bluuebunny/crossref_metadata_2025 huggingface dataset:
Infant Sleep Position Practices 2 Years Into the “Back to Sleep” Campaign
Authors: Gibson Eric , Dembofsky Cynthia A. , Rubin Sara , Greenspan Jay S.
Published: June 2007

Since the 1992 American Academy of Pediatrics (AAP) recommendation to put babies to sleep in the nonprone position and the subsequent 1994 “Back to Sleep” campaign, the U.S. rate of sudden infant death syndrome (SIDS) has decreased more than 40%. This study reports sleep position practices in the greater Philadelphia area during 1996 and 1997. Four hundred and ten parents of infants 6 months of age or less answered a questionnaire by interview in Philadelphia clinics and private pediatric offikes from December 1995 through February 1997. Sleep position practices and other SIDS risk factors were measured among demographic groups and compared with reported rates in a similar population from 1993 and 1994. Data were analyzed by Chi square after analysis of correlation coefficients. Significance is reported at p<O.05. Seventy-two percent of all infants surveyed slept nonprone (NP) compared to 31.8% in 1993 and 59.1% in 1994. The population was 61% African-American (AA), 62% clinic patients. The breast feeding rate was 31%, maternal smoking 17%, and cosleeping 46%. AA infants (67% vs. 82%), infants receiving care at a clinic (66% vs. 84%), and infants >3 months old (65% vs. 76%) are less likely to be placed nonprone. Most parents who place infants on their back report it was recommended by a medical professional (56%). The majority of those placing infants prone do so because their infant is more comfortable or sleeps better (65%), although 73% said their physician/nurse discussed sleep position with them. Nonprone sleeping continues to increase since the initiation of the “Back to Sleep” campaign. Disparity between some demographic groups persists. An excessive number of African-American families and clinic families still choose a prone sleep position. Many who do so cite increased infant comfort, despite knowledge of the AAP recommendation.
Factors Associated with Medication Self Administration in Children with Asthma
Authors: Winkelstein Marilyn L. , Huss Karen , Butz Arlene , Eggleston Peyton , Vargas Perla , Rand Cynthia
Published: June 2007

This study investigated factors associated with early self-administration of inhaled asthma medications by minority children. Specifically, the study evaluated: (1) the reasons parents allow early administration of inhaled medications, (2) childhood activities associated with early medication administration, (3) parent's perception of the child's ability to use a metered-dose inhaler (MDI), (4) the child's actual ability to use an MDI, and (5) concordance/discordance between physician-parent reports and parent-child reports of asthma medications. Study results indicated that 93% of the children were taking inhaled asthma medications without adult supervision. Early self-administration of asthma medications was related to the parent's employment status and the performance of other childhood behaviors such as completion of homework independently and crossing the street alone. Only 7% of the children had effective MDI skills, but 60% of the parents rated their child's MDI skills as excellent. Twenty percent, 67%, and 50%, respectively, of the parents' reports of beta-agonists, daily inhaled steroids, and cromolyn were discordant with the physician's actual prescriptions. Sixty-two percent, 57%, and 79%, respectively, of the children's reports for inhaled beta-agonists, daily inhaled steroids, and cromolyn were discordant with their parents' reports. Implications for anticipatory guidance, future educational strategies, and supervision of MDI technique are provided.
Blood Glucose Monitoring Skills in Children with Type I Diabetes
Authors: Perwien Amy R. , Johnson Suzanne Bennett , Dymtrow Dan , Silverstein Janet
Published: June 2007

While blood glucose monitoring has become increasingly important in diabetes care, studies have yet to address the accuracy of youngsters' performance of blood glucose testing with current reflectance meters. The present study examined testing skills and predictors of accurate testing skills in a sample of 7-14-year-old children attending a summer camp for youth with diabetes (n=266). A 15-item behavior observational skill test was used to assess accuracy of blood glucose monitoring skills with reflectance meters. Accurate performance of individual skills ranged between 14.6% and 99.6% for the sample. However, a number of children made critical errors (errors that were likely to lead to inaccurate blood glucose testing results). When duration of diabetes and metabolic control were controlled, female gender, older age, experience with a particular meter, and absence of hypoglycemia at the time of testing were positively associated with accurate skill performance. Findings suggest that younger children, children using a new blood glucose testing meter, and children suspected of having hypoglycemia should be supervised and observed when testing. Although all young children should be supervised when blood glucose testing, boys may need closer supervision until an older age than girls. This study underscores the need for health care providers to periodically observe children's blood glucose monitoring techniques to assure accurate testing habits and to correct problematic testing behaviors.
Urban Emergency Department Utilization by Adolescents
Authors: Grove Deanna Dahl , Lazebnik Rina , Petrack Emory M.
Published: June 2007

This study describes urban emergency department (ED) utilization and follow-up referral patterns among adolescents. ED visits for 14-19-year-old patients at an urban university hospital with adjacent adult and pediatric emergency departments during specified months in 1993 were retrospectively reviewed. A subgroup (n=150) was randomly selected for detailed chart review. One thousand six hundred and thirty-six adolescents were seen in the ED during the study period. Public assistance (n=763; 47%) and commercial insurance (n=480; 29%) were the most common forms of insurance, followed by self-pay (n=357; 22%). The majority of triage codes for ED visits were nonurgent (n=140; 93%). Twenty-five patients (17%) were not referred for follow-up upon ED discharge. Adolescents on public assistance or without insurance may frequently utilize an urban ED for nonurgent medical problems. A group of patients did not identify a primary care provider at triage and were not referred for follow-up. Defining medical problems for which adolescents utilize the ED may help health professionals to tailor community resources to better serve adolescent health care needs.
Body Temperature of Newborns: What is Normal?
Authors: Takayama John l. , Teng Wang , Uyemoto Jill , Newman Thomas B. , Pantell Robert H.
Published: June 2007

Medical records of 203 healthy full-term infants were reviewed to determine the range of axillary temperatures for newborn infants, factors that affect temperature and nursery management of infants with temperatures outside published normal ranges. The mean birth temperature was 36.50C (S.D. = 0.60C). Temperature was associated with birth weight (p<0.0005) and the presence of maternal fever (p<0.0001) but not with type of environment or time of birth. The mean temperature increased with age, rising 0.20C by 2-3 hours after birth (p<0.0001) and 0.30C by 15-20 hours (p<O.OOOl). Among a subset of 114 eligible neonates the mean temperature dropped 0.20C after bathing (p<0.0001). Although 17% of all temperatures measured were in the hypothermic (<36.30C) range, the only response recorded by nursery staff consisted of warming by modifying the environment, e.g., bundling. Blood cultures were drawn from 51 infants (25%), 43 because of maternal intrapartum antibiotic treatment for maternal fever or prolonged duration of ruptured amniotic membranes (>24 hours) and none for evaluation of abnormal temperatures. No infants had systemic infections and all were discharged in stable condition. Newborn axillary temperatures in our nursery were considerably lower than what has been previously described as "normal." Given the frequency of "hypothermia" and absence of associated illness, we believe the reference range for newborn temperatures should be expanded to include lower temperatures.
Risk Behaviors and the Prevalence of Chiamydia in a Juvenile Detention Facility
Authors: Kelly Patricia J. , Bair Rita M. , Baillargeon Jacques , German Victor
Published: June 2007

The prevalence of Chlamydia trachomatis, a sexually transmitted disease, and the association of selected behavioral risk factors were assessed in a population of adolescents in two juvenile detention facilities. Urine was collected for Chlamydia testing and a brief interview conducted for risk and demographic information. Almost all of the 200 participants were sexually active, many before the age of 13 years. The prevalence of Chlamydia infection was 22.2% among female and 8.7% among male participants. Injection drug use was the only statistically significant variable associated with infection. Education and community services are necessary to break the cycle of infection for this high-risk population.
Withholding Artificially Provided Nutrition and Hydration from Disabled Children-Assessing Their Quality of Life
Authors: Stanley Amanda L.
Published: June 2007

This article focuses on quality of life determinations and limitation of treatment decisions for children with physical and mental disabilities. Issues are addressed through one pediatric convalescent center's ethical dilemma, deliberations and process for decision-making when the organization's definition of quality of life differed from that of the parents wishing to place their child there. The Ethics Committee suggested revised admission criteria to include provision of hydration and nutrition for future admissions.
Problem Identification in Apparently Well Neonates: Implications for Early Discharge
Authors: Jackson Gregory L. , Kennedy Kathleen A. , Sendelbach Dorothy M. , Talley Dale H. , Aldridge Cheryl L. , Vedro Debra A. , Laptook Abbot R.
Published: June 2007

The frequency, time of identification, and type of problems of newborns in an urban indigent population were prospectively studied during their hospital stay to evaluate feasibility of early hospital discharge. Eight percent (563) of 7,021 term and near-term low-risk infants developed one or more predefined problems. Of those with problems, 42.1% received therapy and/or a higher level of care. Tachypnea, temperature instability, and cyanotic episodes were the most frequently treated problems. Nearly 69% of all problems were detected after the initial examination, and 31% developed problems after 24 hours of age; 5% were transferred to the NICU. Problems occurring after 24 hours of age emphasize the need for follow-up within days after hospital discharge in this population.
Clinical Approach to Fecal Soiling in Children
Authors: Loening-Baucke Vera
Published: June 2007

Fecal soiling is common in childhood and can be caused by stool toileting refusal, fecal incontinence due to organic disease, or encopresis due to functional constipation. Anatomical, neurologic, and inflammatory causes for fecal soiling are ruled out by history and physical examination and, if necessary, by anorectal manometry, barium enema, and rectal biopsy. The initial treatment suggestion for children with stool toileting refusal is to put the child back into pull-ups or diapers. Most children with fecal soiling due to organic disease continue with some degree of incontinence despite optimal medical management. Antegrade enema administration helps those with severe fecal incontinence due to organic causes who do not respond to medical management. Successful treatment of constipation and encopresis requires a combination of medical therapy, nutritional intervention, behavioral intervention, and long-term compliance with laxative use. The combined treatment approach improves the constipation and encopresis in all patients who comply with the treatment program. In some children, cow's milk protein intolerance may be the cause. In them, coww's milk protein needs to be eliminated.
The Utility of Skin Biopsies in Pediatric Cancer Patients: A Single-Institution, Retrospective Review
Authors: Walter Eric C. , Hawkins Douglas S.
Published: June 2007

Medical records of all patients who were diagnosed with a malignancy and who underwent a skin biopsy were reviewed to determine the clinical utility of skin biopsies in this population. Skin biopsies resulted in a change or refinement of the prebiopsy diagnosis in 44% of patients undergoing an initial evaluation for a malignancy, 57% of patients on therapy, and 17% of patients off therapy. Skin biopsies led to a change in therapy in 26%, 34%, and 17% of each respective group. Overall, the skin biopsy changed or refined the prebiopsy diagnosis in 45% of cases and altered therapy in 38%. Skin biopsy is a clinically useful tool in pediatric oncology patients for the evaluation of cutaneous findings that elude diagnosis by visual inspection.
Are Follow-up Throat Cultures Necessary When Rapid Antigen Detection Tests Are Negative for Group A Streptococci?
Authors: Mayes Thalia , Pichichero Michael E.
Published: June 2007

The frequency of obtaining false-negative Group A Streptococcal (GAS) rapid antigen detection (RAD) tests utilizing currently available kits in a private practice setting and the cost effectiveness of requiring follow-up throat cultures were studied. Laboratory records of the Elmwood Pediatric Group (EPG), Rochester, NY, were retrospectively reviewed to identify all patients with pharyngeal RAD tests for GAS performed from January 1996 through May 1999. From January 1996 through October 1997 (study period 1), EPG physicians used either a RAD test or a throat culture to identify GAS; from November 1997 through May 1999 (study period 2), RAD tests were used as the primary test on all patients. Rapid antigen detection test negative results were confirmed with culture. During the 3-year study 11,427 RAD tests were performed. 8,385 (73.4%) were negative and 3,042 (26.6%) were positive. In study period 1, 3,547 (73.2%) were negative and 1,299 (26.8%) were positive; in study period 2 4,837 (73.5%) were negative and 1,743 (26.5%) were positive. Of the 8,385 negative tests, 8,234 (98.2%) were followed up with throat cultures. Of these, 200 (2.4%) were identified to have been negative RAD tests that were throat culture positive (132 [3.8%] of 3,474 in study period 1 and 68 [1.4%] of 4,764 in study period 2). A cost analysis was performed for study period 2, which showed that abandoning throat culture confirmation would generate a cost saving of $13,521 per year to the practice. Throat culture confirmation of RAD test negative results in pharyngitis patients may not be medically necessary for most patients with currently available RAD tests and is costly.
Knowledge of Concussion Guidelines Among Practitioners Caring for Children
Authors: Bazarian Jeffrey J. , Veenema Tener , Brayer Anne F. , Lee Edward
Published: June 2007

The objective of this study in Rochester, NY was to determine clinicians' knowledge of the Colorado Medical Society Guidelines (CMSG) on return to contact sports after a concussion. A survey was mailed to 1,140 pediatric, family practice, and emergency physicians, as well as 302 pediatric and family practice nurse practitioners in the Rochester, NY, area. Participants were given 3 hypothetical concussion scenarios and asked to pick 1 of 4 multiple-choice time intervals for when they would advise return to contact sports. Answers were compared with the latest version of the CMSG. The survey response rate was 57%. Only 7.6% responded correctly for Grade I concussion scenario, 56% for the Grade 2 scenario, and 28% for the Grade 3 scenario. Only 5.6% listed the CMSG as the source of the return-to-play advice they gave. Thus, respondents' knowledge of the CMSG was low, with few giving return-to-play advice consistent with the CMSG and even fewer acknowledging the CMSG as the source of such advice. Improving the availability of the CMSG may improve clinicians' knowledge and use of these guidelines.
Frequency of Celiac Disease in Individuals with Down Syndrome in the United States
Authors: Mackey Joanne , Treem William R. , Worley Gordon , Boney Anne , Hart Patricia , Kishnani Priya S.
Published: June 2007

Ninety-three individuals with Down syndrome (DS) were screened to investigate the prevalence of celiac disease (CD) in the United States. Five of the 93 individuals were antiendomysial antibody (EMA) positive. Of the 5 who tested positive for EMA, 4 were biopsied, 1 refused biopsy. Three of the 4 individuals biopsied manifested changes of CD on small bowel biopsy. This gives a frequency of 3.2% of confirmed CD in our DS individuals and suggests the need for periodic screening for celiac disease in this population.
Intervention Strategies for Children Poorly Adherent with Asthma Medications; One Center's Experience
Authors: Sherman James M. , Baumstein Sandra , Hendeles Leslie
Published: June 2007

Poor adherence to medications and other aspects of the treatment plan is common in pediatric patients with asthma, and is a common reason for inadequate asthma control. In selected patients we have used electronic monitoring of pulmonary function, behavior contracts, home nursing visits, and medical neglect reports in an attempt to improve adherence and asthma control. Improved outcomes were seen with the most aggressive intervention, home nursing, and medical neglect referral, but not with less aggressive measures.
Association Among Duration of Unconsciousness, Glasgow Coma Scale, and Cranial Computed Tomography Abnormalities in Head-Injured Children
Authors: Ratan Simmi K. , Pandey Ravindra M. , Ratan John
Published: June 2007

The impact of head trauma leads to generation of forces that cause both the intracranial injuries and loss of consciousness. Glasgow Coma Score (GCS) and cranial CT scan are widely used to gauge the severity of head injury. Milder cranial impacts insufficient to cause intracranial injuries generally cause no or minimal loss of consciousness. Nevertheless, cases with contradictory findings are also seen. This study was undertaken to find out the association among the three above-stated variables. A knowledge of such an association can enable the attending clinician in prognosticating a cranial injury and selecting out those patients with mild head injuries who deserve closer observation. While a significant positive association was found between duration of unconsciousness and GCS, no signifficant association of either of these variables with CT scan findings was noted.
Prolonged Bottle Feeding in a Cohort of Children: Does It Affect Caloric Intake and Dietary Composition?
Authors: Safer Debra L. , Bryson Susan , Agras W. Stewart , Hammer Lawrence D.
Published: June 2007

Little is known about the consequences to children of bottle feeding prolonged beyond age 1 year on caloric intake and overall dietary composition. To obtain these data, 165 children, followed up from infancy, were assessed in these respects for a 24-hour period at age 34 years. Bottle-fed children (n = 14) consumed more milk than their weaned counterparts (p < 0.001), had a higher mean daily calcium intake (p < 0.05), received fewer calories from carbohydrates (p = 0.034), and received a greater percentage of calories from protein (p = 0.033). There were no significant differences between the groups in total caloric intake, total iron intake, total volume ofjuice, or calories from fat. Pediatricians questioned about the effects of continuing to offer children nutritive liquids from bottles as well as cups (versus offering cups alone) may inform parents that this feeding practice is associated with significantly greater milk consumption and daily calcium intake. However, this study could not find evidence that prolonged bottle feeding at age 3? years is associated with a significantly decreased total daily iron intake or an increased risk for factors associated with adiposity such as a greater daily calorie intake, a higher body mass index, or greater percentage of total calories derived from fat.
Neonatal Adrenal Hemorrhage: Clinical and Abdominal Sonographic Findings
Authors: Velaphi Sithembiso C. , Perlman Jeffrey M.
Published: June 2007

Four neonates with adrenal hemorrhage are presented. The clinical manifestations included most often an abdominal mass but also anemia, jaundice, hypotension, bluish discoloration of the scrotum, and abdominal calcification. The diagnosis was established in each case upon abdominal sonographic findings. The review of these patients emphasizes the subtle and diverse clinical presentation of adrenal hemorrhage in a neonate and stresses the importance of abdominal sonography in establishing the diagnosis.
Pediatric Hematuria and Thin Basement Membrane Nephropathy: What Is It and What Does It Mean?
Authors: Roth Karl S. , Amaker Barbara H. , Chan James C. M.
Published: June 2007

Hematuria is seen frequently in the pediatric population and may signal either benign or serious renal patholosis. A significant proportion of children with asymptomatic hematuria will have thin basement membrane nephropathy (TBMN), a benign disorder, yet there is little information about this entity outside the nephrology literature. This article is designed to provide an information base for pediatric practitioners to assist them in making appropriate decisions regarding diagnosis and care. A review of experience over a decade with 9 children with biopsproven TBMN, including follow-up to the present; is presented. In addition, review of literature regarding TBMN, Alport's and Berger's syndromes, which comprise the major clinical entities associated with asymptomatic pediatric hematuria, is presented. Each patient was evaluated for asymptomatic, documented and persistent hematuria. Renal biopsy was performed after clinical evaluation and follow-up. TBMN and Berger's disease (IgA nephropathy) are separable only by renal biopsy results; TBMN is benign and IgA nephropathy may be progressive, mandating referral to a nephrologist. The prognosis of TBMN is excellent.
Restructuring an Academic Pediatric Inpatient Service Using Concepts Developed by Hospitalists
Authors: Ogershok Paul R. , Li Xiaoming , Palmer Hugh C. , Moore Renee S. , Weisse Martin E. , Ferrari Norman D.
Published: June 2007

In an effort to increase continuity of inpatient care by attending physicians, decrease use of hospital resources, and improve medical education without compromising quality of care, an inpatient pediatric ward service was restructured by using concepts developed by hospitalists. This reorganization reduced the number of yearly inpatient attendings, added a consistent 14-day call schedule, and eliminated attending outpatient responsibilities during their ward service. The restructured ward service attending acted as the attending of record for all general and specialty patients, excluding hematology/oncology, with the subspecialists fulfilling a consultant role. To evaluate the impact of this restructuring, a baseline year of the traditional ward service (TWS) was compared with a subsequent year of the restructured ward service (RWS). Our goal was to evaluate the impact of this new system on average costs of hospitalization, length of stay, resource utilization, inpatient mortality, and 7- and 31-day readmission rates. Hospital costs per patient were lower by 13% (p=0.018) in the restructured system. Average lengths of stay in an observation bed were significantly lower on the RWS (p=0.007), but there was no significant difference in admission length of stay. There was decreased resource utilization for laboratory and radiology tests (p<0.01) on the restructured service. Readmission rates were not significantly changed, and satisfaction among attendings, housestaff, students, and patients was uniformly high in both groups. A reorganized academic pediatric medical service, which allows specific attendings to focus on inpatient care and teaching, can decrease hospital resource utilization without compromising the quality of patient care or medical education.
Self-Concept in Male and Female Adolescents with Congenital Heart Disease
Authors: Salzer-Muhar Ulrike , Herle Marion , Floquet Peter , Freilinger Michael , Greber-Platzer Susanne , Haller Alfons , Leixnering Werner , Marx Manfred , Wurst Elisabeth , Schlemmer Michael
Published: June 2007

Cognitive achievement, behavioural problems, and various dimensions of personality were assessed in 48 male and female patients with congenital heart disease (CHD) aged from 12 to 16 years in comparison to a control group. The CHD group showed a lower speed of cognitive processing but seemed to have less state-anxiety and to possess a higher superego strength. Male adolescents with CHD presented with a reduced perceived capacity and self-esteem. This was not true for adolescent girls with CHD. The negative self-concept of boys with CHD may be partly explained by reduced physical ability interfering with peer relationships.
Factors Affecting the Yield of Pediatric EEGs in Clinical Practice
Authors: Gilbert Donald L. , Gartside Peter S.
Published: June 2007

Clinical factors affecting the yield of 2500 pediatric electroencephalograms were analyzed. Electroencephalograms were interpreted as epileptiform in 40% of children with epilepsy. Most electroencephalograms were ordered for seizure in children not taking anti-epileptic drugs; just 15% showed epileptiform features. Six percent of electroencephalograms were epileptiform in non-seizure patients. The neurologist significantly influenced the odds of epileptiform interpretation (P- 0.022) and the recommendation to repeat the electroencephalogram (P< 0.001). In practice most electroencephalograms ordered for seizure are actually for non-seizure. In routine pediatric practice, electroencephalography has a low yield and appears to be over-used.
Vocal Cord Dysfunction Mimics Asthma and May Respond to Heliox
Authors: Weir Michael
Published: June 2007

Vocal cord dysfunction (VCD), an under appreciated cause of wheezing, may be mistaken for or coexist with asthma. The vocal cords involuntarily adduct during inspiration, leading to inspiratory or biphasic wheezing. Asthma therapy offers no benefit and may result in injury. Proof of diagnosis requires endoscopy during an episode. Definitive therapy involves voice training by a speech pathologist, but heliox (20% to 40% oxygen in helium) has been used to reduce symptoms, resulting in dramatic improvement in wheezing and less anxiety. A retrospective review of recent experience with heliox treatment for patients with VCD was conducted, using a search of computerized inpatient and outpatient physician dictation reporting at Scott & White Memorial Hospital and Clinic. Five patients age 10 to 15 years were treated with a favorable response in four. There were no complications of therapy. A high index of suspicion can lead to the diagnosis of VCD, avoiding expensive, inappropriate, and harmful therapy. A trial of heliox inhalation for patients with symptomatic VCD may prove beneficial, analogous to the "reliever" role of β agonists for asthma. Home or school use of heliox may reduce acute care visits, while voice training ("controller" therapy) is instituted.
Kindergarten Health Assessment Reports: What Do Schools Really Learn from Them?
Authors: Clemens Conrad , Doolittle Robert P. , Hoyle Mary
Published: June 2007

The kindergarten health assessment report (KHAR), mandated by most states, is used to identify children at school entry with any health problems that may interfere with school performance. The objective of this study was to review the completeness and accuracy of the reports that schools receive from health care providers. By analyzing 3,952 KHARs of children enrolled in the Guilford County (North Carolina) Public Schools during the 1999-2000 school year we found that only 20% were fully completed and only 32% recorded results of all 6 required screening tests. Results of the 3 screening tests most applicable to school readiness: vision, hearing, and developmental screening, were documented only 55% of the time. Providers failed to properly classify 75% of children who were either underweight or overweight. Abnormal vision screening results were noted in 485 (14.2%) children, of whom only 38% were recommended for follow-up. Results of vision and hearing screening were recorded in only 50% of children noted to have developmental concerns. The information recorded on the kindergarten health assessment forms is incomplete and frequently inaccurate. These findings arouse concern, given that these forms constitute the basis for school districts to identify those children who may have medical problems.
Duchenne Muscular Dystrophy—Parental Perceptions
Authors: Bothwell J. E. , Dooley J. M. , Gordon K. E. , MacAuley A. , Camfield P. R. , MacSween J.
Published: June 2007

Quality of life and availability of services are important for boys with Duchenne muscular dystrophy (DMD) and their families. Families attending our neuromuscular clinic completed a questionnaire on parental perception regarding the importance of services, health issues, and quality of life issues both “now” and “in the future.” Eighty-nine percent of the families (31/35) completed questionnaires. Services and health issues related to prolonging ambulation were most important, especially for the parents of younger boys. Mental health issues such as social isolation, anger, and depression were very important, particularly for the families of older boys and were anticipated to be more important in the future. Pediatricians should be aware of both the immediate needs of families to meet the physical and emotional challenges of DMD and the increasing requirement to address the social needs of these patients and their families as the boys become older.
Is Care in Alternative Settings Safe for Infants with Possible Serious Bacterial Infection?
Authors: Brayer Anne F. , Conners Gregory P. , Kaur Tashveen , McConnochie Kenneth M.
Published: June 2007

Febrile infants are frequently hospitalized for possible serious bacterial illness (SBI). Potential to replace hospitalization of selected febrile infants with care in alternative settings was assessed by estimating risk for deterioration and by determining resource use. Lower and upper bound estimates for the number of infants admitted to a tertiary care hospital from 1994 to 1998 for possible SBI were 537 and 836, respectively. Detailed record reviews were conducted for febrile infants among this group, who, on the basis of positive blood or cerebrospinal cultures, were considered most likely to have SBI. No infant with a positive blood culture who was eligible for alternative setting care (ASC) deteriorated. Ninety-five percent confidence interval for the worst-case (assuming denominator of 537) estimate of risk for deterioration was 0% to 0.56%. Most resource use was compatible with ASC. Alternative setting care for selected febrile infants is both safe and feasible.
Visiting Multiple Sites for Immunization and Vaccine Coverage Levels of Preschool Children in 3 Urban Clinics: Potential Indicator of Record Scatter?
Authors: Joseph Christine L. M. , Giblin Paul T. , Kallenbach Lee R. , Jacobsen Gordon , Davis Ronald M.
Published: June 2007

Record scatter is a clinic-level impediment to accurately reporting immunization coverage levels but may be attributed to certain patient characteristics. We determine the association between visiting multiple sites for immunization and underimmunization among urban clinic patients. After collecting immunization histories for patients aged 3-35 months, caregivers were surveyed by telephone. 159/483 caregivers (32.9%) were interviewed. Visiting > 2 sites for immunizations was associated with underimmunization, adjusted Odds Ratio (95% Confidence Interval) =2.7 (1.2-6.5). An interruption in health insurance showed a trend toward association with visiting > 2 sites. Our results support the need for working registries, clinic outreach, and continued evaluation of both.
Comparison of Temple Temperatures with Rectal Temperatures in Children Under Two Years of Age
Authors: Siberry George K. , Diener-West Marie , Schappell Elizabeth , Karron Ruth A.
Published: June 2007

We assessed the agreement between rectal and noninvasive temporal artery temperature measurements in infants and children. We also evaluated the temple thermometer as a screening tool for rectal fever in this age group. Finally, we compared the performance of parents with that of nurses in using the temple thermometer. The 95% limits of agreement between the difference in rectal and average temple temperature were -1.03 and +1.520C. Mean temple temperatures obtained by parents and by nurses were similar (95% limits of agreement, -0.60C to +0.70C). A maximum temple temperature cutoff of 37.2°C (99.0°F) distinguished children with rectal fever of 238.0°C with 91% sensitivity and 53% specificity. A cutoff of 37.80C (100.00F) distinguished moderate rectal fevers (238.5°C) with 97% sensitivity and 84% specificity. A cutoff of 38.3°C (101.0°F) distinguished a high rectal fever (?39.0°C) with a sensitivity of 95% and specificity of 95%. In conclusion, temple temperatures do not reliably predict rectal temperatures, but the temple thermometer can be used as an effective screen for clinically important rectal fever in children 3-24 months old. The findings do not support use of temple temperatures to screen young infants for rectal fever 238.0°C. Temperatures obtained by parents were comparable to those obtained by nurses.
Influence of the Clinical Rotation on Intern Attitudes Toward Pediatrics
Authors: Al-Asnag Manal A. , Jan Mohammed M. S.
Published: June 2007

Knowledge of graduate student's impressions and attitudes toward pediatrics is important for planning strategies to stimulate their interest in pursuing a career in pediatrics. The clinical pediatric experience may influence many of their misconceptions and apprehension. This study was designed to examine this hypothesis. Rotating interns who were starting pediatric rotations between January 8, 1998 and January 4, 2001 were included prospectively. A structured 2-part, 28-item questionnaire examining their impressions and attitudes toward pediatrics was completed on the first week and at the end of the 8-week rotation. One hundred eighty-eight interns (53.5% males) aged 23 to 30 years (mean 24.8, SD 1.3) were included. One hundred two pre-and 86 post-rotation questionnaires were completed. Selecting pediatrics as the first future career choice did not change significantly at the end of the rotation, from 19.5% to 26% post-rotation. Females were 3.4 times more likely to select pediatrics (95% CI 1.6-7.8, p=0.001). Several impressions about the specialty were significantly changed at the end of the rotation including worry about inflicting pain (28% vs 12%, p=0.01), concerns about difficulties in the examination and cooperation of children (22% vs 8%, p=0.01), and difficulties with intravenous access (43% vs 17%, p=0.0003). Most interns (76%) felt that their pediatric rotation was better than anticipated. To conclude, although the rotation experience did not increase the likelihood of selecting pediatrics as the first future career choice, many impressions and concerns were positively influenced. The majority reported a better than anticipated experience.
Determinants of Infant Sleep Position in an Urban Population
Authors: Moon Rachel Y. , Omron Rodney
Published: June 2007

The incidence of SIDS has decreased by 40% since the Back to Sleep campaign was initiated. However, the rate of SIDS in the District of Columbia continues to be approximately double the national rate. The purpose of this study was to determine the prevalence and determinants of prone sleeping among infants in the District of Columbia and to ascertain what information is being provided to parents by health care professionals by a cross-sectional survey of parents of infants 0-6 months of age presenting for well child care at Children's Health Center, Children's National Medical Center, in Washington, DC. We recruited a consecutive sample of 126 parent-infant pairs, of which 92.9% were African-American. The average infant was 73 days old, was 3,003 grams at birth, and was full term. When asked how the infants were placed for sleep the night before the interview, 34.1% of parents had placed the infant supine, 50.8% side, and 15.1% prone. Nearly half (48%) of infants slept in an adult bed with the mother. More than one third of the infants had been placed prone for sleep at least once since hospital discharge. Most common reasons for sleeping supine included SIDS risk reduction or health care professional advice. Side sleepers did so primarily because of concern about vomiting, health care provider advice, or SIDS. Infants were placed prone primarily because the infant slept better. When asked about information received from a health care provider, 70.6% of parents stated that they had received information about sleep position and 64.3% about the hazards of passive smoking. Eight parents observed nursery personnel placing their infants prone. Only 16.7% of the total study population had received a Back to Sleep brochure, read it, and recalled that it recommended back sleeping. Infants were more likely to sleep prone if there was a grandparent in the home (OR 2.9, p<0.05) or if they were the firstborn (OR 2.17, p<0.05). Infants were more likely to sleep supine if parents had heard a back recommendation from a health care professional (OR 5.7, p<0.001). Infants were least likely to sleep supine if the parents had heard a side or a side/back recommendation (OR 0.26, p=0.001). Infant sleep position was not affected by receiving or reading the Back to sleep brochure. In conclusion, more than one third (35.7%) of infants in this predominantly African-American population have been placed prone for sleep at least once; 15% slept prone the night before the interview. Almost one third of parents received no information about sleep position, but parents receiving a verbal supine recommendation were most likely to place their infant supine. Receiving written information did not affect sleep position. Improved educational efforts for parents of African-American newborns should continue to focus on encouraging supine positioning, smoke cessation, and other safe sleep practices.
Intensive Care Management of the Term Neonate: Are There Regional Differences in Outcome?
Authors: Touch Suzanne M. , Greenspan Jay S. , Kornhauser Michael S. , Spitzer Alan R.
Published: June 2007

The objective of this study was to evaluate the patterns of hospitalization of term infants in 3 major metropolitan areas. We hypothesized that regional practice variation occurred in the care of term infants and that these differences would be reflected in the hospitalization patterns of infants. All infants cared for in an Intensive Care Nursery (ICN) after maternal discharge in 1 of 3 major metropolitan areas followed up by the same neonatal management company were compared (n=4,487). Term infants were grouped into 1 of 2 categories based on illness severity: Group 1 (GI) infants-those who required supplemental oxygen or ventilation for 24 hours or more (n=611); and Group 2 (G2) infants-those infants without an oxygen or ventilation requirement (n=1,549). Excluded were infants in the following categories: birth weight <2,500 grams, major congenital anomalies, surgical patients, extracorporeal membrane oxygenation (ECMO) support, or babies who died before discharge. The number of infants in each of these categories was compared as a percentage of the total number of infants cared for in that region. The average length of stay (ALOS) and percentage of patient days attributed to infants in each category were compared across regions using multiple comparison tests (Tukey). The total ALOS was greatest in City A, as was the ALOS for sick term infants. Patient days for sick term infants were lowest in City C, and healthier term infants comprised the lowest percentage of patient days in City A. This difference resulted in the lowest percentage of patient days for all term admissions in City A. These data demonstrated that significant variation existed in the delivery of care to term neonates among major metropolitan regions. Cities that admitted fewer term infants for observation periods (G2) tended to have sicker term neonates with higher acuity hospitalizations (Gi) and longer lengths of stay (LOS). These findings suggested that a conservative admission policy for this population can decrease overall LOS.
Risk Factors in Congenital Heart Disease
Authors: Roodpeyma Shahla , Kamali Zinat , Afshar Farnoush , Naraghi Shahrbanou
Published: June 2007

A case-control study was conducted to investigate the risk factors of congenital heart disease (CHD). The cases were 346 children with CHD who were admitted to a university hospital in Tehran from 1995 to 2000 and controls (n=346) were randomly selected from children without CHD who were admitted during the same period. The medical records of both cases and controls were reviewed. Ten risk factors were studied and found to be more prevalent among cases (47%) than controls (35%, p<O.005). Extracardiac malformations (OR, 31.1; C195, 15.9-60.9; p<O.001) and chromosomal abnormalities (OR, 34.05; C195, 23.3-49.8; p<0.001) were significant risk factors for CHD. Dysmorphic syndromes (p<0.05) and CHD in siblings (p<0.001) were also significant risk factors. Maternal illness and drug use in the first trimester of pregnancy, maternal history of previous abortions and stillbirths, parental consanguinity, and parental cardiac lesions were not significant risk factors for CHD in offspring. Results suggest that genetic factors more than environmental or reproductive factors can increase the occurrence of cardiac defects.
Barriers to Breastfeeding Among African American Adolescent Mothers
Authors: Brownell Kim , Hutton Laurencia , Hartman Jacqueline , Dabrow Sharon
Published: June 2007

The purpose of this study was to define the barriers to breastfeeding in the inner city African American adolescent mother. The study was conducted at Johnnie Ruth Clarke Health Center in St. Petersburg, Florida from October 1999 to February 2000. The study population included 25 African American adolescent mothers between the ages of 15 and 21 years. The results indicate that these mothers possess adequate knowledge about the benefits of breast milk. The greatest barriers to breastfeeding included pain, embarrassment, and lack of interest. These concerns are appropriate given their developmental stage; however, interventions are necessary to address these issues.
The Health-Related Quality of Life Effects of Once-Daily Cetirizine HCl Syrup in Children with Seasonal Allergic Rhinitis
Authors: Gillman Sherwin A. , Blatter Mark , Condemi John J. , Collins Millicent , Olufade Abayomi O. , Leidy Nancy Kline , Chapman Douglass , Kramer Benjamin
Published: June 2007

Seasonal allergic rhinitis (SAR) can adversely impact children's physical, psychological, and social functioning and well-being, that is, their health-related quality of life (HRQL). This study assessed HRQL in children 6 to 11 years treated with cetirizine HCl syrup, while concurrently assessing symptomatic relief and safety. In an open-label, non-comparative study, 544 children from 124 centers in the United States were instructed to take cetirizine HCl syrup (10 cc of 1 mg/mL) each evening for 4 weeks. Children experienced statistically significant improvements in HRQL with significant reductions in mean symptom score (p<0.001) during the treatment period. Results were consistent across age groups (6-7, 8-9, 10-11 years). These results suggest that the symptomatic relief and tolerability profile of cetirizine HCl syrup daily translates into improvements in the HRQL of children with SAR. This 4-week open label study is among the first to evaluate the effect of antihistamine treatment on HRQL outcomes in children.
Frequency and Timing of Symptoms in Infants Screened for Sepsis: Effectiveness of a Sepsis-Screening Pathway
Authors: Madan Ashima , Adams Marian M. , Philip Alistair G. S.
Published: June 2007

To determine the frequency and timing of symptoms and to evaluate the effectiveness of a sepsis-screening pathway in term and near-term infants, data were collected prospectively for a period of 1 year from December 1, 2000, to November 30, 2001. Results confirmed that a sepsis-screening pathway using a combination of at least 2 serial complete blood cell count and C-reactive protein measurements in both symptomatic and asymptomatic infants is a safe, simple strategy that prevents unnecessary treatment of infants with risk factors with antibiotics. However, most infants with presumed or suspected early-onset sepsis are symptomatic. Routine treatment of asymptomatic infants with risk factors or prior treatment with intrapartum antibiotics is unnecessary. A combined approach of screening in the presence of risk factors and /or symptoms of sepsis and adequate follow-up for infants discharged at less than 72 hours of age may help reduce unnecessary treatment of infants with antibiotics.
Documentation of Asthma Severity in Pediatric Outpatient Clinics
Authors: Cabana Michael D. , Bruckman David , Meister Kirsten , Bradley Joel F. , Clark Noreen
Published: June 2007

National asthma guidelines recommend assessment and documentation of asthma severity at each clinic visit. A cross-sectional medical record review was conducted, which found that only 34% of records had any documentation of severity in the previous 2 years. However, severity documentation is associated with other indicators of quality care such as receipt of an action plan, spacer device, peak flow meter, asthma education, and influenza vaccination. These results suggest that use of a system for classifying asthma severity compels the physician to consider the long-term management of asthma, rather than just acute treatment of the disease. Interventions to improve physician practice should continue to emphasize severity assessment.
Addition of Ipratropium to Nebulized Albuterol in Children with Acute Asthma Presenting to a Pediatric Office
Authors: Kumaratne Mohan , Gunawardane Gamini
Published: June 2007

A prospective, randomized, double-blind study was conducted to determine whether there was any benefit to the addition of ipratropium to a single nebulized albuterol treatment in infants and children with mild to moderate acute asthma presenting to a pediatric office. There were no significant differences between the albuterol group and the combined albuterolipratropium group in the relief of the respiratory distress, disposition of the patients from the office, or in the incidence of relapse. The addition of ipratropium to nebulized albuterol is of no added benefit in the treatment of infants and children with mild-to-moderate acute asthma presenting to a pediatric office.