bluuebunny/crossref_metadata_2025 huggingface dataset:
Insulin-like Growth Factor I and Leptin in Umbilical Cord Plasma and Infant Birth Size at Term
Authors: Vatten Lars J. , Nilsen Stein Tore , Ødegård Rønnaug A. , Romundstad Pål R. , Austgulen Rigmor
Published: August 2004

Objective. To determine the independent contributions to infant birth size of insulin-like growth factor I (IGF-I) and leptin measured in umbilical cord plasma.

Methods. Umbilical cord blood was collected in 12 804 consecutive deliveries, and cord plasma from 585 singleton infants born at term after uncomplicated pregnancies was analyzed for leptin, IGF-I, and 2 IGF-binding proteins (IGFBP-1 and IGFBP-3). In multivariable analyses, we assessed maternal and infant covariates of leptin and IGF-I, and we evaluated the independent contribution of cord levels of leptin and IGF-I on infant birth size.

Results. Cord plasma levels of IGF-I were lower in women who reported smoking at the beginning of pregnancy compared with nonsmokers. In female infants, levels of IGF-I and leptin were higher than in male infants after adjustment for ponderal index and maternal factors. We found a strong parallel increase in umbilical IGF-I and leptin with increasing birth weight and birth length. For IGFBP-1, there was an opposite pattern: IGFBP-1 increased with decreasing birth size. The multivariable analysis, adjusted for length of gestation and maternal age, parity, prepregnancy weight, smoking during pregnancy, and offspring sex, showed that IGF-I and leptin, independent of each other, were associated with birth weight and birth length.

Conclusions. Levels of IGF-I and leptin in umbilical cord plasma were higher in girls than in boys, but in both sexes, these 2 factors contributed independently and positively to birth weight and length. For IGFBP-1, high levels were associated with low birth weight and reduced length. If intrauterine growth is related to the risk of developing adult diseases, IGF-I, IGFBP-1, and leptin may be involved in the underlying processes.1131–1135 insulin like growth factors, leptin, umbilical cord plasma, birth weight.
Enhancing Their Likelihood for a Positive Future: The Perspective of Inner-City Youth
Authors: Ginsburg Kenneth R. , Alexander Penny M. , Hunt Jean , Sullivan Maisha , Zhao Huaqing , Cnaan Avital
Published: August 2004

Inner-city youth must overcome many environmental challenges as they strive for success. Their outcome is influenced by the interplay of protective forces and risk factors.

Objective. To learn directly from youth what solutions they believe would most influence their likelihood of achieving a positive future.

Design. In-school 8th-, 9th-, and 12th-graders in north Philadelphia generated, prioritized, and explained their own solutions through a 4-stage hierarchical process facilitated by AmeriCorps workers. In Stage 1, 60 randomly selected students participated in 8 focus groups to develop the study question. In Stage 2, youth in Nominal Group Technique sessions generated and prioritized solutions. In Stage 3, a survey for each grade that included their top prioritized ideas was distributed, and youth rated each idea on a Likert scale (5= Definitely would make me more likely to have a positive future to 1 = Would definitely not…). One thousand twenty-two ninth-graders (69% of in-school youth at 5 high schools) returned usable surveys. Ninety-three percent of responders were 14 to 16 years old, 44% were male, 54% were black, and 32% were Latino. Four hundred seventeen 8th-graders and 322 12th-graders returned usable surveys. In Stage 4, youth in 10 focus groups added meaning and context to the ideas.

Results. The highest rated items in all grades were solutions that promoted education or increased job opportunities. Ninth-graders ranked helping youth get into college first by the Marginal Homogeneity Test. The creation of more jobs was ranked second. Third rank was shared by more job training, keeping youth from dropping out of school, and better books for schools. The next tier of items focused mostly on opportunities for youth to spend their free time productively and to have interactions with adults. Many items calling for the reduction of risk behaviors or disruptive surroundings were rated lower. The Kruskal-Wallis test found little variation in rating of the ideas by gender, race, or socioeconomic status.

Conclusions. Youth believe that supportive solutions would do more to enhance their likelihood of reaching a positive future than would attempts to reduce “negative” behaviors or disruptive surroundings. This suggests that research and policies should consider how best to augment the protective influences of education, employment, meaningful use of time, and connection to adults.
Gaucher’s Disease and Fatal Hepatic Fibrosis Despite Prolonged Enzyme Replacement Therapy
Authors: Perel Yves , Bioulac-Sage Paulette , Chateil Jean-François , Trillaud Herve , Carles Jacques , Lamireau Thierry , Guillard Jean-Michel
Published: August 2004

We report on the case of a girl with type 1 Gaucher’s disease, treated from age 9 to 15 with high-dose enzyme replacement therapy. This treatment did not avert the development of an extensive mutilating hepatic fibrosis warranting a liver transplantation, which was followed by death.

In some cases of Gaucher’s disease, alternative strategies such as fractionated or further increased ERT, gene therapy, or glucosyltransferase inhibitor should be explored.
Comparative Study of Cefuroxime Axetil Versus Amoxicillin in Children With Early Lyme Disease
Authors: Eppes Stephen C. , Childs Judith A.
Published: August 2004

Cefuroxime axetil has been shown to have efficacy comparable to doxycycline in adults with early Lyme disease (LD). Because of toxicity, doxycycline is usually avoided in children. For children who are unable to tolerate amoxicillin, there is currently no proven alternative oral therapy for LD. This randomized, unblinded study compared 2 dosage regimens of cefuroxime axetil (20 mg/kg/d and 30 mg/kg/d) with amoxicillin (50 mg/kg/d), each given for 20 days. Children were enrolled if they were 6 months to 12 years of age, had erythema migrans, and met other eligibility requirements. Serologic testing occurred at entry and after 6 months. Follow-up evaluations for safety, tolerability, and efficacy occurred at 10 and 20 days, 6 months, and 1 year. Forty-three children were randomized (13 in the amoxicillin group, 15 in each cefuroxime axetil group); 39 completed 12 months of follow-up. At the completion of treatment, there was total resolution of erythema migrans in 67% of the amoxicillin group, 92% of the low-dose cefuroxime group, and 87% of the high-dose cefuroxime group, and resolution of constitutional symptoms occurred in 100%, 69%, and 87%, respectively. All patients had a good outcome, with no long-term problems associated with LD. One patient, who was well at the first 2 follow-up visits, was treated with doxycycline because of new constitutional symptoms. Mild diarrhea occurred in a small number of participants in each group (1 patient was diagnosed and treated for Clostridium difficile-associated diarrhea, which occurred after completing the full course of study medication). No hypersensitivity reactions occurred. The number of patients in this trial was not sufficient to demonstrate a statistically significant difference between the 3 groups; however, both amoxicillin and cefuroxime axetil seem to be safe, efficacious treatments for children with early LD.
Primary Intestinal and Thoracic Lymphangiectasia: A Response to Antiplasmin Therapy
Authors: MacLean Joanna E. , Cohen Eyal , Weinstein Michael
Published: August 2004

Lymphangiectasia is a congenital or acquired disorder characterized by abnormal, dilated lymphatics with a variable age of presentation. We describe a case of lymphangiectasia with intestinal and pulmonary involvement in an adolescent female, who presented with many of the classic features including chylous pleural effusions, lymphopenia, hypogammaglobinemia, and a protein-losing enteropathy. She also presented with recurrent lower gastrointestinal bleeding, which is infrequently described. The patient did not improve with bowel rest and a low-fat medium-chain triglyceride diet and had little improvement with octreotide acetate therapy. However, she had a clinical response to antiplasmin therapy, trans-4-aminothylcyclohexamine carboxylic acid (tranexamic acid) in terms of serum albumin and gastrointestinal bleeding. She continues to have exacerbations of her condition, as well as persistent lymphopenia and chronic pleural effusions.
Controlled Trial of Early Dexamethasone Treatment for the Prevention of Chronic Lung Disease in Preterm Infants: A 3-Year Follow-up
Authors: Romagnoli Costantino , Zecca Enrico , Luciano Rita , Torrioli Giulia , Tortorolo Giuseppe
Published: August 2004

Objective. There is increasing concern in regard to the possible long-term adverse effects of postnatal dexamethasone treatment in preterm infants. The purpose of this study was to assess growth and neurodevelopmental outcome in preterm infants at high risk of chronic lung disease (CLD), treated with early (<96 hours) postnatal dexamethasone.

Design. Three-year follow-up data of physical growth and neurodevelopmental outcome of preterm infants enrolled in a controlled trial to study the effectiveness of early postnatal dexamethasone administration for the prevention of CLD were reviewed. The original trial included 25 treated neonates who received dexamethasone intravenously from the fourth day of life for 7 days (0.5 mg/kg/d for the first 3 days, 0.25 mg/kg/d the next 3 days, and 0.125 mg/kg/d on the seventh day), and 25 untreated neonates as controls. Forty-five surviving infants (22 untreated and 23 treated) completed the 3-year follow-up.

Results. At the end of follow-up, infants pertaining to both study groups had similar values for body weight, height, and head circumference, and a similar incidence of infants with anthropometrics data below the third percentile. Moreover, no differences were detected between the groups in regard to incidence of major cranial ultrasound abnormalities, cerebral palsy, major neurosensory impairment or IQ scores, and distribution.

Conclusions. Early (<96 hours) postnatal dexamethasone administration at the doses employed in this study did not impair physical or neurodevelopmental outcome in preterm infants at high risk of CLD. However, the small sample size of our study was not tailored to look for long-term outcomes and our results are not in agreement with those of larger trials and systematic reviews. The real risks of postnatal dexamethasone administration could be definitely assessed only when more well-designed trials using long-term neurodevelopmental assessment as the primary outcome will be reported.
Hospitalizations for Kawasaki Disease Among Children in the United States, 1988–1997
Authors: Chang Ruey-Kang R.
Published: August 2004

Objective. To evaluate the epidemiologic pattern of Kawasaki disease (KD) in the United States over 10 years.

Methods. The National Inpatient Sample, a stratified national sample of >900 hospitals in 22 states of the United States, was used. Data on hospital discharges from 1988–1997 were analyzed. Patients <18 years of age with a discharge diagnosis of KD were identified.

Results. There were 6442 patients with KD admitted to 651 hospitals. Median age at hospital admission was 2 years. Peak incidence by year of age was 1 year old. Children <2 years old accounted for 36.6% of all cases; <5 years old, 75.6%; and <10 years old, 95.6%. The age distribution seems to be wider than reported from Japan. The incidence for children <5 years old was 8.1 per 100 000 people in 1988, and increased to 18.5 in 1997. There were 3905 males (60.6%) and 2537 females (39.4%), for a male-to-female ratio of 1.54. The incidences were higher in winter and spring (December to May) and dropped to a nadir between July and September. No apparent change in seasonal pattern was noted over 10 years. The South census region showed a seasonal change 2 to 3 months ahead of other regions. The overall in-hospital mortality rate was 0.17%. The mortality rate in children ≥10 years (1.4%) was significantly higher in than children <10 years (0.11%).

Conclusions. KD affects mainly children under 5 years of age, with a peak incidence in children 1 to 2 years of age. The incidence of KD was rising over the study period. There is a male predominance. Although KD occurs year-round, the lowest incidence is seen from July through September. Such seasonal variation did not change over the 10 years. Seasonal pattern may vary in different geographic regions. Mortality from KD is rare, although children ≥10 years are at higher risk.
Risk Factors of Enterovirus 71 Infection and Associated Hand, Foot, and Mouth Disease/Herpangina in Children During an Epidemic in Taiwan
Authors: Chang Luan-Yin , King Chwan-Chuen , Hsu Kuang-Hung , Ning Hsiao-Chen , Tsao Kuo-Chien , Li Chung-Chen , Huang Yhu-Chering , Shih Shin-Ru , Chiou Shu-Ti , Chen Po-Yen , Chang Hong-Jen , Lin Tzou-Yien
Published: August 2004

Objective. In 1998, an enterovirus 71 (EV71) epidemic in Taiwan was associated with hand, foot, and mouth disease (HFMD)/herpangina and involved 78 fatal cases. We measured EV71 seroprevalence rates before and after the epidemic and investigated risk factors associated with EV71 infection and illness.

Methods. Neutralizing antibodies to EV71 were assayed for 539 people before the epidemic and 4619 people of similar ages after the epidemic. Questionnaires, which were completed during household interviews after the epidemic, solicited demographic variables, exposure history, and clinical manifestations.

Results. A total of 129 106 cases of HFMD were reported during the epidemic. Age-specific pre-epidemic EV71 seroprevalence rates were inversely related to age-specific periepidemic mortality rates (r = −0.82) or severe case rates (r = −0.93). Higher postepidemic EV71 seropositive rates among children who were younger than 3 years positively correlated with higher mortality rates in different areas (r = 0.88). After the epidemic, 51 (56%) of 91 younger siblings of elder siblings who were EV71-seropositive were EV71-seropositive; otherwise, 2.2% (4 of 186) of younger siblings were EV71-seropositive (matched odds ratio [OR]: 10; 95% confidence interval [CI]: 3.4–29). Stepwise multiple logistic regression revealed other factors associated with EV71 infection to be older age (adjusted OR: 2.5; 95% CI: 1.9–3.4), attendance at kindergartens/child care centers (adjusted OR: 1.8; 95% CI: 1.3–2.5), contact with HFMD/herpangina (adjusted OR: 1.6; 95% CI: 1.2–2.1), greater number of children in a family (adjusted OR: 1.4; 95% CI: 1.1–1.7), and rural residence (adjusted OR: 1.4; 95% CI: 1.2–1.6). Twenty-nine percent of preschool children who were infected with EV71 developed HFMD/herpangina. Younger age and contact with HFMD/herpangina were significant factors for the development of EV71-related HFMD/herpangina in these children.

Conclusions. An increased incidence of EV71 infection in young children occurred more often in geographic areas with increased mortality rates. Intrafamilial and kindergarten transmissions among preschool children were major modes of disease transmission during the widespread EV71 epidemic in Taiwan in 1998.
Multicenter Analysis of Platelet Transfusion Usage Among Neonates on Extracorporeal Membrane Oxygenation
Authors: Chevuru Srinivas C. , Sola Martha C. , Theriaque Douglas W. , Hutson Alan D. , Leung Wilfred C.W. , Perez Jose A. , Nelson Robert M. , Kays David W. , Christensen Robert D. ,   for the Florida Collaborative Neonatology Research Group
Published: August 2004

Objective. Multiple platelet transfusions are invariably given to neonates on extracorporeal membrane oxygenation (ECMO), and no alternative to repeated transfusions exists. Before any alternatives, such as administration of thrombopoietic stimulators, could be contemplated, data regarding the number of platelet transfusions received by neonatal ECMO patients is needed, and the mechanisms that cause the thrombocytopenia of these patients must be better defined. As a step toward determining this, we analyzed the use of platelet transfusions in this group of neonates. We conducted a historic cohort study of neonates who were treated with ECMO to determine the number of platelet units received as a function of 1) days on ECMO, 2) medical diagnosis for which ECMO was instituted, and 3) type of ECMO used (venovenous [VV] vs venoarterial [VA]).

Methods. We reviewed the hospital records of all neonates who were admitted to the neonatal intensive care units at Shands Children’s Hospital, Arnold Palmer Hospital for Children and Women, and Tampa General Hospital and treated with ECMO between January 1, 1995, and June 30, 2000. Data were expressed as the number of platelet transfusions versus number of days on ECMO, diagnosis for which ECMO was instituted, and type of ECMO used.

Results. Of the 234 ECMO patients, 81 were placed on VV, 138 were placed on VA, and 15 were converted from VV to VA. The average number of platelet transfusions received per day was 1.3 and varied by diagnosis and by type of ECMO. Neonates with meconium aspiration and sepsis required more platelet transfusions per day than neonates with other conditions. Infants who were converted from VV to VA required more transfusions per day (mean: 1.57) than did patients on VA (1.47) or VV (1.06).

Conclusions. Platelet transfusions among neonates on ECMO are dependent of their medical diagnosis; they average 1.3 transfusions per day and are higher on VA than VV ECMO.
Current Chemotherapy Protocols for Childhood Acute Lymphoblastic Leukemia Induce Loss of Humoral Immunity to Viral Vaccination Antigens
Authors: Nilsson Anna , De Milito Angelo , Engström Pär , Nordin Margareta , Narita Mitsuo , Grillner Lena , Chiodi Francesca , Björk Olle
Published: August 2004

Objective. To evaluate viral vaccination immunity and booster responses in children treated successfully for acute lymphoblastic leukemia by chemotherapy and to study the response to treatment of antibody-producing plasma cells that are important for persistence of humoral immunity.

Methods. Forty-three children who were in continuous first remission for a median of 5 years (range: 2–12 years) were studied. Before the leukemia was diagnosed, all children had been immunized against measles, mumps, and rubella according to the Swedish National immunization program. We analyzed levels of serum antibodies against measles and rubella by enzyme immunoassays. Avidity tests for measles antibodies were concomitantly performed by enzyme-linked immunosorbent assay for measles virus immunoglobulin G detection. The proportion of plasma cells in bone marrow was studied by flow cytometry at different times during treatment and follow-up. Children who lacked protective levels of antibodies to vaccination antigens were reimmunized. Serum was collected 3 months after immunization to assess vaccination responses.

Results. After completion of the treatment, only 26 of the 43 children (60%) were found to be immune against measles and 31 (72%) against rubella. The proportion of bone marrow plasma cells decreased during treatment but returned to normal after 6 months. Revaccination caused both primary and secondary immune responses. Six of the 14 children without immunity failed to achieve protective levels of specific antibodies against measles and 3 against rubella.

Conclusions. Our finding of loss of antibodies against measles and rubella in children treated with intensive chemotherapy suggests that reimmunization of these patients is necessary after completion of the treatment. To determine reimmunization schedules for children treated with chemotherapy, vaccination responses need to be studied further.
Kyphosis in a Turner Syndrome Population
Authors: Elder Deborah A. , Roper Mary Gwyn , Henderson Richard C. , Davenport Marsha L.
Published: August 2004

Objective. The purpose of this study was to determine the prevalence of kyphosis in a Turner syndrome (TS) population.

Methods. Standing lateral thoracic spine and standing anterior-posterior (A-P) scoliosis radiographs were obtained on all girls with TS between the ages of 5 and 18 years seen in a TS clinic between July 2000 and March 2001. Medical histories were reviewed, and a pediatric orthopedic surgeon evaluated the radiographs of each patient (N = 25). Excessive kyphosis was defined as an A-P curvature >40°, vertebral wedging as any A-P deformity >5° at an individual vertebral body, and scoliosis as a lateral curvature >10°.

Results. Fifteen (60%) of 25 patients were found to have abnormal radiographic findings: 10 (40%) of 25 with excessive kyphosis, 10 (40%) of 25 with vertebral wedging, and 5 (20%) of 25 with scoliosis. Forty-eight percent of the girls had both excessive kyphosis and/or vertebral body wedging. Two girls had kyphosis ≥55°, and 5 had scoliosis ≥25°. Girls with excessive kyphosis and/or vertebral body wedging were older (13.6 ± 3.9 years vs 10.6 ± 2.8 years).

Conclusions. The prevalence of excessive kyphosis and vertebral body wedging seems to be increased in girls with TS and corresponds with advancing age. Routine radiologic surveillance may facilitate detection of developing deformities so that treatment with a brace can be considered to prevent or slow the process.
Noncompliance With Medical Follow-up After Pediatric Intensive Care
Authors: McPherson Mona L. , Lairson David R. , Smith E. O’Brian , Brody Baruch A. , Jefferson Larry S.
Published: August 2004

Objectives. To describe the medical follow-up ordered, the health care utilization, the appointment compliance, and the risk factors associated with noncompliance in patients who are discharged after a pediatric intensive care unit (PICU) stay.

Methods. A prospective, analytic, cohort study of 111 critically ill children, age 1 day to 16 years, who were admitted to a 30-bed PICU in an urban, tertiary-care, pediatric teaching hospital compared children who were compliant with medical follow-up with those who were not. The main outcomes measured were emergent and unscheduled physician visits during the first 6 weeks after hospital discharge; compliance with ordered medical follow-up after hospital discharge; and comparisons of socioeconomic, demographic, and medical need factors between compliant and noncompliant children.

Discharge orders for follow-up appointments with general pediatricians and subspecialists were collected from the chart at hospital discharge. Patients were contacted after hospital discharge to determine whether and when they received medical follow-up; 28% were found to be noncompliant. Risk factors associated with noncompliance were evaluated. Emergent and unscheduled physician visits were tracked during the first 6 weeks after hospital discharge.

Results.Lack of follow-up orders at hospital discharge did not affect the frequency of emergent visits. Children fell into 2 groups: those who were 100% compliant and those with ≤67% compliance. No socioeconomic or demographic risk factors could be identified between the 2 groups. Compared with the 100% compliant patients, patients who were compliant with ≤67% of appointments were more severely ill, as defined by higher peak pediatric risk of mortality scores during their PICU stay (11.5 vs 8.4), longer PICU length of stays (10.1 days vs 4.6 days), and longer hospital length of stays (25.5 days vs 14 days). Most predictive of noncompliance was the number of medical appointments ordered by physicians. Patients with 3 or more appointments were less likely to be compliant with follow-up. After hospital discharge, children were more likely to visit a primary care physician compared with a subspecialist (95% vs 82%). When patients were ordered to see a specialist, scheduled appointments were much better attended than the recommended appointments (92% vs 67%).

Conclusions. Lack of ordered medical follow-up did not affect emergent visits. In this group of critically ill children, a significant percentage (28%) did not receive timely medical follow-up. No socioeconomic or demographic risk factors were identified in noncompliant children. However, severity of illness (higher peak pediatric risk of mortality score, longer PICU stay, and longer hospital stay) and the number of follow-up appointments ordered were predictors of noncompliance. Potential exists for implementing strategies to improve compliance in identified populations.
Enhancing Their Likelihood for a Positive Future: Focus Groups Reveal the Voice of Inner-City Youth
Authors: Ginsburg Kenneth R. , Alexander Penny M. , Hunt Jean , Sullivan Maisha , Cnaan Avital
Published: August 2004

Objective. To learn directly from adolescents living in a challenging environment what they believe would most influence their likelihood of achieving a positive future.

Design. A teen-centered methodology used focus groups, nominal group technique sessions, and a survey to allow adolescents to develop, prioritize, and explain their own solutions. AmeriCorps workers guided in-school 8th-, 9th-, and 12th-graders in north Philadelphia through a 4-stage hierarchical process. This article reports the qualitative explanations offered by adolescents in Stage 4 explanatory focus groups. In these 10 groups, 91 youth added meaning and context to the ideas their fellow students generated and prioritized. Transcriptions were reviewed for consistent themes. Direct quotations representative of those themes are offered here.

Results. Students in all grades gave highest priority to solutions that would promote educational or job opportunities. Solutions that would ameliorate disruptive surroundings or reduce risk behaviors were generally rated lower. Focus group participants agreed that education, improved employment opportunities, connection with adults, and meaningful uses of their time were the keys to positive change. They also expressed how a risky environment impacted on their chances for success and offered strategies for reducing their risks. They discussed how positive forces might counter the draw of the streets. Although most adolescents remained optimistic, some viewed problems in their neighborhood as intractable.

Conclusions. An individual’s ability to draw from protective resources while avoiding the challenges inherent to a risky environment may determine his/her ability to succeed. Youth have clear ideas about how they can best be supported to succeed. Adults should consider and incorporate their wisdom as they plan strategies to develop productive young adults.
Just a Click Away: Recreational Drug Web Sites on the Internet
Authors: Wax Paul M.
Published: August 2004

The explosive growth of the Internet in recent years has provided a revolutionary new means of interpersonal communication and connectivity. Information on recreational drugs—once limited to bookstores, libraries, mass media, and personal contacts—is now readily available to just about anyone with Internet access. Not surprising, Internet access greatly facilitates the free and easy exchange of ideas, opinions, and unedited and nonrefereed information about recreational drugs. This article presents a patient who came to medical attention as the result of recreational drug-taking behavior directly influenced by her Internet browsing. A second case is presented in which the only information available about the medical effects of a new “designer” drug was found on a recreational drug Internet Web site. Several such Web sites are described in detail. Despite the presence of Web sites that convey antidrug messages, the drug sites that espouse “risk reduction” and “safe” and “responsible” drug use are easily accessible and potentially alluring to children and adults. Health care providers who care for adolescents should be particularly aware of the content of these drug sites.
Metamizole Use by Latino Immigrants: A Common and Potentially Harmful Home Remedy
Authors: Bonkowsky Joshua L. , Frazer J. Kimble , Buchi Karen F. , Byington Carrie L.
Published: August 2004

A 4-year-old boy presented with fever, septic arthritis, and persistent neutropenia. Bone marrow biopsy revealed no evidence of neoplasia. Additional history disclosed that the patient had been given metamizole for pain before onset of his illness. Metamizole, a nonsteroidal antiinflammatory agent, is prohibited in the United States because of the risk of agranulocytosis but is widely used in Mexico and other countries. The increasing number of Latinos in the United States and the extensive cross-border transfer of medicines raise concerns that metamizole use and associated complications may become more frequent. After identification of the index patient, additional inquiry revealed that the patient’s mother was hospitalized previously for overwhelming sepsis associated with metamizole use. These cases prompted an investigation of metamizole use in an urban pediatric clinic, which revealed that 35% of Spanish-speaking Latino families had used metamizole; 25% of these families had purchased the medication in the United States. We conclude that metamizole use is common and may be underrecognized in immigrant Latino patients. Physicians in the United States, especially those who practice primary care, hematology/oncology, and infectious diseases, must be aware of the availability and use of metamizole in specific patient populations and its potential for harmful side effects.
Urinary Excretion of Cross-Linked N-Telopeptides of Type 1 Collagen to Assess Bone Resorption in Infants From Birth to 1 Year of Age
Authors: Lapillonne Alexandre , Travers Rose , DiMaio Massimo , Salle Bernard L. , Glorieux Francis H.
Published: August 2004

Objectives. To evaluate noninvasively bone resorption in infants and more specifically, to assess the accuracy of urinary collagen type 1 cross-linked N-telopeptide (NTX) excretion normalized to creatinine (NTX/Cr) in a spot urine sample as a reflection of daily NTX production in infants and to compute normative values for NTX excretion from birth to 1 year of age.

Methods. NTX/Cr values obtained from a single spot urine sample were compared with daily urinary NTX excretion and NTX/Cr obtained in 24-hour urine collected from 8 hospitalized infants. Normative values for NTX excretion were collated with a cross-sectional study in 70 healthy French infants (42 boys, 28 girls) aged 0 to 374 days (weight: 2700–11 340 g; length: 46–76.5 cm) and free of diseases or treatments that could influence growth, bone mineralization, or renal function.

Results. NTX/Cr values from single spot urine sample were significantly and linearly correlated with both daily NTX excretion (r = 0.783) and daily NTX/Cr (r = 0.952). In healthy infants, NTX excretion is low at birth, increases dramatically and significantly during the first 10 days of life, remains significantly elevated for approximately 3 months, and then decreases progressively to return to values similar to that observed at birth by 1 year of age.

Conclusions. These data provide new insights regarding the use of spot urine analysis for assessing NTX excretion during the first year of life. The normative data demonstrate significant age-related variations in this marker, which probably reflect adaptation to extrauterine life and accelerated bone turnover in infancy and which should be considered for the interpretation of this noninvasive bone resorption marker in the clinical setting.
Maternal Bone Lead as an Independent Risk Factor for Fetal Neurotoxicity: A Prospective Study
Authors: Gomaa Ahmed , Hu Howard , Bellinger David , Schwartz Joel , Tsaih Shirng-Wern , Gonzalez-Cossio Teresa , Schnaas Lourdes , Peterson Karen , Aro Antonio , Hernandez-Avila Mauricio
Published: August 2004

Objective. A number of prospective studies have examined lead levels in umbilical cord blood at birth as predictors of infant mental development. Although several have found significant inverse associations, others have not. Measurement of lead levels in maternal bone, now recognized as the source of much fetal exposure, has the potential to serve as a better or complementary predictor of lead’s effect on the fetus. Our objective was to compare lead levels in umbilical cord blood and maternal bone as independent predictors of infant mental development using a prospective design.

Methods. We recruited women who were giving birth at 3 maternity hospitals in Mexico City that serve a homogeneous middle-class community. Umbilical cord blood lead levels were measured by graphite furnace atomic absorption spectroscopy, and maternal lead levels in cortical (tibial) and trabecular (patellar) bone were measured within 4 weeks of giving birth using a 109-Cd K-x-ray fluorescence instrument. At 24 months of age, each infant was assessed using the Bayley Scales of Infant Development-II (Spanish Version).

Results. A total of 197 mother-infant pairs completed this portion of the study and had data on all variables of interest. After adjustment for other well-known determinants of infant neurodevelopment, including maternal age, IQ, and education; paternal education; marital status; breastfeeding duration; infant gender; and infant illness, lead levels in umbilical cord blood and trabecular bone were significantly, independently, and inversely associated with the Mental Development Index (MDI) scores of the Bayley Scale. In relation to the lowest quartile of trabecular bone lead, the second, third, and fourth quartiles were associated with 5.4-, 7.2-, and 6.5-point decrements in adjusted MDI scores. A 2-fold increase in cord blood lead level (eg, from 5 to 10 μ g/dL) was associated with a 3.1-point decrement in MDI score, which is comparable to the magnitude of effect seen in previous studies.

Conclusion. Higher maternal trabecular bone lead levels constitute an independent risk factor for impaired mental development in infants at 24 months of age. This effect is probably attributable to mobilization of maternal bone lead stores, a phenomenon that may constitute a significant public health problem in view of the long residence time of lead in bone.
CHARGE Syndrome: A Window of Opportunity for Audiologic Intervention
Authors: Edwards Bruce M. , Kileny Paul R. , Van Riper Lori A.
Published: August 2004

Objective. To detail the clinical features of 22 new patients with a syndrome characterized by ocular coloboma, heart defects, atretic choanae, retarded growth or development, genital hypoplasia, and ear anomalies or hearing loss (CHARGE) seen in a tertiary academic medical center; compare auditory brainstem response (ABR) thresholds and behavioral hearing test results; identify a “window of opportunity” for audiologic intervention; review the literature regarding hearing results in CHARGE syndrome; and review the relationship between facial palsy and sensorineural hearing loss.

Methods. Clinical data were gathered to examine 1) the variety of hearing results, 2) the average age at the time of hearing loss identification in 22 children with CHARGE using electrophysiologic and behavioral test methods, 3) the usefulness of the ABR as an early indicator of hearing sensitivity for a select group composed of children from the present study and from an earlier report from the same institution, and 4) the value of congenital facial paralysis as a predictor of sensorineural hearing loss in CHARGE children seen in the authors’ institution since 1983.

Results. All children had 4 or more acronymic features, including colobomatous defects or choanal atresia. Ear anomalies/hearing loss occurred at least as frequently as other primary features. A total of 81% of patients had hearing loss; in this subset, 1 child had a mild degree of loss, and the remaining children had moderate or greater losses. The average age at which ABR confirmed hearing status was 3.8 months, whereas for behavioral testing, that age was 24.7 months, a statistically significant difference. In a select group of 16 children, no statistical differences existed when comparing threshold results of early electrophysiologic testing with behavioral test findings obtained at a later date. Contingency analysis suggests that congenital facial paralysis and sensorineural hearing loss are related.

Conclusions. Hearing loss is prevalent in children with CHARGE syndrome. Within a wide range of results exists a propensity for moderate or greater hearing loss in children with sensorineural or mixed impairments. Congenital facial palsy seems to be a valid statistical predictor of sensorineural hearing loss and can be a useful device in audiologic decision making. A “window of opportunity” for audiologic intervention exists in the first few months of life. Primary care providers are encouraged to recognize the need for immediate, early audiologic referral of their patients suspected to have CHARGE. Evaluation of hearing sensitivity during infancy and, when appropriate, provision of amplification are important components in the process of auditory habilitation. These efforts are in keeping with various professional guidelines that call for early detection of hearing loss and subsequent prompt intervention to minimize effects on infant development.
Isoimmunization Is Unlikely to Be the Cause of Hemolysis in ABO-Incompatible but Direct Antiglobulin Test-Negative Neonates
Authors: Herschel Marguerite , Karrison Theodore , Wen Ming , Caldarelli Leslie , Baron Beverly
Published: August 2004

Objective. It is stated that the direct antiglobulin (Coombs’) test (DAT) may be negative in ABO hemolytic disease of the newborn. Thus, significant jaundice in neonates who are A-B incompatible with their mothers but DAT test negative is often attributed to isoimmunization and another diagnosis is not sought. We wished to determine the rate of bilirubin production, as an objective measure of hemolysis, in 2 groups of DAT-negative neonates—ABO-compatible and ABO-incompatible—and in DAT-positive ABO-incompatible neonates.

Methods. In consecutive, term, healthy newborns who were admitted to the general care nursery, we measured the level in parts per million (ppm) of end-tidal breath carbon monoxide (CO), corrected for inspired CO (ETCOc), an index of the rate of bilirubin production. We compared the levels in DAT-negative ABO-incompatible neonates with those in ABO-compatible neonates and with the levels in DAT-positive ABO-incompatible neonates. Statistical analysis was performed using 2-sample t and χ2 tests.

Results. There was no significant difference between the mean 12-hour ETCOc levels in DAT-negative ABO-incompatible neonates (n = 60, 2.2 ± 0.6 ppm) versus DAT-negative ABO-compatible neonates (n = 171, 2.1 ± 0.6 ppm), although there was a difference between the mean levels in DAT-positive ABO-incompatible neonates (n = 14, 3.4 ± 1.8 ppm) and the DAT-negative groups. Four DAT-negative ABO-incompatible neonates had elevated ETCOc levels; in 2, we diagnosed a specific hematologic abnormality, namely, glucose-6-phosphate dehydrogenase deficiency in 1 and elliptocytosis in the other.

Conclusion. In DAT-negative newborns with significant jaundice or increased bilirubin production, even if ABO-incompatible, a cause other than isoimmunization should be sought.
Comparison of Skin-to-Skin (Kangaroo) and Traditional Care: Parenting Outcomes and Preterm Infant Development
Authors: Feldman Ruth , Eidelman Arthur I. , Sirota Lea , Weller Aron
Published: August 2004

Objective. To examine whether the kangaroo care (KC) intervention in premature infants affects parent–child interactions and infant development.

Methods. Seventy-three preterm infants who received KC in the neonatal intensive care unit were matched with 73 control infants who received standard incubator care for birth weight, gestational age (GA), medical severity, and demographics. At 37 weeks’ GA, mother–infant interaction, maternal depression, and mother perceptions were examined. At 3 months’ corrected age, infant temperament, maternal and paternal sensitivity, and the home environment (with the Home Observation for Measurement of the Environment [HOME]) were observed. At 6 months’ corrected age, cognitive development was measured with the Bayley-II and mother–infant interaction was filmed. Seven clusters of outcomes were examined at 3 time periods: at 37 weeks’ GA, mother–infant interaction and maternal perceptions; at 3-month, HOME mothers, HOME fathers, and infant temperament; at 6 months, cognitive development and mother–infant interaction

Results. After KC, interactions were more positive at 37 weeks’ GA: mothers showed more positive affect, touch, and adaptation to infant cues, and infants showed more alertness and less gaze aversion. Mothers reported less depression and perceived infants as less abnormal. At 3 months, mothers and fathers of KC infants were more sensitive and provided a better home environment. At 6 months, KC mothers were more sensitive and infants scored higher on the Bayley Mental Developmental Index (KC: mean: 96.39; controls: mean: 91.81) and the Psychomotor Developmental Index (KC: mean: 85.47; controls: mean: 80.53).

Conclusions. KC had a significant positive impact on the infant’s perceptual-cognitive and motor development and on the parenting process. We speculate that KC has both a direct impact on infant development by contributing to neurophysiological organization and an indirect effect by improving parental mood, perceptions, and interactive behavior.
The Use of Recombinant Activated Factor VII to Control Bleeding in a Preterm Infant Undergoing Exploratory Laparotomy
Authors: Chuansumrit Ampaiwan , Nuntnarumit Pracha , Okascharoen Chusak , Teeraratkul Sumete , Suwansingh Saranya , Supapannachart Sarayut
Published: August 2004

The case of a preterm infant weighing 1120 g who successfully received recombinant activated factor VII (rFVIIa) without complication for control of a life-threatening bleeding event resulting from a ruptured umbilical artery is reported. After performing an exploratory laparotomy at 27 hours of age, hemorrhage from the surgical wound and various sites persisted. By 63 hours of age, the infant had received a total of 192 mL (171 mL/kg) of packed red blood cells, 115 mL (103 mL/kg) of fresh frozen plasma, 8 mL of cryoprecipitate, and 75 mL (67 mL/kg) of platelet concentrate without stabilization. Hemorrhage ceased after 2 doses of 40 μg/kg/dose recombinant activated factor VII given at 63 and 70 hours of age, with subsequent stabilization of the hematocrit and without need for additional transfusion therapy.
Uses of Drugs Not Described in the Package Insert (Off-Label Uses)
Authors:   Committee on Drugs
Published: August 2004

New regulatory initiatives have been designed to ensure that new drugs and biologicals include adequate pediatric labeling for the claimed indications at the time of, or soon after, approval. However, because such labeling may not immediately be available, off-label use (or use that is not included in the approved label) of therapeutic agents is likely to remain common in the practice of pediatrics. This policy statement was written to address questions practitioners have regarding off-label use. The purpose of off-label use is to benefit the individual patient. Practitioners may use their professional judgment to determine these uses. Practitioners should understand that the Food and Drug Administration does not regulate off-label use.
The Medical Home
Authors:   Medical Home Initiatives for Children With Special Needs Project Advisory Committee
Published: August 2004

The American Academy of Pediatrics proposed a definition of the medical home in a 1992 policy statement. Efforts to establish medical homes for all children have encountered many challenges, including the existence of multiple interpretations of the “medical home” concept and the lack of adequate reimbursement for services provided by physicians caring for children in a medical home. This new policy statement contains an expanded and more comprehensive interpretation of the concept and an operational definition of the medical home.
Summer Sunburn and Sun Exposure Among US Youths Ages 11 to 18: National Prevalence and Associated Factors
Authors: Davis Kourtney J. , Cokkinides Vilma E. , Weinstock Martin A. , O’Connell Mary C. , Wingo Phyllis A.
Published: August 2004

Objective. Epidemiologic evidence suggests that ultraviolet radiation (UVR), from sun exposure and sunburns during early life, is associated with increased risk of melanoma and other skin cancers in adulthood. The objective of this study was to gather national, population-based data on sun exposure and protection behaviors among US youths ages 11 to 18 to quantify the magnitude and patterns of sun exposure and establish baselines for continued surveillance.

Methods. A nationwide survey based on random-digit dialing and stratified, 2-stage national probability sampling was conducted of households with telephones in the 48 contiguous states of the United States during July through October of 1998; a population-based sample of 1192 youth ages 11 to 18 was studied to measure weighted prevalence estimates of summer sunburn and sun exposure and adjusted prevalence odds ratios and 95% confidence intervals from logistic regression analyses of sunburn.

Results. Among youths ages 11 to 18, 72% reported having had at least 1 summer sunburn, 30% reported at least 3, and 12% reported at least 5 sunburns. Before receiving their most serious summer sunburn, 39% of youths reported having applied sunscreen. Factors associated with increased odds of sunburn included greater sun sensitivity, white race, age younger than 16 years, more hours spent outdoors, and high desirability of a tan.

Conclusions. Summer sunburn was the norm among US youths ages 11 to 18. The high frequency of sunscreen use during the sunburning episodes suggests the need to educate youth and parents better about proper use of these agents, as well as the importance of practicing other sun protection behaviors, such as wearing hats and protective clothing and avoiding the sun during peak exposure times. These data may serve as a baseline for tracking progress in skin cancer prevention efforts and will inform the crafting of future public health campaigns.
Neutrophil Activation in Preterm Infants Who Have Respiratory Distress Syndrome
Authors: Nupponen Irmeli , Pesonen Eero , Andersson Sture , Mäkelä Aila , Turunen Riikka , Kautiainen Hannu , Repo Heikki
Published: August 2004

Objective. To study neutrophil activation in circulation as a sign of systemic inflammation in preterm infants with respiratory distress syndrome.

Methods. The study comprised very low birth weight preterm infants who had respiratory distress syndrome and required intubation and mechanical ventilation (n = 51), 1-day-old preterm infants who had no need for mechanical ventilation (n = 12), term infants (n = 47), and adult volunteers (n = 25). Neutrophil surface expression of CD11b was quantified with flow cytometry.

Results. In preterm infants with respiratory distress syndrome, neutrophil CD11b expression during the first day of life was higher than in cord blood (mean: 165 relative fluorescence units [RFU] [standard deviation [SD]: 53], n = 29 vs 83 RFU [SD: 21], n = 11; 95% confidence interval [CI] for difference: 59–106) or in preterm infants without mechanical ventilation (106 RFU [SD: 33], n = 12; 95% CI for difference: 17–90). CD11b expression decreased by age of 10 days. CD11b expression was lower in preterm cord than in term cord blood (95% CI for difference: 5–53). However, in preterm infants with respiratory distress syndrome aged 2 to 5 days, it was higher than in term infants of that age.

Conclusions. The observations demonstrate an early transient postnatal neutrophil activation indicative of systemic inflammation that may contribute to the tissue injury in preterm infants with respiratory distress syndrome.