bluuebunny/crossref_metadata_2025 huggingface dataset:
A Comparison of the Socioeconomic and Health Status Characteristics of Uninsured, State Children's Health Insurance Program-Eligible Children in the United States With Those of Other Groups of Insured Children: Implications for Policy
Authors: Byck Gayle R.
Published: August 2004

Objectives.

To describe the sociodemographic and health status characteristics of the national uninsured, State Children's Health Insurance Program (SCHIP)-eligible population, and to compare this population with Medicaid-enrolled children, privately insured children, and privately insured children who have family income in the SCHIP eligibility range.

Procedures.

Data were analyzed for 50 950 children 0 to 18 years of age included in the 1993 and 1994 National Health Interview Surveys. The survey obtained information on insurance coverage and sociodemographic and health status measures. Bivariate analyses were conducted to identify the relationships between SCHIP eligibility and sociodemographic and health status characteristics. Multivariate analyses were conducted to assess the independent association of the sociodemographic and health status variables with the likelihood of being uninsured, SCHIP-eligible.

Primary Findings.

Results indicate that SCHIP children exhibit markedly different socioeconomic and health status characteristics than do both Medicaid- enrolled and privately insured children, although these differences are less significant in privately insured children. SCHIP children more often live with college- educated (39.4%) and employed adults (91.2%) than do Medicaid-enrolled children (23.0% and 53.9%, respectively). However, SCHIP children live with college-educated and employed adults less than do all privately insured children (66.7% and 96.9%, respectively) and privately insured/same-income children (57.8% and 97.0%, respectively). Parents of SCHIP-eligible children are also disproportionately self-employed or employed in industries (eg, retail trade) and occupations in which health insurance coverage is less available or affordable. SCHIP-eligible children are also 2 times more likely to be adolescents and 1½ times more likely to be in excellent health than Medicaid-eligible children. Compared with privately insured children, SCHIP-eligible children are nearly 3 times more likely to be Hispanic and nearly 2 times more likely to be rated in fair or poor health.

Conclusions.

The results demonstrate that uninsured, SCHIP-eligible children are substantially different from children in these groups, particularly compared with Medicaid-enrolled children. These differences need to be taken into account when setting policies and implementing programs intended to increase health insurance coverage and access to health care.
Climatic Heat Stress and the Exercising Child and Adolescent
Authors:   Committee on Sports Medicine and Fitness
Published: August 2004

This Policy Statement was revised. See https://doi.org/10.1542/peds.2011-1664.

For morphologic and physiologic reasons, exercising children do not adapt as effectively as adults when exposed to a high climatic heat stress. This may affect their performance and well-being, as well as increase the risk for heat-related illness. This policy statement summarizes approaches for the prevention of the detrimental effects of children's activity in hot or humid climates, including the prevention of exercise-induced dehydration.
Firearm Safety Counseling in Primary Care Pediatrics: A Randomized, Controlled Trial
Authors: Grossman David C. , Cummings Peter , Koepsell Thomas D. , Marshall Jean , D'Ambrosio Luann , Thompson Robert S. , Mack Chris
Published: August 2004

Context.

Physicians have been encouraged to counsel families about risks associated with gun ownership, but the effectiveness of physician counseling regarding gun safety is unknown.

Objective.

To determine the effectiveness of gun safety counseling during well-child care visits.

Design.

Group randomized, controlled trial. Physicians, nurse practitioners, and physician assistants were randomized to either the intervention group or a control group.

Setting.

Group Health Cooperative, a staff-model health maintenance organization.

Patients.

Consecutive sample of families (n = 1295) seen for a scheduled appointment for well-child care for a child <18 years of age. Of the families originally scheduled for a visit, 80.3% were seen and completed the outcomes surveys.

Intervention.

Each family in the intervention group was given a 60-second message by their practitioner that depended on the presence of guns in the home. Families without guns were informed of the health risks associated with gun ownership and given a standard information pamphlet. Families with guns were given the same information about risks and were told that if they chose to keep a gun, they should store it locked and unloaded. They were given instructions on storage and a folder with material, including the same pamphlet, a letter from the police department, written storage guidelines, and discount coupons for gun storage devices.

Main Outcome Measure.

Changes in the following self-reported events: 1) acquisition of a safe storage device; 2) removal of firearms from the home; and 3) acquisition of firearms.

Results.

There were no important differences between intervention and control groups in the rate of acquisition of new guns (intervention: 1.3% vs control: .9%) after the intervention. Among households with guns at baseline, there were also no differences between groups in the removal of guns (intervention: 6.7% vs control: 5.7%), but there was a fairly large nonsignificant difference in the proportion who purchased trigger locks (intervention: 8.0% vs control: 2.5%).

Conclusions.

A single firearm safety-counseling session during well-child care, combined with economic incentives to purchase safe storage devices, did not lead to changes in household gun ownership and did not lead to statistically significant overall changes in storage patterns.
Choice of Breastfeeding and Physicians' Advice: A Cohort Study of Women Receiving Propylthiouracil
Authors: Lee Amy , Moretti Myla Emily , Collantes Alexis , Chong Debbie , Mazzotta Paolo , Koren Gideon , Merchant Shehzad Salim , Ito Shinya
Published: August 2004

Objective.

To examine the gap between the current social/medical practice and the evidence-based recommendation in favor of breastfeeding during maternal propylthiouracil (PTU) therapy.

Design.

Prospective, observational, cohort study.

Subjects.

Women requiring PTU during pregnancy, and endocrinologists and family physicians in Ontario, Canada.

Interventions.

Questionnaire.

Main Outcome Measures.

Women were interviewed postpartum regarding their choice of infant feeding method and relevant advice received from physicians. Physicians were questioned about their advice to nursing women receiving PTU.

Results.

Of 78 women, 66 had live births. Thirty-six required PTU postpartum (group 1), and 30 did not (group 2). Thirty-six healthy women served as controls (group 3). Breastfeeding initiation rates for groups 1, 2, and 3 were 44%, 83%, and 83%, respectively. In group 1, 15 women who breastfed received advice from 22 physicians regarding breastfeeding (20 in favor, 1 against, and 1 equivocal). Eleven who formula fed received advice from 17 physicians (4 in favor, 12 against, and 1 equivocal). A logistic regression analysis of group 1 showed that physicians' advice was the only significant predictor of the woman's choice to breastfeed during PTU therapy (relative risk: 5.48; 95% confidence interval: 1.28–23.40). The physician survey showed that 44% of endocrinologists do not recommend breastfeeding during PTU therapy.

Conclusions.

A substantial proportion of the lactating patients on PTU still receive advice against breastfeeding from their physicians. Physicians' advice and attitudes toward breastfeeding during PTU therapy are a major factor in women's final decision to breastfeed. Physicians' compliance with evidence-based data will facilitate breastfeeding in this group. propylthiouracil, breastfeeding, decision-making.
Adult Female Hip Bone Density Reflects Teenage Sports–Exercise Patterns But Not Teenage Calcium Intake
Authors: Lloyd Tom , Chinchilli Vernon M. , Johnson-Rollings Nan , Kieselhorst Kessey , Eggli Douglas F. , Marcus Robert
Published: August 2004

Objective.

To examine how cumulative teenage sports histories and time-averaged teenage calcium intake are related to total body bone mineral gain between ages 12 and 18 years and to proximal femur bone mineral density (BMD) at age 18 years.

Design.

Longitudinal.

Setting.

University Hospital and local suburban community in Central Pennsylvania.

Study Participants.

Eighty-one white females in the ongoing Penn State Young Women's Health Study.

Outcome Measures.

Total body and proximal femur (hip) bone measurements by dual energy radiograph absorptiometry; nutrient intakes, including calcium, from 33 days of prospective food records collected at regular intervals between ages 12 and 18 years; and self-reported sports–exercise scores between ages 12 and 18 years.

Results.

Cumulative sports–exercise scores between ages 12 and 18 years were associated with hip BMD at age 18 years (r = .42) but were not related to total body bone mineral gain. Time-averaged daily calcium intake, which ranged from 500 to 1500 mg/day in this cohort was not associated with hip BMD at age 18 years, or with total body bone mineral gain at age 12 through 18 years.

Conclusions.

The amount of physical activity that distinguishes a primarily sedentary teenager from one who engages in some form of exercise on a nearly daily basis is related to a significant increase in peak hip BMD.
Tone Abnormalities Are Associated With Maternal Cigarette Smoking During Pregnancy in In Utero Cocaine-Exposed Infants
Authors: Dempsey Delia A. , Hajnal Beatrice Latal , Partridge J. Colin , Jacobson Sarah N. , Good William , Jones Reese T. , Ferriero Donna M.
Published: August 2004

Objective.

Maternal cigarette smoking, alcohol use, and other factors confound studies of in utero cocaine exposure. Our goal was to determine whether in utero cocaine exposure is associated with an abnormal neurologic examination in infants, while controlling for concomitant cigarette smoke exposure and other confounding variables.

Design.

Healthy newborns with birth weights ≥2000 g were prospectively enrolled into a race-matched study of cocaine-exposed and cocaine-unexposed infants. Urine and meconium samples were analyzed for illicit drugs, the cocaine metabolite, benzoylecgonine, and the nicotine metabolite, cotinine. A detailed neurological examination was performed at ∼6 weeks of age by an examiner blinded to history.

Results.

At 6 weeks of age, 40 cocaine-exposed infants and 56 cocaine-unexposed infants were examined. Tone abnormalities were the only neurologic abnormalities discovered, predominantly generalized hypertonia. Logistic models found that maternal urine cotinine levels were predictive of an abnormal neurologic examination, whereas cocaine exposure or benzoylecgonine levels were not. No interaction was found between maternal cigarette smoking and cocaine exposure. Race, ethanol exposure, prenatal care, homelessness, and head circumference were not predictive of an abnormal tone examination. The odds ratio for an abnormal examination was 2.9 (95% confidence interval: 1.04–8.25), if the maternal urine cotinine level was >200 ng/mL.

Conclusion.

Our findings suggest that maternal cigarette smoking may be the major predictor of tone abnormalities reported in cocaine-exposed infants.
An Unusual Presentation of Doxycycline-Induced Photosensitivity
Authors: Yong Collin K. K. , Prendiville Julie , Peacock Don L. , Wong Lawrence T. K. , Davidson A. George F.
Published: August 2004

Photoonycholysis in association with a generalized phototoxic reaction or as an isolated event is a well-recognized complication of the tetracycline group of antibiotics. We describe a 14-year-old white girl with cystic fibrosis who developed photoonycholysis of all 20 nails while receiving treatment with doxycycline. Pediatricians who prescribe tetracyclines should be aware of this potential complication.
Antenatal Corticosteroids and Outcome at 14 Years of Age in Children With Birth Weight Less Than 1501 Grams
Authors: Doyle Lex W. , Ford Geoffrey W. , Rickards Anne L. , Kelly Elaine A. , Davis Noni M. , Callanan Catherine , Olinsky Anthony
Published: August 2004

Objective.

To determine whether exposure to antenatal corticosteroid therapy was associated with adverse effects on growth, sensorineural outcome, or lung function of children of birth weight <1501 g at 14 years of age.

Design.

Cohort study.

Setting.

The Royal Women's Hospital, Melbourne, Australia.

Subjects.

One hundred fifty-four consecutive survivors born from October 1, 1980 to March 31, 1982.

Interventions.

The mothers of 78 survivors (51%) had been given corticosteroids antenatally to accelerate fetal lung maturation. Treatment with antenatal corticosteroids was nonrandom. No mother received >1 course of corticosteroids.

Outcome Measures.

The children were assessed at 14 years of age, corrected for prematurity. All assessors were unaware of the exposure of the child to antenatal corticosteroids. The assessments included measurements of growth and neurological, cognitive, and lung function. Growth measurements were converted into zscores (standard deviation) for the appropriate age and gender.

Results.

Of the 154 survivors, 130 (84%) were assessed at 14 years of age. Overall, the children exposed to antenatal corticosteroids were significantly taller (height zscore; mean difference: .39; 95% confidence interval: .001–.79) and had better cognitive functioning (Wechsler Intelligence Scale for Children-Third Edition Full Scale; IQ mean difference: 6.2; 95% confidence interval: .8–11.6) than those not exposed to corticosteroids. There were no other differences in sensorineural outcomes between the groups. Lung function was not significantly different between the groups. No conclusions were altered by adjustment for confounding variables.

Conclusions.

Exposure to 1 course of antenatal corticosteroid therapy was associated with some clinically and statistically improved outcomes at 14 years of age in children of birth weight <1501 g, with no obvious adverse effects on growth or on sensorineural, cognitive, or lung function. corticosteroids, growth, cognitive, IQ, lung function, adolescence.
The Matthew Effect: Infant Mortality in Canada and Internationally
Authors: Dzakpasu Susie , Joseph K. S. , Kramer Michael S. , Allen Alexander C.
Published: August 2004

Objective.

To examine whether the magnitude of improvement in the health status of a population over time is dependent on the previous health status of that population.

Design and Setting.

A study of infant mortality rates in Canada's 12 provinces and territories between the periods 1961–1965 and 1991–1995, and of infant mortality rates in 133 countries between 1960 and 1995.

Main Outcome Measures.

Spearman's rank correlations, relative risks, and risk differences to measure the relationship between infant mortality in the 1960s and changes in infant mortality between the 1960s and 1990s.

Results.

In Canada, regional rankings based on infant mortality rates in 1961–1965 were strongly correlated (inversely) with rankings based on the percent change in infant mortality between 1961–1965 and 1991–1995 (correlation coefficient = −.85). In contrast, internationally, rankings based on infant mortality rates in 133 countries in 1960 were positively correlated with percent change between 1960 and 1995 (correlation coefficient = .56). Regional differences in infant mortality rates, measured using relative risks, declined in Canada (highest relative risk: 4.2, compared with Ontario in the 1960s; highest relative risk: 2.2, compared with Ontario in the 1990s) but increased globally (highest relative risk: 5.0, compared with industrialized countries in 1960; highest relative risk: 15.1, compared with industrialized countries in 1995).

Conclusions.

Canadian regions with higher infant mortality rates in 1961–1965 achieved larger improvements compared with regions with initially lower infant mortality rates. The pattern observed within Canada is unlike the pattern observed internationally.
Abdominal Coarctation and Alagille Syndrome
Authors: Quek Swee Chye , Tan FAMS*; Lenny , FAMS FRACR, , Quek Swee Tian , Yip William , Aw FAMS*; Marion , Quak Seng Hock
Published: August 2004

Structural cardiac defects such as peripheral pulmonary stenosis are well-described in Alagille syndrome (AS), which is transmitted in an autosomal dominant inheritance. The genetic defect, with incomplete penetrance and variable expression, is localized to the short arm of chromosome 20. Abdominal coarctation is an uncommon congenital anomaly, with a spectrum of symptoms that may range from hypertension, intermittent claudication to abdominal pain. The association of abdominal coarctation with AS is rarely described. We report such a patient who also had aberrations of the visceral vascular supply involving the celiac, splenic, and superior mesenteric arteries. The indications to treat the coarctation, and in the context of a patient with AS, in whom liver transplantation may be contemplated at some stage, merit discussion.
Head Growth in Infants With Hypoxic–Ischemic Encephalopathy: Correlation With Neonatal Magnetic Resonance Imaging
Authors: Mercuri Eugenio , Ricci Daniela , Cowan Frances M. , Lessing Daniella , Frisone Maria F. , Haataja Leena , Counsell Serena J. , Dubowitz Lilly M. , Rutherford Mary A.
Published: August 2004

Objectives.

The aims of the study were to establish the relationship between head growth in the first year of life with the pattern on injury on neonatal magnetic resonance imaging (MRI) in infants with hypoxic–ischemic encephalopathy (HIE) and to relate these to the neurodevelopmental outcome.

Methods.

Fifty-two term infants who presented at birth with a neonatal encephalopathy consistent with HIE and who had neonatal brain MRI were entered into the study. Head circumference charts were evaluated retrospectively and the head growth over the first year of life compared with the pattern of brain lesions on MRI and with the neurodevelopmental outcome at 1 year of age. Suboptimal head growth was classified as a drop of >2 standard deviations across the percentiles with or without the development of microcephaly, which was classified as a head circumference below the third percentile.

Results.

There was no statistical difference between the neonatal head circumferences of the infants presenting with HIE and control infants. At 12 months, microcephaly was present in 48% of the infants with HIE, compared with 3% of the controls. Suboptimal head growth was documented in 53% of the infants with HIE, compared with 3% of the controls. Suboptimal head growth was significantly associated with the pattern of brain lesions, in particular to involvement of severe white matter and to severe basal ganglia and thalamic lesions. Suboptimal head growth predicted abnormal neurodevelopmental outcome with a sensitivity of 79% and a specificity of 78%, compared with the presence of microcephaly at 1 year of age, which had a sensitivity of only 65% and a specificity of 73%. The exceptions were explained by infants with only moderate white matter abnormalities who had suboptimal head growth but normal outcome at 1 year of age and by infants with moderate basal ganglia and thalamic lesions only who had normal head growth but significant motor abnormality.
The Influence of Intrapartum Antibiotics on the Clinical Spectrum of Early-Onset Group B Streptococcal Infection in Term Infants
Authors: Bromberger Patricia , Lawrence Jean M. , Braun David , Saunders Brian , Contreras Richard , Petitti Diana B.
Published: August 2004

Objective.

The use of intrapartum antibiotics to prevent early-onset group B streptococcal (EOGBS) infection has left pediatricians in a quandary about the appropriate evaluation and treatment of infants at risk for this infection. The aim of this study was to determine whether intrapartum antibiotic prophylaxis changed the constellation and timing of onset of clinical signs of group B streptococcal (GBS) infection in term infants.

Methodology.

We conducted a retrospective chart review of infants who had EOGBS infection and were born in Southern California Kaiser Permanente Hospitals from 1988 through 1996. Objective criteria were used to ascertain maternal risk of infection, intrapartum antibiotic prophylaxis, and onset of clinical signs of infection.

Results.

Three hundred nineteen infants with EOGBS sepsis, bacteremia, or clinically suspected infection were identified from a population of 277 912 live births. Of the 172 term infants with culture-positive infection who had clinical signs of infection, 95% exhibited them in the first 24 hours of life. All of the infants exposed to intrapartum antibiotics became ill within the first 24 hours of life.

Conclusions.

Exposure to antibiotics during labor did not change the clinical spectrum of disease or the onset of clinical signs of infection within 24 hours of birth for term infants with EOGBS infection. A 48-hour stay is not required to monitor asymptomatic term infants exposed to intrapartum antibiotics for onset of GBS infection.
Volume–Outcome Relationships in Pediatric Intensive Care Units
Authors: Tilford John M. , Simpson Pippa M. , Green Jerril W. , Lensing Shelly , Fiser Debra H.
Published: August 2004

Context.

Pediatric intensive care units (PICUs) have expanded nationally, yet few studies have examined the potential impact of regionalization and no study has demonstrated whether a relationship between patient volume and outcome exists in these units. Documentation of an inverse relationship between volume and outcome has important implications for regionalization of care.

Objectives.

This study examines relationships between the volume of patients and other unit characteristics on patient outcomes in PICUs. Specifically, we investigate whether an increase in patient volume improves mortality risk and reduces length of stay.

Design and Setting.

A prospective multicenter cohort design was used with 16 PICUs. All of the units participated in the Pediatric Critical Care Study Group.

Participants.

Data were collected on 11 106 consecutive admissions to the 16 units over a 12-month period beginning in January 1993.

Main Outcome Measures.

Risk-adjusted mortality and length of stay were examined in multivariate analyses. The multivariate models used the Pediatric Risk of Mortality score and other clinical measures as independent variables to risk-adjust for illness severity and case-mix differences.

Results.

The average patient volume across the 16 PICUs was 863 with a standard deviation of 341. We found significant effects of patient volume on both risk-adjusted mortality and patient length of stay. A 100-patient increase in PICU volume decreased risk-adjusted mortality (adjusted odds ratio: .95; 95% confidence interval: .91–.99), and reduced length of stay (incident rate ratio: .98; 95% confidence interval: .975–.985). Other PICU characteristics, such as fellowship training program, university hospital affiliation, number of PICU beds, and children's hospital affiliation, had no effect on risk-adjusted mortality or patient length of stay.

Conclusions.

The volume of patients in PICUs is inversely related to risk-adjusted mortality and patient length of stay. A further understanding of this relationship is needed to develop effective regionalization and referral policies for critically ill children.
Can Falls on Stairs Result in Small Intestine Perforations?
Authors: Huntimer Cynthia Marie , Muret-Wagstaff Sharon , Leland Nancy Lee
Published: August 2004

Objective.

Abusive parents often report that a fall on stairs resulted in their children's injuries. This review explores whether there is any evidence in the medical literature that a fall on stairs could be a plausible explanation for a small intestine perforation.

Methodology.

The English-language medical literature was searched by Medline, for a 29-year period (1970–1998), for reports of the types of injuries sustained in falls on stairs and for reports of the types of blunt abdominal trauma that result in small intestine perforations. Articles that exclusively focused on infant walker injuries or the elderly were excluded. Duodenal, jejunal, and ileal perforations were included, whereas intestinal hematomas and undescribed intestinal injuries were excluded. All types of injuries to the stomach, colon, and rectum were excluded.

Results.

Falls on stairs were not reported to be a cause for any of the 312 cases of small intestine perforations reviewed. There were no reports of any intraabdominal injuries, including small intestine perforations, in any of the 677 cases of falls on stairs reviewed. Falls on stairs rarely resulted in any type of truncal injury.

Conclusions.

Although falls on stairs have been reported to be the most common cause of injury in childhood, no evidence was found to support the contention that an unobstructed fall on stairs could be consistent with perforation of the small intestine.
Impact of Race and Gestational Age on Red Blood Cell Indices in Very Low Birth Weight Infants
Authors: Alur Pradeep , Devapatla Sri Satish , Super Dennis M. , Danish Elizabeth , Stern Thomas , Inagandla Radha , Moore John J.
Published: August 2004

Background.

Normative data for hematologic values in the very low birth weight infants are limited and inconsistent, with the reported mean hematocrit (HCT) in these infants ranging from 43.5% to 60%. No data are available on the effect of race.

Objectives.

To establish normative data for hemoglobin (Hb) and HCT by arterial sampling obtained during the first 3 hours after birth in black and white premature infants ≤31 weeks of gestation.

Methods.

Retrospective chart review of all infants ≤ 31 weeks of gestation born between June 1994 and October 1998. Inclusion criteria: infant ≤31 weeks of gestation who had an arterial blood sample obtained in the first 3 hours after birth. Exclusion criteria: infants were excluded if they had any medical condition that may affect the red blood cell indices (eg, twin-to-twin transfusion or fetomaternal hemorrhage).

Results.

Of 428 infants, 188 who met both inclusion and exclusion criteria were classified into 3 gestational age groups: group 1 = 23 to 25 weeks of gestation (n = 40); group 2 = 26 to 28 weeks (n = 60); and group 3 = 29 to 31 weeks (n = 88). There were statistically significant differences between groups 1 and 3 in HCT, Hb, mean corpuscular Hb (MCH), and mean corpuscular volume (MCV). No differences in HCT and Hb values were noted in relation to sex, mode of delivery, multiple gestation, antenatal steroids, or maternal smoking. In group 3, the mean Hb, HCT, and MCV values were higher in white infants than in black infants (16.7 ± 1.6 g/dL vs 15.4 ± 1.7 g/dL; 50.0 ± 5.0 vs 45.5 ± 4.6; and 112 ± 5 fL vs 107 ± 8 fL, respectively).

Conclusions.

Hb, HCT, and MCH values are described for premature infants ≤31 weeks of gestation born in North America. Hb and HCT increased, whereas MCV decreased with gestational age. Hb, HCT, and MCV values are statistically higher in white infants than in black infants.
Neonatal Alloimmune Neutropenia in Premature Monozygous Twins
Authors: Felix Jacob K. , Calhoun Darlene A.
Published: August 2004

Alloimmune neonatal neutropenia (ANN) is an uncommon but potentially life-threatening disorder of the neonate and young infant. Hematologically, the mother's peripheral neutrophil count is normal. However, the passive transfer of maternal immunoglobulin G neutrophil-specific antibodies and the subsequent sensitization of fetal neutrophils can result in severe neutropenia in the neonate. Generally, ANN is a self-limiting condition, but with severe bacterial infection, mortality can be high. We present the clinical features of monozygous twins delivered at 33 weeks' postconception with this condition. This case report is unique in that it occurred in twins born prematurely and was attributable to antibodies against 2 neutrophil-specific antigens, NA1 and NB1. A brief review of the diagnosis, management, and treatment of ANN is presented.
Corporal Punishment in Schools
Authors:   Committee on School Health
Published: August 2004

This Policy Statement was reaffirmed May 2006, February 2012, and December 2018.

The American Academy of Pediatrics recommends that corporal punishment in schools be abolished in all states by law and that alternative forms of student behavior management be used.
Precertification Process
Authors:   Committee on Hospital Care
Published: August 2004

This Policy Statement was retired April 2018.

Precertification is a process still used by health insurance companies to control health care costs. Although we believe precertification is unnecessary and not cost-effective, in those instances where precertification is still being utilized, we suggest that the following procedures be adopted. This statement suggests guidelines that should help achieve this goal while allowing optimal access to care for children.
Bacterial Colonization of Toys in Neonatal Intensive Care Cots
Authors: Davies Mark W. , Mehr Samuel , Garland Suzanne T. , Morley FANZCOG‡; and Colin J.
Published: August 2004

Objectives.

To investigate the bacteria and fungi contaminating toys in neonatal intensive care unit (NICU) cots, the colonization rates, and factors that influence them.

Methods.

A cross-sectional, longitudinal bacteriologic survey of all toys in the cots of infants in an NICU. All the toys in an infant's cot were cultured weekly for 4 weeks. Data were collected on the infant's postnatal age, the type of cot, whether humidity was added, characteristics of the toy, and any infant infections.

Results.

Over the 4-week period, there were 86 cultures from 34 toys of 19 infants. Bacteria were grown from 84/86 (98%): 84 of the cultures grew coagulase-negative Staphylococcus, 50 Micrococcus sp, 21 Bacillus sp, 13 methicillin-resistant Staphylococcus aureus, 12 diphtheroids, 4 group B streptococcus, 3 S aureus, 3 nonhemolytic streptococci, 3 group D streptococci, 4 α-hemolytic streptococci, and 2 coliforms. None grew fungi. The colonization rate did not differ with cot type, presence of humidity, size of the toy, toy fiber length, or the fluffiness score. Eight (42%) of the infants had positive blood culture results and 5/8 of the isolates (63%) were of the same type as that colonizing their corresponding toy.

Implications.

With time, all the toys in NICU cots became colonized with bacteria. Many were potentially pathogenic. Toys may be reservoirs for potential infantile nosocomial sepsis. infant, newborn, toys, infection, neonatal intensive care.
A New Look at Intrauterine Growth and the Impact of Race, Altitude, and Gender
Authors: Thomas Pam , Peabody Joyce , Turnier Virginia , Clark Reese H.
Published: August 2004

Background.

Growth curves described in the 1960s are used to classify neonate intrauterine growth as normal or abnormal. Our objective was to determine whether continued use of these curves is appropriate.

Methods.

From 1996 to 1998, we collected birth weight, length, head circumference, estimated gestational age (EGA), gender, race, and place of birth (<4000 feet or ≥4000 feet) on 27 229 neonates to evaluate the effects of each on intrauterine growth and the diagnoses of small for gestational age (SGA) and large for gestational age (LGA). We compared the gestation-specific growth parameters derived from our sample with those reported in 1966 and 1969.

Results.

Gestational age had the largest influence on each growth parameter. Race and gender both had effects on birth weight. Female neonates were smaller than male neonates, and black neonates were smaller than Hispanic and white neonates at each EGA.

For neonates with an EGA <30 weeks, our data had a smaller variance and lower average weights, lengths, and head circumferences than those reported in 1966 and in 1969. For neonates >36 weeks, the variance was similar, but our curves showed that neonates in our sample were larger and heavier. Use of the older growth curves to classify neonates as SGA, LGA, and appropriate for gestational age (AGA) led to significantly different rates of each by gender and race.

Conclusions.

Intrauterine growth patterns previously described and commonly used to classify neonates as AGA are inaccurate for use in current populations and lead to gender- and race-specific diagnoses of SGA and LGA that are misleading. neonates, growth, race, gender.
Sexual Behavior Change Among Human Immunodeficiency Virus-Infected Adolescents With Hemophilia
Authors: Brown Larry K. , Schultz Janet R. , Parsons Jeffrey T. , Butler Regina B. , Forsberg Ann D. , Kocik Susan M. , King Gary , Manco-Johnson Marilyn , Aledort Louis ,   for the Adolescent Hemophilia Behavioral Intervention Evaluation Project Study Group
Published: August 2004

Purpose.

To determine the factors associated with the adoption or maintenance of consistent safer sexual behaviors among human immunodeficiency virus-positive adolescents and young adults with hemophilia.

Methods.

One hundred eleven adolescents at 10 hemophilia care sites participated in an intervention program designed to increase safer sexual behaviors (abstinence, condom use, or nonpenetrative behavior). The theory-based intervention spanned 1 year. Adolescents attended individual sessions, small group activities, and an intensive group retreat.

Results.

Patients who maintained or improved safer sexual behaviors were compared with those who relapsed or did not improve. Logistic regression analyses found that improvement and maintenance of safer sexual behavior were significantly associated with perceived peer support for outercourse (odds ratio [OR]: 5.47; confidence interval [CI]: 1.4–20.8), perceived peer support for abstinence (OR: 5.08; CI: 1.2–20.1), and decreased general emotional distress (OR: 4.65; CI: 1.04–20.6). Perceived health status and previous sexual behavior were unrelated to change in safer sexual behavior.

Conclusions.

These longitudinal data indicate that improvement and maintenance of safer sexual behavior among adolescents during an intervention is strongly associated with perceptions of peer support for safer sex and lesser degrees of emotional distress. Programs for human immunodeficiency virus-infected adolescents may require developmentally appropriate social and psychological approaches to impact peer norms and emotional well-being.
Predictors of Change in the Functional Status of Children With Human Immunodeficiency Virus Infection
Authors: Missmer Stacey A. , Spiegelman Donna , Gorbach Sherwood L. , Miller Tracie L.
Published: August 2004

Objective.

The purpose of this study was to identify important clinical predictors of change in the functional status of children with perinatally acquired human immunodeficiency virus (HIV) infection.

Methods.

Children who were perinatally exposed to HIV underwent evaluation of growth, nutritional, and functional status parameters as part of a prospective study of HIV and nutrition in children. The main outcome measures for HIV-infected children were change over time in: 1) Total Health, 2) General Health, and 3) Responsiveness as measured by the Functional Status II(R) (FSII[R]). Candidate predictors included anthropometric measurements, social factors, HIV disease stage, CD4 T lymphocyte count, medications, and other clinical markers of illness.

Results.

The parents or legal guardians of 35 perinatally HIV-infected children completed 2 FSII(R) surveys over a mean of 16 months. Functional Status scores were significantly correlated with number of times and days hospitalized in the past 6 months and with illness at the time of baseline evaluation. Functional status declined overtime on all 3 scales; however, only the change in Total Health score was statistically significant. Total, General Health, and Responsiveness scores declined by ≥5 points in 20.0%, 17.1%, and 14.3% of children, respectively. Significant univariate predictors of change in at least 1 component of the functional status survey included race, guardianship, height z score, prescription of antiviral medications other than antiretrovirals, and illness at time of baseline evaluation. In multivariate models, adjusting for baseline score and biologic relationship of guardian completing survey, significant predictors of a decline in Total Health scores included non-white race and lower baseline height zscore. The General Health score declined with lower baseline absolute CD4 count and lower baseline height z score. Finally, Responsiveness scores declined in children whose guardian was their biologic parent and in children with lower baseline heightz scores.

Conclusion.

The FSII(R) questionnaire correlates with other markers of disease severity in children with HIV infection. Growth parameters, immune status, and social factors are important predictors of functional status in HIV-infected children.
Predicting the Outcome of Neonatal Bacterial Meningitis
Authors: Klinger Gil , Chin Choy-Nyok , Beyene Joseph , Perlman Max
Published: August 2004

Objective.

To build predictive models of severe adverse outcome at various times in the course of neonatal bacterial meningitis.

Study Design.

Retrospective cohort study with follow-up to a minimum age of 1 year of term and near-term infants, admitted between 1979 and 1998 to a regional tertiary care center. Predictors of adverse outcome detectable at 1 year of age (death or moderate or severe neurosensory impairment) were identified by univariate analysis. Independent predictors of adverse outcome were identified by multivariate analysis. Predictive tree models were constructed at 12, 24, 48, and 96 hours after admission and at discharge.

Results.

Of 101 infants admitted with definitive bacterial meningitis, 13 died and 17 had moderate or severe disability at 1 year of age. Outcomes are known for all patients, to 1 year of age. Twelve hours after admission the important predictors of adverse outcome were presence of seizures, presence of coma, use of inotropes, and leukopenia (sensitivity: 68%; specificity: 100%). At 96 hours the predictors were seizure duration of >72 hours, presence of coma, use of inotropes, and leukopenia (sensitivity: 88%; specificity: 99%).

Conclusions.

Most infants at risk for adverse outcome can be identified within 12 hours of admission. Duration of seizures for >72 hours, presence of coma, use of inotropes, and leukopenia were the most important predictors of adverse outcome. Although these models have good predictive accuracy, they need to be validated in a contemporary cohort in large multicenter studies. bacterial meningitis, neonate, prognostic model.
Pacifier as a Risk Factor for Acute Otitis Media: A Randomized, Controlled Trial of Parental Counseling
Authors: Niemelä Marjo , Pihakari Outi , Pokka Tytti , Uhari Marja , Uhari Matti
Published: August 2004

Objectives.

To evaluate the association between pacifier use and the increased occurrence of acute otitis media (AOM) in an intervention trial.

Methods.

Fourteen well-baby clinics were selected to participate in an open, controlled cohort study. These clinics were paired according to the number of children and the social classes of the parents they served. One clinic in each pair was randomly allocated for an intervention, while the other served as a control. The nurses at the intervention clinics were trained to instruct the parents of children <18 months old to limit pacifier use during their prescheduled visits to the clinic. The intervention consisted of a leaflet explaining the harmful effects of pacifier use and instructions to restrict its use. Two hundred seventy-two children were successfully recruited from the intervention clinics and 212 from the control clinics. The data about pacifier use and the occurrence of respiratory infections and AOM were collected similarly in both groups.

Results.

After the intervention, a 21% decrease was achieved in continuous pacifier use at the age of 7 to 18 months (P = .0001), and the occurrence of AOM per person-months at risk was 29% lower among children at the intervention clinics. The children who did not use a pacifier continuously in either of the clinics had 33% fewer AOM episodes than the children who did.

Conclusion.

Pacifier use appeared to be a preventable risk factor for AOM in children. Its restriction to the moments when the child was falling asleep effectively prevented episodes of AOM.
Clinical Performance of an In-Line Point-of-Care Monitor in Neonates
Authors: Widness John A. , Kulhavy Jeff C. , Johnson Karen J. , Cress Gretchen A. , Kromer Irma J. , Acarregui Michael J. , Feld Ronald D.
Published: August 2004

Objective.

To evaluate the bias, precision, and blood loss characteristics of an ex vivo in-line point-of-care testing blood gas and electrolyte monitor designed for use in critically ill newborn infants.

Study Design.

Study participants included consecutive neonates with an umbilical artery catheter (UAC) in use for clinical laboratory testing. The in-line monitor (VIA LVM Blood Gas and Chemistry Monitoring System, VIA Medical, San Diego, CA) was directly connected to the participant's UAC and the monitor's determinations of pH, Pco2, Po2, sodium, potassium, and hematocrit (Hct) were compared with those simultaneously drawn and measured with a standard bench top laboratory instrument (Radiometer 625 ABL; Radiometer America, Inc, Westlake, OH). The bias (the mean difference from the reference method) and precision (1 standard deviation of the mean difference) performance criteria of the in-line monitor were derived using standard laboratory procedures.

Results.

Sixteen neonates monitored for a total of 37 days had a total of 229 paired blood samples available for comparison by the 2 methods. Bias and precision performance characteristics of the in-line monitor were similar to reports of other point-of-care devices (ie, pH: −.003 ± .024; Pco2: .35 ± 2.84 mm Hg; Po2: .39 ± 7.30 mm Hg; sodium: .52 ± 2.34 mmol/L; potassium: .17 ± .18 mmol/L; and Hct: .61 ± 2.80%). The range of values observed for each parameter included much of the range anticipated among critically ill neonates (ie, pH: 7.15–7.65; Pco2: 25–75 mm Hg; Po2: 25–275 mm Hg; sodium: 127–150 mmol/L; potassium: 2.6–5.5 mmol/L; and Hct: 32%–60%). Mean blood loss (± standard deviation) per sample with the in-line monitor was approximately one-tenth that of the reference method: 24 ± 7 μL versus 250 μL, respectively. There was no evidence of hemolysis and no patient related safety issues were identified with use of the in-line monitor.

Conclusions.

Repeated laboratory testing of critically ill neonates using an ex vivo in-line monitor designed for use in neonates provides reliable laboratory results. The blood loss and hemolysis data obtained suggests that this monitoring device offers potential for reducing neonatal blood loss—and possibly transfusion needs—during the first weeks of life. Before this promising technology can be routinely recommended for care of critically ill neonates, greater practical experience in a variety of clinical settings is needed.
Occult Bacteremia From a Pediatric Emergency Department: Current Prevalence, Time to Detection, and Outcome
Authors: Alpern Elizabeth R. , Alessandrini Evaline A. , Bell Louis M. , Shaw Kathy N. , McGowan Karin L.
Published: August 2004

Objective.

To evaluate selected characteristics of occult bacteremia in the post-Haemophilus influenzae type b (HIB) vaccine era.

Methods.

A retrospective cohort study was performed involving 5901 children 2 to 24 months old with fever ≥39.0°C evaluated with a blood culture at an urban tertiary care children's hospital emergency department (ED) between February 1993 and June 1996. Patients were excluded if immune-suppressed, diagnosed with a focal infection, evaluated by lumbar puncture, or admitted to the hospital during initial evaluation. Prevalence of occult bacteremia, distribution of current pathogenic organisms, and time to positive culture in a continuously monitored system were determined. All patients with cultures positive for pathogenic bacteria were reevaluated and serious adverse outcomes were documented.

Results.

The prevalence of occult bacteremia was 1.9% (95% confidence interval: 1.5%–2.3%). Streptococcus pneumoniae accounted for 82.9% of all pathogens and H influenzae was not a causative organism in this cohort.

The mean time to positive culture was significantly shorter for pathogens compared with contaminants (14.9 hours vs 31.1 hours). A culture that was positive in ≤18 hours was 13.0 (6.3–26.6) times more likely to contain a pathogen than a contaminant.

The average time from positive culture notification to reevaluation in the ED was 10.6 hours and over half of the patients recalled to the ED for positive cultures were admitted to the hospital. Of patients with occult pneumococcal bacteremia, 95.7% had resolution of their bacteremia without the use of parenteral antibiotics. Two patients had serious adverse outcomes. The rate of meningitis or death was .03% (.004%–.12%).

The contamination rate of blood cultures was 2.1% (1.7%–2.5%). Most (85%) of these patients were reevaluated in the ED and more than one third were admitted to the hospital before full identification of the organism.

Conclusions.

Prevalence of occult bacteremia in the post-HIB vaccine era is lower than previously reported.S pneumoniae is the most common causative organism and resolves without parenteral antibiotics in the vast majority of cases. Continuously monitoring blood culture systems allow for early identification and can aid in differentiating contaminated from true pathogenic cultures by time to positive culture. Serious adverse outcome is an uncommon result of occult bacteremia. Updated epidemiology and microbiologic technology may impact the evaluation and treatment of children at risk for occult bacteremia.
Nosocomial Respiratory Syncytial Virus Infections: The Cost-Effectiveness and Cost-Benefit of Infection Control
Authors: Macartney Kristine K. , Gorelick Marc H. , Manning Mary Lou , Hodinka Richard L. , Bell Louis M.
Published: August 2004

Objective.

To determine the cost-effectiveness and cost-benefit of an infection control program to reduce nosocomial respiratory syncytial virus (RSV) transmission in a large pediatric hospital.

Design.

RSV nosocomial infection (NI) was studied for 8 years, before and after intervention with a targeted infection control program. The cost-effectiveness of the intervention was calculated, and cost-benefit was estimated by a case–control comparison.

Setting.

Children's Hospital of Philadelphia, a 304-bed pediatric hospital.

Patients.

All inpatients with RSV infection, both community- and hospital-acquired.

Intervention.

Consisted of early recognition of patients with respiratory symptoms, confirmation of RSV infection by laboratory testing, establishing cohorts of patients and nursing staff, gown and glove barrier precautions, and monitoring and education of staff.

Outcome Measures.

The incidence density of RSV NI before and after the intervention was calculated as the rate per 1000 patient days-at-risk for infection. Intervention costs included laboratory testing, isolation, and administration of the program. The cost of RSV NI was estimated by comparing hospital charges for 30 cases and matched uninfected controls.

Results.

A total of 148 patients acquired NI (88 before and 60 after the intervention). The Mantel-Haenszel stratified relative risk for NI in the period before the infection control program, compared with the postintervention period, was .61 (95% confidence interval: .53–.69). By applying the preintervention stratum-specific rates of infection to the days-at-risk in the postintervention period, an estimated 100 NIs would have been expected, which in comparison to the 60 NIs observed, yielded an estimated program effectiveness of 10 RSV NIs prevented per season. The total cost of the program per season was $15 627 or $1563/NI prevented. In comparison, the mean cost to the hospital was $9419/case of RSV NI, resulting in a cost-benefit ratio of 1:6.

Conclusions.

A targeted infection control intervention was cost-effective in reducing the rate of RSV NI. For every dollar spent on the program, approximately $6 was saved.