bluuebunny/crossref_metadata_2025 huggingface dataset:
Before Viability: A Geographically Based Outcome Study of Infants Weighing 500 Grams or Less at Birth
Authors: Sauve Reg S. , Robertson Charlene , Etches Philip , Byrne Paul J. , Dayer-Zamora Véronique
Published: August 2004

Objective. The primary objective of this study was to determine the likelihood of long-term survival and avoidance of disabilities in a geographically based population of infants born at 20 weeks gestation or more and weighing 500 g or less at birth.

Study Design. This was a 12-year historical cohort follow-up study of all infants born in this gestational age and birth weight category in the Province of Alberta, Canada, between 1983 and 1994. Data were collected from certificates of live births or stillbirths, death certificates, hospital records, and longitudinal multidisciplinary follow-up examinations.

Results. One thousand one hundred ninety-three infants were of 20 weeks gestation or more, weighed 500 g or less, and were born between 1983 and 1994. Eight hundred eleven (68.0%) were stillborn and 382 (32.0%) were born alive. Among the latter, neonatal intensive care was provided in 113 (29.6%) and withheld in 269 (70.4%). The infants receiving intensive care were of heavier birth weight, later gestational age, higher antenatal risk scores, were more likely to be born in a level III center, to have received antenatal steroids, and to have been delivered by cesarean section. Of the infants receiving intensive care, 95 (84.1%) died and 18 (15.9%) were discharged alive, but 5 of these died after discharge because of respiratory complications. The infants discharged alive had later gestational age, were more likely to be small for gestational age, singletons, treated with antenatal steroids, and to have been delivered by cesarean section. Maternal indications were described in the majority of cesarean sections done for live-born infants. The 13 infants who were long-term survivors were followed at ages 12 and 36 months adjusted age. Four had no serious disabilities, 4 had one disability (cerebral palsy or mental retardation), and 5 had multiple disabilities (cerebral palsy plus mental retardation with blindness in 2 cases and deafness in 1 case).

Conclusion. The majority of infants born at gestational age 20 weeks or more weighing <500 g were stillborn. Among live births, neonatal intensive care was withheld in 70% and initiated in 30%. Of the latter, 11% survived to 36 months of age, and of these, 4 infants (31%), most of whom are small for gestational age, female infants, avoided major disabilities but 9 (69%) had one or more major disabilities. Survivors are prone to rehospitalizations early in life, slow growth, feeding problems, and minor visual difficulties; rates of learning-related and behavioral problems at school age are not yet known.

Implications. Parents and caregivers faced with the impending delivery of an infant in this gestational age/birth weight category should understand that survival without multiple major disabilities is possible but rare. They should be made aware of local population-based results and not just isolated reports.
Growing Up With a Facial Hemangioma: Parent and Child Coping and Adaptation
Authors: Tanner J. Lane , Dechert Martha P. , Frieden Ilona J.
Published: August 2004

Objective. To better understand the experiences, challenges, and adaptations of parents with children who have disfiguring facial hemangiomas.

Design. Qualitative, descriptive.

Methods. In-depth interviews were performed with the parent(s) of 25 children, aged 5 months to 8 years. Each child was referred to the Pediatric Dermatology Practice, Department of Dermatology, University of California, San Francisco, with a facial hemangioma of 1 cm diameter or greater. Interviews were ethnographic in style, centering on the description by parents of the particular challenges faced, supports received, and adaptive strategies developed in coping with their child's hemangioma. Analysis was by open coding of interview transcripts. Coded statements were organized within common categories and these further gathered into 4 principal themes: 1) parental emotion and adaptation; 2) experiences with public reactions; 3) issues related to parent-child interactions; and 4) expressed satisfaction/dissatisfaction with medical care.

Results. Disfiguring facial hemangiomas were found to be associated with parental reactions of disbelief, fear, and mourning, particularly during the growth phase. Reactions of strangers forced parents to confront varied aspects of social stigmatization. A broad array of effects on the parent-child interaction were observed, often connected with variables extrinsic to the hemangioma, including especially the support and acceptance by the extended family. Half of those studied expressed substantial dissatisfaction with aspects of their medical care.

Conclusions. Disfiguring facial hemangiomas in young children are frequently associated with parental reactions of loss and grief, despite the generally benign nature of the lesion and the prognosis for eventual involution. Physicians are faced with specific challenges in providing effective anticipatory guidance and support to parents.
Percutaneous Central Venous Catheterization in Premature Infants: A Method for Facilitating Insertion of Silastic Catheters via Peripheral Veins
Authors: Fischer Joachim E. , Fanconi Sergio
Published: August 2004

Peripheral venous cannulation is the preferred method of inserting central venous silastic catheters in premature infants. The standard techniques are placement of the catheter using a breakaway introducer needle or introduction of the catheter through a cannula. In extremely low birth weight infants (<1000 g) successful cannulation is impeded by the small size of the vessels. After repeated attempts, both procedures can be time-consuming and stressful to the infant. We present a modified insertion technique of the standard 2-French silastic catheter with an increased success rate, thus reducing insertion time, stress to the infant, and costs. The method uses the tip of a 20-gauge cannula as dilator/introducer for the 2-French catheter. This tip is inserted into the vessel with a standard 24-gauge cannula. After successful insertion of the dilator/introducer cannula, the standard 2-French catheter can then be advanced easily. Pediatrics 1998:101:477–479;peripheral central venous catheterization, very low birth weight infants, methods.
Cardiovascular Reactivity and Adolescent Boys' Physical Health
Authors: Dobkin Patricia L. , Tremblay Richard E. , Treiber Frank A.
Published: August 2004

Objective. Minor illnesses and major diseases are affected by individual, environmental, and social factors. The purpose of the study was to determine if cardiovascular reactivity, an individual characteristic, was related to adolescent boys' health status and behaviors.

Methods. A total of 89 low socioeconomic status 16-year-old boys who had been classified using teacher ratings during childhood as anxious, disruptive, anxious–disruptive, or normal participated in a laboratory stress experiment. Systolic blood pressure (SBP) and diastolic blood pressure were measured during the Social Competence Interview. Using the upper and lower quartiles of SBP change scores, 21 boys were classified as reactors and 20 boys were classified as nonreactors. Subjects were interviewed to assess health behaviors and outcomes, as well as stressful life events.

Results. No significant group differences were found for minor or major physical health problems. A logistic regression analysis indicated that risky health behaviors were associated with SBP reactivity, personality characteristics, and negative life events. Specifically, nonreactors, who were disruptive, had more negative life events and engaged in more health-compromising behaviors (eg, smoking cigarettes, unprotected sex), which may contribute to future health problems (eg, cancer, AIDS). Anxious individuals may be more vulnerable to cardiovascular diseases in part because of exaggerated cardiovascular reactivity to stress.

Conclusion. Low socioeconomic status boys may be at risk for different health problems caused by differing personality characteristics associated with divergent health-related behaviors.
Early Adiposity Rebound and the Risk of Adult Obesity
Authors: Whitaker Robert C. , Pepe Margaret S. , Wright Jeffrey A. , Seidel Kristy D. , Dietz William H.
Published: August 2004

Objective. At 5 to 6 years of age, body fatness normally declines to a minimum, a point called adiposity rebound (AR), before increasing again into adulthood. We determined whether a younger age at AR was associated with an increased risk of adult obesity and whether this risk was independent of fatness at AR and parent obesity.

Design. A retrospective cohort study using lifelong height and weight measurements recorded in outpatient medical records.

Setting. Group Health Cooperative of Puget Sound (GHC), a health maintenance organization based in Seattle, Washington.

Participants. All 390 GHC members (and their parents) born at GHC between January 1, 1965, and January 1, 1971, who had at least one recorded adult height and weight measurement plus two visits with recorded height and weight measurements in each of three age intervals: 1.5 to 4, 4 to 8, and 8 to 16 years.

Main Outcome Measures. We calculated the mean body mass index (BMI) of each subject during young adulthood (age 21 to 29 years) and the BMI of the parents when each subject was 1.5 years of age. Adult obesity was defined as a BMI ≥27.8 for males and ≥27.3 for females. Curves were fit to each subject's BMI values between ages 1.5 and 16 years, and the age and BMI at AR were calculated from these curves. Subjects were divided into tertiles of age at AR (early, middle, and late), BMI at AR, and parent BMI (heavy, medium, and lean).

Results. The mean age at AR was 5.5 years, and 15% of the cohort was obese in young adulthood. Adult obesity rates were higher in those with early versus late AR (25% vs 5%), those who were heavy versus lean at AR (24% vs 4%), those with heavy versus lean mothers (25% vs 5%), and those with heavy versus lean fathers (21% vs 5%). After adjusting for parent BMI and BMI at AR, the odds ratio for adult obesity associated with early versus late AR was 6.0 (95% CI, 1.3–26.6).

Conclusion. An early AR is associated with an increased risk of adult obesity independent of parent obesity and the BMI at AR. Future research should examine the biological and behavioral determinants of AR.
Three-year Follow-up of Vaccine Response in Extremely Preterm Infants
Authors: Khalak Rubia , Pichichero Michael E. , D'Angio Carl T.
Published: August 2004

Objective. To assess whether the adequate antibody response observed in former extremely premature infants after the primary series of immunizations is sustained after the first booster vaccines.

Subjects and Methods. Sixteen former extremely premature (<29 weeks, <1000 g at birth) and 17 former full-term (>37 weeks) infants had sera obtained for antibody titer measurement at 3 to 4 years of age. All had received the primary series and first booster vaccines for diphtheria, pertussis, tetanus, polio, andHaemophilus influenzae type b. Twelve preterm and 14 full-term children had completed the hepatitis B vaccine series.

Results. At 3 to 4 years of age, former preterm and full-term children had similar geometric mean titer (GMT) values of antibodies to tetanus, diphtheria, and pertussis. Preterm children had a lower GMT value of Haemophilus polyribosylribitol phosphate (PRP) antibody than did full-term children (0.99 vs 3.06 μg/mL). Fifty percent of preterm and 88% of full-term children had PRP antibody >1.0 μg/mL; 100% of preterm and 94% of full-term children had anti-PRP titers >0.15 μg/mL. GMT values of neutralizing antibodies to polio serotypes 1 and 2 were similar, with 94% to 100% of both groups above protective levels (≥1:8). The difference in GMT values of polio serotype 3 approached significance (29 vs 73); fewer preterm children had protective titer values (75% vs 100%). Among children vaccinated against hepatitis B, 75% of preterm and 71% of full-term children were protected (10 mIU/mL).

Conclusions. Preterm children immunized at the recommended chronological ages displayed antibody responses similar to those for full-term children for most immunizing antigens. Responses to PRP and polio serotype 3 were less robust than those of full-term children.
Persistent Low Immunization Coverage Among Inner-city Preschool Children Despite Access to Free Vaccine
Authors: Kenyon Thomas A. , Matuck Michael A. , Stroh George
Published: August 2004

Objective. To compare vaccination coverage among children 19 to 35 months of age from public housing developments where a free vaccine outreach program was in place with children residing elsewhere in the city.

Design. A household survey using a multistage cluster sampling method to compare community areas which accounted for 80% of measles cases during 1989 (high-risk stratum), areas which accounted for the remaining 20% of cases (low-risk stratum), and public housing developments (public housing stratum) having free, on-site vaccination services.

Setting. Inner-city Chicago households, April to May 1994.

Outcome Variables. Antigen-specific and series-specific coverage based on written records.

Results. Based on evaluation of 1244 children, citywide coverage for four doses of diphtheria-tetanus-pertussis vaccine, three doses of polio vaccine, and one dose of measles-containing vaccine (4:3:1) was 47% [95% confidence interval (CI), 40% to 55%]. Coverage was significantly lower among children residing in public housing (23%; 95% CI, 18% to 28%) compared with those residing in high-risk strata (45%; 95% CI, 38% to 52%) and low-risk strata (51%; 95% CI, 43% to 60%). Compared with white children (53%), coverage for the 4:3:1 series was lower among African-American children in public housing (29%) or outside public housing (36%). Moreover, 11% (95% CI, 8% to 14%) of children residing in public housing had never received any immunizations.

Conclusions. African-American children throughout Chicago, particularly in public housing, remain at increased risk for vaccine-preventable diseases and should be targeted further for vaccination services. Vaccination coverage remains low several years after a major outbreak of measles and implementation of a free vaccine outreach program. Cluster surveys may be useful for monitoring vaccination coverage in high-risk urban settings.
Does Child Abuse Predict Adolescent Pregnancy?
Authors: Fiscella Kevin , Kitzman Harriet J. , Cole Robert E. , Sidora Kimberly J. , Olds David
Published: August 2004

Objective. To determine whether sexual and nonsexual childhood abuse are risk factors for early adolescent sexual activity and pregnancy.

Design. Cross-sectional study.

Setting. Prenatal clinic within an inner-city teaching hospital from June 1990 to August 1991.

Population. One thousand twenty-six primiparous, African-American women enrolled in a randomized clinical trial of nurse home visitation.

Main Outcome Measures. Four measures of child abuse were used: sexual abuse, incidents of physical abuse, any major physical abuse, and emotional abuse. The outcome measures were age of first consensual coitus and age of first pregnancy.

Results. After adjustments for household income, parental separation, urban residence, age of menarche, and teen smoking, sexual abuse during childhood was associated with younger age at first coitus (7.2 months; 95% confidence interval [CI], 2.6 to 11.7 months) and younger age at first pregnancy (9.7 months; 95% CI, 3.0 to 16.3 months). Incidents of physical abuse showed minimal effect on age at first coitus (1.2 days per incident; 95% CI, 0.5 to 1.9 days) and no effect on age of first pregnancy. A history of major physical abuse or emotional abuse showed no effect on age of first coitus or first pregnancy.

Conclusion. Child sexual abuse, but not child physical or emotional abuse, seems to be a risk factor for earlier pregnancy among African-American adolescents.
Neurodevelopmental Outcomes in Children With Fontan Repair of Functional Single Ventricle
Authors: Uzark Karen , Lincoln Alan , Lamberti John J. , Mainwaring Richard D. , Spicer Robert L. , Moore John W.
Published: August 2004

Objectives. The purpose of this study was to assess the neurodevelopmental status of children after Fontan repair of functional single ventricle and to examine the relationship between cognitive function and selected patient characteristics.

Study Design. Neurodevelopmental tests including the Stanford-Binet Intelligence (IQ) scale and the Developmental Test of Visual Motor Integration (VMI) were administered to 32 children (26 months to 16 years of age) with complex single ventricle. The mean and distribution of IQ and VMI scores were compared with population norms. The relationship between test scores and patient characteristics was examined utilizing analysis of variance and correlational methods.

Results. The majority of children had intellectual function within the normal range (mean, 97.5 ± 12.1). Below average VMI scores were found in 21.4% of children. There were no significant correlations between intellectual function or visual motor integration ability and preoperative oxygen saturation or age at Fontan. Children who had deep hypothermic circulatory arrest during a prior Norwood procedure tended to have a lower IQ score.

Conclusions. Intellectual development in children with Fontan repair of complex heart defects is essentially within the normal range. Visual motor integration deficits may be more prevalent in these children. In our population, the duration and degree of preoperative hypoxemia had no apparent effect on cognitive function.
Trends in Mortality and Cerebral Palsy in a Geographically Based Cohort of Very Low Birth Weight Neonates Born Between 1982 to 1994
Authors: O'Shea T. Michael , Preisser John S. , Klinepeter Kurt L. , Dillard Robert G.
Published: August 2004

Objective. To analyze whether the increasing survival of very low birth weight infants during the 1980s and 1990s has increased the risk of cerebral palsy among survivors.

Methods. The study cohort consisted of 2076 consecutively born infants, with birth weights of 500 to 1500 g and no major anomaly, born July 1, 1982, through June 30, 1994, to residents of a 17-county region in North Carolina. These infants had a mean birth weight of 1096 g (standard deviation, 251 g) and a mean gestational age of 29 weeks (standard deviation, 3 weeks). One thousand five hundred sixty-eight infants (76%) survived to 1 year adjusted age, at which point 1282 infants (82%) were examined at our medical center. The diagnosis of cerebral palsy was made only if the examining pediatrician and a pediatric physical therapist agreed on the diagnosis. To analyze trends across time, the Cochran-Armitage χ2 test and logistic regression were applied to data for infants categorized into six 2-year epochs according to year of birth.

Results. Mortality did not change significantly through 1990, and then began to decrease in 1990 to 1994. During the study period, mortality decreased from 36.8% between 1982 and 1984, to 13.8% between 1992 and 1994. The prevalence of cerebral palsy among survivors was constant from 1982 to 1988 (11.3%), decreased slightly from 1988 to 1990 (9.2%), and was lowest in 1990 to 1994 (5.2%). These secular trends in mortality and cerebral palsy risk remained significant when adjusted for gestational age, gender, and race. When adjusted for surfactant use, the trend in mortality was no longer significant, whereas the trend in cerebral palsy risk persisted.

Conclusions. The increasing survival of very low birth weight infants in the 1980s and 1990s has not resulted in an increased prevalence of cerebral palsy among survivors.
CandidaSepsis and Association With Retinopathy of Prematurity
Authors: Mittal Madhur , Dhanireddy Ramasubbareddy , Higgins Rosemary D.
Published: August 2004

Objective. To assess the association of Candida sepsis with retinopathy of prematurity (ROP) in extremely low birth weight infants.

Methods. We prospectively identified 253 infants admitted to the Critical Care Nursery at Georgetown University Hospital with birth weights ≤1000 g born between January 1, 1994, and June 30, 1996. Of these 253 infants, 62 died and 55 were transferred to other institutions before ophthalmologic screening for ROP. Clinical data on 98% (133/136) infants were reviewed. Candida sepsis was defined as a positive blood culture for Candida species. Severity of ROP was staged by the International Classification for ROP. Data were analyzed using the χ2 test for nominal data, unpaired t test for continuous data, Mann-WhitneyU test for ordinal data, and logistic regression.

Results. The mean birth weight (±SD) of the population studied was 777 g (±136 g), and the mean gestational age at birth was 26.0 weeks (±1.8 weeks). The overall incidence of ROP was 74%, and it correlated significantly with birth weight, gestational age, days on supplemental oxygen, and 5-minute Apgar scores. The incidence of ROP was significantly higher in the infants who hadCandida sepsis (21/22 [95%]) compared with those who did not (77/111 [69%]). Using logistic regression to control for the influence of birth weight, gestational age, days on supplemental oxygen, and 5-minute Apgar scores, Candida sepsis was an independent predictor of stage 3 or worse ROP. In addition, 9 (41%) of 22 infants with Candida sepsis required laser surgery compared with 10 (9%) of 111 infants without Candidasepsis. This difference was significant independent of birth weight, gestational age, days on supplemental oxygen, and 5-minute Apgar scores.

Conclusions. Candida sepsis is independently associated with increased severity of ROP and the need for laser surgery in extremely low birth weight infants.
The Growth Pattern and Final Height of Girls With Turner Syndrome With and Without Human Growth Hormone Treatment
Authors: Dacou-Voutetakis Catherine , Karavanaki-Karanassiou Kiki , Petrou Vasilis , Georgopoulos Neoklis , Maniati-Christidi Maria , Mavrou Ariadni
Published: August 2004

Background. Shortness is the most frequent and quite disturbing characteristic of girls with Turner syndrome (TS). Human growth hormone administration (hGH) to girls with TS increases growth velocity (GV), but a favorable effect on final height (FH) has not been documented. The aim of this study was to evaluate the effect of hGH administration on the growth pattern and FH in girls with TS.

Methods. The study group was comprised of 123 girls with TS who were cared for in our center. Eighty-two of these girls received hGH (mean dose, 0.78 ± 0.12 IU/kg/week), given subcutaneously 5 to 7 times per week for a period of 2.2 ± 1.2 years (hGH group). The mean chronological age (CA) and bone age (BA) at hGH initiation were 11.5 ± 2.5 years and 9.7 ± 2.3 years, respectively. The remaining 41 girls did not receive hGH and are designated as the untreated control group. In both groups, gonadal steroids were given for pubertal initiation and maintenance.

Results. The GV during the first year of hGH therapy (GV1) was higher than the year before hGH (6.3 cm/year vs 4.0 cm/year) and higher than the GV of the untreated group at a similar CA (4.4 cm/year). The GVs during the second (GV2) and third (GV3) year of hGH treatment (5.4 and 4.9 cm/year, respectively) were lower, but still higher in the hGH group, in comparison with the untreated group (GV2, 4.2 cm/year; GV3, 3.4 cm/year). GV1, GV2, and GV3 were negatively related to age and to BA at hGH initiation. The FH of the 35 hGH-treated girls was not significantly different from the FH of the 27 untreated girls (146.1 cm vs 144.0 cm). The Δ target height-FH was not significantly different in the two groups. The FH standard deviation score of the hGH-treated group was positively related to height standard deviation score for CA at treatment initiation (r = +0.73), maternal height (r = +0.57), target height (r = + 0.66), and birth weight (r = +0.54), but was unrelated to CA or BA at start of therapy or to hGH dose.

Conclusions. hGH therapy in girls with TS, in the dose and duration of treatment applied in this study, significantly accelerated GV but did not significantly improve FH.
Medical Necessity for the Hospitalization of the Abused and Neglected Child
Authors:   Committee on Hospital Care and Committee on Child Abuse and Neglect
Published: August 2004

This Policy Statement was retired October 2007.

The child suspected of being abused or neglected demands prompt evaluation in a protective environment where knowledgeable consultants are readily available. In communities without specialized centers for the care of abused children, the hospital inpatient unit becomes an appropriate setting for their initial management. Medical, psychosocial, and legal concerns may be assessed expeditiously while the child is housed in a safe haven awaiting final disposition by child protective services. The American Academy of Pediatrics recommends that hospitalization of abused and neglected children, when medically indicated or for their protection/diagnosis when there are no specialized facilities in the community for their care, should be viewed as medically necessary by both health professionals and third-party payors.
In-line Skating Injuries in Children and Adolescents
Authors:   Committee on Injury and Poison Prevention and Committee on Sports Medicine and Fitness
Published: August 2004

In-line skating has become one of the fastest-growing recreational sports in the United States. Recent studies emphasize the value of protective gear in reducing the incidence of injuries. Recommendations are provided for parents and pediatricians, with special emphasis on the novice or inexperienced skater.
Cardiovascular Disease Insulin Risk in Mexican-American and Anglo-American Children and Mothers
Authors: Reaven Peter , Nader Philip R. , Berry Charles , Hoy Tricia
Published: August 2004

Objective. To evaluate the relationship between insulin levels and cardiovascular risk factors in children and determine whether it varies among ethnic groups.

Methods. Cardiovascular risk factors and insulin levels were compared in 144 Mexican-American and Anglo-American mother-child pairs, when the children were 11 years of age.

Results. Although mean age did not differ between ethnicities, Mexican-American mothers and children both had a greater body mass index (mothers: 29.2 ± 6.2 vs 27.2 ± 7.9; children: 21.7 ± 4.7 vs 19.7 ± 4.6) and sum of skinfolds than did Anglo-Americans. Triglycerides, very low-density lipoprotein cholesterol, fasting insulin, and cholesterol/high-density lipoprotein ratio were higher, while high-density lipoprotein cholesterol was lower in both Mexican-American adults and children compared with Anglo-Americans. After adjusting for measures of obesity, only high-density lipoprotein cholesterol levels remained significantly lower in Mexican-Americans. For both adults and children, higher quartiles of insulin levels were associated with significantly higher triglycerides, blood pressure and lower high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol/apolipoprotein B levels (estimate of dense low-density lipoprotein size). A summary variable representing cardiovascular risk factors present in adult syndrome X patients was higher in both Mexican-American adults and children than in Anglo-Americans.

Conclusion. Mexican-American children and adults have higher levels of many cardiovascular risk factors, and this appears related to higher insulin levels and overweight. Appropriate nutrition, weight control, and exercise at early ages could be important in slowing the development of atherosclerosis.
Long-term Outcome After Neonatal Meconium Obstruction
Authors: Fuchs Julie R. , Langer Jacob C.
Published: August 2004

Objective. It is unclear whether children with cystic fibrosis (CF) who present with neonatal meconium ileus have a different long-term outcome from those presenting later in childhood with pulmonary complications or failure to thrive. We examined a cohort of patients with meconium ileus, and compared their long-term outcome with children who had CF without meconium ileus and neonates who had meconium obstruction without CF (meconium plug syndrome).

Study Design. Comparative study using retrospective and follow-up interview data.

Patients. Group 1 consisted of 35 surviving CF patients who presented with meconium ileus between 1966 and 1992. Two control groups were also studied: 35 age- and sex-matched CF patients without meconium ileus (group 2), and 12 infants presenting with meconium plug syndrome during the same time period (group 3).

Outcome Measures. Pulmonary, gastrointestinal, nutritional, and functional status were reviewed, and surgical complications were recorded.

Results. Mean follow-up was 12.6 ± 6, 12.6 ± 6, and 9.3 ± 4 years in groups 1, 2, and 3, respectively. Patients without CF (group 3) demonstrated better growth and functional status, and had a lower incidence of pulmonary and gastrointestinal problems. Although the presence of meconium ileus among CF patients was associated with an earlier diagnosis, there were no significant differences between groups 1 and 2 with respect to hepatobiliary, nutritional, functional, or respiratory status. Meconium ileus was associated with a higher risk of meconium ileus equivalent (20% vs 6%), although this difference was not statistically significant. Long-term surgical complications (adhesive small bowel obstruction and blind loop syndrome) were seen in 27% of children with meconium ileus; there were no long-term surgical complications in groups 2 or 3, because these infants did not have any neonatal surgical procedures. Children presenting with complicated meconium ileus had a higher rate of long-term surgical complications than those with uncomplicated meconium ileus (36% vs 17%), and those managed with resection or enterostomy had more complications than those treated by enterotomy and lavage (33% vs 0%).

Conclusions. Long-term outcome is similar in CF patients who present with meconium ileus and those who do not, except for a slightly higher incidence of meconium ileus equivalent, and a significantly higher rate of surgical complications. The risk of surgical complications is highest in those presenting with complicated meconium ileus and those undergoing resection or enterostomy. Patients with meconium obstruction who do not have CF have an excellent long-term prognosis. This information will be useful in counseling the families of infants presenting with neonatal meconium obstruction.
Accuracy of a Polymerase Chain Reaction-based Assay for Detection of Pneumococcal Bacteremia in Children
Authors: Isaacman Daniel J. , Zhang Yingze , Reynolds Ellen A. , Ehrlich Garth D.
Published: August 2004

Objective. To evaluate the utility of a polymerase chain reaction (PCR)-based assay for identifying pneumococcal DNA in the blood of pediatric patients with suspected bacteremia.

Methods. Children evaluated at the Children's Hospital of Pittsburgh who were having blood drawn for culture had an additional 2 to 3 mL of blood (from the same sampling) obtained and placed in a sodium citrate tube for PCR processing (study group). The control group for this study consisted of children having blood drawn for biochemical analysis who were afebrile, well-appearing, and had no recent illnesses. Specimens were frozen at −70°C and then batch-processed for PCR-based analyses with the JM201/202–204 primer/probe set. Amplified products were detected after liquid hybridization format wherein a 32P end-labeled probe was annealed to the amplified DNA and visualized by autoradiographic analysis after gel retardation.

Results. Four hundred eighty study group patients and 103 controls had specimens tested by both PCR and blood culture. Twenty-six (5%) patients had a positive blood culture for a pathogenic organism (21 of which were Streptococcus pneumoniae). Twelve (57%) of the 21 patients with blood cultures positive for S pneumoniae also were positive by PCR. In addition, 206 study group patients and 16 controls with negative blood cultures had positive PCR results. A greater proportion of study group patients were PCR-positive/culture-negative than were controls (206/459 vs 16/103).

Conclusion. Although this assay currently lacks adequate sensitivity and specificity for clinical use, the high frequency of PCR-positive cases in patients with suspected bacteremia may indicate a greater role for S pneumoniae than had previously been appreciated. Further refinement of this assay as well as the development of a rapid PCR-based assay appears warranted.
Intervention to Improve Physician Documentation and Knowledge of Child Sexual Abuse: A Randomized, Controlled Trial
Authors: Socolar Rebecca R. S. , Raines Byron , Chen-Mok Mario , Runyan Desmond K. , Green Cynthia , Paterno Steven
Published: August 2004

Objective. To determine if written feedback improves the chart documentation and knowledge of physicians doing evaluations for child sexual abuse and to learn what other factors are associated with better documentation and knowledge.

Design. Randomized, controlled trial.

Setting. A statewide network of physicians performing child abuse evaluations.

Participants. All physicians who performed evaluations for sexual abuse during 1991 to 1992. One hundred forty-seven physicians were randomized to control (n = 75) and intervention (n = 72) groups, 122 (83%) remained at follow-up, and 87 of the 122 (71%) had done evaluations for child sexual abuse.

Interventions. Tailored written feedback based on chart reviews and relevant articles were sent to a randomly selected one-half of the physicians during a 3-month period.

Main Outcome Measures. The quality of documentation and physician knowledge before and after the intervention.

Results. Documentation by chart review of up to five randomly chosen records per physician (preintervention, n = 552; postintervention, n = 259) by reviewers blinded to intervention status and physician knowledge was assessed by survey (78% completion). Change in documentation and knowledge for physicians in the intervention group was not statistically significant compared with the control group. The risk ratio for a mean overall history rating of excellent/good was 0.89 (0.63, 1.25) and for a mean overall physical examination rating of excellent/good was 1.03 (0.73, 1.45). Both groups improved significantly during the time period. The largest improvements in the time period were in documenting the history of where abuse occurred, in the physical examination position, hymenal description, penile findings, and knowing that chlamydia infection should be assessed by culture. A structured medical record, female physicians, and credits in continuing medical education were associated with better documentation.

Conclusions. Tailored feedback to the physician with directed educational materials did not seem to improve most aspects of documentation and knowledge of child sexual abuse, although notable improvement was seen during the time period studied. This study suggests that chart audits may not be the best use of resources for trying to improve physician behavior; credits in continuing medical education and use of structured records may be more likely to be beneficial.
Increasing Breastfeeding Rates to Reduce Infant Illness at the Community Level
Authors: Wright Anne L. , Bauer Mark , Naylor Audrey , Sutcliffe Emily , Clark Larry
Published: August 2004

Objective. Although breastfeeding is associated with lower rates of a variety of infant illnesses, skeptics have suggested that much of the association is attributable to confounding, even after appropriate statistical adjustment. This article utilizes a novel design to investigate changes in infant illness at the community level after a successful breastfeeding promotion program.

Methods. In this population-based cohort study, the medical records of all infants born in one Navajo community the year before a breastfeeding promotion program (n = 977) and the year during the intervention (n = 858) were reviewed. Outcomes assessed include changes after the intervention in: proportion breastfeeding and/or breastfeeding exclusively; incidence of common infant illnesses in the first year of life; and feeding-group specific incidence of illness.

Results. The proportion of women breastfeeding exclusively for any period of time increased from 16.4% to 54.6% after the intervention. The percent of children having pneumonia and gastroenteritis declined 32.2% and 14.6%, respectively, after the intervention. Feeding-group specific rates of these illnesses were unchanged, indicating that the decline observed was attributable to the increased proportion of infants breastfeeding. In contrast, rates of croup and bronchiolitis increased after the intervention among those fed formula from birth, suggesting a viral epidemic which was limited to those never exclusively breastfed. Finally, sepsis declined in both formula-fed and breastfed infants after the intervention, suggesting that other factors affected this illness outcome after the intervention.

Conclusions. Increasing the proportion of exclusively breastfed infants seems to be an effective means of reducing infant illness at the community level. The experimental design suggests that the increased incidence of illness among minimally breastfed infants is causally related to lack of breast milk, rather than being attributable to confounding.
Adverse Asthma Outcomes Among Children Hospitalized With Asthma in California
Authors: Calmes Daphne , Leake Barbara D. , Carlisle David M.
Published: August 2004

Objective. To use administrative data to determine whether adverse asthma outcomes for pediatric asthma hospitalizations are related to specific clinical and nonclinical patient characteristics.

Design. Cross-sectional study.

Setting. All pediatric (0 to 17 years of age) asthma-related hospital discharges, 1986 to 1993, in California.

Patients. A total of 113 974 eligible patients with asthma-related discharges.

Main Outcome Measure. Adverse asthma outcomes (intubation, cardiopulmonary arrest, and death).

Results. Adverse asthma outcomes occurred in 0.48% of subjects. The frequency of adverse asthma outcomes increased during the 1990s compared with 1986. After controlling for differences in gender, age, specific comorbid conditions, year, race, and insurance type, adverse asthma outcomes were more likely to occur in the 5- to 11-year-old group (odds ratio [OR]: 1.39; 95% confidence interval [CI]: 1.13–1.69) and in the 12- to 17-year-old group (OR: 4.48; CI: 3.20–6.21) compared with those children in the 0 to 4-year-old age group. Asian Pacific-American children were more likely (OR: 1.59; CI: 1.24–2.59) than were white children to experience an adverse asthma outcome. Children who had a secondary diagnoses of pneumonia (OR: 1.54; CI: 1.19–2.00) also were more likely to experience an adverse asthma outcome. The odds of an adverse outcome increased progressively after 1986, becoming significant after 1989. Gender and insurance type were not associated with increased odds of experiencing an adverse asthma outcome.

Conclusions. Adverse asthma outcomes among hospitalized children are increasing in the 1990s and are associated with specific clinical and nonclinical patient characteristics.
Buccal Cell DNA Mutation Analysis for Diagnosis of Cystic Fibrosis in Newborns and Infants Inaccessible to Sweat Chloride Measurement
Authors: Parad Richard B.
Published: August 2004

Objectives. To assess the application of DNA-based cystic fibrosis transmembrane conductance regulator (CFTR) gene mutation analysis as a primary cystic fibrosis (CF) diagnostic test in preterm and term newborns and infants for whom the quantitative pilocarpine iontophoresis test (QPIT) cannot be used.

Design. Retrospective survey.

Setting. DNA Diagnostic Laboratory, Children's Hospital, Boston, Massachusetts. Buccal cell DNA samples were received from inpatients, outpatients, and three neonatal intensive care units.

Outcome Measure. Detection of at least 1 of 12 CFTR mutations.

Patients. Between November 1, 1992, and April 30, 1994, 28 newborns and infants under 12 months of age at risk for CF had CFTR DNA mutation analysis performed because a sweat chloride (SC) value could not be obtained. QPIT was either not performed (infant weight <2 kg, QPIT not available at site of hospitalization, or infant not accessible to QPIT laboratory) or was inconclusive (sweat volume <75 mg or indeterminate SC [≥40, <60 mEq/L]). The postnatal age at time of testing ranged from 1 day to 11 months, and gestational age at birth from 25 to 40 weeks.

Results. Six (21%) of 28 infants with unobtainable or indeterminate QPIT had 1 or 2 CFTR mutations detected. Immediate CF diagnosis by direct detection of 2 CFTR mutations was made in 5 of these 6 patients. Definitive CF diagnosis in the infant with 1 CFTR mutation was delayed until an elevation in SC could be documented. The patients with no CFTR mutations detected had a low likelihood of CF.

Conclusions. For infants in whom CF is suspected but QPIT cannot be obtained, buccal cell DNA-based CFTR mutation analysis can be used as a rapid, noninvasive primary diagnostic test. This simple mode of DNA collection may aid in the diagnosis of other inherited disorders in newborns.
Serum Cholesterol and Triglyceride Distribution in 7767 School-aged Greek Children
Authors: Schulpis Kleopatra , Karikas George A.
Published: August 2004

Objective. To elucidate associations of age and sex with serum cholesterol and triglyceride levels and to provide for the first time percentile distribution data for pediatric lipids.

Participants and Methods. A high sample of 7767 (3980 boys, 3787 girls) fasting schoolchildren, 6 to 14 years of age, were studied in Athens, Greece.

Results. The mean cholesterol ranged from 157 to 174 mg/dL for boys and from 158 to 172 mg/dL for girls peaking at 9 years of age for both sexes. Triglyceride levels also tended to increase gradually and to peak at 11 years of age for both sexes. The high-density lipoprotein cholesterol levels were highest at 9 years of age for both sexes and the low-density lipoprotein cholesterol levels also tended to peak at 9 years of age for boys and at 8 years of age for girls. Atherogenic indices ranged from 1.54 to 1.68 for boys and 1.51 to 1.85 for girls.

Conclusion. According to these findings, it could be suggested that diet changes in the Greek population, especially in children and adolescents, living in big cities is significantly influencing their total cholesterol profiles throughout the last 10 years.
Somatosensory Evoked Potentials in Very Preterm Infants in Relation to l-Thyroxine Supplementation
Authors: Smit Bert J. , Kok Joke H. , de Vries Linda S. , van Wassenaer Aleid G. , Dekker Friedo W. , Ongerboer de Visser Bram W.
Published: August 2004

Objective. To study the effect ofl-thyroxine supplementation on neurologic maturation in very preterm infants with transient hypothyroxinemia.

Design. Randomized, double-blind, placebo-controlled,l-thyroxine supplementation trial.

Setting. Level III neonatal intensive care unit.

Subjects. A total of 200 infants <30 weeks' gestational age.

Intervention. Subjects were randomly assigned to receivel-thyroxine (8 μg/kg birth weight per day) or a placebo during the first 6 weeks of life.

Methods. Median nerve somatosensory evoked potentials were recorded, measuring cortical N1 peak latency at 2 weeks of age, at term, and at 6 months (corrected) age.

Results. Cortical N1 peak latency was not decreased significantly in the l-thyroxine group compared with the placebo group throughout the study period.

Conclusion. l-Thyroxine supplementation during the first 6 weeks of life did not decrease cortical N1 peak latency in infants of <30 weeks' gestational age.
Plasma 3-Nitrotyrosine Is Elevated in Premature Infants Who Develop Bronchopulmonary Dysplasia
Authors: Banks Beverly A. , Ischiropoulos Harry , McClelland Molly , Ballard Philip L. , Ballard Roberta A.
Published: August 2004

Objective. Premature infants are susceptible to bronchopulmonary dysplasia (BPD), a chronic lung disease of infancy that appears to be caused in part by oxidative stress from hyperoxia. To investigate the possible role of nitric oxide-derived oxidants such as peroxynitrite in the etiology of BPD, we measured levels of plasma 3-nitrotyrosine, which is produced by the reaction of peroxynitrite with proteins.

Patients and Methods. Ten premature infants who developed BPD, defined as requiring supplemental oxygen beyond 36 weeks' postmenstrual age, were identified retrospectively from a group of subjects enrolled in a clinical trial of antenatal therapy. Serial plasma samples had been collected on these infants during the first month of life as part of the trial. Sixteen comparison premature infants were identified from the same population: 5 had no lung disease, 6 had respiratory distress syndrome that resolved, and 5 had residual lung disease at 28 days of life that resolved by 36 weeks' postmenstrual age. Plasma 3-nitrotyrosine levels were measured using a solid phase immunoradiochemical method.

Results. All 3-nitrotyrosine values in infants without BPD were <0.25 ng/mg protein, and levels did not change with postnatal age. Plasma 3-nitrotyrosine concentrations were significantly higher in infants with BPD, increasing approximately fourfold during the first month of life. For the 20 infants who had blood samples available at 28 days of life, plasma 3-nitrotyrosine levels correlated with the fraction of inspired oxygen that the infant was receiving (r = 0.7).

Conclusion. Plasma 3-nitrotyrosine content is increased during the first month of life in infants who develop BPD. This suggests that peroxynitrite-mediated oxidant stress may contribute to the development of this disease in premature infants and that 3-nitrotyrosine may be useful as an early plasma indicator of infants at risk for developing BPD.
Cystic Fibrosis: When Should High-resolution Computed Tomography of the Chest Be Obtained?
Authors: Santamaria Francesca , Grillo Giacomo , Guidi Guido , Rotondo Antonio , Raia Valeria , de Ritis Giorgio , Sarnelli Paola , Caterino Marinella , Greco Luigi
Published: August 2004

Objective. To provide indications for high-resolution computed tomography (HRCT) of the chest in patients with cystic fibrosis (CF).

Design. We compared the HRCT and conventional chest radiography (CCR) scores and assessed their correlation with clinical scores and pulmonary function tests.

Setting. Department of Pediatrics, Federico II University, Naples, Italy.

Subjects. A total of 30 patients with CF 6.75 to 24 years of age.

Results. CCR scores correlated highly with HRCT (r = −0.8) and clinical (r = 0.5) scores, whereas total HRCT scores were not related to clinical scores. Of all the specific HRCT findings, only bronchiectasis appeared related significantly to the clinical score (r = 0.6). Most pulmonary function tests were related to CCR and total HRCT scores, but not to HRCT scoring of specific changes. Forced vital capacity and CCR scores appeared the best predictors of the HRCT score (multiple R = 0.58 and 0.79, respectively). In patients with mild lung disease, HRCT detected bronchiectasis and air trapping in 57% and 71% of the cases, respectively. In patients with more abnormal chest radiographs, bronchiectasis and air trapping were demonstrated on HRCT in all cases.

Conclusions. These findings suggest that HRCT of the chest is most useful in the identification of early lung abnormalities in patients with CF with mild respiratory symptoms, whereas for established disease, CCR is still the first-line imaging technique. The advantage of detecting early changes on CT imaging awaits additional confirmation, at least until early therapeutic interventions affecting significantly the final outcome of the disease are demonstrated. In patients with advanced disease, HRCT may be useful in the evaluation of specific lung changes when more aggressive treatment such as chest surgical interventions is indicated. Given the cost of the procedure and the high radiation dosage compared with CCR, a careful assessment of the cost:benefit ratios of HRCT is strongly recommended in CF.