bluuebunny/crossref_metadata_2025 huggingface dataset:
Neonatal Thyroxine Supplementation in Very Preterm Children: Developmental Outcome Evaluated at Early School Age
Authors: Briët Judy M. , van Wassenaer Aleid G. , Dekker Friedo W. , de Vijlder Jan J. M. , van Baar Anneloes , Kok Joke H.
Published: August 2004

Objective.

Transient hypothyroxinemia in very premature infants is associated with developmental problems. A randomized, placebo-controlled trial of thyroxine (T4) supplementation was conducted in a group of 200 infants <30 weeks' gestation. T4 supplementation improved mental outcome at 2 years old in children of 25/26 weeks' gestation only. The effect of T4 supplementation beyond 2 years of age is unknown. We present the effects of neonatal T4 supplementation on outcome at early school age.

Methods.

Standardized measurements were used to assess cognitive, behavioral, and motor outcome, as well as a qualitative assessment of neurologic functioning. Survivors of the T4trial were assessed at the age of 5.7 years.

Results.

Ninety-nine percent of the 157 survivors participated. Outcome on all domains was comparable between the T4 group and placebo group. In children <27 weeks' gestation, a 10 IQ point difference was found in favor of the T4 group, whereas in children of 29 weeks' gestation, a difference of 15 IQ points was found in favor of the placebo group. Teachers' reports showed less behavioral problems in the T4-treated children of 25/26 weeks' gestation, but more behavioral problems in the T4-treated children of 27 weeks' gestation. Differences in motor outcome and neurologic outcome were in favor of the T4-treated children <29 weeks' gestation, but not of the T4-treated children of 29 weeks' gestation.

Conclusions.

We found benefits of T4supplementation for children <29 weeks' gestation, and especially in children of 25/26 weeks' gestation. However, in children of 29 weeks' gestation T4 supplementation is associated with more developmental problems.
Impact of the Joint Statement by the American Academy of Pediatrics/US Public Health Service on Thimerosal in Vaccines on Hospital Infant Hepatitis B Vaccination Practices
Authors: Hurie Marjorie B. , Saari Thomas N. , Davis Jeffrey P.
Published: August 2004

Objective.

To determine the impact of the American Academy of Pediatrics/US Public Health Service (AAP/USPHS) joint statement on thimerosal in vaccines on hospital infant hepatitis B vaccination policies in Wisconsin.

Methods.

The nurse managers of hospital newborn nurseries (n = 110) were surveyed by mail. Nonresponders were resurveyed. Twelve hospitals no longer provided obstetric services. Of the remaining 98 hospitals, 84 (86%) responded to the initial mailing and 14 (14%) responded to the second mailing. The number of hospitals that offered hepatitis B vaccine to infants before July 1999 was compared with that in March 2000. The number of hospitals that had policies in place to vaccinate infants whose mothers' hepatitis B surface antigen status (HBsAg) was positive or unknown during the thimerosal alert (July 1999 through November 1999) was compared with that in March 2000.

Results.

Before July 1999, 81% of the hospitals representing 84% of reported Wisconsin births routinely offered hepatitis B vaccine to all infants. By March 2000, 50% of hospitals, representing 43% of births, had resumed routine infant hepatitis B vaccination. Physician decision to use a combination Haemophilus influenzae type b hepatitis B vaccine was the most frequently given reason for not reinstituting infant hepatitis B vaccination. During the thimerosal alert, 23% of hospitals did not have policies to vaccinate infants whose mothers were HBsAg-positive and 51% did not have policies to vaccinate infants whose mothers' HBsAg status was unknown. By March 2000, 6% of hospitals still did not have policies to vaccinate infants whose mothers were HBsAg-positive and 24% did not have policies to vaccinate infants whose mothers' HBsAg status was unknown.

Conclusion.

The AAP/USPHS joint statement on thimerosal in vaccines has resulted in a 38% decrease in the number of hospitals routinely offering infants hepatitis B vaccine. Although thimerosal-free hepatitis B vaccine is now available, some hospitals still do not have appropriate policies in place for vaccinating infants whose mothers' HBsAg status is positive or unknown. In the future, policymakers should include anticipated consequences that may result from changes in immunization policy in their recommendations.
Bacteremic Infection With Pediococcus: Vancomycin-Resistant Opportunist
Authors: Barton Leslie L. , Rider Evelyn D. , Coen Ronald W.
Published: August 2004

Pediococci are recently recognized Gram-positive human pathogens, resistant to vancomycin and generally susceptible to penicillin. Infection in adults has been seen in patients with chronic underlying conditions as well as those with previous abdominal surgery. Two previous infants with congenital gastrointestinal malformations requiring surgical correction have been reported with sepsis attributable to Pediococcus sp. We report a third infant born with gastroschisis who developedPediococcus bacteremia and meningitis 3 months after surgery, and speculate regarding the role of probiotics in the pathogenesis of this infection.
The Continued Importance of Supplemental Security Income (SSI) for Children and Adolescents With Disabilities
Authors:   Committee on Children With Disabilities
Published: August 2004

In 1996, as part of the Personal Responsibility and Work Opportunity Reconciliation (Welfare Reform) Act, Congress redefined the Supplemental Security Income (SSI) definition of disability for children and removed the individual functional assessment (IFA) step from the disability determination process. As a result, an estimated 100 000 SSI child beneficiaries have lost or will lose their SSI benefits. The publicity associated with this Congressionally mandated change might also have reduced the number of families applying for SSI benefits on behalf of their children because of a widely held belief that the eligibility criteria for disability benefits are now so restrictive that almost no children are determined to be eligible. The purpose of this statement is to provide updated information about the SSI Program's disability and financial eligibility criteria and disability determination process. This statement also discusses how pediatricians can help to ensure that all eligible children receive the SSI monies and associated benefits to which they are entitled.
High Levels of Interferon Gamma in the Plasma of Children With Complete Interferon Gamma Receptor Deficiency
Authors: Fieschi Claire , Dupuis Stéphanie , Picard Capucine , Smith C. I. Edvard , Holland Steven M. , Casanova Jean-Laurent
Published: August 2004

We have found that children with complete interferon gamma (IFNγ) receptor deficiency, unlike patients with other genetic defects predisposing them to mycobacterial diseases, have very high levels of IFNγ in their plasma. This unexpected observation provides a simple and accurate diagnostic method for complete IFNγ receptor deficiency in children with clinical disease caused by bacille Calmette-Guérin vaccines or environmental nontuberculous mycobacteria.
Variation in Clinician Recommendations for Multiple Injections During Adoption of Inactivated Polio Vaccine
Authors: Lieu Tracy A. , Davis Robert L. , Capra Angela M. , Mell Loren K. , Quesenberry Charles P. , Martin Kathleen E. , Zavitkovsky Ann , Black Steven B. , Shinefield Henry R. , Thompson Robert S. , Rodewald Lance E.
Published: August 2004

Objectives.

To describe variation in clinician recommendations for multiple injections during the adoption of inactivated poliovirus vaccine (IPV) in 2 large health maintenance organizations (HMOs), and to test the hypothesis that variation in recommendations would be associated with variation in immunization coverage rates.

Design.

Cross-sectional study based on a survey of clinician practices 1 year after IPV was recommended and computerized immunization data from these clinicians' patients.

Study Settings.

Two large West Coast HMOs: Kaiser Permanente in Northern California and Group Health Cooperative of Puget Sound.

Outcome Measures.

Immunization status of 8-month-olds and 24-month-olds cared for by the clinicians during the study.

Results.

More clinicians at Group Health (82%), where a central guideline was issued, had adopted the IPV/oral poliovirus vaccine (OPV) sequential schedule than at Kaiser (65%), where no central guideline was issued. Clinicians at both HMOs said that if multiple injections fell due at a visit and they elected to defer some vaccines, they would be most likely to defer the hepatitis B vaccine (HBV) for infants (40%). At Kaiser, IPV users were more likely than OPV users to recommend the first HBV at birth (64% vs 28%) or if they did not, to defer the third HBV to 8 months or later (62% vs 39%).

In multivariate analyses, patients whose clinicians used IPV were as likely to be fully immunized at 8 months old as those whose clinicians used all OPV. At Kaiser, where there was variability in the maximum number of injections clinicians recommended at infant visits, providers who routinely recommended 3 or 4 injections at a visit had similar immunization coverage rates as those who recommended 1 or 2. At both HMOs, clinicians who strongly recommended all possible injections at a visit had higher immunization coverage rates at 8 months than those who offered parents the choice of deferring some vaccines to a subsequent visit (at Kaiser, odds ratio [OR]: 1.2; 95% confidence interval [CI]: 1.0–1.5; at Group Health, OR: 1.8; 95% CI: 1.1–2.8).

Conclusions.

Neither IPV adoption nor the use of multiple injections at infant visits were associated with reductions in immunization coverage. However, at the HMO without centralized immunization guidelines, IPV adoption was associated with changes in the timing of the first and third HBV. Clinical policymakers should continue to monitor practice variation as future vaccines are added to the infant immunization schedule.
Effectiveness of a High School Smoking Cessation Program
Authors: Adelman William P. , Duggan Anne K. , MS Patricia Hauptman , Joffe Alain
Published: August 2004

Objective.

To evaluate the impact of a school-based smoking cessation program targeting adolescents interested in quitting.

Design.

Randomized clinical trial over one school year.

Setting.

Large public high school.

Participants.

Students interested in quitting smoking.

Intervention.

Seventy-four students were randomized to receive either: 1) a 6-week, 8-session, classroom-based, smoking cessation curriculum designed for adolescents (n = 35) or 2) an informational pamphlet on how to quit smoking with promise of the classroom curriculum in 3 months (n = 39).

Outcome Measures.

Change in smoking behavior measured by: 1) self-reported smoking cessation and exhaled carbon monoxide <6 parts per million (smoke-free); 2) self-reported quit attempts; and 3) change in cigarettes per day (cpd) at the end of the 6-week curriculum and then 4, 10, and 20 weeks later. Saliva cotinine was also measured at these points to validate these outcome measures.

Analysis.

Intention-to-treat.

Results.

Participants in the classroom group attended an average of 4.4 sessions. At the end of the curriculum, the classroom group was significantly more likely to be smoke-free (59% vs 17%), to have tried to quit smoking (82% vs 54%), and to reduce mean cpd (7.0 vs 1.0). Four weeks later, these differences persisted: smoke-free (52% vs 20%), quit attempt (85% vs 60%), and reduction in mean cpd (6.6 vs 1.6). Changes in saliva cotinine were consistent with reported outcome measures; those who were smoke-free had a significant reduction in saliva cotinine at the end of the intervention, and at 4 weeks. At 10 and 20 weeks after the curriculum, 41% and 31%, respectively, of the classroom group remained smoke-free. Once participants in the pamphlet group underwent the classroom intervention (average attendance of 2.2 sessions) their cessation rates were similar to the initial group: 31% at the end of the curriculum and 27% 10 weeks later.

Conclusion.

A school-based curriculum for adolescent smoking cessation is more effective than an informational pamphlet alone and reduces cigarette use by adolescents. More research is needed to test the reproducibility, sustainability, and generalizability of this curriculum to offer more smoking cessation options to teenagers.
Short-Term Hyperthyroidism Followed by Transient Pituitary Hypothyroidism in a Very Low Birth Weight Infant Born to a Mother With Uncontrolled Graves' Disease
Authors: Higuchi Ryuzo , Kumagai Takeshi , Kobayashi Masakazu , Minami Takaomi , Koyama Hirofumi , Ishii Yuki
Published: August 2004

Transient hypothyroxinemia in infants born to mothers with poorly controlled Graves' disease was first reported in 1988. We report that short-term hyperthyroidism followed by hypothyroidism with low basal thyroid-stimulating hormone (TSH) levels developed in a very low birth weight infant born at 27 weeks of gestation to a noncompliant mother with thyrotoxicosis attributable to Graves' disease. We performed serial thyrotropin-releasing hormone (TRH) tests in this infant and demonstrated that TSH unresponsiveness to TRH disappeared at 6.5 months of age.

The maternal thyroid function was free triiodothyronine (FT3), 21.1 pg/mL; free thyroxine (FT4), 8.1 ng/dL; TSH, <0.03 μU/mL; thyroid-stimulating hormone receptor antibody, 52% (normal: <15%); thyroid-stimulating antibody, 294% (normal: <180%); and thyroid-stimulation blocking antibody, 9% (normal: <25%) on the day of delivery. A nonstress test revealed fetal tachycardia >200 beats per minute, and a male infant weighing 1152 g was born by emergency cesarean section. Thyroid-stimulating hormone receptor antibody was 16% and thyroid-stimulating antibody was 370% in the cord blood. We administered 10 mg/kg per day of oral propylthiouracil from day 1. Tachycardia along with elevated FT4 and FT3 levels in the infant decreased from 200/minute to 170/minute, 4.7 ng/dL to 2.9 ng/dL, 7.0 pg/mL to 4.8 pg/mL, respectively, in the first 33 hours. At 5 days, FT4and FT3 were 1.1 ng/dL and 2.9 pg/mL, respectively, and we stopped propylthiouracil administration. Although FT4decreased to 0.4 ng/dL, TSH was quite low and did not respond to intravenous TRH by 14 days of age. We began daily levothyroxine 5-μ/kg supplementation. The responsiveness of TSH to TRH did not become significant until 4 months old and normalized at 6.5 months old. At this time, levothyroxine was stopped.

We conclude that placental transfer of thyroid hormones may cause hyperthyroidism in the fetal and early neonatal periods and lead to transient pituitary hypothyroidism in an infant born to a mother with uncontrolled Graves' disease.
Shortening the Questionnaire for Identifying Children With Chronic Conditions: What Is the Consequence?
Authors: Stein Ruth E. K. , Silver Ellen Johnson , Bauman Laurie J.
Published: August 2004

Objective.

To determine whether a reduced item set can identify children who have chronic conditions with a level of at least 90% accuracy compared with the complete Questionnaire for Identifying Children With Chronic Conditions (QuICCC).

Background.

The QuICCC was developed to operationalize a conceptually based, noncategorical definition of chronic conditions developed by Stein et al. It contains 39 item sequences administered to a parent that assess 3 types of consequences: functional limitations; reliance on compensatory mechanisms or assistance; and service use or need above usual for age. The QuICCC has been validated and widely adopted as a means of identifying children without using a diagnosis checklist, but there is considerable interest in shortening it.

Design/Methods.

Through secondary analyses of 3 data sets (Ns = 1265, 1388, and 4831), we identified a short list of items that identified >90% of children who were identified by the 39-item QuICCC. We administered these 16 items to 2 new samples of parents. In Study 1 we administered the 16 items in the shortened version first, followed by the other 23 items, and compared the results on the short and reordered long versions. In Study 2, the 39- and 16-item versions were each administered, one in person and the other by phone, in random order to the same respondent within a 2-week period. These data were analyzed to compare the short and longer versions at the 2 time points and within the single, longer 39-item format (simultaneous data).

Results.

In Study 1 (N = 630) only 4 children were missed by the 16-item version who were identified by the longer version (sensitivity 98.6%; specificity 100%; positive predictive value 100%; negative predictive value 98.8% κ 0.987). In Study 2 (N = 552), no children were missed by the 16-item subset of the 39 items when looking at the simultaneous data. When the two forms were administered 2 weeks apart, the 16-item version had a sensitivity of 87%, specificity of 90%, positive predictive value of 93%, negative predictive value of 82%, and κ of 0.78 compared with the longer QuICCC. These results correspond exactly to the data obtained in a 2-week test-retest study for the QuICCC itself. The new form (the QuICCC-R) takes <2 minutes to administer on average (range 1–4 minutes) compared with 7 to 8 minutes for the full QuICCC.

Conclusions.

The results met our criteria for agreement, and we conclude that the QuICCC-R is a satisfactory alternative for screening populations. However, the full QuICCC has other applications beyond screening that may not apply to the QuICCC-R, the shorter version.
Tolerability and Effectiveness of Prochlorperazine for Intractable Migraine in Children
Authors: Kabbouche Marielle A. , Vockell Anna-Liisa Bentti , LeCates Susan L. , Powers Scott W. , Hershey Andrew D.
Published: August 2004

Objective.

To study the effectiveness of prochlorperazine in aborting severe, intractable migraines in children.

Study Design.

Patients for this study were drawn from the population seen and evaluated in the Headache Center at Cincinnati Children's Hospital Medical Center. All patients were diagnosed with migraine headache by both clinical and International Headache Society criteria. The effectiveness of intravenous prochlorperazine in 20 consecutive patients referred to the emergency department for severe, prolonged migraines was retrospectively reviewed.

Results.

Patients evaluated in this study presented with a mean headache severity of 8.4 on a 0- to 10-point scale and an average duration of 54 hours. At 1 hour, 90% of the patients reported feeling better with 50% becoming pain-free. A 50% or greater reduction in severity occurred in 75% of patients at 1 hour and in 95% at 3 hours. At 3 hours, 95% of the patients reported feeling better, and 60% were pain-free. Only 1 patient failed to respond to prochlorperazine.

Conclusion.

Prochlorperzaine was shown to be highly effective in aborting intractable migraines in children. It was well tolerated with no significant side effects. Additional large, double-blinded, randomized, placebo-controlled studies are needed to further investigate its effectiveness.
Effect of Maternal Lead Burden on Infant Weight and Weight Gain at One Month of Age Among Breastfed Infants
Authors: Sanı́n Luz Helena , González-Cossı́o Teresa , Romieu Isabelle , Peterson Karen Eileen , Ruı́z Silvia , Palazuelos Eduardo , Hernández-Avila Mauricio , Hu Howard
Published: August 2004

Introduction.

Transfer of lead from bone to the bloodstream increases during lactation. However, the effect of maternal lead burden on growth in breastfed newborns is still unknown. This study examined early postnatal growth in a cohort of healthy breastfed newborns in relation to maternal bone lead burden.

Methods.

Lead levels were measured among 329 mother–infant pairs in umbilical cord blood at birth and in maternal and infant venous blood at 1 month postpartum. Maternal evaluations at 1 month postpartum included lead measures in blood and bone (measured in the tibia and the patella). Blood lead was determined by graphite furnace atomic absorption spectrophotometry. Bone lead was measured by109Cd Kx-radiograph fluorescence instrument. The primary endpoints were attained weight 1 month of age, and weight gain from birth to 1 month of age, which were analyzed in relation to lead biomarkers and relevant covariates by linear regression models.

Results.

Infants studied had an average weight gain of 33.1 g/day (standard deviation [SD] = 11.6). Mean infant (at 1 month of age) and maternal blood lead levels were 5.6 μg/dL (SD = 3.0) and 9.7 μg/dL (SD = 4.1), respectively. Mean maternal bone lead levels were 10.1 μg of lead/g (SD = 10.3) and 15.29 μg of lead/g (SD = 15.2) of bone mineral for tibia and patella, respectively. Infant blood lead levels were inversely associated with weight gain, with an estimated decline of 15.1 g per μg/dL of blood lead. Children who were exclusively breastfed had significantly higher weight gains; however, this gain decreased significantly with increasing levels of patella lead. The multivariate regression analysis predicted a 3.6-g decrease in weight at 1 month of age per μg of lead per gram bone mineral increase in maternal patella lead levels.

Conclusions.

Maternal lead burden is negatively associated to infant attained weight at 1 month of age and to postnatal weight gain from birth to 1 month of age. Additional studies are needed to better understand this source of exposure and to develop interventions to minimize its impact.
Noninvasive Assessment of the Early Progression of Atherosclerosis in Adolescents With Kawasaki Disease and Coronary Artery Lesions
Authors: Noto Nobutaka , Okada Tomoo , Yamasuge Masao , Taniguchi Kazuo , Karasawa Kensuke , Ayusawa Mamoru , Sumitomo Naokata , Harada Kensuke
Published: August 2004

Objectives.

The severity of carotid arteriosclerosis, defined as increased intima-media thickness (IMT) visible with B-mode ultrasound, is correlated with risk factors for coronary heart disease. Little is known, however, about the relation of IMT, the stiffness of the common carotid artery, and the progression of atherosclerosis in children with Kawasaki disease (KD) and coronary artery lesions (CAL).

Design.

We investigated the associations among total cholesterol (TC), high density lipoprotein cholesterol (HDL-C) , low density lipoprotein cholesterol (LDL-C), triglyceride, TC/HDL-C, ApoE genotype, glycohemoglobin, IMT, and arterial stiffness by high resolution ultrasound in 20 adolescents with KD and CAL (age: 16.6 ± 4.1 years, males: 60%) and 20 sex- and age-matched healthy controls (Cont).

Results.

No significant differences were observed in the values of body mass index and blood pressure between the 2 groups. Also no significant differences were observed in the levels of TC, LDL-C, HDL-C, triglyceride, TC/HDL-C within normal values, or the allele frequency of Apo E4 between the 2 groups. However, the values of IMT, stiffness, and glycohemoglobin in patients with KD were significantly higher than those in Cont (0.53 ± 0.07 vs 0.46 ± 0.05 mm, P < .05; 4.11 ± 0.86 vs 2.94 ± 0.91, P < .001; 5.0 ± 0.4 vs 4.6 ± 0.2%, P < .05). A significant relationship was observed between sex and the mean IMT (r = 0.46) in Cont; however, no significant correlation was found between mean IMT and other variables in either group. Although the arterial stiffness was strongly related to body mass index (r = 0.58) and systolic blood pressure (r = 0.55) in Cont, no significant relationship was observed between the stiffness and any variable tested in patients with KD.

Conclusions.

The less distensible carotid wall in patients with KD compared with that in Cont without major alteration of the lipid profile is likely to be secondary to the changes in arterial walls after a diffuse vasculitis involving noncoronary arteries. These results indicate that the coronary arteries may be predisposed to accelerated atherosclerosis in patients with KD and CAL.
Exposure to X-Rated Movies and Adolescents' Sexual and Contraceptive-Related Attitudes and Behaviors
Authors: Wingood Gina M. , DiClemente Ralph J. , Harrington Kathy , Davies Suzy , Hook Edward W. , Oh M. Kim
Published: August 2004

Objectives.

To examine the association between exposure to X-rated movies and teens' contraceptive attitudes and behaviors.

Methods.

Black females, 14 to 18 years old (n = 522) were recruited from adolescent medicine clinics, health departments, and school health clinics.

Results.

Exposure to X-rated movies was reported by 29.7% of adolescents. Exposure to X-rated movies was associated with being more likely to have negative attitudes toward using condoms (odds ratio [OR]: 1.4), to have multiple sex partners (OR: 2.0), to have sex more frequently (OR: 1.8), to not have not used contraception during the last intercourse (OR: 1.5), to have not used contraception in the past 6 months (OR: 2.2), to have a strong desire to conceive (OR: 2.3), and to test positive for chlamydia (OR: 1.7).

Conclusions.

Additional research is needed to understand the impact of X-rated movies on adolescents' sexual and contraceptive health.
An Assessment of Thimerosal Use in Childhood Vaccines
Authors: Ball Leslie K. , Ball Robert , Pratt R. Douglas
Published: August 2004

Background.

On July 7, 1999, the American Academy of Pediatrics and the US Public Health Service issued a joint statement calling for removal of thimerosal, a mercury-containing preservative, from vaccines. This action was prompted in part by a risk assessment from the Food and Drug Administration that is presented here.

Methods.

The risk assessment consisted of hazard identification, dose-response assessment, exposure assessment, and risk characterization. The literature was reviewed to identify known toxicity of thimerosal, ethylmercury (a metabolite of thimerosal) and methylmercury (a similar organic mercury compound) and to determine the doses at which toxicity occurs. Maximal potential exposure to mercury from vaccines was calculated for children at 6 months old and 2 years, under the US childhood immunization schedule, and compared with the limits for mercury exposure developed by the Environmental Protection Agency (EPA), the Agency for Toxic Substance and Disease Registry, the Food and Drug Administration, and the World Health Organization.

Results.

Delayed-type hypersensitivity reactions from thimerosal exposure are well-recognized. Identified acute toxicity from inadvertent high-dose exposure to thimerosal includes neurotoxicity and nephrotoxicity. Limited data on toxicity from low-dose exposures to ethylmercury are available, but toxicity may be similar to that of methylmercury. Chronic, low-dose methylmercury exposure may cause subtle neurologic abnormalities. Depending on the immunization schedule, vaccine formulation, and infant weight, cumulative exposure of infants to mercury from thimerosal during the first 6 months of life may exceed EPA guidelines.

Conclusion.

Our review revealed no evidence of harm caused by doses of thimerosal in vaccines, except for local hypersensitivity reactions. However, some infants may be exposed to cumulative levels of mercury during the first 6 months of life that exceed EPA recommendations. Exposure of infants to mercury in vaccines can be reduced or eliminated by using products formulated without thimerosal as a preservative.
Role of the Pediatrician in Family-Centered Early Intervention Services
Authors:   Committee on Children With Disabilities
Published: August 2004

There is growing evidence that early intervention services have had a positive influence on the developmental outcome of children with established disabilities or those considered “at risk” for disabilities and their families. Various federal and state statutes now mandate that community-based, coordinated, multidisciplinary, family-centered programs be established, which are accessible to serve children and families in need. The pediatrician, in close collaboration with the family and the early intervention team, plays a critical role in guiding the clinical and developmental aspects of the early intervention services provided. This role can be best served in the context of providing a medical home for children with special health care needs. The purpose of this statement is to assist the pediatrician in assuming a proactive role on the multidisciplinary team providing early intervention services.
Medical Conditions Affecting Sports Participation
Authors:   Committee on Sports Medicine and Fitness
Published: August 2004

This Policy Statement was retired July 2018.

Children and adolescents with medical conditions present special issues with respect to participation in athletic activities. The pediatrician can play an important role in determining whether a child with a health condition should participate in certain sports by assessing the child's health status, suggesting appropriate equipment or modifications of sports to decrease the risk of injury, and educating the athlete and parents on the risks of injury as they relate to the child's condition. This statement updates a previous policy statement and provides information for pediatricians on sports participation for children and adolescents with medical conditions.
The Pediatrician's Role in the Diagnosis and Management of Autistic Spectrum Disorder in Children
Authors:   Committee on Children With Disabilities
Published: August 2004

Primary care physicians have the opportunity, especially within the context of the medical home, to be the first point of contact when parents have concerns about their child's development or behavior. The goal of this policy statement is to help the pediatrician recognize the early symptoms of autism and participate in its diagnosis and management. This statement and the accompanying technical report will serve to familiarize the pediatrician with currently accepted criteria defining the spectrum of autism, strategies used in making a diagnosis, and conventional and alternative interventions.
Thirteen-Year Follow-Up of Children and Adolescents With Chronic Fatigue Syndrome
Authors: MD David S. Bell , Jordan Karen , Robinson Mary
Published: August 2004

Objective.

To describe the educational, social, and symptomatic outcome of children and adolescents with chronic fatigue syndrome 13 years after illness onset.

Methods.

Between January 1984 and December 1987, 46 children and adolescents developed an illness suggestive of chronic fatigue syndrome. Follow-up questionnaires were obtained from 35 participants an average of 13 years after illness onset. Data were obtained concerning subsequent medical diagnoses, amount of school missed, presence and severity of current symptoms, and subjective assessment of degree of illness resolution.

Results.

Of the 35 participants, 24 were female (68.6%) and 11 were male (31.4%). Average age at illness onset was 12.1 years. Eight participants (22.9%) had an acute onset of symptoms, 27 (77.1%) had a gradual onset. No participant received an alternative medical diagnosis that could have explained the symptom complex between illness onset and follow-up. Thirteen participants (37.1%) considered themselves resolved of illness at follow-up; 15 participants (42.9%) considered themselves well but not resolved; 4 (11.4%) considered themselves chronically ill; and 3 (8.6%) considered themselves more ill than during the early years of illness. Correlation with the Medical Outcomes Study Short Form Health Survey was good for current level of symptoms and degree of recovery. Eight participants (22.9%) missed >2 years of school, and 5 of these were still ill at follow-up. Amount of school missed correlated with both illness severity at follow-up and perceived social impact of the illness.

Conclusions.

These data demonstrate the presence of an illness consistent with the current definition of chronic fatigue syndrome. Eighty percent of children and adolescents affected had a satisfactory outcome from their fatiguing illness, although the majority of these participants had mild to moderate persisting symptoms. Twenty percent of participants remain ill with significant symptoms and activity limitation 13 years after illness onset. Chronic fatigue syndrome in children and adolescents may result in persistent somatic symptoms and disability in a minority of those affected.
Risk Factors for Latent Tuberculosis Infection Among Children in New York City
Authors: Saiman Lisa , Gabriel Pablo San , Schulte Joann , Vargas Miosotis Pimentel , Kenyon Thomas , Onorato Ida
Published: August 2004

Objective.

Although identification and appropriate treatment of children with latent tuberculosis (TB) infection (LTBI) is considered critical to the control and elimination of TB in the United States, there are limited data on risk factors for LTBI in pediatric populations.

Methods.

To further improve targeted screening for LTBI, we performed a matched case–control study from September 1996 to December 1998. We actively surveyed 24 primary care clinics serving Northern Manhattan and Harlem twice monthly for case participants 1 to 5 years old with LTBI, defined as a child with a Mantoux tuberculin skin test (TST) ≥10 mm and a normal chest radiograph. Two age- and clinic-matched control participants with TSTs equal to 0 mm were enrolled per case. To determine risk factors for LTBI, a bilingual research worker reviewed the medical records of study participants and administered a questionnaire to the parents of participants.

Results.

We enrolled 96 cases and 192 controls whom did not differ by age, gender, ethnicity, and race; overall, the mean age of participants was 2.9 years, 51% were male, 80% were Hispanic, and 9% black. Logistic regression analysis demonstrated that contact with an adult with active TB, foreign birth, foreign travel, and a relative with a positive TST were predictive of case status. In contrast, a history of a previous negative TST proved protective and BCG immunization was not an independent risk factor for a positive TST, suggesting that boosting was not important in this population.

Conclusions.

We identified several risk factors for LTBI in children that can be used to refine targeted surveillance for TB among Hispanic immigrant populations in the United States.
Scooter Injuries in Children
Authors: Levine Deborah A. , Platt Shari L. , Foltin George L.
Published: August 2004

Objective.

To describe a series of nonmotorized scooter-related injuries to children to increase public awareness and encourage prevention of such injuries.

Design.

A descriptive study of a consecutive series of patients.

Setting.

The pediatric emergency service of a municipal hospital.

Participants.

All children <18 years old who presented to the Pediatric Emergency Service (PES) with a scooter-related injury from July through September 2000.

Methods.

Patients were identified by review of the PES medical records. Charts were reviewed for patient data including age, place of injury, use of protective gear, adult supervision, injury sustained, medical management, and disposition.

Results.

There were 15 children treated in the PES for scooter-related injuries. The mean age was 7.8 years, 73% were male. Approximately 90% of injuries occurred as a result of falling off a scooter. Irregular pavement caused 3 falls and tandem riding caused 2 falls. Inability to use the foot brake caused 1 collision, and 1 child was hit by a motor vehicle while crossing the street. Injuries occurred in a park (33%), on a sidewalk (47%), in a home (13%), and on the street (7%). Adult supervision was present in half of the cases. Only 2 children were wearing helmets at the time of injury; none wore protective padding. Five children (33%) suffered head trauma; 1 lost consciousness, and 2 suffered amnesia. Three children required a head computed tomography scan, and 1 required cervical spine radiographs. All radiographs were negative. None of these 5 children were wearing helmets. Seven children (47%) sustained facial injuries, and 4 of these children required laceration repair. Seven children (47%) sustained extremity trauma, including 1 laceration and 6 fractures (1 supracondylar, 1 distal radius, 2 radius/ulnar, 1 tibia/fibula, and 1 patella). Four fractures involved the upper extremity. Four fractures were managed by closed reduction; 2 required operative repair. One child required splinting of an avulsed tooth. Three of the children (20%) were admitted. The 5 children with head trauma were observed and released.

Conclusion.

The use of nonmotorized scooters by children may result in serious injury, particularly in the young child. Although not life-threatening, these injuries require significant medical intervention and may result in permanent functional and cosmetic deformity. These injuries are potentially preventable with the proper use of protective gear and supervision. Public and parental awareness and education are essential to prevent additional injuries.
Adolescents With Cystic Fibrosis: Family Reports of Adolescent Health-Related Quality of Life and Forced Expiratory Volume in One Second
Authors: Powers Peggy M. , Gerstle Robert , Lapey Allen
Published: August 2004

Purpose.

To assess the relationship between adolescent and parent reports of adolescent health-related quality of life (HRQL) and between adolescent pulmonary function (forced expiratory volume in 1 second as percent of predicted) and reporter perceptions of adolescent health.

Methods.

Twenty-four adolescents with cystic fibrosis (CF), their mothers, and their fathers completed the Child Health Questionnaire during routine CF clinic visits at 2 urban hospitals. Patients were between the ages of 11 and 18 years (mean age: 14.2 years) and were predominantly male (75%). The best measure of forced expiratory volume in 1 second as percent of predicted for the year of the study was also collected for each adolescent.

Results.

Adolescent pulmonary function was related to the perceived adolescent physical health scales. It was not, however, associated to perceptions of adolescent emotional, social, or behavioral HRQL by any of the 3 family reporters. Associations were found between adolescent pulmonary function and self-reports of general health (0.73), role/social limitations-physical (0.47), and bodily pain (0.42). Adolescent pulmonary function was related to mother reports of adolescent general health (0.73), role/social limitations-physical (0.73), bodily pain (0.55), and physical functioning (0.70). Father perceptions of adolescent health were associated to adolescent pulmonary function on general health (0.54), role/social limitations-physical (0.60), and physical functioning (0.64). Associations between adolescent and parent perceptions of adolescent HRQL were also health scale-specific. Mother and child reports of adolescent HRQL were related on adolescent behavior problems (0.71) and role/social limitations attributable to behavior (0.48), role/social limitations attributable to physical (0.62), bodily pain (0.69), physical functioning (0.69), family activities (0.45), and general health (0.66). Associations were found between father and adolescent reports on perceived adolescent behavior problems (0.66); self-esteem (0.65); and role/social limitations attributable to physical (0.49), general health (0.61), and perceived mental health (0.48).

Conclusions.

Results demonstrate the need to include multiple informants and comprehensive, multidimensional measures of HRQL, in addition to pulmonary function, when assessing health in adolescents with CF.
Seeing Is Believing: What Do Boys Do When They Find a Real Gun?
Authors: Jackman Geoffrey A. , Farah Mirna M. , Kellermann Arthur L. , Simon Harold K.
Published: August 2004

Objectives.

To determine how boys behave when they find a handgun in a presumably safe environment and to compare parental expectations of their child's interest in real guns with this observed behavior.

Methods.

A convenience sample of 8- to 12-year-old boys was recruited from families that completed a survey on firearm ownership, storage practices, and parental perceptions. Parents were asked to rate their child's interest in real guns on a scale from 1 to 5: 1–2 = low interest, 3 = moderate interest, and 4–5 = high interest. Parents of an eligible child were asked to bring to the exercise 1 of their son's playmates and/or a sibling in the same age range. After informed parental consent was obtained, each pair or trio of boys was placed in a room with a 1-way mirror and observed for up to 15 minutes. Two water pistols and an actual .380 caliber handgun were concealed in separate drawers. The handgun contained a radio transmitter that activated a light whenever the trigger was depressed with sufficient force to discharge the firearm. After the exercise, each boy was asked whether he thought that the pistol was real or a toy. Before leaving, each child was counseled about safe behavior around guns.

Results.

Twenty-nine groups of boys (n= 64) took part in the study. The mean age of participants was 9.8 years. Twenty-one of the groups (72%) discovered the handgun (n = 48 boys); 16 groups (76%) handled it (n = 30 boys). One or more members in 10 of the groups (48%) pulled the trigger (n = 16 boys). Approximately half of the 48 boys who found the gun thought that it was a toy or were unsure whether it was real. Parental estimates of their child's interest in guns did not predict actual behavior on finding the handgun. Boys who were believed to have a low interest in real guns were as likely to handle the handgun or pull the trigger as boys who were perceived to have a moderate or high interest in guns. More than 90% of the boys who handled the gun or pulled the trigger reported that they had previously received some sort of gun safety instruction.

Conclusion.

Many 8- to 12-year-old boys will handle a handgun if they find one. Guns that are kept in homes should be stored in a manner that renders them inaccessible to children.guns, weapons, firearms, children, childhood behavior, injury prevention.
Effect of Pediatric Surgical Practice on the Treatment of Children With Appendicitis
Authors: Kokoska Evan R. , Minkes Robert K. , Silen Mark L. , Langer Jacob C. , Tracy Thomas F. , Snyder Charles L. , Dillon Patrick A. , Weber Thomas R.
Published: August 2004

Objective.

Acute appendicitis in children is managed by both general surgeons (GSs) and pediatric surgeons (PSs). Our objective was to investigate the economics of surgical care provided by either GSs or PSs for appendicitis.

Methods.

The outcome of children within our state who underwent operative treatment for appendicitis (January 1994 to June 1997) by board-certified GSs were compared with the results of PSs. Data were sorted according to patient age and diagnosis according to the International Classification of Diseases, Ninth Revision. Analysis of variance was performed on continuous data, and χ2 analysis was performed on nominal data; data are depicted as mean ± standard error of the mean.

Results.

GSs (n = 2178) managed older children when compared with PSs (n = 1018; 11.0 ± 0.1 vs 9.1 ± 0.1 years) and less frequently treated perforated appendicitis (18.8% vs 31.9%). Independent of diagnosis (simple or perforated appendicitis), younger children (0–4 years, 5–8 years, and 9–12 years) who were treated by PSs had a significantly shorter hospital stay and/or decreased hospital charge when compared with those who were treated by GSs. However, older children (13–15 years) seemed to have comparable outcomes.

Conclusions.

Younger children with appendicitis have reduced hospital days and charges when they are treated by PSs.
Cisapride Associated With QTc Prolongation in Very Low Birth Weight Preterm Infants
Authors: Dubin Anne , Kikkert Myrna , Mirmiran Majid , Ariagno Ronald
Published: August 2004

Objective.

No systematic study has been performed to evaluate the effect of cisapride on the QT interval in premature infants. Cisapride, which has recently been withdrawn by the Food and Drug Administration and is no longer an approved therapy, was commonly used for preterm infant care to improve the advance of enteral feedings and to reduce reflux and associated apnea. Our aim was to evaluate the effect of recommended doses of cisapride on the QT interval in this population.

Study Design.

Prospective blinded evaluation of electrocardiogram for QT, JT, QTc, and JTc measurements in 25 preterm infants before and after cisapride administration.

Results.

Twelve of 25 infants (48%) developed repolarization abnormalities with cisapride administration: 32% of the infants (8/25) studied had QTc prolongation (≥0.450 seconds), whereas 10/25 had JTc prolongation (≥0.360 seconds). Preterm infants <32 weeks significantly prolonged their QTc interval from 0.41 ± 0.02 to 0.44 ± 0.02. The QTc and/or JTc was prolonged in 54% of infants receiving 0.1 mg/kg/dose and 42% receiving 0.2 mg/kg/dose.

Conclusions.

The QTc and JTc interval significantly prolonged in preterm infants <32 weeks on the recommended dose of cisapride therapy. A QTc ≥0.450 seconds developed in 32% of infants treated with cisapride, whereas the JTc prolonged in 40%. A significant percentage of infants (54%) developed prolonged QTc intervals at a dose of 0.1 mg/kg/dose. From these data we conclude that there is a higher risk of prolongation of the QTc interval and risk of arrhythmias with greater prematurity.
Infant Sleep Problems and Postnatal Depression: A Community-Based Study
Authors: Hiscock Harriet , Wake Melissa
Published: August 2004

Objectives.

To describe infant sleep patterns and investigate relationships between infant sleep problems and maternal well-being in the community setting.

Design.

Cross-sectional community survey.

Setting.

Maternal and Child Health Centers in 3 middle-class local government areas in Melbourne, Australia.

Participants.

Mothers of infants 6 to 12 months of age.

Main Outcome Measures.

Maternal well-being (Edinburgh Postnatal Depression Scale) and infant sleep problems (standardized maternal questionnaire).

Results.

The survey was completed by 738 mothers (94% response rate), of whom 46% reported their infant's sleep as a problem. In the univariate analyses, sleep patterns characterizing a sleep problem included the infant sleeping in the parent's bed, being nursed to sleep, taking longer to fall asleep, waking more often and for longer periods overnight, and taking shorter naps. The same sleep patterns were associated with high depression scores and tended to increase as depression scores increased.

Because of positive skew, the Edinburgh Postnatal Depression Score was analyzed in 3 categories (<10, 10–12, and >12) using validated cutoff scores from community and clinical studies. Fifteen percent of mothers scored above 12 on the depression scale, indicating probable clinical depression, and 18% scored between 10 and 12, indicating possible clinical depression. After adjusting for potential confounders and factors significant in the univariate analyses, maternal report of an infant sleep problem remained a significant predictor of a depression score >12 (odds ratio: 2.13; 95% confidence interval: 1.27,3.56) and >10 (odds ratio: 2.88; 95% confidence interval: 1.93,4.31). However, mothers reporting good sleep quality, despite an infant sleep problem, were not more likely to suffer depression.

Conclusions.

Maternal report of infant sleep problems and depression symptoms are common in middle-class Australian communities. There is a strong association between the 2, even when known depression risk factors are taken into account. Maternal report of good sleep quality attenuates this relationship. Appropriate anticipatory guidance addressing infant sleep could potentially decrease maternal report of depressive symptoms.