bluuebunny/crossref_metadata_2025_split huggingface dataset:
Accelerated Idioventricular Rhythm: A Benign Arrhythmia in Childhood
Authors: MacLellan-Tobert Susan G. , Porter Co-burn J. 
Published: December 2021

Objective. To determine whether accelerated idioventricular rhythm (AIVR) is benign in pediatric patients.
Methods. The records were reviewed of all patients younger than age 15 years who had been diagnosed with a ventricular arrhythmia between 1976 and 1991.
Results. AIVR was diagnosed in 12 patients, ages 1 day to 15 years (mean, 8.9 years). In 3 patients the arrhythmia was discovered on ambulatory electrocardiographic monitoring after presentation with syncope or presyncopal symptoms. One patient had palpitations. The remaining diagnoses were made during routine examinations or at postoperative follow-ups for congenital heart disease. The AIVR rate ranged from 90 to 150 beats per minute. The rate was within 10 beats per minute of the preceding sinus rate in 11 patients. Echocardiograms were normal in 8 patients. Two patients had double-outlet right ventricles; 1 had repair of the tetralogy of Fallot; and 1 had abnormal ventricular septal motion. Seven patients were taking antiarrhythmia medication without control of the AIVR at presentation. Patients were followed for a mean of 68.4 months (range, 31 to 191 months). All patients were alive and asymptomatic, with normal activity at the last follow-ups.
Conclusions. Complete resolution of AIVR may not occur. However, AIVR seems to be a benign arrhythmia. Treatment was not effective in controlling the arrhythmia and is likely unnecessary.
HMOs AND THE NEW HEALERS
Authors: L. J. F. 
Published: December 2021

The illness: a pulled muscle.
The health plan's recommendations: A massage and a potion of healing herbs, including minced palmetto berries and chopped valerian root.
The patient's reaction: "Taking valerian root was a lot easier than some heavy prescription which might have knocked me on my tail," says Skip Dane, a professor at Brigham Young University in Provo, Utah, whose recent injury came about when he was lifting weights.
Clearly, this isn't your parents' health plan ...
... Treatments once scorned by the medical establishment (and still viewed warily by many doctors) are gaining coverage from health-maintenance organizations, insurance companies, and health alliances.
Recombinant Tissue Plasminogen Activator Treatment in Two Infants With Fulminant Meningococcemia
Authors: Zenz Werner , Muntean Wolfgang , Gallistl Siegfried , Zobel Gerfried , Grubbauer Hans M. 
Published: December 2021

Fulminant meningococcemia defines a life-threatening disease with acute onset, severe septic shock, and progressive hemorrhagic necrosis of the skin. Despite advances in intensive care, the case fatality rate of this disease is still between 30% and 50%.1-5
Disseminated intravascular coagulation (DIC) with deposition of fibrin and histologically demonstrable widespread microvascular thromboses contributes significantly to the pathogenesis.6-9 Impairment of fibrinolysis caused by elevation of plasminogen activator inhibitor 1 (PAI-1), the physiologic inhibitor of tissue plasminogen activator, is part of these clotting abnormalities and has prognostic significance; the extent of elevation of PAI-1 is correlated to the development of shock, renal impairment, and mortality.10,11
Treatment Guidelines for Lead Exposure in Children
Authors:   Committee on Drugs
Published: December 2021

This Policy Statement was retired October 2007.
The recent introduction of an effective oral chelating agent for the reduction of a body burden of lead and the changing standards of care for children exposed to lead prompted the Committee on Drugs to review the therapy for lead intoxication. This statement reviews the pharmacology of available chelating agents. Screening standards and detailed discussions of environmental control and nutritional management have been previously published by the American Academy of Pediatrics.1
Lead intoxication has been a problem throughout history. In the early 1940s it was recognized that the amount of lead in the urban industrial environment had increased to the point at which a striking number of children demonstrated hematologic effects and clinical signs of acute lead intoxication. Blood lead levels in children in the United States on average have decreased, and rarely are children seen with blood lead levels of greater than 70 µg/dL. Even in patients with levels of greater than 50 µg/dL, "classic" laboratory and clinical findings of lead toxicity, such as basophilic stippling and encephalopathy, are rarely seen.2 In the past, therapy was based on the ability of chelators to reverse the hematologic effects of lead and halt the progression of lead encephalopathy. The efficacy of chelation therapy for children without the hematologic or neurologic findings has yet to be demonstrated; a decrease in blood lead concentration is the only discernible goal for chelation therapy in this setting. Eliminating the source of lead exposure also can accomplish this result. A recent study of moderately lead-exposed children receiving chelation therapy failed to demonstrate any additional benefit of CaNa2-ethylenediaminetetraacetic acid (EDTA) compared with abatement at improving cognitive function.3
Letters to the Editor
Authors: Wolke Dieter , Meyer Renate 
Published: December 2021

We would like to thank Drs Hill and Hosking for their complimentary remarks. They believe that the statement by the accompanying comment to our paper1 by Carey,2 who considers cow milk allergy to affect only a small proportion of colicky infants, is far too dismissive of data published. Dr Carey, we assume, will answer himself. However, our own conclusions, drawn from published data available, are not so far removed from those of Carey.
The studies cited by Hill and Hosking3-5 in support of the thesis that cow milk protein intolerance (CMPI) is an important cause of colic have a number of methodologic problems.
Immunologic Response of Extremely Premature Infants to Tetanus, Haemophilus influenzae, and Polio Immunizations
Authors: D'Angio Carl T. , Maniscalco William M. , Pichichero Michael E. 
Published: December 2021

Objective. To determine whether extremely premature infants have immunologic responses to tetanus toxoid, Haemophilus influenzae type b polysaccharide and polio vaccines similar to those of full-term infants.
Infants and Methods. Sixteen extremely premature (&lt;29 weeks, &lt;1000 g at birth) infants received separate diphtheria-tetanus-pertussis and H influenzae type b oligosaccharide-CRM,197-conjugated (HbOC) vaccines at 2, 4 and 6 months of chronologic age, enhanced potency inactivated polio vaccine at 2 months, and oral polio vaccine at 4 months. Serum was obtained for anti-tetanus toxoid (TT), anti-Haemophilus b polysaccharide (HbPs) and polio neutralizing antibody assays before the 2-month vaccination and 4 to 6 weeks after the 6-month vaccination. Comparison sera were obtained from full-term infants immunized with the same lots of diphtheria-tetanus-pertussis (n = 46) and HbOC (n 66) vaccines or the same sequence of polio vaccines (n = 10).
Results. Preterm and full-term infants had similar geometric mean titers of anti-TT antibodies, anti-HbPs antibodies, and neutralizing antibodies to polio serotypes 1, 2, and 3 after the completion of the primary series of vaccines. After vaccination, similar proportions of preterm and full-term infants had protective levels of antibody to TT (preterm 100% vs full-term 100% with levels &gt;0.01 IU/mL), HbPS (82% vs 87%, &gt;1.0 µg/mL), and polio serotypes 1 (85% vs 80%, ≥1:8) and 2 (100% vs 100%, ≥1:8). Preterm infants were less likely than full-term infants to have protective levels of neutralizing antibody to polio serotype 3 (31% vs 90%, ≥1:8).
Conclusions. Extremely premature infants have adequate antibody responses to tetanus and HbOC antigens but may have diminished responsiveness to serotype 3 polio vaccine.
Research in Emergency Medical Services for Chi
Authors: Jaffe David M. 
Published: December 2021

Research is the key to future improvements in emergency medical services for chi (EMS-C). Ultimately these improvements should result in better prevention of childhood emergencies and better outcomes for children who experience emergency illness or injury. Research in EMS-C can be descriptive of the system and its users or focused on specific clinical or basic scientific questions. Descriptive research is needed to describe the EMS-C system, its users, the types of problems for which it is used, and the associated outcomes and costs. To facilitate the descriptive research, a uniform data set, a taxonomy of chief complaints, and a method of linkage among databases collected by different components of the system are needed.
Focused research efforts in clinical and basic sciences are also needed. The Institute of Medicine report identified seven research areas for highest priority: clinical aspects of emergencies and emergency care; indices of severity of injury and, especially, seventy of illness; patient outcomes and outcome measures; costs; system organization, configuration, and operation; and effective approaches to education and training, and prevention. Maturity of the subspecialty of emergency medicine will be indicated by the development of basic science research and epidemiology by physicians with clinical interests in emergency medicine. The most exciting discoveries are likely to come in areas that we have not yet imagined. Rapid development of meaningful research will require massively increased funding to support both the research itself and the training of future scientists to work in pediatric emergency medicine.
Anabolic-Steroid Use, Strength Training, and Multiple Drug Use Among Adolescents in the United States
Authors: DuRant Robert H. , Escobedo Luis G. , Heath Gregory W. 
Published: December 2021

Objective. This study examined the relationships between anabolic-steroid use and the use of other drugs, sports participation, strength training, and school performance among a nationally representative sample of US high school students.
Design. Randomized survey data from the 1991 Centers for Disease Control and Prevention Youth Risk Behavior Survey.
Setting. Public and private schools in the 50 United States and District of Columbia.
Patients. A total of 12 272 9th through 12th grade students.
Main Outcome Measured. Prevalence of anabolicsteroid use.
Results. The frequency of anabolic-steroid use was significantly associated with the frequency of use of cocaine, the use of other drugs such as amphetamines and heroin, tobacco smoking, and alcohol use. The weighted prevalences of anabolic-steroid use were higher among male (4.08%) than female students (1.2%). Students living in the South (3.46%) reported higher prevalences than students in the Midwest (3.0%), West (2.02%), or Northeast (1.71%). Students with self-perceived below-average academic performances (5.10%) and students reporting injected drug use also reported higher anabolic-steroid use (51.57%). Based on a multiple logistic regression, the following variables were found to be significant predictors of anabolic-steroid use: injectable drug use (odds ratio [OR], 17.86), use of other drugs (OR, 4.19), male gender (OR, 2.79), alcohol use (OR, 1.38), and strength training (OR, 1.73). The variables that were significantly associated with anabolic-steroid use varied by gender and by region of the country.
Conclusion. These data suggest that adolescent anabolic-steroid users in this country are more likely to engage in strength training, injected drug use, and the use of multiple drugs, even after controlling for sports participation and poorer academic performance. These data confirm previous findings of an association between multiple drug use and anabolic-steroid use. Also, engaging in strength-training exercises continued to be associated with anabolic-steroid use after controlling for drug use and other predictors.
Evaluation of Perinatal Outcome Using Individualized Growth Assessment: Comparison With Conventional Methods
Authors: Ariyuki Yasuhide , Hata Toshiyuki , Kitao Manabu 
Published: December 2021

Objective. To evaluate individualized growth assessment using the Rossavik growth model for detection of growth-retarded neonates with poor perinatal outcomes.
Methods. Rossavik growth models derived from second-trimester ultrasound measurements were used to predict birth characteristics of 154 singleton neonates. Individual fetal growth curve standards for head and abdominal circumference and weight were determined from the data of two scans obtained before 25 weeks' menstrual age and separated by an interval of at least 5 weeks. Comparisons between actual and predicted birth characteristics were expressed by the Growth Potential Realization Index and the Neonatal Growth Assessment Score (NGAS). The proportions of perinatal outcomes (mechanical delivery, low Apgar score, abnormal fetal heart rate [FHR] patterns, neonatal acidosis, meconium staining of amniotic fluid, neonatal intensive care unit admission, and maternal complications), using NGAS, were compared with those by the traditional birth weight-for-gestational age method and the ponderal index, respectively.
Results. Of the 154 fetuses studied, 120 had normal growth outcomes at birth; 18 showed evidence of intrauterine growth retardation; and 16 had macrosomia, based on NGAS. According to birth weight-for-gestational age classification, 32 fetuses were small for gestational age; 118 were appropriate for gestational age; and only 4 were large for gestational age. According to the ponderal index, 55 fetuses had growth retardation, 99 showed appropriate growth and there was no macrosomia. There was a significant increase in mechanical deliveries in cases of growth-retarded neonates, determined using the NGAS classification, when compared with events related to normally grown or macrosomic neonates. However, there were no significant differences in mechanical deliveries among the groups by birth weight classification or ponderal index. Both birth weight classification and NGAS classification showed a significant increase in the low Apgar score, abnormal FHR patterns, and neonatal acidosis in infants classified as growth retarded when compared with appropriately grown or macrosomic infants. However, there were no significant differences in the low Apgar score, abnormal FHR patterns, and neonatal acidosis between growth-retarded and appropriately grown infants when they had been so classified by ponderal index. Three growth category classification methods failed to reveal significant differences in meconium staining of amniotic fluid, neonatal intensive care unit admission, and maternal complications among the groups.
Conclusion. We do cast doubt on the usefulness of the ponderal index for detection of growth-retarded neonates with poor perinatal outcomes, and individualized growth assessment seems to perform at least as well as the traditional birth weight-for-gestational age method.
Reduction in Obstructive Breathing Events During Body Rocking: A Controlled Polygraphic Study in Preterm and Full-Term Infants
Authors: Groswasser J. , Sottiaux M. , Rebuffat E. , Simon T. , Vandeweyer M. , Kelmanson I. , Blum D. , Kahn A. 
Published: December 2021

Objective. To investigate the effect of body rocking on infant respiratory behavior during sleep.
Methods. Eighteen infants with documented obstructive sleep apneas were studied. There were eight premature infants with persistent bradycardias and 10 infants born full-term, admitted after an idiopathic apparent life-threatening event. No cause for the obstructive apneas was found. The infants were recorded with polygraphic techniques during two successive nights. They were randomly assigned to a rocking or a nonrocking mattress. The conditions were reversed the following night, in a crossover design.
Results. In both groups of infants, no significant difference was seen between the two consecutive nights for most of the variables studied: total sleep time, the proportion of non-rapid-eye-movement and rapid-eye-movement sleep, the number of arousals, the number and maximal duration of central apneas, the frequency of periodic breathing, the level of oxygen saturation, and heart rate. During the nonrocking nights, all infants had repeated obstructive breathing events. In seven of the eight preterm infants and in nine of the 10 full-term subjects, body rocking was associated with a significant decrease in the frequency of obstructive events. During rocking, in the preterm infants the obstructions fell from a median of 2.5 to 1.8 episodes per hour (P = .034). In the full-term infants, rocking reduced the obstructive events from a median of 1.5 obstructions per hour to 0.7 (P = .005). No difference was seen for the duration of the obstructive episodes.
Conclusion. In preterm and full-term infants prone to obstructive sleep apneas, gentle side-to-side body rocking is associated with a significant decrease in the frequency of upper-airway obstructions.
ABRAHAM JACOBI ON MASTURBATION IN CHILDREN
Authors: Combs S. 
Published: December 2021

Recently while conducting research on the father of American pediatrics, Dr Abraham Jacobi, I came upon an entire chapter in his Collectanea Jacobi, entitled "Masturbation and Hysteria in Young Children." His concern with the subject and its profound affect on the youth of his day was revealing. Masturbation at the turn of the century was believed not only to promote physical and moral weakness, but also was believed to be a major cause of multiple neuroses. Today, we attribute masturbation to a normal precursor of object-related sexual behavior that occurs in nearly all men and three quarters of women.1 Self-stimulation is a common event in infancy and just as the infant explores the remainder of its body, so does it explore its genitalia. However today, even as in Jacobi's time, such experiences are often strewn with guilt and ridicule.
Jacobi wrote the following: "It is this habit of masturbation in the infant and child, to which I here desire to draw attention. To what extent it is practised (sic) in more advanced years, and how it interferes with a robust physical, mental and moral development of adolescence is but too well known to both physician and pedagogue. But it has often appeared to me that its frequent occurrence in the quite young is by no means fully appreciated ... The causes of masturbation, no matter whether considered as an acquired habit or disease, are very serious indeed. I have positive knowledge of cases in which the habit was contracted by the treatment of infants, both male and female, at the hands of nurses on servants" (sic).
Improving Pediatric Residents' Alcohol and Other Drug Use Clinical Skills: Use of an Experiential Curriculum
Authors: Kokotailo Patricia K. , Langhough Rebecca , Neary Elizabeth J. , Matson Steven C. , Fleming Michael F. 
Published: December 2021

Objective. To evaluate the effectiveness of an experiential alcohol and other drug curriculum on pediatric residents' knowledge, attitudes, and skills in alcohol and other drug (AOD) issues.
Design. Nonrandomized control trial.
Setting. Two university pediatric residency programs.
Participants. Pediatric residents (n = 44).
Intervention. Intervention residents received an experiential AOD curriculum consisting of participation in an adolescent assessment program, interactive didactic sessions, role-playing practice, and interviewing skills sessions. The control group received no formal training.
Main Outcome Measures. Pretesting and posttesting each group using written and Objective Structured Clinical Examination evaluations using standardized patients. Evaluations were videotaped and scored by an expert panel using a standardized scoring process.
Results. Pretest comparisons of written knowledge and clinical skills as assessed by the Objective Structured Clinical Evaluation showed no significant differences between the intervention and the control groups. Analysis of written test scores revealed that residents' general knowledge as well as knowledge of screening techniques and management resources related to AOD issues increased significantly more for the intervention group than for the control group from pretest to posttest (P &lt; .001). Evaluation of the videotapes showed significant improvement for the intervention group compared with controls in overall score and in the use of specific screening techniques and interviewing skills (P &lt; .05). Self-assessment of residents' interest, confidence, and competence in AOD issues improved significantly for intervention residents vs controls (P &lt; .05).
Conclusions. Pediatric residents receiving an experiential AOD curriculum increased their knowledge and clinical skills in AOD issues significantly more than residents receiving no formal training. Similar curricula and evaluation could be used by other primary care residency programs and could be implemented in other areas of adolescent health risk behaviors.
Use of Dexamethasone in the Outpatient Management of Acute Laryngotracheitis
Authors: Cruz Minh N. , Stewart Gail , Rosenberg Norman 
Published: December 2021

Objective. Recent studies have demonstrated that a single intramuscular injection of dexamethasone (0.6 mg/kg) shortens the duration and severity of illness in hospitalized patients with acute viral laryngotracheitis (croup). Our objective was to determine if dexamethasone has a role in the outpatient management of patients with acute viral croup of moderate severity.
Methods. Patients, 6 months to 5 years of age, who came to the emergency department (ED) with acute viral croup, a croup score of at least 2 (range 0 to 17), and a disposition of discharge were randomized in a double-blind fashion to receive a single intramuscular injection of dexamethasone, 0.6 mg/kg, or an equal volume of normal saline before discharge from the ED. Patients were excluded if they had any structural abnormalities, had received any steroids in the preceding 24 hours, or if they required β-agonist therapy, more than one racemic epinephrine treatment, or hospitalization. Patients were followed up by telephone 24 hours and 7 to 10 days after discharge to determine whether additional medical attention was sought for perceived lack of improvement or worsening of symptoms. Secondary outcome included the parents' perception of how the child was doing at 24 hours, based on a 4-point ordinal scale: worse (1), same (2), improved (3), symptoms resolved (4), and the number of days it took for complete recovery.
Results. Of the 38 patients comprising the study group, 19 received dexamethasone. The median age was 19 months (range 6 to 66 months), and median pretreatment croup score was 3 (range 2 to 5) for both groups. The number of patients requiring racemic epinephrine was similar in both groups. Five patients sought additional medical attention within 48 hours. Four of the five patients had received placebo (21% of the placebo group) and one had received dexamethasone (5% of the steroid group) (not statistically significant). At the 24-hour telephone follow-up, significantly more patients in the dexamethasone group had a score consistent with improvement compared with placebo (84% vs 42%, P = .003). There was no difference in the number of days for symptoms to completely resolve between the two groups.
Conclusion. The use of dexamethasone in the outpatient management of viral croup was associated with a reduction in severity of illness within 24 hours after treatment. Patients with viral croup of moderate severity should be considered as candidates for the use of dexamethasone before discharge from the ED.