bluuebunny/crossref_metadata_2025 huggingface dataset:
Heritability of Bronchopulmonary Dysplasia, Defined According to the Consensus Statement of the National Institutes of Health
Authors: Lavoie Pascal M. , Pham Chandra , Jang Kerry L.
Published: September 2008

OBJECTIVE. The goal was to determine the magnitude of genetic effects on susceptibility and risk factors for bronchopulmonary dysplasia by using the clinically validated National Institutes of Health consensus definition as a demonstrated proxy for long-term respiratory and neurodevelopmental outcomes in extremely low birth weight infants.

METHODS. We analyzed clinical data from twin pairs born at ≤30 completed weeks of gestation in British Columbia, Canada, between 1993 and 2006. Differences in correlations between monozygotic and dizygotic twin pairs and model-fitting approaches were used to quantify the relative contributions of genetic, shared environmental, and nonshared environmental effects.

RESULTS. Among 318 twins of known zygosity, monozygotic twin pair similarities were greater than those observed for dizygotic pairs, which suggests significant heritability for bronchopulmonary dysplasia. Model-fitting analyses confirmed that genetic effects accounted for 82% and 79% of the observed variance in bronchopulmonary dysplasia susceptibility, defined on the basis of the need for supplemental oxygen at 36 weeks or the National Institutes of Health consensus definition, respectively. Variations in rates of hemodynamically significant patent ductus arteriosus were largely accounted for by genetic effects, whereas the observed variability in susceptibility to blood-borne bacterial infections was largely attributable to environmental factors, both common and unique to each infant.

CONCLUSIONS. Susceptibility to bronchopulmonary dysplasia and persistence of patent ductus arteriosus are both significantly heritable. Our study strengthens the case for investigating genetic risk stratification markers useful for predicting the most significant long-term respiratory and neurodevelopmental consequences of bronchopulmonary dysplasia in premature neonates.
Critical Illness and Amputation in Meningococcal Septicemia: Is Life Worth Saving?
Authors: Allport Tom , Read Lynley , Nadel Simon , Levin Michael
Published: September 2008

Amputation is an infrequent but devastating outcome of meningococcal septicemia. We assessed daily living functions and quality of life in a cohort of children and young people, 3 to 5 years after limb amputations following severe meningococcal disease. All participants lived with their families in the community, with minimal assistance. Participants used effective strategies to compensate for motor impairment and generally had good quality of life, despite ongoing health problems (predominantly musculoskeletal). The degree of amputation did not predict the functional outcome. The surprisingly good outcomes we report should discourage clinicians from withdrawing intensive care support because of presumed poor outcomes after multiple amputations in severe meningococcal disease.
Objectively Measured Physical Activity and Bone Strength in 9-Year-Old Boys and Girls
Authors: Sardinha Luís B. , Baptista Fátima , Ekelund Ulf
Published: September 2008

OBJECTIVE. The purpose of this work was to analyze the relationship between intensity and duration of physical activity and composite indices of femoral neck strength and bone-mineral content of the femoral neck, lumbar spine, and total body.

METHODS. Physical activity was assessed by accelerometry in 143 girls and 150 boys (mean age: 9.7 years). Measurement of bone-mineral content, femoral neck bone-mineral density, femoral neck width, hip axis length, and total body fat-free mass was performed with dual-energy radiograph absorptiometry. Compressive [(bone-mineral density × femoral neck width/weight)] and bending strength [(bone-mineral density × femoral neck width2)/(hip axis length × weight)] express the forces that the femoral neck has to withstand in weight bearing, whereas impact strength [(bone-mineral density × femoral neck width × hip axis length)/(height × weight)] expresses the energy that the femoral neck has to absorb in an impact from standing height.

RESULTS. Analysis of covariance (fat-free mass and age adjusted) showed differences between boys and girls of ∼9% for compressive, 10% for bending, and 9% for impact strength. Stepwise regression analysis using time spent at sedentary, light, moderate, and vigorous physical activity as predictors revealed that vigorous physical activity explained 5% to 9% of femoral neck strength variable variance in both genders, except for bending strength in boys, and ∼1% to 3% of total body and femoral neck bone-mineral content variance. Vigorous physical activity was then used to categorize boys and girls into quartiles. Pairwise comparison indicated that boys in the third and fourth quartiles (accumulation of >26 minutes/day) demonstrated higher compressive (11%–12%), bending (10%), and impact (14%) strength than boys in the first quartile. In girls, comparison revealed a difference between the fourth (accumulation of >25 minutes/day) and first quartiles for bending strength (11%). We did not observe any relationship between physical activity and lumbar spine strength.

CONCLUSIONS. Femoral neck strength is higher in boys than girls. Vigorous intensity emerged as the main physical activity predictor of femoral neck strength but did not explain gender differences. Daily vigorous physical activity for at least ∼25 minutes seems to improve femoral neck bone health in children.
Iatrogenesis in Neonatal Intensive Care Units: Observational and Interventional, Prospective, Multicenter Study
Authors: Kugelman Amir , Inbar-Sanado Esther , Shinwell Eric S. , Makhoul Imad R. , Leshem Meiron , Zangen Shmuel , Wattenberg Orly , Kaplan Tanya , Riskin Arieh , Bader David
Published: September 2008

OBJECTIVES. The goals were to determine the incidence of iatrogenic events in NICUs and to determine whether awareness of iatrogenic events could influence their occurrence.

METHODS. We performed a prospective, observational, interventional, multicenter study including all consecutive infants hospitalized in 4 NICUs. In the first 3 months (observation period), the medical teams were unaware of the study; in the next 3 months (intervention period), they were made aware of daily ongoing monitoring of iatrogenic events by a designated “Iatrogenesis Advocate.”

RESULTS. The numbers of infants admitted to the NICUs were comparable during the observation and intervention periods (328 and 369 infants, respectively). There was no difference between the 2 periods with respect to the number of infants of <1500 g, hospitalization days, or mean daily occupancy of the NICUs. Although the prevalence rates of iatrogenic events were comparable in the observation and intervention periods (18.0 and 18.2 infants with iatrogenic events per 100 hospitalized infants, respectively), the incidence rate decreased significantly during the intervention period (3.2 and 2.4 iatrogenic events per 100 hospitalization days of new admissions, respectively). Of all iatrogenic events, 7.9% were classified as life-threatening and 45.1% as harmful. There was no death related to an iatrogenic event. Eighty-three percent of iatrogenic events were considered preventable, of which 26.9% resulted from medical errors in ordering or delivery of medical care. Only 1.6% of all iatrogenic events were intercepted before reaching the infants, and only 47.0% of iatrogenic events were corrected. For younger and smaller infants, the rate of iatrogenic events was higher (57% at gestational ages of 24 to 27 weeks, compared with 3% at term) and the iatrogenic events were more severe and harmful. Increased length of stay was associated independently with more iatrogenic events.

CONCLUSIONS. Neonatal medical teams and parents should be aware of the burden of iatrogenesis, which occurs at a significant rate.
Chromosomal Integration of Human Herpesvirus 6 Is the Major Mode of Congenital Human Herpesvirus 6 Infection
Authors: Hall Caroline Breese , Caserta Mary T. , Schnabel Kenneth , Shelley Lynne M. , Marino Andrea S. , Carnahan Jennifer A. , Yoo Christina , Lofthus Geraldine K. , McDermott Michael P.
Published: September 2008

OBJECTIVE. We examined the frequency and characteristics of chromosomally integrated human herpesvirus 6 among congenitally infected children.

METHODS. Infants with and without congenital human herpesvirus 6 infection were prospectively monitored. Cord blood mononuclear cell, peripheral blood mononuclear cell, saliva, urine, and hair follicle samples were examined for human herpesvirus 6 DNA. Human herpesvirus 6 RNA, serum antibody, and chromosomally integrated human herpesvirus 6 levels were also assessed.

RESULTS. Among 85 infants, 43 had congenital infections and 42 had postnatal infections. Most congenital infections (86%) resulted from chromosomally integrated human herpesvirus 6; 6 infants (14%) had transplacental infections. Children with chromosomally integrated human herpesvirus 6 had high viral loads in all sites (mean: 5–6 log10 genomic copies per μg of cellular DNA); among children with transplacental infection or postnatal infection, human herpesvirus 6 DNA was absent in hair samples and inconsistent in other samples, and viral loads were significantly lower. One parent of each child with chromosomally integrated human herpesvirus 6 who had parental hair samples tested had hair containing human herpesvirus 6 DNA. Variant A caused 32% of chromosomally integrated human herpesvirus 6 infections, compared with 2% of postnatal infections. Replicating human herpesvirus 6 was detected only among chromosomally integrated human herpesvirus 6 samples (8% of cord blood mononuclear cells and peripheral blood mononuclear cells). Cord blood human herpesvirus 6 antibody levels were similar among children with chromosomally integrated human herpesvirus 6, transplacental infection, and postnatal infection and between children with maternal and paternal chromosomally integrated human herpesvirus 6 transmission.

CONCLUSIONS. Human herpesvirus 6 congenital infection results primarily from chromosomally integrated virus which is passed through the germ-line. Infants with chromosomally integrated human herpesvirus 6 had high viral loads in all specimens, produced human herpesvirus 6 antibody, and mRNA. The clinical relevance needs study as 1 of 116 newborns may have chromosomally integrated human herpesvirus 6 blood specimens.
Early Treatment of Acute Pyelonephritis in Children Fails to Reduce Renal Scarring: Data From the Italian Renal Infection Study Trials
Authors: Hewitt Ian K. , Zucchetta Pietro , Rigon Luca , Maschio Francesca , Molinari Pier Paolo , Tomasi Lisanna , Toffolo Antonella , Pavanello Luigi , Crivellaro Carlo , Bellato Stefano , Montini Giovanni
Published: September 2008

OBJECTIVES. The American Academy of Pediatrics recommendation for febrile infants and young children suspected of having a urinary tract infection is early antibiotic treatment, given parenterally if necessary. In support of this recommendation, data suggesting that delay in treatment of acute pyelonephritis increases the risk of kidney damage are cited. Because the risk was not well defined, we investigated renal scarring associated with delayed versus early treatment of acute pyelonephritis in children.

METHODS. The research findings are derived from 2 multicenter, prospective, randomized, controlled studies, Italian Renal Infection Study 1 and 2, whose primary outcomes dealt with initial antibiotic treatment and subsequent prophylaxis, respectively. From the 2 studies, we selected the 287 children with confirmed pyelonephritis on acute technetium-99m-dimercaptosuccinic acid scans who underwent repeat scanning to detect scarring 12 months later. The children were 1 month to <7 years of age when they presented with their first recognized episode of acute pyelonephritis in northeast Italy.

RESULTS. Progressive delay in antibiotic treatment of acute pyelonephritis from <1 to ≥5 days after the onset of fever was not associated with any significant increase in the risk of scarring on technetium-99m-dimercaptosuccinic acid scans obtained 1 year later. The risk of scarring remained relatively constant at 30.7 ± 7%. Clinical and laboratory indices of inflammation were comparable in all groups, as was the incidence of vesicoureteric reflux.

CONCLUSIONS. Early treatment of acute pyelonephritis in infants and young children had no significant effect on the incidence of subsequent renal scarring. Furthermore, there was no significant difference in the rate of scarring after acute pyelonephritis when infants and young children were compared with older children.
Difference in Celiac Disease Risk Between Swedish Birth Cohorts Suggests an Opportunity for Primary Prevention
Authors: Olsson Cecilia , Hernell Olle , Hörnell Agneta , Lönnberg Göran , Ivarsson Anneli
Published: September 2008

OBJECTIVES. Sweden experienced a unique epidemic of celiac disease in children <2 years of age. The epidemic was partly explained by changes in infant feeding over time and indicated a multifactorial pathogenesis. The main aim of this study was to analyze celiac disease risk in epidemic and postepidemic birth cohorts up to preschool age, to explore further the opportunity for primary prevention.

METHODS. A population-based incidence register of celiac disease in children covering the entire nation from 1998 to 2003 and part of the country back to 1973 was analyzed. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition diagnostic criteria for celiac disease were used. The annual incidence rate for each age group and the cumulative incidence according to age for each birth cohort were calculated.

RESULTS. A considerable difference in cumulative incidences of celiac disease at comparable ages was demonstrated between birth cohorts from the epidemic and postepidemic periods. The difference persisted during the preschool years, although it decreased somewhat with age. During the last years of the follow-up period, there was again a successive increase in incidence rate among children <2 years of age.

CONCLUSIONS. The difference in celiac disease risk between birth cohorts at comparable ages suggests an opportunity for primary prevention. This highlights the importance of further exploring the role of infant feeding and exogenous factors besides dietary gluten that might initiate or prevent disease development. Moreover, on the basis of postepidemic incidence trends, we speculate that the Swedish epidemic might not have been as unique as thought previously, although its magnitude was striking.
What Accounts for Differences or Disparities in Pediatric Palliative and End-of-Life Care? A Systematic Review Focusing on Possible Multilevel Mechanisms
Authors: Linton Julie M. , Feudtner Chris
Published: September 2008

OBJECTIVE. The goal was to clarify potential mechanisms underlying differences/disparities in pediatric palliative and end-of-life care.

METHODS. We systematically searched online databases to identify articles relating to differences/disparities in pediatric palliative and end-of-life care, retaining 19 studies for evaluation. We then augmented this search with a broader review of the literature on the mechanisms of differences/disparities in adult palliative and end-of-life care, general pediatrics, adult medicine, and pain.

RESULTS. The concept of reciprocal interaction can organize and illuminate interacting mechanisms across 3 levels of human organization, namely, broader contextual influences on patients and clinicians, specific patient-provider engagements, and specific patients. By using this rubric, we identified 10 distinct mechanisms proposed in the literature. Broader contextual influences include health care system structures; access to care; and poverty, socioeconomic status, social class, and family structure. Patient-clinician engagements encompass clinician bias, prejudice, and stereotypes; concordance of race; quality of information exchange; and trust. Patient-specific features include perceptions of control; religion and spirituality; and medical conditions.

CONCLUSIONS. Differences and disparities in pediatric palliative and end-of-life care can be understood as arising from various mechanisms that interact across different levels of human organization, and this interactive multilevel model should be considered in designing studies or planning interventions to understand differences and to ameliorate disparities.
Validation of the Clinical Dehydration Scale for Children With Acute Gastroenteritis
Authors: Goldman Ran D. , Friedman Jeremy N. , Parkin Patricia C.
Published: September 2008

OBJECTIVE. We previously created a clinical dehydration scale. Our objective was to validate the clinical dehydration scale with a new cohort of patients with acute gastroenteritis who were assessed in a tertiary emergency department in a developed country.

METHODS. A prospective observational study was performed in an emergency department at a large pediatric tertiary center in Canada. Children 1 month to 5 years of age with symptoms of acute gastroenteritis who were assessed in the emergency department were enrolled consecutively during a 4-month period. The main outcome measures were length of stay, proportion of children receiving intravenous fluid rehydration, and proportions of children with abnormal serum pH values or bicarbonate levels.

RESULTS. A total of 205 children were enrolled, with a mean age of 22.4 ± 14.9 months; 103 (50%) were male. The distribution of severity categories was as follows: no dehydration (score of 0), n = 117 (57%); some dehydration (score of 1–4), n = 83 (41%); moderate/severe dehydration (score of 5–8), n = 5 (2%). The 3 dehydration categories were significantly different with respect to the validation hypotheses (length of stay, mean ± SD: none, 245 ± 181 minutes; some, 397 ± 302 minutes; moderate/severe, 501 ± 389 minutes; treatment with intravenous fluids: none, n =17, 15%; some, n = 41, 49%; moderate/severe, n = 4, 80%; number of vomiting episodes in the 7 days before the emergency department visit: none, 8.4 ± 7.7 episodes; some, 13 ± 10.7 episodes; moderate/severe, 30.2 ± 14.8 episodes).

CONCLUSION. The clinical dehydration scale and the 3 severity categories were valid for a prospectively enrolled cohort of patients who were assessed in our tertiary emergency department. The scoring system was valuable in predicting a longer length of stay and the need for intravenous fluid rehydration for children with symptoms of acute gastroenteritis.
Air Pollution Threatens the Health of Children in China
Authors: Millman Alexander , Tang Deliang , Perera Frederica P.
Published: September 2008

CONTEXT. China's rapid economic development has come at the cost of severe environmental degradation, most notably from coal combustion. Outdoor air pollution is associated with >300000 deaths, 20 million cases of respiratory illness, and a health cost of >500 billion renminbi (>3% of gross domestic product) annually. The young are particularly susceptible to air pollution, yet there has been only limited recognition of its effects on children's health and development.

DATA SOURCES/DATA EXTRACTION. To fill this gap, we reviewed relevant published environmental studies, biomedical and molecular/epidemiologic research, and economic and policy analyses.

RESULTS. China relies on coal for ∼70% to 75% of its energy needs, consuming 1.9 billion tons of coal each year. In addition to CO2, the major greenhouse gas, coal burning in China emits vast quantities of particulate matter, polycyclic aromatic hydrocarbons, sulfur dioxide, arsenic, and mercury. Automobiles emit nitrogen dioxide and benzene in addition to particulate matter and polycyclic aromatic hydrocarbons. Seventy percent of Chinese households burn coal or biomass for cooking and heating, which contaminates indoor air. Adverse effects of combustion-related air pollution include reduced fetal and child growth, pulmonary disease including asthma, developmental impairment, and increased risk of cancer. A prospective molecular epidemiologic study of newborns in Chongqing has demonstrated direct benefits to children's health and development from the elimination of a coal-burning plant.

CONCLUSIONS. Recognition of the full health and economic cost of air pollution to Chinese children and the benefits of pollution reduction should spur increased use of renewable energy, energy efficiency, and clean-fuel vehicles. This is a necessary investment for China's future.
Diagnosing Hypersensitivity Reactions to Cephalosporins in Children
Authors: Romano Antonino , Gaeta Francesco , Valluzzi Rocco Luigi , Alonzi Cristiana , Viola Marinella , Bousquet Philippe Jean
Published: September 2008

OBJECTIVES. The goals were to evaluate the usefulness of skin tests, patch tests, serum specific IgE assays, and challenges in diagnosing hypersensitivity reactions to cephalosporins and to clarify the pathogenic mechanism of such reactions.

METHODS. Children with immediate manifestations (within 1 hour) underwent immediate-reading skin tests with penicillin reagents and any suspect cephalosporins, serum specific IgE assays, and challenges; some children underwent reevaluations. Children with nonimmediate manifestations (after >1 hour) were assessed with patch tests, delayed-reading skin tests, and challenges.

RESULTS. We evaluated 148 children with hypersensitivity reactions to cephalosporins, mainly cefaclor and ceftriaxone; 105 had experienced nonimmediate manifestations (mostly urticarial eruptions and maculopapular rashes) and 43 immediate manifestations (anaphylactic shock, urticaria and/or angioedema, and erythema). None of the nonimmediate reactors demonstrated positive results in patch tests and/or delayed skin tests; only 1 subject displayed immediate positive responses to penicillin skin-test reagents. Among the 104 patients with negative results, 96 underwent challenges; 95 tolerated the challenges, and 1 reacted to the cefaclor pediatric suspension and tolerated the challenge with a cefaclor capsule. In the first allergologic evaluation, 33 of the 43 children with immediate reactions displayed skin-test positivity. Of the 10 patients with negative results, 7 underwent challenges, followed by therapeutic courses and reevaluations for 4. All challenges and therapeutic courses were tolerated; in the reevaluation, 1 girl demonstrated positive skin-test results for both the responsible cephalosporin and penicillin reagents. Overall, IgE-mediated hypersensitivity was diagnosed for 34 (79%) of 43 subjects.

CONCLUSIONS. Extremely few nonimmediate manifestations associated with cephalosporin therapy are actually hypersensitivity reactions, whereas most immediate reactions to cephalosporins are IgE-mediated. Cephalosporin skin testing is a useful tool for evaluating such reactions.
Pervasive Behavior Problems at 6 Years of Age in a Total-Population Sample of Children Born at ≤25 Weeks of Gestation
Authors: Samara Muthanna , Marlow Neil , Wolke Dieter ,   for the EPICure Study Group
Published: September 2008

OBJECTIVE. The goal was to test whether extremely preterm children have more pervasive behavior problems than classroom peers, by using parent and teacher consensus reports. Is there an excess number of extremely preterm boys with behavior problems?

METHODS. A total-population study of all extremely preterm children in the United Kingdom and Ireland was performed. All children born at ≤25 weeks of gestation in the United Kingdom and Ireland between March and December 1995 were assessed at 76 months of age (range: 62–87 months) (EPICure study). Pervasive behavior problems were defined as scoring >90th percentile on parent and teacher reports with a standard behavior scale, the Strengths and Difficulties Questionnaire. Of the 241 of 308 survivors who responded (78% of survivors), 200 had full reports on behavior problems from teachers and parents; they were compared with 148 control children.

RESULTS. A total of 19.4% of extremely preterm children (boys: 23.2%; girls: 15.6%), compared with 3.4% of control children (boys: 4.6%; girls: 2.5%) had total behavior scores in the clinical range. Hyperactivity (extremely preterm: 30.6%; control: 8.8%) and conduct problems (extremely preterm: 12.5%; control: 5.4%) could be accounted for by cognitive deficits, but attention (extremely preterm: 33.3%; control: 6.8%), peer (extremely preterm: 25.4%; control: 5.4%), and emotional (extremely preterm: 13.5%; control: 4.1%) problems were not explained by poor cognitive functioning. Extremely preterm boys had behavior problems in excess of gender differences found in the control group in hyperactivity, attention, and prosocial problems, and the impact on parents and teachers was greater for extremely preterm boys than girls.

CONCLUSIONS. Pervasive behavior problems are more frequent in children born at the limits of viability than previously reported for larger preterm populations. Extremely preterm boys seem most vulnerable, and the impact on parents and teachers is considerable.
Very Low Birth Weight Preterm Infants With Surgical Short Bowel Syndrome: Incidence, Morbidity and Mortality, and Growth Outcomes at 18 to 22 Months
Authors: Cole Conrad R. , Hansen Nellie I. , Higgins Rosemary D. , Ziegler Thomas R. , Stoll Barbara J. ,   for the Eunice Kennedy Shriver NICHD Neonatal Research Network
Published: September 2008

OBJECTIVES. The objective of this study was to determine the (1) incidence of short bowel syndrome in very low birth weight (<1500 g) infants, (2) associated morbidity and mortality during initial hospitalization, and (3) impact on short-term growth and nutrition in extremely low birth weight (<1000 g) infants.

METHODS. Infants who were born from January 1, 2002, through June 30, 2005, and enrolled in the National Institute of Child Health and Human Development Neonatal Research Network were studied. Risk factors for developing short bowel syndrome as a result of partial bowel resection (surgical short bowel syndrome) and outcomes were evaluated for all neonates until hospital discharge, death, or 120 days. Extremely low birth weight survivors were further evaluated at 18 to 22 months' corrected age for feeding methods and growth.

RESULTS. The incidence of surgical short bowel syndrome in this cohort of 12316 very low birth weight infants was 0.7%. Necrotizing enterocolitis was the most common diagnosis associated with surgical short bowel syndrome. More very low birth weight infants with short bowel syndrome (20%) died during initial hospitalization than those without necrotizing enterocolitis or short bowel syndrome (12%) but fewer than the infants with surgical necrotizing enterocolitis without short bowel syndrome (53%). Among 5657 extremely low birth weight infants, the incidence of surgical short bowel syndrome was 1.1%. At 18 to 22 months, extremely low birth weight infants with short bowel syndrome were more likely to still require tube feeding (33%) and to have been rehospitalized (79%). Moreover, these infants had growth delay with shorter lengths and smaller head circumferences than infants without necrotizing enterocolitis or short bowel syndrome.

CONCLUSIONS. Short bowel syndrome is rare in neonates but has a high mortality rate. At 18 to 22 months' corrected age, extremely low birth weight infants with short bowel syndrome were more likely to have growth failure than infants without short bowel syndrome.
Telling Parents Their Child's Weight Status: Psychological Impact of a Weight-Screening Program
Authors: Grimmett Chloe , Croker Helen , Carnell Susan , Wardle Jane
Published: September 2008

OBJECTIVE. This was a descriptive study examining the psychological impact of a school-based, weight-screening intervention that included feedback to parents.

METHODS. Children from years 3 and 6 (6–7 and 10–11 years old) in London schools were measured in school, and parents were sent information on the child's weight status. Children and parents completed questionnaires 6 weeks before and 4 weeks after the feedback; 358 children and 287 parents completed both questionnaires. The main outcome measures (parental feeding practices, parental perception of child weight, child body esteem, child eating behavior, and weight-related teasing) were assessed before and after feedback. Qualitative data on health-behavior change and parents’ and children's views of the measurement and feedback process were collected at follow-up.

RESULTS. Fifty-one percent of the parents (n = 398) volunteered for child measurements and weight feedback. Feedback was not associated with changes in child feeding among parents of healthy-weight children, but dietary restriction increased in parents of overweight girls. Among healthy-weight children, restrained eating decreased and body esteem increased, but there were no significant changes among the overweight group and no changes in reports of teasing. Perceptions of child overweight did not increase significantly, but 50% of the parents of overweight children reported positive changes in health behaviors. The majority (65%) of parents wanted weight feedback on a regular basis, and most children enjoyed the measuring process.

CONCLUSIONS. Weight feedback was acceptable to the majority of parents participating in an “opt-in” measurement and feedback program; adverse effects were minimal for children and parents, even when feedback indicated overweight. However, a minority of participants found it distressing, which highlights the importance of managing the process sensitively, particularly for families with overweight children.
Rate of Nicotine Metabolism and Withdrawal Symptoms in Adolescent Light Smokers
Authors: Rubinstein Mark L. , Benowitz Neal L. , Auerback Glenna M. , Moscicki Anna-Barbara
Published: September 2008

OBJECTIVES. The rate of nicotine metabolism may contribute to vulnerability in adolescents’ transition from smoking initiation to addiction. The objectives of this study were to examine the associations between the rate of nicotine metabolism and cigarette consumption, addiction, and withdrawal symptoms in a sample of adolescent light smokers.

PARTICIPANTS. Twenty adolescent smokers between 13 and 17 years old, who smoked between 1 and 6 cigarettes daily for ≥6 months, were recruited from several San Francisco Bay area schools and pediatric clinics from 2006 to 2007.

METHODS. Participants underwent 24 hours of supervised tobacco abstinence. Serum was collected at baseline and at 24 hours for measurement of the nicotine metabolites cotinine and 3′-hydroxycotinine. Participants also completed self-report measures, which included smoking behavior, nicotine dependence, and withdrawal scales at baseline and 24 hours after baseline. The ratio of serum 3′-hydroxycotinine/cotinine (the nicotine metabolite ratio), a measure of the rate of nicotine metabolism, was computed by using measurements from the 24-hour serum samples.

RESULTS. Participants were divided into 2 groups: faster metabolizers (3′-hydroxycotinine/cotinine ratio ≥ 0.5; n = 5) and slower metabolizers (3′-hydroxycotinine/cotinine ratio < 0.5; n = 15). Faster metabolizers reported greater withdrawal symptoms after 24 hours of abstinence compared with slower metabolizers even after adjusting for the number of cigarettes smoked per day. The metabolite ratio was significantly correlated with self-described level of addiction.

CONCLUSIONS. This is the first study to report a significant relationship between the rate of nicotine metabolism and withdrawal symptoms and self-reported addiction in adolescent light smokers. Given the association between withdrawal symptoms and nicotine addiction, adolescent smokers who are faster metabolizers of nicotine may be at greater risk for becoming addicted to nicotine compared with slower metabolizers.
Long-term Mother and Child Mental Health Effects of a Population-Based Infant Sleep Intervention: Cluster-Randomized, Controlled Trial
Authors: Hiscock Harriet , Bayer Jordana K. , Hampton Anne , Ukoumunne Obioha C. , Wake Melissa
Published: September 2008

OBJECTIVES. Maternal depression is an established risk for adverse child development. Two thirds of clinically significant depressive symptoms occur in mothers reporting an infant sleep problem. We aimed to determine the long-term effects of a behavioral intervention for infant sleep problems on maternal depression and parenting style, as well as on child mental health and sleep, when the children reached 2 years of age.

METHODS. We conducted a cluster-randomized trial in well-child centers across 6 government areas of Melbourne, Australia. Participants included 328 mothers reporting an infant sleep problem at 7 months, drawn from a population sample (N = 739) recruited at 4 months. We compared the usual well-child care (n = 154) versus a brief behavior-modification program designed to improve infant sleep (n = 174) delivered by well-child nurses at ages 8 to 10 months and measured maternal depression symptoms (Edinburgh Postnatal Depression Scale); parenting practices (Parent Behavior Checklist); child mental health (Child Behavior Checklist); and maternal report of a sleep problem (yes or no).

RESULTS. At 2 years, mothers in the intervention group were less likely than control mothers to report clinical depression symptoms: 15.4% vs 26.4% (Edinburgh Postnatal Depression Scale community cut point) and 4.2% vs 13.2% (Edinburgh Postnatal Depression Scale clinical cut point). Neither parenting style nor child mental health differed markedly between the intervention and control groups. A total of 27.3% of children in the intervention group versus 32.6% of control children had a sleep problem.

CONCLUSIONS. The sleep intervention in infancy resulted in sustained positive effects on maternal depression symptoms and found no evidence of longer-term adverse effects on either mothers' parenting practices or children's mental health. This intervention demonstrated the capacity of a functioning primary care system to deliver effective, universally offered secondary prevention.
Medication Errors in Pediatric Inpatients: Prevalence and Results of a Prevention Program
Authors: Otero Paula , Leyton Andrea , Mariani Gonzalo , Ceriani Cernadas José María ,   and the Patient Safety Committee
Published: September 2008

OBJECTIVE. The objective of this study was to assess the prevalence and characteristics of medication errors in pediatric and neonatal inpatients and to measure the impact of interventions to reduce medication errors.

METHODS. A preintervention and postintervention cross-sectional study was conducted of a sample of prescriptions that were ordered by physicians and medications that were administered by nurses to patients at the NICU, PICU, and general pediatric settings at the Hospital Italiano de Buenos Aires Department of Pediatrics in 2002 and 2004. Number and type of errors, time shift on which they occurred, and whether they had any kind of adverse event on the patient were recorded. Medication errors were stratified according to physicians' and nurses' status. Several interventions, including incorporating a positive safety culture without a punitive management of errors and specific prescribing and drug-administration recommendations were implemented between the 2 phases of the study.

RESULTS. A total of 590 prescriptions and 1174 drug administrations for 95 patients in the first phase of the study and 1144 prescriptions with 1588 drug administrations for 92 patients in the second phase were evaluated. The prevalence of medication error rate in the second phase was 7.3% (199 of 2732) and 11.4% (201 of 1764) in the first phase. The risk difference was −4.1%.

CONCLUSIONS. The development of a program mainly centered on the promotion of a cultural change in the approach to medical errors can effectively diminish medication errors in neonates and children.
Pulmonary Vein Stenosis: Prematurity and Associated Conditions
Authors: Drossner David M. , Kim Dennis W. , Maher Kevin O. , Mahle William T.
Published: September 2008

OBJECTIVE. Pulmonary vein stenosis is a rare, although often lethal, anomaly. Risk factors for the diagnosis of pulmonary vein stenosis are poorly characterized. In this study we sought to identify factors associated with pulmonary vein stenosis, paying particular attention to preterm birth.

METHODS. By review of the cardiac database we identified all of the subjects with pulmonary vein stenosis over a 10-year period at our institution. Those children with anomalous pulmonary venous connection were not included. Patient-related variables were analyzed for their association with pulmonary vein stenosis. Pulmonary vein stenosis was diagnosed by spectral Doppler interrogation of the pulmonary veins (continuous, turbulent flow with calculated mean gradient > 5 mm Hg) and confirmed by cardiac catheterization in nearly all of the cases.

RESULTS. Twenty-six patients with pulmonary vein stenosis were identified. The median age at diagnosis was 7.4 months; range: 1 day to 35 months. Congenital heart defects were present in the majority of subjects. Associated genetic syndromes were present in 8 subjects (31%). The 2-year survival rate from diagnosis was 43%. The majority of subjects (16 [61%]) were preterm. Gestational ages ranged from 24.2 to 41.0 weeks, and birth weights ranged from 460 to 4445 g. Preterm birth was strongly associated with the diagnosis of pulmonary vein stenosis, odds ratio 10.2 (95% CI 4.7–22.6), p < .001. Eleven (42%) of the 26 subjects were treated for bronchopulmonary dysplasia before being diagnosed with pulmonary vein stenosis.

CONCLUSIONS. Prematurity is associated with the diagnosis of pulmonary vein stenosis. It is interesting to note that many of these patients also have intracardiac shunt lesions, which may act in concert with preterm endothelium to produce pulmonary vein stenosis.
Sleep-Disordered Breathing in Children With Metabolic Syndrome: The Role of Leptin and Sympathetic Nervous System Activity and the Effect of Continuous Positive Airway Pressure
Authors: Nakra Neal , Bhargava Sumit , Dzuira James , Caprio Sonia , Bazzy-Asaad Alia
Published: September 2008

OBJECTIVE. The purpose of this work was to determine whether, in children with metabolic syndrome and sleep-disordered breathing, metabolic markers separate them from children with metabolic syndrome without sleep-disordered breathing and whether treatment of sleep-disordered breathing with continuous positive airway pressure is associated with an improvement in metabolic derangement.

PATIENTS AND METHODS. Subjects aged 7 to 19 years old with metabolic syndrome and a positive validated sleep questionnaire were recruited. Subjects underwent overnight polysomnography, during which sympathetic nervous system activity was assessed via 8-hourly measurements of norepinephrine and epinephrine, together with leptin. The next morning, a fasting 3-hour oral glucose-tolerance test was performed to calculate whole-body insulin sensitivity. A fasting lipid panel interleukin 6, adiponectin, and C-reactive protein levels were also measured. Children with sleep-disordered breathing were placed on continuous positive airway pressure for 3 months and studied again. Sleep-disordered breathing and no sleep-disordered breathing groups were compared by using Fisher's exact test and t test for independent samples with analysis of covariance to adjust for age and BMI.

RESULTS. Of 34 children studied, 25 had sleep-disordered breathing (apnea-hypopnea index: >1.5). Mean hourly norepinephrine and leptin levels were higher in the group with sleep-disordered breathing compared with the group without sleep-disordered breathing (P < .005), with no difference in whole-body insulin sensitivity. Eleven subjects with sleep-disordered breathing completed 3 months of nightly continuous positive airway pressure treatment. In the follow-up study, mean hourly leptin levels were significantly lower than in the initial study, with no change in BMI z score or other measurements.

CONCLUSION. Our findings support the hypothesis that sleep-disordered breathing in children with metabolic syndrome is associated with increased sympathetic nervous system activity and leptin levels but not worsening of insulin resistance. Treatment of sleep-disordered breathing with continuous positive airway pressure led to a significant decrease in leptin levels.
Arterial Intima-Media Thickness in 13-Year-Old Adolescents and Previous Antichlamydial Antimicrobial Use: A Retrospective Follow-up Study
Authors: Volanen Iina , Kallio Katariina , Saarinen Maiju , Järvisalo Mikko J. , Vainionpää Raija , Rönnemaa Tapani , Viikari Jorma , Marniemi Jukka , Simell Olli , Raitakari Olli T.
Published: September 2008

BACKGROUND. Children with persistent Chlamydia pneumoniae infection may be at increased risk for atherosclerosis. The impact of antimicrobial therapy for primary prevention of atherosclerotic cardiovascular disease is unsolved.

OBJECTIVE. The purpose of this study was to determine whether treatment with antimicrobial agents effective against C pneumoniae during childhood, regardless of indication, has a favorable influence on the arterial wall-thickness in children by the time they reach adolescence.

SUBJECTS AND METHODS. The association of macrolide, tetracycline, quinolone, and rifamycin use (number of exposure events) between ages 5 and 13 years with carotid and aortic intima-media thickness at age 13 years was investigated among 508 healthy children. Information about the use of medications was obtained from the Finnish prescription register. Arterial intima-media thickness was measured with a high-resolution ultrasound.

RESULTS. Mean aortic intima-media thickness showed a significant direct association with the number of antichlamydial antimicrobial exposure events also after controlling for established atherosclerotic risk factors. Elevated C-reactive protein level had an additional effect on aortic intima-media thickness in a multivariable model. Carotid intima-media thickness was not associated with the number of preceding antichlamydial treatments.

CONCLUSIONS. Recurrent antichlamydial treatments in childhood have no favorable influence on early vascular changes but are associated with increased intima-media thickness in the abdominal aorta. These findings suggest that the use of antimicrobial agents does not offer protection against the potential atherogenicity of repeated infectious insults.
Breastfeeding or Oral Sucrose Solution in Term Neonates Receiving Heel Lance: A Randomized, Controlled Trial
Authors: Codipietro Luigi , Ceccarelli Manuela , Ponzone Alberto
Published: September 2008

OBJECTIVE. The purpose of this work was to compare the efficacy of breastfeeding versus orally administered sucrose solution in reducing pain response during blood sampling through heel lance.

METHODS. We conducted an open-label, randomized, controlled trial at a neonatal unit of a public hospital in northern Italy on 101 term neonates undergoing heel lance with an automated piercing device for routine neonatal screening for congenital disorders. Newborn infants were randomly assigned to breastfeeding during blood sampling or to the oral administration of 1 mL of 25% sucrose solution. We validated the multidimensional acute pain rating scale of the Premature Infant Pain Profile, heart rate increase, oxygen saturation decrease, crying behavior (duration of first cry, cry percentage in 2 minutes, and during blood sampling), duration of sampling, and the number of performed heel lances.

RESULTS. Median Premature Infant Pain Profile scores were lower in the breastfeeding group (3.0) than in the sucrose-solution group (8.5), and the median group difference was −5.0. The median heart rate increase, oxygen saturation decrease, and duration of first cry for the breastfeeding group were, respectively, 13.0, −1, and 3 and for sucrose group were 22, −3, and 21. Medians were significantly different between the groups. There were no significant differences in the sampling duration and numbers of heel lances.

CONCLUSIONS. This study suggests that breastfeeding provides superior analgesia for heel lance compared with oral sucrose in term neonates.
Medical and Mental Health of Children Entering the Utah Foster Care System
Authors: Steele Julie S. , Buchi Karen F.
Published: September 2008

BACKGROUND. Investigators from several states have reported that children entering foster care are at risk for medical and mental health conditions. Additional information based on data from a larger statewide population of children in foster care would assist in the development of appropriate strategies of care for these children.

OBJECTIVES. The purpose of this work was to describe the prevalence of medical and mental health conditions, the number of referrals for specialty care, the use of medications and to compare the prevalence of these conditions across age groups of children entering foster care in Utah.

METHODS. We conducted an analysis of a statewide database containing abstracted medical and mental health information from the initial medical and mental health assessments of all children entering foster care between January 1, 2001, and December 16, 2004.

RESULTS. Of the 6177 children who entered foster care during the study period, 83% were white and 24% were Hispanic. One or more acute or chronic medical conditions were present in 54%, and 44% had ≥1 mental health condition. The most prevalent medical conditions in all of the children were overweight or obesity (35%), 30% had a referral for specialty care. The most prevalent mental health conditions were oppositional defiant disorder or conduct disorder (18%), reactive attachment and adjustment disorders (17%), and mood disorders (15%). The frequency of psychotropic medication use increased with age. Of the 2747 children of all ages with a diagnosed mental health condition, 35% were receiving psychotropic medications.

CONCLUSIONS. This study of a statewide cohort of children entering foster care supports and strengthens previous evidence that children in foster care are more likely to have more health care needs compared with the general pediatric population. Focused strategies are needed that address prevalent conditions, the need for continuity of care, ongoing mental health services, and medication management.