bluuebunny/crossref_metadata_2025 huggingface dataset:
Antipyretic Effects of Dipyrone Versus Ibuprofen Versus Acetaminophen in Children: Results of a Multinational, Randomized, Modified Double-Blind Study
Authors: Wong Anthony , Sibbald Andres , Ferrero Fernando , Plager Mauricio , Santolaya Maria Elena , Escobar Anna Maria , Campos Sandra , Barragán Sergio , De León González Maximiliano , Kesselring Gustavo Lf ,   Fever Pediatric Study Group
Published: June 2007

This study compared the antipyretic effectiveness of acetaminophen, ibuprofen, and dipyrone in young children with fever. The results were based on a modified double-blind, randomized, multinational trial that evaluated 628 febrile children, aged 6 months to 6 year. All three drugs lowered temperature in the 555 patients completing the study. Temperature normalization rates in the ibuprofen and dipyrone groups (78% and 82%, respectively) were significantly higher than the acetaminophen group (68%, P=0.004). After 4 to 6 hours, mean temperature in the dipyrone group was significantly lower than the other groups, demonstrating longer temperature normalization with dipyrone. All three drugs showed comparable tolerability profiles.
Antacid-Induced Rickets in Infancy
Authors: Pattaragarn Anirut , Alon Uri S.
Published: June 2007

A 3-month-old premature infant presented with a “soft skull.” Clinical and radiologic findings confirmed the diagnosis of rickets. Biochemistry revealed normal serum parathyroid hormone (PTH) and undetectable urine phosphate. These findings combined with a history of 5-6 weeks' treatment with high-dose aluminum-rich antacid established the diagnosis of antacidinduced rickets. Discontinuation of the medicine combined with phosphate and vitamin D supplementation resulted in quick resolution of all clinical, radiologic, and biochemical abnormalities. Our patient demonstrates that in premature infants antacid-induced rickets can develop within a few weeks; normal serum PTH concentration and hypophosphaturia are highly indicative of the diagnosis, and contrary to the situation in adults in whom hypercalciuria has been often described, in infants hypocalciuria is more commonly observed. Pediatricians should avoid or minimize the use of aluminum-containing antacids, and when used, carefully monitor mineral metabolism.
Parental Opinions Regarding Poliomyelitis Immunizations
Authors: Epee-Bounya Alexandra , Gitterman Benjamin A. , Moon Rachel Y.
Published: June 2007

The successful eradication of poliomyelitis in the United States has primarily been due to the use of oral poliovirus vaccine (OPV). However, because of the risk of vaccine-associated paralytic poliomyelitis with OPV, the use of inactivated poliovirus vaccine (IPV) has become the accepted option. We performed a cross-sectional survey of parents of children less than 18 months of age to determine parental preference regarding poliomyelitis vaccine options. Parents were asked questions about their knowledge regarding poliomyelitis and available vaccines. Parents were also given information about the risks and benefits of the 3 immunization options (all OPV, all IPV, and sequential IPV/OPV) and then asked to choose among the 3 schedules. We distributed 146 questionnaires, with an 88% response rate. Parents were, on average, 22 years old and had 12 years of education. Fifty-eight percent of parents thought that decisions regarding vaccine choices should be made by the physician and caregiver together. However, when given the choice, 41% could not decide among the different vaccine options. One quarter (25%) chose the all OPV, 13% the all IPV, and 21% the sequential IPV/OPV schedule. Older parents were more likely to choose the all IPV schedule (p=0.042). There was no correlation with the parental level of education. More studies are required to determine if further education will empower urban parents to be more active participants in the medical decision process.
Effect of RSV Bronchiolitis Practice Guidelines on Resource Utilization
Authors: Harrison A. Marc , Boeing Nancy M. , Domachowske Joseph B. , Piedmonte Marion R. , Kanter Robert K.
Published: June 2007

We sought to determine whether institution of respiratory syncytial virus (RSV) practice guidelines decreased resource utilization for a heterogeneous population of children hospitalized with RSV bronchiolitis. Patients less than 24 months old with RSV bronchiolitis at a pediatric referral center were identified by retrospective chart review for consecutive RSV seasons. Before the guidelines were instituted patients were less likely to have a documented physician's assessment of response to albuterol, were more likely to have received supplemental oxygen and cardiorespiratory monitoring, and to be discharged on an albuterol regimen. Patients received more albuterol treatments. After the guidelines were in place fewer resources were utilized in the care of patients with RSV bronchiolitis. RSV practice guidelines may simplify and streamline the care of a heterogeneous population of children with bronchiolitis.
Bacteral Meningitis in Childhood at the Children's Hospital of Pittsburgh: 1988-1998
Authors: Neuman Heather B. , Wald Ellen R.
Published: June 2007

Bacterial meningitis is an important acute infectious disease of childhood that remains a source of substantial morbidity and mortality. The impact of the Haemophilus influenzae type b (HIB) conjugate vaccines on the epidemiology of the other bacterial causes of meningitis in childhood has received little attention. The objective of this study is to report the experience at a tertiary-care children's hospital with the occurrence of bacterial meningitis before and after the licensure of the HIB conjugate vaccine. With use of International Classification of Diseases diagnostic codes for bacterial meningitis, a list of all children admitted to Children's Hospital of Pittsburgh with a primary or secondary diagnosis of meningitis due to H. influenzae, Streptococcus pneumoniae, and Neisseria meningitidis from January 1, 1988, to December 31, 1998, was constructed. Medical records were examined for basic patient demographic information including age, gender, race, bacterial etiology of meningitis, receipt of vaccine for HIB, underlying conditions, and fatalities. Two hundred twenty-one cases of bacterial meningitis caused by H. influenzae, N. meningitidis, and S. pneumoniae were identified. The age of infected children ranged from 1 month to 18 years, with a mean and median age of 38.1 months and 13 months, respectively. Fifty-two percent of the children were female, 83% were Caucasian and 16% were African-American. Before the routine use of HIB conjugate vaccine, HIB was the bacterial species responsible for the greatest proportion of cases (average of 58%/year). The absolute number of cases of bacterial meningitis attributable to HIB declined after 1991 to an average of 2.5 cases/year. The number of cases of meningitis caused by S. pneumoniae and N. meningitidis have remained relatively stable between 1988 and 1998. The case fatality rates for children with meningitis caused by H. influenzae, S. pneumoniae, and N. meningitidis were 0.0%, 9.2%, and 7.5%, respectively. Most cases of meningitis due to HIB occurred in children who had not been immunized. Three children who received the polsaccharide vaccine developed meningitis due to HIB; there were no failures of the conjugate vaccine.
Bronchopulmonary Dysplasia (Chronic Lung Disease of Infancy)
Authors: Nievas F. Fernandez , Chernick V.
Published: June 2007

This paper is a review of the changes that have occurred over the past 35 years in the clinical and radiologic presentation of bronchopulmonary dysplasia (BPD), now more commonly referred to as chronic lung disease of infancy (CLD). Curent thoughts on etiology are only briefly discussed. The major focus is the management of the patient with CLD by the primary care physician once the patient has been discharged from hospital. Oxygen, diuretic, bronchodilator, antiinflammatory and nutritional therapies are discussed in detail. Finally, current information on long-term prognosis and recommendations for the prevention of RSV and influenza infections are reviewed.
L-Carnitine Administration Reduces Number of Episodes in Cyclic Vomiting Syndrome
Authors: Van Calcar Sandra C. , Harding Cary O. , Wolff Jon A.
Published: June 2007

Patients with cyclic vomiting syndrome suffer from recurring episodes of severe nausea and vomiting. This paper presents 6 patients who responded to I-carnitine administration. Average time between episodes was 1.7 months before carnitine administration and increased to 1.1 years after carnitine administration. Average dose of carnitine administered was 50 mg/kg. Oral carnitine may be useful to control the symptoms in patients with cyclic vomiting syndrome.
Mediastinal Tumors in Children: A Single Institution Experience
Authors: Freud E. , Ben-Ari J. , Schonfeld T. , Blumenfeld A. , Steinberg R. , Dlugy E. , Yaniv I. , Katz J. , Schwartz M. , Zer M.
Published: June 2007

Mediastinal masses in children are a heterogeneous group of asymptomatic or potentially life-threatening congenital, infectious, or neoplastic lesions that present complex diagnostic and therapeutic dilemmas. Some patients are asymptomatic; in others, the mass may compress mediastinal structures and cause sudden asphyxia. In these cases, close cooperation is needed among pediatric surgeons, anesthesiologists, intensivists, oncologists, and radiologists. The files of 45 children with mediastinal masses admitted between 1986 and 1999 to the Pediatric Intensive Care Unit (PICU) of Schneider Children's Medical Center of Israel were reviewed. Twenty-one were admitted for perioperative care, and 21 for emergency care, including 19 with respiratory distress. Five of the emergency care group had asphyxia and 10 needed assisted ventilation. Two children were admitted for evaluation and 1 for leukopheresis. The children admitted on an emergency basis had more clinical findings than the postoperative group: almost 80% had dyspnea and more than 45% had oxygen desaturation; 33% had cough and noisy breathing, and 25%, superior vena cava syndrome or hepatosplenomegaly. Eight patients (17.8%) had benign disease and 37 (82.2%) malignant disease. The patients with a benign mass were significantly younger than the patients with a malignant mass (p<0.005); in 5 cases (12.5%), a congenital anomaly presented as a mediastinal mass. Most of the malignant masses were of hematologic origin (40.5%), followed by neurogenic tumors (27%). Twenty-seven patients underwent surgery, including 6 emergency procedures (3 partial resections, 2 biopsies, 1 lymph node biopsy). There were no intraoperative or postoperative deaths. The present series emphasizes the complex care children with a mediastinal mass require. They should be treated in a tertiary center with a multidisciplinary approach.
Comparison of Polyethylene Glycol 3350 and Lactulose for Treatment of Chronic Constipation in Children
Authors: Gremse David A. , Hixon Jamie , Crutchfield Alysia
Published: June 2007

Polyethylene glycol (PEG) 3350 and lactulose were compared in an unblinded, randomized, crossover design for treatment of constipation in 37 children aged 2 to 16 years. Subjects received lactulose (1.3 g/kg/d divided twice daily up to 20 g) or PEG 3350 (10 g/m2/day) for 2 weeks. PEG 3350 significantly decreased the total colonic transit time compared to lactulose (47.6 +2.7 vs 55.3 ±2.4 hours, mean ±SE, PEG 3350 vs lactulose, respectively, p = 0.038). The stool frequency, form, and the ease of passage were similar for each laxative. Polyethylene glycol 3350 is an effective laxative for the treatment of chronic constipation in children.
Continuous pH Monitoring Using the Paratrend® 7 Inserted into a Peripheral Vein in a Patient with Shock and Congenital Lactic Acidosis
Authors: Easley R. Blaine , Johnson Tiffanie R. , Tobias Joseph D.
Published: June 2007

The authors present a 25-year-old woman who was admitted to the ICU for treatment of shock, respiratory failure, and acidosis related to congenital lactic acidosis from pyruvate dehydrogenase deficiency. To aid in ongoing management of the metabolic acidosis, the Paratrend® blood gas monitoring sensor was inserted through a peripheral venous site to provide a continuous measurement of pH and partial pressure of carbon dioxide (Pco2). With the venous insertion of the Paratrend®, a clinically useful correlation with arterial blood gas values was noted. Linear regression analysis of the pH values from the venous blood gas analyses and the Paratrend® monitor revealed r2 = 0.71 with p = 0.001 and r2 = 0.78 with a p = 0.0003 for the Pco2 values. Our preliminary experience suggests that venous placement of the Paratrend® monitor can be used to provide clinically useful, continuous measurement of pH and Pco2.
Physician Beliefs and Practices Regarding SIDS and SIDS Risk Reduction
Authors: Moon Rachel Y. , Gingras Jeannine L. , Erwin Rebecca
Published: June 2007

The AAP has alerted pediatricians to the importance of safe sleep environment for infants. The elements of a safe sleep environment include supine sleep position, safe crib, and avoidance of smoke exposure, soft bedding, and overheating. With the Back to Sleep campaign, prone sleeping among all U.S. infants has decreased to less than 20%, and the incidence of SIDS has decreased 40%. However, the decline in SIDS and prone sleeping has leveled off in recent years. Further declines may be possible with decreasing other modifiable risk factors, such as prenatal and postnatal exposure to cigarette smoking. Prior studies have demonstrated that health care professional advice is influential in determining infant care practices. It is important that physicians caring for infants be aware of the importance of a safe sleep environment and understand other modifiable risk factors for SIDS. We surveyed a random sample of 3,717 physicians in North Carolina and the metropolitan Washington, DC, area to determine knowledge, beliefs, and practices regarding SIDS and SIDS risk reduction among physicians caring for pregnant women and infants. Twenty-three percent (835) responded. Most physicians are aware of prone sleeping and cigarette smoke exposure as risk factors for SIDS. Almost all physicians agree that there are measures that can be taken to reduce the risk of SIDS, and they consider it important to discuss SIDS and SIDS risk reduction strategies with parents of young infants. In spite of this belief, only 56% of family/general practitioners, 18% of obstetrician-gynecologists, and 79% of pediatricians discuss SIDS routinely. Only 35% of pediatricians, 15% of family/general practitioners, and 16% of obstetrician-gynecologists provide written information. In addition, only 38% of physicians recommend supine, while 50% recommend side or back, 6% side, and 7% prone. Only two thirds of pediatricians and one third of family/general practitioners are aware that the AAP recommends supine as the preferred sleep position for infants. Pediatricians are more likely to be aware of the AAP recommendation (p<O.OOOJ) and to discuss SIDS risk reduction strategies with parents (p=0.03). We conclude that many physicians who care for infants are unaware of the AAP's most current recommendation for sleep position and are incorrectly recommending the side position. Physicians may also be unaware of other sleep environment hazards. Further educational efforts must continue for physicians who provide care to pregnant women and children to ensure a continued decline in the incidence of SIDS.
Parental Involvement in Pediatric Cardiology Outpatient Visits
Authors: Mehta Sudhir Ken , Richards Nancy
Published: June 2007

There is a lack of information regarding parental involvement in subspecialty care of their offspring. We evaluated trends in 3,118 parental visits, accompanied by their children to a pediatric cardiology office during a 5-year period. Offspring accompanied both parents 29%, mothers alone 64%, and fathers alone 5% of the total visits. The rates were similar for first-time visits and this trend was similar across all 5 years. Children were significantly younger when accompanied by both parents than by individual parents. Mothers play a major role in a child's subspecialty care. Our findings have important educational, social, research, and marketing implications.
A Vertically Integrated Core Pediatric Education
Authors: Ferguson Laura E. , Crandell Sharon S. , Hormann Mark D. , Moyer Virginia A.
Published: June 2007

The objective of this study was to implement and evaluate a vertically integrated general pediatrics rotation that includes inpatient ward, newborn nursery, and ambulatory components in a format intended to mimic real-world pediatric practice. Separate ward, well-baby nursery, and ambulatory rotations were combined into a 4-month block rotation. Two parallel teams staff the inpatient ward and newborn nursery; on alternating days, the admitting team staffs an afternoon clinic, seeing ward and nursery patients in follow-up as well as regular clinic and referral patients. Two group meetings were held during each rotation for 2 years, and questionnaires were distributed to participating residents. All 90 residents who rotated through the combined service participated in at least 1 group meeting, only 26 returned questionnaires that limited evaluation of the program. The most important positive feature of the rotation was the continuity of patient care allowed by combining the venues into 1 rotation and by the longer duration of the rotation. Concerns included the challenges of time management and fluctuations in workload across the 3 patient care venues. Upper level residents reported that the rotation confirmed career decisions for primary care. These preliminary observations suggest that a vertically integrated rotation provides improvement in perceived continuity of care and introduces residents to the time management challenges of primary care pediatrics.
Influence of Breast-Feeding on Mental and Psychomotor Development
Authors: GÓmez-Sanchiz Manuela , Cañete RamÓn , Rodero Inmaculada , Baeza J. Enrique , Ávila Octavio
Published: June 2007

The purpose of this study was to analyze the effects of breast-feeding on cognitive and motor development. A prospective cohort study was carried out enrolling 249 babies from 2 rural and urban areas. Cognitive development was assessed at the age of 18 months. Results show that adjusted scores on the mental development index were 4.6 points higher in babies breast-fed for longer than 4 months than in those breast-fed for less time. No differences in psychomotor development were found as a function of type of feeding. A statistically-significant linear correlation was observed between the duration of breast-feeding and scores for Bayley's mental development index. These data suggest that breast-feeding for longer than 4 months has a positive effect on the baby's mental development measured at 18 months of age. Parental intelligence quotient also seems to have an influence on cognitive development.
The Effect of Education, Feedback, and Provider Prompts on the Rate of Missed Vaccine Opportunities in a Community Health Center
Authors: Sabnis Svapna S. , Pomeranz Albert J. , Amateau Margaret M.
Published: June 2007

The purpose of this study was to determine whether education, feedback, and provider prompts decrease the rate of missed vaccine opportunities; and the reasons for missed opportunities in the post-intervention group. A nonrandomized, before and after study to evaluate the effect of education, feedback, and provider prompts on missed opportunities was conducted in an inner-city community health center with a predominantly hispanic population. Vaccine opportunities were defined as visits of children 36 months or younger who were vaccination-eligible by ACIP guidelines. Consecutive sampling was used to identify two groups of children with vaccine opportunities: pre- and post-intervention. Feedback was given to vaccine providers on the frequency of missed opportunities in the pre-intervention group. The ACIP recommended vaccine schedule and true vaccine contraindications were reviewed. Nursing personnel were taught to identify and tag charts of children with vaccine opportunities. Physicians were asked to record vaccination status and the reason any vaccination was deferred. Missed opportunities decreased significantly, from 49% (173/352) to 13% (45/344), after the interventions (p < 0.001). The reasons for the 45 missed opportunities in the post-intervention sample were parent refusal (15.6%), moderate or severe illness (15.6%), and incorrect documentation as "up-to-date" (13.3%). In 28.9% there was a missed opportunity for simultaneous immunization. No reasons were documented for the remaining missed opportunity visits (26.6%). The interventions, which emphasized improving provider knowledge of vaccinations and screening vaccine status at each visit, effectively decreased missed opportunities.
How Accurate are Neonatologists in Identifying Clinical Jaundice in Newborns?
Authors: Riskin Arieh , Abend-Weinger Martha , Bader David
Published: June 2007

This study reevaluates the clinical ability to accurately identify jaundice in neonates. Three hundred seventy-one term infants were clinically asseseed forjaundice, before discharge home on day 2 to 3 of life. Bilirubin levels obtained at the same time were significantly higher in the newborns clinically diagnosed as being jaundiced. Our neonatologists were able to diagnose jaundice at clinically low levels, and not to misdiagnose significant hyperbilirubinemia in the majority of the infants. The trained human eye can still discriminate between the jaundiced and nonjaundiced newborn, and clinical impression of jaundice remains a reliable primary screening tool for significant neonatal hyperbilirubinemia.
Survey of Physician Attitudes and Practices Related to Pediatric Obesity
Authors: Jelalian Elissa , Boergers Julie , Alday C. Sloan , Frank Rachel
Published: June 2007

The purpose of this study was to survey physicians regarding their attitudes and practices related to the treatment of pediatric obesity in a primary care setting. Surveys were sent to physicians who were members of the American Academy of Pediatrics and the American Academy of Family Physicians practicing in the Southern New England area (Connecticut, Massachusetts, and Rhode Island). The 14-item survey consisted of three main areas of focus: attitudes toward obesity, treatment and referral approaches, and barriers to addressing weight concerns in children and adolescents. Physicians estimated that 27.7% of their adolescent and 23% of their child patients are overweight. The frequency with which physicians address weight issues with both child and adolescent patients appears to increase incrementally with the patient's level of overweight. When addressing obesity, one fourth of physicians think that they are not at all or only slightly competent, while 20% report feeling not at all or only slightly comfortable. These findings suggest that physicians would benefit from additional training and education regarding safe and efficacious intervention strategies for pediatric obesity, to effectively integrate the discussion of weight issues into the primary care setting.
Congenital Cystic Lung Disease: Diagnostic and Therapeutic Considerations
Authors: Horak Elisabeth , Bodner Johannes , Gassner Ingmar , Schmid Thomas , Simma Burkhard , Grässl Gerhard , Sawyer Susan M.
Published: June 2007

Congenital lung cysts such as congenital cystic adenomatoid malformation, pulmonary sequestration, congenital lobar emphysema, and bronchogenic cysts are rare but fascinating anomalies of lung development. While there are many similarities in terms of their presenting features, there are particular differences between the diagnostic groups that are important to highlight, especially in relationship to approaches to imaging and long-term outcome. A case of each entity is presented with an emphasis on the contemporary approach to diagnostic investigations and therapeutic options.
Clostridium Diffi cile-Associated Diarrhea in a Pediatric Hospital
Authors: Spivack Jordan G. , Eppes Stephen C. , Klein Joel D.
Published: June 2007

This retrospective cohort analysis examined the risk factors, symptoms, and severity of disease associated with C. difficile in pediatric inpatients. Risk factors for a C. difficile-positive test were an oncologic diagnosis, diarrhea of more than 2 days' duration, and gastrointestinal symptoms, especially abdominal pain. Over a 3.5-year period, there was a total of 22 C. difficile-positive patients, and most had mild, self-limiting diarrheal illness. No cases of C. difficile diarrhea were identified. Seventy-eight percent of the C. difficile-positive patients were found to have alternate risk factors for diarrhea. Our data indicate that C. difficile rarely causes severe diarrhea in pediatric inpatients and that C. difficile testing should be limited to patients with severe prolonged diarrhea and abdominal pain.
Shigella Bacteremia: A Retrospective Study
Authors: Greenberg David , Marcu Shai , Melamed Rimma , Lifshitz Matityahu
Published: June 2007

The aims of this study were to determine the risk factors in, and the clinical and laboratory characterizations of, Shigella bacteremia, as well as the subspecies of Shigella, and the antibiotic susceptibility. A retrospective study of all patients younger than 18 years of age with documented Shigella bacteremia from January 1989 through December 2001 was conducted. Fifteen children with Shigella bacteremia were treated at our center. The mean age (± SD) was 20.5 months (± 34.2), median 7 months. Thirteen (87%) patients failed to gain weight. The mean duration of diarrhea was 14.7 days. Patients were hospitalized for a mean (± SD) of 13.5 days (±9.2). There were no fatalities in our study sample. The vast majority (86.7%) of the Shigella isolates were flexneri. Most isolates were susceptible to ceftriaxone, ciprofloxacine, and gentamicin but resistant to ampicillin and trimethoprim/sulfamethoxazole.
The Role of Routine Serum Laboratory Tests in Children Presenting to the Emergency Department with Unprovoked Seizures
Authors: Valencia Ignacio , Sklar Eric , Blanco Felipe , Lipsky Caren , Pradell Lawrence , Joffe Mark , Legido Agustin
Published: June 2007

The role of laboratory tests in the treatment of patients with unprovoked seizures in the emergency department (ED) is unclear. To better determine the diagnostic value of routine serum chemistries (glucose, electrolytes) in these patients, and to identify risk factors predicting abnormality, 107 children who presented to the ED with unprovoked seizures were evaluated prospectively. Serum electrolytes and glucose were determined in 54 patients. The incidence of abnormal serum biochemical values was 14.8%; it was higher in patients with a first seizure, younger age, gastrointestinal symptoms, or change in mental status. These data indicate that serum glucose and/or electrolyte abnormalities are rare in patients evaluated in the ED for unprovoked seizures. Based on these findings and those reported in previous studies, performance of these tests is recommended in children younger than 2 years old, presenting with a first seizure, or when accompanied by gastrointestinal or diffuse neuralgic symptoms.
Growth up to 2 Years in Relationship to Maternal Smoking During Pregnancy
Authors: Karatza Ageliki A. , Varvarigou Anastasia , Beratis Nicholas G.
Published: June 2007

Smoking during pregnancy causes intrauterine growth retardation, but the subsequent growth of these children is not well understood. Two hundred four newborns of mothers who smoked during pregnancy and 204 control neonates were studied. Children were re-examined at 1 and 2 years. Newborns of mothers who smoked 1-9 cigarettes/day had similar anthropometric parameters with the controls. Significant retardation in weight, length, and head circumference was present in the newborns whose mothers smoked >10 cigarettes/day. At follow-up, in children of smoking mothers the retardation of weight improved, head circumference remained stable, and length retardation increased even in children whose mothers smoked <10 cigarettes/day.
The Influence of Pacifier Sucking on Mesenteric Blood Flow in Infants
Authors: Huang Ching-Feng , Tsai Ming-Chih , Chu Chia-Hsiang , Lee Ming-Yung , Shih Yu-Lueng , Cheng Shin-Nan
Published: June 2007

Thirty-six neonates were randomly assigned to 2 groups of 18 neonates each. In the pacifier group, infants were given a pacifier before milk feeding. Newborns in the control group were fed without preprandial use of a pacifier. Doppler measurement of peak systolic velocity, enddiastolic velocity, and Pourcelot resistance index in the superior mesenteric artery was performed in both groups. Peak systolic and end-diastolic velocities were significantly increased after pacifier sucking in the preprandial stage. The resistance index decreased significantly after milk feeding but not after pacifier sucking. The feeding volume was not affected by preprandial pacifier sucking.
Medical Marijuana: A Survey of Teenagers and Their Parents
Authors: Schwartz Richard H. , Cooper Meghan N. , Oria Marife , Sheridan Michael J.
Published: June 2007

Parents and their teenage children were questioned about medical marijuana and whether they believed that passage of medical marijuana laws in their states would increase teenage use of marijuana for non-medical purposes. A 24-question written survey was distributed separately to teenager/parent pairs who visited 1 of 2 suburban general pediatric offices located in Vienna, Virginia or Mason, Ohio. Completed surveys were collected from 393 parent-teen pairs. Only 13% of the teenagers admitted to ever smoking marijuana while 6% admitted smoking it in the past 30 days. There was good agreement between parents and teens (81% of parents and 76% of their teenagers who responded to the survey) that regular use of marijuana causes harm to many or most users, not just "potheads." Although there was close agreement in the range of opinions about medical marijuana (i.e., from liberal use to no use) by parents as a group and the teens as a group, agreement between the answers of parents matched with their own children was poor based on K-coefficient analysis (K=0.20). Twenty-eight percent of the parent group and 55% of the teenagers believed that passage of state laws for medical marijuana would make it easier for teens to smoke marijuana for medical purposes.
Parental Knowledge and Children's Use of Bicycle Helmets
Authors: Bernstein Jill D. , Harper Mark A. , Pardi Lisa A. , Christopher Norman C.
Published: June 2007

Helmet use protects against head injury. Our objective was to assess whether parental knowledge of helmet safety is associated with helmet use in children, and whether a relationship exists between helmet ownership and other safety behaviors. Three hundred forty-one surveys were distributed to parents of third through fifth graders; 97% of parents believed that a helmet confers protection; 49% of parents reported that their child owns a helmet. Of the helmet owners, 27% reported that the child wears it more than 75% of the time. Seat belt usage was associated with helmet ownership (p=0.02) and frequency of wearing a helmet (p=0.04). Although parents are aware of the benefits, a barrier between helmet ownership and usage exists.
The Clinical Spectrum of Mitochondrial Disease in 75 Pediatric Patients
Authors: Skladal D. , Sudmeier C. , Konstantopoulou V. , Stöckler-Ipsiroglu S. , Plecko-Startinig B. , Bernert G. , Zeman J. , Sperl W.
Published: June 2007

The clinical presentation of mitochondrial disorders in childhood is highly variable causing difficulties in diagnosis and management. We assessed records of 75 children (48 male, 27 female) with a biochemically and/or molecularly established mitochondrial disorder in a retrospective, multicentric study. The predominant biochemical defect was an isolated respiratory chain complex IV, followed by respiratory chain complex I, combined respiratory chain, and isolated pyruvate dehydrogenase complex (PDHC) deficiencies. For the 75 patients, the predominant clinical presentations were a nonspecific encephalomyopathy (n = 34) and Leigh syndrome (n = 17). Classical mitochondrial syndromes with associated mutations of the mitochondrial DNA were rare (n = 12). Eleven children had a lethal infantile mitochondrial disease (LIMD). This group comprised a considerable variety of clinical pictures, and the cohort was big enough to show the high frequency and wide spectrum of nonneuromuscular symptoms in mitochondrial disorders in childhood.
Feedback on a Multimedia Violence Prevention Program
Authors: Scholer Seth J. , Goad Sharon
Published: June 2007

The objective of this study is to describe feedback on a multimedia violence prevention program. Professionals and laypersons provided feedback regarding a multimedia CD program by completing an anonymous form. Feedback was obtained from 66% of participants (314). In general, participants felt more comfortable managing childhood aggression after the program (p<0.001). Pediatric residents felt more comfortable counseling parents (p<0.001). Approximately 90% of participants would either strongly or very strongly recommend the program to others. Multimedia programs can increase comfort level with managing childhood aggression, suggesting that they hold promise for use as adjunctive violence prevention tools.
Prudent Layperson Definition of an Emergent Pediatric Medical Condition
Authors: Huang Craig J. , Poirier Michael P. , Cantwell John R. , Ermis Peter R. , Isaacman Daniel J.
Published: June 2007

This study was designed to assess how well parents rated pediatric medical conditions based on their perceived degree of urgency so as to determine if the “Prudent Layperson Standard” is reasonable. A self-administered, supervised survey was given to a convenience sample of 340 caregivers in the emergency department of an urban children's hospital. Respondents were asked to rank the urgency of 15 scenarios. A caregiver response within 1 point of the physician score was considered concordant with medical opinion. A 2-week-old infant with a rectal temperature of 103.7°F was the only emergent scenario underestimated by caregivers. A 11/2-yr-old child with an upper respiratory tract infection, a 7-year-old child with ringworm, an 8-month-old infant with a simple forehead contusion, and a 4-year-old child with conjunctivitis were the non-urgent scenarios overestimated by caregivers. Laypeople are able to identify cases constructed to represent obvious pediatric medical emergencies. Several patient subgroups frequently overestimate medical urgency.
Pediatricians Knowledge, Views, and Perspectives on Smallpox and Smallpox Vaccine
Authors: Di Pentima M. Cecilia , Eppes Stephen C. , Klein Joel D.
Published: June 2007

Increasing concerns regarding smallpox as a biologic weapon have led to massive production of vaccinia vaccine and targeted vaccination campaigns. A regional mail survey was conducted among pediatricians to assess their knowledge and perceptions on smallpox and smallpox vaccine. Fifty-nine percent of the responders were unable to differentiate chickenpox from smallpox, and the majority would not accept vaccination in the absence of an outbreak and would not recommend smallpox vaccine to their patients. Even in previously vaccinated pediatricians, willingness to receive smallpox vaccine is poor and vaccination campaigns in the absence of a smallpox outbreak may not be successful.
Inner-City Adults’ Knowledge About the Effects of Cigarette Smoking on Child Health
Authors: Parker Margaret , Sharif Iman
Published: June 2007

We sought to determine what adults in an inner-city setting know about the specific effects of adult cigarette smoking on child health. A cross-sectional survey was conducted at an inner-city community health center in the Bronx, New York; 684 subjects participated. Overall, 21% were current smokers, 19% had quit, and 60% had never smoked. While the majority of subjects knew about the effects of smoking on adult health, they were unaware of the extent to which smoking was harmful to child health. Notably, 72% did not know that cigarette smoking increased the risk for ear infections in children, 68% did not know that smoking increased the risk of colds in children, and 61% did not know that smoking increased the risk of sudden infant death syndrome. The findings suggest a need for public health education about the effects of adult smoking on child health.
The Use of Complementary/Alternative Therapies Among Children Attending an Urban Pediatric Emergency Department
Authors: Sawni Anju , Ragothaman Ramesh , Thomas Ronald L. , Mahajan Prashant
Published: June 2007

The incidence of and factors associated with complementary/alternative medicine use by pediatric patients was determined by face-to-face interviews with 602 parents/caregivers of children aged birth to 18 years who presented to an urban pediatric emergency department from February 2004 to September 2004. The overall use of complementary/alternative medicine among children was 15% and more common among children older than 5 years (21%). Families who used complementary/alternative medicine thought results were best when both complementary/alternative medicine and conventional medicine were integrated ( P < .001). Most common types of complementary/alternative therapies used were folk remedies/home remedies (59%), herbs (41%), prayer healing (14%), and massage therapy (10%). Complementary/alternative medicine use was significant among the sample of children visiting an urban pediatric emergency department. Pediatricians should inquire about complementary/alternative use in the emergency department, particularly in children older than 5 years and those with parents/caretakers using complementary/alternative medicine themselves.
Natural Course of Fever During Influenza Virus Infection in Children
Authors: Suzuki Eitaro , Ichihara Kiyoshi , Johnson Andrew M.
Published: June 2007

During the 2001-2002 epidemic of influenza virus A/H1N1, A/H3N2, and B, the authors obtained detailed profiles of fever from 118 infected children. The only treatment given was acetaminophen for temperatures greater than 39.0°C. Fever was most prominent in A/H3N2 and young children. Secondary fever was observed frequently at 72 to 132 hours in all types. The duration of fever was associated negatively with the age of the child and positively with the maximal temperature. The information will be no longer available in current era of oseltamivir therapy.
Acellular Pertussis Vaccine Boosters Combined With Diphtheria and Tetanus Toxoid Boosters for Adolescents: Safety and Immunogenicity Assessment When Preceded by Different 5-Dose DTaP/DTwP Schedules
Authors: Pichichero Michael E. , Casey Janet R. , Francis Anne B. , Marsocci Steven M. , Murphy Marie , Hoeger William , Cleary Carolyn
Published: June 2007

A sixth dose of tetanus, diphtheria, acellular pertussis (Tdap) vaccine in adolescents might produce a differing reactogenicity and/or immunogenicity response depending on the composition of the 5 prior doses of DTaP or DT-whole cell pertussis (DTwP) vaccine. Reactions and immune responses following receipt of the Sanofi Pasteur (Adacel) and GlaxoSmithKline (Boostrix) Tdap vaccines were assessed in 229 adolescents. No differences were observed for reactions to either Tdap vaccine regardless of the prior DTaP/DTwP vaccination history. Seroprotective levels and antibody concentrations were comparable regardless of prior DTaP/DTwP vaccine history. A sixth sequential dose of Tdap after 5 doses of DTaP appears safe and immunogenic.
Survival Times and Complications of Catheters Used for Outpatient Parenteral Antibiotic Therapy in Children
Authors: Hussain Sabiha , Gomez Margarita M. , Wludyka Peter , Chiu Thomas , Rathore Mobeen H.
Published: June 2007

Outpatient parenteral antibiotic therapy is routinely used in pediatrics, but few data are available on catheter-associated complications and survival times. Catheter-associated complications, defined as mechanical or nonmechanical, and survival times in peripherally inserted central catheters and central venous catheters used for outpatient parenteral antibiotic therapy in childhood were compared. The life test procedure was performed to determine survival time. Cox proportional hazards model was used to compare the independent effect of variables such as age and gender on catheter survival. There were 104 peripheral and 130 central venous catheters, of which 28 peripheral and 19 central catheters had mechanical complications, and 13 peripheral and 17 central catheters had nonmechanical complications. Peripheral catheters are more likely to develop mechanical complications and have a shorter survival time than central venous catheters. For outpatient parenteral antibiotic therapy longer than 6 weeks, central venous catheters appear to be a better choice.
Resident Training in Developmental/Behavioral Pediatrics: Where Do We Stand?
Authors: Boreman Craig D. , Thomasgard Michael C. , Fernandez Soledad A. , Coury Daniel L.
Published: June 2007

Approximately 25% to 30% of all complaints to a general pediatrician are developmental or behavioral in origin. Despite this, residency education in developmental/behavioral pediatrics has consistently been rated poorly. Changes were set forth in 1997 to include a mandatory 1-month block rotation in developmental/behavioral pediatrics. This study was a nationwide, cross-sectional, self-administered, mailed survey of pediatricians who completed residency either before or after these changes went into effect. Overall, pediatricians’ comfort level in developmental/behavioral pediatrics was unchanged in the 2 groups. Certain areas (behavior problems, learning disabilities, sleep, and depression/anxiety) of developmental/behavioral pediatrics had lower comfort scores. Our data provide direction for the ongoing refinement of pediatric education that is based on feedback from currently practicing pediatricians.
Co-location of Mental Health Professionals in Primary Care Settings: Three North Carolina Models
Authors: Williams Jane , Shore Steven E. , Foy Jane Meschan
Published: June 2007

The pressing need for identification and treatment of behavioral health disorders in primary care has renewed interest in the concept of co-located models of care. The purpose of this article is to describe three North Carolina practice models in which mental health professionals are co-located with pediatric primary care providers. Each of the models was sustainable, partly due to systemic changes brought about by advocacy efforts. In addition to providing practical guidance for possible replication in primary care, this article reflects on how advocacy efforts can impact the success of co-location models.
The Role of Intranasal Corticosteroids in the Management of Pediatric Allergic Rhinitis
Authors: Kaari Jacqueline
Published: June 2007

Allergic rhinitis (AR) is currently the most common chronic disease in children in the United States, affecting as many as 40% of the children in the population. AR can substantially decrease a child’s quality of life and can contribute to school absenteeism. Intranasal corticosteroids (INS) are thought to be the most effective treatment choice for controlling the symptoms of AR. However, parent and physician concerns over INS safety in children have often led to INS being used as a second-line treatment option. More recently, safety studies have shown that the newer INS agents have improved safety profiles compared with older INS agents. The newer INS drugs have been found to have minimal adverse effects on growth and hypothalamic-pituitary-adrenal-axis function in children, which is a concern when prescribing corticosteroids. This review will discuss the pathophysiology, diagnosis, and classification of AR. The mechanism of action, efficacy, and safety of INS will also be discussed by focusing on clinical evidence. Furthermore, other considerations, such as parent or caregiver education and patient compliance, will be reviewed.
Addressing Behavioral Health Issues During Well Child Visits by Pediatric Residents
Authors: Williams Jane , Burwell Stephanie , Foy Capri G. , Foy Jane Meschan
Published: June 2007

The study examined practices by pediatric residents (n = 61) concerning psychosocial care during well child visits. A random sample (n = 719) of well child visits was selected, and a medical record review was conducted. Results suggested that a behavioral health issue was discussed in 38% of the cases. The most frequent type of problem discussed involved a medical component, while problems with mood were rarely discussed (<1%). Residents treated 67% of the cases and referred 20% of the cases with behavioral health concerns. Logistic regression suggested that residents were significantly more likely to treat medically focused problems (P = 0.05), but more likely to refer children with social/environmental or learning problems (P = 0.05). Results suggested the need for further training in recognition of internalizing disorders.
Severe Human Metapneumovirus Infection in Hospitalized Children
Authors: Estrada Benjamin , Carter Macharia , Barik Sailen , Vidal Rosa , Herbert Donald , Ramsey Keith M.
Published: June 2007

Human metapneumovirus is a recently discovered pathogen that causes upper and lower respiratory tract disease in children. This study describes the course of illness in hospitalized children with this infection. During a 6-month period, 11 children were diagnosed with human metapneumovirus infection by reverse transcription-polymerase chain reaction. Oxygen supplementation was required for 82% of patients. Severe disease developed in 45%, and mechanical ventilation was required. An apparent life-threatening event was the indication for hospitalization of 27% of patients infected with human metapneumovirus. Children with underlying asthma or neuromuscular disease had a prolonged hospitalization.
Teaching Practice Management Skills to Pediatric Residents
Authors: Babitch Leland A.
Published: June 2007

To satisfy the core competencies required by the Pediatric Residency Review Committee, the author describes an educational program for the residents in a large pediatric training program. The course provides a year-long overview of multiple medical management topics. The sessions cover nonclinical subjects usually missed in other educational settings, with particular focus on areas of finance, compliance, personnel management, career advancement, and leadership. The series is currently in its third year, with a positive response from the participants, and demonstrated improvement in resident knowledge of the covered areas.
Do First Years Really Last a Lifetime?
Authors: Herrod Henry G.
Published: June 2007

Multiple early childhood intervention programs have been introduced to provide at-risk children with a better start in life. This is due to the recognition that early childhood experiences, both positive and negative, can affect the physical, mental, behavioral, and economic well-being of the child. A few of these programs have evaluated long-term outcomes and have demonstrated that the effects of interventions may still be apparent years after the intervention. Pediatricians need to become more aware of the information available about the impact of early childhood events and become more active in promoting proven best intervention practices at the local, state, and national level.