bluuebunny/crossref_metadata_2025 huggingface dataset:
Ocular Injuries by Elastic Cords in Children
Authors: Da Pozzo Stefano , Pensiero Stefano , Perissutti Paolo
Published: August 2004

Background.

Elastic cords hitting the eyeball as high-speed projectiles can severely damage ocular structures and can produce permanent visual function impairment.

Objectives.

To evaluate the frequency, mechanics, and severity of eye injuries caused by elastic cords in children to adopt the most appropriate preventive measures.

Methods.

A retrospective medical records review of hospital admissions secondary to ocular trauma between 1991 and 1997 in a pediatric ophthalmology unit at an urban tertiary care pediatric hospital was performed to select all children admitted for ocular injury caused by an elastic cord.

Results.

Eight children fulfilled the inclusion criteria; the prevalence ratio was 2% of all pediatric trauma admissions. In all cases the mechanics of trauma was a combination of blunt and high-speed projectile injury. The mechanism of trauma in younger patients was typically a cord that was misused during unsupervised playtime, whereas cord slipping from car roof racks was noted in older patients. One patient suffered a severe permanent visual impairment caused by retinal detachment. All other children regained full visual acuity at the time of discharge and maintained it through a mean follow-up of 22 months (range: 18–29).

Conclusion.

Circumstances of injury in younger children are different from those found in older children, the latter being similar to those reported for adults. Prevention is the primary measure to be taken to reduce the prevalence of this injury and to lower the risk for ocular severe anatomic damage as much as possible. This can be achieved primarily by modifying the design of the hooks, intensifying educational campaigns, and keeping elastic cords out of children's reach.
Sleep and Periodic Limb Movement in Sleep in Juvenile Fibromyalgia
Authors: Tayag-Kier Catherine E. , Keenan Gregory F. , Scalzi Lisabeth V. , Schultz Brian , Elliott Joanne , Zhao RPFT*; Huaqing , Arens Raanan
Published: August 2004

Objectives.

Fibromyalgia has been recently recognized in children and adolescents as juvenile fibromyalgia (JF). In adult fibromyalgia, subjective complaints of nonrestorative sleep and fatigue are supported by altered polysomnographic findings including a primary sleep disorder known as periodic limb movements in sleep (PLMS) in some subjects. Although poor sleep is a diagnostic criterion for JF, few reports in the literature have evaluated specific sleep disturbances. Our objectives were to evaluate in a controlled study the polysomnographic findings of children and adolescents with JF for alterations in sleep architecture as well as possible PLMS not previously noted in this age group.

Methods.

Sixteen consecutive children and adolescents (15.0 ± 2.6 years of age) diagnosed with JF underwent overnight polysomnography. Polysomnography was also performed on 14 controls (14.0 ± 2.2 years of age) with no history of an underlying medical condition that could impact on sleep architecture. Respiratory variables, sleep stages, and limb movements were measured during sleep in all subjects.

Results.

JF subjects differed significantly from controls in sleep architecture. JF subjects presented with prolonged sleep latency, shortened total sleep time, decreased sleep efficiency, and increased wakefulness during sleep. In addition, JF subjects exhibited excessive movement activity during sleep. Six of the JF subjects (38%) were noted to have an abnormally elevated PLMS index (>5/hour), indicating PLMS in these subjects.

Conclusion.

Our study demonstrated abnormalities in sleep architecture in children with JF. We also noted PLMS in a significant number of subjects. This has not been reported previously in children with this disorder. We recommend that children who are evaluated for JF undergo polysomnography including PLMS assessment. juvenile fibromyalgia; periodic limb movement in sleep; restless legs syndrome.
Early Puberty: Rapid Progression and Reduced Final Height in Girls With Low Birth Weight
Authors: Ibáñez Lourdes , Ferrer Angela , Marcos Maria Victoria , Hierro Francisco Rodriguez , de Zegher Francis
Published: August 2004

Objective.

To assess whether, in girls with early onset of puberty, low birth weight is a risk factor for rapid progression to menarche and for short adult stature.

Design.

Longitudinal clinical assessment of 54 Catalan (Northern Spanish) girls followed from early onset of puberty (onset of breast development between 8.0 and 9.0 years of age) to final height. The timing of menarche and the final height were analyzed a posteriori according to birth weight, the cutoff level between normal and low birth weight subgroups being −1.5 standard deviation (SD; ∼2.7 kg at term birth).

Results.

Normal and low birth weight girls had similar target heights and characteristics at diagnosis of early puberty. However, menarche occurred on average 1.6 years earlier in low versus normal birth weight girls (11.3 ± .3 years vs 12.9 ± .2 years), and final height was >5 cm shorter in low birth weight girls (parental adjusted height SD: −.6 ± .2 cm vs .3 ± .2 cm).

Conclusion.

The timing of menarche and the level of final height in Catalan girls with early onset of puberty was found to depend on prenatal growth. Girls with normal birth weight tend to progress slowly through puberty with a normal timing of menarche and normal final height. In contrast, girls with low birth weight tend to progress relatively rapidly to an early menarche and to a reduced final height. If these findings are confirmed in other ethnic and/or larger groups, then a subgroup has been identified that will most likely benefit from any therapeutic intervention aiming at a delay of pubertal development and/or an increase of final height.
Outpatient Treatment of Moderate Croup With Dexamethasone: Intramuscular Versus Oral Dosing
Authors: Rittichier Kristine K. , Ledwith Carol A.
Published: August 2004

Objective.

Steroid use for the treatment of croup has been supported by several studies, although few have addressed the use of oral dexamethasone for outpatient management. The efficacy of oral (PO) versus intramuscular (IM) dosing of dexamethasone in the outpatient treatment of moderate croup are compared in this study.

Methods.

Patients between the ages of 3 months and 12 years with moderate croup (history or presence of stridor, cyanosis, or retractions) were eligible for enrollment in this single-blind, prospective study. Patients were randomized to receive a single dose (0.6 mg/kg, maximum 8 mg) of IM or PO dexamethasone. Parents were contacted by phone to assess resolution of symptoms and need for further evaluation.

Results.

Two hundred seventy-seven patients were enrolled (median age: 2.1 years). One hundred thirty-nine patients received IM dexamethasone, and 138 received PO. At phone follow-up, 141 (51%) had total resolution of symptoms (75 in IM, 66 in PO). Eighty patients (29%) returned for further evaluation (45 in IM, 35 in PO). Twenty-three (8%) received either more steroids, racemic epinephrine, or admission (11 in IM, 12 in PO).

Conclusion.

No statistically significant difference was found in the need for subsequent interventions after a single dose of either IM or PO dexamethasone. A single PO dose of dexamethasone can be effectively and safely used for the outpatient treatment of moderate croup.
Infantile Colic: Crying Time Reduction With a Whey Hydrolysate: A Double-Blind, Randomized, Placebo-Controlled Trial
Authors: Lucassen Peter L. B. J. , Assendelft Willem J. J. , Gubbels Jan W. , van Eijk Jacques ThM. , Douwes Adriaan C.
Published: August 2004

Objective.

To determine the effectiveness of whey hydrolysate formula in the treatment of infantile colic in a primary care setting in the Netherlands.

Study Design.

Randomized, double-blind, parallel trial with a 1-week qualification period and a 1-week intervention period.

Participants.

Forty-three healthy, thriving, formula-fed infants, <6 months old, crying >3 hours per day on at least 3 days per week. Infants were randomized to whey hydrolysate formula (n = 23) or standard formula (n= 20).

Main Outcome Measure.

Difference in duration of crying (minutes per day) between qualification week and intervention week.

Results.

Analysis according to the intention to treat principle showed a difference in the decrease of crying duration of 63 minutes per day [95% confidence interval: 1–127 minutes per day] in favor of the whey hydrolysate formula. Five infants did not complete the trial. The scope of the study was not sufficient to expect significant differences in the subgroup analyses.

Conclusions.

An extensively hydrolyzed whey formula is effective in reducing the duration of crying in a primary care setting.
Do Pediatricians Recognize Mothers With Depressive Symptoms?
Authors: Heneghan Amy M. , Silver Ellen Johnson , Bauman Laurie J. , Stein Ruth E. K.
Published: August 2004

Objective.

To determine whether pediatric health care providers recognize maternal depressive symptoms and to explore whether maternal, provider, and visit characteristics affect pediatric providers' ability to recognize inner-city mothers with depressive symptoms.

Design.

A cross-sectional study was conducted at a hospital-based, inner-city, general pediatric clinic. Two groups of participants completed questionnaires, each unaware of the other's responses: 1) mothers who brought their children ages 6 months to 3 years for health care maintenance or a minor acute illness and 2) pediatric health care providers (attending pediatricians, pediatric trainees, and nurse practitioners). The mothers' questionnaire consisted of sociodemographic items and a self-administered assessment of depressive symptoms using the Psychiatric Symptom Index (PSI). Pediatric providers assessed child, maternal, and family functioning and documented maternal depressive symptoms. Criteria for positive identification of a mother by the pediatric health care provider were met if the provider reported one or more maternal symptoms (from a 10-item list of depressive symptoms), a rating of 4 or less on a scale of functioning, a yes response to the question of whether the mother was acting depressed, or a response that the mother was somewhat to very likely to receive a diagnosis of depression.

Results.

Of 338 mothers who completed the questionnaire, 214 (63%) were assessed by 1 of 60 pediatric providers. Seventy-seven percent of surveys were completed by the child's designated pediatric provider. The mean visit length was 23 minutes. Mothers primarily were single, were black or Hispanic, and had a mean age of 26 years (15–45 years). Almost 25% of mothers were living alone with their children. Eighty-six (40%) mothers scored ≥20 on the PSI, representing high symptom levels. Of these, 25 were identified by pediatric providers (sensitivity = 29%). A total of 104 of 128 mothers with a PSI score <20 were identified as such by providers (specificity = 81%). Pediatric providers were more likely to identify mothers who were <30 years old, living alone, and on public assistance. Also, mothers who were assessed by the child's own primary provider or by an attending pediatrician were more likely to be identified accurately than were mothers whose children were seen by a pediatric trainee or a nurse practitioner.

Conclusions.

Pediatric health care providers did not recognize most mothers with high levels of self-reported depressive symptoms. Pediatricians may benefit from asking directly about maternal functioning or by using a structured screening tool to identify mothers who are at risk for developing depressive symptoms. In addition, training pediatric providers to identify mothers with depressive symptoms may be beneficial.
Prevention of Sexual Harassment in the Workplace and Educational Settings
Authors:   Committee on Pediatric Workforce, Subcommittee on Women in Pediatrics
Published: August 2004

This Policy Statement was revised. See https://doi.org/10.1542/peds.2006-1816.

The American Academy of Pediatrics is committed to all its constituents supporting workplaces and educational settings free of sexual harassment. The purpose of this statement is to heighten awareness and sensitivity to this important issue, recognizing that institutions may have existing policies.
Meningococcal Disease Prevention and Control Strategies for Practice-Based Physicians (Addendum: Recommendations for College Students)
Authors:   Committee on Infectious Diseases
Published: August 2004

The numbers of reported cases of meningococcal disease in 15- to 24-year-olds and outbreaks of meningococcal serogroup C disease, including outbreaks in schools and other institutions, have increased during the past decade. In response to outbreaks on college campuses, the American College Health Association has taken an increasingly proactive role in alerting college students and their parents to the risk of this disease and informing them about the availability of an effective vaccine. Recent epidemiologic studies have demonstrated an increased risk of disease in college students living in dormitories, particularly among freshmen, compared with similarly aged persons in the general population. At least 60% of these cases are potentially preventable by vaccination with the quadrivalent meningococcal A, C, Y, and W-135 polysaccharide vaccine. These findings support immunization of college students, particularly freshmen living in dormitories. Hence, college students and their parents should be informed by health care professionals at routine prematriculation visits and during college matriculation of the risk of meningococcal disease and potential benefits of immunization. Vaccine should be made available to those requesting immunization. College and university health services also should facilitate implementation of educational programs concerning meningococcal disease and availability of immunization services.
Technical Report: Irradiation of Food
Authors:   Katherine M. Shea, MPH MD, ,   the Committee on Environmental Health
Published: August 2004

This Technical Report was retired October 2004.

Recent well-publicized outbreaks of foodborne illness have heightened general interest in food safety. Food irradiation is a technology that has been approved for use in selected foods in the United States since 1963. Widespread use of irradiation remains controversial, however, because of public concern regarding the safety of the technology and the wholesomeness of irradiated foods. In this report, we describe the technology, review safety and wholesomeness issues, and give a historical perspective of the public controversy regarding food irradiation.
Technical Report: Congenital Adrenal Hyperplasia
Authors:   Section on Endocrinology and Committee on Genetics
Published: August 2004

The Section on Endocrinology and the Committee on Genetics of the American Academy of Pediatrics, in collaboration with experts from the fields of pediatric endocrinology and genetics, developed this policy statement as a means of providing up-to-date information for the practicing pediatrician about current practice and controversial issues in congenital adrenal hyperplasia (CAH), including the current status of prenatal diagnosis and treatment, the benefits and problem areas of neonatal screening programs, and the management of children with nonclassic CAH. The reference list is designed to allow physicians who wish more information to research the topic more thoroughly.
Hepatitis B Immunization Coverage Among Vietnamese-American Children 3 to 18 Years Old
Authors: Jenkins Christopher N. H. , McPhee Stephen J. , Wong Ching , Nguyen Thoa , Euler Gary L.
Published: August 2004

Objective.

Persons with chronic hepatitis B virus (HBV) infection are at increased risk of chronic hepatitis, cirrhosis, and liver cancer. Although HBV infection is relatively uncommon in the United States, the disease is endemic in persons born in Southeast Asia, including Vietnamese-Americans. Current US infant immunization recommendations and state-mandated school-entry programs have left many nontargeted age-cohorts unvaccinated and at risk of infection. To assess the need for catch-up hepatitis B immunizations, this study reports the hepatitis B immunization rates of Vietnamese-American children 3 to 18 years old living in the metropolitan areas of Houston and Dallas, Texas, and the Washington, DC, area.

Design.

We conducted 1508 telephone interviews with random samples of Vietnamese households in each of the 3 study sites. We asked for hepatitis B immunization dates for a randomly selected child in each household. Attempts were made to verify immunization dates through direct contact with each child's providers. Low and high estimates of coverage were calculated using reports from providers when reached (n = 720) and for the entire sample (n = 1508).

Results.

Rates of having 3 hepatitis B vaccinations ranged from 13.6% (entire sample) to 24.1% (provider reports, Dallas), 10.3% to 26.4% (Houston), and 18.1% to 37.8% (Washington, DC). Children living in the Texas sites, older children, children whose families had lived in the United States for a longer time, and children whose provider was Vietnamese or who had an institutional provider were less likely to have been immunized. The odds of being immunized were greater, however, for children who had had at least 1 diphtheria, tetanus toxoid, and pertussis shot, and whose parents had heard about HBV infection, and were married.

Conclusions.

The low rates of hepatitis B vaccine coverage among children and adolescents portend a generation which, too old to benefit from infant programs and school entry laws, will grow into adulthood without the protection of immunization. Increased efforts are needed to design successful catch-up campaigns for this population.
Demographic and Therapeutic Determinants of Pain Reactivity in Very Low Birth Weight Neonates at 32 Weeks' Postconceptional Age
Authors: Grunau Ruth Eckstein , Oberlander Tim F. , Whitfield Michael F. , Fitzgerald Colleen , Lee Shoo K.
Published: August 2004

Background.

Management of pain in very low birth weight infants is limited by a lack of empiric knowledge about the multiple determinants of biobehavioral reactivity in infants receiving neonatal intensive care.

Objective.

To examine relationship of early neonatal factors and previous medication exposure to subsequent biobehavioral reactivity to acute pain of blood collection.

Design.

Prospective cohort study.

Methods.

One hundred thirty-six very low birth weight (≤1500 g) infants who underwent heel lance for blood collection at 32 weeks' postconceptional age formed the study sample, after excluding those with significant cerebral lesions (periventricular leukomalacia or cerebral parenchymal infarction [grade 4 intraventricular hemorrhage]) on cranial ultrasound. Pain reactions were assessed using the Neonatal Facial Coding System, infant state, and spectral analysis of change in heart rate variability from baseline to reaction to invasive stimulation. Factor analysis was used to provide an empirical basis for deriving summary pain scores, one factor was primarily behavioral and the other primarily autonomic.

Results.

A normal reaction to procedural pain is characterized by facial grimacing and heightened cardiac sympathetic activity. The most significant factors associated with altered behavioral and autonomic pain reactivity at 32 weeks' postconceptional age were a greater number of previous invasive procedures since birth and gestational age (GA) at birth, both of which were related to a dampened response. After controlling for these variables, exogenous steroid exposure made an independent contribution to both the behavioral and autonomic pain scores, also in the direction of dampening the response. Conversely, previous exposure to morphine was associated with “normalized” (ie, increased) rather than diminished responses. In addition, higher mean heart rate at baseline was associated with lower GA at birth and longer time on mechanical ventilation.

Conclusion.

Early pain exposure at very low GA may alter the autonomic substrate, resulting in infants who are in a perpetual state of stress. The results of this study suggest that the judicious use of analgesia may ameliorate these effects on later pain reactivity. However, although early morphine exposure may “normalize” subsequent pain reaction, this study did not examine its effects on neurodevelopment.
Does Fluorescent Urine Indicate Antifreeze Ingestion by Children?
Authors: Casavant Marcel J. , Shah Manish N. , Battels Ralph
Published: August 2004

Objective.

Fluorescent urine has been reported to indicate antifreeze ingestion. Recently, we evaluated a child who was suspected of ethylene glycol ingestion. Although she had fluorescent urine, subsequent studies showed that she had not ingested antifreeze. We tested whether fluorescent urine indicates antifreeze ingestion by children.

Methods.

A convenience sample of urine specimens from 30 hospitalized children was obtained. All of the patients had been hospitalized for reasons unrelated to poisoning. The specimens were viewed with a Wood's lamp, and the samples were identified as fluorescent or not fluorescent. A second convenience sample of urine specimens from a group of 16 healthy children was obtained, and these specimens were identified as fluorescent or not fluorescent in a similar manner.

Results.

The majority of urine specimens obtained from children are fluorescent. There is variation in the interpretation of urine fluorescence among observers. The type of container used may influence the finding of fluorescence.

Conclusions.

Fluorescent urine is not an indicator of ethylene glycol antifreeze ingestion by children.
Behavior Problems in Children Before First Recognized Seizures
Authors: Austin Joan K. , Harezlak Jaroslaw , Dunn David W. , Huster Gertrude A. , Rose Douglas F. , Ambrosius Walter T.
Published: August 2004

Objective.

It is not known when behavior problems begin in children with epilepsy. The purposes of this study were to: 1) describe the rates of behavior problems in children before their first recognized seizure, 2) determine the differences in behavior problems between children with a first recognized seizure and their healthy siblings, and 3) identify the seizure variables early in the course of the condition that are associated with behavior problems before the first recognized seizure.

Methods.

The sample was 224 children (4–14 years old) with a first recognized seizure and their 135 healthy siblings. As part of a larger study, computer-assisted structured telephone interviews were conducted with mothers to measure child and sibling behavior problems. Behavior problems were measured using the Child Behavior Checklist. Frequencies, t tests, correlational analysis, and multiple regression were used to analyze data.

Results.

Higher than expected rates of behavior problems in the 6 months before the first recognized seizure were found in the total seizure sample, with 32.1% being in the clinical or at-risk range. Rates were highest in children who had previous events that were probably seizures, with 39.5% in the clinical or at-risk range. Children with seizures had significantly higher Total, Internalizing, Attention, Thought, and Somatic Complaints problem scores than their nearest-in-age healthy siblings. Within the seizure sample, variables significantly associated with behavior problems after adjusting for research site, child sex, child age, and socioeconomic status (as represented by primary caregiver's education) were interactions of previously unrecognized seizures with gender and epilepsy syndrome/type of seizures.

Conclusions.

Children with previously unrecognized seizures are already at increased risk for behavior problems at the time of their first recognized seizure. These findings are consistent with the hypothesis that in some children, epilepsy is a pervasive condition that includes both seizures and behavioral problems.
Child Health in the Information Age: Media Education of Pediatricians
Authors: Rich Michael , Bar-on Miriam
Published: August 2004

Objective.

Substantial research has associated exposure to entertainment media with increased levels of interpersonal violence, risky sexual behavior, body image distortion, substance abuse, and obesity. The objective of this study was to determine what pediatric residency programs are teaching trainees about media and the influence of media on the physical and mental health of children and adolescents.

Design.

Survey of residency curricula, consisting of 17 items about children's exposure to media, including television, movies, popular music, computer/video games and the Internet, the effects of this exposure on specific health risks, and associations between program characteristics and media education in the residency curriculum.

Participants.

Directors of the 209 accredited pediatric residency programs in the United States.

Results.

Two hundred four programs (97.6%) responded. Fifty-eight programs (28.4%) offered formal education on 1 or more types of media; 60 programs (29.4%) discussed the influences of media when teaching about specific health conditions. Residents in 96 programs (47.1%) were encouraged to discuss media use with patients and parents; 13 programs (6.4%) taught media literacy as an intervention. Among program characteristics, only media training received by program directors was significantly associated with inclusion of media in residency curricula.

Conclusions.

Despite increasing awareness of media influence on child health, less than one-third of US pediatric residency programs teach about media exposure. Developing a pediatric media curriculum and training pediatric residency directors or designated faculty may be a resource-effective means of improving health for children growing up in a media-saturated environment.
The Pediatrician's Role in Family Support Programs
Authors:   Committee on Early Childhood, Adoption, and Dependent Care
Published: August 2004

Children's brain growth, general health, and development are directly influenced by emotional relationships during early childhood. Contemporary American life challenges families' abilities to promote successful developmental outcomes and emotional health for their children. Pediatricians are positioned to serve as family advisors and community partners in supporting the well-being of children and families. This statement recommends opportunities for pediatricians to develop their expertise in assessing the strengths and stresses in families, in counseling families about strategies and resources, and in collaborating with others in their communities to support family relationships.
Peer, Parent, and Media Influences on the Development of Weight Concerns and Frequent Dieting Among Preadolescent and Adolescent Girls and Boys
Authors: Field Alison E. , Camargo Carlos A. , Taylor C. Barr , Berkey Catherine S. , Roberts Susan B. , Colditz Graham A.
Published: August 2004

Objective.

To assess prospectively the influence of peers, parents, and the media on the development of weight concerns and frequent dieting.

Design.

Prospective cohort study.

Setting.

Questionnaires mailed annually to participants throughout the United States.

Participants.

One-year follow-up of 6770 girls and 5287 boys who completed questionnaires in 1996 and 1997 and were between 9 and 14 years of age in 1996.

Main Outcome Measure.

Onset of high levels of concern with weight and dieting frequently to control weight.

Results.

During 1 year of follow-up, 6% of girls and 2% of boys became highly concerned with weight and 2% of girls and 1% of boys became constant dieters. Peer influence was negligible. Independent of age and body mass index, both girls (odds ratio [OR]): 1.9; 95% confidence interval [CI]: 1.1–3.1) and boys (OR: 2.7; 95% CI: 1.1–6.4) who were making a lot of effort to look like same-sex figures in the media were more likely than their peers to become very concerned with their weight. Moreover, both girls (OR: 2.3; 95% CI: 1.1–5.0) and boys (OR: 2.6; 95% CI: 1.1–6.0) who reported that their thinness/lack of fat was important to their father were more likely than their peers to become constant dieters.

Conclusions.

Our results suggest that parents and the media influence the development of weight concerns and weight control practices among preadolescents and adolescents. However, there are gender differences in the relative importance of these influences.
Review of 49 Neonates With Acquired Fungal Sepsis: Further Characterization
Authors: Makhoul Imad R. , Kassis Imad , Smolkin Tatiana , Tamir Ada , Sujov Polo
Published: August 2004

Background.

Neonatal acquired fungal sepsis (AFS) is a risky condition that warrants every effort for early diagnosis and management.

Methods.

We retrospectively reviewed the medical charts of all 4445 neonatal intensive care unit (NICU) admissions in the past 10 years and detected 49 neonates with AFS. We then compared their data with those of 49 matched control neonates who did not have AFS. The following details were collected: gestational, perinatal and neonatal courses; bacterial sepsis; antibacterial therapy; laboratory and imaging investigations; and antifungal therapy and its complications.

Results.

The incidence of AFS was .4 to 2 cases per 1000 live-births and 3.8% to 12.9% of very low birth weight (VLBW) infants. Compared with 1989 through 1992, between 1993 and 1995 the rate of AFS in VLBW neonates significantly increased (3.8%–5.6% → 9.6%–12.9%), along with a significant increase of NICU admission rate (369–410 → 496–510 admissions/year). Compared with controls, AFS neonates had significantly longer hospitalizations, higher rates of mechanical ventilation, umbilical vein catheterization, and previous treatment with broad-spectrum antibacterial agents (amikacin, vancomycin, ceftazidime, or imipenem). At the onset of AFS, 42.8% of patients had hyperthermia and 40.9% had normal white blood cell count. Causative fungi were as follows: Candida albicans—42.8% of cases, Candida parapsilosis—26.5%, and Candida tropicalis—20.4%. Fungal dissemination was rare, complications of antifungal therapy were infrequent, and no deaths occurred.

Conclusions.

First, non-albicans Candidahave become more frequent in neonatal AFS. Second, mechanical ventilation and antibacterial agents are significant risk factors for AFS. Third, hyperthermia is a frequent presenting sign of AFS. Fourth, a normal white blood cell count does not rule out AFS. Fifth, meningeal involvement in neonatal AFS should be ruled out before initiation of antifungal therapy. Sixth, the policy of empiric antifungal therapy for AFS should be considered on an individual NICU basis. newborn infant, fungal sepsis, clinical signs, risk factors.
The Timing of Neonatal Discharge: An Example of Unwarranted Variation?
Authors: Touch Suzanne M. , Greenspan Jay S. , Kornhauser Michael S. , O'Connor John P. , Nash David B. , Spitzer Alan R.
Published: August 2004

Discharge from an intensive care nursery should be dependent on the infant's clinical and social condition and independent of the day of the week.

Objective. To evaluate admission and discharge dates of 5272 neonates cared for in 5 major metropolitan regions in the United States and managed by a national disease management company for the distribution of the day of the week.

Study Design. All infants discharged to home between July 1, 1996 and September 30, 1998 are included. Data are represented as a percentage of total discharges or admissions for each weekday assignment. Using the normal approximation to the multinomial distribution, we tested for proportional differences on each weekday.

Results. The data demonstrate that the timing of nursery discharge has an uneven distribution across the days of the week, with weekend (Saturday and Sunday) discharge rates that are significantly lower than weekday discharge rates. This uneven distribution exists in both the term and preterm subgroups as well. There is also an uneven distribution of births among the days of the week, with a pattern that reveals fewer weekend births than weekday births in the entire population studied, as well as in both the term and preterm subgroups. Normalizing these weekend discharges to the previous weekday could generate potential saving of $1 569 405 in charges for the total population and 627 days of hospitalization. The average length of stay of infants discharged on Mondays is longer than for those infants discharged on Saturday or Sunday.

Conclusions. We speculate that changes in discharge planning could decrease the variation in day of discharge, shorten length of hospitalization, and potentially reduce cost.
Effect of Intravenous Iron Supplementation on Erythropoiesis in Erythropoietin-Treated Premature Infants
Authors: Pollak Arnold , Hayde Michael , Hayn Marianne , Herkner Kurt , Lombard Kenneth A. , Lubec Gert , Weninger Manfred , Widness John A.
Published: August 2004

Objective.

To test the efficacy and safety of combining intravenous iron in amounts approximating the in utero iron accretion rate and the postnatal iron loss with erythropoietin (EPO) in very low birth weight (VLBW) infants.

Methods.

A prospective, controlled, randomized, unmasked trial lasting 21 days was performed in 29 clinically stable VLBW infants <31 weeks' gestation and <1300 g birth weight not treated with red blood cell transfusions during the study period. Mean (± standard error of the mean) age at study entry was 23 ± 2.9 days. After a 3-day run-in baseline period in which all participants received oral supplements of 9 mg/kg/day of iron polymaltose complex (IPC), participants were randomized to receive 18 days of treatment with: 1) oral IPC alone (oral iron group); 2) 300 U of recombinant human EPO (r-HuEPO) kg/day and daily oral IPC (EPO + oral iron group); 3) 2 mg/kg/day of intravenous iron sucrose, r-HuEPO, and oral iron (intravenous iron + EPO group). To assess efficacy of the 3 treatments, serial blood samples were analyzed for hemoglobin (Hb), hematocrit (Hct), reticulocyte count, red blood cell indices and plasma levels of transferrin, transferrin receptor (TfR), ferritin, and iron. Oxidant injury was assessed before and after treatment by plasma and urine levels of malondialdehyde (MDA) ando-tyrosine.

Results.

At the end of treatment, Hb, Hct, reticulocyte count, and plasma TfR were markedly higher in both of the EPO-treated groups, compared with the oral iron group. At study exit a trend toward increasing Hb and Hct levels and significantly higher reticulocyte counts were observed in the intravenous iron + EPO group, compared with the EPO + oral iron group. During treatment, plasma ferritin levels increased significantly in the intravenous iron + EPO group and decreased significantly in the other 2 groups. By the end of treatment, ferritin levels were significantly higher in the intravenous iron + EPO group compared with the other 2 groups. Although plasma and urine MDA or o-tyrosine did not differ among the 3 groups, plasma MDA was significantly greater in the subgroup of intravenous iron + EPO participants sampled at the end of the 2-hour parenteral iron infusion, compared with values observed immediately before and after parenteral iron-dosing.

Conclusions.

In stable VLBW infants receiving EPO treatment, parenteral supplementation with 2 mg/kg/day of iron sucrose results in a small, but significant, augmentation of erythropoiesis beyond that of r-HuEPO and enteral iron alone. However, to reduce the potential adverse effects of parenteral iron/kg/day on increasing plasma ferritin levels and on causing oxidative injury, we suggest that the parenteral iron dose used should be reduced and/or the time of infusion extended to maintain a serum iron concentration below the total iron-binding capacity.
Hyperuricosuria in Children: Clinical Presentation and Natural History
Authors: La Manna Angela , Polito Cesare , Marte Antonio , Iovene Antonio , Di Toro Rosario
Published: August 2004

Objective.

  Idiopathic hyperuricosuria (HU) was previously reported in only a limited number of children with hematuria. We aimed to outline the clinical presentation and natural history of HU not only in children with hematuria, but also in those with dysuria and/or recurrent abdominal/flank pain and a family history of urolithiasis.

Study Design.

Retrospective analysis of data at diagnosis from 102 consecutive children with HU and outcome analysis of 26 of them who were followed ≥1 years (mean: 3.1) with no specific therapy.

Results.

Sixty-one participants had HU and 41 had HU + hypercalciuria. Fifty-two patients had no hematuria among the presenting symptoms, more than one third had normal urinalysis at our first examination, one half had microcalculi (<3 mm in diameter) at renal sonography, and 12% had stones (4–18 mm). Thirty participants of the 39 with no hematuria at our first examination (77%) showed microcalculi or calculi at renal sonography. The patients with microcalculi were significantly older than were those without microcalculi. During the follow-up, 4 of 26 children never had hematuria and 8 had no hematuria during most of the follow-up period. Two patients who had a calculus at first visit and 3 who formed calculi 4 to 12 mm in diameter, after 1 to 3.5 years subsequently passed them in the urine.

Conclusions.

The lack of hematuria is not predictive of absence of urolithiasis. Therefore, it may be misleading to judge on the efficacy of a given therapy only based on disappearance of hematuria. HU and hypercalciuria have to be suspected in children with dysuria and those with recurrent abdominal/flank pain and familial history of urolithiasis, although they have no hematuria.
Peptostreptococcus asaccharolyticus Renal Abscess: A Rare Cause of Fever of Unknown Origin
Authors: Casullo Veronica A. Mas , Bottone Edward , Herold Betsy C.
Published: August 2004

Renal abscess is uncommon in pediatrics and is rarely a cause of fever of unknown origin. We recently cared for a patient who presented with a 3-week history of fever. An indium scan ultimately led to the diagnosis of a renal abscess. Aspiration yieldedPeptostreptococcus asaccharolyticus. This unusual case prompted a review of the clinical and microbiologic features of renal abscess in pediatric patients at our hospital over the past 10 years. Seven additional patients with a discharge diagnosis of renal abscess were identified. Only 2 of the patients had identifiable risk factors (diabetes mellitus and polycystic kidneys). Staphylococcus aureus or Enterobacteriaceae were responsible for most infections, consistent with hematogenous and urinary tract sources, respectively. No other cases of anaerobic abscess were identified. This case highlights the importance of considering a renal abscess in the differential diagnosis of fever of unknown origin and of processing specimens for both aerobic and anaerobic organisms.
Association of Nonpolio Enteroviral Infection in the Central Nervous System of Children With Febrile Seizures
Authors: Hosoya Mitsuaki , Sato Masatoki , Honzumi Ken , Katayose Masahiko , Kawasaki Yukihiko , Sakuma Hiroko , Kato Kazuo , Shimada Yasushi , Ishiko Hiroaki , Suzuki Hitoshi
Published: August 2004

Objective.

To clarify the relationship between enteroviral infection and febrile seizures.

Study Design.

Cerebrospinal fluid (CSF), serum, throat swab, and rectal swab samples were collected for virologic examination from 67 children with febrile seizures from April 1997 to March 1999. Those samples were examined for the presence of enterovirus using cell culture and 2 polymerase chain reaction (PCR) methods.

Results.

No enterovirus was isolated from cell culture of CSF, throat swab, or rectal swab samples. All samples were screened for the presence of enteroviral sequences using a sensitive PCR method (PCR-Fukushima). We obtained positive results from 14 of 67 CSF samples, 10 of 62 serum samples, 12 of 64 throat swab samples, and 13 of 64 rectal swab samples. Of 21 patients in whom febrile seizures had developed during the summer months (June through August), 13 (61.9%) had positive PCR results in the CSF. Forty-seven of the 49 samples with a positive result using PCR-Fukushima were reexamined independently for the presence of the enteroviral genome using another PCR method (PCR-Mitsubishi). PCR-Mitsubishi had slightly lower sensitivity than PCR-Fukushima but identified genotypes of enterovirus by subsequent sequence analysis of the PCR products. The presence of the enteroviral genome was confirmed in 39 of the samples (83.0%). In 8 of the 9 enteroviruses detected in the CSF and/or serum samples using PCR-Mitsubishi, the genotypes were identified as coxsackieviruses group A, which are usually difficult to isolate using cell culture methods.

Conclusions.

These findings proved that the causative agents of febrile illness associated with seizures in summer were primarily enteroviruses, especially coxsackieviruses group A, and that febrile seizures might be caused by enteroviral infection in the central nervous system.
Low-Grade Systemic Inflammation in Overweight Children
Authors: Visser Marjolein , Bouter Lex M. , McQuillan Geraldine M. , Wener Mark H. , Harris Tamara B.
Published: August 2004

Objective.

Human adipose tissue expresses and releases the proinflammatory cytokine interleukin-6, potentially inducing low-grade systemic inflammation in persons with excess body fat. To limit potential confounding by inflammation-related diseases and subclinical cardiovascular disease, we tested the hypothesis that overweight is associated with low-grade systemic inflammation in children.

Design and Setting.

The third National Health and Nutrition Examination Survey, 1988–1994, a representative sample of the US population.

Participants.

A total of 3512 children 8 to 16 years of age.

Outcome Measures.

Elevated serum C-reactive protein concentration (CRP; ≥.22 mg/dL) and white blood cell count (109 cells/L).

Results.

Elevated CRP was present in 7.1% of the boys and 6.1% of the girls. Overweight children (defined as having a body mass index or a sum of 3 skinfolds (triceps, subscapula, and supra-iliac) above the gender-specific 85th percentile) were more likely to have elevated CRP than were their normal-weight counterparts. After adjustment for potential confounders, including smoking and health status, the odds ratio (OR) was 3.74 (95% confidence interval [CI]: 1.66–8.43) for overweight boys and the OR was 3.17 (95% CI: 1.60–6.28) for overweight girls, based on the body mass index. Based on the sum of 3 skinfolds, these ORs were 5.11 (95% CI: 2.36–11.06) and 2.89 (95% CI: 1.49–5.59) for boys and girls, respectively. Overweight was also associated with statistically significant higher white blood cell counts. The results were similar when restricted to healthy, nonsmoking, nonestrogen-using children.

Conclusions.

In children 8 to 16 years of age, overweight is associated with higher CRP concentrations and higher white blood cell counts. These findings suggest a state of low-grade systemic inflammation in overweight children. inflammation, obesity, children.
Tissue Transglutaminase Enzyme-Linked Immunosorbent Assay as a Screening Test for Celiac Disease in Pediatric Patients
Authors: Chan An-Wen , Butzner J. Decker , McKenna Rachel , Fritzler Marvin J.
Published: August 2004

Objective.

An immunoglobulin A (IgA) anti-tissue transglutaminase antibody assay (anti-tTG) was compared with the conventional IgA anti-endomysium antibody assay (EMA) to assess its reliability as a screening test for celiac disease (CD) in a pediatric population.

Methods.

Seventy-five IgA-sufficient and 2 IgA-deficient children who were scheduled for small intestinal biopsy for the evaluation of history or symptoms suggesting a diagnosis of CD were prospectively evaluated and enrolled in this study (gastrointestinal [GI] patients). In addition, 16 children with type I diabetes mellitus (DM) who had a positive EMA and a small bowel biopsy were included as a separate cohort. IgA anti-tTG was measured by enzyme-linked immunosorbent assay (ELISA), and IgA-EMA titers were determined by indirect immunofluorescence on cryopreserved sections of monkey esophagus.

Results.

Nine of the 75 IgA-sufficient GI patients had a small bowel biopsy consistent with the diagnosis of CD. Eight of 9 IgA-sufficient patients with a positive small bowel biopsy had positive anti-tTG and EMA tests. Four IgA-sufficient patients had a false-positive anti-tTG ELISA and 2 had a false-positive IgA-EMA assay. In the IgA-sufficient patients, the sensitivity was 89% and the negative predictive value was 98% for either assay. The specificities of the IgA anti-tTG and the IgA-EMA tests were 94% and 97%, respectively (not significant). The positive predictive value of the IgA anti-tTG was 67%, compared with 80% for the IgA-EMA (not significant). In the 2 IgA-deficient children, one of whom had biopsy-proved CD, both tests were negative. In the 16 DM children 12 true- and 4 false-positive IgA anti-tTG and IgA-EMA results were identified. Three of 12 complained of GI symptoms. In follow-up, thus far, none of the DM patients with a false-positive anti-tTG have developed CD.

Conclusions.

The IgA anti-tTG antibody assay is equivalent to the IgA-EMA assay as a screening test for CD in IgA-sufficient pediatric patients. Intestinal biopsy remains the gold standard for the diagnosis of CD.
Central Nervous System and Renal Vasculitis Associated With Primary Varicella Infection in a Child
Authors: Caruso June M. , Tung Glenn A. , Brown William D.
Published: August 2004

A 7-year-old girl with primary varicella presented with encephalopathy and focal neurologic deficits 10 days after her first skin lesions appeared. She was discovered to have bilateral wedge-shaped renal infarctions, and ischemic lesions in the conus medullaris, cerebral cortex, and deep gray matter consistent with a medium and large vessel arteritis on magnetic resonance imaging. This complication has never before been reported in an immunocompetent child with primary varicella infection, and it represents a rare but serious complication of childhood chickenpox.
Early Diagnosis of Cystic Fibrosis in the Newborn Period and Risk of Pseudomonas aeruginosa Acquisition in the First 10 Years of Life: A Registry-Based Longitudinal Study
Authors: Wang Sophia S. , FitzSimmons Stacey C. , O'Leary Leslie A. , Rock Michael J. , Gwinn Marta L. , Khoury Muin J.
Published: August 2004

Objective.

Controlled clinical trial data have suggested that identifying asymptomatic cystic fibrosis (CF) patients through newborn screening improves health outcomes of affected children in the first decade of life. However, it is unclear whether these improvements also include a reduction in risk for bronchial infection, the major determinant of CF morbidity. The authors therefore investigated the association between early CF diagnosis and acquisition of Pseudomonas aeruginosa, the major bronchial pathogen, in the first decade of life.

Methodology.

Longitudinal data on 3625 CF patients diagnosed between 1982 and 1990 and before 36 months of age were ascertained from the National Cystic Fibrosis Patient Registry. We compared P aeruginosa acquisition in the first 10 years of life among 4 groups: EAD (early asymptomatic diagnosis)—<6 weeks, by pre/neonatal screening, genotype, family history (n = 157); ESD (early symptomatic diagnosis) (n = 227); LAD (late asymptomatic diagnosis)—6 weeks to 36 months (n = 161); and LSD (late symptomatic diagnosis) (n = 3080). P aeruginosa acquisition was determined from yearly sputum and/or bronchoscopy cultures. Children whose CF diagnoses followed meconium ileus or whose cultures were obtained only from nasal samples were excluded from the study.

Results.

Kaplan Meier analyses for P aeruginosa acquisition were conducted for each diagnostic group. Regression models were used to generate adjusted relative hazards with EAD as the referent group. Relative hazards were 0.9 (95% confidence interval [CI]: 0.7–1.2) for ESD, 0.8 (95% CI: 0.6–1.2) for LAD, and 1.0 (95% CI: 0.7–1.2) for LSD. The risk of acquiringP aeruginosa was therefore not significantly different between children diagnosed early, late, asymptomatically, or symptomatically.

Conclusions.

These data suggest that, despite improvements in other health outcomes from newborn screening for CF, early asymptomatic diagnosis of CF does not affect P aeruginosa acquisition.