bluuebunny/crossref_metadata_2025 huggingface dataset:
Vitamin K Status Among Children With Cystic Fibrosis and Its Relationship to Bone Mineral Density and Bone Turnover
Authors: Conway Steven P. , Wolfe Susan P. , Brownlee Keith G. , White Helen , Oldroyd Brian , Truscott John G. , Harvey Julia M. , Shearer Martin J.
Published: May 2005

Objective. The aim of this study was to assess vitamin K status in an unselected population of children with cystic fibrosis (CF) and to investigate any vitamin K effect on bone turnover and bone mineral status.

Methods. Children ≥5 years of age who were attending the CF unit were invited to enter the study. Fasting blood samples were analyzed for levels of vitamin K1 and prothrombin produced in vitamin K absence; total, undercarboxylated, and carboxylated osteocalcin (OC); and bone-specific alkaline phosphatase and procollagen I carboxy-terminal propeptide (bone formation markers). Levels of N-telopeptide and free pyridinoline and deoxypyridinoline (bone breakdown products) were measured in urine samples. Bone mineral density and bone mineral content were measured at the lumbar spine and for the total body with a GE Lunar Prodigy densitometer. Statistical analyses were performed with Minitab version 9.1.

Results. One hundred six children entered the study. Sixty-five of 93 children (70%) from whom blood samples were obtained showed suboptimal vitamin K status, on the basis of low serum vitamin K1 levels, increased prothrombin produced in vitamin K absence levels, or both abnormalities. Vitamin K1 levels showed a significant negative correlation with undercarboxylated OC levels but showed no significant correlation with any marker of bone turnover or measurement of bone mineral status. Undercarboxylated OC levels were correlated significantly with bone turnover markers, which themselves showed a significant negative correlation with measurements of bone mineral density and content. There were no significant correlations between carboxylated or undercarboxylated OC levels and bone density measurements.

Conclusions. Vitamin K1 deficiency is common among children with CF, and routine supplements should be considered. Through its role in the carboxylation of OC, vitamin K deficiency may be associated with an uncoupling of the balance between bone resorption and bone formation. A cause-effect relationship between vitamin K deficiency and low bone mass has not been proved.
A Content Analysis of E-mail Communication Between Primary Care Providers and Parents
Authors: Anand Shikha G. , Feldman Mitchell J. , Geller David S. , Bisbee Alice , Bauchner Howard
Published: May 2005

Background. E-mail exchange between parents of patients and providers has been cited by the Institute of Medicine as an important aspect of contemporary medicine; however, we are unaware of any data describing actual exchanges.

Objective. The purpose of this study was to evaluate the content of e-mails between providers and parents of patients in pediatric primary care, as well as parent attitudes about e-mail.

Design/Methods. Over a 6-week period, all e-mail exchanges between 2 primary care pediatricians and their patients’ parents were evaluated and coded. An exchange was defined as the e-mails between parent and primary care provider about a single inquiry. Parents also completed a questionnaire regarding this service.

Results. Of 55 parents, 54 (98%) agreed to have their e-mails with their pediatrician reviewed. The 54 parents generated 81 e-mail exchanges; 86% required only 1 e-mail response from the pediatrician, and the other 14% required an average of 1.9 responses. E-mail inquiries were all for nonacute issues (as judged by S.G.A.) and included inquiries about a medical question (n = 43), medical update (n = 20), subspecialty evaluation (n = 9), and administrative issue (n = 9). The 81 exchanges resulted in 9 appointments, 21 phone calls, 4 subspecialty referrals, 34 prescriptions or recommendations for over-the-counter medications, 11 administrative tasks, and 1 radiograph. Of 91 pediatrician-generated e-mails, 39% were sent during the workday (9 am to 5 pm, Monday to Friday), 44% were sent on weeknights, and 17% were sent on weekends. During the study period, the 2 physicians estimated an average of 30 minutes/day spent responding to e-mail. Of the 54 parents, 45 (83%) returned the survey; 93% were mothers and 86% had completed college. Ninety-eight percent were very satisfied with their e-mail experience with their pediatrician. Although 80% felt that all pediatricians should use e-mail to communicate with parents and 65% stated they would be more likely to choose a pediatrician based on access by e-mail, 63% were unwilling to pay for access.

Conclusions. This is the first study to describe actual e-mail exchange between parents and their providers. Exchanges seem to be different from those generated by the telephone, with more e-mails related to medical versus administrative issues and more resulting in office visits. Approximately 1 in 4 exchanges result in multiple e-mails back and forth between parent and provider. Parents who have actually exchanged e-mails with their providers overwhelmingly endorse it, although they are reluctant to pay for it.
Can Tissue Transglutaminase Antibody Titers Replace Small-Bowel Biopsy to Diagnose Celiac Disease in Select Pediatric Populations?
Authors: Barker Collin C. , Mitton Craig , Jevon Gareth , Mock Thomas
Published: May 2005

Objectives. The use of screening tests for celiac disease has increased the number of patients referred for evaluation. We proposed that the subgroup of patients with very high tissue transglutaminase antibody (TTG) titers is positive for celiac disease and a small-bowel biopsy is not necessary to make the diagnosis. A gluten-free diet should be attempted and, if the patient’s symptoms do not improve, then a biopsy should be performed to confirm the diagnosis.

Methods. A chart review of data for 103 patients who underwent both TTG testing and a small-bowel biopsy was performed. We examined the impact of using TTG values of >100 U and <20 U as cutoff values and suggested performing biopsies for patients with TTG values of 20 to 100 U, as is current practice.

Results. Fifty-eight of 103 patients demonstrated positive biopsy results. Forty-nine of 103 patients had TTG levels of >100 U, with 48 of 49 exhibiting positive biopsy results. Only 7 of 16 patients with TTG values of 20 to 100 U exhibited positive biopsy results. Three patients with TTG levels of <20 U had positive biopsies; 2 were IgA negative and 1 had a duodenal ulcer. With the cutoff values of >100 U and <20 U with known IgA status, the sensitivity was 0.980 (48 of 49 cases) and the specificity was 0.972 (35 of 36 cases). An incremental cost analysis found that this proposal could potentially decrease the costs of investigation and diagnosis by almost 30%.

Conclusions. When the cutoff values were changed to >100 and <20 U and IgA levels were verified, the sensitivity and specificity were very high. Patients with mid-range TTG values (20–100 U) or values of <20 U with negative IgA status should continue to undergo biopsies for diagnosis of celiac disease.
Morphine, Hypotension, and Adverse Outcomes Among Preterm Neonates: Who’s to Blame? Secondary Results From the NEOPAIN Trial
Authors: Hall Richard W. , Kronsberg Shari S. , Barton Bruce A. , Kaiser Jeffrey R. , Anand K.J.S. ,   for the NEOPAIN Trial Investigators Group
Published: May 2005

Objectives. Hypotension occurs commonly among preterm neonates, but its cause and consequences remain unclear. Secondary data analyses from the NEOPAIN trial identified the clinical factors associated with hypotension and examined the contributions of morphine treatment or hypotension to severe intraventricular hemorrhage (IVH) (grades 3 and 4), any IVH (grades 1–4), or death.

Methods. In the NEOPAIN trial, 898 ventilated neonates between 23 and 32 weeks of gestation were enrolled, with equal numbers randomized to receive masked morphine or placebo infusions. Additional doses of open-label morphine were administered as necessary by medical staff members. IVH was diagnosed with centralized readings of early and late cranial ultrasonograms. Hypotension was assessed before study drug infusion, during the loading dose, and at 24 and 72 hours during study drug infusion. Logistic regression analyses with stepdown elimination identified the predictor factors associated with the hypotension, severe IVH, any IVH, or death outcomes at each time point.

Results. Hypotension was associated with 23 to 26 weeks of gestation, morphine infusions, severity of illness, additional morphine doses, and prior hypotension. Severe IVH was associated with shorter gestation, higher Clinical Risk Index for Babies scores, no prenatal steroids, pulmonary hemorrhage, hypotension before the loading dose, and morphine doses before intubation and at 25 to 72 hours. Neonatal deaths were associated with 23 to 26 weeks of gestation, higher Clinical Risk Index for Babies scores, pulmonary hemorrhage, patent ductus arteriosus, thrombocytopenia, and hypotension before the loading dose. Morphine infusions were not a significant factor in logistic models for severe IVH, any IVH, or death.

Conclusions. Preemptive morphine infusions, additional morphine, and lower gestational age were associated with hypotension among preterm neonates. Severe IVH, any IVH, and death were associated with preexisting hypotension, but morphine therapy did not contribute to these outcomes. Morphine infusions, although they cause hypotension, can be used safely for most preterm neonates but should be used cautiously for 23- to 26-week neonates and those with preexisting hypotension.
Amino-Terminal Pro-Brain-Type Natriuretic Peptide: Heart or Lung Disease in Pediatric Respiratory Distress?
Authors: Cohen Shlomo , Springer Chaim , Avital Avraham , Perles Zeev , Rein Azaria J. J. T. , Argaman Zvi , Nir Amiram
Published: May 2005

Objectives. The aim of this study was to determine whether plasma levels of amino-terminal pro-brain natriuretic peptide (N-BNP) could differentiate between heart failure and lung disease among infants with acute respiratory distress. In addition, our aim was to determine whether plasma levels of N-BNP could be used to monitor the effects of treatment among infants with heart failure.

Methods. Infants (age range: 1–36 months; median age: 10 months) who presented with respiratory distress underwent physical examination, plasma N-BNP measurement, and echocardiography within 24 hours after admission. Seventeen infants were finally diagnosed with acute heart failure and 18 with acute lung disease. Thirteen healthy infants served as a control group.

Results. Plasma N-BNP levels were significantly higher for the infants with heart failure (median: 18452 pg/mL; range: 5375–99700 pg/mL) than for the infants with lung disease (median: 311 pg/mL; range: 76–1341 pg/mL). Among the infants with heart failure, there was a significant difference in plasma N-BNP levels before and after congestive heart failure treatment.

Conclusion. Among infants with respiratory distress, plasma N-BNP measurements can differentiate between acute heart failure and lung disease and can be used to monitor the effects of treatment for infants with heart failure.
Flexible Insulin Therapy With Glargine Insulin Improved Glycemic Control and Reduced Severe Hypoglycemia Among Preschool-Aged Children With Type 1 Diabetes Mellitus
Authors: Alemzadeh Ramin , Berhe Tseghai , Wyatt David T.
Published: May 2005

Background and Objectives. Insulin replacement regimens now stress the importance of administering throughout the day insulin doses that are based on flexible food choices and focusing on improved metabolic control. A flexible multiple daily insulin (FMDI) regimen (premeal lispro plus bedtime glargine) results in lower hemoglobin A1c (HbA1c) levels and fewer hypoglycemic episodes than does a multiple daily insulin (MDI) regimen among school-aged children and adolescents with type 1 diabetes mellitus (DM). The purpose of this study was to determine the feasibility of FMDI therapy for a group of preschool-aged children with type 1 DM who were transitioned from MDI therapy (premeal lispro plus ultralente insulin twice per day), by comparing BMI, total daily insulin requirements, HbA1c levels, and episodes of severe hypoglycemia.

Research Design and Methods. Data were collected over a 2-year period, during quarterly DM clinic visits, from 35 patients (17 female patients and 18 male patients, 4.8 ± 1.0 years of age) who had received MDI insulin therapy for ≥1 year before being transitioned to a FMDI regimen.

Results. Although there was no significant change in BMI with FMDI therapy (17.1 ± 1.8 kg/m2 vs 17.0 ± 1.7 kg/m2), 43% of patients (6 female subjects and 9 male subjects) were overweight (BMI of >85th percentile for age) both before and after treatment. The total daily insulin requirement (0.67 ± 0.13 U/kg per day vs 0.78 ± 0.14 U/kg per day) and bolus/basal insulin ratio (1.1 ± 0.4 vs 1.9 ± 0.6) were significantly increased and overall glycemic control was improved after transition to FMDI therapy (HbA1c levels: 8.8 ± 0.9% vs 8.3 ± 0.8%). However, HbA1c levels improved only among normal-weight subjects (9.0 ± 1.0% vs 8.3 ± 1.0%) and not among overweight subjects (8.7 ± 0.7% vs 8.4 ± 0.6%) after FMDI therapy. The overall rate of severe hypoglycemia was significantly decreased with the FMDI regimen (25.5 events per 100 patient-years vs 10.6 events per 100 patient-years) but again only for normal-weight children (29.7 events per 100 patient-years vs 7.4 events per 100 patient-years).

Conclusions. The use of FMDI therapy with glargine among preschool-aged children with type 1 DM was associated with improved overall glycemic control and decreased frequency of severe hypoglycemia. Although our study did not have a control group, these findings suggest that FMDI regimens may be a feasible therapeutic alternative to MDI treatment for preschool-aged children with type 1 DM. However, excess body weight status appeared to preclude a desirable therapeutic response in this group of patients.
Obesity at the Onset of Diabetes in an Ethnically Diverse Population of Children: What Does It Mean for Epidemiologists and Clinicians?
Authors: Lipton Rebecca B. , Drum Melinda , Burnet Deborah , Rich Barry , Cooper Andrew , Baumann Elizabeth , Hagopian William
Published: May 2005

Objective. It is often difficult to determine the pathophysiology of childhood diabetes at onset, particularly in overweight children, because obesity has been associated with both type 1 and type 2 diabetes. We compared children at the diagnosis of diabetes in a multiethnic population-based registry to understand the epidemiology of the disease during a time of rapidly changing diagnostic and treatment norms.

Methods. Incident diabetes was ascertained in Chicagoans who were aged 0 to 17 years from 1985 to 2001. We classified as type 2 those with polycystic ovary syndrome, acanthosis, or a physician's note indicating type 2 or those who reported subsequent use of oral agents (n = 203); 73% of them were also obese. Patients with obesity at onset but no other indicator of possible type 2 (n = 197) were classified as having obesity-related/undetermined type. The remaining 842 cases were classified as type 1. Logistic regression analyses were conducted.

Results. Fully 32% of cases were classified as non–type 1, including 37% of non-Hispanic blacks, 30% of Latinos, and 14% of non-Hispanic whites. The proportion of obesity-undetermined and type 2 increased over the 17 years. Comparing the 3 patient groups, type 2 cases were more often female, non-Hispanic black, and older and had a first-degree diabetic relative, whereas Latino boys were overrepresented among the obese/undetermined.

Conclusion. Obesity is prevalent in youths with newly diagnosed diabetes, particularly during recent years. The growth in non–type 1 diabetes in children since 1985 likely reflects both a true increase and greater physician awareness of the possibility that type 2 diabetes may occur in children.
Early Death, Morbidity, and Need of Treatment Among Extremely Premature Infants
Authors: Markestad Trond , Kaaresen Per Ivar , Rønnestad Arild , Reigstad Hallvard , Lossius Kristin , Medbø Sverre , Zanussi Gro , Engelund Inger Elise , Skjaerven Rolv , Irgens Lorentz M. ,   on behalf of the Norwegian Extreme Prematurity Study Group
Published: May 2005

Objective. To determine outcomes, in terms of perinatal and early death, need for treatment, and morbidity at the time of discharge home, among extremely preterm infants.

Design. A prospective observational study of all infants with a gestational age (GA) of 22 to 27 completed weeks or a birth weight of 500 to 999 g who were born in Norway in 1999 and 2000.

Results. Of 636 births, 174 infants (27%) were stillborn or died in the delivery room, 86 (14%) died in the NICU, and 376 (59%) were discharged from the hospital. The risk of being registered as stillborn or not being resuscitated increased with decreasing GA below 25 weeks. The survival rates for all births and for infants admitted to a NICU were, respectively, 0% for <23 weeks, 16% and 39% for 23 weeks, 44% and 60% for 24 weeks, 66% and 80% for 25 weeks, 72% and 84% for 26 weeks, 82% and 93% for 27 weeks, and 69% and 90% for >27 weeks. For the survivors, days of mechanical ventilation decreased from a median of 37 days to 3 days and the proportion in need of oxygen at 36 weeks’ postconceptional age decreased from 67% to 26% at 23 and 27 weeks’ GA, respectively. At 40 weeks’ postconceptional age, the respective figures were 11% and 6%. The proportion with retinopathy of prematurity (ROP) requiring treatment decreased from 33% for GA of 23 weeks to 0% for >25 weeks. Periventricular hemorrhage of more than grade 2 occurred for 6% of the survivors and significant periventricular leukomalacia occurred for 5%, with no significant association with GA. The proportion of survivors without severe neurosensory or pulmonary morbidity increased from 44% for 23 weeks’ to 86% for 27 weeks’ GA. Apart from ROP, the morbidity rate was not associated with GA.

Conclusions. The survival rate was high and the morbidity rate at discharge home was low in the present study, compared with previous population-based studies. With the exception of ROP, the morbidity rates among the survivors were not higher at the lowest GAs, possibly because withholding treatment was considered more acceptable for the most immature infants. The need for intensive care increased markedly for survivors with the lowest GAs.
Assuring Adequate Health Insurance: Results of the National Survey of Children With Special Health Care Needs
Authors: Honberg Lynda , McPherson Merle , Strickland Bonnie , Gage Julia C. , Newacheck Paul W.
Published: May 2005

Objective. The purpose of this article is to report the findings of the 2001 National Survey of Children With Special Health Care Needs regarding the extent to which children with special health care needs (CSHCN) have access to public or private health insurance that meets their needs.

Methodology. As part of its effort to develop systems of care for CSHCN, the US Maternal and Child Health Bureau established a health insurance core outcome. Successful attainment was measured on the basis of whether the child met 3 distinct components at the time of the interview: presence of public or private coverage; continuity of coverage over the previous 12 months; and adequacy of coverage. Adequacy of coverage was measured from the family's perspective of whether their insurance covered needed services, covered a reasonable share of costs, and allowed families to see the providers they felt were best for their child. Bivariate and multivariate statistical methods were used to assess independent predictors of respondents meeting the health insurance core outcome.

Results. Results of the survey indicated that 59.6% of CSHCN nationally met the health insurance core outcome using the 3 components of presence of insurance coverage, continuity of coverage, and adequacy of coverage. Poverty status, race/ethnicity, and functional ability were significant factors in whether a child met the health insurance core outcome as well as each of the 3 components. Of Hispanic and non-Hispanic black CSHCN, 45.2% and 57.6%, respectively, met the health insurance core outcome, compared with 62.5% of their white counterparts. Children with the most limited functional ability were 50% less likely to meet the health insurance core outcome than CSHCN without limitations. More than 10% of Hispanic CSHCN were uninsured at the time of the interview, and 20% of Hispanic CSHCN experienced gaps in coverage. Although insurance met the needs of most families, more than one fourth of families reported that uncovered costs were not reasonable. Children who did not meet the health insurance core outcome were also more likely to have unmet needs.

Conclusions. Results of the survey demonstrated that although the majority of CSHCN have adequate health insurance, additional work is needed to improve the adequacy of insurance, particularly for children below the poverty line, Hispanic children, and children with the most limited functional ability. The survey results also demonstrated the importance of continuous and adequate health insurance, because children who met the health insurance core outcome had fewer unmet needs.
Reduction in Red Blood Cell Transfusions Among Preterm Infants: Results of a Randomized Trial With an In-Line Blood Gas and Chemistry Monitor
Authors: Widness John A. , Madan Ashima , Grindeanu Ligia A. , Zimmerman M. Bridget , Wong David K. , Stevenson David K.
Published: May 2005

Background. Critically ill, extremely premature infants develop anemia because of intensive laboratory blood testing and undergo multiple red blood cell (RBC) transfusions in the early weeks of life. To date, researchers have had only limited success in finding ways to reduce transfusions significantly in this patient population.

Objective. To reduce RBC transfusions for these infants by using a point-of-care bedside monitor that returns analyzed blood to the patient.

Design, Setting, and Patients. This was a prospective, 2-center, randomized, open, controlled, clinical trial with a 1:1 assignment of extremely low birth weight infants (weighing 500–1000 g at birth) to control or monitor groups and analysis with the intention-to-treat approach. Predefined RBC transfusion criteria were applied uniformly in the 2 groups.

Interventions. Clinical treatment of study subjects with an in-line, ex vivo, bedside monitor that withdraws blood through an umbilical artery catheter, analyzes blood gases and sodium, potassium, and hematocrit levels, and returns the sample to the patient.

Main Outcome Measures. The total volume and number of RBC transfusions during the first 2 weeks of life and the total volume of blood removed for laboratory testing.

Results. The trial was terminated prematurely when one center's NICU changed its standard method of laboratory testing. In the first 2 weeks of life, there was a nonsignificant 17% lower cumulative RBC transfusion volume in the monitor group (n = 46), compared with the control group (n = 47). However, data from the first week only (the period of greater catheter use) demonstrated a significant 33% lower cumulative RBC transfusion volume in the monitor group. Cumulative phlebotomy loss was ∼25% less in the monitor group throughout the 2-week study period. There was no difference between groups in neonatal mortality, morbidity, and neurodevelopmental outcome rates at 18 to 24 months. This is the first randomized trial documenting that RBC transfusions administered to neonates can by reduced by decreasing laboratory phlebotomy loss.

Conclusions. As long as an umbilical artery catheter is available for blood sampling with an in-line blood gas and chemistry monitor, significant reductions in neonatal RBC transfusions can be achieved. The patients most likely to benefit from monitor use are the smallest, most critically ill newborns.
Depressive Symptoms Predict Hospitalization for Adolescents With Type 1 Diabetes Mellitus
Authors: Stewart Sunita M. , Rao Uma , Emslie Graham J. , Klein Diane , White Perrin C.
Published: May 2005

Objective. To examine the role of self-reported depressive symptoms in predicting hospitalization for complications of diabetes mellitus over a period of up to 2 years.

Study Design. Two hundred thirty-one adolescent outpatients (age range: 11–18 years) with type 1 diabetes completed the Center for Epidemiological Studies Depression Scale, a self-report measure of depressive symptoms. Glycosylated hemoglobin levels were also assessed, to account for this known predictor of hospitalization. With survival analysis methods, hospitalizations for medical complications that occurred up to 2 years after this assessment were recorded.

Results. After controlling for age, gender, socioeconomic status, and glycosylated hemoglobin levels at baseline, the odds ratio for prediction offered by Center for Epidemiological Studies Depression Scale scores above the cutoff point (12 for boys and 22 for girls) was 2.58 (95% confidence interval: 1.12–5.98).

Conclusions. Young people with type 1 diabetes who show high levels of depressive symptoms are at increased risk for hospitalization for disease complications. Interventions aimed at improving their depressive symptoms may result in positive health outcomes, as well as improved quality of life.
Executive Summary of the Workshop on the Border of Viability
Authors: Higgins Rosemary D. , Delivoria-Papadopoulos Maria , Raju Tonse N.K.
Published: May 2005

One of the most complex areas in perinatal-neonatal medicine remains the care of the mother delivering a newborn infant at the border of viability, referred to as “periviable” gestation. To address the knowledge gaps that preclude optimal, evidence-based care in this critical field of perinatal medicine, the National Institute of Child Health and Human Development organized a workshop in March 2004. This article provides a summary of the discussions, focusing on major knowledge gaps and prioritized suggestions for studies in this area.
The Oxford-Durham Study: A Randomized, Controlled Trial of Dietary Supplementation With Fatty Acids in Children With Developmental Coordination Disorder
Authors: Richardson Alexandra J. , Montgomery Paul
Published: May 2005

Background. Developmental coordination disorder (DCD) affects ∼5% of school-aged children. In addition to the core deficits in motor function, this condition is associated commonly with difficulties in learning, behavior, and psychosocial adjustment that persist into adulthood. Mounting evidence suggests that a relative lack of certain polyunsaturated fatty acids may contribute to related neurodevelopmental and psychiatric disorders such as dyslexia and attention-deficit/hyperactivity disorder. Given the current lack of effective, evidence-based treatment options for DCD, the use of fatty acid supplements merits investigation.

Methods. A randomized, controlled trial of dietary supplementation with ω-3 and ω-6 fatty acids, compared with placebo, was conducted with 117 children with DCD (5–12 years of age). Treatment for 3 months in parallel groups was followed by a 1-way crossover from placebo to active treatment for an additional 3 months.

Results. No effect of treatment on motor skills was apparent, but significant improvements for active treatment versus placebo were found in reading, spelling, and behavior over 3 months of treatment in parallel groups. After the crossover, similar changes were seen in the placebo-active group, whereas children continuing with active treatment maintained or improved their progress.

Conclusions. Fatty acid supplementation may offer a safe efficacious treatment option for educational and behavioral problems among children with DCD. Additional work is needed to investigate whether our inability to detect any improvement in motor skills reflects the measures used and to assess the durability of treatment effects on behavior and academic progress.
Changes in the Classification of Sudden Unexpected Infant Deaths: United States, 1992–2001
Authors: Malloy Michael H. , MacDorman Marian
Published: May 2005

Background. Sudden infant death syndrome (SIDS) makes up the largest component of sudden unexpected infant death in the United States. Since the first recommendations for supine placement of infants to prevent SIDS in 1992, SIDS postneonatal mortality rates declined 55% between 1992 and 2001.

Objective. The objective of this analysis was to examine changes in postneonatal mortality rates from 1992 to 2001 to determine if the decline in SIDS was due in part to a shift in certification of deaths from SIDS to other causes of sudden unexpected infant death. In addition, the analysis reviews the change in mortality rates attributed to the broad category of sudden unexpected infant death in the United States since 1950.

Methods. US mortality data were used. The International Classification of Diseases (ICD) chapters “Symptoms, Signs, and Ill-Defined Conditions” and “External Causes of Injury” were considered to contain all causes of sudden unexpected infant death. The following specific ICD (ninth and tenth revisions) underlying-cause-of-death categories were examined: “SIDS,” “other unknown and unspecified causes,” “suffocation in bed,” “suffocation-other,” “aspiration,” “homicide,” and “injury by undetermined intent.” The average annual percentage change in rates was determined by Poisson regression. An analysis was performed that adjusted mortality rates for changes in classification between ICD revisions.

Results. The all-cause postneonatal mortality rate declined 27% and the postneonatal SIDS rate declined 55% between 1992 and 2001. However, for the period from 1999 to 2001 there was no significant change in the overall postneonatal mortality rate, whereas the postneonatal SIDS rate declined by 17.4%. Concurrent increases in postneonatal mortality rates for unknown and unspecified causes and suffocation account for 90% of the decrease in the SIDS rate between 1999 and 2001.

Conclusions. The failure of the overall postneonatal mortality rate to decline in the face of a declining SIDS rate in 1999–2001 raises the question of whether the falling SIDS rate is a result of changes in certifier practices such that deaths that in previous years might have been certified as SIDS are now certified to other non-SIDS causes. The observation that the increase in the rates of non-SIDS causes of sudden unexpected infant death could account for >90% of the drop in the SIDS rates suggests that a change in classification may be occurring.
Increased Attack Rate of Meningococcal Disease in Children With a Pregnant Mother
Authors: van Gils Elske J. , van Woensel Job B. , van der Ende Arie , Kuijpers Taco W.
Published: May 2005

Objective. To investigate the relationship between meningococcal disease and family composition, especially pregnancy in mothers.

Methods. This was a retrospective matched case-control study. Case patients were children (aged 0–18 years) who had meningococcal disease and were admitted to our hospital from 1990 to 2002. Children who were admitted to 1 of the general pediatric wards of the hospital during the same period and did not have meningococcal disease served as control subjects. One control subject (matched according to gender, age, and yea, and season of admission) was enrolled for each case patient. Parents of case patients and control subjects were asked to fill out a questionnaire on family composition, birth dates of siblings, and pregnancy at the time of hospital admission.

Results. A total of 88 matched case-control pairs were included. In the case group, 17 (19%) mothers reported having been pregnant at the time of hospitalization of their child, compared with 2 (2%) in the control group. Other family characteristics were not different. After adjustment for confounding factors, pregnancy of mothers remained a significant risk factor for meningococcal disease in children (odds ratio: 11.7; 95% confidence interval: 2.6–53.9).

Conclusions. Meningococcal disease in children was highly associated with pregnancy of the patient's mother during hospitalization. Mechanisms by which the presence of a pregnant mother in a family affects the attack rate of meningococcal disease in her children need additional investigation.
The Epidemiology of Pertussis: A Comparison of the Epidemiology of the Disease Pertussis With the Epidemiology of Bordetella pertussis Infection
Authors: Cherry James D.
Published: May 2005

In the prevaccine era pertussis epidemics followed a cyclic pattern, with peaks every 2 to 5 years. With the marked reduction of pertussis by vaccination, the same cyclic pattern still occurs. Studies relating to reported pertussis and Bordetella pertussis infection have been reviewed and analyzed. The increase in reported pertussis over the last 2 decades is mainly due to a greater awareness of pertussis and perhaps to the use of several less efficacious vaccines.

Studies of prolonged cough illnesses in adolescents and adults reveal that 13% to 20% are a result of B pertussis infection. Serologic studies suggest that the rate of B pertussis infection in adolescents and adults is ∼2.0% per year. The rate of cough illnesses (pertussis) caused by B pertussis infection in adolescents and adults is between 370 and 1500 per 100 000 population. These data suggest that there are between ∼800 000 and 3.3 million cases per year in the United States.

The coming availability of adolescent- and adult-formulated diphtheria and tetanus toxoids and acellular pertussis vaccines for adolescents and adults and their widespread use should reduce the reservoir of B pertussis disease. It is suggested that a universal program of adolescent and adult boosters would decrease the circulation of B pertussis in these age groups and possibly could lead to the elimination of the organism from the population.
Responding to Parental Refusals of Immunization of Children
Authors: Diekema Douglas S. ,   and the Committee on Bioethics
Published: May 2005

This Clinical Report was revised. See https://doi.org/10.1542/peds.2023-065483.

The American Academy of Pediatrics strongly endorses universal immunization. However, for childhood immunization programs to be successful, parents must comply with immunization recommendations. The problem of parental refusal of immunization for children is an important one for pediatricians. The goal of this report is to assist pediatricians in understanding the reasons parents may have for refusing to immunize their children, review the limited circumstances under which parental refusals should be referred to child protective services agencies or public health authorities, and provide practical guidance to assist the pediatrician faced with a parent who is reluctant to allow immunization of his or her child.
Death of a Child in the Emergency Department
Authors: Knapp Jane , Mulligan-Smith Deborah ,   and the Committee on Pediatric Emergency Medicine
Published: May 2005

Of the estimated 40000 American children ≤14 years old who die each year, approximately 20% die or are pronounced dead in outpatient sites, primarily the emergency department (ED). The ED is distinguishable from other sites at which children die, because the death is often sudden, unexpected, and without a previously established physician-patient care relationship. Despite these difficult circumstances and potentially limited professional experience with the death of a child, the emergency physician must be prepared to respond to the emotional, cultural, procedural, and legal issues that are an inevitable part of caring for ill and injured children who die. All of this must be accomplished while supporting a grieving family. There is also a responsibility to inform the child's pediatrician of the death, who in turn also must be prepared to counsel and support bereaved families. The American Academy of Pediatrics and American College of Emergency Physicians collaborated on the joint policy statement, “Death of a Child in the Emergency Department,” agreeing on recommendations on the principles of care after the death of a child in the ED. This technical report provides the background information, consensus opinion, and evidence, where available, used to support the recommendations found in the policy statement. Important among these are the pediatrician's role as an advocate to advise in the formulation of ED policy and procedure that facilitate identification and management of medical examiners' cases, identification and reporting of child maltreatment, requests for postmortem examinations, and procurement of organ donations.
Novel Water‐soluble Photosensitizer Based on Starch and Containing Porphyrin
Authors: Nowakowska Maria , Sterzel Monika , Zapotoczny Szczepan
Published: May 2005

Novel water‐soluble polymeric photosensitizers (SPO) based on starch and containing porphyrin chromophores were synthesized and studied. The polymers were soluble in water and in dimethyl sulfoxide. Photophysical studies and solubilization of molecular probes proved the formation of hydrophobic, rigid microdomains in an aqueous solution of SPO; they were created due to the clustering of porphyrin chromophores attached to the polymer chain. SPO polymers absorbed light from the UV‐visible spectral region. The polymers could sensitize photochemical reactions mediated by electron transfer, energy transfer or both, from the singlet‐excited state of porphyrin chromophores to the molecules of organic compounds solubilized in the hydrophobic microdomains or residing in the water phase.
Comprehensive Photochemistry and Photophysics of Land‐ and Marine‐based β‐carbolines Employing Time‐resolved Emission and Flash Transient Spectroscopy
Authors: Becker Ralph S. , Ferreirar Luis F. V. , Elisei Fausto , Machado Isabel , Latterini L.
Published: May 2005

The photophysical and photochemical behavior of Norharmane (Norh), Harmane (Hara) and Harmine (Hari) and their cations have been examined as a function of the nature of the solvent. Time‐resolved emission in nonprotic polar solvents showed fluorescence for all and also phosphorescence for Hari. All emissions were assigned as those of the neutral molecules. Norh and Hari showed fluorescence of both the neutral and the cation in methanol as well as phosphorescence of the neutral while Hari also had fluorescence of the zwitter ion. In ethanol, Norh and Hari displayed fluorescence and phosphorescence of the neutral. The ground‐state cations of Norh and Hari exhibited fluorescences of the cation and Hari also had a phosphorescence (cation). The flash transient spectra in nonprotic solvents of all three carbolines had long‐lived triplet transients only of the neutral. Triplet and singlet oxygen yields were quite high, 0.31–0.40. Direct excitation of any of the cations gave only the cation triplet. The triplet yields of the cations appear to be low (0.01–0.10 range). Theoretical calculations were done relative to location of triplet states. Some new information will be reported on other naturally occurring differently substituted marine‐based β‐carbolines. The impact of all of the foregoing observations on the photosensitizing potential of all compounds is discussed.
An Empirical Model for Estimating Annual Consumption by Freshwater Fish Populations
Authors: Liao Hongsheng , Pierce Clay L. , Larscheid Joe G.
Published: May 2005

Population consumption is an important process linking predator populations to their prey resources. Simple tools are needed to enable fisheries managers to estimate population consumption. We assembled 74 individual estimates of annual consumption by freshwater fish populations and their mean annual population size, 41 of which also included estimates of mean annual biomass. The data set included 14 freshwater fish species from 10 different bodies of water. From this data set we developed two simple linear regression models predicting annual population consumption. Log-transformed population size explained 94% of the variation in log-transformed annual population consumption. Log-transformed biomass explained 98% of the variation in log-transformed annual population consumption. We quantified the accuracy of our regressions and three alternative consumption models as the mean percent difference from observed (bioenergetics-derived) estimates in a test data set. Predictions from our population-size regression matched observed consumption estimates poorly (mean percent difference = 222%). Predictions from our biomass regression matched observed consumption reasonably well (mean percent difference = 24%). The biomass regression was superior to an alternative model, similar in complexity, and comparable to two alternative models that were more complex and difficult to apply. Our biomass regression model, log10(consumption) = 0.5442 + 0.9962 · log10(biomass), will be a useful tool for fishery managers, enabling them to make reasonably accurate annual population consumption predictions from mean annual biomass estimates.
Does Pectoral Spine Extraction Cause Mortality to Channel Catfish?
Authors: Michaletz Paul H.
Published: May 2005

Pectoral spines have been commonly used to age channel catfish Ictalurus punctatus. Recently, use of otoliths has increased because they may provide more accurate and precise estimates of age. A presumed advantage of using pectoral spines instead of otoliths is that fish can be released alive and experience little mortality. However, little information is available to test this presumption. I used mark and recapture of channel catfish in two impoundments to assess whether recapture rates differed between fish that had their left pectoral spine removed and those that did not. Channel catfish were marked in June and recaptured in October. There was no difference in the proportion of channel catfish recaptured that had their spine removed versus those that did not in either impoundment. My findings suggest that pectoral spine extraction causes little if any mortality to channel catfish.
Spatial and Seasonal Dynamics of Brook Trout Populations Inhabiting a Central Appalachian Watershed
Authors: Petty J. Todd , Lamothe Peter J. , Mazik Patricia M.
Published: May 2005

We quantified the watershed‐scale spatial population dynamics of brook trout Salvelinus fontinalis in the Second Fork, a third‐order tributary of Shavers Fork in eastern West Virginia. We used visual surveys, electrofishing, and mark–recapture techniques to quantify brook trout spawning intensity, population density, size structure, and demographic rates (apparent survival and immigration) throughout the watershed. Our analyses produced the following results. Spawning by brook trout was concentrated in streams with small basin areas (i.e., segments draining less than 3 km2), relatively high alkalinity (>10 mg CaCO3/L), and high amounts of instream cover. The spatial distribution of juvenile and small‐adult brook trout within the watershed was relatively stable and was significantly correlated with spawning intensity. However, no such relationship was observed for large adults, which exhibited highly variable distribution patterns related to seasonally important habitat features, including instream cover, stream depth and width, and riparian canopy cover. Brook trout survival and immigration rates varied seasonally, spatially, and among size‐classes. Differential survival and immigration tended to concentrate juveniles and small adults in small, alkaline streams, whereas dispersal tended to redistribute large adults at the watershed scale. Our results suggest that spatial and temporal variations in spawning, survival, and movement interact to determine the distribution, abundance, and size structure of brook trout populations at a watershed scale. These results underscore the importance of small tributaries for the persistence of brook trout in this watershed and the need to consider watershed‐scale processes when designing management plans for Appalachian brook trout populations.
A Rapid, High‐Throughput Technique for Detecting Tanner Crabs Chionoecetes bairdi Illegally Taken in Alaska's Snow Crab Fishery
Authors: Smith Christian T. , Grant W. Stewart , Seeb Lisa W.
Published: May 2005

Tanner crabs Chionoecetes bairdi and snow crabs C. opilio are both important commercial species for Alaskan fisheries. The geographical ranges of Tanner and snow crabs overlap in the southeastern Bering Sea where a commercial fishery targets the more abundant snow crabs. Morphological identification of these species and of hybrids has proven difficult and impedes monitoring of the harvests. Techniques for the genetic identification of these species have been developed, but it may not be possible to process the desired number of samples because of throughput limitations and sample requirement constraints. Here we present a rapid, high‐throughput assay for identifying these species based on single nucleotide polymorphisms (SNPs) in the nuclear rRNA internal transcribed spacer 1 region and the mitochondrial DNA 16S rRNA gene. These SNPs can also be used to infer the direction of hybridization (i.e., the species of each gender).
Development and Evaluation of a Fish Assemblage Index of Biotic Integrity for Northwestern Great Plains Streams
Authors: Bramblett Robert G. , Johnson Thomas R. , Zale Alexander V. , Heggem Daniel G.
Published: May 2005

Quantitative indicators of biological integrity are needed for streams in the Great Plains of North America, but it was not known whether the index of biotic integrity (IBI) approach would be effective in this semiarid region. Great Plains streams have a depauperate and tolerant ichthyofauna and highly variable physicochemical conditions that may mask the effects of non‐point‐source pollution and stream habitat degradation. We developed an IBI based on fish assemblages by screening metrics for range, responsiveness to human influence, precision, and lack of redundancy; we then tested the IBI's ability to detect anthropogenic effects by validating the index with an independent data set. The IBI was composed of 10 metrics based on species richness and composition, trophic and reproductive guilds, and age structure. These 10 metrics had many significant correlations with substrate and water chemistry variables but had fewer significant correlations with riparian condition and watershed variables. Of the watershed variables, road density had the highest number of significant correlations with final IBI metrics. The IBI was validated by demonstrating its responsiveness to aggregate measures of human influence, site‐level habitat, and water chemistry, and its lack of responsiveness to factors that varied naturally, such as stream size and site elevation. The IBI was also temporally stable within and between years during repeat visits to a subset of sampled reaches. This IBI can be used as a measure of biological integrity for management of prairie streams faced with threats such as introduced species, intensive agriculture, grazing, and coalbed natural gas extraction. Although we developed this IBI based on data from Montana prairie streams only, our IBI can probably serve as a framework for other North American plains streams and our results suggest that the IBI approach may be useful in other semiarid regions of the world.