given. Also, the doses of vaccine are provided in micrograms by individual product instead of volume, as several different concentrations of recombivax-HB (Merck, Sharp and Dohme) vaccine are available.
3. A bar has been added at 11-12 years of age to indicate that adolescents who have not previously received three doses of hepatitis B vaccine should initiate or complete the three-dose series.
4. Varicella zoster virus vaccine (Var) has been added to the schedule. In addition to the previously issued Academy recommendations, answers to commonly asked questions are addressed in a recent AAP News article.2,3
5. Information on inactivated poliomyelitis vaccine (IPV) has been added to reflect the Academy's current policy.
Examination Findings in Legally Confirmed Child Sexual Abuse: It's Normal to be Normal
Authors: Hobbs C. J. , Wynne J. M. 
Published: December 2021

This paper (Adams et al, Pediatrics. 1994;94:310-317) causes us great concern and if not challenged will be quoted by every advocate the world over to dismiss the validity of physical signs seen in association with child sexual abuse (CSA) at a time when experienced researchers are making sense of a difficult clinical area.
The legal data on the cases is incomplete, and any possible correlation between the physical signs and the crime committed was irrelevant because of plea bargaining but also poor clinical date.
How Safe Are Day Care Centers? Day Care Versus Home Injuries Among Children in Norway
Authors: Kopjar Branko , Wickizer Thomas 
Published: December 2021

Objectives. The study's objective was to examine and compare injury rates of children ages 6 months to 6 years in day care centers and homes. More specifically, we tested the hypothesis that the injury rate is lower in day care centers than at homes, as suggested by previous studies.
Methods. A comprehensive prospective injury registration was carried out in Stavanger, Norway, during 1992. We obtained data from this system to identify injuries occurring in day care centers, homes, and other places during 1992. Exposure-adjusted incidence rates were calculated to compare the risk of injury at day care centers, homes, and other places. We also obtained data from medical records on use and costs of medical care. In addition, a parent questionnaire was developed and used to gather data on the amount of injury-related restricted activity.
Results. Among 9454 children ages 6 months to 6 years in Stavanger, 770 injuries occurred during 1992: 96 in day care centers, 472 at home, and 202 at other places. For children ages 6 months to 2 years, the rate of injuries was significantly lower in day care centers than at home (1.2 and 2.5, respectively, per 100 000 children-hours), but for children ages 3 to 6, the rates of injuries were similar in day care centers and at home (1.3 and 1.5, respectively, per 100 000 children-hours). The great majority of children attending day care centers were from 3 to 6 years of age. No significant differences were found in the severity of the injuries.
Conclusions. For children ages 3 to 6 years, which included most of the children attending day care centers in Stavanger, Norway, day care centers were not found to be safer than homes. We think continuing attention should be paid to injury control in day care centers.
Research in Pediatric Residency Programs
Authors: Brouhard Ben H. , Doylel Wilma , Aceves José , McHugh Michael J. 
Published: December 2021

Background and Objectives. We have required residents in pediatrics at the Cleveland Clinic Foundation to give research presentations since 1989; this article reviews our experience with this program. Additionally, we sought to determine how many other accredited ted pediatric programs in the United States also require this.
Methods. Retrospective review of the Cleveland Clinic program; descriptive statistics of other United States residency programs, obtained by questionnaire.
Results. Pediatric residents at the Cleveland Clinic have given 108 research presentations since 1989, and have developed 33 (30.5%) of them into manuscripts or abstracts. We mailed questionnaires to 215 pediatric recidency program directors and received responses from 177 (82%). Of these, 48 (27%) indicated their programs had a research requirement; residents could present their findings in departmental meetings or submit an abstract or manuscript to a professional society or journal. Respondents cited several barriers to research: residents are too busy, there are too few faculty members to mentor them, financial resources are limited, and there is no residency review committee requirement.
Conclusions. Even though only approximately one fourth of the pediatric residency programs in the United States require research, we feel it is worthwhile experience. Despite barriers, residents can and do perform research and publish their findings.