bluuebunny/crossref_metadata_2025 huggingface dataset:
Crowd Out: Evidence From the Florida Healthy Kids Program
Authors: Shenkman Elizabeth , Bucciarelli Richard , Wegener Donna Hope , Naff Rose , Freedman Steve
Published: August 2004

Objective.

To determine the percentage of children who had insurance coverage in the 12 months preceding enrollment in a state-subsidized program; the percentage of parents who had access to employer-based family coverage; and the cost of the families' share of the premium per month.

Methods.

We randomly selected 930 families whose children were enrolled in the Florida Healthy Kids Program for a period of between 1 and 3 months and conducted telephone interviews with them in 1998 about their children's insurance coverage before program entry and their access to employer-based family coverage. There were 653 families in the final sample.

Results.

Only 5% of the children had employer-based coverage before program enrollment. However, 26% had access to family coverage through their employers with the family share of the premiums representing on average 13% of their incomes. Access to employer-based coverage varied significantly by family income.

Conclusions.

Throughout the development of the State Children's Health Insurance Program legislation, policy analysts expressed concern that families may crowd out or substitute a subsidized state plan for employer-based coverage. This substitution could result in fewer improvements in access to care and health status than were anticipated, because families are simply moving to a different form of health insurance. There is some degree of crowd out in the Healthy Kids Program. The economic burden to near-poor families to purchase employer-based coverage is significant. Some degree of substitution may need to be tolerated to ensure that children receive needed health insurance.
Comparison of Perinatal Outcomes Among TennCare Managed Care Organizations
Authors: Cooper William O. , Hickson Gerald B. , Mitchel Edward F. , MS Jr, , Ray Wayne A.
Published: August 2004

Objective.

To compare perinatal outcomes among the managed care organizations (MCOs) providing care to beneficiaries enrolled in TennCare, Tennessee's capitated Medicaid managed care program.

Design.

Retrospective cohort analysis.

Subjects.

Infants born in Tennessee during 1995 to women enrolled in TennCare.

Primary Outcome Measures.

Prenatal care use, birth weight (BW), death in the first 60 days of life, and delivery of extremely low BW (<1000 g) infants in hospitals without level 3 neonatal intensive care units.

Results.

During 1995, 34 402 infants were born to mothers enrolled in TennCare. The MCOs differed widely in the demographic characteristics of their enrollees. In addition, there were small differences in prenatal care utilization, but no differences in BW outcomes among the MCOs. In multivariate analysis, however, infants born to women enrolled in 1 MCO were 2.8 times more likely to die in the first 60 days of life than were infants born to women enrolled in the largest MCO (OR: 2.81; 95% CI: 1.31–6.03). Women enrolled in this same MCO seemed to have a higher proportion of extremely low BW (<1000 g) infants delivering in a hospital lacking a level 3 neonatal intensive care unit (38% vs 20% in the largest MCO).

Conclusion.

The differences among MCOs in early infant death and in the delivery of high-risk infants in hospitals lacking appropriate neonatal facilities suggest that monitoring of care delivery to vulnerable children should include assessment of appropriate use of specialized services.
Firearm Injury Prevention Counseling: Are We Missing the Mark?
Authors: Becher Elise C. , Christakis Nicholas A.
Published: August 2004

Objective.

To determine whether pediatricians accurately estimate the likelihood of gun ownership among their patients' families.

Design.

Self-administered, written surveys completed simultaneously by pediatricians and their patients' parents.

Setting.

A total of 23 pediatric practices and hospital-based clinics in three cities in the United States.

Subjects.

A total of 66 pediatricians paired with 169 of their patients' parents.

Main Outcome Measures.

Parent survey: ownership and storage of guns, willingness to admit gun ownership, and previous counseling by pediatrician. Pediatrician survey: estimated prevalence of gun ownership, likelihood of gun ownership by each participant family, and beliefs about firearm injury prevention counseling.

Results.

All parents who owned guns indicated they would acknowledge owning a gun if asked by their pediatricians. Of the participating families, 28% owned at least one gun; 39% of the homes with guns contained a gun that was unlocked, loaded, or both. Of the parents, 11% reported that their pediatrician had discussed firearm safety with them. Pediatricians' average estimate of the overall prevalence of gun ownership in their patient populations was 25%. When asked to predict the likelihood of gun ownership by the specific families in the study, pediatricians predicted a 0% likelihood of gun ownership for 33% of the families. Of those families, 30% reported owning at least one gun. Considering physician predictions of any likelihood of gun ownership >0% (1%–100%) to be a positive prediction and using parent reports as the gold standard, physician estimates of gun ownership were only 65% sensitive. Approximately half (55%) of the participating pediatricians believed that pediatricians should discuss gun safety with all families, and 98% believed that pediatricians should discuss gun safety with all gun-owning families.

Conclusions.

Pediatricians believe that all families with guns should receive firearm safety counseling. However, pediatricians significantly underestimate the likelihood of gun ownership by specific families. Parents who own guns indicate that they would acknowledge gun ownership if their pediatrician asked about guns in the home. Therefore, rather than relying on assumptions about whether particular patients seem likely to be gun owners, pediatricians should ask all families whether they own guns.
Varicella Outbreaks After Vaccine Licensure: Should They Make You Chicken?
Authors: Buchholz Udo , Moolenaar Ron , Peterson Carol , Mascola Laurene
Published: August 2004

In 1998, 3 years after vaccine licensure, child care centers (CCC) in Los Angeles County continued to report varicella outbreaks. We investigated outbreaks at 2 CCCs to determine the cause for them, such as low vaccination coverage levels or unexpected low vaccine effectiveness. We collected information on past history of varicella, illness during the outbreak, and prior varicella vaccination among CCC attendees. We found that CCC “H” had a vaccination coverage of 87% (34/39) compared with 30% (6/20) in CCC “L.” The overall attack rate was lower in CCC “H” (31%) than in “L” (61%; P value = .03). Vaccine effectiveness for any varicella was 71% in “H” and 100% in “L.” Vaccinated children with varicella had milder disease than unvaccinated. In conclusion, we found varicella outbreaks in CCCs with both high and low vaccination coverage. Vaccine effectiveness was within the range predicted by the literature. Vaccination led to a lower attack rate in the highly vaccinated CCC and appeared to protect from severe disease.
Possible Association of Intussusception With Rotavirus Vaccination
Authors:   Committee on Infectious Diseases
Published: August 2004

This Policy statement was retired January 2000.
Current Incidence of Retinopathy of Prematurity, 1989–1997
Authors: Hussain Naveed , Clive Jonathan , Bhandari Vineet
Published: August 2004

Objective.

To report the current incidence and the need for surgery for retinopathy of prematurity (ROP) in neonates (22–36 weeks' gestational age [GA], July 1, 1989 through June 30, 1997).

Study Design.

Retrospective analyses using computerized perinatal database kept on all admissions, a review of patient charts, and eye examination log books.

Setting.

Level 3 regional referral NICU.

Patients.

A total of 2528 infants <37 weeks' GA were admitted during this time. Of these infants, 950 met the criteria for eye examination beginning at 4 to 6 weeks of age and repeated every 2 weeks until complete vascularization of the retina or death or discharge.

Results.

The incidence of ROP was (202/950) 21.3% for any stage and 4.6% (44/950) for stage 3 ROP or greater. No ROP was noted in infants born at >32 weeks' GA. No infant born at >28 weeks needed retinal surgery. Using birth weight (BW) criteria, stage 3 ROP was not noted in infants with BWs >1500 g; retinal surgery was not needed in infants with BWs >1000 g. A number of perinatal factors were associated with ROP on univariate analysis. However, using multiple logistic regression analyses of these factors, only GA and days on supplemental oxygen therapy were associated significantly with the development of ROP. Despite increased survival of extremely low BW infants, we found a considerable reduction in incidence and severity of ROP compared with reports from an earlier chronological period. However, infants <28 weeks' GA or with BWs <1000 g were still at considerable risk for retinal surgical treatment for ROP.

Conclusion.

We conclude that the incidence and severity of ROP have decreased significantly in the present era of surfactant therapy.
Television-viewing Habits and Sleep Disturbance in School Children
Authors: Owens Judith , Maxim Rolanda , McGuinn Melissa , Nobile Chantelle , Msall Michael , Alario Anthony
Published: August 2004

Objective.

To investigate the relationship between specific television-viewing habits and both sleep habits and sleep disturbances in school children.

Methods.

The parents of 495 children in grades kindergarten through fourth grade in three public elementary schools completed two retrospective survey questionnaires, one assessing their children's sleep behaviors and the other examining television-viewing habits of both the child and the family. Sleep domains assessed included bedtime resistance, sleep onset delay, sleep duration, anxiety around sleep, parasomnias, night wakings, and daytime sleepiness. Teachers from all three schools also completed daytime sleepiness questionnaires (N = 402) for the sample.

Results.

Most of the television-viewing practices examined in this study were associated with at least one type of sleep disturbance. Despite overall close monitoring of television-viewing habits, one quarter of the parents reported the presence of a television set in the child's bedroom. The television-viewing habits associated most significantly with sleep disturbance were increased daily television viewing amounts and increased television viewing at bedtime, especially in the context of having a television set in the child's bedroom. The sleep domains that appeared to be affected most consistently by television were bedtime resistance, sleep onset delay, and anxiety around sleep, followed by shortened sleep duration. The parent's threshold for defining “problem sleep behavior” in their child was also important in determining the significance of the association between sleep disturbance and television-viewing habits.

Conclusion.

Health care practitioners should be aware of the potential negative impact of television viewing at bedtime. Parents should be questioned about their children's television-viewing habits as part of general screening for sleep disturbances and as part of anticipatory guidance in regards to healthy sleep habits in children. In particular, the presence of a television set in the child's bedroom may be a relatively underrecognized, but important, contributor to sleep problems in school children.
Relative Efficacy of Amethocaine Gel and Lidocaine–Prilocaine Cream for Port-a-Cath Puncture in Children
Authors: Bishai Raafat , Taddio Anna , Bar-Oz Benjamin , Freedman Melvin H. , Koren Gideon
Published: August 2004

Background. Lidocaine–prilocaine cream (EMLA) is currently standard therapy to alleviate procedural pain in children. One of the disadvantages of lidocaine–prilocaine is the need to wait for 60 minutes for adequate skin anesthesia. Amethocaine gel (Ametop) is a new topical anesthetic that requires a shorter application time for skin anesthesia.

Objectives. To compare the relative efficacy and safety of amethocaine gel and lidocaine–prilocaine cream in children with cancer undergoing Port-a-Cath puncture and to determine which patient factors influence judgments about pain.

Methods. Randomized, blinded, crossover study. Each child received either 1 g of amethocaine gel for 30 minutes, preceded by a placebo gel for 30 minutes, or 1 g of lidocaine–prilocaine cream for 60 minutes. Children rated the pain using the faces scale, for which scores ranged from 0 to 5. Parents and attending nurse operators rated pain on a 10-cm visual analog scale.

Results. Thirty-nine children participated. The mean age was 10.2 years (range: 5–16 years), and 69% were male. There were no differences in mean pain assessments between amethocaine and lidocaine–prilocaine as rated by the children (2.0 vs 0.5), parents (2.6 vs 6.4), or nurse operators (2.0 vs 0.9). No serious adverse effects were detected with either preparation. Pain scores assigned by parents and children were not influenced by age, gender, duration of diagnosis, or anesthetic regimen (amethocaine versus lidocaine–prilocaine) in the child. Nurses, however, rated pain higher for younger children, and in males during pretreatment with lidocaine–prilocaine.

Conclusion. Amethocaine achieves similar anesthesia to lidocaine–prilocaine during Port-a-Cath administration in children, with an application time that is half of lidocaine–prilocaine. Pain assessments were not influenced by age, gender, or duration of diagnosis of the child. Nurses may perceive that pain is greater for younger children and in males. lidocaine–prilocaine, amethocaine, pain, children, Port-a-Cath puncture.
Clinical Indicators of Intracranial Injury in Head-injured Infants
Authors: Greenes David S. , Schutzman Sara A.
Published: August 2004

Objectives.

1) To determine whether clinical signs of brain injury are sensitive indicators of intracranial injury (ICI) in head-injured infants. 2) To determine whether radiographic imaging of otherwise asymptomatic infants with scalp hematoma is a useful means of detecting cases of ICI. 3) To determine whether head-injured infants without signs of brain injury or scalp hematoma may be safely managed without radiographic imaging.

Methods.

We performed a 1-year prospective study of all infants younger than 2 years of age presenting to a pediatric emergency department with head trauma. Data were collected on historical features, physical findings, radiographic findings, and hospital course. Follow-up telephone calls were made 2 weeks after discharge to assess for any late deterioration.

Results.

Of 608 study subjects, 30 (5%) had ICI; 12/92 (13%) infants 0 to 2 months of age had ICI, compared with 13/224 (6%) infants 3 to 11 months of age, and 5/292 (2%) infants 12 months of age or older.

Only 16/30 (52%) subjects with ICI had at least one of the following clinical symptoms or signs of brain injury: loss of consciousness, history of behavior change, seizures, emesis, depressed mental status, irritability, bulging fontanel, focal neurologic findings, or vital signs indicating increased intracranial pressure.

Of the 14 asymptomatic subjects with ICI, 13 (93%) had significant scalp hematoma. Among subjects who had head computed tomography, significant scalp hematoma had an odds ratio of 2.78 (95% confidence interval: 1.15,6.70) for association with ICI.

A total of 265 subjects (43%) were asymptomatic and had no significant scalp hematoma. None (95% confidence interval: 0,1.2%) required specific therapy or had any subsequent clinical deterioration.

Conclusions.

Clinical signs of brain injury are insensitive indicators of ICI in infants. A substantial fraction of infants with ICI will be detected through radiographic imaging of otherwise asymptomatic infants with significant scalp hematomas. Asymptomatic infants older than 3 months of age who have no significant scalp hematoma may be safely managed without radiographic imaging.
Rehospitalization for Respiratory Syncytial Virus Among Premature Infants
Authors: Joffe Steven , Escobar Gabriel J. , Black Steven B. , Armstrong Mary Anne , Lieu Tracy A.
Published: August 2004

Objectives.

New interventions to prevent respiratory syncytial virus (RSV) have recently become available. Clinical decisions about the use of these interventions require a better understanding of the incidence of and risk factors for RSV. We sought to characterize the epidemiology of severe RSV disease among premature infants and to identify high-risk subgroups.

Design.

Retrospective cohort.

Setting.

Kaiser Permanente Northern California, July 1992 to April 1996.

Participants.

One thousand seven hundred twenty-one premature infants born at 23 to 36 weeks who were discharged from a neonatal intensive care nursery (NICU) within 12 months before the December to March RSV season. A secondary analysis included 769 infants discharged during the RSV season.

Outcome Measures.

Hospitalization for RSV.

Results.

Of 1721 infants already home from the NICU at the start of the season, 3.2% were rehospitalized for RSV. In a multivariate model, risk factors for RSV hospitalization included gestation ≤32 weeks (odds ratio [OR], 2.6), ≥28 days of perinatal oxygen (OR, 3.7), and NICU discharge during September to November (OR, 2.7). Predicted risk of hospitalization varied by subgroup, ranging from 1.2% to 24.6%. Among 769 infants discharged from the NICU during the RSV season, 3.5% were rehospitalized for RSV during the same season; gestation and perinatal oxygen were not associated with admission.

Conclusions.

Most premature infants in this population were at less risk of severe RSV disease than previous studies in other populations have suggested. Preterm infants with a lower gestational age, a prolonged perinatal oxygen requirement, and NICU discharge within 3 months of the RSV season were most likely to require hospitalization for RSV disease. Cost-effectiveness analyses are needed to help define the role of available prophylactic interventions.
Relative and Attributable Risks for Moderate to Profound Bilateral Sensorineural Hearing Impairment Associated With Lower Birth Weight in Children 3 to 10 Years Old
Authors: Van Naarden Kim , Decouflé Pierre
Published: August 2004

Objective.

To determine the prevalence, relative risks, and attributable fractions for congenital bilateral sensorineural hearing impairment in relation to lower birth weight among children born in the 1980s and living in the metropolitan Atlanta area from 1991 through 1993.

Methods.

We used the population-based, active case ascertainment Metropolitan Atlanta Developmental Disabilities Surveillance Program that conducts surveillance in the five-county metropolitan Atlanta area. Hearing impairment was defined as a bilateral, pure-tone hearing loss at frequencies of 500, 1000, and 2000 Hz averaging 40 dBs or more, unaided, in the better ear. Case children, 3 to 10 years of age, with sensorineural loss of presumed congenital origin were included in these analyses (n = 172). Prevalence rates and relative risks were computed for various birth weight categories by hearing level, sex, race, the presence or absence of coexisting developmental disabilities, and gestational age. Attributable fractions were calculated for low birth weight and very low birth weight children by race.

Results.

The overall prevalence rate of presumed congenital bilateral sensorineural hearing impairment was 5.3 cases per 10 000 3-year survivors. The prevalence was 4.1 per 10 000 among children weighing ≥4000 g, 3.7 per 10 000 among those weighing 3000 to 3999 g, 6.6 per 10 000 among those 2500 to 2999 g, 12.7 per 10 000 among those 1500 to 2499 g, and 51.0 per 10 000 among those <1500 g. There was virtually no difference in birth weight-specific rates of hearing impairment across three hearing levels. The presence of coexisting developmental disabilities was associated with a much stronger inverse trend with birth weight. Black children weighing <2500 g had much higher rates of hearing impairment than comparable white children. The overall percentage of moderate to profound congenital bilateral sensorineural hearing loss in the entire study population that was attributable to children weighing <2500 g or <1500 g was estimated to be 18.9% and 9.4%, respectively. Prematurity did not alter the magnitude of risk among children weighing <2500 g.

Conclusions.

The results presented here provide recent estimates of the rates, relative risks, and attributable fractions for congenital bilateral sensorineural hearing impairment by birth weight among children in the United States. The elevated relative risks among children weighing 2500 to 2999 g and 1500 to 2499 g may have implications for future newborn hearing screening criteria.
Weight Concerns, Weight Control Behaviors, and Smoking Initiation
Authors: Tomeo Catherine A. , Field Alison E. , Berkey Catherine S. , Colditz Graham A. , Frazier A. Lindsay
Published: August 2004

Objective.

To examine the cross-sectional relationships between weight concerns, weight control behaviors, and initiation of tobacco use among youths.

Study Design.

Smoking status, weight concerns, and weight control behaviors were assessed in a cross-sectional sample of 16 862 children, 9 to 14 years of age, in 1996. Logistic regression was used to examine the relationship between weight concerns, weight control behaviors, and early stages of smoking initiation (precontemplation, contemplation, and experimentation). All analyses were adjusted for age, body mass index, and known predictors of initiation.

Results.

Approximately 9% of participants had experimented with cigarettes, and 6% were contemplating cigarette smoking. Contemplation of tobacco use was associated with misperception of being overweight (boys: odds ratio [OR], 1.65; 95% confidence interval [CI], 1.10–2.48), unhappiness with appearance (girls: OR, 2.05; 95% CI, 1.48–2.84; boys: OR, 1.60; 95% CI, 1.05–2.42), and a tendency to change eating patterns around peers (girls: OR, 2.87; 95% CI, 2.28–3.62; boys: OR, 1.83; 95% CI, 1.25–2.66). Experimentation with cigarettes was associated with daily exercise to control weight among boys (OR, 1.92; 95% CI, 1.07–3.43) and with monthly purging (OR, 2.54; 95% CI, 1.27–5.07) and daily dieting among girls (OR, 1.79; 95% CI, 1.09–2.96).

Conclusions.

Our findings suggest that, among both girls and boys, contemplation of smoking is positively related to weight concerns. Experimentation seems to be positively related to weight control behaviors. It is important for both pediatricians and comprehensive school health programs to address healthy methods of weight maintenance and to dispel the notion of tobacco use as a method of weight control.
The Use of Physician Financial Incentives and Feedback to Improve Pediatric Preventive Care in Medicaid Managed Care
Authors: Hillman Alan L. , Ripley Kimberly , Goldfarb Neil , Weiner Janet , Nuamah Isaac , Lusk Edward
Published: August 2004

Objective.

Immunizations and other cost-effective preventive services remain underused by many children, especially those living in poverty. Given the effectiveness of provider-based tracking systems and the widespread use by managed care organizations of financial incentives to influence physician practice patterns, we designed and tested an intervention combining these strategies. We studied whether a system of semiannual assessment and feedback, coupled with financial incentives, could improve pediatric preventive care in a Medicaid health maintenance organization (HMO).

Methodology.

We randomly assigned primary care sites serving children in a Medicaid HMO to one of three groups: a feedback group (where physicians received written feedback about compliance scores), a feedback and incentive group (where physicians received feedback and a financial bonus when compliance criteria were met), and a control group. We evaluated compliance with pediatric preventive care guidelines through semiannual chart audits during the years 1993 to 1995.

Results.

Compliance with pediatric preventive care improved dramatically in the study period. Repeated measures ANOVA demonstrated a significant increase in all three study groups throughout the time in total compliance scores (from 56%–73%), as well as scores for immunizations (from 62%–79%) and other preventive care (from 54%–71%). However, no significant differences were observed between either intervention group and the control group, nor were there any interaction (group-by-time) effects.

Conclusions.

Feedback to physicians, with or without financial incentives, did not improve pediatric preventive care in this Medicaid HMO during a time of rapid, secular improvements in care. Possible explanations include the context and timing of the intervention, the magnitude of the financial incentives, and lack of physician awareness of the intervention.
Nocardia farcinicaPneumonia in Chronic Granulomatous Disease
Authors: Shetty Avinash K. , Arvin Ann M. , Gutierrez Kathleen M.
Published: August 2004

Infection with Nocardiaposes a diagnostic challenge in patients with chronic granulomatous disease (CGD) because the signs and symptoms are often nonspecific, delay in diagnosis is common, and invasive procedures are frequently required to obtain appropriate tissue specimens. We present the first reported case of N farcinica pneumonia in an adolescent with X-linked CGD. Differentiation of N farcinica from other members of N asteroidescomplex is important because of its propensity for causing disseminated infection and antimicrobial resistance. Physicians caring for patients with CGD should maintain a high index of suspicion for nocardiosis, especially in those receiving chronic steroid therapy. Early diagnosis remains critical for decreased morbidity and occasional mortality.
Pediatric Physician Profiling
Authors:   Committee on Practice and Ambulatory Medicine and Committee on Medical Liability
Published: August 2004

This Policy Statement was retired May 2007.

Employers, insurers, and other purchasers of health care services collect data to profile the practice habits of pediatricians and other physicians. This policy statement delineates a series of recommendations that should be adopted by health care purchasers to guide the development and implementation of physician profiling systems.
Safe Transportation of Newborns at Hospital Discharge
Authors:   Committee on Injury and Poison Prevention
Published: August 2004

All hospitals should set policies that require the discharge of every newborn in a car safety seat that is appropriate for the infant's maturity and medical condition. Discharge policies for newborns should include a parent education component, regular review of educational materials, and periodic in-service education for responsible staff. Appropriate child restraint systems should become a benefit of coverage by Medicaid, managed care organizations, and other third-party insurers.
Transporting Children With Special Health Care Needs
Authors:   Committee on Injury and Poison Prevention
Published: August 2004

Children with special health care needs should have access to proper resources for safe transportation. This statement reviews important considerations for transporting children with special health care needs and provides current guidelines for the protection of children with specific health care needs, including those with a tracheostomy, a spica cast, challenging behaviors, or muscle tone abnormalities as well as those transported in wheelchairs.
Neurofibromatosis Bright Objects in Children With Neurofibromatosis Type 1: A Proliferative Potential?
Authors: Griffiths Paul D. , PhD FRCR, , Blaser Susan , Mukonoweshuro William , Armstrong Derek , Milo-Manson Golda , Cheung Sylvester
Published: August 2004

Objectives.

The purpose of this study was to investigate the natural history of the high signal intensities shown on long TR sequences—neurofibromatosis type 1 bright objects (NBO)—in children with neurofibromatosis type 1 (NF1). We have paid particular attention to the development of tumors in these areas of abnormality.

Methods.

During a 12-month period in 1992 to 1993, 46 children with clinically proven NF1 had a magnetic resonance (MR) examination at our institution. These were reviewed along with any previous or subsequent MR examinations that had been performed. We recorded the number, volume, and distribution of the abnormal high signal intensities and their change with time when serial examinations were performed.

Results.

NBO were found in 93% of 46 children with NF1 on the original cross-sectional study. The most common anatomic sites were the globus pallidus (30.4%), cerebellum (23.5%), and midbrain (16.2%). The number and volume of NBO varied significantly with age. NBO were uncommon in children younger than 4 years but were very common and extensive between 4 to 10 years. A significant reduction in the number and volume of NBO was demonstrated in children older than 10 years as shown on both the cross-sectional and longitudinal portions of the study. Eight brain tumors (nonoptic pathway) were demonstrated in the 46 children (17%) with 1 child having two tumors. Only 1 child had symptoms referable to the tumor at the time of diagnosis. Five tumors developed in NBO that were documented on serial MR examinations. All those cases developed in children aged 7 to 12 years, and all these children had higher than average numbers and volumes of NBO.

Conclusions.

NBO occur commonly in children with NF1 and are most prevalent between the ages of 4 and 10. We have shown a high frequency of brain tumors in our children with NF1, but the majority of these were asymptomatic. We have demonstrated proliferative change NBO in 11% of 46 children. Most NBO regress with age and seem to be benign, however, young children with a large number and volume of NBO should be followed closely with regular MR examinations because of an increased risk of proliferative change. neurofibromatosis type 1, magnetic resonance, tumor, astrocytoma, childhood.
Breastfeeding Patterns in Relation to Thumb Sucking and Pacifier Use
Authors: Aarts Clara , Hörnell Agneta , Kylberg Elisabeth , Hofvander Yngve , Gebre-Medhin Mehari
Published: August 2004

Objectives.

To analyze the influence of thumb sucking and pacifier use on breastfeeding patterns in exclusively breastfed infants, on the duration of exclusive breastfeeding, and on the total breastfeeding duration.

Study Design.

Descriptive, longitudinal, prospective study.

Setting.

The subjects were recruited from a population of 15 189 infants born in the maternity ward at the University Hospital, Uppsala, Sweden between May 1989 and December 1992.

Study Population.

506 mother–infant pairs.

Methods.

Daily recordings by the mothers on infant feeding from the first week after delivery through the duration of the study. Fortnightly home visits with structured interviews by a research assistant.

Results.

Pacifier use was associated with fewer feeds and shorter suckling duration per 24 hours, shorter duration of exclusive breastfeeding, and shorter total breastfeeding duration compared with no pacifier use. These associations were not found for thumb sucking. The possible negative effects of pacifiers on breastfeeding seemed to be related to the frequency of their use. Maternal age and education only slightly modified the association between pacifier use and breastfeeding duration.

Conclusions.

More frequent use of a pacifier was associated with shorter breastfeeding duration, even among a group of mothers who were highly motivated to breastfeed. breastfeeding duration, breastfeeding pattern, exclusive breastfeeding, pacifier use, thumb sucking.
Behavioral Effects of Corticosteroids in Steroid-sensitive Nephrotic Syndrome
Authors: Soliday Elizabeth , Grey Shannon , Lande Marc B.
Published: August 2004

Objectives.

The objective of this study was to define the frequency and severity of steroid-related behavioral side effects in children with steroid-sensitive idiopathic nephrotic syndrome (SSNS) during treatment for relapse.

Study Design.

We conducted a prospective, repeated- measures study in which 10 children with SSNS underwent behavioral assessment using the Child Behavior Checklist at baseline and during high dose prednisone therapy for relapse.

Results.

Of the 10 children, 8 had normal behavior at baseline. Of these 8 children, 5 had Child Behavior Checklist scores above the 95th percentile for anxious/depressive behavior and/or aggressive behavior during relapse. Such scores are in the range normally considered appropriate for referral to a mental health provider. The 2 children who had abnormal behavior at baseline also experienced a worsening of their behavior during relapse. The behavioral changes occurred almost exclusively at prednisone doses of 1 mg/kg every 48 hours or more. Regression analysis showed that prednisone dose was a strong predictor of abnormal behavior, especially increased aggression.

Conclusion.

Children with SSNS often experience serious problems with anxiety, depression, and increased aggression during high-dose prednisone therapy for relapse.
Early Perinatal Hospital Discharge and Parenting During Infancy
Authors: Britton John R. , Britton Helen L. , Gronwaldt Virginia
Published: August 2004

Objective.

To evaluate the relationship between early perinatal hospital discharge and several parenting outcomes during infancy, including breastfeeding, mother–infant interaction, and mother–infant attachment.

Study Design.

A prospective, longitudinal, nonrandomized study of mother–infant dyads discharged ≤36 hours after birth (early discharge), compared with those discharged >36 hours after birth (late discharge).

Methods.

Demographic, perinatal, and psychosocial factors were determined from medical record review and maternal questionnaires. Questionnaires also assessed maternal perceptions of the hospital stay and breastfeeding rates. Mother–infant interaction was assessed at 3 months after birth using the NCAST Feeding Scale and at 9 months after birth using the NCAST Teaching Scale. Security of attachment was measured in the Ainsworth Strange Situation at 12 months after birth.

Results.

Early and late discharge groups were similar with respect to major demographic, perinatal, and psychosocial characteristics and perceptions of the hospital stay. Even after adjusting for these factors in regression analyses, no significant association was found between early discharge and breastfeeding at 3 months, NCAST scores at 3 and 9 months, and security of attachment at 12 months.

Conclusion.

Parenting outcomes, such as breastfeeding, mother–infant interaction, and attachment, are not influenced by early perinatal hospital discharge.
Candidal Mycetoma in the Neonatal Kidney
Authors: Benjamin Daniel K. , Fisher Randall G. , McKinney Ross E. , Benjamin Daniel K.
Published: August 2004

Objective.

To determine the natural history of renal mycetoma (fungal balls) in the neonate.

Design.

Retrospective chart review of all neonatal intensive care unit patients with systemic candidiasis and sonographic evidence of renal mycetoma admitted to the Duke University Medical Center between January 1, 1993, and July 1, 1998.

Results.

Fourteen patients were reviewed. Three died from fungemia, and 3 died from other causes months after completing treatment. Ten patients had urine cultures obtained within 1 week of diagnosis; each had a positive routine or fungal urine culture for candida. The rate of improvement of renal mycetoma by ultrasound was variable, ranging from 10 days to 4 months and was not predictive of survival or long-term renal function. All patients who were discharged from the hospital had creatinine ≤0.5 mg/dL on discharge. Only 1 patient had surgical intervention (nephrostomy tube placement). Of the 11 patients who survived fungemia, 7 were treated for 3 weeks from the time negative cultures were obtained, while 4 were treated for 5 weeks or more after negative cultures. A declining platelet count was suggestive of fungemia in the patients we reviewed.

Conclusions.

For our patients with renal mycetoma without complete obstruction (patients continued to have urine output) surgical intervention was rarely necessary, the rate of sonographic improvement neither correlated with clinical course nor necessitated longer therapy, and long-term creatinine levels were normal. Sustained declines in platelet count of 10% per day or more in a neonate on broad-spectrum antibiotics for suspected sepsis may be indicative of fungemia.
Isolated Congenital Malabsorption of Folic Acid in a Male Infant: Insights Into Treatment and Mechanism of Defect
Authors: Malatack J. Jeffrey , Moran Mary M. , Moughan Beth
Published: August 2004

An instructive case of isolated congenital folate malabsorption provides insight into the understanding of this rare disease. Folate loading tests with both timed serum and cerebrospinal fluid folate determinations suggest that both of the two mechanisms involved in gastrointestinal folate absorption are defective in this condition.
Sweet's Syndrome as an Initial Manifestation of Pediatric Human Immunodeficiency Virus Infection
Authors: Brady Rebecca C. , Morris Joan , Connelly Beverly L. , Boiko Susan
Published: August 2004

We report a 3-month-old infant in whom Sweet's syndrome was a presenting manifestation of pediatric human immunodeficiency virus infection. Although rare in children, Sweet's syndrome may be associated with certain infections and malignancies. The diagnosis of Sweet's syndrome in a child should always prompt a thorough evaluation to assess for an associated systemic disease.
The Child in Court: A Subject Review
Authors:   Committee on Psychosocial Aspects of Child and Family Health
Published: August 2004

This Policy Statement was retired May 2014.

When children come to court as witnesses, or when their needs are decided in a courtroom, they face unique stressors from the legal proceeding and from the social predicament that resulted in court action. Effective pediatric support and intervention requires an understanding of the situations that bring children to court and the issues that will confront children and child advocates in different court settings.
Investigation and Review of Unexpected Infant and Child Deaths
Authors:   Committee on Child Abuse and Neglect and Committee on Community Health Services
Published: August 2004

Although there is a continuing need for timely review of child deaths, no uniform system exists for investigation in the United States. Investigation of a death that is traumatic, unexpected, obscure, suspicious, or otherwise unexplained in a child younger than 18 years requires a scene investigation and an autopsy. Review of these deaths requires the participation of pediatricians and other professionals, usually as a child death review team. An appropriately constituted team should evaluate the death investigation process, review difficult cases, and compile child death statistics.
Contraception and Adolescents
Authors:   Committee on Adolescence
Published: August 2004

The risks and negative consequences of adolescent sexual intercourse are of national concern, and promoting sexual abstinence is an important goal of the American Academy of Pediatrics. In previous publications, the American Academy of Pediatrics has addressed important issues of adolescent sexuality, pregnancy, sexually transmitted diseases, and contraception.1–3 The development of new contraceptive technologies mandates a revision of this policy statement, which provides the pediatrician with an updated review of adolescent sexuality and use of contraception by adolescents and presents current guidelines for counseling adolescents on sexual activity and contraceptive methods.
Improving Usage of Pediatric Information on the Internet: The Virtual Children's Hospital
Authors: D'Alessandro Donna M. , Kreiter Clarence D.
Published: August 2004

Objective.

Digital health sciences libraries (DHSLs) bring order to the chaos of the Internet by making authoritative medical information easily and conveniently available to patrons. The goal of this project was to perform a baseline usage analysis of the pediatric-related information in a general DHSL and to determine whether reorganization of the pediatric-related information into its own pediatric DHSL could increase the usage of the pediatric-related information.

Methods.

From March through August 1997, a baseline analysis of a general DHSL (Virtual Hospital) was conducted using computer server log file analysis programs. The quantity of pediatric-related information in the general DHSL and its baseline usage were determined. In September 1997, the pediatric-related information was reorganized into its own pediatric DHSL (Virtual Children's Hospital), and server log file analyses were conducted of the pediatric DHSL from September 1997 to August 1998. Statistical analysis was performed by time series autoregression.

Results.

During the baseline, the general DHSL and the pediatric-related information received a monthly average of 2 320 782 and 141 444 qualified hits, respectively. After the intervention, the general DHSL and the pediatric DHSL received a monthly average of 2 765 454 and 256 998 qualified hits, respectively. This is an increase of 19.2% for the general DHSL and 81.7% for the pediatric DHSL. These changes were statistically significant at theP > .0001 level. The most requested pediatric-related content in the pediatric DHSL did not change substantively from preintervention to postintervention.

Discussion.

On the Internet, as in real life, children's services must have their own distinct identity and must be differentiated from adult services. Therefore, pediatric-related information will receive increased usage if it is part of a pediatric DHSL rather than part of a general DHSL. Others can use this process and the lessons learned to develop and enhance their own pediatric-related information on the Internet. Internet, pediatrics, digital health sciences libraries, digital library, medical library.
Increased Susceptibility to Measles in Infants in the United States
Authors: Papania Mark , Baughman Andrew L. , Lee Susan , Cheek James E. , Atkinson William , Redd Stephen C. , Spitalny Kenneth , Finelli Lyn , Markowitz Lauri
Published: August 2004

Background.

Women born in the United States after measles vaccine licensure in 1963 transfer less measles antibody to their infants than do older women. This may result in increased susceptibility to measles among infants.

Objective.

To determine the effect of maternal year of birth on the risk for measles in infants.

Methods.

We enrolled 128 unvaccinated infants ≤15 months of age who had documented exposure to measles from 1990 through 1992 in a retrospective cohort study. We interviewed their mothers by telephone to obtain demographic data, medical and vaccination history, and details of measles exposure and outcome. We used logistic regression analysis to estimate the effect of maternal year of birth.

Results.

Infants whose mothers were born after 1963 had a measles attack rate of 33%, compared with 12% for infants of older mothers. In logistic regression analysis, the adjusted odds ratio for maternal year of birth (born after 1963) was 7.5 (95% confidence interval 1.8, 30.6). Other significant risk factors were older infant age, mothers who developed measles after delivery, and exposure within 2 days of the rash onset of the exposing case.

Conclusions.

Infants whose mothers were born after 1963 are more susceptible to measles than are infants of older mothers. An increasing proportion of infants born in the United States may be susceptible to measles. Infants at high risk of exposure to measles should be vaccinated at 12 months of age. Vaccination programs that reduce transmission of the measles virus in the general population reduce the risk of infant exposure to measles.
Weight Gain in Infants Breastfed by Mothers Who Take Fluoxetine
Authors: Chambers Christina D. , Anderson Philip O. , Thomas Ronald G. , Dick Lyn M. , Felix Robert J. , Johnson Kathleen A. , Jones Kenneth Lyons
Published: August 2004

Objective.

Despite the manufacturer's recommendation that fluoxetine not be used by women while breastfeeding, many women choose to do so. There is little information available in the literature to suggest that this practice is or is not safe. The purpose of this study was to examine weight gain in infants who are breastfed by mothers who take fluoxetine, compared with weight gain in infants who are breastfed by mothers who do not take any psychotherapeutic medication. A secondary goal was to assess the frequency of reported side effects in infants who are breastfed by mothers who take fluoxetine.

Methodology.

A retrospective cohort study design was used. Subjects were identified from an ongoing pregnancy outcome study conducted through the California Teratogen Information Service and Clinical Research Program. A total of 64 women were interviewed who had taken fluoxetine during a pregnancy between the 1989 and 1997; 26 of these women breastfed their infants and continued to take the medication, and 38 breastfed their infants but did not take the medication. Postnatal weight gain was taken from pediatric records, and the frequency of side effects was measured by maternal response to the interview questionnaire.

Results.

Using linear regression analysis, the infants who were breastfed by mothers taking fluoxetine demonstrated a growth curve significantly below that of infants who were breastfed by mothers who did not take the drug. The average deficit in measurements taken between 2 weeks and 6 months of age was 392 g (95% confidence interval: −5, −780). Using a repeated measures analysis of covariance for those infants with more than one postnatal weight measurement available, the difference between the two groups was similar, ∼1.2 standard deviations (P = .005). In response to interview questions regarding side effects, no mother who breastfed her infant while taking fluoxetine reported any unusual symptoms that could be attributed to the medication.

Conclusions.

These data do not suggest that women who breastfeed while taking fluoxetine are likely to note unusual behavior in their infants that they consider related to use of the medication. However, although there was no excess of infants in the fluoxetine group with postnatal weight measurements >2 standard deviations below the mean, these data indicate that breastfeeding while taking fluoxetine is associated with reduced growth that may be of clinical importance in situations in which infant weight gain is already of concern.