bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of Zinc Supplementation on Diarrheal Morbidity and Growth Pattern of Low Birth Weight Infants in Kolkata, India: A Randomized, Double-Blind, Placebo-Controlled, Community-Based Study
Authors: Sur Dipika , Gupta Dhirendra N. , Mondal Sujit K. , Ghosh Subrato , Manna Byomkesh , Rajendran Krishnan , Bhattacharya Sujit K.
Published: August 2004

Objective. To assess the impact of zinc supplementation on diarrheal morbidity and growth pattern of low birth weight (LBW) infants.

Methodology. In a randomized, double-blind, placebo-controlled, community-based study conducted in the Tiljala slum of eastern Kolkata, India, between 1999 and 2001, a birth cohort of 100 LBW infants was randomly allocated into either an intervention group receiving 1 mL daily dose of 5 mg of elemental zinc as zinc sulfate in vitamin B complex-based syrup or a placebo group receiving an identical placebo of 1 mL of vitamin-based syrup from birth up to 1 completed year of age. Active weekly surveillance was conducted for detection of diarrhea. Anthropometric measurements of each child were recorded once every month as close to the child’s birth date as possible. Data were analyzed by using statistical software packages SPSSPC+ 4.0 (SPSS, Inc, Chicago, IL) and Epi Info 6.0 (Centers for Disease Control and Prevention, Atlanta, GA).

Results. Among the zinc-supplemented group, diarrheal incidence of 1.36 episodes per child per year were observed, whereas it was 1.93 episodes per child per year among the placebo group, giving a relative risk of 1.4 (95% confidence interval: 1.02-2.00). Linear growth and weight for age showed significant differences between the supplemented and placebo groups only at the end of 1 year. Interestingly, the impact of zinc supplementation was masked to a large extent by the protective action of breastfeeding.

Conclusions. The study showed that zinc supplementation had a beneficial impact on the incidence of diarrhea and also weight gain among LBW infants.
Corrected End-Tidal Carbon Monoxide Closely Correlates With the Corrected Reticulocyte Count in Coombs’ Test-Positive Term Neonates
Authors: Javier Maria Cristina , Krauss Alfred , Nesin Mirjana
Published: August 2004

Objective. To evaluate clinical usefulness of corrected end-tidal carbon monoxide (ETCOc) measurements in healthy, term, Coombs’ test-positive neonates and correlate it to the corrected reticulocyte count (RC).

Methods. ETCOc and RC were determined (at 36 ± 12 hours of age) in 50 Coombs’ test-positive neonates and compared with the ETCOc values of 50 Coombs’ test-negative neonates.

Results. Fifty percent of Coombs’ test-positive infants had RCs <5% (within a normal range for a healthy newborn) and ETCOc = 1.8 ± 0.34 parts per million (ppm) and likely did not exhibit hemolysis. Among infants with elevated RCs, 72% had RCs between 5% and 8% and ETCOc = 2.77 ± 0.68 ppm, and 28% had RCs >8% and ETCOc = 4.52 ± 0.83 ppm. There was an almost linear correlation (r = 0.86) between the RC and the ETCOc among Coombs’ test-positive infants. The 50 Coombs’ test-negative infants had ETCOc = 1.6 ± 0.45 ppm. Serial ETCOc measurements were performed in 14 Coombs’ test-positive infants: in all but 1 infant ETCOc values declined over time.

Conclusions. There is a good correlation between ETCOc and RC in Coombs’ test-positive infants. ETCOc >2.5 ppm predicts a significant elevation of RC in 90% of Coombs’ test-positive infants.
Not Only a Matter of Epilepsy: Early Problems of Cognition and Behavior in Children With “Epilepsy Only”—A Prospective, Longitudinal, Controlled Study Starting at Diagnosis
Authors: Oostrom Kim J. , Smeets-Schouten Anneke , Kruitwagen Cas L. J. J. , Peters A. C. Boudewyn , Jennekens-Schinkel Aagje ,   for the Dutch Study Group of Epilepsy in Childhood (DuSECh)
Published: August 2004

Objective. To understand early educational and behavioral predicament in childhood “epilepsy only.”

Methods. A multicenter, prospective, longitudinal study was conducted of 51 outpatient schoolchildren with newly diagnosed idiopathic or cryptogenic epilepsy and 48 sex-matched classmate control subjects. All children underwent neuropsychological assessment 3 times within the first year after diagnosis; parents and teachers completed behavior questionnaires, and patients’ parents were interviewed to inventory contextual adversity. Principal components analysis of cognition and behavior disclosed 6 major components that were related with the interview data (repeated measures analysis of variance).

Results. Despite similar intelligence and educational background, significantly more patients (51%) than control subjects (27%) required special educational assistance. Patients obtained worse scores across components of cognition and behavior. Parents and teachers perceived patients to have more behavioral problems. Differences between groups existed at pretreatment baseline. Over time, notwithstanding stable percentages of poor scores in both groups, nonpersistence of poor scores was impressive (each time other children scored poorly in other domains). Rather than epilepsy characteristics, contextual adversities were significant risk factors.

Conclusion. Already in the earliest stage of the illness, children with epilepsy are liable to vicissitudes in cognitive and behavioral functioning. Contextual variables are all-important.
Long-Term Results of Pediatric Cardiac Surgery in Finland: Education, Employment, Marital Status, and Parenthood
Authors: Nieminen Heta , Sairanen Heikki , Tikanoja Tero , Leskinen Markku , Ekblad Henrik , Galambosi Päivi , Jokinen Eero
Published: August 2004

Objective. This population-based study was designed to examine the psychosocial outcome of Finnish patients who had been operated on for congenital heart disease during childhood.

Methods. A questionnaire was mailed to 3789 adult patients who had been operated on for congenital heart defects in Finland. Of these, 2896 (76%) answered the questionnaire. The mean age of patients was 33 years (range: 18–59 years), and they had had their first operation 9 to 46 years earlier.

Results. The patients had coped well with their defects when compared with the general Finnish population. The educational level of patients was comparable to and employment level was higher than expected (70% vs 66%, respectively). They were living in a steady relationship as often as the general population, but the number of parents among the patients was lower than that expected (47% vs 49%, respectively). The incidence of congenital heart disease among the 2697 children of the patients was 2.4%.

Conclusion. Our results confirm that in addition to high survival rate, the long-term psychosocial outcome of patients with surgically treated congenital heart defects is good if they do not have any additional syndromes that cause mental retardation.
Cost-Effectiveness of Inhaled Nitric Oxide in the Treatment of Neonatal Respiratory Failure in the United States
Authors: Angus Derek C. , Clermont Gilles , Watson R. Scott , Linde-Zwirble Walter T. , Clark Reese H. , Roberts Mark S.
Published: August 2004

Objective. Two recent randomized controlled trials (RCTs) reported that inhaled nitric oxide (iNO) decreased the incidence of extracorporeal membrane oxygenation (ECMO) or death in term and near-term newborns with hypoxic respiratory failure. Our objective was to estimate the cost-effectiveness ratio of iNO in this population.

Methods. We studied 1000 simulation cohorts (n = 483 for each cohort) of term/near-term newborns with hypoxemic respiratory failure. We conducted our study following US Public Health Service Panel on Cost-Effectiveness in Health and Medicine guidelines, adopting the US societal perspective. We constructed a decision tree reflecting iNO use, subsequent ECMO use, death, and long-term neurologic and respiratory morbidity in survivors, as determined from the combined outcomes of the 2 RCTs (n = 483). We estimated costs on the basis of length-of-stay data for the initial episode of care from 1 of the RCTs, unit costs from administrative data sets, and current pricing for iNO. We ran a Monte Carlo simulation to generate estimates of differences in costs and effects at 1 year, along with the stochastic uncertainty around these estimates. We expressed effects as quality-adjusted survival, assuming quality of life = 1 with no comorbidity, 0.7 with 1 comorbidity, and 0.49 (0.7 × 0.7) with 2 comorbidities. We constructed a base case, in which iNO was initiated at tertiary care ECMO centers (mimicking the RCTs) and a Public Health Service Panel on Cost-effectiveness in Health and Medicine reference case, in which iNO was initiated at the local hospital before transfer (mimicking real-world practice). We exposed our assumptions to a sensitivity analysis.

Results. Direct application of the trial results (base case) suggested that iNO was both more effective and cheaper (cost savings of $1880 per case despite acquisition costs of $5150, predominantly as a result of decreased need for ECMO), with 84.6% probability that the cost-effectiveness ratio was better than $100 000 per quality-adjusted life-year. Under the reference case, iNO was also more effective (though slightly less so) and was even cheaper (cost savings of $4400 per case), with 71.6% probability that iNO was cheaper and more effective and 91.6% probability that the cost effectiveness ratio was better than $100 000 per quality-adjusted life-year. Sensitivity analyses showed these estimates to be sensitive to patient selection and the price of iNO but insensitive to assumptions regarding quality of life.

Conclusions. From a US societal perspective, iNO has a favorable cost-effectiveness profile when initiated either at ECMO centers or at local hospitals in term/near-term neonates with hypoxemic respiratory failure.
A Novel Mutation in the Anion Exchanger 1 Gene Is Associated With Familial Distal Renal Tubular Acidosis and Nephrocalcinosis
Authors: Cheidde Lara , Vieira Teresa Cristina , Lima Paulo Roberto Moura , Saad Sara Teresinha Ollala , Heilberg Ita Pfeferman
Published: August 2004

Objective. The anion exchanger gene (AE1) or band 3 encodes a chloride-bicarbonate (Cl−/HCO3−) exchanger expressed in the erythrocyte and in the renal α-intercalated cells involved in urine acidification. The purpose of the present study was to screen for mutations in the AE1 gene in 2 brothers (10 and 15 years of age) with familial distal renal tubular acidosis (dRTA), nephrocalcinosis, and failure to thrive.

Methods. AE1 mutations were screened by single-strand conformation polymorphism, cloning, and sequencing.

Results. A complete form of dRTA was confirmed in the 2 affected brothers and an incomplete form in their father. All 3 were heterozygous for a novel 20-bp deletion in exon 20 of the AE1 gene. This deletion resulted in 1 mutation in codon 888 (Ala-888→Leu) followed by a premature termination codon at position 889, truncating the protein by 23 amino acids. As band 3 deficiency might lead to spherocytic hemolytic anemia or ovalocytosis, erythrocyte abnormalities were also investigated, but no morphologic changes in erythrocyte membrane were found and the osmotic fragility test was normal.

Conclusions. A novel mutation in the AE1 gene was identified in association with autosomal dominant dRTA. We suggest that RTA be considered a diagnostic possibility in all children with failure to thrive and nephrocalcinosis.
Do Needs Drive Services Use in Young Children?
Authors: Horwitz Sarah McCue , Gary Lisa C. , Briggs-Gowan Margaret J. , Carter Alice S.
Published: August 2004

Objective. To determine whether different factors predicted parental recognition of mental health problems in children and use of services for those problems and to determine whether mental health problems elicit service use in the same way as physical health or developmental problems.

Methods. Survey of the parents of an age- and sex-stratified random sample of children who were born in 1 Connecticut hospital selected from state birth records.

Results. Logistic regression results demonstrate that a number of child and family factors are related to problem recognition, defined as thinking about seeking services and/or talking to a professional about a problem. However, factors related to the third outcome of interest—service use—are more limited and include only physical health and developmental problems, parental worry about language, and family conflict. Furthermore, mental health problems were not discussed with professionals, and they were not associated with receipt of services at the same rates as physical health or developmental problems.

Conclusions. The correlates of problem recognition (defined as thinking about seeking services or actually speaking to a professional about a problem) differ from those of service use, and, whereas mental health, physical health, and developmental problems all affect problem recognition, mental health problems do not result in service use. Furthermore, rates of service use vary dramatically across the 3 categories. These results suggest that needs alone do not drive service use. Rather, other factors may influence which needs are met.
Evidence Assessment of the Accuracy of Methods of Diagnosing Middle Ear Effusion in Children With Otitis Media With Effusion
Authors: Takata Glenn S. , Chan Linda S. , Morphew Tricia , Mangione-Smith Rita , Morton Sally C. , Shekelle Paul
Published: August 2004

Objectives. We report the findings of an evidence assessment on the accuracy of methods of diagnosing middle ear effusion in children with otitis media with effusion (OME).

Methods. We searched Medline (1966–January 2000), the Cochrane Library (through January 2000), and Embase (1980–January 2000) and identified additional articles from reference lists in proceedings, published articles, reports, and guidelines. Excluded were nonhuman studies; case reports; editorials; letters; reviews; practice guidelines; non–English-language publications; and studies on patients with immunodeficiencies, craniofacial anomalies (including cleft palate), primary mucosal disorders, or genetic conditions. From each eligible study, we calculated the sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and prevalence of OME in the cohort. We determined the number of studies for each comparison of a diagnostic method and a reference standard listed within the scope of our assessment. For comparisons with 3 or more studies, we derived random effects estimates of sensitivity, specificity, and prevalence rate. Using the pooled estimates, we plotted the performance of each diagnostic test in terms of sensitivity and (1 − specificity) and identified the best performer among the tests included in the comparison.

Results. Among 8 diagnostic methods, pneumatic otoscopy had the best apparent performance with a sensitivity of 94% (95% confidence interval: 92%–96%) and a specificity of 80% (95% confidence interval: 75%–86%). However, examiner qualifications were reported inconsistently, and training was not specified.

Conclusions. The finding that pneumatic otoscopy can do as well as or better than tympanometry and acoustic reflectometry has significant practical implications. For the typical clinician, pneumatic otoscopy should be easier to use than other diagnostic methods. The important question may be what degree of training will be needed for the clinician to be as effective with pneumatic otoscopy as were the examiners in the studies reviewed in this report.
Spontaneous Regression of Severe Acquired Infantile Hypothyroidism Associated With Multiple Liver Hemangiomas
Authors: Konrad Daniel , Ellis Graham , Perlman Kusiel
Published: August 2004

A 9-week-old infant presented with severe postnatal hypothyroidism. His hypothyroidism corrected only after his l-thyroxine dose was progressively increased to 28 μg/kg/d. At 6 months of age, multiple clinically asymptomatic hepatic hemangiomas were detected and support a diagnosis of consumptive hypothyroidism as a result of increased type 3 iodothyronine deiodinase activity in the hemangiomas. Coincident with the involution of the hemangiomas, the child’s hypothyroidism improved and l-thyroxin replacement could be stopped at the age of 3 years. Despite some degree of hypothyroidism for several weeks during infancy, his growth and development have been normal.
Streptococcal Intertrigo: An Underrecognized Condition in Children
Authors: Honig Paul J. , Frieden Ilona J. , Kim Ho Jin , Yan Albert C.
Published: August 2004

Group A β-hemolytic streptococci have been implicated in a variety of common childhood cutaneous infections. Infants and young children may be particularly susceptible to a form of streptococcal intertrigo that has heretofore been underrecognized in this population. Manifesting as intense, fiery-red erythema and maceration in the intertriginous folds of the neck, axillae, or inguinal spaces, the condition is characterized by a distinctive foul odor and an absence of satellite lesions. Specific clinical features help differentiate this condition from its clinical mimics. Topical and oral antibiotic therapy with or without concomitant low-potency topical steroid application is generally curative.
Use of Intravenous Immunoglobulin in Children With Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: Seven Cases and Review of the Literature
Authors: Metry Denise W. , Jung Peter , Levy Moise L.
Published: August 2004

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis are the most severe cutaneous reactions that occur in children. Off-label use of human intravenous immunoglobulin (IVIG) has been reported in a number of autoimmune and cell-mediated blistering disorders of the skin, including severe cutaneous drug reactions. We review 28 previous reports in which IVIG was used in pediatric patients with SJS and toxic epidermal necrolysis and discuss our experience in 7 children with SJS, in whom no new blisters developed within 24 to 48 hours after IVIG administration and rapid recovery ensued. IVIG seems to be a useful and safe therapy for children with severe cutaneous drug reactions. Well-controlled, prospective, multicenter clinical trials are needed to determine optimal dosing guidelines and to compare the efficacy and safety of IVIG with other potentially effective modalities.
Families and Adoption: The Pediatrician’s Role in Supporting Communication
Authors: Borchers Deborah ,   Committee on Early Childhood, Adoption, and Dependent Care
Published: August 2004

Each year, more children join families through adoption. Pediatricians have an important role in assisting adoptive families in the various challenges they may face with respect to adoption. The acceptance of the differences between families formed through birth and those formed through adoption is essential in promoting positive emotional growth within the family. It is important for pediatricians to be informed about adoption and to share this knowledge with adoptive families. Parents need ongoing advice with respect to adoption issues and need to be supported in their communication with their adopted children.
Revised Indications for the Use of Palivizumab and Respiratory Syncytial Virus Immune Globulin Intravenous for the Prevention of Respiratory Syncytial Virus Infections
Authors:   Committee on Infectious Diseases and Committee on Fetus and Newborn
Published: August 2004

This Policy Statement was retired October 2006.

Palivizumab and Respiratory Syncytial Virus Immune Globulin Intravenous (RSV-IGIV) are licensed by the Food and Drug Administration for use in preventing severe lower respiratory tract infections caused by respiratory syncytial virus (RSV) in high-risk infants, children younger than 24 months with chronic lung disease (formerly called bronchopulmonary dysplasia), and certain preterm infants. This statement provides revised recommendations for administering RSV prophylaxis to infants and children with congenital heart disease, for identifying infants with a history of preterm birth and chronic lung disease who are most likely to benefit from immunoprophylaxis, and for reducing the risk of RSV exposure and infection in high-risk children. On the basis of results of a recently completed clinical trial, prophylaxis with palivizumab is appropriate for infants and young children with hemodynamically significant congenital heart disease. RSV-IGIV should not be used in children with hemodynamically significant heart disease. Palivizumab is preferred for most high-risk infants and children because of ease of intramuscular administration. Monthly administration of palivizumab during the RSV season results in a 45% to 55% decrease in the rate of hospitalization attributable to RSV. Because of the large number of infants born after 32 to 35 weeks’ gestation and because of the high cost, immunoprophylaxis should be considered for this category of preterm infants only if 2 or more risk factors are present. High-risk infants should not attend child care during the RSV season when feasible, and exposure to tobacco smoke should be eliminated.
Revised Indications for the Use of Palivizumab and Respiratory Syncytial Virus Immune Globulin Intravenous for the Prevention of Respiratory Syncytial Virus Infections
Authors: Meissner H. Cody , Long Sarah S. ,   Committee on Infectious Diseases, and Committee on Fetus and Newborn
Published: August 2004

Palivizumab and Respiratory Syncytial Virus Immune Globulin Intravenous (RSV-IGIV) are licensed by the Food and Drug Administration for use in preventing severe respiratory syncytial virus (RSV) infections in high-risk infants, children younger than 24 months with chronic lung disease (formerly called bronchopulmonary dysplasia), and certain preterm infants. This report summarizes the clinical trial information on which the guidance in the accompanying policy statement for administering RSV prophylaxis to certain children with a history of preterm birth, chronic lung disease, or congenital heart disease is based. On the basis of results of a recently completed clinical trial, palivizumab is appropriate for infants and young children with hemodynamically significant congenital heart disease. RSV-IGIV should not be used in children with hemodynamically significant heart disease. Palivizumab is preferred for most high-risk infants and children because of ease of intramuscular administration. Monthly administration of palivizumab during the RSV season results in a 45% to 55% decrease in the rate of hospitalization attributable to RSV. Because of the large number of infants born after 32 to 35 weeks’ gestation and because of the high cost, immunoprophylaxis should be considered for this category of preterm infants only if 2 or more risk factors are present.
Childhood Obesity: A Risk Factor for Omental Torsion
Authors: Theriot Judy A. , Sayat Jon , Franco Sofia , Buchino John J.
Published: August 2004

Purpose. To determine the risk factors and clinical presentation of primary omental torsion (POT) in children.

Methods. Histopathology records of a pediatric hospital from January 1993 to March 2003 were reviewed to identify cases of POT. Hospital charts of patients diagnosed with POT were reviewed for demographic data and clinical presentation.

Results. A diagnosis of POT was recorded in 12 of 41 987 pathology records reviewed. Most of the patients were white (92%), male (75%), and 9 to 16 years old (75%). Weight percentiles were ≥95th in 11 (92%) of 12 patients. Body mass index was calculated in 9 of the 12 cases with 8 >95th percentile. Clinical presentation including right-sided abdominal pain, tenderness, and anorexia closely mimics acute appendicitis.

Conclusions. Obesity seems to be an important risk factor for POT in children. The presentation for POT seems to be less acute than with other causes of surgical abdomen.
Value and Limitations of the von Reyn, Duke, and Modified Duke Criteria for the Diagnosis of Infective Endocarditis in Children
Authors: Tissières Pierre , Gervaix Alain , Beghetti Maurice , Jaeggi Edgar T.
Published: August 2004

Objective. To compare the sensitivity of 3 different criteria—von Reyn, Duke, and modified Duke—in diagnosing infective endocarditis (IE) in children.

Study Design. Retrospective case study in a tertiary pediatric hospital.

Methods and Results. Between 1985 and 2001, 41 episodes of IE were documented in 40 children (median: 7 years old; range: 1 week to 18 years). The diagnosis was based on echocardiographic and microbiologic or pathologic findings. The initial echocardiogram suggested IE in 95% of the cases. Main findings were vegetations in 36, perivalvular abscess in 4, and/or new valvular leaks in 6 cases. In 31 (76%) of the 41 episodes, the causative organisms were identified directly by specimen bacteriology or blood cultures (BCs) or indirectly by polymerase chain reaction or serology. Sensitivities of the von Reyn, Duke, and modified Duke criteria in diagnosing IE were 63%, 81%, and 88%, respectively. In 10 cases (22%), the diagnosis of IE was “rejected” by the von Reyn criteria but was “definite or possible” by the Duke and modified Duke criteria. In 3 cases, the diagnosis of IE was “possible” by the Duke but “definite” by the modified Duke criteria: 2 of the 3 cases had 1 major and ≥3 minor symptoms, and 1 had Q fever. Five episodes (12%) were classified as “possible” IE by the modified Duke criteria: although major findings were present on echocardiography, no organism was identified on repeat BCs. Positive BC was the only criterion that differentiated “definite” from “possible” IE.

Conclusions. The modified Duke classification was more sensitive in diagnosing IE in children than the von Reyn and Duke criteria. Still, 12% failed to be classified as “definite” IE by the modified Duke criteria. This illustrates the importance of positive BCs as a major IE criterion while significant echocardiographic findings are less considered by the presently used criteria.
Chromosome 22q11 Deletion in Patients With Ventricular Septal Defect: Frequency and Associated Cardiovascular Anomalies
Authors: McElhinney Doff B. , Driscoll Deborah A. , Levin Elissa R. , Jawad Abbas F. , Emanuel Beverly S. , Goldmuntz Elizabeth
Published: August 2004

Background. A ventricular septal defect (VSD) is the most common form of congenital heart disease and is one of the most common cardiovascular anomalies in individuals with chromosome 22q11 deletion syndrome. However, the frequency of a chromosome 22q11 deletion in patients with a VSD is not known. In addition, among patients with a VSD, it is not clear whether particular types of VSD or associated cardiovascular phenotypic features are associated with a chromosome 22q11 deletion.

Methods. We prospectively enrolled 125 patients with a conoventricular (n = 100), posterior malalignment (n = 14), or conoseptal hypoplasia (n = 11) VSD who were admitted to Children’s Hospital of Philadelphia between November 1991 and December 2001. Patients were studied for a chromosome 22q11 deletion by using fluorescence in situ hybridization.

Results. A chromosome 22q11 deletion was detected in 12 (10%) of the 125 patients. Anatomic features that were significantly associated with a chromosome 22q11 deletion included abnormal aortic arch sidedness, an abnormal aortic arch branching pattern, a cervical aortic arch, and discontinuous pulmonary arteries. There was no correlation between the type of VSD and chromosome 22q11 deletion. Of 20 patients with an abnormal aortic arch and/or discontinuous pulmonary arteries, 45% had a chromosome 22q11 deletion compared with only 3% of those with a left aortic arch, normal aortic arch branching pattern, and continuous branch pulmonary arteries

Conclusions. A chromosome 22q11 deletion is common in individuals with a conoventricular, posterior malalignment, or conoseptal hypoplasia VSD and anomalies of the aortic arch or branch pulmonary arteries. On the basis of these findings, at a minimum, we recommend testing for a chromosome 22q11 deletion in patients with these types of VSD who have abnormalities of aortic arch sidedness or branching, a cervical aortic arch, and/or discontinuous pulmonary arteries. Testing of patients with these types of VSD but a normal aortic arch and pulmonary arteries may be performed routinely or guided by the presence of associated noncardiovascular features of chromosome 22q11 deletion syndrome.
Lyme Disease Presenting With Persistent Headache
Authors: Moses James M. , Riseberg Robyn S. , Mansbach Jonathan M.
Published: August 2004

Increased intracranial pressure in patients with Lyme disease is an uncommon but reported finding. We discuss 2 patients from Lyme endemic areas who initially presented with headache, nausea, and vomiting and were eventually found to have increased intracranial pressure, a mild cerebrospinal fluid pleocytosis, and positive Lyme titers. It has been shown that increased intracranial pressure in association with neuroborreliosis can lead to blindness. In endemic areas, it is important for practitioners to consider Lyme disease when patients present with persistent headache, especially in those who have evidence of increased intracranial pressure.
Neurosarcoid Presents Differently in Children Than in Adults
Authors: Baumann Robert J. , Robertson William C.
Published: August 2004

Background. Neurosarcoid is seldom recognized in children. In the absence of any large pediatric series, it has been assumed that the presenting signs and symptoms are identical in adults and children.

Objective. To test the hypothesis that childhood neurosarcoid differs in presenting signs and symptoms from neurosarcoid in adults.

Methods. We tabulated the initial neurologic signs and symptoms in all reported cases of childhood sarcoid with evidence of central nervous system involvement. These data then were compared with published studies of adult neurosarcoid.

Results. Twenty-nine cases (from the English, French, and German literature) had descriptions of presenting signs and symptoms. Ages were 3 months to 18 years; 48% (14 of 29) presented before 13 years. Seizures were the most common presenting symptom (38%, 11 of 29), and 73% of these children (8 of 11) were <13 years old at presentation. Twenty-one percent (6 of 29) had cranial nerve involvement at presentation, and all were ≥12 years old. Twenty-one percent (6 of 29) had hypothalamic dysfunction. Five children presented with headache, 4 with motor signs, and 3 with papilledema. Twenty-four percent (7 of 29) had mass lesions on imaging.

Conclusions. Children with neurosarcoid present differently than do adults. Children are more likely to have seizures, less likely to have cranial nerve palsies, and perhaps more likely to have a space-occupying lesion. Our analysis of the cases available for review in the published literature suggests that children evolve to an adult pattern as they progress through adolescence.
Diaphragmatic Hernia Simulating a Left Pleural Effusion
Authors: Wooldridge Jamie L. , Partrick David A. , Bensard Denis D. , Deterding Robin R.
Published: August 2004

We review a case of a diaphragmatic hernia simulating on chest radiograph left lower lobe pneumonia and associated pleural effusion. We also characterize the atypical chest radiographic findings of this patient and recommend further imaging with computed tomography in unusual patient presentations.
Henoch-Schonlein Purpura Following a Meningococcal Vaccine
Authors: Lambert Emily M. , Liebling Anne , Glusac Earl , Antaya Richard J.
Published: August 2004

We report a 17-year-old girl who developed Henoch-Schonlein purpura 10 days after receiving a meningococcal vaccine (Menomune). To our knowledge, this is the first case report of Henoch-Schonlein purpura temporally associated with the tetravalent serogroups A, C, W-135, and Y meningococcal vaccine administered in the United States.
Are Children With Kawasaki Disease and Prolonged Fever at Risk for Macrophage Activation Syndrome?
Authors: Muise Aleixo , Tallett Susan E. , Silverman Earl D.
Published: August 2004

Kawasaki disease (KD) patients are known to be at increased risk for coronary artery lesions. We present evidence of another possible complication associated with KD: macrophage activation syndrome (MAS). In this case, a patient with KD and prolonged fever developed MAS. This case is of particular interest because of the late age of onset and recurrent nature of KD as well as the complication of MAS. We also present a review of the literature that supports the inclusion of MAS as an infrequent complication of KD.
Using Telemedicine to Provide Pediatric Subspecialty Care to Children With Special Health Care Needs in an Underserved Rural Community
Authors: Marcin James P. , Ellis Jeff , Mawis Roland , Nagrampa Eule , Nesbitt Thomas S. , Dimand Robert J.
Published: August 2004

Objective. For children with special health care needs (CSHCN) that live in rural, medically underserved communities, obtaining subspecialty care is a challenge. Telemedicine is a means of improving access to these children by addressing rural physician shortages and geographic barriers. This article reports a medical-needs assessment of parents/guardians with CSHCN and the status of a telemedicine program for CSHCN as well as the results of parent/guardian and local provider satisfaction with the telemedicine program.

Design. We report the results of a pretelemedicine medical-needs survey conducted in March 1999 by using a convenience sample of CSHCN living in a rural, medically underserved community located 90 miles north of the University of California Davis Children’s Hospital (Davis, CA). In April 1999, a telemedicine program was initiated to provide consultations to CSHCN and has continued since. We also report the parent/guardian’s perceptions of the appropriateness and quality of telemedicine consultations and the local provider’s satisfaction with telemedicine consultations completed from April 1999 to April 2002.

Results. The pretelemedicine medical-needs assessment demonstrated several barriers in access to subspecialty care including traveling >1 hour for appointments (86% of parents/guardians), missing work for appointments (96% of working parents/guardians), and frequently relying on emergency department services and/or self-regulation of their child’s medications. From April 1999 to April 2002, 130 telemedicine consultations were completed on 55 CSHCN. Overall, satisfaction was very high. All the parents/guardians rated satisfaction with telemedicine care as either “excellent” or “very good,” and all but 2 of the rural providers’ surveys reported satisfaction with telemedicine as “excellent” or “very good.” The frequency of telemedicine consultations has increased with time.

Conclusions. Pediatric subspecialty telemedicine consultations can be provided to CSHCN living in a rural, medically underserved community with high satisfaction among local providers and parents/guardians. Telemedicine should be considered as a means of facilitating care to CSHCN that, relative to the customary delivery of health care, is more accessible, family-centered, and coordinated among patients and their health care providers.
Health Status and Health Services Utilization Among US Chinese, Asian Indian, Filipino, and Other Asian/Pacific Islander Children
Authors: Yu Stella M. , Huang Zhihuan J. , Singh Gopal K.
Published: August 2004

Objective. This study examines the health status and health services access and utilization characteristics of US Chinese, Asian Indian, Filipino, other Asian/Pacific Islander (API), and non-Hispanic white children by using nationally representative data.

Methods. We analyzed the aggregated data file from the National Health Interview Survey from 1997 to 2000 including 334 Chinese, 287 Asian Indian, 292 Filipino, 696 “other API,” and 29 016 non-Hispanic white children <18 years old. Bivariate and multivariate analyses were conducted to examine the relationship between Asian ethnicities and dependent variables including components of health status, health services access, and utilization.

Results. Logistic regression reveals that all Asian American children were less likely to miss school because of illness or injury or have learning disabilities compared with non-Hispanic whites. Other APIs were less likely to be taking prescription medication for at least 3 months, and Asian Indian children were half as likely to have chronic conditions. Chinese, Filipino, and other API children were more likely to be without contact with a health professional within the past 12 months. Citizenship/nativity status, maternal education attainment, and poverty status were all significant independent risk factors for health care access and utilization.

Conclusions. Asian ethnicities and being foreign-born are generally associated with more favorable health status measures such as school absence, learning disability, use of prescription medications, and chronic conditions. However, these attributes are negatively associated with health care access and utilization, suggesting the need for outreach to Asian immigrant populations to educate them on accessing the US health care system.
Use of the Cygnus GlucoWatch Biographer at a Diabetes Camp
Authors: Gandrud Laura M. , Paguntalan Helen U. , Van Wyhe M. Michelle , Kunselman Betsy L. , Leptien Amy D. , Wilson Darrell M. , Eastman Richard C. , Buckingham Bruce A.
Published: August 2004

Background. Detection and prevention of nocturnal hypoglycemia is a major medical concern at diabetes camps.

Objective. We conducted an open-label trial of the Cygnus GlucoWatch biographer to detect nocturnal hypoglycemia in a diabetes camp, a nonclinical environment with multiple activities.

Methods. Forty-five campers (7–17 years old) wore a biographer. The biographer was placed on the arm at 6:00 pm, with the low alarm set to 85 mg/dL (4.7 mmol/L). Overnight glucose monitoring occurred per usual camp protocol. Counselors were to check and record blood glucose values if the biographer alarmed.

Results. Biographers were worn for 154 nights by 45 campers. After a 3-hour warm-up period, 67% of biographers were calibrated, of which 28% were worn the entire night (12 hours). Thirty-four percent of readings were skipped because of: “data errors” (65%), sweat (20%), and temperature change (16%). Reported biographer values correlated with meter glucose values measured 11 to 20 minutes later (r = 0.90). Of 20 low-glucose alarms with corresponding meter values measured within 20 minutes, there were 10 true-positive alarms, 10 false-positive alarms, and no false-negative alarms. Campers reported sleep disruption 32% of the nights, and 74% found the biographer helpful. Campers reported they would wear the biographer 4 to 5 nights each week.

Conclusions. Half of the biographer low-glucose alarms that had corresponding blood meter values were true-positive alarms, and the remaining were false-positive alarms. There was close correlation between the biographer and meter glucose values. The majority of campers found the biographer helpful and would use it at home.
Effects of Fast-Food Consumption on Energy Intake and Diet Quality Among Children in a National Household Survey
Authors: Bowman Shanthy A. , Gortmaker Steven L. , Ebbeling Cara B. , Pereira Mark A. , Ludwig David S.
Published: August 2004

Background. Fast food has become a prominent feature of the diet of children in the United States and, increasingly, throughout the world. However, few studies have examined the effects of fast-food consumption on any nutrition or health-related outcome. The aim of this study was to test the hypothesis that fast-food consumption adversely affects dietary factors linked to obesity risk.

Methods. This study included 6212 children and adolescents 4 to 19 years old in the United States participating in the nationally representative Continuing Survey of Food Intake by Individuals conducted from 1994 to 1996 and the Supplemental Children’s Survey conducted in 1998. We examined the associations between fast-food consumption and measures of dietary quality using between-subject comparisons involving the whole cohort and within-subject comparisons involving 2080 individuals who ate fast food on one but not both survey days.

Results. On a typical day, 30.3% of the total sample reported consuming fast food. Fast-food consumption was highly prevalent in both genders, all racial/ethnic groups, and all regions of the country. Controlling for socioeconomic and demographic variables, increased fast-food consumption was independently associated with male gender, older age, higher household incomes, non-Hispanic black race/ethnicity, and residing in the South. Children who ate fast food, compared with those who did not, consumed more total energy (187 kcal; 95% confidence interval [CI]: 109–265), more energy per gram of food (0.29 kcal/g; 95% CI: 0.25–0.33), more total fat (9 g; 95% CI: 5.0–13.0), more total carbohydrate (24 g; 95% CI: 12.6–35.4), more added sugars (26 g; 95% CI: 18.2–34.6), more sugar-sweetened beverages (228 g; 95% CI: 184–272), less fiber (−1.1 g; 95% CI: −1.8 to −0.4), less milk (−65 g; 95% CI: −95 to −30), and fewer fruits and nonstarchy vegetables (−45 g; 95% CI: -58.6 to −31.4). Very similar results were observed by using within-subject analyses in which subjects served as their own controls: that is, children ate more total energy and had poorer diet quality on days with, compared with without, fast food.

Conclusion. Consumption of fast food among children in the United States seems to have an adverse effect on dietary quality in ways that plausibly could increase risk for obesity.
A Novel Developmental and Immunodeficiency Syndrome Associated With Intrauterine Growth Retardation and a Lack of Natural Killer Cells
Authors: Bernard Frédéric , Picard Capucine , Cormier-Daire Valérie , Eidenschenk Céline , Pinto Graziella , Bustamante Jacinta-Cecilia , Jouanguy Emmanuelle , Teillac-Hamel Dominique , Colomb Virginie , Funck-Brentano Isabelle , Pascal Véronique , Vivier Eric , Fischer Alain , Le Deist Françoise , Casanova Jean-Laurent
Published: August 2004

Objective. To describe a novel syndrome characterized by severe prenatal and postnatal growth failure, mild skeletal and facial abnormalities, and primary immunodeficiency.

Design. The syndrome was observed in 2 sisters. The elder child died of cytomegalovirus infection when she was 18 months old, whereas the younger sister is doing well at 5 years old. We report here clinical, hematologic, and immunologic data for both sisters and compare them with all known inherited disorders with similar clinical or immunologic features.

Results. The immune defect consists of a lack of detectable natural killer cells and small numbers of CD8 αβ T cells and polymorphonuclear neutrophils. This is the first report of prenatal and postnatal growth failure associated with mild skeletal and facial abnormalities and primary immunodeficiency.

Conclusion. This novel syndrome probably is caused by an autosomal recessive gene defect impairing both intrauterine growth and natural killer cell development. The identification of other kindreds with this syndrome would facilitate the search for its genetic basis.
Ethical Considerations in Research With Socially Identifiable Populations
Authors:   Committee on Native American Child Health and Committee on Community Health Services
Published: August 2004

Community-based research raises ethical issues not normally encountered in research conducted in academic settings. In particular, conventional risk-benefits assessments frequently fail to recognize harms that can occur in socially identifiable populations as a result of research participation. Furthermore, many such communities require more stringent measures of beneficence that must be applied directly to the participating communities. In this statement, the American Academy of Pediatrics sets forth recommendations for minimizing harms that may result from community-based research by emphasizing community involvement in the research process.
The Effect of Hospital Volume of Pediatric Appendectomies on the Misdiagnosis of Appendicitis in Children
Authors: Smink Douglas S. , Finkelstein Jonathan A. , Kleinman Ken , Fishman Steven J.
Published: August 2004

Background. Although appendicitis is a common pediatric surgical condition, it is often misdiagnosed. Because higher hospital volume has been associated with improved outcome for many surgical procedures, the current study investigates whether hospital volume of pediatric appendectomies is associated with misdiagnosis of appendicitis in children.

Methods. The Kids’ Inpatient Database is a national sample of pediatric discharges from 2521 hospitals in 22 states in 1997. In this study, misdiagnosis was defined as a patient with a principal International Classification of Diseases, Ninth Revision procedure code for nonincidental appendectomy without a corresponding diagnosis code for appendicitis. Hospitals were stratified into 5 groups based on the number of nonincidental appendectomies performed on children in 1997: lowest (<1 per month), low (≥1 per month but <1 per week), medium (1–2 per week), high (2–3 per week), and highest (≥3 per week). Using generalized estimating equations to control for clustering within hospitals, we developed a logistic regression model of the effect of hospital volume on misdiagnosis while adjusting for patient age, gender, race, and insurance status.

Results. In the database, 37 109 nonincidental appendectomies were performed on children 1 to 18 years old in 1997. Of those, 3103 (8.4%) were misdiagnosed. Of all appendectomies, 24 655 (66.4%) were performed at lowest- or low-volume hospitals. After adjusting for patient characteristics, lowest- (odds ratio [OR]: 1.5; 95% confidence interval [CI]: 1.0–2.2) and low- (OR: 1.6; 95% CI: 1.1–2.3) volume hospitals had a significantly increased likelihood of misdiagnosis compared with highest-volume hospitals. Misdiagnosis at medium- (OR: 1.5; 95% CI: 1.0–2.2) and high- (OR: 1.4; 95% CI: 0.9–2.2) volume hospitals was similar to misdiagnosis at lower-volume hospitals, although not statistically different from highest-volume hospitals.

Conclusions. Almost two thirds of pediatric appendectomies are performed at hospitals performing <1 pediatric appendectomy per week. Lower hospital volume of pediatric appendectomies is associated with a significantly increased likelihood of misdiagnosis of appendicitis in children.