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Showing papers in "Pediatrics in 1989"


Journal Article
TL;DR: Nicotine, psychotropic drugs, and silicone implants are 3 important topics reviewed in this statement that are important to protect nursing infants from untoward effects of maternal medication but also to allow effective pharmacologic treatment of breastfeeding mothers.
Abstract: The American Academy of Pediatrics places emphasis on increasing breastfeeding in the United States. A common reason for the cessation of breastfeeding is the use of medication by the nursing mother and advice by her physician to stop nursing. Such advice may not be warranted. This statement is intended to supply the pediatrician, obstetrician, and family physician with data, if known, concerning the excretion of drugs into human milk. Most drugs likely to be prescribed to the nursing mother should have no effect on milk supply or on infant well-being. This information is important not only to protect nursing infants from untoward effects of maternal medication but also to allow effective pharmacologic treatment of breastfeeding mothers. Nicotine, psychotropic drugs, and silicone implants are 3 important topics reviewed in this statement.

951 citations


Journal ArticleDOI
TL;DR: Observances of blood pressure and other factors made during the school-aged years suggest that strategies to prevent the acquisition of excess ponderosity during adolescence may be useful in preventing adult hypertension.
Abstract: In adult populations, elevated blood pressure is related to the development of occlusive atherosclerosis, stroke, and renal disease The significance of blood pressure levels in childhood, unless extremely elevated, has not been related to disease outcomes In this study, the risk of high blood pressure in young adult life is evaluated based on the observations of blood pressure and other factors made during the school-aged years Subjects, 2445 in number, were first observed at ages 7 through 18 years and again between 20 and 30 years During childhood, measurements of blood pressure, height, and weight were made in alternate years At adult ages, the same measurements were again made and a health questionnaire was administered According to the data, adult blood pressure is correlated with childhood blood pressure, body size, and change in ponderosity from childhood to adult life Adult ponderosity is related to childhood ponderosity, and those who are most obese as adults show the greatest increase in weight for height from their childhood years These observations suggest that strategies to prevent the acquisition of excess ponderosity during adolescence may be useful in preventing adult hypertension

638 citations


Journal ArticleDOI
TL;DR: When iron deficiency progresses to anemia, but not before, adverse influences in the performance of developmental tests appear and persist for at least 3 months despite correction of anemia with iron therapy, suggesting prevention of iron deficiency anemia in early infancy becomes the only way to avoid them.
Abstract: In a double-blind, placebo-control prospective cohort study of 196 infants from birth to 15 months of age, assessment was made at 12 months of age of the relationship between iron status and psychomotor development, the effect of a short-term (10-day) trial of oral iron vs placebo, and the effect of long-term (3 months) oral iron therapy. Development was assessed with the mental and psychomotor indices and the infant behavior record of the Bayley Scales of Infant Development in 39 anemic, 30 control, and 127 nonanemic iron-deficient children. Anemic infants had significantly lower Mental and Psychomotor Developmental Index scores than control infants or nonanemic iron-deficient infants (one-way analysis of variance, P 3 months were correlated with significantly lower motor and mental scores (P

501 citations


Journal ArticleDOI
TL;DR: Thirty-nine newborn infants with severe persistent pulmonary hypertension and respiratory failure who met criteria for 85% likelihood of dying were enrolled in a randomized trial in which extracorporeal membrane oxygenation (ECMO) therapy was compared with conventional medical therapy (CMT).
Abstract: Thirty-nine newborn infants with severe persistent pulmonary hypertension and respiratory failure who met criteria for 85% likelihood of dying were enrolled in a randomized trial in which extracorporeal membrane oxygenation (ECMO) therapy was compared with conventional medical therapy (CMT). In phase I, 4 of 10 babies in the CMT group died and 9 of 9 babies in the ECMO group survived. Randomization was halted after the fourth CMT death, as planned before initiating the study, and the next 20 babies were treated with ECMO (phase II). Of the 20, 19 survived. All three treatment groups (CMT and ECMO in phase I and ECMO, phase II) were comparable in severity of illness and mechanical ventilator support. The overall survival of ECMO-treated infants was 97% (28 of 29) compared with 60% (6 of 10) in the CMT group (P less than .05).

451 citations


Journal ArticleDOI
TL;DR: It may be possible to improve early case identification of children at risk for anorexia nervosa and perhaps improve intervention strategies by focusing on the early development of dieting behavior in young children.
Abstract: Many studies document the high prevalence of dieting and abnormal eating behaviors in adolescents and young adults. The age of onset of eating disorders remains unclear because there are no published surveys of voluntary dieting and eating attitudes in young children. A total of 318 girls and boys were surveyed from two randomly chosen schools in middle-income neighborhoods. The children were equally distributed among grades 3 through 6. The survey included a children's version of the Eating Attitudes Test and a demographic and dieting questionnaire. Results showed that 45% of the children wanted to be thinner, 37% had already tried to lose weight, and 6.9% scored in the anorexia nervosa range, closely matching the published results concerning teenagers and young adult women. Several questions were isolated by univariate and multiple regression analyses that accurately (P less than .05) predicted children's Eating Attitude Test scores. The fact that young children admit having diet preoccupation and atypical eating attitudes is shown in this study. It may be possible to improve early case identification of children at risk for anorexia nervosa and perhaps improve intervention strategies by focusing on the early development of dieting behavior in young children.

443 citations


Journal ArticleDOI
TL;DR: The mortality and incidence of sequelae following status epilepticus was low and primarily a function of etiology, and age did not affect outcome within each cause.
Abstract: In an ongoing study of status epilepticus, 193 children with status epilepticus of varying causes have been followed up for a mean period of 132 months Of these, 97 patients were recruited prospectively The patients' ages ranged from 1 month to 18 years (mean, 50 years) The cause of the status epilepticus was classified as idiopathic in 46 cases, remote symptomatic in 45, febrile in 46, acute symptomatic in 45, and progressive neurologic in 11 The mortality and incidence of sequelae following status epilepticus was low and primarily a function of etiology Seven children died within 3 months of having the seizure New neurologic deficits were found in 17 (91%) of the 186 survivors All of the deaths and 15 of the 17 sequelae occurred in the 56 children with acute or progressive neurologic insults Only two of the 137 children with other causes sustained any new deficits (P less than 001) Duration of the status epilepticus affected outcome only within the acute symptomatic group (P less than 05) Neurologic sequelae occurred in 29% of infants younger than 1 year of age, 11% of children 1 to 3 years of age, and 6% of children older than 3 years of age However, this was a reflection of the greater incidence of acute neurologic disease in the younger age groups Within each cause, age did not affect outcome Of the 193 children, 61 (32%) had a history of prior unprovoked seizures Of the 125 surviving children with no history of prior unprovoked seizures, 37 (30%) had subsequent unprovoked seizures(ABSTRACT TRUNCATED AT 250 WORDS)

439 citations


Journal ArticleDOI
TL;DR: Comparison of this study's overall mortality with previous reports indicates improvement of survival in US patients less than 20 years of age with sickle hemoglobinopathies, and this improvement is most likely due to parental education and counseling about the illness and the early institution of antibiotics in suspected infections.
Abstract: A study of the natural history of sickle hemoglobinopathies was begun in March 1979. By August 1987, a total of 2824 patients less than 20 years of age were enrolled. There have been 14,670 person-years of follow-up. Seventy-three deaths have occurred. Most of the deaths were in patients with hemoglobin SS. The peak incidence of death was between 1 and 3 years of age, and the major cause in these young patients was infection. Cerebrovascular accidents and traumatic events exceeded infections as a cause of death in patients greater than 10 years of age. There was limited success in identifying risk factors for death. Comparison of this study's overall mortality of 2.6% (0.5 deaths per 100 person-years) with previous reports indicates improvement of survival in US patients less than 20 years of age with sickle hemoglobinopathies. This improvement is most likely due to parental education and counseling about the illness and the early institution of antibiotics in suspected infections.

382 citations


Journal ArticleDOI
TL;DR: Exclusively breast-fed infants tended to have fewer skin infections during the initial months of life and older infants who continued to breast-feed had fewer infections than those who did not, and none of the results could be explained by differences in the socioeconomic status of the infants' families.
Abstract: Longitudinal studies of the feeding practices and morbidity from infectious diseases of 153 Peruvian newborns from an underprivileged, periurban community were completed during their first year of life. Feeding practices were assessed by monthly questionnaires, and illnesses were identified by thrice-weekly, community-based surveillance. All infants were initially breast-fed, but only 12% were exclusively breast-fed at 1 month of age. At 12 months of age, 86% of children still received some breast milk. Incidence and prevalence rates of diarrhea in infants younger than 6 months of age were less among those who were exclusively breast-fed compared with those who received other liquids or artificial milks in addition to breast milk. The diarrheal prevalence rates doubled with the addition of these other fluids (15.2% v 7.1% of days ill, P less than .001). Infants for whom breast-feeding was discontinued during the first 6 months had 27.6% diarrheal prevalence. During the second 6 months of life, discontinuation of breast-feeding was also associated with an increased risk of diarrheal incidence and prevalence. Upper and lower respiratory tract infections occurred with lesser prevalence among exclusively breast-fed younger infants. The prevalences of skin infections by category of feeding practice were not as consistent, but exclusively breast-fed infants tended to have fewer skin infections during the initial months of life and older infants who continued to breast-feed had fewer infections than those who did not. None of the results could be explained by differences in the socioeconomic status of the infants' families.

361 citations


Journal Article
TL;DR: A nested case-control analysis was conducted within the Nurses' Health Study cohort to examine the relation between timing of severe sun exposure and incidence of melanoma and no material association was found between blistering sunburns after 30 years of age and melanoma.
Abstract: Despite strong evidence that sun exposure causes malignant melanoma, the details of this relation remain unclear. A nested case-control analysis was conducted within the Nurses' Health Study cohort to examine the relation between timing of severe sun exposure and incidence of melanoma. The subjects were 130 white women aged 38 to 65 years with confirmed cutaneous melanoma (other than acral lentigenous) who reported no history of melanoma in first-degree relatives. The control subjects were 300 women matched by race, date of birth, and cycle of questionnaire who also reported no history of melanoma in first-degree relatives. We used conditional logistic regression to evaluate the relation of sun damage after 30 years of age and sun damage from 15 to 20 years of age to the incidence of melanoma. Blistering sunburns between 15 to 20 years of age were associated with risk of melanoma (relative risk = 2.2 for five or more burns vs none, 95% confidence interval 1.2 to 3.8). This association persisted when a history of burns after 30 years of age was controlled in the analysis. No material association was found between blistering sunburns after 30 years of age and melanoma. Similarly, a more equatorial latitude of residence between 15 and 20 years of age was positively associated with melanoma; latitude after 30 years of age was less strongly and not significantly related to melanoma risk. Sun exposure prior to 20 years of age is more closely associated with melanoma risk than sun exposure after 30 years of age.

306 citations


Journal ArticleDOI
TL;DR: A parent report questionnaire concerning sleep habits and problems was developed by the parents of 1000 unscreened elementary school children attending the third, fourth, and fifth grades and found boys who slept poorly were significantly more likely to have insomniac fathers.
Abstract: Few data currently exist concerning the sleep problems of preadolescents. A parent report questionnaire concerning sleep habits and problems was developed. The questionnaires were completed by the parents of 1000 unscreened elementary school children attending the third, fourth, and fifth grades. The schools were randomly selected from an urban area. Of the 1000 questionnaires, 972 were completed and could be used for statistical analysis. Among the parents, 24% reported sleeping poorly and 12% regularly relied on sedatives to induce sleep. Sleep difficulties lasting more than 6 months were present in 43% of the children. In 14% (132 of 972), sleep latency was longer than 30 minutes, and more than one complete arousal occurred during the night at least two nights per week. The following variables were seen among the poor sleepers: lower parental educational and professional status, parents who were more likely to be divorced or separated, and more noise or light in the rooms were they slept. They also presented a higher incidence of somnambulism, somniloquia, and night fears (nightmares and night terrors) than the children who slept well. Boys who slept poorly were significantly more likely to have insomniac fathers (P less than .010). Regular use of sedatives was described in 4% (5 of 132) of the children who slept poorly. Among the "poor sleepers," 21% (33 of 132) had failed 1 or more years at school. School achievement difficulties were encountered significantly more often among the poor sleepers than among the children without sleep problems (P = .001). Of the families with children suffering from sleep problems, 28% expressed a desire for counseling.(ABSTRACT TRUNCATED AT 250 WORDS)

298 citations


Journal Article
TL;DR: Surprisingly little is known about the special needs of long-term survivors of childhood cancer or the factors that make this growing population vulnerable to chronic psychologic disorders, but awareness of the high-risk groups described in this report should facilitate more timely identification of problems and referral of the children to appropriate services.
Abstract: Relatively little is known about the special needs of long-term survivors of childhood cancer or the factors that make this growing population vulnerable to chronic psychologic disorders. We therefore surveyed 183 children who had been treated for cancer at St Jude Children's Research Hospital and were free of the disease for greater than or equal to 2 years after completing therapy. Parental responses to the Child Behavior Checklist, a standardized inventory of social competence and behavioral problems, were analyzed in relation to demographic and medical variables, as well as the children's appearance and functional status. School-related problems and somatic complaints of undetermined origin were increased fourfold relative to age- and gender-adjusted rates for peer groups in the general population. The presence of functional but not cosmetic impairments increased the risk of academic and adjustment problems. An older age at evaluation, treatment with cranial irradiation, and residence in a single-parent household were also associated with an increased risk of psychologic problems. General pediatricians must eventually assume responsibility for the extended follow-up care of children who have survived a malignancy. Their awareness of the high-risk groups described in this report should facilitate more timely identification of problems and referral of the children to appropriate services.

Journal ArticleDOI
TL;DR: The rate of second-case Kawasaki disease occurring among 1788 siblings of children with the disease was derived from data obtained from questionnaires mailed to the members of the Japanese Association of Parents of Children With Kawasaki Disease.
Abstract: The rate of second-case Kawasaki disease occurring among 1788 siblings of children with the disease was derived from data obtained from questionnaires mailed to the members of the Japanese Association of Parents of Children With Kawasaki Disease Within 1 year after the onset of the first case in a family, the overall second-case rate was 21% for siblings, as compared to an overall incidence of approximately 019% in the general population of children 0 to 4 years of age in Japan in the epidemic year 1982 For siblings younger than 1 year of age, it was 84%, and for those between 1 and 2 years of age, it was 93% More than half (541%) of the second cases developed 10 days or less after the first cases occurred

Journal ArticleDOI
TL;DR: The records of 136,086 boys born in US Army hospitals from 1980 to 1985 were reviewed for indexed complications related to circumcision status during the first month of life and found that circumcision may be beneficial in reducing the occurrence of urinary tract infections and their associated sequelae.
Abstract: The records of 136,086 boys born in US Army hospitals from 1980 to 1985 were reviewed for indexed complications related to circumcision status during the first month of life. For 100,157 circumcised boys, there were 193 complications (0.19%). These included 62 local infections, eight cases of bacteremia, 83 incidences of hemorrhage (31 requiring ligature and three requiring transfusion), 25 instances of surgical trauma, and 20 urinary tract infections. There were no deaths or reported losses of the glans or entire penis. By contrast, the complications in the 35,929 uncircumcised infants were all related to urinary tract infections. Of the 88 boys with such infections (0.24%), 32 had concomitant bacteremia, three had meningitis, two had renal failure, and two died. The frequencies of urinary tract infection (P less than .0001) and bacteremia (P less than .0002) were significantly higher in the uncircumcised boys. Serious complications from routine prepuce removal are rare and relatively minor. Circumcision may be beneficial in reducing the occurrence of urinary tract infections and their associated sequelae.

Journal Article
TL;DR: The use of steroids in the treatment of hospitalized children with croup is supported and, in the absence of a randomized clinical trial of sufficient size, the most reliable estimate of the impact of steroid therapy on the morbidity associated with croups is provided.
Abstract: The use of adrenocorticoids to reduce the morbidity associated with laryngotracheitis (croup) remains controversial despite ten published reports of randomized trials involving 1,286 patients. To determine whether, viewed in aggregate, these studies demonstrate a significant benefit of steroid treatment for this disorder, a meta-analysis of the nine methodologically satisfactory trials was performed. Clinical improvement 12 and 24 hours posttreatment and incidence of endotracheal intubation were evaluated. For each end point, an estimate of the overall effect was obtained by calculating a typical odds ratio and 95% confidence interval. This analysis indicates that the use of steroids in children hospitalized with croup is associated with a significantly increased proportion of patients showing clinical improvement 12 hours (odds ratio = 2.25, 95% confidence interval = 1.66, 3.06) and 24 hours (odds ratio = 3.19, 95% confidence interval = 1.70, 5.99) posttreatment and a significantly reduced incidence of endotracheal intubation (odds ratio = 0.21, 95% confidence interval = 0.05, 0.84). Higher initial doses of steroid (greater than or equal to 125 mg of cortisone or greater than or equal to 100 mg of hydrocortisone) were associated with a larger proportion of patients improved 12 hours posttreatment than was seen with lower doses. These results support the use of steroids in the treatment of hospitalized children with croup and, in the absence of a randomized clinical trial of sufficient size, provide the most reliable estimate of the impact of steroid therapy on the morbidity associated with croup. In addition, the results of this meta-analysis may be used to estimate the number of subjects who would be required to conduct a randomized clinical trial of steroids for the treatment of croup.

Journal ArticleDOI
TL;DR: Cocaine use during pregnancy results in newborn infants with growth retardation and microcephaly, and neither narcotic withdrawal symptoms nor illness could distinguish the infants born of cocaine-using mothers from the control infants.
Abstract: The newborn infants of 56 mothers who used cocaine were prospectively studied in to determine the effects of cocaine. There were no differences with respect to maternal preeclampsia or cesarean section rate. Meconium-stained amniotic fluid was increased (10 of 56 cases [17.8%]) compared with the control group (3 of 56 cases [5.3%]) (X2 = 4.2, P less than .05). Fetal distress recorded with fetal monitoring and Apgar scores at 1 and 5 minutes were similar. The weight, length, and head circumference growth curves of the infants born to cocaine-using mothers were shifted below the 25th percentile. Microcephaly was present in 12 of 56 (21.4%) infants whose mothers used cocaine during pregnancy (X2 = 5.96, P less than .01), and 15 of 56 (26.7%) had intrauterine growth retardation (X2 = 9.53, P less than .01) compared with the control infants (2 of 5 [3.5%] and 3 of 56 [5.3%], respectively). There was no increase in teratogenicity. Neither narcotic withdrawal symptoms nor illness could distinguish the infants born of cocaine-using mothers from the control infants. In conclusion, cocaine use during pregnancy results in newborn infants with growth retardation and microcephaly.

Journal ArticleDOI
TL;DR: Low birth weight, decreased head circumference and length, and an increased rate of fetal alcohol effects were all found to be significantly correlated with exposure to alcohol during the first 2 months of the first trimester.
Abstract: In this prospective study of alcohol and other substance use during pregnancy, a cohort of 650 women was interviewed at each trimester of pregnancy Data are presented concerning the status of 595 live singleton births A relationship was demonstrated between prenatal maternal alcohol use and growth and morphologic abnormalities in the offspring Low birth weight, decreased head circumference and length, and an increased rate of fetal alcohol effects were all found to be significantly correlated with exposure to alcohol during the first 2 months of the first trimester

Journal Article
TL;DR: A classification of seizures is proposed that includes the following as major seizure types: subtle, clonic, tonic, and myoclonic; and the possibility that neonatal clinical phenomena not accompanied by EEG seizure activity are nevertheless epileptic in origin.
Abstract: In recent years, prolonged EEG monitoring with simultaneous observation by video recorder on by direct inspection has produced findings that suggest that (1) the number of certain neonatal seizures (when identified only clinically) has been overestimated in the past, and (2) the total number of neonatal seizures (identified electrographically but clinically silent) has been underestimated in the past. In this article, we propose a classification of seizures that includes the following as major seizure types: subtle, clonic, tonic, and myoclonic. Subtle seizure phenomena include those alterations in neonatal behavior, motor functions, and autonomic function that are easily overlooked and that are not characterized by clonic, tonic, or myoclonic activity. Such seizures include certain ocular phenomena, oral-buccal-lingual movements, peculiar limb movements, autonomic alterations, and apnea. Subtle seizures appear to be more common in premature than in full-term infants, and some subtle clinical phenomena in full-term infants are not associated with simultaneous EEG seizure activity. Clonic seizures include focal and multifocal varieties—both are accompanied by simultaneous EEG seizure activity. Tonic seizures include focal episodes (less common) and generalized episodes (more common). Generalized tonic seizures mimic decerebrate and decorticate posturing and are not consistently accompanied by EEG seizure activity. Focal tonic episodes are consistently accompanied by such electrographic activity. Myoclonic seizures may be focal, multifocal, or generalized. Only the last of these is commonly accompanied by EEG seizure activity. Thus, the clinical seizure types commonly associated with EEG seizure activity are certain subtle seizures, focal and multifocal clonic seizures, focal tonic seizures, and generalized myoclonic seizures. Neonatal clinical seizures not accompanied by EEG seizure activity may represent movements or posturing generated by diencephalon-brainstem, "released" from the inhibitory influence of cerebral cortex. This hypothesis is supported by the common occurrence of such clinical phenomena in infants with severe bilateral cerebral injury and certain experimental findings in animals subjected to decortication. The possibility that neonatal clinical phenomena not accompanied by EEG seizure activity are nevertheless epileptic in origin is raised by documentation of apparent epileptic phenomena in older patients in the absence of surface-recordable electrographic seizure, Certain observations in human newborns and in neonatal animals also suggest this possibility. Further study is needed to resolve this issue. Distinction of epileptic and nonepileptic phenomena can be made at the bedside in many cases. Thus, nonepileptic phenomena generally are provoked or exacerbated by sensory stimulation, are suppressed by passive restraint, and are not accompanied by autonomic phenomena; the opposite is true for epileptic phenomena. The issues raised have important implications for management—in particular, decisions concerning whom to treat, criteria for determining adequacy of therapy, and determination of duration of therapy. It has become increasingly clear that most infants with neonatal seizures require only relatively brief treatment with anticonvulsant medications.

Journal Article
TL;DR: The analysis suggests that proportionality among intrauterine growth-retarded infants represents a continuum, with progressive disproportionality as severity of growth retardation increases, and the absolute magnitudes of the deficits in length and head growth remain substantial.
Abstract: Despite the popular current distinction between "proportional" and "disproportional" intrauterine growth retardation, it has never been shown that variation in body proportions is greater among growth-retarded than nongrowth-retarded infants of the same birth weight, nor that proportionality is distributed bimodally among growth-retarded infants. Based on a cohort of 8719 neonates born between 1980 and 1986 of mothers with concordant (+/- 7 days) menstrual dating and early ultrasound estimates of gestational age, we used a continuous measure of birth weight for gestational age to define four study groups: nongrowth retarded (n = 5163) and mild (n = 411), moderate (n = 226), and severe (n = 147) intrauterine growth retardation. Compared with non-growth-retarded infants of the same gestational age, growth-retarded infants had substantially lower lengths, head circumferences, and proportionality ratios, and the magnitude of the deficits increased significantly with increasing degrees of growth retardation. When the comparison was based on birth weight rather than gestational age, however, growth-retarded infants had slightly but significantly greater lengths and head circumferences, with increased variability in body proportions, but no evidence of the bimodality that would characterize two distinct subtypes. The analysis suggests that proportionality among intrauterine growth-retarded infants represents a continuum, with progressive disproportionality as severity of growth retardation increases. Moreover, despite evidence of some "sparing," the absolute magnitudes of the deficits in length and head growth remain substantial.

Journal ArticleDOI
TL;DR: Because upper gastrointestinal series x-ray studies failed to detect upper gastrointestinal lesions in 13 patients of 69 of those with upper gastrointestinal disease, endoscopy should be considered in all children and adolescents in whom a diagnosis of Crohn disease is entertained.
Abstract: This retrospective study of Crohn disease in 230 children and adolescents with a mean age of 12.5 years at the time of diagnosis and an average follow-up of 6.6 years showed that 30% had lesions of the esophagus, stomach, and duodenum. Three patients had Crohn disease isolated to the upper gastrointestinal tract. The 169 patients with both small and large bowel disease were at greater risk (33%, P less than .05) of having upper gastrointestinal lesions than the 37 with isolated small bowel disease and the 21 with disease limited to the colon and/or rectum. An aggregate of symptoms and signs more likely present in those with upper gastrointestinal involvement included: dysphagia, pain when eating, nausea and/or vomiting, and aphthous lesions of the mouth. Furthermore, weight loss was more severe and hypoalbuminemia more frequent. Because upper gastrointestinal series x-ray studies failed to detect upper gastrointestinal lesions in 13 patients of 69 of those with upper gastrointestinal disease, endoscopy should be considered in all children and adolescents in whom a diagnosis of Crohn disease is entertained. Endoscopy and biopsy of the upper gastrointestinal tract should be done in any patient with symptoms suggestive of proximal involvement. Finally, in view of the fact that endoscopy established the diagnosis of Crohn disease in five patients previously thought to have chronic ulcerative colitis, the procedure should routinely be performed in all patients with chronic ulcerative colitis or indeterminate colitis before surgery is performed.

Journal ArticleDOI
TL;DR: Newborn circumcision has potential medical benefits and advantages as well as disadvantages and risks and the benefits and risks should be explained to the parents and informed consent obtained.
Abstract: Properly performed newborn circumcision prevents phimosis, paraphimosis, and balanoposthitis and has been shown to decrease the incidence of cancer of the penis among US men It may result in a decreased incidence of urinary tract infection However, in the absence of well-designed prospective studies, conclusions regarding the relationship of urinary tract infection to circumcision are tentative An increased incidence of cancer of the cervix has been found in sexual partners of uncircumcised men infected with human papillomavirus Evidence concerning the association of sexually transmitted diseases and circumcision is conflicting Newborn circumcision is a rapid and generally safe procedure when performed by an experienced operator It is an elective procedure to be performed only if an infant is stable and healthy Infants respond to the procedure with transient behavioral and physiologic changes Local anesthesia (dorsal penile nerve block) may reduce the observed physiologic response to newborn circumcision It also has its own inherent risks However, reports of extensive experience or follow-up with the technique in newborns are lacking Newborn circumcision has potential medical benefits and advantages as well as disadvantages and risks When circumcision is being considered, the benefits and risks should be explained to the parents and informed consent obtained

Journal Article
TL;DR: The incidence of periventricular-intraventricular hemorrhage was lower in infants born by cesarean section than those delivered vaginally, but the decrease could not be attributed to an increased number of deliveries by cesian section.
Abstract: Ultrasound has been routinely used since late 1979 to diagnose periventricular-intraventricular hemorrhage in infants whose gestational age was 34 weeks or less. During the years 1980 to 1987 the ultrasound scans were interpreted by one person, and a steady decline in incidence of periventricular-intraventricular hemorrhage was observed. Both for infants of 34 weeks or less and for very low birth weight (

Journal Article
TL;DR: From September 1984 to December 1987, the children's tuberculosis clinic in Houston, TX, cared for 110 children with active tuberculosis, which has been shortened from 12 to 18 months to 6 to 9 months, but 39% were noncompliant with treatment and required twice-weekly supervised therapy to complete treatment.
Abstract: From September 1984 to December 1987, the children9s tuberculosis clinic in Houston, TX, cared for 110 children with active tuberculosis. The median age was 24 months. Approximately one half of the cases were in Hispanic children, but one third were in black children. Only 11% were foreign-born. Diagnosis resulted from case contact investigation in 50% of cases, routine tuberculin screening in 6%, and evaluation of an ill child in 44%. Intrathoracic disease alone was present in 77% of cases, and extrathoracic disease in 23%, including involvement of the cervical and supraclavicular lymph nodes, meninges, brain, liver, and skin. Gastric aspirates yielded Mycobacterium tuberculosis from 39% of the children with pulmonary disease. Of six children infected with drug-resistant tuberculosis, two became critically ill before referral because the probability of resistance was not recognized by the referring physician. Presently, 94% of patients have successfully completed therapy, which has been shortened from 12 to 18 months to 6 to 9 months. However, 39% were noncompliant with treatment and required twice-weekly supervised therapy to complete treatment. Tuberculosis remains a serious cause of morbidity in children; specific expertise in obtaining cultures, selecting drugs, and assuring compliance is crucial for adequate results.

Journal ArticleDOI
TL;DR: Although both treatments were more effective than waiting for the child to outgrow this problem, parents of the positive routine group reported significantly improved marital satisfaction, suggesting additional benefits of this treatment strategy.
Abstract: A total of 36 toddlers and preschool children exhibiting bedtime tantrum activity were randomly assigned to one of three groups: positive routines, graduated extinction, or control Positive routines involved changing the child's bedtime to coincide with when he naturally fell asleep, as well as parent and child engaging in a series of four to seven enjoyable activities before the child being placed in bed During the treatment period, bedtimes were systematically scheduled earlier such that the child went to bed at the time parents had originally used Graduated extinction consisted of the parent putting the child to bed and ignoring the tantrum activity for increasingly longer amounts of time throughout the treatment Children in these two treatment groups had tantrums less frequently and for shorter periods than control subjects during 6 weeks of treatment and during two follow-up observations 3 and 6 weeks after treatment Although both treatments were more effective than waiting for the child to outgrow this problem, parents of the positive routine group reported significantly improved marital satisfaction, suggesting additional benefits of this treatment strategy

Journal Article
TL;DR: It was concluded that the use of EMLA cream substantially reduces pain caused by venous, subcutaneous drug reservoir, and lumbar punctures in children and may therefore be offered to young patients, particularly those repeatedly submitted to such procedures.
Abstract: A new topical anesthetic ointment (EMLA, "eutectic mixture of prilocaine and lidocaine was studied in a double-blind, placebo-controlled trial to evaluate its efficiency in alleviating pain associated with venous, subcutaneous drug reservoir and lumbar punctures in children. Pain intensity was scored by the children themselves, using a visual analogue scale in which 0 corresponded to absence of sensation and 10 to the worst imaginable painful sensation. Venipunctures were performed on 18 children (6.1 to 12.2 years of age) equally divided in the study and control groups; EMLA cream was associated with lesser pain scores than those with placebo (means +/- SD: 2.8 +/- 2.4 vs 6.8 +/- 2.1, P less than .01). A crossover trial was used in the studies of subcutaneous drug reservoir and lumbar punctures, eight children (6.1 to 15.1 years of age) were tested for subcutaneous drug reservoir punctures; pain induced by this procedure was rated at 3.9 +/- 2.2 with placebo compared with 1.2 +/- 1.8 with EMLA cream (P less than .04). In lumbar punctures (14 children studied, 5.5 to 15.3 years of age), EMLA cream was again associated with less pain (1.9 +/- 1.9) than was placebo (5.6 +/- 3.0, P less than .01). It was concluded that the use of EMLA cream substantially reduces pain caused by venous, subcutaneous drug reservoir, and lumbar punctures in children and may therefore be offered to young patients, particularly those repeatedly submitted to such procedures.

Journal Article
TL;DR: It is urged that caution be exercised in using tests for predicting the risk of developmental problems in young children unless the tests have acceptable levels of sensitivity and specificity.
Abstract: Developmental screening tests are in widespread use, but few reliable and valid tests are available. The most frequently used screening instrument for detecting young children who are at risk for developmental delays is the Denver Developmental Screening Test (DDST). Although the DDST has excellent test specificity, overreferring few children, results from more than a dozen studies of the DDST's concurrent and predictive validity fail to replicate the original validation and demonstrate a uniformly poor sensitivity, ie, a high proportion of underreferrals. Whether samples are stratified by age, risk, duration of time between predictor and outcome, or type of outcome measure used, these studies demonstrate that the DDST underrefers children at nearly a 2:1 ratio. Several other screening tests with more optimal psychometric properties are presented. It is urged that caution be exercised in using tests for predicting the risk of developmental problems in young children unless the tests have acceptable levels of sensitivity and specificity.

Journal Article
TL;DR: Children with persistently positive CSF cultures had a significantly higher incidence of neurologic abnormalities at the time of hospital discharge and at follow-up and of moderate to profound hearing impairment than did those with prompt sterilization of CSF.
Abstract: To determine the clinical importance of CSF cultures that are persistently positive for pathogens in patients treated for meningitis with the new cephalosporins, the records of 301 infants and children with bacterial meningitis enrolled prospectively in four clinical efficacy trials of cefuroxime or ceftriaxone therapy were reviewed. CSF culture results were positive for 20 patients and they were sterile at 18 to 36 hours after start of therapy for 281 patients. Seizures, subdural effusions, and hemiparesis were found significantly more often during hospitalization in those with delayed sterilization of CSF. Children with persistently positive cultures had a significantly higher incidence of neurologic abnormalities at the time of hospital discharge (45% v 19%) and at follow-up (41% v 13%) and of moderate to profound hearing impairment (35% v 15%) than did those with prompt sterilization of CSF. Repeat CSF examination is a useful prognostic indicator in infants and young children with bacterial meningitis.

Journal ArticleDOI
TL;DR: An improvement in weight gains after zinc supplementation demonstrates that mild zinc deficiency can be one of the etiologic factors in nutritional failure to thrive during infancy.
Abstract: The objective of this study was to determine whether zinc deficiency is one of the factors involved in nutritional failure to thrive in infants and toddlers. Participants were selected on the basis of anthropometric criteria, particularly a decline in weight velocity preceding changes in length gains. The investigation was designed as a double-blind, randomized, pair-matched, controlled study of dietary zinc supplementation of 6 months' duration. Anthropometric data were collected at 0, 1, 3, and 6 months. Twenty-five pairs of infants completed the project. When compared with placebo-treated control children, the zinc-supplemented group (combined sexes) and the supplemented boys showed significant improvements in standard deviation scores for weight for all three intervals, the largest differences occurring for the 0- to 3-month interval (P less than or equal to .0001). The zinc-supplemented girls demonstrated a trend toward improvements in changes in standard deviation scores for weight (P = .056). There were no differences in length gains for either boys or girls. This improvement in weight gains after zinc supplementation demonstrates that mild zinc deficiency can be one of the etiologic factors in nutritional failure to thrive during infancy.

Journal Article
TL;DR: A segment of male adolescents are using anabolic steroids without fully understanding the risks of such behavior, and health care providers need to become knowledgeable about steroids so that they may better educate adolescents about the potential deleterious effects of these agents.
Abstract: Anabolic steroids have recently been used by professional and college athletes to improve athletic ability by increasing muscle size and strength. A study was done to determine the extent of steroid use and knowledge about these drugs in a population of high school male adolescents in a southern state. A self-report questionnaire, which allowed multiple answers for each question, was administered to 853 male students in six high schools. Results indicated that an average of 11% had used or were using anabolic steroids. The following were assessed: the reasons for steroid use, the sources from which the students received information about steroids, their familiarity with the physiologic effects and complications of steroid use, and the extent of their involvement in sports. The results suggest that a segment of male adolescents are using anabolic steroids without fully understanding the risks of such behavior. Health care providers need to become knowledgeable about steroids so that they may better educate adolescents about the potential deleterious effects of these agents.

Journal ArticleDOI
TL;DR: Early diagnosis of hemoglobinopathies should be in the newborn period as mentioned in this paper, even though screening has not received widespread acceptance for the past 15 to 20 years, even though the technology to screen infants in the new period has been available for more than 20 years.
Abstract: Hemoglobinopathies represent one of the major health problems in the United States and constitute the most common genetic disorders in some populations Sickle cell disease (SS, SC, S-β-thalassemia) alone affects about one in 400 American black newborns, as well as persons of African, Mediterranean, Asian, Caribbean, Middle Eastern, and South and Central American origins For the past 20 years, the medical profession has known that children with sickle cell anemia have an increased susceptibility to severe bacterial infection, particularly due to Streptococcus pneumoniae The risk of major infection and death posed by this organism is greatest in the first 3 years of life and can occur as early as 3 months of age In fact, this infection may be the first clinical manifestation of disease The infection can be fulminant, progressing from the onset of fever to death in a matter of hours, and the case fatality rate is reported as high as 30% In addition, acute splenic sequestration, another acute catastrophic event, contributes to early mortality in children with sickle cell anemia and may occur as early as 5 months of age It has been proposed that early diagnosis to identify infants with major sickle hemoglobinopathies, who have a high risk of early mortality and morbidity, is essential to institute appropriate ongoing care and effective measures of prophylaxis and intervention Early diagnosis of hemoglobinopathies should be in the newborn period Even though the technology to screen infants in the newborn period has been available for the past 15 to 20 years, screening has not received widespread acceptance

Journal Article
TL;DR: In conclusion, bovine whey protein can elicit symptoms of infantile colic in colicky formula-fed infants.
Abstract: There are several causes of infantile colic. The aim of this study was to evaluate, under controlled conditions, whether bovine whey proteins can elicit symptoms of infantile colic in colicky formula-fed infants. The mean age for entering the study was 6.4 weeks and the mean age for colic debut was 3.7 weeks. In 24 of 27 infants with severe colic, the symptoms disappeared when they were given a cow's milk-free diet (Nutramigen). These 24 infants were entered into a double-blind crossover study. The infants (receiving cow's milk-free diet) were given the contents of identical capsules with each meal during day 6. The same procedure was repeated on day 10. The capsules contained either whey protein powder (with Nutramigen added) or human albumin powder (with Nutramigen added). Eighteen infants receiving the whey protein-containing capsules reacted with colic, two infants receiving placebo reacted with colic (P less than .001), and four infants did not react at all. Crying hours per day for the 24 infants were 5.6 hours for formula-fed infants and 0.7 hour for cow's milk-free diet-fed infants (P less than .001). Crying hours per day were 3.2 hours for the infants receiving whey protein capsules and 1.0 hour for those receiving placebo (P less than .001). In conclusion, bovine whey protein can elicit symptoms of infantile colic in colicky formula-fed infants.