bluuebunny/crossref_metadata_2025 huggingface dataset:
Twenty Years of Outpatient Respiratory Syncytial Virus Infection: A Framework for Vaccine Efficacy Trials
Authors: Fisher Randall G. , Gruber William C. , Edwards Kathryn M. , Reed George W. , Tollefson Sharon J. , Thompson Juliette M. , Wright Peter F.
Published: August 2004

Background. Respiratory syncytial virus (RSV) is the most important viral respiratory pathogen of infancy and childhood. Much has been written about inpatients with severe disease. Inpatients, however, represent only a minority of RSV-infected children. We studied the characteristics of symptomatic outpatient RSV infection in healthy children to gain a better understanding of RSV disease and to provide a background for the testing of intervention strategies in children without high-risk conditions.

Methods. A total of 1113 children were followed during 20 consecutive RSV seasons. Signs and symptoms of respiratory infection were monitored. Cultures were obtained for febrile upper respiratory infection, acute otitis media, and lower respiratory infection (LRI). Rates of febrile upper respiratory infection, acute otitis media, LRI, and hospitalization were calculated. Given those rates, numbers of children needed to demonstrate efficacy of a vaccine product were calculated.

Results. Mild disease from RSV infection lacked some of the classic features of RSV infection seen in hospitalized children. Involvement of the lower respiratory tract was, however, noted to be much higher in RSV infection than it was in infection with other viral respiratory pathogens. LRI was, therefore, considered the best candidate endpoint for vaccine trials. A product with 60% efficacy could be proven, with a power of 0.8, to be efficacious with as few as 1500 infants.

Conclusions. RSV infection is common and often involves the lower respiratory tract, even in outpatients. Our 20-year study of RSV infection provides a basis for calculation of sample sizes to be used in trials of vaccine candidates. respiratory syncytial virus, outpatient, epidemiology, vaccine, bronchiolitis.
Pediatric Injury Resulting From Family Violence
Authors: Christian Cindy W. , Scribano Philip , Seidl Toni , Pinto-Martin Jennifer A.
Published: August 2004

Objective. Children who live in violent households are at risk for emotional and physical injury. Although recent research has addressed the emotional impact of witnessing family violence, no study has addressed the inadvertent physical injuries that result to children who witness family violence. The objective of this study was to describe the causes, types, and patterns of pediatric injuries resulting from family violence.

Methods. We reviewed the medical records of 139 children who presented to the emergency department with injuries resulting from domestic violence for demographic information, mechanism of injury, type, location, and severity of injury, treatment, and disposition.

Results. Children who were injured during domestic violence ranged in age from 2 weeks to 17 years. Although the mean age of the children identified was 5 years, 48% of the children were younger than 2 years. Although the most common dyad involved in the fight was the mother and father (57% of cases), extended family members and nonrelated adults were involved in almost one third of the cases. The most common mechanism of injury was a direct hit (36%). Of the injured children who were younger than 2 years, 59% were injured while being held by parents. Thirty-nine percent of the children were injured during attempts to intervene in fights. The majority of injuries were to the head (25%), face (19%), and eyes (18%). Young children sustained more head and facial injuries than older children, who had disproportionately more extremity trauma. Medical intervention was indicated in 43% of patients, of which 9% required hospital admission and 2% required surgical or intensive care intervention. Of the 91% of children discharged from the emergency department, 73% returned home, and 27% went to alternative homes.

Conclusions. Children sustain a wide range of physical injuries from family violence. Because the majority of injuries are minor, specific inquiry into the causes of all pediatric injuries may help further identify children living among family violence. domestic violence, child abuse, family violence, physical injury.
Australian Collaborative Trial of Antenatal Thyrotropin-Releasing Hormone: Adverse Effects at 12-Month Follow-up
Authors: Crowther Caroline Anne , Hiller Janet Esther , Haslam Ross Roger , Robinson Jeffrey Samuel ,   the ACTOBAT Study Group
Published: August 2004

Objective. The Australian Collaborative Trial of Antenatal Thyrotropin-Releasing Hormone (ACTOBAT) assessed the efficacy of 200 μg of thyrotropin-releasing hormone (TRH) in combination with glucocorticoids in the prevention of neonatal lung disease.1 This paper reports the 12-month follow-up of the infants from the trial completed in 1994.

Design. This was a double-blinded randomized controlled trial.

Setting. Women were recruited from level 3 perinatal centers throughout Australia.

Participants. Mothers who had not withdrawn from treatment and whose infants were discharged alive (1262 infants). Extensive efforts were made to trace this entire cohort.

Outcome Measures. A questionnaire was mailed to parents for self-completion immediately before their baby's/babies' first birthday. The questionnaire included a checklist to assess sensory, motor, language, and social development, and use of health services.

Results.  Milestone scores were developed from items on the follow-up form. Treatment with TRH was associated with an increased risk of motor delay, social delay, fine motor delay, sensory impairment, and early language impairment. No differences were seen between treatment and placebo groups for motor impairment.

Multivariate analyses were performed, adjusting for chronological age, duration of gestation at randomization, time from randomization to delivery, parity, history of perinatal death, history of preterm rupture of the membranes, infant sex, singleton or twin status, maternal age, and maternal blood pressure (systolic and diastolic) at randomization. For the total cohort (N = 1022), treatment with TRH was associated with motor delay (odds ratio [OR], 1.51; 95% confidence interval [CI] 1.11 to 2.05); social delay (OR 1.40; 95% CI 1.01 to 1.95); sensory impairment (OR, 2.00; 95% CI 1.06 to 3.74); severe impairment (OR, 1.75; 95% CI 1.07 to 2.87); and a trend toward motor impairment (OR, 1.50; 95% CI .97 to 2.33), early language impairment (OR, 1.27, 95% CI .90 to 1.79), and fine motor delay (OR, 1.15; 95% CI .83 to 1.60).

There were no differences between the treatment groups in hospital admissions (OR, 1.08; 95% CI .83 to 1.42), doctors' visits (general practitioner OR adj, 1.09; 95% CI .79 to 1.50 or specialist OR adj 1.15; 95% CI .87 to 1.49), respiratory symptoms (OR adj, 1.16; 95% CI .88 to 1.53), or behavioral disturbances (OR adj, .93; 95% CI .71 to 1.21).

Conclusions. Because antenatal administration of TRH is associated with small, consistent deficits in major milestone achievements at 12 months of age, it is essential that additional planned trials make provision for long-term follow-up. Antenatal TRH should only be used in the context of a clinical trial.
Tubefeeding and Mortality in Children With Severe Disabilities and Mental Retardation
Authors: Strauss David , Kastner Theodore , Ashwal Stephen , White James
Published: August 2004

Objective. To study the contribution of tubefeeding to mortality for children with severe disabilities and mental retardation. Previous research has suggested an association between tubefeeding and mortality. However, risk has never been determined using population-based data or defined in regard to patient variables.

Methods. Retrospective analysis of a comprehensive statewide data set comprised of 4921 children with severe disabilities and mental retardation living in community and congregate care settings. The outcome measure was mortality; primary study variables included the presence of a feeding tube, measures of functional independence, type of residence, and medical comorbidity.

Results. There were four findings. First, the use of a feeding tube was associated with virtually every disability. Second, when no study variables were controlled, statistically significant differences in mortality rates were noted between children who were tubefed and those who were not. The relative risk of mortality associated with use of a feeding tube was 2.1. Third, the use of a feeding tube was associated with a reduction in relative risk of mortality in children with tracheostomy (relative risk of mortality: .55). However, this association did not achieve statistical significance. Fourth, when study variables were controlled in a multivariate analysis, feeding tube use was associated with no identifiable increase in mortality among children with very severe disabilities, but was associated with an approximated doubled mortality rate among those with less severe disabilities.

Conclusions. We hypothesize that the increased mortality associated with tubefeeding may be attributable to a differential increase in pulmonary disease secondary to overly vigorous nutritional maintenance and subsequent aspiration after tube placement. For children with tracheostomy this risk may be reduced. If tracheostomy proves to be associated with a relatively more favorable outcome for tubefeeding, we hypothesize that it would reflect the benefits of tracheostomy in allowing access to the airway for suctioning and ventilation. Given the observed higher mortality rates among the less severely disabled children who are tubefed and the substantial costs associated with tubefeeding, a prospective, controlled study may be clinically indicated, ethically justifiable, and economically warranted.
Epidemiology of Choanal Atresia With Special Reference to the CHARGE Association
Authors: Harris John , Robert Elisabeth , Källén Bengt
Published: August 2004

Objective. To present epidemiologic data on the relatively rare malformation choanal atresia, based on a large collection of material and with special stress on the significance of the so-called CHARGE (coloboma, heart defect, choanal atresia, retarded growth and development, genital anomaly, and ear defect with deafness) association.

Methods. Data from three large registries of congenital malformations were used. Based on more than 5 million births, 444 infants with choanal atresia were identified.

Results. The average rate of choanal atresia is 0.82 per 10 000 and varies among programs. There is no statistically significant difference between races in rates, even though white infants have a higher rate than those of other races. The higher rate found in the California program is mainly attributable to unilateral, isolated cases. Unilateral atresia occurs equally often on the right and left. Among all cases of choanal atresia, the sex distribution is normal, a slightly increased risk at twinning exists, and no effect of maternal age or parity is seen. Chromosome anomalies are found in 6% of infants with choanal atresia, and 21 infants (5%) have monogenic syndromes or conditions. An analysis of associated malformations (present in 47% of the infants without chromosome anomalies) indicated that although a weak nonrandom association can be demonstrated between the malformations entering the so-called CHARGE complex, only a small proportion of infants with choanal atresia and other components of that condition probably represent this entity. The term CHARGE association seems to be overused in clinical practice.

Conclusion. To be meaningful, the term CHARGE should be restricted to infants with multiple malformations and choanal atresia and/or coloboma combined with other cardinal malformations (heart, ear, and genital) and with a total of at least three cardinal malformations. Growth retardation should not be used in the definition.
Coagulopathy in Pediatric Abusive Head Trauma
Authors: Hymel Kent P. , Abshire Thomas C. , Luckey Dennis W. , Jenny Carole
Published: August 2004

Objectives. Coagulopathy is a potential complication of head trauma that may be attributable to parenchymal brain damage. The objectives of this study were to assess the frequency of coagulation defects in pediatric abusivehead trauma and to analyze their relationship to parenchymal brain damage.

Methods. We reviewed the records of 265 pediatric patients hospitalized for head trauma. One hundred forty-seven patients met study inclusion criteria: (1) radiologic evidence of head trauma, (2) multidisciplinary validation that head trauma had been inflicted, and (3) coagulation screening performed within 2 days of presentation. Using nonparametric analysis, initial coagulation test results were compared between study patients without parenchymal brain damage and those with parenchymal brain damage.

Results. Mild prothrombin time (PT) prolongations (median 13.1) occurred in 54% of study patients with parenchymal brain damage and only 20% of study patients withoutparenchymal brain damage. Among pediatric abusive head trauma patients with parenchymal brain damage who died, 94% displayed PT prolongations (median 16.3) and 63% manifested evidence of activated coagulation.

Conclusions. PT prolongation and activated coagulation are common complications of pediatric abusive head trauma. In the presence of parenchymal brain damage, it is highly unlikely that these coagulation abnormalities reflect a preexisting hemorrhagic diathesis. These conclusions have diagnostic, prognostic, and legal significance.
Patterns of Cognitive Development in Very Low Birth Weight Children During the First Six Years of Life
Authors: Koller Helene , Lawson Katharine , Rose Susan A. , Wallace Ina , McCarton Cecelia
Published: August 2004

Background. Cognitive development in very low birth weight (VLBW, ≤1500 g) infants typically has been reported based on mean endpoints in cross-sectional studies. These overall group means mask individual patterns of cognitive development. Given the heterogeneity of VLBW infants, it is important to identify individual patterns of development and the factors associated with the different patterns.

Objective. We sought to determine individual patterns of cognitive development over the first 6 years in VLBW children and to examine the relative influence of selected biomedical and sociodemographic factors on these patterns.

Method. VLBW infants (N = 203) were followed from birth to six years. Cognitive scores were obtained at four yearly intervals, and biomedical and social data were obtained beginning with the neonatal period. Cluster analysis was used to identify individual patterns of cognitive development.

Results. Five developmental patterns were identified: average–stable (13% of the sample); average–declined to low average (24% of the sample); average–declined to below average (43% of the sample); very low–increased to low average (8% of the sample); and very low–stable (12% of the sample). The patterns could be differentiated by several biomedical factors, including birth weight, gestational age, neonatal health, and 1-year assessments of neurological status and head circumference, as well as by level of maternal education. In particular, abnormal neurological status at 1 year was associated with a pattern of very low stable scores, and a suspicious status was associated with a pattern of improving cognitive development. Maternal education was influential among children born at the upper end of the VLBW range, who had a more favorable set of biomedical factors.

Conclusions. Biomedical factors are of major importance for the cognitive development of VLBW infants, and their influence increases as birth weight declines. Differences in neurological integrity at 1 year were an important indicator of different patterns of cognitive development, especially for infants at the lower end of the VLBW range.
Neuroradiographic Findings in the Newborn Period and Long-term Outcome in Children With Symptomatic Congenital Cytomegalovirus Infection
Authors: Boppana Suresh B. , Fowler Karen B. , Vaid Yoginder , Hedlund Gary , Stagno Sergio , Britt William J. , Pass Robert F.
Published: August 2004

Objective. To determine whether newborn cranial computed tomographic (CT) scan abnormalities predict an adverse neurodevelopmental outcome in children with symptomatic congenital cytomegalovirus (CMV) infection and to examine the association between clinical findings at birth and imaging abnormalities.

Methods. The data from 56 children with symptomatic congenital CMV infection who underwent cranial CT scans as newborns and were enrolled in a long-term follow-up study were analyzed. The incidence of sequelae was compared between the groups of children with normal and abnormal imaging studies. The relationship between CT scan results and other newborn findings was also examined.

Results. Abnormal CT scans were noted in 70% of subjects; intracerebral calcification was the most frequent finding. Most of the children with an abnormal newborn CT scan (90%) developed at least one sequela, compared with 29% of those with a normal study. Only 1 child with a normal CT scan had an IQ <70, in contrast to 59% of those with imaging abnormalities. In addition, almost half of the children with CT abnormalities had an IQ <50 compared with none of those with a normal CT scan. Newborn CT abnormalities were also associated with an abnormal hearing screen at birth and hearing loss on follow-up. None of the neonatal neurologic findings were predictive of an abnormal CT scan.

Conclusion. In neonates with symptomatic congenital CMV infection, a cranial CT scan is a good predictor of an adverse neurodevelopmental outcome. In addition, newborn clinical and laboratory findings did not predict neuroradiographic abnormalities in neonates with symptomatic congenital CMV infection.
Promoting Mealtime Communication Between Adolescent Mothers and Their Infants Through Videotape
Authors: Black Maureen M. , Teti Laureen O.
Published: August 2004

Objective. To use social learning theory to develop and examine the effectiveness of a 15-minute, culturally sensitive videotape in altering mealtime communication and attitudes among African-American adolescent mothers.

Design. Randomized clinical trial with baseline and follow-up evaluations.

Setting. High schools, WIC (Women, Infants, and Children) Clinics, and Family Support Centers serving low-income families.

Participants. Fifty-nine first-time, African-American adolescent mothers of infants.

Intervention. Intervention group viewed and received a copy of a videotape titled “Feeding Your Baby With Love.” The messages, title, music, and setting were designed by an advisory group of six African-American adolescent mothers who were filmed feeding their infants in their homes.

Measurements and Results. During baseline and follow-up evaluations, mothers were videotaped feeding their baby and completed a questionnaire on attitudes toward mealtime behavior. Analysis of covariance with repeated measures indicated changes in both behavior and attitudes. At follow-up, intervention mothers were more involved with their infant and reported more favorable attitudes toward feeding and communication than control mothers.

Conclusions. Brief culturally sensitive videotapes may be effective strategies to promote parenting skills and to prevent social and health problems among adolescents.
Revised Guidelines for Prevention of Early-onset Group B Streptococcal (GBS) Infection
Authors:   Committee on Infectious Diseases and Committee on Fetus and Newborn
Published: August 2004

This Policy Statement was retired October 2002.

In 1992, the Committee on Infectious Diseases and Committee on Fetus and Newborn of the American Academy of Pediatrics provided guidelines for prevention of early-onset group B streptococcal (GBS) disease through intrapartum chemoprophylaxis of selected maternal GBS carriers.1 The guidelines were based on demonstrated efficacy in randomized, controlled clinical trials and selected only women with GBS colonization who had an obstetric risk factor.2 The guidelines were controversial34and their implementation incomplete.5 Since 1992, additional data have become available, and experience with the guidelines has been gained in numerous medical centers. Recently, consensus guidelines were developed by obstetricians, pediatricians, family practitioners, and public health authorities and published by the Centers for Disease Control and Prevention.6 These recommendations are supported by the American College of Obstetricians and Gynecologists7 and the American Academy of Pediatrics. This statement reviews the selection of pregnant women for chemoprophylaxis and provides an algorithm for management of their newborns.
Childhood Burn Injuries Related to Gasoline Can Home Storage
Authors: Kennedy Christopher S. , Knapp Jane F.
Published: August 2004

Objective. To examine the risks associated with home storage of gasoline and to outline prevention strategies to avoid further injury and death.

Design. Case series.

Patients and Other Participants. Twenty-five patients less than 6 years old were selected for study (3 by presentation to a tertiary care Children’s Hospital Emergency Department, and 22 from the National Electronic Injury Surveillance System Data during the same calendar year).

Main Outcome Measures. Data collected included child’s age; burn injury, either percent body surface area or minor, moderate, or major burn classification; mortality; circumstances related to ignition of gasoline, such as behaviors, and if can was opened or closed; and flame source.

Results. Boys were involved in 95% of cases. Mean age was 2.7 years. The source of ignition was a pilot light in 100% of cases. Forty-four percent of patients died. Only vapors were ignited in 56% of cases. The gasoline can was described as closed in 64% of cases.

Conclusion. Gasoline is dangerous. The rectangular red metal gasoline can is not safe either. National building codes and can specifications are needed to prevent serious injury and deaths among young children. gasoline storage, pediatric burn injuries, fire safety.
Clinical Features and Virological Findings in Children With Primary Human Herpesvirus 7 Infection
Authors: Suga Sadao , Yoshikawa Tetsushi , Nagai Takao , Asano Yoshizo
Published: August 2004

Objective. To elucidate clinical features of patients with primary human herpesvirus 7 (HHV-7) infection and serologic and virologic findings between HHV-7 and human herpesvirus 6 (HHV-6).

Materials and Methods. During a 19-month observation period, 71 infants and children (35 boys and 36 girls with a mean age of 14.5 months [range, 1 month to 48 months]) who had acute febrile respiratory illness with or without skin rash were examined clinically and virologically. Heparinized blood samples were used for isolation of HHV-6 and HHV-7 and detection of both virus DNA sequences by a nested polymerase chain reaction amplification. Both virus antibody activities were measured by an indirect immunofluorescent assay.

Results. HHV-7 infection was observed in 15 (6 boys and 9 girls with a mean age of 12.9 months [range, 7 months to 27 months]), 1 of 10 with upper respiratory infection and 14 (28%) of 50 with febrile exanthem, whereas HHV-6 infection was in 22 (44%) of the 50. Fever (37.5°C) was observed in all 15, with an average maximum body temperature of 38.7°C (range, 37.6°C to 39.8°C), which persisted for 2.9 days (range, 1 to 5 days). Papular, macular, or maculopapular rash was observed in 14 (93%) of the 15, which appeared on day 2.9 of fever (range, days 2 to 5) on the face, trunk, and extremities and persisted for 2.7 days (range, 1 to 5 days). A convulsive seizure that persisted for a few minutes developed in 1 patient on the first day of elevation of fever. HHV-6 antibody was demonstrated in 13 (87%), and a simultaneous significant increase to HHV-6 antibody titers was observed in 8 (53%) of the 15 during primary HHV-7 infection. HHV-7 and HHV-6 DNAs were almost always detected in mononuclear cells (MNCs) during acute and convalescent phases, whereas HHV-7 DNA was positive in some plasma samples obtained during the acute phase of the disease.

Conclusions. Primary HHV-7 infection occurred somewhat later than HHV-6, which was confirmed by the isolation of HHV-7 from blood and/or seroconversion to the virus. Clinical features of a virologically confirmed patient with primary HHV-7 infection were comparable with those of primary HHV-6 infection. Preexisting HHV-6 antibody increased significantly in the half of patients with primary HHV-7 infection. HHV-7 DNA was detected in peripheral blood MNCs and plasma in the acute phase and persisted in MNCs thereafter. human herpesvirus 7, human herpesvirus 6, exanthem subitum, roseola infantum, polymerase chain reaction.
Juvenile Delinquency and Adolescent Trauma: How Strong Is the Connection?
Authors: Conseur Amy , Rivara Frederick P. , Emanuel Irvin
Published: August 2004

Objectives. To determine whether youth convicted of juvenile offenses have a greater risk of injury resulting in hospitalization compared with nonoffending adolescents.

Design. A statewide hospital discharge database was linked to juvenile justice records to identify all hospitalizations occurring at ages 13 to 17 years for juvenile offenders and nonoffenders.

Subjects. Juvenile offenders and nonoffenders in Washington State during 1989 through 1992.

Main Outcome Measures. Incidence of hospitalizations attributable to injury, analyzed by cause of injury and intent.

Results. The prevalence of delinquency was 19.1% of male and 9.5% of female adolescents. Hospitalization for injury was 2.7-fold greater for male and 1.6-fold greater for female offenders compared with nonoffenders. The greatest risk of hospitalization was for intentional injury, especially that attributable to firearms, and for drug overdoses.

Conclusions. Juvenile offenders are much more likely to be hospitalized for an injury than nonoffenders. Admission to the hospital for trauma may serve as an opportunity for health providers to intervene with youth exhibiting high-risk behavior. delinquency, injuries, trauma, hospitalization.
PICNIC (Pediatric Investigators Collaborative Network on Infections in Canada) Study of the Role of Age and Respiratory Syncytial Virus Neutralizing Antibody on Respiratory Syncytial Virus Illness in Patients With Underlying Heart or Lung Disease
Authors: Wang Elaine E. L. , Law Barbara J. , Robinson Joan L. , Dobson Simon , al Jumaah Suliman , Stephens Derek , Boucher François D. , McDonald Jane , Mitchell Ian , MacDonald Noni E.
Published: August 2004

Objective. To determine the effects of age and respiratory syncytial virus (RSV) antibody status on frequency and severity of RSV infections in children with underlying heart or lung disease.

Design. Cohort study conducted during two consecutive RSV seasons.

Setting. Ambulatory patients at eight Canadian pediatric tertiary care centers.

Methods. Subjects under 3 years old with underlying heart disease who were digoxin-dependent or had not received corrective cardiac surgery or with underlying lung disease were enrolled. Demographic information and an acute sera for RSV neutralizing antibody was obtained on enrollment. Weekly telephone follow-up consisting of a respiratory illness questionnaire was followed with a home visit to obtain a nasopharyngeal aspirate when there was new onset of respiratory symptoms. The specimen was used to detect RSV antigen. RSV illnesses were grouped as upper or lower respiratory tract infection (LRI) based on clinical and radiographic findings. RSV hospitalizations were considered to be those RSV infections that resulted in hospitalization.

Results. Of 427 enrolled subjects, 160 had underlying lung disease only, 253 had underlying heart disease only, and 14 had both. Eleven percent and 12% of lung and heart disease groups, respectively, had an RSV LRI. Three percent and 6% of lung and heart disease groups, respectively, were hospitalized with RSV infection. A significant decrease in frequency of RSV LRI and RSV hospitalization occurred with increasing age, with a major drop in those older than 1 year vs those younger than 1 year. Acute sera were available from 422 subjects. Geometric mean RSV antibody titers demonstrated a U-shaped distribution with increasing age. The trend to lower antibody concentrations in premature infants did not reach statistical significance. The frequency of RSV infection and RSV LRI was lower in patients with antibody at a titer more than 100, although the difference for RSV hospitalization was not statistically significant. These differences remained significant after age adjustment.

Conclusion. Both age and RSV antibody status impact on RSV illness and LRI. Reduction in illness frequency with increasing age may lead to more informed targeting of those children most likely to benefit from RSV immune globulin prophylaxis. respiratory syncytial virus, cohort study, passive prophylaxis, neutralizing antibody.
Outcomes of Annual Tuberculosis Screening by Mantoux Test in Children Considered to be at High Risk: Results From One Urban Clinic
Authors: Serwint Janet R. , Hall Barbara S. , Baldwin Robert M. , Virden Jane M.
Published: August 2004

Background. In January 1994, the American Academy of Pediatrics recommended that annual screening with the purified protein derivative tuberculin skin test, Mantoux method, be used for tuberculosis screening in high-risk children. This test has a better sensitivity and specificity than the previously used multiple puncture test, and patients need to return for a reading done by palpation by a health care professional.

Objective. To estimate the prevalence of reactivity to purified protein derivative tuberculin in an urban primary care clinic whose patients meet high-risk criteria and to determine if annual screening is warranted, to determine the adherence to return to the clinic for reading of the skin test, and to describe the characteristics of patients who have tuberculosis infection and disease.

Research Design. Cross-sectional study.

Setting. Inner-city, hospital-based primary care pediatric clinic in Baltimore, MD.

Subjects. A total of 1433 consecutive children attending this clinic from March through September, 1994, who were at risk for tuberculosis because of frequent exposure to poor and medically indigent city dwellers.

Methods. The Mantoux test (5TU intradermal injection of purified protein derivative) was administered to children at annual health supervision visits. Patients were tracked to determine those who returned for a reading by a health care professional and find those with a positive Mantoux test. The charts of children with a positive test were reviewed.

Results. Five hundred seventy-three (40%) patients returned for a reading by a health care professional. Five patients had a positive Mantoux test, giving a prevalence rate of 0.8% of reactivity to purified protein derivative tuberculin. One child with a positive Mantoux test also had chest radiograph findings consistent with tuberculosis disease but was asymptomatic.

Conclusions. In our city with a low prevalence of disease, children whose only risk factor for tuberculosis was exposure to poor and medically indigent city dwellers did not represent a high-risk group. Our results are supportive of the 1996 American Academy of Pediatrics screening statement that annual screening is not warranted. Sixty percent of children did not return for a reading of the Mantoux test by a health care professional. Alternative strategies that are more convenient for parents are needed to obtain accurate readings by health care professionals when skin testing is deemed necessary.
Immunogenicity of Hepatitis B Vaccine in Preterm Infants
Authors: Kim Susan C. , Chung Esther K. , Hodinka Richard L. , DeMaio John , West David J. , Jawad Abbas F. , Watson Barbara
Published: August 2004

Objective. To determine the immunogenicity of hepatitis B vaccine in preterm infants when the first dose of vaccine is delayed until hospital discharge.

Methods. One hundred two preterm infants (23 to 36 weeks' gestational age) born to hepatitis B surface antigen-negative mothers were enrolled. Immunization was initiated just before hospital discharge with subsequent doses 1 and 6 months later. Serum specimens were obtained before the administration of each vaccine dose and 3 months after the last dose and were tested for antibody to hepatitis B surface antigen (antiHBs).

Results. Eighty-seven infants (85%) completed the study. Ninety percent (n = 78) of infants who completed the study seroconverted (antiHBs ≥10 mIU/mL); 10% (n = 9) remained seronegative at study completion. The geometric mean antibody titer to hepatitis B surface antigen for infants who seroconverted was 200 mIU/mL. Nonresponders (NR) differed from responders (R) in birth weight (NR = 2090 g, R = 1560 g) gestational age (NR = 33 weeks, R = 31 weeks), and weight gain before vaccine initiation (NR = 244 g, R = 633 g). There were no differences in weight or age at vaccine initiation, Apgar scores, interval between vaccine doses, or bacterial infections, steroid use, or transfusions before vaccine initiation.

Conclusions. Ninety percent of preterm infants responded to hepatitis B vaccine when the first dose of vaccine was delayed until hospital discharge. Nonresponders were more likely to be preterm infants of higher birth weight and higher gestational age, and to have gained less weight before vaccine initiation.
High Endothelin-1 in the Airways of Preterm Infants Is Associated With Less Severe Respiratory Distress During the Early Postnatal Period
Authors: Andersson Sture , Merritt T. Allen , Orpana Arto , Viinikka Lasse , Ylikorkala Olavi
Published: August 2004

Objective. To study the relationship between endothelin-1 (ET-1) in the airways and respiratory distress in preterm infants.

Methods. ET-1 was determined in 60 tracheal aspirates from 11 preterm intubated infants (gestational age 28.0 ± 2.5 weeks) during the first week of life.

Results. The concentration of ET-1 of the aspirates was 6 to 2760 pg/mL (median 293 pg/mL). Negative correlations existed between mean log ET-1 and mean airway pressure (R2 = .812) and fraction of inspired oxygen (R2 = .591), whereas a positive correlation was found between the arteriolar/alveolar oxygenation ratio within 3 hours of birth and mean log ET-1 on the first day (R2 = .555).

Conclusion. The association of high ET-1 in the airways with less severe respiratory distress in the early postnatal period may be attributable to effects of ET-1 on surfactant secretion or development of airway epithelium.
Tinea Capitis in California Children: A Population-based Study of a Growing Epidemic
Authors: Lobato Mark N. , Vugia Duc J. , Frieden Ilona J.
Published: August 2004

Objectives. To describe trends in tinea capitis incidence among California children and to determine subpopulations at increased risk.

Design. Retrospective population-based study.

Setting. California, 1984 through 1993.

Population. Children <10 years of age enrolled in Medi-Cal.

Outcome Measures. California Medi-Cal provider data for first-time prescriptions of oral griseofulvin suspension were used to estimate annual incidence of tinea capitis and calculate risk ratios.

Results. From 1984 through 1993, the incident rate for prescriptions of oral griseofulvin suspension increased by 84.2% for all children, 140.4% for white children, and 209.7% for African-American children. In 1993, incidence rates (per 10 000 enrolled) were 252.1 claimants for African-American children, 23.1 for white, 17.5 for Hispanic, and 14.3 for Asian/Pacific Islander. The highest rate by location was San Francisco County (172.2). In age groups <5 years and 5 to 9 years, African-American children were 13.1 and 17.6 times more likely to be prescribed griseofulvin than Hispanic children. Since 1987, incidence rates for children 5 to 9 years of age were higher compared with children ages <5 years.

Conclusions. Tinea capitis is epidemic among California children with higher rates in the northern counties studied. African-American children are the most affected by this epidemic; however, white children have also experienced increased rates.
Athletic Participation by Children and Adolescents Who Have Systemic Hypertension
Authors:   Committee on Sports Medicine and Fitness
Published: August 2004

Children and adolescents who have systemic hypertension may be at risk for complications when exercise causes their blood pressures to rise even higher. The purpose of this statement is to make recommendations concerning the athletic participation of individuals with hypertension using the 26th Bethesda Conference on heart disease and athletic participation and of the Second Task Force on Blood Pressure Control in Children as a basis.
Environmental Tobacco Smoke: A Hazard to Children
Authors:   Committee on Environmental Health
Published: August 2004

Results of epidemiologic studies provide strong evidence that exposure of children to environmental tobacco smoke is associated with increased rates of lower respiratory illness and increased rates of middle ear effusion, asthma, and sudden infant death syndrome. Exposure during childhood may also be associated with development of cancer during adulthood. This statement reviews the health effects of environmental tobacco smoke on children and offers pediatricians a strategy for promoting a smoke-free environment.
Respiratory Syncytial Virus Immune Globulin Intravenous: Indications for Use
Authors:   Committee on Infectious Diseases Committee on Fetus and Newborn
Published: August 2004

Respiratory syncytial virus immune globulin intravenous (RSV-IGIV) has been approved by the Food and Drug Administration for use in the prevention of severe RSV infections in infants and children younger than 24 months with bronchopulmonary dysplasia or a history of premature birth (≤35 weeks of gestation). RSV-IGIV administered monthly during the RSV season resulted in a 41% to 65% reduction in hospitalization rates in two clinical trials; however, RSV-IGIV is costly, and intravenous administration can be logistically demanding. RSV-IGIV should be considered for infants with bronchopulmonary dysplasia who are receiving or have received oxygen therapy in the past 6 months. Infants with gestational ages of 32 weeks or less may also benefit clinically from RSV-IGIV prophylaxis. Immunization with measles-containing vaccines should be delayed for 9 months after the last dose of RSV-IGIV, but no changes need to be made for all other routinely administered vaccines. RSV-IGIV has not been approved for use in children with congenital heart disease, and available data indicate that RSV-IGIV should not be administered to children with cyanotic congenital heart disease because of safety concerns.
Term Newborns Who Are at Risk for Sepsis: Are Lumbar Punctures Necessary?
Authors: Johnson Candice E. , Whitwell Judy K. , Pethe Kalpana , Saxena Kapil , Super Dennis M.
Published: August 2004

Objectives. To determine: (1) whether a lumbar puncture (LP) is indicated in asymptomatic full-term newborns delivered by mothers at risk of intrapartum sepsis; and (2) whether gentamicin improves bacterial coverage for such newborns when used with ampicillin.

Design. A retrospective chart review from 1987 through 1993 of all newborns with positive blood and/or cerebrospinal fluid cultures in the first 7 days of life.

Methods. Pregnant women were screened in the second trimester for group B streptococci and given ampicillin during labor if two or more risk factors were present: group B streptococci colonization, maternal fever or leukocytosis, rupture of membranes at more than 18 hours, foul-smelling amniotic fluid, and fetal tachycardia. After sepsis evaluation (LP, blood culture, white blood cell count, and differential), asymptomatic infants received ampicillin and gentamicin for 48 to 72 hours unless cultures grew pathogens.

Results. Of approximately 24 452 full-term births in 7 years, 7% (1712) had evaluations for symptoms of sepsis, and 14% (3423) were asymptomatic but had evaluations for maternal risk factors. There were 11 cases of meningitis, all involving symptomatic newborns; 10 of these 11 had positive blood cultures for the same organism. In asymptomatic infants, none of the 3423 had meningitis (95% confidence interval, 0 to 0.0008), although 35 grew contaminants. Of 73 pathogens isolated from blood or cerebrospinal fluid, 7 (9.5%) were resistant to ampicillin. Addition of gentamicin provided coverage for only 2 of these 7 pathogens. Of 5135 infants who received ampicillin and gentamicin, only 2 required gentamicin for improved coverage.

Conclusions. (1) LP is unnecessary in asymptomatic full-term newborns. (2) Empiric coverage for asymptomatic newborns with maternal risk factors need not include gentamicin at all hospitals, because it only improved the coverage of ampicillin alone from 90% to 93% of pathogens, but it exposed more than 5000 infants to the side effects of gentamicin. (3) The presence of leukopenia (<5000 white blood cells/mm3) is highly predictive of bacteremia. newborn, lumbar puncture, meningitis.
Physicians’ Opinions on Compensation for Telephone Calls
Authors: Sorum Paul Clay , Mallick Rajiv
Published: August 2004

Objectives. To describe the attitudes of pediatricians and other physicians practicing in a fee-for-service environment toward compensation for telephone encounters with patients.

Design. Survey by mail.

Participants. The 67 pediatric and 634 other private physicians and medical school faculty of Albany County, NY.

Results. A total of 479 of all the physicians (68.3%) and 55 of the pediatricians (82.1%) returned the questionnaire. Of these, 69.9% of the total (95% confidence interval, 65.5% to 74.1%) and 58.2% of the pediatricians (95% confidence interval, 44.1% to 71.3%) indicated physicians should be compensated for calls with patients, especially for after-hours calls. This opinion was significantly associated with greater concern about liability for calls, more negative sentiments about after-hours calls, and a longer reported duration of calls. After adjusting for these factors, surgeons and pediatricians were significantly less likely to favor compensation than the group as a whole. Pediatricians in favor of compensation suggested charging a mean of $9.18 (SD $5.05) for 1 to 5 min, $14.00 (SD $8.87) for 6 to 10 min, and $22.27 (SD $12.62) for >10 min. Pediatricians reported documenting in patients’ charts a mean of 35.3% (SD 39.9%) of after-hours calls.

Conclusions. In a mostly noncapitated environment, the majority of pediatricians and other physicians favor compensation for telephone calls with patients. Some specialists, in particular pediatricians and surgeons, are, however, less likely to support this. Additional research into the reasons for these interspecialty differences may help to guide policy decisions on the financing of health care. telephone calls, physician compensation, physician opinion, health care system, survey.
Nasopharyngeal Carriage of Penicillin-resistantStreptococcus pneumoniaein Children With Sickle Cell Disease
Authors: Daw Najat C. , Wilimas Judith A. , Wang Winfred C. , Presbury Gerald J. , Joyner Royce E. , Harris Sylvia C. , Davis Yvonne , Chen Gang , Chesney P. Joan
Published: August 2004

Objective. We studied the prevalence of nasopharyngeal (NP) carriage, antimicrobial susceptibilities, and serotypes of Streptococcus pneumoniae (SP) in children with sickle cell disease (SCD) in the Mid-South. In addition, we examined risk factors for NP carriage of penicillin-resistant SP (PRSP).

Study Design. Between July 1994 and December 1995, we obtained NP cultures from 312 children with SCD followed at the Mid-South Sickle Cell Center, 208 (67%) of whom were receiving penicillin prophylaxis.

Results. Among the 312 patients, colonization with SP occurred in 42 (13%), 30 (71%) of whom were receiving penicillin prophylaxis. Twenty-three of the 42 SP isolates (55%) were resistant to penicillin; 5 of the 23 (22%) were highly resistant. PRSP organisms were also resistant to cefotaxime (43%), trimethoprim-sulfamethoxazole (57%), and erythromycin (22%). Serotypes 6A, 6B, 14, 19A, and 23F accounted for 19 (90%) of 21 resistant strains. Children who were treated with antibiotics during the preceding month were more likely to carry PRSP than children who were not treated.

Conclusions. There is a high prevalence of NP carriage of PRSP in children with SCD in the Mid-South, which raises concerns regarding the continued effectiveness of penicillin prophylaxis in these children. Further studies on the antimicrobial susceptibilities of resistant organisms and the relationship between NP carriage of SP and invasive disease are needed before developing new recommendations for prophylaxis and treatment. Streptococcus pneumoniae, penicillin resistance, colonization, sickle cell disease.
Statewide Assessment of Lead Poisoning and Exposure Risk Among Children Receiving Medicaid Services in Alaska
Authors: Robin Laura F. , Beller Michael , Middaugh John P.
Published: August 2004

Objective. Lead poisoning is a well-recognized public health concern for children living in the United States. In 1992, Health Care Financing Administration (HCFA) regulations required lead poisoning risk assessment and blood lead testing for all Medicaid-enrolled children ages 6 months to 6 years. This study estimated the prevalence of blood lead levels (BLLs) ≥10 μg/dL (≥0.48 μmol/L) and the performance of risk assessment questions among children receiving Medicaid services in Alaska.

Design. Measurement of venous BLLs in a statewide sample of children and risk assessment using a questionnaire modified from HCFA sample questions.

Setting. Eight urban areas and 25 rural villages throughout Alaska.

Patients. Nine hundred sixty-seven children enrolled in Medicaid, representing a 6% sample of 6-month- to 6-year-old Alaska children enrolled in Medicaid.

Outcome Measure(s). Determination of BLL and responses to verbal-risk assessment questions.

Results. BLLs ranged from <1 μg/dL (<0.048 μmol/L) to 21 μg/dL (1.01 μmol/L) (median, 2.0 μg/dL or 0.096 μmol/L). The geometric mean BLLs for rural and urban children were 2.2 μg/dL (0.106 μmol/L) and 1.5 μg/dL (0.072 μmol/L), respectively. Six (0.6%) children had a BLL ≥10 μg/dL; only one child had a BLL ≥10 μg/dL (11 μg/dL or 0.53 μmol/L) on retesting. Children whose parents responded positively to at least one risk factor question were more likely to have a BLL ≥10 μg/dL (prevalence ratio = 3.1; 95% confidence interval = 0.4 to 26.6); the predictive value of a positive response was <1%.

Conclusions. In this population, the prevalence of lead exposure was very low (0.6%); only one child tested (0.1%) maintained a BLL ≥10 μg/dL on confirmatory testing; no children were identified who needed individual medical or environmental management for lead exposure. Universal lead screening for Medicaid-enrolled children is not an effective use of public health resources in Alaska. Our findings identify an example of the importance in considering local and regional differences when formulating screening recommendations and regulations, and continually reevaluating the usefulness of federal regulations. lead poisoning, child health services, mass screening, government regulations, Medicaid.