bluuebunny/crossref_metadata_2025 huggingface dataset:
A Multicenter Evaluation of How Many Infants With Permanent Hearing Loss Pass a Two-Stage Otoacoustic Emissions/Automated Auditory Brainstem Response Newborn Hearing Screening Protocol
Authors: Johnson Jean L. , White Karl R. , Widen Judith E. , Gravel Judith S. , James Michele , Kennalley Teresa , Maxon Antonia B. , Spivak Lynn , Sullivan-Mahoney Maureen , Vohr Betty R. , Weirather Yusnita , Holstrum June
Published: September 2005

Objective. Ninety percent of all newborns in the United States are now screened for hearing loss before they leave the hospital. Many hospitals use a 2-stage protocol for newborn hearing screening in which all infants are screened first with otoacoustic emissions (OAE). No additional testing is done with infants who pass the OAE, but infants who fail the OAE next are screened with automated auditory brainstem response (A-ABR). Infants who fail the A-ABR screening are referred for diagnostic testing to determine whether they have permanent hearing loss (PHL). Those who pass the A-ABR are considered at low risk for hearing loss and are not tested further. The objective of this multicenter study was to determine whether a substantial number of infants who fail the initial OAE and pass the A-ABR have PHL at ∼9 months of age.

Methods. Seven birthing centers with successful newborn hearing screening programs using a 2-stage OAE/A-ABR screening protocol participated. During the study period, 86634 infants were screened for hearing loss at these sites. Of those infants who failed the OAE but passed the A-ABR in at least 1 ear, 1524 were enrolled in the study. Data about prenatal, neonatal, and socioeconomic factors, plus hearing loss risk indicators, were collected for all enrolled infants. When the infants were an average of 9.7 months of age, diagnostic audiologic evaluations were done for 64% of the enrolled infants (1432 ears from 973 infants).

Results. Twenty-one infants (30 ears) who had failed the OAE but passed the A-ABR during the newborn hearing screening were identified with permanent bilateral or unilateral hearing loss. Twenty-three (77%) of the ears had mild hearing loss (average of 1 kHz, 2 kHz, and 4 kHz ≤40-decibel hearing level). Nine (43%) infants had bilateral as opposed to unilateral loss, and 18 (86%) infants had sensorineural as opposed to permanent conductive hearing loss.

Conclusions. If all infants were screened for hearing loss using the 2-stage OAE/A-ABR newborn hearing screening protocol currently used in many hospitals, then ∼23% of those with PHL at ∼9 months of age would have passed the A-ABR. This happens in part because much of the A-ABR screening equipment in current use was designed to identify infants with moderate or greater hearing loss. Thus, program administrators should be certain that the screening program, equipment, and protocols are designed to identify the type of hearing loss targeted by their program. The results also show the need for continued surveillance of hearing status during childhood.
Disabling Conditions and Registration for Child Abuse and Neglect: A Population-Based Study
Authors: Spencer Nick , Devereux Emma , Wallace Ann , Sundrum Ratna , Shenoy Manjula , Bacchus Claire , Logan Stuart
Published: September 2005

Objective. To study the relationship between disabling conditions and registration for child abuse and neglect in a 19-year whole-population birth cohort

Setting. West Sussex area of the United Kingdom.

Study Design. Retrospective whole-population cohort.

Main Outcomes. Child-protection registration, physical abuse, sexual abuse, emotional abuse, and neglect.

Population and Participants. Infants born in West Sussex (119729) between January 1983 and December 2001 with complete data including birth weight, gestational age, maternal age, and postal code.

Results. Cerebral palsy, speech and language disorder, learning difficulties, conduct disorders, and nonconduct psychological disorders were all significantly associated with child-protection registration before adjustment, and all but cerebral palsy retained significance after adjustment for birth weight, gestational age, and socioeconomic status. Autism and sensory disabilities (vision and hearing) were not associated with an increased risk of child-protection registration. Conduct disorders and moderate/severe learning difficulty were associated with registration in each of the 4 categories after adjustment for socioeconomic status, birth weight, and gestational age. Children with speech and language disorders and mild learning difficulties were at increased risk of physical abuse, emotional abuse, and neglect. Nonconduct psychological disorders were associated with all categories except neglect, and cerebral palsy was associated with all categories except physical abuse and neglect.

Conclusions. Children with disabling conditions seem to be at increased risk of registration for child abuse and neglect, although the pattern of registration varies with the specific disabling condition. The strong association with registration noted for conditions such as conduct disorder and learning difficulties is likely to arise, in part, because these conditions share a common etiologic pathway with child abuse and neglect.
Diaper Dye Dermatitis
Authors: Alberta Lauren , Sweeney Susan M. , Wiss Karen
Published: September 2005

Diaper dermatitis is a common problem in outpatient pediatric office settings. Although most diaper rashes represent a form of contact dermatitis in response to irritants in the diaper environment, other rashes may be the result of an allergen in the diaper. On the basis of clinical examination results for 5 patients and patch testing results for 2 patients, we suspect that the patients demonstrated allergic contact dermatitis in response to the various blue, pink, and green dyes in diapers. Although topically administered corticosteroids are useful in the treatment regimen, the preferred treatment for allergic contact dermatitis in the diaper area is the use of dye-free diapers for allergen avoidance. Patch testing may also be valuable in identifying the allergen, because allergen avoidance is the key to prevention of recurrent disease.
Factors Associated With Increased Resource Utilization for Congenital Heart Disease
Authors: Connor Jean Anne , Gauvreau Kimberlee , Jenkins Kathy J.
Published: September 2005

Objective. To identify patient, institutional, and regional factors that are associated with high resource utilization for congenital heart surgery.

Methods. We used hospital discharge data from the Healthcare Cost and Utilization Project (HCUP) Kids’ Inpatient Database (KID) year 2000 (data from 27 states). Patients who had congenital heart surgery and were younger than 18 years were identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes. High resource utilization admissions were defined as those in the highest decile for total hospital charges. Univariate and multivariate analyses with and without deaths were used to determine demographic and hospital predictors for cases of high resource use. Case-mix severity was approximated using Risk Adjustment for Congenital Heart Surgery risk groups. Regional and state differences were also examined.

Results. Among 10569 cases of congenital heart surgery identified, median total hospital charges were $53828. Statewide differences in the number of high resource use admissions were present; California, Colorado, Florida, Hawaii, Pennsylvania, and Texas were more likely to have high resource use cases, and Maine and South Carolina were less likely. Subsequent analyses were performed adjusting for baseline state effects. Multivariate analyses using generalized estimating equations models revealed Risk Adjustment for Congenital Heart Surgery risk category (odds ratio [OR]: 1.66–14.1), age (OR: 3.81), prematurity (OR: 4.85), the presence of other major noncardiac structural anomalies (OR: 2.53), Medicaid insurance (OR: 1.48), and admission during a weekend (OR: 1.62) to be independent predictors of a higher odds of high cost cases. Although some institutional differences were noted in univariate analyses, gender, race, bed size, teaching and children’s hospital status, hospital ownership, and hospital volume of cardiac cases were not independently associated with greater odds of high resource utilization.

Conclusions. States varied in the frequency of high resource utilization for congenital heart surgery. Patients who had greater disease complexity, younger age, prematurity, other anomalies, and Medicaid and were admitted during a weekend were more likely to result in high resource utilization. Institutions of various types did not differ in high cost admissions, regardless of children’s hospital or teaching status.
Efficacy and Safety of Lovastatin Therapy in Adolescent Girls With Heterozygous Familial Hypercholesterolemia
Authors: Clauss Sarah B. , Holmes Kathryn W. , Hopkins Paul , Stein Evan , Cho Meehyung , Tate Ann , Johnson-Levonas Amy O. , Kwiterovich Peter O.
Published: September 2005

Objective. The present study was designed to evaluate the lipid-altering efficacy, safety, and tolerability of lovastatin treatment in adolescent girls with heterozygous familial hypercholesterolemia.

Methods. A total of 54 postmenarchal girls, aged 10 to 17 years, were enrolled in a 24-week, double-blind, randomized, placebo-controlled study. After a 4-week diet/placebo run-in period, patients were randomized to 1 of 2 groups: (1) treatment with diet plus lovastatin 20 mg/day for 4 weeks, followed by diet plus lovastatin 40 mg/day for 20 weeks, or (2) diet plus placebo for 24 weeks.

Results. Baseline values of lipids, lipoproteins, and apolipoproteins (apo) were comparable between treatment groups. Lovastatin treatment was efficacious at reducing low-density lipoprotein cholesterol by 23% to 27%, total cholesterol by 17% to 22%, and apo B by 20% to 23% at weeks 4 and 24, respectively. Between-treatment group differences were not statistically significant for triglycerides, very-low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, or apo A-I. Lovastatin was generally safe and well tolerated. There were no clinically significant alterations in vital signs (blood pressure and pulse rate), anthropomorphic measurements (height, weight, and BMI), hormone levels (luteinizing hormone, follicle-stimulating hormone, dehydroepiandrosterone sulfate, estradiol, and cortisol), menstrual cycle length, or tests of liver and muscle function.

Conclusions. Lovastatin offers an efficacious and well-tolerated treatment option for improving lipid profiles in adolescent girls with familial hypercholesterolemia.
Folate Status of Mothers During Pregnancy and Mental and Psychomotor Development of Their Children at Five Years of Age
Authors: Tamura Tsunenobu , Goldenberg Robert L. , Chapman Victoria R. , Johnston Kelley E. , Ramey Sharon L. , Nelson Kathleen G.
Published: September 2005

Objective. There are limited data relating folate nutritional status of mothers during pregnancy to mental and psychomotor development of their offspring. Using an existing data set from a study on the effect of prenatal zinc supplementation on child neurodevelopment, we evaluated the association between folate nutritional status of mothers during pregnancy and neurodevelopment of their children.

Methods. Maternal blood folate and total homocysteine (tHcy) concentrations were measured at 19, 26, and 37 weeks of gestation. At a mean of 5.3 years of age, 355 black children with low-socioeconomic background were given 6 tests: Differential Ability Scales, Visual and Auditory Sequential Memory, Knox Cube Test, Gross Motor Scale, and Grooved Pegboard. The scores of the tests between the 2 groups of mothers with poor versus adequate folate nutritional status classified by blood folate or tHcy concentrations were compared.

Results. There were no differences in the test scores of neurodevelopment between the 2 groups.

Conclusion. Folate nutritional status of mothers in the later half of pregnancy assessed by plasma and erythrocyte folate and plasma tHcy concentrations had no impact on neurodevelopment of their children at age 5. It is unknown whether our findings in a low-socioeconomic population can be readily extrapolated to other populations.
Neurodevelopmental Outcomes of Extremely Low Birth Weight Infants <32 Weeks’ Gestation Between 1993 and 1998
Authors: Vohr Betty R. , Wright Linda L. , Poole W. Kenneth , McDonald Scott A. ,   for the NICHD Neonatal Research Network Follow-up Study
Published: September 2005

Objective. This study evaluated the impact of changes in perinatal management on neurodevelopmental impairment (NDI) at 18 to 22 months’ corrected age of low gestation (22–26 weeks) and higher gestation (27–32 weeks) extremely low birth weight infants (401–1000 g birth weight) who were cared for in the National Institute of Child Health and Human Development Neonatal Research Network during 3 epochs (1993–1994, 1995–1996, and 1997–1998). It was hypothesized that outcomes would improve over the 3 epochs.

Methods. A multicenter cohort study was conducted of the outcomes of 3785 infants with assessments at 18 to 22 months’ corrected age. Regression analyses were completed to evaluate for epoch effects, gestational age effects, and time plus gestational age interaction. Regression analyses were also performed to identify the independent associations of epoch and 4 study perinatal interventions: antenatal steroids (yes, no), high-frequency ventilation (yes, no), number of days to regain birth weight as a marker of nutritional intake, and postnatal steroids for treatment of bronchopulmonary dysplasia (yes, no) with outcomes.

Results. Survival improved for both the low (55%–61%) and higher (82%–86%) gestational age groups during the 3 epochs. Regression analyses indicated that the decreased risk for adverse outcome was significantly lower in epoch 2 compared with epoch 1 with decreased rates of low Bayley Mental Development Index (MDI) and neurodevelopmental impairment (NDI). Antenatal steroids were associated with decreased risk for moderate to severe cerebral palsy (CP) and low Bayley Psychomotor Development Index. High-frequency ventilation was associated with a low Bayley MDI and NDI, and postnatal steroids were associated with moderate to severe CP, any CP, low Bayley MDI, low Bayley Psychomotor Development Index, and increased NDI.

Conclusion. Survival of extremely low birth weight infants improved between 1993 and 1998. Although some outcomes remained unchanged, the rates of low Bayley MDI scores and NDI improved. Antenatal steroid administration was the only study intervention associated with improved outcomes.
Post-PCV7 Changes in Colonizing Pneumococcal Serotypes in 16 Massachusetts Communities, 2001 and 2004
Authors: Huang Susan S. , Platt Richard , Rifas-Shiman Sheryl L. , Pelton Stephen I. , Goldmann Donald , Finkelstein Jonathan A.
Published: September 2005

Objective. The introduction of heptavalent conjugate pneumococcal vaccine (PCV7) has raised concerns for replacement with nonvaccine serotypes in both invasive disease and asymptomatic carriage. Analysis of colonizing serotypes among healthy children in the community provides critical data on such changes.

Methods. Nasopharyngeal specimens were obtained from children who were younger than 7 years during well-child or sick visits in primary care practices in 16 Massachusetts communities during 2001 and 2004. Susceptibility testing and serotyping were performed on isolated Streptococcus pneumoniae strains. Vaccination history with PCV7 was abstracted from the medical record.

Results. Among colonizing pneumococcal isolates, PCV7 serotypes decreased from 36% to 14%, and non-PCV7 serotypes increased from 34% to 55%. Overall carriage did not change (26% to 23%); neither did carriage of potentially cross-reactive serotypes (30% to 31%). The most common non-PCV7 serotypes were serotypes 11, 15, and 29. There was a substantial increase in penicillin nonsusceptibility from 8% to 25% in non-PCV7 serotypes; 35% were highly resistant to penicillin. Penicillin nonsusceptibility increased from 45% to 56% among PCV7 serotypes while remaining stable among PCV7 potentially cross-reactive strains (51% vs 54%).

Conclusions. Pneumococcal colonization has changed after the introduction of PCV7, both in serotype distribution and in patterns of antibiotic resistance. The frequency of nonvaccine strains has increased, and the proportion of nonvaccine isolates that are not susceptible to penicillin has tripled. This shift toward increased carriage of nonvaccine serotypes warrants vigilance for changes in the epidemiology of invasive pneumococcal disease.
Association of Intrapartum Antibiotic Exposure and Late-Onset Serious Bacterial Infections in Infants
Authors: Glasgow Tiffany S. , Young Paul C. , Wallin Jordan , Kwok Carolyn , Stoddard Greg , Firth Sean , Samore Matthew , Byington Carrie L.
Published: September 2005

Objective. Recommendations to prevent vertical transmission of group B Streptococcus (GBS) infections have resulted in many women's receiving antibiotics during labor with an associated reduction in early-onset GBS infections in their newborn infants. However, a potential relationship of intrapartum antibiotics (IPA) to the occurrence of late-onset (7–90 days) serious bacterial infections (SBIs) in term infants has not been reported. The objectives of this study were to determine whether infants with late-onset SBI were more likely than healthy control infants to have been exposed to IPA and whether there was a greater likelihood of antibiotic resistance in bacteria that were isolated from infants who had an SBI and had been exposed to IPA compared with those who had not.

Methods. We used a case-control design to study the first objective. Cases were previously healthy full-term infants who were hospitalized for late-onset SBI between the ages of 7 and 90 days. Control subjects were healthy full-term infants who were known not to have an SBI in their first 90 days. Cases and control subjects were matched for hospital of delivery. In the second part of the study, rates of antibiotic resistance of bacteria that were isolated from infected infants were compared for those who had and had not been exposed to IPA.

Results. Ninety case infants and 92 control subjects were studied. Considering all types of IPA, more case (41%) than control infants (27%) had been exposed to IPA (adjusted odds ratio [OR]: 1.96; 95% confidence interval [CI]: 1.05–3.66), after controlling for hospital of delivery. The association was stronger when IPA was with broad-spectrum antibiotics (adjusted OR: 4.95; 95% CI: 2.04–11.98), after controlling for hospital of delivery, penicillin IPA, maternal chorioamnionitis, and breastfeeding. Bacteria that were isolated from infected infants who had been exposed to IPA were more likely to exhibit ampicillin resistance (adjusted OR: 5.7; 95% CI: 2.3–14.3), after controlling for hospital of delivery, but not to other antibiotics that are commonly used to treat SBI in infants.

Conclusions. After adjusting for potential confounders, infants with late-onset SBI were more likely to have been exposed to IPA than noninfected control infants. Pathogens that cause late-onset SBI were more likely to be resistant to ampicillin when the infant had been exposed to intrapartum antibiotics.
A National Study of Neighborhood Safety, Outdoor Play, Television Viewing, and Obesity in Preschool Children
Authors: Burdette Hillary L. , Whitaker Robert C.
Published: September 2005

Objective. To test the hypothesis that preschool children have a higher prevalence of obesity, spend less time playing outdoors, and spend more time watching television (TV) when they live in neighborhoods that their mothers perceive as unsafe.

Methods. In a cross-sectional survey in 20 large US cities, mothers reported the average daily time of outdoor play and TV viewing for their 3-year-old children, and the children's BMI was measured. Maternal perception of neighborhood safety was assessed with the Neighborhood Environment for Children Rating Scales; the scale score was used to divide children into tertiles of neighborhood safety.

Results. Of the 3141 children studied, 35% lived in households with incomes below the US poverty threshold. After adjustment for sociodemographic factors (household income and mothers' education, race/ethnicity, age, and marital status), obesity prevalence (BMI ≥95th percentile) did not differ in children from the least safe to the safest neighborhood safety tertile (18% vs 17% vs 20%) or in weekday (160 vs 151 vs 156 minutes/day) or weekend (233 vs 222 vs 222 minutes/day) outdoor play time. Children who lived in neighborhoods that were perceived by their mothers as the least safe watched more TV (201 vs 182 vs 185 minutes/day) and were more likely to watch >2 hours/day (66% vs 60% vs 62%). TV viewing and outdoor play minutes were not significantly correlated to each other or to BMI.

Conclusions. In a national sample of preschool children, mothers' perception of neighborhood safety was related to their children's TV viewing time but not to their outdoor play time or risk for obesity.
Acute Vitamin D Intoxication in a Child
Authors: Barrueto Fermin , Wang-Flores Helena H. , Howland Mary Ann , Hoffman Robert S. , Nelson Lewis S.
Published: September 2005

We present the unique case of a previously healthy, 2-year-old boy with resistant hypercalcemia and hypertension resulting from an unintentional overdose with an imported vitamin D supplement. The patient presented initially to the emergency department with colic and constipation and was discharged after a benign physical examination. The symptoms persisted and, on the second visit, the patient was found to have a serum calcium level of 14.4 mg/dL. Despite therapy with intravenously administered 5% dextrose solution at one-half normal strength, furosemide, calcitonin, and hydrocortisone, the calcium concentration increased to 15.0 mg/dL on the second hospital day and did not decrease until the fourth hospital day, when it fell to 13.9 mg/dL. The vitamin D concentration peaked at 470 ng/mL on hospital day 3. With additional questioning, the mother revealed that she had been giving her son a daily dose of 1 ampule of Raquiferol, an imported vitamin D supplement, instead of the recommended 2 drops per day. Each ampule contained 600000 IU of vitamin D; therefore, the boy received a total of 2400000 IU over 4 days. The patient's hypercalcemia persisted for 14 days and was complicated by persistent hypertension. No renal, cardiac, or neurologic complications were noted. At discharge, the vitamin D concentration was still elevated at 389 ng/mL and the total calcium level had decreased to 11 mg/dL. The boy made a complete clinical recovery. This case highlights the need for caution when using imported and/or unregulated medicines, as well as the dangers of parental dosing errors.
Tacrolimus Ointment 0.03% Is Safe and Effective for the Treatment of Mild to Moderate Atopic Dermatitis in Pediatric Patients: Results From a Randomized, Double-Blind, Vehicle-Controlled Study
Authors: Schachner Lawrence A. , Lamerson Cindy , Sheehan Mary P. , Boguniewicz Mark , Mosser Joy , Raimer Sharon , Shull Toni , Jaracz Eileen ,   for the US Tacrolimus Ointment Study Group
Published: September 2005

Objective. This study was designed to compare the safety and efficacy of tacrolimus ointment 0.03% with vehicle ointment for the treatment of mild to moderate atopic dermatitis (AD) in pediatric patients.

Methods. A total of 317 patients (2–15 years of age) with mild to moderate AD were randomized to receive tacrolimus ointment or vehicle ointment twice daily in a 6-week, multicenter, double-blind study. Efficacy evaluations, including the Investigators' Global Atopic Dermatitis Assessment, eczema area and severity index, percentage of total body surface area affected, and patient assessment of itch occurred at baseline, day 4, and weeks 2, 4, and 6. Cutaneous adverse events were recorded to evaluate safety.

Results. At the end of study, 50.6% (80 of 158) of the patients were treated successfully with tacrolimus ointment based on Investigators' Global Atopic Dermatitis Assessment scores, a significant improvement compared with patients treated with vehicle ointment (25.8% [41 of 159]). The percent improvement from baseline in eczema area and severity index scores was also significantly greater in tacrolimus-treated patients (54.8%) compared with vehicle-treated patients (20.8%). There was also a significant improvement in the percentage of total body surface area affected of tacrolimus-treated patients (50.5% reduction from baseline) compared with vehicle-treated patients (16.4%). Patient itch scores were significantly lower in tacrolimus-treated patients (2.1) versus vehicle-treated patients (3.7). Overall, the incidence of cutaneous adverse events reported was similar for both treatment groups. There was no significant difference in the incidence of burning or stinging between treatment groups. Significantly fewer tacrolimus-treated patients prematurely discontinued from the study because of a cutaneous adverse event in the treatment area or experienced increased itching and erythema at the application site.

Conclusion. Monotherapy with tacrolimus ointment 0.03% is a safe and effective treatment alternative for pediatric patients with mild to moderate AD.
Breastfeeding-Associated Hypernatremia: Are We Missing the Diagnosis?
Authors: Moritz Michael L. , Manole Mioara D. , Bogen Debra L. , Ayus J. Carlos
Published: September 2005

Objectives. To assess the incidence and complications of breastfeeding-associated hypernatremic dehydration among hospitalized neonates.

Study Design. A retrospective study was conducted at Children's Hospital of Pittsburgh over a 5-year period, to identify otherwise healthy term and near-term (≥35 weeks of gestation) breastfed neonates (<29 days of age) who were admitted with serum sodium concentrations of ≥150 mEq/L and no explanation for hypernatremia other than inadequate milk intake.

Results. The incidence of breastfeeding-associated hypernatremic dehydration among 3718 consecutive term and near-term hospitalized neonates was 1.9%, occurring for 70 infants. These infants were born primarily to primiparous women (87%) who were discharged within 48 hours after birth (90%). The most common presenting symptom was jaundice (81%). Sixty-three percent of infants underwent sepsis evaluations with lumbar puncture. No infants had bacteremia or meningitis. Infants had hypernatremia of moderate severity (median: 153 mEq/L; range: 150–177 mEq/L), with a mean weight loss of 13.7%. Nonmetabolic complications occurred for 17% of infants, with the most common being apnea and/or bradycardia. There were no deaths.

Conclusion. Hypernatremic dehydration requiring hospitalization is common among breastfed neonates. Increased efforts are required to establish successful breastfeeding.
An Epidemiologic Study of Irritable Bowel Syndrome in Adolescents and Children in China: A School-Based Study
Authors: Dong Liu , Dingguo Li , Xiaoxing Xu , Hanming Lu
Published: September 2005

Objectives. To explore the prevalence of irritable bowel syndrome (IBS) and its distribution characteristics of adolescents and children in China and its contributing factors.

Methods. This study was a stratified, randomized study by clustering samples, which involved 5403 students whose age range was 6 to 18 years from 9 schools, and was conducted in Heilongjiang Province and Shanghai. All students studied were requested to fill in a questionnaire. IBS was diagnosed according to Rome II criteria.

Results. The prevalence of IBS according to Rome II criteria in adolescents and children in China was 13.25%. The ratio of boys to girls was 1:1.8. There was a higher prevalence (14.02%) of IBS in Heilongjiang province than that (11.72%) in Shanghai. The prevalence in children 12 years and younger was not statistically significantly higher than that of adolescents 13 years and older (11.86% and 11.44%, respectively). The prevalence of IBS in minority students (21.15%) was not statistically significantly higher than that in Han race students (16.08%). Our study indicated that psychological factors, food habit, bad exterior environment, personal habits, and family conditions might be important contributing factors, and exposure to coldness (odds ratio: 2.83) is most prominent.

Conclusion. IBS was a common disorder in adolescents and children in China. The prevalence of IBS in adolescents and children was different in different geographic areas. Our study indicated that IBS in adolescents and children might have possible relations with psychological factors, food habit, bad exterior environment, and family condition.
High Prevalence of Overweight Among Pediatric Users of Community Health Centers
Authors: Stettler Nicolas , Elliott Michael R. , Kallan Michael J. , Auerbach Steven B. , Kumanyika Shiriki K.
Published: September 2005

Objective. With the increasing prevalence of pediatric obesity, it is important to identify high-risk populations of children to direct limited resources for prevention and treatment to those who are most vulnerable. The objectives of this study were to determine the prevalence of overweight in children who are clients of community health centers in medically underserved areas of the Health Resources and Service Administration regions II and III (Mid-Atlantic and Puerto Rico), compare this prevalence to nationally representative data, and contrast prevalence data between geographic areas and racial/ethnic groups.

Methods. The charts from a representative sample of 2474 children using 30 community health centers in 2001 were abstracted to collect clinically measured weight and height. Overweight was defined as a body mass index of ≥95th percentile of a reference population. To generate an unbiased estimate of overweight, multiple imputations were used for missing data. These data were compared with the 1999–2002 National Health and Nutrition Examination Survey.

Results. The prevalence of overweight was elevated in this sample of children aged 2 to 5 years (21.8%; 95% confidence interval [CI]: 19.1–24.8) and 6 to 11 years (23.8%; 95% CI: 16.9–27.7) compared with the 1999–2002 National Health and Nutrition Examination Survey (10.3% and 15.8%, respectively). No significant differences in prevalence were observed between Asian American (18.2%; 95% CI: 11.2–28.3), Hispanic (24.6%; 95% CI: 21.3–28.2), non-Hispanic black (25.6%; 95% CI: 20.8–30.9), and non-Hispanic white (22.8%; 95% CI: 19.0–27.0) children. Furthermore, no differences in prevalence were observed between children using community health centers in continental urban (23.7%; 95% CI: 20.6–27.2), suburban (24.0%; 95% CI: 20.0–28.5), or rural (22.9%; 95% CI: 19.3–26.9) areas.

Conclusions. The present study identified a population of children at particularly high risk for obesity based on the type of health care delivery system they use regardless of race/ethnicity or geographic characteristics. Because community health centers are experienced in prevention and serve >4.7 million children in the United States, they may be a particularly promising point of access and setting for pediatric obesity prevention.
Psychosocial Correlates of Adolescent Males' Pregnancy Intention
Authors: Rosengard Cynthia , Phipps Maureen G. , Adler Nancy E. , Ellen Jonathan M.
Published: September 2005

Objective.To identify psychosocial differences between sexually experienced male adolescents who indicate intentions to get someone pregnant and those who do not.

Methodology.Cross-sectional study of 101 sexually experienced adolescent males recruited from a sexually transmitted disease clinic in northern California. We used Student's t tests and regressions to examine psychosocial differences between males who reported any intention versus no intention to get someone pregnant in the next 6 months, and we used analyses of variance to examine differences among different combinations of pregnancy plans/likelihood.

Results.Adolescents' reports of their plans for getting someone pregnant differed from their assessments of the likelihood that they would do so (χ2 = 24.33; df = 1). Attitudes toward pregnancy and participants' mothers' educational attainment differentiated those with clear pregnancy intentions (planning and likely) from those with clear intentions to avoid pregnancy (not planning and not likely)

Conclusions.To reduce the rates of adolescent childbearing, males' pregnancy intentions must be assessed and asked about in multiple ways.
A Randomized, Controlled Trial of a Multifaceted Intervention Including Alcohol-Based Hand Sanitizer and Hand-Hygiene Education to Reduce Illness Transmission in the Home
Authors: Sandora Thomas J. , Taveras Elsie M. , Shih Mei-Chiung , Resnick Elissa A. , Lee Grace M. , Ross-Degnan Dennis , Goldmann Donald A.
Published: September 2005

Objective.Good hand hygiene may reduce the spread of infections in families with children who are in out-of-home child care. Alcohol-based hand sanitizers rapidly kill viruses that are commonly associated with respiratory and gastrointestinal (GI) infections. The objective of this study was to determine whether a multifactorial campaign centered on increasing alcohol-based hand sanitizer use and hand-hygiene education reduces illness transmission in the home.

Methods.A cluster randomized, controlled trial was conducted of homes of 292 families with children who were enrolled in out-of-home child care in 26 child care centers. Eligible families had ≥1 child who was 6 months to 5 years of age and in child care for ≥10 hours/week. Intervention families received a supply of hand sanitizer and biweekly hand-hygiene educational materials for 5 months; control families received only materials promoting good nutrition. Primary caregivers were phoned biweekly and reported respiratory and GI illnesses in family members. Respiratory and GI-illness–transmission rates (measured as secondary illnesses per susceptible person-month) were compared between groups, adjusting for demographic variables, hand-hygiene practices, and previous experience using hand sanitizers.

Results.Baseline demographics were similar in the 2 groups. A total of 1802 respiratory illnesses occurred during the study; 443 (25%) were secondary illnesses. A total of 252 GI illnesses occurred during the study; 28 (11%) were secondary illnesses. The secondary GI-illness rate was significantly lower in intervention families compared with control families (incidence rate ratio [IRR]: 0.41; 95% confidence interval [CI]: 0.19–0.90). The overall rate of secondary respiratory illness was not significantly different between groups (IRR: 0.97; 95% CI: 0.72-1.30). However, families with higher sanitizer usage had a marginally lower secondary respiratory illness rate than those with less usage (IRR: 0.81; 95% CI: 0.65-1.09).

Conclusions.A multifactorial intervention emphasizing alcohol-based hand sanitizer use in the home reduced transmission of GI illnesses within families with children in child care. Hand sanitizers and multifaceted educational messages may have a role in improving hand-hygiene practices within the home setting.
Catastrophic Presentation of Infant Botulism May Obscure or Delay Diagnosis
Authors: Mitchell Wendy G. , Tseng-Ong Linda
Published: September 2005

Three infants with infant botulism are presented to illustrate how atypical, early, and severe features may obscure or delay diagnosis. Two boys aged 6 weeks and 20 days, respectively, presented with rapid deterioration after brief periods of poor feeding, one with an apparent life-threatening event at home and the other with a full cardiopulmonary arrest. Initial abnormal laboratory findings of coagulopathy suggested sepsis in the first infant. In the second infant, severe acidosis and hypoglycemia suggested an underlying metabolic disorder. A third infant, aged 1 month, was hospitalized originally with an admitting diagnosis of “pharyngitis” resulting from his inability to take adequate feedings. He received intravenous fluids and antibiotics. One week later he suffered a respiratory arrest. Laboratory findings of severe hyponatremia and acidosis at the time of his arrest suggested a metabolic etiology. Even retrospectively, none of these infants had the typical initial complaint of constipation, and none were noted to have ptosis or facial weakness before catastrophic collapse. However, in each case, the parent had initially brought the child to the physician for “poor feeding” or “poor suck,” which was not recognized by medical personnel as a result of bulbar weakness. Ultimately, all 3 infants were found to have infant botulism. All 3 had received antibiotics before catastrophic collapse, possibly contributing to the rapidity of the deterioration. Each recovered, although the delay in diagnosis made them ineligible for treatment with botulism immunoglobulin.
Prevalence of Household Firearms and Firearm-Storage Practices in the 50 States and the District of Columbia: Findings From the Behavioral Risk Factor Surveillance System, 2002
Authors: Okoro Catherine A. , Nelson David E. , Mercy James A. , Balluz Lina S. , Crosby Alex E. , Mokdad Ali H.
Published: September 2005

Objectives. To examine the prevalence of household firearms and firearm-storage practices in the 50 states and the District of Columbia and estimate the number of children exposed to unsafe storage practices.

Methods. We analyzed data from the 2002 cross-sectional Behavioral Risk Factor Surveillance System survey of 240735 adults from randomly selected households with telephones in the 50 states and the District of Columbia.

Results. Nationally, 32.6% of adults reported that firearms were kept in or around their home. The prevalence of adults with household firearms ranged from 5.2% in the District of Columbia to 62.8% in Wyoming (median: 40.8%). The prevalence of adults with loaded household firearms ranged from 1.6% in Hawaii, Massachusetts, and New Jersey to 19.2% in Alabama (median: 7.0%), and the prevalence of adults with loaded and unlocked household firearms ranged from 0.4% in Massachusetts to 12.7% in Alabama (median: 4.2%). Among adults with children and youth <18 years old, the prevalence of loaded household firearms ranged from 1.0% to 13.4% (median: 5.3%), and the prevalence of loaded and unlocked household firearms ranged from 0.3% to 7.3% (median: 2.3%); in each instance, Massachusetts had the lowest prevalence and Alabama had the highest. Findings indicate that ∼1.69 million (95% confidence interval: 1.57–1.82 million) children and youth in the United States <18 years old are living with loaded and unlocked household firearms.

Conclusions. Substantial state variations exist in the prevalence of household firearms and firearm-storage practices. It is vital that surveillance systems such as the Behavioral Risk Factor Surveillance System continue to monitor the prevalence of household firearms and firearm-storage practices so that future interventions to promote safe storage of firearms can be evaluated and more widely implemented based on their efficacy.
Is Blood Pressure Increased 19 Years After Intrauterine Growth Restriction and Preterm Birth? A Prospective Follow-up Study in the Netherlands
Authors: Keijzer-Veen Mandy G. , Finken Martijn J.J. , Nauta Jeroen , Dekker Friedo W. , Hille Elysée T.M. , Frölich Marijke , Wit Jan M. , van der Heijden A.J. ,   on behalf of the Dutch POPS-19 Collaborative Study Group
Published: September 2005

Objective. To determine whether intrauterine growth restriction (IUGR) is a predisposing factor for high blood pressure (BP) in 19-year-olds who were born (very) preterm.

Methods. A prospective follow-up study was conducted at age 19 in individuals who born preterm in the Netherlands in 1983. Systolic, diastolic, and mean BP values and plasma renin activity concentration were obtained in 422 young adults who were born with a gestational age (GA) <32 weeks. BP values were also measured in 174 individuals who born with a GA of ≥32 weeks and a birth weight of <1500 g.

Results. An increased prevalence of hypertension and probably also of prehypertensive stage was found. IUGR, birth weight, GA, and plasma renin activity were not associated with BP. Current weight and BMI were the best predicting factors for systolic BP at the age of 19 years.

Conclusions. The prevalence of hypertension is high in individuals who were born preterm when compared with the general population. In the individuals who were born very preterm, no support to the hypothesis that low birth weight is associated with increased BP at young adult age can be given.
Fat and Energy Contents of Expressed Human Breast Milk in Prolonged Lactation
Authors: Mandel Dror , Lubetzky Ronit , Dollberg Shaul , Barak Shimon , Mimouni Francis B.
Published: September 2005

Objective. To estimate fat and energy contents of human milk during prolonged lactation.

Methods. Thirty-four mothers, of term, healthy, growing children, who had been lactating for >1 year (12–39 months) were recruited. Control subjects were 27 mothers, of term infants, who had been lactating for 2 to 6 months. Fat contents of the milk samples were estimated as creamatocrit (CMT) levels. Energy contents of the milk were measured with a bomb calorimeter.

Results. The groups did not differ in terms of maternal height and diet, infant birth weight, gestational age, or breastfeeding frequency. They differed significantly in terms of maternal age, maternal weight, and BMI. The mean CMT levels were 7.36 ± 2.65% in the short-duration group and 10.65 ± 5.07% in the long-lactation group. The mean energy contents were 3103.7 ± 863.2 kJ/L in the short-duration group and 3683.2 ± 1032.2 kJ/L in the long-duration group. The mean CMT levels and mean energy contents were correlated significantly with the duration of lactation (R2 = 0.22 and R2 = 0.23, respectively). In multivariate regression analysis, CMT levels (or energy contents) were not influenced by maternal age, diet, BMI, or number of daily feedings but remained significantly influenced by the duration of lactation.

Conclusions. Human milk expressed by mothers who have been lactating for >1 year has significantly increased fat and energy contents, compared with milk expressed by women who have been lactating for shorter periods. During prolonged lactation, the fat energy contribution of breast milk to the infant diet might be significant.
Unmet Dental Care Needs Among Children With Special Health Care Needs: Implications for the Medical Home
Authors: Lewis Charlotte , Robertson Andrea S. , Phelps Suzanne
Published: September 2005

Background. Little is known about the characteristics of children with special health care needs (CSHCN) who have unmet dental care needs.

Objective. We sought to describe the magnitude of unmet needs for dental care among CSHCN and to characterize those with unmet dental care needs.

Design, Setting, and Subjects. We used data from the National Survey of Children with Special Health Care Needs, which used a telephone survey to identify 750 CSHCN from each of the 50 states and the District of Columbia. Families of 38 866 CSHCN were interviewed, and the data were weighted to represent 9.32 million CSHCN nationally.

Outcome. Our primary outcome of interest was unmet dental care need, defined as whether CSHCN were said to have needed dental care but were unable to obtain it. We also considered reasons why a child had an unmet dental care need and compared other categories of health care service needs and unmet needs with dental care. Bivariate and multivariate analyses were conducted to determine factors associated with unmet dental care needs.

Results. Overall, 78% of CSHCN were reported as needing dental care in the past 12 months, which was second only to prescription medications in the frequency of need. Of those who reported a dental care need, an estimated 755 581 or 10.4% of CSHCN did not receive all of the dental care they needed. Relative to all other health care service categories, unmet dental care needs affected the most children. Poorer children, uninsured children, children with lapses in insurance, and children with greater limitations attributable to disability had significantly greater odds of unmet dental care needs in multivariate analyses. Children with a personal doctor or nurse were significantly less likely to have unmet dental care needs.

Conclusions. Dental care is the most prevalent unmet health care need for CSHCN, affecting substantially more children than any other health care need category. Moreover, the perceived need for dental care for CSHCN exceeds the need for either preventive or specialty medical care. Given these findings, dental care should be an integral and explicitly stated part of the comprehensive coordinated services that the medical home aims to provide for CSHCN. Greater efforts to improve access to dental care for poor and more disabled CSHCN are needed.
Increased Prevalence of Obesity in Children With Functional Constipation Evaluated in an Academic Medical Center
Authors: Pashankar Dinesh S. , Loening-Baucke Vera
Published: September 2005

Objective. The rapidly increasing prevalence of obesity in children is the most important problem facing pediatricians today. A recent study suggested an association of obesity and constipation in children but lacked a control group for comparison. The objectives of this study were to evaluate the prevalence of obesity in a large cohort of children with functional constipation and to compare it with a control group representative of the general population.

Methods. Retrospective chart review was performed on 719 children, between the ages of 4 and <18 years, with chronic functional constipation seen in the general pediatric and pediatric gastroenterology clinics between July 2002 and June 2004. Data collected included age, gender, BMI, and signs and symptoms of constipation including fecal incontinence. Obesity was classified as a BMI of >95th percentile and severe obesity as a BMI of ≥5 kg/m2 above the 95th percentile for age and gender. The control group consisted of all 930 children (4 to <18 years of age) presenting to the pediatric clinic for a well-child visit between January and June 2004. The χ2 and t tests were used for analysis.

Results. Overall prevalence of obesity was significantly higher in constipated children (22.4%) compared with control children (11.7%), and this higher prevalence was also seen for severe obesity. The prevalence rates of obesity were significantly higher in constipated males (25%) than in constipated females (19%) and were significantly higher compared with the control males (13.5%) and control females (9.8%). Constipated boys in all 3 age groups had significantly higher rates of obesity than the control boys; the constipated girls had significantly higher obesity rates for the age groups between 8 and <18 years. Fecal incontinence (encopresis) was present in 334 of 719 (46%) constipated children. The prevalence of obesity was similar in constipated children with and without fecal incontinence.

Conclusions. There is a significantly higher prevalence of obesity in children with constipation compared with age- and gender-matched controls. This higher prevalence is present in both boys (4 to <18 years of age) and girls (8 to <18 years of age) with constipation and is not related to the presence of fecal incontinence among constipated children. The higher prevalence of obesity may be a result of dietary factors, activity level, or hormonal influences and needs additional evaluation.