The Journal of Pediatrics via MedWorm.com

Erratum

The Journal of Pediatrics — Mon, 22 Feb 2010 15:35:02 +0100

In the Reply to the Letter to the Editor, “Cerebral blood flow velocities in extremely low birth weight infants,” by Kaiser and Lightburn, J Pediatr 2009;155:944-5, the order of the authors should be as follows: Marla H. Lighburn, MD, and Jeffrey R. Kaiser, MD, MA. (Source: The Journal of Pediatrics)

Errata

The Journal of Pediatrics — Mon, 22 Feb 2010 15:35:02 +0100

In the article, “Association and Socioeconomic Status with the Use of Chronic Therapies and Healthcare Utilization in Children with Cystic Fibrosis,” by Schechter et al, J Pediatr 2009;155:434-9, the cities and states should be added for the following authors: Susanna A. McColley, MD, Chicago, IL; Stefanie Silva, MS, San Francisco, CA; Tmirah Haselkorn, PhD, Sunnyvale, CA; and Michael W. Konstan, MD, Cleveland, OH. (Source: The Journal of Pediatrics)

Exhaled nitric oxide and childhood asthma

The Journal of Pediatrics — Mon, 22 Feb 2010 15:35:02 +0100

To the Editor: Sivan et al investigated the use of exhaled nitric oxide (FeNO) in the diagnosis of asthma in school-age children. They found a remarkable high diagnostic yield of FeNO and concluded that the test should be considered in the evaluation of children suspected of having asthma. (Source: The Journal of Pediatrics)

Hispanic youth: violence and aggression ecological influences

The Journal of Pediatrics — Mon, 22 Feb 2010 15:35:02 +0100

To the Editor: The focus on social influences of Hispanic youth is intriguing because they are an underrepresented ethnic group in family therapy research literature. Although Ferguson et al report that their results cannot be generalized across ethnic groups, Szapocznik et al has facilitated 25 years of research specifically with antisocial delinquent Hispanic youth. (Source: The Journal of Pediatrics)

Neuraminidase inhibitors beneficial for treatment and prevention of influenza in children

The Journal of Pediatrics — Mon, 22 Feb 2010 15:35:01 +0100

Shun-Shin M, Thompson M, Heneghan C, Perera R, Harnden A, Mant D. Neuraminidase inhibitors for treatment and prophylaxis of influenza in children: systematic review and meta-analysis of randomised controlled trials. BMJ 2009;339:b3172. (Source: The Journal of Pediatrics)

Decision rules can identify children at very low risk of clinically important traumatic brain injury

The Journal of Pediatrics — Mon, 22 Feb 2010 15:35:01 +0100

Kuppermann N, Holmes J, Dayan P, Hoyle JJ, Atabaki S, Holubkov R, et al. Identification of children at very low risk of clinically important brain injuries after head trauma: a prospective cohort study. Lancet 2009;374:1160-70. (Source: The Journal of Pediatrics)

Nomogram can help estimate risk of serious hyperbilirubinemia in healthy infants

The Journal of Pediatrics — Mon, 22 Feb 2010 15:35:01 +0100

Varvarigou A, Fouzas S, Skylogianni E, Mantagou L, Bougioukou D, Mantagos S. Transcutaneous bilirubin nomogram for prediction of significant neonatal hyperbilirubinemia. Pediatrics 2009;124:1052-9. (Source: The Journal of Pediatrics)

Two developmental screening tests may identify different groups of children

The Journal of Pediatrics — Mon, 22 Feb 2010 15:35:01 +0100

Sices L, Stancin T, Kirchner HL, Bauchner H. PEDS and ASQ developmental screening tests may not identify the same children. Pediatrics 2009;124:e640-7. Among children at increased risk for developmental delays, do the Parents' Evaluation of Developmental Status (PEDS; parent concern questionnaire) and the Ages & Stages Questionnaires (ASQ; parent report of developmental skills) perform similarly as a screening test? (Source: The Journal of Pediatrics)

Anti-pyretic agents are ineffective in the prevention of febrile seizures

The Journal of Pediatrics — Mon, 22 Feb 2010 15:35:01 +0100

Strengell T, Uhari M, Tarkka R, Uusimaa J, Alen R, Lautala P, et al. Antipyretic agents for preventing recurrences of febrile seizures: randomized controlled trial. Arch Pediatr Adolesc Med 2009;163:799-804. (Source: The Journal of Pediatrics)

Propranolol may benefit those with severe infantile hemagiomas

The Journal of Pediatrics — Mon, 22 Feb 2010 15:35:01 +0100

Sans V, de la Roque ED, Berge J, Grenier N, Boralevi F, Mazereeuw-Hautier J, et al. Propranolol for severe infantile hemangiomas: follow-up report. Pediatrics 2009;124:e423-31. (Source: The Journal of Pediatrics)

An interactive booklet reduces antibiotic use for children with respiratory tract infections

The Journal of Pediatrics — Mon, 22 Feb 2010 15:35:00 +0100

Francis NA, Butler CC, Hood K, Simpson S, Wood F, Nuttall J. Effect of using an interactive booklet about childhood respiratory tract infections in primary care consultations on reconsulting and antibiotic prescribing: a cluster randomised controlled trial. BMJ 2009;339:b2885. (Source: The Journal of Pediatrics)

50 Years Ago in The Journal of Pediatrics: Epidemic Nephritis in South Trinidad

The Journal of Pediatrics — Mon, 22 Feb 2010 15:35:00 +0100

Symonds BER. J Pediatr 1960;56:420-4 This manuscript was a detailed description of a large outbreak of post-streptococcal glomerulonephritis that occurred in Trinidad in late 1958 and early 1959. Two-hundred-sixty-three children were admitted to the San Fernando General Hospital, and the author notes that several children with acute nephritis were admitted to other hospitals during this interval. In addition, several children with milder disease were treated as outpatients. This manuscript and subsequent studies of these children were seminal in defining the acute clinical course and the short- and long-term prognosis of children with post-infectious glomerulonephritis. (Source: The Journal of Pediatrics)

Caffeine Increases Cerebral Cortical Activity in Preterm Infants

The Journal of Pediatrics — Mon, 22 Feb 2010 15:34:57 +0100

Caffeine improves the rate of survival without neurodevelopmental disability in preterm infants. The mechanisms underlying neuroprotection are incompletely understood. In 51 preterm infants studied by amplitude-integrated electroencephalography from 2 hours before to 2 hours after intravenous caffeine administration, we found that caffeine increases amplitudes and periods of continuity. (Source: The Journal of Pediatrics)

50 Years Ago in The Journal of Pediatrics: A Critical Evaluation of Therapy of Febrile Seizures

The Journal of Pediatrics — Mon, 22 Feb 2010 15:34:56 +0100

Millichap JB, Aledort LM, Madsen JA. J Pediatr 1960;56:364-8 In the 1950s after a febrile seizure, initiation and continuation of phenobarbital was the norm, although a minority of neurologists hypothesized that anticonvulsant therapy was indicated only at the time of febrile illness. In a landmark paper 50 years ago in The Journal, Millichap et al showed that “continued administration of anticonvulsant drugs is unwarranted in the prophylactic treatment of seizures which occur only in association with fever.” Instead they recommended phenobarbital in “relatively large doses” at the onset of fever, in conjunction with antipyretic therapy. (Source: The Journal of Pediatrics)

50 Years Ago in The Journal of Pediatrics: Testicular Feminization and Color Blindness

The Journal of Pediatrics — Mon, 22 Feb 2010 15:34:55 +0100

RJ Blattner. J Pediatr 1960;56:425-7 A comprehensive description of the clinical manifestations of resistance to androgens was first provided in 1953 by John Morris, who coined the term “testicular feminization.” Seven years later, Blattner used the same term in the title of his comments on this disorder of sex development. In the past few years, most clinicians have abandoned the term “testicular feminization” and adopted the term “complete androgen insensitivity syndrome” (CAIS), which more accurately reflects the pathophysiology of this disorder and is less controversial and disturbing to patients and families. In his article, Blattner correctly describes the physical characteristics of a woman with CAIS (normal breast development, absent or scant pubic and axillary hair, b...

50 Years Ago in The Journal of Pediatrics: Hydrocephalus

The Journal of Pediatrics — Mon, 22 Feb 2010 15:34:55 +0100

Ransohoff J, Shulman K, Fishman RA. J Pediatr 1960;56:399-411 Fifty years ago in The Journal, Ransohoff et al reviewed the physiology, etiology, diagnosis, and treatment of hydrocephalus. They defined hydrocephalus as “a pathologic state characterized by an increased volume of cerebral spinal fluid (CSF) under increased pressure, most commonly due to an obstruction in the circulation of this fluid.” Little has changed since then in understanding hydrocephalus pathophysiology; however, we have made significant improvements in diagnosis, management, and prevention. (Source: The Journal of Pediatrics)

50 Years Ago in The Journal of Pediatrics: Evaluation of Prepared Milks for Infant Nutrition: Use of the Latin Square Technique

The Journal of Pediatrics — Mon, 22 Feb 2010 15:34:52 +0100

Brown GW, Tuholski JM, Sauer LW, Minsk ID, Rosenstern I. J Pediatr 1960;56:391-8 Fifty years ago in The Journal of Pediatrics, Brown et al proposed the use of the Latin square technique as a means of evaluating and comparing the nutritional adequacy of infant formulas. Although some of the concepts and ideas proposed by Brown still hold true today, modern technology and knowledge have changed the way clinical trials are conducted in a pediatric population. (Source: The Journal of Pediatrics)

50 Years Ago in The Journal of Pediatrics: Current Immunization Problems

The Journal of Pediatrics — Mon, 22 Feb 2010 15:34:52 +0100

Gaisford W, Feldman GV, Perkins FT. J Pediatr 1960;56:319-30 Vaccinologists from Manchester and London provide primary data and much insight surrounding problems of providing protection for infants against major pathogens of 1960. They ask the same questions of each vaccine—questions that we ask today. Is an effective vaccine antigen available? Is protection important? Can the vaccine be given at the age when protection is most needed? Is it safe? (Source: The Journal of Pediatrics)

50 Years Ago in The Journal of Pediatrics: Etiology of Mongolism

The Journal of Pediatrics — Mon, 22 Feb 2010 15:34:50 +0100

Warkany J. J Pediatr 1960;56:412-9 Although Down syndrome had been described by John Down in 1866, it took almost 100 years until the cause of this disorder was identified, leading to a “Conference on the Etiology of Mongolism” held on October 19, 1959. Only 3 years before, it was determined that the actual number of human chromosomes was 46. This exciting new discovery led to identifying the cause of numerous syndromes, including Down syndrome (trisomy 21), the most common chromosome disorders. The field of genetics and birth defects has significantly progressed since this publication, and it is likely that the authors did not foresee the sequencing of the entire human genome, including identification of all the genes on chromosome 21. (Source: The Journal of Pediatrics)

Cough in the Pediatric Population

The Journal of Pediatrics — Mon, 22 Feb 2010 15:34:50 +0100

Cough is the most common presenting symptom for medical office visits in the United States. Cough in children is usually related to viral respiratory tract infection and typically resolves spontaneously. Between 35% and 40% of school-age children still cough 10 days after the onset of a common cold, and 10% of preschool children have cough 25 days after respiratory tract infection. In children, cough has been associated with environmental factors, such as outdoor and indoor air pollution, including particulate matter, irritant gases, environmental tobacco smoke exposure, and dampness in the home. The frequent presentation of cough in children is further complicated by studies documenting that parental reporting of cough in children correlates poorly with objective measurement of frequency,...

The Pulmonary Collectins and Respiratory Syncytial Virus: Is There a Clinical Link?

The Journal of Pediatrics — Mon, 22 Feb 2010 15:34:50 +0100

More than a decade of basic science research suggests that the pulmonary collectins, surfactant protein A (SP-A) and D (SP-D), are critical components of the lung innate immune system. Mouse models of collectin deficiency indicate that SP-A and SP-D are required for normal clearance of a variety of pulmonary pathogens such as respiratory syncytial virus (RSV) and that if infection occurs in the absence of these proteins, the lungs fill with host immune cells that release excessive amounts of inflammatory cytokines, oxygen radicals, and metalloproteinases. Despite the considerable innate immune defects that are associated with SP-A or SP-D deficiency in animal models, we have yet to find susceptibility to pulmonary infection that is clearly caused by mutations in either of these genes. (Sou...

Role of Intervention Strategies for At-risk Preterm Infants

The Journal of Pediatrics — Mon, 22 Feb 2010 15:34:49 +0100

Despite increased survival rates of preterm infants, the prevalence of developmental disabilities in preterm survivors is still high. Although the rates of major handicaps have remained relatively constant in the last decade, the prevalence of milder dysfunctions seems to be increasing. Cognitive, behavioral, and mild motor problems without major motor deficits are now the most dominant neurodevelopmental sequelae in children born preterm. These problems include learning disabilities, borderline to low IQ scores, attention-deficit, and specific neuropsychological deficits affecting visuomotor integration and executive function. These abnormalities occur in >50% of children born preterm with very low birth weight (VLBW; < 1500 g) and often do not occur in isolation. The situation is further...

e-Professionalism: Challenges in the Age of Information

The Journal of Pediatrics — Mon, 22 Feb 2010 15:34:49 +0100

Recent advances in technology have revolutionized the medical environment and expanded the reach of communication both within and outside the medical community. Clayton Christensen, a noted professor at Harvard Business School, has discussed the concept of “disruptive technologies” and their role in creating organizational change. “Health care may be the most entrenched, change-averse industry in the United States,” according to Christensen. The age of information clearly has affected the culture of medicine in ways that we are just beginning to understand. Never before have there been so many ways to communicate. In the past, we were limited to face-to-face conversations, postal mail, telegrams, and telephone calls. Physicians communicated about their credentials through listings ...

Information for Readers

The Journal of Pediatrics — Mon, 22 Feb 2010 15:34:49 +0100

(Source: The Journal of Pediatrics)

Editorial Board

The Journal of Pediatrics — Mon, 22 Feb 2010 15:34:49 +0100

(Source: The Journal of Pediatrics)

The Journal of Pediatrics — Mon, 22 Feb 2010 15:34:49 +0100

(Source: The Journal of Pediatrics)

Evaluation of the child who presents with coughing

The Journal of Pediatrics — Mon, 22 Feb 2010 15:34:49 +0100

Coughing is the most common presenting complaint to pediatricians in the United States, and the possible etiologies vary by season and the age of the child. The topic of coughing in children, including diagnosis and treatment, is the subject of a Medical Progress report by Goldsobel and Chipps in this issue of The Journal. (Source: The Journal of Pediatrics)

Clostridial spores in powdered infant formula

The Journal of Pediatrics — Mon, 22 Feb 2010 15:34:49 +0100

Infant botulism, the intestinal toxemia form of botulism, most commonly follows unavoidable exposure to spores in the environment, such as through contact with dust or soil. During a transient period in infancy, gut flora may not inhibit intestinal outgrowth of ingested clostridial spores. Clostridia then can replicate and produce toxin that is absorbed and causes neuromuscular blockade. Until the practice of avoiding the feeding of honey to infants under 1 year of age, infant botulism in California was highly associated with infants consuming honey that contained clostridial spores. (Source: The Journal of Pediatrics)

Relapsing polychondritis in childood: rare but important

The Journal of Pediatrics — Mon, 22 Feb 2010 15:34:49 +0100

French investigators report a case series with detailed clinical information and longterm follow-up of 10 children with relapsing polychondritis (RP). They also report a systematic review of other pediatric cases and compare the clinical characteristics of RP in children with those of adults (in whom disease is more common). Together these data provide a snapshot of childhood presentation and complications of RP, which in most ways looks like adult-onset disease. But the authors point out a few important clinical points. Chondritis is the heralding event in most patients. Children frequently have a family history of autoimmune disorders. There is a long delay in diagnosis in children, likely related to lack of familiarity of pediatricians with the entity. Cardiac complications may be under...

Missed opportunities?

The Journal of Pediatrics — Mon, 22 Feb 2010 15:34:49 +0100

The Journal has published a number of studies related to diabetic ketoacidosis (DKA) in the past few years; most of these have made reference to prevention as the best strategy for avoiding the significant morbidity (and occasional mortality) consequent to DKA. (Source: The Journal of Pediatrics)

Pertussis compared with viral respiratory tract illnesses in neonates

The Journal of Pediatrics — Mon, 22 Feb 2010 15:34:49 +0100

Using polymerase chain reaction techniques to confirm the diagnosis of pertussis and a variety of tests to confirm the diagnosis of viral respiratory tract infections in neonates, clinical features of the two groups were studied retrospectively. Comparing 33 cases each of pertussis and non-pertussis viral disease, investigators found certain symptoms (paroxysmal cough, apnea, cyanotic spell) and severe course (prolonged hospitalization, need for oxygen, and use of respiratory supportive care upon discharge) more common in pertussis cases. An additional important clue to the microbiologic diagnosis was probable acquisition – from ill parent (82% for pertussis vs. 50% for non-pertussis cases) and from ill sibling(s) (30% for pertussis vs. 75% for non-pertussis cases). Thinking of the diagn...

A new concern—in utero iron status

The Journal of Pediatrics — Mon, 22 Feb 2010 15:34:49 +0100

Clinicians caring for preterm infants routinely evaluate the hematocrit/hemoglobin status at birth, track hematocrit/hemoglobin with postnatal age, transfuse as necessary, and supplement with oral iron. Questions remain about how much transfusion is “necessary” and when and how much iron to supplement. In this issue of The Journal, Amin et al have added a new wrinkle to concerns about iron status. They used cord blood ferritin measurements to identify fetal iron status of infants born preterm. Of 80 infants born between 27 and 33 weeks gestation, 44% had latent iron deficiency, which correlated with abnormal auditory neural maturation – a window to brain maturation. Iron deficiency is well known to be a modulator of brain development, and some prenatal conditions (maternal iron defic...

Blame inappropriate implementation for failure of intrapartum antibiotic prophylaxis for group B Streptococcus

The Journal of Pediatrics — Mon, 22 Feb 2010 15:34:48 +0100

In this issue of The Journal, Blaschke et al from Salt Lake City, Utah, provide the case that was bound to happen. With increasing resistance of group B Streptococcus (GBS) to erythromycin and clindamycin, and too-quick, too-easy reflex to substitute clindamycin for penicillin or ampicillin when mother has a history of penicillin “allergy,” the math was going to add up to transmission and disease due to a clindamycin-resistant GBS in a newborn. Blaschke et al provide the case—an “old fashioned” one—of severe early-onset disease in an otherwise healthy term infant, whose mother received IAP with clindamycin. (Source: The Journal of Pediatrics)

Correction

The Journal of Pediatrics — Mon, 25 Jan 2010 15:34:30 +0100

In the Supplement article, “Potential Roles and Clinical Utility of Prebiotics in Newborns, Infants, and Children: Proceedings from a Global Prebiotic Summit Meeting, New York City, June 27-28, 2008,” by Sherman et al, J Pediatr 2009;155:S61-70, the location of Abbott Nutrition on p S61 should be Columbus, OH. (Source: The Journal of Pediatrics)

Reply

The Journal of Pediatrics — Mon, 25 Jan 2010 15:34:30 +0100

To the Editor: The letter by Trevisanuto et al reports an evaluation of the educational impact of Neonatal Resuscitation Program training on the performance by Iraqi residents. They report marked improvement in performance using the tool we developed and tested. (Source: The Journal of Pediatrics)

Neonatal resuscitation in developing countries

The Journal of Pediatrics — Mon, 25 Jan 2010 15:34:29 +0100

To the Editor: In a recent study, Carlo et al assessed the effectiveness of the American Academy of Pediatrics Neonatal Resuscitation Program (NRP) in improving knowledge, skills, and self-efficacy of 127 nurse midwives in Zambia. After training, written scores (knowledge evaluation) and performance scores (skills evaluation) improved from 57% ± 14% to 80% ± 12% (mean ± SD; P < .0001) and from 43% ± 21% to 88% ± 9% (P < .0001), respectively. The authors concluded that the NRP training improved educational outcomes in college-educated practicing nurse midwives. (Source: The Journal of Pediatrics)

Obesity and the kidney

The Journal of Pediatrics — Mon, 25 Jan 2010 15:34:25 +0100

To the Editor: We read with great interest the article by Liao et al and congratulate them for their elegant study. They found a high prevalence of elevated blood pressure in children with abnormal urinalysis results, with a strong association with body mass index (BMI) and stated that “obesity was the most important factor associated with blood pressure elevation, followed by hyperlipidemia, elevated urea nitrogen, creatinine, and albumin levels in this population with abnormal urinalysis results.” Their findings are consistent with those in other studies of a nonobese young population. (Source: The Journal of Pediatrics)

Acute liver failure and pediatric ALF: strategic help for the pediatric hepatologist

The Journal of Pediatrics — Mon, 25 Jan 2010 15:34:25 +0100

To the Editor: Acute liver failure (ALF) is a devastating illness with numerous causes. The diagnosis portends a downhill clinical course, with death related to rapid neurologic deterioration/intracranial hypertension, sepsis, systemic inflammatory response syndrome, organ dysfunction, and the multiple associated effects of a nonfunctional liver. (Source: The Journal of Pediatrics)

Reply

The Journal of Pediatrics — Mon, 25 Jan 2010 15:34:25 +0100

To the Editor: We thank Degraeuwe and Nieman for their interest in our work. They are concerned with the accuracy of inter-α inhibitor proteins for the diagnosis of neonatal sepsis. They lament the lack of a sample size calculation and question the estimates of sensitivity, specificity, and positive and negative predictive values. We do not disagree with their conclusions. This was a convenience sample of 573 neonates, which, although robust, was somewhat short of the 831 patients they calculate would be required to have at least 99% negative predictive accuracy with an α of 0.05. We would like to point out that this was a pilot study of a new diagnostic marker. Strengths of our study include the relatively large sample of patients enrolled and the fact that it was a population-based, s...

The diagnostic value of inter-alpha inhibitor proteins for neonatal sepsis

The Journal of Pediatrics — Mon, 25 Jan 2010 15:34:25 +0100

To the Editor: The article by Chaaban et al evaluating inter-alpha inhibitor proteins (IaIp) as a diagnostic marker for neonatal sepsis drew our attention because of the apparently excellent test accuracy. However, a critical appraisal of the report yielded disappointing findings. (Source: The Journal of Pediatrics)

Epidermodysplasia Verruciformis Associated with Natural Killer/T Cell Lymphoma

The Journal of Pediatrics — Mon, 25 Jan 2010 15:34:25 +0100

We report a 12-year-old boy who had hypopigmented smooth macules and wart-like lesions for 10 years (). He was referred for facial swelling and erythema of his right cheek. The right nasal cavity was completely filled with a smooth mass. A biopsy specimen obtained from the nasal cavity revealed high-grade malignant tumor infiltration (). The immunophenotype of this tumor was CD56+, CD3+, and CD20-, consistent with natural killer (NK)/T cell lymphoma. Weak staining for Epstein-Barr virus (EBV) was evident. (Source: The Journal of Pediatrics)

To Inhale or Not to Inhale: Is That the Question? A Simple Method of DPI Instruction

The Journal of Pediatrics — Mon, 25 Jan 2010 15:34:24 +0100

Dry powder inhalers (DPIs) are commonly prescribed to deliver inhaled medication to children, yet there is a need to ensure that patients use these devices correctly. Inhaler technique has been shown to be inadequate in many adult and pediatric patients and may not improve despite detailed inhalation instructions. A common pitfall, particularly in young children and elderly patients, is the confusion between inspiration and expiration through the device to obtain the aerosol medication. This is probably because the patients, both children and adults, are not familiar with inhaling forcefully and consistently, are not taught how to use the devices correctly, and fail to comprehend or are confused by the written instructions. Furthermore, instructors may find it difficult to explain inhalat...

Coarctation of the Aorta and Associated Patent Ductus Arteriosus. II. Postoperative Study of Infants: Behrer M, Peterson F, Goldring D. J Pediatr 1960;56:246-52

The Journal of Pediatrics — Mon, 25 Jan 2010 15:34:24 +0100

This article reports the follow-up course in those 9 patients. (Source: The Journal of Pediatrics)

Propranolol for the Treatment of a Life-Threatening Subglottic and Mediastinal Infantile Hemangioma

The Journal of Pediatrics — Mon, 25 Jan 2010 15:34:24 +0100

An infant with a subglottic hemangioma remained in respiratory distress after multiple treatments failed and was found to have an enlarging mediastinal infantile hemangioma compressing the trachea. Treatment with oral propranolol resulted in resolution of symptoms within 2 days and a 50% reduction in lesion size within 1 week. (Source: The Journal of Pediatrics)

Recent Experience in the Treatment of Diarrhea in Infants: Darrow DC, Welsh JS. J Pediatr 1960;56:204-10

The Journal of Pediatrics — Mon, 25 Jan 2010 15:34:24 +0100

One of the greatest opportunities of the pediatrician is to save the life of a baby with dehydration. A step back into history allows The Journal of Pediatrics to honor the man for whom an early intravenous rehydration solution was named: Daniel C. Darrow. Darrow carefully recorded the electrolyte and water balances of infants with diarrhea while working at Johns Hopkins in the 1940s. By 1960, one may imagine him rounding at the Children's Mercy Hospital in Kansas City, with scores of crying, dehydrated, and/or malnourished babies housed in a large room, purging on cloth diapers, slowly advancing dilute feedings. None would have the advantage of a central line, parenteral nutrition, nasogastric tube, or amino acid formula. (Source: The Journal of Pediatrics)

Anti-N-methyl-D-Aspartate-Receptor Encephalitis in a Four-Year-Old Girl

The Journal of Pediatrics — Mon, 25 Jan 2010 15:34:24 +0100

We report on a 4-year-old girl presenting with seizures after nonspecific viral-like symptoms, progressing to severe aphasia, upper limb dyskinesias, fluctuation in consciousness, and inability to walk. Anti-N-methyl-D-aspartate-receptor encephalitis should be included in the differential diagnosis of acute/subacute encephalitis in children. (Source: The Journal of Pediatrics)

Failure of Resolution of Portal Fibrosis during Omega-3 Fatty Acid Lipid Emulsion Therapy in Two Patients with Irreversible Intestinal Failure

The Journal of Pediatrics — Mon, 25 Jan 2010 15:34:24 +0100

We report our experience using Omegaven in 2 patients with irreversible intestinal failure and intestinal failure-associated liver disease. Despite biochemical and histologic improvement in cholestasis, both patients had persisting, significant portal fibrosis on liver biopsy. (Source: The Journal of Pediatrics)

Parenteral Fish Oil-Associated Burr Cell Anemia

The Journal of Pediatrics — Mon, 25 Jan 2010 15:34:24 +0100

We report the development of burr cell anemia in an infant with short bowel syndrome who received parenteral fish oil (Omegaven, Fresenius-Kabi, Graz, Austria) after development of total parenteral nutrition–associated liver disease. Parenteral fish oil was discontinued, and the burr cell anemia disappeared, suggesting that parenteral fish oil might be associated with hemolytic anemia. (Source: The Journal of Pediatrics)

Empyema of Preexisting Subdural Hemorrhage Caused by a Rare Salmonella Species after Exposure to Bearded Dragons in a Foster Home

The Journal of Pediatrics — Mon, 25 Jan 2010 15:34:24 +0100

An infant had a subdural empyema caused by the rare Salmonella species enterica subspecies houtenae (IV) serotype 44:z4,z23:- after only indirect exposure to exotic reptiles in her foster home. Infants recovering from preexisting subdural hematoma are at risk for development of empyema. (Source: The Journal of Pediatrics)

Periocular Ulcerative Dermatitis Associated with Gentamicin Ointment Prophylaxis in Newborns

The Journal of Pediatrics — Mon, 25 Jan 2010 15:34:23 +0100

We report a series of 26 newborns in whom a characteristic periocular ulcerative dermatitis developed after gentamicin ointment administration at 2 Philadelphia hospitals. (Source: The Journal of Pediatrics)

Diabetes Mellitus: Observations, Theoretical and Practical: Bessman SP. J Pediatr 1960;56:191-203

The Journal of Pediatrics — Mon, 25 Jan 2010 15:34:19 +0100

In this article, written by Bessman in 1959, emphasis is first placed on the limited number of diabetic children experiencing coma (ie, diabetic ketoacidosis) at diagnosis (2 of 20 patients, in the author's experience). Such small prevalence was due, according to the author, to the “detection programs….identifying most of the early cases.” Interestingly, in a recent study on diabetic children and adolescents, the prevalence of ketoacidosis was not negligible (25.5%). This prevalence, which has not significantly changed in the past 50 years, suggests the need for more effective measures to prevent diabetic ketoacidosis. A few years ago, a community intervention to raise awareness of the symptoms of diabetes was found to reduce the prevalence of diabetic ketoacidosis from 78% to 12.5%....

Anticipatory Guidance in Pediatric Practice: Hill LF. J Pediatr 1960;56:299-307

The Journal of Pediatrics — Mon, 25 Jan 2010 15:34:18 +0100

In 1960 pediatricians were first and foremost infectious disease specialists. Haemophilus influenzae meningitis and epiglottitis, Streptococcus pneumoniae meningitis and pneumonia, Neisseria meningitides disease, newborn sepsis, and other life- and limb-threatening infectious diseases were the battleground that were daily fought by our colleagues. The articles published in pediatric journals at that time were concerned with these infectious diseases, the treatment of premature infants, and trauma. Hill's prescient discussion about anticipatory guidance is an early look at what has become the main focus of primary care pediatrics in the 21st century. The conquering of the deadly infectious diseases with the Haemophilus influenzae type B, pneumococcal, and meningococcal vaccines, as well as ...

On the Role of Infections in Neonatal Mortality: Nelson WE. J Pediatr 1960;56:274-84

The Journal of Pediatrics — Mon, 25 Jan 2010 15:34:17 +0100

In 1960, infection was an underrecognized cause of neonatal mortality. In this treatise (most closely aligned with The Journal's 2010 “Medical Progress” manuscripts), W. E. Nelson points out the inadequacy of data existing at that time. He proposes that on careful evaluation (by obtaining appropriate cultures of the placenta and neonate, along with microbiological and microscopic examination at autopsy), infection often was revealed as the immediate cause of death instead of the clinician's recorded cause, such as “prematurity,” “congenital malformation,” “intracranial hemorrhage,” or “hyaline membrane syndrome.” (Source: The Journal of Pediatrics)

Hyperglycemic Hyperosmolar State: An Emerging Pediatric Problem

The Journal of Pediatrics — Mon, 25 Jan 2010 15:34:16 +0100

In his 1886 Bradshawe lecture on diabetic coma, Dreschfeld described a relatively uncommon form that he and other European authors had noted, in which dyspnea and the acetone smell of the breath were absent, and the urine did not contain acetone or aceto-acetic acid. He described a clinical presentation of shock occurring chiefly, but not exclusively, in older people who had diabetes symptoms for some time and were, “still stout and well-nourished at the time of attack.” Despite this early description and occasional subsequent reports of diabetic coma without significant ketosis/acidosis, the report of Sament and Schwartz in 1957 is widely credited as the original description of what has been variously referred to as hyperosmolar nonketotic coma, hyperglycemic hyperosmolar nonketotic s...

Measurement Matters

The Journal of Pediatrics — Mon, 25 Jan 2010 15:34:16 +0100

Obesity prevention and treatment strategies that lead to sustained benefits for pediatric patients remain elusive. The authors of the American Medical Association's Expert Committee Recommendations emphasized the lack of a solid clinical evidence base for Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity. Most clinical studies are too small to have adequate power to detect differences in treatment and vary in description of participants, interventions, and outcomes. A recurring observation has been the lack of standardized estimates of fatness and change in fatness so that our capacity for comparison or meta-analysis is limited. Consistent characterization of study participants' phenotypes has the potential to identify predictors of response to specific i...

Familial Hypercholesterolemia: A Decade of Progress

The Journal of Pediatrics — Mon, 25 Jan 2010 15:34:16 +0100

Natural history studies of familial hypercholesterolemia (FH), a genetic disorder associated with elevated cholesterol level and premature coronary artery disease and with a frequency of about 1 of 500 in the general population, were first conducted in the 1970s. Homozygotes, with cholesterol levels >500mg/dL, experience coronary events as early as adolescence, and heterozygotes (with 1 normal and 1 abnormal gene) are affected prematurely in middle age. The first major breakthrough in understanding the disease came with the discovery of the low-density lipoprotein (LDL) receptor by Brown and Goldstein, in work that won the Nobel prize. (Source: The Journal of Pediatrics)

Magnetic Resonance Imaging Sheds Light on the Nature of Smoking-Induced Effects on Fetal Brain

The Journal of Pediatrics — Mon, 25 Jan 2010 15:34:16 +0100

In this issue of The Journal, Ekblad et al report as a part of the PIPARI study the effects of smoking during pregnancy on fetal brain volumes with magnetic resonance imaging (MRI). Specifically, the data are not pregnancy-based but are based on neonatal unit recordings. A subgroup analysis of prenatal exposure to cigarette smoking was carried out in 232 very low birth weight infants, of whom a total of 42 infants were exposed to smoking during pregnancy. The main findings were that the frontal lobe and the cerebellar volumes were significantly decreased in exposed infants without changes in head circumference. The observed differences remained significant after controlling for a number of confounding factors. (Source: The Journal of Pediatrics)

Strategies to Design an Effective Mentoring Program

The Journal of Pediatrics — Mon, 25 Jan 2010 15:34:16 +0100

Mentoring is valued in academic medicine as a process to support and develop learners, trainees, and faculty. There is limited evidence available, however, that defines the key elements of effective mentoring or that provides a specific framework on which to structure a successful program. Varying models for mentoring programs have been described, but the lack of defined outcomes demonstrating success limits the ability to apply lessons learned from the efforts of others. (Source: The Journal of Pediatrics)

Information for Readers

The Journal of Pediatrics — Mon, 25 Jan 2010 15:34:16 +0100

(Source: The Journal of Pediatrics)

Editorial Board

The Journal of Pediatrics — Mon, 25 Jan 2010 15:34:16 +0100

(Source: The Journal of Pediatrics)

The Journal of Pediatrics — Mon, 25 Jan 2010 15:34:16 +0100

(Source: The Journal of Pediatrics)

High intensity training increases spontaneous physical activity in children

The Journal of Pediatrics — Mon, 25 Jan 2010 15:34:16 +0100

A controlled study of a physical training intervention was performed by Eiholzer et al in Zurich using two junior ice hockey teams. One team acted as the control whereas the other was assigned to resistance training performed twice weekly for 4 months. The outcome showed a significant increase in spontaneous physical activity in the intervention group compared with the control group at 4 months, which persisted until the 12 month follow-up point. In addition, their arms and legs became stronger during the training intervention. The authors conclude that resistance training might be an effective strategy to prevent childhood obesity. (Source: The Journal of Pediatrics)

More on sodium in “maintenance” fluids

The Journal of Pediatrics — Mon, 25 Jan 2010 15:34:15 +0100

The rather spirited debate regarding the appropriate tonicity of intravenous maintenance fluids shows no sign of abating. Many have called for some sort of randomized trial to shed light on the controversy, although the logistics of designing such a trial are daunting. (Source: The Journal of Pediatrics)

Guidelines, when followed, work for management of acute gastroenteritis

The Journal of Pediatrics — Mon, 25 Jan 2010 15:34:15 +0100

There are many published studies of effect of single interventions (eg, rehydration solutions, diet, medications) on the course of acute gastroenteritis. The study reported in this issue of The Journal by Albano et al from Naples is different. It assessed efficacy of a global guideline in a randomized control study by provider. Investigators took the four major intervention tenets proposed by the European Society of Paediatric Gastroenterology, Hepatology, and Nutrition, randomly assigned pediatricians to a control group for management of acute gastroenteritis, or a 2-hour educational intervention group, and then assessed outcomes of approximately 1300 children managed by these 150 pediatricians. (Source: The Journal of Pediatrics)

Celiac disease and autoimmune thyroid disease

The Journal of Pediatrics — Mon, 25 Jan 2010 15:34:15 +0100

What is the long term clinical significance of anti-thyroid antibodies detected during surveillance of patients with celiac disease? In this issue of The Journal, Cassio et al have shown that despite a high prevalence of positive screening tests for autoimmune thyroiditis, the rate of development of clinical hypothyroidism is low. The development of autoimmune markers did not correlate with gluten ingested. In fact, many of the subjects developed thyroid antibodies while adhering to a gluten-free diet. (Source: The Journal of Pediatrics)

Quality-of-life measures for pediatric liver transplant recipients

The Journal of Pediatrics — Mon, 25 Jan 2010 15:34:15 +0100

The study by Alonso et al shows that outcomes of liver transplantation in infants, children, and adolescents can no longer simply be described on the basis of patient and graft survivals. Rather, it is incumbent on pediatric practitioners to ensure that post-transplant complications including: renal dysfunction, hyperlipidemia, hypertension, opportunistic infections, graft rejection, and overall quality-of-life are monitored carefully and interventions appropriately taken in a timely fashion. The present cross-sectional analysis of selected centers, part of the Studies of Pediatric Liver Transplantation (SPLIT) consortium, highlights gaps in emotional and school functioning that need to be addressed in the future so as to be able to enhance the day-to-day functioning and long-term outcomes...

Statistically twins

The Journal of Pediatrics — Mon, 25 Jan 2010 15:34:15 +0100

Premature birth is common for twins and higher multiple births. Consequently, clinical studies of preterm infants must consider how to deal with twins, and there are three options: exclude twins, randomize them separately, or randomize the twins as a “cluster” of two to the same intervention group. Excluding twins means that 20-30% of the very low birth weight infants population will not be available for the trial. Parents seem to prefer that both infants receive the same randomization. Biologically, twins are not independent as they have shared genetics and maternal environment as fetuses. Thus, there is a problem with dealing with twins statistically, a situation addressed by Hibbs et al in this issue of The Journal. They report that many trials in neonatal medicine ignore the proble...

Development in children with congenital heart disease

The Journal of Pediatrics — Mon, 25 Jan 2010 15:34:15 +0100

With increasing success in the management of children with congenital heart defects emerges the question of whether motor and social development are normal. Better understanding of these issues would help pediatricians and pediatric cardiologists organize care to improve ultimate outcomes. In this issue of The Journal, Eek Brandlistuen et al report on a study from Norway. They took advantage of a large cohort study to serve as the comparison group. They found increased odds of motor impairment at 6 months of age in the group with congenital heart disease and increased odds of social impairment in the group with congenital disease and comorbid conditions, such as intestinal malformation, compared with controls. These findings indicate that motor and social problems begin early in life for p...

Are phthlates precocious?

The Journal of Pediatrics — Mon, 25 Jan 2010 15:34:14 +0100

This article notes that phthalates are not the cause but neither proves nor disproves that endocrine disrupting chemicals are a cause of precocious puberty in children. (Source: The Journal of Pediatrics)

Reply

The Journal of Pediatrics — Mon, 25 Jan 2010 00:00:00 +0100

To the Editor: We thank Caudri and de Jongste for their interest in our article and thoughtful comments. Their first comment has been addressed at length in the discussion of our article and also in the meticulous debate presented by Bush and Eber. In brief, there is no question that asthma may be diagnosed without difficulty by the primary physician on the basis of typical history, response to therapy, and, when needed, additional tests. However, even though this statement holds for many or even most children in the community with clinical symptoms suggesting asthma, it may not be true for a relatively small percentage of children with less-specific complaints or who ignore mild to moderate symptoms or do not respond characteristically to treatment. Because of the high incidence of asth...

Reply

The Journal of Pediatrics — Mon, 25 Jan 2010 00:00:00 +0100

To the Editor: Brooks comments on risk factors that we did not explore that also might play some role in youth violence. Naturally, in any single analysis, it is difficult to consider all risk factors, although we explored a number that had been identified as important in past research. (Source: The Journal of Pediatrics)

Reply

The Journal of Pediatrics — Fri, 08 Jan 2010 00:00:00 +0100

This study was done at the suburb of the megametropolis Kolkata, with a strong industrial base. Though the enrolled children were moderately malnourished, it was not severe enough to cause mucosal damage and make them vulnerable to intractable diarrhea cycle (the so-called threshold effect of malnutrition). In fact, all of them recovered from the index episode. These children were admitted for diarrhea per hospital policy and World Health Organization guidelines for treatment at diarrhea management centers (Plan B), not for any other illness. Severely ill children were excluded from the study. Eleven of 210 children had parasites in the stool. This is common in this setting, and such a small number is unlikely to affect the outcome of the study. (Source: The Journal of Pediatrics)

The optimal use of probiotics in acute diarrhea of childhood

The Journal of Pediatrics — Fri, 08 Jan 2010 00:00:00 +0100

To the Editor: I read with great interest the study by Misra et al. Although it is a well-designed randomized controlled trial, I would like to delineate a few limitations of this study. The trial evaluates a highly selective population, hospitalized malnourished infants and children in rural India. Unfortunately, no data are presented about the indication for hospitalization. Such subjects may have a variety of systemic disorders that affect the study results. In addition, the high proportion of lactose intolerance (81.9%) may result from diffuse small intestinal mucosal damage caused by malnutrition, other gastrointestinal abnormalities, or both. There is no information about the results of testing of stool for parasites. Such confounding factors may adversely affect the clinical benef...

An Unusual Dermatosis in a Child

The Journal of Pediatrics — Fri, 08 Jan 2010 00:00:00 +0100

A 9-year-old boy presented to the emergency room with various macular erythematoses and ecchymotic lesions with geometric shapes and well-defined edges on his left hand and forearm (). Initially, the child denied that the lesions were self-inflicted. But during the anamnesis, his grandmother mentioned that she had noticed that her albuterol inhaler had run out before she had expected. We confirmed that the shape of the distal part of the inhaler corresponded exactly with the borders of the child's skin lesions. Finally, the child confessed that he had created the lesions by heating the inhaler on a vitroceramic hotplate and then applying it to his skin. (Source: The Journal of Pediatrics)

Complication after “Home Treatment” of Polydactyly

The Journal of Pediatrics — Fri, 08 Jan 2010 00:00:00 +0100

A 24-day-old African American infant presented to our Pediatric clinic for an initial visit. At birth he was found to have bilateral pedunculated postaxial extra digits on the upper extremities. An outpatient appointment had been scheduled with a pediatric surgeon. The infant was born premature but was otherwise healthy. Two days before presentation, the patient's grandmother tied the base of both extra digits with thread. (Source: The Journal of Pediatrics)

Clindamycin-Resistant Group B Streptococcus and Failure of Intrapartum Prophylaxis to Prevent Early-Onset Disease

The Journal of Pediatrics — Fri, 08 Jan 2010 00:00:00 +0100

We report a case of clindamycin-resistant GBS disease in a newborn infant whose mother received clindamycin IAP, and we review clindamycin susceptibility testing. (Source: The Journal of Pediatrics)

Clinical Characteristics and Outcomes of Neonatal Pertussis: A Comparative Study

The Journal of Pediatrics — Fri, 08 Jan 2010 00:00:00 +0100

We describe the features and outcomes of neonatal pertussis and compare these with neonates with non-pertussis acute respiratory illness from July 2000 through December 2007. Patients with pertussis had a more severe course of disease as evidenced by the clinical presentation, length of hospitalization, and oxygen requirement. Clinicians should have a high index of suspicion so that appropriate supportive care can be initiated promptly. (Source: The Journal of Pediatrics)

Adrenal Insufficiency in Newborns with Congenital Diaphragmatic Hernia

The Journal of Pediatrics — Fri, 08 Jan 2010 00:00:00 +0100

Newborns with congenital diaphragmatic hernia frequently have catecholamine-unresponsive systemic hypotension and respiratory failure. We found that adrenal insufficiency frequently complicates the clinical course of infants with congenital diaphragmatic hernia and was associated with increased severity of illness. (Source: The Journal of Pediatrics)

Very Long-Chain Acyl-CoA Dehydrogenase Deficiency in a Patient with Normal Newborn Screening by Tandem Mass Spectrometry

The Journal of Pediatrics — Fri, 08 Jan 2010 00:00:00 +0100

We report a patient who died as a result of severe brain injury due to hypoglycemia. Newborn screening was normal. Postmortem enzyme analysis and molecular testing confirmed the diagnosis of VLCADD. (Source: The Journal of Pediatrics)

Treatment Adherence in Patients with Sickle Cell Anemia

The Journal of Pediatrics — Fri, 08 Jan 2010 00:00:00 +0100

Advances in the treatment of sickle cell anemia (SCA), including hydroxyurea therapy, hold the promise of improving health outcomes for children and adolescents with this very challenging chronic condition. Close adherence to the prescribed treatment is necessary to maximize the efficacy of hydroxyurea. However, this treatment is part of a multifaceted and very demanding regimen that can include multiple medications and hydration. Earlier evidence suggests that adherence to the range of prescribed treatments for pediatric SCA, including hydroxyurea, is less than ideal. Consequently, there is an important need to gather clinically relevant scientific data on the prevalence and potential health-related consequences of non-adherence. (Source: The Journal of Pediatrics)

Fellowships

The Journal of Pediatrics — Tue, 15 Dec 2009 15:04:03 +0100

Pediatric subspecialties and general academic pediatric training. Although most of the sponsoring institutions indicated that they were accredited by the Accreditation Council for Graduate Medical Education (ACGME), this fellowship listing is based on information supplied by the sponsoring institution and does not confirm approval by an accrediting agency. Please contact the Director of the program for further information.∗ The sponsoring program did not indicate accreditation by ACGME. (Source: The Journal of Pediatrics)

Erratum

The Journal of Pediatrics — Tue, 15 Dec 2009 15:04:03 +0100

In the article, “Mollaret Meningitis Associated with Occipital Dermal Sinus,” by Shimizu et al, J Pediatr 2009;155:757, Tetsuo Kubo, MD, PhD, Department of Pediatrics, Hokushin General Hospital, Nakano, Japan, should have been included as the last author. (Source: The Journal of Pediatrics)

Reply

The Journal of Pediatrics — Tue, 15 Dec 2009 15:04:03 +0100

To the Editor: We greatly appreciate the interest of Pinheiro in our study and would like to address his concerns. Pinheiro finds that the values that we report are strikingly high, in comparison with findings of other authors and international recommendations. A careful review of references 1 to 4 reveals the following: reference 4 is not an original study and consists of expert opinion given at a time when there was little or no data available at that time and was mostly based on extrapolation of existing data on larger babies. Reference 1 relates to the work of Loew et al, mostly related to the relationship between infant length and endotracheal tube (ETT) depth. In that study, there were only 49 infants between 26 to 45 “postconceptional” weeks, with a postnatal age ranging from b...

Orotracheal tube length in ELBW neonates

The Journal of Pediatrics — Tue, 15 Dec 2009 15:04:03 +0100

To the Editor: Amarilyo et al report strikingly high values for ideal tip-to-lip distance of endotracheal tubes (ETTs) in extremely low birth weight (ELBW) neonates in comparison with findings of other authors and international recommendations. An ongoing quality improvement project at our center uses digital radiography methods similar to those reported by Amarilyo et al to determine the ideal ETT depth; we operationally defined the mid-tracheal target for the ETT tip as the T1 to T2 intervertebral space. Reviewing the information from the first 33 ELBW neonates from whom we have measurements this year, we find that only 3 had an ideal depth >7 cm, and 25 (76%) had an ideal depth (Source: The Journal of Pediatrics)

Reply

The Journal of Pediatrics — Tue, 15 Dec 2009 15:04:03 +0100

To the Editor: Zimmerman and Strasburger offer numerous errors, omissions, and polemics rather than meaningful dialogue. We offer a point-by-point rebuttal: (1) Of the articles they say we “missed,” most did not meet inclusion criteria (no measure of aggressive behavior, no contrast between violent and non-violent media). The remainder were published or indexed in PsychINFO after the time of our study search. They present a rather dishonest list, failing to inform the readers why these studies were not included. (2) They puzzlingly assert omission of a study that was included. (3) Our article does not refer to attenuation because of unreliability, which Zimmerman and Strasburger reference, rather unstandardized assessments of aggression. Unstandardized assessment allows researchers t...

Violence in media research

The Journal of Pediatrics — Tue, 15 Dec 2009 15:04:03 +0100

To the Editor: Readers of a recent meta-analysis by Ferguson and Kilburn could be forgiven for taking away the impression that exposure to media violence has no meaningful effect on aggressive behaviors. In fact, the opposite is likely true. The meta-analysis has several flaws, any one of which would call into serious doubt the inferences drawn from the analysis: (Source: The Journal of Pediatrics)

Successful prevention of severe infection in Japanese siblings with interleukin-1 receptor–associated kinase 4 deficiency

The Journal of Pediatrics — Tue, 15 Dec 2009 15:04:03 +0100

To the Editor: Three years ago, our group reported a Japanese patient with interleukin-1 receptor–associated kinase 4 (IRAK4) deficiency. Subsequently, this patient's younger siblings, a 3-year-old brother and a 32-month-old sister, were born with the same IRAK4 gene mutation, with absence of tumor necrosis factor-α and interleukin-6 production from mononuclear cells in response to lipopolysaccharide. To date, we have successfully prevented severe infections in these 2 patients. Here we report additional information on their favorable clinical course. (Source: The Journal of Pediatrics)

Also Noted

The Journal of Pediatrics — Tue, 15 Dec 2009 15:04:03 +0100

Koster MP, Stellato N, Kohn N, Rubin LG. Needle length for immunization of early adolescents as determined by ultrasound. Pediatrics 2009;124:667-72. The purpose of this interesting study was to determine the appropriate needle length for intramuscular injection of vaccines in adolescents ages 11 to 15. Given the increasing percentage of overweight and obese children, ensuring the delivery of the vaccine into the deltoid muscle is important. With ultrasonography, the investigators measured muscle depth at the deltoid injection site, when the area was bunched or flattened. In this population, 26% weighed (Source: The Journal of Pediatrics)

Ambulatory treatment of infants with presumed febrile urinary tract infection may be feasible

The Journal of Pediatrics — Tue, 15 Dec 2009 15:04:03 +0100

Dore-Bergeron MJ, Gauthier M, Chevalier I, McManus B, Tapiero B, Lebrun S. Urinary tract infections in 1- to 3-month-old infants: ambulatory treatment with intravenous antibiotics. Pediatrics 2009;124:16-22. (Source: The Journal of Pediatrics)

Amoxicillin/potassium clavulanate is effective treatment for acute bacterial sinusitis in children

The Journal of Pediatrics — Tue, 15 Dec 2009 15:04:03 +0100

Wald ER, Nash D, Eickhoff J. Effectiveness of amoxicillin/clavulanate potassium in the treatment of acute bacterial sinusitis in children. Pediatrics 2009;124:9-15. Among children diagnosed with acute bacterial sinusitis (ABS), how effective is high-dose amoxicillin/potassium clavulanate compared with placebo? (Source: The Journal of Pediatrics)

Fever and hypoxia predict radiographic pneumonia among children with wheezing

The Journal of Pediatrics — Tue, 15 Dec 2009 15:04:03 +0100

Mathews B, Shah S, Cleveland RH, Lee EY, Bachur RG, Neuman MI. Clinical predictors of pneumonia among children with wheezing. Pediatrics 2009;124:e29-36. Among children with wheezing in the emergency department (ED) setting, what factors predict radiographically-confirmed pneumonia? (Source: The Journal of Pediatrics)

Ibuprofen elevates total bilirubin in preterm infants

The Journal of Pediatrics — Tue, 15 Dec 2009 15:04:03 +0100

Zecca E, Romagnoli C, De Carolis MP, Costa S, Marra R, De Luca D. Does ibuprofen increase neonatal hyperbilirubinemia? Pediatrics 2009;124:480-4. Among preterm infants born at (Source: The Journal of Pediatrics)

Xylitol syrup can reduce dental caries progression in young children

The Journal of Pediatrics — Tue, 15 Dec 2009 15:04:01 +0100

Milgrom P, Ly KA, Tut OK, Mancl L, Roberts MC, Briand K, et al. Xylitol pediatric topical oral syrup to prevent dental caries: a double-blind randomized clinical trial of efficacy. Arch Pediatr Adolesc Med 2009;163:601-7. (Source: The Journal of Pediatrics)

Amoxicillin treatment increases rate of late recurrence of acute otitis media in young children

The Journal of Pediatrics — Tue, 15 Dec 2009 15:04:01 +0100

Bezakova N, Damoiseaux RA, Hoes AW, Schilder AG, Rovers MM. Recurrence up to 3.5 years after antibiotic treatment of acute otitis media in very young Dutch children: survey of trial participants. BMJ 2009;338:b2525. (Source: The Journal of Pediatrics)

Perimenarchal Menorrhagia: Evaluation and Management

The Journal of Pediatrics — Tue, 15 Dec 2009 15:04:01 +0100

A pale 13-year-old girl presented to a local Emergency Department with excessive vaginal bleeding and fainting. Menarche occurred 1 month before presentation. Her second period started 17 days preceding hospital arrival. She was nonobese with a hemoglobin of 5.9 g/dL but with normal platelets, white count, coagulation studies, Factor VIII antigen, Ristocetin cofactor assay, thyroid-stimulating hormone, prolactin, and a negative pregnancy test. She received a total of 12 units of packed red blood cells, 25 mg Premarin intravenously ×1, and 100 mg progesterone intramuscularly ×1. Pelvic ultrasound demonstrated a 16-mm endometrium. Once hemodynamically stable, she was discharged home with iron supplements and Lo/Ovral (ethinyl estradiol and norgestrel) (Wyeth Pharmaceuticals, Madison, New J...

Pulmonary Hypoplasia in a Newborn with Goldenhar Syndrome

The Journal of Pediatrics — Tue, 15 Dec 2009 15:04:01 +0100

A female infant born to a 31-year-old mother (G2P2) by cesarean section at 35 weeks' gestation was referred for facial asymmetry and facial paralysis (, A). The parents are not relatives. The pregnancy was complicated by polyhydramnios with no known intrauterine teratogenic exposure. On physical examination, the infant appeared alert, active, and well. Her weight was 2280 g (50th percentile), length was 44 cm (10th to 50th percentile), and head circumference was 33 cm (50th percentile). The following dysmorphic features were noted: left facial hypoplasia, ipsilateral ear anomalies (i.e., malformed, low-set ear; microtia; preauricular tags; external auditory canal atresia), mandibular hypoplasia, and hypertelorism. A chest radiograph revealed nearly complete opacification of the left hemith...

Autoimmune Focal Encephalitis Shows Marked Hypermetabolism on Positron Emission Tomography

The Journal of Pediatrics — Tue, 15 Dec 2009 15:04:01 +0100

A 22-month-old toddler presented with involuntary movements, hemiparesis, and behavioral changes. Magnetic resonance imaging showed no abnormality, but positron emission tomography (PET) showed focal hypermetabolism. By immunohistochemical technique with the patient's sera in control brain sections, autoantibodies recognizing the same areas as found by PET scanning were identified and disappeared after intravenous immunoglobulin therapy. PET scanning may be useful in the diagnosis of autoimmune encephalitis. (Source: The Journal of Pediatrics)

Brown Recluse Spider (Loxosceles reclusa) Envenomation Leading to Acute Hemolytic Anemia in Six Adolescents

The Journal of Pediatrics — Tue, 15 Dec 2009 15:04:01 +0100

Loxosceles reclusa (brown recluse spider) bites often cause local envenomation reactions; however, acute hemolysis from systemic loxoscelism is rare. To highlight this important diagnostic consideration for unexplained hemolysis in areas endemic for brown recluse spiders, we report on 6 adolescents with acute hemolytic anemia from presumed L reclusa bites. (Source: The Journal of Pediatrics)

50 Years Ago in The Journal of Pediatrics: The Blood Volume of Infants: Alterations in the First Hours After Birth

The Journal of Pediatrics — Tue, 15 Dec 2009 15:04:01 +0100

Sisson TRC, Whalen LE. J Pediatr 1960:56:43-7 Eighty milliliters per kilogram: the newborn's blood volume. It's a number that was drummed into me by learned superiors during training. One knows this number instinctively, but rarely question from where it comes. However, it guides much that we do. (Source: The Journal of Pediatrics)

Incidence of Invasive Community-Onset Staphylococcus aureus Infections in Children in Central New York

The Journal of Pediatrics — Tue, 15 Dec 2009 15:04:01 +0100

We determined the incidence of invasive community-onset Staphylococcus aureus infections, clinical characteristics, and antibiotic susceptibilities in 128 hospitalized children in central New York. The prevalence of invasive S aureus infections in our institution remained (Source: The Journal of Pediatrics)

Massive Pulmonary Embolism in Children

The Journal of Pediatrics — Tue, 15 Dec 2009 15:04:01 +0100

We present 3 children with massive pulmonary embolism and review 17 recent pediatric reports. Malignancies were a frequent cause (40%), and sudden death was common (60%). Compared with adults, diagnosis was more likely to be made at autopsy (P < .0001), more children were treated with embolectomy/thrombectomy (P = .0006), and mortality was greater (P = .03). (Source: The Journal of Pediatrics)

Low Body Adiposity and High Leptinemia in Breast-fed Infants Born Small-for-Gestational-Age

The Journal of Pediatrics — Tue, 15 Dec 2009 15:04:00 +0100

Breast-fed infants born small-for-gestational-age (SGA) (n = 28) were found to develop lower adiposity across early infancy, when compared with appropriate-for-gestational age infants (n = 46). The SGA infants were also found to have 2-fold higher (P < .001) levels of circulating leptin at 4 months. This paradoxical hyperleptinemia in early infancy may contribute to a program that produces a process from fetal underweight to adult overweight. (Source: The Journal of Pediatrics)

An Ethical and Policy Analysis of Elective Transplantation for Metabolic Conditions Diagnosed by Newborn Screening

The Journal of Pediatrics — Tue, 15 Dec 2009 15:03:59 +0100

Liver transplantation (LT) is a therapeutic option for some metabolic conditions; however, unlike other causes of liver failure, some of these conditions can be treated with dietary means. For those conditions, LT has been described as “elective.” Both maple syrup urine disease (MSUD) and methylmalonic acidemia (MMA) are 2 such metabolic conditions. The main ethical issue is a justice concern: whether to list children and adults with MSUD and MMA for an “elective” LT when other patients with non-metabolic liver failure die because there is an inadequate supply of deceased donor liver grafts. According to the United Network for Organ Sharing/Organ Procurement and Transplant Network (UNOS/OPTN), at the end of 2008, 15 848 people were on the deceased donor liver transplant (DDLT) wait...

50 Years Ago in The Journal of Pediatrics: Clothes and the Man

The Journal of Pediatrics — Tue, 15 Dec 2009 15:03:59 +0100

Editor's Column. J Pediatr 1960;56:134. The “clothes” referred to in this editor's note was the newly unveiled “jacket” for The Journal in 1960−a spiffed up “gray Journal.” Just during my time on the Editorial Board since the mid 1990s, we ventured briefly into a shiny purple affair, which 1 reader complained was so slick that it fell off his lap onto the floor or into the bath water for goodness sake! Then, more recently, the cover of the “gray Journal” became blue-on-blue, and now, since July 2009, black-and-blue on white. (Source: The Journal of Pediatrics)

50 Years Ago in The Journal of Pediatrics: The Leukocyte Response in Patients with Shigellosis

The Journal of Pediatrics — Tue, 15 Dec 2009 15:03:58 +0100

Donald WD, Winkler CH Jr. J Pediatr 1960;56:61-5. Although shigellosis is less of a health risk for children now than 50 years ago, Shigella species certainly have not been eradicated, and local or widespread person-to-person and food-borne outbreaks of disease keep the pathogen on the mental differential diagnosis when evaluating infants and children with acute diarrheal disease. The study report by Donald and Winkler of 67 children admitted to the Hospital of the University of Alabama in a 3-year period with shigellosis (Shigella flexneri, 62 patients; and S sonnei, 5 patients) represents a piece of the primary data on which we base current conclusions of the predictive value of the peripheral blood leukocyte count in children with a diarrheal illness. (Source: The Journal of Pediatrics...

50 Years Ago in The Journal of Pediatrics: Intermittent Peritoneal Dialysis in the Treatment of Experimental Salicylate Intoxication

The Journal of Pediatrics — Tue, 15 Dec 2009 15:03:54 +0100

Etteldorf JN, Montalvo JM, Kaplan S, Sheffield JA. J Pediatr 1960;56:1-10. Reading this manuscript is quite interesting, because complications from therapy with salicylate was an important problem 50 years ago and is quite uncommon today. (Source: The Journal of Pediatrics)

50 Years Ago in The Journal of Pediatrics: Coarctation of the Aorta and Associated Patent Ductus Arteriosus. I. Experimental Study in Dogs