bluuebunny/crossref_metadata_2025 huggingface dataset:
Free Thyroxine Levels During the First Weeks of Life and Neurodevelopmental Outcome Until the Age of 5 Years in Very Preterm Infants
Authors: van Wassenaer Aleid G. , Briët Judy M. , van Baar Anneloes , Smit Bert J. , Tamminga Pieter , de Vijlder Jan J. M. , Kok Joke H.
Published: August 2004

Background. We have conducted a randomized trial with thyroxine (T4) in 200 infants <30 weeks’ gestation. T4 treatment was associated with better 5-year outcome in infants <29 weeks’ gestation, but with worse outcome in infants of 29 weeks. These effects could be related to low, respectively high free thyroxine (FT4) levels

Methods. For each infant, the average FT4 of 5 scheduled measurements was calculated between day 3 and day 28. Infants of the placebo and the T4 group separately were divided in 2 groups. The placebo group consisted of a group of infants with average FT4 in the lowest quartile and a group in the upper 75%. The T4 group consisted of a group of infants with average FT4 in the upper quartile and a group in the lower 75%. Developmental outcome (mental/cognitive, motor, and neurologic) at 2 and 5.7 years was compared between high and low FT4 groups, and then compared separately for the T4 and placebo group.

Results. In the placebo group, low FT4 was associated with worse outcome on all domains at both time points. After correction for confounding variables, mental and neurologic outcome remained significantly different at 2 years, and motor outcome at 5 years.

In the T4 group, high FT4 was not associated with worse outcome, neither at 2 nor at 5 years.

Conclusions. In untreated infants, low FT4 values during the first 4 weeks after birth in infants born at <30 weeks’ gestation are associated with worse neurodevelopmental outcome at 2 and 5 years. In T4-treated infants, high FT4 is not associated with worse outcome. Other factors than high FT4 concentrations must play a role in the worse outcome of the T4-treated group of 29 weeks’ gestational age.
Comparison of Oral Versus Normal and High-Dose Rectal Acetaminophen in the Treatment of Febrile Children
Authors: Scolnik Dennis , Kozer Eran , Jacobson Sheila , Diamond Shelley , Young Nancy L.
Published: August 2004

Objectives. To compare the defervescent effect of high-dose rectal suppository acetaminophen with the recommended oral and rectal dosages and to evaluate acceptability of rectal acetaminophen.

Methods. A randomized, controlled trial was performed in 70 patients aged 6 months to 6 years with fever ≥39°C. Group A received rectal acetaminophen 15 mg/kg, group B received rectal acetaminophen 30 mg/kg, and group C received oral acetaminophen 15 mg/kg. Primary outcome was maximal change in temperature during the 3-hour study period after initial treatment.

Results. There were 24 patients in group A, 23 in group B, and 23 in group C. There was no significant difference in temperature change between the groups during the 3 hours or in the maximum drop in temperature or final temperature. Visual analog scores for satisfaction of parents did not reveal any significant differences between the oral and rectal routes.

Conclusions. There was no difference between the temperature decrement in patients treated with 15 mg/kg oral acetaminophen and the same or double dose rectally. Thus, there seems to be no evidence to support the use of higher doses of rectal acetaminophen for the treatment of fever in children. The rectal route proved to be as acceptable as the oral among parents.
Abraham Morris Rudolph: An Appreciation
Authors: Hoffman Julien I.E.
Published: August 2004

Dr Abraham Rudolph is one of the most distinguished pediatric cardiologists in the world. He entered pediatric cardiology (almost by accident) when the subject was still in its infancy and was present at—and indeed contributed to—most of its advances. He is best known for his studies on the pathophysiology of congenital heart diseases and for imaginative studies of fetal cardiovascular development and the transition to postnatal life.
Birth Weight and Hearing Impairment in Norwegians Born From 1967 to 1993
Authors: Nafstad Per , Samuelsen Sven O. , Irgens Lorentz M. , Bjerkedal Tor
Published: August 2004

Objectives. To estimate the association between birth weight and hearing impairment among Norwegians born between 1967 and 1993, taking other pregnancy-related conditions into consideration.

Methods. A cohort study was conducted of all Norwegian live births from 1967 to 1993 (n = 1 548 429) linking information of the Medical Birth Registry of Norway and the register for the National Insurance Administration, which covers all Norwegians. The Medical Birth Registry of Norway has recorded information on birth weight and other pregnancy-related conditions as well as diseases of the mother before and during pregnancy. The register of the National Insurance Administration contains information on all Norwegians who have received cash benefits for a disease/disability, including hearing impairment. Data up to 1997 are included; thus, the follow-up period varies between 29 and 3 years.

Results. The occurrence of hearing impairment was 11 per 10 000, decreasing from 60 per 10 000 for birth weights <1500 g to 6 per 10 000 for birth weights >4499g. Compared with birth weights between 3000 g and 3499 g, the adjusted rate ratio of hearing impairment was 7.55 (95% confidence interval: 4.81–11.87) for birth weights <1500 g and 0.50 (95% confidence interval: 0.34–0.73) for birth weights >4499 g. The association did not change substantially with adjustment for other pregnancy-related conditions. Restricting the analyses to term born, the association between hearing impairment and low birth weight became stronger.

Conclusions. Birth weight was a strong predictor of hearing impairment in the Norwegian population. Children who were born at term with a low birth weight seemed to be a particularly vulnerable group.
Validation of 2 Pain Scales for Use in the Pediatric Emergency Department
Authors: Bulloch Blake , Tenenbein Milton
Published: August 2004

Objective. To determine the construct, content, and convergent validity of 2 self-report pain scales for use in the untrained child in the emergency department (ED).

Methods. A prospective study was conducted of all children who presented to an urban ED between 5 and 16 years of age inclusive after written informed consent was obtained. Children were excluded if they were intoxicated, had altered sensorium, were clinically unstable, did not speak English, or had developmental delays. Children marked their current pain severity on a standardized Color Analog Scale (CAS) and a 7-point Faces Pain Scale (FPS). They were then asked whether their pain was mild, moderate, or severe. Children were then administered an analgesic at the discretion of the attending physician and asked to repeat these measurements. For assessing content validity, the scales were also administered to age- and gender-matched children in the ED for nonpainful conditions. Convergent validity was assessed by determining the Spearman correlation coefficient between the 2 pain scales.

Results. A total of 60 children were enrolled, 30 with pain and 30 without, with a mean age of 9.3 ± 3.3 years. Boys accounted for 38 of the enrollees (63.3%). The median score before analgesic administration was 6.0 cm (interquartile range [IQR]: 4.0–8.0) on the CAS and 3.0 faces (IQR: 2.0–5.0) on the FPS; after analgesic administration, the median scores decreased to 3.1 cm (IQR: 1.1–4.3) and 2.0 faces (IQR: 1.0–3.0), respectively. As the reported pain intensity increased, so did the scores on the 2 pain scales. The 30 children with no pain had a median score on the CAS of 0.0 (IQR: 0.0–1.0) and on the FPS of 0.0 (IQR: 0.0–1.0), whereas the 13 children with severe pain had a median CAS of 7.0 (IQR: 6.0–8.0) and a median FPS of 5.0 (IQR: 4.0–6.0). The Spearman correlation coefficient between the CAS and the FPS was positive and strong (r = 0.894).

Conclusion. The CAS and the FPS exhibit construct, content, and convergent validity in the measurement of acute pain in children in the ED.
Clinical Chorioamnionitis, Elevated Cytokines, and Brain Injury in Term Infants
Authors: Shalak Lina F. , Laptook Abbot R. , Jafri Hasan S. , Ramilo Octavio , Perlman Jeffrey M.
Published: August 2004

Objectives. To determine the initial inflammatory cytokine response in term infants born to mothers with clinical chorioamnionitis and to assess whether the cytokine response is associated with birth depression, abnormal neurologic examination, and hypoxic-ischemic encephalopathy (HIE).

Methods. Infants who were exposed to chorioamnionitis and admitted to the neonatal intensive care unit (n = 61) were studied prospectively. Cytokine concentrations were measured from umbilical cord blood and at 6 and 30 hours after birth. Control values (n = 50) were determined from cord blood of healthy term infants. Enzyme-linked immunosorbent assays were performed for interleukin (IL)-1β; IL-6; IL-8; regulated on activation, normal T-cell expressed and secreted (RANTES); macrophage inflammatory protein-1α; and tumor necrosis factor-α. Serial blinded neurologic examinations using a modified Dubowitz score were performed simultaneously at 6 and 30 hours.

Results. Cord IL-6 (1071 ± 1517 vs 65 ± 46 pg/mL), IL-8 (2580 ± 9834 vs 66 ± 57 pg/mL), and RANTES (95 917 ± 16 518 vs 54 000 ± 14 306 pg/mL) concentrations only were higher in infants with chorioamnionitis versus control infants. IL-6 increased at 6 hours to 1451 ± 214 pg/mL, followed by a 5-fold decline at 30 hours in contrast to progressive decreases over time in IL-8 and RANTES. There was no relationship between cytokines and birth depression. Modified Dubowitz score correlated with IL-6 at 6 hours (r = 0.5). Infants with HIE/seizures (n = 5) had significantly higher cytokine concentrations at 6 hours versus infants without either (n = 56): IL-6 (3130 vs 1219 pg/mL), IL-8 (5433 vs 780 pg/mL), and RANTES (97 396 vs 46 914 pg/mL).

Conclusions. There was a significant association between abnormalities in the neurologic examination and cytokine concentrations, with the highest cytokines concentrations observed in infants who developed HIE/seizures.
Effect of Intense Exercise on Inflammatory Cytokines and Growth Mediators in Adolescent Boys
Authors: Nemet Dan , Oh Youngman , Kim Ho-Seong , Hill MaryAnn , Cooper Dan M.
Published: August 2004

Objective. Exercise can enhance growth and development in children, but recent investigations have revealed an intriguing paradox. Namely, the early (4–5 weeks) response to training programs in children lead to a catabolic, growth hormone (GH)-resistant state rather than the expected anabolic activation of the GH→insulin-like growth factor-I (IGF-I) axis. This paradox led us to hypothesize that single bouts of exercise in children could stimulate proinflammatory cytokines known to inhibit directly anabolic activity of the GH→IGF-1 axis (interleukin [IL]-6, IL-1β, and tumor necrosis factor-α [TNF-α]).

Methods. Eleven healthy high school-age boys, age 14 to 18.5 years, performed a single, typical, 1.5-hour wrestling practice session. Blood was sampled before and after the session.

Results. We found significant decreases in anabolic mediators: total IGF-I (−11.2 ± 2.3%), bound IGF-I (−11.2 ± 2.4%), and insulin (−42 ± 10%. However, there was no change in unbound IGF-I. Remarkable increases were found in proinflammatory cytokines IL-6 (795 ± 156%), TNF-α (30 ± 12%), and IL-1β (286 ± 129%) and in IGF-binding protein-1 (835 ± 234%), which itself is stimulated by inflammatory cytokines and is known to inhibit IGF-I. Evidence for compensatory mechanisms to counter the antianabolic inflammatory response to acute exercise were also noted: IL-1ra increased (80 ± 20%) and IGF-binding protein-3 proteolysis (which can maintain unbound, biologically active IGF-I despite losses in total IGF-I) increased significantly (101 ± 39%) as well.

Conclusions. These data demonstrate that an intense exercise bout in male adolescents leads to reductions in anabolic mediators and profound increases in inflammatory cytokines. This might explain the development of what seems to be a paradoxical catabolic state in the initial phases of exercise training programs.
Trends in Incidence and Antimicrobial Resistance of Early-Onset Sepsis: Population-Based Surveillance in San Francisco and Atlanta
Authors: Hyde Terri B. , Hilger Tami M. , Reingold Arthur , Farley Monica M. , O’Brien Katherine L. , Schuchat Anne ,   for the Active Bacterial Core surveillance (ABCs) of the Emerging Infections Program Network
Published: August 2004

Objective. Although increased use of intrapartum antibiotics caused significant declines in early-onset group B Streptococcus (GBS) infection, the effect on infections caused by other pathogens is not clear. The objective of this study was to determine trends in the incidence of early-onset sepsis caused by organisms other than group B streptococcus in the era of antimicrobial prophylaxis.

Methods. We conducted surveillance for early-onset sepsis as part of the Active Bacterial Core surveillance. A case was defined as isolation of bacteria from blood or cerebrospinal fluid from an infant who was 0 to 6 days of age and born in the surveillance area during 1998 through 2000 (248 184 births).

Results. We identified 408 cases of early-onset infection. GBS caused 166 (40.7%) cases (52 in 1998, 51 in 1999, and 63 in 2000 for incidences 0.62, 0.62, and 0.76 cases per 1000 live births, respectively). Other bacterial pathogens were identified in 242 cases (82 in 1998, 79 in 1999, and 81 in 2000 for incidences 0.99, 0.95, and 0.98 per 1000 live births, respectively) of early-onset sepsis. Escherichia coli caused 70 cases (0.25, 0.28, and 0.31 cases per 1000 live births, respectively, in 1998–2000). The proportion of E coli infections that were resistant to ampicillin increased significantly among preterm infants from 29% (2 of 7) in 1998 to 84% (16 of 18) in 2000 but not in full-term infants: 50% (4 of 8) in 1998 and 25% (1 of 4) in 2000.

Conclusions. Whereas rates of early-onset sepsis caused by GBS and other pathogens were low and did not change significantly during the study period, antibiotic-resistant E coli infections among preterm infants increased. Overall, these trends are reassuring, but careful evaluation of the increase in resistant infections in very young infants is critical in the future.
Barriers to Booster Seat Use and Strategies to Increase Their Use
Authors: Simpson Edith M. , Moll Elisa K. , Kassam-Adams Nancy , Miller Gwenyth J. , Winston Flaura K.
Published: August 2004

Objective. Children who have outgrown child safety seats and been placed in adult seat belts are at increased risk for injury. Pediatricians and other advocates have been called on to encourage booster seat use in these children. The objective of this study was to identify barriers to booster seat use and strategies to increase their use.

Methods. A qualitative study consisting of focus groups and follow-up in-depth discussions were conducted among parents and/or children to elicit barriers and strategies to appropriate/best practice child restraint system use. Phase I focus groups (parents and children) identified barriers to booster seat use along with children’s self-reported likes and dislikes about booster seats. Phase II focus groups (parents only) identified additional barriers to booster seat use and suggestions for strategies to increase the use of booster seats. In-depth telephone discussions (parents only) were conducted after each phase of focus groups to identify new themes and to explore further previously emerged topics that were not conducive to probing in focus group settings.

Results. This study demonstrated that although knowledge of the benefits and purpose of booster seats is an important issue in promoting booster seat use, it is not the only issue. In particular, differences in risk perception, awareness/knowledge, and parenting style were noted when comparing parents of children in booster seats with those whose children were in seat belts. Media campaigns, improved laws, parenting education, and extending the use of child restraints to older ages were among the strategies suggested by parents to increase booster seat use.

Conclusions. Anticipatory guidance regarding booster seats may be new for many pediatricians. This article arms pediatricians with insights from parents about their perceptions regarding booster seats and how parents think that the booster seat message can be most effectively delivered. Furthermore, it gives insight into how parents make safety decisions for their children and the important role of children in this decision-making process.
Variables Associated With Medication Errors in Pediatric Emergency Medicine
Authors: Kozer Eran , Scolnik Dennis , Macpherson Alison , Keays Tara , Shi Kevin , Luk Tracy , Koren Gideon
Published: August 2004

Objective. Medication errors are a common cause of iatrogenic morbidity and mortality. The incidence of medication errors in pediatric emergency departments (EDs) has not been described. The objective of this study was to describe the incidence and type of drug errors in a pediatric ED and determine factors associated with risk of errors.

Methods. A retrospective cohort study was conducted of the charts of 1532 children who were treated in the ED of a pediatric tertiary care hospital during 12 randomly selected days from the summer of 2000. Two pediatricians, blinded to other study variables, independently decided whether a medication error occurred and ranked it according to a severity score. Disagreement was resolved by consensus.

Results. Prescribing errors were identified in 10.1% of the charts. The following variables were associated in univariate analysis with an increased proportion of errors: patients seen between 4 am and 8 am (odds ratio [OR]: 2.45; 95% confidence interval [CI]: 1.10–5.50), patients with severe disease (OR: 2.53; 95% CI: 1.18–5.41), medication ordered by a trainee (OR: 1.48; 95% CI: 1.03–2.11), and patients seen during weekends (OR: 1.48; 95% CI: 1.04–2.11). Among trainees, there was a higher rate of errors at the beginning of the academic year (OR: 1.67; 95% CI: 1.06–2.64). Logistic regression revealed increased risk for errors when a medication was ordered by a trainee (OR: 1.64; 95% CI: 1.06–2.52) and in seriously ill patients (OR: 1.55; 95% CI: 1.06–2.26).

Conclusions. In the pediatric ED, trainees are more likely to commit prescribing errors, and the most seriously ill patients are more likely to be subjected to prescribing errors.
Ethnic Differences in the Presence of Secondary Sex Characteristics and Menarche Among US Girls: The Third National Health and Nutrition Examination Survey, 1988–1994
Authors: Wu Tiejian , Mendola Pauline , Buck Germaine M.
Published: August 2004

Objective. To assess measures of puberty—presence of pubic hair, breast development, and menarche—for 3 racial/ethnic groups of girls in the United States.

Methods. Using data from the Third National Health and Nutrition Examination Survey, this study sample was restricted to 1623 girls aged 8 to 16 years (466 non-Hispanic white, 589 non-Hispanic black, and 568 Mexican American) for whom information was available on Tanner stages of pubic hair and breast development. Subsequently, the sample was restricted to 1168 girls aged 10 to 16 years (330 non-Hispanic white, 419 non-Hispanic black, and 419 Mexican American) for whom menarche data were available. Tanner stage II or higher was used to define pubic hair and breast development; menarche status was self-reported. The percentage of girls who had pubic hair and breast development and had achieved menarche was computed by age and race/ethnicity. Probit and failure time models were applied to estimate mean ages at onset of pubic hair, breast development, and menarche. The racial/ethnic differences also were examined after adjustment for social and economic variables and current body mass index.

Results. Black and Mexican American girls had pubic hair and breast development and had achieved menarche at younger ages than white girls. For example, 49.4% of black girls aged 9 years had breast development compared with 24.5% of Mexican American girls and 15.8% of white girls. The mean age at onset of pubic hair, breast development, and menarche was 9.5, 9.5, and 12.1 year for black girls; 10.3, 9.8, and 12.2 years for Mexican American girls; and 10.5, 10.3, and 12.7 years for white girls. These ethnic differences remained even after adjustment for current body mass index and several social and economic variables.

Conclusion. Black girls on average enter puberty first, followed by Mexican American and then white girls.
Early Postnatal Dexamethasone Decreases Hepatocyte Growth Factor in Tracheal Aspirate Fluid From Premature Infants
Authors: Lassus Patrik , Nupponen Irmeli , Kari Anneli , Pohjavuori Maija , Andersson Sture
Published: August 2004

Objective. To evaluate in preterm infants the effect of dexamethasone on hepatocyte growth factor (HGF), an epithelial cell mitogen, and on vascular endothelial growth factor (VEGF), an endothelial cell mitogen, in tracheal aspirate fluid (TAF).

Methods. Thirty preterm infants (birth weight: 1000–1500 g) with respiratory distress syndrome were randomized to receive dexamethasone or to serve as control subjects. Dexamethasone was started at the age of 12 to 24 hours at a dose of 0.5 mg/kg/d for 2 days and 0.25 mg/kg/d for the subsequent 2 days. HGF and VEGF levels were examined from TAF samples during the first postnatal week. For eliminating the effect of dilution, the concentration of the secretory component of immunoglobulin A was determined. Student t test, 1-way analysis of variance, χ2, and simple regression analysis were used for statistical analysis.

Results. Mean HGF concentrations were similar in the dexamethasone and control groups on days 1 to 2, but the dexamethasone group had a lower mean HGF concentration on days 3 to 4 and 5 to 7. In contrast, no differences existed in mean VEGF levels between the dexamethasone and control groups.

Conclusions. In preterm infants who received early postnatal dexamethasone, reduced levels of HGF were seen in tracheal aspirates. This reduction may participate in the suppressive effects of dexamethasone on lung development.
Cost-Benefit Analysis of Universal Tandem Mass Spectrometry for Newborn Screening
Authors: Schoen Edgar J. , Baker John C. , Colby Christopher J. , To Trinh T.
Published: August 2004

Objective. To estimate potential costs and benefits of routinely using tandem mass spectrometry (MS/MS) to screen newborns for inborn errors of metabolism.

Method. Analysis of costs and benefits resulting from use of MS/MS in screening of 32 000 newborn infants using data from the Kaiser Permanente Medical Care Program of Northern California plus other published data.

Setting. A large health maintenance organization.

Results. In the base scenario, the cost per quality-adjusted life year saved by MS/MS screening was $5827; in the least favorable scenario, this cost was $11 419, and in the most favorable scenario, $736.

Conclusion. Costs per quality-adjusted life year saved by MS/MS screening for inborn errors of metabolism compare favorably with other mass screening programs, including those for breast and prostate cancer.
Death of a Child in the Emergency Department: Joint Statement by the American Academy of Pediatrics and the American College of Emergency Physicians
Authors:   Committee on Pediatric Emergency Medicine, American Academy of Pediatrics,   Pediatric Emergency Medicine Committee, American College of Emergency Physicians
Published: August 2004

Note: Please be advised that the American Academy of Pediatrics and the American College of Emergency Physicians are in the process of independently developing technical reports on this issue that will provide more in-depth educational and clinical information for their respective members on the death of a child in the emergency department. When completed, these reports will be published separately by each organization to supplement this joint policy statement.
Relation of Age at Menarche to Race, Time Period, and Anthropometric Dimensions: The Bogalusa Heart Study
Authors: Freedman David S. , Khan Laura Kettel , Serdula Mary K. , Dietz William H. , Srinivasan Sathanur R. , Berenson Gerald S.
Published: August 2004

Objective. To assess secular trends in menarcheal age between 1973 and 1994 and to determine whether childhood levels of height, weight, and skinfold thicknesses can account for racial (white/black) differences in menarcheal age.

Methods. Data from 7 cross-sectional examinations of school-aged children, with menarcheal age obtained through interviews, were used for both cross-sectional (11 218 observations) and longitudinal (n = 2058) analyses. In the latter analyses, the baseline examination was performed between ages 5.0 and 9.9 years, and the mean follow-up was 6 years.

Results. Black girls experienced menarche, on average, 3 months earlier than did white girls (12.3 vs 12.6 years), and during the 20-year study period, the median menarcheal age decreased by approximately 9.5 months among black girls versus approximately 2 months among white girls. As compared with 5- to 9-year-old white girls, black girls were taller and weighed more, characteristics that were predictive of a relatively early (before age 11.0 years) menarche. However, even after adjustment for weight, height, and other characteristics, the rate of early menarche remained 1.4-fold higher among black girls than among white girls.

Conclusions. Additional study of the determinants of menarcheal age is needed, as the timing of pubertal maturation may influence the risk of various diseases in adulthood.
Study of 22 Egyptian Patients With Diamond-Blackfan Anemia, Corticosteroids, and Cyclosporin Therapy Results
Authors: El-Beshlawy Amal , Ibrahim Ilham Youssry , Rizk Samia , Eid Khalid
Published: August 2004

Objective. Diamond-Blackfan anemia is a rare congenital hypoproliferative anemia of infancy and early childhood. Treatment with corticosteroids is commonly used, but with limited success. Trials with cyclosporin-A (CSA) are not frequently reported. Therefore, in this study we analyzed our results in the management of this rare disease by different medical treatments.

Design. The results of 22 patients diagnosed at our Hematology Center in the New Cairo University Children’s Hospital during the period 1991–2001 were retrospectively analyzed. Our patients first received prednisolone (2 mg/kg/d) for different courses according to their response. Since the year 2000, the steroid nonresponders received CSA (3–12 mg/kg/d) for 6 months unless treatment complications developed.

Results. The age at the onset of the disease ranged from 1 to 24 months (median: 2.5 months). The mean values of the hemoglobin, the reticulocyte count, and the myeloid/erythroid ratio at the onset of the disease were 4.75 ± 1.79 g/dL, 0.14 ± 0.16, and 39.4 ± 27.08, respectively. Patients received prednisolone from 0.25 to 10 years (median: 2 years). Ten patients were nonresponders (45.5%), and 5 patients (22.7%) responded to corticosteroid therapy. Two of 5 responders are off treatment with a hemoglobin level of >9 g/dL, and 3 of 5 are currently corticosteroid-dependent. Of 10 patients not responding to steroids, 8 received CSA for 6 months. Four patients (50%) responded to CSA therapy. A significant positive association was found between CSA dose and response.

Conclusion. CSA therapy should be tried in steroid-resistant Diamond-Blackfan anemia patients before blood transfusion or corticosteroid therapy complications are instituted.
Imbalance Between Production and Conjugation of Bilirubin: A Fundamental Concept in the Mechanism of Neonatal Jaundice
Authors: Kaplan Michael , Muraca Maurizio , Hammerman Cathy , Rubaltelli Firmino F. , Vilei Maria T. , Vreman Hendrik J. , Stevenson David K.
Published: August 2004

Objective. The objective of this study was to evaluate the roles of production and conjugation of bilirubin, individually and in combination, in the mechanism of neonatal jaundice.

Methods. A cohort of healthy, term male newborns was sampled on the third day of life, coincident with routine metabolic screening, for blood carboxyhemoglobin determination, a reflection of heme catabolism, and for serum unconjugated and conjugated bilirubin fractions, reflecting bilirubin conjugation. The former was determined by gas chromatography, corrected for inspired CO (COHbc), and expressed as percentage of total hemoglobin. Serum bilirubin fractions were quantified by alkaline methanolysis and reverse phase high performance liquid chromatography. The sum of all bilirubin fractions comprised serum total bilirubin (STB). Total conjugated bilirubin (TCB) was comprised of the sum of the conjugated fractions and was expressed as percentage of STB (TCB[%]). A “bilirubin production/conjugation index” (COHbc/[TCB(%)] represented the combined roles of these modalities in the mechanism of bilirubinemia. Relationships between STB concentrations on the one hand, and COHbc values, TCB(%) proportions, and the production/conjugation index on the other, were determined by applying a best-fit regression analysis methodology.

Results. Mean (± standard deviation) STB concentration at the time of sampling was 114 ± 48 μmol/L (range: 8–263 μmol/L). Mean COHbc value was 0.77 ± 0.19%, and median (interquartile range) TCB(%) was 0.737 (0.465–1.260)%. COHbc values correlated directly with STB concentrations (r = 0.38; s = 46.1), and TCB(%) correlated inversely with STB (r = 0.40; s = 45.8). The production/conjugation index correlated positively with STB values (r = 0.61; s = 45.8), the r value for the index being higher than that of either COHbc or TCB(%), individually. The bilirubin production/conjugation index seemed to have a biphasic relationship to STB: STB values rose steeply in concert with increasing index values in the lower range of the index, and subsequently plateaued in the higher range of the index.

Conclusions. Within the range of STB concentrations encountered, both increasing bilirubin production and diminishing bilirubin conjugation contributed to STB. The production/conjugation index confirmed that imbalance between production and conjugation of bilirubin plays an important role in the mechanism of neonatal bilirubinemia. alkaline methanolysis, bilirubin, bilirubin conjugation, carbon monoxide, carboxyhemoglobin, gas chromatography, hemolysis, high performance liquid chromatography, physiologic jaundice.
Loffler's Endocarditis Presenting in 2 Children as Fever With Eosinophilia
Authors: Horenstein M. Silvana , Humes Richard , Epstein Michael L. , Draper David
Published: August 2004

Hypereosinophilic syndromes are defined by the presence of peripheral and bone marrow eosinophilia and by the infiltration of multiple organs by mature eosinophilic cells. Loffler's endocarditis is a condition in which mature eosinophils infiltrate and damage the endocardium and myocardium. Male adults who live in the tropics are the population predominantly affected by this condition. Typical clinical features include weight loss, fever, cough, rash, and congestive heart failure. In this article, we report the typical presentation of an unusual illness that occurred in 2 pediatric patients in different geographic locations. In addition, we believe that these are the youngest patients with Loffler's endocarditis reported.
Perinatal Care at the Threshold of Viability
Authors: MacDonald Hugh ,   Committee on Fetus and Newborn
Published: August 2004

In the United States, an increase in the number of births of extremely preterm infants and in their survival potential has occurred over the last decade. Determining the survival prognosis for the infant of a pregnancy with threatened preterm delivery between 22 and 25 completed weeks of gestation remains problematic. Many physicians and families encounter the difficulty of making decisions regarding the institution and continuation of life support for an infant born within this threshold period. This report addresses the process of counseling, assisting, and supporting families faced with the dilemma of an extremely preterm delivery.
Is Obesity Associated With Early Sexual Maturation? A Comparison of the Association in American Boys Versus Girls
Authors: Wang Youfa
Published: August 2004

Background. Increasing evidence suggests a close association between early sexual maturation (SM) and obesity in girls and female adults. Earlier maturing girls are more likely to be obese than nonearly maturers. However, limited research has been conducted in boys.

Objective. To examine the influence of early SM on fatness in boys and compare it with girls, and to test the hypothesis that the associations differ by gender because of the differences in growth and SM patterns in boys and girls.

Study Design. Cross-sectional study.

Subjects. One thousand five hundred one girls and 1520 boys (aged 8–14 years) who participated in the Third National Health and Nutrition Examination Survey survey (1988–1994) and had complete anthropometry (weight, height, skinfold thickness) and SM data.

Methods. Based on each individual’s age and SM status (Tanner stages: genitalia stages for boys and breast stages for girls), the subjects were classified as: 1) early maturers (those who reached a certain Tanner stage earlier than the median age for that stage), and 2) the others (average and later maturers). Overweight was defined as a body mass index (BMI) ≥85th percentile, and obesity ≥95th percentile. Logistic regression analysis was to test how early maturation affected the risks for overweight and obese. Using multiple linear regression models, the associations between fatness (BMI and skinfold thickness) and SM were systematically examined. Covariates including age, ethnicity, residence, family income, energy intake, and physical activity were adjusted.

Results. Early SM was positively associated with overweight and obesity in girls, but the associations were reverse for boys. The prevalence of overweight in early maturers versus the others was 22.6% versus 31.6% in boys and 34.4% versus 23.2% in girls; the figures for obesity were 6.7% versus 14.8% and 15.6% versus 8.1%, respectively. Odd ratios and 95% confidence intervals for obesity were 0.4 (0.2, 0.8) for boys and 2.0 (1.1, 3.5) for girls, and covariates were adjusted. Most significant differences in overweight and obesity among ethnic groups disappeared after controlling for SM. Fatness (BMI and skinfold thickness) was associated with SM stages and with early maturation in boys and girls, but the associations were in opposite directions. Compared with their counterparts, early maturing boys were thinner, whereas early maturing girls were fatter.

Conclusions. Obesity is associated with sexual maturation in both boys and girls, but the association differs. There is positive association in girls, but a negative one in boys. Maturation status should be taken into consideration when assessing child and adolescent obesity.
The Efficacy Of Noncontact Oxygen Delivery Methods
Authors: Davies Patrick , Cheng Danny , Fox Adam , Lee LLeona
Published: August 2004

Objectives. “Wafting” oxygen is a possible strategy to deliver oxygen to a patient who may not tolerate delivery systems that involve contact on the face. We wished to assess the concentration of oxygen delivered to the patient with various methods of “wafting” oxygen.

Design. Three methods of wafting oxygen were examined: an infant resuscitator bag, a standard pediatric Hudson RCI face mask, and a piece of standard green oxygen tubing. Contour lines for oxygen concentrations of 30% to 70% in 10% intervals were found with a Teledyne oxygen meter, at an oxygen flow rate of 5 L/min and 10 L/min. Experimental conditions simulated an infant in a cot in a pediatric ward.

Results. The resuscitator bag can not be recommended for wafting oxygen delivery, as the flow-back valve may close and result in insignificant levels of oxygen delivery. Oxygen tubing gave a useable area too narrow for use with an active patient, with 30% oxygen concentration being available in an area with width of only 18 cm. This is, however, a suitable method in short-term attended administration, either during feeding, or in the situation of a neonatal resuscitation. The standard pediatric Hudson RCI face mask, at a flow rate of 10 L/min, delivers 30% oxygen to an area 35 cm wide and 32 cm from the top of the mask. At 10 L/min, 40% oxygen is delivered to an area 16 cm wide and 14 cm from the top of the mask. This is an area large enough to be usable in the infant who will not tolerate other methods of oxygen delivery. The contour lines are presented graphically.

Conclusions. Although wafting can never replace conventional methods of oxygen delivery to children, if these have failed, a standard pediatric oxygen mask can give significant oxygen therapy without irritating the patient. Care should be taken to place the mask in the area described (ie, opposite the chest) to give the maximum benefit. Short-term administration can be appropriate with standard oxygen tubing aimed at the airway.
Crotaline Fab Antivenom for the Treatment of Children With Rattlesnake Envenomation
Authors: Offerman Steven R. , Bush Sean P. , Moynihan James A. , Clark Richard F.
Published: August 2004

Objective. There is little data regarding safety or efficacy of Crotalinae polyvalent immune Fab (ovine) antivenom (crotaline Fab) in pediatric patients. Our objective was to provide the first information regarding safety and effectiveness of this new drug in children.

Methods. Data were collected prospectively and retrospectively for all consecutive pediatric patients bitten by rattlesnakes and treated at 2 urban hospitals during 2001. Cases were included if there were signs of envenomation at presentation, patient age was 13 years or less, and there was administration of crotaline Fab. Cases were excluded if antivenin (Crotalidae) polyvalent (equine origin, the conventional antivenom) was given. Primary outcome variables were snakebite severity scores throughout the course of therapy, number of vials of crotaline Fab administered, occurrence of allergic reactions, adjunct surgical therapy, and the presence of permanent sequelae or serum sickness identified at follow-up.

Results. In the 12 cases studied, ages ranged from 14 months to 13 years (mean: 6.9; standard deviation: 4.2). Presentation snakebite severity scores ranged from 2 to 9 (mean: 5.3; standard deviation: 2.3). Total crotaline Fab doses ranged from 4 to 22 vials (mean: 12.7; standard deviation: 5.4). Initial control of symptoms was achieved with 4 to 16 vials (mean: 7.7; standard deviation: 3.7), and severity scores stabilized or improved within 24 hours in all patients. Recurrence of local swelling occurred in 1 case despite scheduled repeat doses of antivenom. No cases required surgical intervention, and no permanent sequelae were identified. No immediate or delayed hypersensitivity reactions occurred.

Conclusion. In this group of pediatric patients treated for rattlesnake envenomation, crotaline Fab antivenom was safe and seemed to be effective.
Gang Involvement and the Health of African American Female Adolescents
Authors: Wingood Gina M. , DiClemente Ralph J. , Crosby Rick , Harrington Kathy , Davies Susan L. , Hook Edward W.
Published: August 2004

Objective. To examine the association between gang involvement and female adolescents’ health.

Methods. African American adolescent females (N = 522) completed a survey that assessed their history of gang involvement and health behaviors and provided specimens that were analyzed for marijuana use and sexually transmitted diseases.

Results. In logistic regression analyses, adolescents with a history of gang involvement were more likely to have been expelled from school (odds ratio [OR]: 3.6), be a binge drinker (OR: 3.3), have a positive toxicologic test for marijuana (OR: 2.6), have been in 3 or more fights in the past 6 months (OR: 3.8), have a nonmonogamous partner (OR: 2.4), and test positive for Trichomonas vaginalis (OR: 2.2) and Neisseria gonorrhoeae (OR: 3.6).

Conclusion. This study extends the current research on risk behaviors associated with gang involvement to include biological markers for substance use and sexual health outcomes, namely, marijuana use and sexually transmitted diseases.
Impact of Mandatory Helmet Legislation on Bicycle-Related Head Injuries in Children: A Population-Based Study
Authors: Macpherson Alison K. , To Teresa M. , Macarthur Colin , Chipman Mary L. , Wright James G. , Parkin Patricia C.
Published: August 2004

Objective. Childhood bicycle-related head injuries can be prevented through the use of helmets. Although helmet legislation has proved to be a successful strategy for the adoption of helmets, its effect on the rates of head injury is uncertain. In Canada, 4 provinces have such legislation. The objective of this study was to measure the impact of helmet legislation on bicycle-related head injuries in Canadian children.

Methods. Routinely collected data from the Canadian Institute for Health Information identified all Canadian children (5–19 years) who were hospitalized for bicycling-related injuries from 1994–1998. Children were categorized as head or other injury on the basis of International Classification of Diseases, Ninth Revision, codes. Rates of head injuries and other injuries were compared over time in provinces that adopted legislation and those that did not.

Results. Of the 9650 children who were hospitalized because of a bicycle-related injury, 3426 sustained injuries to the head and face and the remaining 6224 had other injuries. The bicycle-related head injury rate declined significantly (45% reduction) in provinces where legislation had been adopted compared with provinces and territories that did not adopt legislation (27% reduction).

Conclusion. This country-wide study compared rates of head injury in regions with and without mandatory helmet legislation. Comparing head injuries with other non-head-injured children controlled for potential differences in children’s cycling habits. The strong protective association between helmet legislation and head injuries supports the adoption of helmet legislation as an effective tool in the prevention of childhood bicycle-related head injuries.
Pain Reduction at Venipuncture in Newborns: Oral Glucose Compared With Local Anesthetic Cream
Authors: Gradin Maria , Eriksson Mats , Holmqvist Gunilla , Holstein Åsa , Schollin Jens
Published: August 2004

Objective. A number of studies have shown that orally administered sweet-tasting solutions reduce signs of pain during painful procedures. The local anesthetic cream EMLA has recently been shown to be safe for use in neonates. This study compared the pain-reducing effect of orally administered glucose with that of EMLA cream during venipuncture in newborns.

Methods. Randomized, controlled, double-blind study including 201 newborns undergoing venipuncture for clinical purposes. Ninety-nine of the newborns received EMLA on the skin and orally administered placebo (sterile water), and 102 received glucose 30% orally and placebo (Unguentum Merck) on the skin. Symptoms associated with pain at venipuncture were measured with the Premature Infant Pain Profile (PIPP) scale (also validated for full-term infants). Heart rate and crying time were recorded.

Results. There were no differences in background variables between the 2 groups.

The results shows that the PIPP scores were significantly lower in the glucose group (mean: 4.6) compared with the EMLA group (mean: 5.7). The duration of crying in the first 3 minutes was significantly lower in the glucose group (median: 1 second) than in the EMLA group (median: 18 seconds). There were significantly fewer patients in the glucose group who were scored having pain (defined as PIPP score above 6); 19.3% compared with 41.7% in the EMLA group. The changes in heart rate were similar in both groups.

Conclusions. We found that glucose is effective in reducing symptoms associated with pain from venipuncture in newborns and seems to be better than the local anesthetic cream EMLA.
Tattooing and High-Risk Behavior in Adolescents
Authors: Roberts Timothy A. , Ryan Sheryl A.
Published: August 2004

Objectives. We sought to determine the prevalence and sociodemographic characteristics of tattooed adolescents in a nationally representative sample and to evaluate the association between tattooing and several high-risk behaviors.

Methods. This is a secondary analysis of the National Longitudinal Survey of Adolescent Health Public Use Dataset, which provides a nationally representative sample of 6072 adolescents collected in 1995 and 1996. The association among permanent tattoos, sociodemographic factors, and high-risk behaviors was evaluated using bivariate and logistic regression analyses using SUDAAN.

Results. Of the total sample of youths, 4.5% reported having permanent tattoos. Tattooing was significantly associated with older age, living in a single-parent household, and lower socioeconomic status but was not significantly associated with gender, ethnicity, or neighborhood type. Tattooing was strongly associated with peer substance use. Adjusting for sociodemographic factors and peer substance use, tattooing in adolescents was independently and significantly associated with reported sexual intercourse, substance use, violent behaviors, and school problems.

Conclusion. Permanent tattoos are strongly associated with high-risk behaviors among adolescents. In the clinical setting, the presence of a tattoo noted during clinical examination of an adolescent should prompt in-depth assessment for a variety of high-risk behaviors.
Longitudinal, 15-Year Follow-up of Children Born at Less Than 29 Weeks’ Gestation After Introduction of Surfactant Therapy Into a Region: Neurologic, Cognitive, and Educational Outcomes
Authors: D’Angio Carl T. , Sinkin Robert A. , Stevens Timothy P. , Landfish Nancy K. , Merzbach Joan L. , Ryan Rita M. , Phelps Dale L. , Palumbo Donna R. , Myers Gary J.
Published: August 2004

Objective. To measure the primary and secondary school-age neurologic, cognitive, and educational outcomes in a cohort of extremely premature infants born after the introduction of exogenous surfactant therapy in a circumscribed region.

Methods. Two hundred thirteen infants born at <29 weeks’ gestation were cared for at a regional referral center during 1985–1987. At primary school age, neurologic and cognitive outcomes, educational achievement, school placement, health status, and socioeconomic status were determined by follow-up visit. At secondary school age, school placement and health status were evaluated by telephone interview.

Results. One hundred thirty-two infants survived to school age, of whom 127 (96%) were evaluated in 1992–1995 and 126 (95%) were evaluated in 2000. Mean ages were 7.0 years at first follow-up and 14.1 years at second follow-up. At primary-school age follow-up, 19 children (15%) had cerebral palsy, 24 (19%) had a general cognitive index <70, and 41 (32%) were placed in a self-contained, special classroom. Thirty-nine children (31%) had no physical or educational impairment, whereas 27 (21%) had at least 1 severe disability. At secondary school age, cerebral palsy incidence remained unchanged, whereas 36 children (29%) were placed in a special classroom. Fifty-one children (41%) had no physical or educational impairment, whereas 24 (19%) had at least 1 severe disability. Neonatal intraventricular hemorrhage and low socioeconomic status were the strongest predictors of adverse outcomes.

Conclusions. Premature infants born in the surfactant era remain at high risk of neurodevelopmental compromise. Although many of these children do well, a significant minority will require intensive special educational services through secondary school age.