bluuebunny/crossref_metadata_2025 huggingface dataset:
The Safety of Acetaminophen and Ibuprofen Among Children Younger Than Two Years Old
Authors: Lesko Samuel M. , Mitchell Allen A.
Published: August 2004

Background.

Recently ibuprofen has been introduced as a nonprescription analgesic/antipyretic for use in children.

Objective.

To compare the incidence of serious adverse clinical events among children <2 years old given ibuprofen and acetaminophen to control fever.

Study Design.

A practitioner-based, randomized clinical trial. A total of 27 065 febrile children were randomized to receive acetaminophen (12 mg/kg), ibuprofen (5 mg/kg), or ibuprofen (10 mg/kg). Rates of hospitalization for acute gastrointestinal bleeding, acute renal failure, anaphylaxis, Reye's syndrome, asthma, bronchiolitis, and vomiting/gastritis were compared by randomization group.

Results.

The risk of hospitalization with any diagnosis in the 4 weeks after enrollment was 1.4% (95% confidence interval, 1.3%–1.6%) and did not vary by antipyretic assignment. No children were hospitalized for acute renal failure, anaphylaxis, or Reye's syndrome. Three children were hospitalized with gastrointestinal bleeding; all 3 had been assigned to treatment with ibuprofen. The risk of hospitalization with gastrointestinal bleeding among children randomized to ibuprofen was 17 per 100 000 (95% confidence interval, 3.5–49 per 100 000) but was not significantly greater than the risk among children given acetaminophen. The risk of hospitalization with asthma, bronchiolitis, or vomiting/gastritis did not differ by antipyretic assignment.

Conclusions.

The risk of serious adverse clinical events among children <2 years old receiving short-term treatment with either acetaminophen or ibuprofen suspension was small and did not vary by choice of medication. These data do not provide any information on the safety of these medications when used for prolonged periods or when used together, regardless of duration.
Intact Survival in Extremely Low Birth Weight Infants After Delivery Room Resuscitation
Authors: Finer Neil N. , Tarin Thomas , Vaucher Yvonne E. , Barrington Keith , Bejar Raul
Published: August 2004

Objective.

None of the 20 previously reported infants weighing <750 g at birth who received cardiopulmonary resuscitation (CPR) in the delivery room (DR) survived. To clarify whether such resuscitation is futile in our center, we evaluated our experience with DR-CPR over a 4-year period.

Study Design.

We retrospectively reviewed the outcomes of all inborn infants with birth weights <1000 g at University of California, San Digeo Medical Center from January 1993 to December 1996. Surviving infants and matched control infants were followed for ≤40 months' adjusted age using standardized neurodevelopmental assessments.

Results.

Of the infants with birth weight <1000 g born during this period, 29% (51/177) died, including 44% of those <750 g and 16% of those ≥750 g. Overall, 19 infants received DR-CPR, of whom 12 were <750 g. Of the infants who received DR-CPR, 79% (15/19) survived, including 10 of 13 infants <750 g and 5 of 6 infants ≥750 g. Of the 15 survivors, 10 were followed beyond 10 months' adjusted age (median: 28 months). At last examination, 70% were both neurologically and developmentally normal. Two infants had cerebral palsy with mild cognitive and severe motor developmental delay. Of 7 infants with birth weight <750 g, 6 had normal neurodevelopmental outcomes. The mean composite mental and motor scores of DR-CPR survivors were 93 ± 10 and 89 ± 25, respectively. No differences were found in neurologic or developmental outcome between DR-CPR survivors and control infants matched for gestational age, sex, and year of birth.

Conclusions.

Our results indicate that intact survival is possible for infants weighing <750 g at birth after DR-CPR.
The Validity of the Uriscreen Test for Early Detection of Urinary Tract Infection in Children
Authors: Waisman Yehezkel , Zerem Elisheva , Amir Lisa , Mimouni Marc
Published: August 2004

Objective.

To determine the validity of the Uriscreen, a rapid diagnostic test based on the detection of urine catalase for the early detection of urinary tract infection (UTI) in children, compared with standard urinalysis and dipstick tests.

Study Design.

Cross-sectional study.

Study Population.

Children 1 month to 17 years of age who presented to the emergency department of a pediatric tertiary care center between March and November of 1996 with symptoms suggestive of UTI.

Methods.

Urine specimens obtained from a random sample of 121 patients were evaluated simultaneously for possible UTI by Uriscreen (catalase test), urinalysis (microscopic pyuria), dipstick (leukocyte esterase and nitrite), and quantitative urine culture. All specimens were collected by one of three sterile techniques (midstream void technique, bladder catheterization, or suprapubic aspiration), as appropriate for age, and tested immediately. Using the quantitative urine culture as the gold standard (reference test), the sensitivity, specificity, and positive and negative predictive values of all the screening tests were determined and compared. Age, sex, temperature, presenting symptoms, and method of urine collection were recorded for each participant.

Results.

Of the 121 patients, 35 (28.9%) had positive culture results: 30 girls (85.7%) and 5 boys (14.3%). Compared with urinalysis and dipstick tests, Uriscreen had the highest sensitivity (100% vs 88.6% and 97.1%, respectively) and the highest negative predictive value (100% vs 95% and 98.6%, respectively), but the poorest specificity (68.6% vs 88.4% and 82.5%, respectively) and positive predictive value (56.4% vs 75.6% and 69.4%, respectively).

Conclusions.

The clinical use of Uriscreen for the presumptive diagnosis of UTI in children is limited and not significantly superior to urinalysis or the dipstick test. However, because of its 100% sensitivity and negative predictive value and its ease of use, rapidity, and low cost, it is recommended highly for ruling out the diagnosis of UTI. In laboratories, a negative Uriscreen result may prevent the need for performing expensive urine cultures.
Smoking During Pregnancy and Hospitalization of the Child
Authors: Wisborg Kirsten , Henriksen Tine Brink , Obel Carsten , Skajaa Elisabet , Østergaard John R.
Published: August 2004

Objectives.

To study the association between smoking during pregnancy and hospitalization of the child before 8 months of age.

Design.

A follow-up study of 1974 children born in 1991 and 1992.

Results.

Overall, 158 (8%) of the children were hospitalized during the first 8 months of life. Compared with children whose mothers did not smoke during pregnancy, children with mothers who smoked 1 to 14 cigarettes per day had no increased risk of being hospitalized (relative risk: 1.1; 95% confidence interval: 0.8–1.5), whereas children whose mothers smoked 15 or more cigarettes per day had twice as high a risk of being hospitalized (relative risk: 2.0; 95% confidence interval: 1.2–3.3). When only hospitalizations before 2 months of age were analyzed, smoking during pregnancy was associated an increased risk similar to that described above. Hospitalization of the child was independent of the smoking habits of the father, and an increased risk of hospitalization associated with smoking was found not only among children with symptoms from the respiratory system but also among children with symptoms from the gastrointestinal system and the skin. The association between smoking during pregancy and hospitalization of the child persisted after adjustment for postpartum smoking habits and a number of socio-demographic and lifestyle factors.

Conclusions.

Smoking 15 or more cigarettes per day during pregnancy influenced the health of the children, and several points indicated that the effect of in utero exposure was independent of postpartum smoking habits. If all pregnant women smoking 15 or more cigarettes per day stopped smoking, ∼5% of all admissions to hospitals before 8 months of age could be avoided. smoking during pregnancy, hospitalization of children.
Parent-reported Language and Communication Skills at One and Two Years of Age in Relation to Otitis Media in the First Two Years of Life
Authors: Feldman Heidi M. , Dollaghan Christine A. , Campbell Thomas F. , Colborn D. Kathleen , Kurs-Lasky Marcia , Janosky Janine E. , Paradise Jack L.
Published: August 2004

Objective.

As part of a study of possible effects of early life otitis media on children's development, we attempted to determine whether levels of language and communication skills at 1 and 2 years of age are associated with the cumulative duration of middle ear effusion (MEE) in the first 2 years of life.

Methods.

Subjects (N = 2156) were followed at one of eight study sites in the Pittsburgh area. Middle ear status was monitored closely throughout the first 2 years of life. For each child, the cumulative percentage of days with MEE was estimated based on diagnoses at visits and interpolations for intervals between visits. For each child also, 1 or both parents completed the MacArthur Communicative Development Inventory–Words and Gestures (CDI–WG) when the child was 1 year of age and the MacArthur Communicative Development Inventory–Words and Sentences (CDI–WS) when the child was 2 years of age.

Results.

Unadjusted correlations between scores on the CDI–WG and percentage of days with MEE in the first year of life were close to zero, and there were no statistically significant negative correlations. Unadjusted correlations between scores on the CDI–WS and the cumulative percentage of days with MEE in year 2 and in years 1 and 2 combined were generally negative and statistically significant, but the magnitudes of those correlations were no higher than 0.09. After adjustment for sociodemographic variables, only the Vocabulary Production Scale of the CDI–WS remained correlated significantly with the percentage of days with MEE, and the percentage of days with MEE accounted for only a negligible percentage of the variance in scores on this scale.

Conclusions.

In this diverse sample of children, parent-reported levels of language skills at 1 and 2 years of age were correlated negligibly with the cumulative percentage of days with MEE in the children's first and second years of life. otitis media, otitis media with effusion, language, communication.
Emergency Preparedness for Children With Special Health Care Needs
Authors:   Committee on Pediatric Emergency Medicine
Published: August 2004

Children with special health care needs are those who have, or are at risk for, chronic physical, developmental, behavioral, or emotional conditions and who also require health and related services of a type or amount not usually required by typically developing children. Formulation of an emergency care plan has been advocated by the Emergency Medical Services for Children (EMSC) program through its Children With Special Heath Care Needs Task Force. Essential components of a program of providing care plans include use of a standardized form, a method of identifying at-risk children, completion of a data set by the child's physicians and other health care professionals, education of families, other caregivers, and health care professionals in use of the emergency plan, regular updates of the information, 24-hour access to the information by authorized emergency health care professionals, and maintenance of patient confidentiality.
The Changing Pattern of Neonatal Mortality in a Regionalized System of Perinatal Care: A Current Update
Authors: Hein Herman A. , Lofgren Maria A.
Published: August 2004

Objective.

Our earlier studies about the changing pattern of neonatal mortality were based on data from 1978–1979 and 1982–1983. In this report, we provide a modern update of the causes of neonatal deaths to help focus prevention measures.

Study Design.

We reviewed neonatal deaths for the years 1995 and 1996 and assigned a clinical cause of death. Deaths were reviewed and analyzed by place of birth and death, according to level of care. We provided an estimate of the change in causes of death between 1982–1983 and 1995–1996 and calculated an idealized neonatal mortality rate for each level of care and for the entire state.

Results.

The major changes in causes of death occurred in the respiratory distress syndrome (RDS) and extremely low birth weight (ELBW) categories. RDS showed a substantial decline, but ELBW deaths increased by nearly the same amount that RDS declined. The idealized neonatal mortality rate calculations suggest that fewer potentially medically preventable deaths occur now than in 1982–1983. Currently, more neonatal deaths of level I births occur in level III facilities than in 1982–1983. However, at that time, Iowa had only one tertiary facility, and the level II regional hospitals were the site of more deaths.

Conclusion.

We believe that assigning deaths to a clinical category rather than to a catastrophic final event helps focus on sources of preventable death in the medical care system. To reduce neonatal mortality, the incidence of lethal congenital malformations and ELBW infants must be impacted.
Determination of Timing of Brain Injury in Preterm Infants With Periventricular Leukomalacia With Serial Neonatal Electroencephalography
Authors: Hayakawa Fumio , Okumura Akihisa , Kato Toru , Kuno Kuniyoshi , Watanabe Kazuyoshi
Published: August 2004

Objective.

The aim of this study was to determine the timing of brain injury in infants with periventricular leukomalacia (PVL) with serial electroencephalography (EEG) recordings during the neonatal period.

Patients and Methods.

We evaluated 172 preterm infants having a gestational age <33 weeks and weighing <2000 g. Initial EEG was recorded within 72 hours of life and then recorded once every 1 to 4 weeks. Serial cranial ultrasonography was performed and cystic PVL was diagnosed when multiple cystic formations of >3 mm in diameter were observed.

Results.

Of the172 infants studied, 26 were diagnosed as having cystic PVL by ultrasonography. EEG abnormalities were observed in 25 of 26 infants with PVL, although EEG abnormalities were seen in 20 of 146 infants without PVL. The initial EEG recordings were normal in 7 infants, but EEG abnormalities were observed later in 6 of these infants. In these 6 infants, the timing of injury was presumed to be postpartum. Only acute stage abnormalities were observed on initial EEG recording in 14 infants, and the timing of injury was presumed to be just before or around birth. Chronic stage abnormalities were recognized already on initial EEG recordings in the other 5 infants, and the timing of injury was presumed to be some time before birth.

Conclusions.

Our study indicates that it may be possible to determine the timing of injury in infants with PVL by serial EEG recordings.
Randomized Trial of Permissive Hypercapnia in Preterm Infants
Authors: Mariani Gonzalo , Cifuentes Javier , Carlo Waldemar A.
Published: August 2004

Objective.

To determine whether a ventilatory strategy of permissive hypercapnia (PHC) reduces the duration of assisted ventilation in surfactant-treated neonates weighing 601 to 1250 g at birth.

Design.

Forty-nine surfactant-treated preterm infants (birth weight: 854 ± 163 g; gestational age: 26 ± 1.4 weeks) receiving assisted ventilation were randomized during the first 24 hours of age to a PHC group (Paco2: 45–55 mm Hg) or to a normocapnia group (NC; Paco2: 35–45 mm Hg). The primary outcome measure was the total number of days on assisted ventilation. Uniform extubation and reintubation criteria were used for both groups. All patients received aminophylline before extubation.

Results.

The total number of days on assisted ventilation expressed as median (25th–75th percentiles) was 2.5 (1.5–11.5) in the PHC group and 9.5 (2.0–22.5) in the NC group (Mann-Whitney U test). The number of patients on assisted ventilation throughout the first 96 hours after randomization was lower in the PHC group (log rank test). During that period, the ventilated patients in the PHC group had a higher Paco2 and lower peak inspiratory pressure, mean airway pressure, and ventilator rate than did those in the NC group. The percentage of patients requiring reintubation within 24 hours postextubation (PHC 17% vs NC 28%) and supplemental oxygen at 28 days of life (PHC 43% vs NC 64%) and the total days of oxygen supplementation (PHC 15 [4–53] vs NC 32 [17–50]) did not differ between the groups. There were no differences in mortality, air leaks, intraventricular hemorrhage, periventricular leukomalacia, retinopathy of prematurity, or patent ductus arteriosus.

Conclusion.

A ventilatory strategy of PHC in preterm infants who receive assisted ventilation is feasible, seems safe, and may reduce the duration of assisted ventilation. assisted ventilation, respiratory distress syndrome, gentle ventilation, lung injury.
Assessment of Medical Personnel Exposure to Nitrogen Oxides During Inhaled Nitric Oxide Treatment of Neonatal and Pediatric Patients
Authors: Phillips Margaret L. , Hall Thomas A. , Sekar Krishnamurthy , Tomey Jeanine L.
Published: August 2004

Objective.

This study was an assessment of potential exposures of medical personnel to nitrogen oxides during simulated and actual inhaled nitric oxide treatment of newborn and pediatric patients.

Design.

Breathing zone exposures to nitric oxide (NO) and nitrogen dioxide (NO2) were monitored using data-logging personal dosimeters during simulated and actual administration of NO gas to patients in an intensive care setting.

Sample.

A total of 28 bedside nurses and 18 respiratory therapists were monitored during 6 different patient treatments.

Analysis.

The highest measured concentrations of NO and NO2 in the personal breathing zones of the nurses and respiratory therapists were peak readings (<1 minute in duration) of 6.7 parts per million (ppm) NO and 3.1 ppm NO2. Exposures averaged throughout 15 minutes and throughout the work shift were below the limit of detection (0.8-ppm NO and 0.5-ppm NO2).

Conclusion.

Detectable exposures to NO and NO2were brief, infrequent, and well below Occupational Safety and Health Administration permissible exposure limits or any other exposure guideline, eg, American Conference of Governmental Hygienists Threshold Limit Values.
Level of In Utero Cocaine Exposure and Neonatal Ultrasound Findings
Authors: Frank Deborah A. , McCarten Kathleen M. , Robson Caroline D. , Mirochnick Mark , Cabral Howard , Park Henry , Zuckerman Barry
Published: August 2004

Objective. 

To assess whether there is an association between the level of in utero cocaine exposure and findings on neonatal cranial ultrasound, controlling for potentially confounding variables.

Study Design.

In a prospective longitudinal study, three cocaine exposure groups were defined by maternal report and infant meconium assay: unexposed, heavier cocaine exposure (>75th percentile self-reported days of use or of meconium benzoylecogonine concentration) or lighter cocaine exposure (all others). Neonatal ultrasounds from 241 well, term infants were read by a single radiologist who was masked to the exposure group.

Results.

Infants with lighter cocaine exposure did not differ from the unexposed infants on any ultrasound findings. After controlling for infant gender, gestational age, and birth weightz scores and for maternal parity, blood pressure in labor, ethnicity, and use of cigarettes, alcohol, and marijuana during pregnancy, the more heavily cocaine-exposed infants were more likely than the unexposed infants to show subependymal hemorrhage in the caudothalamic groove (covariate adjusted odds ratio: 3.88; 95% confidence interval: 1.45, 10.35).

Conclusions.

This is the first study to demonstrate that ultrasound findings suggestive of vascular injury to the neonatal central nervous system are related to the level of prenatal cocaine exposure. Inconsistency in previous research in identifying an association between prenatal cocaine exposure and neonatal cranial ultrasound findings may reflect failure to consider dose effects.
Managing Pediatric Epilepsy Syndromes With New Antiepileptic Drugs
Authors: Pellock John M.
Published: August 2004

The management of epilepsy in the pediatric patient requires careful evaluation, classification, and pharmacologic treatment. Despite best efforts on the part of clinicians, approximately 25% of children remain refractory to appropriate medical therapies. The development of an improved classification system and the emergence of several new antiepileptic drugs have enabled some progress in this area, specifically in children with disorders such as Lennox-Gastaut syndrome and infantile spasms, which are notoriously difficult to control. However, limited data are available that define the optimal use of new antiepileptic agents in pediatric patients. To most effectively treat children with epilepsy syndromes, further research must be completed to validate the positive effects described in case reports, open-label clinical trials, and early controlled clinical trials.
Pancreatic Duct Stenting as a Treatment for Hereditary Pancreatitis
Authors: Vaughan David , Imrie Cameron , Kelleher Jerry , Drumm Brendan , Osborne Henry
Published: August 2004

Hereditary pancreatitis is a genetically transmitted condition usually presenting in childhood or adolescence. The natural history of the condition is that recurrent episodes of pancreatitis may be followed by the development of pancreatic exocrine and endocrine failure. Treatment options are limited, usually consisting of surgical drainage procedures whose efficacy is uncertain and whose effect on disease progression is unknown. We report a child with hereditary pancreatitis treated by means of a pancreatic duct stent placed via endoscopic retrograde cholangiopanctreatography resulting in long-term control of symptoms and speculate that earlier intervention may alter the disease course.
Inappropriate Use of Nonculture Tests for the Detection of Chlamydia trachomatis in Suspected Victims of Child Sexual Abuse: A Continuing Problem
Authors: Hammerschlag Margaret R. , Ajl Stephen , Laraque Danielle
Published: August 2004

The introduction of nonculture tests for detection of Chlamydia trachomatis has revolutionized the management of chlamydial infections in sexually active adolescents and adults. However, these tests are insufficiently specific for use in genital and rectal sites in children; false-positive tests can be frequent. We report here 4 cases involving inappropriate use of nonculture tests in children in New York City during 1998. Two cases involved the use of enzyme immunoassays with vaginal specimens. In both cases the initial results were positive, however, cultures forC trachomatis performed later were negative. In the third case, the DNA probe test for C trachomatis was used. The fourth child was being evaluated for sexually transmitted diseases after rape. Although the pediatrician sent a rectal culture to a large commercial laboratory it was later determined that the laboratory was using an enzyme immunoassay for culture confirmation leading to a false-positive result. At the least the use of these inappropriate tests resulted in unnecessary retesting and at the worst, unnecessary hospitalization, erroneous reports of sexual abuse and possibly unjustified prosecution and incarceration. Because of the social and legal implications it is important that practitioners be aware of these recommendations and require that commercial laboratories adhere to approved C trachomatisculture methods.
Spinal Epidural Abscess in Preverbal Children: A Case Report With Currarino Triad
Authors: Liu Kenneth A. , Luhmann Jan D.
Published: August 2004

Spinal epidural abscess is rare in preverbal children and leads to permanent neurologic deficits if not treated promptly. Currarino triad (anorectal malformation, sacral bony abnormality and presacral mass) is also rare in children. We report the association of extensive spinal epidural abscess and Currarino triad in a young child.
The Treatment of Neurologically Impaired Children Using Patterning
Authors:   Committee on Children With Disabilities
Published: August 2004

This Policy Statement was retired December 2022.

This statement reviews patterning as a treatment for children with neurologic impairments. This treatment is based on an outmoded and oversimplified theory of brain development. Current information does not support the claims of proponents that this treatment is efficacious, and its use continues to be unwarranted.
Natural History of Human Immunodefiency Virus Type 1 Infection in Children: A Five-Year Prospective Study in Rwanda
Authors: Spira Rosemary , Lepage Philippe , Msellati Philippe , Van de Perre Philippe , Leroy Valeriane , Simonon Arlette , Karita Etienne , Dabis François ,   for the Mother-to-Child HIV-1 Transmission Study Group
Published: August 2004

Objective.

To compare morbidity and mortality of human immunodeficiency virus type 1 (HIV-1)-infected and HIV-1-uninfected children and to identify predictors of acquired immunodeficiency syndrome (AIDS) and death among HIV-1-infected children in the context of a developing country.

Design.

Prospective cohort study.

Setting.

Maternal and child health clinic of the Centre Hospitalier de Kigali, Rwanda.

Participants.

Two hundred eighteen children born to HIV-1-seropositive mothers and 218 born to seronegative mothers of the same age and parity were enrolled at birth.

Outcome Measures.

Deaths, clinical AIDS, nonspecific HIV-related manifestations, and use of health care services.

Results.

Fifty-four infected and 347 uninfected children were followed up for a median of 27 and 51 months, respectively. With the exception of chronic cough, the risk of occurrence of nonspecific HIV-related conditions was 3 to 13 times higher in infected than in uninfected children. The recurrence rate and severity of these findings were increased systematically in infected infants. Estimated cumulative risk of developing AIDS was 28% and 35% at 2 and 5 years of age, respectively. Estimated risk of death among infected children at 2 and 5 years of age was 45% and 62%, respectively, a rate 21 times higher than in uninfected children. Median survival time after estimated infection was 12.4 months. Early infection, early onset of HIV-related conditions, failure to thrive, and generalized lymphadenopathy were associated with subsequent risk of death and/or AIDS, whereas lymphoid interstitial pneumonitis was predictive of a milder disease.

Conclusions.

In Africa, HIV-1-infected children develop disease manifestations early in life. Specific clinical findings are predictive of HIV-1 disease, AIDS stage, and death. Bimodal expression of HIV-1 pediatric disease is encountered in Africa, as in industrialized countries, but prognosis is poorer. human immunodeficiency virus infection, children, vertical transmission, natural history, Africa.
Cost-Effective Use of Echocardiography in Children With Kawasaki Disease
Authors: Scott John S. , Ettedgui José A. , Neches William H.
Published: August 2004

Objective.

To determine whether a third echocardiogram, performed 6 months to 1 year after the onset of Kawasaki disease (KD), as recommended by current American Heart Association guidelines, identified any case of coronary artery abnormalities when previous echocardiograms were normal.

Methods.

Children diagnosed with KD were identified by searching our institution's database. Cases were included in the study if diagnosed between June 1988 and December 1996 and if at least two echocardiograms were documented, including at least one study between 2 weeks and 2 months from the onset of KD and another in follow-up. The patients' charts were reviewed and videotapes of the echocardiograms were reviewed if reports were unclear or contradictory. McNemar's test for discordant pairs was used for statistical analysis. Additionally, a complete review was performed in all other cases of KD in the database in which a coronary artery abnormality had been identified.

Results.

There were 203 patients diagnosed during the study period who had 2 or more echocardiograms performed, and 67 had the requisite studies in the subacute period and later follow-up. The median age at onset of KD was 3.0 years (range: 0.2–16), the median duration of follow-up was 12.5 months (range: 1.7–100), and the median number of echocardiograms performed was 3 (range: 2–8). Intravenous immunoglobulin was given in 62 cases, and high-dose aspirin was given in 63. There were 35 children with no echocardiographic abnormalities at any point, and 15 other children had early abnormalities (including coronary ectasia, perivascular brightness, pericardial effusion, and ventricular dysfunction) but had a normal echocardiogram between 2 weeks and 2 months. Of these 50 children, none were noted to have abnormalities on later studies. Three children had effusion and/or perivascular brightness after 2 weeks; follow-up studies were normal in each. Six children had coronary ectasia after 2 weeks; it persisted on follow-up in 1 child and had resolved in 5 children. Eight children had coronary aneurysms on studies after 2 weeks; in 3 children, the aneurysm resolved on later follow-up. No coronary abnormalities were demonstrated on a late follow-up echocardiogram in any child with normal coronaries between 2 weeks and 2 months.

Conclusions.

All children with KD should have an echocardiogram at the time of diagnosis with a follow-up study 4 to 6 weeks after the onset of fever. In the current environment of cost-containment, additional echocardiographic studies are justified only if abnormalities are present at 4 to 6 weeks. Kawasaki disease, coronary artery aneurysm, echocardiography, coronary ectasia.
Dexamethasone Therapy Increases Infection in Very Low Birth Weight Infants
Authors: Stoll Barbara J. , Temprosa Marinella , Tyson Jon E. , Papile Lu-Ann , Wright Linda L. , Bauer Charles R. , Donovan Edward F. , Korones Sheldon B. , Lemons James A. , Fanaroff Avroy A. , Stevenson David K. , Oh William , Ehrenkranz Richard A. , Shankaran Seetha , Verter Joel
Published: August 2004

Background.

Infection is a major complication of preterm infants, resulting in increased morbidity and mortality. We recently reported the results of a multicenter trial of dexamethasone initiated at 14 or 28 days in very low birth weight (VLBW) infants who were at risk for chronic lung disease; the results showed an increase in nosocomial bacteremia in the group receiving dexamethasone. This study is an in-depth analysis of bacteremia/sepsis and meningitis among infants enrolled in the trial.

Methods.

Data on cultures performed and antibiotic therapy were collected prospectively. Infections were classified as definite or possible/clinical.

Results.

A total of 371 infants were enrolled in the trial. There were no baseline differences in risk factors for infection. For the first 14 days of study, infants received either dexamethasone (group I, 182) or placebo (group II, 189). During this period, infants in group I were significantly more likely than those in group II to have a positive blood culture result (48% vs 30%) and definite bacteremia/sepsis/meningitis (22% vs 14%). Over the 6-week study period, 47% of those cultured had at least one positive blood culture result (53% in group I vs 41% in group II) and 25% of the infants had at least one episode of definite bacteremia/sepsis/meningitis (29% in group I vs 21% in group II). Among infants with definite infections, 46.8% were attributable to Gram-positive organisms, 26.6% to Gram-negative organisms and 26.6% to fungi. The factors present at randomization were evaluated for their association with infection. Group I assignment and H2blocker therapy (before study entry) were associated with increased risk of definite infection, whereas cesarean section delivery and increasing birth weight were associated with decreased risk.

Conclusions.

Infants who received a 14-day course of dexamethasone initiated at 2 weeks of age were more likely to develop a bloodstream or cerebrospinal fluid infection while on dexamethasone therapy than were those who received placebo. Physicians must consider this increased risk of infection when deciding whether to treat VLBW infants with dexamethasone.
Looking Beyond the Physical Injury: Posttraumatic Stress Disorder in Children and Parents After Pediatric Traffic Injury
Authors: de Vries Aiko P. J. , Kassam-Adams Nancy , Cnaan Avital , Sherman-Slate Elisabeth , Gallagher Paul R. , Winston Flaura K.
Published: August 2004

Background.

Traffic crashes are the leading health threat to children in the United States, resulting in nearly 1 million injuries annually. The psychological consequences of these injuries are primarily unknown. The aims of this study were to estimate the prevalence of posttraumatic stress disorder (PTSD) in traffic-injured children and their parents and to identify risk factors for PTSD development.

Methods.

A prospective cohort study of traffic-injured children between 3 and 18 years of age was conducted at a level 1 Pediatric Trauma Center. The children were enrolled as part of an ongoing surveillance system of traffic-related injuries. Presence and severity of PTSD were determined in the children and their parents through a validated diagnostic questionnaire 7 to 12 months after child injury.

Results.

Twenty-five percent of the children and 15% of the parents suffered diagnostic PTSD, but only 46% of the parents of affected children sought help of any form (including from friends) for their child and only 20% of affected parents sought help for themselves. Child PTSD was associated with older child age and parent PTSD. Parent PTSD was associated with younger child age, child PTSD, and parent witnessing the event. Injury severity was not predictive of PTSD.

Conclusions.

PTSD in children and their parents is a common, yet overlooked, consequence of pediatric traffic-related injury with prevalence rates similar to those found in children exposed to violence. Physicians managing the pediatric trauma patient, regardless of injury severity or whether the injury was intentional, should screen for PTSD and refer for treatment where appropriate.
Short-term Health and Economic Benefits of Smoking Cessation: Low Birth Weight
Authors: Lightwood James M. , Phibbs Ciaran S. , Glantz Stanton A.
Published: August 2004

Objectives.

To estimate excess direct medical costs of low birth weight from maternal smoking and short-term cost savings from smoking cessation programs before or during the first trimester of pregnancy.

Methods.

Simulations using data on neonatal costs per live birth. Outcome measures are mean US excess direct medical cost per live birth, total excess direct medical cost, reductions in low birth weight, and savings in medical costs from an annual 1 percentage point drop in smoking prevalence among pregnant women.

Results.

Mean average excess direct medical cost per live birth for each pregnant smoker (in 1995 dollars) was $511; total cost was $263 million. An annual drop of 1 percentage point in smoking prevalence would prevent 1300 low birth weight live births and save $21 million in direct medical costs in the first year of the program; it would prevent 57 200 low birth weight infants and save $572 million in direct medical costs in 7 years.

Conclusions.

Smoking cessation before the end of the first trimester produces significant cost savings from the prevention of low birth weight.
Tumor Necrosis Factor-α, Interleukin-1β, and Interleukin-6 Levels in Febrile, Young Children With and Without Occult Bacteremia
Authors: Strait Richard T. , Kelly Kevin J. , Kurup Viswanath P.
Published: August 2004

Objective.

To determine the utility of plasma levels of tumor necrosis factor-α (TNF), interleukin 1β (IL-1), and interleukin 6 (IL-6) in the prediction of occult bacteremia in febrile, young children.

Study Design.

Prospective, case-control study conducted in a large, urban, children's hospital emergency department. Eligibility criteria were: 0 to 36 months of age, febrile, nontoxic appearing, immunocompetent, no apparent bacterial source for fever on physical examination, and blood culture obtained. Additional blood, procured at the time of the blood culture, was analyzed by enzyme-linked immunosorbent assay for TNF, IL-1, and IL-6. Children with positive blood cultures for pathogenic bacteria served as cases. Two age-matched controls for each case were selected from the children with negative cultures.

Results.

Out of 1329 enrollees, 33 cases and 66 controls were evaluated. IL-6 levels were significantly higher for the cases than controls but with moderate overlap in their ranges. TNF and IL-1 levels were not significantly different between cases and controls. Height of fever, duration of fever, acute illness observation score, absolute band count, and white blood cell count were all much less predictive of bacteremia than either IL-6 or absolute neutrophil count (ANC). The optimum IL-6 threshold value had a sensitivity of 88%, a specificity of 70%, a positive predictive value (PPV) of 7.0%, a negative predictive value (NPV) of 99.6%, and an odds ratio (OR) of 16.7 (95% confidence interval [CI], 4.8–71.6). The optimum ANC threshold value had a sensitivity of 82%, a specificity of 74%, a PPV of 7.5%, a NPV of 99.4%, and an OR of 12.8 (95% CI, 3.2–59.7). The best predictor was a combination of IL-6 and ANC. It had a sensitivity of 100%, a specificity of 78%, a PPV of 10.4%, a NPV of 100%, and an OR which is undefined because of the 100% sensitivity (95% CI, 33.0-∞). For comparison, a WBC >15 × 109 cells/L had a sensitivity of 48%, a specificity of 79%, a PPV of 5.5%, a NPV of 98.3%, and an OR of 3.5 (95% CI, 1.1–10.7).

Conclusions.

In febrile children 0 to 36 months of age, IL-6 levels may be helpful in the prediction of occult bacteremia, but TNF and IL-1 levels are not. IL-6 levels alone or notably when combined with an ANC were more predictive of occult bacteremia than traditional tests and clinical criteria. The wide range in the IL-6 values for cases and controls detracts from the precision of the findings. The lack of rapid processing and clinical availability of IL-6 assays hampers its present application. However, despite these drawbacks and given the poor ability of traditional clinical and laboratory criteria to predict occult bacteremia, these results suggest a possible future role for IL-6 in predicting occult bacteremia when rapid assays become available.
Wood's Lamp Utility in the Identification of Semen
Authors: Santucci Karen A. , Nelson David G. , McQuillen Kemedy K. , Duffy Susan J. , Linakis James G.
Published: August 2004

Background.

The accurate detection of semen is critical to forensic, medical, and legal personnel. The Wood's lamp (WL) emits ultraviolet light (UVL) and has been identified as useful in rape evaluations because it is purported to cause semen to fluoresce. This study was intended to determine if semen can be distinguished from other products by WL analysis.

Methods.

Investigators reviewed the previous training and frequency of use of the WL by emergency medicine and pediatric emergency medicine physicians at 2 medical centers. The participants were asked to use a WL to distinguish between a semen sample (<6 hours old) and 13 commonly used products. Next, 29 semen samples were collected and evaluated under high-power microscopy and under UVL.

Results.

A total of 41 physicians participated in the study (68% male). The number of years practicing in an emergency setting spanned from .3 to 25 years with a mean of 7.1 years. A total of 51% of participants trained in emergency medicine, 23% in pediatrics and pediatric emergency medicine. A total of 22% reported formal training in the collection of forensic evidence. A total of 62% of the physicians believed they have identified semen in the past; one third felt they could differentiate semen from other products under UVL. None of the 41 physicians were able to differentiate semen from other products using a WL. Moreover, the semen samples used for the study did not fluoresce under WL analysis. None of the 29 semen samples fluoresced whether wet or dry. The medicaments most commonly mistaken for semen were A&D ointment (Cardinal Health, Inc, Dublin, OH), Surgilube (Division of Atlanta, Inc, Melville, NY), Barrier cream (Carrington Laboratories, Inc, Irving, TX), and bacitracin (Division of Atlanta, Inc, Melville, NY).

Conclusions.

Participating physicians were unable to distinguish between semen and other common products, using the WL. Although the WL has been purported to be a useful tool as a screening device for the detection of seminal stains, the investigators have found it to be unreliable. Semen, previously reported to fluoresce under WL analysis, does not appear to do so. The correct identification of semen may be complicated by the presence of previously existing ointments and creams, some of which may be iatrogenically introduced (ie, Surgilube).
Risk Factors for Chronic Lung Disease in the Surfactant Era: A North Carolina Population-based Study of Very Low Birth Weight Infants
Authors: Marshall Diane D. , Kotelchuck Milton , Young Thomas E. , Bose Carl L. , Kruyer Lauree , O'Shea T. Michael ,   the North Carolina Neonatologists Association
Published: August 2004

Objective.

To identify risk factors for chronic lung disease (CLD) in a population-based cohort of very low birth weight infants, born in an era of surfactant usage. We specifically investigated the effects of antenatal steroids, nosocomial infection, patent ductus arteriosus (PDA), fluid management, and ventilator support strategies.

Methods.

Data were prospectively collected on 1244 infants born in North Carolina in 1994 with birth weights 500 to 1500 g, and treated at 1 of the 13 intensive care nurseries across the state. The outcome of interest was CLD, defined as dependency on supplemental oxygen at 36 weeks' postmenstrual age. Multivariate odds ratios (OR) and 95% confidence intervals (CI) were estimated with logistic regression models.

Results.

Among 865 survivors to 36 weeks' postmenstrual age, 224 (26%) had CLD. Nosocomial infection (OR: 2.0; 95% CI: 1.4–3.3), fluid intake on day 2 (OR: 1.06 per 10 mL increase; 95% CI: 1.01–1.11), and the need for ventilation at 48 hours of life (OR: 2.2; 95% CI: 1.3–3.7) were associated with an increased risk of CLD. Among infants ventilated at 48 hours, nosocomial infection (OR: 1.64; 95% CI: 1.02–2.62) and PDA (OR: 1.9; 95% CI: 1.2–3.1) were associated with an increased risk. No association was found with antenatal steroid receipt or increased levels of ventilator support.

Conclusion.

This analysis suggests that with widespread use of surfactant, nosocomial infection, PDA, and water balance persist as risk factors for CLD.
Persistence of Dyslexia: The Connecticut Longitudinal Study at Adolescence
Authors: Shaywitz Sally E. , Fletcher Jack M. , Holahan John M. , Shneider Abigail E. , Marchione Karen E. , Stuebing Karla K. , Francis David J. , Pugh Kenneth R. , Shaywitz Bennett A.
Published: August 2004

Objective.

The outcome in adolescence of children diagnosed as dyslexic during the early years of school was examined in children prospectively identified in childhood and continuously followed to young adulthood. This sample offers a unique opportunity to investigate a prospectively identified sample of adolescents for whom there is no question of the childhood diagnosis and in whom highly analytic measures of reading and language can be administered in adolescence.

Design.

Children were recruited from the Connecticut Longitudinal Study, a cohort of 445 children representative of those children entering public kindergarten in Connecticut in 1983. Two groups were selected when the children were in grade 9: children who met criteria for persistent reading disability in grades 2 through 6 (persistently poor readers [PPR]; n = 21) and a comparison group of nondisabled children, subdivided into average readers (n = 35) and superior readers (n = 39). In grade 9, each child received a comprehensive assessment of academic, language, and other cognitive skills.

Results.

Measures of phonological awareness (but not orthographic awareness) were most significant in differentiating the 3 reading groups, with smaller contributions from measures of word finding and digit-span. Academic measures that best separated good from poor readers were decoding and spelling, whereas measures of math and reading comprehension did not. Measures of phonological awareness, followed next by teacher rating of academic skills were the best predictors of decoding, reading rate, and reading accuracy. In contrast, the best predictor of reading comprehension was word finding, with digit span and socioeconomic status also contributing significantly. Using a growth curve model (quadratic model of growth to a plateau) all 3 groups demonstrated similar patterns of growth over time, with the superior group outperforming the average group, and the average group outperforming the PPR group. There was no evidence that the children in the PPR group catch up in their reading skills.

Conclusions.

Deficits in phonological coding continue to characterize dyslexic readers even in adolescence; performance on phonological processing measures contributes most to discriminating dyslexic and average readers, and average and superior readers as well. These data support and extend the findings of previous investigators indicating the continuing contribution of phonological processing to decoding words, reading rate, and accuracy and spelling. Children with dyslexia neither spontaneously remit nor do they demonstrate a lag mechanism for catching up in the development of reading skills. In adolescents, the rate of reading as well as facility with spelling may be most useful clinically in differentiating average from poor readers.
Previously Healthy Infants May Have Increased Risk of Aspiration During Respiratory Syncytial Viral Bronchiolitis
Authors: Khoshoo Vikram , Edell Dean
Published: August 2004

Objective.

Respiratory illnesses may cause feeding difficulties in infants. We studied the safety of oral feeding during respiratory syncytial viral (RSV) bronchiolitis in previously healthy infants.

Methods.

Twelve previously healthy infants (3–12 months) with RSV bronchiolitis underwent barium swallow studies during the acute phase of illness. Those with abnormal studies underwent repeat studies 2 to 4 weeks later.

Results.

The initial barium studies revealed aspiration in 3 infants. All repeat studies, performed 2 to 4 weeks later, were normal.

Conclusions.

Even previously healthy infants may be at risk of aspiration during RSV bronchiolitis.
Prevention of Poliomyelitis: Recommendations for Use of Only Inactivated Poliovirus Vaccine for Routine Immunization
Authors:   Committee on Infectious Diseases
Published: August 2004

This Policy Statement was retired October 2003.

Since 1997, when the American Academy of Pediatrics (AAP) initially recommended expanded use of inactivated poliovirus vaccine (IPV) for routine childhood immunization against poliovirus infection, the occurrence of vaccine-associated paralytic poliomyelitis (VAPP) has decreased in the United States. However, VAPP will not be eliminated until oral poliovirus vaccine (OPV) no longer is given. As a result of continuing progress toward global eradication of poliomyelitis, the risk of imported infection has continued to decrease. Concomitantly, the use of IPV has increased substantially with the corresponding decrease in the use of OPV, indicating widespread acceptance by health care professionals and parents of the sequential or all-IPV immunization schedule previously recommended by the AAP. In addition, availability of OPV will be substantially diminished beginning in early 2000. To eliminate VAPP in the context of decreasing risk of wild-type poliovirus importation, the AAP recommends an all-IPV schedule for routine childhood immunization beginning in early 2000. The AAP further recommends that, effective immediately, OPV no longer should be purchased for routine use. Guidelines are given for utilization of remaining supplies of OPV during the transition in early 2000 to the all-IPV schedule.