bluuebunny/crossref_metadata_2025 huggingface dataset:
Neuroimaging in Children With Newly Diagnosed Epilepsy: A Community-Based Study
Authors: Berg Anne T. , Testa Francine M. , Levy Susan R. , Shinnar Shlomo
Published: August 2004

Background.

Neuroimaging is generally considered a part of the evaluation of seizures and epilepsy. There is limited information about its current use in the initial evaluation of pediatric epilepsy and about its yield during the initial diagnosis of epilepsy. We describe the patterns in the use and yield of diagnostic imaging in children with newly diagnosed epilepsy in a community-based study.

Methods.

Children were recruited when first diagnosed with epilepsy by participating physicians in Connecticut (1993–1997). Definitions for etiology and underlying epilepsy syndromes are as published by the International League Against Epilepsy.

Results.

Of 613 children, 488 (79.6%) had imaging: 388 (63.3%) magnetic resonance imaging, 197 (32.1%) computed tomography scans, and 97 (15.8%) both. Half of children with idiopathic generalized epilepsy had imaging studies compared with 70% to 100% of children with other forms of epilepsy, depending on the specific type. Etiologically relevant abnormalities were found in 62 (12.7% of those imaged). Fourteen of these children had otherwise completely normal presentations and histories. Their abnormalities included tuberous sclerosis (N = 4), tumors (N = 2), an arteriovenous malformation later diagnosed as a tumor, a cavernous angioma, cerebral malformations (N = 3), and other abnormalities (N = 3). Thirteen of the 14 had partial seizures and 12 had focal electroencephalographic (EEG) findings. Only 1 had neither.

Conclusions.

In children with newly diagnosed epilepsy, neuroimaging reveals a small but significant number of serious abnormalities not previously suspected. Most of these children have partial seizures or focal EEG abnormalities. Neuroimaging should be considered during the evaluation of children with newly diagnosed epilepsy, especially for those with neurologic deficits or partial seizures or focal EEG abnormalities that are not part of an idiopathic localization-related epilepsy syndrome.
Functional Hyperactivity of Hepatic Glutamate Dehydrogenase as a Cause of the Hyperinsulinism/Hyperammonemia Syndrome: Effect of Treatment
Authors: Huijmans Jan G. M. , Duran Marinus , de Klerk Johannis B. C. , Rovers Marinus J. , Scholte Hans R.
Published: August 2004

Objective.

The combination of persistent hyperammonemia and hypoketotic hypoglycemia in infancy presents a diagnostic challenge. Investigation of the possible causes and regulators of the ammonia and glucose disposal may result in a true diagnosis and predict an optimum treatment.

Patient.

Since the neonatal period, a white girl had been treated for hyperammonemia and postprandial hypoglycemia with intermittent hyperinsulinism. Her blood level of ammonia varied from 100 to 300 μmol/L and was independent of the protein intake.

Methods.

Enzymes of the urea cycle as well as glutamine synthetase and glutamate dehydrogenase (GDH) were assayed in liver tissue and/or lymphocytes.

Results.

The activity of hepatic GDH was 874 nmol/(min·mg protein) (controls: 472–938). Half-maximum inhibition by guanosine triphosphate was reached at a concentration of 3.9 μmol/L (mean control values: .32). The ratio of plasma glutamine/blood ammonia was unusually low. Oral supplements withN-carbamylglutamate resulted in a moderate decrease of the blood level of ammonia. The hyperinsulinism was successfully treated with diazoxide.

Conclusion.

A continuous conversion of glutamate to 2-oxoglutarate causes a depletion of glutamate needed for the synthesis of N-acetylglutamate, the catalyst of the urea synthesis starting with ammonia. In addition, the shortage of glutamate may lead to an insufficient formation of glutamine by glutamine synthetase. As GDH stimulates the release of insulin, the concomitant hyperinsulinism can be explained. This disorder should be considered in every patient with postprandial hypoglycemia and diet-independent hyperammonemia.
Herbal Vitamins: Lead Toxicity and Developmental Delay
Authors: Moore Cynthia , Adler Robert
Published: August 2004

A case of lead poisoning from an Indian herbal vitamin is presented. The patient who was developmentally delayed was given an herbal vitamin from India to strengthen his brain. The tablet contained large amounts of lead and mercury, leading to significant lead burden. Vulnerability of families and lack of awareness of health care professionals of dangers of unknown herbal supplementation are discussed.
Human Granulocytic Ehrlichiosis Presenting as Abdominal Pain
Authors: Gershel Jeffrey C.
Published: August 2004

Human granulocytic ehrlichiosis (HGE) is an emerging infectious disease that primarily affects adults. Typical clinical features include fever, headache, and myalgias. This case represents the youngest reported patient with HGE. Her clinical presentation was unusual in that she presented with severe abdominal pain. In addition, she did not develop the typical spectrum of laboratory abnormalities that has been reported in adults. This patient's course suggests that the presentation of HGE may be more varied than previously reported.
Effect of Passive Smoking in Pregnancy on Neonatal Nucleated Red Blood Cells
Authors: Dollberg Shaul , Fainaru Ofer , Mimouni Francis B. , Shenhav Michael , Lessing Joseph B. , Kupferminc Michael
Published: August 2004

Objective.

We evaluated whether the absolute nucleated red blood cell (RBC) count is elevated in term, appropriate for gestational age (AGA) infants born to women exposed to passive smoking in pregnancy.

Patients and Methods.

We compared absolute nucleated RBC counts taken during the first 12 hours of life in 2 groups of term, vaginally delivered infants, 1 group born to mothers who were routinely exposed to tobacco smoke during pregnancy (n = 55) either at home or at the workplace, and the other to mothers who were not routinely exposed to any tobacco smoke (n = 31). We excluded infants of women with conditions known to elevate nucleated RBC counts.

Results.

There were no differences between groups in birth weight, maternal age, gravidity, parity, maternal analgesia during labor, 1- and 5-minute Apgar scores. Gestational age was minimally higher in the control group (39.6 ± 1.1 vs 39.2 ± .8 weeks). The median absolute nucleated RBC count in the passive smoking group was 357 × 106/L (range: 0–5091 × 106/L) versus 237 × 106/L (range: 0–1733 × 106/L) in nonsmoking controls. Stepwise regression analysis that included Apgar scores, gestational age, and the passive smoking status (yes/no) as independent variables showed significant correlation of absolute nucleated RBC count only with the passive smoking status.

Conclusion.

At birth, term AGA infants born to mothers exposed to passive smoking have increased circulating absolute nucleated RBC counts compared with those of controls. We speculate that passive smoking in pregnancy should be avoided, because it may have subtle negative effects on fetal oxygenation.
Distal Sensory Polyneuropathy in a Cohort of HIV-Infected Children Over Five Years of Age
Authors: Araújo Alexandra Prufer de Q. C. , Nascimento Osvaldo J. M. , Garcia Orlando S.
Published: August 2004

Background.

Peripheral neuropathy in children with human immunodeficiency virus (HIV) infection has not been systematically studied.

Objectives.

To describe the symptoms and signs of peripheral neuropathy in HIV-infected children and to determine their frequency.

Methods.

A cross-sectional study was conducted on a convenience sample from a cohort of children older than 5 years of age at the pediatric HIV outpatient clinic of the Federal University of Rio de Janeiro. Those patients were interviewed and examined systematically for peripheral nerve symptoms and signs.

Results.

A total of 39 patients were clinically evaluated. Their ages ranged from 5 to 14 years, and 13 patients (34%) had symptoms and signs of peripheral nerve involvement. Distal paresthesia and/or pain plus diminished ankle jerks and/or diminished vibration sense were the most common clinical findings. Symptoms were chronic and fluctuating, and pain was, in general, not severe. Nerve conduction studies primarily revealed axonal changes.

Conclusions.

Peripheral neuropathy occurs in one third of HIV-infected children, and, in general, has less severe features than the distal sensory polyneuropathy described in adults. peripheral neuropathy, human immunodeficiency virus, children.
Coarctation of the Abdominal Aorta and Renal Artery Stenosis Related to an Umbilical Artery Catheter Placement in a Neonate
Authors: Adelman Raymond D. , Morrell Rose Ellen
Published: August 2004

Umbilical artery catheters have been associated with thrombotic complications, such as partial or complete occlusion in the aorta, the renal arteries, and other blood vessels. There have been few reports of the long-term consequences of either symptomatic or asymptomatic thrombi. We report a patient, now 22 years of age, born with a normal aorta, who developed hypertension at the age of 2 months after use of an umbilical artery catheter. An intravenous pylegram and nuclear renal scan were compatible with occlusion of left renal artery and of the distal aorta. At 6 months of age, the patient presented with reduced femoral pulses. Angiography demonstrated an acquired coarctation of the abdominal aorta and renal artery stenosis. An abdominal ultrasound performed at 22 years of age revealed partial obstruction of the lower abdominal aorta and marked atrophy of the left kidney. This case underlines the importance of long-term follow-up studies of infants who have undergone umbilical artery catheterizations.
Spinal Epidural Abscess in a Young Child
Authors: Bair-Merritt Megan H. , Chung Charles , Collier Albert
Published: August 2004

This is a case report of a spinal epidural abscess, caused by Staphylococcus aureus, in a 3-year-old girl. The child presented with fever and hip pain, but without any neurologic deficit. After normal plain films and a normal bone scan were obtained, the diagnosis was made via magnetic resonance imaging (MRI). The neurosurgery and pediatric infectious disease teams evaluated the patient, and the decision was made to forgo surgical drainage and to treat medically with appropriate intravenous and then oral antibiotics. Several months later, the child was doing well without any signs of neurologic sequelae. Because of the rarity of this disease in children, the treatment guidelines are controversial. Many suggest that a spinal epidural abscess must be drained surgically. Our experience adds to the literature a case of a child successfully treated with antibiotics alone. We believe that this success is related to the fact that the child was diagnosed by MRI early in the course of the disease and that she never displayed any neurologic deficits.
Endocarditis Attributable to Group A β-Hemolytic Streptococcus After Uncomplicated Varicella in a Vaccinated Child
Authors: Laskey Antoinette L. , Johnson Tiffanie R. , Dagartzikas Maria I. , Tobias Joseph D.
Published: August 2004

Varicella is generally a benign, self-limited childhood illness; however, severe, life-threatening complications do occur. A live, attenuated vaccine exists to prevent this illness, but controversy remains concerning the need to vaccinate children for what is generally a benign, self-limited disease, although more states are currently recommending this vaccine. We report a previously healthy 3-year-old who developed varicella 6 months after vaccination with no apparent skin superinfections, who subsequently developed group A β-hemolytic streptococcus (GABHS) bacteremia resulting in endocarditis of a normal heart valve. We are unaware of previous reports of endocarditis related to GABHS after varicella.

After developing a harsh, diastolic murmur that led to an echocardiogram, aortic valve endocarditis was diagnosed. A 6-week course of intravenous penicillin G was administered. Two weeks after the initiation of therapy, the diastolic murmur was harsher, and echocardiography revealed a large vegetation on the posterior leaflet of the aortic valve, with severe aortic insufficiency and a dilated left ventricle. The patient subsequently developed congestive heart failure requiring readmission and aggressive management. One month after the initial echocardiogram, a repeat examination revealed worsening aortic regurgitation and mitral regurgitation. The patient received an additional 4 weeks of intravenous penicillin and gentamicin followed by aortic valve replacement using the Ross procedure.

Our patient, the first reported case of bacteremia and endocarditis from GABHS after varicella, illustrates the need for the health care practitioner to consider both common and life-threatening complications in patients with varicella. While cellulitis, encephalitis, and septic arthritis may be readily apparent on physical examination and commonly recognized complications of varicella, the possibility of bacteremia without an obvious skin superinfection should also be entertained. The case we report is unique in that the patient had normal immune function, had been previously vaccinated, and developed a rare complication of varicella–endocarditis–in a structurally normal heart with a previously unreported pathogen. Although a child may have been vaccinated against varicella, the chance of contracting the virus still exists and parents should be informed of this risk. group A β-hemolytic streptococcus, endocarditis, varicella, Varivax, complications of varicella.
The Prevalence of Genital Human Papillomavirus Infections in Abused and Nonabused Preadolescent Girls
Authors: Stevens-Simon Catherine , Nelligan Donna , Breese Paula , Jenny Carole , Douglas John M.
Published: August 2004

Objective.

To compare the prevalence of genital human papillomavirus (HPV) infections in sexually abused and nonabused preadolescent girls and assess the feasibility of conducting a longitudinal study of the natural history of HPV infection in this population.

Method.

Consecutively referred, 5- to 12-year-old girls who were evaluated for sexual abuse by a Child Advocacy and Protection Team were invited to participate in the study. During a standard forensic medical examination, 2 specimens for HPV testing were obtained (one by rubbing a Dacron swab over the perineum and the other by lavaging the vagina with phosphate-buffered saline). The specimens were evaluated for HPV DNA by polymerase chain reaction using MY09/11 consensus primers and high-risk (16,18,31,33,35,39,45,51,52, 56,58) and low-risk (6,11,42,43,44) types were detected with a solution hybridization assay, the SHARP Signal System (Digene Diagnostics). The genital area was examined for warts and subclinical, colposcopic evidence of HPV. Participants were invited to return for longitudinal evaluation at 4-month intervals for 2 years.

Results.

Sexual abuse was confirmed in 29 (72.5%) of the 40 study participants, suspected in 2 (5%), and ruled out in 9 (22.5%). None of the girls had genital warts or abnormal colposcopic findings. HPV DNA was detected in 5 (16%) of the 31 girls with confirmed or suspected sexual abuse (1 with high-risk and 4 with low-risk types) and none of the nonabused girls (Fisher's exact test). Girls who tested positive and negative for HPV did not differ significantly in age or type of abuse. Despite close telephone follow-up and numerous attempts to schedule appointments, none of the participants returned for follow-up.

Conclusions.

Genital HPV infection is more common among sexually abused than nonsexually abused girls, with the majority of infections not clinically apparent. Because it is so difficult to study the natural history of these infections in abused children, it may be necessary to draw inferences about the long-term sequelae of pediatric HPV infections from longitudinal studies of girls who voluntarily initiate sexual activity soon after menarche.
Video Recording as a Means of Evaluating Neonatal Resuscitation Performance
Authors: Carbine Douglas N. , Finer Neil N. , Knodel Ellen , Rich Wade
Published: August 2004

Objective.

To determine the compliance to Neonatal Resuscitation Program (NRP) guidelines in our institution, by the use of videotaped newborn resuscitations.

Background.

NRP is the standard of care for newborn resuscitation. The application of NRP guidelines and resuscitation skills in actual clinical settings is undocumented.

Design/Methods.

A video recorder, mounted to the radiant warmer in the main obstetrical operating room, was used to record all high-risk resuscitations. All members of the resuscitation team were NRP-certified. The videotapes were reviewed within 14 days of the resuscitation and then erased. This ongoing review was approved as a quality assurance (QA) project ensuring confidentiality under California law. The first 100 resuscitations were evaluated to assess NRP compliance. Each step in the resuscitation (positioning, oxygen delivery, ventilation, chest compressions, intubation, and medication) was graded. A score was devised, with 2 points being awarded for every correct decision and proper procedure, 1 point for delayed interventions or inadequate technique, and zero points for indicated procedures that were omitted or for interventions that were not indicated. The total points were divided by the total possible points for that patient. The scores for the first 25 resuscitations (group 1) and the last 25 resuscitations (group 2) were compared.

Results.

Fifty-four percent of the 100 resuscitations had deviations from the NRP guidelines. Ten percent received overly aggressive stimulation and 22% had poor suction technique. Of the 78 infants given oxygen, this decision was considered incorrect in 15% and the delivery technique was poor in 10% of the infants given oxygen. Of those requiring mask ventilation (n = 18), 24% had poor chest expansion, 11% used an incorrect rate, and 17% had inadequate reevaluation. Twelve infants were intubated; only 7 were successfully intubated on the first attempt and only 4 were intubated in <20 seconds. The longest intubation attempt was 50 seconds. Naloxone was given to 2 patients. One was breathing spontaneously with a heart rate >100. Resuscitations receiving a perfect evaluation score were more likely to occur in infants needing less intervention. The level of resuscitation required for groups 1 and 2 were statistically similar. There was no difference in resuscitation scores between the 2 groups. Only the inappropriate use of deep suctioning improved, with 8 of 25 events in group 1, and 0 of 25 in group 2.

Conclusions.

We have found a significant number of deviations from the NRP guidelines. Video recording of actual clinical practice is a useful QA tool for monitoring the conduct of newborn resuscitation. We are now conducting repeat video assessments of individual NRP providers to determine whether there is improved performance.
Costs and Effectiveness of Ultrasonography and Limited Computed Tomography for Diagnosing Appendicitis in Children
Authors: Garcia Peña Barbara M. , Taylor George A. , Fishman Steven J. , Mandl Kenneth D.
Published: August 2004

Background.

A protocol of ultrasonography (US) followed by computed tomography with rectal contrast (CTRC) has been shown to be 94% accurate in the diagnosis of acute appendicitis in children.

Objective.

To evaluate the changes in patient management and costs of a protocol using US and CTRC in the evaluation of appendicitis in children.

Design, Setting, and Subjects.

Prospective cohort study of 139 children between 3 and 21 years of age who had equivocal clinical findings for acute appendicitis seen in the emergency department of a large, urban pediatric teaching hospital between July 1998 and December 1998.

Protocol.

Children with equivocal clinical presentations for acute appendicitis were prospectively evaluated with US. Patients with positive findings for acute appendicitis went directly to the operating room. Patients with negative or equivocal findings on US underwent CTRC. Surgical management plans were recorded before imaging, after US, and after CTRC.

Main Outcome Measures.

Surgical management plans before and after the imaging protocol as well as total hospital direct and indirect costs incurred or saved by each change in management were determined. Costs were obtained through the hospital's cost database and by ratios of costs to charges.

Results.

Of the 139 children, the protocol resulted in a beneficial change in management in 86 children (61.9%), no change in management in 50 children (36.0%) and an incorrect change in management in 3 children (2.1%). US alone resulted in a beneficial change in management decision in 12/31 children (38.7%), while US followed by CTRC resulted in a beneficial change in management in 74/108 children (68.5%). The protocol resulted in a total cost savings of $78 503.99 or $565/patient.

Conclusion.

A protocol of US followed by CTRC in children with negative or equivocal US examinations results in a high rate of beneficial change in management as well as in total cost savings in children with equivocal clinical presentations for suspected appendicitis.
Pneumococcal Mastoiditis in Children
Authors: Kaplan Sheldon L. , Mason Edward O. , Wald Ellen R. , Kim Kwang Sik , Givner Laurence B. , Bradley John S. , Barson William J. , Tan Tina Q. , Schutze Gordon E. , Yogev Ram
Published: August 2004

Objective.

To determine the impact of antibiotic resistance on the frequency, clinical features, and management/outcome of mastoiditis attributable to Streptococcus pneumoniae.

Design.

Retrospective review of the medical records of children with mastoiditis caused by S pneumoniae from September 1993 through December 1998.

Patients.

Infants and children with pneumococcal mastoiditis cared for at 8 children's hospitals in the United States.

Results.

Thirty-four children with pneumococcal mastoiditis were identified. The median age of the children was 12 months (range: 2 months–12.5 years); 28 (82%) were ≤2 years old. Six children had recurrent otitis media. A subperiosteal abscess was noted in 13 children (37%). The mastoids were abnormal in all 25 patients on whom computed tomography was performed. There was no trend toward increasing numbers of cases per year despite increasing proportions of pneumococcal isolates, which were nonsusceptible to penicillin. Serogroup 19 accounted for 57% of isolates, serogroup 23 for 14.3% of isolates, and serotype 3 for 10.7% of isolates. Except for receipt of less antibiotic therapy in the previous 30 days, children with penicillin-susceptible isolates had similar demographic features and clinical findings and surgical treatment as did children whose isolates were nonsusceptible to penicillin.

Conclusions.

Pneumococcal mastoiditis occurs primarily in children <2 years of age and usually is not associated with a history of recurrent otitis media. The number of cases of mastoiditis caused byS pneumoniae occurring among 8 children's hospitals has remained stable despite increasing rates of antibiotic-resistantS pneumoniae. Serogroup 19 is the leading serogroup associated with pneumococcal mastoiditis. Streptococcus pneumoniae, mastoiditis, serotypes, resistance.
Venous and Arterial Hematologic Profiles of Very Low Birth Weight Infants
Authors: Obladen Michael , Diepold Katharina , Maier Rolf F. ,   the European Multicenter rhEPO Study Group
Published: August 2004

Objective.

In very low birth weight (VLBW) infants, diagnostic and therapeutic decisions depend on hematologic values. As few data are available, we studied the course during the first 6 weeks of life.

Design.

Four prospective longitudinal cohort studies were retrospectively combined assessing hematologic profiles of 562 VLBW infants. For characterization of red blood cells and iron, infants receiving erythropoietin were excluded. For characterization of white blood cells and platelets, infants receiving antibiotics were excluded.

Results.

The third (3rd)/median/97th percentiles on day 3 were as follows: hemoglobin: 11.0/15.6/19.8 g/dL; hematocrit: 35/47/60%; red blood cells: 3.2/4.2/5.3 × 1012/L; reticulocytes: .6/7.1/27.8%; platelets: 58/203/430 × 109/L; white blood cells: 3.6/9.5/38.3 × 109/L; neutrophils: .7/4.7/25.3 × 109/L; ferritin: 27/140/504 ng/mL; iron: .8/7.5/26.7 μmol/L; transferrin saturation: 2.6/22.7/79.8%. Transferrin saturation was <24% in 51%, ferritin concentration <100 ng/mL in 32%, and platelets <150 × 109/L in 29% of this population. The steady decrease of red cell parameters was mitigated by transfusions. Neutrophils decreased steadily, and were <1.75 × 109/L in 35% at 6 weeks.

Conclusions.

Iron indices and platelet counts on day 3 and neutrophil counts at 2 to 6 weeks of age are lower than previously assumed in VLBW infants and lower than in larger prematures.
When to Suspect Fungal Infection in Neonates: A Clinical Comparison ofCandida albicansandCandida parapsilosisFungemia With Coagulase-Negative Staphylococcal Bacteremia
Authors: Benjamin Daniel K. , Ross Kelly , McKinney Ross E. , Benjamin Daniel K. , Auten Richard , Fisher Randall G.
Published: August 2004

Objectives.

To determine the epidemiology of candidemia in our neonatal intensive care unit; to compare risk factors, clinical presentation, and outcomes for neonates infected with Candida albicans, Candida parapsilosis,and coagulase-negative staphylococcus (CoNS); and to suggest a rational approach to empiric antifungal therapy of neonates at risk for nosocomial infection.

Design.

Retrospective chart review of all neonatal intensive care unit patients with systemic candidiasis or CoNS infection between January 1, 1995 and July 31, 1998 at Duke University Medical Center.

Results.

Fifty-one patients were reviewed. Nine of 19 patients infected with C parapsilosis and 5 of 15 patients infected with C albicans died of fungemia. Seventeen neonates had >2 positive cultures for CoNS obtained within 96 hours and 1 died. There was no statistically significant difference in birth weight, gestational age, or age at diagnosis between patient groups; however, candidemic patients had a sevenfold higher mortality rate. Before diagnosis, candidemic patients had greater exposure to systemic steroids, antibiotics, and catecholamine infusions. Of the 51 patients, 32 received third-generation cephalosporins in the 2 weeks before diagnosis and 19 did not. Twenty-nine of the 32 who were treated with third-generation cephalosporins subsequently developed candidemia, while candidemia occurred in only 5 of 19 patients who were not treated with cephalosporins. At the time of diagnosis, candidemic patients were more likely to have required mechanical ventilation and were less likely to be tolerating enteral feeding. Multivariate clustered logistic regression analysis revealed that candidemic patients had more exposure to third-generation cephalosporins. Once the clinician was notified of a positive blood culture for Candida, patients infected with C parapsilosis retained their central catheters longer than patients infected with C albicans.

Conclusions.

In this retrospective review, we were able to identify aspects of the clinical presentation and medication history that may be helpful in differentiating between candidemia and CoNS bacteremia. Those key features may be used by clinicians to initiate empiric amphotericin B therapy in premature neonates at risk for nosocomial infections. Prolonged use of third-generation cephalosporins was strongly associated with candidemia. There was no statistically significant difference in the morbidity and mortality between patients infected with C parapsilosis and those infected withC albicans. Observed delays in removal of the central venous catheter may have contributed to finding a mortality rate fromC parapsilosis that was higher than was previously reported.
Different β-Casein Fractions in Icelandic Versus Scandinavian Cow's Milk May Influence Diabetogenicity of Cow's Milk in Infancy and Explain Low Incidence of Insulin-Dependent Diabetes Mellitus in Iceland
Authors: Thorsdottir Inga , Birgisdottir Bryndis Eva , Johannsdottir Inga Maria , Harris D. Paul , Hill Jeremy , Steingrimsdottir Laufey , Thorsson Arni V.
Published: August 2004

Objectives.

To compare children with insulin-dependent diabetes mellitus (IDDM) with controls in Iceland regarding their consumption of cow's milk in infancy, and to investigate the β-casein fractions in Scandinavian and Icelandic cow's milk. The A1 variant of β-casein has been shown to be diabetogenic in animal studies, and suggestions have been made that the B variant of β-casein acts similarly. Differences in the relative proportions of β-casein fractions might explain the lower incidence of IDDM in Iceland than in Scandinavia.

Methods.

A retrospective case–control study on IDDM patients and matching controls was performed in Iceland to compare their diets in infancy. Fifty-five children with IDDM born in Iceland over a 16-year period and randomly collected controls (n = 165) were recruited to the study. Mothers of the children answered questions on breastfeeding habits and on when cow's milk products were introduced. Samples of cow's milk from randomly selected milk batches from the largest consumption areas in Iceland and Scandinavia were collected. The milk samples were freeze-dried and their β-casein fractions were analyzed using capillary electrophoresis.

Results.

No significant difference was found between IDDM patients and controls in the frequency and duration of breastfeeding or the first introduction of cow's milk products. The analyses of milk samples showed that the percentage of the A1 and B variants of β-casein in Icelandic milk was significantly lower than in the milk from the Scandinavian countries.

Conclusions.

Cow's milk consumption in infancy is not related to IDDM in Iceland. The lower fraction of A1 and B β-caseins in Icelandic cow's milk may explain why there is a lower incidence of IDDM in Iceland than in Scandinavia.
Otitis Media in Early Childhood in Relation to Preschool Language and School Readiness Skills Among Black Children
Authors: Roberts Joanne E. , Burchinal Margaret R. , Jackson Sandra C. , Hooper Stephen R. , Roush Jackson , Mundy Martha , Neebe Eloise C. , Zeisel Susan A.
Published: August 2004

Objective.

To examine whether otitis media with effusion (OME) and associated hearing loss (HL) during the first 5 years of life were related to children's language skills during the preschool years and to school readiness skills at entry to kindergarten.

Methods.

In a prospective study, the ears of 85 black children primarily from low-income families and recruited from community-based childcare programs were repeatedly examined from 6 months to 5 years of age for the presence of OME and from 6 months to 4 years of age for HL when well and ill with OME. Assessments were made annually of the children's child-rearing environments at home and in childcare, and children's language skills between 3 and 5 years of age and readiness skills in literacy and math were evaluated at entry into kindergarten.

Results.

Children had either bilateral or unilateral OME ∼30.4% and HL 19.6% of the observation time. OME and associated HL were significantly positively correlated with some measures of expressive language at 3 and 4 years of age; however, these direct relationships were no longer significant when the child's gender, socioeconomic status, maternal educational level, and the responsiveness and support of the home and childcare environments were also considered. Further, both OME and HL were moderately correlated with school readiness skills at entry to school, with children having more OME scoring lower in verbal math problems and with children with more HL scoring lower in math and recognizing incomplete words. These associations continued to remain significant even after partialing out the child and family background factors.

Conclusions.

There was not a significant relationship between children's early OME history or HL and language skills during the preschool years. However, children with more frequent OME had lower scores on school readiness measures. These associations were moderate in degree, however, and the home environment was more strongly related to academic outcomes than was OME or HL. These results should be interpreted cautiously when generalizing to other populations.
Racial Differences in Access to the Kidney Transplant Waiting List for Children and Adolescents With End-Stage Renal Disease
Authors: Furth Susan L. , Garg Pushkal P. , Neu Alicia M. , Hwang Wenke , Fivush Barbara A. , Powe Neil R.
Published: August 2004

Context.

Renal transplantation is the treatment of choice for pediatric patients with end-stage renal disease (ESRD). Black patients wait longer for kidney transplants than do white patients.

Objective.

To determine whether the increased time to transplantation for black pediatric patients is attributable not only to a shortage of suitable donor organs, but also to racial differences in the time from a child's first treatment for ESRD until activation on the cadaveric kidney transplant waitlist.

Design.

National longitudinal cohort study.

Setting.

US Medicare-eligible, pediatric ESRD population.

Patients.

Children and adolescents ≤19 years old at the time of their first dialysis for ESRD between 1988 and 1993, followed through 1996. Patients who received living donor renal transplants were excluded from study.

Main Outcome Measures.

Time from first dialysis for ESRD until activation on the kidney transplant waiting list, relative hazard of activation on the waiting list for black compared with white pediatric patients.

Results.

Comparisons of the time from first dialysis for ESRD to waitlisting among the 2162 white (60.7%) and 1122 black (31.5%) patients studied using survival analysis revealed that blacks were less likely to be waitlisted at any given time in follow-up. In multivariate analysis, even after controlling for patient age, gender, socioeconomic status, geographic region, incident year of renal failure, and cause of ESRD, blacks were 12% less likely to be waitlisted than were whites at any point in time (relative hazard: .88: 95% confidence interval: .79–.97).

Conclusions.

Racial disparities in access to the renal transplant waiting list exist in pediatrics. Whether these disparities are attributable to differences in time of presentation to a nephrologist, physician bias in identification of transplant candidates, or patient preferences warrants further study.
Biphasic Anaphylactic Reactions in Pediatrics
Authors: Lee Joyce M. , Greenes David S.
Published: August 2004

Objectives.

The objectives of this study were to: 1) determine the incidence of biphasic reactions in children with anaphylaxis; 2) establish what risk factors can predict progression to a biphasic reaction; and 3) assess the utility of inpatient observation for patients whose anaphylaxis appears to have resolved.

Methods.

We performed a retrospective analysis of all children admitted to Children's Hospital inpatient service between 1985 and 1999 with acute anaphylaxis. Data were collected from the medical records regarding past medical history, presenting signs and symptoms, treatment, and hospital course. Patients were considered to have resolution of anaphylaxis if they were documented to have cessation of all symptoms and needed no therapy for at least 1 hour. Biphasic reactions were defined as a worsening of symptoms requiring new therapy after resolution of anaphylaxis. Significant biphasic reactions were defined as those requiring oxygen, vasopressors, intubation, subcutaneous epinephrine, or unscheduled bronchodilator treatments. Patients were considered to benefit from a 24-hour observation period if they had a significant biphasic reaction within 24 hours of admission.

Results.

Of 108 anaphylactic episodes, 2 (2%) were fatal, and 1 (1%) was a protracted anaphylactic reaction. Among the remaining 105 children with resolution of anaphylaxis, 6 (6%) [95% confidence (CI): 2, 12] had biphasic reactions, of which 3 (3%) [95% CI: .6, 8] were significant. Of those who had a biphasic reactions, the median time from the onset of symptoms to the initial administration of subcutaneous epinephrine was 190 minutes, versus 48 minutes for those without a biphasic reaction. Patients with or without biphasic reactions did not differ significantly in the incidence of initial epinephrine use, initial steroid use, or serious respiratory or cardiovascular symptoms on initial presentation. Two of 105 (2%) [95% CI: .2, 7] patients clinically benefitted from a 24-hour observation period.

Conclusions.

We found an overall incidence of biphasic reactions of 6%, and an incidence of significant biphasic reactions of 3%, among pediatric patients admitted with anaphylaxis. Delayed administration of subcutaneous epinephrine was associated with an increased incidence of biphasic reactions. Approximately 2% of patients with anaphylaxis potentially benefitted from a 24-hour period of observation after symptoms had resolved.
Visual Field Constriction in Children With Epilepsy on Vigabatrin Treatment
Authors: Iannetti Paola , Spalice Alberto , Perla Francesco Massimo , Conicella Elena , Raucci Umberto , Bizzarri Barbara
Published: August 2004

Vigabatrin is considered the drug of choice for infantile spasms and simple and complex partial epilepsy in childhood. Its mechanism of action relies on the irreversible inhibition of γ-aminobutyric acid (GABA) transaminase. Since June 1997 several articles have been published reporting visual field constriction in adult patients on vigabatrin therapy. Recently, 7 pediatric patients, 1 on vigabatrin monotherapy and 6 on add-on therapy with visual field constriction have been described. We have observed 30 pediatric patients with epilepsy (14 boys and 16 girls), ages ranging from 4 to 20 years (mean: 11 years and 2 months) treated with vigabatrin for infantile spasms, simple and complex partial epilepsy, who had never complained of ophthalmologic disturbances. Twenty-one patients underwent complete routine ophthalmologic examination (fundus oculi, visual acuity, intraocular pressure, and visual field tests); 9 children (<6 years old) underwent only fundus examination, because collaboration was lacking. We report on 4 children showing constriction of visual field, prevailing in nasal hemifield. In 1 child, visual abnormalities were stable even 10 months after vigabatrin discontinuation, while in another a greater improvement was observed 5 months after discontinuation. The possible mechanisms have been discussed and the cone dysfunction, connected with GABA augmentation in the outer retina, has been outlined. We suggest a possible protocol to control visual abnormalities in epileptic children.
Environmental Tobacco Smoke Exposure Among Urban Children
Authors: Hopper John A. , Craig Kelly A.
Published: August 2004

Background.

Environmental tobacco smoke (ETS) exposure is a well-known health hazard for children. Poor urban children may be at increased risk of exposure from nonparental sources of tobacco smoke. The unique problems of ETS exposure in urban children have previously not been well-defined.

Objectives.

This study was conducted: 1) to identify the sources of ETS exposure for children attending a hospital-based pediatric resident practice; and 2) to examine caregivers' perceptions of the pediatrician's role and action in addressing ETS exposure.

Design.

Questionnaires were administered to a convenience sample of 174 caregivers of children visiting a children's hospital-based resident practice. A structured face-to-face interview was used.

Results.

All caregivers agreed to participate in the study. Most of the caregivers interviewed were mothers (87.9%). Although only 14% of caregivers were smokers, 49.4% reported caring for at least 1 smoke-exposed child. Most smoke exposure occurred in the home; smoking is allowed in the home of 75% of the children who live with a smoker (48/64). Thirty-four percent of the caregivers who reported no smoking in the home reported having a child who spends time in homes where other people smoke. Most exposure outside the home occurred at a grandparent's home. A ban on smoking in the home did not eliminate a child's risk of residential smoke exposure but did predict whether smoking occurred in the same room as the child. All caregivers reported believing that tobacco smoke is harmful. Approximately one half of caregivers who smoke (54.2%) would like smoking cessation advice from the child's pediatrician. Interest in receiving advice on helping others quit smoking was also high (51.3%) among nonsmoking caregivers who cared for a smoke-exposed child.

Conclusions.

Nonparental sources of ETS exposure are reported to be common in urban children. Children may be exposed to tobacco smoke even in homes where smoking is banned. Many caregivers would like help from pediatricians in reducing children's exposure to tobacco smoke.
Relations of Parental Obesity Status to Physical Activity and Fitness of Prepubertal Girls
Authors: Treuth Margarita S. , Butte Nancy F. , Puyau Maurice , Adolph Anne
Published: August 2004

Objective.

To determine whether physical activity and fitness differ among normal-weight-for-height, multiethnic, prepubertal girls whose parents are lean, obese, or both.

Setting.

Conducted in Houston, Texas.

Study Participants.

Normal-weight white, black, and Hispanic prepubertal girls (mean age ± standard deviation: 8.5 ± .4 years) participated in this study. Girls were recruited according to parental leanness or obesity defined as follows: girls with 2 lean parents (LN group; n = 30); girls with 2 obese parents (OB group; n = 27); and girls with 1 lean and 1 obese parent (LNOB group; n = 44).

Intervention.

Each child wore a heart rate monitor for two 24-hour periods, underwent a treadmill exercise test, answered an activity questionnaire, and completed energy expenditure measurements by basal calorimetry and doubly labeled water.

Outcome Measures.

The amount of time spent above 125% and 150% of basal heart rate (BHR) was calculated during each 24-hour period (n = 84). Fitness (n = 97), habitual physical activity (n = 101), and physical activity level (PAL = total energy expenditure/basal metabolic rate; n = 101) were also measured.

Results.

The times spent above 125% and 150% of BHR were similar among LN, LNOB, and OB groups. Black girls spent less time than did white girls on the weekend above 125% BHR and above 150% BHR. No significant familial or ethnic differences in peak oxygen consumption or habitual physical activity were observed. PALs were as follows: LN = 1.6 ± .21; LNOB = 1.64 ± .27; OB = 1.58 ± .20; white = 1.63 ± .23; black = 1.58 ± .24; and Hispanic = 1.65 ± .25. PAL was related to time spent above 125% BHR and 150% BHR (r = .31,.39).

Conclusions.

Physical activity and fitness of normal-weight prepubertal girls predisposed to obesity did not differ from girls without a family history of obesity. obesity, children, energy metabolism, exercise, heart rate monitoring.
Aerobic Fitness, Not Energy Expenditure, Influences Subsequent Increase in Adiposity in Black and White Children
Authors: Johnson Maria S. , Figueroa-Colon Reinaldo , Herd Sara L. , Fields David A. , Sun Min , Hunter Gary R. , Goran Michael I.
Published: August 2004

Background.

Low levels of energy expenditure and aerobic fitness have been hypothesized to be risk factors for obesity. Longitudinal studies to determine whether energy expenditure influences weight gain in whites have provided conflicting results. To date, no studies have examined this relationship in blacks or whether aerobic fitness influences weight gain in white or black children.

Methods.

One hundred fifteen children, 72 white (55 girls and 17 boys) and 43 black (24 girls and 19 boys) were recruited for this study. Aerobic fitness, resting, total, and activity-related energy expenditure and body composition were measured at baseline. The children returned annually for 3 to 5 repeated measures of body composition. The influence of the initial measures of energy expenditure and fitness on the subsequent rate of increase in adiposity was examined, adjusting for initial body composition, age, ethnicity, gender, and Tanner stage. Because 20 children did not attain maximum oxygen consumption, the sample size for the combined analysis was 95.

Results.

Initial fat mass was the main predictor of increasing adiposity in this cohort of children, with greater initial fat predicting a higher rate of increase of adiposity. There was also a significant negative relationship between aerobic fitness and the rate of increasing adiposity (F1,82 = 3.92). With every increase of .1 L/minute of fitness, there was a decrease of .081 kg fat per kg of lean mass gained. None of the measures of energy expenditure significantly predicted increasing adiposity in white or black children.

Conclusions.

Initial fat mass was the dominant factor influencing increasing adiposity; however, aerobic fitness was also a significant independent predictor of increasing adiposity in this cohort of children. Resting, total, or activity-related energy expenditure did not predict increasing adiposity. It seems that aerobic fitness may be more important than absolute energy expenditure in the development of obesity in white or black children. energy expenditure, fitness, longitudinal, obesity.