bluuebunny/crossref_metadata_2025_split huggingface dataset:
High-Frequency Jet Ventilation in the Early Management of Respiratory Distress Syndrome Is Associated With a Greater Risk for Adverse Outcomes
Authors: Wiswell Thomas E. , Graziani Leonard J. , Kornhauser Michael S. , Cullen James , Merton Daniel A. , McKee Linda , Spitzer Alan R. 
Published: December 2021

Objective. The objective of this investigation was to determine if high-frequency jet ventilation (HFJV) used early in the treatment of premature infants with respiratory distress syndrome was effective in reducing pulmonary morbidity without increasing the occurrence of adverse neurologic outcomes.
Study Design. A total of 73 premature infants who met the inclusion criteria (gestational age of less than 33 weeks, birth weight of more than 500 g, age of less than 24 hours, need for assisted ventilation with peak inspiratory pressure of more than 16 and FIO2 more than 0.30, and roentgenographic evidence of respiratory distress syndrome) were randomized to either conventional (n = 36) or to high-frequency jet (n = 37) ventilation. Our goals were to maintain the infants on the assigned ventilator for at least 7 days unless they could either be extubated or meet crossover criteria. Univariate analyses were initially used to compare the two groups. Stepwise logistic regression was subsequently used to assess whether various factors independently influenced adverse outcomes.
Results. The two groups of infants were similar in all obstetrical, perinatal, and neonatal demographic characteristics. The mean birth weight and gestational age in the conventional group were 930 g and 26.6 weeks and in the HFJV group, 961 g and 26.9 weeks. The infants were randomized at similar ages (7.1 and 7.3 hours of life, respectively). Their prerandomization ventilator settings and arterial blood gases were nearly identical. There were no differences in pulmonary outcomes (occurrence of air leaks, need for oxygen or ventilation at 36 weeks postconception), and there were no differences in the mean number of days oxygen was required, number of days ventilated, or length of hospital stay. Infants ventilated with HFJV were significantly more likely to develop cystic periventricular leukomalacia (10 vs 2, P = .022) or to have a poor outcome (grade IV hemorrhage, cystic periventricular leukomalacia, or death) (17 vs 7, P = .016). Logistic regression analysis revealed HFJV to be a significant independent predictor of both cystic periventricular leukomalacia and a poor outcome. The presence of hypocarbia was not an independently significant predictor of adverse outcomes.
Conclusions. With the HFJV treatment strategy that we used, use of the high-frequency jet ventilator in the early management of premature infants with respiratory distress syndrome resulted in significantly more adverse outcomes than in those treated with conventional mechanical ventilation.
Would Better Adherence to Guidelines Improve Childhood Immunization Rates?
Authors: Lieu Tracy A. , Black Steven B. , Sorel Michael E. , Ray Paula , Shinefield Henry R. 
Published: December 2021

Objective. To evaluate the contribution of three provider practices to underimmunization of children with financial coverage for vaccines.
Design. Retrospective cohort study of children in a large health maintenance organization, based on computerized databases and chart review.
Setting. Large health maintenance organization in northern California.
Patients. The population included 24 268 children who had at least one immunization recorded in the health plan tracking system and had continuous health plan membership between 15 and 24 months of age in 1992 through 1993. The study group (N = 4691) were those who had missed one or more of the immunizations due during their second year.
Results. Most (57%) of the underimmunized children had made at least one clinic visit between 15 and 24 months of age. Among those underimmunized children who made well care visits, 90% had been partially immunized at the visit but had not been simultaneously given all vaccines for which they were eligible. When a provider did not give all possible vaccines simultaneously, there was a 9% chance that the child would go on to miss the remaining immunization. Simultaneous administration alone would have achieved full second year coverage of 30% of the underimmunized children in this population. Most underimmunized children (53%), including 35% of those children who had not made any well care visits, had made urgent visits between 15 and 24 months of age. Chart review of randomly sampled patients showed no obstacle or contraindication to immunization at 79% of urgent visits and at 71% of well care visits at which vaccines were withheld. A policy to use weekday urgent visits to promote immunization could potentially reach 27% of the underimmunized children.
Conclusions. Provider practices play an important role in underimmunization of children who have insurance coverage for vaccines. Of the three guidelines evaluated, simultaneous administration of all possible vaccines has the greatest potential effectiveness to improve coverage rates in this population. Other guidelines, such as immunizing at urgent visits, are potentially effective but their costs and logistics need further study.
A Randomized Controlled Trial of Prenatal Pediatric Visits for Urban, Low-income Families
Authors: Serwint Janet R. , Wilson Modena E. H. , Vogelhut Judith W. , Repke John T. , Seidel Henry M. 
Published: December 2021

Background. Prenatal pediatric visits have been recommended by the American Academy of Pediatrics to allow the pediatrician to counsel parents on infant care issues, establish a supportive relationship, and provide pediatric practice information to parents. We hypothesized that prenatal pediatric visits would have an impact on breastfeeding decisions, health care behaviors, health care utilization, and the doctor-patient relationship.
Methods. We conducted a randomized controlled trial of prenatal pediatric visits for urban, low-income families to measure the impact on breastfeeding decisions, infant car safety seat use, circumcision, health maintenance, and emergency room visits and the pediatrician's perception that he/she would know the mother better. Pregnant women were recruited prenatally from the obstetrics clinic. Outcomes were measured by maternal interview prenatally and when the infant was 2 months old, in addition to review of the nursery record. Physicians were interviewed after the 2-month visit. Health care utilization was measured by chart review at 7 months.
Results. A total of 156 pregnant women were enrolled and randomized, 81 to the intervention group and 75 to the control group. Of mothers who breastfed, 45% in the intervention group changed their mind in favor of breastfeeding after enrollment compared with 14% in the control group. Mothers in the intervention group compared with the control group were more likely to make fewer emergency room visits, 0.58 compared with 1.0. Pediatricians were more likely to think that they knew mothers in the intervention group well, 54% versus 29% in the control group, yet 67% of mothers in both groups agreed their pediatrician knew them well. There were no differences between groups in initiation or duration of breastfeeding at 30 or 60 days, infant car safety seat use, circumcision, or health maintenance visits.
Conclusions. Prenatal pediatric visits have potential impact on a variety of health care outcomes. Among urban, low-income mothers, we found beneficial effects on breastfeeding decisions, a decrease in emergency department visits, and an initial impact on the doctor-patient relationship. We suggest urban practices actively promote prenatal pediatric visits.
Parental Attitudes Do Not Explain Underimmunization
Authors: Strobino Donna , Keane Virginia , Holt Elizabeth , Hughart Nancy , Guyer Bernard 
Published: December 2021

Objective. This article describes the results of a community-based study to determine the effect of family knowledge and attitudes on the immunization rates of a random sample of children younger than 2 years in the poorest census tracts of Baltimore.
Design and Methods. The two sources of data were (1) parent interviews that provided data on knowledge, attitudes, and beliefs related to immunization and sociodemographic characteristics, and (2) medical record audits from which data on immunization status were obtained. The protection motivation theory, a model of behavioral change, was used to select the variables to assess the relation of parental attitudes with immunization status. A multivariate logistic regression analysis included only variables found to be significantly associated with immunization outcome in the preliminary analysis.
Results. Mothers were well informed and generally had favorable attitudes toward immunizations. Immunization status was more strongly associated with the sociodemographic characteristics of the children than with the protection motivation theory variables. Only two protection motivation theory variables were associated with more than one immunization outcome. The children of mothers who perceived that timing of vaccination did not matter were less likely to be immunized than children of care takers who thought that it did matter and children whose parents believed in the safety of multiple immunizations were less likely to be immunized than children whose parents did not hold this belief.
Conclusions. In this study, parents' attitudes and beliefs had little effect on their children's immunization levels. Interventions intended to heighten parental awareness about immunization may have little impact. In poor urban neighborhoods, African-American children whose mothers are young, have multiple siblings, and do not use the Women, Infants and Children program may be at highest risk for delayed immunization.
TOSSING TEN HEADS IN A ROW
Authors: Student  
Published: December 2021

[Think of a coin-tossing tournament.] One player tosses and the other calls; the winner advances. The winner of this tournament will be that single player who has won n consecutive coin-tosses without a loss, depending on how many rounds it takes to complete a tournament.
There is something strange and trivial about this tournament, but what is it? The winner does have a rather remarkable property. How often have you ever met anyone who just won, say, ten consecutive coin-tosses without a loss? Probably never. The odds against there being such a person might seem enormous, and in the normal course of events, they surely are. If some gambler offered you ten-to-one odds that he could produce someone who before your very eyes would proceed to win ten consecutive coin-tosses using a fair coin, you might be inclined to think this a good bet. If so, you had better hope the gambler doesn't have 1,024 accomplices (they don't have to cheat—they play fair and square). For that is all it takes 2 competitors) to form a ten-round tournament. The gambler wouldn't have a clue, as the tournament started, which person would end up being the exhibit A that would guarantee his winning the wager, but the tournament algorithm is sure to produce such a person in short order—it is a sucker bet with a surefire win for the gambler.
Comments From the Co-Editors
Authors: Dewitt Thomas G. , Roberts Kenneth B. 
Published: December 2021

"It takes about 6 to 12 months to learn how to practice in an office after completing a residency in pediatrics." This common assertion has been heard so frequently as to have become almost axiomatic. It reflects what has been termed the "residency-practice training mismatch," a problem more extreme in pediatrics than in any other specialty. The effort to combat the mismatch by providing pediatrics residents "real world" experience in community settings is not new, but the movement has taken on new momentum. The Residency Review Committee Program Requirements now mandate "structured educational experiences that prepare residents for the role of advocate for the health of children within the community." Several programs nationally have led the way in developing, implementing, and evaluating models in practices, schools, and various community agencies. The conference, of which this supplement is a summary, provided a "State of the Art" review of basic and applied educational principles for residency education in community settings.
The forerunner of the conference was an invitational symposium in Worcester, MA, on June 13 and 14, 1992, supported by the Maternal and Child Health Bureau. The 1992 conference brought together experienced, knowledgeable individuals from programs with education activities in their communities and served as the basis for the development of Pediatric Education in Community Settings. A Manual. The manual was supported by the Maternal and Child Health Bureau, the American Academy of Pediatrics, and the Ambulatory Pediatric Association. The 1996 national conference was designed to take place shortly after the printing of the manual, to reinforce basic elements of education—with special reference to education outside the hospital setting—and to promote active discussion and networking.
The "Angel Dust" States: Phencyclidine Toxicity
Authors: Cohen Sidney 
Published: December 2021

Phencyclidine (1-[1-phenylcyclohexyl]piperidine, PCP, hog, sheets, angel dust, Sernylan, and many other common names) is a primate anesthetic that has emerged as a common drug of abuse and as a medical emergency problem during the past few years. Phencyclidine abuse is primarily a youthful activity. It is associated with multiple clinical states, an unusual amount of aggressive behavior, and a variety of problems in management.1
Thirty years ago phencyclidine was developed as an intravenous anesthetic for humans, but the frequency and intensity of emergence deliriums made it unsuitable. It is currently used as a veterinary anesthetic. Because of the availability of its precursors, its ease of manufacture, and its relative inexpensiveness, it became a common street drug during the late 1960s. At that time it was sold when mescaline, psilocybin, or tetrahydrocannabinol was requested, and it served as a virtually universal adulterant for hallucinogens. Not highly regarded among users of psychedelics, it was only infrequently purchased under its own name. During the past few years the picture has changed. Now it is a preferred substance, the most widely available and used hallucinogen. It usually is consumed as part of a polydrug abuse pattern along with alcohol, sedatives, and marihuana.
PREVALENCE
The extent of its usage is not easily assessed, the wide variety of names and of dosage forms make surveys imprecise.
Pharmacologic Management of Childhood Asthma
Authors: Rachelefsky Gary S. 
Published: December 2021

Asthma is characterized by an increased responsiveness of the airways to various stimuli, which results in narrowing of the airways and in a prolongation of the expiratory phase of respiration; in the early phase the airway obstruction is usually completely reversible, either spontaneously or as a result of therapy. There are three therapeutic approaches to asthma: the avoidance of allergens and irritants causing or aggravating the disease; the use of immunotherapy; and the use of pharmacologic agents.
Increasing knowledge of the pathophysiologic aspects of bronchial asthma in the past decade has led to significant advances in its pharmacologic management. The basic alteration of respiratory function is an increased resistance to flow of air through the airway secondary to a combination of three factors: smooth muscle spasm, mucosal edema, and retained viscid secretions. In mild asthma and during remissions the airways less than 2 mm in diameter (the small airways) are obstructed, whereas during an acute attack and with chronicity, both small and large airways are involved. Although both phases of respirations are affected, the increased airway obstruction is more pronounced during expiration.
EVALUATION OF THE ASTHMATIC CHILD
The diagnosis of asthma is based on history, characteristic physical findings and laboratory tests. Asthmatic attacks of infants are usually associated with viral upper respiratory infections; the infants are usually febrile and frequently have otitis media.
Television and Children
Authors: Rothenberg Michael B. 
Published: December 2021

Much of the programming and commercial message content of television programs being watched by children and youth is potentially, and often demonstrably, a mental and physical health hazard to the young. This is particularly true for those viewers who are at high risk because of ongoing conditions, such as developmental disabilities, mental retardation, psychoses, and impulse disorders.
In recognition of this situation, the American Academy of Pediatrics and the American Academy of Child Psychiatry have both issued Position Statements on the effects of television viewing on children and youth. Both groups have recommended to their membership the inclusion, during their work with children and their families, of questions concerning the television viewing habits of the child and his on her family. Pediatricians and child psychiatrists have also been urged to make attempts to assess the impact of television viewing on children and youth and, where appropriate, make specific recommendations concerning viewing habits.
Pediatricians and child psychiatrists have been asked to familiarize themselves with current programs provided both by the commercial networks and the public broadcasting system which are deemed to have positive influences on the psychosocial growth and development of their child and adolescent viewers, so that this information can be passed on to children and their families.
Cost-Benefit of Urinary Tract Infection Work-up Debated
Authors: RAPKIN RICHARD H. , H. R. J. 
Published: December 2021

Several letters have been received questioning whether Dr Rapkin's proposal for work-up of children with one urinary tract infection (UTI) was realistic (Pediatrics in Review 1:133, 1979). Dr Weagly of the Quincy Clinic, Quincy, Illinois, pointed out that the cost in their clinic was as follows:
[See table in the PDF file]
He feels that it is unrealistic to expect a family to attempt to finance this expense. He ends his thoughtful letter with "I feel that there must be a middle ground that will help the patient and still keep expenses under control." Dr Berger of the University of New Mexico School of Medicine, comments similarly that Dr Rapkin's recommendations that patients with even one documented UTI should have radiographs to rule out associated anomalies of the urinary tract, would be very costly.
Controversies in Pediatrics: What Tests Are Indicated for the Child Under 2 with Fever
Authors: McCarthy Paul L. 
Published: December 2021

Most articles in PEDIATRICS IN REVIEW are presented in a didactic manner, sometimes more so than the authors would like. But other topics are still so controversial that to present only one side or one view would do disservice to authors and readers. From time-to-time we will present such controversies in pediatrics in this section. Such an instance is "fever in young children." Since the studies a few years ago that demonstrated bacteremia in more of these children than most of us previously suspected, all of us are more anxious than before about such children. Can we trust our clinical judgment as to who requires blood cultures and antimicrobial therapy? What tests are useful in making this difficult decision? McCarthy has done a series of studies over the years which he summaries below. But the experts do not always agree. Smith has added his view of the problem. Unfortunately, some things in medicine are still not so clear. But the reader will know that experts share his uncertainties.
R.J.H
One of the common reasons that a child visits the pediatrician is for the evaluation of a febrile illness. In our emergency room, 20% of children evaluated have a fever. Therefore, a well thought out approach to the febrile child is essential in pediatric practice.
Cancer in Adolescents
Authors: Finkelstein Jordan W. 
Published: December 2021

Cancer is the fourth leading cause of death in the adolescent age group, preceded only by accidents, homicide, and suicide. Table 1 lists by age, sex, and race cancer incidence rates (per million) for a three-year period (1969-1971) reported by the National Cancer Institute. Table 2 lists the most commonly involved sites. There are significant differences between the younger and the older age groups. With the advent of improved treatment, survival rates have increased. Table 3 lists the survival rates for the most common forms of cancer and includes all children under 15 years of age. Although survival rates are increasing, the majority of children with cancer still die. Table 4 lists cancer mortality rates for adolescents.
The issues involved in diagnosis, treatment, survival, and death present problems for all of those who care for the adolescent with cancer—the patient himself or herself, family and friends, the physician, and other health care professionals. The objectives of this article are: to increase awareness of the types of problems commonly encountered in caring for adolescents with cancer and to describe some of the ways of dealing with these problems. The problems are by no means clear-cut, and the suggested methods of dealing with them must be individualized to meet the needs of all involved.
Fetal Drug Syndromes: Effects of Ethanol and Hydantoins
Authors: Smith David W. 
Published: December 2021

We are now into the era of fetal medicine.* Most of the handicapping disorders of infants and children that we care for today are the consequence of problems in prenatal development. Though the majority of these problems appear to have a genetic basis, it is extremely important to recognize those which have an environmental etiology since they are more readily preventable. When a chemical agent becomes recognized as causing problems in fetal development, ie, as being teratogenic, every attempt should be made to prevent the exposure of the fetus to dangerous levels of that chemical agent. This information should reach all women of reproductive age who are receiving the teratogen or who are liable to receive it after conception.
Mothering before birth is direct mothering. It is direct in the sense that most chemical agents that the mother takes during pregnancy are also "taken" by the fetus. This is graphically portrayed in Fig 1.
If we can simply foster the concept of mothering from conception, this will be a major philosophic advance toward prenatal preventive medicine. For example, every woman needs to know that her cigarette smoking or alcohol ingestion is cigarette smoking or alcohol ingestion by the fetus. Just as she would not wish her infant to smoke or drink after birth, it is even more important that the fetus not be exposed before birth, by her own smoking or drinking.