bluuebunny/crossref_metadata_2025 huggingface dataset:
A Family With Extrinsic Allergic Alveolitis Caused by Wild City Pigeons: A Case Report
Authors: Sarvaas Gideon J. du Marchie , Merkus Peter J. F. M. , de Jongste Johan C.
Published: August 2004

We describe a family in which the mother died of unresolved lung disease and whose 5 children, some of whom had previous signs of asthma, were subsequently affected by extrinsic allergic alveolitis caused by contact with wild city pigeon antigens. The children received systemic corticosteroids for 1 month and inhaled steroids for 24 months, while antigen exposure was reduced as much as feasible. This was followed by a quick clinical recovery and a slow normalization of chest radiographs and pulmonary function indices, especially of diffusion capacity, during a follow-up of 24 months.

Because pigeon-breeder's lung caused by free-roaming city pigeons has not been previously described, it remains unclear whether this family developed the disease because of high antigen exposure or because of increased susceptibility. None of the supposedly high-risk human leukocyte antigen types were found in the children. Whether human leukocyte antigen B7 in 1 child played a role in the course of the illness remains speculative. It is unknown to what extent pigeon-breeder's lung caused by nondomestic birds remains undetected and misdiagnosed as difficult or steroid-resistant asthma. The question remains whether free-roaming city pigeons are indeed a public health risk. We suggest that atypical outdoor antigens be considered in all patients with nonresolving chest disease or therapy-resistant asthma.
Counseling Parents Regarding Prognosis in Autistic Spectrum Disorder
Authors: Coplan James
Published: August 2004

A triaxial model for autistic spectrum disorder (ASD) is presented, incorporating age, degree of intelligence, and severity of autistic features. As the name implies, ASD can vary in degree of expression from minimal to profound. Furthermore, the symptoms of ASD change in predictable ways with the passage of time. For example, echolalia during early childhood may be replaced by verbal literalism and difficulty with verbal humor during later childhood or adolescence. The prognosis for children with ASD is governed by the joint impact of the degree of expression of ASD and the degree of developmental delay, if any. All combinations of ASD and intellect are possible (ie, severe ASD plus severe mental retardation, severe ASD plus normal general intelligence, and so forth). The relationship among these 3 parameters—severity of ASD, level of general intelligence, and change in symptom expression over time, is represented schematically as a 3-dimensional graph. The utility of this graph as a counseling tool, and as the basis for future research on the prognosis of ASD are discussed.
A Custodian Cured the Doctor!
Authors: Bahna Sami L.
Published: August 2004

Opinions expressed in commentaries are those of the authors and not necessarily those of the American Academy of Pediatrics or its Committees. Commentaries are not peer-reviewed.
Clinical Auscultation Skills in Pediatric Residents
Authors: Gaskin Peter R. A. , Owens Susan E. , Talner Norman S. , Sanders Stephen P. , Li Jennifer S.
Published: August 2004

Objective.

The aim of this study is to determine the level of clinical auscultation skills in pediatric residents at Duke University Medical Center.

Methods.

Forty-seven residents from pediatrics and joint medicine/pediatrics training programs at Duke University Medical Center were enrolled in this study. They were asked to examine the cardiovascular patient simulator, Harvey, and report their findings. Five common conditions seen in the pediatric population were presented: ventricular septal defect, atrial septal defect, pulmonary valve stenosis, combined aortic valve stenosis and insufficiency, and innocent systolic ejection murmur. The responses were scored by the number of features and diagnoses accurately reported. Five pediatric cardiologists and cardiologists in training were also asked to participate in a manner similar to the trainees.

Results.

The mean score of features identified for the resident group was 11.4 ± 2.6 of a possible 19. The diagnostic accuracy was 33%. There was no significant difference between residents by year of training or by type of residency program, although there was a trend toward improved performance with more training. The difference in performance between the pediatric cardiology group and the residents group was striking. The condition that was most frequently misdiagnosed was the innocent systolic ejection murmur.

Conclusions.

The clinical auscultation skills of pediatric residents in this study were suboptimal. There was a trend toward improvement as training progressed, although not statistically significant. These skills are likely to improve further with increased exposure to patients with cardiovascular disease especially in the ambulatory care setting.
Medication Use Among Children With Asthma in East Harlem
Authors: Diaz Theresa , Sturm Toni , Matte Thomas , Bindra Monisha , Lawler Kate , Findley Sally , Maylahn Chris
Published: August 2004

Purpose.

To examine daily use of antiinflammatory medication among children with asthma in East Harlem, where hospitalization rates for asthma are among the highest in the United States.

Methods.

We analyzed parent/guardian reports of medications used by children with current asthma (defined as physician diagnosis and wheezing during the previous 12 months) identified from a cross-sectional survey conducted in 2 elementary schools.

Results.

From an overall sample of 1319 children, 298 with current asthma were included in this analysis. Most of those with asthma were Puerto Rican (136 [46%]) or black (98 [33%]), 168 (57%) were boys, and the median age was 8 years old. Overall, 65 (22%) were using antiinflammatory medication on a daily basis. A subgroup of 107 children with asthma had been hospitalized during the previous 12 months or had used β2-agonist on a daily basis, suggesting persistent or severe asthma. Of these 107 children, 42 (39%) were taking antiinflammatory medication on a daily basis. Multivariate analysis of these 107 children revealed that daily use of antiinflammatory medication was associated with using a spacer tube (adjusted odds ratio [AOR]: 3.08; 95% confidence interval [CI]: 1.27,7.47) and having seen a physician in the past 6 months (AOR: 3.46; CI: 1.01,11.9). Compared with Puerto Ricans, blacks (AOR: .32; CI: .12,.89) or children of other races/ethnicities (AOR: .27; CI: .09,.85) were less likely to use antiinflammatory medication on a daily basis.

Conclusion.

Daily use of antiinflammatory medication for children with persistent or severe asthma in East Harlem was underused. Differences in access to care may explain some findings; however, reasons for ethnic differences in use remain unclear. Both community interventions and additional provider education are needed.
Do Clinical Markers of Barotrauma and Oxygen Toxicity Explain Interhospital Variation in Rates of Chronic Lung Disease?
Authors: Van Marter Linda J. , Allred Elizabeth N. , Pagano Marcello , Sanocka Ulana , Parad Richard , Moore Marianne , Susser Mervyn , Paneth Nigel , Leviton Alan ,   the Neonatology Committeefor the Developmental Epidemiology Network
Published: August 2004

Objective.

To explore the hypothesis that variation in respiratory management among newborn intensive care units (NICUs) explains differences in chronic lung disease (CLD) rates.

Design.

Case–cohort study.

Setting.

NICUs at 1 medical center in New York (Babies' and Children's Hospital [Babies']) and 2 in Boston (Beth Israel Hospital and Brigham and Women's Hospital [Boston]).

Study Population.

Four hundred fifty-two infants born at 500 to 1500 g birth weight between January 1991 and December 1993, who were enrolled in an epidemiologic study of neonatal intracranial white matter disorders.

Case Definition.

Supplemental oxygen required at 36 weeks' postmenstrual age.

Results.

The prevalence rates of CLD differed substantially between the centers: 4% at Babies' and 22% at the 2 Boston hospitals, despite similar mortality rates. Initial respiratory management at Boston was more likely than at Babies' to include mechanical ventilation (75% vs 29%) and surfactant treatment (45% vs 10%). Case and control infants at Babies' were more likely than were those at Boston to have higher partial pressure of carbon dioxide and lower pH values on arterial blood gases. However, measures of oxygenation and ventilator settings among case and control infants were similar at the 2 medical centers in time-oriented logistic regression analyses. In multivariate logistic regression analyses, the initiation of mechanical ventilation was associated with increased risk of CLD: after adjusting for other potential confounding factors, the odds ratios for mechanical ventilation were 13.4 on day of birth, 9.6 on days 1 to 3, and 6.3 on days 4 to 7. Among ventilated infants, CLD risk was elevated for maximum peak inspiratory pressure >25 and maximum fraction of inspired oxygen = 1.0 on the day of birth, lowest peak inspiratory pressure >20 and maximum partial pressure of carbon dioxide >50 on days 1 to 3, and lowest white blood count <8 K on days 4 to 7. Even after adjusting for white blood count <8 K and the 4 respiratory care variables, infants in Boston continued to be at increased risk of CLD, compared with premature infants at Babies' Hospital.

Conclusion.

In multivariate analyses, a number of specific measures of respiratory care practice during the first postnatal week were associated with the risk of a very low birth weight infant developing CLD. However, after adjusting for baseline risk, most of the increased risk of CLD among very low birth weight infants hospitalized at 2 Boston NICUs, compared with those at Babies' Hospital, was explained simply by the initiation of mechanical ventilation.
Thrombopoietin in the Thrombocytopenic Term and Preterm Newborn
Authors: Albert Timothy S. E. , Meng Y. Gloria , Simms Paul , Cohen Robert L. , Phibbs Roderic H.
Published: August 2004

Objectives.

Neonatal thrombocytopenia occurs commonly in neonatal intensive care units. The role of the thrombopoietin (Tpo) system in normal neonatal platelet regulation and neonatal thrombocytopenia is not well understood. The purpose of our study was to: 1) determine the normal Tpo level at birth in healthy nonthrombocytopenic term (NTT) and nonthrombocytopenic preterm (NTP) infants and in infants born to women with preeclampsia; and 2) measure Tpo levels in infants during and after the resolution of thrombocytopenia. Characterizing Tpo levels in the healthy and thrombocytopenic newborn is an important step in furthering our understanding of the pathophysiology of neonatal thrombocytopenia.

Methods.

This study is comprised of 2 parts. For the first part, cord blood was obtained at birth from both term (gestational age [GA]: 38–42 weeks) and preterm (GA: 25–36 weeks) infants. If birth platelet levels were ≥140 × 103/μL and the infant fit criteria for being normal, or if the infant was born to a women with preeclampsia, Tpo levels were measured. For the second part, serial Tpo levels and concomitant platelet counts (Plts) were measured in both preterm and term infants during a period of marked thromboctyopenia (Plt < 100 × 103/μL) until its resolution (Plt ≥ 140 × 103/μL).

Results.

Median cord blood Tpo levels from NTP infants (n = 35) were higher than those of NTT infants (n = 32; 95 pg/mL vs 48 pg/mL, respectively). In addition, preterm infants born to women with preeclampsia (n = 11) had lower Tpo levels than NTP infants with a similar GA (<41 pg/mL vs 95 pg/mL). For infants with marked thrombocytopenia, median Tpo levels during thrombocytopenia were similar between term (n = 12) and preterm (n = 14) groups (223 pg/mL and 179 pg/mL, respectively), with the majority of individuals showing a decrease in Tpo with resolution of thrombocytopenia. Within each group, there was large variability in the Tpo response to thrombocytopenia.

Impression.

These data show that the Tpo system is intact in NTP and NTT neonates. Preeclampsia may be an example of a disorder that perturbs this system. The great variability in Tpo levels seen in infants during thrombocytopenia may be related to the mechanism of thrombocytopenia. The finding that, in general, Tpo levels decreased with resolution of thrombocytopenia is consistent with what has been described in adults and children.
Fetus In Fetu: A Case Report and Literature Review
Authors: Hoeffel Christine Caroline , Nguyen Khoang Quy , Phan Hai Thanh , Truong Nghia Hieu , Nguyen Trung Sao , Tran Trai Thanh , Fornes Paul
Published: August 2004

Fetus in fetu is a rare condition in which a fetiform calcified mass often is present in the abdomen of its host, a newborn or an infant. We report on a case of a 19-month-old girl whose plain abdominal radiograph, ultrasonography, and computed tomography scan revealed a mass in which the contents favor a fetus in fetu rather than a teratoma. The noncalcified vertebral column invisible on the radiographs was identified by the pathologist; therefore, the nonvisualization of the vertebral axis on radiography or on computed tomography scan does not exclude the diagnosis of fetus in fetu.
Race/Ethnicity, Gender, Socioeconomic Status—Research Exploring Their Effects on Child Health: A Subject Review
Authors:   Committee on Pediatric Research
Published: August 2004

Data on research participants and populations frequently include race, ethnicity, and gender as categorical variables, with the assumption that these variables exert their effects through innate or genetically determined biologic mechanisms. There is a growing body of research that suggests, however, that these variables have strong social dimensions that influence health. Socioeconomic status, a complicated construct in its own right, interacts with and confounds analyses of race/ethnicity and gender. The Academy recommends that research studies include race/ethnicity, gender, and socioeconomic status as explanatory variables only when data relevant to the underlying social mechanisms have been collected and included in the analyses.
Infection Control in Physicians' Offices
Authors:   Committee on Infectious Diseases and Committee on Practice and Ambulatory Medicine
Published: August 2004

Infection control is an integral part of pediatric practice in outpatient settings as well as in hospitals. All employees should be educated regarding the routes of transmission and techniques used to prevent transmission of infectious agents. Policies for infection control and prevention should be written, readily available, updated annually, and enforced. The Centers for Disease Control and Prevention standard precautions for hospitalized patients with modifications from the American Academy of Pediatrics are appropriate for most patient encounters. As employers, pediatricians are required by the Occupational Safety and Health Administration (OSHA) to take precautions to protect staff likely to be exposed to blood or other potentially infectious materials while on the job. Key principles of infection control include the following: hand-washing before and after every patient contact, separation of infected, contagious children from uninfected children, safe handling and disposal of needles and other sharp medical devices, appropriate use of personal protection equipment such as gloves, appropriate sterilization, disinfection and antisepsis, and judicious use of antibiotics.
Health of Children Adopted From China
Authors: Miller Laurie C. , Hendrie Nancy W.
Published: August 2004

Objective.

Since 1989, American parents have adopted 18 846 Chinese children. This study assesses the health and developmental status of these children after their arrival in the United States.

Patients and Methods.

A total of 452 children (443 girls) in 2 groups were evaluated. The clinic group children (n = 192) included all Chinese adoptees seen in an international adoption clinic between 1991 and 1998. The travel group comprised 260 of 325 Chinese children placed by a single Massachusetts adoption agency between 1991 and 1996 whose adoptive parents and American physicians responded to mailed questionnaires. One hundred ninety-one of the travel group children were cared for by 1 of us (N.W.H.) during the adoption process in China.

Results.

Growth and developmental delays were frequent in the clinic group. Z scores ≤−2 were found in 39% of children for height, 18% for weight, and 24% for head circumference. The duration of orphanage confinement was inversely proportional to the linear height lag (r = .9), with a loss of 1 month of height age for every 2.86 months in the orphanage. Of the children, 75% had significant developmental delay in at least 1 domain: gross motor in 55%, fine motor in 49%, cognitive in 32%, language in 43%, social–emotional in 28%, activities of daily living in 30%, and global delays in 44%.

The incidence of medical problems was similar in both groups of children (travel group and clinic group). Overall, among the 452 children, elevated lead levels were found in 14%, anemia in 35%, abnormal thyroid function tests in 10%, hepatitis B surface antigen in 6%, hepatitis B surface antibody in 22%, intestinal parasites (usually Giardia) in 9%, and positive skin test results for tuberculosis in 3.5%. One child each had hepatitis C exposure and congenital syphilis. No child had human immunodeficiency virus infection. Unsuspected significant medical diagnoses, including hearing loss, orthopedic problems, and congenital anomalies, were found in 18% (81/452) of the children.

Conclusions.

Chinese adoptees display a similar pattern of growth and developmental delays and medical problems as seen in other groups of internationally adopted children. An exception is the increased incidence of elevated lead levels (overall 14%). Although serious medical and developmental issues were found among the children, overall their condition was better than expected based on recent publicity about conditions in the Chinese orphanages. The long-term outcome of these children remains unknown. China, adoption, orphanage, institutionalized child.
Mycobacterium bovis as a Significant Cause of Tuberculosis in Children Residing Along the United States–Mexico Border in the Baja California Region
Authors: Dankner Wayne M. , Davis Charles E.
Published: August 2004

Objective.

To determine the role ofMycobacterium bovis in active pediatric tuberculosis (TB) in a United States–Mexico border region.

Method.

We reviewed all new cases of pediatric (<15 years old) TB presenting to San Diego hospitals and clinics from 1980 to 1997. Patients were categorized by age, ethnicity, country of origin, culture results, and disease manifestations. Case definitions were similar to those used by the Centers for Disease Control and Prevention. M bovis was distinguished fromMycobacterium tuberculosis by standard biochemical tests.

Results.

The median age of the 563 identified patients was 4.1 years old. The yearly incidence began rising in 1989 and peaked in the mid-1990s. Hispanics constituted 78.9% of the patients, but they were less likely to be foreign-born (21.6%) than were black children and Asian/Pacific Islanders. Overall, M boviscaused 10.8% of all TB during this period. Of the 180 patients with positive culture results, however, M bovis accounted for 33.9% and M tuberculosis 66.1%. This high percentage of M bovis infections was largely attributable to its contribution to extrapulmonary TB (55.2% of all culture-positive specimens). M bovis patients were also even more likely to be Hispanic (90.2%), to present with extrapulmonary disease (95.1%), and to be older than 12 months (96.8%).

Conclusion.

These data demonstrate the dramatic impact of this underappreciated cause of zoonotic TB on US children at the Mexican border and underscore the need for cross-collaboration to enforce existing Mexican pasteurization laws.
Prolonged Hepatitis B Surface Antigenemia After Vaccination
Authors: Lunn Eric R. , Hoggarth Bernard J. , Cook Walter J.
Published: August 2004

Infection with hepatitis B virus can lead to serious long-term complications including chronic hepatitis B virus infection leading to hepatocellular carcinoma, liver failure, and death. We report a case of prolonged hepatitis B antigenemia after routine vaccination with Engerix B. A positive hepatitis B surface antigen was found when the individual donated blood 18 days after vaccination. This resulted in rejection of the donated blood and permanent deferral from further donation. It also led to referral to a physician, creating anxiety in the individual and additional unnecessary testing. Additional studies are needed to identify the length to time of hepatitis B surface antigenemia after hepatitis B vaccination, and blood collection centers should be aware of the potential for donors to have a prolonged false-positive hepatitis B surface antigen after vaccination against hepatitis B. hepatitis B, hepatitis B vaccine, hepatitis B surface antigen, vaccine-induced positive hepatitis B surface antigen, Engerix B.
Assessment of Stress in Mothers of Children With Severe Breath-Holding Spells
Authors: Mattie-Luksic Michele , Javornisky Gregory , DiMario Francis J. , MD Jr,
Published: August 2004

Background.

Severe breath-holding spells (BHS) in children consist of a stereotypical sequence of provocation to cry, noiseless expiration, color change, and loss of consciousness. Parenting a child who exhibits BHS is likely more stressful than parenting a healthy child, owing to this additional medical concern. It is also likely more stressful than parenting a child with a convulsive seizure disorder (SD), because it is often not recognized or misdiagnosed as behavioral rather than medical. Mothers of children with BHS were hypothesized to suffer significantly greater stress than mothers of children with SD or mothers of children without any significant medical conditions.

Objectives.

To examine maternal stress in parenting a child who exhibits BHS, and to identify the specific areas of stress impact, compared with mothers of children with a convulsive SD and mothers of control children.

Methods.

The Parenting Stress Index and questions regarding how mothers coped were individually administered to 34 mothers of children with BHS, 16 mothers of children with SD, and 16 mothers of children with no medical conditions (controls).

Results.

Mothers of children with BHS or SD experience more overall stress and disruption in their attachment or understanding of their child, compared with control mothers. These groups of mothers (BHS and SD) also perceived their child as more distractible/hyperactive, less adaptive, and more demanding than did control mothers. However, mothers of the BHS group alone showed significant disruption in their sense of competence as a parent, maintaining self-identity, and receiving positive reinforcement from their child. Mothers of children with SD showed a similar trend, but it was not significant. These findings were not related to maternal health or feelings of depression/isolation, insufficient spousal support, child's mood, or other life stresses.

Conclusion.

Parenting a child with BHS or SD impacts a greater degree of life stress on mothers of these children than does parenting control children, although the stress is greater for the BHS group than for the SD group.
New Immunoassay in Stool Provides an Accurate Noninvasive Diagnostic Method forHelicobacter pyloriScreening in Children
Authors: Braden Barbara , Posselt Hans-Georg , Ahrens Peter , Kitz Richard , Dietrich C. F. , Caspary Wolfgang F.
Published: August 2004

Objective.

The noninvasive13C-urea breath test (UBT) is a reliable diagnostic method for detection of Helicobacter pylori infection in children, and it avoids invasive gastrointestinal endoscopy. In this study, we compared a noninvasive, newly developed fecal H pylori antigen test with the UBT.

Methodology.

One hundred sixty-two children (76 girls and 86 boys) were tested for H pylori infection using the UBT and a new antigen test in stool samples. The H pylori stool test is based on a sandwich enzyme immunoassay with antigen detection.

Results.

Twenty-four of the children (14.8%) with dyspepsia tested positive for H pylori according to the breath test results. In 22 of the 24 patients, H pyloriantigen could be detected in the stool (sensitivity: 91.6%). Of 138 patients with negative UBT results, 136 were H pylori-negative in the stool test (specificity: 98.6%).

Conclusions.

The new, noninvasive, low-cost H pylori antigen test in stool can replace the UBT for detection of H pylori infection in children with comparable reliability and accuracy.
Indications for Management and Referral of Patients Involved in Substance Abuse
Authors:   Committee on Substance Abuse
Published: August 2004

This statement addresses the challenge of evaluating and managing the various stages of substance use by children and adolescents in the context of pediatric practice. Approaches are suggested that would assist the pediatrician in differentiating highly prevalent experimental and occasional use from more severe use with adverse consequences that affect emotional, behavioral, educational, or physical health. Comorbid psychiatric conditions are common and should be evaluated and treated simultaneously by child and adolescent mental health specialists. Guidelines for referral based on severity of involvement using established patient treatment-matching criteria are outlined. Pediatricians need to become familiar with treatment professionals and facilities in their communities and to ensure that treatment for adolescent patients is appropriate based on their developmental, psychosocial, medical, and mental health needs. The family should be encouraged to participate actively in the treatment process.
Identification and Care of HIV-Exposed and HIV-Infected Infants, Children, and Adolescents in Foster Care
Authors:   Committee on Pediatric AIDS
Published: August 2004

This Policy Statement was retired August 2021.

As a consequence of the expanding human immunodeficiency virus (HIV) epidemic and major advances in medical management of HIV-exposed and HIV-infected persons, revised recommendations are provided for HIV testing of infants, children, and adolescents in foster care. Updated recommendations also are provided for the care of HIV-exposed and HIV-infected persons who are in foster care.
Intensive Training and Sports Specialization in Young Athletes
Authors:   Committee on Sports Medicine and Fitness
Published: August 2004

Children involved in sports should be encouraged to participate in a variety of different activities and develop a wide range of skills. Young athletes who specialize in just one sport may be denied the benefits of varied activity while facing additional physical, physiologic, and psychologic demands from intense training and competition.

This statement reviews the potential risks of high-intensity training and sports specialization in young athletes. Pediatricians who recognize these risks can have a key role in monitoring the health of these young athletes and helping reduce risks associated with high-level sports participation.
Frequency, Natural Course, and Outcome of Neonatal Neutropenia
Authors: Funke Annette , Berner Reinhard , Traichel Birgit , Schmeisser Doris , Leititis Jekabs U. , Niemeyer Charlotte M.
Published: August 2004

Objective.

We studied the frequency, onset, duration, and prognosis of neutropenia in a neonatal hospital population to define subgroups of neonates who might benefit from cytokine therapy.

Study Design.

The study comprised of 2 parts: in a first retrospective study (I), clinical data of neonates with sepsis (n = 168) were analyzed; in a second retrospective and prospective study (II), clinical data of neonates with neutropenia (n = 131) were studied. In study I, the analysis focused on septic neonates with and without neutropenia, and in study II, on neutropenic neonates with and without primary infection. In the prospective part of study II, granulocyte colony-stimulating factor (G-CSF) plasma concentrations were analyzed in neutropenic neonates (n = 32).

Results.

Thirty-eight percent of septic neonates were neutropenic. Neutropenia lasted <24 hours in 75% of these patients. It was recorded before or on the day of the clinical onset of sepsis in 87% of patients. The overall incidence of neutropenia was 8.1%. Seventy-two percent of these neutropenic episodes occurred in patients without infection at the time of diagnosis of neutropenia. In the latter patients, the risk of infection secondary to neutropenia was 9%, affecting only premature neonates. Neutropenic episodes without infection were of longer duration and were accompanied by lower G-CSF plasma concentrations than were episodes associated with infection. The percentage of neutropenic episodes primarily associated with infection was higher in VLBW neonates than in term neonates. Likewise, the risk of infection secondary to neutropenia (27%) and the mortality attributable to infection and neutropenia (28%) were significantly higher than in term newborns.

Conclusion.

Considering the priming time for induction of neutrophilia, G-CSF therapy in neonates presenting with severe bacterial infection and neutropenia may be too late. In contrast, neutropenic very low birth weight neonates without primary infection might benefit from prophylactic G-CSF treatment. neonatal sepsis, neutropenia, granulocyte colony-stimulating factor.
Specialized Assessments for Children in Foster Care
Authors: Horwitz Sarah McCue , Owens Pamela , Simms Mark D.
Published: August 2004

Objective.

To investigate the differences in health problems identified and health services received by children newly entering foster care who participated in a comprehensive multidisciplinary program, compared with children newly entering foster care who received customary community-based services.

Methods.

Using a 2-group quasiexperimental design, 120 young children entering foster care were enrolled in a multidisciplinary intervention program (n = 62) or were followed by customary care providers (n = 58). An interview with the foster parent; a complete medical examination; and a battery of developmental, psychological, speech/language, and motor assessments were completed for each child at baseline. Children in both groups participated in follow-up assessments at 6 and 12 months.

Results.

No significant differences between the 2 groups existed in medical, educational, developmental, or mental health problems identified by foster mothers. However, children in the intervention group were more likely to be identified with developmental (56.5% vs 8.6%) and mental health problems (37.1% vs 13.8%) by providers than children in the comparison group. Children in the intervention group were also more likely to be referred for health services at baseline (71.0% vs 43.1%) and receive follow-up care at 6 and 12 months of age than children in the comparison group.

Conclusions.

Findings indicate that community providers identify medical and educational needs but do not recognize developmental and mental health needs of young children newly entering foster care. The discrepancies in the number of recommended services and follow-up care between the 2 groups make a case for the establishment of specialized services for children entering out-of-home care.
Police Enforcement as Part of a Comprehensive Bicycle Helmet Program
Authors: Gilchrist Julie , Schieber Richard A. , Leadbetter Steven , Davidson Stephen C.
Published: August 2004

Background.

Bicycle-related head injuries cause >150 deaths and 45 000 nonfatal injuries among children in the United States annually. Although bicycle helmets are highly effective against head injury, only 24% of US children regularly wear one. Georgia mandated bicycle helmet use for children, effective July 1993. During that summer, 1 rural Georgia community passed an ordinance instructing police officers to impound the bicycle of any unhelmeted child. We evaluated the effect of active police enforcement of this ordinance, combined with a helmet giveaway and education program.

Methods.

During April 1997, ∼580 children in kindergarten through grade 7 received free helmets, fitting instructions, and safety education. Police then began impounding bicycles of unhelmeted children. We conducted an observational study, unobtrusively observing helmet use just before helmet distribution, several times during the next 5 months, and once 2 years later.

Results.

Before the program began, none of 97 observed riders wore a helmet. During the next 5 months, helmet use among 358 observed children averaged 45% (range: 30%–71%), a significant increase in all race and gender groups. In contrast, adult use did not change significantly. Police impounded 167 bicycles during the study, an average of 1 per day. Two years after program initiation, 21 of 39 child riders (54%) were observed wearing a helmet.

Conclusions.

Without enforcement, the state and local laws did not prompt helmet use in this community, yet active police enforcement, coupled with helmet giveaways and education, was effective and lasting.
Acute Appendicitis Risks of Complications: Age and Medicaid Insurance
Authors: Bratton Susan L. , Haberkern Charles M. , Waldhausen John H. T.
Published: August 2004

Objectives.

To describe the epidemiology of acute appendicitis in children from Washington State, and to determine important risk factors for complications.

Design.

Retrospective cohort study.

Setting.

All children (<17 years old) treated in Washington State who were identified by hospital discharge diagnosis codes from 1987 through 1996.

Methods.

The hospital discharge data were reviewed for all children with a primary diagnosis code for acute appendicitis. Complicated disease was defined as perforation or abscess formation.

Results.

Young children (0–4 years old) had the lowest annual incidence of acute appendicitis, but they had a 5-fold increased risk of complicated disease (odds ratio: 4.9; 95% confidence interval: 4.0–5.9), compared with teenagers. Children with Medicaid insurance had a 1.3-fold increased risk of complicated disease, compared with children with commercial insurance (odds ratio: 1.3: 95% confidence interval: 1.2–1.4). Children with Medicaid insurance had significantly longer average length of stay (4.0 ± 3.7 days) than all other payers (commercial insurance: 3.3 ± 4.0 days; health maintenance organization: 3.5 ± 3.1 days; and self-insured: 3.7 ± 5.8 days).

Conclusions.

Very young children had the greatest risk of complicated disease. Children with Medicaid insurance had increased risk of complicated disease, compared with children with commercial health insurance and longer length of stay. Additional studies are needed to evaluate barriers to care for children with Medicaid insurance.
Short- and Long-Term Outcome of Children With Congenital Complete Heart Block Diagnosed In Utero or as a Newborn
Authors: Eronen Marianne , Sirèn Marja-Kaisa , Ekblad Henrik , Tikanoja Tero , Julkunen Heikki , Paavilainen Terho
Published: August 2004

Objectives.

Few data are available in the literature regarding the long-term outcome of newborns with congenital complete heart block (CHB). The aims of this retrospective study were to assess neonatal morbidity and mortality, incidences of dilated cardiomyopathy (DCM), and associated heart defects, and to establish prenatal and postnatal factors that might predict adverse outcome in children with CHB.

Design and Setting.

The cohort includes 91 infants with CHB diagnosed in 5 tertiary centers in Finland between 1950 and 1998.

Patients.

Maternal connective tissue disease was evident in 89% of the patients. At birth, the median gestational age was 37.1 weeks, and the median weight was 2969 g. Of the 91 infants, 60 (66%) were girls and 7 (8%) were twins.

Results.

Incidences of perinatal morbidity and mortality were 58% and 7%, respectively. The total mortality of CHB was 16%; 11 of 15 (73%) died during the first 12 months. Cumulative probability of survival at 10 years old was 82%. Pacing as a newborn was indicated in 48 of 90 cases (53%), and 36 received pacemakers at older ages. Cardiac defects not causally related to CHB were found in 38 of 90 patients (42%), of whom 22 were operated on. DCM was found in 21 (23%), of whom 13 died. During the follow-up, among 75 survivors with a median age of 9 years, 54 (72%) are free from symptoms. Poor outcome defined as clinically or pathologically evident congestive DCM was associated with intrauterine hydrops, low fetal and neonatal heart rate, low birth weight, male sex, and neonatal problems attributable to prematurity or neonatal lupus.

Conclusions.

Despite early pacing, CHB carries high mortality during the first 12 months of life. High incidences of DCM and associated heart defects indicate close echocardiographic monitoring of all children with CHB.
Cardiovascular Changes During Mild Therapeutic Hypothermia and Rewarming in Infants With Hypoxic–Ischemic Encephalopathy
Authors: Thoresen Marianne , Whitelaw Andrew
Published: August 2004

Background.

Clinical trials of mild cooling to 35°C or below in infants with early hypoxic–ischemic encephalopathy are under way. The objective of this study was to systematically document cardiovascular changes associated with mild therapeutic hypothermia and rewarming in such infants.

Patients and Methods.

Nine infants with gestational ages of 36 to 42 weeks, with 10-minute Apgar scores of 5 or less, clinical encephalopathy, and an abnormal electroencephalogram before 6 hours were cooled by surface cooling the trunk (n = 3) or by applying a cap perfused with cooled water (n = 6) for a median of 72 hours. The target core temperature was 34.0°C to 35.0°C for head-cooled infants and 33.0°C to 34.0°C for surface-cooled infants. Maintenance heating and rewarming were provided by an overhead heater.

Results.

Mean arterial blood pressure increased by a median of 10 mm Hg during cooling and fell by a median of 8 mm Hg on rewarming. Heart rate decreased by a median of 34 beats/minute on cooling and increased by a median of 32 beats/minute on rewarming. A large increase in the output of the overhead heater decreased mean arterial blood pressure in 5 infants. Anticonvulsant drugs, sedatives, or intercurrent hypoxemia also produced falls in temperature. The inspired oxygen fraction had to be increased by a median of .14 to maintain oxygenation during cooling with 2 infants requiring 100% oxygen, an effect probably attributable to pulmonary hypertension, which was reversible with rewarming.

Conclusions.

Therapeutic cooling produces changes in heart rate and blood pressure that are not hazardous, but the combination of inadvertent overcooling and inappropriately rapid rewarming, together with sedative drugs that can impair normal thermoregulatory vasoconstriction, can cause hypotension in posthypoxic newborn infants. Infants who already require 50% oxygen should be cooled cautiously because pulmonary hypertension may develop. Knowledge of these cardiovascular changes, careful monitoring, anticipation, and correction should help to avoid potential adverse effects in the upcoming clinical trials.
How Much Antibiotic Suspension Is Enough?
Authors: Dusdieker Lois B. , Murph Jody R. , Milavetz Gary
Published: August 2004

Objectives.

Pilot data suggest that inadequate antibiotic volumes are often dispensed. Study goals were to determine the frequency of inadequate antibiotic volumes dispensed by local pharmacies, develop prescription-writing guidelines to ensure that adequate antibiotic suspension volumes are dispensed, and document the adequacy of verbal/written counseling pharmacists provide.

Methods.

Sixty-one local pharmacies filled prescriptions for penicillin potassium (PCN; 250 mg/5 mL [5 mL orally 3 times daily for 10 days]) and Bactrim (trimethoprim-sulfamethoxazole [TMP-SMX] 5 mL orally twice daily for 10 days). The prescriptions noted only to “dispense a 10-day supply.” Volumes were measured first as total amount dispensed and then into total doses dispensed. Written/verbal instructions were documented.

Results.

The volume of PCN dispensed was 195 ± 25 mL (range: 105–222 mL) for an average of 29.4 doses, where 30 doses were needed. TMP-SMX dispensed had a volume of 107 ± 5 mL (range: 98–120 mL) resulting in an average of 16.5 doses, where 20 doses were needed. Twenty pharmacies (33%) did not dispense a measuring device. Verbal counseling by the pharmacist and written instructions were not uniformly given.

Conclusions.

We suggest calculating the actual volume needed plus an additional 10% to 30% of volume (depending on the viscosity). The prescription should also request a medication-measuring/administering device. Patient counseling and instruction should be expanded.
Childhood Weight, Stature, and Body Mass Index Among Never Overweight, Early-Onset Overweight, and Late-Onset Overweight Groups
Authors: Wisemandle Wayne , Maynard L. Michele , Guo Shumei S. , Siervogel Roger M.
Published: August 2004

Objective.

To determine the effects of timing of onset of overweight (OW) on childhood anthropometric adiposity levels using long-term serial data from the Fels Longitudinal Study.

Classification.

OW was defined as body mass index (BMI; kg/m2) >25, and the age at first measurement of BMI >25 was the age of onset of OW. Early onset of OW (early-OW) and late onset of OW (late-OW) were defined as having onset of OW before and after 25 years of age, respectively, whereas never OW (never-OW) was defined as never having a BMI >25.

Subjects.

Subjects consisted of 67 males and 47 females in early-OW groups, 62 males and 48 females in late-OW groups, and 80 males and 114 females in never-OW groups.

Results.

Levels of weight and BMI in early-OW males and females were significantly greater than those in never-OW and late-OW males and females beginning at the time of adiposity rebound, which generally occurs between 4 and 8 years of age. Median BMI and weight patterns between never-OW and late-OW males were similar throughout childhood. However, significant differences in median levels of BMI for never-OW and late-OW females began at 11 years of age, although onset of OW was not until >25 years of age in the latter group.

Conclusions.

For both males and females, adiposity rebound is likely an effective time in a child's development to detect and initiate prevention for childhood and early adulthood onset of OW. Although later-onset OW needs additional study, puberty seems to be a critical phase in the development of later adult onset of OW in females.
Use of C-Reactive Protein in Minimizing Antibiotic Exposure: Experience With Infants Initially Admitted to a Well-Baby Nursery
Authors: Philip Alistair G. S. , Mills Pamela C.
Published: August 2004

Objective.

To evaluate the use of a clinical pathway for neonatal sepsis in decisions about initiating and continuing antibiotic treatment.

Setting.

A district hospital primarily served by private pediatricians practicing in a managed care environment.

Patients and Laboratory Tests.

All infants admitted to the well-baby nursery in 1997–1998 were eligible for this study. Infants born with a variety of risk factors (eg, borderline prematurity, membranes ruptured for over 18 hours, mother positive for group B streptococcus [GBS], and maternal fever) or clinical manifestations suggesting possible infection (either clinical signs or persistent hypoglycemia) were evaluated with white blood cell count, differential, and C-reactive protein (CRP) soon after birth and 12 hours later. Decisions to transfer to the neonatal intensive care unit and to treat with antibiotics were based on abnormal laboratory test results, particularly an increased level of CRP (>1 mg/dL), persistent hypoglycemia, or clinical signs. Discontinuation of antibiotic treatment was primarily based on return to normal of the CRP.

Results.

Of 8299 live births, 7562 initially went to the well-baby nursery. Evaluation occurred in 1894 (25%) and 425 were transferred to the neonatal intensive care unit. In 162, antibiotics were discontinued within 48 hours. The majority were treated for 3 to 5 days, with only 19 (3 with GBS sepsis) treated for 6 days or more. There were 216 infants transferred because of risk factors and 209 because of clinical findings. Peak CRP primarily determined the duration of antibiotic treatment, with the mean peak CRP rising from 2.8 mg/dL in those treated for 3 days, to 3.8, 4.3, 8.4, 8.9, and 13.7 mg/dL in those treated for 4, 5, 6, 7, or >7 days, respectively. The mean duration of treatment was 3.1 days. No infant initially treated with antibiotics and discharged when the CRP returned to normal was readmitted within the next month. No infant with normal values on the sepsis screen was readmitted within 1 month with evidence of bacterial infection, but 1 infant with no risk factors was readmitted at 22 days of age with GBS sepsis and meningitis.

Conclusions.

Using a clinical pathway for neonatal sepsis, which is based primarily on CRP determinations, can minimize antibiotic exposure and shorten hospital stays.
Neonatal Myiasis
Authors: Bapat Sonali S.
Published: August 2004

This case involves an orphan female neonate—abandoned in a dustbin in Poona, India—who was infected by the larval forms of the blowfly. The blowfly causing this infestation belonged to the family Calliphoridae and genus Calliphora.The fly of this genus is of importance in Indian veterinary science and is found abundantly around decaying matter in Poona. The larvae occurring in carrion, flesh, etc, usually infest open wounds of animals and rarely infest humans.
Outpatient Pediatric Blood Cultures: Time to Positivity
Authors: McGowan Karin L. , Foster Jill A. , Coffin Susan E.
Published: August 2004

Objective.

Using a continuously monitoring blood culture system, we determined the time to positivity of blood cultures performed on immunocompetent infants and children who were not receiving antibiotics at the time of culture.

Study Design.

This study was conducted prospectively using blood cultures taken in the emergency department and outpatient clinics of an urban pediatric teaching hospital from February 1, 1993, through December 31, 1996. Cultures were excluded if obtained from patients receiving antibiotics, patients with a central line, patients with prosthetic devices, or those being followed by the oncology division. Our measures included: 1) recording the time to positive culture obtained by using a continuously monitoring blood culture instrument, 2) patient information derived from the hospital computer system concerning antibiotic use and the presence of indwelling central venous catheters and prosthetic devices, and 3) a chart review of 10% of patients from whom positive cultures were obtained.

Results.

During the 47-month study period, 10 200 single bottle blood cultures were obtained, 711 (6.97%) of which became positive. Patients ranged in age from <1 week to 24 years (mean: 2.00 years). Two hundred fifty-eight cultures (36.3%) contained only pathogens, 370 (52%) contained only skin contaminants, and 83 (11.7%) contained a mixture of contaminant and pathogen. Of the 258 cultures containing only pathogens, 14% were positive by 12 hours, 87% by 24 hours, 92% by 36 hours, 95% by 48 hours, 98% by 60 hours, and 99.7% by 72 hours. Ninety-five percent of critical pediatric pathogens including Streptococcus pneumoniae,Salmonella and other Enterobacteriaceae,Neisseria meningitidis, and groups A and B streptococci were detected in <24 hours.

Conclusion.

Because 87% of all cultures containing pathogens were detected within the first 24 hours of incubation, this study can assist emergency department, clinic, and primary care clinicians when making critical decisions concerning patients on whom blood cultures were obtained. Data on time to positivity of blood cultures can be used in conjunction with clinical status to support clinicians in making patient management decisions. Use of short stay (≤24 hours) or extended care units requiring less patient supervision may be easier to justify when a continuously monitoring blood culture instrument is used in the microbiology laboratory.bacteremia, sepsis.